(Photo of the 2010 Sand Sculpting Festival at Revere Beach - taken this morning.)
This is community nursing.
A month or so ago, Jean, a 30-year nursing veteran of the Visiting Nurse Association of Boston, mentioned that her morning routine frequently included a stop at the famous Kelly's on Revere Beach. When I told her of my own Revere Beach roots, she invited me to stop by some morning for a cup of coffee. Today was that morning.
I expected (in addition to the early morning traffic-snarled scoot up the Expressway through the City and over the Tobin toward Revere) a casual stroll along the beach, coffee in hand, talking to one of our most seasoned nurses. I didn't expect to peer into the heart of true community nursing.
Gracie, Ralph and others were sitting under one of the seemingly ancient structures covering rows of benches and tables surrounding the beachfront. Jean introduced me to them (and their dogs) and then we proceeded to talk about home health over the 30+ years that Jean has been at it. We talked about the changes at the VNA of Boston and of the changes in the profession. High tech gadgetry is replacing paper and pen, but the fundamental building blocks of compassion and clinical skill remain essential to the task. Jean spoke fondly of her colleagues, fellow veterans of a profession that has been "the soul" of this organization for many decades.
Jean asked if I'd like to see the Jack Satter House, the nearby residence for seniors age 62 and up, where she spends time caring for the individuals who call it home. On our way there, Jean and I passed by the table with Gracie, Ralph and the others and Jean happily dispensed advice regarding the health needs of one of their recently rescued dogs. During the conversation, it was clear to me that Jean was not merely passing by, she was caring for the members of that community. The familiarity and trust was apparent to me within seconds and after I had a chance to speak with them, I understood that Jean's morning routine was about much more than grabbing coffee at Kelly's and walking along the beach.
Two gentlemen stood in front of the Satter House and welcomed us both there. When I was introduced, one promptly told me about what Jean means to the residents. He described her contributions. Her caring. We then visited Eleanor (not her real name, obviously), a woman who describes herself as the "bionic woman of Mass General". If you heard her orthopedic surgical history, you would understand. Eleanor was not shy about discussing her current challenges and at one point, pointed a firm and resolute index finger toward Jean and said: "this woman saved my life." Jean, without flinching, without looking up from her tablet computer where she was pecking through the necessary documentation regimen, offered: "ok, ok, enough about me... tell me about..."
As we left Eleanor's room and advanced toward the first floor, I again had an opportunity to observe how Jean interacted with the members of her community. Words like trust, credibility, continuity and compassion ran through my mind.
Health care is increasingly becoming fragmented and disjointed. Economic and other pressures drive us toward what Dr. Gary Gibbons has referred to as "conveyor belt medicine". We roll along toward increasing specialization and all our resources, even human ones, are increasingly viewed as interchangeable parts we can deploy and redeploy with the flick of a wrist. Those economic pressures are real and we do need to work toward ever greater levels of efficiency, but we can't lose the trust, credibility, continuity and compassion in the process.