The Ghosts of Christmas

PAST

Given the holiday season, let’s use Charles Dickens’ novella, A Christmas Carol, for the construct of this month’s Culture Moment. You may recall the protagonist, Ebenezer Scrooge, encounters three ghosts: Christmas Past, Christmas Present and Christmas Future. ?

Similar to the Ghost of Christmas Past, you may recall from the October Culture Moment that my mom went in for a routine PCP appointment earlier this year, was sent for an MRI and then referred to a specialist for what appeared to be a cyst on her kidney.

Similar to the book’s first ghost, who had some juxtaposition of character, there was some juxtaposition in these past healthcare events, too. On one side, care was being provided. Her new PCP took the time to review her previous history and was quick to schedule an MRI based on progress notes. The specialist referral was then based on the MRI results. On the other hand, my mom had no recollection of her previous PCP sharing any kidney-related information. And while she did not believe an MRI was warranted, there was gentle nudging by her new PCP to “go ahead and do it anyway”.

PRESENT

The Ghost of Christmas Present is a larger-than-life character in both stature and affect. His portrayal in the book is perhaps most akin to jolly Old St. Nicholas. You may recall that due to rural, access issues, my mom had to wait nearly two months to see the specialist. Like the second ghost, my mom was jovial about the whole affair. She was neither concerned about waiting for the visit, nor about being referred to a Urologist specializing in Oncology care. I had offered to make the 4+ hour drive to take her to the appointment, but she politely declined. She noted most doctor visits are just…and I quote… “blah, blah, blah or being sent for more tests”. Since she was not expecting bad news, she didn’t think it was worth my time to come. Her calm demeanor was one of “been there, done that” like any other doctor visit. ?

Of course I started looking at kidney information using reputable sites. The good news is very low levels of cancer are found in simple cysts and just monitored (perhaps that’s what her previous PCP had written in her chart?). Complex kidney cysts have a spectrum – with some at lower risk of cancer (monitor), while others with higher probability are removed. Without additional detail, the “present” was simply a moment to gather information and wait. ?

FUTURE

The Ghost of Christmas Future is the most foreboding spirit in the book. Dressed like the grim reaper, with no discernable face and no word uttered, the spirit simply shepherds Scrooge to view his own future demise - pointing to an unkempt headstone. In Scrooge’s case, he is in charge of his destiny and has the power to write a new ending to his story.

As for my mom? Well, she was right – more tests. The specialist ordered a CT scan. It’s been two weeks and the CT has still not been scheduled. So again, we wait. As I’ve said before, the waiting is the hardest part. As I reviewed clinical protocols for a CT scan, my impression is that the specialist may simply be dotting I’s and crossing T’s. Perhaps the mass is still indeterminate, despite a previous ultrasound and MRI. And in our litigious environment, the CT scan is hopefully just one a final check to ensure ongoing monitoring is the best option. Time will tell.

A HOLIDAY WISH FOR OUR HEALTHCARE SYSTEM

As journey toward achieving our Mission of the Quadruple Aim, like the Ghost of Christmas Past, we must first examine and accept our past with integrity. We should learn as much from our healthcare system “wins” and clinical advancements as we do from our failures. Similar to the Ghost of Christmas Present, we should honor a human-centered patient/member experience, by keeping patients informed along the healthcare continuum and by augmenting clinical guidelines, as needed, based on the uniqueness of each population and/or person. For example, some test results vary based on race/ethnicity. And like the Ghost of Christmas future, we should be focused on outcomes. As each ghost painted a picture for Scrooge, it was his wake-up call to help others and himself. He envisioned the best picture of physical health for Tiny Tim and through his experience, his own mental health/outlook was greatly improved.

Wishing you all peace, joy and good health during the holiday season and the new year ahead. ???

Culture Moments represent the opinions of Rose Bernards and do not represent the view of any organization she has currently or previously worked with. Any healthcare related content should not be taken as medical advice. Content is for informational purposes only and because each person is so unique, please consult your healthcare professional for any medical questions.