The End of a Career?

How do you feel at the end of a career?
With the economy in bad shape, many people who are not ill are facing the end of their career. I recently experienced the death of a colleague from breast cancer. Anna was very angry about the way the hospital treated her at the end of her life. I understood completely. Anna was much better at expressing her anger than I am, but I can learn. I remember her yelling at me that she had given her best to the hospital every day. Her reward was to have her benefits terminated the night before her mastectomy. Part of this was her own fault, in that she did not push the benefits office hard enough to tell her the amount she would have to pay to COBRA her benefits. On the other hand, why must it be like pulling teeth without anesthesia to get information from your own benefits office? It should be very straightforward. If you are not able to work, and you pay the premium of $2,000 per year (an arbitrary number), you are entitled to continue all of your benefits. This is a little less than $200 per month. After a year on social security disability benefits, you become eligible for Medicare. You should not become another statistic measuring the number of uninsured. You should not have to think about whether you can afford your medications. You should not have to go to the emergency room for your daily health care. This only compounds an already overburdened system of care. The last time I went to the emergency room, I waited five and a half hours before I was seen by a physician. The care was spotty at best. Miscommunication was rampant. I was coughing and had pain in my chest. This should have been an emergent situation. In fact, I had fractured ribs and a collapsed lung. I was not getting enough oxygen but was not put on supplemental oxygen immediately. It was not until the CT scan showed the collapsed lung that the ED staff became concerned. I was admitted to the hospital for 4 days during which time I began chemotherapy.
My benefits ended on February 14, 2009. Happy Valentine’s Day. We love you; now stay well and out of the hospital. Yesterday I felt sick all day, but I didn’t want to go to the clinic. If each week of chemo costs over $8,000, how much would it cost to be sick? Can I afford it? It is certainly cheaper to stay home and take anti-emetics, Tums, and other medications than it is to go see the doctor. If I had insurance, I could afford the $25 co-pay for my oncologist. Since my benefits terminated, I have no way of knowing how much an office visit will cost. It is not just the co-pay; it is the entire amount. Two days of hydration and antiemetics with a unit of transfused blood cost in excess of $30,000.
Let me go back and tell you about my friend Anna. She was a nursing assistant on the oncology/hematology floor. She rarely took a break and we had to nag her to eat. She would go out of her way to make patients feel comfortable. Warm baths, warm blankets and towels to dry off were the natural course of events. Then there was the moisturizing lotion, the baby powder, and anything else that could add to your comfort. I remember her going up to the gift shop for warm, fuzzy socks that nor only kept my feet warm, but were soft and feminine (if socks can truly be considered feminine) If you wanted something the hospital did not have, she might go to the store after work and get it. I once watched this woman, who was barely 5 feet tall; carry a tree to a co-worker’s housewarming party. Patients would ask for Anna specifically. I am always cold and Anna made sure I was warm during and after my shower each day. She was so thoughtful. Was the hospital thoughtful when it came to Anna’s care? I know that her medical team cared a great deal about her. I spoke to her surgeon the night before her mastectomy, when we were struggling to get the surgery covered. He was prepared to do the surgery whether he was paid for his time and talents or not. We tried to reassure Anna that she would have her surgery at the scheduled time. She worried that she would arrive at the hospital at 5 AM only to be turned away. “They use me up and then they throw me away,” she told me. I knew just what she meant. I also feel I have much I can still offer the hospital. I am a great teacher, I listen well, and I mentor leadership in others, so they will in turn mentor other leaders. This is how a great organization grows. Recognize the talents of your staff encourage them, be grateful for their willingness to share their time and talents, and allow them to mentor others. Stanford is a magnet hospital. It is easy to see why. We have a magnetic staff that encourages greatness in all of us. Ideas are respected, nurtured and shared. I hope that Anna saw that before she died. We valued the contribution to patient care that she made. We recognized its importance.
Anna used to tease me by introducing me to her family and friends as her “boss.” I never felt we had that type of relationship. Yes, I was the assistant manager on her unit. We all felt that we were a cohesive unit, available to provide the best cancer care possible, by working together. It was not a tiered system. It was an unbroken circle of care, with the patient and their family at the center. This is the model of care we chose for our patient population. Cancer is an overwhelming disease. It requires an army of caregivers to keep patients symptom free and happy.
This is a story of mixed blessings. Anna had her surgery and lived for a few more months. I hope she knew how much she was appreciated by her coworkers and by the patients she served. Patients and family members still ask about her. It is difficult to make the transition from caregiver to patient; difficult for the patient and difficult for those who were your patients. In the end, I hope Anna did not believe the hospital had “thrown her away.” I continue to mourn her absence. Stanford is made up of so many people like Anna, who give as much as they can to make the patient’s experience as tolerable as possible. As a patient, I feel blessed to have these colleagues care for me. As an employee, I am honored to work with them. I feel fortunate to receive my care at Stanford and will feel even more fortunate if their football team continues to hand over the axe to Cal. [Sorry, the California Golden Bear Rally Committee member in me could not resist that ending.]