John Livingston

Healthcare through the eyes of a Physician turned Patient

I am convalescing at home this evening after having undergone my second and hopefully my last total hip surgery. I related in an article 2 months ago how grateful I was to the entire OR crew at St. Luke’s in an article in The Gem State Patriot. My surgeon and friend Dr. Ron Kristenson led a team of over 40 people including pre-op, anesthesia, pharmacy, physical therapy, recovery, and post-op transition. Pre-op consultants in internal medicine and cardiology made big contributions during the process. Talent, competence, a work ethic, compassion, and focus are frequently referred to as the surgical virtues. They were 47 years ago when I trained, and they are today. Nothing has changed in that regard.

What has changed are the tools of the surgeon. CAD/ CAM for humans. What is next 3-D printing on an operating room table? The entire operation, all the geometry and trig, the measuring—measure twice….” are done preoperatively with a MAKO CAT SCAN used as a template. What used to take 2-4 hours just 25 years ago now takes 35 minutes. The big morbidities and mortalities of heart attack, pulmonary embolus, infection and air embolus have declined exponentially. The Captain of the ship—the surgeon made technical and clinical decisions for sure, but this evening I would like to talk about “The Executive Officers” and engineers who controlled the process, cadence, and efficiency of the experience

There were 6 RN’s that orchestrated my journey from the waiting area into the OR. They were the “Executive Officers”. They each were the center of one node of activity—the next node was dependent on the previous node for the patient to proceed through the system. These are technical systems. Redundancy is built into the process hopefully approaching “fail safe”, just like the activities in the cockpit of a plane or the bridge of ship. There was a lot of IT and maybe some AI working behind the scenes. But here is the point—the process of handing off information between the nodes will never be able to be handled by a computer or robot. Even the so-called robots used in laparoscopic surgery point out to us that robots really are simply—TOOLS, to be used by real people who through higher functions must deploy knowledge, judgement, and wisdom. AI and robots in a car or a plane or in manufacturing yes. Transferring knowledge about humans to other humans, not so much.

Those who practice in the professions of engineering, law, the trades, medicine—and I very much include physicians, PA’s FNPs, pharmacists, physical therapists, and very importantly nurse anesthetists and anesthesiologists, uniquely exercise judgement where judgement is required. In any of those fields and others, where different options are available as solutions to problems involving people, the computer can sort out the options, but only a person can point those he/she is advising to where they want to end up. The same problem and options when applied to different people may end up with a very different solution. The computer is the tool. The professional is the craftsman. It will always be that way.

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The very last 10 mins of my stay in the recovery room was uplifting. There were many people going home that day and only three transporters to take them out in wheelchairs to their vehicles.

My wait after getting dressed was 15 mins longer than my surgery and my wife was waiting for me in the parking lot. Patience is one of several virtues that I have been practicing with varying degrees of success for all my life. I have been told since I was a child that “I want for several of the virtues”, but most of all it seems patience tops the list.

Talent, competence, an applied work ethic, focus, and compassion are the pillars of surgical education. When combined with a faith in God and prayer the pieces of the puzzle are able to finally fit together. The founders of St. Luke’s—Episcopal Ministers and lay people, and the Founders of ST. Al’s—Catholic Holy Cross Sisters all had as their foundation a faith in God.

Many—not all, of the doctors, nurses, and technicians reflect and share the values of those who came before them. We have been so lucky to share with our colleagues and with our patients’ similar experiences. The pioneers that proceeded before us, understood the value of the doctor patient relationship and for most of them it was why they practiced medicine.

When the wait for me became unbearable I made one feeble attempt to let somebody know about my place in hospital purgatory. After 10 years in retirement, I was reminded of the visual reprimand that seems to be ingrained in nurses and Catholic Sisters who teach 4th grade. So, I decided to do something that I will do more often from now on. I prayed silently in my wheelchair. I prayed in thanksgiving for the journey with its success and complications. I prayed for my wife’s journey for the same reason and with increased vigor. In silence my solitude and peace seemed to catch the attention of an elderly lady across the hall who also was waiting a long time. She too, started to pray, or maybe it was she who inspired me—I was on lots of drugs. Then the patient transfer aid came in the room, and I asked for 2 minutes to finish of my prayer. He agreed and he stood silently behind me. When I turned around his eyes were closed. So were several of the nurses down the hall and the lady across the way. I didn’t say anything, and we moved forward. When he dropped me off at the car, he said thanks for the prayer and I said, “same to you”.

Pew Research estimates today there are 64% of our people in the USA that identify as Christians. Only half attend church regularly with about the same number that say grace as a family or pray together. They also estimate that the fastest “flight from faith” occurs in the top 2% of income earners and in academia. These are the people that are CEOs of large Fortune 500 companies, and that are teaching our children at Colleges and Universities.

My own hope and prayer is that those individuals, at the top of the managerial food chain, those in the upper “elite” that sit on hospital boards, will take time to reflect on their mission. As you do, prioritize your actions and please think about 1. What you do? 2. How you will do it? And most importantly (this should be number 1) why you are doing it—to Glorify God. The many “worker Bees” that take care of patients understand all this. They deserve to be led by people who likewise reflect these values, or at least understand the moral predicate that was the inspiration for those founding fathers and Sisters who traveled across a great desert 135 years ago. It wasn’t money or status or a desire for political power that motivated them Only FAITH IN GOD. Only physical, moral and intellectual courage could inspire such a journey. A journey that continues today, continues to bare witness to their faith in God, but is becoming more monetized and corporatized across all institutions including business, education, health care and all levels of government

Thanks to all who are taking care of me and my family. Our hearts are full of thanks, humility and gratitude.

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