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  • Writer's pictureJayma Anne Montgomery

FALSE EXPECTATIONS

I had this phenomenal plan in mind. We were staying at this beautiful, spacious VRBO just minutes away from our besties and God-children. We were going to relax, catch up, and have plenty of time for me to attend to TWT business. What happened instead was a series of unfortunate events culminating in yet another chronic illness to add to my already distressingly long list (which is distressing simply because it exists). I was all set to regale you guys with the intriguing story of my diagnosis with diabetes while ‘vacationing’ in Jersey. Instead, I’m just going to give you the BLUF (military speak for bottom line up front) I have been sick for weeks but ignoring it because that’s what women, physicians, and driven people do. The travel day was atrocious. Frustrations abounded. I’m still mad at the Avis lady for implying that I don’t tend to my children appropriately even though I was doing precisely that and she had a customer in front of her who was not me to attend to herself. I checked my blood sugar and it was over 500. I went to the ER nearby and got 1.5/5 star treatment. I called an NP friend of mine to help me get the insulin that I needed and more than 12 hours after leaving the ER I was finally giving myself the first injection (mind you, the ER did not give me a lick of insulin because apparently the new standard of care is to treat diabetic crisis with IV fluids only. What is this world coming to?). Anyway, I’m bored with all of this already. I’m eating better, taking my meds, and trying to get on a consistent exercise plan. End of story.


Instead, I want to talk about what it’s like to have most people constantly assume the worst about you. I have spoken before about being frequently underestimated in my line of work. That’s a slightly different tendency that doesn’t actually cause me offense the vast majority of the time. However, this tendency to assume that I am not the attending physician can further lead to the assumption that I am also not a good one. I’m going to tell two stories that have happened to me within the past 24 hours to illustrate my point. If the impulse is to get indignant on my behalf, I get it. But that’s not the point of this piece. I’m speaking out for others like me who constantly find themselves the target of low expectations. Over time, these things have eaten away at my self-worth and self-image. It's taken a lot of 'heart' work to undo some of it. I hope I’m able to work through some ways to process all of this in a more positive light, mine the hidden lessons, and ultimately grow from it.


There is a Cardiologist at my hospitalist who trained at a rather prestigious fellowship program. He clearly thinks very highly of himself and is known for being rather condescending towards other staff, whether they are PAs, NPs, or other physicians. He was consulted on one of my new patients and had recommended that he be discharged home with outpatient follow-up. When I saw the patient, he looked well but on paper was quite ill. His kidneys were failing and he needed a blood transfusion. He was also having frequent arrythmias on the heart monitor that the nurses were understandably worried about. At this point, the Cardiologist had signed off of the case but I reached out to him to review the tracings. He wasn’t concerned. I ordered an intervention that I felt was appropriate and left for the evening. When I came back the next day, I found that my intervention had been discontinued. In speaking to the night hospitalist, I learned that the nurses had reached out to the Cardiologist and he verbalized that order. I also saw that there was no note in the chart from that evening or the following morning. I ended up consulting the kidney specialist to talk through how to best manage the patient. We agreed on an intervention and I placed the orders.


A few hours later, I was accosted by condescending messages from the Cardiologist over the chat messenger. He implied that my management was inappropriate and that I was unprofessional for not including him in the management decisions for the day. From there, ensued an unpleasant back and forth. He became increasingly accusatory, mean-spirited, and reprimanding. I will admit that he got under my skin. Accusing me of mismanaging a patient when I am busting my tail to do what’s best for them is a huge pet peeve of mine. So, I politely told him that he was unapproachable and that interacting with him makes me feel like a bother. I also added that the rest of the hospitalist group feels the same way. He then blew his gasket and reprimanded me for having the conversation over a private chat. I then added my boss to the chat and politely ended the conversation to attend to my 22 other patients.


This guy is probably way smarter than I am about Cardiology. He might even be smarter than me about Nephrology and hospital medicine. I honestly don’t care. His bedside manner sucks and he is unprofessional towards his colleagues. As far as I’m concerned, he should be experimenting on lab rats in a basement somewhere, not taking care of fragile human beings.


In a calmer head space, I can now see the Lord’s hand at work in the midst of all of it. This guy has been a problem for years and nothing has been done about it. He recently insisted that a patient wasn't having a heart attack and didn't need to be admitted. Two hours later, that patient coded from that heart attack and died. The fact that my interaction with him was fully documented and I was able to simply forward it to my chain of command is a tremendous blessing. I actually got a text message from my boss’s boss commending me for the way I handled the situation. The entire hospitalist team has rallied around me in support and are seizing this as an opportunity to hold him accountable for unprofessionalism and poorly managing other patients as well. The Lord often chooses to use me as a wrecking ball rather than a peacemaker in situations. Its downright painful at times. I look around at the debris I have caused and wonder how in the world any of it can be made right again. But He always makes a way.


Now, onto my second story. I got an email from my practice manager asking me if I was present on particular days at the hospital. Apparently, a few nurses called my boss (this is my other part-time job) to tell him that they hadn’t seen me at the hospital. This didn’t surprise me. I started this job two months ago and my boss introduced me to a few people on my first day. He also sent out an email that apparently most people never read. Almost everyday that I am there, another nurse, tech, respiratory therapist, or other colleague says something like this: “Oh, I didn’t know you were a doctor!” “I didn’t know they hired another doctor.” “I have seen you around but I assumed you were a wound care nurse or something.” Not one of them has ever come up to me, introduced themselves, and asked who I was. In fact, one nurse last week seemed to take pleasure in telling me that she assumed I just never wanted to come in. Why in the world you would tell an attending physician who you have just formally met a presumptuous statement like that is beyond me.


I do everything I can to make sure I’m seen. I wear brightly colored scrubs with matching head scarves and artistic shoes. I document in the nurse’s station at times. My name and title are embroidered onto my scrubs. I introduce myself by name and title and always show my badge to patients and their families. None of it seems to matter. Assumptions are far more powerful than facts. I look young. I’m five foot 1. I’m a black woman. These are all things that no one expects their doctor to be. At my other job, I have taken to writing “Dr. Comer was here" followed by the time and date on the white board so that no one can accuse me of not seeing my patients. This will now be my practice at the long-term acute care hospital. It shouldn't have to be this way, but it is. I put some dry erase markers in my work bag this morning in preparation for this new routine.



I couldn’t be an arrogant person even if I tried. I have many built-in factors that keep me humble and not looking the part of a silver-haired, white male doctor is one of them. After talking things out with my practice manager today, I accepted the fact that this is never going to go away. I am always going to have to be prepared to defend myself, my job, and my decision-making to people who are bent on their false assumptions. I can choose to walk around with a chip on my shoulder about the unfairness of it all or I can choose to rejoice in the fact that the Lord continues to provide safe relationships, favorable work opportunities, and platforms for me to show people a better way of seeing the world and thinking of others. Perhaps our first impressions sometimes prevent us from getting to know some really great and interesting people. Perhaps our menial expectations sometimes create a self-fulfilling prophecy that would have otherwise been avoidable. Perhaps none of us is as wise, fair, or just as we believe we are.


Stay thoughtful, friends.







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