My Moment With Larry

I am not sure why I waited to post this. I guess I wasn’t ready to share something like this publicly until now. It was just too personal for me.  But now I feel a need to express my thoughts about the gap in caring for a struggling healthcare system.  Additionally, I needed to explain my frustration at not being able to improve it after spending decades of my life in support of a very broken system, don’t get me wrong, I love serving others in this industry, but sometimes it hits really close to home. Moments like these remind me how much more we need to do to restore trust, compassion, health, simplicity, and hope in a “health” system that has lost sight of its purpose and broken faith with both our patients and those in healthcare who want to serve them. We are rapidly losing ground with both.

It was the week of Thanksgiving 2022. I was in a small-town hospital ICU in north Texas with my sister and her family as my brother-in-law struggled to stay with us. We all were hoping for a great outcome, but the truth was rapidly becoming reality: he was likely not going to win this last fight. This was tough for me, as he had been my friend and “brother” since we were 15 years old. I was a small, wise-cracking teenager who used his wit to navigate those awkward teenage years. Little did I know, silently in the background, this man here on life support had often and quietly used his brawn, courage, and brains to help me out of the trouble my mouth would get me into. He always had my back. I was very happy when he chose to marry my sister; they have such a great family.

After hours of no change in his status, a physician was called at 1 am to check his vitals. Thirty minutes later, he arrived from the ER. He walked in with no introduction, placed a stethoscope on his neck, turned to the nurse, and said, “Call it at 1:32. I am sorry for your loss,” and left the room, not once speaking directly to the family. An anonymous face in and out in less than 15 seconds. An entire life “called” in 15 seconds … really?

As the doctor quickly walked past, it hurt to see the pain in the family, not to mention the rush of memories and emotions that flashed through my own mind. He was gone. This strong, larger-than-life friend was now gone. As the family left to get some sleep, I decided to stay with him until arrangements were completed with the funeral home. It was at that time I experienced another perspective about healthcare, death, and those who choose to serve. I had a special moment of silence and reflection that sent memories rushing through my head like a movie on fast-forward. I glanced at him and remembered 50+ years of living that he and I had shared. The fun, the hijinks, the brotherhood. Goodness, he was only a year older than me … this was much too soon.

As I sat in the early morning hours, quietly reliving our history, the ICU nurse walked in and asked if it was all right to begin removing his life support equipment while I was there. I told her I had no problem with that. Little did she know I had experienced this firsthand while I served as a trauma center commander in the military over a decade before. As she quietly, without emotion, disabled the equipment and began to remove the various tubes and monitors, I noticed she did this quietly, efficiently, and with no emotion. I had seen this before with staff in other healthcare settings. They could not become emotionally engaged with every patient to protect themselves emotionally. I started a conversation asking her how long she had been doing this. She said she had been in that ICU for over five years and worked almost every day during the pandemic. I acknowledged how heroic and hard that must have been. I asked if what she was doing now was routine. She said it was much too routine … usually a few times a night. At that moment, I knew I had to ask her an important question, one that I would often ask during my decades of healthcare leadership experience. I asked her, “How are you doing?” In that instant, she froze, started to breathe heavily, and tears began to appear. She answered, “I am not sure, I have never been asked.” I was devastated. Have we really created a leadership culture in healthcare today that doesn’t ask how people are doing? How can you lead and not care about those you serve? Especially in healthcare, where many of us are called to give so much of ourselves to serve the needs of others. As an executive in healthcare, you must serve them all. Their well-being is more important than your compensation or bonus. They are counting on you to care about them.

As a former healthcare executive and combat veteran who has had various healthcare leadership roles for over 40 years, I now teach and mentor healthcare physicians about purpose, leadership, and its conflicts with our very cold, confusing system. Sometimes I think we have lost our way with such a strong focus on the business and its potential for limitless profit. We could focus on the health of our staff and our patients, but often they are the means to an end. For instance, how often do we really measure real health as an outcome? Sadly, our proxy measure is more insurance and consequently more healthcare, which only incentivizes the business. My moment with Larry reminded me how important it is to ensure that the connection between caregivers and patients is special and supported by effective leadership. Maybe the right thing to do is to accept a reasonable profit and take better care of your staff and patients. That would be a new idea.  But the truth is, just walking around, listening with your eyes, and looking at the family when you say, “I am sorry for your loss” or asking the nurse, “How are you doing?” would be important in restoring that trust between patient and staff, then staff and leadership.  Neither engagement costs a dime, just a moment.  So why is it so hard? Why do we not see the need for caring?  Leadership needs to know that serving in health is a calling that transcends business, and we need to lead in a way that understands the importance of this unique service to people. My fear is we just lack the will and leadership to redirect us to our “true north” of caring for each other.