Begin Again

I’ve started writing a post several times over the last few weeks (honestly over the last few years, but trying to put my thoughts into something I want to share with the whole internet has felt daunting). I’ve even finished a few pieces. And at the end, when I go to reread what I wrote, I get distracted part-way through and set it aside. My inner critic says “if you can’t even be bothered to read what you wrote, why would you expect others to make the time to do so?”. [My inner critic is part realist, part asshole, with a sprinkle of cynicism].

I ask myself, “why am I writing this”. Not “why” in the existential “why are we all here anyway”, but really “Why am I putting this out there?”. “What am I hoping to accomplish?”. “What is the intention here?”.

To plant seeds of ideas.

To invite others into the garden of my mind and have a look around.

To point out prickly weeds and worry burs.

What is missing (for me) is the other side of the experience. The reader. Their insights. The community of minds on the internet.

Everything just feels so separate right now. Disjointed. Disconnected. Lonely. Isolated.

I write because I enjoy watching my thoughts become words. I get even more joy out of words becoming action.

Instructions unclear

I keep coming back to work, and wanting to unscramble Modern American Healthcare. What I’m experiencing, in hearing stories from frontline healthcare workers, is… disheartening. I am fortunate to work in a position where I provide orientation to new home health field clinicians, and welcome them from all areas and walks of life. I welcome nurses, therapists, aides, social workers, pharmacy techs, HME drivers, liaisons, managers, directors, nurse practitioners, chaplains, schedulers, office staff, and so on. Some I see once and off they go. Others I see on a recurring basis in classes or in the field. Some keep in touch as they go through orientation and beyond, but mostly it’s when I initiate the conversation. And sometimes, not even then. They are busy learning how to do their jobs. And I’m busy figuring out how to make that job as easy to learn as possible.

The disconnect, I feel, is the disparity between what I teach and what work is actually like. Ideal vs. Real.

And that, right there, is where I get stuck. How far do we need to drift from “ideal” before it’s a problem? A problem that those outside of healthcare are aware of?

Here I am again, looking up at what I wrote. And asking “Why?”.

If my mind is a garden, and thoughts/ideas are seeds, then take a look at this gigantic boat someone dropped over here in a pond with very little water. The boat is called, The Ship of Modern American Healthcare. And it’s in rough shape. The sides are dented and battered, and there are people doing repairs to paint over the blemishes as quickly as possible. Make it pretty, quick!

Those in the garden are standing witness to the collapse of Modern American Healthcare. It’s not just cosmetic damage, the bones, the engine, the staff all need attention. I believe the pandemic shone a light on some of the cracks. But I also believe that a big change is needed… and I (alone) don’t know what it is… I don’t know what to do.

The path forward as either:

A. Paint over the cracks with a shiny veneer… hoping nobody looks too closely, don’t touch or it’ll break…

or B. Call attention to the cracks. Honestly. Openly. Objectively. Compassionately. Swiftly. And bring these brilliant minds together to really get to work. What’s missing? What’s making the cracks worse? What can we unload from the ship?

Want some specifics?

• How can we ease the burden of documentation for all healthcare workers, so they can spend more time caring for patients and less time proving they did it to bill for services? I’m not just talking about reducing the number of clicks, I mean the fundamental trust that healthcare workers are providing excellent care and improving patient lives, without the fear of liability or unmet metrics if they forgot to phrase something a very specific way. We get into patient care to care for humans, and we spend (a majority? of) our time staring at a screen trying to capture everything we did in the medical record. This needs to get change.

• Why are those providing the most intimate care to human bodies (aides) getting paid so little they have to work two (or more) jobs to make ends meet? Why are caregiver services in the community so expensive to the client, yet the workers are paid so little? Is there an opportunity to train folks in the community to volunteer to care for their neighbors, friends, and family?

• Why are healthcare workers at all levels providing care to more patients than they can manage? How do we decide what’s “enough” at these different levels of acuity and need? How do we empower healthcare workers to use their words to say, “this is too much” and “no, I can’t take any more”?

And then I begin again, and again, and again.

I’ve started writing this so many times. It’s gotten as long as a book, and as short as a paragraph before I’ve given up.

And then I begin again.

And again.

And again.

Why? Because what else can I do?

What can we do?

Now.