Best friends are like that.
As I noted in that column, my wife and I struggled with “how much physical distress, how much intervention we afford to an older, sleep-most-of-the-day arthritic dog.” Not knowing if the mass was benign or malignant, should we work it up or just let nature sort it out? If we treated, should we diagnose and stage the tumor, blindly surgically remove it, or just give palliative chemotherapy? What if it was isolated and surgery would be curative? What if it was metastatic and surgery just added morbidity? What if this was benign and Hogan died in the operating room? What would Hogan want? Hogan trusted me to make the right decision.
Best friends are like that.
This was the easiest column I’d ever typed but the hardest I’d ever written. I wrote it in about an hour and then cried about it for two days. I was distraught, miserable, and unmoored in the way that only pet-lovers who have faced the demise of a loved one can understand.
I was truly confounded, and the act of writing was cathartic. It was my first venture beyond standard professional content. I spent two weeks deciding if I could really publish it. It was difficult, I found, to expose myself—to be vulnerable in this manner.
No one can beat you up for saying we should care about patient safety and improve quality. Dedicating an entire column to a dog? What if my peers, the society, my bosses found it immature or self-pitying? What if they didn’t get it?
Within days of publishing the column about Hogan, I’d received hundreds of comments from readers, most relating their similar experiences, all expressing support—by far more interest than I got about anything else I’d written.
Turns out, you got it.
What’s Next?
I wonder what my next 55 columns would have looked like. I surely would continue to discuss HM’s struggles to operationalize the quality and safety promise we hold. This should continue to be our singular goal.
I’d likely write about bundled payments and ACOs. I believe these are potential game-changers in much the same way the prospective payment system was in the 1980s. The latter laid the groundwork for hospitalists. Will new payment models prove a boon or a death knell?
I’d spill ink, no doubt, about the financing of HM groups. As hospital reimbursement fades, can hospitalist salaries be far behind? Will this push us toward more encounters and more shifts, leaving less time for meaningful process improvement work, less time for personal and professional balance, less satisfaction in our careers?
I would wrestle with how we can attract the best and brightest to our field. Who will fill the next 20,000 hospitalist positions?
I would, no doubt, chronicle the tribulations of my kids (a record to be leveraged when I look to move in with them in 2040), send a few more barbs my father’s way (payback for the 1980s, Dad!), and deprecate a few of my future dimwitted moves.
And I might even devote a few more inches of column to Hogan.
Because, you see, Hogan is doing well. He’s cancer-free nearly three years after surgery and chemotherapy for metastatic pulmonary adenocarcinoma. I’ll skip the details and just say “thanks.”