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Monday, May 9, 2011

Megan’s Jacket: Lost in the Slough

Lost in the Slough

Yesterday was Mother’s day and tomorrow is my birthday.  After painting most the day, I went down to the mailbox.   There was a card from my Mother.   I had just spoken to her yesterday on the phone to wish her a happy Mother’s day.  She never writes very much.  This time it was “Happy Birthday With Love, Mom.  P.S. Wishing you many more Happy Birthdays.” 

My mother only has an eighth grade education.  She doesn’t like to write very much although she has excellent penmanship.   She often laughs after making a statement. As though to say, if I didn’t say that right, it was only a joke.  I tend to do this too, especially if I am nervous.  She has the sweetest crooked smile that resulted from a case of Bell’s palsy long ago when I was only five years old.  I remember the eye patch she wore as she helped me with my homework.  I was trying to learn my letters.  I had written them all backward.  She held the sheet up to a light and turned it around and said,  “See, that is the way it is supposed to look.”  After teaching me my letters, she felt out of her depth as the curriculum became harder and harder.  But she would read to us at night.  I would cherish the times I would nuzzle against her with my sister as she read us the entire Little House on the Prairie Series by Laura Ingalls Wilder. 

I vividly remember one scene in the book “The Long Winter.”  In that chapter Laura and her younger sister Carrie decide to take a “shortcut” through the tall swamp grass or “slough” (rhymes with new.)    Prior to entering the grass they could see their Pa across the field, but as they waded deeper into the tall grass, they realized their very dangerous mistake.  They could not see above the grass around them.  They walked on and on tired and thirsty.  They had no idea if they were going in the right direction.  This image came to my mind last week as I heard Paul H. O’Neill Former Secretary, U.S. Department of the Treasury speak at the New Frontiers in Patient Safety, a Rosenthal Lecture presented by the IOM (Institute of Medicine.)   

I had been invited to attend this IOM event as I had attended some prior events hosted by the organization.  It was on Wednesday the May 4th, 2011 at 5:00 pm.  Now, it is rather hard to find a sitter at that time.  I went through my regular list of sitters and then contacted Megan Mitchell to see if she could watch the boys.  Megan is 14 but very dedicated and responsible.  She has been helping me host art workshops and community art projects for the last four years.  
Megan and Eleanor prepping for the Clinovations Art Show
She and her friend Eleanor helped create the nametags for the Clinovations Art Show last July.
They were even at the Gallery Event that night, though, as they are quiet and young I am not sure how many people saw them.   Megan said she could watch the boys, so I dressed in my best suit and left for the lecture at the Keck Center at 500 Fifth Street.
As I approached the building I saw incised into the wall a quote by Albert Einstein, “The right to search for truth, implies also a duty; one must not conceal any part of what one has recognized to be true.”  I thought this a very important and a centering statement to read prior to entering the building.
"Where do thoughts come from and Where do They GO?
When I entered, I saw some amazing art as I climbed the stairs.  I stopped to peruse this piece on the second floor while the tide of attendees rushed up the stairs or sidestepped the experience by taking the elevator.  The piece was an amazing tromp l’oeil by Robert Van Vranken created in 2002 and though untitled it is subtitled: “Where do thoughts come from and where do they go?”  It pictures an airy laboratory filled with the ephemera of life and the inclusion of such mundane accruements in such a vast piece elevates these items to a level of great importance.  

The speakers at the Rosenthal Lecture were very accomplished in their fields.  I was pleased to see them announce at the very beginning the Twitter hashtag for the event, and then saddened to see only four of us live tweeting.  The keynote speaker was the Honorable Kathleen Sebelius.   She delivered a powerful speech.  She pointed out that although pockets of excellence are nice, they are not enough.  She reminded us that this room was filled with national leaders in patient centered care.  She challenged us to raise our expectations.  Our goal ten years after the IOM report was not to reduce line infections it was to eliminate them.  0% is the acceptable rate for hospital injury.  She went on to say, “If we only improve care in the next decade as much as the last, we are FAILING.”

Harvey V. Fineberg, MD PhD President of the IOM then introduced the rest of the panel.  Donald Berwick, MD Administrator for CMS, Carolyn M. Clancy MD from AHRQ, Brent C. James MD, M Stat CQO Intermountain Healthcare and Paul H. O’Neil former Secretary of the US Department of the Treasury.  And they all had a lot to say about institutional morass.  I looked up to count the patients on the panel.  I counted 4 MD’s and Paul.  I counted 4 men and one woman, even though 70% of caregivers are women. 
Lost in the Slough
When Paul began to speak I was very happy to hear a voice as frustrated as mine often is, as he applied the standards in business to medicine.  He said before the crowd,  “It is like there is a Mountain in the middle of a prairie and no one seems to see the mountain!” And in that moment I saw Megan’s jacket for The Walking Gallery.  I could see a way you could miss a mountain in a prairie.  I could remember Little House.  When you are stuck in your traditional workflows and processes it is really hard to see the larger problem.  If you want to see the mountain you might need to work together as a team and stand on the shoulders of the patient community.  You might want to include a patient on a panel at an IOM lecture.

After Paul wrapped up.  The floor was open for questions and I waited patiently to ask a patient centered question.  They called on two gentlemen to speak and as was about to get to ask a question when the delightful Danielle Turnipseed, an IOM staffer was flagged to the front to hand the Microphone to another man.  Then time was up.

I went to Harvey Fineberg afterwards, and thanked him for the event and told him in the future he might want to call on a few women in the audience.  He looked at me quizzically, his kind face wrinkling in concern, “I hadn’t noticed that I had only called on men.”
Megan the Mighty Mountain
Sometimes when we are in the slough we don’t notice things, we don’t see things.  I know I have a closet full of jackets I need to paint that are the property of some pretty important people, but I painted Megan’s jacket today.  I painted her jacket because she is young, kind, and oh so very quiet.  She is exactly the kind of person you might not see.  She will turn 15 a few days before she wears this jacket.  She will be the same age Laura Ingalls was when she finished her education, the age my Mother was when she too had to stop learning and start working.  I want I want a bright future for Megan, for she is mighty and solid like that mountain. She is that invisible patient, that hidden mountain anyone of us could see if we only stopped and looked above and beyond our daily life.

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