The Day I Quit My Job

by Natascha Zeljko

Enise Lauterbach is a cardiologist who worked in large clinics for many years until finally throwing in the towel. Only then did possibilities arise. Now she's breaking new ground: AI and cardiology

I like being a doctor. I’m good with patients – they trust me. I’m ambitious, hands-on, persistent, and highly motivated. I have invested years, even decades, in my training and further education. But at some point, it was enough. I couldn’t and I didn’t want to keep doing it anymore. And, from one day to the next, I left.

The situation for female doctors has fundamentally improved in recent years. During my studies and at the beginning of my further education it was more difficult. At that time, there were really only two models: after studying, you became a specialist and at some point became a senior physician – and sacrificed motherhood. I know a few colleagues who chose this path, and not everyone was happy with the decision. Or, after studying medicine, you could bid farewell to the profession and have three, four, or five children – and that’s it. But I wanted to reconcile children and career. In the rest of Europe, in the States, and even in Turkey, the home of my parents, that was also a possibility.

The part-time trap

And yet it is still difficult to find your way – especially in the field of cardiology. Similar things are heard from female surgeons, particularly thoracic and cardiac surgeons. I had two children and between the two I became a specialist in internal medicine and cardiology, then specialized in electrophysiology, a subspecialization that deals with the diagnosis and therapy of cardiac arrhythmias.

After my second child, I returned to the clinic. I had actually wanted to start full-time, as I had after the first child, but the senior physician, my boss, relented: “Take your time, the children are still small, why don’t you start part-time first?” He wanted “to protect me”, as he said. But “part-time” – according to him – still meant 40 hours from the first day on. A full-time job.

The role, which he had promised would lead to me becoming a senior physician, was an illusion. I discovered that the two assistant doctors who were my substitute during my parental leave were immediately dismissed. This meant that I additionally had to do the regular ward work. Then there was also the aftercare of the implanted devices in outpatient care. I hardly had time for the actual job he had promised me, which was implanting and training in invasive electrophysiology. It was just a runaround. If I didn’t manage something or was simply overwhelmed by the overabundance of tasks, my boss said that he was already disappointed in me and had imagined it differently. I could never please him. Nothing was ever praised, even if something went wonderfully. On the contrary, after I had finished a surgical procedure which had gone well, I heard him saying something like: “That was luck.” Some complex procedures that went well were simply ignored – not to mention not applauded. This came from external staff, such as engineers from the medical technology companies who regularly accompanied the 3D procedures. The engineers said they were impressed with how well and confidently I mastered the procedures.

The stalling tactics

But I have an enormous will to persevere. In spite of the difficult situation and the strain I continued. I worked and worked and worked. I often had my little children with me during this time. They were in the laboratory as my husband, who is also a cardiologist at the same clinic, was working in another cardiac catheter laboratory at the same time. I often joked that the children would soon be able to do electrophysiology. But it was anything but fun. The next step, the promotion to senior physician, simply failed to materialize. In the meantime I was over 40 and more frustrated from year to year. And I became more and more exhausting for the boss. Everything was fine as long as I did my job quietly. But the fact that I demanded something vehemently became a nuisance to him. I always prepared myself well for these conversations, listed what I did and how much I brought to the clinic. But he stalled me. He said that I wasn’t ready yet or that I was a mother. But it wasn’t clear if that was supposed to be an insult, or humiliation, or what he meant. And his boldest statement? My husband was already a senior physician – I wouldn’t need to become a senior physician, too.

A new specialist, who I had helped to train at the beginning of his training period, came to our department to enlarge the team. He was supposed to support me, but now there was a new clique: the boss (now appointed chief of medicine), the senior physician, and the young specialist. They got along quite well. And while I brought myself bread from home – there was never time for a break for me – the three men relaxed and went to lunch together. All kinds of important things were discussed, of which I couldn’t know about. And then two things happened in quick succession which finally sealed the deal.

Migrant Stereotyping

A few days before my departure – of which I myself had no idea at the time – I stood at the table in the cardiac catheter lab with the boss. Only the two of us, already sterile and in lead aprons. The others, about ten people, were behind thick lead discs and connected via intercom. In a discussion, it was questioned whether a procedure that has not been performed for a long time could still be remembered after months or years. It went back and forth and the boss said: “Oh, you know, it’s like cycling. You don’t forget that.” He made a dramatic pause, and then came the absolutely unspeakable, as well as bad, example: “Oh, you’re Turkish. Can you ride a bicycle at all? As far as I know, Turkish women don’t ride bikes!” I was offended, angry, and yes, also humiliated. There was a lot of laughter outside, they thought it was hilarious; Turkish-bashing is always great. That was a new low point. A few days later I was to visit his private patients and bring the private ward up to speed: make rounds, echoing, admitting patients, writing letters, discharging patients. I reluctantly went up to the ward. There we had a private assistant doctor who was overwhelmed with her tasks. When I returned downstairs, he complained about where I had been for so long and that I had to do my job. The next day it escalated. We had a meeting in the morning and the boss wanted to transfer me to the station again. I refused. He said that this was an order, and he wouldn’t accept a “no”. And that was the point where I’d finally had enough. I said that no, I wouldn’t do the private ward. That was my final word. I would otherwise leave, forever, and never turn around. “I don’t believe it, you wouldn’t,” he said. I got up, went to the door and closed it behind me. I was out.

The next job took no time to find, and it was to build up the cardiology department in a rehabilitation center as chief of medicine. There were other problems, though. I came out of the frying pan into the fire. The despotic head of administration barked at the doctors to do their job and bring in money but he didn’t want to hear any assessment from them. There was a terrible atmosphere, including bawling young employees who were exploited and sometimes did three or four jobs in parallel. After half a year it was clear: that was it. Employment in a clinic was over for me.

What happened next

In my job I’ve had to deal a lot with digital applications. In modern electrophysiology, the origin and mechanism of a cardiac arrhythmia can be detected and curatively treated using special catheters and three-dimensional mapping. Digitalization has been with me for a long time, and I’m very open to new technologies. Especially AI fascinates me. I’ve had the idea of combining AI and cardiology for quite some time. Using digital care concepts would improve the quality of life and care, e.g. for patients with cardiac insufficiency. Telemonitoring for these patients, which is already established, and telemonitoring models in studies show benefits for these patients. But all this still runs completely without AI, without algorithms. I have researched and investigated for days, but my idea of “AI and heart failure” does not exist in this form. Artificial intelligence could provide patients with heart failure with a learning and responsive early warning system that could reduce hospitalization and mortality rates. In Germany alone, two million people are affected by this condition. While in the researching phase, I came across the “Make Your Wish” program from Microsoft and submitted my idea. The project was accepted and suddenly it says on the homepage: in implementation. Awesome! I still can’t believe it. Will Microsoft contact me? Will I be involved? I’m thinking about what the next steps are: start a company? Finance it? Take care of a patent? European or worldwide? These are some of the many questions on my mind right now. A lot is still open, but one thing is certain: something big is happening, something that is completely turning my life around and giving me a new direction.

What I’ve learned

My husband and I have always had many and very innovative ideas that we’ve discussed with each other at home and also with our superiors. But we didn’t implement any of them ourselves. We continued to work diligently, turning the little cog. The ideas lay fallow until someone else had success with them years later. Today I ask myself: why do we always have such great respect for new things? Why aren’t we braver? Why do we overestimate others and constantly question ourselves? We should finally stop it, become more courageous, accept challenges, and trust ourselves and our abilities. And then something big can happen: we grow beyond ourselves.

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