As we begin to emerge from the bottom of a V-shaped recession, we all pray that it does not evolve into a W-shaped recession. Having been a witness for the majority of this economic challenge rather than an officer in charge, I’ve observed several significant issues that have impacted the hospital industry.  They have included the downgrading of bonds, a serious lack of access to capital financing, cutbacks in elective surgeries and elective donations to our health care foundations,  All of which has resulted in a deep degree of uncertainty as to when  all of this will be over.

The fact that many of the economic practices that got us into this mess have still not been discontinued or are being reshaped into the newest version of the scam du jour does not bring peace of mind to the vast majority of us, a deeply concerned citizenry.  Add to that the billions and now trillions that we are committed to repay over the next several generations, and one has to wonder about the ability of our current political system to respond appropriately to these challenges.

Warren Buffett’s annual letter to Berkshire Hathaway shareholders criticized Wall Street executives and board members in a way that most of us would liked to have expressed, but which only Buffet could articulate. This is because his comments are clearly supported by his business acumen and investment skills.  He broadsided the leadership of Wall Street for failing to control risk and for avoiding  what very clearly should have been the “severe” consequences of these failures.  He chastised the bankers in particular for designing and implementing their own industry’s doom and then piling the losses onto investors, while they themselves have managed to maintain lavish lifestyles.

“It has not been shareholders who have botched the operations of some of our country’s largest financial institutions,” Buffett wrote. “Yet they have borne the burden, with 90% or more of the value of their holdings wiped out in most cases of failure. Collectively, they have lost more than $500 billion in just the four largest financial fiascos of the last two years. To say these owners have been ‘bailed-out’ is to make a mockery of the term.”

“The CEOs and directors of the failed companies, however, have largely gone unscathed…Their fortunes may have been diminished by the disasters they oversaw, but they still live in grand style. It is the behavior of these CEOs and directors that needs to be changed: If their institutions and the country are harmed by their recklessness, they should pay a heavy price – one not reimbursable by the companies they’ve damaged nor by insurance.”

With his sentiments firmly ensconced in my mind, I have to wonder about the current rounds of outrageous health insurance increases perpetrated upon the customers of many of our largest and most profitable insurance companies.  As a hospital CEO, I learned very early on that no matter how low we held our charges, those savings would not be passed on to the patients because the middle man controlled this aspect of the “business.”  Incentives are completely upside down in the system at many levels, and the political commitment to truly work toward meaningful change seems not only misguided but also seriously uninformed.

Bottom line?  We need to be heard.  We need to work toward systems that make sense: protection from catastrophic financial situations brought on by major illnesses or accidents, primary care that truly helps the patient manage their health challenges at a reasonable cost, and a complete change from a sickness-based to a wellness-based reimbursement system that is not dependent upon the insurance companies for the decision making proposition.

Sometimes right is truly black and white, and until we embrace palliative care, incentivize individuals for taking care of themselves, and deal with tort reform, progress will be only a delusion.

U.S. Health Care Reform Timeline: 1910-2010

Click image above to view full-size, interactive timeline. (Will open in a new web browser window.)

As the pulse is still an indicator of health in human beings and other animals, health care-related inflationary indices can be a measure of economic health, growth, and change in our business.  After perusing nearly six pages of single-spaced inflationary projections in an Amerinet-produced report, two jumped out at me, the two highest.  One was more significant than the other, but both tell their own story.

Ice-covered Orange Tree Photo credit: Eric Zamora - University of Florida IFAS

The first was coffee/juice, and the projected costs for these two items are up 10 percent. At first my curiosity was piqued by this, but then I saw the explanation further over on the page.  It said that these increases were based on the recent freezes in Florida, which will have a significant impact on juice pricing.  I guess that makes sense.  The trees and oranges froze and were ruined, but it was interesting to me that every other orange-growing country in the world hadn’t jumped into the market and taken advantage of this shortage situation.

The even more difficult quandary created by this coffee/juice category, however, was that the coffee wasn’t explained.  Surely, everyone knows by looking at a world map in Starbucks that coffee comes from places that are not Florida. Maybe it’s just a “calf path” item. You know, some ancient, primeval calf made a trail in the woods named “coffee/juice” and we still follow that path today.

I’m sure that many of you are now wondering what the second category is, the second highest predicted commodity increase for health care, and, honestly, I can’t wait to tell you.  Why am I excited about this one?  It’s because, you see, it is a NIGYSOG (Now I’ve Got You, You Son of a Gun) moment.  For nearly five years, I’ve been predicting some very obvious changes that are about to sweep through the healthcare delivery system.  Our blogs, newspaper columns, and speeches have all directed you toward these changes, and over and over, the vast majority of healthcare management professionals have either ignored or rejected these pronouncements; sometimes out of fear and sometimes out of a “wake me when it gets here” mindset.  Honestly, when it comes to prognosticating, it made me feel like Punxsutawney Phil.  (Oh, and what was that advertisement I read today?  “You have just survived the worst snow storm in this area in the past 100 years.”)

The second most highly inflationary bell ringer from the Amerinet report is one that spot-on supports our predictions completely.  (Drum roll, please.)  It is biotech products.  The prediction is that the cost of biotech products will increase an average of about nine percent.  Upon examining the comment section beside this category, the following sentence appears:  “Increased demand will drive these price increases.”

Many of you may still be scratching your collective heads in wonderment.  “What are ‘biotech products,’ and why should I care about them?,” you may be asking.  Let’s take a quick historic look at life in the biotech lane.  In 2001, when we co-founded a research institute that had specialty areas in biomedical informatics, tissue banking, proteomics, and genomics, it cost approximately $100,000,000 (that’s 100 million) to map ONE human genome. This year, that number will fall to below $500. If you take that ratio of product-to-cost and project it forward, it doesn’t take too much imagination to conclude that not so many years or months from now, your physician will potentially have (or want to have) access to your molecular profile.  It will provide insights into your personal health that were heretofore unavailable, even unimaginable.

Once issues involving insurance coverage, confidentiality, and ethics are resolved satisfactorily, these tests will become a routine part of your annual physical.  Complete Blood Counts, lipid profiles, prostate or breast testing, and genomic and proteomic analysis will provide your caregiver with answers that make the practice of medicine until now seem hit-or-miss by comparison.

“It’s not the critic who counts. It’s not the man who points out how the strong man stumbled or whether the doer of the deed could have done better.

The credit belongs to the man who is actually in the arena, whose face is marred by the dust, sweat and blood, who strives valiantly, who errs to comes short again and again because there is not effort without error and shortcoming.

It is the man who actually does strive to do the deeds, who knows the great enthusiasm, the great devotion, who spent himself in a worthy cause who at best knows in the end the triumph of high achievement and who at the worst if he fails, at least fails while daring greatly so that his place shall never be with those cold and cruel souls who know neither victory nor defeat.”

—Theodore Roosevelt (26th president of the United States)

Yesterday’s phone call from the Somerset Daily American caught me off guard.  ”Hi, Nick, have you heard?  Congressman Murtha passed away this afternoon.  Could you give us a quote?”  the reporter said.   Truthfully, I was not ready for this call.  Having talked to friends who had been with him only a week earlier, everything seemed like it was going to be okay, but obviously, okay was not what it was.  He had one of the 500,000 or so laparoscopic cholesystectomies performed each year to remove a gallbladder.  This surgery has a .05% complication rate, but the call proved that, regardless of the percentages, there is always risk from human involvement.

I’ve decided to dedicate this as a very personal look back at my journey with Jack Murtha.  Ironically, we had grown up practically as Pennsylvania neighbors in Westmoreland/Fayette Counties.  My first real meeting with Mr. Murtha was during the 1977 Johnstown Flood.  I was a young teacher and volunteer who was mopping the floors of the relief centers,  getting things ready for survivors who had lost their homes when I heard a helicopter come flying in and saw a tall, impressive, 44 year old Congressman deplane.  He had only been in Congress for a few years, but had clearly learned enough about the  System to keep then-President Carter on his toes and get legislation passed to help his home district.

My very next encounter with Mr. Murtha wasn’t until about three years later, when his Washington office called me to see if they could help my employer at that time, Laurel Arts of Somerset, with a bill that was going through the House before Ronald Reagan took office.  Nothing came out of that call except for the fact that I realized that his employees were parents of former students and people who liked and respected my work from those days.

Then the big encounter hit.  Mr. Murtha was looking into bringing the National Park Service into Cambria County to start what became the America’s Industrial Heritage (Tourism Development) Project.  He and several other Congressmen came to the University of Pittsburgh in Johnstown to hold a Congressional hearing on the project, and, as the newly-elected President of the Laurel Highlands Convention and Visitors Bureau, I testified against the plan and explained that if they didn’t include Westmoreland, Somerset, and Fayette Counties, we would not display any literature promoting it at all of the tourist sites that we controlled.  They agreed, and not many months later, he ended up representing Fayette County as part of his district.   It worked out for both of us.

A few years later, I had transitioned into healthcare senior leadership and  invited Mr. Murtha to introduce Bob Hope at a fund raising event for the Mercy Hospital of Johnstown.  Approximately 6,000 people were in attendance and Mr. Murtha got as much applause as Mr. Hope.  The following year he helped us bring in Henry Mancini and his orchestra for a similar event and our respect for each other began to grow.

Rep. John P. Murtha speaking at Biotechnology Expo (2004)

In 1997, when I became the President of Windber Medical Center, Mr. Murtha and I were seated near each other at a dinner party.  It was there that we  began to discuss healthcare, and his vision for the future.  Anything that would help the soldiers stay well, prevent illness, or stop it before it became an issue was his goal.  I heard him speak at the opening of one of his many health center initiatives at Walter Reed Army Medical Center, and he said, “I have 13 honorary degrees, hundreds of awards, and am well known as for my work in defense, but I want my legacy to be healthcare, prevention, and wellness.

His contributions to healthcare, however  small they may seem compared to what he has done for the world and for mankind, through his tireless and dedicated work were where his heart was.  His strength and vision made him the most impressive human being that I have ever known, and my love and respect for both him and his wife, Joyce, cannot be calculated in mere human measurements.  I am proud of him, his work, and his commitment, and I know that the seeds that he has planted in Breast Cancer Research will go on to save thousands of lives someday.

Ironically, it was healthcare that took his life.  No one can ever replace Jack Mutha; his knowledge of the system, his guts and determination, his singular efforts to help a district that had been devastated by natural disaster, his kindness and great personality.  No one.  So, today, I write with great sadness that our great friend is gone, but at the same time, I vow that his name, his contributions to humanity, and his memory will never be gone.

Look at wriwindber.org or windbercare.com, and see what Jack Murtha built.  We loved you, Jack.

When you do the math, you can rather quickly determine that, as the aging process continues with the Boomer generation, federal funding for health care and Social Security will become more and more scarce. At the same time, we have all read the sobering national statistics regarding unnecessary deaths from hospital missteps. The CMS (Center for Medicare and Medicaid Services) previously introduced a form of pay for performance, or –more accurately– no pay for performance, which has already caused a great deal of change in the American Healthcare System.

As is widely known by now, CMS has decided to literally stop paying for the treatment costs of preventable medical complications.  This actually may seem like an intelligent idea. This approach is referred to by some as visibility for good care, and there is no doubt that it will represent the beginning of a stampede from the third-party insurance payers to follow the CMS “Big Dog.”  In fact, several companies have already announced that they will not be reimbursing hospitals for similar errors, as well.  The truth of the matter, however, is that this step does not even begin to address the problem.

The problem is not about penalizing hospitals, it’s about creating an incentive system that is not disease and sickness based.  Until the pyramid is flipped, we will not see the necessary changes to halt this financial slide to economic oblivion.

Sanjay Saint, MD, MPH

About 9% of U.S. hospitals presently use daily reminders to help physicians remember which patients have urinary catheters in place.  According to the University of Michigan’s Sanjay Saint, a professor of internal medicine, about 74% of hospitals don’t keep tabs on how long the catheters are in place.  But the real issue is that about 98% of hospitals and physicians don’t completely address issues of wellness and prevention that can allow us to remain well until we die because there is little or no incentive to do so.

Logic would dictate that because financial reimbursements will be connected to these hospital-created mistakes, infections or injuries, someone will surely pay more attention to the current misses.  But what if the entire system was based on keeping people healthy?  What if all of our focus was on exercise, appropriate food consumption, and stress management?

Unfortunately – or fortunately, depending upon your perspective – the United States has become the most proficient country in the world when it comes to capitalism, and much of capitalism is based on manipulating people to get them to consume what will bring the financial success and rewards to the corporations.  If you doubt this, just go to Eastern Europe to see what is happening in an environment with unregulated tobacco advertising.  The circle has started all over again.

In the old carrot-and-stick arrangement, there will be plenty of hits.  Wouldn’t it have been interesting, though, to reward hospitals where mistakes are almost nonexistent so that the less successful medical centers might line up to learn from them, or to reward docs and hospitals for helping to keep people healthy all the time. Carrots work, too, and with much less grief.

What’s the old line?  “We’re going to beat the troops until morale improves.”

The origin of the name of this blog, HealingHospitals.com came from decades of seeking a better way to transition an old model to a more meaningful, experiential approach to caring for people.  This would actually provide transformational experiences for the patients and their families in a more interactive and participatory way.  (HealingHospitals was named a top 50 hospital administration blog.)

In a recent conversation with a clinical psychologist, I learned that we generally become our habits or, in fact, our habits become us. Accordingly, to change, to grow, to transition and to flourish, we have to work very hard at changing those habits that are not benefiting us personally: over indulgence, negativity, low self-esteem, or whatever the issue(s) may be.

How does this apply to an organization?  Every organization that I have ever experienced has a distinct personality and, in its own way, habits, as well.  Sometimes the personality of the organization is imposed by its leaders, but usually there are layers and layers of practice that have become part of the culture of that organization; practices –for better or worse– that have accumulated over time.

My observations of numerous hospitals have also provided me with an understanding of the myriad of habits that no longer make sense in today’s world; habits still being embraced that literally produce negative results, and are not only insensitive to the needs of both the staff and the patients, but also are many times intellectually and emotionally caustic to all participants.  We’ve written several times about the disparaging nature of the “parent-to-child” management styles prevailing in many hospitals amongst staff, physicians, and administrators, but this is just the proverbial tip of this particular iceberg.

Many hospitals are wonderful examples of business models that flourished during the Industrial Revolution.  Employees still swipe time cards into time clocks, bells and pagers go off all day and all night; professionals poke and prod patients without any explanation.  How many times have you observed the 84-year-old being wheeled into a cold, uncarpeted hallway, parked near a wall with nothing to see, nothing to do, and no one to talk to for long stretches of time while waiting for tests about which he or she knows very little?

In many hospitals patients are referred to by staff members by their  body parts: the kidney in 101, the heart in 543, the stroke in 300.  It is also common that the procedures administered are at the total convenience of the staff and docs without much consideration for the patient.  Numerous hospitals still ask loved ones to leave promptly at 8:00 PM each night, and many times bad news is delivered via the phone.

Consequently, the blog name, HealingHospitals.com which may seem almost like an oxymoron, is intended to help us all to create environments for healing. For the most part, we can probably agree that it would be great if hospitals were places where you could go to begin that healing process.  We might even agree that it would be wonderful if we could be nurtured there, to be helped to find the road to recovery through healing, and even more dramatically, to have a transformational experience that would help us break or modify those habits that keep bringing us back.

It would also be fantastic if, at the end of life, our loved ones could be admitted to control pain, or if the family could have respite.  More importantly, it would be amazing if relationships could be healed before the transition to the other side.

In the late eighties, when I entered healthcare administration, it was my passion to make hospitals more like hotels and spas. But, most importantly, it was all about making the hospitals healing places where patients would have a chance to change their lives in a meaningful way; mentally, physically, and spiritually, via a transformational center of caring.  Let me certify that we did just that, and it is going on to this day. The point is that “you can, too.”

This blog post is dedicated to “getting the word out” about your Healing Hospitals. So, let’s start at the beginning.  Actually, let’s start at my beginning.

In 1969, business communication consisted largely of yellow legal tablets, Bic pens, daily reminder calendars, newsletters that were pasted-up by hand, then run off on the mimeograph or ditto machine, and an occasional public meeting for the employees.

I remember one hospital whose philosophy was “We’re the biggest and the best, and if you don’t come here, you’re stupid and will probably die.”  Their CEO was totally against press releases, advertising, or public outreach of any kind. He would say, “If they don’t know us well enough from our work, we need to do better work.”

News coverage was pretty simple at that time, too.  You sent your news release to the local paper(s), local radio, and, if available, local television stations.  Grand slam home runs in communications in that era would consist of a story that hit the wires or made either the New York Times or Wall Street Journal. Not unlike scenes from Ozzie and Harriet or Leave it to Beaver, things were formal and “normal.”

The interesting thing about today’s world, is that just the description of  “how to communicate” from a business perspective would take thousands of words.  Without beating all of those digital horses to death, we now have hundreds of television cable choices, Satellite radio, dozens of specialty publications, 24 hour/real-time web-based everything, and so much spin that even the late S.I. Hiyakawa would be flabbergasted.

So, the question becomes, “What’s the ticket?”  “How do we get the word out about our work, our facility, our philosophy?”  To that end, it is important to understand that the entire vision of healing hospitals is a wholesome, caring, loving, nurturing philosophy that is profoundly newsworthy. How do you capture the hearts and minds of current patients, their families, their neighbors, and their neighbor’s neighbors?   Interestingly enough, the first approach and my initial recommendation is education for your employees.

Many employees have not yet made the connection between this type of unique care and publicity.  Obviously, not unlike the old CEO quoted above, it is the power of “word of mouth” that can carry the day locally, but –not unlike my last CEO experience, if there is not enough population to produce growth, then you need to reach beyond the local geographic boarders. By doing so, we tripled in size over a decade of population decline.

There is an old saying that “anyone who is 50 miles from home can become an expert.” For the most part, most people are not aware of your quality care, your commitment to humankind, your nurturing attitude even 30 miles away.  Consequently, media is the key.  What I have found is that national media can bring a halo of credibility to an organization that years of local media could never bring.  Unfortunately, unless you have done something wrong or a meteor drops onto your grounds, national media is not that easy to attract.

We were fortunate in that we had the Wall Street Journal, USA Today (four times), the New York Times, the Today Show, the Philadelphia Inquirer, Oncology International, Forbes, Fortune, and several stories in Reuters releases and at least three placed with the Associated Press that were picked up internationally.  How did we do it you might ask?  We often times did it by linking local stories to national topics. It takes creativity, persistence, and a strong desire.

You need to do news releases to just about everyone. Pick topics that are timely, informative, and have a unique angle, and then work at it constantly.  The other way that we promoted our organizations was through social media and Web 2.0.   My original blog, Nick’s Blog at the time – started in 2005, now HealingHospitals.com (i.e., this blog), was the first hospital CEO blog in the world, and that brought a tremendous amount of new traffic to our organization.  We also became active on You Tube, Twitter, and Facebook long before many others in (and outside) the healthcare community accepted these phenomena.

Bottom line?  It can be done cost-effectively with great success, and we’re here to help.

Each year I put up the tree and begin to believe that it is magic. The room feels and looks warmer. Often, I’ve considered leaving it up all year as a symbol of joy, love, and happiness, but when I returned home last evening it hit me that it was not the tree as much as it was the carefully wrapped packages beneath it. Once they were gone, the room seemed void of its magic.

It hit me that those packages represented anticipation, love, and sharing in ways that truly touch your soul. Those acts of love represent the essence of that entire experience, price or cost don’t really matter.  It’s the giving.

I try to end every night by reading CarePages from a local children’s hospital website; stories of young children that have many times reached the end of effective treatment and are waiting to meet their destiny decades before their time might have been.  The outpouring of the deep, soulful hurt that their parents, siblings, and grandparents are experiencing from this journey is always profoundly moving to me.  In many of these instances, the only gifts that we have left to give them are our  love and support.  That, however, is not the case for the majority of our fellow men in this country.

It won’t be long until the final product of the healthcare reform effort will appear.  We all know by now that it will be a patchwork quilt of sometimes horrendous compromise.  We can also count on the fact that the negative rhetoric will reach decibel levels typically heard only when standing in close proximity to a jet engine.  The pundits will parade up and down the isles of righteousness, and they will be spouting off their theories regarding what should have happened.  At the end of the day, however, when we approach our bathroom and bedroom mirrors for that last inevitable look, we must all dig into our humanity and ask one very real question: “Will it be better for the uninsured than it had previously?”

As a former hospital CEO, it became evident to me in the first six months of my administrative training that only those without insurance were destroyed by the system.  Only those who were not under Medicaid or an other insurance were hit with the awful burden of paying for everything at the full, retail price.  The fallout was clear.  Due to the risk of having to pay full costs to the hospital, they either were too frightened to go for treatment until it was too late, or they lost what little they had; their homes, their savings, and their possessions.

In a country with such unbelievable abundance, where not just the number but also the quality of the cars, clothes, and even pets that we own are held up as barometers of success, we have often allowed our fellow man to suffer and die for economic reasons.

That fact is no more obvious than at any children’s hospital in Pennsylvania, where you’ll see parents from conservative states where childhood transplantation surgeries were always denied, so as to avoid increased taxes.  You’ll see these parents waiting in line to establish residency here so that they can at least have a chance to save their child’s life.

Regardless of your politics, regardless of the dysfunctional (mal-)functioning of our government, in which some of our representatives and senators have taken us to the brink of collapse due to their inability to co-operate; regardless of these issues, we are looking at the beginning of health care reform.  I just pray that we don’t revert to the inhuman practices of our recent past.

It’s time for a human win.

Last year at this time, as word of the global economic meltdown was beginning to take hold, we saw the beginning of a decline in all aspects of purchasing, including the  optional surgeries and tests in our hospitals.  At the same time, as a member of several volunteer boards, we began to see declines in ticket sales that went as high as 20%.  Later, we met with restaurateurs who indicated that their business was down between 10 and 20%, an amount that proved to be terminal for numerous marginal companies.

As the year proceeded, we saw  hospitals make extensive cutbacks in employee  education, travel, and marketing.  This trend became the norm in the industry.  The healthcare-related industries that seemed to hurt the most were those involved in construction and new equipment acquisition.  One type of firm that did well was financial consulting groups, like SunStone Consulting, LLC , organizations that specialized in finding money that hospitals had already earned, but had either not been staffed deeply enough to pursue or that did not know the processes necessary to generate these funds.

For those of us in administrative consulting, the year has been interesting.  Decision makers stepped back a little and waited to see where Obamacare was heading, to collect more cash in a society where “cash was definitely king,” and to cut back on new initiatives until things had settled down economically.  These leaders watched the markets, looked at investment activities, counted revenue versus expense results, and generally became more conservative in their leadership approaches.

What’s on the horizon:  There is an old saying that “He who looks into a crystal ball to predict the future will get crystal in his eye,” that is not far from truth.  Are we completely out of the woods?  Not by a long shot.  Will there be additional taxes, additional expenditures that are not budgeted nationally?  Yes, most assuredly, there will be, but are we certainly seeing more positive signs in virtually every economic indicator that would predict at least a somewhat more optimistic overall outlook.

Wall Street Journal: Pointing to renewed signs that the global slump is bottoming out, the International Monetary Fund on Wednesday upgraded its outlook for 2010 while slightly trimming this year’s forecast.

The overleveraged global financial system continues to cast a shadow over the economic outlook, however, and the fund urged policymakers not to become complacent about recent market improvements.

“Financial conditions have improved, as unprecedented policy intervention has reduced the risk of systemic collapse and expectations of economic recovery have risen,” the IMF said in its updating its outlook for the world economy and financial system. “Nonetheless, vulnerabilities remain and complacency…

So, if we embrace those little rays of hope as a means of restarting the economic engines, if we visualize a better future for all of us, if we focus on the positive, at the very least we most likely will find a better parking space at the Mall!

Happy Holidays and here’s knowing that 2010 will be a better year for everyone.  (It wouldn’t take much!)

{Taking a business blogging break this week for a little holiday fun.}

This holiday thing is intense. I was reading the other day that people started really getting into celebrating Christmas around 354 A.D. So, we made it from 354 until about 1954 before things really became so commercial. It took 1600 years for capitalism to take hold, but when it did, WOW! I’m not exactly sure what a Christmas recession looks like in other countries, but in the United States, we seem to still buy everything; we just try to get it on sale.

So, in the spirit of holiday capitalism, I went to the mall today with three of the little kids; the six, four, and almost two year old.  We went there to see Santa Claus, or, as their mom called him, “The Big Cheese.” When she called Santa that, there was a three kid pause, and finally, the four year old said, “Cheese?” Who is the “Big Cheese?” “Santa,” her mom said, “Santa Claus is the Big Cheese.” Nina said, “Why is he cheese? I thought he was Santa.” By then mom realized that it was not good to confuse little kids about elves, magical people, and such because it was already confusing enough.

Photo Credit: AP

The day’s plan was simple: get their picture taken with Santa. We needed Annie Sullivan, Helen Keller’s teacher to pull off that miracle. The oldest one with two missing front teeth, played with everything in the garage before agreeing to be strapped into his seat, and the baby somehow flipped the lining of her seat and buried the belt latches. Only the four year old, who was wearing her Christmas dress, sliver dancing shoes, and holiday hair ribbon climbed into her seat and said, “Let’s go see Santa.” Not unlike her three year old cousin, Lucy, who spent hours under the Christmas tree staring mesmerized up into the lights and decorations, Nina was completely into it all.

When we arrived at Santa’s workshop, we watched a string of tiny kids panicking on the ole boy’s lap. The two year old was no different. Nothing helped. Squeaking reindeer toys, binkies and funny faces, were all in vain as she screamed in the arms of this strange, red suited man. After the trauma, we bought their Christmas picture. It had one terrified baby and two older kids looking off into space as if a hypnotic alien was on top of the camera. It could have been a scene from “Transformers 2: Revenge of the Fallen.”

During lunch we discovered that Santa had known exactly what the middle child wanted for Christmas, and that he had even discussed the particulars with her in detail.  The magic continued. It was also during this meal that  we had a very serious reindeer discussion. The boy’s mother looked at me and said, “Ask your grandson to name the reindeer that pull Santa’s sleigh.” So, I did just that. To which he replied, “Well, Poppa, you see, there’s Dasher and Dancer and Prancer and Vixen, Comet, Cupid, Donner and Blitzen plus Rudolph and Olive.” “Olive?,” I said out loud. “Yes,” he replied strongly, “Olive the other reindeer …used to laugh and call him names.” The absolute truth about the reindeer is that Dunder and Blixem, Dutch words for Thunder and Lightning, had their names changed to Donner and Blitzen several years ago for better song rhyming. (Another list of reindeer names that I saw included: Fireboy, Leroy, Pablo and Clarice, so Olive worked for me.)

In fact, this week I got another E-mail describing a third grader who was reading a story in class when he yelled out, “Mr. Markle, what’s a frickin’ elephant?” The teacher walked quickly over to the student’s desk to assure him that he was incorrect when he saw that the boy was reading a story about an “A-frican elephant.”? He was obviously Hooked on Phonics. So, “Ho, Ho, Ho, Merry Christmas to all and to all a good night.”