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Tracy. Arturo. Elham.

Like most people with the internet I read Mona Simpson’s eulogy for her brother, Steve Jobs.  An author, Ms. Simpson has a way of delivering the truth and celebrating those qualities that made her brother insanely creative and well, difficult at the same time.   The entire eulogy can be found here.   As a nurse, this line registered the loudest.

“Even ill, his taste, his discrimination and his judgment held. He went through 67 nurses before finding kindred spirits and then he completely trusted the three who stayed with him to the end. Tracy. Arturo. Elham.” 

So maybe 4 percent of the nurses who passed through Steve Jobs life in his last months met his standards?  Wow.

My first thought was that Steve Jobs must have been the patient from hell.   We’ve all had them and there is probably an element of truth in that statement.   He was known for being demanding of his employees and very passionate about his work.  But we’ve all taken care of passionate and demanding patients and didn’t get replaced.  It’s just our burden as nurses to understand that some patients are put on earth to make us question career decisions and reaffirm our dedication to those patients who deserve us.  Let me emphasize that this was my first thought but not my last on the Steve Jobs as a patient theme.

Steve Jobs had advantages that our typical patient does not have.  He was very curious about a lot of things including electronic gadgets and from I read from his sister, tea roses.  I have no doubt that he knew more about his rare form of pancreatic cancer than 99 percent of nurses on the planet.  He probably memorized every side effect of every drug and had a spreadsheet for lab results.  Steve Jobs, unlike the vast majority of our patients knew who was competent and who did not adequately prepare to take care of him.

The second thing that Mr. Jobs had was money.  Our patients never cut us a check.  They never the see the huge sums of money that go into providing them the care they receive from home health agencies and all associated providers.  As a result, the care seems to be ‘free’ to our patients and therefore, they expect a little less.  Or they never question their doctor’s referral to your agency and so they believe that they really don’t have a choice.  Sadly, sick people without financial resources or insurance often do not receive our care.

So then I asked myself how long I would have made as Steve Jobs’ nurse.  Hmmm……  I am not sure they make stopwatches that measure such tiny increments of time.  Being that I am an information junkie, I might have gotten the pathophysiology and medications right but when it comes to patient care, I do so much work with Medicare and other payors that I often refer to myself as a once removed government employee paid by the hour.  I’m afraid I would have to insist on doing things my way to meet ‘evidence based practice’.

Steve Jobs had his own ideas about everything and I am quite certain that he had some ideas about how he wanted to be treated that differed from traditional nursing care and evidence based practice.  I wonder how many of the 96 percent who didn’t make the cut tried to impose their will upon a terminal man who was quite certain about what he wanted in life and as it turns out, death.

Were the 96 percent of rejected nurses in awe of the fact that they were taking care of one of the most creative geniuses in the world; the Steve Jobs?  Or did they see just another patient?  I suspect that Tracy, Arturo and Elham simply saw a father and a husband spending some time with his family before he was permanently deleted from this planet’s hard drive.

I will never find out if I could make the cut.  There are no openings in the Eternal Care Unit.  But I do know that my attitudes about direct patient care are not the same as they were when I graduated Nursing School and went to work in the Intensive Care Units.

Do you have what it takes to be in the elite four percentile?  If you had been Steve Jobs’ nurse would you have done what it took to be competent in helping him make decisions about his care?  Do you make it a point to really know who your patients are and what they want?

We do not work for the feds, y’all.  Medicare and other federal agencies have no clue about what we do.  We are not employees of large insurance companies.  You don’t even work for the agency that signs your check.

You work for the patient and with the patient at whatever level they are when they come to you.

Steve Jobs was not a perfect man but he changed the world because of his passion and his will.  He did it in beautiful ways that are fun to play with.  I ordered an iPad before they were released and I have only been without it for one night.  I was very close to checking myself into detox before morning.

Your patients also changed the world.  They fought in wars and raised families and built communities.  They have taught school, doctored sick people, worked as double shifts during harvest until they were so tired they felt it in their bones.  Some of them did very little with their lives because they just didn’t possess the gifts required but that doesn’t mean they didn’t mean as much to someone as Steve Jobs meant to us.

I’m sure it was an honor to take care of Steve Jobs just like it is an honor to take care of all of our patients.  Whether we like our patients or don’t, that’s what we do.  We take care of sick people in their homes so they can be with their loved ones.

Nobody was more deserving of excellent nursing care than Steve Jobs.  Nobody is less deserving of excellent care either.


That’s all.  Just talk amongst yourselves while I get back to work.

7 Comments Post a comment

  1. Probably a matter of personalities that he clicked with. Dying is such an intimate thing. I think of all the nurses that I have worked with, some great, some okay. All have good points, bad points, strong points, weak points. Who would I want in my home, in my life? It really is a small percentage of them that I feel comfortable sharing intimate details with.

    Most patients never get to choose, but money can buy those things that the rest of us do not have. I don’t blame him. My father died of pancreatic cancer. I have hospice experience also. I think I might have made the elite 4 percent if I had tried. Trouble is, I never would have tried.This sort of private nurse to the rich is definitely not for me.

    November 10, 2011

  2. Conrad was also in the Elite4… just a thought…

    November 10, 2011
  3. Susan #

    The best line you said in that post was “Nobody was more deserving of excellent nursing care than Steve Jobs. Nobody is less deserving of excellent care either.”

    I lost my personal respect for the man a long time ago, way before many people even knew who he was. But I have taken care of prima donna’s before. I was ever so glad to be fired.

    Everyone deserves to be treated like a human being. To be a part of their care. To be listened to.

    Could I have taken care of Steve Jobs? Yes. Would I have? Not for all of Bill Gates money. You think it is likely because they wouldn’t listen to him, and for some it probably was. I’m sure there were others, who like me, couldn’t get to the door fast enough.

    There are two parts to the nurse-patient relationship for it to really truly work. I’m not sure it was always the nurse part who was broken.

    November 10, 2011

    • I edited out a line of the original post that maybe I should have left in and it was, “Would any of your patients fire you if they had resources and intelligence to do so?”

      I obviously did not know Steve Jobs. Had he called me, I would have insisted on a few more keys on his standard keyboard. I love my iPad but until his sister’s eulogy the most personal detail I knew about the man is that he liked black turtlenecks.

      You say that you would not have taken care of Steve Jobs because you lost your personal respect for him a long time ago. If he was a traditional Medicare Hospice patient and you were assigned to his care, I bet you would have taken care of him. You would have treated him like a human being, allowed him to be a part of his care and listened to him. You might very well have arranged for his care to be transferred to another nurse as soon as you could do so responsibly and sometimes that is in the best interest of both the patient and the nurse. I have no idea who you are but a nurse who is glad to be fired obviously did not quit and walk away from a patient in need.

      My post was more about the kind of care that our patients would receive if they felt like they had more choices. You certainly got my message that nobody is less deserving of excellent care than Steve Jobs. My point was that maybe Mr. Jobs did receive better care than a patient who is not bright enough or interested enough to catch on to the fact that we missed a visit or two or got his meds wrong on the med list. Our patients trust us implicitly and that trust is worth more than all of Bill Gate’s money. It should be our mission to make sure that even the most illiterate, poorest patient on service is respected and cared for as well as Steve Jobs was. We may not be able to give the patient as many hours but we need to make sure that each minute we spend with the patient and preparing to visit the patient is put to good use.

      November 10, 2011
      • Susan #

        I guess mostly, I’m tired of everyone putting him on a pedestal that he did not deserve. No one does.

        November 14, 2011

        • I completely agree with you there. I think we were sort of making the same point but coming at it from different angles. I think that because most Medicare patients never realize how much is actually paid for their services they expect less than wealthier folks who pay for private duty. Being on a pedestal must be a lonely existence. Me, I have been voted most likely to die of a closed head injury in yoga class. I would never get on a pedestal with my lack of grace and distorted sense of balance (although I am exceptionally good at headstand – maybe the upside down perspective?).

          November 14, 2011
          • Karine #

            Love it, love the article, love the replies, good to know perspectives. We all need to do more thinking and ethics and etiquette should be considered most.

            November 16, 2011

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