In a crowded, overextended, and dingy community clinic in a college town in the central United States, the Chief Medical Officer had a dilemma – there was so much need in the community, yet there were so few resources available to the clinic and to the patients so that the patients could be adherent to their courses of treatment.  This doctor had to be extremely flexible in scheduling because her medical assistants worked strict hours, they weren’t eligible to get overtime pay, and they weren’t always available to help for long medical procedures that were done in the office.  Plus, the medical assistants and their nurse manager complained that when the doctor graciously worked in patients needing such procedures into an awkwardly assembled schedule, the office seemed to get “backed up” where patients who made appointments (as well as those who walked into the clinic off the street) had to wait longer than the nurse manager would have liked to have seen.  Supporting the doctor were two competent, experienced mid-level professionals – a Physician Assistant and a Nurse Practitioner.  But, unfortunately, most of the patients couldn’t be dissuaded from seeing this doctor, no matter how incredibly awesome the mid-level providers were, because the patients thought they were getting the best medical care possible from the physician.

But, the doctor had a lovely, pleasant receptionist who came in early to answer the phones and make appointments.  The receptionist was not adverse to scheduling appointments for necessary medical procedures early in the day or late in the afternoon when the medical assistants were not available and the doctor could take all the time needed.  These procedures that were performed were simple enough where they required only a clean room, a clean exam table, and sterile equipment (like instruments, small surgical drapes/fields, gloves, gauze, saline, etc.).  The receptionist found out from the patients that if she and the doctor did not schedule these patients at “off times” (at least, when the medical assistants were off) that the patients would have to go to the emergency room, and they would incur outrageously-priced bills that they couldn’t pay. 

One such patient with this problem was an older lady by the name of “Sue”.  Sue, unfortunately, developed a huge abscess on her face and initially went to the emergency room (ER) for treatment.  They did a good job with the initial drainage, but they found that Sue had a drug-resistant bacterial infection on their initial wound cultures, and the abscess just kept coming back until the right drugs were found for treatment.  Sue received an exorbitant bill from the local ER for over $4000 for just one visit, and unfortunately required repeat medical care for weeks until the infection cleared.  To not treat this problem could have been deadly for Sue; thus she discovered this little community clinic which had a $4 per visit co-pay. 

Not only did Sue have financial difficulties, but she had transportation issues where she could not come in as frequently as she needed.  The wound was so nasty for weeks and required so much bandaging that she could not afford to change the dressings more than every other day when they should have been changed twice daily.  Sue worked a minimum wage part-time job which was on the bus route which went right by her apartment.  To make extra money, she watched her 9-year old grandson after his mother left very early in the morning for her job and Sue was responsible for getting her grandson to school every morning.  The only time that would work out for Sue to return the clinic was on Friday mornings before her grandson needed to be in school, and one of her neighbors could drive her to straight to the clinic where the wonderful receptionist and gracious physician greeted her and took care of her health needs.  Sue and her neighbor had to bring the grandson to the clinic while she was undergoing treatment because of his age and her tight Friday morning routine.  But, it wasn’t long before the neighbor and the grandson felt comfortable sitting in the procedure room with Sue as she underwent more care.  A lot of times, the doctor asked about the grandson’s life at school to keep the grandson occupied, and made the startling discovery that the kid was a very poor speller even though he was exceptionally bright and loved high-tech subjects.

To dress up this cheerless, drab little community clinic with decorations to feel more like a friendly for the patients, the doctor and the medical assistants would find cast-off art from relatives and shop drastically marked-down bargains at the local craft store.  Several of the staff at the clinic had either an interest in science fiction and/or space exploration, so the procedure room took on an “Out of This World” ambience as NASA photos, vinyl mini-planets that stuck to stuff, and Star Wars memorabilia began gracing the walls.  Also, each exam room had its own theme -- such as the Beach room, the Cowboy room, and the Africa room.  Somebody’s mother had donated old hand-crafted owl pictures from various craft modalities popular in the 1970’s like macramé, string art, velvet paintings, recycled junk, etc., so one of the hallways leading to the dental clinic in the building became the “Owl Hall”.  And every holiday season, the patients looked forward to the doctor bringing in a handmade menorah which doubled as a Kwanzaa decoration in the waiting room (a former-alcoholic patient made this for the doctor after she helped him to stop drinking/get treatment and he unexpectedly discovered he had more time on his hands than before, so he started a new hobby).

One Friday morning when Sue and her entourage came to the clinic for more care on the wound, her grandson had brought in one of his personal devices and a catalog from an electronics store chain.  He was dreaming about what he could buy if he had the money.  When everybody assembled in the procedure room, the grandson spied a Star Wars poster that was an artist’s rendition of a lot of the battle equipment and every single character who had appeared in the first 6 Star Wars movies.  The grandson thought the poster was the greatest thing in the world, and he started naming off each piece of military hardware that was depicted.  Some of them had really weird acronyms of letters and numbers and it didn’t really make sense why these weapons of war were named as they were.  But he got everything right according to Sue and her neighbor.

 Then he moved on to look at the catalog and was talking about all of the different electronic devices that he would like to have someday.  He talked about items which the doctor had heard about from her high-tech husband (known as the Gadget Guru to many), but she didn’t have the time to learn the actual names so that she could converse intelligently on the subject.  Just like the Star Wars weapons on the poster, these devices had 3 and 4 letter acronym names that honestly sounded like what one could see on their spoon if one was eating a bowl of alphabet soup.  Once again, he was absolutely correct rattling off all the letters in order for these brand names of electronics.

The doctor was suddenly inspired, and told the grandson, “Look!  Who says you can’t spell?  You can spell all of these machines and devices you’re interested in, and the letters don’t even make sense and form real words!  I’ll bet if you showed the same interest in studying for your spelling tests as you do learning this other stuff, you would be making ‘A’s’ in spelling!  You definitely have the brains and ability to do it, but you just don’t believe in yourself.  All it takes is a little study each day.” 

Sue and her grandson both brightened up.  “Gee, doc, do you really think I can do that?” said the boy. 

“Sure!” said the doctor.  “You just need the incentive to start studying your spelling words better.”

Sue had a brainstorm and said, “If you study hard and get ‘A’s’ on your spelling tests for the next 3 weeks, I’ll buy you that Star Wars poster for your room!  But you have to get serious about studying and about obeying better your mom, your teacher, and me before I’ll get it for you.”  Now, Sue could no longer afford to buy this $3 poster than buy a trip on the Space Shuttle or become a tourist on a Russian space launched-rocket mission.  But she was resolute in her offer and intended to stick by the agreement.

“Wow!  I’ll do it – just you watch!  I’ll make you proud, Grandma,” said the grandson.  And, by golly, he did everything he needed including getting perfect papers on two out of three spelling tests.  Per his teacher, his conduct in class was much improved.  At the end of 3 weeks, he was a much happier kid and Sue bought the Star Wars poster for his room at home.

During the New Gregorian Year’s celebrations, we often make resolutions about things we wish to change about ourselves and a lot of time we have good intentions -- but we aren’t motivated or we don’t stay motivated.  Then about a week into the New Year, we fizzle out on whatever it was that we wanted to fix and then we become discouraged thinking nothing can ever change.  We talk ourselves out of accomplishing these improvements because we don’t believe we can do it. 

But sometimes, all we need is a “shot in the tucchus” to get us moving forward again.

 Sometimes, the people closest to us may be the best helpers we have to figure out how we can make these resolutions happen, or we may need to be accountable to a small group of people like this grandson was to Sue’s Friday morning entourage.  It only takes 21 days, or 3 weeks, to change our routines where the intended activities become long-term habits.  But that first 21 days can be “a real bear”.  For example, when incorporating daily exercise routines, initially you are so worn-out and sore from your first work-out that you want to sleep for 3 days.  Or starting a diet and feeling like you’re starving for a few days until you get used to the regimen.   If you have little set-backs like these, try to make a reasonable “adjustment” to what was initially intended like “for the first week, I’ll exercise every other day to give my muscles a chance to recover from the new work-out” or “on my diet, I’ll have low-calorie snacks on hand for when hunger hits”.  After all, what you’re doing now with your resolution is a whole lot better than what you were doing, and you have to keep convincing yourself that while incorporating an adjustment isn’t ideal, it isn’t the end of the world and that you can eventually reach your goals. 

The above story is true.  The names and pronouns have been changed to make the story more interesting and less dry to read.

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