Great Exudations

It dawned on me one day, when I went into CHASE to ask about a home loan about twenty years ago, that pretty much everyone in a commercial bank who isn’t a teller is called “Vice President.” It was an impressive sounding title when you saw it on a business card (who has those anymore?) or heard it casually mentioned at a speed-dating event. The name implies a singular position. Second in command (or maybe third in the case of Al “I am in control here” Haig). I think the gig is up on that now and the title isn’t budging the needle anymore. But a recent article in the New York Times exposed the trend of employers giving more workers the title of “manager” or “assistant manager” (they listed absurd examples of “food cart manager” and “lead reservationist”) who are near the cut-off for the federal requirement of overtime pay beyond 40 hours/week (the current cut off is a salary of $35,500/year). So it’s a fancy title in lieu of a pay increase, or, in their case, pay that is justly due but withheld. And also don’t tell it to academic radiology departments. As in most every field, doctors are working harder for the same money or less. And with burn-out at an all-time high, they have to think of clever inducements. One very cheap perk is a phat-ass title like VICE-CHAIR! That sounds really important, right? Well, for starters it never really was, even in the days when only one sucker filled the thankless job. But in the last 5-10 years, there has been a slo-mo explosion of new titles in medicine with the first wave looking something like this:

Vice Chair of Research

Vice Chair of Operations

Vice Chair of Quality and Safety

To be clear, some of these are necessary and were already in place, it’s just that they weren’t at the level of “Vice Chair.” As hospital systems have grown, their management has become unwieldy and complex tasks have to be spread around. I get that. More work for everyone, both clinical and administrative. But with reimbursement under constant siege (something that never seems to happen with C-suite compensation or marketing/advertising budgets), there is limited room to advance pay. So whether consciously or not, the powers-that-be landed on a solution that shoves almost everything and everyone to the level of VICE!! We humans do LOVE our titles, and many will endure whatever humiliation necessary to receive them. You see them awkwardly brandished on white coats and in e-mail salutations, like stackables from the The Container Store. And let’s just face facts — most doctors are total fucking dorks. My own professional society, the ASNR, could officially change its name to the American Society of Nerdoradiology and no one would miss a beat (our national meeting makes Comic-Con look like the free concert at Altamont and should be sponsored by Rockport and whoever makes pocket protectors). So then there came a second wave:

Vice Chair of Education (we also see a rise of the tack-on title or “ampersandwich”….. such as VC of Education & Diversity or, given the burgeoning numbers of MD-MBA’s who are secretly hoping to evade clinical responsibilities while drawing a higher salary, VC of Operations & Finance)

Vice Chair of IT (medical informatics tends to run about 15 years behind finance and about 5 years ahead of government, so we informally call it hospital “shitformatics” or “ShIT”)

Vice Chair of Wellness & Mindfulness & Gratitude & Work-Life Balance. Their main role is to send you platitudinal quotes and reminder e-mails about mid-morning group yoga that you cannot attend due to the clinical work-load (if you were to go, you would find mostly vice chairs from various departments doing light stretching and shooting the shit).

But work titles, like hospital administrators, are an ever-expanding phenomenon. It’s simple physics. Soon the only ones in the department who are beneath the Vice Chair level will be the “tellers.” And below are some proposed new/improved titles for the coming third/turd wave:

Vice Chair of Parking

Vice Chair of Ergonomics

Vice Chair of Box Lunches

Vice Chair of Marketing Strategies and Social Media

Vice Chair of Bathrooms (includes hand-washing stations)

Vice Chair of Fashion, Hair and Make-up

Vice Chair of Music (Yanni led a recent national survey of departmental playlists; some departments combine with Vice Chair of Wall Art)

Vice Chair of Modules, Credentialing Forms, and Surveys (remote from Guantanamo Bay, Cuba)

Vice Chair of Foreign Bodies (VCFB, hee-hee!)

ADDENDA:

1. One friend (JS) read the post and would like to be Vice Chair of Proofreading for my tendency to make numerous spelling and syntax errors in my initial posts, though he realizes that a blog, like life itself, is a work in progress.
2. Another friend (BR) requested that he become Vice Chair of Vice-Chairs (VCVC). And to that I say, “There’s always room for one more near the top-middle!”

Laugh if you will, but hemorrhoids are no joking matter! In the US alone, hemorrhoidal flare-ups cost the economy 1.2 Billion dollars in lost productivity annually. And while I totally made up that statistic, they literally are a pain in the arse; the itch you cannot satisfyingly scratch. Well, okay, between bouts they are kinda funny. But this shit DOES actually work! Just tuck it and go, go, go!! Plus Amazon saves you the embarrassment of store check-out. Which brings me to my proposed new TUCKS brand jingle:

“You might be Captain Kangaroo

Or you might be Mrs. Maisel

You might shop at consignment stores

Or you might wear couture labels

You might suffer constipation

Or you might just prefer anal

But if your backside’s acting up

Then slap-on some Witch Hazel!

TUCK it! TUCK it! TUCK it up!

Tuck that pad up in your butt!

TUCK it! TUCK it! TUCK it up!

Turn that limp into a strut!

With TUCKS!!”

“I WASN’T PREPARED FOR HIS PERFORMANCE IN SUCCESSION. I CAN’T SEE HIM ANYWHERE IN IT, AND I DON’T KNOW WHERE IT CAME FROM. I DON’T KNOW IF I’VE EVER BEEN SO SURPRISED BY AN ACTOR.”

— Colin Firth on his friend and fellow actor matthew macfadyen (tom wambsgans)

I love this quote (snatched from Vanity Fair… behind a paywall but, alas, not far enough!), not only since he’s my favorite character on “Succession,” but because one of the greatest gifts we can give our friends and family is this element of, shall we say, “contained surprise.” Stipulate that the full-fledged version of join-the-circus-or-worse-yet-a-cult-or-even-Amway is almost never a welcome event. Yet there is room in the folds and interstices of our textured personalities to find another voice — the way Barry Gibb stumbled onto his during an eventful recording session. Maybe a little Vaseline behind the ear to serve up the occasional spit-ball. I’m going to go so far as to say that this is our obligation to one another. And surely to ourselves. We should be seeking these joyful moments of, might we then coin, “expectation arbitrage.” Leave them agog at the Thanksgiving table as you quote Tolstoy in the voice of Beavis and/or Butt-Head. Go ahead and order that phat Appletini. The joke’s on them. All the better if you actually like the taste! Go bowling once in a while. And if you’re already a league bowler then try karaoke axe-throwing. To paraphrase Logan Roy from the same series, “The only rule is there are no rules!” Our goal is not to induce seizures; but it is to seize the moment, every now and again (i.e. Carpe fuck ’em!!). Balance and timing are key, of course. Done too often, it becomes a schtick. Too ham-fisted, you aren’t invited back. But remember this: it’s only not funny if it isn’t funny to you….

Chief Complaint: “Doc, my foot feels stuck!”

History of Present Illness (HPI): 52 y/o male with h/o fibromyalgia and chronic fatigue presents to Podiatry Clinic stating that his left foot has not been functioning normally for about six months, getting worse over the last several weeks. He reports no pain or tenderness. No fever or chills. No major trauma. He does recall walking on the boardwalk in Ocean City, MD last summer while barefoot when he stepped on a piece of ABC Gum (he clarified that this means “already been chewed”). He thought that he had removed all the gum using a small stick and then went about his business. Several months later he began to experience mild cramping of the medial left foot in the metatarsal region and this has progressed, altering his gait and causing mental distress.

Past Medical History: Borderline hypertension, GERD, hepatic steatosis, shingles (2016)

Past Surgical History: Appendectomy (1995), hemorrhoidectomy (2003)

Medications: Omeprazole, CBD oil, Xanax

Allergies: Penicillin, Marriage/Commitment

Social History: Occasional smoker, 10-12 drinks per week (the doubling rule applies here), sporadic marijuana use, works in finance

Physical Exam: Nontender left foot without swelling, ulceration, warmth, redness, or drainage.

X-ray Findings: Bridging bony excrescence joining the mid-shaft of the left first and second metatarsals. No acute fracture or erosion. Normal bone density. Mild DJD of the first MTP joint.

Assessment: Penetrating gum injury to the plantar surface of the medial left foot with proximal migration and secondary ossification resulting in ankylosis of the first and second metatarsals.

Plan: Regional block with open osteotomy and de-gumming in two weeks. The patient was advised to always wear shoes when walking outdoors and to never-ever-ever remove stuck gum from the skin surface with a stick or other sharp object. The patient appears to understand and agrees with the proposed course of action.

Time: I attest to spending approximately 15 minutes with the patient.

“We Got Game”

Rare the times and quick to go

You see the line not being shown

Unleashed lightning underground

Arms awave without a sound

Pebbled fingers drape the orb

That with a flicker spins and soars

In fading back you trace the arc

Knowing well it’s on the mark and

Knowing no one’s keeping score