In our role as case managers, we are called upon daily-no, several times every day-to solve other people's problems. The reason we are called upon so often is because we are good at what we do. Assessing in a heartbeat, coming up with at least a working plan, coordinating with all the right players and stakeholders, facilitating and coordinating the best care possibilities that we can find, and advocating to make sure it all happens and happens when it matters: now. This is the stuff of great case management; but what happens when the client is someone near and dear and all our education, experience, skills, and abilities are taxed to the maximum? As was so beautifully sung in "The Lion King," it is the circle of life. Unfortunately, there are times for all of us when that very circle smacks us right between the eyes.

I have been advocating for more than 20 years for the use of Health Care Directives, also known as Living Wills, and in some states, Power of Attorney for Health Care. Then the phone call comes, and it always seems to come between 2 and 5 in the morning. There is a doctor on the other end of the line, bombarding you with entirely too much information and there is a decision to be made. You learn (if you did not already know) that someone who trusts you has designated you as his or her health care representative/proxy. You learn that all reasonable steps to save someone's life have been exhausted, that there is no further hope for a meaningful quality of life. You are told that current means are simply sustaining life. What do you want us to do?

The older we get, the more trusted we are, the more this conversation will occur. From the one who has been doing a lot of the advocating for this dignified end of life, let me tell you: it is not an easy decision to make. The first and sometimes most important thing to know at such times is that you do not have to make an instant decision. As a health care proxy, you are entitled and I would suggest you have a duty to get as much information as you need to make this very important decision. The first time I was called upon, I happened to be 3,000 miles away from the individual who had designated me as her proxy. As so many of you know and have experienced, for some reason that has no medical foundation or logical explanation, dying people seem to wait for the primary decision-makers to either leave, although they have been at arm's length for months or years, or to arrive, sometimes from a great distance just before it is time to say goodbye. So at 2:30 a.m. PST, the phone rang, the doctor called, and when I regained my breath, I asked, "Can I have a little time to decide?" The doctor was gracious and of course agreed.

The good news was that moment and other difficult moments that have followed, I (like so many of you) have developed a network of knowledgeable, loving case management friends. They help us remember in that moment that we have an arsenal of tools. They help us use our tools. They help us remember that we really do know best. They hold our hands (even across the miles that divide) and most importantly, they are there.

In loving memory of

Lillian Leah Reitman

In the March/April 2009 Editorial-it seems like a blink ago-I wrote about speaking (with my Mother) at the Canadian Seminar. She was so impressed and wrote a note to each and every one of you, which I will repeat. She always kept her promises, so I know she is putting in a special word for all case managers.

To all case managers: it is time someone told you the truth about you!

I believe that you have no idea how important and needed you really are, how much peace of mind, comfort, and well-being you bring to those lucky people under your wing, with your expertise-your caring expertise! I know, because I, too, have needed you while I was afraid and completely lost in the hospital; leaving the hospital with a new and different illness is so scary.

I went to one of your seminars in Canada and heard you discussing some of your stories. I listened in amazement as you relayed to each other some of the things you did to make the patient more comfortable, found a procedure for better health care, improved their mental state, contacting doctors for the client-no detail was too small or too large. And you did it so matter-of-factly. This is what made me believe that you do not realize how special (and important) you are. I fell in love with you-and that is no small matter with such a big crowd!

I may not be able to let everyone know about the wonderful job you do for them, but-by golly-I am going to put in a BIG REQUEST when I pop off and tell God to put in a special wing for the Angels of Case Management: and believe me, you are in the "Angel" category. So, dear people, in another 120 years when you are ready to go, I'll be there to lead you to your rewards!

-Suzanne Powell

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