Wednesday, August 10, 2011

Death and Birth

It's been about a week and and a half, and my return to Shmeens has started a bit smoother than I expected.  Considering how tense and nasty everyone was acting the last time I was there, I clamped down and tried extra hard to be sweet to everyone I spoke to.  I encountered a nurse or two who I had gotten into throwdowns with, and thankfully they didn't remember me, so I was able to start over with them and act extra grateful (even if all they were doing was a basic task).  I would have tried to do this anyway, since I was scheduled to spend a lot of time at Shmeens, but I had a separate reason for doing so.

Without revealing too many details, it is looking a bit likely that my home base hospital may close.  Sadly, this is the story not just for our facility but for many many others in the metropolitan area.  It seems to be a clusterfuck of a situation, for lack of a better word, because all of the hospitals' debt is being called out at the same time that corruption in the governing hospital systems is being called out, at the same time that the state is unable to provide funding despite acknowledging a need for hospitals in underserved areas like ours.  There has been a lot of rallying on the part of the community and doctors and nurses to save our facility from a terrible fate, but I fear that it's just too late for what seems to be a done deal.

The kind of pall this sort of event throws on everyone, it's hard to describe.  When we first heard news (which wasn't even news), the nurses went into a super-chicken mode in which they basically screeched and clucked the news to anyone and everyone who would hear, even if there wasn't anything definitive to report.  There is so much sadness that everyone feels for the community residents, many of whom cannot seek medical help elsewhere because of economics and geography.  The attendings have all gallantly tried to roll up their sleeves to help, but of course must think of their families and so are quietly exploring jobs elsewhere.  Everyone agrees that it's a tragedy of Greek proportions.

This, of course, puts the residents in an uncomfortable position.  Because of the nature of residency programs and spots nationwide, when a program shuts down, residents don't lose their positions - they are typically redistributed to other programs (who happily take on the $150,000 value + resident labor) and the spot is later lost after the resident graduates.  In other words, while the hospital closing creates drama as far as where we will all go, we are not in the same boat as everyone else in terms of job security, and it's hard to look everyone in the eye when they're struggling and we aren't.  This is especially true of the surgical program, because our director is working hard to preserve the program itself as a living structure - to do this, we are trying to shift our home base to Shmeens.

We are very fortunate because we already were spending so much time at Shmeens, running their service and staffing their OR, that the program disseminating would be a massive blow to them.  Additionally, Shmeens once had a residency many years ago and lost it, and there has always been an interest to re-acquire one if possible.  All of our attendings there have been exceptionally supportive of the plan to relocate permanently, and seem excited to have us.  The chairman in particular has shown a lot of enthusiasm to further develop our program and utilize affiliations to create new outside rotations that we can add to our roster and boost our academic strength.  And fortunately, we already share one attending with the home base, to help ease the transition.

I'm not really sure of how I feel about it.  Or rather, I know how I feel, but then I'm overwhelmed by guilt about it.  Our program will have an easier transition by far than the other residencies at the home base, and they are still fighting to stay open.  One in particular will likely be split into two programs, a travesty because that program is quite coveted in the area because of the specialty it trains for.  On my part, I almost wish closure would happen as soon as possible so that we could all move on with Shmeens, but the reality of that would mean expediting the loss of nearly a thousand jobs in a relatively poor area.  Being at Shmeens where it feels safe, I'm taken away from the tragedy and heartbreak.  I don't want to go back.

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