Opening for what comes next

The health reform battle was already ugly when I wrote my last post, and it sure didn't get any better over the subsequent months. I have to admit that I got so tired of the incessant emails begging me to write my Congressmen (yes, they're all men in this case), I started deleting them. And then it passed.

"Health Reform" didn't pass in the form anyone wanted, but who thought it would? What will the present version really do? Who knows? But the fact that inertia and fear was finally nudged off their pedestal makes me optimistic.

Unfortunately the last week at work was not terrible optimism-engendering. We already knew that 2 attending physicians were leaving the practice at the end of June, just in time to not be there to weather the yearly transition of all our experienced 3rd year residents out of the practice and the introduction of the new interns. Those of us remaining in our small department were already anticipating the coverage and administrative issues with anxiety. Then on Tuesday, another attending announced a move to another city at the same time. Then on Wednesday, a fourth admitted she is interviewing for other jobs. This is scary, folks. All have reasonable reasons for leaving, it isn't that. It's how in the world we cover all their work when hiring and training new people takes months.

I have considered how to protect my time to do research and yet chip in when needed in crisis. I am about ready to pre-empt any random or misguided assignments by volunteering for the ones I would rather do, and to only volunteer for them on a specific timeframe. But having to do all this mental negotiation has surprisingly made me feel less dread than I would have expected. I was a bit angry at first, I admit. But I have a feeling it will be ok. Something about this made me realize how amazing it is to be able to say, if absolutely necessary, I'll do this with the students or that with the residents. What a great job you have when over half the things you're usually saying no to are all things you would really love to do if you had the time?

Of course I need to keep protecting my time and sanity as much as I possibly can. Finding that balance will never be easy. But having the attending loss become more than just an inconvenience and now a real problem will necessarily open up a lot of possibilities we've never thought about, opportunities we never would have had. Health care reform is similar - it's not perfect, it won't solve anything, and some parts may turn out to be outright bad. But it's an opportunity, an opening, to release the stranglehold of the status quo and the invested identities and perhaps let creativity and compassion come in.

We do this with our patients all the time. We use motivational interviewing to identify their needs and help them make small changes. But it isn't uncommon for someone who has struggled to stop smoking for years suddenly just do it. Or someone else finally loses those 20 pounds, or leaves the abusive partner. Inevitably they say that some event, usually something fairly dramatic but not always, suddenly opened this up. It somehow changed their understanding of the importance of the change or their self-confidence to make it. Often they can't really explain it, but the classic case of preparation meets opportunity strikes again.

Trouble is that we never feel prepared for change. But that doesn't mean we aren't. I suppose every one of us has been preparing for change our whole lifetime.