I delivered the following message at the memorial service for Carol Overholt on April 24, 2013. Rest in peace, my dear friend.
I met Carol 18 years ago, when she first came to my office, around the same age then as I am now, looking for a primary care physician. The first time I met Carol, it was obvious that she had suffered a previous brain injury...with that injury, she had a tendency to talk incessantly. I had previously cared for a brain injured patient who was just like that and actually let Carol know that sometimes I would have to cut her off, but that didn’t mean that I didn’t want to listen to what she had to say. I told Carol about the other patient and the fact that I would sometimes actually leave the exam room while she was still talking. We would laugh about this, but it was important for her to know that I understood who she was. Over the years, this understanding came to define our relationship as doctor and patient, and ultimately, as friends.
For several years prior to my leaving Denver last year, Carol and I would meet at the Fresh Fish Company for lunch. I know that Carol was proud to be having lunch with her doctor, but honestly, I was the one who was proud to be having lunch with the person that I feel was the most heroic and bravest person that I have ever met.
Carol was the single most complex and challenging patient I ever cared for. She had multiple medical problems and was on many medications. She had severe arthritis and needed crutches to get around, which she playfully called her “blue sticks”. She was constantly in great pain, but rarely let on. She once walked into my office complaining about some pain in her knee. It turned out that her femur had gone straight through her kneecap. But she was still walking with her “blue sticks”.
Carol had an uncanny knack for hitting our inadequate healthcare and social system squarely between the eyes. It is in this arena that I believe she has the opportunity to leave us with her greatest gift. Years of being on Medicare and Medicaid, fighting an unwieldy social and health system, had forced Carol to be a stubborn and tenacious defender of the limited resources that she had. Many years ago, Carol came to my office asking for assistance in putting together supporting documentation to help her with some claims that to you and I might only be the price of a night out at the movies. For Carol, this was a significant portion of her monthly income. I’d like to say that I helped her with this, but in truth, it was one of my staff, Maulana, who always did a yeoman’s job assisting Carol in putting together the necessary documentation. She did this year after year, knowing how important it was to Carol. I know that Carol was always grateful to Maulana for her help, as was I. Maulana is and always has been the epitome of patience and kindness, and honestly, a model for anyone in our health care system to follow. Carol gave her the opportunity to shine. In many ways, Carol gave many people the opportunity to shine, but unfortunately, many chose not to take the opportunity.
Over the years, Carol came to be friends with a number of wonderful people. She would speak glowingly of her friends and they meant the world to her. I will not name them all here today, but I did want to give a very special thanks to her friend David, whose support Carol valued very much. I also wanted to thank her best friend Pat, who was with her through thick and thin, and devoted more of herself to Carol than I can possibly relate. If I were to look up the word friend in the dictionary, I would expect to see Pat’s name.
Unfortunately, Carol’s circumstances forced her to rely on social support systems. One year, Carol came to me to explain a fairly arcane casino online issue regarding errors in her subsidized housing assistance. Again, she needed support. I made a few phone calls, letting people know that Carol was rational and of sound mind. To be very honest, I briefly wondered if she could actually be right about the errors. Heck, the county must know what it’s doing, right? As was always the case, and I repeat, always the case, Carol was found to be correct. Over the years, I came to trust Carol’s knowledge of the Medicaid system. If she said that there was a mistake, I believed her. Keep in mind, we’re talking about subsidies of perhaps $600 a month. They would try to nickel and dime her out of some of that money, which she needed to live on. I think that over the years Carol’s resolve hardened. She began to take it upon herself to notice issues like a home care aides documenting work that wasn’t done. She began to feel that it was her obligation to report these things. She somehow felt a need to make things “right”. In some ways this reached a nadir a few years ago when the county took Carol to a collection agency to recover several thousand dollars they alleged that they had mistakenly paid her many years earlier due to an administrative error. Carol was devastated. How does a system that is supposed to protect its citizens cause such harm to them. Ultimately, the case was dropped.
Carol seemed to be a magnet for such types of issues. As such, she taught me many of the things that are wrong with our social and health care systems. I hope that we can honor her life by continuing to work to improve these systems. I hope that all of us can learn from the struggles that Carol went through. For many years, Carol would have easily been eligible to move into a nursing facility, at great cost to Medicaid. However, for many reasons, the biggest being her fierce independence, she refused to even consider the possibility. Over the years, she saved the taxpayers hundreds of thousands of dollars by her valor. In return, she was hassled, literally for pennies, by the very system that she was saving money for, the very system that was supposed to serve her. I’ve often wondered how others who have less cognitive skills manage to deal with this complex system. The unfortunate answer is that they don’t. We need to remember that the most vulnerable in our society need our help and assistance.
Carol made me a better doctor. She was often seen as being demanding, but this was because she had learned to be her own advocate. As I’ve recently learned through some personal family experiences, our health care system doesn’t tend to like advocates. Advocacy seems to be a threat to a provider’s control. So, despite the fact that she was in constant pain, Carol, through her persistent advocacy for herself had an uncanny way of making people think that she was crying wolf. Maybe it was her innate optimism that ran counter to her actual circumstances? Maybe it was the obsessive nature of a brain injured patient? Maybe it was the learned stubbornness of someone who had fought the system for so many years? Whatever the reason, it was undeserved, for Carol was a brave and compelling hero.
I can’t talk about Carol without sharing one of the most fulfilling experiences of her life, a trip she took a couple of years ago to Germany under the auspices of The Wish of a Lifetime Foundation. In the 1960’s when Carol was young and carefree, she spent a few years in Germany, working as a laboratory technician. She made some good friends, one of whom she had continued to correspond with through the years. Having been involved with Wish of a Lifetime for it’s commitment to respecting the dreams of older individuals, I once asked Carol what her Wish would be, and she immediately said that it would be to visit her friend, Eckhardt, in Germany. Remarkably, Wish of a Lifetime made this happen, and Carol became a great example that just because someone is old and frail, that doesn’t mean that they don’t have dreams and hopes. Furthermore, despite her disabilities, she summoned the courage and strength to make the trip. Carol was a dreamer, setting an example that I hope we will all remember as we deal with those who are old and frail.
Over the last few years, as she was declining and developing greater and more challenging health problems, Carol went through numerous home health agencies. She demanded excellence. She demanded accuracy. She demanded that they help her. It was somehow a seemingly foreign concept, that she wanted and needed help in order to stay in her apartment and not go to a nursing home. Over time, most of these agencies dropped her. Honestly, to be very blunt, they all failed. The thinking clearly was that if they couldn’t make Carol happy, then something must have been wrong with Carol. It is an unfortunate human characteristic, that, if we can’t help someone, instead of taking ownership and responsibility for our own failures, we blame the person. Carol was often blamed. Yet, she persevered, continuing to maintain her independence as she gradually declined.
Not surprisingly, as Carol declined, her situation became more challenging and educational. I was Carol’s Durable Power of Attorney for Health Care, and she had made me promise her that she would not die in a nursing home. Over the years, I have had many patients who actually did better in a nursing home, but in Carol’s case that would have been problematic. She had a long and storied history of developing iatrogenic problems in both hospitals and nursing homes. Furthermore, it was her wish. We often forget that just because someone is old and frail they are still human beings and should be allowed to make their own decisions. We may not agree with their decision, but trust me, none of us know all of the answers. And so it was that I was empowered as her Power of Attorney to let everyone know that she refused to go to a nursing home. Of course, everyone else in the health care system portended to know what was best for Carol, once again trampling on the concept of patient autonomy.
Carol’s longstanding battle with the health care system reached another low point, when, a week before she died, Carol was dropped from care by a local hospice because they perceived her as crying wolf. As health care providers we have an obligation to care for our patients. It is not for us to judge whether they are crying wolf, it is for us to provide care. Let that judgement be made in another time and place. Unfortunately, like many providers before them, because they couldn’t satisfy Carol’s needs, they put the blame on her and decided that she wasn’t appropriate for hospice. They failed, and it is my hope that the staff of that hospice learned a valuable lesson that they will never again repeat. They weren’t the first to be given the opportunity to learn a lesson from Carol, but they were ultimately the last. Fortunately, thanks to the wonderful people at Lutheran Hospice, who stepped in to pick up the slack, Carol was allowed to die with dignity.
In death, as in life, Carol was a shining example of the human spirit. She was a wonderfully creative and caring individual. She lived life as best she could on her own terms. Carol would often ask me why she was still alive, and I would tell her it was because she was still needed to teach others lessons. Perhaps she ran out of lessons. Perhaps her suffering became too great for even her to go on. I am comforted by the knowledge that Carol is no longer in pain, that she is in a better place. I hope that you will all honor Carol by remembering her and working to help others like her.
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