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.