Give people a fact or an idea and you enlighten their minds; tell them a story and you touch their souls. - -Hasidic proverb

Professional Case Management journal is full of ideas, data, and facts. These form the basis of evidence-based case management and, year-by-year, this has moved case management from a grassroots initiative to a respected profession. But I love stories, and as the quote says, it is stories that touch the soul. So, for this "National Case Management Week" Editorial, I want to relay a story. The message of the story is clear: We do not know when we will touch our patients, or what words or deeds will be used, but we do touch lives.

Leah Reitman is a feisty 85-year-old woman. She is a mother of three, a grandmother of seven, a great-grandmother of two, and a loving wife and caregiver to her 92-year-old husband, and she still finds time to volunteer at the "old folks home" in her community. But a much younger Leah was an activities director at a nursing home in Chicago during the 1960s (a very different environment than today). It was during those years that this "story" occurred.

It was a beautiful sunny spring day and, on my way to work, I saw some wildflowers (the kind most people called "weeds" back then). I picked a handful and decided to go upstairs at the nursing home to see Maddie. The second floor was designated to residents who were unable to come down to my activities. I went upstairs often-taking simple things for them to do in bed or sitting by the side of the bed.

Maddie must have been a beautiful young woman, as even now she was so dignified and genteel. She was still in bed and, as usual, was running her hand back and forth over the bedrail repeating "orbliss, orbliss." As long as anyone could remember, Maddie never spoke any other word.

As I often did, I wished her a smiling "good morning" on this beautiful, sunny spring day and showed her the flowers I had picked. I described the lovely day, how wonderful the warm sun felt, and about the butterfly and squirrel I had observed earlier that morning. And all the while, she kept looking at my smiling face, constantly repeating, "orbliss, orbliss, orbliss."

"Because of all the sunshine, my roses are doing beautifully!!" I told Maddie.

This is when it happened.... With her hand going back and forth against the bedrail, she said, "Orbliss, orbliss.... I had a rose garden.... Orbliss, orbliss." She was in there, just like in the poem "Crabby Old Woman!!"1 Although she never again deviated from "orbliss," I knew that, on some level, she was listening and relating.

Never underestimate your power to touch lives or think that even small things do not make a difference (remember that a small "O" ring costing less than $1 caused the Challenger disaster in 1986). Yes, we must be cognizant of numbers; we must watch that readmission numbers are low and that length of stays are appropriate, for example. We must strategize the discharge plans and consider Plan A and Plan B. This is the "head" of case management.

We must craft the discharge plans with thoroughness and accuracy. They must be handled in conjunction with the needs and wishes of the patient and the family. These are the "hands" of case management.

We must help our patients articulate questions about their disease, their care, and their discharge. We educate and inform and this is the "breath" of case management.

And, as in the story, we strive to touch the patients and their families. This is the "heart" of case management.

During this National Case Management Week, as in every working day, I know you will all be doing your part. But think about a time when you really impacted a family's burden or a patient's course, when you bought back a memory long since forgotten in a brain that no longer navigates correctly, or improved a quality of life that, except for you, would not have been improved. Think about these times during our special week, because this is your story and it is what defines case management.

CRABBY OLD WOMAN

What do you see, nurses?

What do you see?

What are you thinking

When you're looking at me?

A crabby old woman,

Not very wise,

Uncertain of habit,

With faraway eyes?

Who dribbles her food

And makes no reply

When you say in a loud voice,

"I do wish you'd try!!"

Who seems not to notice

The things that you do,

And forever is losing

A stocking or shoe?

Who, resisting or not,

Lets you do as you will,

With bathing and feeding,

The long day to fill?

Is that what you're thinking?

Is that what you see?

Then open your eyes, nurse,

You're not looking at me.

I'll tell you who I am

As I sit here so still,

As I do at your bidding,

As I eat at your will.

I'm a small child of ten

With a father and mother,

Brothers and sisters,

Who love one another.

A young girl of sixteen

With wings on her feet

Dreaming that soon now

A lover she'll meet.

A bride soon at twenty,

My heart gives a leap,

Remembering the vows

That I promised to keep

At twenty-five now,

I have young of my own,

Who need me to guide

And a secure happy home.

A woman of thirty,

My young now grown fast,

Bound to each other

With ties that should last

At forty, my young sons

Have grown and are gone,

But my man's beside me

To see I don't mourn.

At fifty once more,

Babies play round my knee,

Again we know children,

My loved one and me.

Dark days are upon me,

My husband is dead,

I look at the future,

I shudder with dread.

For my young are all rearing

Young of their own,

And I think of the years

And the love that I've known.

I'm now an old woman

And nature is cruel;

'Tis jest to make old age

Look like a fool.

The body, it crumbles,

Grace and vigor depart,

There is now a stone

Where I once had a heart.

But inside this old carcass

A young girl still dwells,

And now and again,

My battered heart swells.

I remember the joys,

I remember the pain,

And I'm loving and living

Life over again

I think of the years

All too few, gone too fast,

And accept the stark fact

That nothing can last.

So open your eyes, people,

Open and see,

Not a crabby old woman;

Look closer ... See ME!!!!

An Update from the National Case Management Network (NCMN)

Since recently receiving a generous grant from Health Canada, our organization has been given the necessary resources to serve as the authoritative voice on Case Management in Canada. With this new source of funding, we are seeking to expand our network as well as the services it provides to our members, achieving some notable developments over the past few months:

Writing and Publishing of NCMN Standards of Practice for Case Management

Entitled Developing Case Management in Canada: Standards of Practice, Learning Resources and Professional Association the goal of this project is to unify Case Management providers into an interdisciplinary collaborative body of providers who develop, collect, implement, and disseminate a uniform knowledge base and best practices in Case Management. The Standards are now available as a free downloadable file from our website at http://www.ncmn.ca as well as in hard copy.

Online Educational Resource Library (ERL) Set Up and Ready to Access

NCMN now provides its members with access to Case Management Society of America's dynamic, flexible and innovative online Educational Resource Library. The completely web-based library offers access to educational programs and tangible education tools members can use to increase their strategic relevance and worth to employers as well as to clients and their families. An Education Committee will review the ERL resources and recommend course content for translation into French.

Gaining Speed: Membership and Sponsorship

In line with our efforts to increase the benefits of NCMN membership, we are engaged in a large campaign to attract new members through a series of marketing and public relations initiatives. Our website now offers a range of different options for individual, group, and corporate memberships, making this opportunity more accessible to all. We are also working to gain corporate support for our annual conference "Soaring to New Heights in Case Management", which takes place September 19th and 20th at the Sheraton Toronto Airport Hotel and Conference Centre in Toronto. Conference Highlight:

Competency Profile & Assessment Project

The ongoing development of a Competency Profile for use by practitioners will reflect the knowledge, skills, abilities, attitudes and judgment necessary to practice Case Management safely and effectively. This will be a roundtable session facilitated by Assessment Strategies Inc. where conference delegates will have the opportunity to share their input.

1 The complete poem is given at the end of this Editorial. [Context Link]