“Everybody wants to go to heaven, but no body wants to die.”  That’s what Jim’s dad, Carl, used to say on Thursdays in the 1970’s when we looked to him for his wisdom and advice.  Actually, he used to say it when we were complaining about how hard it was to accomplish something.  It’s funny, but applies to so many areas of our life.

Creating the future, or at least creating a positive future, is something that everyone wants, but when it’s time to step out and make it happen, it’s a good idea not to stop and look behind you, because, usually, there’s a very short line of risk takers standing there with you.

John F. Kennedy used to refer to the Irish writer, Frank O’Connor, who wrote about his childhood and about the early formation of his risk taking philosophy by saying, “He and his friends would make their way across the countryside and when they came to an orchard wall that seemed too high, too doubtful to try and too difficult to permit their voyage to continue, they took off their hats and tossed them over the wall, and then they had no choice but to follow them.”

It was Henry Ford who said, “If you think you can, you’re right.  If you think you can’t, you’re right.”

As an organization, we are facing our future head on.  We must re-invent ourselves on a daily, weekly and monthly basis.  Business as usual will not cut it here anymore.

Only through our creativity, our persistence, our desire to succeed . . . only through throwing our hats over the wall, putting a stake in the ground, taking a stand and being there for our patients, our physicians, our partners and our loved ones can we be successful.

Dream our future as an International Center of Excellence, and dream individually of our new centers of excellence, the ones that you will work to create.  Then, create and support them.

We’re only in a competition with ourselves, and we are not the enemy.  Let’s start each morning by saying, “If we think we can, we’re right,” because, as Ralph Waldo Emerson said, “A Hero is no braver than an ordinary man, but he is braver five minutes longer.”

Be brave.  Focus on a positive future and it will be ours!

This e-mail arrived this morning from a friend:

“Well, I have been back to the doctor and the surgeon. They can’t put in a stent because my arteries are too small. They want to do compression wraps for seven weeks which should cause new arteries to grow. Well, the co-pay for each treatment is $40 which adds up to $200 a week. The simple answer is that we don’t have the money. I figured out that next year, when I can start collecting social security, a whole $300 a month, I can save up $1400 and have it done then. Of course, it will probably cost more then. I just wanted to keep you updated and thank you for your prayers.”

In my position as President of both a medical center and research institute, it is obvious to me that filmmaker Michael Moore’s new movie, Sicko, has, in many ways, nailed it. It deals with this country’s health issues. We live in an incredibly prosperous country, but it is a one that has never had a health policy. Many of us in this profession believe that it is unconscionable that we have an estimated 45 million uninsured individuals in our country, and that number does not even include the underinsured.

We are also placed in the uncomfortable position of observing on a daily basis the absurdity of squandering 30 percent of our health care dollars on the last thirty days of life when, in many cases, palliative care is available as the intelligent alternative.

As a profession, we are also sensitive to the fact that the segment of the population that is most negatively impacted by this existing system is a group that does not have political clout; single mothers and their children. More than 8 million children had no health insurance in 2005, according to the latest federal report on the well being of U.S. children. Children who were uninsured were nearly 16 times as likely as those with private insurance to have no ongoing source of care.

Of course, Moore neglects to mention the failures of the Canadian system, or the challenges of paying for a single payer system. He also doesn’t spend much time talking about the single-digit percentage of our nearly $2 TRILLION in health care expenditures that are dedicated to preventative medicine, but, nevertheless, his reality is largely the truth.

So, as the challenge continues, we in health care administration are busy re-arranging the deck chairs while our Federal officials continue to mark time and the uninsured wait hour after hour to be seen and treated in our over crowded emergency rooms, the part of our system that is strained to the breaking point. These people are OUR people, and they need to be treated as human beings, not as cost centers.

When the crawl moves across your television screen, and you hear a dull, duck-like buzzer sound coming from the speakers, it’s a signal to look up to see where the severe weather —tornados, floods or blizzard conditions— will be hitting next. The National Weather Service lets us know when it’s coming… minute by minute.

On the 4th of July, we rode around the Allegheny River on my kid’s boat as I checked moving radar maps on my cell phone, but as a kid, we weren’t so well tuned in, and we were more dependent on our instincts.

In a discussion with one of my board members today, as I described some inclement weather of sorts that was approaching, he laughed and said, "But before I go after those varmints, I’m gonna sing you this song."

At first I hesitated and was a little concerned that he had lost it until I asked, "Gene Autry?" "Yep," he said, "He’d jump on his horse and say those famous words." For those of you who are half a century too young to know who that was, Google Gene Autry. He was a famous movie, radio and television cowboy who looked a little like my Uncle Bill… or anyone’s Uncle Bill, for that matter.

A review of one his movies described this scene: "There was a bust-up-the-joint fight and a furious stagecoach chase at the end, and then Gene sings the title song When the Bloom Is On the Sage." Yes sir, that about sums it up: Punch ’em out, shoot ’em up… and then sing. Those were the days when macho-manhood and the arts worked well together. Now, our society is all about bust-up-the-joint and take no prisoners. We see it everyday in all aspects of life. The unspoken rules have become really unspoken and, in most cases, completely ignored. The lines of ethical consideration are so blurred they remind you of a child’s finger painting efforts. What ever happened to Rules of Civility?

Well, we are not in a position to discuss varmints here, but we are in a position to discuss the challenges of inclement weather. It’s something that we all need to prepare for… because we know it’s just a matter of time until the blue clouds move away and the thunder heads move in from the West.

It’s not enough to have a flashlight, batteries and candles ready. You need to have a commitment. Thirty years ago when the Johnstown Flood hit, I was a volunteer. I worked at first aid centers and shelters for the first few days and then moved into the ugly volunteer job of cleaning up mud and debris.

Well, that experience has made me mindful of the forces that surround us on this earth and has helped me to realize that they can reap great havoc on our existence, and, like the flood, are capable of wiping out our possessions. But the reason that we are still here was not because of our stuff, it was because of our spirit, our willingness to stick with it, and our commitment to creating a future that will be better than our past.

Of course, there will always be varmints and thunderheads, and all forms of pestilence that can be brought down on us, but we need to smile, look directly ahead, and prove that we have the power, the will and the determination to withstand anything that is thrown our way. That’s what made it all work in ’77: attitude. If we get knocked down, we get back up, dust ourselves off, and get on that horse again.

Like Gene used to profess:

I’m Back in the Saddle Again
Out where a friend is a friend
Where the longhorn cattle feed
On the lowly gypsum weed
Back in the saddle again