As I’ve been mentally preparing for the next several pieces, there is at least one common theme developing. Step Zero just has one prepared IN CASE you need to make a change down the road. Before one actually changes and develops a viable plan, you need a motive. A reason. A kick in the @$$. An “Ah ha!” moment. Or, as Sam Jackson states in Pulp Fiction, “a moment of clarity.”
In my chemistry days, I’d call this a catalyst to jump start a reaction. In my biochemistry days, you need an enzyme (which reminds of a terribly inappropriate medical school joke). Unfortunately, one can’t plan for these. Unlike a reaction, you can’t just add an ingredient that is not directly consumed in the process. You’re on a timeline, and it’s just not yours.
I hope for more people, that they don’t have to be whacked with as many 2×4’s as I was. But it’s hard to change if you don’t have a receptive mind. You have to make yourself change, or by experience, understand the need to do so. The only thing I can suggest to someone is to know yourself. If you think you might want to take a sabbatical, and you don’t want to take my type of route, then you somehow have to find a catalyst to accept a lower threshold to change. I can’t explain it any other way.
Rather than explain in esoteric terms how to prepare mentally to make a change, I’ll just relate how I got there. Hopefully, if anyone out there is looking at making a major change in their own life, that you can do so with less convincing than I required.
As I’ve well documented before, Sonia had her “Ah ha!” moment when I had meningitis. For me, that event was kind of like a bottle of smelling salts. I was aware at that point that I could start an alternate plan. I just wasn’t fully cognizant enough to finish off the process.
As it turns out, I needed two more catalysts in order to start an exit plan, and then actually make one.
For about six years, I was in an office that was in a small, urban township. The office shared a building with another business, a mom & pop convenience store. For the first five years, things were really good with the business next door. They didn’t open super early and weren’t open ungodly late. Best of all, they didn’t have a liquor license. They sold milk, soda, Twinkies, candy bars, and salty snacks.
It was a very non-AAP approved arrangement. I had a lot of talks in the office about junk food and appropriate nutrition. But the people running the business were nice, people walked in and out of the store all day, and the customers largely left our patients and staff alone. And, if I needed a caffeine fix or a snack after being up all night, it could grab coffee, a cola of my choosing, or a candy bar (the medical assistant I worked with for a decade tossed me one Snickers Dark with Almonds, and my sweet tooth hasn’t been the same since.)
I don’t remember exact dates, but somewhere towards the end of tenure, the old business moved out. After a bit of remodeling, a new one moved in. It was also a convenience store. Cool!
The uncool part was that the city, in their infinite wisdom, had granted the new business a liquor license. I’m not a lawyer. I don’t have a degree in urban planning or land utilization. I surely don’t have a MBA. But that seemed like a very, very, extremely, non-doubt-about-it, stupid idea. I understand communities need revenue. But children, families, doctors offices, and alcohol don’t mix. Our office tried to raise this point as a legitimate concern. I don’t know why, and I’m not sure who was responsible, but our concerns went unheeded. Whether this was on the city or my organization (or both) is a debate for another day. It probably doesn’t matter anymore.
We started having a number of issues, even in (and especially) broad daylight during hours we were seeing patients. Drunk people wandering into the office asking to use our restroom. Drunk people harassing our families. Random people making threats to our staff, or me. One summer day, I stabilized a person that had been hit by a car outside the office (it was a hit and run), with a fairly hysterical group of people looking on (some people asked me why I didn’t bring an ambulance. I had to explain to them that I was a good Samaritan and I wasn’t the EMS. They were SHOCKED). None of them called 911; we did that. Our whole office helped until EMS got there. My shoes and clothes were blood soaked.
I called Sonia as I was driving home; I had to clean up and shower before going back to work. She was on the receiving end of this phone call:
“Hi, sweetie. I’m coming home. I’m covered in blood; it’s not mine. I’m ok. I’ll be home in fifteen minutes. Please be outside with a black garbage bag. Wear disposable gloves. I’ll explain when I get there. Love you! Bye!”
This might be normal for some people in an ER, but not a pediatric office.
I got home, and started stripping in our front yard. Magic Mike had nothing on me. She threw away every stitch of clothing I had on. I showered and went back to work – in scrubs.
Then we started having more crime issues. A drive by shooting, murder, and police chase took place right by our office while seeing patients. We did not receive notification from the local police that anything had happened so close to our office. I left work, or tried to, surrounded in all directions by police tape. Getting home was tricky. I called Sonia to check the news – she actually told me what had happened.
I also had different issues. I’d be alone in the office after the office was closed, finishing my work. When it was dark, the drunk people and belligerent folks really came out. I had one person “park me in” as I was leaving very late one evening (essentially, they pulled up behind my car’s back bumper and T’d me in) and demand that I examine their child in the parking lot. Maybe they didn’t mean to be combative, but that’s sure how it seemed. (A funnier version of this was one day I had a long discussion with a Spanish speaking mom about reducing allergy exposure in their home for their child. The next day, the father caught me as I was leaving and we had a very kind but impassioned discussion in Spanish about how he was willing to rip out carpets and put in all hardwood floors if needed to. We talked for 20 minutes. Talk about things I wasn’t expecting before driving home.) Scared the bejeezus out me.
The build up of these ongoing issues wasn’t great, but our office was ok. Medical facilities are usually a safe haven. Then, on a Friday in the summer (I was out on vacation), the office had an unusually slow day. The office closed at 5 PM sharp, and the staff left quickly. Not even a minute after they left, a person was gunned down in the parking lot right by our office. On any other day, there would have been patients still finishing up, or staff working late. Who knows what would have happened any other day we were open.
I told my organization that they needed to move our office to a safer location for the sake of the families and children that utilized our office, as well as the safety of our staff. The city had cast their lot with the liquor store over community health. I know when I’ve lost. We had a security guard by our office for a few weeks, which while helpful, didn’t exactly engender confidence of our patients and families.
Again, Sonia wanted me to leave and take time off. I wasn’t sure; I still wanted to help my patients. I signed a two year contract, but told Sonia that in 2015, I was evaluating my situation in the new office. If things were better, great. If not, I would put in 12+ months of notice to my organization out of respect to them and the recruitment process. 2016 would then be my swan song, and I would keep it quiet for as long as possible. I was now open to the idea of change. Catalyst numero uno was done.
If you’ve read my other blogs, you know how this ends. If this is your first blog, I left my job. I’ve never discussed catalyst #2 before outside of my family.
2015, for various reasons, did not go well. I discussed this in my first two blogs. It was clear to me, by late September 2015, that things wouldn’t change in any time frame that either I, my family, or my health could handle. I drafted a resignation letter in mid-October and scheduled a meeting with my office manager, with whom I got along very well.
The day of the meeting was her first day back at work after one of her family members had been sick in an ICU for over a week. I could not, in good conscience, resign after she had finally gotten her head above water (“Hi! Welcome back! I quit!!”) When we had our meeting, I did let her know what was on my mind. We agreed to meet the first Friday of December 2015, and I would tell her my decision. I spent the next seven weeks deliberating one more time my professional future with my organization.
I thought. I prayed. I talked with my family. I pondered. But it was clear. As much as I would miss co-workers, families, and children, it was time for me to go. The week of Thanksgiving 2015, I changed the date on my resignation letter. I was all systems go for resigning in early December. 12.5 months notice. That’s good communication and preparation if I dare say so myself.
But I still felt a twinge of guilt. Like I was admitting defeat. I knew what I had to do and wanted to do. Maybe I just didn’t want the long goodbye. But the unsettled feeling was there; it was palpable. My determination was profound, but it didn’t make the deed any easier to stare down.
Then, enter catalyst #2 from stage left.
It was Thanksgiving Day 2015. I had finished rounds at the hospital and left for home at 10 AM. I made a right turn off a small street, and on to the local state highway, near some steel mills.
There weren’t that many cars out. Only me and a white truck in front of me by a little bit. There were two men on the far side of the street standing and talking to each other. It cool outside; I don’t remember if it was sunny or cloudy. The urban setting by the mill would have fit into some Springsteen lyrics, probably something from the Nebraska album. In this part of town, NOTHING was going on.
I’ve come to understand from several sources that our memories are somewhat unreliable, and that each time we remember, we’re actually remembering the memory of a memory. I think I’m being accurate, but as a Tim O’Brien has said, sometimes we can only relate how things SEEMED. Sometimes, that’s as truthful as the actual happening. This is a long way of saying that I will state what I remember witnessing, but it’s already been 2.5 years, and I really don’t want to misrepresent the event one way or the other.
I do know I saw a gun go out the window of the white vehicle in front of me, pointing at the two men on the sidewalk.
I don’t know if they fired a shot. I was close to the truck, but not tailgating them. I assume I would have heard a gunshot, but I don’t know. My windows were up, and the radio was on. (Thanksgiving Day radio in St. Louis is really uninspiring, but this was the least of my problems at this very moment).
Apparently, the two men on the sidewalk saw the same thing I did. One man took off running away from the street, to my left. The other man ran behind the truck and in front of my vehicle. I nearly hit him, but fortunately, I didn’t. He looked scared; like he was frightened for his life. He seemed to dance out of the way.
The truck turned off the street I was on, and went right. As I got to the same side street, they were trying to turn around quickly (the side street was short and a dead end).
I didn’t know why a shot wasn’t fired. Maybe the gun jammed. Maybe they didn’t anticipate any witnesses and saw me. Maybe they lost their nerve. I’ll never know.
I did call 911 while I was driving to report what I witnessed. I called Sonia, which maybe was a bad idea; she had a long wait for me to come home. It seemed like every vehicle behind me was a white truck. I’ve never been so hyper aware of vehicles on the highway before. I swore that for sure I was being followed. I was waiting for bullets directed at my car. This was close to the level of paranoia that Jagger sings about in “Flight 505” or “Fingerprint File.”
When I got home, Sonia and the kids washed my car; they figured it would change the appearance of my vehicle as it was really dirty. They took off all the bumper stickers so my car would be harder to identify (the “Take Your Blood Out for a Spin” and running store bumper stickers did make my car stick out). We switched vehicles for the next week.
I’ll be honest, I had it better than people who live in difficult places. They may want to escape violence, poor schools, and bad neighborhoods, but it’s not really an option. Yes, Kieran, I was lucky. You better believe that I know it. I was fortunate that I had the capability to make a choice, and some people (even some I know) aren’t so lucky.
Later that weekend, I went for a run. My training had been terrible for weeks – probably due to me being mentally distracted and exhausted from what I knew I would do – resign. I had a FANTASTIC tempo run. I nailed the workout, and ripped through the closing two miles. I got to our house and let out a guttural, visceral “AAAUUUGH!!!” Part celebration, part frustration. I felt better and walked inside.
Sonia asked me if I was OK – she heard my yell – as did half our neighborhood (I’ve never been accused of having an “inside voice.” Sonia will “be loud” to get our kids’ attention. I’ll tell her to yell; she always says, “I am!” My response? “That’s not loud; I’ll show you loud.”) She asked me not to do that again. Andrew had heard my yell, and assumed I had been shot. He was in his room and in tears. It took a while to talk him down. Ladies and gentlemen, I thought I had hidden the stress from my children fairly well. I was wrong. This had a more profound effect on my family than I had imagined.
Catalyst #2 was complete. I handed in my resignation a week later. I cried giving the news to my office manager. She was kind and supportive. She knew I would still be very reliable during my last year. As sad and concerned as I was for my patients and families, I was no longer racked by feelings of guilt. Those went right out the window with the handgun that I saw on Thanksgiving.
For part of 2014 and most of 2015, we had started running some very basic scenarios as to what time off might actually look like. We weren’t completely surprised. But now it was official. The chemical reactions were over. We only had one thing left to do.
Time to make the exit plan.