This and that
It's July 15th - originally, before baby, I would have been 15 days old as a full-fledged gastroenterologist, my fellowship having ended. I keep thinking about the same time 4 years ago, when residency was ending, and comparing it to now. Back then, it felt like the world was ending, and now, I'm sort of just... floating along. Relieved, almost.
I was also talking to someone this week, and I exclaimed at one point: Man, I miss being a resident. And the other person said, Wow, that is a really sad statement.
But it's true, residency was fun. Fellowship, on the other hand, has sucked. So, this led me to think and compare and contrast some more, and try to figure out exactly what has made this so bad, hard work and personalities notwithstanding.
There are just so many things.
First of all, as a resident, I solidly felt backed up by the attendings. We had their trust and benefit of the doubt, no matter the issue, be it a crazy ER attending trying to admit everyone, an unreasonable nurse, another service giving a hard time. I could safely say, "Feel free to call my attending," and expect to be supported and/or defended where necessary.
Here, on the other hand, calling the attending is like a threat designed to beat you into submission. And every time something goes a bit off, the first question is ALWAYS, "where was the fellow?" It is ALWAYS the fellow's fault. Benefit of the doubt is not even a part of the vocabulary. In fact, there was recently an instant when I couldn't reach the attending who was supposedly on call to discuss a management issue while under pressure from another team, and when he finally got back to me 4 hours later, I was told, "don't worry, it's not your fault." Which means, he thought it was and I should have been worried. Which is ridiculous. But anyway.
Maybe this is a function of how I have done here (more on that later), but I'm pretty sure that it isn't, as I've heard other people, who weren't quite as hapless as I, complain about it as well.
Secondly, there is the autonomy issue. As residents, we essentially ran the hospital. We saw the attending for about 2 hours each day, addressing management issues, and for teaching rounds, but the rest of the time, we ran a service, and made important decisions by ourselves. Or at least, coming up with a plan that we would then bounce off the attending and put into play. Attendings didn't have to do walk rounds with us, and the clinic preceptor stopped coming in to see our patients and double check on our history and physicals after month 6 of internship.
As fellows, on the other hand, autonomy is zero. There are more attendings than fellows, and each one has their own tune to play. So, you really cannot make your own decisions because each attending is just gonna wanna do his own thing. Here, midlevel practitioners are allowed to book advanced tests (wrongly, half the time), while a pgy 7 physician has to argue about ordering a flex sig vs a full colo - and lose! Attendings go to a room with a senior fellow, and essentially re-do the history and physical and get all the same info. Maybe that's why right now, on the verge of graduation, I still don't feel like I could conjure up a plan with which everyone would agree.
Then, of course, we have the institutional issues. My current place is just a gigantic spool of neverending red tape. For every point on the bylaws there is a team or a commission of midmanagement monkeys with clipboards who are walking around checking off boxes and ensuring "compliance," which, by the way, is a horrendously annoying buzzword everyone is throwing around these days. For every measure an individual department may take to increase efficiency, there are 10 bureaucratic reasons why said measure is not possible, and 21 ways to change the efficient way of doing things into a super non-efficient difficult but - hey, compliant! - way to do things. There is a policy for everything, and no one wants to go out of their way to do anything to make things easier for anyone.
I'd like to compare this to my old place, but to be honest, the current place has just completely taken over and I don't remember anything else...
All that aside, though. Were I truly happy here, I think I could have let these things slide off my skin. What makes one happy in the workplace? I wish I could say it's the work, because if it were, I should have been perfect: I love me some doctorin'. But it isn't. Mostly, I think it's comfort. Do you feel comfortable with your coworkers? As a resident, the 75 people in the program (25 per class), we were a tight knit group. We got to know and love each other, and, save a few notable exceptions, even the weirdos were OUR weirdos. Going to work was like going to hang out, despite the actual work. I think that's key.
Well, I have clearly not done that well in this place. And I've complained and fretted about it for the past 3 years to no end. I've been reflecting on how things have played out. I've been watching the new fellows who started a few weeks back, sometimes in wonder. One of them has signed up to scope FOUR weeks in advance. I heard the PD refer to her as "amazing."
I think of myself when I started. I was terrified of starting fellowship because everyone scared me about how bad it was going to be. I had many things that were distracting to me at that time, and my focus was completely off. Plus, throw in my natural tendency to roll down the path of least resistance, and I was done for from the beginning... Part of the problem was that I started on an easy endoscopy rotation. Once I realized my presence wasn't technically required during the first month, I gave in totally to the distractions. I think if I had been in the service vise from the beginning, I may have set a different theme. But instead, and especially since in residency, "elective" meant "elect to do nothing," I took the afternoons off, thinking no one would notice. But they noticed. I think that's how I must have really screwed up in the beginning, and thereby screwed myself. Flags were raised. Eyebrows, too. And once I felt antagonized, my reflex attitudinal rejection of authority kicked in. Why should I bend, who do they think they are? It's like my inability to apologize, it's pathologic, I think.
Did I even try? I think I did... But it was too late. I was already walking a tightrope, and it only got tighter. I also think I was so self-conscious, that when a misstep was possible, it was expected, and so, I took it. It became a self-fulfilling prophecy. That dumbass always screws up... There was no benefit of the doubt to begin with, and now, it was the dysbenefit of no doubt, so to say. And I had no redeeming qualities. Not too smart, not too procedurally excellent, not detail oriented AND distracted? A disaster.
I really dug a hole. How did I stack all these blocks against myself?
I kept saying, too, I can't believe it, this has never happened to me before... but that's not true, is it. What I meant was, this has not happened to me ... during residency. Because in reality, this has a precedent. Who can forget Genzyme? I got fired from there two weeks after starting for "attitude problems." I thought I was too good for that place, and they all felt it. Then, of course, we have LJ or whatever her name was, the dental resident on surgery, and Kim Z., the intern, who told me I need to "learn to play the game of saying sorry." I refused to be abused by the surgery service. And OB. Africa S. Hating all those girls. Recoiling from the cattiness. Refusing to fawn over the one male chief. They must have known it.
Bottom line, whatever the reason, if I'm not excited, everyone knows it, and I can't fake it. Then, it gets called an attitude problem.
(strangely enough, I cannot remember specifics at all. Just an overall similarity of not being able to get along no matter what I did.)
I was desperately unhappy, and so angry at everyone that now, it literally hurts me to get the words out and be honest with myself by recognizing my part in this whole debacle.
God. So many things gone wrong over the last three years. And I seem to have made it through. For all my apprehension, I can't wait to get out of here and start anew...
I was also talking to someone this week, and I exclaimed at one point: Man, I miss being a resident. And the other person said, Wow, that is a really sad statement.
But it's true, residency was fun. Fellowship, on the other hand, has sucked. So, this led me to think and compare and contrast some more, and try to figure out exactly what has made this so bad, hard work and personalities notwithstanding.
There are just so many things.
First of all, as a resident, I solidly felt backed up by the attendings. We had their trust and benefit of the doubt, no matter the issue, be it a crazy ER attending trying to admit everyone, an unreasonable nurse, another service giving a hard time. I could safely say, "Feel free to call my attending," and expect to be supported and/or defended where necessary.
Here, on the other hand, calling the attending is like a threat designed to beat you into submission. And every time something goes a bit off, the first question is ALWAYS, "where was the fellow?" It is ALWAYS the fellow's fault. Benefit of the doubt is not even a part of the vocabulary. In fact, there was recently an instant when I couldn't reach the attending who was supposedly on call to discuss a management issue while under pressure from another team, and when he finally got back to me 4 hours later, I was told, "don't worry, it's not your fault." Which means, he thought it was and I should have been worried. Which is ridiculous. But anyway.
Maybe this is a function of how I have done here (more on that later), but I'm pretty sure that it isn't, as I've heard other people, who weren't quite as hapless as I, complain about it as well.
Secondly, there is the autonomy issue. As residents, we essentially ran the hospital. We saw the attending for about 2 hours each day, addressing management issues, and for teaching rounds, but the rest of the time, we ran a service, and made important decisions by ourselves. Or at least, coming up with a plan that we would then bounce off the attending and put into play. Attendings didn't have to do walk rounds with us, and the clinic preceptor stopped coming in to see our patients and double check on our history and physicals after month 6 of internship.
As fellows, on the other hand, autonomy is zero. There are more attendings than fellows, and each one has their own tune to play. So, you really cannot make your own decisions because each attending is just gonna wanna do his own thing. Here, midlevel practitioners are allowed to book advanced tests (wrongly, half the time), while a pgy 7 physician has to argue about ordering a flex sig vs a full colo - and lose! Attendings go to a room with a senior fellow, and essentially re-do the history and physical and get all the same info. Maybe that's why right now, on the verge of graduation, I still don't feel like I could conjure up a plan with which everyone would agree.
Then, of course, we have the institutional issues. My current place is just a gigantic spool of neverending red tape. For every point on the bylaws there is a team or a commission of midmanagement monkeys with clipboards who are walking around checking off boxes and ensuring "compliance," which, by the way, is a horrendously annoying buzzword everyone is throwing around these days. For every measure an individual department may take to increase efficiency, there are 10 bureaucratic reasons why said measure is not possible, and 21 ways to change the efficient way of doing things into a super non-efficient difficult but - hey, compliant! - way to do things. There is a policy for everything, and no one wants to go out of their way to do anything to make things easier for anyone.
I'd like to compare this to my old place, but to be honest, the current place has just completely taken over and I don't remember anything else...
All that aside, though. Were I truly happy here, I think I could have let these things slide off my skin. What makes one happy in the workplace? I wish I could say it's the work, because if it were, I should have been perfect: I love me some doctorin'. But it isn't. Mostly, I think it's comfort. Do you feel comfortable with your coworkers? As a resident, the 75 people in the program (25 per class), we were a tight knit group. We got to know and love each other, and, save a few notable exceptions, even the weirdos were OUR weirdos. Going to work was like going to hang out, despite the actual work. I think that's key.
Well, I have clearly not done that well in this place. And I've complained and fretted about it for the past 3 years to no end. I've been reflecting on how things have played out. I've been watching the new fellows who started a few weeks back, sometimes in wonder. One of them has signed up to scope FOUR weeks in advance. I heard the PD refer to her as "amazing."
I think of myself when I started. I was terrified of starting fellowship because everyone scared me about how bad it was going to be. I had many things that were distracting to me at that time, and my focus was completely off. Plus, throw in my natural tendency to roll down the path of least resistance, and I was done for from the beginning... Part of the problem was that I started on an easy endoscopy rotation. Once I realized my presence wasn't technically required during the first month, I gave in totally to the distractions. I think if I had been in the service vise from the beginning, I may have set a different theme. But instead, and especially since in residency, "elective" meant "elect to do nothing," I took the afternoons off, thinking no one would notice. But they noticed. I think that's how I must have really screwed up in the beginning, and thereby screwed myself. Flags were raised. Eyebrows, too. And once I felt antagonized, my reflex attitudinal rejection of authority kicked in. Why should I bend, who do they think they are? It's like my inability to apologize, it's pathologic, I think.
Did I even try? I think I did... But it was too late. I was already walking a tightrope, and it only got tighter. I also think I was so self-conscious, that when a misstep was possible, it was expected, and so, I took it. It became a self-fulfilling prophecy. That dumbass always screws up... There was no benefit of the doubt to begin with, and now, it was the dysbenefit of no doubt, so to say. And I had no redeeming qualities. Not too smart, not too procedurally excellent, not detail oriented AND distracted? A disaster.
I really dug a hole. How did I stack all these blocks against myself?
I kept saying, too, I can't believe it, this has never happened to me before... but that's not true, is it. What I meant was, this has not happened to me ... during residency. Because in reality, this has a precedent. Who can forget Genzyme? I got fired from there two weeks after starting for "attitude problems." I thought I was too good for that place, and they all felt it. Then, of course, we have LJ or whatever her name was, the dental resident on surgery, and Kim Z., the intern, who told me I need to "learn to play the game of saying sorry." I refused to be abused by the surgery service. And OB. Africa S. Hating all those girls. Recoiling from the cattiness. Refusing to fawn over the one male chief. They must have known it.
Bottom line, whatever the reason, if I'm not excited, everyone knows it, and I can't fake it. Then, it gets called an attitude problem.
(strangely enough, I cannot remember specifics at all. Just an overall similarity of not being able to get along no matter what I did.)
I was desperately unhappy, and so angry at everyone that now, it literally hurts me to get the words out and be honest with myself by recognizing my part in this whole debacle.
God. So many things gone wrong over the last three years. And I seem to have made it through. For all my apprehension, I can't wait to get out of here and start anew...
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