Is Redemption Possible for a Physician Executive?

By tradition, my portrait as the hospital CEO is prominently displayed in the lobby. During these difficult financial times, the carefree smile belies the strain of ensuring high-quality patient care as well as offering a fulfilling work experience for our caregivers. I find myself wondering how a nice girl like me ended up sitting at a computer all day reading e-mail and spreadsheets, and whether I'm in need of some sort of redemption.

Though generally a methodical person, my decision to become a physician was nothing short of a revelation. In the midst of my senior year of college, my firmly established plan of a music career vanished on the sidewalk in front of Jewish Hospital. My maternal grandmother, Oma, had just suffered her first heart attack. The whole family had gathered to wait and worry throughout the night.

As morning arrived, I went for a short walk to seek relief from the building sense of helplessness that smothered me. As I took in a long deep breath, a random thought quickly transformed into an unwavering conviction: "I am going to be a doctor." The emotions and resolve stirred in me at that moment shaped not only an entire medical career, but who I am as a human being.

In hindsight, I guess it was an audacious idea. I was about to become the first person in my entire family to graduate from college and had never even known anyone who was a doctor. My father bitterly resented the entire medical profession. My mother blindly believed I could do it, but questioned how in the world would I pay for it?

My grandmother Oma was my only connection with the health profession. She worked the midnight shift on the obstetrics ward as a nurse's aide. While we often heard the story of her participation in the delivery room at our births, the thousands of bedpans she emptied over her career were not really mentioned.

My earliest memories of Oma were Sunday dinners at her home. After a delicious meal of her famous chicken and dumplings, Oma would lay down for an hour or so. Before we left, she would be up, wearing her crisply ironed pink uniform dress and freshly polished white shoes. She looked very professional - but, oh so tired. After my grandfather's health worsened, Oma was the sole provider for her family. After working the 11 p.m.-7 a.m. shift at the hospital, she would walk across the street to work another eight-hour day shift at the nursing home. I am now the age she was in my memories, and I don't know how she did it. In retrospect, the toll on her health was obvious.

Her exhausting schedule didn't leave her resentful of others: Oma's house was frequently our safe haven from my father's alcohol-fueled rages directed at my mother. A few years after my parent's divorce, my father was in an apartment fire. Escaping from the blaze, he sustained severe burns to both hands and was hospitalized for many months. Oma went every day - before and after work - to help feed and bath her former son-in-law.

Failing health finally forced her into retirement. The county hospital's retirement pension for 33 years of service as a nurse's aide was $33.00 a month. (I didn't leave out a zero). Too young for Social Security benefits, this widowed woman who had raised a family during the Depression and World War II, cared for a dying husband, and worked two jobs was forced to apply for food stamps. Unable to pay her mortgage, she moved in with my aunt on the East Coast. Within a matter of months, Oma endured the loss of her health, job, home, church, community, friends, and close contact with most of her children and grandchildren.

Once I began my medical training, Oma shared her past experiences as a patient in a busy intensive care unit with me. It was in my third year of medical school, during cardiology rounds, that I realized Oma's poignant stories were equally relevant to the patients I was visiting. At the foot of each bed, the third-year medical student would recite the case presentation. The cold factual account would be followed by a scholarly discussion among the medical staff. I felt uncomfortable watching the medical team act oblivious to the presence of a suffering patient. Many times I lagged behind to briefly reassure the patient that I would be back later to talk.

One of my biggest regrets is that my grandmother did not live to see me become a doctor. However, I am comforted that her life nurtured the doctor I became. I practiced medicine for many years, when, unexpectedly, I was asked to take the dual role of CEO and medical director at my hospital. Truly believing physicians should guide hospital decisions, I accepted the position.

The day-to-day administrative work of contract negotiations, personnel issues, and audits can feel far removed from the hospital's basic mission of patient care. The recession has further ramped up the converging forces that create and recreate financial and ethical dilemmas.

Surrounded by incredibly talented people, the hospital has experienced unprecedented success. I am very appreciative, but at times feel like singer Dan Fogelberg's description of his life on tour, "the audience is heavenly, but the traveling is hell."

Recently, to rationalize a staff-related business decision, I sarcastically referred to two of my much-admired colleagues as "members of the bleeding hearts club." The business decision was necessary - the rest of my behavior was not. It alarmed me. My medical practice had flourished based on the simple principle of providing the same empathic care that I would want for my loved ones, the kind of care my Oma offered to others. Now I have an entire hospital of patients, employees, and their families counting on my decisions to be financially savvy, yet compassionate. I needed a little walk.

Passing through the lobby it is hard to miss that big picture. Stopping, as if seeing myself for the first time, I pondered the question of how people will remember my leadership. I could not keep from smiling as I thought, "I hope they will say 'she was a proud member of the bleeding hearts club.'"

Peggy Stephens, MD, is the CEO, superintendent, and medical director of Madison State Hospital in Madison, Ind. She completed her medical training at the University of Kentucky and Harvard University. Dr. Stephens is a past president of the Kentucky Medical Psychiatric Association.

This article originally appeared in the March 2011 issue of Physicians Practice.