Archive for June, 2010

An Open Letter to Francis S. Collins . . . for Father’s Day

June 20th, 2010

Dear Dr. Collins:

In 1974 my father was diagnosed with a rare form of lung cancer, and our lives were changed forever.  He had stopped smoking back in 1960 when the Surgeon General had finally declared that cigarettes are “bad for your health,” but it was already too late.  My son had been born one year earlier and my daughter was born two months before my father’s death on July 5, 1975.  During his death watch he proclaimed that, “Had science been honest with us, he would never have smoked.” 

Dr. Collins, I was involved in running hospitals for over 22 years but did not realize the  depth of this science  problem until I helped to create a research institute in 2000.  Because my background was originally music performance , education, and then hospital administration, I did not have all of those preconceived notions about science that you and your peers have been strapped with over the centuries.  Upon interviewing our first three PhDs for positions at the research institute, it was very clear to me that the “Calf Paths” (poem by: Samuel Walter Foss) of science completely controlled our journey to cures, or, as in my father’s case, to the lack of cures.

When I asked them why they had not won the Nobel Prize, their answers were open, honest, and priceless.  They were following the long established paths that had been put in place by the people who preceded them.  Then they explained to me that, not unlike the training that our Diva’s receive in music school, it was “All About THEIR INDIVIDUAL SKILLS and TALENTS.”  Heaven forbid that they share the ideas for their secret sauce because the person to their right or their left might take away their “NIH grant,” grants which have become suspiciously “Good Ole Boy” grants given primarily to members of “The Club.”   The rules of the system are:  “Don’t share information; don’t ever tell anyone the key to your secret research; don’t co-operate.”  The incentives are completely misaligned.

Until you approach science like a Ensemble with soloists rather than Soloists backed up by minions, the men, women, and children of this generation will continue to die needlessly as well.  Dr. Collins, it’s 2010, 35 years since my dad passed, and I miss him as much today as I did then.  The NIH and medicine knew well before the 60’s that cigarettes were killing people, yet we still manufacture them and push them into the hands of our children today. 

You know that “the system” that you oversee is “BROKEN,” but, unlike what is being attempted in healthcare reform, there is NO EFFORT to implement SCIENCE REFORM.  Not unlike the generals of wars past who must live the remainder of their lives remembering the blood that is on their hands from the decisions that they have made, unless you work to change this ridiculous system of science, you too will have to live the remainder of your days realizing that you allowed the Calf Paths to remain in place.  Step back; look at the insanity of a system that does not encourage people to truly share their data in meaningful ways; that embraces the status quo and tradition so completely that truly significant progress has not been made since Nixon declared war on cancer; that penalizes researchers financially for trying to change the Calf Path, and the mirror will still contain the images of the organizations that you direct.

This dog is no longer in that hunt, but I want progress to be made for my kids and my grand kids.  I want you and everyone around you to admit that the status quo is broken, to begin to reward people significantly for opening their hard drives and notebooks, for exploring the hundreds of ignored orphan diseases; and for playing as an ensemble instead of making demands like a Diva. 

My Father was a wonderful, intelligent, caring man.  My children were raised without his input, his insight, his knowledge, and his ever present love.  He smoked cigarettes with asbestos filters.  Smoking and asbestos . . . two strikes, and you’re out!   Continuing on the current Calf Paths of science; three strikes and we’re all OUT.

Happy Father’s Day!


Running to a Hospital

June 13th, 2010

Periodically, it brings me comfort to return to my home base, and that is a place where not enough of my former peers have still journeyed.  One of my more spiritual friends always stops my conversations by saying, “Nick, you need to let go, and ask to be directed to the place where you can do the most good.”  She is talking about spirituality, believing in the universe, allowing destiny to present itself to you.  Truthfully, I spend a lot of my time being frustrated, wondering why others can’t see the light regarding such simple issues as: Transparency, Kindness, Patient and Employee-centeredness.

U.S. Veterans Affairs Secretary, Hon. Eric Shinseki

U.S. Veterans Affairs Secretary, Hon. Eric K. Shinseki

Interestingly, the largest public health system, the U.S. Veterans Administration (which has 17,272 beds and 153 hospitals) began their journey of “change” about five years ago when several of their administrators first approached Planetree.  I’ve been writing about, involved in, and literally living Planetree for decades now, and my passion for this philosophy of care has not waned.  It is about humanizing the healthcare experience, being transparent, centering your focus on employees, staff, and patients in ways that have not been considered even before the United States universities produced more attorneys than physicians.

Unfortunately, our business-minded organizations continue to look upon kindness as weakness, upon transparency as stupidity, upon patient and employee centered activities as pandering, and the price that we pay because of this archaic thinking is very high for all of us.

So, why would the VA get involved?  They “saw the light,” and the light was pretty darn bright.  When you look at the statistics regarding infections, lengths of stay, litigation, and patient and employee satisfaction, there  appears to be no decision.  Of course we can achieve several of these “dashboard” goals by producing human widgets, by treating people like objects, by taking over entire geographies and making sure that no one has a choice about anything, and we can continue to rack up profits in the billions, but are we really doing our  job?

Generations of Valor - WW II meets IraqThe VA thought not and started their journey, hospital by hospital, toward a kinder, gentler world.  Will they be successful with a culture bred out of military medicine?  Can they change a system that has long since been openly criticized as broken?  I think they can and they will, and with pending legislation that will permit our military and retired military personnel to “seek care where it is best delivered,” it will be interesting to see how well they do.

If you are in hospital administration and have little or no competition, ask yourself what would happen if your new competition allowed the patients to access their medical records; if  loved ones were invited to stay and become part of care giving teams; if there was 24 hour a day 7 day a week visiting hours; if employees were always treated with diginty; respected, rewarded, and recognized for their work;  if patients were always at the center of their own care?

Hopefully, someday, the masses will get it, and we will go from treating “organs” to treating people; we will focus on prevention not cleaning up train wrecks; we will embrace kindness, openness, transparency, healing and respect; and finally, we will acknowledge that the value of a human being is not based upon the value of his or her estate.  When that happens your patients will be “Running to a hospital” …your hospital.


Big Bird vs. The Status Quo

June 4th, 2010

Feeling “funny,” is something that would describe me pretty well today. Not ha ha funny, stomach ache funny. I’m thinking that Abraham Lincoln, Franklin Roosevelt, John Wayne, Amelia Earhart, and even Hawkeye Pierce from MASH may have ruined me. They stood up for what they believed, right or wrong, left or right. They had chutzpah, nerve, and . . . well, you know.

So, what’s making me feel funny? It’s those darn birds. Those birds have touched my heart. Tell me this; how can you not feel empathy for the baby birds being oiled down in their nests, and how about the tiny little birds that are still flying around a few feet from the oncoming disaster with absolutely no clue as to how bad things are going to be in a very short amount of time. I’ll admit that, unlike my mom, I’m not a passionate bird lover, but those big, oil soaked birds are really getting to me.

I’ll be the first to tell you that I’m allergic to shell fish, and even though, according to some oil company spokesperson, “Louisiana isn’t the only place that has shrimp,” according to my memory, their shrimp was some of the best in the world. So, if you’re not a big bird fan, how about a big shrimp fan, or a big fan of places where people live? How about a big fan of being able to sit on the beach or of jobs; fishing jobs, tourism jobs, even oil jobs? What will it take to get our leaders to show some real passion? I’m thinking Sesame Street.

We all know that getting the kids involved has helped remind us to start wearing our seat belts and bike helmets, to stop drinking and driving, and now texting and driving. Maybe we need Sesame Street to get our country to finally scream out from the top of their lungs, “S-T-O-P it.“ Could you imagine Big Bird or better still the President of that oil company dressed as Big Bird all soaked in oil being pushed out into the Gulf and gasping for air as he slowly is washed away forever? It would make the time they did the “Mr. Hooper is dying thing” seem tame.

One of my favorite sayings is “The problem is never the problem,” and the problem here is, once again, the status quo. It’s that philosophy of “don’t change ANYTHING because I’m personally comfortable with my life.” Just this week, a group of scientists who literally have brought 44 people out of deep, irreversible comas; soldiers, policemen, firemen, coal miners, and little boys and girls had their federal grant blocked because the status quo scientists and doctors involved said that “It was not the traditional methodology for treating coma patients.” Yikes, tell that to the people who lived, many of whom are back to leading functional lives. Come to think of it, that would be a good Sesame Street show, too. Oscar the grouch in Critical Care with tubes, the Cookie Monster administering the Last Rites, and Bingo Bango he’s awake and grouchy again.

Is it possible that no one wants to stand up for what they believe in and take it on the chin anymore? Somewhere there still must be some lines, some sacred requirements that we must meet in order to qualify as human beings on this planet? Could you imagine how different those John Wayne movies would have been? “It’s okay, pilgrim, let ‘em rob the bank. We need their support for re-election.” How about Neil Armstrong? “You want me to do what?” “Are you crazy?”

I still feel funny. Where the heck is Big Bird and Hawkeye when you really need them? We’ve had seagull management in this country for far too long now as they “Fly in, squawk, poop on our heads, and fly back to D.C. “ Pelicans UNITE!


I Remember Stephen

June 2nd, 2010

In the 1970’s, my career was wrapped completely around teaching, not just teaching, but teaching and playing music.  It was during that decade that my trumpet playing reached its peak, and between the numerous big bands in the area, I could play at least two weekend and one weekday nights every week.  The music was good, the musicians were friends, and the audiences were appreciative.

Johnstown Pennsylvania - A History - Part 2 - Randy WhittleThe Lemon Drop, Casa Romani, Mynderbinders, Bimbo’s, the Holiday Inn, the Ramada Inn, and a dozen other clubs with mostly ethnic or fraternal names were the sites of many a part-time playing job.  Be it the Johnstown Jazz Workshop, the Barnum and Bailey Circus, the Ice Capades, or Disney on Ice, my playing salary for the year often rivaled my teaching salary; neither of which came to more than $500 a month.

Along with those playing “gigs” there was one other primary, part -time employment opportunity and that was teaching private trumpet lessons.  It was my choice to teach at the Johnstown College of Music which was owned by Peg and Bob Hornick.  My schedule there was always packed full from 5:30 PM until 9:00 PM Tuesdays, Thursdays, and Saturday mornings.  There were kids of all ages from all school districts, and in the 1970’s those kids helped me pay the mortgage.  Even though I was usually pretty tired by 9:00 PM and often dreamed of learning to sleep with my eyes open, I never did.

One of my smallest students was Steve.  He was a little toe-headed, 7th grader from Forest Hills when he came to me, and he loved music.  He loved the fact that he was learning to play the trumpet from a professional and each week he got a little better.  Steve understood what it meant to work for something that he loved, and he didn’t mind getting an occasional tongue lashing if he hadn’t focused enough on his practicing that week.

Well, one night in 1976, I rushed through dinner, grabbed my jacket, and started for the door when my son, then three years old, stopped me and said, “Daddy, where are you going?”  I explained that I had to go to work.  He very slowly replied, “Daddy, you just came home from work.”  I signed and said, “I know, buddy, but I have to make some extra money.”  He looked at me quizzically and said, “What for, Daddy?”   To which I countered, “To buy you shoes.”  At that point he looked up at me and said in a very stern voice, “Daddy, I have shoes; please don’t leave me.”

It broke my heart to leave that night, but I did because I knew that I had an obligation, and when my first student walked in the door, I took a deep breath and thought to myself, “Steve, I’m here for you tonight, “ but those words were never spoken.
Ironically, there was an obituary in the newspaper last week, and it was an obituary for a 47 year old man who also left behind a son.  The age and the picture drew me further into the printed word where I read a name that seemed strangely familiar to me, Stephen Yanzetich.  It was Steve, my Steve, little 7th grade, toe-headed Steve who shared me that night.

Unbelievably, after 34 or so years, in his parting recognition, the author acknowledged that I had taught Steve trumpet, and as I sat back and read my own name in that obituary, I realized, once again, that it had been worth it, that 34 years later my time with Steve had been important to both of us.  That simple acknowledgement said to me, “Thank you, Mr. Jacobs, for caring enough about me to teach me all of those nights.”  To which I can candidly reply,”Thank you, Steve, for being such a good kid, and may God bless you.”