Thursday, July 17, 2008

It only takes a few seconds......

It only takes a few seconds....

1. To say "Hi" with a smile.
2. To answer the business phone with a kind hello and your name.
3. To ask, "How was your weekend?"
4. To empathize, "How is dealing with your ailment(s)/pain affecting you?"
5. To ask, "How do you feel about your diagnosis?"
6. To remember, "How's your dad doing after that fall and hospitalization?"
7. To help someone with directions on the street.
8. To ask the toll attendant, "How's your day going?"
9. To bring light and cheer into every day.
10. To remember an anniversary.
11. To stop and be grateful for everything you have, no matter how much you think you still don't have.
12. To take a b-r-e-a-t-h. Breathe calm into your life.

It really only takes a few seconds to make a difference in your or someone else's day.

It really only takes a few seconds to make a difference in the World.


Sunday, July 13, 2008

Dare I Return? Part II - Brooklyn, A Cat and Mouse Game, and an Angel?

This is the second in a series of blog entries describing the incredible events that took place in the creation of my new office space. I'm not sure how long the series is going to be, but it will continue until it ends. While I was in the midst of this metamorphosis, it didn't seem like all fun and games, but as any hardships are in retrospect, they don't seem as hard, and usually there's something to laugh about. The process was transformative and educational and contributed to my growth as an individual. It made me a better businessman, and gave me the confidence that I can accomplish anything I put my head to. For that matter, anyone can! Our biggest defeater is ourselves, when the doubts set in. They are this nagging voice that crops up out of nowhere, but if you're not careful, can become a very strong character player in our lives. The challenge we have is to turn off the naysayer inside all of our heads.


It was only 2 1/2 weeks from the opening date of the new space, and things certainly were not going at the right pace. The walls were not finished, the IT wiring had not been started, we were still dealing with plumbing issues, we didn't know what type of doors we would use, and the list went on and on.... I was about to lose my head, but given the even-tempered person that I tend to be, I was doing my best to keep my cool, while exploding behind the scenes. The contractor would say whatever I wanted to hear, and then not do what was agreed upon. It seemed he and his business manager had mastered the art of con. Anyway, it was too far into the project to change contractors mid-ship, but still so far away from completion. But it wasn't too far to learn how to manage the contractor to get the results I wanted.

Meanwhile, I wondered what I had gotten myself into, and really thought at this point that maybe my colleagues were right. Doing something at this scale, to this extent, maybe was overzealous. No, it was crazy! I wasn't even sure the volume of my practice would support the cost of the new location. How could I ever think I could pull off constructing an entire office from scratch? Little did I realize 3 months prior, how many details went into one little (well, maybe not so little) space. Every single wall socket, light fixture, switch, doorknob, nail, screw, etc... (you get the picture -- every little detail) had to be accounted for. It was a lot to manage at once. I had my doubts, and I wondered, 'Did I make a mistake?' Man, how do I explain this one to my parents. Well, no time for that. When you're a small businessman trying to make it in this business environment and the insurance medical jungle, there is NO turning back. Survival itself becomes a prime motivator. When you have no other choice but to succeed, you find a way to do things. I put all doubts aside and just kept treading forward with faith in the final outcome, as I had already jumped off the edge of the cliff. No turning back! I was in freefall, and the only thing to buffer my fall was a well-executed, usable space.

A Game of Cat and Mouse

Well, when a contractor is not doing what they're supposed to, it's time to start dangling the money carrot slightly beyond their reach. The project kept coming to a halt with complaints that he was running out of money and that he needed such and such to continue. Well, my only choice was to pay less and give him bits at a time to motivate him to speed up the job. It became a game of cat and mouse. Things got pretty hairy at times. Payments were delayed until certain check lists had been fulfilled. There were tears, there were random threats. It was getting to be quite intense, but I knew below it all, the contractor wanted to please, because this was one of his first commercial projects. I had been honest and paid easily in the beginning, but had to change the tune when I realized what was happening. Nice guys get trampled by savvy contractors. But a contractor always wants to get paid, which means if criteria are created for that payment, they will fulfill them to get paid. It can become a face-off.

Unfortunately, he also enjoyed having me pick up the slack for their lack of competence and organization. One of the things I found out when I got back from Florida was that the counter-tops had not been selected. Small detail, but BIG problem. Fingers were pointed, but hey, it's the one who needs them the most that is motivated. That would be me. So the contractor came up with a place I would meet him at in Brooklyn the same day I had to run another errand there to find lighting fixtures.

Somewhere in Brooklyn

It was a hot summer day. A patient/friend had hooked me up with a buddy of his that has a lighting store in Brooklyn (far out there). I didn't realize at the time, but to get to the store from the subway, I had to go along the outskirts of East New York, not the best neighborhood to be in, and this was at 10am. There were beatnecks randomly hanging out on street corners, drunks asking for money. It did not feel safe. Damn, 10 blocks to go, I walked fast enough to move quickly, but not too fast to look like I was nervous. When I got to the store, the door was locked. "S&@t!" I thought it was closed. 'Oh, a buzzer.' The store had a security lock -- they had to buzz me in -- and I understand why. With random shootings happening there everyday, it was not a neighborhood to be taken lightly. The only stores I know that do that are the diamond dealers in midtown Manhattan. But a lighting store? Wow, the staff looked at me cross-eyed when I told them what subway stop I had walked from. I guess I should have called to get better directions. At least, the lighting was one of the easier problems to resolve.

Well, lighting fixtures solved, I was ready to have my contractor pick me up to go to the stone cutters where we would choose the countertops, but guess what? He can't. He calls me all apologetic. He can't pick me up, but he'll meet me there. He gives me vague directions, and says to just go there and speak to Elijah. If I had known I would be playing tourist in Brooklyn for the day, I would have brought a map. Good thing I had the foresight to ask the staff at the lighting store another way to a subway stop, which actually took me directly to the stone cutters. I camped out at a nearby coffeeshop to figure out a plan. Everyday had a plan -- a list of things to do, places to go, errands to run. A project like this is a 9 - 5 job!

An Angel Intervenes

So a 30 minute treck to the subway, another 5 stops, and I was within walking distance. At this point, the traveler spirit in me had kicked in, and I was in for the adventure. It was a get down on your knees and get dirty type of day. I had lived in NYC for 8 years, but had never been to these parts of Brooklyn. Granted, there's nothing touristy about eastern Brooklyn, but it was an adventure nonetheless. Besides, I was supposed to meet my architect to give him a payment, and I much rather be doing this. I called to cancel on him, because at this point, a deadline was more important. Brooklyn is bigger than it looks on the maps.

Around a big field, down a deserted street that seemed to mostly be lined with construction-related businesses, I found the stone company I was looking for. I just walked in, into a tiny lobby. A bearded man with a yamaka who was busy working with other clients asked me matter-of-factly and with a slight Israeli accent, "What are here for?" I guess they weren't used to people just walking in off the street. He directed me down a corridor to the back door. The door led to a gigantic warehouse, where there were rows upon rows of BIG stone slabs of all different types, colors, dimensions, patterns, etc... There were over-sized clips hanging from a ceiling device that could navigate the entire floor area picking up a slab and moving it to another position or truck for cutting and processing. I watched as they moved what looked like an 8ft by 14 ft slab onto a truck. It must have weighed a ton. Giant slabs, over-sized machines, a towering 40 ft ceiling, made my 6 feet feel short. The whole scene was very IMPRESSIVE.

I had an idea what color(s) I was looking for, so I set off walking down the aisles, seeing everything they had. A young gentleman -- I'll call him Elijah -- asked me if I needed any help. I obviously did not look like I belonged there. He showed me around, and explained to me the different types of stone, their strengths, and cost. It wasn't long before he got distracted by a high-priority client, an Eastern European couple shopping for slabs for their home remodeling. They were well-dressed -- that type of dress that exudes money. I, on the other hand, certainly didn't.

By now I had forgotten about my contractor, who had bailed on me. I was once again alone with no support, trying to figure out how I was going to solve the counter problem. It wasn't really coming together for me.

When Elijah was done with the well-to-do couple, he came back to me, and started asking why I was looking to buy stone. I explained to him that I was a doctor, building a new office for myself in Midtown Manhattan, and that I wanted to have durable surfaces for the front desk as well as the treatment rooms. In his slight foreign accent, he couldn't believe that I was a doctor at my age, and I guess felt some sympathy for what I was going through. He told me, "Look, if you buy from us, it's going to be very expensive for you, but I can give you a name of someone who buys from us wholesale and can do the job for you for much cheaper. But, you can't let my boss know I'm doing this." "Are you serious?" I looked at him incredulously, but with a smirk of inner joy. I had been through one of the most heart-wrenching weeks of the project. Nothing had been working right, and to have someone just offering to help me out, felt like I was being offered water in the middle of the desert. He went as far as calling his friend, putting him on the phone with me, and directing me on how to get there. It was his Palestinian connection. In retrospect, I don't know if I was dealing with mafia, but hey, they got the job done. I walked around the warehouse a bit more, figured out which stones I wanted, and made note to tell the stone cutters what I wanted. It seemed like the tide had turned, and there was a moment of light in what had been a very stressful week. I headed yet to another remote area of Brooklyn.

On my way there, I couldn't help but remember one of my favorite books, The Alchemist by Paolo Coelho. When you find yourself in a series of circumstances that seem fortuitous and not completely in your control, but seemingly along the right track, even though not the one you expected, you must be on the right path. It's as if the path is directed for you by a series of events that are leading towards a resolution of the problem. The day had started with a simple trip to one part of Brooklyn, and ended up in this meandering adventure around the burrough, with one event dictating the next. Only when things are born through journeys like this can one really appreciate the final result.
Off to the Brooklyn shipyards....

To be continued...

Dare I Return?: Part I

April 19th, 2007 was my last post. What happened after that was a tornado of chaotic, but somehow organized activity to manifest the new space where my practice would boom. My philosophy has always been more patient-centered, than doctor-centered -- thus, my dislike for sterile, white surroundings which seem to have become the norm in the doctor world. When did doctors become so boring? It seems that doctors were at war with their patients, rather than in the consciousness of making them feel comfortable and healed. Well, I'm not sure how I developed a sensibility for the patient's side, but perhaps it came from my very love-hate relationship with this career. Now that I have created the holistic, earthy and inviting venue from which healthcare is administered in my office, however, I realize that it was not medicine that I disliked, it was the way it was delivered, from staff attitude to environment, that I hated. I despised my time at the hospital and working for a thankless multi-specialty group, with all the politics and territoriality it involved, but now I love getting up and going to work everyday. Being a solo practitioner, a doctor under my own terms, is where I have found my fulfillment in this challenging profession, especially in its forgotten step-sister -- primary care.

So, I stopped writing last year because suddenly the daily tasks to accomplish this move the way I wanted it to happen, while still running what felt like a full-time schedule at the time, overtook me. I am no Donald Trump, but I sure felt like one: weekly meetings with real estate broker to find the space, weekly meetings with the architect once I chose a space working on the details of the layout, figuring out how I was going to do the billing once I left my sheltered shared services lease (which in retrospect I realize was more detrimental than helpful), and finally, the hiring of my own staff for the very first time.

Standing on the Edge of the Cliff

I was watching Donny Deutsch's "The Big Idea," a great show for any up and coming entrepreneur (which any solo doc running his or her own business should think themselves as), and he talked about the moment in an entrepreneur's life when you've got all the bases loaded, and it's time to take that big risk. He called it "that edge of the cliff moment" when you look down and you know you have to throw yourself off the edge to get to your goals, but it's scary. Well, my edge of the cliff moment was when I hired the architect to draw up plans on a space I would totally demolish and rebuild into a doctor's office. I had searched and searched for a space for months, and nothing I saw satisfied me, until I found a space with a very desirable layout in a building I knew to have good management I could work with. So I decided to move into my own space, and for a business decision I will explain later, take on space greater in size than what I needed, which has turned out to be the best decision I made, and build it out from scratch. If I had taken a space that only fit the needs of the small practice I was running at the time, I would have outgrown it overnight. After all, I knew my practice would grow. So I stood at the edge of the cliff, and began writing checks for the demolition and build-out that followed. Of course, somewhere in there I projected what my expenses would be, obtained a business loan, then started making the payments when work commenced -- probably the greatest risk I have taken in my medical career to date. As they say, innocence is bliss. Once the money starting flowing out, the feeling is of a free-fall off the edge of the business cliff. Well, that for sure is the point of no return.

Beyond the Point of No Return

Things got sticky. In any project, Murphy's Law always makes its facetious face known, I feel only to test the doer's commitment and resolve. When building anything from scratch in an old building whose use has probably been modified several times, watch out for the traps. A bathroom absolutely had to built within the space, because I would not have patients walking down the hall to the community bathrooms with urine specimens in hand. You never know who your neighbors will be, and it's always best to keep biohazards under control. Anyway, only 4 weeks into the project, and 4 weeks away from opening day, a minor glitch with the bathroom. They couldn't get the pipes through for the toilet. The walls, the connections, etc... something didn't fit. This is where one is tested. I had absolute faith that a solution could be found, so I stood by that commitment and as team leader for this project, I urged the contractor to find a solution "ASAP," since I was beyond the point of no return. It had to work! No ifs, ands or buts!!! Well, it finally did, but other glitches soon made the craggy face known. The main one was problems with the contractor's ability to stick to their own proposed schedule. Well, if you've ever worked with a contractor you'll know that that's just par for the course. It didn't matter to me, because the job had to get done, and I didn't have another 3 months for it to finish. I had left my old lease behind, taking the dive off of the cliff head first, and was headed towards my future at an accelerating pace. We had solved the toilet problem and conquered the NYC building department, what else could be harder?

A Detour for the Parents

Well, now the ball was rolling in New York City. The location had been chosen. After multiple revisions, the plans had been set with 3 treatment rooms, and 2 consult rooms, a big enough waiting area and an expansive reception desk to meet the future needs of the practice. Any wrenches had been removed from the construction engine, and now I had to leave New York to help my parents move out of the house I grew up in. My fellow doctors thought I was crazy. "You're gonna what?" "I'm going to take a month off to get all affairs in order for the move, and spend 2 weeks of that month in Florida helping my parents move out of 30+ years of memories and pack-ratting." They retorted, "What's going to happen to your patients?" I arranged for a doctor to cover for my practice for the month, and off I was. I had ended my lease with the doctor I was sharing space with so I wouldn't have to pay rent for that month off. He agreed, graciously, to allow me to continue to receive mail at the old location and have the in-house biller continue to follow-up on claims from the prior few months. I was a free man. They thought my patients wouldn't return to me, but they all did. I knew they would -- when you offer a good service others are not offering, you know your clients will return.

Anyway, back to Florida, parents now moved to new apartment, and the house is a residual mess of memories and junk. My task: to separate the memories from the trash. Thankfully, my aunt flew in from California to assist, as both my father and mother could not due to ongoing health problems. I really needed to do this. This was the house I was brought home to from the Hospital when I was born. I was attached to it. 2 weeks was just the right amount of time to say goodbye, as I enjoyed it for the last time. Everyday we took bags upon bags of donations to the Salvation Army. At the very least good would come from the dissolution of the house I grew up in. I enjoyed the pool for the last few times, and said my goodbyes. As I saw my parents grow old in front of me, a chapter in our lives was ending simultaneously. Draw what parallels you may from these two moves -- it was a cleansing, a rebirth out of old stagnant stuff. We cannot sit in the past forever, no matter how scary venturing into the future unknown may seem or feel.

Cloudy Skies ahead....

Upon my return to New York, I found the project at a stand-still. Apparently, in my absence, the contractor diverted most of his workforce towards other projects, knowing that I wouldn't be there to monitor its progress. For anyone doing any sort of renovation or construction, remember, never look the other way. As great as it was to make peace with the changes at home, I returned to a mess here in New York City. Now with opening day only 2 1/2 weeks away, I could not see how everything would be done by then. I was furious!!! I called the architect and arranged an emergency meeting with the contractor. A lot of stuff needed to get done, and since no one (including the contractor) was taking a leadership role, I grabbed this runaway bull by the horns and became the project manager. I had to be tough. I had to be shrewd. I had to go to the Brooklyn shipyards looking for cimstone for the counter-tops. [All part of the vision, my friends.] But most importantly, I had to not take no for an answer! Good thing I had watched a few seasons of The Apprentice -- perhaps it helped me take the reins with confidence. As a doctor, I work to be a compassionate healer, but as a project manager, one has to be a tough and ruthless SOB or they'll walk all over you. It was a crash course in Hard Knocks 101. Doctoring makes us organized and detailed and those skills came in handy while directing how this project would be completed in as close to schedule as possible. But, it didn't happen without a few more glitches, and with a few angels to let me know I was on the right track.

To be continued....
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