Tuesday, August 21, 2012

Welcome to Neurology

I sent a text to a small audience: Got z call! I’m top o z list and I accepted! So z factor that most affects a start date is z re-credentialing pkg. Mahalo!!! U may un-pretzel now! (keepg all appendages crossed). More soon!!! Xoxo   ~L

Amid the yippees, yee-haws, and congratulatory texts, one stood out at the end of the day: SUPER NEWS!!!! Congratulations and welcome to Neurology. Welcome to Neurology... they can’t take it back now; can they?

After a six-year hiatus, I would soon return to Kaiser Permanente (KP) as a Nurse Practitioner (NP). I held my breath and spoke not a word. Beyond that core group of friends, I shared the news with no one. I waited in disbelief, bracing for the call rescinding the offer with sincerest apologies for their error. When a week had passed without retraction, I told my Mom and called my manager.
“This has been a great place for me to land,” I said. “It expanded me and in doing so, it expanded the NP team at Mercy General, where we now manage the diabetes of all post-op open-hearts.” The ripple effect through my life is seldom so clear. “But it is one of my heart’s greatest desires to work as a nurse practitioner for Kaiser.
“I understand,” she said, “Were I in your shoes, I’d do the same. You have been an asset to this department and we will miss you.” Ditto.

Six years ago, my job with Kaiser's Hospital Based Service (the internist group that cares for hospitalized patients) was mortally wounded by line-item veto during a budget battle. I found employment as a staff RN in the ED (Emergency Dept.) overnight. A year later, I moved into diabetes management where I have flourished in an expanded-RN position. But an expanded-RN role is far from an NP role.
Saturdays at the General, I round independently, write orders, confer with other clinicians, and sometimes call for specialist consultations. Mondays at KP, my orders require approval and a doctor’s signature. The weekly demotion is acute, the loss of status - sometimes humiliating.

In a recent conversation, a physician said, “Your diabetes work is inspired, and authentic, and transparent. You’ve found expression there, and joy, and it enlivens you. It’s kind of a sweet spot.” 
“Yes,” I nodded.
“I am wondering how you reconcile this sweet spot as you look about for something else in your want to work as a nurse practitioner.”
“Well, you know,” I started slowly, “There is growing where I'm planted AND I am not my circumstance. The quality of my life will not be determined by my circumstance... and sometimes it is.”
“So you have a commitment to growing where you’re planted?” 
“Yeah, I guess,” I cast a long, backward look through my memory. “It’s always kinda been that way. Growing where I’m planted is certainly one way I live and I am intrinsically happy; I make lemonade. There is also recognizing when I am planted in fallow ground. My life is not a spectator sport. If I can’t play ball, if I can’t put down roots to nurture me, I’ll take my ball elsewhere.”
Diabetes Management had been anything but fallow ground.

If I knew then what I know now... I turned my nose up at two jobs in 2005-2006. One job involved migraines. Migraines? Does that have anything to do with the heart? 
Pause in think: When my favorite cardiovascular surgeon is particularly playful, he will respond to my questions saying, “Wait a minute, does this have anything to do with anything between the zenith of the aortic arch and diaphragm? Hmm? Then why are you asking me?” At which time we bust a gut. Thus my tangential, rhetorical question regarding migraines. But I digress.
The other job involved caring for Kaiser patients in skilled nursing facilities - the smells of which make me wretch, while managing monthly blood work held little appeal to daily, even hourly labs.

But if I knew then what I know now... that the KP tide would turn from NPs and I was in for a six year drought through which I would work split days-off to keep a particular skill-set alive. 
“I’m proud of you, at your persistence and creativity in the face of disappointment,” my friend said.
Yes, I’ve made lemonade and enticed many into drinking the Kool-Aid. Its been fun, rewarding, expanding, all that... and underneath it all has been my deep and sometimes despairing disappointment in not working for KP as an NP.

So its back to from expert to novice yet again for me. This is what I noticed... fear.
Fear that my friends Jack and Rochelle (neurologists both) will find out that I’m not very smart, and not all that teachable, and stubborn, and argumentative, and that all my work in diabetes was flukey and coincidental. Basically, I fear they will find out I’m a fake.
“Oh,” Blake said, “You’re suffering from the Imposteur Syndrome.”
“Impostor Syndrome; what’s that?”
“The Imposteur Syndrome,” he explained, “Usually felt by someone who has taken on something big and it’s working. They feel a little out of their league, hence a fake. And they are usually playing a bigger game.”
“Yep, that’d be me, z imposteur.”

Self-censoring internal dialogue - we all have it and it flares, fanned by circumstance. They’ll find out I’m a fake is some version of I’m not good enough - a primordial conversation for human being along with: There’s something wrong, I don’t belong, and I’m on my own. 
When these conversations run hidden in the background like elevator music... ever leave an elevator humming the song that played within? It’s so subtle. When self-censoring, internal dialogue plays in the background without our awareness (Landmark calls this undistinguished), and our actions and decisions are based upon disempowering beliefs about ourselves and others... life can be reflexive and knee-jerk.

In a recent training THE take-home message for me was this: A key aspect of integrity is knowing how I occur for myself.
How I occur for myself is like a brown pair of shoes at a black-tie affair, like an imposteur, a fake. How that manifests is that I withhold and keep secrets because if I told you of the fourteen patients who have weaned themselves from insulin and countless others who have lost weight and take a fraction of their previous medications, you might look deeper and finding that some have backslid - deem me a charlatan.

On a conscious, rational level, I know that inspiring and motivating people into new action is no different from that which supports them once change is made. However, my workflow does not include both. I am paid to do one and work in the other steals time from that for which I am paid. So I move people to take action but once they achieve the goal, I work elsewhere. 
And truly - if I didn’t have this justification, this human being would likely find another. My Landmark training helps me distinguish that the entire conversation is in service of: I feel like a brown pair of shoes at a black-tie affair. When I can see that, when it is distinguished, I can set my concerns for hiding, faking, and looking good aside to share my excitement in life with others.

It takes enormous courage to try out new ways of being in the face of fear and by choosing to do so, we become less reflexive and more author of our own experience. Choosing requires courage - and courage leads to the ontological discussions of being
Ultimately, there IS no reconciliation with where I am and what I want. Sometimes, rarely, I have been resigned that I might never work for KP as an NP. Nonetheless, I show up and play. The venue may change but my heart is not tied to the venue. My heart is tied to being: who I get to be and how I get to play. 
As it turns out - my new playground is spelled NEUROLOGY.

Those who know me well, know this as my creed, BaconiOS, if you will:
A person who is a master in the art of living makes little distinction between their work and their play, their labor and their leisure, their mind and their body, their education and their recreation, their love and their religion. They hardly know which is which, they simply pursue their vision of excellence and grace, whatever they do, leaving others to decide whether they are working or playing. To them they are always doing both. ~ Lawrence Pearsall Jacks

I must be re-credentialed at KP. The background checks should fly as I am a KP employee and currently working as an NP (thus possess a DEA number, furnishing license, etc.) Ultimately, the credentialing process allows me to write orders, prescriptions, and bill for my work. It is a two-three month paper-chase. I now await arrival of the tome, a two-inch-thick packet from Human Resources.
Realistically, I expect to land in Neurology (fingers crossed) in November.

Mahalo for your support through these many years. 
Play on and I’ll keep ya posted!


  1. Great News! Although I had some trouble following all you said, I can relate to the "I'm a fake" syndrome. When I landed at The Upjohn Company after graduation, I felt that way for a long time. They were paying me a lot of money, and I kept thinking, "Oh boy. Wait til they find out I'm not worth it."

    But I was. And you are. I think the doubt is embedded in humility. Better than strutting in pride, because "Pride goes before the fall."

    You ARE and will be wonderful. Your patients will be blessed.

    1. Mahalo Patricia for your bleadership, kind words, and support.

  2. CONGRATULATIONS!!!! What a blessing you're going to be (continue to be) to your patients!

    1. Mahalo TeanaBeana for your many blessings!