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Who’s Going to Pay? Before and After the Affordable Care Act

March 16, 2017 Leave a comment

There’s nothing like getting current, though it’s hard to do when you write for a monthly. Still, in this cover story I wrote for the March 2017 issue of The Reader (http://www.thereader.com) I think I mostly managed to stay relevant to the topic of health care coverage in America, the forces pushing and pulling for and against the Affordable Care Act and what the ACA has meant in terms of gains and what its repeal and replacement would mean in losses. For the piece I spoke to local professionals on the provider and insurer sides of the equation for their take on how we got here and where we might be heading. The story went to press with us knowing Congress was working to repeal and replace Obamacare, though no one knew what that entailed, and then just about the time our story got published that plan was unveiled. As you know by now, the proposed new plan was met with disdain from all quarters, especially consumer rights groups and elected officials, even conservative Republicans, who heard loud and clear from constituents that they they oppose the called for cuts that would cause many people to lose insurance. As the push back continues, town halls and debates ensue, and presumably negotiations, revisions and compromises will get made. Meanwhile, America still can’t get its health care system to work equitably and efficiently.

 

Who’s Going to Pay? Before & After the Affordable Care Act

©by Leo Adam Biga

Appearing in the March 2017 issue of The Reader ((http://www.thereader.com)

One accident, one illness could be catastrophic. Not just medically, but also financially.

Families stood to lose almost everything in medical bankruptcies when health insurance companies rejected those with pre-existing conditions and capped their policies with lifetime limits.

Uncovered costs helped health care expenditures soar, more than tripling in the last 20 years according to the federal National Health Spending Report. In 2015, the federal government was the largest payer of health care, covering 37% of the total cost through its two programs Medicaid and Medicare.

The curve was starting to bend.

According to the Kaiser Family Foundation, health insurance costs increased 63% from 2001 to 2006 and 31% from 2006 to 2011. That number dropped to 20% from 2011 to 2016.

Part of the reason was the Affordable Care Act and a landmark shift in how health care was being offered. Through a series of tax increases targeting high-income earners, the ACA was able to fund experiments in in- novation while subsidizing the cost of bringing almost 30 million Americans into the health insurance system.

With the end of Obamacare at the top of the national conversation, The Reader talked to the major stakeholders about life before and potentially after the Affordable Care Act.

It’s not just the $2 billion in federal revenues Nebraska passed up for health insurance, or the 275,000 Nebraskans with pre-existing conditions that could be denied health insurance, according to the Kaiser Family Foundation. It’s not even the estimated 165,000 Nebraskans that would lose health insurance, an increase of 111% of the uninsured, according to the Economic Policy Institute, leading to almost 3,000 jobs lost and $400 million in federal health care dollars gone that we subsidize.

It’s also about the way we take care of each other.

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Quality of Health Care Over Quantity

America treating healthcare as a commodity helps explain its high delivery and coverage expense. Characterized by historic lack of incentives to drive prices down, providers and insurers dictate terms to consumers. Subsidies to assist low income patients who can’t pay out of pocket get passed along to other consumers. But affording care and its coverage is a burden even for the middle classes.

Amid runaway costs and coverage gaps, America’s clunkily moving from a volume to a value-based system as part of long overdue healthcare reform. The Affordable Care Act was passed in 2010 after contentious bipartisan debate. The statute’s full roll-out began in 2014.

Nebraska Medicine CEO Daniel DeBehnke said, “The tipping point that brought the ACA forward is really the unsustainable growth in our country’s healthcare costs.”

The calculus of people not being able to afford care translates into real life implications. Untreated chronic diseases worsen without treatment. Early diagnoses are missed absent annual physicals or wellness checks.

Championed by President Barack Obama, who promised reform in his campaign, the ACA’s enacted consumer protections and mea- sures holding providers account- able for delivering value.

Nebraska Methodist Health System CFO Jeff Francis said organizations like his have “con- tracts and monies at risk for hit- ting certain quality items, not just with Medicare, but with some of our commercial insurers as well, Five or ten years from now,” he added, “we’ll probably have more at risk financially from a quality and outcome standpoint. Recent federal legislation changed the way physicians get paid by CMS (Centers for Medicare and Medicaid Services). Starting in 2019 they’re having potential penalties depending on whether they’re hitting certain quality metrics or not.”

He said the stick of such punitive measures works.

A new Standard in American Health Care

Aspects of Obamacare, such as the individual mandate and public health exchanges, have detractors. Federal lawsuits challenging it have failed. But its intact survival is in jeopardy today. A chief critic is President Donald Trump, who with the Republican controlled Congress vowed to repeal and replace, though that’s proving more daunting in reality than rhetoric. On February 16, GOP leaders shared a replacement plan with tax credits for buy- ing insurance and incentives for opening healthcare savings accounts, but no details for funding the plan or its projected impact on the insured and uninsured.

Debehnke said, “I don’t think there’s any question, regardless of where you land politically, there are components of the current ACA that require tweaking. Even Democrats will tell you it wasn’t exactly perfect – nobody said it was going to be perfect. It was understood there were going to need to be changes as things move along.”

There’s widespread consensus about the benefits accruing from the ACA. New subsidies allowed millions more people nationwide and tens of thousands more in Nebraska to be insured, in some cases getting care they deferred or delayed. Insurers cannot deny coverage for pre- existing conditions or cancel coverage when someone gets sick. Plans must cover essential care and wellness visits. Adult children can remain on their parents’ insurance until age 26.

Francis said, “A lot of good things have come out of this. We’re focusing on well- ness, we have fewer uninsured, we’re having better outcomes for patients. I think there’s satisfaction with the improvements. I just think there’s disagreement with how it’s occurring or being done.”

“You can’t believe the difference it’s made by setting minimum standards for health insurance,” said One World Community Health Chief Medical Officer Kristine McVea, “so that things like child immunizations and mammograms are covered.”

Since the ACA’s adoption, uninsured 18-to 24-year-olds in Nebraska dropped from 25.5 percent in 2009 to 12.4 percent in 2015, according to the Kids Count in Nebraska Report.

McVea said, “At One World people get assistance in enrolling for health insurance. Counselors guide them through the market- place. People are really becoming more savvy shoppers. Improved health literacy has been a result of this process, you can really compare for the very first time apples to apples in terms of different plans. That has been a tremendous boon to clients.”

Not everyone included – Nebraska drops the Kick- back

Healthcare disparities still exist though. In Omaha 24% of adults living below the poverty line

lack health coverage while 3% of adults with medium to high in- come are uninsured. Some 36% of Hispanic adults, 15% of black adults and 5% of white adults are uninsured in the metro, ac- cording to numbers reported by The landscape, a project of the Omaha Community Foundation.

McVea said, “The poorest of the poor are not eligible for the marketplace at all because that part of the Affordable Care Act carved them out thinking states would cover them with Medicaid. Well, Nebraska’s elected not to expand Medicaid, so there’s this whole gap of people not insured. Then there’s prob- ably another tier who do get assistance through the marketplace, but considering the economic pressures they’re under, even with the assistance, it still falls outside their reach to get good healthcare.”

The Kids Count Report found 64 percent of uninsured Nebraska children are low-in- come — likely eligible for but not enrolled in Medicaid or Children’s Health Insurance program (CHIP).

Past Nebraska Medical Association president Rowen Zettermen said, “In Nebraska we have somewhere in the neighborhood of 60,000 to 90,000 uninsured people that would have otherwise been eligible for Medicaid expansion. you find the highest percentage uninsured rates in rural counties. We still have 20 some million uninsured in this country. A number may have insurance but they’re underinsured for their various conditions. Ideally, everybody should be able to establish a healthcare proposition with their physician, nurse practitioner or physician’s assistant to access care whenever they need it.”

Then there are federal DSH monies to fund Medicaid expansion the state foregoes because the legislature’s voted against expansion. Gov. Pete Ricketts opposes it

as well. Disproportionate Share Hospital payments are subsidies paid by the federal government to hospitals serving a high percentage of uninsured patients. Nebraska hospitals write off uncompensated care cost while getting no money back for it.

Zetterman said, “We could expand Medic- aid and take advantage of the roughly $2 to $2.5 billion that’s failed to come into the state. It would have paid salaries for more people in physicians offices and a variety of things that would be taxed and bring in more revenue.”

DeBehnke of Nebraska Medicine said, “Being a large hospital health system that takes all comers, we have a Medicaid percentage of our business. We would be better off in a Medicaid expanded state. We would like to see more coverage for the working poor. That’s what Medicaid expansion is – providing coverage to the working poor. Those who don’t currently qualify for it would under an expansion.”

Proposed federal community block grants could expand coverage. DeBehnke cautioned, “We just have to be sure there’s good control around how those dollars are used and they actually go for healthcare coverage. Expanding coverage to all people is really the key.”

Nebraska State Senator Adam Morfield is the sponsor of lB 441, which would expand Medicaid in Nebraska. The bill is scheduled for a March 8 Health and Human Services Committee hearing.

The care-coverage-income gap may be more widespread than thought. Kids Count Report findings estimate 18.5 percent of Nebraskans are one emergency away from financial crisis.

Preventative Care is Long-Term Savings

Having coverage when you need it is a relief. Insurance also motivates people to get check-ups that can catch things before they turn crisis.

“A woman having symptoms for some time didn’t have any insurance and she waited

before she sought care,” McVea said. “By the time she came to us for diagnosis she already had a fairly advanced stage of colon cancer. She’s undergone chemo- therapy and surgery and is now living with a colostomy. That didn’t have to happen. We see things like that every day – people who’ve let their diabetes and other things go to where they have coronary artery dis- ease, and that’s not reversible. We’re trying to get them back to the path of health with treatments, but they’ve lost that opportunity to maintain a high quality of health.”

Zetterman said, “There’s good data to show patients with cancer who don’t have insurance tend to arrive with more advanced disease at the time of initial discovery because they come late to seek care.”

That pent-up need is expressed more often, McVea said, as “people have insurance for the first time or for the first time in a long time.”

“We’ve seen a lot of people come in as new patients saying, ‘I know I should have come in a long time ago, and I’ve just been putting it off.’ Many are middle-aged. They’ve been putting off chronic health conditions or screening tests or other things for years. We see people come in with diabetes or high blood pressure that’s out of control and within three months we get them to a point where everything’s in control, they’re feeling better, they have more energy, they’re feeling good about their health. We’ve maybe given them advice about diet and exercise and ways they can keep themselves healthy.”

More positive outcomes are prevalent across the healthcare spectrum.

“I would say overall the average patient is having a better experience and outcome now than they were five years ago,” Nebraska Methodist’s Jeff Francis said.

One World’s CEO, Andrea Skolkin, said, “We’ve been able to reach more people living on limited income so our services have been able to expand both in terms

of numbers of patients we care for as well as types of services and locations.” One World opened two new satellite clinics with help from ACA generated monies. “As we’ve opened new clinics we’ve seen a number of people that had never been seen or delayed being seen with very complex

medical and sometimes mental health issues – and it’s more costly. We grew from about nine or ten percent of patients with insurance to close to 15 per- cent. For newly insured patients it’s meant some peace of mind.”

 

 

Fewer insured people, Higher Costs

She and her community health center peers favor more afford- able coverage to increase the numbers of those insured.

Zetterman said high premiums and co-pays present obstacles that would be lessened if everybody got covered. “The financial burden on the individual patient and family for health- care right now is too high.”

DeBehnke said, “A lot of the

burdens of those premiums in terms of high deductibles and other things have been shifted to families. There has to be some degree of subsidization if we’re going to make this all work. Regardless of where we land with this, the financial burden on the individual patient and family for health- care right now is too high.”

For the poor, the last resort for care continues to be the ER.

“If you’re uninsured the one place you can go in this country is to the emergency room of a hospital because the laws say you cannot turn anyone away from there,” said Zetterman. “As a consequence the uninsured make use of the ER because it guarantees they’ll get cared for – at least at that moment. The ER is the most expensive place to go for things that could otherwise be handled in a healthcare office.”

Zetterman said America’s handling of its social contract and safety net means “we cost shift in the healthcare environment to pay for things.” “In Nebraska, where we didn’t expand Medicaid,” he said, “we cost shift from private insurance and healthcare providers to people who have private insurance. They help pay for the uninsured-underinsured. We’ve estimated that to be well over a billion dollars. We can’t control costs reliably until everybody is in the system with some kind of a paid healthcare benefit. That can include all the current federal and state programs as well as commercial insurance that’s out there.

“Once we no longer cost shift to pay for healthcare we can begin to address the questions where are we spending our money and why are we spending it in those areas. Then we have a chance to control the growth of healthcare costs.”

Skolkin said, “A lot of hands in the pot helps add to the cost. There’s a lot of system inefficiencies, particularly in billing and credentialing, that could be made a lot of easier. That would save resources.”

DeBhenke said, “As the healthcare industry, we have not been engaged to the degree we need to be to actually decrease overall cost of care because frankly from a pure financial standpoint it’s not been in our best interest. The health systems, providers and other organizations have to really get be- hind this whole idea of providing value, of decreasing overall total cost of care while improving outcomes for patients. That’s got to work in parallel with legislative and subsidization levels at the federal level.”

He said until there’s more buy-in from “young invincibles” – 20-somethings in good health – to broaden or balance the risk pool and thus reduce payouts, costs will be a problem.

“Certainly the pricing needs to be attractive to those individuals to broaden the pool. And frankly the benefits associated with products on the exchange need to be attractive so those individuals feel comfort- able and actually want to have coverage. Those least likely to go to the marketplace and buy individual health insurance plans are exactly the people we want to do that to broaden the pool. Healthy individuals that don’t utilize healthcare much soften the financial blow.”

Repeal Without replace is A mess, Why not repair?

The ACA’s meant adjustments from all healthcare stakeholders. Opponents have resisted it from the start and that fight continues. In early January the Republican-led Senate began reviewing ACA to try and garner enough votes to repeal it through the budgetary reconciliation legislative process.

“Unfortunately President Trump has focused on what he’s going to take away without have a plan in place,” said Kristine McVea, “I think that’s been harmful. There’s a lot of fear and uncertainty among our patients. These are people who struggled without health insurance who finally got a chance at taking care of their health and are now very afraid of the possibility that’s all going to be taken away. We hear this every day from people coming into the marketplace and coming into see us for care, I think the capricious statements made by this administration have fueled that.”

More recently, talk of flat-out repeal has given way to amend or modify in acknowledgment of the gains made under ACA and the difficulty of dismantling its far-reaching, interrelated tentacles, absent a ready-to-implement replacement. The political fallout of taking away or weaken- ing protection people have come to rely on would be severe.

“Once leadership has really started to

dig into what it would mean to repeal this outright and try to replace it they’re finding it is not a simple thing to do and the health and coverage of millions of people are at stake,” said James Goddard, an attorney with the public advocacy group Nebraska Appleseed. “So things are slowing down with the recognition they need to be careful with this, and of course they do.

“I think the change in the way it’s being discussed is a reflection of the reality that this is a dramatic thing you’re discussing altering and they need to do it the right way. Much of the ACA hangs together and one thing relies on another and if you start pulling pieces of it apart, you have the potential for the whole thing to fall down.”

Zetterman said he and fellow physicians favor a cautionary approach.

“Most of us would say the Affordable Care Act should be maintained and improved. There are dangers in taking it away and replacing it because it’s now in so many different places.”

Nebraska Appleseed attorney Molly McCleery said total repeal would affect many. “Initial Congressional Budget Office projections show 18 million people would lose coverage, and then in the out years, 32 million would lose coverage – both private and public. The Urban Institute’s state-by- state impact study found 200,000-plus Nebraskans with a pre-existing condition would be impacted if that consumer protection would be taken away.”

Jeff Francis said, “The new ‘r’ word I’m hearing is repair. The consensus seems to be to keep what’s popular and working and change what’s not.”

EDITOR’S NOTE: Details of the recently proposed GOP replacement had not been released as of this printing.

Daniel DeBehnke said of the current climate, “I think it’s extremely confusing because it’s complicated. It’s like a balloon – you poke in one area and something bulges out in another. I think people are frustrated, and rightly so, they pay a lot for healthcare. It’s not just as simple as I-pay- a-lot-for-my-healthcare, ACA is bad, let’s get rid of it.’ There are layers of complexity. We may not like exactly how things are funded or how some components are dealt with. We may not agree totally with all the tactics to get there, but at the end of the day we’ve got more people covered.

I don’t think anybody has the appetite to change that back.

“We just have to figure out how to incrementally lessen the financial burden while maintaining the real goal – more people covered and providing value for the money being spent.”

He said the best course of action now for providers is to “just take really good care of patents and decrease unnecessary utilization and duplication of services,” add- ing, “It’s what everybody wants anyway.”

 

bcbs-01

 

Fixing the marketplace

Meanwhile, on the insurers’ side, some carriers have left public health exchanges after incurring major losses. This state’s largest healthcare insurer, Blue Cross Blue Shield, opted out of the volatile marketplace.

“Since we started selling on the ACA marketplace we’ve lost approximately $140 million,” executive vice president Steve Grandfield said. “We have a responsibility to all our members to remain stable and secure, and that responsibility was at risk

if we had continued to sustain losses. The public marketplace is unstable, which has driven increased costs and decreased com- petition and consumer choice. The higher premiums go, the more likely people, especially healthy people, drop their coverage. That means the majority of people remain- ing on ACA plans are sick, with increasingly higher claims, which drives premiums up even further.”

He cited instances of people gaming the system by buying plans when they need care, then dropping them when they longer need it.

Granfield said Blue Cross supports a well modulated ACA overhaul.

“It’s important to put in place a smooth transition. We would like to see regula- tory authority for insurance returned to the states, including rate review and benefit design and closing the coverage loopholes that lead to higher consumer costs.”

He has a long wish-list of other changes he wants made.

The leaders of two major Nebraska health provider systems say they haven’t seen any impact from the BCBS defection because there are many other insurers and products on the market. The executives were not surprised by the move given the fluid healthcare field.

Nebraska Methodist’s Jeff Francis said, “There were a lot of unknowns. I think it takes several years through the insurance cycle to be able to correct those kinds of unknowns, especially the way the federal government handles the bidding and setting of rates That’s why you won’t see craziness or changes in the rates in the years to come because they now have several years of experience with this new population and they’re then able to price accordingly.”

Daniel DeBehnke of Nebraska Medicine said, “Regardless of what happens in Washington, if the exchanges are kept in place there will be some changes made either in the pricing or pool that will help organizations like Blue Cross perhaps get back in that business.”

Quality Health Care Starts with Collaboration

Collaboration is key for containing costs in a system of competing interests. More U.S. healthcare decisions are happening outside silos.

Francis said, “A big change in the last 10 years is opportunities to work more collaboratively. In the past it would have been much more stand-alone. Now the hospitals and physicians are working more closely. Nebraska Methodist is part of an account- able care organization – Nebraska Health Network, along with Nebraska Medicine and Fremont Health. We recognize the importance of learning better practices from each other so we can pass that along to make healthcare better for the community and for employers paying for their employees insurance.”

One result, he said, is “less antibiotics pre- scribed by our family doctors at Nebraska Medicine and Methodist Physicians Clinic.”

Omaha fight doctor Jack Lewis of two minds about boxing


Omaha’s fight doctor, the late Jack Lewis, was of two minds about boxing. He championed the closely regulated amateur side of the sport but he decried the anything-goes excesses of the professional game. He saw more fights than he could remember as a ringside physician. He was also a sideline physician at countless football games in his role as team doctor for his alma mater, Omaha Central High School. He was an athlete and scholar there and he went on to be an athlete and scholar at Stanford University. The story I’m posting here is an advance piece I did about the 2006 National Golden Gloves tournament held in Omaha. I got Dr. Lewis and two other venerable members of the local boxing community, Harley Cooper and Tom Lovgren, to weigh in on the event and the sport. Lewis was a much honored member of Omaha’s sports and medical community. He was an inductee in the Central High Hall of Fame as well as the Nebraska High School Sports Hall of Fame. He, his father and his son comprised three generations of physicians.
It is worth noting that world pro boxing champion Terence Crawford of Omaha made it to the finals of that National Golden Gloves tournament in his hometown only to lose a controversial decision. It pretty much marked the end of his amateur career and the last time he fought in Omaha until defending his newly won WBO lightweight title at the big arena downtown, which by that time was renamed the CenturyLink Center.
Before leading you to the story, here is an Omaha Central High Foundation announcement about Dr. Jack’s passing:
Omaha Central High School Foundation's photo.

Omaha Central High School Foundation

 

It is with heavy hearts that we share the passing of Dr. Jack Lewis. A 1952 graduate of Central, Dr. Lewis served as the team doctor at Central for over 50 years, performing thousands of physicals and walking the sidelines of hundreds of football games. Dr. Lewis received numerous recognitions and sat on many different boards, including being inducted into the inaugural Central High School Hall of Fame in 1999, Nebraska High School Sports Hall of Fame, and Omaha Public Schools Athletic Hall of Fame. After receiving his first degree from Stanford University, Dr. Lewis obtained his medical degree from the University of Nebraska College of Medicine where he then served as a professor of internal medicine. Football games won’t feel the same this fall when Dr. Lewis isn’t on the sideline, offering decades of expertise to our student athletes. Dr. Lewis loved Central, and we will miss him dearly.

The visitation will be held on Thursday, June 23, from 4 – 6:30 pm at the Heafey-Hoffmann Dworak & Cutler Bel Air Chapel on 12100 West Center Road. The service will be held on Friday, June 24, at 11 am at the Presbyterian Church of the Cross on 1517 S 114th Street.

 

 

Dr. Jack Lewis, who turns 81 this week, has his physician son watching for mistakes as Lewis sees up to 30 patients a day. “If I made a mistake, I’d be the first one to quit here,” he said.

Dr. Jack Lewis

 

Omaha fight doctor Jack Lewis of two minds about boxing as the city readies to host the National Golden Gloves

©by Leo Adam Biga

Originally published in the New Horizons

 

For the first time since 1988, Omaha plays host to the National Golden Gloves boxing tournament, one of the nation’s showcases for amateur boxing. The 2006 tourney is a six-day event scheduled for April 24-29 at two downtown venues. The preliminary and quarterfinal rounds will be fought at the Civic Auditorium the first four days, with the semi-final and championship bouts at the Qwest Center Omaha the final two days.

Historically, the national Golden Gloves has produced scores of Olympic and world champions. Former Gloves greats include Joe Louis, Ezzard Charles, Muhammad Ali, Sugar Ray Leonard, Evander Holyfield and Roy Jones Jr.

Three men with long ties to the local boxing scene recently shared their thoughts on the Gloves with the New Horizons.

The man heading up the event is Omaha’s fight doctor, Dr. Jack Lewis, a 71-year-old internal medicine physician. As a doctor who loves a sport that gets a bad name from the medical community, he’s a paradox. While a staunch supporter of amateur boxing, Lewis is a fierce critic of the professional fight game, which he has come to abhor.

His experience in the prizefighting arena included serving as ringside physician for the 1972 world heavyweight title fight in Omaha between champ Joe Frazier and contender Ron Stander from Council Bluffs. Lewis stopped the fight after the fourth round with a battered Stander blinded by blood in his eyes.

“I love the sport of amateur boxing. I was involved in pro boxing and I didn’t like that from a medical standpoint,” Lewis said. “After just a few years working with the pros, I quit. In some cases, I didn’t know who the fighters were. They were fighting under fake names. I’d ask all these questions and the boxer would say the last time he lost a fight was a month ago in Chicago, and then some guy would come up later and tell me that same guy got knocked out last night in Chicago.

“Those pro boxers move around, have fake names, won’t give you their true medical history.”

Lewis continued, “Those pro boxing days are behind me. That sport needs to be cleaned up.”

More than just a fan of amateur boxing, Lewis is a veteran ringside doctor and longtime president of the Great Plains Boxing Association, the main organizing body for amateur boxing in Nebraska. This is the second time under his leadership his hometown of Omaha is presenting the Golden Gloves nationals.

Lewis is optimistic the event will fare better than recent national Gloves tourneys in cities like Kansas City, where the event failed miserably at the gate.

“We’ve done this before. I think our sales are going very well,” he said.

With Omaha’s success as College World Series host, with the Qwest Center filled to capacity for Creighton University men’s basketball home games, with the arena slated to host a slew of NCAA post-season events over the next several years, plus the U.S. Olympic swimming trials, the Omaha’s known as an amateur sports-friendly town. That’s why there’s talk of Omaha trying to host the Golden Gloves on a regular basis. The event is bid out a few years in advance, so it would be awhile before Omaha could host the event again after 2006.

“Omaha knows how to put people in the seats. Plus, this is really a fight town,” said Harley Cooper of Omaha. The former two-time national Gloves champion is seving as the 2006 tournament director. “It’s an outstanding event, Fans will see the best boxing in the country and probably see some future Olympic and professional champions.”

Omaha boxing historian Tom Lovgren joins many others in calling the Qwest “a great facility for boxing.” “The people there do a superb job,” he added.

While he never boxed, Lewis lettered in football and rugby at Stanford University, backing up future NFL great John Brodie at quarterback in the late 1950s. He said his athletic background and internal medicine specialization “lent itself” to begin treating athletes.

After graduation from Standford and the University of Nebraska Medical School, Lewis did his internal medicine residency in Oakland, California. He came back to Omaha in 1964 to practice with his physician father.

Right away, Lewis’ sports medicine interest found him treating a variety of athletes – jockeys at the Ak-Sar-Ben thoroughbred race track, football players at his alma mater Central high School, where he has been team physician since 1964, and boxers at the Omaha and Midwest Golden Gloves tournaments.

Lewis’ passion for amateur boxing has only grown. He enjoys the purity of the sport. He applauds the protective headgear and other measures taken to ensure fighters’ safety. He believes the competition inside the ropes instills discipline in its participants.

“I think the greatest athlete is the guy that steps in the ring and some guy comes after you. I think it builds character. I think it teaches you resraint. It helps you collect yourself. Through those years I’ve been to many meetings and been to many nationals. I’ve been he ringside physician at hundreds of fights and taken care of a lot of medical problems at the fights. Even though I never fought, I’ve educated myself in boxing and in all the trials and tribulations of the kids.”

Lewis said amateur boxing has suffered unfairly from the ills of its pro counterpart.

“There has been a lot of deaths and those deaths really hurt amateur boxing because then parents don’t want their kids to go into boxing. There’s been a lot of unscrupulous stuff. When I started it was a more popular sport. Today, kids are into doing all kinds of other things. They just don’t go into boxing anymore. And the coaching ranks have really declined. It’s an uphill battle.”

 

Tom Lovgren

 

Despite the smaller number of young boxers, Tom Lovgren said “there are kids around that can fight and the Golden Gloves is still a major contributor to the U.S. Olympic boxing team. He said a Gloves title still carries weight in the world of boxing.

“If you are a national Golden Gloves champion, you’re highly respected when you make a turn to the pro ranks.”

Lewis said another thing unchanged in the sport over the years is that ethnic-racial minorities are disproportionately drawn to boxing.

“Our best known boxers in the state now are Latino. There’s been a great influx of Spanish-speaking kids. Unfortunately, many of them don’t have U.S. citizenship and the rules require you to be a citizen in order to compete at nationals (Golden Gloves).”

In the history of the Golden Gloves there have been but five national champions from Nebraska. According to Lovgren, the best of the bunch was Harley Cooper, who won his titles in 1963 and 1964 (the first at heavyweight and the second at light heavyweight). He won those titles when he was in his late 20s. which is much older than the typical Gloves fighter. Since retiring from the ring, Cooper’s devoted time to developing and suporting area amateur boxing. He never turned pro.

“Everybody wanted him to fight for them,” said Lovgran, a former prize fight matchmaker and a longtime observer of the local fight scene. “The first time anybody saw hiim in the gym they knew this guy was going to be a national champion. He could punch. He could box. He could do it all. He was the most complete fighter I ever saw from around here. I never saw Harley Cooper lose a round in amateur fights in Omaha. He was that dominant.”

Besides Cooper, the only other Nebraska boxers crowned national Gloves champions were Carl Vinciquerra and Paul Hartneck in 1936, Hartneck again in ’37, Ferd Hernandez in 1960 and most recently Lamont Kirkland in 1980. A number of other Nebraskans advanced to the semi-finals or finals, only to lose.

In general, Lewis said, area kids are at a distinct disavantage.

“Amateur programs here are not strong. We don’t have enough coaches to train these kids. We don’t have enough fighters to have regular smokers that season them. Every year, our kids go to nationals with maybe 10 to 12 fights under their belt and they face opponents with 70 to 80 fights.”

Harley Cooper said Omaha holding the nationals can only help raise the level of the amateur boxing scene here.

“It wil let our kids see what they have to strive to obtain – the different skills and knowledge they will need to be a world-class boxer. Seeing is much better than someone explaining it to you.”

He added the biggest difference between “our boxers and the fighters from bigger cities is the opponents’ strength, size and skill.”

“It’s going to be a great weekend for amateur boxing in Omaha, Nebraska” Lovgren said. “I just hope a couple of guys from Omaha can go as far as the finals.

A raucous home crowd could help spur a local fighter to do great things.

“It can’t hurt,” Lovgren said. “Who knows? Anything can happen. Boxing’s a funny game.”

“There’s still some kids out there. We should see some real good boxing,” Lewis said.

A final elimination stage before the nationals will be held March 17 and 18 at the Omaha Civic Auditorium’s Mancuso Hall. Winners in this Midwest Golden Gloves Tournament of Champions will complete Nebraska’s 11-man contingent for the April national tourney.

Tickets for the nationals may be purchased at the Qwest Center box office or via Ticketmaster by phone at 402-1212, or online at http://www.ticketmaster.com.

For more details, call the Qwest Center at 997-9378 or go online at http://www.qwestcenteromaha.com.

Hearts and Minds: Dr. James Hammel Leads Omaha Children’s Hospital Team Beyond Borders to Repair Heart Defects in Young Patients in La Paz, Mexico


It seeems as though every year or so now I get an assignment to write about a medical mission team from Omaha that travels beyond borders to deliver care. In this Journeys story for Metro Magazine I write about the trips led by Dr. James Hammel and his team to the peninsula Mexican state of Baja Sur California and the city of La Paz, where life saving operations are done on infants and toddlers.

Visit the digital edition of the magazine, including my story, at–

http://www.spiritofomaha.com/Metro-Magazine/The-Magazine/

 

 

 

Hearts and Minds: Dr. James Hammel Leads Omaha Childrens Hospital Team Beyond Borders to Repair Heart Defects in Young Patients in La Paz, Mexico 

©by Leo Adam Biga

Appearing in the May-June-July 2016 issue of Metro Magazine (http://www.spiritofomaha.com/Metro-Magazine/The-Magazine/)

 

The peninsula Mexican state of Baja Sur California is a tourist draw for its ocean-front beaches and vistas. But isolation from the Mexican mainland makes it hard for residents to access specialized medical care. Poor residents lack the means to travel, much less afford treatment. A lack of pediatric heart services results in many congenital defects going unevaluated and undiagnosed. Consequently, many children die before getting an opportunity to be treated.

To bridge that care gap Cardiothoracic Surgeon Dr. James Hammel twice a year leads a medical mission trip to the southern city of La Paz in that Mexican state. He and his all Children’s Hospital & Medical Center team were there in November and they’re back again this April.

Before starting the La Paz trips four years ago, Hammel was a veteran of medical missions to Honduras and Nicaragua. His work in Mexico grew out of a collaborative with a Sioux Falls, S.D. health center that received children cancer patients from Big Sur through the Los Cabos Children’s Foundation based on the peninsula. Foundation founder Tom Walsh is from South Dakota. Children sent to Sioux Falls who presented heart problems then came to Omaha for treatment.

When a boy named Mario died before ever making it to a Chidlren’s operating room, Hammel resolved to provide care in Southern Baja in order to circumvent the delays that result in such needless tragedy.

 

“Before we went down for our first trip there was no pediatric cardiologist in that state of Mexico, there was no cardiac surgeon, adult or pediatric. There had never been an open heart operation performed there historically. There was no intensive care unit team either, And there obviously was no familiarity with doing heart surgery, so we were really pioneering something there.” – Dr. James Hammel

 

“It was obvious to me he’d been turned away again and again and again,” Hammel says. “His mother was very sweet and she had taken him repeatedly across to the mainland and sort of begged for surgery from one of the centers there. But they just couldn’t get it. That case firmly cemented my commitment to this charitable foundation and when the opportunity did arise to work down there that seemed like a lot better option than bringing people up.

“Bringing kids up is very expensive, cumbersome, difficult. It takes a long time and it’s only possible to do in very small numbers. I thought. Well, for the same amount of money we could treat a dozen children there by bringing our team down.”

Hammel leads some 20 medical professionals, most specializing in critical care, on each 10-day trip. They’ve instituted many firsts there.

“Before we went down for our first trip there was no pediatric cardiologist in that state of Mexico, there was no cardiac surgeon, adult or pediatric. There had never been an open heart operation performed there historically. There was no intensive care unit team either, And there obviously was no familiarity with doing heart surgery, so we were really pioneering something there.”

He brings intensive care doctors, children’s pediatric intensive care nurses, a perfusionist to run the heart-lung bypass pump, cardiac anesthesiologists, operating room nurses and a surgical assistant. Everyone volunteers their time. Their care is entirely free to families.

 

“What we do is a calling, a passion, it’s what we love to do, but it is a job and you don’t always appreciate and grasp the enormity of what you’re able to do until you give it to somebody for free. What we give down there is something nobody in the United States will ever appreciate the way the people in La Paz do. I cannot over-stress the amazing feeling you get when you save the life of a child whose family has tried every avenue and lost hope and then you do that for them and they are so grateful. I can’t imagine not doing this work. I’m in it for the long haul.” – Dr. Bridget Norton

 

It’s taken awhile to build trust with local leaders but a permanent program is now in the works.

“Little by little the administration of the hospital we’re working in and the government health ministry and the state government began to take an interest in the possibility of making an ongoing program. That’s when my goals took their last maturational step,” Hammel says. “We’ve been back every six months for a total of six missions and we’ve operated on 68 children – some with simple diseases but some with very complicated heart defects. Mostly they’ve done fine.”

 

 

 

 

 

 

 

 

 

 

Some children require multiple surgeries.

“My goal is to establish a new cardiac treatment program to be a permanent part of that state’s health care system. In all of Mexico there are about 11 pediatric cardiac surgery programs and eight are located in Mexico City itself, thus the distribution of this resource is really poor and access is really limited. There are probably 18,000 children born in Mexico with heart defects every year and probably only about 3,600 corrective operations and catheter procedures performed. So, nearly 80 percent of the children with heart defects likely die, It’s a really big unmet need in the country.”

His goal is to help the Mexicans “build a viable, self-sustaining program that goes on treating these children when we’re not there and even after we stop coming.” He adds, “We have recruited to the state two pediatric cardiologists, a pediatric intensive care doctor and the first cardiac surgeon in the state. We have trained a group of pediatric intensive care nurses in special techniques for cardiac intensive care nursing. We trained the operating room staff.”

Before it can be self-sustaining, he says a “critical mass of manpower” is needed. Progress to get there is being made.

“It’s a gradual thing. This last summer the program performed its first open heart operation without us being there. They have performed a larger number of non-open heart cardiac cases, simpler cases, so they’re beginning to get going.”

He expects the program to reach a major milestone in 2016.

“When we get the program fully accredited by the Mexican federal government the hospital system can begin to receive some reimbursement for each case they do. It amounts to about $6,000 or $7,000 per case, but we can do it for that. It’s going to take a little more investment for needed supplies before we get to that point.

“In the meantime, we go and we do a dozen cases twice a year and that’s wonderful. It’s a great thing for the children we treat and their families, but it’s not enough. I would estimate there are about 60 children born in this state of Southern Baja a year with critical heart defects who need an operation, so we’re not reaching all of them.”

 

“The trip has evolved and the camaraderie has become much more important and never more so than last trip when the kids were much sicker.”  – Shannon Hoy

 

 

 

 

 

 

 

He’s created a nonprofit, Abriendo Corazones – Opening Hearts, to coordinate the medical care and logistics of the trips. It partners with the Los Cabos foundation. Children’s may soon be formally involved.

“Our hospital administration has seen the positive effect this kind of work has on our staff as far as their resourcefulness, their creativity, their career satisfaction. It’s something that really brings us together

and that has real tangible benefits in terms of our ability to do our job with excellence. I think Children’s is coming to see this work as a two-way street with great benefit to the people there and to our patients and staff here.”

Dr. Bridget Norton, a Specialist in Pediatric Critical Care Medicine, has been on all but one La Paz mission. She says it’s a “team-building” experience for both her and her fellow professionals who go.

“We make relationships and connections and friendships with colleagues we wouldn’t necessarily make without that experience.”

Many things Children’s does in Omaha, such as blood conservation and comfort med administration, have come out of what the team’s learned to improvise with in resource-poor La Paz.

Norton says the trips put in perspective the gifts she and her mates have to give.

“What we do is a calling, a passion, it’s what we love to do, but it is a job and you don’t always appreciate and grasp the enormity of what you’re able to do until you give it to somebody for free. What we give down there is something nobody in the United States will ever appreciate the way the people in La Paz do. I cannot over-stress the amazing feeling you get when you save the life of a child whose family has tried every avenue and lost hope and then you do that for them and they are so grateful.

“I can’t imagine not doing this work. I’m in it for the long haul.”

Perfusionist Joe Deptula, who’s made multiple Central American mission trips with Hammel, says the work is about “being able to give back.”

Shannon Hoy, a Certified Registered Nurse Anesthetist (CRNA), has made many mission trips herself. She sums up the La Paz mission as “a great experience,” adding, “The trip has evolved and the camaraderie has become much more important and never more so than last trip when the kids were much sicker.”

The team can’t forget a patient named Oscar.

“Oscar came to us with a very serious congenital heart defect, which was previously operated on during a different trip,” Hammel says. “Due to his age and heart defects, his heart had sustained a lot of wear and tear and we were unsure how well he would do despite the repair.”

When the team left for home his vitals looked good. Then a fire in the unit forced a patient evacuation. His lines were cut and he expired off the meds. News of his death hit the team hard as he’d twice beat the odds only to lose his life anyway.

Most operations are scheduled in advance but families often show up unexpectedly with a sick child. The parents of a 6-month-old named Derek drove hours to reach La Paz, where the team found the baby so fragile they simply admitted him for observation without a single line or anything started lest the trauma prove too much. The boy’s surgery the next morning went well and today he’s totally repaired and healthy.

The life-and-death surgeries and the intense emotions take their toll.

“You are exhausted and not just physically,” Norton says. “It’s hard work and we work long hours. We do overnights in the hospital. But it’s also emotionally draining. You just have a lot of feelings and emotions you work through.”

Once back home, some decompression is necessary. Thoughts of La Paz, however, are never far from Children’s team members’ minds. Not only do patients and families leave an imprint, but so do staff.

“We’re like family,” Norton says of her team and the Mexican team they work alongside. Collaboration is vital to the program’s success. “They’ve been amazing and are on-board with the mission. We really couldn’t do anything we do without them – all the support services they provide, the hoops they jump through, taking care of the equipment we leave down there. Any blip that comes up, they handle it.”

Los Cabos foundation former executive director Greg Edwards now heads Abriendo Corazones – Opening Hearts with Dr. Hammel. He says building the program has inherently high stakes and complexities because it’s critical care. Since that care is largely delivered by Omaha specialists, much coordination and navigation is required. These specialists not only practice their healing arts in La Paz but impart expertise there. Locals also travel to Omaha for training.

“The support of Dr. Hammel’s team and friendships that exist at Children’s has been essential for this to happen,” Edwards says. “You cannot have a cardiac program without intensive care. Building a pediatric cardiac care program is no small task. It has meant creating relationships with Mexican officials. recruiting qualified staff, turning the surgeries into not only life-saving operations but a training theater for the local Mexican medical staff, creating a pipeline for medical supplies needed for the surgeries and intensive care from Omaha to Baja.

“It really is a huge undertaking.”

Abriendo Corazones accepts donations to support its efforts at strengthening hearts. Contact Dr. Hammel at 402-955-4360.

For more on the trips, visit http://www.loscaboschildren.org/donate/.

OPEN WIDE, Dr. Mark Manhart’s Journey in Dentistry, Theatre, Education, Family, and Life /A Biography

October 28, 2011 2 comments

 

OPEN WIDE

Dr. Mark Manhart’s Journey in Dentistry, Theatre, Education, Family, and Life /A Biography

©by Leo Adam Biga

 

 

Mark Manhart

 

 

A Life in the Open

We all lead a few lives or, if you prefer, double lives. Mark Manhart knows something about the mirrors of life. In his professional life, he is a dentist. In his personal life, he is a writer, director, history buff, landscaper, father, grandfather, and husband among a few different pursuits. “I think everybody has that kind of dual life going, especially people who get into such specialized things as dentistry. A professional has to lead two lives. Your open life and your other lives,” he said. The Omaha, Nebraska resident has an opinion on most everything, and he usually has a philosophy to support his viewpoint. Try this one on for size: “One needs a real work-a-day life and then at least one other life, some hobby, avocation, distraction, to work on to nearly inane proportions, so one can return to home base refreshed, go to bat again, and make your way before the inning and game is played out. I have gone through many family and professional things that were very much like sitting in the dental chair. All have been adventuresome.”

For this man of many interests and talents, life is also full of what he likes to call “natural wonders”—those unforgettable people and events that he enjoys experiencing and cultivating. He is all about opening new horizons of discovery in his personal and professional lives.

One domain feeds the other; one dimension offers solace from the other. “All of this, in any position or occupation, is terribly important to one’s sanity, pleasure, growth, and accomplishment,” is how he sees it.

For fifty years Manhart has indeed left the confines of home for the office, leaving behind his domestic incarnation for that of the highly trained, working professional who not only practices dentistry but is actively engaged in developing new treatments or therapies.

Then there is the life that revolves around some inner passion that enables him to return to work recharged, ready to resume life in the open and persevere. For Manhart, it is the world of arts and letters that feeds or fulfills him with the sustenance to carry on with renewed vigor. Specifically, it is the life of the theatre and his work as a playwright and director, and occasionally as an actor, that is a source of satisfaction, of solace, of energy, of intellectual and emotional discovery that offers a balance or complement to his professional and family endeavors.

There is also the life he maintains with his spouse. Here, too, Manhart is well-versed in that song and dance called marriage. He has been married twice. His first marriage lasted more than two decades and resulted in eight children. That union ended in divorce, but when he was ready to start a new chapter in his life, he did not hesitate to marry again, to a woman with a pair of children of her own. This second marriage-go-round has now exceeded more than two decades itself, which would seem to indicate he is the marrying kind.

He and his wife, a spitfire named Bonnie Gill, make it work despite being very different personalities. They may not see eye to eye on many things, and they may handle situations quite differently, but when it comes to what is important in life, they are simpatico. They are both searchers, ever inquisitive to turn the next page in life, to see what is over the next hilltop, to experience a new culture or way of doing things. Both are principled people. Both would rather give than take. Both are creative souls.

It seems Mark Manhart’s thirty-year dental partnership with Dr. Tom Steg can be thought of as a kind of marriage in itself. The two men are opposites in most ways but are kindred spirits where it counts most, as people of high character, intense curiosity, extreme professionalism, and with a penchant for pushing beyond the norm of dentistry to find the best ways of caring for patients.

With his tall frame, angular features, shock of silver hair, confident pose, resonant voice, formal manner, and reserved personality, Manhart cuts a striking, classic figure. He comes across at once as a bold, magnetic personality with an authoritative air and yet at the same time as a quiet, pensive, somewhat shy, even insecure soul. It is that duality that is so much a part of him. It is an expression of his charm and his complexity.

Call it fate or coincidence, but this practitioner of the healing art of dentistry also became a creative artist somewhere along the line. More likely, he was an artist  right from the start and his muse simply waited for when the time was right to finally bloom. Many of the qualities that make up a healer, after all, are much the same as those that characterize an artist: empathy, discernment, problem- solving, discipline, craft, even imagination.

Manhart still lives that personal brand, striking a balance between right- and left-brain activities that put him squarely in the mix of Omaha culture, community, and commerce. Long before social networking became a catch-word and lifestyle for the online era, he was engaging people from all walks of life and exploring ideas from disparate sources.

 

 

Calcium Therapy Institute

 

 

He was ahead of the curve on the Internet as well, launching a website for his practice back in 1995. He is on LinkedIn, Facebook, and all the other go-to social media sites. He blogs. He even conducts online training sessions for dentists from around the globe. He is as connected as anyone of his generation.

His inclusive, progressive approach to dentistry may best illustrate how open-minded and receptive he can be to new ideas and new collaborators. Eager to always improve his craft, he makes a habit of seeking out the latest advances by poring over dental journals from around the globe. Staying current this way has spurred him to make his own breakthroughs and to share his advancements with peers in the United States and abroad.

Away from dentistry, his work as a playwright and theatre director reflects his eclectic tastes, ranging from sentimental love stories to historical dramas to bawdy comedies to high- brow treatises to full-blooded biographies to English manor mysteries. From kitsch to classic, Manhart embodies it all.

Not so very different from the way he seeks to break new ground in dentistry, he actively seeks out new forums and challenges in theatre. He has done the same in education, too, as a champion for the Montessori method of early childhood instruction and for home-schooling. Although he has been a clinician most of his working life, he has also taught dentistry formally at the university level and informally in workshops and trainings.

Whether navigating the worlds of medicine, business, education, or art, he is an enterprising, energetic innovator open to new, even unconventional ways of doing things. He is what some people call today “a creative.” It is really another word for “eccentric” or for how one of his own children described him—“a half bubble away from genius.” That missing other half of the effervescent bubble can sometimes make him look like a fool or an idiot some people very close to him will tell you. It is a risk he is willing to take.

 

 

Great Plains Theatre Conference

 

 

His work and life are expressions of an inquisitive mind and a sensitive disposition. His office displays pictures of the charming digs he kept in The Passageway of Omaha’s historic Old Market district, the cultural heart and soul of the city he felt right at home in. Once the wholesale produce center for the city, the district was redeveloped beginning in the late 1960s and early 1970s into a European-style marketplace.

The Mercer family of Omaha led efforts to preserve and reuse the century-old warehouses as restaurants, galleries, theaters, shops, and residences. Manhart fit right in with the Old Market’s creative class denizens.

The Old Market has become one of the state’s largest tourist attractions, along with the world-class Henry Doorly Zoo as a magnet bringing visitors to the city. Due to health issues of his own, Manhart long ago had to set aside this second office in The Passageway at 10th and Howard Streets. The Market and his affection for that Old World location is evident in the photographs he displays of the brick-hewn office and environs he practiced in there. He also keeps an antique dentist’s chair in his West Omaha office as a token of his appreciation for “good old-fashioned” dentistry, craftsmanship, and values.

Manhart’s full life is not just a professional or aesthetic exercise. His life extends to family. He came from a huge clan, and he is the father of eight himself.

“I always wanted a large family of twelve children. A lot of kids who could become ‘adult’ adults. As a granddad, it is hard to see much success in that regard, so I must wait it out. I think I was a good father but that is slightly biased. People would say I am too harsh, too outspoken, too busy elsewhere, distracted too easily, too liberal, too persistent, frugal to cheap, an exaggerator, cold with little emotion, a trouble starter, and more. An old friend, a Jewish lady, hit it for me: ‘You are a starter. We have enough finishers.’ My obligation to the kids was to house, feed, protect them from others and each other in a way that they would be able to do the same as adults, and love them. Most of the love was, and will remain, secret between each one and me. Some day I want to write about that,” he said.

Cast members of plays from Great Plains Theatre Conference

Those who know Manhart from his life in the arts may not even know he is a family man, much less a dentist. Just as those who identify him as a dentist may not be aware of his other lives. That is all par for the course for someone who throws himself passionately into whatever endeavor he is engaged in at the moment. It is not as though he focuses on a passion to the outright exclusion of everything else, but he does tend to lose himself in whatever it is he is engaged in at the moment.

His single-minded devotion is evident in his dental career. He has been in private practice now forty-five years. Counting his time doing dentistry in the United States Air Force Dental Corps and his time in dental college, he has been actively engaged in the field of dentistry for more than half a century. However, the way he has chosen to practice, by utilizing noninvasive calcium treatments of his own design, has made him an outcast of sorts within his field. And being shunned by the dentistry establishment was just the beginning; legal action to stop him followed, but each case served to strengthen his resolve.

To further his somewhat nontraditional approach to dentistry, he founded and directs the Calcium Therapy Institute in his hometown of Omaha. The Institute is the vehicle for Manhart to do dentistry and science side-by-side, using his preternatural inquisitiveness and idiosyncrasy to investigate dental problems and treatment options along lines that do not necessarily conform or adhere to organized dentistry’s prescribed ways. That is just the way he likes it, too. Tweaking the nose of authority is a Manhart trait.

He enjoys playing the contrarian. Much the same way his late father, a farmer-turned-attorney-turned-inventor, was his own man who went his own way, damn the consequences, Manhart is a maverick accountable only to himself. He takes the road less traveled, whether in his personal or professional affairs, following an inner muse that neither brooks compromise nor suffers fools gladly nor worries about what people say.

There have been times when he has severed major threads in his life in order to do what he felt was right, regardless of how others perceived him and his decisions. For example, he and his first sweetheart, Mary, married and raised a large family together. She is the mother of his eight kids. After the kids were grown, the couple decided to end the marriage.

“Mary and I were happily married for a long time,” he said. Then they simply reached a place in time when they determined they would be better off apart.

Following years as an active member of the American Dental Association and officer in the ADA’s Omaha branch, he set aside organized dentistry as well. He has practiced without direct affiliation with the dental establishment— that is, his ADA membership and a position teaching at his dental school. However, the tradeoffs became more focused on his patient care, clinical research, and life beyond dentistry. At the time he won a lawsuit over patient treatment that was egged on by dentists who opposed his research in the advanced uses of calcium materials. When a number of specialists testified against him, there were subsequent, immeasurable losses to his reputation and health.

Aside from getting some of his findings published in the preeminent international dental journal more than twenty- five years ago, and in a few minor journals, his attempts to publish his work in America have been repeatedly rebuffed, much to his frustration. Nonetheless, in 2009 a prestigious European dental journal published his latest findings almost immediately and without reservation. His perceived banishment in the United States is a source of bitterness with him but just how much it bothers him is hard to gauge as he tends to dismiss it or brush it aside as no big deal. His wife, Bonnie, knows differently.

 

 

Bonnie Gill

 

 

How much has he been hurt by all this? “Very hurt. More than you can imagine,” she said. “I cannot even talk to him about it, and some of it I think he has brought on himself. But I think as he gets older it is killing him and I keep telling him, ‘You gotta let it go.’”

Bonnie said her husband can be hard to read, even for her, because he is such a mix of things and because he can hide behind an inscrutable, sphinx-like mask that serves to insulate and isolate him from those around him.

“I know him probably better than anybody else, I would say better than any human being on Earth,” she said. “He is a very complicated soul and a very kind person. It is sometimes the bane of his existence and actually what probably drew me to him. I knew before I ever got hooked up with him that he was incredibly honest. What I do not admire is that he can seem to turn that on and off and be extremely cruel when he wants to be, too. This is one of his flaws—it’s my way or no way—he cannot ever see the gray areas on some of this stuff, which he is very good at seeing on other things.”

She has no trouble standing up to him when she feels he is wrong and telling him so. He can handle being called out on his mistakes and has no problem with Bonnie’s candidness and her telling him like it is.

Bonnie said, “You know, it takes a pretty strong guy to accept being told, ‘I think you’re full of it.’ But that is the kind of relationship we have. It’s perfect because I do not ever have to get up wondering who I should be today.” In other words, she can be herself. With Mark,” she said, “I always know I can be who I am, warts and all, and it might be a little grumpy, but it’s going to get worked out.”

She has been there through the highs and lows of his dental life. She has seen the toll it has taken on him to seek the kind of vindication and recognition he wants but that has not been forthcoming and that likely will not come anytime soon, much less in his lifetime. “One time I asked Mark in the throes of this, ‘Do you want to be rich or do you want to be famous?’ And I did not even have to ask him because I knew what the answer was. He threw me a curve ball though by saying, ‘Both.’ I said, ‘You cannot have both, you can only have one.’ And then he said, ‘Famous,’ and I said, ‘I knew that.’”

Despite setbacks he has doggedly carried on, determined to prove people wrong. Call him intransigent or stubborn or willful or simply determined, he is like the proverbial dog that won’t give up a favorite bone without a scrap. As stressful and contentious as his dentistry battles have been, the bulk of his work in the field has been fulfilling. It is why he still does what he does at an age when the vast majority of his peers are long retired.

“Look at when dentists retire. I mean, dentists retire pretty darn early, and I passed that opportunity up fifteen years ago. I keep on because our calcium therapy works and it is such a delight to practice dentistry,” he said. “You know every day I see people who have troubles and we solve them. What more of an ego trip could you want?”

A pursuit quite apart from dentistry that Manhart is no less passionate or obstinate about is the theatre. This dramatic arts enthusiast has taken the hobby seriously enough to have helped form and operate three community theatre venues: the Rudyard Norton, the Kingsmark II, and the Grande Olde Players (GOP). He co-founded and directed the latter with Bonnie. Their Grande Olde Players established a niche by producing works featuring seniors and intergenerational casts. After a twenty-four year run the Grande Olde Players Theatre, which also featured jazz concerts, staged its final season in 2008.

Manhart has also participated in the Great Plains Theatre Conference hosted by Metropolitan Community College. The college’s historic Fort Omaha campus is the site of play labs where Manhart’s work has been read and where he and Bonnie have directed play lab readings of works by other playwrights. The conference receives submissions from playwrights across America, even from abroad. It is an intensive week-long concentration on craft. Some of theatre’s greatest talents participate as readers, respondents, mentors, and panelists, all in service of furthering the work of new and emerging playwrights.

Manhart does not kid himself. He knows he is not in the same league as many of the participants, who have included Pulitzer, Tony, and Obie award winners. The experience of having his work critically evaluated has not discouraged him but has emboldened him to keep writing and improving.

He has already accomplished much in local theatre. Without a lick of formal training he taught himself how to write, produce, cast, and direct productions and to manage theatre companies. He still writes plays and he still takes directing assignments today. Bonnie also continues to write and direct. Much like his experience in dentistry, he has often butted heads with theatre colleagues and collaborators, but, right or wrong, he has always remained true to himself, which is that of a stubborn, “tough old German,” as he likes to say with a wry smile. He is actually Swiss and German, with a little French thrown in, although the borders of those countries changed so often in the not-so-distant past that his precise lineage on his father’s side, the German side, cannot be determined with absolute certainty. On his mother’s side, the Swiss side, however, the family line can be traced back some eight hundred forty years.

The worlds of dentistry and theatre could not be more unalike on the surface. But look closer and what at first seems incongruent reveals similarities, which is why Manhart has drawn from each to enrich the other. Of course, when you think about it, dentistry entails a performance aspect. After all, the practitioner fulfills the role of expert healer for the patient, who comes in search of relief. The drama and expectation alone make it a kind of theatre. Conflict is at the heart of any drama and the inherent conflict in the doctor- patient relationship is that the healer may have to cause the patient discomfort, even pain, before healing occurs.

For many patients the mere thought of going to the dentist produces extreme anxiety. Sitting in the examination chair, surrounded by all that cold, hard, sterile equipment, which for all the world resembles instruments of torture, is enough to raise anyone’s blood pressure. Then there is the whir of the drill. Add to that the unpleasant past experiences many have had in a dental office, from scrapings to extractions to injections, and you have the makings for a tense situation.

Then there is the often exorbitant cost of dentistry that not all patients have the insurance to cover. The financial burden of care is a source of some resentment. It is routine nowadays for a few extractions or a root canal, for example, to cost many hundreds of dollars. When you talk about bridges, crowns, and implants, the bill ratchets up into the thousands. Finally, some doctors do not exactly have a winning chairside manner with their condescending, paternalistic I-speak-you- listen, I am-the-expert-you-are-the-patient attitude.

 

 

Manhart went to India to lecture on calcium therapies

 

 

In stark contrast to that dysfunctional model, Manhart goes out of his way to provide high-quality service at a reasonable rate and to deal with patients in a respectful manner that makes them a part of the care plan. He has also refined his craft to the point that his supple hands have a sure touch. He said there are qualities, some tangible, some intangible, that separate a master practitioner from a run-of- the-mill one.

“It is their touch, their approach, their finesse, whatever you want to call it,” he said. As a young dentist he had a chance to not only see but to feel some masters at work. “I thought, there is the kind of practitioner I would like to be.” By all accounts, he has become one. He said, “My rule always has been, man, if I can get my hands on you, you will never go anywhere else.”

Such finesse only comes through an assurance and confidence that cannot be approximated or faked. You either have it or you don’t. “That’s everything, yeah,” said Manhart. “You cannot really hide it. It’s there and it’s in everything you do. I worked for an orthodontist named Dr. Elmer Bay, and as a teacher this guy was absolutely wonderful because you never knew you were being taught. I used to make his appliances for orthodontics, and I saw his superlative results in everything. He was very old-fashioned. A few years ago Dr. Steg [Manhart’s dental partner] said to me, ‘I had a patient who was told by so- and-so she should not go to us because we are old-fashioned dentists.’ Well, that is the best compliment anybody has ever given us because those old-fashioned dentists like a whole lot we grew up with were just wonderful.”

One old-time dentist Manhart worked with, Dr. Leo Ripp, was so well-loved and appreciated that at his funeral mourners eulogized what a great dentist he was. Manhart never heard of such a thing. “Old Dr. Ripp, he could make the most beautiful gold crown you could ever believe seeing with the oldest crap you could ever think of using,” he said. “He really just was superb. He would put a crown in someone’s mouth, and if it did not stay forty years, something was wrong here.”

Manhart has the utmost respect for the men who taught him because they were working dentists. They were the first practitioners and second teachers he has tried emulating.

“Most of my training was given to me by dentists who were practicing fulltime and coming in a little bit each week and teaching. That kind of dentist is a clinical, hands-on dentist. They really know what is going on. But since the middle 1970s or somewhere in there, the dental school faculties have been dominated by fulltime teachers who go to practice a little bit and that changes the whole picture. That changes it even in the sense of the patient-dentist relationship. When you are working on your own patients and you are listening to them, you are really listening to them, number one, and you are making decisions together, number two, and you know little things like if this patient is not happy, they are going to go home and tell seventeen people. Now you either make them happy or you are in big trouble,” he said.

Conversely, he said a sense of accountability tends to be in shorter supply among dentists who teach fulltime because in college dental clinics dentists are not seeing their own patients, they are seeing whoever walks in for treatment, and these patients are apt not to get the same attention they would in a private setting. From where Manhart sits, too, there is something to the old adage, “Those who can, do, and those who can’t, teach.” Therefore, let the buyer beware.

In such a setting, he said, the dentist tends to be insulated from any repercussions that attend substandard care. A gulf or separation existing between dentist and patient is not consistent with quality care. He feels this insularity is engendered, too, in some dentists who belong to the American Dental Association, who use the organization as a buffer. “That insulation makes you act differently,” he said. Less compassionately or less empathetically perhaps. Rather than hide behind an association, Manhart puts himself right out there, taking full ownership of who he is and what he does. “When you go onto the Internet—this is the first thing I found out—you open yourself up to the entire world and a lot of dentists cannot allow themselves to do that,” he said.

Furthermore, Manhart strives to do the most for his patients with the least overhead for fancy equipment. He has developed an array of techniques, products, and applications that treats patients in minimally invasive or entirely noninvasive ways that are also quick and painless. He is efficient enough to get patients in and out of his office in short order but without resorting to shortcuts or rushing through procedures. That is because he has reduced procedures from several steps to just a few steps, eliminating waste, excess, and overkill. Yet he still takes time to actually examine the inside of the patient’s mouth, explain things, ask questions, and lay out options. He is all about finding long-term solutions, not quick fixes. It is the way informed consent is supposed to work, he said.

Arlene Nelson has been a patient of his for nearly forty years, and she appreciates his inclusive approach. “He shows me the X-rays every time. He says, ‘I want you to look at this.’ He just explains things to you and you just get a clear picture of what is going to be done and how long it is going to take and how many treatments or whatever. You feel like you are a part of the improvement. You really are, too. He puts you right in there. You are right there and you are a part of the healing process. He gives you an ear-by-ear, side-by-side walk with the healing,” she said. “He has really done me right. I have just been very pleased. He is very gentle, very sure.”

His old-fashioned approach is something she appreciates. “You know, I kind of like that. Not only that, but I had a tooth that was bothering me that was way in the back, and I actually called him at home on a Sunday and he said, ‘I want you to meet me at the office at one o’clock,’ and I did. I did not ever think I would be calling a dentist at home. It turned out he had someone flying in from wherever for treatment that day. I thought, oh my gosh. He is just so ready to help me. He is my kind of dentist.”

Paul Luc appreciates the holistic way Manhart treats dental problems. A Hong Kong native living and working in Tennessee, he is typical of Manhart’s patients from all over the country, even all over the globe, who have discovered the Calcium Therapy Institute (CTI) via the World Wide Web. Dozens more do every day.

Diagnosed with advanced periodontal disease, Luc studied the CTI website, contacted Manhart, and arranged to come to Omaha for a treatment. People from coast to coast and from overseas venture in every other week. Like so many of Manhart’s patients, Luc came to the Institute after “seeing and consulting with a variety of general dentists and periodontists … the options offered to me were not satisfactory. The mainstream approach may be clinically acceptable, but it is too generic and statistical in nature and not patient- oriented,” said Luc, who is a scientist. “I was searching for a holistic dentist. The trip was everything I had hoped for and more. Dr. Manhart’s approach is entirely patient-oriented. His method of treatment and diagnosis is very practical, realistic, and above all very scientific. There was no pain, no surgery, no blood, no X-ray, and no anesthesia. Within twenty-four hours after the initial treatment, my condition was under control. It improved drastically after two more days of intensive treatment.”

Luc found Manhart’s “genuine concern” encouraging. He also appreciated that Manhart was willing to share his immense knowledge with him, patiently answering his many questions and offering him the best options for his particular needs. Like more and more CTI patients, Luc uses several of its self-care products at home, including the Calcium Toothbrush, the Oral-Cal mouthwash, and the Calcium Chip set. “My gums and teeth are getting better every day. I am really amazed by the power and effectiveness of the simple, common sense approach and solution.”

There is more to the story. Luc was so taken by the results that he began focusing his scientific mind on a practical application for determining the presence of periodontal disease. Long story short, Luc devised a home test that he then presented to Manhart, who immediately saw that his patient had hit upon something worth developing.

“Paul came up with a superb test for periodontal disease,” he said. “It is very neat. He adapted our products in a certain way so that you test yourself at home to tell whether you have periodontal disease or anything to worry about with your gums being infected. Paul is very creative, and he came up with a very clever oxidase process for testing. All I did was tweak it and put it in a sequence of what to do. If we had some company to work with, it could be made very inexpensively with materials we have.”

A doctor being open to accepting an idea from a patient is rare enough. It shows that Manhart is not so high and mighty as to dismiss something a mere civilian suggests or, in this case, invents. He has too often been on the other side himself of being cast as the amateur or dilettante intruding into the holy domain of the experts or specialists. So he knows what it is like to be ridiculed and spurned and not taken seriously. He has a long history of being open to ideas from many quarters.

 

 

Manhart found a high standard of care in India

 

 

In September 2009 he and Bonnie were presenting the calcium therapies in Nice, France, when one of the attendees answered the following question Manhart posed: “What causes such an infection?” To which a man in the audience responded with, “Thumb sucking.” Manhart, the expert dentist, was bewildered that he had never thought of that explanation.

In his practice Manhart must be a people-person and thus he can turn on the charm and therefore transform the often awkward patient-doctor interaction into a relaxed exchange that disarms patients and makes them collaborators in their own care. Humility goes much further than arrogance he has learned. But with him, there is no ring of phoniness to the interaction. He is genuinely engaged and in the moment with you. You feel his full attention on you.

“I always remember how theatre helped me become a better dentist, because you have to play a role,” he said. “If you go into the office and play the role of a student, people do not buy it. If you cannot play the role of a dentist who is competent, who knows what the hell you are doing even though you maybe have to go in your office and read a little to make sure you know what you are doing, then you are going to fail at it. And it works the other way, too. You learn things on stage that work and make sense that can be applied to your dental work, and one of them for me was that we were always taught in dental school never to say things like, ‘Ooops’ or ‘Sorry, I didn’t mean to cut your lip off.’ You were taught to be impervious to mistakes. Well, it is an everyday thing because you are hurting people every day, and so how do you respond?

“I remember we were taught you never give a person an injection and say, ‘I’m sorry.’ That is heresy or it used to be, maybe it is not so much anymore. I just figured out, no, I have to say that, and so it has gotten to be a habit with me. Almost every time I give someone an injection and I know I have hurt them, I have to say, ‘I’m sorry,’ and it has to be real. That makes a person a better dentist, just simple empathy. Otherwise, it is not believable.”

Just as he has learned that genuineness is a big part of being a healing arts practitioner, he has learned it is equally critical to being an artist on the stage. In each circumstance it is about transparency and professionalism. It is all about being authentic or real. Anything less than that will not hold or convince the audience. People can smell a phony act from a mile away.

He has taken his ability to authentically, transparently engage people a step further by devoting much time to teaching his craft. For four years he was an associate professor at his alma mater, Creighton University Dental School in Omaha. One of his former students, Tom Steg, is now his partner. The two make an interesting contrast. Manhart is the tall, thick figure whose bigger-than-life vibe and presence draws eyes to him. Steg is a slight man with an insular personality and a just-above-a-whisper voice. But where they differ outwardly they share the same probing intellect that enjoys the give- and-take of rigorous inquiry.

For years, Manhart has demonstrated techniques to colleagues at dental conventions across America, even abroad. At various times he conducts seminars for dentists in his office or their offices, turning the quarters into teaching labs where he works on actual patients while dentists and hygienists observe. His work as a clinician-teacher is widely respected because he is not only skilled and informative but knows how to play to the crowd and work a room. He makes eye contact, he changes the inflection of his voice, he pauses for effect, he gestures with the tools of his trade in his hands. Like any good actor or orator, he uses his entire body and whatever props are available as expressive instruments of communication.

Being able to “perform” in front of people when the pressure is on is a knack he developed early on in competitive athletics and refined as a dentist and later in Rotary International and community theatre. The Rotary International website’s “About Us” section describes itself as “the world’s first service club organization, with more than one million members in thousands of clubs worldwide. Rotary club members are volunteers who work locally, regionally, and internationally to combat hunger, improve health and sanitation, provide education and job training, promote peace, and eradicate polio under the motto Service Above Self.”

Sounds like a hand-to-glove fit for Manhart, the man of varied interests, especially when the Rotary site gets around to the part that says “the benefits of a Rotarian include serving the community, networking and friendship, and promoting ethics and leadership skills.” That is Manhart to a tee. He can and did hold his own with Omaha movers-and-shakers when he was active in Rotary. He is not so much active in it anymore, but he still follows the organization’s principles in his private and professional lives.

He suffered stage fright during his first forays in theatre but interacting with patients and with peers as a dentist and getting up and addressing an audience at Rotary meetings helped instill a composure that he then transferred to the stage. In turn, he took what he learned in theatre and applied it to his profession, especially to the public speaking, demonstrations, and teaching he does. “It taught me in a way how to present myself in giving a clinic or giving a lecture. It taught me that talent,” he said.

He remembers the first time he ever went and presented anything in Chicago, host of the dental convention in America. He said, “It is like being on the best stage in dentistry, it really is,” and how much smoother and assured he was in that rarefied environment after honing his public speaking and theatre chops. He likes being on stage, whether in the playhouse or the examination room or the classroom or the convention hall. His hands are sure, his voice steady, his posture erect, and his demeanor confident in these respective arenas. Each is a turf he feels completely comfortable and competent on.

He transferred this same nonplused quality to local cable television, for which he wrote, directed, and hosted talk shows that produced some one hundred programs featuring guests from all walks of life. He developed and hosted a talk show on Omaha’s KLNG Radio for a time. He has also appeared in a number of local TV and radio commercials. The ham in him cannot help it. Besides, he is just one of those high- energy people, as is Bonnie, who has to be doing something.

Add to that his boundless curiosity, his stage presence, and his gift for gab and you have the proverbial talking head.

He is sure there is a correlation between the intuitive breakthroughs that have come to him in dentistry and the creative breakthroughs he has experienced as an actor- writer-director. Breakthroughs only come if you are open and available to them. It means preparing yourself for invention by putting in the work ahead of time and then letting your subconscious take over to incubate and birth ideas when they are ready to emerge.

“To me it is allowing your subconscious to think for you because your subconscious is always going,” he said. “A lot of these discoveries in dentistry were being worked on just like anything else and then suddenly there it was in front of you.”

He recalls the time the idea came to him of how a paper point used in root canals can be coated with calcium. “I always remember there it was right in front of me all along on the bracket table, and I had seen that a thousand times before, but now my subconscious had put two and two together, and I saw that putting the paper point plus the calcium together gave you a wonderful way of getting calcium where you need it—inside the tooth. I really think there are people who do not allow their subconscious to do much for them or they think, If I don’t think of something right now, I am never going to. But the harder you try, the worse it is. That surrender to the subconscious—I will think of it later—is where those discoveries come from. And one kind of discovery leads to discoveries in other fields.”

 

 

Manhart demonstrating techniques in Poland

 

 

His life in theatre has not only served as an inspiration and gateway for his professional career, it has also served as a buffer and sanctuary from his life in dentistry. For Manhart, there is no greater satisfaction than knowing he has rendered service to patients. But the demands of dentistry, as with any profession, can be taxing. That is why he prizes having the theatre to go to. He can leave the work-a-day world behind in order to lose himself in a realm of make-believe.

“It is such a welcome distraction from dentistry because dentistry would drive any person crazy. The theatre is such a complete change that it’s good for you. It is wonderful to go from the office and go do theatre, and completely forget you are a dentist and really use a lot of your talents and experiences to create something on stage,” he said. “And for so many people, myself included, the theatre is where you discover talents and abilities you never dreamed you had. Theatre is so much a part of the world and you can learn so much from it. In other words, if you can play something on stage and you can do it in front of people and make them a part of what you are doing, you make people laugh and cry and solve their problems … that is irreplaceable.”

“The most fulfilling thing about my involvement in theatre,” he said, “is that I get to show that the world is a stage and it is more rewarding to realize it in different ways than to be lost in a black hole of politics or religion.”

As he says, the theatre can be a place to work things out, such as unresolved issues and emotions. It is a freeing space. Therapeutic even. Seen in that light, it is no accident he has gravitated to the therapeutic side of dentistry. You might say it is his calling. Reading, painting, listening to music, landscaping, dining out, and traveling are other pursuits that help him escape. Tennis used to do the same for him. Before that, as a youth, it was basketball. “Those kinds of things let your other mind work, free it up,” is how he describes it.

 

 

Logo for the Grande Olde Players Theatre

 

 

His appreciation for the finer things extends to home. The residence he and Bonnie share is an open modern showplace whose many windows bathe the interior in natural light. Their passion for art and music is seen throughout the spacious, muted living quarters, including paintings he has done that hang on the walls and an upright piano in the dining room. They love to entertain, and their jazz nights transform their place into an intimate atmosphere.

Their love of nature and design is expressed in a walkout patio and garden whose landscaping Manhart conceived and executed. His knack for gardening comes from his mother and her proverbial “green thumb.”

The serene yet dynamic living space is an aesthetic retreat that reflects the cultured couple who inhabit it. It is easy to see what drew them there.

“We looked for almost a decade for this home, stumbled on it, and bought it the next day in September of 2000,” he said. “It and the three houses to our east were designed by

Stanley How, who must have been a serious student of Frank Lloyd Wright, the iconic architect of Fallingwater, the most famous residence in modern architecture. The design of our home, which was built in 1963, is nothing less than genius. Its modern layout is for all the senses and weather of this area of the world. The only things we did were move the laundry upstairs, put in some mirrors Wright would have liked and kept it simple and uncluttered. I hope to die in it. We have studied Wright’s architecture a long time and have toured his buildings and homes, especially his Taliesin East and West homes. I see our home as an homage to his concrete, long-lasting contribution to American culture.”

Then, too, there is the life we experience with our own siblings or kids. This is a bit more problematic where Manhart is concerned. He likes children. He fathered and helped raise eight of them, after all. But he has been by his own admission a somewhat distracted parent with a tendency to get caught up in his own activities to the diminution of his kids’. He can also be a bit of a distant curmudgeon who unconsciously withholds the affection and approval that presumably his children, even though they are all grown now with families and careers of their own, still crave from him, the strong, patrician-style patriarch. He also is not inclined to do family things or to attend family reunions unless persuaded or nudged, and then he invariably enjoys the gatherings.

Moreover, there is the life we carry on with friends, with neighbors, with associates, and so on. Manhart can hardly count the lives he has touched in the various guises he has filled, whether as doctor or teacher or speaker or director or friend or neighbor. His has been a long, varied life well- lived and one marked by all the connections he has made with people in his many roles. He likes the many hats he has worn and continues to wear. The fact there are many different constituencies and peer groups he can call his own is a manifestation of his diverse life.

Certainly, each of us leads an intense private existence that exists apart from but not entirely separate from our gainfully employed experience. A life of any length accrues with it a host of endeavors, roles, affiliations, associations, not to mention baggage, of both the personal and professional kind, whose whole is greater than the sum of the parts—each a reflection of different aspects of our self.

If nothing else, the biographical subject of this book, veteran dentist Mark Manhart, leads a rich life that seems a bundle of contradictions upon first glance. Now in his seventies, the native Omahan is equal parts old-fashioned practitioner, alternative dentist, “mad scientist,” artist, pragmatist, dreamer, searcher, connoisseur, businessman, inventor, family man, lover, disciplinarian, libertarian, and iconoclast.

A contemporary of Manhart’s, Father Jim Schwertley of Omaha, once told him, “Manhart, you are just like mercury, just when we think we have got a hold of you, you squirt out someplace else.”

Manhart admits, “That is a fair assessment.” Manhart’s wife said, “I am going to put that (the mercury epitaph) on your tombstone.” That is how “perfect” Bonnie thinks the metaphor is in capturing her mate’s fluidity.

The word mercury comes from the quixotic Greek god of the same name. A derivation of that word is mercurial. One definition of mercurial reads: “being quick and changeable in character.” That is not to suggest Manhart is a chameleon or that he acts a certain way one instant and another way the next, at least not anymore than the rest of us play various roles to suit the company or the occasion or the situation. No, it is just that he is one of those people who cannot be easily pinned down or pigeonholed because he is into so many things and seemingly all over the place at once. So, for the purposes of this bio, he might be dubbed Manhart the Mercurial. It not only has a nice, alliterative ring to it, it happens to accurately describe the man’s multifarious nature.

All are expressions of his different sides and lives. But in truth there is no secret life for Manhart. His life is an open book, relatively. Isn’t everything relative? His very public theatre work has certainly been no secret. His running for the Omaha City Council put him out there on the front lines of public-media scrutiny. His lay leadership in the Omaha Archdiocese made him a lightning rod for church- lay issues. His wholehearted embrace of the Montessori method of early childhood education put him at odds with the local education cabal. His attempts to introduce some of his calcium therapy innovations in the classroom met with stiff resistance and, eventually, resulted in his outright dismissal. His outspoken objection to traditional endodontic and periodontal approaches in favor of noninvasive calcium- based alternatives made him a pariah among dentistry’s specialist community.

The person we become at seventy or seventy-five, if we live long enough to find out, is naturally an accumulation and a conglomeration of everything that has gone on before: the incidents, the milestones, the highs, the lows, the decisions, and the mistakes we made. Our lives are the product of many commissions and omissions. No one is without fault or blame. The best we can do, as Twelve-Step recovery programs phrase it, is to strive for progress, not perfection.

Manhart has something to say about this live-and-let-live ethos, too: “Long, long ago I decided to avoid reliving the past myself or through others, like raising the kids. If I had done one thing different, I would not be here talking about all this. All since would have changed, so history is what it is and regret is a cop out or a waste. I try to learn from the past, repeat the good parts. I love to read history and concentrate on the present, and maybe on tomorrow till about noon. I do not wake till 10 a.m., nor believe in God till after lunch. I try to see people from angles and steal the good sides.”

 

 

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A Hospice House Story: How Phil Hummel’s End of Life Journey in Hospice Gave His Family Peace of Mind and Granted Him a Gentle, Dignified Death

October 27, 2011 3 comments

 

 

When Omaha Magazine inquired if I would be interested in tackling a story that followed a family’s experience with hospice I immediately jumped on it because both my parents received hospice care in their final days. The Hospice House in Omaha offered their cooperation and identified the family who I profile in the story that follows, the Hummels. The plan was for me to spend an extensive amount of time with the patient, Phil Hummel, and his family and I did at first and then, as things often unfold in such situations, circumstances changed and I was unable to get the same access I had before. But I did get to know Phil, his wife Jo Ann, and their son Al fairly well before Phil passed and then I got to visit with Jo Ann and Al the day of their loss. My piece is the cover story in the November/December issue of the magazine, which is distributed at select sites all over the metro. You can subscribe to the publication. To see the story as it appears in its 12-page spread visit omahapublications.com or http://www.readonlinenow.com.

 

Phil Hummel near the close of his coaching-teaching career

 

 

A Hospice House Story: How Phil Hummel’s End of Life Journey in Hospice Gave His Family Peace of Mind and Granted Him a Gentle, Dignified Death

©by Leo Adam Biga

Published in Omaha Magazine

Even though the end of life comfort care known as hospice is better understood today than decades ago, misconceptions linger. Some mistake it as denying care. Others assume it’s only for special cases. The myths and misapprehensions make sense given how death and dying tend to be topics avoided rather then engaged in America. No two end of life scenarios unfold alike. But charting a real life journey through hospice can remove some of the fear and unknown that follow a terminal prognosis, which is why the Hummel family agreed to share their experience at Hospice House, the Josie Harper Residence. Executive director Gary George welcomed this reporter in to give readers a glimpse at a patient-family-caregiver story. The center, at 7415 Cedar Street. just east of the Bergan Mercy Medical Center, is a collaborative between Alegent Health, Methodist Hospital, the Visiting Nurse Association and the Nebraska Medical Center.

 

 

 

 

Phil Hummel

Inducted into Iowa Association of Track Coaches Hall of Fame.

 

 

A Rich Life

Family patriarch Phil Hummel of Woodbine, Iowawas a resident there 10 weeks last summer. Hospice provided a dignified end of life path and offered loved ones peace of mind his every need was met. Hummel, 78, died gently in Room 2 on September. 1. That last day, like each of the 69 preceding it, Phil’s wife JoAnn and son Alan were present. They were with him when he drew his last breath. In the weeks leading up to his death, his daughter Gail was on hand along with other family members and figures from his career as a high school educator and coach.

Married 56 years, JoAnn and Phil met at Tarkio (Mo.) College. She attended on an academic scholarship. He, on an athletic scholarship. Phil, a Riverton, Iowa native, excelled in sports at Sidney High School, where’s he’s a Hall of Fame member. His football-track exploits also earned him a spot in the Tarkio College Athletic Hall of Fame. After the couple married Phil was drafted in the U.S. Army and JoAnn followed him, first to New Jersey, then to Japan.

 

 

JoAnn and Phil in Japan

 

 

Back home, his military hitch over, the couple started their family and taught together at Woodbine High School. Her speciality was business ed. He taught U.S. government and American history. Summers he ran a house painting crew that did work all over western Iowa and the Omaha metro area. He was by all accounts as demanding a boss as he was a coach. During a highly decorated coaching career he led teams in many different sports but mostly made his mark as a cross country and track coach. He won several coach of the years honors and was a longtime Drake Relays official. The Iowa Association of Track Coaches Hall of Fame inductee twice led USA Track and Field youth teams to China. “Sports were a big part of our life, that’s for sure,” said JoAnn. “He was really busy coaching, and then on the side he was an official, and he refereed. He was gone a lot. And then when he wasn’t doing that he was hunting and fishing. It was a good thing I loved sports because that was Phil’s life. I was at all the games.”

 

 

Phil HummelHummel pictured with a star runner, Brady Dickinson.

Phil earlier in his coaching-teaching career

 

 

Her husband, who made his runners take the steep cemetery hills on the west edge of town, was a living legend. “Phil was known all over the state of Iowa,” she said. A measure of the impact he had on young people is the seven pages worth of condolence memories on the Fouts Funeral Home web page after his death. Like any good coach, Hummel was a surrogate father to his athletes. One young man he drew especially close to was Guy Mefferd, who with Phil’s guidance turned his life around and went on to serve as a U.S. Navy SEAL. Jan Sauvain, a family friend Phil coached in basketball, said he could be a strict disciplinarian “but never vindictive or to humiliate you or to demean you, just to give you a little insight into what you did wrong, and he cared about the kids after they graduated.” She said Hummel, unsolicited, recommended her to an AAU basketball coach in Omaha and wrote a glowing reference letter for her brother. “He did care, absolutely,” said JoAnn, who typed her hubby’s correspondence in her unofficial role as “Phil Hummel’s administrative assistant.” She said, “He was always interested to see what happened to students down the line. That’s why so many people came to see him in the Hospice House. Sometimes we had five to ten a day. They came from all over.”

Comfort and Care

When word got out Phil was dying, scores of athletes he coached, along with fellow coaches, even old teammates, came to see him. Each shared a piece of Phil’s end of life journey with him. As did Hospice House staff and volunteers. With its many windows looking out on nature and the great room’s soaring cedar ceiling, there’s a bright, uplifting feel to Hospice House. Also an intimacy and communal aspect quite unlike a hospital. Community meals are convened. Families and volunteers share treats. Musicians come to perform music. Children and therapy pets visit. The emphasis, said Ann Cole, a staff registered nurse, is comfort. ”

Death is really the final stage of growth and dying is a natural part of life and if we have enough time to work with people we can help them and make this really a positive time,” she said. “We can help them to accept what’s going on. First of all, we’re able to control the adverse symptoms that go along with the dying process — things like pain, nausea, vomiting, anxiety, constipation, agitation. Those are all things we often see in varying stages as the dying process progresses. “If we can control those symptoms and the patient knows you’re going to be with them, you’re going to support them, and you have enough time to develop this relationship, then there’s always something we can offer to comfort them. We can control these symptoms, make them the least they can be, so they can live a really comfortable life until death comes naturally. This is our area of expertise.”

Because Phil was alert and active almost his entire stay, he savored many moments with those dear to him and developed rapport with caregivers. He felt well enough most days to relax in the courtyard. He even went on regular outings to favorite haunts, such as the Horseshoe Casino and Olive Garden restaurant. He told stories and shared memories but mostly he listened, laughed and cajoled, holding court on the deck or in his room.

My intro to the Hummels came via a phone call to JoAnn’s cell. She answered from Phil’s room with, “We just got back from the casino with some of Phil’s friends. Phil just ordered Jimmy Johns.'” It’s not what I expected — a dying man living it up, so to speak. I came to see it as his serene surrender to fate — making the most of what time he had and appreciating everybody and everything around him. “He wasn’t scared,” said JoAnn.

Phil loved singing the praises of Hospice House. “Oh, I mean, they are so good it’s unbelievable,” he told me, his voice a heavy rasp from the radiation that seared his mouth and throat tissues. “That doesn’t mean we get everything we want. It’s just — they have a care and a love, and people come in and it doesn’t take long for people to understand that. I don’t know where you can move to a better place. There might be one, but I don’t know of any.”

For those, like Phil, given the opportunity to appreciate the life left to them, hospice is not the dour, bitter end but the last bright stage of things.

Bonds

“People think of hospice as a death sentence so often and it’s really about quality of life,” said Cole. “Hospice is working with the patient and family — supporting, teaching, making that quality of life a real possibility, and I think that’s what we did for Phil. If you can help families know what to expect, what will be done, and follow through on those things, they really learn to trust and the trusting relationship is very important.”

JoAnn and Alan praise the staff for easing the path. “They were wonderful there. It’s just a fantastic place,” she said. When she and her son left to go home at night, she said, they could be assured Phil was in good hands. Said JoAnn, “We knew if he needed any little thing they’d be running right over here because the nurse’s station is just around the corner.”

Alan admits he wasn’t sold on Hospice House before placing his father there. After moving him in though he became a convert. “Looking back now it could have been a cave as long as those people were there. The people that work there make that place what it is. Ninety-nine point nine percent go far beyond the call of duty.” JoAnn, a native Missourian with a show-me attitude, noted the sincere empathy. “When they had kind words to say I never felt they were just making it up to make me feel good. I think they really felt that way. That’s why they’re there.” A little warmth goes a long way. Besides, said Ann Carol, “Who wants a cold nurse?”

 

 

 

 

It wasn’t just healthcare providers who impressed JoAnn either. “The volunteers are fantastic. Like the Cookie Lady. Her husband was a resident there and she wanted to do something for the Hospice House, so she decided she’d bake cookies. Every Thursday she brings them in. It smells so good. Even the cleaning ladies are fantastic. Nice, pleasant, do a beautiful job.”

Gary George, who’s headed the center since its 1998 opening, said everyone who works there embodies “a sense of passion,” adding, “We want to be doing this kind of work.” He describes it as “a calling to be working with people at end of life that then links to an honoring of life and a recognition that end of life is part of life, not something to be feared, not something to be run from. It’s recognizing all the rich…things that can come out of end of life when people are being walked through that journey.”

“Compassion,” is the common denominator said certified nursing assistant Joanne Waltsky, who, like Ann Cole, got close to Phil. “These people are like our family. We get some of the crabbiest people in the world and they always end up loving us — I mean, always. It’s awesome, it just makes us feel good.” The Hummels shared how Waltsky’s habit of singing while making her rounds rubbed Phil the wrong way, at first, before he melted under her buoyant charms.

“The first night I came in here it was a helluva night,” Phil said. “Six o’clock the next morning, somebody came in here singing. Who the hell can be that happy in the morning? I told my wife,’ I don’t think I can put up with that.’ By noon she had me won over. You want to know why? This gal had everything we needed whenever we needed it, before we knew we needed it. That’s not a joke. “And she’s still going, and the others are just like her, just happy as clams, which made us happy of course. I can’t say any more about this place than if I tried, and I’m trying, because they’re good.”

 

 

The following was read at the funeral:

A Thank You from Phil:

How can you thank your wife for almost 57 years of support and loyalty and
for the work doing the driving to Omaha 60 miles down, 60 miles back, not
letting anyone share the load?

How do you tell your children thanks for being the people they are after their father spent more time with other people’s children?

How do I show Bob Sauvain my feelings about my old hunting and fishing
buddy, who took me with him even when he knew I was long past my prime?

There are others in my neighborhood.like Dave and Jane Gardner for the
food. And Jane for getting the flowers and planting them in the pots on our
deck, knowing how well I like the deck with flowers.

To Bob and Sharon’s kindness and help at our beckon call.

To Joe and Cheryl Book for the many times they helped us out of many
simple things we were unable to do anymore.

To Randy Taylor for all the help that was given to us.

To John, Peggy and Matt Monahan for helping us during the winter snows
and also the summer yard work.

I was blessed to be hired by the Woodbine School District and to able to
teach and coach with some of the best in the profession. With me it became a love affair each day. I was where I wanted to be.

To Carter Oliver, who always stopped by in the evenings to see how the old
folks were doing.

I was lucky to meet many coaches across the state and many in the Mid-West who shared their views and thoughts.

Thanks to the Iowa Association of Track and Field Coaches for the many
cards, letters, phone calls and emails. Particularly Denny White, Steve
Halligan Family, Ira Dunworth and Kirk Schmaltz for the visit.driving all
the way to Omaha from Ames to see me.

To The Boys Association and Drake University for the opportunity to serve
on their committees and Drake Jury.

Thank you to all in the Woodbine community for support in taking the
Washington, DC trips, trusting me to take their children for 6 days on a trip
they would remember for a lifetime.

To Sue: I was off to college and in the Army before you became my little
sister. Had things been a little different, I know we could have been a lot
closer.

Last but not the least, Brother Ted: I love you Ted. The one thing most I
remember is when we were growing up in the summer. Every day when
breakfast was over, dishes done, I was out door. I would grab the bat, ball,
glove, jump on the old bike, down the hill, go up the dusty road stirring as
much dust for you as I could. All the time you were yelling wait for me, give me a ride, take me with you. How I wished I had stopped and picked you up.

Thank you All.It’s been a great run.

Posted by: Gail Hummel – Sioux Falls, SD – daughter Sep 16, 2011

 

 

 

Because Phil was there so long and his wife and son there so much, the bonds between caregivers, patient and family had time to to ripen. “Everybody was really attached to him and they were really fond of him,” Alan said. “They want to keep from getting attached but your dad won them over,” JoAnn told Alan. “They won him over,” Alan replied.

Attitude is Everything

Waltsky said in contrast to some patients who sink into despair and wallow there despite her and her workmates’ best efforts, Phil embraced his remaining life. “We try to bring people up but they don’t always want to,” she said, “but Phil every morning got the day planned and told us what he was doing. He touched everybody there. He was so independent. He was everybody’s friend. He had so many visitors. When his coaching friends and past students would come in he’d always introduce me like I was family. I just loved him.”

She said the entire Hummel family made an impression. She was struck by how JoAnn and Alan befriended a woman without any family in the room next to Phil’s, checking in on her, bringing her goodies. “They’re just loving people, you know, and everybody loved that. They were just joy.” JoAnn Hummel returns the compliment by saying she never conceived hospice would be such “a positive thing. I’m so glad we went there. That was the only place for that kind of care. It was either that or go back to Woodbine to a nursing home, and Phil didn’t want to do that. This was just perfect.” She’s certain Hospice House helped extend his life. When he arrived in June, he was given less than a week to live. Ten weeks later, he was still there.

A Life Interrupted

His cancer jolted the couple. They were busy enjoying their hard-earned retirement, traveling to Las Vegas, wintering at a Florida condo, spending time with family and friends. The Council Bluffs casinos were favorite getaways. Phil loved the outdoors. Then, in April, he discovered a large lump on his throat while shaving. After going in for tests at Methodist Hospital, the bleak diagnosis of cancer unsettled his and JoAnn’s world. “The worst you can have,” is how a physician put it. Inoperable. An aggressive regimen of chemo and radiation in Omaha followed. “I truly think the doctors knew it was an impossible slide but worth a shot and I thought it was worth a shot, because the alternative would not be any good if you just left it alone,” said Phil. “I had all the faith in the world the treatments were going to fix it,” said JoAnn.

Only Phil didn’t get better. The tumor didn’t respond as hoped. “I just saw him get sicker and sicker and more miserable,” said JoAnn. Making one-hour drives each way for debilitating treatments took their toll. “We would drive back and forth every day,” she said. “On the weekends he would just go in the bedroom and stay in there in the dark. He couldn’t eat. It was terrible. His neck was getting worse and worse, just burned.” “I couldn’t get anything down,” Phil said. On Mondays it began all over again. “It was a hard time,” said JoAnn. Spring turned into summer when the oncologist reported what the couple already suspected — the tumor wasn’t shrinking. “That was a bad day for me when he said we are going to stop all treatment,” said JoAnn. “I know when it was exactly — the 22nd of June. We came in here (Hospice House) the 24th.”

Phil was precariously near death. “When we came in here the doctor said maybe five days,” JoAnn recalled, “Phil hadn’t had anything to eat or drink for two weeks, only kept alive with hydration. He couldn’t raise his head off his chest.” I couldn’t move. I was bad,” Phil said to me.

Phil Accepts Impending Death but Continues Embracing Life in Hospice

But then a remarkable thing happened. “When the swelling began to go down from the radiation treatments he began to be able to sip a couple sips of water and eat a little apple sauce,” said JoAnn. “It wasn’t long before he was eating more things.” Alan plied his father with food but Phil could never hold it down. Yet the better Phil felt, the hungrier he got for his favorites, including hamburgers. It’s all he talked about. Alan was reluctant to give him one, until he finally threw caution to the wind. “It took us awhile to figure out it doesn’t matter — give him whatever he wants. I went to Five Guys Burgers and Fries and brought it back. He didn’t eat very much of it but it was the first time in at least a week he was able to hold down food,” recounted Alan. “You would have thought it was the first hamburger, the best hamburger, some kind of divine hamburger. Seriously, the look on his face…That hamburger is when he turned the corner from being where we thought there was no way to maybe there’s some hope he’ll hang in there a little while, and it was.”

Rebounding

Phil gradually regained strength. Not long after his rebound began, tells JoAnn, the doctor that gave Phil precious little time to live stopped by Phil’s room. “He sat down and pulled his chair right up to Phil’s face.” “Nose to nose,” is how Phil put it. “And,” JoAnne continued, “that doctor said, ‘I can’t believe what I’m seeing.’ That he’d come around. And you have to give a lot of credit to this place because it’s a wonderful place.” Phil agreed, saying, You know, I feel so far from where I was when I came in, but I accepted it (his fate). Maybe it’ll give me some more days down the road, I don’t know.” “It’s a miracle you’re even here,” Alan told him then. Five days turned into 10, 10 into 20…

Certainly no one expected Phil to venture out, albeit confined to a wheelchair, to eateries and attractions, but that’s what he did and if residents get there early enough it’s how hospice ideally transpires.

“The fact he was so positive about going out on his little excursions, and I’m sure he probably didn’t always feel the best, is what hospice is about. It’s to go out and do the things you love to do. You’re not confined to bed in this place. We encourage people to do what they can do. We’ve had people go home and stay overnight a couple days and come back,” said Cole.

The turnaround Phil experienced, said George, “is neither usual nor unusual, it happens sometimes, and for who knows how many reasons.” He added, “Sometimes people do seem to have some spark, some different amount of energy when they get here, and for some people it may be due to more stimulation and activity, for other people it might be a sense of relief — some sort of freeing up and letting go of responsibilities, letting loose of some things.

“Lots of people bring treasures here that mean things to them. For many people that’s photos. For one guy it was a full life-size cutout of John Wayne. For one of our earliest residents, John, it was a little bookshelf filled with these thick novels and I said, ‘Oh, John, you must have brought along your favorite books,’ and he said, ‘Oh, those aren’t my favorites, those are just ones I have left to read.’ I don’t know how many he got to read while he was here but that’s what he planned to do. I thought that was amazing. “People come with a bit of a sense of adventure sometimes. I always admire that attitude of here’s something new and different — kind of leaning into it.”

That same leaning into one’s dying days is what Phil Hummel exemplified. A small bulletin board in his room displayed photos of things and people he cherished: family, friends, track. An American flag emblem. And a hand printed Bible verse from his granddaughter Jessica about the virtues of love. He literally lived for visits by friends and loved ones, former schoolboy tracksters, hunting-fishing cronies, and for those casino-restaurant forays. Not everyone can be so active. For most, their illness is too advanced to allow for much mobility or independence, whereas Phil prided himself on going to the bathroom alone.

“Our residents tend to come to us later in their disease process then they used to, so on the continuum Phil was a little bit more on the active end of things when he came,” said George. “Most of our residents are no longer at a point where they’re any longer coming and going so freely and wanting to do that even. But he also was a person who came, it seems to me, with that drive — this is what I want to do, this is how I want to do this. He kind of made that happen along with his family.”

 

 

 

 

An Unforgettable Character

Phil himself theorized his “cantankerous” spirit may have spurred his comeback. Action follows attitude, even when dying. Phil Hummel’s gregarious, generous attitude set the tone for his end of life experience and everyone around him. “You know, he was one of those patients none of us will ever forget,” said Cole. “He was just a delight, really a people lover. I picked that up. He really, really cared about people. He talked about his coaching days. It was so obvious he cared about everybody. And even the last couple of days, he was not a complainer. “You had to really take a lot of nonverbal cues as to what’s going on, which is something we do all the time. He always thought about other people, never about himself. ‘How was your weekend?’ he’d say.”

Alan Hummel remarked, “I don’t know how he did it. I thought he was in a bad mood for maybe only one day — and that was the first day.”

The Beginning of the End

After thriving for so long, the end came rather abruptly. On Friday, August 26 Phil was, if not a picture of health, a still vital man. He was keen for the college football season to start so he could root on his beloved Iowa Hawkeyes. Still stinging from a “disasterous” day at the casino, he anticipated better-luck-next-time. He played amiable host to two journalists in his room. Small talk came easy to him as he relaxed in the tranquil courtyard. The last image of him was a tired but content man ready to meet whatever life next presented him, even death.

When I called JoAnn Wednesday, August 31about stopping by she informed me in a taught, severe voice, “Phil’s taken a turn for the worse.” The morning after I saw him he’d suffered a bathroom fall, not breaking any bones, but hitting his head and scuffing his arms and legs. He didn’t lose consciousness. JoAnn and Alan were there. Alan was the first one in to help his father. The nurses were soon on the scene to attend to his scrapes and bruises and make him as comfortable as possible in his recliner. The fall precipitated a rather rapid decline.

“Thats what started it. From then on it was down hill all the way,” said JoAnn. “He whacked his head pretty good. I think he might have been a little concussed,” said Alan. “I don’t know he was in a lot of pain, he didn’t talk about pain,” said JoAnn. “He would have never told anybody if he was,” said Alan. “Had to be strong,” added JoAnn.

Acting on cues, the nurses gave him morphine. “We left him in his chair and he slept the whole day, and then that made him sore,” said JoAnn. “He didn’t eat anything. That was Saturday.” “He slept all day Sunday,” said Alan.”He was conscious but he just didn’t want anything to eat, and he really didn’t want to talk,” said JoAnn. Another sign Phil’s body was shutting down and he was slipping away was when he stopped showing interest in the therapy dogs he used to enjoy. Through the weekend and into Monday and Tuesday he was more and more in a somnambulant state. “He’d wake up, talk a little bit, say a few words, and go right back to sleep,” said JoAnn. “He started babbling, too, like talking to someone who wasn’t there, reaching for stuff,” said Alan. “It was the beginning of the end I’m afraid,” said JoAnn.

Into Wednesday though Phil clung on to what he could. “When they tried to put him into bed he absolutely refused,” said Alan. “They had to sedate him to get him out of his recliner into the bed. Mom said he didn’t want to go to the bed because he knew once he did that was it — he wouldn’t come out…” The robust Phil they knew soon disappeared. “That’s the last we heard from him. When his eyes would open it looked like no one was home…they were all glassy,” said Alan. “Usually when I said something he would look toward me,” said JoAnn. No more. “That was extremely hard to watch, extremely,” said Alan.

The Gift of Time

For the family, there was the consolation of two extra months. A true gift. “How many times did I say that today?” Alan said to his mother the day Phil died. Even though they knew it was coming, losing a loved one still hurts. “At the risk of being cliche, and Mom said it this morning, too — you say you’re prepared, you think you’re prepared, and there is no preparing. You just can’t be prepared,” Alan said. “I figured we would have been at this point a long time ago. We knew the outcome was going to be bad, but he had a good couple of months, seriously.”

Sitting at the dining room table in Alan’s home only hours after Phil passed, son and mother recounted the blessing the Hospice House turned out to be. “All those people who came to see him. Dozens and dozens and dozens of people,” JoAnn said. “I should have kept track of the names.” “It’s been really good,” said Alan. “I think he actually had fun.” “He did,” JoAnn confirmed. “It sounds horrible, but it’s true, I think he had a good time,” added Alan. “When all the track people came from eastern Iowa, they stayed five hours. They sat out on the patio and Phil ordered Jimmy Johns. They all had lunch out there. He had a great time. It made him forget what the situation was,” said JoAnn.

If we have the choice, maybe we should all go the way Phil did. “Absolutely,” said Alan. “Millions of people never get that opportunity.” JoAnn said while “it hasn’t been easy” what helped make it more tolerable was the gradual transition Phil made “from one stage to the next stage,” the “wonderful” care he received and his own serene attitude. “Phil was just resigned, too. He didn’t fight it. If this is the way it’s going to be, it’s the way it’s going to be.”

Hospice House became such a routine in the family’s life that being separated from it feels like a loss, too. “I’m going to miss it, I hate to say that. It’s going to be funny not to go there,” said Alan. “We were there a lot of days,” JoAnn said. “It was weird to leave there after cleaning out the room and it was empty. No one there. None of my favorite girls around,” said Alan.

Lasting Impressions and a Request Fulfilled

What workers were present the day Phil died were moved by Phil’s passing. “A lot of tears were shed that day by the staff,” JoAnn said. He seemingly touched everyone there.

“Phil was a leader and teacher all the way to the end of his life,” said Gary George. “I will remember Phil and his family taking every opportunity to continue to come and go from Hospice House to enjoy life to its fullest. On many occasions I saw them heading out the front door for some adventure together.” The same front doors Phil and family came in and out of are the doors Phil exited for the final time after his death. “We do not want to ‘usher death out a side door,’ or make it seem that death is too awful to look at ” George said. “This I believe is an important feature of Hospice House.”

For Ann Cole and Joanne Waltsky, Room 2 will always be Phil’s. Said Cole, “You couldn’t help but love the guy. He was totally about seeking the positive things in people and affirming that and making them better. You would walk away from his room and just feel so good and hope that you had given him half of what he gave you. He was, oh, so gracious.”

George said when a resident dies “families and friends are given the time, space support they need and my co-workers stand by ready to offer whatever they can,” adding, “This may involve tears, hugs, tissues, offers of a beverage, another chair, a shoulder to cry on…silence, storytelling, or tears mixed with laughter.”

The giving goes both ways. JoAnn and Alan brought flowers from Phil’s funeral to Hospice House, where, per tradition, a candle burned in his memory. JoAnn will be back — she has walnuts and gooseberries for the Cookie Lady. The family asked that memorial donations be made to Hospice House and many were made. Typical of the man, Phil Hummel wasn’t interested in how he would be portrayed. But he did request we emphasize the quality caregiving and warm sense of community at Hospice House. “I want you to give as much attention as you can to this facility,” he said.

One Day at a Time, A Recovering Alcoholic’s Story

August 4, 2010 4 comments

General view of part of the South Water street...

Image by The Library of Congress via Flickr

I met the subject of this New Horizons story, John H., while on assignment for another story.  His intelligence and honesty struck me and when he revealed some hard things about his life I knew I wanted to write his story.  This is the result.  This account of his struggle with alcoholism is written mostly in John’s own words. After all, he’s lived it, and because he came out the other side to become a treatment specialist at a detox unit, he can speak with the authority of someone who’s been there, done that.  I lost track of John after the story appeared.  I don’t even know if he’s still around.  I really like him though. Maybe I’ll make a call and see if he’s still in town.  I have no doubt that if he’s still living, he’s still helping others out of the dark and into the light., because that very service is part of his own recovery process.

One Day at a Time, A Recovering Alcoholic‘s Story

©by Leo Adam Biga

Originally published in the New Horizons

“I always knew I was going to die drunk. Now I know I will die a drunk, but hopefully a sober one. And there’s a difference.”

The bittersweet words belong to John H., an Omaha resident and recovering alcoholic who works as a treatment specialist in the detox unit at the Omaha Campus for Hope, a Catholic Charities counseling and shelter site formerly known as St. Gabriel’s. It is precisely where John finally got dried out some 11 years ago after decades of abusing alcohol and other drugs. If nothing else, his journey from client to staff member there proves addicts can make a fresh start if they really want to.

Born into a family of heavy drinkers in Chicago, John tried quitting booze several times but could never stay on the wagon more than a few months. His drinking wrecked four marriages, strained relations with his children, cost him several jobs and sent him on an odyssey around the country as he fruitlessly searched to escape his worst enemy — himself and his addiction. He suffered frequent blackouts, developed cirrhosis of the liver and squandered opportunities in a constant quest for getting his next buzz or fix. In the end, it took a savage assault that nearly left him dead before he realized a higher power was looking after him and he finally accepted the fact his life was too valuable to waste away in a permanent vodka-induced stupor.

 

Omaha Campus for Hope

 

Today, John shares a modest home in north Omaha with his youngest child, Shawn. The house, whose exterior is ablaze in color from all the flowers John has planted, is mere blocks from both his job and from the scene of his catharsis. A witty and intelligent man with an Irishman’s gift for turning phrases, John works one-on-one with active drunks and drug addicts in trying to help them kick the habit. In detox he sees desperate people contending with the agony of withdrawal.

“Getting clean hurts,” he said. “It’s easier to stay clean than it is to get clean.” It is not a pretty sight between the night sweats and the hallucinations, but it is exactly what John himself went through himself and that experience allows him to empathize with clients and, hopefully, use his own story as a model of sobriety. “I love it,” he said of his job. “Where I work we try to share our experience, strength and hope. That’s all we can do. I think sometimes it helps if clients know you’ve been there yourself. I let them know I have.”

As he sees it, the job boils down to providing unconditional support to those with no where else to turn. “We can’t fix anybody,” he said. “What we try to do is help them fix themselves by talking straight to them. No alcoholic-addict gets clean and sober until they hit bottom and the only place they can go then is up. What we try to do is raise their bottom so they don’t have to go so far down. We never see our successes. They go out and lead normal lives and we never see them again. We see the failures. We don’t really consider them failures as individuals, but they’re people who just haven’t got it right yet and keep coming back.”

He said the last thing users need is reprimanding because that only exacerbates the depression and self-loathing that accompany drug abuse. “Alcoholics-addicts have no self-esteem and no self-worth. I think they know what they’re doing isn’t right, but telling them that won’t do any good. They’re already down and all you’re doing then is deflating their own low opinion of themselves. Besides, they have a disease. It’s not a matter of choice after awhile.”

With the perspective of time, John has come to understand how and why drinking overwhelmed his life. The roots of his problem extend to early childhood, when he and his siblings were weaned on alcohol as a rite of passage.

“Both of my folks were alcoholics, as were my grandfolks and aunts and uncles. From a very early age there was always drinking around me. Being the oldest of four kids, I saw how my folks would pour some Rock and Rye in a glass and stick their finger in it and rub my sisters’ and brother’s gums. So, I suppose, that’s when I started drinking too. My folks were also the type of people who gave us a small glass of wine or a weak high ball with dinner when we were children. The assumption was, ‘Well, they’re going to drink when they get on the outside, so they may as well learn how to do it at home.’ The whole family drank. It was just the status quo. There were lots of arguments because of the booze. It got very, very ugly at times.”

Drinking shadowed every family activity, even the clan’s shared passion for the Chicago Cubs. One of his clearest schoolboy memories is coming home after class and finding his mother well on the way to tying one on while rooting for the Cubs.  “We lived in a 3rd floor apartment within walking distance of Wrigley Field and in the summer I can remember coming home from school and entering the apartment, which had no air conditioning, and there would be my mother in her bra and half-slip with a quart of beer in a Pilsner glass in one hand and an iron in the other while watching the Cub game on television.”

 

Wrigley Field and surrounding neighborhood

 

His own serious drinking habit developed in his teens. “In retrospect, I know now that I was more than likely an alcoholic in high school,” he said. As a young man, he somewhat successfully masked his drinking but in reality he was what he calls “a functional alcoholic.” He adds, “I could still maintain some decorum of sensibility and reasonableness. Then, by the end of the disease, I would just fall off the edge of the world when I drank.” Bothered by the turmoil in his family, he often stayed away from home. He left home for good at 17 when he and his girlfriend eloped the night of their high school graduation. The young couple lived in Texas and a number of other places before the marriage collapsed. He worked his “way back up north” and it was in Kansas City that he met wife No. 2. She was an Omaha native and her desire to return to her roots first led John here.

In his mid 20s John and his second wife suffered the loss of a young child to cancer, an event that may have triggered more intense drinking in the grieving father, who acknowledges he was bitter and inconsolable over his son’s death.

With no real skills to speak of, other than a gift for gab and an intimate knowledge of liquor, he gravitated to the one line of work he seemed eminently qualified for — bartender. He was a natural, plus the job gave him access to all the booze he could guzzle on the sly, only he didn’t always get away with it. “I was a good bartender at first until, toward the end, when I became my own best customer. Then it was not so good. It got me fired a couple of times,” he said.

Between bartending gigs he put his people skills to work selling women’s shoes and hawking greeting cards as a traveling salesman. For several years he hit the road selling door to door, relocating several times along the way. including to Atlanta and Nashville. When regular jobs like these petered out, he always went back to tending bar. All this moving around, he said, was his desperate bid to find “the geographical cure for alcoholism,” which, of course, doesn’t exist. By the time he moved back to Omaha in the 1970s, John had been through three broken marriages and several careers. He was back to tending bar again and his drinking was worse than ever. He was descending into a kind of oblivion whose end result was inevitably going to be imprisonment or death.

“Alcoholism is a progressive disease. It keeps getting worse. By the time I finally got help there was no high, there was no enjoyment, there was no pleasure in drinking. I drank so I didn’t get sick. It was pure maintenance drinking.”

 

 

 

 

His first couple attempts at getting help did not take. “I was in two treatment programs. First, I went to Immanuel Hospital as an out-patient and after a few weeks, I said, ‘I’m wasting your time and my money because by coming in only a couple times a week I keep going right back to the same environment doing the same things.’ Later, I went to Immanuel as an in-patient and I stayed there a month. I stayed clean and sober for, oh, maybe three months and then I went back and stayed out for maybe eight years.” Why didn’t these tries at sobriety work? “I wasn’t ready,” he said. “It wasn’t anybody’s fault. It was on me. Alcoholism is a disease where you’re not going to get clean and sober until you’re ready to get clean and sober. It just depends on you. It’s strictly up to you.”

For a long time, he convinced himself he could control his drinking by moderating it. He knows now he was fooling himself. “I will never control it. Even now, going on 11 years of sobriety, I don’t control it. Abstinence is the only thing that will work for me. So, as long as I don’t take the first one (drink), I don’t have to worry about the last one.”

The leap from dependency to sobriety is a great one because it involves changing an entire mind-set. As John explains, an addict is obsessed with the acquisition and consumption of his/her drug of choice. “Your life revolves around the alcohol or drugs. You wake up in the morning planning on using. I would wake up at a quarter to six. By the time I got up, got dressed and walked to the liquor store on 30th and Laurel, it was 6 o’clock. I would get a half-pint of vodka. That was my breakfast. I would drink it on the way home, come into the house, smoke two cigarettes and start getting the kids up for school. Then I would go back and get a larger bottle and get serious about it.”

As the disease evolves John said an alcoholic alienates and isolates himself more and more from the mainstream of life until he or she is totally, utterly alone. “You start out drinking socially but you eventually hit a point where it’s just you and the bottle. You weed out people one at a time because you don’t even want your fellow drinkers to know how much you’re drinking. I had a drinking buddy for, oh, like 19 years. He had an old, battered pickup truck and we would drive to a park and sit there and drink. He and I would take turns trying to get sober. He did get sober a year before I did and that was the longest year I ever spent in my life because now it was just me and the bottle.”

Just as in the classic 1941 drama about alcoholism, The Lost Weekend, John said the shame of addiction led him to try and conceal his drinking from disapproving spouses and the disorientation of drunkenness put him on constant edge.

“You think you’re hiding it, but you’re not hiding anything. Everybody knows you have a problem except you.” In his case, he usually confined his drinking to public settings, although he sometimes snuck a bottle home. “I would very seldom bring a bottle in the house. I would just go up to the store and get some and drink it on the way back. I could kill a pint of straight booze in a few blocks. When I finished it I’d just throw it in the alley. Once in a while I would bring a pint home and hide it somewhere. I would go to bed, wake up an hour later and take a couple nips, then go back to bed and wake up another hour later to take a couple more. Well, you do this three or four times and you get paranoid, and you move it. Now, the next time you get up you can’t find it. You don’t know whether you can’t remember where you put it or whether your wife found it and threw it away. And you sure enough can’t ask her, ‘Did you find the bottle I hid in here last night?’”

By 1990 John was a wreck. He was separated from his fourth wife and raising their two oldest children alone. He functioned, but moved through life like a ghost. Life was a blur. Everything was muted and dulled in a kind of permanent haze or fog. He was about to get a rude awakening.

On a September night he walked from his house to fetch — what else? — a half-pint of vodka on his way to a meeting at the Viking Ship community center in nearby Miller Park.

“I was cutting through the park and I saw three guys sitting on the side of a hill and one of them stood up as I approached and asked me if I had a cigarette. I reached down to grab one and as I looked up I got hit in the face and that’s the last thing I remember for a month,” he said.

 

Immanuel Medical Center

 

 

The beating he absorbed at the hands of the strangers, who were never apprehended, left him with five fractured ribs, a jaw busted in three places, broken bones above and below his left eye (whose sight is permanently damaged), a broken nose and countless cuts and abrasions. Amazingly, he managed walking home, where his kids answered the door to find a grotesque figure sagging on the porch. They did not even recognize their own father for all the blood, bruising and swelling. He was rushed to St. Joseph Hospital, where he drifted in and out of consciousness and needed weeks for his concussion and other injuries to heal.

What happened to John that night had nothing at all to do with his alcoholism, yet he attributes the event and others following it with finally getting him to make the pledge to stop drinking stick.

“I have very mixed emotions about it,” he said of the beating. “It was a negative event but it had a positive result.”

Before he could make the commitment to stop drinking, he still had one last bender to go on.

“My jaw was wired shut and when I got it unwired I went out and got drunk that night, and I drank for a couple months. My last drunk was like a two-week drunk and it was a real bad one. Eight consecutive days are a total black out. Then, I finally got sick enough that I quit. In the meantime, my wife filed papers with the Douglas County Attorney that I was a danger to myself and others, and I more than likely was. Sheriff’s deputies came to my house and hauled me off in handcuffs to the psyche unit at Immanuel Hospital (Medical Center).

 

Miller Park....North Omaha:

 

“Sitting there at three-four in the morning the light bulb finally went off in my head and I thought, ‘Hey, whoever is keeping you alive isn’t doing it so you can go get drunk again.’ And at that time I finally made peace with God. Ever since I lost my son to cancer, God and I didn’t get along. We agreed to disagree for about 30 years. But after I made peace with Him it got easier. And from that point on I’ve never really had the urge to go drink.”

After his release from Immanuel John checked himself into then St. Gabriel’s detox unit. Before entering detox, however, he had a whole weekend on his hands at home, which posed yet another test to his resolve. “I had free reign to do what I wanted and yet I found myself not even wanting to drink. Even in my fuddled-up condition I thought, ‘There’s hope now.’ That was the start of it.”

Upon completing treatment at St. Gabe’s, he joined Alcoholics Anonymous, whose program he continues in today and that he intends participating in the remainder of his life. These days John is a content man who finds love and support among both his AA family and his own family. His son Shawn is living with him and sharing in his new life. He said, “Shawn got a lot of the benefits of my being sober. I’ve taken him places and done things with him that I never did with the older kids, who were out of the house by time I got sober. There was some resentment by my older kids, but we’ve been able to talk about it and work our way through it.” John’s dream is to one day retire to Mesa, AZ, where his beloved Cubs have spring training. Until then, he remains ever vigilant.

“Recovery is a continuing process. The first time I think I’m recovered, I’m drunk. I was an alcoholic yesterday. I’m one today. I’ll be one tomorrow. They’ll always make the stuff. They’ll always sell it. I’ll always be addicted to it. That doesn’t mean I have to give into it, though,” he said.

He realizes that without the support of his AA sponsor and circle of friends, he would be lost again. His philosophy about sobriety reflects the AA creed.

“It starts with attitude. And for the first time in my life I am comfortable in a sober world. I am not comfortable with my sobriety in that I take it for granted. I do what I have to do to maintain it.”

That means attending daily AA meetings. For John and others like him, sobriety is a one day at a time thing,

“All it is a daily reprieve,” he said.

I’ll Be Seeing You, An Alzheimer’s Story


Alzheimer’s scares me.  I suspect it does many people.  I cannot hardly think of anything more devastating or tragic than having your mind slip away or watching helplessly as a loved one’s mind fades into confusion, and ultimately oblivion. All of which is to say I was a bit queasy when I got the assignment to profile a woman with Alzheimer’s, or more accurately to profile a family and their odyssey with the afflicted loved one in their care.  But I was struck by the love this family has for each other and for their beloved Lorraine, who was variously a wife, mother, grandmother to them. The way they rallied behind her is a testament to the family.  Of course, not all families are as close or loving, and not all Alzheimer’s victims are fortunate to have such attentive support.  If you’re in the mood for a sentimental story that is based in fact, than this might be your cup of tea.  The piece originally appeared in the New Horizons.

 

 

I’ll Be Seeing You, An Alzheimer’s Story

©by Leo Adam Biga

Originally published in the New Horizons

I’ll be seeing you in all the old familiar places, and in all the old familar faces…

Blessed with the voice of an angel, the former Lorraine Clines of Omaha enchanted 1930s-1940s audiences with her lilting renditions of romantic ballads as the pert, pretty front singer for local bands. Billed as Laurie Clines, she was also featured on WOW radio’s “Supreme Serenade,” whose host, Lyle DeMoss, made her one of his “discoveries.”

From an early age, she used her fine singing voice to help her poor Irish Catholic family get by during the Great Depression — winning cash prizes in talent contests as a child and, after turning professional in her teens, earning steady paychecks singing with, among others, the Bobby Vann and Chuck Hall orchestras at area clubs and ballrooms. After the war, she gave up her performing career to marry Joe Miklas, an Army veteran, semi-pro baseball player and Falstaff Brewery laborer. The couple raised seven children and boast 17 grandchildren.

The memories and meanings bound up in such a rich past took on added poignancy at a recent Miklas family gathering during which Lorraine, a victim of Alzheimer’s Disease since 1990, sang, in a frail but charming voice, some standards she helped popularize in the big band era. Her family used the occasion to preserve her voice on tape, thus ensuring they will have a record of her singing in her senior years to complement the sound of her voice on platters she cut years before. While even advanced Alzheimer’s patients retain the ability to hum or sing, Lorraine has clung to music with an unusual ardor that reflects her deep feeling for it and the significant role this joyous activity has played in her and her family’s life.

“There was always music in the house — singing, records, dancing,” daughter Kathy Miklas said. “When we were little we each learned two songs Mom recorded, “Playmate” and “Little Sir Echo,” and we all learned how to dance to “Ball and the Jack.” At their mother’s insistence, the Miklas kids took piano lessons and at their father’s urging, they played ball. “We really were lucky Dad loved sports and Mom loved music. It was a great combination. They made sure we did both. It was a nice foundation to have,” daughter Theresa Ryan said, adding the family participated in neighborhood talent shows and competed in softball leagues as the Miklas team.

 

 

 

 

Even though she went from headliner to homemaker, Lorraine never stopped making music. She harmonized doing chores at home. She sang lullabies to her kids. She broke into tunes on holidays and birthdays. Away from home, she taught music at St. Adalberts Elementary School, vocalized in the church choir, led singalongs on family road trips and performed for her children’s weddings. Ryan said she and her siblings knew that whenever Mama made music, she was in a merry mood.

“You would get a yes if you asked her a favor while she was singing. You knew that was a good time.” Even now, despite the ravages of Alzheimer’s, music continues to hold a special place in Lorraine’s mind and heart. In a reflective moment one September Sunday afternoon Lorraine commented, ‘We gotta get all the music we can.” And then, as if remembering how music enriched life for her and her family despite scant material comforts, she said, “We haven’t had a lot of other things, but we sure have had a lot of music.” Accompanied on piano by Carolyn Wright, Lorraine found most of the words, with some prodding from husband Joe, to ballads like “I’ll Walk Alone” and “Girl of My Dreams.” When she got around to singing the bittersweet “I’ll Be Seeing You,” which is about being true to an absent loved one, Joe broke down in tears — the lyrics hitting too close to home.

“Not having her around” is the worst agony for Joe, who loses a little more of his wife each year. “It’s hard to live alone,” said Joe, breaking down with emotion. As he has seen Lorraine slip further and further away into the fog that is Alzheimer’s, he has had to content himself with memories of “the good old days.” He said, simply, “We had some good times.” A son, Joe Miklas, Jr., said the cruel reality of the degenerative disease is that it feels like losing a loved one, only the afflicted is not dead but stranded in a dementia that makes them increasingly unreachable. unknowable, unrecognizable. They are present, yet removed, their essence obscured in a vague shadowland of the mind. “Physically, she’s there, but she’s not Mom anymore. We’ve lost our mother and yet she’s still here.” Kathy Miklas describes the experience as akin to “a slow grieving process.”

Bill Miklas, the youngest among his siblings, is convinced his mother is, on some level, aware of the prison her impaired brain has confined her to, although she is unable to articulate her predicament. Evidence of that came only last year when, Kathy Miklas said, her mother confided to her, “‘I think something’s wrong with me, but I don’t know what it is. It makes me feel bad that people are having to do things for me that I used to have to do for them.’”

The sad thing, Bill said, is “this disease has forced her to be isolated, not only from those around her, but from herself. She has to live within her world. She has to travel this journey, for however long, by herself. It must be very frustrating to her to realize when she talks she’s not making sense. She can see the reactions on our faces, but her pride won’t allow her to show she’s debilitated. It’s hard for her to look me in the face and say, ‘I don’t remember your name.’ Yet even as debilitating as this disease can be…she still likes to sit and talk, and she’s still a happy person.”

As Alzheimer’s evolves, its victim presents changing deficiencies, behaviors and needs. Mirroring the patient’s own journey are the changing emotions and demands felt by family members. Just as no two sufferers are alike, the experience for each family is individual. Every step of the way, the Miklas clan has made Lorraine’s plight a family affair. “Everybody just kind of took their part in it and did what had to be done,” said Ryan. “I don’t know what I would have done without them,” Joe said of his family’s pitching-in. Not everyone always sees eye-to-eye on how to handle things, but the Miklas’s remain united in their commitment to do right by Mom. And, no matter what, they’ve stuck together, through thick and thin, in illness and in health. “We’ve kind of become our own support group,” Joe, Jr. said. “We don’t always agree, but we always communicate, which is the key.”

Married 54 years, Joe and Lorraine hail from a generation for whom the vow “for better and for worse” has real import. That’s why when she was stricken with Alzheimer’s he put his life on hold to become her primary care giver at the couple’s home, where she continued living up until about a year ago. Lorraine’s first symptoms were shrugged off as routine forgetfulness, but as her memory deficits and confused states grew more frequent and pronounced, her family could no longer ignore what was going on. It all began with Lorraine making repeat phone calls to family members without knowing who she was dialing and not remembering she made the exact same call just minutes before.

Ryan said, “At first, we laughed it off among ourselves. It was like, ‘Oh, did Mom call again to ask who’s making the turkey for Thanksgiving? I told her 10 times.’ And then, we got a little upset with her. We’d say, ‘Mom, would you pay attention. You’re just not listening.’ There were other signs. Normally a precise, productive person who kept on top of her large family’s many goings-on, she could no longer keep track of things. She let the house and herself go. She grew disorganized. And she seemed to just shut down. “I think one of the things we first started noticing is that she just wasn’t doing as many things as she was doing before,” Kathy said. “One of the striking differences was she’d always been very organized and efficient” but not anymore.

Concerned, Kathy convinced her mother to be evaluated by the University of Nebraska Medical Center geriatric team. “When the doctors said she didn’t have any physical reason for this — that it’s probably Alzheimer’s — I was totally shocked,” she said. The entire family was. Lorraine went on living at home with Joe. “I think our family…was in denial,” Bill said. “We didn’t want to mention Alzheimer’s in front of Mom. I think a lot of us thought there was a mixed diagnosis. That, you know, it’s not really Alzheimer’s — Mom just forgets things. It’s not that big a deal.” From denial, the family gradually accepted Lorraine’s fate, the diminished capacity that accompanies it and the demands her care requires.

To get to that point, however, the Miklas children first had to come to terms with how their mother’s condition was affecting their father. “We were all kind of going on with our lives,” Ryan said, “but I don’t think we were focused too much on the disease because Dad was there to do the day to day caring.” As the disease progressed and Lorraine grew more unmanageable, the job of caring for her 24/7 consumed Joe’s life. He halted his active recreational life to attend to her needs. “Dad started to give up a lot of the things he likes to do,” Ryan said. It got so that it was dangerous leaving her alone, even for brief periods, and no longer possible for anyone untrained like Joe, now 79, to always be on call. Overwhelmed by it all, he could no longer hack it alone, and that’s when the family began the long, winding odyssey to find the right care giving situation.

 

 

 

 

Kathy, a private practice speech-language pathologist, steeped herself in Alzheimer’s — from possible causes to drug therapies to support services to care providers. “I felt like I could deal with it better if I understood it. So, I started talking to the Alzheimer’s Association and reading lots of stuff. As a family, we shared information about what Alzheimer’s is and what goes on with it. I didn’t want to miss an opportunity to do something or to have something because we didn’t know about it.”

Family members also attended conferences to glean more understanding — from health professionals and family care givers alike — about what to expect from Alzheimer’s and what adjustments the family could make to ease things for themselves and for Lorraine. For further insight about her condition and how to manage it, they consulted one of the world’s preeminent Alzheimer’s experts, Dr. Patricio Reyes, director of the Center for Aging, Alzheimer’s Disease and Neurodegenerative Disorders at Creighton University Medical Center. “We just lived and made adaptations and accommodations as needed,” Kathy said. “We knew not to ask Mom to do certain things because she wouldn’t remember them and we reminded her to do things she maybe still remembered how to do.”

The family explored several care giving options: first, enrolling her in a respite day care program; next, arranging for a home health nurse to come each morning to assist with her personal needs; and, then, when respite/home care was no longer sufficient to accommodate her unfolding illness, they sought more intensive aid.

“In November, we decided it was not a good idea for Dad to have to constantly be on duty all the time,” Kathy said. “We could see his health deteriorating from the stress…so we started looking at nursing homes.” Lorraine was placed in one, but the family found its medically-based approach and strictly-regulated environment stifling for their mobile, verbal, social mother, who felt uneasy in such a restrictive setting.

According to Kathy, the site “just wasn’t set-up to handle somebody like Mom. They had everybody get up at seven, eat breakfast at eight and go to bed by seven-thirty. Well, having been a singer — Mom never gets up at seven and she’s used to going to bed at about one o’clock in the morning. Plus, they had her heavily medicated. One night, they called and said, ‘Your mom is having a behavior episode we can’t manage.’ Well, I got there and she was having ice cream with a nurse. She was fine. Mom was very frustrated because in her mind this was her house and at night she got terrified. She would ask, ‘Why are all these people in my house?’ After a month of that place, we decided it wasn’t working out.”

Searching for the best care facility for a love one means weighing many complex issues and making many difficult decisions, not the least of which are financial. Although the nursing home was unsatisfactory, it did have the advantage of being Medicaid certified. As the Miklas’s looked around for an alternative, they discovered most quality care centers do not accept Medicaid patients, are cost prohibitive on a private pay basis and, even if the family could afford to pay privately, they would face a two or three-year waiting list.

“We were struggling with what we were going to do,” Kathy said. That’s when they found new hope and the right fit in Betty’s House, a residential assisted care facility, where Lorraine resides today. Where, at the large, institutional nursing home, Lorraine was anxious and irritable, the family has seen “a dramatic difference” in her mood at Betty’s House, Kathy said, adding: “It’s been a godsend. It’s small and home-like, not like a nursing home. The lady who runs it, Mary Jo Wilson, cared for her own Alzheimer’s-sticken mother for 10 years. She knows how to do Alzheimer’s. She knows what you say, when you argue, when you don’t argue, what’s important, what’s not important and she teaches her staff…that you give residents praise and tell them how happy you are they’re there, and I really think that positive feedback is part of the reason Mom’s been so calm and so happy the past few months. She’s doing well.”

And, relieved from the pressure of daily care giving, Joe Miklas began doing better, too. “Now, he can relax,” Kathy said.

Joe is just relieved Lorraine is situated where she seems at peace. “She’s safe. She seems to be happy,” he said. “They’re very good out there. The owner does a hands-on job. She’s always around, supervising things. She’s got some good help. It makes a lot of difference. I try to make it out there every other day if I can. Lorraine talks about coming home, and I’m not sure whether she has this (he gestured to mean their home) in mind or what. I thought she considered that (Betty’s House) her home. It’s hard to know.”

He does know she’s content whenever she breaks into song, as she did upon overhearing a conversation he had with another visitor to Betty’s House. “We got to talking about music when Lorraine suddenly sang ‘When Irish Eyes Are Smiling’ and she just took it up right from there.” Anything Irish elicits a response from her, said Kathy. “She’s always been passionate about her heritage. St. Patrick’s Day was a big day at our house. She’d sing Irish songs. Even now, when you mention something about being Irish, she’ll go into her version of an Irish brogue” and maybe start up a song.

Music remains a vital conduit to the past. “Still, in spite of all the things she can’t do, if you put a microphone in front of her, she turns into Laurie Clines, the singer,” Kathy said. “Her body moves as a singer. Her voice changes and her intonation, her breath and her rhythm become that of the singer again.” This transformation was evident the night son Tim Miklas appeared with his band, the Pharomoans, at Harvey’s Casino. “I went down into the crowd where Mom was and we sang “When Irish Eyes Are Smiling” together. That was pretty special,” Tim said.

Family and faith have defined Lorraine’s and Joe’s lives. Growing up within blocks of each other in south Omaha, each lost their father at a young age and each began working early on to support their family during tough times. They attended the same school and church, St. Adalberts, but didn’t start dating until after the war.

“I thought she was the prettiest girl in school,” Joe said, “but I didn’t think I had a chance to get a date with her, so I just kind of put it out of my mind.” After marrying and starting their own family, the pair made sure all their kids attended parochial school, scraping together the tuition from his modest Falstaff salary, and even saved enough for family vacations. “Family was very big to her and she passed that on,” Theresa Ryan said. “I think they both wanted that family environment and worked very hard to achieve it.” Bill Miklas added, “One of their man ambitions was to raise a great family, and I think they did a wonderful job.”

Through the process of Lorraine’s sickness, the Miklas’s, always close to begin with, have drawn ever closer. If there’s anything they’ve learned about dealing with a loved who has Alzheimer’s it is, Tim Miklas said, “to try to maintain the courage to go on and make sure that person is still a member of your family. Maintain your relationship with that person as much as possible. At some level, some of the things get through to them.” Whatever the family occasion, Joe knows his wife still “wants to be part of it, that’s for sure.”

Kathy Miklas advises others to “really value the time and the experiences you have with your loved one because you don’t know what it’s going to be like three months or six months from now. Like many people with Alzheimer’s, physically Mom’s going to last a lot longer than she is mentally.” Another piece of advice she has is: “Give people choices. Give people dignity and the ability to have some control over their lives. For example, giving my mother the choice of when gets dressed eliminated a lot of arguments.”

In the end, this Alzheimer’s story is about the enduring love of a man and a woman and of a resilient family. “Theirs was a very subtle love,” Bill Miklas said of his parents. “It was something you always felt. The same with the faith they lived. It was a constant. There was never a question — never a doubt. It was a very stable reality. I think Mom taught us a lot about faith and about commitment — to ourselves and to our family. She taught us not to focus on what you don’t have but to enjoy what you do have and to find the value in that. Somehow, if I can take that to my family than that will be Mom’s greatest legacy.”

I’ll see you in the morning sun and when the sky is grey.  I’ll be looking at the moon, but I’ll be seeing you…

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