When Clayton Osbon, the pilot of that Jet Blue plane lost it a few weeks ago, the entire world stepped back and asked what was wrong?  Did the weight loss shakes that he sold somehow impact his neurons?  Was he so sleep deprived that he became in-congruent?  What made him snap?  Everyone described him as a rock solid, non-controversial human being, and all of his neighbors, friends and family were shocked by his actions.  

Interestingly, while listening to a talking head about the soldier, Staff Sergeant Robert Bales, who was accused of killing 17 Afghan citizens, the commentator indicated that, sleep deprivation and stress can turn any human being into a moral moron. “Your decisions become so clouded and incongruent that anything becomes possible,” he said.

As a hospital CEO, one of my saddest physician practice memories occurred when one of our top docs began speaking in incomprehensible sentences and acting erratically.   The result was an agreed upon early retirement after which he came back to his full, normal functional capacity.  In a casual conversation with him months later, he believed that he had embraced a personal diagnosis.  You see, he had been working, taking calls, and visiting patients late into the night and was back on the floors by 5 AM every morning.  He attributed his incoherent activities to his sleep deprivation.

Now to a very disconcerting Pittsburgh meltdown; last week a highly respected, top CEO in this area cracked and was arrested for fighting with the husband of his mistress.  His listed salary was about $4,000,000, but more importantly, he was working to lead his organization in a new direction that could literally be a prime example of what may be possible in the new health care arena of these United States. 

Dr. Ken Melani was leading the way in the creation of an Accountable Care Organization that would cover all aspects of healthcare from cradle to grave.  His path was truly one of great risk, amazing strength, and deep understanding of the new Healthcare Reform legislation. It meant taking on the UPMC juggernaut while preserving choice in healthcare in the Pittsburgh region.  It also meant managing numerous very strong personalities who either agreed, disagreed, or thought they could do whatever was to be done in a better way than their leader. 

 Literally at stake were millions and millions of dollars and a $1.2B debt was also knocked into the risk portfolio because of Dr. Melani’s meltdown.   More importantly, however, in this “Battle of the Titans” was the two million or so patients who would be blocked out of the competitions health system when Highmark stood its ground. 

Many countries regulate the work week by law, such as stipulating minimum daily rest periods, annual holidays and a maximum number of working hours per week.  During a conversation with the wife of the Finance Minister in the Netherlands, I told her I would see her in August to which she replied, “You really don’t understand, do you?   We threw out the Pilgrims and Puritans and you still live by their standards.  We have 54 days off a year, and no one will be here in August.” 

It’s a well known fact that US workers put in the longest hours on the job in industrialized nations, and we are spending the most on our health in the United States with some of the worst outcomes, and we are the ONLY nation that does not provide health coverage for its population. Bottom line, maybe Dr. Melani,   Staff Sgt Bales  and Capt Clayton Osborn all needed a break.   Battle fatigue can be a dangerous enemy, and the results can be both economically and physically lethal.  We can’t turn back the clock for any of these individuals, but we can learn to carve out 20 or 40 minutes a day to nurture ourselves, to breathe deeply and to rid our minds of the unnecessary.   Change or DIE. 

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