Why me?

 I will start with a disclaimer that I have total and severe imposter syndrome about being the speaker at this first NowEM Qld event. When Shani first contacted me about this, my immediate response in my head was:  Why me?!

There are SO MANY women I can think of that SHOULD be giving this talk – in fact so many women whom I myself would love to hear speak.  

In addition, I have no story about overcoming hardship, either professionally or personally. If anything, my path has – for the most part – not only revealed itself to me, but paved its way just ahead of where I’ve been at. I have had a dream journey through EM so far (touch wood!), and I owe that to many, many people who have played a part in it.

So why me? It’s a question I have asked myself often over my professional life, and feel like I ask it even more frequently of late. The response that has slowly revealed itself is: “Why not me?”

My rationalisation for why it is I who is here and not those many other women is that perhaps NowEM was in fact looking for someone ordinary with whom the audience might connect easily, rather than someone super-stellar who may seem unreachable. 

Also, Victoria Brazil is overseas right now anyway.  So, why not me?

I’ve been a doctor for nearly 22 years and working in EM for 17 of those years.  As time passes, and as I realise that I am in fact now a proper “grown-up”, I reflect upon what it is that truly defines me, not just professionally but also personally. And I think that, when all is said and done, the attribute that I most value about myself – is my ordinariness. 

So I think I can guess what you’re thinking: “Wow – she’s so amazing – and she’s so humble too – which makes her even more amazing! Imagine her saying that she’s ordinary”.  

Well, I’m afraid you are totally mistaken.

Maybe I am a little amazing – but I promise you that it’s no more amazing than any of you here. And I’m definitely not humble. In fact, I take great pride in my ordinariness.  I have worked hard to come to this position. Let me explain. Like – I suspect – many of you, I ambuilt with a Type A personality that tends towards perfectionism. I like to be organised, for things to be just so, and to be in total control of situations.

I used to think that it was an act of irony that landed me in EM. But actually it makes perfect sense that I like to take a situation that is in chaos and then try to convert it into some kind of order. In fact, I would say that most of the women I know in EM are pretty much this kind of person!

Being in control was how I spent about the first 30 years of my life: studying really hard at school to do well enough to get into Medicine, studying hard at Uni to get my degree, jumping into residency and training and continuing to work hard to achieve Fellowship. 

Somewhere along the way, fitting in marriage and children, and the creation of my own nuclear family and household.  Working hard at work to keep up with the requirements of the job, and with my colleagues – who inevitably always looked like they were so much more competent and capable than I ever felt. Working hard at home to keep the humans fed, clothed, educated and happy.

And then maintaining a persona on those fronts plus socially that was the picture of the functional, together working parent who was totally sorted. I wasn’t intentionally trying tolooklike this – I was just built to bethis person – like many of us are. Paddling away furiously below the surface to keep my head above water and pointing in the right direction.

And it was exhausting!

So I have spent the last five years purposefully and intentionally discarding this persona – not only has it been liberating, but it’s been empowering, and it’s actually (surprisingly) opened a way into finding my niche within the medical profession.

It has slowly and gradually dawned upon me that my power lies in my acceptance that I am imperfect and I am vulnerable.  And, totally unexpectedly, I have discovered that when I out my imperfection and vulnerability, those around me start to share their own inner story with me. It’s like my sharing empowers them – but then, their sharing empowers me!

How did I learn this?  Well, it took time and frequent reflection.

My EM infant and toddler years were spent at RBH. I remember meeting people like Victoria Brazil and Tony Brown. Not only were they hands-down inspiring – for their knowledge, technical skill and professionalism – but they knew how to get the most out of their team. 

For my part, I remember arriving to my first shift as a JHO in ED, trembling as usual and petrified that I would find myself out of my depth. The first patient I picked up was in a cubicle and Tony Brown was conducting an initial assessment. As I entered the room, he looked up and smiled, and said loudly to the patient, “Ah, here’s Shahina. She is one of our star residents. You will be in good hands”. He then handed over the patient and promptly left.

Now I promise you that I was no star resident. Sure, I was diligent and methodical and conscientious, but when it came to synthesis and formulation I could barely get out of the blocks. I was shocked that Tony Brown even knew my name, let alone had this impression of me. To this day, I am confident that he was simply being strategic about how to motivate a junior team member, but you can be sure that I spent that day and the rest of my term in ED absolutely busting my gut to live up to that impression.

Similarly, I crossed paths with Vic several times during my resident years, and then again just as I was about to take over from her as ICU registrar – my first registrar rotation. The department was short and I was called up towards the end of my SHO year, post primary, to come on board as a trainee. The director of ED, Rooks Pillay, was standing and talking to Vic who had come to assess a patient there. As I walked past, he made a casual (and completely true) comment along the lines that ICU would be lamenting its loss of Vic and its “gain” of me. Without missing a beat, Vic replied, “Ah, but that’s just because they don’t know Shahina yet”.

And these are the kinds of privileged interactions I had with the tribal elders of EM – interactions that confirmed for me that they in fact were my tribe and that the ED was my village; interactions that made me believe that I may be capable of learning the craft of EM; and interactions that taught and inspired me not only to hone my technical skill but to pay careful attention to professional and humanistic attributes also.

So, I set about my journey of EM training, moving from Brisbane to the Gold Coast largely because my extended family lived down there. I was incredibly fortunate to find that the EM village and its villagers down south emulated the same attributes that I had valued in Brisbane. If anything, being a smaller hospital at the time, meant that relationships were even stronger, and strengthened further when I had an episode of burnout later in that first year.  

I remember once disclosing to a nurse colleague, Fran, with whom I’d developed a deep connection over the years, that I arrived at work every single shift, unable to overcome a sense of fear, and even of dread at times. Her gentle advice to me was to try to embrace the fear. I had no idea what this meant. She rationalized to me that fear meant that we cared – we cared about doing a good job, and about always working to do better. She suggested that it was possible that I would always feel frightened in this context – that fear may be a lifelong companion – and therefore I may as well purposefully allow it along for the ride.

And so I’d trudge to work each time, with the weight of fear and apprehension on my heart, trying to accept it, at first begrudgingly but then wholeheartedly. I went through my training and my exams, secured a staff specialist position, and then stopped to have a child.  My return from maternity leave saw a resurgence and new heights to this fear – I felt deskilled and deconditioned. 

Would I know what to do for APO? What were the current anti-platelet agents being used in a STEMI? What on earth was a NOAC? Could I still even cannulate, let alone intubate or insert an ICC?

I didn’t know with certainty if I could do any of those things. I did know, with certainty, that I was definitely not going to be the best at any of those tasks. However, what I had now that I hadn’t had before was a level of wisdom: that my job was not to be the best at those tasks – someone fresh and new had graduated into that position; my job was to manage the team and run the department. 

I remembered the guidance given to me by James Collier a couple of years prior.  I’d just returned to work after passing my fellowship exam, and was dismayed to discover that despite having just demonstrated to everyone just how competent and capable I was, I still wasn’t always able to make a diagnosis. That evening, I emailed James to say: “Thanks so much for being instrumental in my exam success. But I’ve returned to work and I still don’t know all the answers”. James’s reply was kind and brief: “Shahina, you don’t need the answers; you just need a plan”.

With further age and experience has come insight, clarity and the ability to be resourceful – and that is what my ED needs from me now.

Of course, that is not to say that I don’t need to remain skilled at the tasks.  Of course I do – and that takes concerted effort and deliberate practice, and a fair amount of discomfort and humility: to work in the Children’s pod at intervals and step up to cannulate the squishy child; to agree to be the Team Leader in the multi-team in-situ sim with the critical eyes of peers upon me. Stepping out of my comfort and confidence zone means risking failure, and none of us likes to do this.

But growth is limited if we don’t.  To maintain and develop our skills requires us to regularly step up and test where we are at. And at times, we may not pass the test.

Probably my most challenging professional experience has been not in my clinical role, but around my role in the Director of Clinical Training (DCT) position. I occupied this role at 0.5FTE for three years, until three years ago.

My first challenge was growing into the position. Curiously, the ‘leadership’ was something that came somewhat inherently to me. I was good at forming relationships, just by being kind and curious about people, be they in my team or outside my team; I was energetic about our shared vision for the unit; I was hard-working and determined about seeing our objectives met. 

The part of the job I really sucked at was ‘management’. The job had been taught to me by the wonderful and capable people already in the unit – they invested in me wholeheartedly and grew me from unconscious incompetence to conscious competence. We started with the natural dynamic whereby I was the student – almost the child – and they were the teachers – almost the parents. Over time, what needed to evolve was a reversal of this dynamic, and I really didn’t do very well at this. I prided myself on working collaboratively and leading from the centre, and I was terrible at stepping up and giving firm feedback and direction when it was needed.  

But I must have got slowly better as towards the end, I did have a crucial conversation with one of my team.  They made the comment, “Shahina, your style has changed and – I must say – it doesn’t suit you”. I found myself replying “You’re right – my style has changed – and I’m afraid I think it actually doesn’t suit you”.

My second challenge in the role was leaving it. For three years, I had limped from temporary contract after temporary contract. I asked for the role to be advertised – because that is what the organization and its junior doctors deserved – and I clearly stated that I would be very willing to apply. After months of inaction, I delivered an ultimatum: that my next 3-month contract would be the last I would accept, and I would then vacate the role. 

We had built strong visibility as a unit, strengthened relationships, and achieved our strongest intern accreditation ever. Therefore, what I expected to happen was that the organization - which felt like it valued my contribution - would progress the advertising of the role. What actually happened is … nothing.  The three months came and went, and at the end of it I had to honour what I had pledged and walk away.  

My ego wants me to tell you that this was my choice, and that I left the role because I was done. 

That they begged me to stay, and promised that another three months would see it sorted. 

But I wasn’t done – I still had a lot to do, and I had a team to lead and nurture.  I desperately wanted to continue.  And no one begged me to stay – at least no one that had the power to keep me in the role.

I was honestly heart-broken. I took a pre-planned three weeks off and licked my wounds. I worried about the team and worried about the junior doctors. 

But I had to learn that my sphere of influence had contracted way smaller than my sphere of concern. And I had no choice but to accept this. An annoying and unwelcome phrase “Surrender to the universe” came to me repeatedly. I wasn’t built to surrender to the universe – and so the universe had to beat me into submission.

The reality is that none of my journey over the subsequent 3 years would have come to pass if I was still immersed in the DCT role. My priorities and demands would have been such that I would not have had the capacity to pursue my interest in wellness and professionalism. Turns out the universe had a plan – a good plan – after all. Who knew?

Ironically, I discovered that my ability to advocate for the junior doctors was stronger outside the role than it had been within it. While I was the DCT, I often had to toe the executive party line – to navigate the balance between pastoral and professional care vs operational parameters. Outside of the role, and purely as an EP, I found that I was braver about speaking up on behalf of our junior (and senior) doctors. I reconnected with my clinical identity, and this in turn enhanced my credibility.  It meant that while I was spruiking the wellness and professionalism agenda, I was doing it from a position that was stronger and less vulnerable than that one I had been in. 

Back in the ED at increased hours, I was warmly welcomed back into the fold. I was reminded of a sense of community and of belonging. Of working with people I could trust immensely and implicitly to have my back. And, back home, my internal growth-and-acceptance journey continued.

One day, after a trauma sim and during the debrief, the trauma fellow was quite harsh in his feedback on one particular component of my management as Team Leader.  Afterwards a colleague kindly caught up with me to acknowledge this and to ask if I was okay.  I discovered that I was actually okay.  I was okay for a number of reasons:

1. There was in fact little criticism that someone else could give me that I hadn’t already given myself 

2. I could accept the feedback about my action or inaction, and not let it spill into my value as a whole – not let it mean that I was globally inadequate or lacking

3. I could do this without resentment or a sense of injustice – that the feedback was fair (even if the delivery could have been gentler) and that I would take it on board and work to do better next time.

I discovered that day that I was UNMESSWITHABLE. Unmesswithable, or its far more effective synonym unf*withable, is an adjective that describes that state when you are truly at peace with yourself, and nothing anyone says or does bothers you, and no negativity can touch you. That state where you recognize that nothing has meaning apart from the meaning you choose to give it.

So these days, I am much kinder to myself than I used to be. And I hope that at the end of my career, that that will be a part of my legacy.

The message that we are all in this together, women and men. That we are all wobbly on the inside while looking totally capable on the outside. That we will truly see each other in all our vulnerability and imperfection, and therefore be kind to each other also.

The message that some of us will distinguish ourselves via some stellar achievements in our EM career: achievements that will revolutionise the way we deal with clinical conundrums (like Louise Cullen who has saved millions of dollars and a ton of morbidity by slashing the timeframe in which we work up patients with CP); or the way we deliver care that is truly quality (like Vic Brazil who has opened our eyes to how we do better together, when we pay attention to our team and system dynamics); or shaping the discourse around EM be that outward (like Alex Markwell with her political leadership with the AMA and now the Clinical Senate) or inward (like Kim Hansen and her tenacious advocacy within ACEM).

The message that others of us will never make quite as big a splash, but that we will have worthy ripples of our own – because we work hard to remain current in our knowledge and skill; because we contribute to our local training program; because we hold an un-glamourous but necessary portfolio within our ED; or simply – and importantly – because we are known for our kindness and curiosity – not just with our patients, but with each other, and because, as such, we set the tone for our departments. 

So, whether you’re a tsunami or whether you’re a ripple, know your value, know that you are enough, and know that you are totally worthy of being celebrated as a woman in EM.

And the next time, you are posed a challenge or an invitation, and you hesitate – for whatever reason – and lament to yourself through gritted teeth “Why me?”, perhaps you might ask yourself instead “Why not me?”