5.07 RB (GIA 3X) in Leon Mege Setting

[LLJsmom]

It was nice to see my husband. He finally got in from New York late last night because of the snowstorm. I was happy.



I can easily see why all the changes in your life put you there. I don’t have children. Just pets. But my friend who is also Cardiac, her whole outlook changed with her first baby as well.

I asked for a week in April. They have not approved it. I wrote it on the calendar… but haven’t had the nerve to actually ask for the days off.



Thank you. It’s just the headache that is bad. And I’m also having a bit of “word finding/ searching” I get just the slightest confused over which words to describe what I want to say. But it will get better in days to come.

When I first finished fellowship, I got a job in Montreal Quebec. My dream job. Covid hit and my hospital in Montreal became a designated Covid center. They shut down all cardiac surgery. I waited for 1 year, probably operating… 1 case a month, before I gave up. As of this writing, cardiac surgery is still cancelled in my hospital.

So I left to take this job in US before I lost all my technical skills. I took this job without visiting, having never been to the state or the city.

We were supposed to be 3 surgeons. They had a senior surgeon here, and had hired a new female partner (she’s about 60 years old) at same time as me.

I’ve been here 5 months. The senior partner just announced his retirement 4 weeks ago (February 25 is his last day). And they FIRED the female out of nowhere. I thought they would restrict her privileges, remedial work. But literally 1 week ago, on Friday at 4:45 pm they called me and said “can you take Dr. X call this weekend?” And then 5 minutes later she was being escorted out of the building.

The senior partner (understandably) is disconnected and refusing all call until his last da. So I’m alone and it’s overwhelming. They ask me what I need to keep this program going…. They ask me to organize the entire program…. Organize the relationship with the SICU (previously contentious) organize the VA ECMO program. That is a job for a senior surgeon who has the experience to be a leader. I graduated yesterday and I’m trying to survive in a new system… operating for the first time as an attending.

And the hospital is freaking out because it is a level 1 Trauma center. One of the criteria for that designation is a cardiac surgeon on call. Aka: me. This hospital is also the Quaternary referral system for all cardiac surgery of a very large hospital system in the state. I know what you are thinking “and all they have is a new grad”

The endless years of super fellowship (6 more then an ordinary American grad) made me an excellent technical surgeon. I can do things that the senior surgeon who by all accounts was exceptional could NOT do. I did a procedure my second week here that had never been done in this hospital system, and is usually referred to 1 specific center in US. And the administration heard about it quickly and knew they could bank on me.

The problem is: I get very scared not having back up. I need to have someone to ask questions. I have a lot of self doubt, and my confidence can be shaky. I can get anxious in the OR, and the only thing that helps is… “I can always call Dr Z for help” I usually figure it out. But knowing that he’s somewhere in the city, calms me down. Sometimes standing there in front of the patient, the weight of responsibility is crushing. And cardiac surgeons that are left alone often go crazy. Meaning they lose perspective and clinical judgement because there’s no one to hold them accountable. Currently I have 3 virtual cardiac surgeons that I bounce thoughts, review cases with. But it’s not the same as being there. Sometimes… you just need a colleague to peak into OR.

The surgeons here have been incredibly nice rallying around me to try and get me through this and to stay. Vascular, trauma and general surgeons have all met with me individually to offer a hand or a shoulder.

There’s a kindness here that I have not had anywhere else. And this community needs the level 1 trauma. And it needs a good destination for catastrophic cases.

For example, that patient that I rushed to ER for, he was at another center. There was a cardiac surgeon there, much older and experienced then me. He declined the case, said he wasn’t comfortable. They called a larger center with 5 cardiac surgeons. They declined as well. Said it was too complex. I was their 3rd choice. I didn’t decline because I’m an aortic surgeon and while it’s a a high risk case, I did many on fellowship in Texas. So I stood the good chance at it and willing to give it a go. But the problem is the patient was stranded in the ER for 2.5 hours while they tried to find a hospital to accept. And while I did not succeed in saving this patient… that ER physician at referring hospital now knows that this hospital will take and manage these cases… and maybe next time I won’t be third choice and the patient will get here on time.

So I don’t feel like I can just leave. At least not until they find someone to take over. It would be wrong.

I'm not in the medical profession, and I bow my head to those of you who are. Just based on your story, you are an awesome, caring, brilliant, dedicated doctor. You have been doing and are still doing everything you can. And you are Human. You will have insecurities and fears, and especially now in the midst of Covid, and the demands that PEOPLE have placed on doctors, nurses, and all the people in the health care profession are so beyond what people in general can comprehend. I thank you from the bottom of my heart on just being there. I know you want to give up. I would. And the fact that you want to, but you are still there, I start choking up when I think how you must feel. But like you explained, you are all they have. Please do everything you can to care for yourself. As @yssie said, you cannot care for others if there is nothing left of yourself. You are going through so much right now. Can you have a therapist on call, a care giver that can spend time with you? Can you get a driver on call? Can you get people to come to your house, clean it, bring food, do whatever can be done for you so you don't need to stress about those things. You need care. Other people can't do the doctor part. But they can do everything else. I'm just trying to come up with ideas. You want to stay, but you're burnt out, tired, lacking resources and support. As soon as your DH gets home, can he just stay and care for you for an extended period? You poor girl. My heart breaks for you.

 

[mrs-b]

@allycat0303 -

You have a headache and are having problems word searching? You have concussion? Are you currently on call?

Dear girl - it's time to stop. Right now. You're not in a position to be operating on anyone - at least for a few days till the concussion effects have 100% gone. I know you feel guilty and responsible for...well, it seems like they've tried to make you responsible for *everything* where you work! But this just isn't feasible.

I'm not a doctor, but I have a bunch of experience as a patient. Lots and lots of surgeries. I have a set of standard questions I ask my surgeons before each surgery I have: did you have a decent night's sleep? Have you had breakfast? Have you consumed any alcohol in the last 8 hours? Almost no surgeon answers yes to the 'did you have a decent night's sleep' question anymore, but I'd draw the line at a surgeon who had been drinking. But - way more than that - I would *really* draw the line at getting a yes to the question "Do you currently have a concussion?"

For your own safety - mentally, but also legally - please stop. You are clearly a wonderful, precious, currently fragile human being. As a psychologist, but also as a woman who understands what it is to be pushed beyond one's limits, I'd like to wrap a blanket around you, get you a nice mug of hot chocolate, put you in front of an open fire somewhere with your husband - and get back to you in a WEEK.

Allycat - you poor girl - you need to sleep. You need to rest. You've hit the danger zone. Pull back. Pull back.

Big, warm, supportive hugs coming your way from Boston.

 

[Lula]

Bravo, @mrs-b! Well said.

@allycat0303, I am so glad that your husband returned home safely, and that you got to spend some time with him and your beautiful new ring.

Like others I’m worried about what you’re experiencing at work. I work in healthcare education at a large teaching hospital. My background is in mental health and public health. If one of my students was experiencing the emotional and physical symptoms you describe in this thread, I’d have no choice but to pull them from their clinical site. It would be unethical for me to let it go on, because the student would be a danger to themselves and others.

It sounds like you’re beyond burnout. You’re experiencing moral injury and moral distress, as @nyquestioner noted above. You cannot get through this without support. The physician support groups are a good place to start, But ultimately it is your employer’s responsibility to fix this. They are abusing you by allowing this situation to continue. They need to provide you what you need to practice safely and ethically.

 

[allycat0303]

@allycat0303 I take my hat off to you, you sound like a dedicated and talented surgeon. It is very hard as a single person running a service. I’m not in the US so I don’t really understand how your system is, where I work (UK) if this happened there would be a merger of departments, especially if within the same city. Is there no scope for that? Pooling resources? I hope your hospital is trying to recruit more staff!

The problem is, the hospital administration made 2 mistakes:
1. A very bad hire who was dangerous
2. Allowing the senior partner existing surgeon to run off any other surgeons.

They didn't have a foundation.

They are trying to recruit staff. But since it took TWO years to find me.........

We had one interview last week (another dangerous surgeon) I vetoed that. And there is another one coming on Friday.

You are suffering from extreme moral injury. The expectations on you are too much for any one person, and in the middle of a pandemic that's pushed most of us in health care to our breaking points. Some of my colleagues who are ex-military have described the current situation in the pandemic as worse than war. Because in a war you have a tour of duty and then you rotate out. We can never rotate out because it takes a decade to train a doctor and there are not enough people to take our places. It's just relentless, and while with the vaccine we are no longer risking our own lives, seeing people die who didn't have to die is very difficult. I don't know if you've seen the data that the majority of doctors right now have either depression, anxiety, PTSD or some combination of the three. My thoughts...are you in any of the physician facebook groups? It can help just to vent to people who understand what you are going through. And people who have been in similar situations as surgeons might have some advice for you. Also have you considered contacting the Physician Support Line? It is anonymous and free and they of course have extended hours to accommodate our schedules. We are taught throughout our training to just buckle down and get through but there comes a point where that is not possible any more.
Your ring is very beautiful. What I wish for you is for you to be able to get to a place where you can enjoy it. Because you deserve that.

I have a lot of support here. Not from my specialty, but the other ones. My closest friend here (Vascular) she's helping me navigate the insurance claim for the car, and also the specifics of organizing this service. There were inherent areas of abuse by the senior partner, which I have to stop to be able to recruit good people.

Oh honey no I’m just fine, it’s you I’m concerned about!! You’ve accomplished a ton in your career but you aren’t defined by your career - you’re a person outside of your work. Please take care of the human being behind that career and work. Like someone else said earlier - burn out is real!

Yssie, I do agree with you. I've been training for so long, I don't know what I am anymore. To be honest, I have more free time now, then ever before. But I didn't realize (stupidly) that the mental stress of responsibility is so much higher then when I was a fellow.

from one tired female surgeon to another - sending all the hugs, the "you got this", and support that is possible. I appreciate what you are trying to do for these patients - but at some point you need to breath, rest a few days (week) and then start over. when I got so burned out I almost quit, I made a promise to myself to plan time off - regardless of my partners... 1 week every quarter, and 1 off call weekend away each month... I plan them months in advance - and that helped tremendously (of course, COVID has cancelled much but not all of that)... they *NEED* you, they can find a locums coverage or something else so you can take time off.... because if they burn you out then those patients have no one at all.... taking time for you isn't selfish - its actually guaranteeing the patients will have the best most brilliant surgeon available to them...

Sunny, I feel like the hospital is in *survival mode* with my service. Just to keep limping until it gets better. I think it will be a rough 4-6 months until we can safely emerge. I will then take some time off, and try to get more down time. They have a locums coming for 8 days of February. Aside from that, its all on me.

I'm not in the medical profession, and I bow my head to those of you who are. Just based on your story, you are an awesome, caring, brilliant, dedicated doctor. You have been doing and are still doing everything you can. And you are Human. You will have insecurities and fears, and especially now in the midst of Covid, and the demands that PEOPLE have placed on doctors, nurses, and all the people in the health care profession are so beyond what people in general can comprehend. I thank you from the bottom of my heart on just being there. I know you want to give up. I would. And the fact that you want to, but you are still there, I start choking up when I think how you must feel. But like you explained, you are all they have. Please do everything you can to care for yourself. As @yssie said, you cannot care for others if there is nothing left of yourself. You are going through so much right now. Can you have a therapist on call, a care giver that can spend time with you? Can you get a driver on call? Can you get people to come to your house, clean it, bring food, do whatever can be done for you so you don't need to stress about those things. You need care. Other people can't do the doctor part. But they can do everything else. I'm just trying to come up with ideas. You want to stay, but you're burnt out, tired, lacking resources and support. As soon as your DH gets home, can he just stay and care for you for an extended period? You poor girl. My heart breaks for you.

From the *real life* point of view, I don't do much. I don't have a lot of responsibilities aside from taking care of the pets. My husband has always hired a lot of help to cook and clean. I just have to work. I feel like the demands have been much worst on nurses, ER staff, and ICU staff then the rest of us. But I also think the world in general, has had a difficult time. 2 (going on to 3 years) for children, is a significant part of their childhood. It's just a shame.

@allycat0303 -

You have a headache and are having problems word searching? You have concussion? Are you currently on call?

Dear girl - it's time to stop. Right now. You're not in a position to be operating on anyone - at least for a few days till the concussion effects have 100% gone. I know you feel guilty and responsible for...well, it seems like they've tried to make you responsible for *everything* where you work! But this just isn't feasible.

I'm not a doctor, but I have a bunch of experience as a patient. Lots and lots of surgeries. I have a set of standard questions I ask my surgeons before each surgery I have: did you have a decent night's sleep? Have you had breakfast? Have you consumed any alcohol in the last 8 hours? Almost no surgeon answers yes to the 'did you have a decent night's sleep' question anymore, but I'd draw the line at a surgeon who had been drinking. But - way more than that - I would *really* draw the line at getting a yes to the question "Do you currently have a concussion?"

For your own safety - mentally, but also legally - please stop. You are clearly a wonderful, precious, currently fragile human being. As a psychologist, but also as a woman who understands what it is to be pushed beyond one's limits, I'd like to wrap a blanket around you, get you a nice mug of hot chocolate, put you in front of an open fire somewhere with your husband - and get back to you in a WEEK.

Allycat - you poor girl - you need to sleep. You need to rest. You've hit the danger zone. Pull back. Pull back.

Big, warm, supportive hugs coming your way from Boston.

I was seen by ER, and then later neurologist, and cleared for work. I do have a mild concussion. They documented it, but felt I could work as it seems to be word finding only, and will likely last a few weeks/months.

I am not doing elective cases right now. But yes, still on call. For call, they have me on *divert* mode this week. Meaning only transfers that were refused elsewhere or true emergencies. I did a emergency yesterday and it went well. A lot of what I do...it's kind of automatic to be honest. There's not so much thinking involved during actual OR.

I think most of the thinking happens before surgery...should we go to surgery? What is the appropriate treatment plan. What is the surgical plan? and what is the contingency plan.

Bravo, @mrs-b! Well said.

@allycat0303, I am so glad that your husband returned home safely, and that you got to spend some time with him and your beautiful new ring.

Like others I’m worried about what you’re experiencing at work. I work in healthcare education at a large teaching hospital. My background is in mental health and public health. If one of my students was experiencing the emotional and physical symptoms you describe in this thread, I’d have no choice but to pull them from their clinical site. It would be unethical for me to let it go on, because the student would be a danger to themselves and others.

It sounds like you’re beyond burnout. You’re experiencing moral injury and moral distress, as @nyquestioner noted above. You cannot get through this without support. The physician support groups are a good place to start, But ultimately it is your employer’s responsibility to fix this. They are abusing you by allowing this situation to continue. They need to provide you what you need to practice safely and ethically.

They are working on it. The delays are just frustrating. And unfortunately, there aren't so many good candidates floating around. Once we hire, it will be 3 months to get credentialed and licensed in this state. So there's no foreseeable relief. And while I do think hiring one is needed ASAP. But I won't advocate hiring anyone that is a danger to patients. It's better to have no cardiac surgeon, rather than a bad one.

On different topic, the ring is sized. It is still a bit loose, but much more manageable. As for the stone? Well I'm feeling better about it then last week. I do wear it to work, and surprisingly, it does not get a lot of notice. I don't think I'll ever be crazy about it, but I do like it more then my original engagement ring. I especially love the setting which is very delicate.

My husband ordered a wedding band from Leon in case I ever felt like wearing one. I don't think I will, but he thought it would be nice to have a set.

We will give it a month of regular wear, if not, he's going to get a 3 carat stone, and set it in similar setting (same basket, no halo), for work. So there's a plan
I personally think having 2 different rings to switch out is a bit much, but it's up to him.

 

[blingmeupscotty]

I'm sorry, all I can think of to scream in text is.. YOU GO WITH YOUR BADASS SELF!!!!!!! <3 Wear it in great health its beautiful!!!!!

 

[mrs-b]

@allycat0303 -

Just thinking of you today and sending warm thoughts.

 

[diamondyes]

The problem is, the hospital administration made 2 mistakes:
1. A very bad hire who was dangerous
2. Allowing the senior partner existing surgeon to run off any other surgeons.

They didn't have a foundation.

They are trying to recruit staff. But since it took TWO years to find me.........

We had one interview last week (another dangerous surgeon) I vetoed that. And there is another one coming on Friday.

I have a lot of support here. Not from my specialty, but the other ones. My closest friend here (Vascular) she's helping me navigate the insurance claim for the car, and also the specifics of organizing this service. There were inherent areas of abuse by the senior partner, which I have to stop to be able to recruit good people.



Yssie, I do agree with you. I've been training for so long, I don't know what I am anymore. To be honest, I have more free time now, then ever before. But I didn't realize (stupidly) that the mental stress of responsibility is so much higher then when I was a fellow.


Sunny, I feel like the hospital is in *survival mode* with my service. Just to keep limping until it gets better. I think it will be a rough 4-6 months until we can safely emerge. I will then take some time off, and try to get more down time. They have a locums coming for 8 days of February. Aside from that, its all on me.


From the *real life* point of view, I don't do much. I don't have a lot of responsibilities aside from taking care of the pets. My husband has always hired a lot of help to cook and clean. I just have to work. I feel like the demands have been much worst on nurses, ER staff, and ICU staff then the rest of us. But I also think the world in general, has had a difficult time. 2 (going on to 3 years) for children, is a significant part of their childhood. It's just a shame.


I was seen by ER, and then later neurologist, and cleared for work. I do have a mild concussion. They documented it, but felt I could work as it seems to be word finding only, and will likely last a few weeks/months.

I am not doing elective cases right now. But yes, still on call. For call, they have me on *divert* mode this week. Meaning only transfers that were refused elsewhere or true emergencies. I did a emergency yesterday and it went well. A lot of what I do...it's kind of automatic to be honest. There's not so much thinking involved during actual OR.

I think most of the thinking happens before surgery...should we go to surgery? What is the appropriate treatment plan. What is the surgical plan? and what is the contingency plan.


They are working on it. The delays are just frustrating. And unfortunately, there aren't so many good candidates floating around. Once we hire, it will be 3 months to get credentialed and licensed in this state. So there's no foreseeable relief. And while I do think hiring one is needed ASAP. But I won't advocate hiring anyone that is a danger to patients. It's better to have no cardiac surgeon, rather than a bad one.

On different topic, the ring is sized. It is still a bit loose, but much more manageable. As for the stone? Well I'm feeling better about it then last week. I do wear it to work, and surprisingly, it does not get a lot of notice. I don't think I'll ever be crazy about it, but I do like it more then my original engagement ring. I especially love the setting which is very delicate.

My husband ordered a wedding band from Leon in case I ever felt like wearing one. I don't think I will, but he thought it would be nice to have a set.

We will give it a month of regular wear, if not, he's going to get a 3 carat stone, and set it in similar setting (same basket, no halo), for work. So there's a plan
I personally think having 2 different rings to switch out is a bit much, but it's up to him.

What a guy! Great plan! You deserve it!!!

 

[Dmndsr4evr11]

Take care of yourself, @allycat0303.

 

[caolsen]

I hope, if nothing else, with your husband home you can get a solid night’s sleep. That can do wonders.

And as for the car accident, that’s what you pay insurance for. The other driver wasn't hurt. Thankfully. Insurance will sort them out and they’ll get a new car in the end.

 

[maita13]

Echoing all the well wishes on this thread.

 

[kah42]

Just wanted to check in and see how you and that lovely ring are doing, @allycat0303 ! I hope you are recovering and getting some help at work.

 

[allycat0303]

Hi kah42,

Thanks for checking in My headaches briefly got better last week and then returned this week. I thought it was over, but neurologist said it can be a fluctuating course…

The insurance company has STILL not gotten back to me about my car so currently still have a rental.

As for work… they had a locum come in for 7 days. I’m back on call for another 3 weeks, and then another locum is coming. It’s still a lot of call.

My husband had my ring sized… and it fits. I do wear it to work. He ordered a matching wedding band from Leon which will arrive soon.

 

[diamondringlover]

I am not sure how I missed this thread...your ring is just stunning!!!!!! sorry about the accident I hope your headaches get better soon! and I would like to thank you for your service, any doctor or nurse right now has to be stressed out beyond belief but without doctors and nurses our human race would greatly suffer. FYI cant wait to see the matching band, I will admit I am a little partial to Leon's jewelry...I think you inspired me too wear a ring to the grocery store...lol its the only place I go anymore....

 

[mrs-b]

Hi kah42,

Thanks for checking in My headaches briefly got better last week and then returned this week. I thought it was over, but neurologist said it can be a fluctuating course…

The insurance company has STILL not gotten back to me about my car so currently still have a rental.

As for work… they had a locum come in for 7 days. I’m back on call for another 3 weeks, and then another locum is coming. It’s still a lot of call.

My husband had my ring sized… and it fits. I do wear it to work. He ordered a matching wedding band from Leon which will arrive soon.

Hi @allycat0303

Have you found that sizing the ring has addressed some of your earlier issues with it? I'm really curious to see which way you go with it - especially given my own previous experiences.

And yay to the wedding band! How lovely! Hoping your headaches are completely gone very soon. Like - now!

 

[Mreader]

I did want to share this (I asked for permission). Right before my husband presented me with the ring, he took me to a rustic diner for breakfast (to throw me off the trail). I snapped a picture of him laughing at me. He just told me “you’ll never find the ring, I put it in a place you can’t get to”. I thought he looked so self satisfied and pleased with himself.

Embarrassed to admit he was actually right. I never would have found it. Thank you all for letting me share

Purrrrrrrrrrr. (Oh I’m talking about the ring. Yeah.) lol!

 

[allycat0303]

Hi @allycat0303

Have you found that sizing the ring has addressed some of your earlier issues with it? I'm really curious to see which way you go with it - especially given my own previous experiences.

And yay to the wedding band! How lovely! Hoping your headaches are completely gone very soon. Like - now!

It fits better which is helpful but still spins a lot. I wear it. Kind of a love/ hate relationship with it. Sometimes I like it, sometimes I don’t.

I love the setting though. It’s exactly what I dreamed of having.

I think there’s a few options:

3 carat in same setting
3 carat in same setting (without halo)

I think a 9 mm diamond might be the sweet spot..

But I’ll wait to get the wedding band and see if that changes anything.

 

[Fabtwinsmom]

@allycat0303, I only saw your thread today and wanted to say that I’m sorry to hear about your accident and the stressful situation at work. Sending positive vibe and hugs from Toronto.

And congratulations on your gorgeous ring—it’s a vision! I’ve been admiring Leon Mage designs and he’d be one artisan I’d consider redesigning my mom’s solitaire should I ever decide to pull the trigger one day. Her diamond is about the same size as yours. I’ve never got used to wearing it finding it looks big as a solitaire (like a giant ball) and sits quite high up because of the depth of the stone (I prefer shorter/lower profile on my rings). I’m definitely saving this thread as inspiration for my potential future project.

You may find that regardless of the ring size, even as you sized it quite small, it may still spin if the band on the ring is thin. Mine/my mom’s has a thin band and because of my finger’s shape, it still spins left and right especially in the cold weather. I was finally able to solve this by wearing it with another band that pushes the ring about 2-2.5 mm further up on to the fleshier part of my finger. So hopefully having a wedding band may help—again it may depend on your finger’s shape as well.

It may take months for you to get used to wearing your new ring so give it a chance. It took me at least a year or may be even two years to get used to going from a 1 ct round to 2.4 ct oval. Enjoy your beautiful ring!

PS: now that the Canadian border is open again, you may be able to come back to visit a lot easier.

 

[Mamaofmany]

It fits better which is helpful but still spins a lot. I wear it. Kind of a love/ hate relationship with it. Sometimes I like it, sometimes I don’t.

I love the setting though. It’s exactly what I dreamed of having.

I think there’s a few options:

3 carat in same setting
3 carat in same setting (without halo)

I think a 9 mm diamond might be the sweet spot..

But I’ll wait to get the wedding band and see if that changes anything.

Im a 7 and I wear a 9mm (3.03ct 'march 3rd is our anni')and it's perfect, it'd give you more "there" but not as "THERE" as what you have now.

Hope you're healing well in mind and body.