A lovely note crossed my desk recently. "You know something?" began the letter from 74-year-old Mrs. P, who received home care for complications from diabetes. "I would sooner do this than complain. People take the time to complain, but they will never tell you when something is going really well."
One of the great privileges of my job overseeing patient care services at the Visiting Nurse Service of New York is that I get to hear from people like Mrs. P, telling me when things are indeed going well--and how that impacts their lives and the lives of those whom they dearly love. The note from Mrs. P went on to praise one of our physical therapists, Peter Wu, for "everything about him, his mannerisms, his demeanor, the way he pushes you when you feel like you are not being pushed."
Looking over these letters as Thanksgiving approaches, I am reminded that health care--amid all the debates about regulations and costs and insurance coverage--is fundamentally about human relationships. It's about how we as people can make one another feel better, through health care yes, but also through compassion, connection and commitment.
My colleagues often speak about what an honor it is to come into people's homes, to enter their personal space and sanctuary. And it's true that every home, just like every patient, is unique. It is more than a healthcare transaction when we enter a home filled with the smells of lou fo tong or sancocho or borscht cooking on the stove, and photos of children and grandchildren as babies and in graduation caps. These are the sights and smells of life. We find knitting-in-progress, sports-team memorabilia, a favorite program on the television and music collections spanning decades. In short, we find each individual's avenues of human connection. I still remember one of our physical therapists telling me about an elderly patient of his who was inspired to work hard at her recovery from a stroke just so she could bake him the old-fashion lemon cake that the two talked about during her therapy.
Care involves seeing someone as an individual--someone with needs, feelings and fears that are just as real as your own. A letter from Mr. R, a New Yorker recovering from a total knee replacement, illustrates just what is possible when health care is delivered human being to human being: "I have been openly gay since the onset of the AIDS crisis. Too many times, I've seen health care workers who were 'indifferent' to people they had no empathy for. The [care team's] empathy towards me ... was obvious and genuine, and I can't thank you enough for that."
As home care workers, we meet people at some of the most miserable and uncomfortable times in their lives, when they are suffering from illness or injury, recovering from debilitating surgery, or when a chronic condition has become unmanageable. Receiving care is not always easy for some patients, which means that in addition to the crucial clinical of dressing a wound, checking blood sugars or improving balance, simple human kindness is essential, and often goes a long way. As one daughter wrote to us, "My mother who has been difficult ... engaged in conversation and was pleasant for once in a very long time. You can tell that Dahlia enjoys her job and she is one of the best I have ever encountered."
One of my favorite letters from a thankful patient ends with a quote from Florence Nightingale: "The amount of relief and comfort experienced by the sick after the skin has been carefully washed and dried, is one of the commonest observations made at a sick bed." Mrs. S, a Brooklyn woman with diabetes and a non-healing wound, thanks her team, including nurse Mikelange Herve, for being "patient, inspirational and serene," which sounds to me like a good recipe for healing the spirit as well as the body.
Thank you for listening
We often get letters from patients or family members who are most grateful for an advocate in a healthcare system that can feel overwhelming, impersonal and bogged down with red tape. When you are used to hearing "no"--or, worse, getting no response--having someone take your side and take up your cause goes a long way in the healing process.
One handwritten note thanks social worker Shoshana Averbach for making her husband "feel like a person and not a number, and we thank her. Shoshana made calls to people that I wouldn't have made, because I wouldn't have any idea about. Shoshanna helped [him] medically and personally when everyone turned their backs on us."
Nurse Laura Lau earned the eternal thanks of the daughter of a veteran who suffered from behavioral health issues, hallucinated when he went off his medication and called 911 repeatedly. After a VA doctor suggested the daughter handle the father's behavioral health problems on her own, Laura connected with the patient's primary care physician and advocated for him to receive intensive behavioral health follow-up in the home.
Home Is Where the Gratitude Is
Our patients' gratitude is amplified, I believe, because we are with them in the home, where improvements in health can be felt directly in their daily lives. We work with them to move around safely in their homes and communities, to get to the grocery store, the pharmacy, the doctor or to visit a friend for lunch. Marc Goldberg, the physical therapist who worked with Mr. R, notes that for people who have arrived home from a rehab facility by ambulance and cannot get out of their apartment again until they can climb stairs or get to the grocery store until they can board a city bus, physical therapy is nothing short of a ticket back to their lives.
For Mr. R, the foremost goal of care was measured on four legs, not two. "We would do our exercises, then we would walk his greyhound," says Marc. "We were working on range of motion, and cleaning up after his dog fit into our routine perfectly. This helped him get back to the real world."
For another client, the goal was equally real-world: to gain the strength and balance needed to get into the old claw-foot bath tub in his small New York City apartment--and finally take a shower after many weeks. "He was so grateful," Marc says.
So, too, was the daughter of a Chelsea man who suffered a debilitating stroke that limited mobility in his right side. She praised the team--a nurse, physical therapist and occupational therapist--for helping her father recover his sense of self. "My father is an incredibly strong-willed and independent man," the daughter wrote. "After the stroke, he has wanted more than anything to go back to his old self, to be able to go on walks, and run his errands. [The team] taught him that he can be self-sufficient despite the limitations he has. My family and I will be forever grateful for it."
The gratitude goes both ways. "I am thankful to be part of the solution," says Marc. "In home care, I experience those firsts right alongside people--the first time they can walk down the stairs, get on the bus to go out for lunch, or simply get up out of a chair and walk to the next room. Sharing this together with people in the community is more powerful to me than seeing them walk out the door of a clinic and hoping they'll be able to carry out the tasks we worked on."
So, as we give thanks on November 24th this year, I hope you'll join me in expressing gratitude to those in our lives who not only bring care and healing into our lives, but to those who allow us to offer up our skill and kindness and care to them as well.