I didn’t go through that to go through this.

“She doesn’t know how to work within a system,” said Snakeskin Shoes.

Narcissists grow and thrive in children’s hospitals. Their strategy is to inflict moral injury upon physicians by gaslighting and silencing those who speak up for patient safety or for themselves, while also controlling a false narrative about them.

Snakeskin Shoes, the former VP of marketing and communications, is a poster boy narcissist. As he enters the room, the lights dim, everyone starts smoking their cigarettes, and Snakeskin Shoes skitters up on the stage to scat a jazzy tune. It’s all improvisation as he makes up his act as he slinks along.

Snakeskin Shoes is a jazzy cat who wears a three-piece suit and his trademark pair of snakeskin shoes.

I didn’t go through that to go through this.

I didn’t go through college, graduating with honors in biochemistry, then endure the rigors of medical school. I worked tirelessly in a pediatrics residency, often putting in 110 hours per week in the NICU, learning how to take care of the sickest and most complex patients, particularly the tiniest ones. I became a pediatric hospitalist and built a practice with patients I loved as a community pediatrician. I followed my vision of “creating community solutions for children’s health” and launched my nonprofit organization to address childhood obesity from scratch. I spent three years developing and funding a pediatric weight management clinic and a population health center addressing ACEs. Yet, despite all this, I found myself caught in the crosshairs of a narcissist at a children’s hospital. Unfortunately, my experience is not unique and is happening to physicians across the U.S. in epidemic proportions.

There are four stages of the narcissistic abuse pattern, and as a visionary pediatrician at a children’s hospital, I experienced all four. It’s important to note that these events are not singular or linear.

Stage 1: Idealization is the love-bombing stage, where you may receive a lot of attention, grandiose gestures, a lack of boundaries, attempts to isolate you, and a sense of ownership.

“Karla, we hope you will lead this. We don’t have your vision for children or your energy or passion,” said Bait and Switch (COO) and Snakeskin Shoes at the final board meeting of my nonprofit when the board voted on dissolving the organization and transferring the assets to the hospital to launch a population health center. Neither I nor my board of directors, despite seeking clarification, were ever informed about the operational details of the population health center, the fate of the acquired assets I built from scratch, or the fact that my position would be placed under Snakeskin Shoes.

Stage 2: Devaluation is when the gaslighting abuse starts. The narcissist(s) believe they have you where they want you, so they begin their abusive behaviors. The devaluation phase may include behaviors such as attempting to change you, increasing criticism and insults, gaslighting (making you feel as if you are “losing your mind”), threats, lack of communication, violation of boundaries, triangulation, increased control, and withholding.

It took 100 days to get my contract in place as the medical director of the new population health center. My attorney had to create it from scratch.

“You’re different from other physicians. It’s tricky,” said Snakeskin Shoes, explaining why I didn’t have a contract and wasn’t getting paid. He was stalling and waiting for the dissolution of my nonprofit.

When I finally received the back pay for the 100 days, as requested by my attorney, Bait & Switch asked, “Karla, what are you going to do with all your money?”

Stage 3: Rejection is the betrayal stage.

“Who do you think you are? You are ruined. Your reputation and career are ruined. I will be fine. I’ll have you know ‘counsel’ (senior VP general counsel) sent your email to the entire leadership team, and you are ruined.”

Snakeskin Shoes yelled this statement at me over the phone after I sent an email asking for help from “counsel” and “stewards of existing systems” (former CFO) to address the abusive behavior I was experiencing. My consent was never given to share my email, which was a cry for help, with the leadership team at the hospital.

The narcissist will employ all tactics to silence you. If you speak up about patient safety and/or quality of care, you will face whistleblower retaliation, gaslighting, and moral injury. They will likely dismiss you as “emotional” and claim you need to stick to the facts. The narcissist may weaponize the performance evaluation to both protect themselves and use it against you by fabricating lies. They will use their “flying monkeys” to gather information for them. Once the narcissist has a facilitated conversation with you, often a gaslighting manifesto, they will have what they want. Their strategy involves documenting, emailing, and facilitating conversations.

Stage 4: Discard is when you have been used up, and now the narcissist either disengages from their gaslighting or considers you such a risk that they employ all tactics to make you leave. I refer to this stage as the “you are onto them, so they need to get rid of you” stage.

Name it. It’s not physician burnout; it’s moral injury. When you have 20 narcissistic gaslighters participating in whistleblower retaliation against you, from the president/CEO to the board of directors, as was the case for me, it becomes institutional betrayal.

There is a direct correlation between your level of vision and expertise in children’s health and the risk of experiencing narcissistic abuse and gaslighting. The more of an expert, advocate, visionary, or, especially at my level, a child health activist you are, the more susceptible you are to suffering from narcissistic toxic gaslighting, emotional abuse, and moral injury at the hospital.

Over three years ago, I resigned, effective immediately, per my attorneys’ directive at 10:30 p.m. on a Sunday, leaving everything behind.

If you are currently experiencing gaslighting and narcissistic abuse, know this: You did not go through all of that to go through this.

Karla Lester is a pediatrician, certified life and weight coach, and diplomate, American Board of Obesity Medicine. She is founder, IME Community, and can be reached on Twitter @DrKarlaA, TikTok, Instagram @ime_community, Facebook, and YouTube.