Journey to Joy: Painting Regina Benjamin, MD

On July 13^th 2010, I met Surgeon General Dr. Regina Benjamin.  She stood at the podium and explained from the provider perspective the importance of electronic medical records in clinical practice.  Moments later I stood in her place and spoke about the importance of access to the electronic medical record from the patient perspective.

That day was the announcement of stage one Meaningful Use.

Based on her account on that day I painted a picture upon a jacket.  For over nine months Ted Eytan, MD has worn that story on his back to venue after venue.  His has told many of the powerful work of Regina Benjamin, primary doctor.

On September 13^th 2011, I met Regina again.  She was onstage at the ONC Consumer e-Health Launch.  That was a magical day.  On that day the patient stood front and center.  I stood in the back of room and painted speaker after speaker as they addressed the need for patient participation in healthcare.  An entire panel of patients sat upon the stage.

I painted joy that day and Dr. Regina Benjamin was in the middle of that joy.

Afterwards she came to my easel, she was so happy to see the resulting painting.  A few weeks later, I walked to the metro with the painting in hand.  Then took the train to the closest Metro Stop.  Then walked to HHS.  I think Regina would appreciate my healthy journey to deliver the painting.  I left the art in her office on loan and in good hands.

On February 23^rd, 2012 I greeted Regina once again.  We were at HIMSS in Las Vegas and would both be keynoting the opening session of Leading From the Future.  I spoke first and mentioned her within my slides.  Then I descended from the stage and Regina began to speak.

She took us on a journey filled with words and pictures.  As she spoke, I began to paint.



She told us she lost her paper medical records twice to flood waters and once to fire.  She explained how she and her staff lay page after page of medical records upon the sunny ground surrounding the practice.  Ah, the bravery of this woman! When others might fear a HIPPA violation, and so let such data molder, she did all she could to help her patients maintain their treatment history.  She said that after the hurricane she had no prescription forms and tore up pieces of bond paper and hand wrote prescriptions.  Many of her patients had no funds for food let alone medicine.  She covered the cost of many of those prescriptions herself.

So in this painting, Regina holds her torn prescription sheets and they fly around her to become the data that fills an EHR.  Behind her blue water flows upward, a red ribbon of fire destroys the paper past and green data streams save lives.

As she said that day “An EHR means never having to dry wet charts in the sun again.” 

But Regina speaks of far more than data, she told us about her better health campaign.  She wants to increase the health level of patients at every stage of life.  She told us we must not focus on what we can’t do; instead focus on what we can do. 

We must start our journey to joy. 

She said one in four American’s do not know that they have diabetes.  She said we must become aware of our health status and we must learn about our family medical history through generations.

She addressed the power of social media to spread the message of better health.  She spoke of a partnership with Facebook to report suicidal comments.  She explained that she had recently joined twitter as @SGRegina and participated in a heart chat that reached over three million people. 

She spoke about reason some women forgo exercise and said it was okay to have a “bad hair day.”  As the daughter of her hair stylist, Regina was well aware many women were not getting the exercise they needed, as they were concerned about maintaining their hairstyles.  Some people may consider this a “soft” issue, but women must often choose between economic viability and exercise.   If that is the choice, most women will choose to look professional and maintain employment. She also spoke of her continuing outreach to hair stylists as health ambassadors.  People see their hairstylists and barbers often.  She said hair professionals could be a great resource for promoting public health. I was so glad to hear this, as I am very aware of the palliative effect of hairstyling.

After her speech, we both stood upon the stage and answered question after question in tandem.  It was beautiful. It was participatory medicine at its finest and I am so honored to join Regina in her journey to joy.

Shoot the Moon: Ted Eytan's Jacket

In January 1993, I learned a very important concept in card playing.  It was semester break at Oklahoma State University and I was spending hour upon hour playing hearts with my best friend T. J Jones and her fiancée Evan.  I was often a cautious player, but when the deck was stacked against me and my back was against the wall, I would “Shoot the Moon.”  I would either win the hand or fail miserably.  There was no in between.  At that time in my life I was only 20.  I was preparing to join the Navy and had not yet kissed a man named Fred Holliday II.  He was only 22 years old himself.   I was having trouble paying rent and was most definitely following the path of many an artist and theatre major, by failing half of my college classes.

My life was at a crossroads.  I would have to make a fateful decision, to fold my hand or to “Shoot the Moon.”  I wrote the poem below during this period.

Hearts

Though darkness is spreading all over my land,

The cards, they still could lie.

The Black Sister hides her face this night,

Not yet my time to die,

At least not with these hearts in my hand.

~Regina Hollliday

I ended up joining the Navy and becoming engaged to Fred.  Fred was very sad when I left.  I made it through boot camp, even running a mile and a half on a knee with torn ligaments.  On a sunny day in July, I graduated from Boot Camp. I was so proud to wear my dress whites on the parade field in Orlando.  Then I spent two glorious weeks with Fred on leave before going to technical school in Chicago.  I even painted a mural in the local Navy recruiting office and received a commendation.  Then, I left for technical school and darkness descended.  Both Fred and I sank deep into depression in our lonely rooms so far apart.  I did not want to fail again.  I did not want to fail in school.  I did not want to fail in love.  I wanted to stick it out and succeed in the Navy, but that wasn’t in the cards.  So, I folded.  I left with an entry-level separation for situational depression. 

I never wore my dress whites again.  I got married, and became a toy store asst. manager and a part-time pre-school art teacher.  I would support my husband both emotionally and economically for many years.  We would have two wonderful sons.  And I thought I would never march again. 

On another sunny day in July 17 years later, and I was thinking about dress whites.  It was July 13^th 2010 and I was seated on stage with another Regina.  This was Regina Benjamin, Surgeon General.  She looked vibrant and resplendent in her uniform.  Her forehead was beaded with little drops of sweat.  The HHS building was crowded that day because it was the announcement of the final rule of Stage One Meaningful Use.  Regina Benjamin was the fourth speaker the day and she recounted the powerful reason she supports electronic medical record adoption.

Here is an excerpt the words she spoke that day:

Finding My Way to Electronic Health Records

Regina Benjamin, MD, MBA

The current oil spill in the Gulf Coast may prove to be one of the great ecological challenges of our lifetime.  It is yet another devastating blow to the Gulf, a place I call home.  My heart goes out to the people in the region who are concerned about how this will affect our livelihood and our health.  While the full effects of the spill remain to be seen, already the health needs of Gulf Coast inhabitants are increasing during this time of crisis.  Physicians in the area will therefore need to adapt, and find innovative ways to efficiently deliver health care for an already underserved population.   I think back onto my journey as a physician during the crises of Hurricanes Georges and Katrina, and try to remember how I adapted. 

The day after Katrina hit, I drove through Bayou La Batre, a small fishing village on the Gulf Coast where I practiced medicine for 23 years.  The damage didn’t look so bad when I pulled up to my clinic.  However, when I opened the door, I nearly fell sick from the smell of dead fish and crabs.  Furniture had been tossed around the office every which way. All the patient information, all the paper records – were ruined.  I remember thinking to myself how I had tried to prepare for this, and recall that I had strongly considered electronic health records.  However, as for many small practices across the country, money was tight, and it eventually became a choice between the light bill and an EMR system.  Searching for a source of courage, I tried to think back to why I chose to become a family physician. 

Like many physicians just out of school, I believed strongly in primary care – my mother, father, and brother all died of preventable diseases.  As a National Health Service Corps scholar, I now had the privilege of making a difference in a small community.  

In 1998, Hurricane Georges made landfall in the Gulf Coast, causing over $100 million in damage to Alabama alone.  My clinic was destroyed.  Without a building to treat patients, for the next two years my nurse Nell Bosarge and I drove my pick-up truck to their homes.  Eventually I mustered up the resources to rebuild the Bayou La Batre Rural Health Clinic—on higher ground this time, and on four-foot stilts.  Meanwhile, we managed to save the drenched paper records of our patients by carefully drying them in the hot Alabama sun. 

In 2005, Hurricane Katrina came, again threatening to destroy the Bayou La Batre Rural Health Clinic.  We had 48 hours to evacuate the area, and given the new secure location of the building, saw no reason to pack away all of the paper medical records.   When I returned to the Bayou, the building was destroyed by the water.  Nell and I knew we had to get everything out of there, or else it would mildew.  We spent just as much time clearing out the medical records – again placing them in the 90 degree sun to dry them, carefully turning them over – as we did trying to salvage the structure of the place.  This time, I could not make house calls to my patients’ homes, because the vast majority of their homes had been destroyed, too.   Meanwhile, our staff set up a makeshift clinic in the auditorium of a local shelter, while volunteers and donations helped us prepare for a January 2^nd reopening. 

Tragedy befell the Bayou Clinic once again, when in the early morning hours of New Year’s Day, just before our clinic was to reopen, a fire occurred and the clinic burned to the ground.  This time, the precious patient records, the ones Nell, the staff, and I on two separate occasions spent precious hours drying and recovering, were now completely destroyed.  We now had to rely on memory and intuition in treating our patients.  Any information on allergies, co-morbidities, and specific family history was now left to recollection. 

Having lost the Bayou Clinic on three separate occasions – twice to hurricanes, and once to a fire – I knew we had to have a better way of practicing.  I needed to find a way to deliver high quality health care to people who didn’t have a lot of money.  From the experience with Hurricane Georges, Katrina, and the fire, I knew we had to be able to evacuate the clinic quickly, while still safeguarding the vital patient information.  Prior to that, I had strongly considered an electronic health system, but I couldn’t afford one.  However, now, I realize I couldn’t afford not to have one. 

Our trials did not go unnoticed.  Wonderful people from all over volunteered their time and money to help us rebuild.   A generous donation from the Health Information and Management Systems Society (HIMSS) supported our efforts through the Katrina Phoenix program, helping us rebuild our clinic with computer hardware in coordination with a generous EMR vendor thru the good-hearted student volunteers from Bentley College.  They also provided us with support through the processes of learning how to use the system and implement it in our practice.  Needless to say, Nell and I were relieved when we turned on the switch and became a paperless office. 

Though it is challenging to convince some doctors and nurses to convert from paper records, “buy-in” was not an issue at the Bayou, as Nell and the rest of the staff were adamant about never having to “bake charts in the sun” again.  The new system we implemented allowed us to easily track and document our patient histories, and with a click of a button we can send a prescription, or remind patients of upcoming mammograms, thus improving the quality of care.   Practicing medicine became easier for the clinicians and better for the patients. 

With the availability of new incentive payments in place from the HITECH Act, and support transitioning to electronic health records available from local regional extension centers, small practices like mine have the kind of support I did—and fewer reasons to delay a decision that was obvious from the start. 

Until the day we turned on our EHR system, I was still using pens with waterproof ink.  It is so good not to need those pens anymore.”

-Vice Admiral Regina Benjamin, MD, MBA is a Family Physician, and the 18^th Surgeon General of the United States. 

 

I was so honored to speak after Regina.  I spoke about the importance of electronic medical record to patients.  After I spoke, Regina and I exchanged contact information.  Visions of floating medical records danced behind my eyes.  I swore, someday I would paint the scene she so eloquently described.

So one month ago when I proposed the idea of The Walking Gallery, I asked Ted which story would he like to present.  He responded that he would like to wear Regina Benjamin’s powerful story.

There have been 23 men who have held the position of surgeon general acting or otherwise in the 100 plus years of this office.  There also have been four women to serve in this role.   I was pleased to learn that every woman who has attained this role in public health was a woman of color.  I wonder though if many people know their names?  I was hard pressed to think of a name of any Surgeon General other than C. Everett Coop who served in his role from 1982-1989.  I remember this name even though I heard it as a child and then a teenager.  In my mind, his name means say no to cigarettes and use condoms to prevent Aids.  And if you Google him with his titles you will get over 75,000 hits, even though he served over twenty years ago.  Regina Benjamin has been at her post for almost two years in a 24/7 digital age.  If you Google her with title to her office, you will get 70,000 hits.

Now some people say that the role of Surgeon General is only a figurehead, she has no real power.  But, I must say that using a public platform in a digital age can result in great positive change within the populace.  I would like people far and wide to hear her message.  As I painted this painting, I was saddened to how small Regina’s ripple was within the tide of social media.  So I painted her reflection in the water as indistinct with only the smallest hint of her dress whites in the water. 

A scene of tragedy lit by the moon.  That is what I painted for Ted.  I painted a Doctor who when all seemed lost would not give up.  When the darkness was spreading all over her land of Bayou La Batre, Dr. Regina Benjamin decided to “Shoot the Moon.”  She would either fail miserably or she would succeed.  No great change is possible without the chance of great failure.  Now, I hope that Regina brings her wit, passion and fortitude to “Shooting the Moon” in the world of medicine and social media.

I am happy that shall I march again.  I shall march with Ted Eytan at my side.  We will both be spreading messages as part of a movement.  That movement is The Walking Gallery and we are redefining the meaning of mobile health and data access.