Cell Phone Free Christmas

Like most adults under the age of 60, Romeo Sierra and I tend to be tethered to our cell phones.   Regardless of the day of the week, where we're physically located, or how we're feeling, the cell phone is always along for the ride.  And while that instant connectivity in the palm of the hand can be great, there's also a downside to it in that we lose sight of what's in front of us in the here and now.  So while the world celebrates Christmas, Romeo Sierra and I have decided to make it a "Cell Phone" Holiday, which means no looking at, touching, or using the phone until 5 P.M.   Computers, TV, Xbox and other technology is OK for the day, so while she catches a few extra winks of sleep, I'm  hopping on the blog.

Regardless of the what you celebrate, the holidays are a good time to slow down, take inventory of what is going on, and look forward to what's on the horizon.  And although I'll keep some of my reflection to myself, I figured I'd throw together a "Year in Review" to take a look at what 2012 was all about.

When I began writing on the blog, I shared some thoughts around a framework I used to define health.  I essentially "chunked" life into major components (my physical health, my career, my finances, my hobbies, and my relationships) and set some goals about what it would look like to be "healthy" in each component of life.  My thinking was that if I could objectively define what "success" or "happy" looks like in each of these areas, I could focus my time, resources, and efforts on those activities that I believe will translate to a 'better' state.  For example, if financial health meant saving $X in a certain time period, I could set up a savings plan to save that dollar amount.  If physical health meant working out a certain number of times each month, then I'd track how many times I went to the gym, and so on and so forth.  I even took it so far as to set goals and track the number of books I read, concerts I attended, and rounds of golf I played.

Over time, I've gotten a little less objective about how I'd define happiness but I still find value in shining a spotlight at each area of life as I think about where I'm at and how things are going.  The last few months have been very intense and at times dramatic on the "physical health" side of things, so we'll start there and see where this "year in review" takes us.

Its no secret to regular readers of ADW (Adventures of Delta Whiskey) that I've had a long history with health challenges.  Around age 12, I was diagnosed with Crohn's Disease, which is a not so fun gastrointestinal ailment.  Throughout my teens, into my 20's, and eventually my 30's, Crohn's cast a shadow over life; and at times that shadow got pretty dark.  Back in 2006, after years of fighting with my gut, I had the bulk of my plumbing removed, with a small portion left behind in case I decided to 'reconnect' things at some point down the road.  After that initial surgery, I went through adjustments both physically and mentally, and got more comfortable with having a body that was different than other 30-somethings.  Although I wasn't crazy about my "little buddy" (my ostomy), it allowed me to be active and live a life that did not revolve around a toilet, doctor's office, or pharmacy.

In the years since my initial surgery, my doctors in both Seattle and Chicago advised against "reconnecting" my parts, and after consulting with Romeo, my doctors, my family, my friends, and my conscience, I decided to have the remaining parts of my colon removed.   The risks of keeping those parts around (Cancer, Infection, etc.) were far greater than the benefits of attempting a very risky reconnection and the longer I kept those parts around, the greater the risk became.  So on October 22, I had the remaining parts taken out for good.  

I wish I could tie a nice bow around this story, and say it all ended perfectly, but that is not the case.  I was hospitalized for five days following my surgery and went home later in the week feeling "OK" despite the incisions in my belly and other parts of the body.  I probably underestimated the impact the surgery was going to have on my day-to-day life, and the first week or so out of the hospital was rough.  Getting in and out of showers, bed, cars, and even chairs had its challenges, and although I was able to walk I was pretty 'home bound' during that first week of recovery. 

About a week after coming home from the hospital, I was enjoying a Fontano's Sub Sandwich with Juliet Mike (a prior ADW guest) when I began to feel "not so good."  After spending about 24 hours praying to the Kohler Gods, Romeo and I ventured back to the hospital's Emergency Department to see what was wrong.  After running me through a few tests, they determined I had a blockage (obstruction) keeping me from digesting foods and they'd need to set me up to an NG tube to help 'move things through or move things out.'  This tube would run out of my stomach and through a tube in my nose to the wall, so that suction and pressure could relieve whatever was stuck. 

 

For three days, I laid in a bed, attached to the wall while my body's pipes were emptied--no food, no drink, no moving, and no fun.  Those were among the three most miserable days I had in 2012, and as you can imagine those days were mentally grueling as I relied on others to take care of me while I counted down the minutes until the tube was removed.  Eventually, that tube (and others) was yanked, and I went home to continue my recovery.  I joked afterwards, but if they're looking for new terrorist interrogation tactics, NG tubes would be a good alternative to waterboarding.  

Since the second hospitalization, I've been on a steady, incremental trend upwards.  My strength and muscle is returning, the areas where I've had surgery aren't as sore, and I'm gradually getting back into the activities I did prior to October 22.  Most importantly, I'm thankful to be without Crohn's for the first time in 20+ years.  This past few months has given me a humbling reminder about how delicate our health can be, and how important it is to everything we do--from our relationships at home to our success at work.   

You might expect, with all that time in the bed, alone with my thoughts that I'd have some deep, profound epiphany on life, health, and how all of these setbacks or challenges with my health are tied to some 'greater purpose.'  But the only insight I can think of came from my aunt who said, "sometimes shitty stuff just happens."  Plenty of shitty stuff happened to me, and as much as I want to try to piece together the underlying cause and reason for it all; I find myself a heck of a lot happier  taking the "acceptance" road and enjoying what I've got rather than complaining or griping about what I don't. 

So in conclusion, my holiday message would be this:  we're all lucky to some degree to be alive, healthy, and surrounded by people who bring joy into our lives.  I hope the coming year allows you to spend your time and effort enjoying those things, rather than dwelling on some of the "shit that happens."

Happy Holidays!

My Idea to Fix Chicago's Worst Problem

I'm on a Medical Leave from work, and with time on my hands, I am back to the blog.  As some readers know, the past few months have had personal health challenges, but I am on the mend and closer to returning to a life I enjoy.  But today's post will not be some deep reflection on my experience (although that may come at a later date)--today's post is an open letter to whomever is willing to listen to an idea that could improve safety in the city of Chicago. My hope is you'll read this, add a comment or two below, or pass along to folks who may be able to do a bit more about this problem than I can.

Dear Chicago, Cook County and Illinois Residents,

For starters, let me begin by saying that I am not an expert on criminology, sociology, or why murder happens.  In fact, I have very little understanding for why people take to violence to solve problems.  I do not look down upon those who do, in fact, my guess is those acts of violence are a "means to an end" for folks living in a pretty crappy situation. 

But what I can say with confidence is that I love the city of Chicago and am troubled by the rate of violence in my hometown.  As of today's post, there have been 476 homicides in the city of Chicago.  More than once per day, a person is being killed in our town.  (And by the way, if you are curious about the data, the Chicago Redeye provides an updated spreadsheet to the public) Each one of these homicides is tragic for the individuals involved, their families, and the communities.  Young lives are permanently changed (or ended) and nothing good comes out of these killings for anyone.

In addition, I can say with confidence that each of these incidents are EXTREMELY expensive for all parties involved.  Beginning with healthcare, victims of violent crime often require very expensive surgeries, treatments, doctor visits, physical rehabilitation, etc, ...and sometimes even the best of modern medicine cannot save a life. Paying for these services is often the obligation of the state, as victims are frequently enrolled in Medicaid, a state-run health insurance program for low-income individuals that is intended to pay healthcare-related expenses for those without insurance. 

The healthcare cost of each gunshot is estimated at approximately $50,000, and for those who know about our state's Medicaid program, we are broke.  So you can start doing the math in your head, but let me cut to the chase:  these incidents are contributing to our state, county and city financial crisis.  If we only looked at homicides, the state has incurred approximately $23 Million in expenses...and this is only 2012, and only healthcare expenses for victims who have died.  This dollar amount does not take into account the cost of the courts, the cost of the rehabilitation system (prison/jail), and other downstream costs that are incurred when someone decides to resort to violence. 

And if you have picked up a newspaper in the last two years, you know our city, county, and state are BROKE.  So those bills that are sent to the state are being paid, but often with long delays and at a very small percentage of what it actually costs for those patients to receive care.

On top of it, the organizations that care for victims (hospitals, instituations) are running on shoe-string budgets and swimming in operational messes.  Ever visit an Emergency Department on a Saturday night in the city of Chicago?  Well I have, and its not pleasant when you're there for a legitimate health concern, feeling miserable, and the nurses/doctors and others are not available.  And what happens when a victim shows up an ED?  Nurses, doctors and others swarm to the victim, taking services from others in need.  This creates delays, chaos in our emergency departments, and awful care for patients. 

So to recap:

• People are dying every day from violence in Chicago; more frequently than any other major city in the United States
• Each of these deaths are expensive to the state and the organizations who serve victims of crime
• The costs of these incidents are staggering and bills are not being paid or are being paid late.
• Considering ONLY healthcare related costs, we in Illinois have spent somewhere in the neighborhood of $23,000,000 on care for people who eventually died.

None of this is newsworthy, I'm merely summarizing the current state of the problem.  But what I'd like to propose is an idea that I think could work with the right support from everyone involved.  I have shared this idea with a handful of people and have yet to hear it is a bad idea, so I'm taking to the blogosphere in hopes that someone on the world wide web will see this and pass along to someone who can make decisions that would move the idea forward.

So here goes:

About a year ago, I had a chance to see The Interrupters--a fantastic Documentary that tells the story about Cure Violence's (formerly Cease Fire) work in our community to minimize the frequency of violence.  The film (which I highly, highly recommend) shows the powerful story of how “interrupters” work alongside members of their community to prevent the gunshot, the stabbing, the assault, etc., before it happens. If you saw Hoop Dreams, this film was done by the same producers and is outstanding--whether you live in Chicago or elsehwere.

In addition to the work of the Interrupters themselves, the film includes their Physician Champion highlighting the data/metrics that validate the impact their work has had in some of the city’s most violent neighborhoods (their website has info about the film and data if you are curious). While controversial; Cure Violence hires former gang members, criminals, etc., to work alongside current gang members and kids to minimize violence before it happens.  This idea, involving those who have "been there before" has been known to work on many public health problems--just think about the success of 12-step programs and the millions they have helped if you're looking for an example.


After watching the film I couldn’t help but think about where many of the victims end up after the incident: our hospitals and trauma centers in the Chicago area. And as I thought about the tremendous costs of these hospitalizations, the chronic overcrowding of EDs, and the missions of our local healthcare entities (to keep the public healthy), an idea came to me.

My idea is to create a “Shared Savings” program between geographic areas where Cure Violence is involved and Chicago's local hospitals/trauma centers. In a nutshell: if Cure Violence is successful in reducing the frequency of violence in specific areas, we should see fewer admissions to these facilities. With fewer admissions, there should be some type of cost savings for these facilities, given who the payer is (Medicaid) and the high cost to care for victims.

With the money the hospital saves, a portion could be returned as a “payment” from local hospitals back to the Community (or Cure Violence) based on improved performance in a designated geographic area. We’d need some good information about the true costs of each violent act, and good data on location/site of each incident, but I'd imagine we could dig this up or figure that out that amount based on some historical data.

So with my idea, let’s say Neighborhood A has 200 victims brought to a Trauma Center Z in 2012 at a cost of $10M (based on $50K/per estimate). If this number is reduced to 150 in 2013, Trauma Center Z would save $2.5M, and provide a payment back to the Neighborhood (or Cure Violence) based on what the hospital saved by having 50 fewer victims brought to their facility. Even if Trauma centers paid just 5% of the savings to the community, this would be $125,000; enough to pay a salary or two for the Cease Fire team, another social worker in the community, etc. All in all, it could be a "win win" all around: fewer kids dying, fewer victims taking up beds, money saved by the hospital, money gained by the community/group solving the problem, and an ongoing revenue stream to support those working to solve the problem. 
And if you think this idea is crazy or unique, it is not.  A similar type of “shared savings” initiative with the community is going on in Camden, New Jersey with the work mentioned in a fantastic New Yorker article from several months back by Atul Gawande. Although the work in Camden is focused on different conditions (Asthma, Diabetes, etc.) my concept is very similar—using geographic data to identify frequency of admissions and providing financial rewards to community-based efforts that reduce the admissions. As time has gone on, the folks in Camden have found, there is something very powerful about returning savings back to the organization, community, and people most effective in solving the problem and I believe in the people of Chicago when it comes to tackling the problem.

I could even envision posting "real time" performance metrics so that communities and the city is aware how geographic regions are performing relative to their goal...I mean, if we can post deaths due to traffic accidents on highways, the speed I'm travelling, and all sorts of nonsense on billboards, why can't we display death rates so others can track something meaningful to them and their areas?

My thinking is the money returned to the Community could be spent on anything the community (or Cure Violence) feels will prevent even more violence….whether its training or treatment programs, lighting on streets, more parks, special events, Gun “Buyback Programs”, more Cure Violence staff, etc. but I suppose that is getting ahead of ourselves and something I know very little about.

But this idea of spending the money on what the community feels is needed can be very powerful—when those involved in the problem have a vested interest in its solution, we tend to see traction/engagement (this is one of Lean’s core tenets…those closest to it are the best ones to fix it). In Camden, there are buildings in the worst neighborhoods where citizens (not trained Administrators or Physicians) are making decisions about how they want to spend the money they’ve received from hospitals that came due to avoidable ER admissions!

The way I see it, we are getting precisely the type of results (Homicides) that our Government, Healthcare, Judicial, and Law Enforcement system is set up to create.  If we'd like to see a different outcome, we need to think radically different about how we tackle the problem before it becomes a problem and reward what we want to see, rather than resorting to methods that have shown to be ineffective, expensive, and far from proactive.

If what you read about here interests you, I'd welcome feedback, ideas and suggestions to build on the idea and bring it to the right folks.  Before you suggest Cure Violence and a major health system...yes, I have reached out and no I have not heard anything.  This probably needs to get to the Mayor, Alderman, County, State, or other entity so if you have friends in high places, feel free to pass along.

Morning Radio, Moms, Work, and Life

I joke with Romeo Sierra and my friends about my completely irrational, dramatic, and over-the-top reactions after tough sports losses.  I revert back to the 8 year old Delta Whiskey, the one who wants his way and blows a gasket when it doesn't work out.  And this past week stung.  So one of my tactics is to shut down all media consumption related to Sports.  It keeps the painful reminders out of sight, out of mind, and I can move on mentally.  It doesn't mean I forget about it, just means I'm not going to keep revisiting the pain.  Another of my tactics is the Web, which allows me to vent in short form (twitter, facebook) as well as long form (Adventures of Delta Whiskey).

A challenge with throttling down my sports consumption is that I need to surf the FM side of the dial or my iphone for entertainment as I travel back and forth to work.  Normally, my ride consists of toggling back and forth between Mike and Mike (National Sports Talk Radio) and Mully and Handley (Local Chicago Sports).  The Local show is where I spend most of my time, and I get a kick out of the 'experts' who like to solve all sorts of problems on the field in the radio booth.  The hosts do a nice job of giving callers space to blab about all sorts of problems with the current state, ideas about a target state, and proposals to close the gaps.  Most of the proposals involve firing someone, spending lots of money, or getting rid of players.  Just interesting how much blaming of people go on, without looking at the results/data to validate those observations.  And of course, this is Chicaaaaaago, home of da most biased, one-sided fan base on the planet.  Those bits on Saturday Night Live are not too far off from what you'll hear on the airwaves.

So back to my radio dilemma, I spent Friday morning bouncing around the FM dial and landed on the old reliable, Lin Brehmer and 93 WXRT.  This is what my alarm clock at home is set to, its the #1 preset on my radio, and its the most complete station on the radio.  In addition to the best variety in music (Past, Present, Future?), their On-Air personalities are insightful, funny, and seem to love what they do.  I remember riding the bus to junior high with Mr Bruss behind the wheel, hearing Lin Brehmer and all sorts of interesting music blaring out of that tiny speaker next to his seat--and I continue to enjoy what Lin and his gang pull together in the morning.  Lin himself is also a golfer, a die hard sports fan (Cubs/Bears/Bulls/Hawks profile), and a guy who seems to "get" the important things in life.

One of my favorite features is "Lin's Bin", which occurs on Friday mornings, when Lin tackles a listener question.  Lin's responses are always very well written, with accompanying music in the background that highlights key points and messages.  So yesterday, I jumped in mid-stream to hear Lin talking about Mothers, and figured I'd add my $.02 about Moms, and my mom in particular.  If you'd like to hear Lin's entire entry (and hear old ones), you can click here.

As you'll hear Lin describe, moms do so much that we forget as we age.  Every thing they do, starting at pregnancy, is intended to help us grow into living, breathing, human beings.  That's a big job!  And in my case, my mom had that job times 4 kids, aged three years apart.  So I wanted to give a brief shout out to moms, as they are one of the primary reasons we are who we are.

Throughout my life, my mom (aka "Ma") has been the beacon of support and helped me learn (sometimes painfully...for both of us) at every stage of my development.  I've interviewed her on the blog, which you can access that interview in my archive (over there to your right), or just click here.  Reading that interview was entertaining for me; and good gosh are those photos of me (and siblings) awful!  I don't need to rehash everything from that interview, but much of what she taught me is reflected in her responses.

What I thought about as I re-read that interview was how she was able to cram so much into every day, with four kids running around the house, involved in activities, and at different stages of life.  She spent time with all of us, taught us much about what is important in life, how to treat others, and how to work hard.  And for those lessons, I am and will forever be eternally grateful for her. We still talk a few times a week, mostly about things like upcoming family events, work, pets, and the like, and anyone who knows my mom knows there's always a "movie I've gotta see." And I know its not just me she spends time with, she continues to be a source of inspiration, support, and guidance for all of her kids.

There is MUCH happening in my world, so I will segue into a brief update on other topics and news/notes in the world of Delta Whiskey.

The World of Work

Work has been unbelievably busy over the past eight weeks or so, and the gas pedal will be coming off the floor in the coming weeks.  I've been working on all sorts of interesting things and am psyched about work these days.  It has not been easy, and I am challenged daily (sometimes every hour), but I am enjoying the people I work with, the work I do, and the impact it has on the world.

This week, I spent time with a team of doctors, nurses, administrators, and IT people to define how we need to improve the use of a patient "portal", which allows as a patient to access their records, send requests to their doctor/staff for things like prescription refills, and see upcoming appointments.  As you can probably imagine, technology offers an opportunity for us to streamline processes, reduce the time for patients to get what they need, and access any information they may want to see from their chart.

But the technology alone is not the answer.  There are workflows to service those requests and needs that aren't running as smoothly as patients would like.  The team looked at everything that happens from the time a patient hears about the portal (aka Marketing) until requests are fulfilled, and identified a bunch of ways this can run better.  My job (along with those who work on my team) is to help the team see this reality through facts, data, pictures, and group exercises.  The team pulled together some ideas on how to 'fix' these things, which will involve both technical 'rollouts' as well as improvements to how work is done in a clinical setting.   While these things won't be fixed overnight, it was a good week to set a course of action for how we intend to make things better.

The neat thing for me this week was bringing in a patient to help the team understand and incorporate a patient's feedback into the process.  So often, healthcare gives an "ironclad" impression to its customer, and I really enjoyed bringing someone with no agenda into the room to help the team see and hear what he's experiencing.  The patient who joined us was perfect--very blunt about what he observed, but also insightful about ideas/solutions that could make the process and our technology more useful for him.

But work like this is VERY resource intensive on me, and I've had several events like the one I describe above over the past few months.  I've been working with teams on everything from pre-operative workflows to planning space needs, so needless to say there is much on the plate.  Over the next few weeks, things will slow down and I can spend more of my energy on things like writing, reading, travel (New Orleans, San Diego, Minneapolis, Traverse City ALL in the next 5 weeks), and some exercise/golf.

On the health front

Most of my health concerns these days are between the ears.  Keeping my stress level down, finding time to exercise, and taking it easy are important things I need to do.  With less time to be spent on work in the weeks to come, I should be able to find more time to work out.  For those who visit our home, you know Romeo and I are visually tracking our monthly on the kitchen chalkboard and I  had only ONE workout in the month of April!  Yes, I have been busy, but that is no excuse--so I will be heading down the gym immediately after this entry is complete.  But relatively speaking, health is pretty stable these days...

On the fun front

All of the upcoming travel is going to be fun, and included are a few bachelor parties--one in New Orleans (never been) that will be next weekend.  The trip coincides with the NATO summit in Chicago and I am glad to be skipping town during that nonsense.  In addition to the bachelor parties, I'll be headed back out to San Diego to see the greatest endodontist in the world, so I can finally get my missing tooth replaced.

This weekend I am not doing ANY work (that has become a pattern) and tomorrow will be a blast, as we celebrate Mothers day with our moms (Our being Romeo Sierra and myself) and prematurely celebrate my nephews 5th birthday.  He doesn't know this yet, but he's getting his own basketball hoop, which I am PUMPED to break it in with him on the driveway.  One of the best things my folks did for us was hanging a basket above our garage, which provided hours of endless individual and group entertainment.  In the evening, we'll be spending time at Second City with Romeo's mother which will be a great capper to the weekend.

Down the road, there are a few great concerts on our calendar (The Wall at Wrigley Field, Wilco, Lollapalooza?), a number of weddings, and some summer travel for the two of us at a location yet to be determined.

On the sports front

It wouldn't be a blog entry without a final commentary on the 2012 Bulls, so I will get this off my chest and be done with it.

Everyone gave up on the Bulls' hopes after Rose, then Noah went down with injuries.  My father, who has had season tickets for 30+ years sold his game 5 tickets on the internet--a first in his time as a season ticket holder.  There were a handful of believers (myself included) that thought they could make a good run through the playoffs with what they had, but as the series went on it was tough to see them competing with the Heat or other serious contenders.

In my case, I just wanted to see how far they could take it, and it stung to see a good group of guys have such a disappointing outcome from their work.  It was obvious how hard they battled to get back into the series and I watched game 6 proud to be a Bulls fan.  Guys like Taj Gibson, Omer Asik (I know he missed those last few free throws, but his defense in games 5/6 erased probably 18-30 points), Luol Deng (can't dribble with his left hand due to injury), and others laid it out there over the past few months.  Played hurt, played tired, and played a LOT and I commend them for the effort.   I acknowledge there's room for roster improvements (would not be shocked to see a guy like Kirk Hinrich return), and I believe there are learning lessons they will incorporate into future seasons.

In a nutshell, I'm disappointed and down about it, but also hopeful about the franchise, the team's nucleus, and their leadership.  Titles are hard to win, but I'm confident these guys will get one with their approach and discipline.  Hang tough, bulls fans....