Anxiety

Nearly two years ago, I sat with my younger sister at the airport in Houston, Texas waiting for our respective flights.  She was going back home to New Jersey, and I was headed back to California.  While waiting, she passed the time browsing SAT prep sites on her iPad.  Her oldest child, my nephew, was starting his junior year of high school that fall, and she wanted to make sure his summer was well spent, and that he had the opportunity to prepare for the exam which would determine his future college options.  As she talked about the merits of one approach over another—classroom instruction versus private tutoring– I felt my anxiety level rising like an uncomfortable expanding bubble in my chest, gradually cutting off my air supply.  The pressure was palpable.  After listening for a few minutes, I said to her, “Please stop talking about this—you’re making me very nervous and I’m not even TAKING the exam.”  She looked at me in surprise, and we moved to other topics.

 

On Sunday evening on our way out to dinner, I went with my daughter to take sign out from the intern who was leaving the ward service the next day, and turning the very sick patients over to my daughter’s care.  I tried to position myself unobtrusively, in the far corner of the residents dictating room, sinking as deep into the shelter of my wrinkled hooded raincoat as I could, but even from my self made cocoon I could hear them discussing in hushed tones the low platelet counts, the mucosal bleeding, the fevers unresponsive to antibiotics in these acute leukemic patients.   It was seven pm after a long weekend on call, and the interns and residents looked exhausted.  The white cubicles and the scuffed linoleum on the floor reflected the fluorescent ceiling lights overhead. The faint smell of stale fried food and sweat combined to form a vaguely nauseating aura.  Suddenly I was transported back thirty-five years to my own internship, and to my first night on the cancer service and in that instant, I felt every bit of anxiety that I felt so many years ago.  For anyone who has done an intensive medicine or surgery residency, these feelings form the impetus to learn and become competent—the overwhelming sense that a human being’s life is in your hands, and this night, and every night, you must be vigilant; you must perform and do your very best.  The end of shift can never come soon enough.

 

It’s been many years since I taught a class of high school students, or staffed an inpatient service run by interns and residents.  But if I ever do either again my recent “flashbacks” will serve me well.  It’s good to remember the fear and tension associated with being a learner in a stressful situation.  Teaching has always been a passion for me, and those are the memories and feelings which will make me a better teacher.

Moving Mom

 

Another guest blog tonight from my friend Jackie–I can certainly relate and I know many of you can too!

 

My Mother turns 90 next month. She is selling her house of 28 years and moving in with us. It’s official: I am a grown-up.

Time is a funny thing. I remember I couldn’t wait to grow older when I was young. It seemed forever to reach that 16th milestone; then 21, then 30 and OMG I was 40. Officially OLD. My eldest son is 35 and honestly and I can actually remember being 35 and yet here I am at 61 taking on the role of care-giver and life-manager for my mother. I raised 4 kids with an alcoholic husband, got through a miserable divorce, survived the deaths of my father and sister, but I never felt like a grown-up until now. It’s a little scary.

In conversations with my peers I discovered we are all going through this challenge together; what to do when your parents are not capable of living independently but don’t want to go to “one of those places”. I researched a lovely retirement community near us a few years ago and told my mother all about it. She was quiet, and refused to come visit us for almost a year, fearful we would surprise her by leaving her there and abandoning her. Of course this was never our intention; we thought that living in a high rise condo community with chef-prepared meals everyday, an on site beauty shop and library, shuttle service for shopping ~and even a town car chauffeur on duty daily~ would be lovely! I wanted to go live there myself! But she shut down any conversations about this idea and insisted she was fine in her big two story home – alone – and lonely.

In a tough conversation three years ago I explained to her that I had given up on trying to re-locate her nearer to us. Although we are only a three hour drive away, that is a long stretch in an emergency. She agreed “in principle” that living so far away wasn’t a good thing, but she just couldn’t bring herself to part with her home and all her things. I explained to her that I wanted to help move her closer but without some cooperation on her part it was just too hard. She promised to try and at least start sorting through her house and throwing things away in preparation for the “someday move that she didn’t want to make”. I asked her to begin with the magazines. There were 500 magazines from 25 years of saving neatly stacked in piles in her family room cabinet. The next time I visited I checked and the magazines were still there. We had a long way to go.

Last year as we grieved the loss of my sister, her perspective shifted. She was ready to be closer to us; her being alone was becoming more difficult and she realized I couldn’t hop into a car and drive long distance just to help her to a doctor’s appointment. Oh – and she was still driving. Last year when she turned 89 her Driver’s License needed renewal. “AHA” I thought – when we go to the Department of Public Safety office they will surely make her take a test or maybe do a refresher driving exam. And then she couldn’t live alone and she would have to move. Nope. She filled out the one page form and checked “no” to all the pertinent boxes – she had not had a stroke, or was disabled, or had a chronic illness that made her unable to perform driving tasks. When I saw the box “Are you Hearing impaired?” I jumped up and asked the clerk if being deaf in one ear was an issue. Her response “Can she hear a officer if he stopped her vehicle and spoke to her?” Mom answered “Oh yes last year when I forgot my new Vehicle registration sticker a nice officer pulled me over to tell me and I heard every word.” She paid her $7 and got a new photo taken and we were finished. I asked the clerk when this license would expire and she answered “When she is 96.” I asked if there would be any tests or refresher driving exams and she nodded, sadly, “no”. Fast forward to now and we have all agreed that it’s time to turn in the keys. Whew.

The choices had become more complicated since a few years back when I thought the condo life was the answer; she was no longer a candidate for an active retirement community and certainly not ready for an assisted living situation. She still enjoys puttering outside in her garden and managing her meals and laundry – so what was the solution? As I thought about it I reflected back to 1986 when my parents built their dream home and included a suite so my then-90 year old grandmother could permanently live with them. I guess the cycle has come full circle as my husband and I are now planning our dream house but with one significant addition – a small cottage on the property so that she may live near us and with us as she needs and I will be close to help out when that time comes. She’ll have a bright and shiny new place to live just steps away from us, and if she needs care, there is an extra bedroom.

And so the clean-out of her home began. I started with ( guess what) those magazines. Mom kept trying to save them back – I kept throwing them in sacks. We finally agreed if we took them to the Library they could be enjoyed by many people and we didn’t have to move them. Over the past months several more trips to her home for clean out sessions followed and before long the house was show-ready. It sold in 8 days after 4 different offers. The sale will be final in early May and the serious packing has begun. Mom told me recently that she really can’t believe she is going to be 90 soon. She still feels in her mind that she is younger; where have the decades gone? Perhaps it’s a myth that you are supposed to feel your “real” age. Whatever the case, I am embracing this challenge and look forward to having Mom closer. I know it will not always be easy but that’s okay. It will be a privilege to make her final years happy and safe. On those really hard days I will remember what my daughter said to me recently “Ya know Mom, when you are old we will be taking care of you”. So perhaps the bigger lesson here is that family is family, and sometimes that’s all that matters. I can do this. And after all, I AM a grown-up now.

Mel’s Posh Junk

With apologies to any of the really nice people who live in Aspen, Colorado

I admit it—I have a little bit of an eBay habit.  May I be permitted to say that cruising eBay helps me relax after a long day at the office?  I have all my favorite searches set to notify me if one of my desired tchotchkes suddenly comes up for sale, and I have my favorite sellers marked.  One of them, a dealer from the UK, calls himself “Mel’s Posh Junk.”  I love that, since both my father and my stepdaughter are named Mel.  I’ve bought more than a few items from Mel’s junkyard, which seems to be a jewelry shop specializing in Victorian and Edwardian costume jewelry. Queen Victoria had nothing on me when it comes to gaudy brooches from the Scottish hinterlands.

This past weekend, I was tasked with traveling back to Colorado to make a disposition on the contents of my father’s townhome in Snowmass.  I love Aspen and Snowmass in the summer, when the lupines and Indian paintbrush dot the hills in front of the Maroon Bells.  I can remember some lovely trail rides from the T Lazy 7 Ranch and Brush Creek Outfitters.  I also remember taking a summer ride in the high speed gondola up Aspen Mountain, affectionately known as Ajax.  I was so dizzy from the added height and movement of the gondola up over 11,000 feet that I insisted on crawling down the mountain.  Literally crawling, on my hands and knees, all the way down.  I do not like heights.  Or icy cold.  Or falling down.  Hence, I am not nor will I ever be a skier. But that is another story.

Dad is here in San Diego now, and the sale of the condo closes in two weeks, and it was time to decide what was going where.  He decided to buy new furniture here, scaled to his smaller apartment rather than move the grander furnishings of the place there.  My chief mission was to get his art moved.  An artist himself, he has been a collector all his life, and the paintings that hung on the walls in Colorado are his most treasured possessions.  But what to do with the furniture, and the rather impressive contents of my mother’s closet?  I called ahead to several consignment shops in the area.  The first woman, from Aspen proper, came through with the realtor days before I got there.  With one dismissive wave of her well-manicured hand, she declared, “I can’t use ANY of this.  It’s SO very DATED.”  I decided to move “down valley”, as the natives say.  I figured that surely the good people of El Jebel, Basalt and Carbondale could use a living room and two bedrooms full of high end furniture.  I figured wrong.  The lady from Basalt was equally dismissive.  She walked the floors solemnly, proclaiming that no, she couldn’t sell this, or that, or even those.  Until she stopped at the table where I had placed my mother’s silver and antique Limoges for safe packing.  She said, “I’ll take THOSE.”  I said, “No, I don’t think so.”

On Saturday, my friend who had met me in Snowmass with her cargo van to transport the art, and I painstakingly went through my mother’s clothing.  She was a petite woman, barely 100 pounds.  Unfortunately for me, I cannot wear a size 4.  But she had exquisite taste, and a penchant for fancy labels.  We loaded the truck full of Burberry, and Ralph Lauren, and St. Johns, and cashmeres from Sak’s Fifth Avenue and leather jackets custom made in Italy.  We drove to the second hand store in Basalt where the proprietor could not be bothered to even direct us where to park, or help us unload the van. She took one disdainful look at the offerings, and said, “Most of this stuff will go directly to charity.”

My friend and I made the 960 mile drive back safely from Colorado in 16 hours on Sunday.  We did not want to stay overnight on the road with our precious cargo of Dad’s art, and Mom’s antiques. On Monday, Hector from Habitat for Humanity will pick up the contents of my parents’ 3000 square foot condominium.  I am quite certain that Habitat will find folk who are thrilled to have down stuffed couches in perfect condition, and sleeper sofas, and beautiful lamps, and my father’s custom made walnut desk and file cabinets. I am happy about that, because I want people who appreciate quality and construction to have the furniture.  I guess that Mel’s posh junk just wasn’t posh enough for Aspen.  Oh well!

There’s Hope For The Rest of Us

This morning I had the opportunity to speak about radiation oncology before a group of high school girls in a program called BeWISE, which stands for Be a Woman In Science and Engineering.  The organizer of this morning’s seminar had purposely chosen an all- woman faculty, so that the students would get an opportunity to mingle with and question those of us who had chosen the pathways of scientific research and medicine.  During a break in the program, these two conversations were overheard.

From an accomplished female radiologist who is married to one of the country’s greatest gastrointestinal cancer surgeons—“I was picking up my husband downtown at a conference with the kids in the car and as my husband hopped in, another speaker at the conference leaned into the car window and asked my daughter if she wanted to be just like her dad when she grew up.  She said, “No, he’s just a SURGEON!  I want to be a Doctor, like Mommy”.”

From a female gynecologic cancer surgeon, also married to a physician—“I took my daughter to work on Take Your Daughter To Work Day.  We were in the OR, all scrubbed and ready to go, and my scrub nurse said, “Do you want to be a doctor like your Mommy or like your Daddy.”  She said, “I want to be a MOMMY, like my Mommy.”

Whether we identify our busy lives with respect to our children as “benign neglect,” or whether we prefer to think of ourselves as allowing—no– EXPECTING our children to “step up” and take more responsibility for their schoolwork, their pets, their siblings and the household chores, we must be doing something right, ladies!

Nina

Sometimes you just get lucky. When I was pregnant with my first child, during my radiation oncology residency, we had a guy living in the apartment over our garage, which we liked to refer to as “the carriage house.” He was a dog trainer by trade, and in his spare time he played softball in a local adult league. When we told him he had to move out, because we wanted the apartment for a live in childcare provider, he had a different idea. He wanted us to hire a woman he knew—the mother of one of his softball teammates. He told us about this woman in detail—that she was the mother of six children and that she had also raised her nieces and nephews when their parents were killed in a car crash, and that she was currently doing foster care for the state but had grown tired of that and disillusioned with “the system. “ He pronounced, without a shadow of doubt, “She will be PERFECT for you.”

 

Nina came to interview on a hot summer day, and she never left. At least not until we left HER to move to San Diego almost nine years later. We never checked another reference and we never interviewed another person. There was just something about her that seemed so, well, “motherly. “ That was it. She was uneducated, grew up in a poor family in Newfoundland Canada, and we only learned later that she could barely spell when she began to write down phone messages while we were at work during the day, after my maternity leave was over. It mattered not a whit. My only hesitation in hiring her was that she was fifty-six years old at the time. Since I was only thirty, I thought that was old. I think differently now.

 

About a month into Nina’s tenure with our family, my father called to ask how things were going with our new babysitter. I told him, “She’s fine, but she has one annoying habit. She shows up at work early every day. It cuts into my bonding time with my baby.” Really, I said that. My father, having relied on my mother to raise HIS three children, retorted, “And this is a PROBLEM? Do you realize how LUCKY you are?” That may have been the smartest thing my father ever said to me.

 

A year after we left Boston, Nina suffered a massive heart attack while watching the Boston Marathon. She was rushed to Brigham and Women’s Hospital, and had emergency bypass surgery and survived. A few years after that, she was diagnosed with inoperable esophageal cancer, and underwent chemotherapy and radiation therapy and again, she survived. Last year, she lost Charlie, her beloved husband of more than sixty years, and still, she survived. And two months ago she fell, hit her head and had a subdural hematoma. At eighty-five years old, she is the definition of “survivor.”

 

On our way to Boston, my daughter said, “I think we should go see Nina on Sunday.” The last time she saw Nina was nearly ten years ago, when she was in college. So Sunday we drove out to Framingham, where her old babysitter lives in a senior housing project, attended to by her daughters who live close by. On the way there, we passed the Sunshine Dairy, where Nina used to take her for ice cream as a child. Alex said, “We have to get some for Nina. She loves their maple walnut. “ She was right. We were greeted at the door by Nina, a very diminished and frail Nina wearing a single strand of pearls I bought her for her sixtieth birthday. She smiled at us, and congratulated my daughter on her medical school graduation. I burst into tears. This woman more than anyone else, had made it all possible.

 

Young woman doctors—residents, fellows and medical students—sometimes ask me how to choose a “nanny”, as they are called now. I have no idea. Mine seemed to fall into my lap and stayed forever in my heart. I hope fervently for these young mothers that they get as lucky as I was.

Happy Mother’s Day

They lied to us, they did–Betty Friedan and Gloria Steinem and all the others who told us back in the 60’s and 70’s that we could have it all. Or maybe they weren’t exactly lying to the impressionable girls graduating from high school and like me, beginning their college and subsequent careers as professionals in schools and fields once exclusively reserved for men.  Maybe they truly didn’t know the physical and emotional tolls our lofty goals would exact on ourselves, our marriages and our children.  We have come of age now, and we are tired.

To the stay at home moms, who ran the carpools, acted as room mothers, cheered at every Little League game and had a healthy dinner on the table at six pm, I salute you.  I was secretly envious of the time you were able to spend with your children.  You didn’t miss a thing in their lives, and if you were secretly envious of me—my financial independence, my ability to walk out the door in the morning and leave the chaos behind to enter the adult world where you could actually reason with people most of the time—I never knew it.

To my fellow female doctors, lawyers, business women, veterinarians and leaders in industry, I salute you also.  No matter how tired you were at the end of the day, you made time for your children—you rushed out of work to get to the ballet recital, you helped with their homework, you got down on the floor and you played games when your back hurt and your eyelids were closing as you read “Goodnight Moon” one more time.  You were consumed by guilt most of the time—at work when you felt you could not give it your all after a sleepless night, at home when your child called you by your caregiver’s name.

This Mother’s Day is my first without a mother—she passed away in January, having lived her life as the wife of a busy plastic surgeon—the endless nights of caring for three children while he was on call, the arguments over promised wealth as a private practitioner versus the academic life he chose, the pampered later years when she could and did have anything she wanted.  But when I was a sophomore in college, majoring in English, she took me aside and said, “You have to DO something!  Don’t be like me. You must choose a career where you never have to depend on anyone but yourself.”  I listened and went to medical school.  Forty years later, it was the right choice for me.

When I was a junior medical resident at Beth Israel Hospital, Betty Friedan’s daughter Emily was one of my medical students.  In a week, my own daughter graduates from medical school.  As my children grew up, I had only one bit of advice for them that I remember repeating like a mantra:  Whatever you do, wherever you go, at the end of the day, every day, be able to look in the mirror and feel good about yourself.

And don’t think it’s going to be easy.  Motherhood never is.  Happy Mother’s Day everyone!

Empty Nest

My sister was here recently to help me out while my father was in the hospital.  She is much kinder and more patient than I am, so I was very grateful for her help. She is leaving to go home to New Jersey tomorrow.   Tonight before dinner we took the deerhounds for a walk.  In my better days, I could walk four at a time.  Last weekend, I tried three on three leashes and it did not work out too well.  They spotted a man they did not know walking up our street.  Perhaps they found him threatening.   With three hundred pounds of dog lunging and barking, it took all my strength to maintain control.  It turned out to be a very short walk.  Today, my little sister took Magic, who outweighs her by at least 20 pounds, while I took the two Q’s, Queen and Quicksilver.  We had a pleasant time.

As we ended our walk this evening by coming through the back gate, near the barn, Norman the Lipizzaner stuck his head out the stall door and nickered softly.  I said to my sister, “Let’s go visit the horses before we cook dinner.”  Into the barn we went, where the two old geldings called to us with some degree of impatience.  We loaded their mangers with Purina Equine Senior and horse treats and prepared to close up.  As we walked by the closed door of the tack room, I stopped.  I said to my sister, “Do you want to see the saddest thing?”  She looked at me, her eyes questioning, then said yes.

I pulled open the door to the tack room.  In that room there were five closed tack trunks, each stamped with the initials of a family member.  Saddles were cleaned and covered and neatly perched on their racks, ranging in size from a small child’s Western saddle with full Quarter Horse bars, to my husband’s beautiful dressage saddle.  Blankets were washed and wrapped in plastic.  Shipping wraps were bleached white and stacked in place.  Bridles were oiled and ready and bits were gleaming and polished.  But there was no one home—just old framed photographs on the walls.  I said to my sister, “Enjoy your children while you may.  This room is the ghost of childhood past.”

I hope that my children appreciate and look back with fond memories on the years when we would saddle up and ride out together.  It was a special time to me.  Lucky and Harmony and Veronica are gone now, but Dash and Norman and the memories remain.  To me, it was time and love and money well spent, and I hope that my kids, now grown, feel the same.

Closing up Shop

They say that as we age, time accelerates.  Those endless waits for summer vacations, Christmas and our birthdays that we experienced at age six, become a mere blink of an eye at age sixty.  And if you’re approaching sixty, you will remember, like I do, those old Kodak commercials:  “Turn around, turn around, turn around and they’re gone.”  Indeed they are.

 

A few weeks ago I visited a good friend in Arizona.  We were talking about her horse, a beautiful and rare Fell pony that she bought as a two year old stud colt, mahogany bay and full of promise.  She has had very little time to train or ride him, and now gelded, he lives on her small ranch, solitary and unworked.  I asked her, “What are you going to do with Scooby?  He’s six and a half now, and he’s being wasted.  Surely there are people who would love to have him as a riding or driving pony!”  She protested, “There is NO way he could be six years old already!”  I replied, “Oh yes, he most certainly is—I remember driving with my daughter from California to Texas four years ago when she started medical school.  We stopped in to see your new horse. You had just gotten him—he was two and a half. You know she is graduating in two months.”  She was completely taken aback.  How is it possible that four years have gone by this quickly?

 

Four years ago we came to Texas and looked at condominiums to buy.  Texas is very supportive of its young doctors in training—if you become a homeowner, after one year you qualify to become a state resident, and the cost of attending medical school drops by two thirds.  Texas of course, has that Texan way of thinking—if you live here for a few years, and grow to know and love the state, you won’t ever want to leave.  In many cases, it’s true, and those of us who eventually do leave feel pangs of regret and forever when asked, we say, “I’m from Texas.”  Four years ago, we looked at my parents condominium—empty and unused after they retired and left for the mountains of Aspen, Colorado.  The maintenance costs were too high, and we settled on a nice one bedroom within walking distance from the Texas Medical Center, the Museum District and the live oak shaded avenues around Rice University.  My daughter has loved living here, in this light filled place with her cat perched on the eighth floor windowsill.

 

My parents’ place is now “under agreement” and I spent the day Thursday sorting through their possessions that remain there.  Today my daughter and I will do the same for her place, and this afternoon we meet with a realtor.  Four years—still a near eternity for her, with the rigors of medical school being what they are.  For me, a mere blink of an eye.

Back to the Future

I am in Houston, Texas today—the place where I grew up.  From the moment I got off the plane on Wednesday, I had a strong sense of déjà vu—the small town feel of Hobby Airport, the banners welcoming me to the Houston Fat Stock Show and Rodeo, the drive to the Texas Medical Center where I visited my Dad at his office as a child.  But there is no possible sense of déjà vu more powerful than I felt today, in the sunny courtyard of my former medical school, waiting for the results of “The Match” to be unveiled.  For those of my readers who are not doctors, and who do not come from medical families, the Ides of March is the day that every fourth year medical student in the country finds out where they are going to do their residency.  Earlier in the year, aspiring internists, pediatricians, surgeons and obstetricians applied for internships and residencies, interviewed and finally made a list, in order of preference, of programs they wished fervently to attend.  Residency programs did the same, for students they fervently wished to attract.  And then a computer program called the National Residency Matching Program did its thing.  Today at precisely 12 pm EST, the results were announced in a white envelope.  The tension, as they say, was palpable.

 

Exactly 34 years ago today, I stood in the same place as my daughter stood today and felt my life change.  I would be leaving my hometown, my boyfriend, and last but not least my dog, to move to a city where I knew absolutely no one, because I had been given the gift of an opportunity to do my internal medicine residency at Boston’s Beth Israel Hospital, now known as Beth Israel-Deaconess Medical Center, one of the three Harvard training programs in internal medicine.  While I was there, I learned to practice medicine from some of the finest teachers and clinicians I have ever met, people who remain friends and mentors to this day.  I met my best friends, I married my husband, I got my first Scottish deerhound and I had my three children there in that order.  I hated the cold weather, but I loved the values which were instilled in me there, and which I hold to this day—in medicine, the patient always comes first;  family and tradition are paramount, and the Red Sox must ALWAYS beat the Yankees.

 

At 11:02 today Central Standard Time, the waiting and the culmination of four hard years ended.  My daughter opened her envelope and learned that she too would be headed for Boston, to the same place her father and I met so many years ago.  I think she was very pleased.  As for me—well, I did what any proud parent would do.  I beamed, took a picture, and burst into tears.   Well done, Alex, and I hope I didn’t embarrass you too much!

The Irony of It All

My son wants a government job. After obtaining a Masters degree in Public Policy, with an emphasis on economics, he was the envy of his classmates when he actually got a job.  He has been working for the last seven months for a giant consulting corporation.  Early every Monday morning, at the bidding of his superiors, he takes an early flight from Los Angeles to Denver.  Once he gets there, he rents a car and drives it to the company where he is consulting to remedy an old story—the company grew too big, too fast, and the folks who had the great idea, and who started their little company at the ground floor are baffled and bewildered by the demands of a grown up interstate business.   My son works from early in the morning until early in the morning—sixteen to seventeen hour days being the norm.  At the end of the week, he flies back to Los Angeles, where he actually lives.  By the end of this month, he will hear whether he won the Presidential Management Fellowship he applied for.  If he did, he will go to Washington, DC and join one of the bureaus or the State department where he will learn the intricacies of our government while making low wages and in all likelihood, being expected to work nine to five.

I don’t get it, as much as I admire public service.  Perhaps it is because I actually HAVE a government job, but only in the sense that I am paid through the University of California. My benefits and retirement plan are top notch.  My mentality however, if not my salary, is still back in the private practice customer service mode.  In my little satellite department, we start early and we work late and we get the job of treating cancer patients done, no matter how long it takes.  When I took this job five and a half years ago, I was at the “mother ship” cancer center for a year, while the satellite was being built.  This gave me the opportunity, for the first time in my career, to observe folks who actually treat the business—no, the “calling”—of caring for cancer patients as a government job.  Each role, whether it be receptionist, billing specialist, or medical assistant is fragmented down to its smallest components, and each person is judged by whether they can manage their own limited but particular task.  Never have the words “not in my job description” been adhered to so strictly.

When I hired my staff for the new satellite in 2008, my prime objective was to get people who shared my vision of service to patients, and who I knew would go above and beyond their job descriptions if necessary.  People who could cross cover other department members, and who were eager to learn new skills were at the top of my list.  I did not want to hire anyone who used an answering machine to screen calls.  I wanted one thing—plain and simple—commitment to the best care for our mutual patients.  No matter what the job description or who pays the salary and the rent, caring for cancer patients cannot be just another “government job.”

I know my son well enough to know that wherever he lands, he will be a leader, and he will strive for excellence and demand that others do so as well.  Give him a little time, and the government may never be the same!