We are living and working in a dynamic time for healthcare. New and exciting therapies are being developed and technology allows us to successfully, safely and effectively treat patients who previously would have died. However, we also face many challenges – such as a significant number of our patients who remain uninsured or underinsured.
And yet, there are a lot of things about the delivery of healthcare that separate it from being just a job, a source of income or a place to which to go every day. We assist, treat and care for patients and often times, become inspired by the people with whom we have regular contact. The sources of that inspiration are many and often include colleagues, ancillary staff and our patients.
The source of inspiration can be subtle and come unexpectedly. Such an instance happened to me just last week. I was asked to see a gentleman to evaluate an arteriovenous fistula (AV fistula) on his left arm which he uses four or five times a week for hemodialysis.
For those who don’t know, kidney failure is a very difficult problem to manage. When one gets to end stage kidney failure, dialysis treatment is necessary to stay alive.. One of the more common forms of access to the bloodstream for hemodialysis is to surgically connect a patient’s artery to a vein. This connection is usually done in the arm, and, when it functions properly, provides a high flow, superficial access site for fairly large needles which allow for blood to be taken out of the body and then, once cleansed, returned safely back into the body.
As I frequently try to do, I scanned the patient’s problem list in his electronic medical record so I would have at least some idea about his overall medical condition before the appointment. With a mental picture of a chronically ill and obese patient in mind, I entered the exam room to find a very fit looking gentleman waiting for me. I thought I had the wrong room but immediately realized that this was the patient I was just reading about. A quick exam of his AV fistula showed that it was working fine and did not require any intervention at this time. We then discussed other health related issues and I asked him about his weight and history of morbid obesity.
He shared instances of some very challenging times that resulted in taking very poor care of his health. His weight ballooned above 350 pounds and with it came associated problems of back pain, high blood pressure and diabetes. Those issues coupled with medications for the chronic back pain took their toll on his kidneys, ultimately requiring him to start dialysis. That scenario is common and frustrating for all.
And yet that was not the patient standing in front of me that visit. This gentleman appeared fit, proactive and engaged in his healthcare. He was doing home dialysis which requires patients to be quite skilled in medical techniques. When done well, it provides patients with greater flexibility, freedom and sense of autonomy.
I asked about his weight loss – he no longer weighs 350 pounds. He said that he decided that he could not go on living the way he was and decided to change his life. He decreased his food portions. He cut out soft drinks and began to exercise regularly. He lost weight steadily and his overall health began to improve.
It was a fairly brief visit. I was not expecting to be “inspired” when I walked in but I certainly walked out with tremendous respect for what this patient has accomplished. How did he gather the strength to get control of his life? What was the source of this inner strength? Why now and not earlier in his life? How could I understand it better so I could use his formula to improve the lives of my other patients? How could I learn from him to improve my own life?
Healthcare delivery is not always easy. It is frequently complicated by a multitude of factors. It is easy to develop a negative outlook. If we are not careful, that outlook can negatively affect how we feel about what we do. But if we take the time to listen to our patients, our colleagues, our staff and others, we will find much to inspire us to do better.
We will realize that there is a lot for which to be thankful.