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Enema Angel

When I was growing up in the Midwest, my mother hoped I would become a doctor or a dentist. I think she wanted to introduce me as "my son, the doctor," a respected pillar of the community, with a good family and income, and a useful role to play in life.

The problem was, I had no interest in becoming a doctor. When I went to college, I took an aptitude test that confirmed I was ideally suited to be a lawyer. I briefly entertained this notion until I happened to skim a law textbook and concluded that this would be like death itself.

Instead, I ended up following my whims, reading novels and scribbling thoughts on paper. I drifted into a life as a teacher, a professional musician, a fund raiser and then a foundation executive. I don't have a clue as to why I chose the things I did, other than they seemed like good ideas at the time. Some things work out, some don't. The best thing that one can hope for in life is to stumble on a few surprises and be curious enough to pursue them.

In that context I've been thinking lately about the "workforce issue" in health care. Amid the doom and gloom of prognostications on the medical professions and the cynical business of counting profit and loss, there are still plenty of people who have a sincere desire to help others and look forward to coming to work every day in hospitals and clinics.

My sister-in-law is one example. After years of working in banking, she chucked it all for life in a lakeside cottage in a small town and got a job as a nurse's aide. She refers to herself as the "Enema Angel," and loves taking care of the basic needs of patients who depend on her for the most personal and intimate of daily tasks. She's going back to school to become a registered nurse, and at 52 she's reinvented herself in a new career that has meaning and dignity. Nursing was a surprise, and she jumped at it.

Contrary to what we often read in the professional journals and popular press, there are many people like my sister-in-law. Young people still enroll in medical, dental and nursing schools for all the right reasons, and this despite the disillusionment and bitter advice of their senior and seasoned colleagues who think the best days are behind them.

Not that they don't have a point. An acquaintance of mine, a respected general surgeon, makes the prophet Jeremiah look like a raging optimist as he describes how excessive administrative overhead, a suffocating tangle of rules and regulations, obscene malpractice insurance costs and low reimbursement rates from bloated health plans have conspired to ruin his practice.

"The system is at the breaking point," he intones ominously. "People have no idea how bad it really is."

"So why do you stick with it?" I ask.

"I don't know," he replies. "I guess the few times I get to actually practice my craft and talk to patients, it energizes me."

Exactly. He finds the signal in the noise, the connection to immediacy and meaning. Ironically, in our zeal to do the right thing, to be fair and impartial and get people the care they need, we create ever more Byzantine layers of specialization, administration and brokers that filter out the natural surprise and connectivity of an unplanned life, until we wake up one day to discover we're playing second fiddle in someone else's orchestra and are no longer in control of our lives.

The way I see it, the antidote is less specialization, not more. The answer is fewer barriers between those who seek care, and those who provide it. The answer lies not in thinking we can channel young people into mechanical chairs and routines of numbing regularity and mindless consumption, but in fanning the flames of their idealism and desire to do something meaningful with their lives.

Few occupations offer as many opportunities for meaning and service as those that provide care and comfort for those in need. Every great religion stresses this point. You would think more of us would start to pay attention to it.

As for my mother, she was finally able to introduce "my son, the doctor" to her friends, although she confided to one of them that "he's not the kind of doctor who can help anybody."

She's gone now, and passed the last days of her life in the care of her own "enema angels," a band of cheery nuns from the Philippines who were imported to ease the shortage of American nurses. My mother was a lapsed Catholic, and it meant the world to her to come back into the Church in the presence of these caring people.

For sure they were doing God's work.