Monday, August 04, 2008

Reasons I'm Leaving Emergency Medicine (number 5)

It is a hard day when you surrender your childhood fantasy that folks are basically good.

I chose poorly with a job I took soon after residency. I ended up with a group of physicians, nice folks till you got to know them, who were all under the lash of the Queen Bee.

I met the Queen Bee at a national conference. She was drunk. She saw that I was a soon to be graduated resident and proceeded to woo me telling me what a bunch of worthless sons-of-bitches were working for her at the time and how badly I was needed. (Note to self: Do not accept job offers from drunk women who talk their employees down during your first meeting).

The Queen Bee had never done a residency (she had only done an internship and got a license), but had been at the right place at the right time, and got a contract to run what was, at that time, a relatively sleepy ER in a smallish town.

Over the years she 'grandfathered' into the specialty and held herself in the highest esteem. The town grew, the hospital grew, and she grew quite powerful within the hospital.

With magical hypnotizing rays which emanated from her hair-helmet she was able to subjugate many a physician to be her willing thrall. At the time I worked for her she was losing her mojo a bit... in the span of a few years she lost 14 physicians. Some of them were fired for unprovable reasons... "too many patient complaints... the nurses don't like you... you aren't a good fit" etc...

Conveniently, she managed to get rid of many of them early in their careers thereby avoiding paying them as a "partner". This is quite common with many groups, getting well-trained residents to strain at the lash for a couple of years, and then firing them before having to pay them at full reimbursement. More often, they pull the pussy stunt they did with me, making it obvious that one is not welcome anymore but not taking on the liability for firing someone without cause.

Other doctors quit in disgust and went elsewhere. The dagger for me came from wormtongue, an excellent doc, one of the best I've known (who was my 'mentor' and 'friend'), who delivered the news to me the day before I was to make partner, that I was going to be put on "probation". No warning. He chose money. I saw the writing on the wall so off I went.

In the last meeting we had the Queen Bee was all over me about a particular chart I had dictated. As it happened I had a patient go into cardiac arrest and I was called to the room. There was no bag-valve mask available so I gave the little old dude mouth-to-mouth resuscitation and then intubated him as CPR was continued.

"Goddamit Dr. 911, you are a physician... you never give mouth-to-mouth." Cross my heart and hope to die those were her exact words. Her face looked like a tomato and she was apoplectic while delivering this pearl that I had not actually learned in medical school (or residency). I was more afraid of her saliva than the lip-lock with the old dude... I saw "Alien" after all.

What she was really angry about was that I had dictated in the chart the reason that I HAD to give mouth-to-mouth... no equipment in the room where it was supposed to be... she was afraid of a lawsuit. Strangely, and in spite of the Queen's anger at me, the hospital itself gave me an award for putting myself at risk for this patient.

So, Queen Bee, may your hive be smoked. Sleep well, and, if you choose, you may see a picture of yourself in the dictionary under "bitch" (or at the top of this post).


  1. Bitch? No no no....
    She graduated to the "C" word.


    I had the lovely experience of working under a monster like that. After she fired a doctor and an NP for stupid reasons, half of the clinic left.

    Their board was unhappy with the Idiot CEO, so they merged with us!

    She was also a micromanaging nut. It was was really fun because I was managing the finance department, that took over her mess of a finance department.

    Sometimes the clip board managers uses "finance" as an excuse for everything.

    In this case, giggle, the finance department helped prove what a disaster she was!


  2. I have a question!

    so I'm anorexic, blah blah blah, boring shit, however.

    I've been eating rolls of toilet paper for the last few months. Rolls. I mean, it tastes really good. So shut up. And I only eat the boring stuff.

    However, I'm having troubles taking a shit.

    So I crave and eat toilet paper and can't take a shit.


  3. If this isn't a joke...

    Hannah, I can answer that one for you. Check yourself into psych. Now. People get pica when they're missing vital nutrients. All of that paper could cause a blockage of some sort. But, fixing the pica and fixing a blockage are the least of your problems.

    You're joking right?

    911- I hate that lady for you. My husband just took a masters after completing 3/4 of a PhD for a lady almost just like that. Maybe they are sisters?

  4. No, I'm not joking. Sadly. However, I am eating toilet paper. I got around to googling "I eat toilet paper" and found that it may be an iron deficiency. Eating toilet paper has given me gastric reflux and general nauseated stuff.

    lol at checking myself into psych. Seriously. :P I've been in psych too often to count.

  5. Ugh, that sucks Hannah. Iron will just make you more constipated. Try eating some steak, it will go down better than toilet paper.

  6. Hannah: Just be glad you CAN poop, if you treat your body with respect, that is. My son fell 65 feet off a cliff onto a pipe between his legs, and he is slowly recovering from cauda equina syndrome--sort of. He has ED and can't take a poop easily, and he had a catheter in for months.
    Your health and well-being can be gone in a flash, and you're a fool to abuse your body. I once was an anorexic teenager, weighing sixty pounds less than I do today (I'm normal weight). I ate and I got over it by the power of reasoning with myself, and you can too. Don't squander your youth and health.

  7. hannah: what does your anorexia have to with anything on this site? Stop eating toilet paper: anorexia is just another addiction--to starvation. Stop looking for help and attention through your weakness/addiction. Time to grow up, take care of yourself and quit the "poor me" shit

  8. hannah,

    I recommend you only partake with used toilet paper of both varieties. This way you get all your dietary needs sufficed.

    For desert, you can have grandpas handkerchief.

  9. It just goes to show what kind of people are left in charge to do this kind of work.

  10. Wow...that's about as bad as administrator stories get. I'm speechless...

  11. please - enough random self disclosure/ stuff that doesn't pertain to the post. Ta.

  12. Methinks Hannah got lost. Wrong blog, dear. 911, as always, your stories leave me speechless. You realize, of course, that you're now responsible for turning my four book series into a ten book series. Boyo, my main characters have a lotta stuff to do...

  13. Thank God most of those "Grandfathered" old Farts are dead or retired. It wouldn't be so bad if they actually had some real wisdom to pass on, but they were usually the biggest ones advocating for residency length to be increased to 10 years.

  14. If I code, I hope (1) 911doc is on and (2) there is no ambu in the room.


  15. 911 -

    Your reasons for getting out of Emergency Medicine seem to be getting more bitter and vitriolic.

    My skipper said to me one day when I was contemplating the big "career change" from Navy Lieutenant to civilian said to me, "When it stops being fun, it's time to quit." It stopped being fun for me after that conversation and I handed in my resignation. (That's not to say they spent the better part of the next 12 months trying to re-define "fun" to get me to stay in, though...)

    It sounds as though you should have had that wisdom passed to you a long time ago.

    Go ahead and vent your frustrations but don't let them overcome you. Remember, unless you are working for yourself, you'll always have the potential for idiots running your show. If you work for yourself, bear in mind that you are waking up every day unemployed - some people thrive on that.

    I wish you fair winds and following seas....

    H the IH

  16. hey harry the ih,

    you are correct. i should have left long ago. bit of the 'golden handcuff' syndrome AND a bit of stubborness as i trained so long to do this it feels a bit like quitting to leave.

    bitter? hell yeah. i also think you are correct that i need to try it on my own and work for myself.

    when and if that fails then i will look back on the people that stick in my minds as villains and reconsider my judgments of them.

    'cat is racing me for the exit sign and we both have the same general idea of what we are doing next.

    i hope that the big crash in emergency medicine does not come but with work in a few states over a bunch of years it SEEMS to be getting much worse for many of the reasons we talk about here. the core problem SEEMS to be that the american public has internalized the "my health is someone else's problem" belief after learning that it's cheaper in the short run to dump your insurance and pcp and simply "go to the ER".

    that's a problem i can't fix and don't pretend to have any interest in trying... to do that you have to have power and because of folks like the good queen above i have less and less.

    i do believe that when the crash comes that all of a sudden docs with good insight into cutting out the BS and giving good and efficient care will be wanted again.

    right now, ER groups want skilled physicians who salute the powers that be in the hospital and keep their traps shut about the money shuffling game.

    now i'm rambling. do appreciate your comments.

    nurse k, i'm blushing.

  17. 911: I'm sorry--unbelievable. Administrators are bloodless borderline personalities.

  18. 911 and 'Cat:

    Didn't I hear some time ago something about starting a "Private ER" business? What if you, Cat, and Ambulance Driver go for the whole privatization thing? Got to do it like Hillsdale College - never accept one federal dollar and tell the feds to go pound it.

    I wonder what it would take to do such a thing - how many millions?

  19. This really sucks. Lady73 is right. The C word is a perfect fit for your ex-boss.

    Sorry you're going through this crap.


  20. 911: Spot on assessment of the "belief" that is driving ERs to crash. God help us when those that believe this way out number the ones of us who don't. Wonder who will take care of them then. Hmm..

    So sorry you are leaving EM, but I totally get it. Thanks for your many years of hard work and dedication Bro.

  21. Congrats on being a blog of note. After reading your blog I really never wanna go to the hospitl.. unless of course you're my doctor.

    - Tim

  22. Good job on saving the little old guy. Maybe he has magical powers and can make the Queen Bee less of a cunt rag. Sorry for your troubles at work, but congrats for be a Blog of note.

  23. That's very funny and sad at the same time. People like that should not be in charge especially when it comes to hospitals.

  24. I loved the blog. It's a great view of how liberalism has destoryed the medical industry. If you get the chance take a look at mine.

  25. It's amazing what people will do to jeopardize care when they are afraid of liability. Folks think liability is a big problem in the US, and I'm willing to hear a case made about it, but I was surprised as can be to discover it was lethally dangerous in Honduras.

    I traveled with a volunteer surgical team to perform operations on an impoverished and underserved community in the middle of noplace. While there, we had a patient whose kidney wasn't possible to save. There wasn't an ill part that could be removed; the whole thing was scar tissue, and it had grown in size several times and encroached upon and melded with numerous other structures in the area.

    Including the ascending vena cava.

    Needless to say, the operation ran long, and was bloodier than hoped. I kept an eye on the patient's face, and she was getting scarily pale.

    The hospital didn't have a blood bank.

    We went around the room trying to ascertain whether we had among us any plausible donors -- without the ability to test for pathogens, we didn't dare recruit locals -- and it turned out that as an O+, I was the only person in the room whose blood would not kill the B+ patient.

    This is where the liability got crazy. The physician with the contract to attend the hospital -- a local Honduranian -- instructed the lab tech not to give me a blood bag. Without the blood bag, my mission to donate a unit of blood was in jeopardy.

    After a while arguing -- they claimed the risk involved in not-exactly-type-matched blood was dangerous, and I explained that since they weren't planning to test for minor antigens anyway, it didn't matter, and that without the transfusion she was certainly going to die, which made the theoretical risk she might die due to a fatal mismatch among minor antigens a fairly good bet by comparison.

    About this time they decided they didn't speak English any more. So I let into them with my broken Spanish. And, let me tell you, my Spanish was pretty broken. The upshot was that their behavior would kill the patient, and that whatever I was proposing, therefore, had only the possibility of helping.

    However, it was more important to the physician contracted to the hospital that he keep his job by avoiding the appearance of having contributed to killing the patient. If the patient died under an American knife, he was blameless. If he allowed a donation using his blood bag and the donation's complications were implicated in the immediate cause of her death, then he could face trouble, and he feared for his position.

    And they weren't offering any known clean B+.

    Eventually, the tech took a blood bag out of a drawer, placed it on the table behind her counter without giving it to me, and took a break. I understood it was my responsibility to steal the blood bag without permission.

    Then I donated into the blood bag, carried it to the OR, and passed out while I watched it given.

    Turns out dehydration and blood donation don't mix.

    My take-home lesson came in several parts. One, drink lots of fluids in the hot dry mountains of Honduras in the summer. Two, the U.S. isn't the only place folks do silly things for fear of liability. Three, the local nurses will make fun of you in Spanish if you are seen passing out, and they will make jokes about whether the patient will be doomed to pass out after getting your weak-assed gringo blood. But three is OK: they know you kept her alive long enough for the next three donors to get back from a supplies run in the next town, and that without you the poor girl would have died and her husband would have been left alone, so the nurses are smiling at you as they giggle when you pass.

  26. Reason 401 on exactly why I think the Honduras is a shitty place I don't plan on visiting.

  27. You, whoever you are, you ROCK!!!!