Archive for the ‘Family’ category

Warm Memories During The Holidays

December 19th, 2010

On those snow-covered roads of the 50’s and 60’s, the drive to my grandparents was always unforgettable. It seemed that the roads were hardly ever plowed, and there was no salt – just those coal black ashes mixed with tiny pieces of metal that would puncture a tire at least once or twice each winter.  The trip to their house really was over the river and through the woods, as we crossed the old wooden plank bridge, and started up the back roads to the park, where they lived.

Dad was not shy about winter driving on snow drift covered roads. As we slid and crashed through the white stuff on those old, back country roads at breakneck speeds, he would laugh as if nature was just something with which to play. Rear wheel drive in those clunky old 50’s cars was just crazy fun, as the Buick turned into a high tech, machine powered sleigh.  We would drive into total isolation where no unchained car had gone before us and thrill at making those first tire tracks in that freshly fallen snow. Mom would always be yelling, “Be careful, Charlie, don’t go too fast,” but he just laughed that baritone laugh as he put the pedal to the metal.

Winter, mid-1950s - Nick Jacobs, FACHE

After our snow driving fun, we would have our snow playing fun as we romped and rolled in the snow in our grandparents’ yard. That could go on for hours or until our blue jeans were completely frozen. Then we walked like icicles toward the heat of grandma’s kitchen. We were so cold that even our long underwear was frozen. In fact, we looked like cold, hard kid-cicles.  Once inside we would peel off layer after layer of wool and cotton until we were down to our frozen long  johns.

Our grandparents’ house was a place where we were surrounded with more fun, love and craziness than a kid could ever imagine. Oh, and food?  There were pots and pans bubbling and jumping on every burner of her old gas fired stove; spaghetti, meat sauce, home grown vegetables, cookies, and every type of Italian fruit or vegetable. In the middle of the table there was always a bowl filled with black gold, those wonderful fat, black olives that became candy to me. When the spaghetti was finally put on the table it was in a serving dish that reminded me of a soup bowl for Jack and the Beanstalk’s Giant. It could have been a bassinet for triplets. There had to have been at least two or three pounds of specially cooked pasta just waiting to become part of our collective muffin tops!

After we said grace (during which Grandma could be heard mumbling in Italian under her breath), Granddad would pass the wine around the room to all of the adult males at the table.  His philosophy as he poured his homemade wine from the gallon jug was that warmth, laughter, love and fun came from the fruit of the vine.  Throughout the entire meal, they would drink and laugh and sing to the tune of those carefully-cultivated grapes.  I loved the lighthearted, happiness of those meals. We never talked about anything serious and if anyone tried to bring up a serious category, granddad would do something just plain crazy like dump his peaches into his coffee cup, and my Grandmother would begin her ritual, a ritual that she surely seemed to enjoy as she scolded him by yelling out, “Patsy, Patsy, you gonna make-a da boys be bad!”  He would smile with that knowing smile that seemed to say, “Oh, they’ll be bad, alright, but not because of tonight. It will be because they have my genes!”

We loved the hugs, the love and the laughter. We always left there feeling that total nonjudgmental, complete love that only a grandparent can give.

It was all about that love.

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Engage With Grace

November 26th, 2010

Excerpts from: Chapter 18 of  Taking the Hell out of Healthcare

by Nick Jacobs

When Dying is Finally Enough


The Dichotomy of Death

On Thursday evenings from 1970 until 1975 there was a standing invitation to play pool at Jim’s Dad’s house.  Now, the truth of the matter was that, as young school teachers, most of us barely owned houses, let alone a pool table, so one of my colleagues parents’ opened their home to allow us to have some safe recreation. During those innocent days of my mid twenties, many of the world’s problems were solved. Jim’s father was a wise old philosopher in his early sixties,  a retired coal miner who loved to be around the kids.

One night, we began discussing religion, faith, and death as we mechanically yelled out lines like “16 in the side pocket.”  The discussion became particularly heated when it came to hypocrisy of our healthcare system. We kids or at least this kid listened in amazement as old Carl explained how life was in the old days. His relatives from the old country had salves and ointments, herbs and mustard plasters that took care of virtually every ailment known to man, and when they failed and death was inevitable, death was accepted. He used to laugh and say, “But now, everyone wants to go to heaven, but nobody wants to die.”

It was then that the subject changed to today where there was truly a cure for nearly everything, or so it seemed at age 23.  Get sick? Take a pill or get a shot. But then, a few weeks earlier, my father had been diagnosed with lung cancer and was given less than a three percent chance of survival. As Carl and I discussed this situation, he put his arm on my shoulder, and wished me luck. At 58, my dad was still a young man, and neither my education, my prayers, nor my love would be able to save him.

The American way of death seems to be that death is not acceptable at any age, at any time or for any reason. Death is rarely seen as the inevitable future that we all face. Our American system of death is that it should not  happen. Death is no longer accepted as part of life. Oh, yes, we hear those words, but when it is our loved one, they are very difficult to embrace or articulate.

Our medical schools, our nursing schools, our technology schools train  our students in most cases that death is failure. This is why we have a system of health care that is crumbling under our very eyes. Through drugs, machines, and other advances, we have the ability to allow individuals to live longer than ever in the history of mankind. It is absolute reality that more people will have an opportunity to live longer than 100 years of age than ever in history, but at what cost, and with what degree of quality?

Engage With Grace - The One Slide - Nick Jacobs, FACHE - Healing Hospitals - Taking the Hell Out of Healthcare

Because of our culture, we fight death until we are shocked by it, and the result is that we, as families miss the wonderful opportunity to allow our loved one a peaceful, beautiful, comforting transition.

Palliative care, a.k.a., hospice care, provides that transition.  In a hospice program, we experience love in all forms until death. Hospice provides a womb-like environment where love can replace fear, where family can be the center of that love, and where the transition can be a beautiful, healing journey for everyone involved so that it becomes a peaceful transition.

What Can You Do?

Do your personal homework. Begin to talk to your loved ones early on about their wishes.  Make those wishes as clear as you can. Do not be fearful that anyone will let you die before your time. Trust that your family or friends can support you in your intentions, and be sure that you put everything in writing that you possibly can. Most importantly, however, try to find peace with yourself.

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The Obligation is Real

September 21st, 2010

On Saturday night a group of people will gather at a restaurant  for a celebration of life since graduation from high school. I won’t be there. Neither will Joe, Butch, Tommy and half a dozen others,  but their absence is for a very different reason: they have passed away. I, on the other hand, will just be passing. So, why not go this year?

Nick Jacobs, FACHE at the beach with his grandchildrenWell, it’s a kid thing. You see, part of my birthday present to each of my kids was an overnight stay at a resort with their spouses, and, low and behold, there is no one to watch three of the grandkids and the brand new chocolate lab; no one, that is, but me. Why would I sacrifice the opportunity to hang with my old buddies for the chance to change diapers, mop up housebreaking accidents, and argue over bathing and bedtime issues?  Why?  Because it was part of the commitment, that kid commitment.  They will be my kids until either I die or they do, and with that come certain obligations that are real.

Why bother you with all of this personal blog stuff?  It’s about obligations.

The other day, a bright young man met with me at lunch to ask me questions about the American Healthcare System. Interestingly enough, I don’t believe that  my answers were what he had expected. You see, we have certain beliefs about our rights to generate, earn, and receive money in this country. What is missing, however, is a realistic reward system that aligns the appropriate reimbursements with the actual needs of the country. When he asked me how many hospitals would invest in purchasing his product, one that might help to eliminate hospital infections, my response was “Not many.”

You see, with obligatory bottom line orientations, many of the hospital CEO’s and CFO’s are not anxious to spend money on a  product that might work.  More importantly, with a lack of transparency, the public exposure that most organizations have relative to this infection problem is still somewhat limited.  It was easy to explain that if “St. Elsewhere” was exposed for having a 24% infection rate, not unlike a five star hotel having bed bugs, you can darn well bet that something would be done and done quickly, but the issue is not so pressing when it is under the basket.

Over the last few years, I have lost some wonderful friends who have had fantastic surgeries at highly respected hospitals.  These surgeries would have been impossible to have in a “normal” hospital, but, having said that, two of them died and one lingered near death for two years due to the infections they acquired there.

If this was widely publicized public knowledge, might he be able to sell more product?  The question was rhetorical and the answer is absolutely, positively, yes. So, back to obligations. Why is it that we must be exposed in order to become aggressive about serious problems in our systems?  The answer is simple: It costs money, and resource allocation is the number one challenge of most hospitals.  Hence my point about our financial incentives.  If we were reimbursed, rewarded and paid, not in an unconnected, cottage industry manner, our treatment regimes and protocols would change.  If we knew that it would be our financial responsibility to amputate limbs for advanced diabetes, would we be more eager to spend money on wellness initiatives?

Truthfully, it’s our obligation, and, as our fellow human beings suffer, we are currently seeing a movement toward political groups intent upon repealing reform measures. That is a backward view of an already complex challenge. It is our obligation to help our fellow man. “Do unto others …or pray you don’t lose your health insurance.”

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The Fate of Modern Day Gladiators

October 12th, 2009
The warrior in the picture is my buddy and grandson, Jude. He is about to go to war for candy. It’s his Halloween costume, but a fitting example of a warrior, and one that works well for the topic of this blog post.

Jude

When I first saw this picture, it reminded me of my peers who are out there in the day to day fight trying to work their way through the current financial crisis. Then the picture reminded me of a much bigger and more threatening challenge. Last week’s New Yorker ran an article entitled “The Catastrophist” by Elizabeth Kolbert. It was about another type of warrior, James Hensen, Director of NASA’s Goddard Institute for Space Studies. He is fighting for our children and their children’s future. He is the top scientist for NASA who successfully made early recommendations about chlorofluorocarbons creating holes in the Ozone, and was instrumental in getting the world to ban them and stop the holes in the atmosphere from progressing.

For the last several years, he has been fighting a personal war to get the world to take the steps necessary to stop global warming before it is too late. At a recent rally in New Hampshire, he described our situation as a one in which, “climate history is being run in reverse and at high speed, like a cassette tape on rewind. Carbon dioxide is being pumped into the air some ten thousand times faster than natural weathering processes can remove it.”

The world has not yet responded to his and the majority of scientists discoveries, but he fights on for his grandchildren while the pundits say it is all hype and without substance. “The world goes through cycles,” they say, “and this is just another cycle.”

Then, I read a comprehensive article by Malcolm Gladwell in this week’s New Yorker magazine (I know, I know – It’s New York) …entitled “Offensive Play.” Mr. Gladwell examined the realities of professional football, boxing, NASCAR, and the world of fighting dogs that can only be described as painfully chilling. In this treatise, he examined the frequency and degree of damage that professional football players endure from multiple head injuries. In fact, it was not limited to professional football players, but players of all levels.

Tom E. Puskar/Associated Press Steelers quarterback Ben Roethlisberger, with Dr. Joseph Maroon, being taken away after sustaining a concussion.
Pittsburgh Steelers Quarterback  Ben Roethlisberger after sustaining a concussion – Tom E. Puskar/Associated Press

He met with scientists who have studied the autopsied brains of these men, men who have made their living as modern day gladiators and warriors. Men who, as he described it, “had game.” No matter the degree of injury, they were ready and driven to get back in and play. He likened this attitude to Marines and young doctors and asked the question “If you have people who are willing to march over a cliff for you, you cannot march them close to the edge of the cliff?’

In this analysis, he gave the example of a veteran football player who might be exposed to 18,000 head hits during a ten year period. He also provided example after example of famous NFL players who had tragic endings to their lives because of these injuries. These were often times great player who became abusive toward loved ones or lost their personal direction in life and committed suicide.

These “modern day gladiators,” not unlike boxers, have some degree of information regarding the potential risks that they face. But, also like boxers, about 22%  of whom end up with dementia, they will most likely continue to do this work as long as we are willing to pay them millions in order to observe their physical prowess.

NASCAR, on the other hand, has worked year after year to improve survivability of their drivers from even horriffic accidents. NASCAR can make their sport relatively safe, but football has a much greater challenge because helmets don’t really stop the impact of hitting your head at 80 miles or more an hour, the equivalent of going through an automobile windshield at that speed. Yet a NASCAR driver escaped injury in a head on collision of 180 miles an hour last year.

NJ_cover_comp2Maybe the idea of having “game” is not limited to football, or soldiering, or medicine. If you look at the level of stress that many executives endure with the blessing and even pressure to do so from their bosses, their stakeholders, and their stockholders, the same type of moral question seems to surface. Kevlar gas tanks keep Grand Prix automobiles from exploding. What keeps modern day gladiators from exploding? Clearly, it is not more Yang.

I’m just the reporter, and this reporter is going to borrow my grandson’s battle gear as I fight on through the economic downturn. By the way, my new book,  You Hold Em. I’ll Bite Em. should be out next month. Talk about the result of a head injury. We played without pads or helmets!

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