Orcas, a Whiff of Roses and What’s Right with Medicine in America




Tom Robertson, Executive Director, Vizient Research Institute

On the northern end of Vancouver Island in British Columbia is a small harbor called Telegraph Cove. With its roots in a tiny logging outpost early in the last century, it’s situated along a remarkable marine ecosystem known as the Johnstone Strait. Home to approximately 150 resident orcas, Telegraph Cove has an international reputation for whale watching done right – with respect for the whales and an expressed acknowledgement that they, not we, are at the center of things.

On the southern tip of Vancouver Island, in the city of Victoria, is Butchart Gardens, an extraordinary botanical preserve created in what was once a limestone quarry. One memorable summer holiday, we awoke in Telegraph Cove, enjoyed a life-altering morning with the orcas, then drove approximately six hours south to Butchart Gardens where we literally stopped and smelled the roses before calling it a day. I recently had an encounter with the American medical system that caused me to reflect on that day years ago in a beautiful corner of Canada.

I got the call that none of us ever wants to get. During a routine CT scan looking for kidney stones, they discovered a mass. It’s funny how quickly you can go from listening intently to only partially hearing. After 40 years in health care, my brain started to finish the doctor’s sentences, then raced ahead on its own, still processing words that it heard while asking and answering its own questions at an accelerated pace. By the end of the call, it was hard to distinguish what I had heard from what I had thought. The thoughts were every bit as loud as the conversation.

Hearing that you have cancer is like falling into the rapids of an icy river. Numbness gives way to tumbling that at times feels out of control. You gasp for air when your head is above the surface and hold your breath when you feel yourself going under. In between, you tumble. If you’re lucky – and I am – your family jumps into the roiling water with you. They don’t wait to take off their shoes, or to find something that will float, they just jump. If you’re really lucky – and I am – you have among your closest friends some of the world’s most brilliant physicians who appear out of nowhere in lifeboats, grasping your shoulders and pulling you out of the churning water before you hit the rocks.

Writing this essay as I recover from surgery, it feels like time to pause and be grateful for everything that is right about medicine in America. Professionally, I make my most significant contributions, modest as they are, by challenging health care providers to do better, or to do more with less, but today I feel compelled to congratulate the system on how far it has come. Tomorrow I will return to being a curmudgeon; today I would like to say thank you.

Thank you to the folks who meet frightened patients and their terrified families in the dark at 5:00 am with kindness and walk them to where they need to be.

Thank you to the pre-op nurse who could easily focus on the tasks of keeping the patient safe but who talks about everything except for surgery in order to put the patient at ease.

Thank you to the operating room professionals, for whom this is one of a thousand procedures but who remember that for the patient this is the only one that matters.

Thank you to the recovery room staff who realize that it can be unsettling to wake up alone.

Thank you to the nurses, who patiently stay to talk when it would be so much easier not to.

Thank you to the physicians, both those who treated me and those friends who cared for me ... you know who you are.

And thank you to the pioneers, both physicians and patients, who made minimally invasive surgery commonplace. To walk only hours after the removal of a kidney, and to walk out of the hospital 24 hours after surgery is the stuff of science fiction.

There is a lot wrong with health care in the United States: it costs too much, wastes a lot, and at its worst can be harmful. But there is even more right with medicine in America. The science is breathtaking. The technological advances are incomprehensible. The compassion is heartwarming. And the best of the best are better than anywhere in the world. Tomorrow we get back to holding ourselves accountable for unmet potential, but today we celebrate what we have achieved.

If I am tempted to think that I have everything figured out, I will return to Telegraph Cove and to the orcas. A few hours on the water is a bracing reminder that the world is bigger than me. And if I get frustrated by the slow pace of change, or by problems unsolved, I will return to Butchart Gardens and pause to smell the roses. The challenges facing the health care system are bigger than any of us can handle alone but they are not too big for us all to tackle together. In the meantime, it’s worth stopping from time to time to appreciate how far we have come along the way.

About the author and the Vizient Research Institute™. As executive director of the Vizient Research Institute, Tom Robertson and his team have conducted strategic research on clinical enterprise challenges for 20 years. The groundbreaking work at the Vizient Research Institute drives exceptional member value using a systematic, integrated approach. The investigations quickly uncover practical, tested results that lead to measurable improvement in clinical and economic performance.

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