A common phrase heard from the general population is "I can't". Spend your day eavesdropping at your favorite local people-watching site, and guaranteed you'll hear it more than once. It is used to mean many different things. Sort of a socially acceptable way of saying, "I am unable," "I don't want to," or even simply in place of "no."
I personally do not like the phrase. And believe that if an individual honestly believes that "with God all things are possible," it should be a phrase that never escapes one's lips. Because with God, you can. And saying "I can't" puts up boundaries that God will respect and in so doing one is limiting what God is able to do in your life; a.k.a. what wonders He is able to work in your life.
I knew this would be a difficult hurdle for me to tackle moving from a tertiary care center to a community hospital of much smaller scale and capability. As the tertiary care center of Westchester County in NY, approximately 66.67% of our patient population was transferred to us from the surrounding hospitals. There was one rule. We never said no. We as residents would hit our 25th consult and exclaim something along the lines of "closed for business" or "shut down the ED, we're going on diversion." But we knew no one was listening and the 26th consult would beep over the pager, and the 27th, and so on and so forth. My top 24 hour call was 34 consults (this included traumas).
So now I'm on the other side of that equation. I still want to say yes, and I'll go and see the patient. Swallowing my pride and saying, "this case would be best served with the expertise of a specialist" feels to me like I'm saying, "I can't."
Systems-based practice is one of the 6 core competencies defined by the ACGME. It's one of the harder concepts to describe and if you google it, some nice sounding explanations can be provided. But in short it is the ability to adjust to your environment and still maintain effectiveness. I have before me a culture shock, and I need to learn this new system and adjust to my environment in order to be effective. And so though I'm struggling with it now, I will swallow my pride trusting in the will and provision of my Father that once my environment changes again in the future, and should I find myself back in a system in which "yes, I will manage that" is always the answer I will be able to adjust again and provide effective care as needed.
As I have witnessed the group attempt to transfer a handful of cases the past couple of weeks to the regional tertiary care centers, I have been taken aback to hear a negatory response. Honestly, we weren't allowed to say no to a transfer in New York. I asked around, and the general response was of similar surprise. Usually a transfer is not so readily rejected. The cause of our current predicament in the state of Indiana.... none other than COVID. COVID numbers going up, hospitalizations going up, and ICUs being filled with COVID patients. My heart sinks to feel like COVID followed me from New York and I greatly miss being in a culture accepting of the vaccine. The worst part about it here is that it's not just that COVID patients are taking up beds. There are actually beds open. But the limiting factor is actually staffing, and finding individuals who are still willing to care for those patients. Honestly, here in Indiana numerous medical staff have retired or quit in the past year, and those that were attempting to hang on have been walking out mid-shift refusing to go through the process of caring for something that we have the means of making manageable.
I saw a meme the other day that illustrates a bit of what this process is feeling like here.
On a much lighter note, I also saw this illustration and got quite a chuckle from it. #surgeonhumor
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