Readers, you are welcome to ask questions of your own, through the comments section.

Probably the most appropriate to the season is the topic of forgiveness.  The capacity to forgive is a gift that benefits both parties, and it’s also essential to a stable society.  But it’s much easier to behave as though you’ve forgiven someone, than actually to do so.  And while society requires only the behavior, its gift of redemption is reserved for the genuine article.

One current cultural shift within medicine is in its response to errors.  I see this, in a way, as a rebellion against the tyranny of the lawyers.  In the past, when an error occurred, it was always considered an individual error, and the person responsible must be found and punished.   Then, possibly in defense against sophisticated arguments designed to assign the hospital (and its far deeper pockets) a portion of responsibility, systematic contributions to human error became a target of improvement.  Possibly that was not the reason, but I’ve seen enough of hospital management to know that in the end, it’s a business like any other.

Risk management is also behind the other major shift in dealing with errors, which is to approach the victims with candor and compassion rather than stonewalling.  Human beings want a human response.  They want what everyone wants from someone to whom they’ve entrusted their life: honesty, transparency and empathy.  Just as in any relationship, you know when any of them are missing.  You may not be able to identify exactly what it is, but you know that something’s not right, and that you’re not getting the whole story.  Most people don’t get mad when the mistake is made, no matter how awful the results.  They get mad when they see the wagons starting to circle, to deny fault or shift blame or whatever the lawyers are recommending as a legal defense.  All that most people really want is to know that you did your best, or that if an error was made, that you feel awful about it and want to keep it from happening to anyone else.

Supposedly there are people out there who are looking for a quick buck, and see your mistake as an opportunity to take you to the cleaners financially.  But I’ve worked in health care for around 25 years now (I started before I was in high school.  Not kidding.), and I’ve never met anyone who wanted anything more than compensatory free service.  Which I think is the least that you owe someone who’s been harmed while under your care.

At this point, these practices are fairly well-established with respect to patient care.  What’s disappointing is that those who advocate this approach in clinical medicine don’t seem able to make the connection to other aspects of their lives.   For example, education.  Residency is still very much about ascribing error to individuals rather than examining the process of teaching and learning.  To some extent, this has value in that one of things we must learn is to avoid mistakes, and to take responsibility, examine and remediate our weaknesses.  But so much of the time, we’re only doing what we’ve seen others do without rebuke or remediation, yet the program chooses one particular resident to castigate for it.  It might be you.  Or it might be a colleague who’s under some kind of unusual stress outside of residency, or perhaps comes to residency insufficiently prepared in some way by their medical school.  The program never has to defend that choice, because the only real record of the action is the fact that it was disciplined, or perhaps a report of it by someone with a malicious agenda, so it looks to any outside inquiry that only one resident was guilty of it.  When those of us on the inside, if we’re being honest, know that this is not the case.  How can the resident ever obtain justice?  And how can they ever find forgiveness, even if only for their own mental health, for the program and the people who treated them so?

I’ve been thinking about this lately with respect to Tulane.  I am still angry about what happened with my OB/GYN rotation, and I’m angry because people there behave as if they know they’ve done something wrong, but no one will admit it, and no one will apologize.  They made me sign a statement absolving them of blame before they would send the records the state board requires for my application for licensure.  Apparently they don’t know what duress means, or its significance with regard to any statement made under it.  They offered to send me my records, and then reneged when I took them up on the offer, saying that the board needed them directly.   Which makes me think there’s something in them that they’re afraid of me seeing, and they were betting that the offer would suffice to gain my trust.  I wasn’t looking for reasons to sue, but now I wonder what they’re hiding that’s so damning.  I would prefer to like and trust the school that granted my medical degree, and be proud to be an alumna, but they’re making it difficult.

And so I wonder: does forgiveness have to come first, for transparency to follow?  Or will it simply feed the monster?

Her freshman chemistry professor told her point blank that she had no business being pre-med, or a science major.  She was obviously here for her MRS degree, and should stop wasting everyone’s time.  Or something to that effect.  Which was consistent with my own experience with that professor, and that of several friends.  I won’t mention his name, but that episode kept him from getting a very prestigious teaching award, with significant money attached.  Shame on him for thinking that anyone could be so insignificant as to be treated that way with impunity.   You just never know what the future holds for a freshman in college, and any college professor should know better than to judge like that.

I could go on with the examples of people who underestimated and misjudged her, because it was the story of her whole undergrad experience.  But really I just want to offer my sincere congratulations on the award.  She has excelled, from circumstances in which even an average career is a great accomplishment.

I’m still trying to wrap my head around the breakup. Not in an emotional sense–I’m actually totally fine in that respect. It’s just that nothing about his behavior made much sense, from an external perspective, nor could I imagine any scenario that would at least make it internally consistent. One week he would be all in, and the next he’d be talking about how he didn’t deserve me and how I deserved so much better and he wanted to break up. Seriously, WTF? In his defense, his mom had just been diagnosed with Alzheimer’s disease, and that would certainly be a heavy burden for anyone to bear. But if I were in his position, I’d want more support around me, not less. Frankly, it all sounded like an elaborate version of, “it’s not you, it’s me.” And it’s not my policy to argue with men who say they don’t deserve me, and that I’d be better off without them. My policy is to agree, and get out of there ASAP. But I hesitated because of the situation with his mom. Finally I told him that I didn’t care what he thought either of us deserved, or should do. I said to tell me what he wanted, and we’d go from there. And he said he didn’t want to be in a relationship, and that was that. Very self-destructive. It made me sad.

That was all well before I decided to move here, so if the move turns out to be a poor decision, I have no one to blame but myself. And correspondingly, the theme of these last few weeks seems to be, “what the hell was I thinking?”

Working at the county jail at first sounded like a novel and interesting experience. And before I started, I was toying with the idea of just staying there for the rest of the year. But now, I think not. I’m happy to get them caught up with their backlog of orders, but come January 1st, I hope to God there’s a better option for employment. Seriously, the pharmacy there is just a chain-link-fenced area of concrete sub-basement with mood lighting, no windows and no bathroom. And razor wire along the top, like frosting on a cake. I mean, we always joke about how the pharmacy is a dungeon. But this one really IS a dungeon.

The jail staff call the cavernous sub-basement where it’s located the “superdome.” I can’t decide whether that’s inappropriate-but-funny, or just totally inappropriate.

And a few weekends ago I got a random text from a guy friend, who somehow always manages to convey a more than casual interest, without saying anything that’s actually inappropriate. And I keep verbally pushing him away for extremely good reasons I won’t discuss here. Anyway, a few days later I realized it was CNS week. It’s just as well, because another conference-full of longing stares across a hotel lobby is really the last thing I need right now.

Last time, despite the injury, I felt great after just one week of walk/jogging.  I’d always wondered why people become such fanatics about running.  It looks boring and uncomfortable: hot, sweaty, altogether gross.  You’d think that if there really were any euphoria involved, then walking should produce at least a similar, albeit less intense, feeling.  And obviously, that isn’t the case.

But I think people must be meant to run, because it really is a self-reinforcing activity, in a way that other kinds of exercise are not.

The guy and I broke up, probably for good, about a month ago, and I just ended the Facebook profile block I’d put in place for him.  Not that I was actually mad, or anything;  I just needed to re-establish some boundaries.  A temporary profile embargo is a nifty way to gain some space and privacy without actually de-friending.  Perfect for the civilized breakup.

I moved away from Fellowship City.  We actually broke up before I moved, but my reasons for moving remained valid despite that. I’m sad, though, because I really liked living there.  It’s not nearly so scenic here, and I really hate the weather.  But it’s an airline hub, and a big city with lots of opportunity for work.  And despite the city’s size, I somehow managed to land an apartment within a 10-minute drive of just about everything, and easy back street access to the major hospitals.  Good workout equipment in the fitness center, too.

There was no exceptional planning on my part, I freely admit.  The things that have made it a good choice were not at all the things on which I based my decision to rent this place.  And the job I moved here for disappeared, so now I’m taking matters into my own hands and sending out applications instead of relying on my employment agency.  My recruiter seems a bit unfocused right now, and I can probably do a better job of selling my skills.

I’m still waiting on the state board to process my application.  But at least all the paperwork should be there by now.   A medical license would help immensely right now.

Readers (if I still have any), what do you think?

Things have been a little crazy these last couple of weeks.  But it looks like I may have an actual doctor job for this year.  Stay tuned for further updates.