The view from Mountain View: No going back

Lius_Ba_Sept2013When we left the Coast of Maine a few days ago, the goal was to conflate a few disparate agenda items into a short trip. We needed to transport a few fragile items from our DC home back to Maine. The invitation to chair a board-level meeting at my hospital inspired us to revisit civilization, arrange the items for transport and take a non-stop to California to visit my son, daughter-in-law, and grandson. There are no direct flights to anywhere from Down East, Maine. So if you have to get in your car to take a flight you might as well get other things done, or vice versa.

The meeting I chaired went well and I hope will contribute to a small step forward in patient safety and education.

Subsequently, a lunch meeting I had with the former hospital CEO was very pleasant. It concluded with the observation that after a career dealing with systems he wanted to devote part of his retirement energy to helping one family at a time break out of the cycle of poverty. I represented the obverse. After a career helping one patient at a time, I have developed a desire to change the system.

Reflections from Mountain View

I am now writing and reflecting from Silicon Valley where my lawyer son is “secunded” to Google. It is great to see him in action and great to see my daughter-in-law thrive. Currently that is taking the distinctive form of an eight-month pregnant belly. It is the greatest to see my grandson; more about that later.

Silicon Valley is not what I expected but I have not yet seen it all. What I have seen is Mountain View. It is not much of a valley, having true mountains on only the west side.

I have been to San Francisco several times over the years, including side trips to Monterey and Napa Valley, and I am surprised at how like Southern California the architecture and the demographics are here.

Demographically, Maine is the poorest, whitest, and oldest state in the Union. Here the streets are alive with East Asians, South Asians, Central Americans and, if my appreciation of foreign languages is accurate, Eastern and Western Europeans. I suspect I will miss that diversity during the long winter months in Maine so my plan is to soak it up now.

From my modest hotel in a neighborhood of bungalows I have yet to see the evidence of conspicuous consumption that I suspect dot com money has inspired (unless you think that walking your dog at night with an illuminated collar is an unnecessary indulgence), but I am sure it is out there. I am advised that the bungalows go for a million dollars, or more.

The boulevards seem to be unnecessarily wide and every business along El Camino Real, whether thriving or shuttered, is surrounded by near-empty parking lots. Gun shops, massage parlors and beauty salons stand cheek-by-jowl with upscale day care centers. The commercial architecture favors one to three-story structures without eye appeal. It is hard to tell apartment complexes from hotels or brake-and-lube shops.

Although the ethnic diversity is appealing, the services it has inspired – particularly the restaurants – lack the sophistication of Brooklyn, another rationalization to soothe me during the long winter months in Stonington.

Hard to describe the excitement of Google

We toured Google this week with my son. The energy and excitement are hard to describe. The pleasant workspaces, reasonable hours and pro family attitudes make it an appealing workplace. Expectations are set high but with the added comforts of on campus carwashes, haircuts, oil changes, dry-cleaning, etc., employees are inspired to produce.

The best part of the trip was to be recognized by my grandson with whom I had not hugged for three months. It is heartwarming when that happens.

At age 22 months, his grasp of the English language resembles my grasp of French, a language with which I am trying to become reacquainted. We both understand more than we can articulate. We both suffer the occasional catastrophic misinterpretation, hearing and believing the opposite of what was intended. Even when we do understand perfectly there is a problem integrating and then synthesizing a response, resulting in a ten-second delay between instruction and action. Our pronunciation is tortured.

We both view the world with chronic perplexity.

He is great fun.

So where do these reflections take me?

News Flash from GYA60

If you do not have specific plans to go back to your old life, do not try to do so. Look forward.

GYA60 is neither a sabbatical nor a gap year between levels of higher education. Rather, it is a little of both and then some. A traditional sabbatical is underwritten by your place of employment with the understanding that you will recharge your brain cells and return to work re-inspired, re-energized and with improved efficiency. A traditional gap year is paid for, or at least subsidized by, your parents with the understanding that you will return to school re-energized and more mature and that you will apply yourself to your studies with renewed focus.

A Gap Year After Sixty is subsidized by your children…

GYA60 is paid for by your children (with money they will not inherit). The understanding is that you will recharge your batteries and return to the work force as a new person with different motivations. You have looked at your career to date and said, with satisfaction, “Been there, done that.” And gaining maturity has nothing to do with GYA60. Been there and done that, too. Revitalizing may require throwing off a layer of responsibility and maturity to let the inner you grow.

In planning my GYA60 I wanted to maintain contact with DC job prospects. I wanted to hold my options open. I wanted to shelter the possibility of returning to a semblance of my former career. After three months of reflection and active self-redefinition I am realizing there is no possibility of returning to my old work life. I will never be a full time clinician again. No time. No where.

No going back

So do not hedge your bets. Do not waste that time and energy. Change and then make change happen.

With each day forward I am a step further away from my old career. There is no going back.

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Gap Year metrics: how to fit it all in

DEM_RAM_Aug2013Andy*, this one is for you, but you have to read to the end to get the rant.

It has been about two weeks since I returned to Maine from visiting my father in Milwaukee. This is peak summer vacation time and, indeed, that is what I have used it for.

A Gap Year principle that I am passing along is: do not over schedule; you will fail. That’s especially important when your body clock says “Maine! Vacation!”

As I have said before, if I could practice medicine, run the business of a private practice, serve on non-compensating boards and committees, maintain a family life as well as a Washington social life AND… write a book, reform health care and plan exotic trips, then I would not need a Gap Year.

But I cannot do all those things and so I need a break in August.

Reminder: why a Gap Year

Now that I have the time to enjoy an extended family visit in my favorite place on the planet, I still do not have the mental energy or strength to pay my day-to-day bills, play golf, sail, repair motor boats, babysit for two toddlers, prepare fresh seafood for island guests and in-laws AND research health care reform, research French lessons, research exotic travel (safe, yet outside the “tourist bubble”) and think about job opportunities for next year.

Something has got to go.

I have to remind myself that when I first began this year I knew that June would be a month of transition, July would be a combination of events and projects (finish the guest house, go to the World Domination Summit, visit my father) and August would be spent trying to have an extended summer vacation without the time pressure of past visits.

Measuring the perfect eight-hour day

The lesson I have learned is that while I had hoped to plan and research my Gap Year projects simultaneously, that is not going to happen.

My dream of a structured eight-hour day of research reading, personal growth reading, exercise, writing (touchy-feely blog posts, health care rants, personal notes), French exercises, etc. has not worked. I am unsettled over the fact that I cannot do it all and cannot decide what to do first.

Therefore, I am letting my grand plans wait a few more days until my grandbaby toddlers decamp and I can dial down in-law visits. Then, I promise I will get my schedule set and Debbie and I will start and end each day with briefings, progress reports and a review of Gap Year “metrics.” [Ed note: looking forward to this. – Debbie]

And now… a rant about healthcare metrics

Ok, let me rant about metrics for a minute. Does your business have metrics? Is it ruled by metrics? Do they work?

I suppose metrics have a role in terms of dollars and cents, time sensitive production issues and quality control of widgets. They may even have some role in the management of hospital systems and medical care.

I will grant that keeping the “post sternotomy blood sugar below 200 mg/dl” is associated with better outcomes and fewer wound infections (I’ll bet most of you don’t know what that means and never thought it would be measured) and is a laudable goal.

But is it a metric we should pursue? Everything can be turned into a metric. Should we do so?

Our rankings have slipped; what metric shall we improve?

I remember well a quality committee meeting at a WFMC (World Famous Medical Center, to the uninitiated) where the business people outnumbered the health care providers.

Three issues come up over the course of an hour. These were how many patients were dying of septic shock per month; how many patients dying of septic shock should be or were palliative care patients; and how much time elapsed between the first symptoms of septic shock, its diagnosis and the initiation of treatment.

Because of the high mortality of septic shock patients at this WFMC, its standings in the U.S. News and World Report rankings had slipped and the bean counters wanted to improve these metrics.

Conflating improved patient care with improved metrics

Suddenly these issues were conflated into a single management tool. It was proposed that a Septic Shock Rapid Response team could be created and the time from notification to treatment could be monitored.

Recognizing that much of the delay in treatment (and therefore the success of treatment) could be attributed to family discussions about appropriate care in a palliative care situation, it was proposed that diagnosis and treatment be instituted before a definitive family decision.

Well, if you have not seen the initiation of a septic shock work up you do not want to see one now. And, if you have you would not wish it on a family member in or near a palliative care status. It is brutal.

Fortunately, reason prevailed, at least briefly, and the metric managers looked elsewhere for something to monitor.

Patients are not widgets

People are not widgets. ER throughput of patients (another metric) should not be about filling beds to make more money but should be about getting the patient to the appropriate care level in the appropriate time period (a judgment, not a metric).

I am going to play golf, but I am so angry thinking about metrics that I am not going to keep score.

[Ed note: thanks to cousin Andy for being a loyal reader of this blog. As for golf, Sam reported back that he was six over par after six holes. Then he quit. – Debbie]

Transition: is it the new normal?

New_office_SMALLER_July2013Sam has been writing a lot about measurable sign posts as our Gap Year progresses, week by week. In fact, he’s been writing a lot. Much more than I have.

I’m going to chalk that up to the eagerness of a first-time blogger. I’ve been blogging for a decade and I’ve developed some bad habits. I want everything I write to be original and fresh.

Fuhgeddaboudit.

That isn’t possible. And if you get stuck on that approach to blogging you will quickly become constipated, cramped and cranky.

In other words, there is nothing truly new on this planet. There is only originality of voice and perspective and the occasional gleaming turn of phrase… if you are lucky and in the flow.

Today’s topic: transition

Perhaps because of his 31 years in medical practice with office visits stacked one on top of another, Sam tends to be organized and goal-oriented. He talks about three weeks and six weeks into his Gap Year and what he has – and has not – accomplished.

If he (aka we) can just unpack the boxes… if he (we) can just declutter the house.

For the record, I think the guy is remarkably well adjusted for someone who has gone from 60MPH to 10 or 15MPH in the space of a few weeks. He has moments of anxiety but so far they relate to things like his frustrations with the U.S. Postal Service and Blue Cross Blue Shield. Specific, tangible problems that he can wrestle with, however aggravating.

But yes, we are both measuring progress by whether the boxes are getting unpacked in our new guesthouse. (Yes! See my new office above.) Whether extraneous stuff is being sorted through and disposed of.  Bottom line, whether the level of chaos caused by a semi-move to the coast of Maine is abating.

The grandbabies arrive, bringing new (delightful) chaos

Picnic_July2013But then… the grandbabies arrive and move into the guesthouse (with their parents). And more chaos ensues.

I am beginning to wonder if this kind of transition isn’t permanent. At least for a while. I am feeling much calmer than I was a few weeks ago when I wrote about feeling unmoored. Perhaps I am learning to drift.

Take today as an example. Part of the day will be taken up with the ebb and flow of grandbaby activities. I’m not responsible for constant baby care (thank goodness) but I love to dip in and out of what the little girls (ages one and three) are doing: playing outside, squealing, having a snack, making a mess…

I am so grateful that they are ensconced in our guesthouse next door. And not under the same roof with us. It’s only a separation of a few feet but it affords Sam and me a cushion of quiet and peace. And our daughter and son-in-law seem to love having their own place.

My new office is on the second floor of the guesthouse (see above) so I’m not using it just now. I’ve told my son-in-law, a law professor, to set up a spot for himself and he has happily obliged. The office has a panoramic view of the Deer Isle Thorofare. It’s marvelously bright. But it gets quite hot by the early afternoon. I will have to get shades. Tick. Another item for the To Do list. But I am looking forward to that.

Is transition good or bad? What does it mean?

Back to the concept of transition. What is it? What does that mean? What does it feel like?

Well, there is a sensation of gentle movement and of being carried along but in a not unpleasant way. And I am getting used to it. I know that this particular time is transient – this wonderful visit with my daughter and son-in-law and the babies. And I relish it, knowing that it is so special and that it will end.

But it does call into question: how does one measure time? How do you measure progress? Is it important to have goals? What should they be? Are they different when you are experimenting with how you spend your time?

You will note that I haven’t said a word about my work with authors or about my own writing. My writing on topics other than our Gap Year is suffering at the moment. The interruptions do affect me. I can’t deny it. I can hear three-year-old Dorothea shrieking through my window. I am going to investigate.

And yes, this blog post counts as a chunk of writing for today.