Married to Medicine

Married to Medicine

Monday, May 30, 2011

Once a lawyer, always a lawyer. At least if you're a mom.

As a lawyer, you either innately possess or you quickly develop the following qualities:

  • The ability to develop and maintain a strong sense of loyalty to your client;
  • The love of a good fight or debate; and
  • The ability to say anything that needs to be said without caring what anyone else thinks.
These all came naturally to me (a little too naturally...).  But another quality did not.  As a lawyer (really, as a litigator) you basically need to be a very suspicious person, and generally assume the worst of others at all times.  This goes for the opposing counsel on a case - who may have been a colleague in law school, and even - or especially - for your your own client.  Anything else will only land you in a pot of hot water.

Natural or learned, these qualities have stuck with me into motherhood.  My love for and loyalty to my son is absolutely beyond comprehension, I would lay down my life for him without question (true of all good parents, of course).  I certainly loved him "at first sight" in the hospital, and I believe I loved him with my whole heart even then.  Thus I can only conclude that my heart periodically expands as I experience the deeper and more intense attachment that comes with watching his sweet personality unfold before my eyes, and creating memory after memory with him.

So as a loyal, former-litigator, suspicious-of-everyone mom, I have major bone to pick with the system that just cost my son 3 full days and 2 evenings of his father's very limited and very precious time with him - and may well cost him next weekend too, after which we won't have weekends for awhile (update:  it did.  UGH.).  What sort of a system, you might ask, is that?  It's called the "hit list" and it's what most hospitals do when a resident is out sick or on a family emergency.  Basically, everyone has a few weeks "on the list" while they are otherwise working good, 9-5, no-weekend rotations.  Then, if someone on a bad rotation has an "emergency," the person from the good rotation has to step in and cover their crazy hospital shift, most often working overnight for them.

Seems sort of fair right?  "What goes around comes around"?  Well, in theory.  Except that there are no rules establishing what is and is not a valid reason to use the list, or how many days you get for certain types of emergencies.  This, according to my father and other medical family members, worked fine until more recently.  But as the culture of medicine changes, these lists are used more and more frequently for lesser reasons... by some residents, not all.  The results is an asymmetrical redistribution of work - and nobody is paid a dime for the extra hours they pick up.

But even if everyone could still be trusted, there's plenty of reason to get rid of such an inhumane system.  Back when I was pregnant and worried I would deliver early (Ha...ha), my husband was not comfortable with the idea of having to use the list for my delivery, thereby slamming some other colleague with even more work and less sleep than that person already had that year.  I knew that he'd at most take 3 days off... probably even if I had delivered by cesarean section.  There is simply no way my husband would ever have any colleague cover a week's worth of bad rotations for him, for any reason.

It's too bad, isn't it, that they don't make the system more humane for everybody?  Perhaps residents who are "hit" could recoup their extra hours by getting days off of their next easy rotation, since their presence on those rotations is not truly necessary.  Really, when your family time is already at a major premium, each resident should finish the year at least having had the limited time they're owed. 

I've long since been annoyed with this system and its vulnerability to abuse.  But as the loyal, protective, suspicious mother that I am, I just spent this long holiday weekend absolutely stewing over it.  Why?  Because a week ago today my husband was hit for FIVE DAYS, including this long holiday weekend he should have had with Matthew - and two evenings.

Yes, OVER a week ago we found out that someone in his program declared she was using the list for EIGHT DAYS.  I won't include the details in a public posting, and I don't need to.  My husband wouldn't have used the list for eight days unless I was delivering our child and whether I'd live through the delivery was unclear for all eight days.  While such a situation may be medically possible (or may not...) even if it is, how did this person know a week ago TODAY that she'd still need to be using the hit list... today?  Sorry, people.  Not believable.

If this were the first time this had happened to us, I might be less infuriated (well, probably not).  But each time my husband has been hit (three so far, in the year and a half I've lived out here) it's always been a sort of questionable story.  One girl called my husband in to work her overnight shift when she found out her grandpa died - not for the funeral, mind you, just for finding out that he died - she must have hit somebody else to cover the funeral.  Most professions, like teaching, don't allow you to suddenly leave work in the middle of the day for the death of a non-immediate family member.

The key word here is "profession."  As the "culture of medicine" changes, physicians are increasingly seen as employees and they increasingly see their own work as "shift work" instead of defining it through their patients.  That's another blog post though.  The other time he was hit was for a Sunday evening overnight shift, Superbowl Sunday - a day in advance.  What kind of a family emergency is scheduled in advance for a Sunday evening, during the Superbowl?  We still have no idea.... because that person never even bothered to email my husband and thank him and explain.  EVER.  Two out of the three hits never even contacted him personally.  If you think I'm going to give these people whom I've never met the benefit of ALL reasonable doubt after THAT, sorry to say, think again.

What a stupid system.  I can think of at least five ways to change it and make it better, off the top of my head -

(1) Follow the neurosurgery program's example, and have the person using the hit list repay the time to the hit person.  [Can you believe this isn't done automatically??]  That way, people would only use the list for situations they *themselves* were willing to put in extra time for later - instead of having a colleague put in the extra time.  And they wouldn't have to feel guilty, like my husband would, for using it. 

(2) Most simply and painlessly:  As I mentioned above, give the hit person as many days off of a later easy rotation as they were hit for. 

(3) For each hit shift, put the person using the hit list on the list for additional weeks.  Example:  A hits B.  A covers B's next weeks on the hit list. 

(4) Pay the hit resident as a moonlighter, since that's what their extra time is worth anyway.  My husband just worked an additional 55 hours over 5 days and is not getting paid a dime more.  He may work another 30 this coming weekend.  Ridiculous!  Still, I'd rather the time back than money; I'd prefer solution (1) or (2). 

In any case, I'm not afraid to say:  As a mom, I'm pissed.  This system is a truly awful one.  It was one thing last year when I was the one paying the price... I kept my mouth shut.  Now that it's my son, and I have to watch him look around for daddy in the mornings and sometimes at bed time, and then give up looking.... you can bet I'll be opening my mouth to anyone who will listen.  Sadly, pretty much nobody.

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