Change and storytelling

The word change has departed my lips more often lately than I would have predicted it might a year or two ago. I accepted a faculty and administrative position in Wake Forest University's School of Medicine this past summer, leaving behind a great job, two supervising physicians who were like family, and many wonderful friends. I also left the fertile South Carolina soil that has faithfully supported me all the days of my life. I sold the home that my wife and I built before the birth of our first daughter. We had intentionally built it in the right school district and amidst wonderful neighbors. I have even changed my diet—forcibly, I might add—although the absence of Charleston cuisine, which is characteristically buttery, may be the best thing that has happened to my coronary arteries in a long while.

In my new place of employment, the word change is used many times each day and is often preceded by words like strategic or transformational. Even the newspapers and professional journals are describing changes that are occurring within our evolving health care system. We are heralding the move to patient-centered care. I suppose this means our current care is not patient-centered. Regardless, there is lots of change all around me. And most of the recent changes have been intentional and ultimately very positive for my family.

Change hit me in the face like a two-by-four recently. My only surviving grandfather spoke to a classroom filled with Wake Forest University's first-year PA students last week. I invited him to be the inaugural speaker for a new lecture series called “On Leadership.” My grandfather was a public school educator and administrator for more than 40 years, an honored US Marine and intimidating drill instructor, the mayor of my hometown, a respected leader within the Southern Baptist Convention, a dedicated public servant and philanthropist, and the list goes on and on. He is the first leader that I remember meeting, and he remains the most influential and inspirational person I have ever known. Maybe you know someone who always makes the right choice or does the altruistic thing, even when it may not be popular or easy to do so. Well, that's who he is. When he was running for mayor of my hometown, no competing candidates blasted negative ads or tried to discredit him. During his talk with my students, he charmed them with his sweet Southern drawl, Citadel bow tie, and stories that were as funny as they were poignant. The stories he told were of survival and the experience of losing so many friends and fellow soldiers during World War II. His story was about how he believed his life was spared for a higher purpose, and thus he accepted a call to leadership and a life of public service.

My first reaction as he talked was probably very different from the reactions of the students and other faculty members in the lecture hall. I was hit by the image of an aging grandfather who frequently steadied himself on the podium and strolled slowly across the stage with a gait that only two 25-year-old artificial hips can deliver. I saw the severity and fragility of age in his skin, and I heard it affect his familiar voice. Now, I must admit there is not one ounce of my being that does not love and respect this man. But, like you, I am a clinician trained to assess, diagnose, and treat. My grandfather has been a source of strength to me all my life, and I do not know why his image impacted me like it did that day. I told myself not to be selfish and to be thankful that I still have a grandfather. Then I focused on his stories and allowed them to reconnect me with a childhood when he was my invincible hero. And the roars of laughter from the audience at many familiar punch lines (and some new ones) just washed away the rest. He has changed. I'm guessing that those physiologic changes I noticed were not changes he invited or welcomed.

My grandfather is a master storyteller. He inherited this gift from his father, who was a rural physician and the first Reamer in our family. I feel really lucky to have been given this name and be connected to the legacy it holds. I realize there are a lot of great storytellers out there, but my grandfather has also lived a rich, adventurous life that has created stories that are worth sharing. One of the highlights of his lecture was a familiar tale in which he talks about the life and near death of James Cash Penney, the American businessman and founder of JCPenney. The Great Depression left Penney in financial ruin, and he attempted suicide. He awoke from an intentional overdose in a treatment facility to the sound of the hymn “God Will Take Care of You,” which was an experience Penney credited with helping to reshape his outlook on life. Rather than just naming the song, my grandfather reached into his pocket and pulled out an old harmonica and played the hymn—quite beautifully, I might add. My grandfather has been singing in the Lake City Baptist Church choir for the past 75 years and is very musical. He told my students that he began his choir service as a soprano, until puberty lowered a few things, including his voice, to bass. The sound of those breathy harmonica notes against an audience that was completely silent would have gotten to you, too. My mind went back to a childhood memory of when I would sit on my grandfather's lap and reach stealthily into his silk-lined blazer pocket and pull out that harmonica. He would graciously crank out a tune—my favorite being the “Sloop John B” by The Beach Boys because it starts off with the line “We come on the Sloop John B, my grandfather and me.” I was reassured that some things do not change, like the feeling I get listening to him play that harmonica.

He revisited the lives of several famous leaders and some personal friends who had been particularly devoted to public service. He encouraged the students to be more than just great PAs. He called them to take care of their patients as they would want to be cared for, but also he asked them to lead their communities and be the light that our country needs to envision a healthier and more hopeful future. Then he talked about respect, and he told a story about my grandmother (I call her “Nana”), who has been his wife for nearly 65 years. You can make your own judgment as to whether or not I am a decent writer, but she made me a much better one. As a retired English teacher and lifelong student of literature and rhetoric, she helped me shape nearly everything I wrote between kindergarten and my senior year in high school. After school, I would head to their old house on Main Street and stay for several hours. We drank lemonade, read poetry, played Scrabble, did cryptograms, played cards, and worked on my homework. I can still see her handwriting in my mind—a tight cursive that fits perfectly in between the lines of prose that I had mistakenly formed without the right amount of precision or maybe even with a grammatical error (which warranted a thick red line and a verbal “bless his heart”). She taught me about how great writers shaped stories with signature ebbs and flows. (As an aside, the editor of JAAPA is no less astute than my grandmother, but she usually hits me with Microsoft® Track Changes and has not yet offered lemonade to ease the sting of critique.) It wasn't what my grandfather said about Nana that struck me. it was how he said it. His face brightened, his voice sweetened, and his cadence slowed to a well-known pace he reserves for the people he cares about most. Immediately, I sent a mental request into the universe that my wife WILL still love me like that in 65 years, because I do give her a run for her money sometimes. My grandfather ended his lecture with some encouraging words and shared his confidence in and respect for our profession.

Change, or the process of becoming different, affects everyone and everything at every moment. We may accept or reject it, but it's inevitable. We may or may not be able to control it to various degrees. But, I have gleaned a few new coherent thoughts about change since my grandfather spoke to that classroom full of PA students.

PAs embrace change.

In a way, PAs are experts in change. We perform physical examination maneuvers and order diagnostic studies to assess it. We interpret the magnitude of change to diagnose illness and formulate prognoses. We prescribe therapies to try to deter or provoke it. If we feel unsatisfied in a specialty, we can even change our careers. We change the way we practice, if needed, to reflect better the style of our supervising physicians.

Excellent clinicians recognize subtle changes.

The more we know and understand our patients, the more sensitive we can be in identifying illness and disease. What we learn in our training programs about signs, symptoms, and epidemiology is certainly helpful, but the more carefully we listen to and really see our patients, the better we can discern those changes that require care, whether emotional or physical. I bet you could even change the way you document your physical examination to help the next provider that sees that patient be alert to key changes in their condition.

Being a PA provides unique opportunities for personal and professional growth.

As PAs, we recognize changes that occur in the people around us—our patients, colleagues, friends, and family. With this ability comes great responsibility and opportunity. If we blend positive thinking and compassion into the care we provide, PAs can help orchestrate positive change. Our ability to recognize these subtle changes makes us influential and creates a natural aptitude for leadership. We gain a deeper understanding of the human condition when we truly see and allow ourselves to be affected by the people we encounter and the stories they tell. And I believe that if we use these skills, allow ourselves to be open, and accept responsibility for the future of health care, we will grow into the kind of people and profession that will fill stories told to future generations about the heroes who took charge and took care of America's health.

Reamer Bushardt is professor and chair of the Department of Physician Assistant Studies, School of Medicine, Wake Forest University Baptist Medical Center, Winston Salem, North Carolina.