If this is not a meat bun from heaven, Dr. Wu doesn’t know what would it be. A meat bun from heaven (天上掉馅饼) is a Chinese saying, meaning pure luck.

Dr. Wu has worked as a Rehab physician in the hospital in Texas for a few years. A few weeks ago, her department chief, only in his fifties, suddenly left. At staff level, people don’t know nor do they care about why this hasty departure, except the fact that Dr. Wu has not noticed any difference in her workplace. “What does a chief do, anyway?”

On Monday, out of the blue, the secretary of the hospital president sends Dr. Wu an email and asks her to come to the executive suite to meet the president.

“Meet the president?” She blinks at the computer screen, thinking, Did I do something wrong?

Five minutes before her meeting time, she arrives at the executive suite on the ninth floor. She has not been here before. In the hallway by the suite, she sees previous presidents’ portraits in large mahogany frames hung neatly on the wall. Their names and date of their service are engraved on golden plates below the frames. All of the previous presidents are Caucasian males, dressed in dark suits with matching bow ties. Under the current president’s frame it reads, Dr. Adam Weston, 2000-Present. He’s been the president for ten years. Dr. Wu makes a mental note.

When Dr. Wu enters the office, the president stands up. He is tall and slim and wears a navy-blue suit with a light blue tie. They shake hands and sit down at the round mahogany table by a large window that overlooks the city skyline.

“Pleased to meet you, Dr. Wu,” the president begins.

“Nice to meet you too,” she replies.

“I’ve heard a lot of good things about you,” he continues.

“About me?” She raises her eyebrows.

“Oh, yes. People talk. I hear everything.” He smiles.

“Oh.”

“You’ve raised patient care standard since you’ve come here.”

She shakes her head. “I haven’t done anything. I’m just a regular doctor, like everyone else.”

“Trust me. I have ears. All the chiefs from other departments have said good things about you, including Nursing.”

“That’s very kind of them. We have a good team here.”

“I asked you to come today to talk about the chief’s position in your department.”

“Oh.”

“I’ve discussed the position with Mr. Gilman, the director of the hospital. Instead of looking for a chief elsewhere, we’d like you to be the acting chief. The hospital rule is that if you do well, which I’m pretty sure you will, then in six months you’ll transition to be the chief. What do you think?”

“I’m not sure. I know nothing about the chief’s job. I’m only a clinician.”

“You can learn. Everyone does. I don’t make decisions like this lightly.  You’re recommended by the chiefs of Medicine, Surgery, and Nursing. I trust them. I hope you’ll accept the job.” He smiles again and waits for her answer.

“I really don’t know much about it. But if you think I can do it, I’ll try. I’ll do my best.”

“Thank you very much. From now on, you’ll report directly to me. Don’t hesitate to contact me if you need any help.”

On her way back to her office, Dr. Wu feels that this promotion is like a dream. She doesn’t even know if she should have negotiated a raise, or if so, how much. It has all come too fast.

By the time she comes back to her office and turns on her computer, she sees a new email from the president, announcing her new position as the acting chief, effective immediately. Wow, he’s fast.

Lynne, the department manager, or lead secretary, almost runs into her office yelling, “Congratulations!”

Dr. Wu likes Lynne. She is a tall woman with brown curly hair. She always has a warm smile on her face that says how are you or how can I help? She is fifty-eight and has worked in the hospital for nearly forty years. She knows the hospital like the palm of her hand.

“Lynne, Thank you. I’m so glad to have you here because I’ll need your help.”

“I’m glad to work with you. If you have any questions, just ask me.” Lynne winks.

The Rehab department is a relatively small service in the hospital and has about eighty staff, including physical therapists, occupational therapists, some medical support personnel and five doctors across three campuses. Within the first week, Lynne brings Dr. Wu to tour the campuses and meet everyone.

A few days later, Dr. Wu moves to a new, slightly larger office that fits an L-shaped mahogany desk and a small round table with four wooden chairs. It is windowless. Lynne finds a large painting of the ocean and sailing boats. She hangs it on the wall. Right away, the room seems to be larger and open to the sea and blue sky. Dr. Wu thanks Lynne. A bigger room with a view is an incentive to become a chief.

Dr. Wu continues her clinical routine as before. She doesn’t feel much different wearing the chief’s hat, but she acknowledges that she has more meetings and more people ask her for her signature. The paper work to be signed is usually discussed ahead of time, then prepared by Lynne or the section supervisors. She just has to sign her “John Hancock,” as her staff puts it. Although her handwriting has not improved, the size of her ego has adjusted to the new position rather quickly.

Six months pass before she even realizes it, and now, she is the chief, not acting as one. She knows she can do it. Chiefs don’t have bigger heads, after all.

*

Two months later, Lynne tells Dr. Wu that Sam, a medical clerk who shares the same front office with Dora, another clerk, complained about his co-worker. “Sam is very conscientious. Perhaps too much so. He wants things to be done right away and by the book,” Lynne explains.

“That’s a double-edged sword. A rule follower can be inflexible, a bit like me. What is he complaining about?”

“He said that Dora often falls asleep or reads her Bible at her desk. She ignores her patients waiting to be checked in.”

“That’s not acceptable,” Dr. Wu frowns.

“Actually, I saw her do that a few times myself. I told her this is not right and she must put patients first. But she hasn’t changed.”

“Do you want me to talk to her?”

“Not now. I only want to make you aware of this. I can handle this. Dora is friendly with me. But with Sam, it’s a different matter. Naturally, she doesn’t see him as her supervisor.”

Dr. Wu appreciates Lynne’s strength working with staff and with a positive attitude. She can bring people together with her big heart. She says, “Okay. Let me know if you need me to do something.”

A month later, Lynne tells Dr. Wu that Sam has the same complaint again.

“Did you talk to Dora again?”

“Yes. Yesterday, we had a long talk. Dora said that she hasn’t slept well for a long time and is tired. She promised to improve.”

“So, if she has some health issues, has she been seen by a doctor for that?”

“I think so. Actually, Sam isn’t the only one who complains about her. A few others have similar concerns. It’s a long story. Dora is known to the hospital. She’s been here for more than thirty years. Before she came to our service, she had changed, God knows, how many departments. Nobody wants her because of her poor performance. She’s like a hot potato. Two years ago, she landed here. You see, we’re a small department.”

A hot potato? I thought I got a meat bun.

 

Lynne’s office is next to Dr. Wu’s. Many times, Dr. Wu leaves her office door ajar when there isn’t anyone else in her office. This way, she can get some fresh air. However, sometimes, she can hear Lynne talking on the phone. One day, Dr. Wu hears Lynne saying, “Thank you for letting me know. I’ll talk to her again. I’m sorry that happened. I appreciate you seeing the patient for her. I’ll make sure you get compensation time.”

After a click, Dr. Wu sees Lynne at her door. She waves her hand for Lynne to enter.

Lynne’s face is as red as a peach.

“Is it about Dora again?”

“Who else? Yes, it’s her again. Do you know Dan?”

“Yes. I know him well. He used to work at this campus. He’s very good, very responsible and levelheaded.”

“Dan complains about Dora too.”

“What for?”

“This is not the first time that Dora makes scheduling mistakes. Lydia is on vacation this week, which was requested a month ago. Dora forgot about it. So, two patients showed up for Lydia. Dan was kind enough to see them, but they were unhappy because they had to wait longer. One patient yelled at Dan.”

“Lynne, I understand that about patients because it has happened a couple of times to me. Patients are always asked to come on time or even fifteen minutes earlier, but being told to wait for another hour is upsetting. This is, I don’t’ know, how many times I hear about Dora. This is unacceptable. We have to do something about it.”

“I agree. There is something we can do, but it’s not easy. There are rules.”

“Of course, we’ll follow the rules.”

“Well, the first thing is to ask staff and patients to write down reports of contact (ROC). It has to come from them. My writing doesn’t count.”

“Fair enough. Let’s ask them to write these reports. That should be easy.”

“Next, once I have the ROCs, I have to talk to the employee in question to verify if the complaints are valid. If yes, we can give the employee a verbal warning. Then, for each ROC, I have to provide education and training, monitor the employee’s performance and document all of them. The motto here is ‘If It’s not written done, it’s not done.’ Then, if there is no improvement in three months, we can proceed to a written warning.”

“Three months?” Dr. Wu frowns and shakes her head.

“Yes. We must give the employee in question enough time to learn and to improve.”

“Fair enough.”

“As long as we stick to the rules, maybe in six months, Dora will either improve and stay, or she’ll have to leave,” Lynne says.

“Let’s do whatever is necessary for the sake of patients.”

“The only thing is that Dora is a fifty-plus-years-old female employee, which can be viewed as targets of discrimination. Hospitals don’t want any lawsuits,” Lynne warns.

“That’s why we must follow the rules.”

“I’ll do my best,” Lynne promises.

Several weeks later, Dr. Wu hears Lynne talking to a patient on the phone. “I’m sorry about this, Sir. I’ll ask someone to help you. Do you mind waiting for a moment?”

A moment later, Lynne appears at Dr. Wu’s door. She shakes her head. “Dr. Wu, it’s the same old same old. Dora double-booked a patient for Christine. Christine agrees to see both patients, one at her lunchtime. But that patient doesn’t want to wait. He’s upset and wants to report to the CEO’s office.”

“Tell the patient that instead of going to the CEO’s office he’s better off writing down a ROC.”

“No way. He’s so mad. He said this isn’t the first time that his schedule is messed up.”

“Perhaps you can call him and ask him to write a report later. A patient’s report carries more weight.”

“Sure. I’ll call him later when he’s calmed down.”

Several weeks have passed. Lynne tells Dr. Wu that none of the staff wants to write their complaints.

“Why? How do they expect us to do something without proof?”

“People are afraid of retaliation. After all, they see each other day in and day out, and nobody wants to make enemies.”

“How about patients? They don’t care about them?”

“They do. But I can understand their awkwardness. To be honest, even patients who complained don’t want to be involved for the same reason.”

“Please explain the situation to them. We don’t have other choices. We have rules to follow,” Dr. Wu says.

Finally, a few patients and staff have written down ROCs about Dora. With these in hands, Dr. Wu and Lynne arrange a meeting with Dora.

 The chief meets Dora for the first time. She sees a woman with curly gray hair and notices her green shawl on her shoulders and a golden chain with a cross.

They sit down at the table and Dr. Wu begins. “Dora, I hope you know why we are meeting today.”

“Yes, doctor,” Dora replies.

“First, I would like to say that I appreciate your hard work.”

Dora nods.

“But as you know, sometimes just working hard is not good enough.”

Dora nods again.

“You have made scheduling mistakes multiple times over the last several months, and they have affected patient care and patient satisfaction. And staff are also stressed because of the overbookings.” Dr. Wu pauses.

“Yes, I know, I’ve tried not to make mistakes.”

“I know you don’t make mistakes on purpose. We understand your difficulties because of your sleep problems. But your job is critical. You’re the front line of patient care.”

“I know,” Dora agrees.

“It seems to me that this job is too difficult for you. Perhaps the new scheduling software is too complicated. Have you considered looking for something else in the hospital? Something more suitable for you.”

Dora nods. “Actually, I saw an opening in the Laundry Service, I can try there.”

“Sounds good. That might be a good fit for you. Why don’t you try, and I’ll be happy to write a letter of recommendation for you.”

“Thank you,” Dora smiles.

The meeting ends on a positive note.

While they wait for Dora to look for a job, Lynne and Sam continue to help Dora do her job in addition to their own. But complaints continue to surface about Dora.

Another month has passed. The situation is unchanged. So, Dr. Wu, Lynne and Dora meet again.

“How is your job search, Dora?” Dr. Wu asks.

“The Laundry Service doesn’t want me. I’m still trying,” Dora replies.

“I hear that you still make the same mistakes. Lynne suggested that you use Post-it or index cards and a calendar system to help you remember things, but they don’t seem to work. I don’t like to do this, but this is my job to ensure the quality of care in our department, and we have to give you a verbal warning for your persistent poor performance.”

Dora is silent.

Dr. Wu continues. “You’ll have three months to improve. During this time, Lynne will continue to assist you and provide the training that you need. Do you understand?”

“Yes.”

“I hope you’ll do better. However, if there is no change in three months, we’ll proceed to a written warning. Do you understand?”

Dora nods again.

“I suggest that you keep looking for a different job, and, in the meantime, I’m still happy to write a letter for you if you need it.”

Dora says she is grateful for Dr. Wu’s advice.

Dr. Wu writes meeting minutes that includes date and time of the meeting, the names of the attendees and the discussion about the verbal warning. She sends the minutes to Dora, Lynne, and herself for review.

Now, it’s up to Lynne and staff to keep up with documentations and necessary trainings.  By now, everyone is sick and tired of the if it’s not written down, it’s not done motto.  Only the thought of doing the right thing helps them to pass the next three months.

Monday is the day of the three-month mark. Lynne schedules another meeting with Dora. There is not any change in Dora’ performance. Dr. Wu and Lynne plan to move to the next step, unless Dora has found another job somewhere. That will be ideal. Dr. Wu prays for another meat bun from heaven.

Before eight o’clock in the morning, Lynne knocks on Dr. Wu’s door.

“Hi, Lynne, what’s up? Are you ready for our meeting with Dora this afternoon?”

“Dora called in sick today.” Lynne sighs.

“Sick? I hope it’s not serious? Let’s reschedule the meeting.”

“She’s taking a three-month sick leave.”

“Three months? What’s wrong with her?”

“She has a doctor’s letter that requires her to rest for three months due to mental distress.”

“Oh?”

“And the hospital’s rule is that when she returns, we’ll have to start from the beginning.”

“You must be kidding!”

“No. I suspect that Dora knows the rule.”

*

Three months later, Dora returns. This time not only is Dora the same person as before, she is also aggressive toward Sam and calls him “backstabbing” her in the office.

Sam is upset. Lynne tells him to write another ROC. He refuses and gives Lynne a look of what’s the use.

Due to the same poor performance, the chief asks Dora to have another meeting. Dora tells Lynne that she wants a union representative to be present this time.

“I’m the chief. I’m her supervisor. What does the union have to do with this?” Dr. Wu asks Lynne.

“To make sure the employee that they represent is treated fairly. This is her right,” Lynne explains.

After waiting for three weeks, Wendy, a union representative, is available. She is in her late fifties. She has short brown hair and wears a pair of silver frame glasses and a blue cardigan. She sits up straight with an air of seriousness, looking like a judge waiting to examine the evidence.

Lynne explains to the group about staff and patients’ complaints and Dora’s performance. She also acknowledges Dora’s difficulties about the job. Wendy listens and asks Dora if she has anything to say. Dora repeats her earlier excuses: poor sleep, too much stress, inability to concentrate, and poor memory.

Dr. Wu says, “Dora, I know you’ve tried hard to improve, and both Lynne and I appreciate it. Lynne has provided training for you over the last several months. None of this has helped. Patients are upset because of your inattention and your repetitive scheduling mistakes. I can attest that it’s not a pleasant feeling to be treated like this. I know from my own experience.”

Wendy lowers her head, stares at Dora over the rim of her glasses and frowns.

“Because of your continued underperformance, we give you a verbal warning today. If you’ll improve, meaning we’ll have fewer patients or staff complaints in the next three months, the warning will be removed from your file. Otherwise, we’ll proceed to a written warning. Is it clear, Dora?”

“Yes, doctor.”

“Since you have sleep and concentration problems, I encourage you seek medical attention and find a more suitable job.”

“I will.”

After the meeting, Dr. Wu writes detailed meeting minutes and sends it to all attendees.

In the meantime, Dr. Wu hears that Lynne has diabetes and has increased insulin dosage. Dr. Wu tells her, “Lynne, please don’t stress yourself too much. I don’t want you to get sick.”

“Dr. Wu, don’t worry. I won’t.”

After another three months of painstaking documentation, training and retraining, Dr. Wu and staff have reached the stage when the written warning is required. They arrange a meeting with Dora and Wendy again.

At the meeting, Dr. Wu and staff repeat the same experience as before. Wendy flips through the thick pile of papers on the table, then she turns to Dora and asks, “Anything else, Dora?”

Dora shakes her head.

“Then, we’ll have to give you a written warning today,” Wendy says with authority.

Dr. Wu urges Dora to look for other opportunities again.

“I will, doctor,” Dora says.

Two days later, Lynne tells Dr. Wu that Dora has filed an EEO complaint against her.

“Against you? For what? You’ve been so patient with her. I’ve never heard you raise your voice to her or to anyone.” Dr. Wu’s eyes widen.

“Yes, because I’m her direct supervisor.” Tears fill her eyes. She blinks them back.

“You’re doing your job! We have the ROCs from patients and staff. Do people expect we do nothing about this? Let me talk to my boss. He can speak to HR.” Dr. Wu never likes to use her boss as a weapon of defense. This time, she feels that to stand her ground, she needs support.

“Don’t bother. Dr. Weston can’t help us. I’ve been here long enough to know. We had similar cases before that brought lawsuits to the hospital. Some lawyers around here have made a fortune doing this kind of businesses.”

Dr. Wu feels her chest is about to explode. She glances at the ocean painting on the wall. The sea looks near, yet unreachable.

The following week, Lynne tells the chief that Sam is leaving.

“Sam isn’t the one who’s supposed to leave.”

“It’s toxic in that office. I don’t blame him.”

“Where is he going?”

“Mental Health Service on the fifth floor. He’s good. People know. They grabbed him right away. Besides, he’s promoted to be a supervisor.”

“Well, good for them and bad for us.”

As if Sam’s leaving and the EEO complaint are not bad enough, the next decision from HR is fatal. HR tells Lynne that her documentation is not detailed enough. “Those training documents are the same as before,” they claim. “Therefore, they can’t use them.”

Dr. Wu reads the email from HR on the black screen and wants to crush the computer.

Is this a trick that HR plays? Nobody wants to sign off on a case like this.

By now, Dr. Wu knows what the chiefs do: meetings and more meetings. Some are necessary and many are necessarily unnecessary. Who can solve problems with hands tied up with red tape? Thank God my department is smaller than others.           

The question now is what do they tell their staff? Sorry, we have to start again?

Unfortunately, what Dr. Wu tells her staff next is a bombshell: Lynne has decided to retire. She says it is for personal reasons unrelated to her work.  Nobody believes it, but who can blame her for abandoning the ship?

*

A few months later, the department hires Kate, a new manager to replace Lynne. Kate is thirty-two and used to work in a commander’s office in the military. She is a hard-working, efficient, and no-nonsense type of person.

It doesn’t take long for her to see Dora’s problem. “Dr. Wu, people complain about Dora,” Kate tells the chief.

“I know. That’s not new. We tried to do something before and it didn’t work. Dora is almost sixty, perhaps she’ll retire in a couple of years.” Afraid of reopening the wound, Dr. Wu tries to talk down the issue.

“We can’t let this go on. Two years is too long. Plus, what didn’t work doesn’t mean it won’t work now,” Kate says firmly.

“HR has rigid rules about ROCs and documentation. Their motto is if it’s not written down, it’s not done.” Dr. Wu is so sick and tired of this motto by now that Kate detects a trace of sarcasm in her tone.

“I know. I can do it,” Kate says, appearing fearless.

Hearing Kate’s words, Dr. Wu thinks, Yes, doing something is better than doing nothing. In her injured heart, there is a tiny flame of hope that refuses to die.

Kate goes to the campus where Dora works half day a week to get firsthand information.  She stands by Dora and watches her working. She catches Dora’s errors and teaches her on the spot. Dora behaves better when Kate is by her side. She slips back to her old self when Kate is away.

Kate’s military style of persistence pays off. When they meet again with Dora and Wendy, Wendy can’t find any excuses to give Dora a verbal warning for the third time.

Just when Dr. Wu feels the matter with Dora starts to move forward, she hears some staff complain about Kate. “She’s too abrasive,” and “She isn’t as patient as Lynne.”

People are so difficult to please. Dr. Wu keeps her thought to herself. She has to talk to Kate. She asks Kate to come to her office and says, “Kate, you’ve worked hard and very efficiently. You’ve done a great job so far. I appreciate that.”

“Thanks,” Kate replies.

“You’ve especially put in a tremendous amount of effort helping Dora, which hasn’t been easy. I need to tell you that we have to pay attention not only to what we say but also the way we say it. Under no circumstances can we allow ourselves to behave unprofessionally: not to raise our voice or to slam things on the table. We’re not at home. This is a workplace. In a workplace, we have all kinds of people. Like senator John McCain said, You don’t go to the war with the army you want; you go to the war with the army you have.”

Kate says, “I know I’m not patient. I just can’t…”

“I’m the same. That’s why whenever I feel disappointed, I think about this McCain’s quote.”

Kate nods.

“There is another saying: if you want to go fast, you go alone; if you want to go farther, you go with the team. You’re a supervisor. You have a team to lead.”

Kate nods again.

Dr. Wu feels that she is asking too much of a young person. She likes her. It’s Kate’s I can attitude that keeps the tiny fragile flame of hope flicking in Dr. Wu’s heart. If anyone can, Kate can.

Dr. Wu is right. With Kate’s impeccable documentation, they arrive at the written warning stage again. At their meeting, Wendy flips through the thick pile of papers and acknowledges the documentation is undisputable. Then she tells the group bluntly, “You have to provide another three months of training to be fair.”

“Excuse me. I’m all for fairness. Isn’t the HR rule three months?” Dr. Wu leans forward and tries to keep her voice low and even.

“Three months is the minimal. Everyone is different. Dora has difficulties, so she needs more time.” Wendy lowers her head and stares at Dr. Wu over the rim of her glasses, as if to say, don’t argue with me.

Wendy’s look reminds Dr. Wu of one of her elementary school teachers. When she was in the 5^th grade, a boy in her class made a mistake in reciting Chairman Mao’s quote. Instead of saying, “First, don’t be afraid of hardship, and second, don’t be afraid of death,” and he added, “third, don’t be afraid of teachers.” Young Dr. Wu giggled and was expelled from the class for that day as punishment. But the teacher’s face has stuck in her mind. How familiar. Wendy has the same righteousness as that teacher.

While the chief’s ego is crushed, Kate lifts her chin up and says calmly, “No problem. I can train her for another three months.”

At this point, the chief is too depleted. Who can fight City Hall?

In the next three months, Kate continues to work diligently with Dora side-by-side one day per week and documents all the details. When they meet again in Wendy’s office, Dora admits her persistent underperformance, “I just can’t concentrate.”

“It looks like your health condition is preventing you from doing your job. Have you considered applying for disability benefit?” Dr. Wu feels bad for Dora.

“Yes. But, a disability check isn’t enough to pay the bills.”

No Wonder. The jobs that Dora has been looking for pay even less.

The group gives Dora a written warning. Wendy offers her help in Dora’s hunting for a job. She reminds Dora, “You have three months to improve. Try harder.”

Kate tries harder too. She’s increased her time from one half day to two half-days per week to help Dora. But her effort is fruitless. So, with solid evidence, HR agrees to draft a standard proposal which says Dora has to leave the department immediately. She can look for another job in the hospital. If Dora fails to secure a different position in two months, she will have to leave the hospital.

Dora reads the proposal and says she need three days to think about it before signing.

Fair enough. Everyone agrees. After all the ordeals, three more days won’t make a difference.

Three days later, Dora sues the hospital. A powerful local attorney is on her case. The hospital chooses to settle. Dora stays.  

When Dr. Wu hears the news, a Chinese saying comes to mind, 人在屋檐下，不得不低头: “When a man stands under eaves, he can’t not lower his head”—a thousand years of wisdom! If every human being would learn sayings like this one, or a quote like that of John McCain’s, life would be easier.

A month later, Dr. Wu suddenly receives a phone call from the director’s office of the hospital. The director wants to talk to me? What for? I report to Dr. Weston, not him.

 Ah, apparently, a patient complained to his congressman about his bad experience with a medical clerk at the hospital and the employee in question was Dora. The congressman sent a letter to the director and demands an investigation. Now, the hospital has to act on this matter ASAP.

The chief is accountable. Am I going to be fired? Or, is there a silver-lining? Dr. Wu asks Kate to bring all the ROCs and other training documents with her to the director’s office.

The director says he doesn’t need to see these. He has a plan. He proposes to remove Dora from doing frontline work with patients, and the hospital will create a new position for her in his nonclinical realm. “This is a win-win situation,” he says.

“Perfect,” the chief says.