Side note that this post has changed titles about 20 million (slight exaggeration) times and I’m still not sure if this is right…but we’re just gonna go with it ‘cause I’ve been thinking about it all day and it is time to give up and just hit post ‘cause probably no one cares as much as me…lol…so I figured I’d just pick something that I know doesn’t really pull all the things together and run with it…love the refrain of this song though…”feels so good to be alive” because I’m realizing regardless of what I’ve been through I still have my life and that is worth something.
I’ve been quiet for a while. That last post was something I felt like I needed to post. After responding to threats with obedient silence and secrecy I felt like there were people who might need to hear my story and I felt like those words trapped inside me needed to break free. But as much as the story needed to be told, it also incited a lot of fear. I am very aware that everything I do carries with it risk. And sometimes posting again just feels too far into unsafe territory…but like always, I refuse to let fear win.
When I posted that last post I really thought I was going to wake up in the morning completely regretting it. It was weird yet empowering to get up in the morning and not see someone standing right outside my door waiting for me. I’ve still felt a little extra on edge at times, but at the same time I’ve also felt a little extra safe after realizing I did that and haven’t reaped any consequences yet. But that’s the key word. Yet. I still feel like it is just a waiting game until something happens, and it is scary. I still remember a little over a month after getting brave enough to contact ASHP getting that knock on the door as I was getting ready for the u-haul woman to arrive…so as much as it felt like it would be instant, I also know innately that it could happen at any time…and I wish I knew if someday the fear subsides and I can really feel fully safe again. I want to know if this is a part of trauma that lasts forever or if eventually I’ll reach a point at which it has been long enough that I feel comfortable that I’ve outrun the bad guys and reached the end of the marathon where safety lives. I want to know if there even is a place where I can drink from the well of safety. But I feel like getting those words out into the world was incredibly empowering and healing. I thought I was posting it for others, but I realized it was a marker for me that I was starting to feel safer. I feel like I’ve been practically willing myself to just not exist because if I don’t exist I can’t be found and I can’t be hurt. And that post made myself and what I experienced real, and I needed that. And yet I am very aware that bad things can happen to good people. Someone recently told me about being attacked by a former boyfriend with whom she’d broken up years ago when both sides mutually agreed it wasn’t going to work – so you never know when someone is going to find and hurt you even without any real inciting factor besides existing…but I need to exist. I need to find a way to keep living, because it feels like if I don’t then the bad guys win.
Wanna hear a story about a time recently I realized my experience in life had not prepared me with the appropriate knowledge for my current situation? So I came up to this intersection. I stopped at the red light. On the other side was a train tracks, which I didn’t think much about…until…the light turned green. I started across the intersection, and then as I was almost all the way across the flashing/beeping started, and I stopped because I was startled. Then I gunned it because oh cr*p red light. Then I hit the brakes because oh wait, cr*p, that means a train is coming. And then I finally figured out I better get going because I was in the middle of an intersection and definitely in danger as soon as the light headed the opposite direction turned green, plus I was probably too close to the tracks for safety anyway…the drivers manual tells you not to try to race a train and to stop when you see the lights, but it doesn’t address at all what to do if you’re in the middle of an intersection when the lights start. And I think that is a problem, because like I still don’t know what the right thing to do is, and I also feel like in the moment I would probably do the same thing again the next time…I also have a whole lot of opinions like America has so many better ways of moving both people and objects than trains, so why are we continuing to use such an antiquated technology that is responsible for so many dangerous situations? Wanna get somewhere far away faster than by car? Airplane. Otherwise cars, and bikes, and feet are significantly more convenient…and maybe busses in case you rode the airplane to a new city and just need to get from the airport to your hotel but obvi didn’t carry your car on the airplane and it is too far to comfortably walk…hashtag opinions…like I have no problem with metrolink because it’s basically a bus that can’t go a different way around the block, but I feel like trains don’t make sense anymore…they are basically the rotary phones of today. Sure, they can theoretically work, but they are neither convenient nor trendy.
I was listening to TTFA today (today being a very relative term…) and there was one thing in particular that was incredibly validating. They said sometimes you have to let go of saving someone else in order to save yourself, and it feels incredibly guilty, but it is the right thing to do…and y’all, I so needed to hear that. My heart breaks that I can’t protect everyone from the people who have hurt me, but I felt like I needed to save myself…and it felt wrong. And it feels so important that it is normal to feel guilty for that, but doesn’t make it wrong.
A month or so ago I was doing a neonatal and pediatric code training for pharmacists. By doing I mean I was leading a group of pharmacists through how to respond to these emergencies. Hashtag rewind a few years…I was preparing for interviews and a couple coworkers were telling me things they felt like were important for me to talk about…and most of the things they thought were impressive about my career were things that to me were throwaway items…and to be honest I didn’t take a lot of their advice because trying to talk about it would have felt really not genuine. At that point in life trying to use my words at all was a lot of work, so anything not genuine probably wasn’t going to work for me even if my moral compass didn’t prohibit me from saying anything that could be construed as lying in an interview…yes, I know, that probably costs me a lot of jobs because everyone else is selectively and manipulatively displaying themselves and elevating how much what they did was actually worth while I am more concerned with giving an honest picture of what I am like…but I feel it is not honest to exaggerate, and I also feel like why would I want someone’s first impression of me to be a version of me that is going to lead all other interactions to lead to disappointment because I was trying to be someone I wasn’t? Plus, every job I have had has happened for a reason. God has opened and closed doors to put me where he needed me to be at the time. Anyway, the point of this aside was that someone said that it was important for people to know that I was involved with students because it was a good way to ensure I was engaging in lifelong learning…and I felt like that made no sense…I mean, wasn’t I the one doing the teaching? Like I mean occasionally someone mentioned something that I had to look up to confirm because at the time I was primarily working in the adult world but in school had taken care nearly exclusively of pediatric patients so there were definitely things I was not as confident in as I perhaps should have been, but for the most part I was on the teaching side…Oh sweet naïve mini me…at the time I may not have had a lot of learning on my side, but during the code training I was doing recently did teach me something. One of the participants was like at my previous job I found this app that might be helpful. Is it a reliable resource? I hadn’t seen the app before so I searched it in the app store to test it out. There are two apps with very similar names, so at first I apparently downloaded the wrong one. It was called PedsGudie and is put out by Mercy Children’s Hospital. As soon as I saw Mercy Children’s I was like I am 90% sure this is going to be legit…and y’all, it was so much more legit. It was impressive. There is so much incredibly information and guides within that app. Just going to throw it out there that anyone working in pediatrics should have this app. Do I feel like I know what I need off the top of my head pretty darn well, absolutely, but y’know what, you never know when you’re going to forget key information and need a backup plan. Sure, I have created emergency dosing cards and recommended people utilize PALS dosing cards, but this is so much more accessible and frankly provides more information and more specific information. Like it has built in a conversion between estimated gestational age and estimated weight. It has so many drugs and quickly brings up the most commonly used drugs and doses when you choose what problem and body system you are working with (resuscitation – circulation; diabetes – cerebral edema; etc).
As it turns out, that was not the app she was talking about…so when I was done thanking her for informing me about this app she showed me what her app looked like. It is called Ped Guide. The logo is a bear. And the app isn’t worthless, but it pales in comparison to PedsGuide. For all of ACLS it has a picture of the diagram – no calculated doses and you’re gonna have to really zoom in to even read it. The part of the app that does calculate doses has a short list of meds it can calculate, and I’m not sure exactly what weights it accommodates, but I was unable to enter the 0.5kg test patient I wanted to trial it on, and it does not have anywhere to enter a gestational age or an age that is less than one month postnatal. It does have a decent list of “situations” but a lot are things that are not as urgent, and most when you click on them come up with an overwhelming list of medications without any guidance on when or why to use any particular drug. Probably the biggest issue is when I clicked on “infection” and then clicked on zosyn. A recommended mg/kg range is given, but not whether that is in mg piperacillin or mg zosyn. And I’ve seen it dosed both ways in real life. I’ve used it enough to know which they were dosing by based on the recommended doses given, but yikes. Also, the entirety of the information you get is mg/kg, concentration to infuse, and infuse over 30 minutes…lol, I do understand that most people have some sort of actual dosing reference on their phone, but the recommended dilution they gave was very dilute, was again not documented whether they meant mg pip or mg zosyn, and no instructions on how to get that from a vial or from a premix bag….so yeah, my response was you are welcome to use that if it makes you feel safe, but be cautious that you are using standard concentrations rather than the concentrations in the app, and verify dosing in a different source if there is any question. You can also tell it is old and hasn’t been updated because the only H2RA included is ranitidine – which isn’t a thing anymore…based on the terms and conditions the app was created when I was in college and hasn’t been updated since then, so that is a while. Versus PedsGuide I am not sure how long it has been around or when it was last updated, but considering one of the references was from 2018, it is at least more recent than college graduation and I didn’t find anything concerning there.
So yeah, I now have two new resources, one of which is super useful, the other of which I kept because I don’t believe you can ever have too many resources. Kinda like how I have the Lexicomp app I no longer have access to because it stores the last drug or two accessed in offline memory, so if I ever want to know anything about melatonin in Neonatal and Pediatric Lexi-Drugs then BOOM mission accomplished. Okay, and also because I have a mild maintenance of sameness issue…I also still have the UpToDate app I haven’t had a valid password for in two years…and in a folder on my shelf is a script about solid organ transplant that I was supposed to read to my preceptor at the end of the week the week I left PGY-2…and for some reason even though I know the chances of me ever going back to that hospital are about 0.1% and even if I went back I would not be going back as a resident because I am pretty sure I am done going backwards at this point in life. I’ve had some fantasies about applying to some of the residencies in the Scramble because there are SO MANY more of them than usual this year and some of them I know are connected to incredible RPD’s and I would love to have that kind of relationship again, but the problem is that these are not residencies in specialty areas that I actually care about at this point, so it would not make professional sense to do them…and honestly with everything I’ve gone through since the end of September, I don’t think any residency is what I need professionally anymore. I might love it, but I don’t want to take an incredible spot away from someone who does legitimately need it (and I obvi don’t want to take a less than stellar spot if my goal is primarily a relationship…and let’s be real. You can choose a job based on the people, but you probably shouldn’t do residency for the relationship. Not that life is about money, but residencies don’t tend to pay overly well compared to pharmacist pay.
The other thing that happened related to that code was training was remembering how much I really value and respect people who are willing to admit what they don’t know. The next day the student who I had been most concerned about but who had successfully answered the required questions and had verbally confirmed that she felt comfortable approached me after I’d finished some more training and admitted that she’d been worried all night because she realized she didn’t know enough to safely care for patients. I could see that was a scary realization for her and I also realized how vulnerable it must feel to admit you didn’t understand what your peers totally get, so I set aside what I’d planned for my evening and sat down with her to figure out which points were muddy. Together we learned how to get into an abboject container (important first step) and how to put it together so the drug can come out (also important and something I didn’t realize I didn’t know when I graduated pharmacy school until I was at a code alone holding the pieces and trying to figure it out the first time – I’d drawn meds from vials and predrawn syringes in my prior experience and therefore never needed to know these things so that part is something I make sure all learners have experienced at LEAST once before being out in the world). We learned how to draw up meds – and make sure there is med and not just air in your syringe…and of course the part I was supposed to focus on, the pharmacy math or use of dosing references to know how much to give, because even with adults, but especially with kids just ‘cause the vial has 10mL doesn’t mean you should give 10mL… (lol, especially if the vial is fentanyl…) It is also a really good feeling to know that I am someone people feel comfortable asking for help. I want to be approachable.
Recently I was researching burnout and resiliency for someone…I came across a recommendation for residency programs to enhance their residents’ wellbeing…it was to force residents to take pto and not do work on those pto days. I am so glad I’ve never ended up somewhere like that. First, I don’t think anyone should get to command what I do or do not do on my time off…plus, not doing the work on pto means having even more work to do when you come back which would mean even more stress. That does not sound good for mental health at all. Second, I feel like residents (or anyone) should not be pressured to take pto when they don’t need or want it. You never know when someone will get sick or otherwise legitimately need their time off, and also some places pay out time off when a person leaves the organization, so you are also financially impacting people by forcing them to take pto. I’m also someone who has only once ever taken pto for anything that wasn’t career related or to volunteer with kids, so it definitely would have pushed me out of my comfort zone to take pto for no reason.
Something I saw online recently that was incredibly meaningful to me. It was very validating.
“I just want to honor all it cost you to know what you know”
Sometimes I don’t want to be brave. Sometimes I’d rather to have continued to struggle with imposter syndrome than to go through all that I went through this year. Yes, I did learn a lot about what sacrifices I am not willing to make and about identifying safe people, and about the sorry state of the American justice system, and about the social services systems, but that learning wasn’t free. The price tag on that learning was emotional. It was financial. It was an incredibly high price. And most days I wouldn’t change it because of all I learned, but that doesn’t discount the price I paid. That learning wasn’t on the clearance rack. Sometimes I have significant buyers remorse. What happened to me was absolutely not okay. There were multiple people and systems who failed to act correctly towards me. I survived, but what didn’t kill me didn’t make me stronger. That is a myth. It did make me more determined than ever to prove my value, but also made me terrified of doing anything too amazing, because the trouble with being too awesome is the threat to my safety of publicity. I’ve never wanted to be in the limelight, but now it is not only unwanted but also unsafe for me to be in the limelight. The last thing I want is for my name to be plastered all over the pharmacy community. And yet I have also felt like a measure of success is people recognizing your name as a frequent contributor to the community…it is a very challenging place to be in. I don’t want to be defeated and live in fear, but I also am sometimes weary of painting on a brave face every day.
I am very aware that this post will be incredibly dangerous to post and could potentially put me at risk, but I’ve been thinking about it and I feel like this is a story that needs to be told, and I’m currently feeling brave. I have survived hard things and I have conquered big challenges. If I have to do more hard things I know that God has a plan in it. As hard as things have been, God has been with me through each step of the way even when it seemed like I was incredibly alone.
Like I’ve discussed previously, I think I needed the things that happened this fall to recognize that I didn’t need residency to prove that I was valuable. I needed the events that happened to learn that I didn’t need a “normal” career path to earn the position I wanted…and if I hadn’t learned those lessons and been able to speak to that confidence I wouldn’t be where I am now. (And recently I attended an ASHP webinar on imposter syndrome and learned one of the pharmacists in my small group was in a role I’d been told was not possible without two years of residency – and she hadn’t completed even one year of residency). That was incredibly validating to see also that there are other people who didn’t take anything close to the typical path yet have an incredibly successful and fulfilling career unhindered by not fitting into the mould.
But anyway, back to the story time I have been debating about sharing for a long time…
On the first day at my job last summer we’d each selected a work space in the room they kept the residents in to keep them away from the rest of the staff (yes, they did make it clear that was the intention). The room was shaped like a very narrow L and the monitors and chairs were arranged in a J around the perimeter of the room with just barely enough room to walk through the room. I’d very intentionally selected the desk on the end next to the door to give me clear access visually and physically to the outside world. But we’d been told that we needed to be flexible in our arrangements and especially the PGY-2’s needed to be thoughtful of the needs of the PGY-1 residents, so when a PGY-1 asked to switch with me I moved to the desk at the other end of the J, putting me in the back corner…and putting someone next to the door who preferred that the window be completely covered at all times.
If I’d been at the desk that I originally had been set up at, I would likely have had enough access to the outside world they wanted to separate us from that I’d have accepted what they wanted to be my place in life and stayed there at all times. Instead I yearned for connection and so desperately needed to be somewhere I could have relationship that I reached out to my RPD who said there was no reason I had to stay in my office and was welcome to work wherever outside of my office would work better for me. So I found a corner of the hospital that was never used, was not in a patient care area nor inhabited by visitors, had a couch and chairs, and was close enough to the pharmacy to allow me to finally start to get to know people as they walked past, and to at least see the culture of the pharmacy even if I wasn’t totally involved in it.
If you’ve been reading for a while, you’ll know that quiet place to work one day became the reason my residency fell apart.
Brief intermission from that story. There are a lot of reasons I should have left this residency before that point. On day one we each got a note from last year’s residents. I don’t know whether all notes were the same, but I do know that mine essentially said hold on, this will be an awful year but you’ll get through it (which I suppose I am getting through it, just not as a resident). It was already clear that residents were employed as cheap labor not due to anyone desiring to give back or mentor newer pharmacists. It had been made clear that my RPD believed that a PGY-2 was to enable the pharmacist to work in administration rather than clinically – and she couldn’t understand why I would have any interest in PGY-2 when my career goal was as a clinical position rather than administration. And even forgetting the rank list and application comments making it clear I was unwanted, it was very clear that my RPD was hoping I’d choose of my own volition to leave. Y’all, one of the first things she said to me in my planning meeting on July 21 was to ask me if I was sure I should be in residency because she thought I probably shouldn’t be there because I’d mentioned in one of the things I’d had to fill out that my dad had died just under two years prior. I give people the benefit of the doubt so I chose to believe she meant well but just didn’t quite understand grief. I should have seen it for the red flag that it was. But I’d already ignored rows upon rows of red flags because I really believed that because this residency was labelled pediatric critical care and that it was coming immediately after my pediatric PGY-1 that it was what was going to make me feel like people would see me as worthy of having the position I’d wanted since forever.
Basically this had been the entire path from match day in March to that day in July and yet I was still naively, obliviously, convincing myself that I was misinterpreting the signs and being too sensitive, that these weren’t *actually* problems, that there wasn’t *really* anything wrong…but there were absolutely some things wrong. I was working incredibly hard to make everyone happy and made significant contributions to the department and yet I was not shown any appreciation and while a few people may have commented that I was doing impressive work and significantly exceeding expectations, most people made it clear they felt I wasn’t doing enough and that I couldn’t really be trusted to perform. I tried to focus on the people who were in awe of my work, but especially for the weeks I didn’t have any patient care responsibilities at all that lack of value while I was being given so much work that I pretty much exclusively worked, went to bed, got up, and worked again was starting to lead towards burnout. And even if I had felt valued, there is only so long you can answer texts every 30 minutes all night. Eventually if you are burning the candle not just from both ends but also from the middle, it will burn out.
Anyway, let’s return from intermission, especially ‘cause I was getting rant-y and no one needs my crabby recounting of the things that should never have happened…
It was Thursday, July 29, and I was sitting in that place that I’d found working on my CE presentation, making some really good progress. If anything, I was ahead on my projects…but up comes my manager. He is angry and tells me I need to be getting my work done. I wonder what he thinks this whole looking at research articles and taking notes is, but simply non-argumentatively state that I am actually working on my CE presentation. He asked why I wasn’t at my desk and I answered that I’d prefer to be around my coworkers. I wanted (hoped) the conversation was over and tried to go back to my work. He stood over me and told me it was unacceptable for people to see me and my choices were either to go staff in the pharmacy or go to the breakroom. I had a lot of work to get done so I went to the breakroom to defuse the situation.
A breakroom is obviously not an environment conducive to work, particularly when it is still lunch-ish time so it is full of people taking a break and not only is it an atmosphere of conversing, but there isn’t really space to set out the materials required to get work done, so as soon as I was fairly certain he was gone I went to my desk to try to get my work done. I was still on edge from being yelled at and humiliated in the hallway, and I was a little overwhelmed from all the conversations in the breakroom (because, hi, I’m Wiggle Worm, the most introverted extravert you’ll ever meet) so I needed a moment to chill alone, but I’d vented to a coworker who was really concerned about me and taken a moment to calm down and was just about to get back to my CE presentation when in comes my manager. I am instantly afraid. He asks the other residents to leave. He moves to the back of the office where my workspace is and moves a file cabinet so I am trapped in that back corner between him and my desk. He then proceeds to yell at me for an hour about how I am ungrateful, unprofessional, and he wishes he’d never hired me. In a brief pause I try to assert myself and ask for the conversation to be put on hold and am told that sometimes we have to do things we don’t like and he keeps going. It is terrifying and there is no way for me to escape. This is a man with very visible muscles and a history of violence and he is red with unexplained anger and I am in one of the few places in the hospital with no cameras and there is no visibility into the room from the hallway. At one point I hear a key in the door and think I am about to be rescued. He hears it too, and as the door opens he stops talking and tells the resident to leave because I needed to talk with him privately. I was too afraid to contradict him and ask the resident to stay. The resident backed out of the office and I was alone with him again. I couldn’t tell you now everything that was said, but I do remember the clear threat that he better not hear that anyone has heard about this. I’m so thankful he realized he had somewhere to be so that he finally left. I didn’t know what to do, so I emailed my RPD to let her know that the office situation we’d been planning to discuss further the next day was now more than just a desire to be more included, then I went to the bathroom because I felt like that was the only safe place I could go.
Eventually I realized that I couldn’t stay in the bathroom forever, and though I really wasn’t sure what I was doing or where I was going next I needed to leave the bathroom. I left, and there was my RPD. She acted like she cared. I felt relieved. She showed me how to get outside, gave me permission to do my next meeting outside where I’d feel safer, and walked with me get my laptop. Learning how to get outside was a life saver in getting through the next month. In the hospital I didn’t know how to get around and was refused a campus map, but outside the hospital I knew I could run multiple directions and still know where I was, and I couldn’t be trapped outside. There weren’t outlets outside, so it wasn’t an all day location even in good weather, but it was a good temporary spot.
The next day we had the meeting we had previously scheduled…but my RPD tried to run the meeting like she didn’t remember what had happened the previous day. I was okay with that at the beginning of the meeting thinking we’d resolve the situation after talking through what we’d originally planned, but then she tried to end the meeting and I was like, umm, this would be fine if it weren’t for what happened yesterday, but I can’t go back to that office and my charger is there and I don’t know what to do or where to go and my laptop is out of battery…and she had already explained that letting me officially work somewhere else wasn’t an option because there weren’t enough spots for all 7 residents and it might seem like favoritism to move only me or only a few residents, so she suggested I start the ADAA process. I was a little resistant because I do not see myself as an American with Disabilities requiring accommodations, but she insisted and convinced me that I deserved to have a safe place to work and this was the way to do it because then it would no longer be a decision of who most needs to be included.
I worked really hard on that process, and it gave me a lot of insight into what people go through who have disabilities that must be accommodated in every position they take. It has also given me knowledge that has helped me help other people who know that things aren’t currently working and don’t know how to find something that will work…
Unfortunately for me, the ADAA people sent me a letter giving me less than a week to have a counselor sign a form stating that the accommodations I was requesting would reasonably resolve my problems. By this point I had already contacted my EAP figuring it was possibly worth giving counseling another try but hoping to do it outside of the workplace, so I’d contacted a few counselors. Unfortunately, none of them responded to me, and I therefore could not turn in the paperwork and my request was closed until I could get that paperwork signed and re-open the request.
I had agreed to a reconciliation meeting with my manager scheduled and mediated with my RPD, and I’d been hoping for it to be scheduled sooner rather than later, but it wasn’t scheduled until late August…well, technically my RPD had asked to schedule it on August 19, but we all know that isn’t a good day for me so I requested if it couldn’t be sooner that it be after that date. The ADAA request closed right around the same time as the meeting so I thought I could wait until that meeting to see if we could come to a different solution before continuing to search for a counselor, because while I still wished I had a home base to store my things during the day, I had gotten used to finding and reserving classrooms throughout the day and the friends I’d made in July started sometimes coming to see me in those classrooms, so it at least kinda worked to provide some community, so it wasn’t the emergency it originally was even if this meeting didn’t work. But anyway, somewhere around like August 25 we met. My manager did not admit he’d done anything wrong, and acted like he was the victim, but did agree to not have any future conversations alone with me, and agreed to implement a new rule that the window into the resident office must not be fully covered if the office is occupied. That made me feel safe enough to go back to the office.
Retrospectively I also recognize that I was told to tell no one and I told my RPD. I think to me that didn’t count just like the year before when my RPD felt like it wouldn’t count to tell someone some of my information for advice on whether there was something she should do to help me. And just like once I let my PGY-1 RPD know how that had made me feel and she recognized that it hadn’t gone ideally, I soon recognized in this situation that it would have been better to not tell my PGY-2 RPD what my PGY-2 manager had done. I found out that she was really offended that I had told her which didn’t make a lot of sense to me at the time, but later made a lot of sense when I found out she and my manager were very close…but it also gave me a better understanding of why someone might say they won’t tell anyone then turn around and tell someone, because these actions both felt like the next right thing in the moment…in PGY-1 telling me it would be my choice whether anyone else knew gave me autonomy and was a step in showing that my life matters, and contacting someone else really was a good faith effort that she legitimately didn’t realize I would mind…and I know I am very sensitive to private conversations becoming public because of my history in college that she would have had no way of knowing about. And in PGY-2, I saw really no other choice but to agree when there was a very clear threat attached to contradicting that demand to ensure no one found out…but I also knew that while I had longed for community prior to that point, my desire had changed and all I wanted was safety that I didn’t know how to find, and I’d told my friends I was giving it at least a 6-week trial period and had only made it like 4 weeks in, so leaving didn’t seem like the right option.
Honestly, I don’t know what I would have done differently if I had it to do again…obviously knowing what I know now I wouldn’t have applied to this program, but I didn’t have any way to know that back then. On paper it was a good program…but I wasn’t applying to work for a paper hospital. Even on day one when I saw just how bad things were, I am so open-minded and willing to give additional chances and dedicated to fulfilling my commitments beyond just basic expectations that I don’t think I would have been ready to walk away even if I had been offered my dream job. Hindsight is 2020, but knowing who I am, it isn’t realistic to think I would have considered walking away at that point.
But problems both small and large continued to stack up. Per the syllabus I could have two NICU rotations…per preceptor availability I could only have one…so much for being a critical care resident (as it turns out, one of the NICU preceptors was leaving – she was an incredible pharmacist and an incredibly kind person, so I am glad she got out). And once my schedule was set, I was excited to start in the PICU…and then like a week before the rotation was to start it mysteriously changed to management. I excelled in management, and while my personal philosophy of effective management styles did not align with my preceptor’s philosophy, my preceptor was clearly thrilled with me. I know that communication skills are not my strength, so it really filled my tank when towards the end of the rotation my preceptor told me that going into the rotation he’d been dreading having me on rotation because based on my application/interview he thought I wouldn’t be able to contribute, but he was surprised to see that while it may take me a little longer to speak than some people when put on the spot that when given a minute I could communicate very effectively, and because I was stopping to listen and to think I was able to provide excellent insight when I did speak. A week or so later we had a meeting where he had me type my final evaluation because he was sure I could put it into words much better than he could. As we started working through the evaluation he told me that he isn’t supposed to mark anyone with 4’s or 5’s on a first rotation, so when he told me on the first question that he was impressed with my skills I marked a 3…and he told me I definitely deserved better than that. The majority of my evaluation was 5 out of 5 (5 is achieved for residency, 4 is consider achieved for residency, 3 is satisfactory progress, 2 is may need to repeat the objective and rotation, 1 is must repeat the objective). I protested because I didn’t want to get him in trouble for giving me too high of a score, because I knew by this point how my RPD responded when things didn’t go her way, but he insisted that this is what I deserved. I hadn’t really felt valued on this rotation, but this evaluation made me realize that this person valued my work even if he hadn’t really shown that it was valued.
While management may not have been the rotation I was hoping to start with, it ended up being probably a good thing for me. As any reader from September onward is well aware, I began looking for a new job. I only included a very small sampling of my projects on my CV, because no one wants to read a list of the 50 things you did. Even with just like a top 5-ish projects that seemed un-confidential enough to put on a CV, I had more than one interviewer tell me how impressive it was that I had completed that many projects while on that rotation (and of course I am too modest to admit that was just like maybe 5-10% of my work). Although I may not have felt valued doing the projects, these comments, again, made me realize just how significant an impact I was able to make even if I’d only been there a short time. It also made me realize that perhaps if I’d spoken up that I’d been given too many projects that the projects would have slowed down – it wasn’t that all these things had to be done and had to be done by me, but more that I was there and accepted everything gracefully and got things done by the deadline which apparently was atypical, so more projects just kept landing in my lap. I don’t know if that made a difference in getting or not getting interviews, but I do know those conversations are good fuel for the fire of my confidence on the days I’m starting to waver in my belief in my own competence.
Anyway, my next rotation was PICU. I feel like this post is already too long even after deleting things that felt too vulnerable to share, so I’m going to try to stick to just the facts really necessary to tell this story. Learning from PGY-1 I expressed early on that when I feel like I am being watched it has a huge impact on my ability to communicate until I am feeling really comfortable with my team. My preceptor didn’t want to discuss rounding until I could take notes on the entire unit in an hour. I don’t see value in speeding through taking notes on patients because I feel I can better care for my patients if I take my time and know exactly what I meant by all my comments rather than being like yay I’m done but for this intervention I wrote fluid mgmt and I have no idea without re-evaluating the patient what part of fluid management I wanted to change, watch, or ask about…but if that was what was needed to discuss rounding that was what I was going to do.
Here’s the problem. I did that and my preceptor’s response was that she did see that clinically there were no concerns about my ability to care for my patients and she could see both that I had okay communication skills and that they were rapidly improving, but that she was going to stand right next to me until I was assertive on rounds. I tried to explain that I was unlikely to reach that point if she was standing there, but she seemed to be uninterested in discussing and I wasn’t sure how to politely continue to explain my point without seeming argumentative, so I just left it at vaguely suggesting we’d discuss again later. If there was a possibility my patients wouldn’t be cared for I would totally understand, but I was speaking with my team and I was discussing the relevant points of my patients’ care.
I realized that night though that with her constantly by my side, I was going to be actively moving away from my goals of residency rather than towards them because between the lack of ability to be my team’s point person because of course any question was initially going to be directed at the person with whom they were familiar and because it was pushing my anxiety on rounds higher and higher which ultimately decreases my ability to communicate. I seriously considered quitting, because I knew while progress may be slower without the cheer squad/accountability partner of a preceptor, that I also didn’t have those things in this rotation and wasn’t sure what I’d have for future rotations. The next day though I was rounding with a former resident because my preceptor was off. By rounding with, what actually happened was that at first she was with me, but she could quickly see that I was much more competent than my RPD had led her to believe and she backed off, so I was rounding mostly alone, and I thrived. Suddenly rounding was something enjoyable again. I emailed my preceptor to ask whether we could consider that success rather than having her stay at my side to see it herself, and if not if we could discuss other alternatives. I was hesitant to send the email because I didn’t want to get this former resident in trouble for not staying by my side…I should have been hesitant because I learned later she used my very intentionally sensitive, thoughtful, and inquisitive words to try to show that I was insubordinate…
The day she came back she was later to rounds than usual, and I was able to interact with my team independently before she arrived and because of our formation it was a few patients in before she could even really try to break into the group, and by that point she had seen enough to see that I could very competently show assertiveness and handle my team without her and stayed backed off. I was very thankful for that, and that afternoon she confirmed that I’d finally be rounding completely on my own the next day. Finally things were looking up.
…but not for long. After rounds one Tuesday I got a meeting invite. I thought it was for the joy in the workplace meeting I’d been dreading because I knew while they were going to ask us to be honest about areas for improvement that any area recognized can and would be used against us, but I also didn’t want to lie and say everything was excellent. Long story short, the meeting started by saying they thought I would agree with the recommendations in this meeting. I knew in that moment this wasn’t about joy in the workplace, but now I thought they were going to recommend that I find a counselor because my RPD knew that my grief group had stopped meeting unexpectedly at the end of June. I didn’t feel by this point that I wanted a counselor, but I also was thinking like if this is what is going to keep the peace then fine, let’s do this…it wasn’t a recommendation for me to see a counselor. It was telling me that I was no longer employed. I’m not ready to talk a lot about that online at this time, but it was definitely a shock – all my evaluations had been much more positive to this point than I’d even thought about myself, and I’d had no written or verbal warning that anything was wrong after that one-time comment in August that my RPD hadn’t felt it appropriate for me to tell her about what happened with my manager…and that conversation had ended with a promise to let me know immediately if there were ever anything else whether verbal or written that didn’t sit right with her so we could figure out how to communicate better between each other, and I had heard absolutely nothing further about anything not feeling right to her, and had been praised about my communication.
I did not agree at first that this was at all good for me. I felt like they had just erased my chance at success in life. I also felt like my PGY-1 had poured so much effort into teaching me that I had value and I was a good pharmacist and it wasn’t fair to them because this basically drained all that out of me. And I found out my coresidents had been planning a birthday party for me and so I had wrecked their plans. I felt alone and hopeless and helpless. The day before my birthday I even applied to come back. I knew it hadn’t been a good place to work, but I thought not having to really ever see my former manager in the role I applied for I could continue to work with the patients who needed me, continue to be part of my community, have better work life balance because I could choose how many hours I wanted to work, and could even probably complete the projects I’d been in the middle of when I left. I’d been told that another manager at the hospital really wanted the value I’d add to the team and the position was mine if I wanted it.
Soon though, I realized I didn’t want it. First, someone leaked to me that they overheard my manager with my RPD making threats regarding me and while this person didn’t hear everything that this person heard enough to know I needed to be really careful – I was already concerned about potentially at some point seeing them in a hallway (they never really entered the pharmacy and my potential new role would be almost exclusively in the pharmacy) if I came back, but this solidified to me just how unsafe I was if I ever encountered them again. Second, I realized that it wasn’t going to be great for me to be in an environment that allowed people to be treated like that because while others were not as bad as my manager, there were other bad actors, and a culture as a whole of fear of what might happen next, so within a few weeks I had pretty much completely moved on and was excited about the potential opportunities to come. I was applying and interviewing and realizing how thankful I was that God found a way to get me out of a situation I wouldn’t have known how to remove myself from on my own.
And that is how not getting the desk by the window really saved my life. I can’t say with certainty, but I think there is a good chance that things wouldn’t have come to a head the way they did if I’d been in that position. As a result everyone around me would have continued to watch me fade away as I continued to be taken advantage of, unvalued, and unrespected, and while I think I would have survived the year, I would have ended up in such a low place that I don’t think I’d have been ready to start my dream job, and I’d have been trained in learned helplessness for so long that I may not have thrived even if I did somehow end up in a good job following residency. I really feel like while that desk may or may not have saved my physical life, it absolutely saved my mental, emotional, and professional life. Being treated that way, and going into work terrified each day is not a sustainable way to live life, and I wish I had seen that sooner and recognized that leaving was going to be better for my career than staying…but I am nothing if not stubborn when I put my mind to things. That determination served me really well in finding an incredible PGY-1 residency, but it would have better served me to let go of my PGY-2 pediatric critical care dream, wake up from that nightmare, and get out so much sooner. But here’s the thing…in October 2020 by a few hours into day 2 of my ED rotation I really believed I may not live to the end of that rotation if things didn’t change. I reached out and was willing to do almost anything to figure out an alternative and the answer was I’m sorry it isn’t going well, but no, we don’t make changes once the rotation has started…and to be honest, I did come close to not making it to the end of that rotation, but I did make it…and I think that experience was one more thing playing into why I was willing to stay in my PGY-2 so long. I felt empowered that I could do hard things and I could survive, and that if I could find the positives along the way that I could fulfill my commitment, serve my patients and coworkers, bring value to the department…and, ok, also have that piece of paper that proved that I deserved to be taken seriously…and looking back, that was the wrong answer. I should have known myself well enough to know that, sure, yes, I may have remained alive, but after a year of that I wasn’t going to be a functional person.
Instead, I got what I wanted from residency and more from leaving. People reached out and told me how incredible of a pharmacist I was. I was wanted at the hospital by a team who barely knew me, but in the tiny amount they knew were sure I would be a valuable part of their team. People didn’t see me as a failure – they saw me as brave and competent and resilient, and I realized that I was worthy of the position of my dreams. My primary goal in residency was to feel competent and confident, and by leaving I gained those things. God knew what I needed to achieve my goals. It was incredible to see how my confidence grew in ways I didn’t feel like would be possible through a situation designed to dissolve the little baby confidence sprouts that had been cultivated throughout PGY-1…but now I firmly believe that I am a valuable part of a NICU team who deserves to have her voice heard. I have learned to stand up for myself and to advocate for what is best for my team. I still believe in second chances and in compromises…but now I know that when I am people-pleasing it is okay to count myself among the people. My voice doesn’t have to be left out.
…and there is one more piece of the puzzle that I’m going to be a little more vague about because it feels even more risky to share…plus, yikes, this is getting way too long like the 10-page posts I started this blog with…
So shortly after leaving PGY-2 (like maybe 1 or 2 days later) I talked to one of my friends. We only could talk for the couple minutes while she was driving her kids to sports practice, and I don’t remember most of the words we said, but I remember her encouraging me to ride my bike…and I remember thinking, but I can’t, I very much look like I’m unhappy and so I don’t want strangers staring at me wondering what is wrong if I leave my apartment like that…but this was a time when my stubbornness and desire to do what I’m told is the right thing served me really well. The next morning I strapped on my bike helmet and was like okay, so you don’t have to leave now, but you are wearing this bike helmet until you are ready to leave…and eventually I went. Over the course of the next week and a half I had a pretty regular path figured out that I was biking near daily. (I would have said within a few days, but the first attempt at finding a path was really incredible until, umm, oops, it was a little later than I thought when I left and by the time I got back I was riding in pitch blackness in an area with no lighting and trying to mostly just feel my way through the woods on foot because my tiny promo flashlight was doing basically nothing to help me find my way, so to keep that from happening again I needed to try a different way).
It was really the perfect path – long enough to not feel like an elementary school kid going around the same block over and over, but relying mostly on looping some of the same blocks so that without getting lost the distance could be modified based on how much time and energy I had at the moment…and there was a waterfall which anyone who *really* knows me knows that water is my happy place…and it isn’t much of a secret that being around kids is my absolute favorite thing in the world, so it was perfect that there were a couple playgrounds…and there was a road that had a name that made me smile because it reminded me of a memory of my PGY-1 RPD. There was one scare when I thought I saw my PGY-2 RPD waving at me and I was afraid, but she claimed it wasn’t her – and I don’t know why I believed her, but I did…
Until it was definitely not the perfect path. I learned that shortly after putting my complaint in with ASHP, in retaliation, two people had started formally tracking me. They had been taking videos of me on various roads as I biked. I felt scared and violated. I’m going to admit something that feels really embarrassing – I started leaving my apartment in leggings without a dress or shorts covering my bottom because I figured I never saw anyone I knew on my bike rides anyway, and knowing someone has pictures and videos of my like that really ups the ante on how violated I felt, because it wasn’t just images of me, but using my body against my will. And I know this sounds super rape-culture-y, but I’m also dealing with shame as I feel like it is partly my fault for not wearing something that would cover my bottom – you couldn’t have taken booty pics if I’d at least covered my bum bum with more than just a pair of leggings.
The bigger issue is the fear that I will be found. I completely stopped biking for months because it felt so scary to be that exposed. I still am mindful every day about how to keep my location private and how I will escape and get help if I ever see the perpetrators again…and I worry that I won’t be able to find safety. And this concern for my safety makes a huge impact on my life. For example, I recently took a road trip. I would have LOVED to announce to everyone I knew that I was coming so that I could maximize how many people I could see, but instead I only told one person and I only halfway told her in texting and halfway told her on facebook so that if either one was somehow being tracked that individually it wouldn’t be very possible to know where or even whether I was going anywhere, and it was done super last minute in hopes that even if my location was somehow leaked that it wouldn’t be enough time to find me there before I was gone again. I do have to admit that surprising people was a little bit fun and that in some ways it was nice to go into it with no expectations so that any positive thing was above and beyond my plans rather than having to hope I’d be able to live up to even half my over the top ideas I’m sure I’d have had if I had been able to make the announcement…but oh my, unless you’ve been there you can’t really understand the terror when I got an email maybe a week or so later that said something like your location history, how was your trip to (insert primary location here) and even included a marker of “unknown location” in Louisiana…when all I did was stop at a gas station. Every day the fear is present at some level that I will be found…and how could this possibly be good?
Well, I think it really is making me realize how strong I am, and it is forcing me to be a problem solver, but to also be brave. And the whole situation taught me a lot about our court system…it gave me a lot of empathy and understanding…if I hadn’t gone through something like this that barely seems believable if I weren’t living it, I would have a hard time not doubting there was something I wasn’t being told when someone who’s story I don’t want to tell for her included a night in jail when she went to the police to report a crime against herself…it’s just that our justice system in this country is super messed up and I can’t speak to other demographics, but at least in my experience, young women get the short end of the stick. I know multiple young white women like myself who have seen things that definitely di not include justice through our justice system…and while I tend to see the good in people, until you’ve been there, it is hard to believe that the US government that seems so perfect when you learn about it in school is not nearly as incredible in real life. I do absolutely think that there are police officers, judges, and lawyers who are really trying to do the right thing, but a few bad apples can spoil the bunch. And, I mean, this also pushed me from social media to real life communication, because I really need to talk about what happened, but it doesn’t feel safe to talk about it much online.
And now that I have typed this I think I am going to post it without re-reading it for edits or anything, because I’ve kinda written it in my head over and over and over for the past month or so, and if I don’t just post it I think I might lose the inertia and the fear might keep me from posting this, and I don’t know who need to know they aren’t alone, or who needs to know that even in what seems like a dark situation God is orchestrating it for good, or whatever else, and I don’t want to get in the way of people having access to stories that might help them…so there are probably typos galore and I’ll probably have like twenty-five more things I meant to say that I didn’t, but I want to capitalize on the brave I have now because some days the fear is a lot more oppressing than others, so on good days I try to do the things that are harder on the bad days, and I don’t want to decide to delete this post and lose the hours I’ve poured into typing it just to get brave and regret that decision…the end and good night 🙂
A journey through trauma & triumph 