Some Unrelated Ramblings

So, I just dropped Amy off at Corpus Christi International Airport. I love that I can get to the airport in 20 minutes and drop Amy off 45 minutes before her flight. I love that security is quick and easy and they say to you, “you come through here a lot”. I am amused by the fact that we have 6 gates! I giggle each time when I read the sign about our international airport. They are correct in calling it that, there are flights to Mexico. While I am amused by our airport, I love its convenience and ease of travel. I was at my car, after getting my bags that were checked through four minutes after my scheduled arrival time on my last trip! That never happens at Midway or O’Hare! On the other hand, I miss the options for travel times at those other airports. All told, I am growing to love this international airport!

I had a colleague point out that the title of this blog is moving to Chicago. I am showing my lack of technical savvy in that I can’t figure out how to change the title. I apologize to my new home, but ask that everyone accept that I know that I am in Corpus Christi, I’m just a computer dope. Maybe next time I’m in Chicago, my kids will fix it for me.

I joked in Chicago that the city couldn’t decide if it was Midwestern or a city. They cut you off in traffic, but then wave. Here, people are just plain nice. Everyone says hello. People ask you where you are from. They wish you a nice day. And, all that is out in the community! In the hospital, they take it to another level. Everyone greets each other with a large smile. People go out of their way to make everyone feel comfortable and appreciated. Now, the downside is if you don’t feel like talking or making eye contact, then you kind of stand out. I almost had to tell the waiter at one restaurant, “Your story is really interesting, but can I have my food now” as he stood there telling me his life story while holding my dinner! I’ll take these minuscule inconveniences in order to have the warmth and welcoming culture any day!

A business associate/friend in Chicago heard I was moving to Texas. He is from here and he took time out of his busy day to prep me for my arrival before I left Chicago. After spending over an hour with me (at least I bought him breakfast) telling me about the culture and the do’s and don’ts, he shared an email he sent me with more about Texas culture with his Texas buddies and they offered more advice. I will share some of what they offered here and in future posts:

“Get to know people, embrace a few traditions (college or high school football, hunting or fishing, boating or sailing, bbq or tex-mex, alt/country music, hardwork/mowing your own lawn), forgive some incidents of dumb-assed ignorance (and there’s a HUGE difference between well-intended ignorance and intolerance down there), and impress with skillsets they admire (treating their children and winning at poker would be recommended #1 and #2), and you’re going to be in good shape. That said, have no patience for intolerance.

Use “y’all” a lot, never say “yeehaw”, show that you care to learn/aren’t judging, don’t fall into “liberal yankee” traps/unnecessarily feed stereotypes (unless you know how to make yourself the butt of your own joke), and learn the fine art of knowing when you’re supposed to speak your mind bc ppl really want to know and simply be pleasant bc no one gives a damn. The latter is more common than the former, assuming those same people know that you’ve had a good meal recently.

The fusion of toughness/strength fused with fairness/generosity is the Texas spirit. Doesn’t matter if you’re a liberal yankee or conservative southerner. It’s all respected and cherished…even if not understood. There is strident liberalism, open mindedness, and true artistry if you’re paying attention. In the end, stand tough in the face of a few punches in the nose and you’ll start earnin your Texas stripes right quick! Oh…and maybe take someone’s money who thinks that they’re a good car player to get folks attention.

As you can see, I love my home state and hometown and this officially scratches the surface of insights/perspectives.”

They also sent some amusing memes.

More to follow….

As far as how things are going at the hospital: I feel like I am definitely getting my feel for the place. There haven’t been any huge surprises (which is great) and they really are committed to doing a great job for all the kids of South Texas. People are extremely receptive to my suggestions and are including me in the right things. My learning curve is still very steep, but people are happy to take the time to get me up to speed and have been ridiculously accepting of my perspectives and suggestions. While I was truly skeptical picturing myself a Texan, I am embarrassed to say I had an unfair bias about what I would find here and am now thrilled to be here!

The New Guy

Being the new guy (NG) has its advantages and disadvantages.  I mentioned in the earlier post that I am struggling to be patient with myself and want to jump in and be helpful, but I know that if I jump in too quickly, I will make too many mistakes.  So, in an attempt to force some patience on myself, I am contemplating the ins and outs of  being the NG.

People are super nice to the NG.  They introduce themselves, show you around, give you advice about neighborhoods and make sure that you know where the bathroom is located.  Having said that, they don’t remember all the things that aren’t what “everyone” knows.  Every hospital has an over abundance of acronyms and people use them not realizing that they aren’t speaking in English.  {I must digress and write about my two favorite acronyms:  The first is the brain child of my wonderful colleague, Mary Dano —  TLA is the abbreviation for “3-letter acronym”.  The second was told to me by my daughter, Samantha.  PUMA stands for “please use more acronyms”.}  People use the names of others as if I know who John, Frank or Susan are.  They are always happy to explain when I ask, but fall back into the pattern of their normal speech and again, leave me confused.  There is no malice in any of this, this is just the way we all think and talk (it’s kind of like the fish not noticing the water).

When I got to Chicago, I put together a spread sheet with acronyms to try to help with the alphabet soup that was flying at me (I am doing the same thing here at Driscoll).  I swore to never fall into the habit of speaking in acronyms.  Lo and behold, I am human like the rest of us and had the displeasure of being horrified when I found myself speaking in acronyms to a new employee.  Acronyms are more efficient than full words, I guess (he writes while not fully believing it).

I try to view the challenge of learning the language, directions in the hospital and the people as just that, a challenge.  I have been meeting colleagues at their office as a way to try to learn the geography of our hospital.  The cool thing is we have a strategy here called “The Driscoll Way” that helps me if I ever get lost.  Basically, if anybody asks an employee a question, it is our responsibility to help them.  If we don’t know the answer, we help them find someone who does.  Amy and I were unaware of this the first day and I was astounded when two gentlemen who we asked about directions escorted us from the parking lot, through the building, all the way to my new office.  My strategy for learning people’s names is I am using flash cards.  Yvett, the administrative assistant who has primary responsibility to keep me on the straight and narrow (all the assistants have each others’ backs here — amazing team work!), put them together for me and I’m slowly learning names and titles.

So, all of that is the normal stuff.  The bigger challenge is as the NG, you don’t have the important institutional memory.  People give me tons of information and background, but as the NG, I don’t have the mental map to categorize some of the information.  I am seen as a potential ally to “finally get that proposal approved” or to “fix” a challenging relationship.  The NG will fix it!  Not knowing the history, I don’t know what people’s motives are.  The nice thing is I haven’t seen evidence of any malice.  I am not naive enough to think that everything I hear hasn’t gone through people’s filters, but I am truly impressed how aligned people seem to be.

In Chicago, I was told that my NG status had been revoked after about six months.  I was horrified as I thought I would get at least a year to use that moniker.  There, I learned a lot about how I do things and how a hospital that isn’t the one in which I grew up professionally (Nationwide Children’s) might do things and that is helping me manage this adjustment much more smoothly.  I don’t know that I will need a year (today, I actually felt useful on a couple different things), but I know that I’m nowhere close to ready to give up my NG title!

Sorry this post wasn’t very interesting or funny.  I just needed to get some thoughts down as I work to grow more comfortable at Driscoll Children’s.

So, I guess I’m a Texan…

I have approximately two weeks under my belt here at Driscoll Children’s.  I have many observations, but first and foremost is I’m not very patient.  Despite knowing that I need to listen and learn and have to allow myself time to do so, I am vexed by the desire to get going and do meaningful work.  It’s funny, Lurie taught me that I like to build new things and learn a bunch, but that’s looking at the virtues of the learning in retrospect.  When in the middle of it, I just want to get going.  Pam (my much wiser sister) is going through something similar in her job as she recently got a promotion and is creating her new to the organization role.  My advice to her about enjoying the process and the learning and give herself time to get up to speed makes perfect sense when I say it to her.  I just wish I was as good at hearing this advice as I am at offering it.

So, living in Texas…  The area is beautiful.  The bay is beautiful.  The people are super nice.  The weather is much warmer (no snow this week).  People were complaining about the cold wave.  We dipped into the high 40’s for about a minute (it took everything I have to not roll my eyes at the people complaining about how cold it had gotten).  Things move more slowly here.  I have always thought of myself as friendly and able to talk to anyone (I once had a 15-minute conversation with a chair!), yet I find myself wanting to say, “How about you stop talking and give me my dinner that you are standing there holding?” to the waiter at one of our fine establishments.  Speaking of which, Chicago is not being threatened with being overtaken by Corpus from a culinary standpoint (no surprise).

The hospital has been incredibly welcoming to me.  I have only had my initial impressions about their commitment to serving needy children and raising the bar in that care validated.  There are many opportunities for improvement already identified by the people here.  Like any institution with bright, strong-minded people, there is a lot of agreement on the issues, but less so on the solutions.  But, that means I have work to do!  I’m not worried about running out of opportunities!  I have found some things confusing.  I am surprised there are no medical staff dues (this might make it harder for me to successfully get the medical staff officers (at least the chief of staff) compensated for the work, but that’s something to be figured out).  They don’t have department heads from the traditional academic institution view point (these are rotating 2-year terms) which makes it more “democratic”, but less commitment or effort to go in a particular direction.  While there are people who want to do more research, the infrastructure is not fully developed.  I don’t get the feeling that Driscoll should emulate traditional academic institutions, but we can take from them what is useful and ignore that which isn’t.

Amy is down for the weekend.  We wen to the King Ranch yesterday.  It has over 800,000 acres of land and is bigger than Rhode Island (and is 10 lots away from where we are building our home).  They grow crops (cotton), raise steer, manufacture leather goods, host hunting parties (I’m not sure that’s the right term), bird watching and conservation efforts.  It was very interesting, but I wasn’t very pleased by one of the signs that welcomed us.

We did see one rattle snake on the tour.  Thankfully, it was on the road and we were in the bus!  I will confess, my respect for rattle snakes might border on being a phobia, but I’m trying to keep that in check.

“He is a “little one”, only about 4 feet long.”

Here are some pictures of the cows (they don’t give me the heebie-jeebies (sp?).

More updates later…

What makes an expert?

Expert: one with special skill or knowledge representing mastery of a particular subject

The term, expert, has come up a lot in conversations lately and I will confess the term intrigues me.  When I was being interviewed by the headhunter for my current position, he asked me if I consider myself an expert in Quality Improvement.  My response was an unequivocal, “God no!”.  He then proceeded to ask me if I was an expert in Safety and Process Improvement.  Again, my answers were absolute denial of this possibility.  Honestly, I was a bit taken aback by the question and had to wonder who out there considers themselves an expert.  Is this a title one gives themselves or are they awarded it by others?

I spoke with Dr. Brilli about this shortly after my interview.  I consider him an expert in Quality Improvement and Patient Safety and was a little surprised when he also denied having the qualities to support such a moniker.  I thought, if he isn’t an expert, than who is?

I dismissed the question for a while until I arrived in Chicago.  Here I found people expressing excitement about my arrival and they shared the belief that I was going to bring great things to Lurie Children’s.  I became a bit uncomfortable because I still didn’t, and don’t, see myself as an expert, but assured people that I would happily work with them to effect the needed changes.

I was asked to give a talk to the Anesthesia Department about my intended plans for their department around quality and safety.  One of the most important tenets of Quality Improvement work is that the people who do the actual day to day work are the experts and the best approaches cannot be passed down by a leader who doesn’t actually get their “hands dirty”.  Yet, I was expected to pronounce where their work should take them.

I met with a “physician leader coach” — a position that Lurie Children’s has for their physicians who are rising in the ranks — and discussed what I perceived to be a conundrum.  He felt that I had to establish my position as an expert and couldn’t go in to the talk not claiming to be one or I would lose credibility.  I explained that for quality improvement to work, we have to treat the people doing the real work as the experts.  He reiterated that he feared I would lose credibility if I didn’t establish myself as an expert.  We agreed that it would be reasonable to acknowledge that they are indeed the experts in Anesthesia Improvement and I would provide expertise in how to get the work done.  This seemed like a reasonable compromise in so much that I didn’t feel that I was overstating my qualifications.

Amusingly, the coach then relayed a story to me.  When he was a young consultant, he had a similar conundrum around the title of expert.  A senior consultant told him, “As long as you know more than the people with whom you are speaking, you are an expert.”  I’m not comfortable with that definition, but did find it a little amusing (and perhaps a lot disturbing!).

One of the incredible things about Chicago is the opportunity to do things and see important people.  I went to a 1-day conference on teaching residents about Quality and Safety that I wouldn’t have attended if it weren’t so conveniently located in the city in which I find myself.  The night before, Atul Gawande, spoke at a local hotel.  He is the Massachusetts surgeon who writes regularly for The New Yorker and has written several books including the Checklist Manifesto which has shone a lot of light on how we can practice medicine in a more safe manner.  He was giving a talk and promoting his newest book, Being Mortal (which I strongly encourage everybody who has a parent that is getting into their later years to read.  In fact, if you would listen, I would insist that you read it!)  I went up to him and told him that his work has helped set the stage for much of what I do professionally.  I cannot do justice to how humbly and sincerely he said, “Thank you so much for sharing that with me, you don’t know how much it means to hear you say that.”  I consider Dr. Gawande to be an expert and he treated me like I gave him some sort of a gift.

Bottom line, I think the people who I respect the most are the ones who are trying to do the right things and aren’t worried about titles such as “expert”, but I will admit that it might be fun to feel certain that I know exactly what to do and when.  If Atul Gawande is humbled by things a stranger tells him, I guess I can comfortably continue decidedly not feeling like an expert!

Get his book and read it.  You won’t regret it.

Why the move?

I warned you all that I don’t really understand this blog thing.  The embarrassing reality is, I was trying to remember what I wrote about before and went to look at my previous posts only to discover that I don’t know how to pull up the old entries.  I am now faced with the quandary, “Do I tolerate the embarrassment of asking one of my teenagers (or worse, Amy) how to find the old ones or do I just trust the memory of a nearly 50 year-old?”  Foolishly, I’m going with option B, but am confessing this to those of you who are still reading my ramblings.  This is the reward for staying interested in what I have to say.

The story of my exodus to Chicago is known by many of you, but to clear things up for the rest of you, here goes…

Even during medical school, I was shocked that our healthcare system really isn’t logical in its setup.  I remember going back to patients’ rooms after their doctor explained what was going on in language that they didn’t understand so that I could explain to them what was happening around their care.  Often the services provided to patients seem to be at the whim of the physicians in charge or what treatment modalities they had available to them rather than being based on anything with true scientific basis. Limitations around resources often left me feeling that people frequently weren’t receiving the best care or the type of care they desired.  My frustration with our system grew throughout my training and when I went into private pediatric practice, I was frequently baffled by how much of the system didn’t make much sense to me.  Two simple examples of how the economics of medicine don’t make sense follow:

1. If I saw a patient with a complex illness and it took me 5 visits to make the correct diagnosis, I would get paid 5 times as much as my partner who was smart enough to make the diagnosis on the first visit.  Physicians get paid for “doing” healthcare, not necessarily for making accurate diagnoses or treatments, per se.
2. If a patient came in for a wart treatment, the treatment along with explaining the risks and benefits took about 8 minutes.  I would be reimbursed the same amount when I spent an hour and a half with a patient and diagnosed their depression and prevented an attempted suicide.  We get rewarded for doing procedures disproportionately when compared to counseling or using our cognitive skills.

So, although I truly loved (and still do love) taking care of patients, I was dissatisfied with the system within which we worked and things came to a huge crescendo when we went through the treatment of my mom’s cancer that eventually took her life and I became even more galvanized in my resolve that I have to be part of the effort to improve our healthcare system.  My mom was a bright, college-educated, successful businesswoman who had adequate financial means, married and with 2 kids in town, one of whom is a pediatrician and half the time we didn’t know where we were supposed to be and why we were doing what we were doing in her care.  I couldn’t help but imagine how hard this would be for a single woman without her education and wherewithal who had the benefit of a loving husband and children who was unfortunate enough to be going through a similar experience.   My mom’s internist is a friend, mentor and confidant for me and my family and he did what he could to make things better, but still, we were often confused and uncertain that we (or the other docs caring for her) were doing everything that was in my mom’s best interest.  I found myself wondering how the subspecialist was chosen (as a pediatrician, I select subspecialists who I believe do a good job (we know who is bad, but it is hard to measure levels of “good”), who communicate well with my patients, who communicate back to me, and who I have had the chance to meet or hear of their skills (there might be somebody out there who is great that I don’t know yet)).  I trusted that my mom’s doc gave us his best recommendation, but does he or any other doc know who is best?  The subspecialists themselves don’t have adequate metrics to know who is truly “best”.  Anyway, we muddled through the system.  We found ourselves doing much of our mom’s care (when I say “we”, I mostly mean my sister.  My dad and I (with help from Amy) did what we could to care for her, but Pam (with help from Stacy) was truly the one who did the greatest amount of the work (including spending countless nights with my mom when admitted to the understaffed, under-delivering hospital).  The point is, despite well-meaning talented professionals who gave us “special” care because my mom and the rest of us treated her caretakers with great respect and I am “one of their own”, much of her care was left to us or it felt that it was left to chance.

I found myself frequently saying that we have excellent healthcare in America, just not very good healthcaring. The frustration with the healthcare system along with it’s economics and the belief that we could and have to do better led to my slowly diminishing clinical role and my expanding administrative role.   I tried to help build systems that made our care better in my practice, in the corporation that my practice was a member (Central Ohio Primary Care Physicians) and ultimately at Nationwide Children’s (NCH).  I moved more of my time to the hospital in large part because of their aspirational goal to eliminate preventable harm to all the children cared for there.  I was having a great time working at NCH and felt that I was involved with things that really mattered around the care of children.  We had incredible success and I was proud to contribute to this effort in some way.  While I had been simply trying to make things better, I later learned that there was a standard mehodolgy that could be applied using scientific principles to improving healthcare quality and safety.  Dr. Richard Brilli was one of my mentors and he had been responsible for NCH’s aspirational goals around safety.  I learned a ton from him and credit him with getting me to appreciate the science of QI work and harm elimination.

So, this leads us to why the move?  Dr. Rick McClead, another of the people who has driven NCH’s incredible journey, asked me if I would be interested in his nominating me for the position, Medical Director for the Center of Excellence at the Ann & Robert H. Lurie Children’s Hospital of Chicago.  Besides being overwhelmed by the title and being unclear what the job entailed, I immediately said “no thank you” as I was happy in Columbus and wasn’t interested in moving after 28 years there (med school, residency and my entire career).  My sister’s family, my father, Amy’s parents and Amy’s sister also live in Columbus along with all our friends we had made over those years.  Walking away from that much support, history, comfort, and hopefully some level of credibility was quite frightening.  Amy and I had toyed with leaving after the kids moved out (the general theme was the hope that the Children’s Hospital in San Diego would offer obscene amounts of money for us to come to where it is always sunny and 72 degrees!).

I went home and told Amy about Rick’s offer as I viewed it as quite a compliment that he felt that I might be ready for such a position.  I expected we would laugh it off and almost fell off my chair when Amy said, “We’d move”!  To this day, she won’t admit that she had a fight with her family or mine which was the only explanation that made sense to me as I don’t generally think of Amy as a big risk taker.  To say that she has rolled with this whole move incredibly well would be an obscene understatement.  She has handled this uprooting to a place where I had a great job to go to and she had a great life that she was leaving in a way that I am truly in awe.

When she gave the green light, I told Rick to go ahead and put my name in for the job. I truly didn’t think they would take my application seriously as I don’t have numerous publications in QI work and certainly don’t consider myself an “expert” (I think that word will make the theme for my next entry as it has come up a lot lately).  As I went through the interview process and fell in love with the scope of the job.  The person hired would get to be the medical leader of Quality, Safety, Patient Experience and Risk.  Although I admittedly don’t know much about Risk, I hoped if I could work on the other three, Risk would take care of itself.  I believe the Patient and Family Experience with healthcare has a huge impact on a patient’s care.  Not only does their understanding of their care improve their adherence with planned treatments, but as their comfort levels increase, they are better able to communicate with their providers and will be able to share critical pieces of information.

Much to my surprise, the folks in Chicago decided to offer me the opportunity to help them on their journey to improving the quality and safety of the care of their patients and it really felt like a chance to do all the things that I really care about.  To this day, I am amazed they offered me the position.  As I mentioned, I don’t have the publications or resume that would make someone certain I could do this job.  I joke that either they were brilliant for offering the job to someone who has passion for this stuff and who fits into their culture well or they will discover they were fools and that the emperor wears no clothes.  For all of our sake, let’s all hope that I remain well dressed!

Update

I haven’t written anything in a while.  I would love to say that it is because I am completely comfortable now and I no longer need the therapeutic benefit of writing my thoughts down.  Alternatively, it is possible that I have been too busy.  Honestly, it’s most likely because I didn’t think I had anything really worth writing!

We bought a home and are in contract to close in late December.  The current owner is an empty nester who is moving downtown.  We can move the schedule up if she finds a place sooner (this seems likely to me).  We are very eager to get our stuff back.  Although the home where we are temporarily located is wonderful, it doesn’t have our stuff.  I feel like a bit of a baby being frustrated by that, but it kinda goes back to that whole anchoring thing I wrote about before.

We are all jealous of Marshall.  He has already found a group of friends with whom he hangs out during the majority of his free time.  The rest of us are still struggling to develop our meaningful friendships.  People have been incredibly nice.  Many have reached out to have coffee or to go to dinner and we were even invited to a Sukkah open house last weekend.  Amy, Tori and I just haven’t gotten into a groove like Marshall.  Today, I felt like a humongous loser as I was hoping to watch the Browns today (they are actually favored to win!!!!).  We don’t have cable (don’t ask) and so I found myself texting people that I really don’t know very well to see if they would go to a sports bar with me to watch the game.  I feel like the bird in the Dr. Seuss book, Are You My Mother?, except I’m asking if they will be my friend.

An unrelated aside, while watching Marshall’s JV game yesterday (where he forced two fumbles!), one of our defensive backs made a nice play.  A gentleman who is apparently that player’s father yelled out, “I know that man’s father.”  Another dad responded, “So do I, but the bad news is it isn’t you!”  It made me laugh along with all the other people whose names I didn’t know.

We visited Columbus for Jacob’s birthday (and Yom Kippur) two weeks ago.  We were a little nervous that the ride home might involve some feelings of sadness (especially for Tori).  We were thrilled when both she and Marshall commented, “Columbus has our friends, but Chicago has things that Columbus will never have and we’ll make new friends in Chicago.”  It honestly gave me goose bumps because getting their buy-in is critical to feeling like we made a good decision moving here.  I really think that was a huge step in this process.  That and finding a home make me feel that we are very much on our way to getting settled.  We will get cable for the house, we are all working on establishing our friendships, now, if I could just find a poker game!

Warning: this next paragraph is potentially bigoted (you should consider skipping it) — It is likely just my weird perception of the world, but for an area with so many Jews, it doesn’t seem to me that it should be so hard to find a good bagel (the New Yorkers claim that it has something to do with New York water, but I find that implausible), there is allegedly no good Chinese food in this area (you have to go to China town), and I have yet to find a poker player (that Jews have a penchant for playing poker is a stereotype that is likely held only be me and I have no basis for my unfounded belief).

On the work front, things are getting more into a groove.  At first, I was overwhelmed with learning everything I could in as short a time as possible.  I am getting a better feel, but still have tons to learn.  I was getting a little agitated in that I didn’t feel that I was contributing in any meaningful way and was just going to meetings to meet people.  Of late, I am feeling that I am involved in a lot more things and have gone from feeling that they should give me more things to do to feeling like I am drowning in the things I want to accomplish.  There are more than enough “opportunities” for things that we can work on here (as I expect is the case anywhere where they are striving to optimize what they do).  I am still struggling with the notion that I am one of the people that will help lead all this, but one of the consultants here confided in me that “you are an expert as long as you know at least a little more than the people you are advising”.  Perhaps not the bar I would require to call myself an expert, but I’m pretty certain that I will never be comfortable with that term, so I’ll forge ahead thinking of myself more as an advisor.

I am attending the annual retreat of the Anesthesia Department on Saturday.  I will be talking to them about our Center of Excellence (quality, safety, risk, and patient experience) and how we would like to work with them.  I’m nervous as this is my first “dog and pony show” and have never done any safety and quality work related to Anesthesia, but am very exited about getting going working with colleagues to improve what we do for children.   Interestingly, Anesthesia is traditionally the field of medicine that has led the push to improve quality.  It does seem fitting that they are one of the first groups with whom I will converse.

It feels like I have gotten a little too serious here (I’m bored reading what I wrote).  It is time for a true confession: besides having a penchant for over utilizing parentheses, I have some OCD tendencies (no surprise to many of you).  I have all my ties in order and go through them  in a circumscribed order.  My thought is that if I wear them all equally, they will all be worn out equally.  I tell people I have my ties in order so none of the ties get their feelings hurt if I wear them less than the others (this is probably the real reason).  In any event, this leads me to wear some ties out of season.  So here is the lesson for this blog:  Don’t make winter jokes (even on your tie) in October in Chicago, people get a little (or a lot) put out by this.

Language

“Yes, that’s the touchdown area,” she said with the same certainty that I would have stated that the sky is blue.  I was looking for a meeting, but the door was closed.  I asked if I could sit outside and was given that response.  I wanted to respond, “The crow flies at night,” because it seemed equally clear and relevant.  Later it was explained to me that this is the area that people who work in another building can “touch down” and do their work while on the floor.  Well, that made sense once I had a clue about what she was talking.

Language is fascinating to me.  Coming from one hospital to another, I expected there to be some cultural differences (and boy, are there), but I really thought that I was staying in medicine, so how different could the language actually be?  In fact, I was moving from one high-functioning pediatric academic institution to another and both are in the Midwest.  So, the language should be the same, right?  Not so much.

I don’t really have the admino-speak thing down.  Sure, I know terms like paradigm shift, dovetailing and glide path (always stated with one hand making the motion of a plane taking off), but I certainly didn’t understand who reports to whom based on their titles and just learned yesterday the true meaning of a tollgate (it’s not what you think it is).  I am fascinated though, by how words like “Administrator” were clearly not in my lexicon meaning the same things that they mean here.  I think of “administrator” being a term that defines what many of the people with whom I work, do.  Here it is a very lofty position.  It is above a Director who is above the Managers.  So, for the uninitiated, Administrator is not a term for all people who administrate, nor is it short-hand for somebody who is an administrative assistant.  Interestingly, Administrators report to Chiefs.  When I look at it on the organization chart it becomes much more clear —  I would say my understanding has gotten to the opacity of red wine (which is better than the chocolate milk it appeared like to me just a week or two ago).

I’m a big fan of acronyms and abbreviations.  They help us remember things and make titles shorter.  Sometimes they can be confusing.   Lurie Children’s likes to use acronyms for efficiency, but for the uninitiated it can be overwhelming.  Like any institution, we even have some that many people forget what the letters are abbreviating.  We know what the committee does, but not everyone knows what all those initials are.  The other thing I like is that many of the acronyms spell a word.  (Mike confided in me that he wanted the FIRST Call (Family Initiated Rapid Safety Team) to be named the Family Activated Rapid Team — THAT, I could remember!).

Perhaps the language challenges I find the most remarkable are the ones around medical terms.  Medicine is medicine is what I had thought, but again, different institutions use different abbreviations.  I can’t remember (sadly) the other ones that have tripped me up, but congenital diaphragmatic hernia is DH here and it was CDH in Columbus.  How much should a silly little “C” matter?  Embarrassingly, that C made it indecipherable to me.  When I shared my confusion with a colleague, she confided that when she was at a national conference, they added the C and that tripped her up.

Bottom line, I am realizing language matters even more than I realized.  I expected language to be different on some levels, but not on so many levels.  The books that I read about leadership tell you to learn about the culture, but nowhere did I realize how challenging this language part would be.

I am constantly reminded of the two concepts that helped me get through medical school.  Although I am not quoting accurately, my perception of these concepts is as follows.  My Great Uncle Danny gets credit for the first — “If you’re not nervous, it means you don’t care”.  My addition to this is, “I must care a lot!” (this came up while doing my first spinal tap or lumbar puncture).  This one doesn’t apply here nearly as much as what his grandson, Paul, my second cousin and the heretofore only other physician in my family told me, “Medicine is a series of steps, the steps ahead of you are huge, the steps behind you are small. The steps behind you used to be in front of you.”  The steps saying applies to this transition (and I suspect most things we do in life).

Commuting is now almost a small step behind me (I still make mistakes), I look forward to when this foreign language I am learning (LSL? — Lurie Children’s as a Second Language) becomes a small step that is behind me.  In the meantime, I will continue to populate my Excel spreadsheet with Lurie Children’s Lexicon.

Until next time…

Anchoring

First, to complete the discussion about how not to use public transport.  When you go to the train station, you have to pay $2 for parking. You remember your parking space, go to the station building and there are machines to pay.  Amy found a cool app that allows you to use your phone to pay for it with a credit card.  I did that the first day and discovered there was a 25 cents “convenience fee”.  Although 25 cents isn’t much, I didn’t find enough more convenient than putting $2 into a machine to justify the 12.5% surcharge… so I thought.  The next day, I used the machine and had no troubles (and was quite smug about the quarter I had saved).  I rode in on the train, took the shuttle to work, worked all day and left in the afternoon and I found the shuttle!  “I’ve got this nailed!”, I thought. Then, on Thursday morning, I parked, took note of the number on my spot, and went to the machine to pay. I didn’t have change, so punched in my number, put my $10 bill in the machine and waited for my change.  I’m still waiting!  It turns out the machine takes any surplus money you put in.  I saved 25 cents at the small cost of throwing away $8.  Incredible.  

Planning to never make that mistake again, the hope now is that I have found every possible way to screw up commuting to downtown Chicago and conquered it.  I guess time will tell.

Before you proceed, please read the following warning/disclaimer:  This one is much more serious than my first offering.  I plan to use this entry in 3 ways.  1. To keep letting people know how we are doing.  2. To act as some sort of road map for others who choose to forego a really comfortable, wonderful experience and lifestyle for the dream of something possibly even better.  3. And to remind me of the process when I look back from a much more established and comfortable position down the road.  So, if you are looking for more humor, skip this one and tune in later. 

Thus far, I am finding a lot of things fascinating.  Although in concept, I knew I was losing my “anchors” when I left Columbus to move my family to Chicago.  Amy and the kids had their friends, sports, routines, hobbies, etc.  I had my family, friends, poker game, biking group, workout buddies, favorite stores and restaurants (so many more options here), preferred routes, but I never did learn the cable channels in Columbus.  In Chicago, I find myself surrounded by nice people who are all offering to help, but I don’t know them yet.  I don’t have stories. I don’t say 1 or 2 particular words that make us crack up about the story those words bring to memory.  I also don’t have the credibility that I would like to believe all those years in Columbus afforded me.  So, in search of anchors, I find a lot of things worthy of notice that would have been missed by us in normal circumstances.

When we go to events like a meal, shopping or a football game, I find myself looking for people I know (without success).  I fall back on an old game we used to employ at poker games, I name strangers on the train, at stores, and at football games (“crazy football parent” was getting overused so I will have to be more creative moving forward).

Oddly, one of my coworkers was going to visit Columbus this last weekend and she asked me what she ought to visit.  Here was an opportunity for me to think about the things I did in Columbus that anchored me.  The weird part was I couldn’t come up with much beyond the zoo (I’ve been twice) and The Tiki Bar (also twice).  I think of Columbus as a great place to live, but not terribly interesting to visit.  How do you tell someone whose office is 25 yards from the Magnificent Mile that she can’t possibly miss the great shopping at Easton?  Moreover, I didn’t think she would appreciate my telling her about some awesome poker games or my friends she should visit.  I have since asked Columbus friends for other suggestions and we added the Franklin Park Conservatory.  Amy later pointed out that I should have mentioned the Santa Maria replica and COSI.  

The point of all of this is I keep asking myself, “What anchored me in Columbus that I don’t yet have here?”  The Santa Maria (which I still haven’t visited) and the zoo weren’t what made me comfortable in Columbus. I can only conclude it is the stories and the experiences.  The stories have mostly to do with the people — patients and their families, friends, coworkers, etc.  There are great people here in Chicago.  Some really, really nice people with whom we have already enjoyed spending time.  We just need more “meat on the bones” of our relationships and this will come with time.  

Obtusely related, one also gets used to the “rules” where they live.  I went to get the cars registered in Illinois, but failed because I didn’t have my social security card.  I had my passport, but no SS card.  So we left and went to register our cars with the town in which we live (Wilmette).  We spoke to the not so helpful clerk in Wilmette who told us we can’t register the cars until we get license plates.  The kicker was, we have to sign up each car for $80 each.  Amy accordingly asked if that is necessary for parking.  We got a somewhat, “why are you wasting my time” “No” response.  “Do we need it to go to the beach?” “No, but you do have to pay for parking at the beach and then pay to go on the beach.” “So what does this actually get us?”  “The roads” (duh, was implied by this oh so charming octogenarian). Thinking I was being helpful, I asked, “Why don’t you just charge more taxes?”  She had lost her amusement with us at this point and advised that we ask someone else.  

The next day, I went to the Social Security office to order a new card.  Guess what you need to get a social security card — a passport!  That would be the identification that I brought to the Department of Motor Vehicles that was not adequate, but it was perfect for getting the thing I needed to prove I’m me to the DMV.  Annoying bureaucracy is not unique to Illinois, but these are challenges you don’t deal with if you don’t move.  Sometime in the future remind me to tell you about the 3 different identification badges I wear at the hospital.

Ironically, the space the hospital rents to have our offices is in a very fancy downtown building.  It seems that the office building has a thing for the different offices having themes.  It turns out that my office is reminiscent of being on a ship (this was lost on me until a coworker pointed it out). So, although I don’t have my anchor yet, it seems that I have a porthole and coat hooks that are reminiscent of fish hooks (I think).

BTW, this is the view from my window on a rainy day

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My next posting won’t be so dull.  I plan to write about learning new languages at a new place of work.

Commuting

So, after 28 years of living in the Columbus, Ohio area, raising 4 children, living with many members of Amy’s and my families, having a successful career and on and on, we have decided to move to Chicago (more on that later).  This blog will be used to chronicle my learning a new job and a new city.

It turns out that one of my greatest worries about this move — navigating public transportation — was well founded!  Last week, Amy and I met my colleagues for lunch.  I came into the city first to go through my physical and Amy came in after dropping Tori off at school.  I took the train without any difficulties and even managed the shuttle to the hospital area.  A bit later, I discovered that my office is in a swanky building with a nice view of other buildings.  Amy came a bit later only to discover that the shuttle had stopped running for the morning.  Like a trooper, she walked the 1.8 miles to meet me at the office.  When we returned to Wilmette, we took a cab to Ogilvie (the transportation center) because the shuttle hadn’t started up again for the afternoon.

So, yesterday (my first day), I assumed that I would have no problems doing the train-shuttle routine.  Well, I got to work ok and when I headed out to return to our home, I assumed that I would be picked up where I was dropped off that morning.  Thirty minutes later, I started to clue in that they must pick people up elsewhere.  Since Amy had taught me one could walk, I decided to hoof it.  40 minutes later, after battling (and mostly losing) with googlemaps, I made it to the station.  There is this cool app that shows you when your train is running.  I looked up my train, found it and started to head to the tracks.  I noticed on the departure board that there was an earlier train heading north, so I took it (and only slightly wondered why it wasn’t on the app).  5 minutes into the ride north, it dawned on me that I had probably gotten onto an express rather than a local.   The “train dude” (the guy who collects the tickets) came by and I asked him if the train was an express – it was.  I asked him if I can get off in Evanston and take the next train.  He said that he didn’t know where the next train was stopping (it was clear that that was all the help I was going to get).  Thanks to the app, I did figure out that I could get off at the stop north of Wilmette and take the train back.  The “train dude” on this train rolled his eyes at me and told me “someone has this happen every day”.  I was thrilled to provide the normalcy for him that day.  I actually got into Wilmette a couple minutes earlier than if I had taken the right train.

I got up plenty early enough to get the train I wanted this morning. I went to the station and when I got out of my car, I realized that I didn’t have the ID badge that holds my train ticket in my pocket (despite remembering putting it there in the morning).  I realized I had 12 minutes to run back to the house and make it for the train (a long shot, but worth trying).  I found the badge on the floor of my room (I guess I missed my pocket?) and raced back just in time to be stopped by the train track’s gate and lights as I watched other people get on the train I was hoping to ride :(.  Half an hour later, I got to ride the next train…  Undaunted, I proceeded to the shuttle (no doubt I know where it is as this is the third time taking it, right?  Wrong!).  I stood where I thought I was supposed to catch the shuttle.  15 minutes later, I realized I must be in the wrong place (at least I’m catching on more quickly!).  I had left the brochure telling me exactly where to catch the bus in my office last night.  So, I walked to my office where Dolly (the administrative assistant who really runs the hospital and answers all my questions) asked how my shirt got so wet.

Observations: 1. Use the information available for commuting.  2. Don’t leave stuff you need in the office or at home. 3. Thank goodness for googlemaps!  4. Thank goodness that I don’t have Jay’s sense of direction!

Hopefully this will be my last commentary on commuting as I have to get better at this, don’t I?