The other night I was watching PBS and saw a show about the bridges of Pittsburgh.  As a kid there was a bridge between downtown and the North Side.  When I looked it up on Wikipedia, I found the following story:  The Fort Duquesne Bridge is a steel tied arch bridge that spans the Allegheny River in Pittsburgh. It was colloquially referred to as the Bridge to Nowhere because it was constructed from 1958-1963 by PennDOT, and never opened for traffic until October 17, 1969.

When we look at our own personal journeys, it is sometimes very interesting to trace the origins and destinations of our bridges; where they have been and where they could be or more importantly where they are actually taking us.  The journey always has a series of connectors, confluences, and mergers that were as unpredictable and unimaginable as could ever have been conceived. 

Sometimes those connectors were mentors; sometimes partners, sometimes friends, but more often than not, those people who have had the most influence on our progress and on moving us toward our goals have been people who did not like, support, or believe in our work, our mission, or our dreams. 

Many times, our inspiration came from the power of those people who were most passionately against us than from those who supported us. Bob Strauss in his e-How blog writes:  Like duels and opera hats, the concept of mortal enemies has fallen by the wayside in modern times, and more’s the pity. The fact is, everyone can use a good mortal enemy: there’s nothing like the possibility of being waylaid, fisticuff-ed, and tied to a railroad trestle to make a guy just glad to be alive.

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As very small children, the funniest jokes that kids can come up with always seem to be "poopy talk" jokes.  As we age, it is interesting that we remain shy about our natural functions.  In fact, some people are so shy that they would rather die than say, do, or even think about anything related to their colons. 

The E-mail that I received this week was a challenge to "Take the Test," and, although it was an advertisement, there were enough good points made in that E-mail that I decided to dedicate this week’s blog to Katie Couric.  In 2000, Katie submitted herself to a public colonoscopy on national television.  Why?  Because she had lost her husband at the relatively young age of 42 to colon cancer. 

After Katie’s big adventure, among the 400 gastroenterologists surveyed, the number of colonoscopies performed each month rose from an average of 15 before the Couric exam to 18.1 after.  It was so successful that it is still referred to as the Couric Effect.

As indicated in the correspondence, over 150,000 people are diagnosed with colon cancer each year and at least 1/3 of them die.  Unlike ovarian and numerous other cancers, there are several screening tests available to determine the presence of colon cancer. 

At a meeting last year our Chief of Medicine stated that "There is no longer a reason why anyone should die from colon cancer."

Even though it was part of my suggested battery of tests the year before, my colonoscopy was completed a few months ago.  Except for the fact that I woke up with a few children’s tattoos on my body from our playful employees and a threat that there would be a video at 11, all went well. 

Okay, I will admit that the preparation for the test was somewhat of a drag, but it wasn’t as bad as being a long term patient.

The goal of their E-mail was for us to persuade everyone to use their diagnostics. The quoted website was: www.DoYouHaveTheGuts.com 

The goal of this blog is to get you to think about taking care of yourself.  It is to convince you to love yourself and your family enough to ensure that you all have a future.  It is to get you to be saved by having a colon test, some test, any test. 

If you’re still embarrassed by colon jokes, GET OVER IT.

It could truly be a matter of life or death.

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The other day a very compelling story appeared on America Online (AOL).  I’m sorry that the name didn’t catch my attention, but, in fact, Tony Chen pointed it out to us on his Hospitalimpact.org blog.  Glenn Beck, a correspondent for CNN, had a bad experience in a hospital and then shared that experience. 

What Tony had pointed out was that my recent post on Hospital Impact was also about empathy.  Two of the quotes from that post were:  Maya Angelou who said, "I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."  And: As we move about in our world every day . . . remember that warmth, concern, compassion, and empathy are NOT bad things.

Glenn had a hospital experience that very nearly put him over the edge, and, in fact, due to the pain cocktail that he had received, he admits that he was even contemplating suicide.  Here are some quotes from his article Put the ‘care’ back in health care, featured on CNN.com/health:

"At the hospital I was often treated more like a number than a patient.  At times, staff members literally turned their back on my cries of pain and pleas for help."

He went on to say, "I’ve now seen our system at its very best and I’ve also experienced it at its very worst.  But in each case, the difference had nothing to do with whether the hospital had the latest equipment or whether it looked like the Taj Mahal.  It had to do with compassion.  It had to do with respect.  It had to do with treating people the way you’d want to be treated going through something unfamiliar and frightening."

From the website: ReligiousTolerance.org we find 21 different religious and six different philosophical interpretations of the Christian phrase, "Do unto others as you would have others do unto you."  Just a few of those are listed below:

Confucianism:  "Do not do to others what you do not want them to do to you."
-Analects 15:23

Buddhism:  "…a state that is not pleasing or delightful to me, how could I inflict that upon another:" 
-Samyutta Nlkaya v. 353

Hinduism:  "This is the sum of duty: do not do to others what would cause pain if done to you. 
-Mahabharata 5:1517

Islam:  "None of you (truly) believes until he wishes for his brother what he wishes for himself." 
-Number 13 of Imam "Al-Nawawi’s Forty Hadiths."

Unitarian:  "The Inherent worth and dignity of every person:’  "Justice, equity and compassion in human relations…"

Native American Spirituality:  "All things are our relatives; what we do to everything, we do to ourselves."

Shinto:  "the heart of the person before you is a mirror.  See there your own form"

Judiasm:  "thou shalt love thy neighbor as thyself." 
-Leviticus 19:18

If these were not convincing enough, there are nearly 20 more included from other religions and philosophies like Yoruba, Zoroastrianism, Ancient Egyptian, Brahmanism, and the Baha’i Faith.

How is it that the world embraces this philosophy, that the "Golden Rule" is our guide, yet we permit environments in health care that tolerate the intolerable?  This, my friends, is a leadership issue.  Do not blame the employees.  Do not blame the physicians.  Do not blame the environment.  BLAME THE LEADERSHIP.  Hold the leadership accountable.  Every department manager, vice president, or president who allows this should be challenged, should be confronted, and, if it is not corrected, SHOULD BE REMOVED.

It is not a matter of choice. It is not business. It is human dignity.  Transparency provides the information needed to correct these indignities, and if they are not corrected via change, you have not exerted your God given rights as a human being, and this is one time when compassion should be trumped by accountability!

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Well, I bought two new FAT suits on sale last week, and today one of them wouldn’t fit me.  Yep, after ten years of stable, no weight gain, my middle started to inflate; five, ten then 15 pounds.  I’ve spent more on having my pants let out than I have on gasoline this month.  Pinching an inch would be a dream.  Pinching a Michelin is more like it. 

Don’t get me wrong, I know what I did to cause this, really I do.  It is also clear what I will need to do to reverse it, but it is the holidays, after all, and, for the first time since 1998, I am not limited to eating only the garnishes at all of the parties.  Free at last.  I’m free at last!

The rules had always been the same: Eat breakfast each and every day.  Drink tea for the antioxidants.  Brush your teeth. Don’t miss your Omega 3 fish oil. Get enough sleep.  Make sure you have at least one hobby; exercise and join something where you can socialize at least once a week.  Use sun screen, drink plenty of water and cut out saturated fats.  So, what went wrong? 

I moved from my Ornish Heart Disease Reversal diet to the modified Mediterranean diet; went from working out three days a week to working out two days a week; and, after ten years of abstinence, started eating chocolate and drinking one 200 calorie chai tea a day.  Do the math.  That’s 200 new calories a day, seven days a week, four weeks a month. Add that to the lack of exercise, and it represents a caloric train wreck.  The chocolate?  Well, that easily accounted for at least five pounds of extra me.  Ten years of make-up work in twelve short months.

The problem with having all of this knowledge is that, periodically, it’s important to feel like you are alive, and living can be defined in hundreds of ways.  The more conservative you are, the fewer things you will probably have to do to make things feel a little more wild.  I can’t get away with most of the things that I’ve day dreamed about, but this departure from my diet was major for me.

One of my most vivid memories from my former life was the trip that I made from Pittsburgh to San Diego.  I know I mentioned this a hundred or so blogs ago, but it was almost a primal moment.  As the plane took off, I looked down and saw an M&M between my shoes.  I stared at it for what seemed like hours and then actually reached a point of temptation and desperation that was so intense, I almost bent down to pick it up and eat it. Then I kicked it as far away as I could and realized how pathetic my life had become. 

So, even if my pants don’t fit this year, I have to say that it was an amazing year, a year of personal caloric freedom. 

It’s time, however, to get back into my suits. 

So, I’ll see you at the gym…with my big sweat pants and a pocket full of Hershey kisses!   

Happy Holidays everyone, and thanks for a great year.

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Before embarking on my path to hospital administration, I was a teacher.  Many of you know that several of my former students are now working with us.  The names and faces of hundreds of these kids float through my conscious and subconscious mind every day and night.  It is not unusual to think about the opposite ends of the bell shaped curve, the great ones and the ones who needed the most attention and help.  Three of my former students have written to me recently, all three phenomenal people with amazing talents, and all have gone on to do wonderful things with their lives. They were the top of the curve.

The first is from one of my favorite students of all time.  She was trying to explain the challenges that I would face on a potential visit to Australia:

Did you know that it is the HOTTEST, DRIEST, FLATTEST, and MOST INHOSPITABLE place of all the inhabited continents?  Yes…I’m talking NO WATER, NO SHOWERS!  It’s DIRTY, DUSTY, and INFERTILE. The so-called Romantic Outback, is just a VAST, REMOTE, BAKING, BOUNDLESS VOID, teeming with all manner of POISONOUS ANIMALS that want to eat each other AND Y-O-U!

If you’re not bitten by one of the world’s 10 most DEADLY SNAKES, you could be bitten by a funnel web spider. This baby has massive fangs that are large and powerful enough to easily penetrate YOUR fingernails and cripple your writing hand! OR… you could be bitten by one of the other hundreds of poisonous insects or arachnids that inhabit Australia.

Take a walk outside to get a breath of fresh air and you may be kicked in the head by a deranged kangaroo or trip over a dehydrated wallaby.  Go too close to water and you may receive a fatal chomping from a man eating “protected” crocodile, or die a slow, painful death from the sting of a box jelly fish. Oh yeah…they  also have that Opera House thingy…big deal.

And the next one was from another of my FAVORITE students . . .

	Mr. Jacobs Meets Maynard Ferguson

I can’t ‘not’ call you “Mr. Jacobs” because that’s how I remember my time in Junior High School, playing in the marching band, the orchestra, and the most fun of all, Stage Band.  It was the mid-70’s, and I thought you were the greatest band director on the face of the earth

.

All I ever wanted to do was sing and play my instrument. Fast forward 30-some years, and I’m the CEO of a hospital.

It’s not a surprise to me that you ended up where you did.  How different is managing a hospital than it is to be in the middle of nearly 200 junior high school kids, all with their own levels of talent, all self-absorbed, crisis-prone, gossip-focused, crashing into one another verbally and emotionally.  Wait, are we talking about the band here, or staff in general?

Your November 9th blog says it all. You might as well title it, “How Do You Know What You Don’t Know” (or what no one bothers to tell you).  And it usually hits you in the areas (of the hospital of course) that you think are humming along.  People you trust are doing wonderful things, just like you thought they were, until you figure out you’ve been had.

A million policies and procedures can never safeguard you against the people who look like adults, sound like adults and dress like adults, but who are sometimes as emotional as 12 years old with not much common sense.

Much of the time I walk around going, “How did this happen?”  “What was he/she thinking?” “When was anybody going to tell me about this?”

It’s . . . often a scary feeling of, “Is this real? Did that person just actually say that?”

If you’re a CEO, or in any significant management position, you had better be micro-managing daily…and it had better be your communications process.  I’m convinced communication either makes or breaks an organization, and for the CEO, fueling that effort never ends.

It’s not enough that you’re in charge of people’s lives, and the people who take care of them 24 hours a day, 7 days a week.  You have to be all over the information generated from every area, all the time.  And be prepared to understand that there are many sides to every story, and even then, it might not be entirely in focus.

I loved you as a band leader, and I would love to visit your hospital and see some of the things you’ve done to make it less institutional.

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Glamorous? Yep, that’s how some people see my life, glamorous. Heck, I’ve been to Bosnia, Nigeria and now, Serbia. The day started at 5:00 AM as I walked up to the ticket counter for my 6:45 flight. It was a short hop to New York, but this particular day would be very long. Typical trans-continental flights leave at around seven or so at night and land at about seven or so in the morning. Six or more hours magically disappear as you fly into the future. During that flight it is not unusual to be waited on a half dozen times with food and beverages, that fact alone keeps even those with sleep eye masks and ear plugs from sleeping for more than a few hours at a time.

Upon landing, a greeting party consisting of the physician in charge of the conference and a representative from the hotel met us at the exit door from the airplane’s walkway, they escorted us through Passport security and took us to the hotel where they informed us that lunch will be served in 20 minutes. Following lunch, we had about 20 more minutes before my presentation and then the opening ceremonies. Approximately 900 physicians were in attendance at this three and a half day event. Present at the opening were the His Royal Highness, Alexander, Prince of Serbia, the Minister of Health, the general in charge of military medicine and numerous other dignitaries and prominent physicians.

The following day was filled with lectures and workshops, but we were on a mission to visit a rehabilitation hospital and spa. It was a three and a half hour trip each way, but our driver had amazing driving skills, and we made in two and a half hours each way without being arrested or killed. (Other drivers that we had over the three days were arrested twice for speeding and one had an accident and parked the car on a streetcar track.) The visit to the spa was amazing, the physicians were amazing, and the concept was amazing, one level beyond even our current span of modalities.

We returned to the hotel in time to jump in another car and meet personally with HRH Alexander, the Crown Prince of Serbia, a friendly man who was born and raised in England and the United States. His great grandmother was one of the Queens of England. His wife was a Greek Princess and immediately began to talk to us about her knowledge of Johnstown and her visits to Pittsburgh to assist in encouraging U.S. Steel in their successful efforts to purchase a plant in Belgrade.

The next morning we met with the Minister of Health in a private meeting, spent time at the conference and toured Belgrade. Later that afternoon we returned for the major dinner of the conference. It was during that event that we experienced a truly amazing celebration of Serbian heritage. There was an ox, sheep, and pig roast (not a good day to be a vegetarian); the country’s winning ethnic, brass band and presentations and awards for everyone, including yours truly.

At 8:30 AM the following morning we had a private meeting with the general in charge of military medicine at the country’s version of Walter Reed Army Medical Center, a one-thousand bed hospital that specialized in every aspect of care including transplant surgery.

We returned to the city for lunch, went back to our rooms to pack, had a quiet dinner and left for the airport at approximately 11:30 PM Wednesday evening, 5:30 AM Belgrade time. For the next 24 hours we were in transit from Belgrade to Paris, Paris to NYC, New York to Pittsburgh and then drove from Pittsburgh to home. Truthfully, it was a nice break. Our organization’s pins are now firmly planted on lapels throughout the Balkans, and only time will tell what the future will bring. We met with several medical students who are interested in doing research with us, several physicians who have vowed to visit us from as far away as Korea and as near as the Cleveland Clinic and have made new friends from Bosnia, Slovenia, Russia, Greece, Italy, France, England, and Montenegro, to name a few.

Our work continues to be heard, discovered and embraced internationally, and our desire to make Windber an international center of excellence continues to move forward. It once again reinforces the fact that we really are all one world and that a child in Serbia has the same hopes and dreams as a child anywhere. So do his parents.

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It’s about 11:30 AM on Saturday, 10/12/07, and I’m on my way to Kennedy.  That’s JFK Airport in New York City.  This will be a very long day as I wait until 7:00 PM for a connecting flight to Paris, and then run for 45 minutes through that airport to make my next fight to Belgrade. Once in Serbia, we will deplane and almost immediately make a speech to the participants of the World Health Congress on Cardiology.

I’m not exactly sure what we will be finding there, but, not unlike my trips to Nigeria and Bosnia, the one thing that I am sure that I will find will be wonderful, friendly people.  In fact, my brother, Charlie and a Serbian-born friend, Steve, will be there with me.

We will be meeting with the Minister of Health, the Head of Military Medicine and a Health Spa.  Then we will head home on Thursday.  It will be lots and lots of travel, lots and lots of talking, and not much sleep, but next weekend will give me plenty of time for that.

So, hang on to  your hats.  I’ll try to connect from Serbia, but, since getting Serbian dollars at the exchange here has not been possible, we’ll just see  how things go. 

The adventure begins.

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Nick’s note: Our dog, Brody, died today, and so, with permission from myself, here is an updated version of a blog that I wrote a few weeks ago for another website:

I am writing this as a health care provider, a hospital CEO, and a concerned citizen.  In the past we have talked almost incessantly about the 47 million uninsured in our nation, and the lack of funding for domestic issues ranging from education to infrastructure.  The Pittsburgh Tribune-Revue last week wrote about the absurdity of suggesting increases in cigarette taxes in order to provide health care for poor children as a very bad idea because this tax plan would have a negative impact on the poor as well?  That logic escapes me as the pieces of the backwards thinking rings in my head.  Getting people to stop smoking, be they rich or poor, is a very good thing.

An article in the New York Times by Sarah Kershaw opened with this pertinent piece of information,

“The federal government has told New York State health officials that chemotherapy, which had been covered for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage. The decision sets the stage for a battle between the state and federal governments over how medical emergencies are defined.”

At our hospital, the decision to treat or not to treat will remain the same: We will treat.

The Washington Post’s Christopher Lee wrote recently that,

“If anything looked like a sure thing in the new Congress, it was that lawmakers would renew, and probably expand, the popular, decade-old State Children’s Health Insurance Program before it expires this year.”

This surely seems like a dream come true for any politician, something that creates a health care safety insurance program for children who otherwise might not have the coverage or financial wherewithal to pay for this care.  What politician would even consider vetoing an already established program that offers health insurance for kids?

Interestingly, President Bush did veto it.  It’s important to note that his veto was not because he is concerned that this program doesn’t work. He has acknowledged that S-CHIP works very well.  He has also indicated that he would not veto it because it is fiscally irresponsible. In fact, this plan is, overall, a very reasonable expenditure. Yes, he objects to any expansion of the plan, but, it appears that this was not the only reason for his veto.

It seems that Mr. Bush’s decision to take this stand is ideological.

The program is diametrically opposed to his philosophy of government.  If you take care of kids, and that plan works, then you can take care of adults, too.  Expansion of government is not something that this president embraces.  But the administration clearly continues to embrace the Iraq war, and that costs money, lots of money.

  From The New York Times, January 17, 2007 by David Leonhardt:

“…For starters, $1.2 trillion would pay for an unprecedented public health campaign” a doubling of cancer research funding, treatment for every American whose diabetes or heart disease is now going unmanaged and a global immunization campaign to save millions of children’s lives.

Combined, the cost of running those programs for a decade wouldn’t use up even half our money pot. So we could then turn to poverty and education, starting with universal preschool for every 3- and 4-year-old child across the country. The city of New Orleans could also receive a huge increase in reconstruction funds…”

It truly is all a matter of ideology?

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