To recap: Back in November 2017, I was a new father and was desperate to get back into medicine. I thought my best bet would be to get back into residency (I was hoping to get into anesthesiology back then). In September 2018, I began what I thought was going to be a temporary work taking care of patients with wounds in nursing homes. I soon realized that I was good at closing wounds and that it was a financially sound field. In June of 2019, I started my own private practice and built a solid reputation in the metropolitan area. I moved into my own home in January 2020, which was a dream come true. For more detail, I would refer you to the following posts:
First post on 11/30/17: CA license, but no board cert. How to get life back on track with a baby?
Second post on 7/15/19: Re: CA license, but no board cert. How to get life back on track with a baby?
Third post on 8/2/19: Re: CA license, but no board cert. How to get life back on track with a baby?
Fourth post on 2/21/20: Second update to "CA license, but no board cert. How to get life back on track with a baby?
Within a month of my last update, COVID absolutely shutdown everything in my city. In April one of my nurse friends died from COVID while working at a nursing home I rounded at. I still have the text messages from her telling me that she thinks she has COVID and that she was going to the hospital to get tested. (This was way before tests were as widespread as it is today). I didn't hear back from her so I texted her a couple days later. No answer. I called her family and found out that she was in ICU at the academic center on ECMO. She died less than a week after that last conversation. She had three grown sons. That was devastating.
The first difficulty we had was obtaining PPE. I remember scrambling to find N95 masks and was glad to be spending 500 dollars on fifty masks designed for construction work. As elsewhere in the country, nursing homes were hit hard. The two biggest problems were 1. lack of staffing and 2. patient isolation. Nursing homes were really short of staffing, especially in the fall and winter of 2020. I remember going to take care of emergency cases and seeing trash piled up in the hallways because all of the housekeepers and CNAs were out with COVID.
Patient isolation was a big problem because a lot of patients lost the will to live when the family members were no longer allowed to come in. One of the things I began to do was to arrange for patients to be sent home on hospice (provided that they didn't have COVID to bring home). I realized that if a patient was going to be dying anyways, they needed to be home with loved ones when they do. At first, this was really tough. To tell the spouse and children that their loved ones were dying and that the right thing was to make sure they do not die alone in a nursing home. I attended funerals when I could, and the families always reassured me that I had done right by them and that they are thankful to be there for their loved one at the time of their passing. This is something I continue to do.
The vaccine really changed things for us. Our practice had been pretty lucky through the whole of 2020. None of the clinicians got COVID, but more and more of our nursing homes succumbed to outbreaks. By December 2020, things were crawling to a halt for our practice, and a lot of our nurses were out quarantining. The Pfizer vaccine became available about this time, and this was a godsend. COVID was knocking at our door full force, but within a month of vaccine availability, the cases receded. I got my second dose in January 2021, and by February, things were looking optimistic for the first time since the beginning of pandemic.
As my practice matured and we continued to capture more of the market share, I began to ask myself what it was that I was trying to do because I was doing more than just taking care of wounds and surgical issues. It was on a long drive in April that the question came to me, which was "what is the nature of my business?" "Wound care" was not a very satisfying answer. Yes, that is what we do and something we strive to do well. But the answer that came to me like a lightening from the heavens was "I am in the business of protecting my patients dignity."
At first, I didn't understand what it meant to be in the business of dignity. I was trying to digest the idea like an entrepreneur would. How do I define the problem of dignity? What is the solution to this problem? And how would the value of that solution be coupled with money in the marketplace?
That was a frustrating exercise, and it only began to make sense when I began to think as that young idealistic medical student I once was. My practice provided what I envisioned as optimal delivery of mobile surgical care in the post acute setting. However, some of our successful outcomes felt pyrrhic in nature when, at the end of the day, the patient died along with a clean and healing wound.
I eventually came to accept that the ultimate purpose of my practice should be to protect the dignity of the patients. Wound care was a vehicle thru which we advocated for patient dignity.
These days we make decisions based on the principle of dignity. Ultimately, our mission is to protect patient dignity. All services that we provide is provided with this as the end goal. This is something that I really feel passionate about these days. Each week, I spend hours on the phone with families to help them understand what is going on and to make the decisions that lead to more dignity for the patients.
It has been a wild ride for sure. I remember the day when I first wrote out that original post. I was in my own little quiet coffee shop in the back alley somewhere in Seoul. Never in my wild imagination could I have predicted the course I would eventually take to get to where I am. It has been a relentless pursuit, and the most defining period of my career thus far.
I hope this saga is helpful to someone down the road.
First post on 11/30/17: CA license, but no board cert. How to get life back on track with a baby?
Second post on 7/15/19: Re: CA license, but no board cert. How to get life back on track with a baby?
Third post on 8/2/19: Re: CA license, but no board cert. How to get life back on track with a baby?
Fourth post on 2/21/20: Second update to "CA license, but no board cert. How to get life back on track with a baby?
Within a month of my last update, COVID absolutely shutdown everything in my city. In April one of my nurse friends died from COVID while working at a nursing home I rounded at. I still have the text messages from her telling me that she thinks she has COVID and that she was going to the hospital to get tested. (This was way before tests were as widespread as it is today). I didn't hear back from her so I texted her a couple days later. No answer. I called her family and found out that she was in ICU at the academic center on ECMO. She died less than a week after that last conversation. She had three grown sons. That was devastating.
The first difficulty we had was obtaining PPE. I remember scrambling to find N95 masks and was glad to be spending 500 dollars on fifty masks designed for construction work. As elsewhere in the country, nursing homes were hit hard. The two biggest problems were 1. lack of staffing and 2. patient isolation. Nursing homes were really short of staffing, especially in the fall and winter of 2020. I remember going to take care of emergency cases and seeing trash piled up in the hallways because all of the housekeepers and CNAs were out with COVID.
Patient isolation was a big problem because a lot of patients lost the will to live when the family members were no longer allowed to come in. One of the things I began to do was to arrange for patients to be sent home on hospice (provided that they didn't have COVID to bring home). I realized that if a patient was going to be dying anyways, they needed to be home with loved ones when they do. At first, this was really tough. To tell the spouse and children that their loved ones were dying and that the right thing was to make sure they do not die alone in a nursing home. I attended funerals when I could, and the families always reassured me that I had done right by them and that they are thankful to be there for their loved one at the time of their passing. This is something I continue to do.
The vaccine really changed things for us. Our practice had been pretty lucky through the whole of 2020. None of the clinicians got COVID, but more and more of our nursing homes succumbed to outbreaks. By December 2020, things were crawling to a halt for our practice, and a lot of our nurses were out quarantining. The Pfizer vaccine became available about this time, and this was a godsend. COVID was knocking at our door full force, but within a month of vaccine availability, the cases receded. I got my second dose in January 2021, and by February, things were looking optimistic for the first time since the beginning of pandemic.
As my practice matured and we continued to capture more of the market share, I began to ask myself what it was that I was trying to do because I was doing more than just taking care of wounds and surgical issues. It was on a long drive in April that the question came to me, which was "what is the nature of my business?" "Wound care" was not a very satisfying answer. Yes, that is what we do and something we strive to do well. But the answer that came to me like a lightening from the heavens was "I am in the business of protecting my patients dignity."
At first, I didn't understand what it meant to be in the business of dignity. I was trying to digest the idea like an entrepreneur would. How do I define the problem of dignity? What is the solution to this problem? And how would the value of that solution be coupled with money in the marketplace?
That was a frustrating exercise, and it only began to make sense when I began to think as that young idealistic medical student I once was. My practice provided what I envisioned as optimal delivery of mobile surgical care in the post acute setting. However, some of our successful outcomes felt pyrrhic in nature when, at the end of the day, the patient died along with a clean and healing wound.
I eventually came to accept that the ultimate purpose of my practice should be to protect the dignity of the patients. Wound care was a vehicle thru which we advocated for patient dignity.
These days we make decisions based on the principle of dignity. Ultimately, our mission is to protect patient dignity. All services that we provide is provided with this as the end goal. This is something that I really feel passionate about these days. Each week, I spend hours on the phone with families to help them understand what is going on and to make the decisions that lead to more dignity for the patients.
It has been a wild ride for sure. I remember the day when I first wrote out that original post. I was in my own little quiet coffee shop in the back alley somewhere in Seoul. Never in my wild imagination could I have predicted the course I would eventually take to get to where I am. It has been a relentless pursuit, and the most defining period of my career thus far.
I hope this saga is helpful to someone down the road.
