Right now, at this moment, it feels like summer is hardly the light-hearted, joyful playtime of my childhood. Even as all of us see some progress in capping the renegade oil well in the Gulf, the damage done is almost inconceivable, let alone reversible. Then, schools, the backbone of our Democracy and certainly the ruler of all summer schedules, are broken if for nothing else than their blood line is connected to the much too vulnerable pump of property values and taxes.

On Saturday Night Live last week, a rerun, the opening was a press conference between Win Jung Tao, President of China, and our own President Obama. Simple direct question: How is insuring 31 million uninsured Americans going to make money? Of course, it was a funny skit and the questions were never full answered. But, I suggest here, that the question itself, one being asked over and over here, is the WRONG question. In fact, most of the questions regarding education and health care are the wrong questions.

On Talk of the Nation yesterday, educators along students callers, were debating the plague…growing plague…of cheating: Students plagiarizing work from the internet…buying papers rather than writing them. Some implied that the pressure is so great that the only recourse is to cheat. I question that on more levels than I can write here. Cheating is cheating. It has always been cheating…using someone else’s work as your own, stealing, …hard to believe there is any justification. The ultimate cheat these years was the Ponzi scheme…using one person’s money to pay another. This whole discussion would have all believe that pressure is a reasonable defense.

I bring all of this to the fore because when we talk about skills and competence, the requisite ability of nurses and doctors to put together a bunch of unrelated symptoms to arrive at a plan of action that is suppose to be healing, I personally do not want to know that the person working on my health cheated…for any reason. I don’t want to know that their schools were over-crowded because property owners and businesses drew the line in the sand and refused to fund schools and colleges.

This fall, the health care reform law begins to do its work. Many preventive measures, such as mammograms, well-baby exams, immunizations, and more…will be available at no cost to those with insurance..and those without, will also have access. However, in an uneducated population, prevention is too long a word to understand.

How are we going to fix this?

As you may know, this month is our 18th anniversary of producing the C.A.R.E. Channel. I must admit that I am stunned not so much by the number of years we have been doing this work, but by the fact that we have survived so many changes in our society and in health care. At the time we started, we just wanted to do this work…and, that is still where we are. At the same time, we have grown, health care has changed, the world is a different world.

When I was 18, we were recovering from the assassination of JFK and moving further into Vietnam. Detroit was thriving before the riots. I could go on about the dramatic changes that went on then, but in reality, the same and greater changes are going on now.

I look at the oil spill, the chaos and loss that it has caused, and the debate and questioning about the risks at hand. Then, I turn not 90 degrees to look at the continuing violence and loss of life impacting whole generations by war, disease, and hunger. Again, I turn another 90 degrees and see an ongoing question about whether the richest country in the world can afford to take care of its own, can afford to provide health care for all of its citizens.

The Gulf oil spill is still taking up a spotlight far brighter and more focused than any other of these other pressing issues. Don’t misunderstand me as I am hardly diminishing this catastrophic event and the consequences that will last for generations. Rather, I am pointing to how easy it is for us to collectively become habituated to the pain around us and have it move out of focus.

In the last year, I have written over and over about the weaknesses and risks inherent in the current health care system. We now have taken a baby step in change. Small, but as significant as an actual first step taken by baby. And, the realities for those without health insurance are not different as I write this. Yes, everything takes time; and time is both friend and foe when illness hits.

These last 18 years will not be as significant as the next 18 years. The future has much more power of potential than the past. However, the improving the human condition is what inspired the work Dallas and I started in 1992 and is what fuels our commitment and the work we do to this day.

Again, I am stunned that we are here at this time and able to continue to live this vision. Clearly, the need is there…and we are here, along with our amazing staff, to respond to it.

In 1996, we (Dallas and I) were asked to do a presentation on Florence Nightingale. So, together with lots of her writings and books, we developed “Florence Nightingale: In Her Own Words.” This combines Nightingale’s words and our music to bring the telling of her story together with the emotional component that only music can deliver. Until that time, I knew little about Florence Nightingale other than her title, “Mother of Modern Nursing.” In fact, I knew little about why nursing became modern and what it was prior to Nightingale. Since then, of course, I have learned over and over that the history of nursing is one that tells the tales of healthcare probably more than any other profession.

Doing this presentation now for so many years, I have come to feel that Nightingale is whispering in my ear. In costume and with what seems to be a channeled British voice, I have told her story in the first person as a means of bringing to life her intolerance for even one life ended because of, as she said, “what we neither knew nor practiced.” And, the knowing and the practicing may not come together even today.

As I look at the hospital of today and the most common assumptions we all make and what we accept as hospital practices, it is clear that nursing has undoubtedly progressed while the hospital environment has been victim to competing interests.

For example, Nightingale claimed that daylight and fresh air were critical to patient recovery. It took a study in 1984 by Roger Uhlrich to attach the science to Nightingale’s theory to change hospital construction standards to require patient rooms have windows. While fresh air is yet to be re-added to the hospital room, what is clear is that our ventilation systems are far from effective in ensuring that the air is as clean as needed.

Nightingale opened her School of Nursing at St. Thomas Hospital as the first secular school of nursing. Until then, all nurses were Religious women or, as is today, sisters, daughters, wives, or mothers. And, the profession has expanded dramatically. Today, one can be a certified nursing assistant, a registered nurse (either 2 or 4 year degree program), a clinical nurse specialist, a nurse practitioner, or a Doctor of Nursing. These many levels of expertise play out at the bedside in dramatic ways, with Nurse Practitioners being able to not only examine patients, but prescribe medications and perform many functions that were once limited only to physicians.

The relationship of nurses and doctors have been dramatized, with physicians portrayed as being heavy handed and nurses as sruggling to save their patients. This is not wholly true nor wholly false. Nurses are, to my thinking, the professional patient advocates…the persons who take on ownership of the patient’s journey from illness into recovery. The Physician does not advocate in the same way; rather the physician diagnoses and authorizes treatment for the patient. Even when a patient is in the hospital, the doctor does patient rounds, but nursing is done over the full 24 hours, being available in moments as the patient needs require.

I can say, without exception, that the physicians and patients serving the needs of our communities are the heroes. Those who cannot or could not take the stress created by a system that continually monetizes the value of life, of health, the value of illness versus recovery. The nurses are the ones doctors count on to take care of their patients; and, to the patient, the nurse is the one who is the voice of hope as well as the sure hand in relieving pain and suffering.

One more thought: Intolerance for careless that carries with it a human price tag is not difficult to defend. If you read her Notes on Nursing, specifically the footnotes, you will find Nightingale’s pithy voice of such intolerance. Again, neither difficult to defend or adopt.

To give you an idea of her attitude and directness, her treatise, Notes on Hospitals, begins with

It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. It is quite necessary, nevertheless, to lay down such a principle, because the actual mortality in hospitals, especially in those of large crowded cities, is very much higher than any calculation founded on the mortality of the same class of diseases among patients treated out of hospital would lead us to expect.

The hope I have is that the progress of nursing and medicine are forward; that science monitors and checks itself. What we know and practice is getting better.

If you are interested, here is the URL to Florence Nightingale: In Her Own Words which we made into a free, downloadable podcast series. http://healinghealth.com/hhs/site/page/podcasts

As I wrote about Florence Nightingale’s standard of expectation…to use well the powers we have…I felt the sudden relief that I was not responsible for what I could not do, nor change, nor influence. Nor should I worry about skills I may never have, knowledge I may never acquire, athleticism that is clearly not in the stars for me… Such a realization!

So, do I really want to be relieved or do I want to be held to account for “using well the powers I have…” and what are they?

Perhaps this is the quandary of educators, of public school teachers who are required to somehow come up with a way to make all students equal under the testing guidelines. Maybe this is the challenge of physical therapists that must measure capacity against studies that have arrived at what is normal for ones age.

So, now we have health care reform and we are putting together the vision of each of us having the opportunity to be healthy, to maintain our health, to be cared for…and, in truth, regarding health and physical stamina and capacity, we are each so very unique. No Child Left Behind tried desperately to equalize education…when, of all places, opportunity does not equal outcome. And, as Dr. Lee Kaiser once asked, “Who, among all these kids, is the next Mozart…without a piano?”

Considering how we apply the opportunities we have, how we use our personal skills and aptitudes, how we get honest about those abilities we may want but may never have…. maybe the real genius is the one who can find their place of brilliance and let go of the rest….

As I said in my message, research, science, and pursuit of new knowledge is ever present for me. When I was in the 7th grade I joined a nuclear science club and went to the Fermi Institute in Ohio… I was really into Einstein, who he was and how amazing he was to think up the theory of relativity. I remember vividly how much sense it made to me that if you take a sheet of paper and weigh it, then tear it in two, the weight of the two parts will be less that the weight of the whole. “That difference is energy,” so the science teacher said. It made sense to me. And, today, I wonder about the “whole” being more than the separated parts.

We are in the midst of a values-crisis that looks like an economic crisis. Having been to India, Nepal, Myanmar…it is difficult to take seriously the claim that there is not enough money in this vast and rich nation to take care of our own. I see veterans homeless, kids on the streets because of foreclosures, houses empty that would do better occupied. This cannot be about money, I say to myself, … in Nepal, it is about being undeveloped, about lack of roads, phones, infrastructure. But, here??

We have gone through periods of unemployment, recessions are cyclical. THis time is like the industrial revolution when the printing press made caligraphers grasp for their jobs; later, when blacksmiths had to learn how to repair cars; when music copyists had to get a handle on the software that made it possible to not just copy, but to transpose, orchestrate, create whole scores. We have gone through this before.

This time, however, all I hear is about money or lack of it.

Then, when I look at the research about nature and music, about how, to the patient, a nurse’s kindness does more than her efficiency, about how due consideration and respect for the process of healing is not a budget item… I know it is not about money.

We are in the middle of a values crisis that is forcing us to prioritize what matters. I think it is about time…

What do you think??