Wednesday, January 21, 2009
Yesterday, I buried a dear patient.
I am a family nurse practitioner and not a stranger to death, but like many health care providers, I have viewed the death of a patient as a failure. Not this time. Karen taught me how to let go. How to accept. How to truly partner with my patients. Thank you, Karen, for the gift of your life and for the gift of your dis-ease that bonded us. Thank you for the grace of your death.
On the morning of her death, I felt Karen—like a bubble of delight floating through me. Not an hour later, her daughter called to tell me Karen had just passed. For the first time in 25 years of healing, I experienced the grace of death.
I chose to become a nurse; not a doctor as my father had hoped or as my college professors had guided me toward. I chose to become a nurse because I wanted the barometer by which I served my community to be one of wellness, not disease. Medicine honorably focuses on relieving illness, but I wanted to do more. I wanted to help my patients achieve their optimal state of well being.
I consciously chose nursing over medicine, not because I couldn’t handle the work. I was valedictorian of my high school, graduated cum laude from UCLA. School was easy for me. I chose nursing because I wanted a full life.
In the early eighties, I had no models of female physicians who had a successful practice, a loving spouse and a healthy, happy family. I wanted it all, so I chose nursing. So I graduated from UCLA School of Nursing with honors and married my high school sweetheart. We are still joyously married after 25 years. He is my best friend, my closest confidante, the Divine Masculine to my Sacred Feminine. We are soul mates.
A year later, I gave birth to our first child, prematurely. We both nearly died. My young husband and I had to make a very difficult choice. Our baby was born intersex. I had had a dream of a blond baby boy, so it was no surprise when our baby’s chromosome test revealed the male XY pattern. But the pediatric endocrinologist advised we raise our child as a girl. Back then we were told, “It’s easier to make a hole than a pole.” I was shocked, not by the bluntness, but by the total lack of consideration for the effect of “his” hormones on the developing brain, and if we raised “him” as a “her” what psychological trauma would “she” undergo at puberty or later in young adulthood. The experts didn’t know. So I followed my intuition, and we raised our baby as a boy.
I then began the struggle that so many other parents of medically challenged children face. I struggled with our managed care insurer to get our son the best care possible. Because we had not followed accepted medical standards at the time, the fight was long and hard. I cannot imagine how much more difficult it would have been if I wasn’t a nurse. Yet even being a nurse wasn’t enough, so when our son was just a year old, I went to graduate school and became a family nurse practitioner.
With a Masters in Nursing, I was better prepared to research my child’s options. Following my intuition, I found the best treatments, many of them out of standard medical procedure, but which are now accepted. In fact, my entire career as a health care provider has proven that my intuition is rarely wrong. I am fortunate to be licensed to order the appropriate diagnostic tests to prove what I “know,” but my patients have come to believe in my knowing. They have witnessed the proof in their in own care and that of my son.
Although with my son’s condition, we could not change our insurance, I refused as a health care provider to be part of a system that would keep me from providing the best care possible. So I avoided working under managed care. After becoming board certified as a Family Nurse Practitioner, I started a family practice within an urgent care. Because of my focus on wellness, the family practice grew quickly. The physician owners saw a business opportunity and signed up with managed care contracts. While the physician employees did not appreciate having their hands tied by the HMO’s, they sorely resented having their compensation tied to managed care. So the other doctors started handing me the HMO patients in favor of the better insured patients.
So I left that practice to work with an up-and-coming OB-GYN. He needed the TLC of a nurse practitioner in the office while he perfected his surgical skills. There I honed my skills in treating the Hormonally Challenged. Six years later, he too was seduced by managed care. By then I had another dream-to start my own holistic health care practice.
With my expertise in hormones and in the face of the aging of baby boomers, my dream manifested into a viable practice. I chose not to deal with insurers. I figured you get what you pay for. Patients paying a $10 copay for a routine office visit left feeling they got about ten dollars worth of care. And providers pressured by the need to see more and more patients in less and less time, delivered ten-dollar care.
Although a cash based practice was a novel idea back then, many of my patients had already been paying out of their pocket to see me, so why not? I left the gynecology practice seeing 27 or more patients a day as an employee to slow down and spend quality time with my own patients; time that they gratefully compensated me for.
In 1997, Karen supported my entrepreneurial nature by following me into my new solo practice. While working her up for postmenopausal bleeding, I had an uneasy feeling and asked the ultrasound technician to look higher in her abdomen. Karen hardily agreed. She had witnessed the power of my intuition a few years earlier when during a routine pelvic exam; I discovered a problem with her liver. So the ultrasound tech lubed up her stomach and placed the probe. That is when we discovered the tumor.
I had diagnosed patients with cancer before. I had even lost a few to the disease. But this beloved patient was different. Her cancer became our dance floor. I learned to partner with her to the rhythm of her dis-ease, to the changing beat of her desire, to the symphony of her life’s purpose. I held nothing back, dancing with her through choices that I may not have chosen, orchestrating a care plan that fit her needs—physically, emotionally, mentally and spiritually. I researched every option, conventional and alternative. She fought the good fight, but at the end…she showed me how to slow dance.
Karen’s death was the first I’ve accepted graciously. The others I resisted and thus could not fully receive the gift of their passing. But hers, I embraced. I surrendered to loving her as a person, to getting close to her family, to being a part of her circle.
At the funeral, others commended me for coming. How could I not? I came to honor Karen, to support her family and to let her go. Like many of her loved ones, I shared my thoughts. Mostly I thanked her as her delightful spirit, free now from pain, played with her little grandson.
This is the way it used to be. Before insurance carriers and malpractice, we used to get involved with our patients. We knew their families, we birthed them, we helped them get through tough times in their lives, and we buried them. We understood the circle of life. They understood too. We respected one another; we were part of a community.
My practice now is on my property. You walk through an herb garden to be greeted by a friendly tabby cat. My mother meets you at the door. She manages my practice. My medical assistant has been with me for eight years. Both joined me at the funeral. My patients love these two wise ladies who put my comparative youth into perspective. Everyone gets a hug. We genuinely care for our patients, and they care about us.
An initial consult is two hours of face-to-face time with me. There is no wait. I have nothing to do that is more important than to be fully present with my patients. We provide all the medical services customary to family practice, but sometimes we do them a little differently. Sometimes a wary toddler is best examined in the garden. Sometimes a reluctant patient opens up with a purring cat in her lap.
One of my new patients just commented during her pelvic exam that the experience with me reminded her of her doctor in France who had her office in her home, made her feel very safe, and that she actually looked forward to medical exams. Her little boy, diagnosed with autism, had been through the mill with medical providers. They were shocked at how patient I was during his exam and consequently how willing he was to “do it again!” His treat for the day was to meet my horses. We might get him into equine therapy for this little one has a way with animals.
From the time I became a nurse, I have been trying to change the face of health care. As president of the California Association of Nurse Practitioners, I led my professional organization to increase access to care for patients. I have tried to enlighten my colleagues—doctors, nurses, and health care providers both conventional and alternative. Until now, many have not been ready to receive such an evolutionary practice model. So I learned my lesson from my patients and began with myself. How can you heal others if you do not first heal yourself?
I transformed my own practice into one that suits my patients, my family and my life. I’ve never advertised. Patients come to me from around the world. I have a unique expertise as a neuro-immune-endocrinologist. My goal is to help patients get their Hormones in Harmony. I educate rather than medicate. With aging baby boomers, hormone specialists are all the rage now. In spite of my expertise and the aging baby boomers, I do not believe that is why my practice has been growing during the recession. They come to me because I dance their dance. I partner with my patients.
If you are a patient, then I believe you, too, can become empowered to partner with your health care provider to get the best care ever and learn to heal yourself.
If you are a health care provider then you can become enlightened on how to joyfully partner with your patients and survive this recession, make a place for yourself in the new administration.
A month ago, I got a call from a dear friend. She was laid off from her job as a pharmaceutical sales rep. A single mom with a medically challenged child -- this did not come at a good time. Or did it? That’s why she called me, to find the light in the darkness. “Nancy,” I said, “this is your opportunity to transform yourself.” She took the ball and ran with it.
We are partners now in a brand new business. FULL-LIFE-SOLUTIONS
Our mission is to transform the business of health care.
Our plan is to Empower Patients, Enlighten Providers, and Educate Personnel.
Check us out at www.full-life-solutions.com
On Saturday February 21, 2009 we are offering our first workshop for the Hormonally Challenged—Hormones in Harmony. It will be small, intimate, a safe place for women to share their concerns and learn the secrets to perfect hormonal heath. There’s only room for 20 participants. And even before we’ve launched our site, women have signed up for this empowering workshop. Come, join us.
There is lots of room for change. A new paradigm of health care is evolving. The time is ripe for us to dance.
“For what is to die but to stand naked in the wind and to melt in the sun? And what is it to cease breathing, but to free the breath from its restless tides that it may rise and expand and seek God unencumbered? Only when you drink from the river of silence shall you indeed sing. And when you have reached the mountaintop, then you shall begin to climb. And when the earth shall claim your limbs, then you shall truly dance.” Kahlil Gibran
Thank you, Karen. May your dance be one of joy. Farewell, beloved partner.