Translator: Robert Tucker Reviewer: Denise RQ
Darkness.
I couldn't see anything but perfect black.
But I heard a voice,
"Gary, you don't have to bounce from home to home,
you don't have to be drunk or high all the time,
and you don't have to bounce in and out of jail."
It was the voice of my father who had killed himself many years before.
The only thing in that darkness that I was aware of was that voice telling me,
"You don't have to be this way."
When I opened my eyes, I was tied to a bed with a tube in my throat.
I was in the intensive care unit.
The paramedics that saved me came to visit me after I was discharged.
They told me about that night I died.
They told me about how blue I was from lack of oxygen,
about the CPR and the many defibrillations needed to reset my heart.
Losing my life and gaining it back again made one thing very clear.
I need to help others.
I knew exactly what I had to do.
I became a paramedic, and then a nurse,
and for the past 20 years, I have been trying to repay that debt.
I've seen many changes in our healthcare system over time:
where the focus used to be on helping people and making them healthy,
now there's great pressure to turn them into walking dollar signs.
Medicine has become strictly business, and it's putting people at risk,
people like my mother, your fathers, and our grandparents, in harm's way.
As a manager of a care unit,
I had many discussions with hospital leaders
about this very issue.
In frustration, one of them finally asked me,
"Whatya, do you think you can do this any better?"
"Yeah, I do, I do, I think I can do this better.
I can do it more safely, I can deliver the care.
And you know what? I quit."
(Laughter)
Well, now I was going to have to figure out
how I was going to fulfill that promise I just made to myself.
I took a position with a telemedicine company
to help develop their telemedicine cardiology program.
The CEO of that program asked me another question,
"Gary, do you see telemedicine working in any other way?"
Yes I do, a new model is born.
Stan happens to be
one of the first patients we've ever seen in this model.
Now, Stan lives 120 miles away from the nearest hospital.
Stan is a neurologist and a professor of the neurosciences.
In his late twenties,
a disgruntled student shot Stan in the spine
rendering him a quadriplegic.
He has a weakened immune system, and he's prone to skin breakdown.
When he starts becoming feverish,
he knows he's getting an infection, and he'll have to be hospitalized.
This circle was beginning to repeat itself
when Stan's wife recalled she heard about a program
that brings the doctors and nurses to them.
She rifles through her purse,
she finds a business card and wonders, "Can this be the option?"
But she hesitates and calls Stan's doctor's office instead.
"What do you mean you can't see him for three weeks?"
"Ma'am, I'm sorry, that's the earliest appointment we have.
However, if you feel like it's an emergency, please call 911."
Click.
Sound familiar?
Her next call is to us.
One hour later, nurse Nancy arrives at Stan's house,
with her medical bag, her iPad, and her laptop computer.
She begins by asking questions, obtaining vital signs,
and listening to Stan's breath sounds;
the whole time entering the information into her laptop computer.
120 miles away, Dr Williams is reviewing the information
as quickly as Nancy can enter it.
When everything is complete, Nancy explains,
"Stan, in a short time your Dr Williams is going to come and connect with us
over the iPad on our telemedicine platform."
"You mean, I can see a doctor here? I don't have to go anywhere?"
"Yes, that's correct."
With Nancy at Stan's side, and Dr Williams on the screen,
the entire process takes 45 minutes from beginning to end.
Blood cultures are drawn, a chest X-ray is ordered and obtained,
and a diagnosis is made, all in Stan's home.
There are two sources of infections found:
1) a pneumonia,
and 2) a skin infection.
IV antibiotics are ordered, and Nancy starts the IV.
So, how did we fulfill the promise to provide better care?
Stan called his doctor and couldn't see the doctor for up to 3 weeks,
and was told to go to the ER.
We saw Stan the same day.
Stan being a larger man, and a quadriplegic,
would need an ambulance to transport him to the hospital,
where he would have to be admitted, worked up, and then admitted.
We saw Stan in his home, where he was our only focus,
and not another person in a queue.
Stan would have to spend five days, maybe more, in the hospital to recover,
all the time being exposed to hospital-acquired infections.
We allowed Stan to stay home, where he's at less risk,
and he recovered quickly.
Now, some of my friends have told me
that some of the equipment we use is kind of like Star Trek.
It's very, very cool stuff.
But the reality is,
is placing that skilled nurse in your home is the secret to our success.
The nurses become the eyes, and the ears, and the hands of the physician.
Now, technology, it's a great tool,
but what we need, is we need our greatest tool, the human clinician.
Sharing in your life, listening, and touching,
and measuring, to make you feel healthy.
So, why should you care about what I just told you?
All of this is far more affordable and accessible
than driving to you nearest hospital or urgent care center.
We provide care where it's most needed in this rural and large state.
The whole time while we're doing this,
we fill many healthcare gaps in New Mexico.
In the future, the future generations will look back
at the way we practice medicine today;
they're going to look at it as ineffective and wasteful,
waiting hours to see a doctor,
waiting weeks and months to see a specialist, or obtain a diagnosis.
It's going to seem absolutely ridiculous in hindsight.
But maybe, just maybe, this is going to be the time that that all changes,
this is the time when we start using 21st century technology
to bring humanity back to medicine.
So, what did I hear that night?
I heard more than just a voice, more than just my father's voice.
I heard a calling, a call to action:
that I need to help others, I need to fight for my patients,
I need to do things right.
And that voice speaks very loudly,
very, very loudly to all of us in healthcare today.
We don't have to treat patients this way, and we can do it better.
(Applause)