I used to write a monthly column, "Health Matters," for the local business paper. Like this blog, it was mostly about the business and organizational aspects of healthcare. Each year as the holiday season approached I found myself mostly uninterested in writing about sucy topics. So in 1998, I wrote this (registration required). As it turns out, it was one of the more remarked upon columns I wrote (at least to my face). It's below, slightly re-written. It still applies. The best to you and yours.
As we enter the holiday season, it's worth reminding ourselves how the health care "business" is not just commerce. So here are a couple of stories. As usual, some names have been changed.
Health care professionals
Joe Doolittle tells a story of four nurses in the continuing-care department of a health maintenance organization receiving a bouquet of roses from a 61-year-old patient. The patient had died two weeks earlier.
But the card was addressed to each of them, signed in the patient's own hand and read, "Thank you for all that you did for me."
These nurses will tell you that they didn't do all that much for her. Well, yes, they had known her since her initial diagnosis two years prior, and had been with her through her surgery and chemotherapy. Since the patient lived alone, they had made sure there were rides for her, and people to be there with her.
As time passed, they saw a lot of her at home and in and out of the hospital. Despite the fact that these nurses didn't think they had done much, the patient obviously thought differently; they had done a lot for her. She'd planned ahead to say thank you to people who had become an important part of her life.
For these professionals, it may have seemed all in a day's work. But to the patient, it was far from routine. It was valuable enough to be recognized at the end.
Health care organizations
Jane is a 47-year-old grandmother. Because her daughter has a drug problem, Jane has taken in her grandchild, who is about 8 years old. Painfully, this is a pretty common story these days.
What makes Jane's story even more wrenching is that she herself has multiple sclerosis.
Each day, staff from a visiting nurse organization help Jane get up and into her wheelchair, take her medications and take care of her catheter. Under new federal rules, this agency's payments for Jane's care are based on an average number of visits far below what's required for Jane's care and far below what's necessary for her to live independently.
This agency is going to lose money on Jane, and it had resigned itself to that fact.
However, when Jane was hospitalized a few months ago, she was discharged from the agency's care. Of course, when Jane was ready to leave the hospital, she wanted to return home. Under both federal and state rules, nothing required the agency to take her back. It did anyway.
Knowing it was going to lose money (and probably a lot), this agency promised to continue the services that allow Jane to continue living at home and caring for her grandchild. Absent those services, Jane likely would have spent the rest of her life in a nursing home, and her grandchild would have spent the rest of his youth in foster care.
Pat was in her late 20s when she died of cancer. After 15 months of trying just about everything, her physicians finally told her there was nothing left they could do, and she went home.
Her last few weeks were just what you would expect: painful for her and her family. Pat lived in a rural community with no hospice. She had gotten extraordinary hospital care during her illness (despite being uninsured), but during her last few weeks, the organizational supports pretty much disappeared.
Mary was a nurse who lived down the road. She knew Pat, but really only enough to say hello when they passed on the road. When Pat went home for the last time, Mary simply arrived, having heard about Pat's plight.
During those last weeks, Mary went to see Pat every morning before she went to work, every afternoon after she returned, and every night before bed. She often left work during her lunch hour to drop by.
Mary was the one who gave Pat her pain medication, who called the doctor when it was time to increase the dosage, and who remained a steady presence during those last weeks. She never asked for anything.
After Pat's death, her family offered to pay Mary, but she shrugged it off. "Yes, it's my profession, but I'm a neighbor," she said. "My profession simply enables me to do things that I couldn't otherwise."
Every day, thousands of professionals, family members, friends, neighbors, volunteers and just folks share in the joys of a healthy newborn and the relief of a recovery from illness or injury. Every day, these same folks struggle with the issues that arise in the most intimate, vulnerable and painful moments of our lives.
At the end of the year, it's worth remembering them and reminding ourselves that every day, they do it with skill, energy, generosity and grace.
So for the moment, we'll ignore business strategy, the economics of health insurance, government regulation and whatever the latest aggravation is. Instead, we'll salute and thank all of those folks and remind ourselves that the real core of the health care enterprise is both human and humanitarian.