Monday, May 21, 2018

A Testament to The Life of Mookie Bollich: A Eulogy



For those of you that don’t know, or haven’t seen me since I was twelve. I’m William Mills. I’m Andrea & Bill's son.

Now, I’m not going to stand here and make a joke about how I was PawPaw’s favorite grandson, but I would venture to say I was at least in the top 3. You probably knew my PawPaw as Mookie, because everyone knew him as Mookie, but I knew him as PawPaw. But the thing about the name PawPaw, or Mookie, is that it carried so many different adjectives along with it.

Daddy, Husband, Grandpa, Farmer, Hunter, Korean War Veteran, boxer, every Wednesday night card player, ultra light fligher (and crasher), sausage maker, cook, duck raiser, crawfisher, carpenter, gas saver, daily soap opera watcher, stubborn, phone caller, weather asker, “put on your cruise” driver, giver, lover, Aunt Dianne once called him an ornery ole cusp, monkey blood wearer, grass cutter, pine cone picker, combine driver, gardener, handkerchief holder, practical joker, pull your legger, and friend.

I’m here to talk to you about a few of the most vivid memories I have of Pawpaw that I think embodied the man that he was, and how he has effectively shaped the man that I am now.

So the first

I’ve been here a lot. WE have been here a lot. PawPaw was one of many children. A lot of his brothers and sisters and cousins have passed along before him, and I’ve been to most every one of their funerals. But the thing about PawPaw is he didn’t let his personality change in the wake of a death in the family.

So one day I was here (at the funeral home), for the funeral of one of his brothers, Uncle Elmo I believe. We were sitting together in the back left corner because we were late, he was probably feeding his ducks or something before, and on the way in he had to stop and talk to an old friend who was outside smoking, as well as he had to tell them how bad smoking was for them and that they should immediately quit.

So we were in the back. And the priest who was doing the service was either breathing in a weird way or adding a little noise at the end of every sentence that sounded funny enough for one of us to start laughing. And then one looked at the other, and it was game over. It turned into one of those church/serious moments where you’re trying not to laugh, and the fact that you aren’t supposed to be laughing makes it that much funnier. Well, we silently laughed so hard we cried.

I’ll never forget this moment, but he looked down at me and with one hand over a grin and one hand wiping tears from his eyes he said, “Ya know what William, I hope ya’ll are laughin’ this much at my funeral, I know Uncle Elmo wouldn’t have wanted us to be sad.”

So, clinging to that memory, I hope I don’t cry too much while I’m up here.

The only time I ever saw him cry was the day he told me the story of the day that he thought he was going to die. When he was in Korea, he and his battalion were in a camp that was stationed at the bottom of a hill that was held by the enemy, other missions had been led to take it, but were all unsuccessful. He said that he hadn’t slept in days because the roof would shake from bombings every 10 minutes. They received orders that night that they would be storming the hill. He looked at me, eyes watering, and said, “William, I thought I was going to die that night.”

I was confronted with a situation where the hardest and emotionally stout man I knew was crying, and I didn’t know what to do with myself. We sat their silently for a few minutes, and he finished the conversation with, “But here we are.”

PawPaw loved us all in his own way. He wanted to give the world to his family but wasn’t the best at expressing his emotions. He was an actionable man. I think I received a lot of PawPaw’s traits into my genetic coding, the ability to grow an awesome mustache, his sarcasm, his drive, his problems with expressing emotion (unless he was short on patience, we never seem to have a problem with that), but I missed out on his wit. He was the sharpest minded, quick-witted, and easy going people person I’ve ever met. He could talk to anyone, he loved people, and he loved to talk.

Reflecting on his life, I’ve learned these lessons that I want to share with you. Pawpaw was all about teaching us something or another, whether that be sitting there for an hour and a half while he worked on something, mindlessly picking up pinecones, or going on a drive with him into town, it all meant something.  

Here’s what I learned:

·        Make light of situations in the best way you can
o   Pawpaw did it with his humor and lightheartedness
·        Express what you have on your mind to the ones you love
o   Pawpaw wasn’t the best at this, I wasn’t, and have not been the best at this. I only recount two instances where I ever felt like Pawpaw was upset or disappointed in me. But because we were never good at this, we never talked about it. And I waited too long, and now we can’t. I’m going to have to live… to some degree with a sense of regret. Please, don’t make the same mistake as me. If you need to ask for forgiveness from someone, do it. If you need to forgive someone, do it.
o   Let them know, PawPaw was incapable of holding a grudge.
·        Work HARD
o   About 10 years ago PawPaw’s hands gave out on him, he had rheumatoid arthritis, and it got to the point where you couldn’t shake his hand because it hurt too much. He’d give you an elbow bump instead.
o   Pawpaw’s favorite line when it was time to leave our house was “We needa get back to the house Jackie.” It was a famous line from him – because he always had something that needed to get done back at the house.
o   If I work at 10 percent of the capacity at which this man worked I will achieve all the dreams that he allowed to happen, I hope my work can make him proud.
·        Pray
o   One night as a young boy I was staying at the house, we had finished eating dinner, and he was nowhere to be found. I went to look for him in the back of the house. For some reason I was being quiet and didn’t call his name, I started to open his cracked door, but before I could place my hand on the door, I saw him at the side of the bed, knelt down in prayer. I froze, and I just watched. It was the first time I’d seen him pray, but thereafter I made an effort to check back in to see if he still did it. Pawpaw knelt by the bed to pray every night until he could no longer kneel.
o   At a young an impressionable age, I learned what prayer meant, even at the time I had no idea what I was doing. I watched, and I learned.
o   The lesson I learned was consistency. Pawpaw was a habit kind of man, and his prayer life taught me what it meant to be consistent. Practically it meant that prayer would happen most every day, but if it didn’t, if I were to say stray from the path, the consistency always brought me back.
o   On the way here my Mom said that Pawpaw always said he would pray while cutting grass and on the combine. Life depended on rain, and he was always praying for it. When it would finally begin to rain, he would walk outside and stand in the rain with his arms stretched out, smiling and thanking God. I imagine him doing this in heaven surrounded by God’s grace.
o   I encourage you, that if you haven’t prayed in awhile to try it, get down on your knees tonight and pray. Pawpaw would highly recommend it… about as much as he’d highly recommend you quit smoking.

It has been wonderful to see all of you these past couple of days, and hear all of your favorite Mookie stories. It has been just as wonderful to hear that Pawpaw was always the same man regardless of the situation. My hope is that he is with Jesus, rejoicing, working the perfect garden, and “pullin’ everyone’s leg.”

Remember, Larry/Mookie/Pawpaw would’ve wanted you to laugh instead of cry, share instead of hold it in, and pray instead of go to bed. Thank you all.


Monday, February 5, 2018

FUBAR



FUBAR.



A military acronym that stands for ( lets use the sanitized version ) [Fouled] Up Beyond All Recognition. Apparently Fubar originated back in WW2 and is slang (mangled German) for the word "Furchtbar" which means terrible or horrible. When it comes to the current state of the healthcare system, terrible or horrible just don’t do it justice. The healthcare system is, in my opinion, FUBAR.

As a physio for almost 24 years I have been through the healthcare trenches, and seen many changes. I mean, when I started EMR wasn’t even thought of! We were scribbling notes out and writing out charges. In PT school I may have touched a computer once. I literally had to photocopy ( 10 cents a page) every article I wanted to read! In short, … I’m old!

We have made incredible progress over the years in our profession with some amazing clinicians developing and progressing the profession. However at the same time we, collectively (PTs, MDs, admins, politicians, insurance companies – the medical industry)  have completely failed our patients. Sure , there are amazing stories of innovation, we are saving more people from maladies that would have killed them years ago, we are transplanting organs, performing surgeries only once dreamed of, and many people are living healthy lives in the western world. Yet at the same time, when we look in at the experience of the patient, our client, the person right in front of us that has come to us for help it is a frightening tale of failure.

This really rang true to me this week with a couple of patient encounters. The saddest part is that these two stories are not rare in today’s system. I guess I should have written this earlier. I don’t know why it has struck me now to speak out… maybe I’m just getting into my grumpy old PT mode as I age…. Or maybe healthcare is getting worse.

Patient 1:  A middle aged gentleman. Referred by an orthopedic doctor with the diagnosis of “tennis elbow.” He tells me his pain started a month ago when he was turning a stuck valve and felt a pop. He has had increased pain since. He tried OTC meds without relief and it got to the point that picking up objects was painful and really affecting his work and home life. He saw an MD and, of course with NO alternate options on their mind for musculoskeletal pain, went through a month of NSAIDS, then injections- all with no relief.  After a follow up visit in a month it (for some reason) occurred to the MD that a referral to physiotherapy may be appropriate. If it persisted, imaging was the next stop (MRI).

On a brief evaluation he had pain and tenderness at the radio humeral joint and pain with resisted supination. No real pain with any resisted wrist motion, no radial nerve signs and an otherwise clean exam. After a manipulation of the radial head and soft tissue work and dry needling to the supinator he reported instant relief.   
   
Lets look at a few of the multiple problems here:
1) The same insurance paid the physician 4x as much as they paid for my service – TWICE. Then paid for medications, and steroid injections, and almost an MRI.
2) This man spent a month in pain affecting his work and family life all based on a diagnosis that really appears to be wrong.
3) Taking NSAIDS (which did not help) can have significant effects on the GI system and as was recently highlighted by the FDA heart attack and stroke risk increase even with short-term use, and the risk may begin within a few weeks of starting to take an NSAID. Furthermore, steroid injections are also not without risks and side effects.

Patient 2:  An 81 year old gentleman who comes for evaluation for chronic back pain. He has had pain on and off since his twenties which has become constant and severe. Reviewing the history I see that he has had an implanted spinal stimulator, injections, has been on opioids and has been followed by “pain management” for years. He recently had his opioids cut back. Sixty years of pain (30 of them bad by patient report), this wasn’t exactly an eval I was excited to be a part of. Yet when I went in the room I was met by a pleasant and kind man who explained that he was primarily frustrated because his pain is limiting him from caring for his wife who is suffering from dementia and needs almost around the clock care and supervision.

He had placed her in an assisted living center but when he went to visit found she was not receiving good care and he wanted better for her – thus bringing her back home. He is doing everything at home and even obtained a bed alarm that alerts him when she gets up at night and wanders. She had once wandered out of the house alone in a confused state. He also reports that he is no longer able to sleep well.

I went through my eval and did discover some issues I felt we could address physically - significant loss of hip and knee mobility, hypomobility through the lumbar spine and significant trunk and hip weakness to highlight a few. Along with the obvious need for pain neuroscience education I felt that we could definitely help this man, at least to some degree. The most shocking part of my evaluation is when he told me he had not seen PT before. He stated that he was “tired of going from medication to medication and having injections” and continuous procedures. He literally said, “I feel like exercise and moving is what I need.”

This gentleman had been stuck for decades in the medical industrial complex being pushed from one med to another, one intervention to another, and obtaining no relief. He underwent procedures that had risks and side effects and was taking numerous meds and opioids with all of their risks. At no point did anyone actually place their damn hands on the man and assess his movement. At no point in all these years was therapy suggested. At no point was he provided education on pain to decrease catastrophizing and fear avoidance behavior.

I was dumbfounded. We, collectively as a medical system and as a society, have failed this man. I believe that even after all these years he can improve. However, think of the possibilities if he had been managed differently all these years. How would that affect his life now? How would that affect his wife’s life now? We will never know what could have been but I do know it could have been better.

I want to be clear that I do not write this so as to place blame on other providers and elevate my abilities. I mess up on a daily basis. I don’t make the right decisions on treatment every time I see a patient. I don’t always address psychosocial issues as much as I should. I don’t always progress and develop my treatments as well as I should. We are all human. Almost all medical providers have nothing but the best of intentions. However they are often stuck in a system that is FUBAR.
I know I can do better. I know we can all do better. We need to do all we can to get our voices out there and let everyone know that we are the alternative to meds, imaging and surgery. I am so grateful for so many voices in our profession that have begun to speak over the noise and bring forward thinking solutions and promoted the profession like never before. @timothywflynn , @jeffmooredpt, @theaphpt, @dr.mitch.dpt, @ryansmith.dpt, @updocmedia, @theducklegs, and of course @physio.praxis  (Just to name a few)


Physical Therapists are the answer to so many of our systems issues. We owe it to our patients to work on being a solution and not another cog in an out of control system.