As some of you know. I have been hospitalized for the past three weeks, so I am a little delayed in posting.  Should be OK, now.  LZ



Leonard Zwelling

(for Dr. Frank Allen)

         One of my most important spiritual teachers gifted me the
concept that the only rational response to life was gratitude. I have come to
learn, as with most of the things he taught me, this was true.

         So when I look back at my past year, which has sure had its
ups and downs, I still am grateful for both the highs and lows, especially
because what appears to be bad at the time of its occurrence, is often good
in the end.

         2014 is the first year since 1984 that I did not work a day
for the University of Texas MD Anderson Cancer Center. For this I am extremely
grateful. The retirement structure made available to me was more than generous
and even though I thought I had more to contribute to the institution, the
Promotion and Tenure Committee, Dr. Hong, Dr. Mendelsohn, Dr. DePinho and Mr.
Fontaine all made it clear that they vehemently disagreed. As usual, I had
become a truly square peg that could not be accommodated by any of the round,
triangular or trapezoid holes available to faculty. I hadn’t cared for cancer
patients in over 20 years so that was not an option once my position as Vice
President was re-aligned. I had no interest in doing basic research and there
were no useful roles for me in administration since it had been determined that
I had overplayed my hand as a VP and was causing more problems than I was
solving when in a leadership role. The short stint in Smithville and the leadership
of the Pharmaceutical Development Center were place holders, but once Dr. Powis
left, I wasn’t even a fifth wheel.

         Given what I have witnessed from afar since leaving on
September 30, 2013, I am very grateful I do not to have to go to that place
every day. Despite repeated appeals from faculty and staff alike that the
patient care product is suffering from an insatiable desire for money
triggering ever more saturated clinic templates and a real negative impact on
the creative time faculty had come to expect for research and teaching, plus no
major improvements in research, clinical care or financial infrastructure
systems, it sounds like working at MD Anderson isn’t very much fun

          Then I began my
sojourn ay Legacy Community Health, a federally-qualified health clinic that claimed
to want to improve its quality, do more research with the TMC institutions, and
in general be a bigger player on the Houston health care landscape. I had
served on its board for three years and thought that Legacy was a well-run
organization and this might a laboratory to combine my experience in
administration with my concern for health policy. I was to serve the needs of
the Chief Medical Officer as his VP.

         Suddenly, 10 weeks into my tenure, that CMO quit and I was
asked to step in as the organization searched for a replacement. I agreed to do
so and was not a candidate.

         Then I found out why the CMO quit.

         The entirety of the clinical operation of this $50M or so multi-clinic
system was in the control of the Chief Operating Officer, an Army nurse. He had
been in a year-long war with the recently departed CMO and the physicians that sounded
amazingly similar to the one I had seen develop at Anderson. The actual
physicians were in less and less control of their schedules, hours, and
administrative roles. Care teams formed and dissolved and reformed almost
constantly leading to inconsistent care and great dissatisfaction among the
doctors. There was rarely a day that went by in which some doctor wasn’t in my
office complaining about the COO and the people who worked for him. We were at
an impasse. The COO wanted total control of all aspects of patient care other
than what happened behind the examining room door. I was unwilling to grant him
that degree of autonomy as I thought it essential for those caring for the
patients to contribute to how care was to be given. Once again, I lost.

the ensuing time a new CMO was found and the COO was to report to her. He quit
instead and the entire quality movement there is in limbo when I last checked
several weeks ago.

wish Legacy well, but the board really needs to understand that Legacy makes
about 85% of its revenue from health care delivery and thus it might be a good
idea to have people leading the organization who know something about that.
That several of the major power players at Legacy have served hard prison time
is also a bit concerning.

I am a retired writer. The book is near done and should be available around
mid-January we hope. I have had a serous setback with some big league abdominal
surgery from which I am trying to recover after about 20 days in Hermann, but
still grateful. I am still breathing and typing and hopefully soon chasing golf
balls with Ron DePinho’s picture on them (see last blog).

I am very grateful for 2014. I still have the best looking wife in Texas and
two good kids plus a great daughter-in-law and son Andrew’s dog Onyx, the
putting phenom. (Look her up on youtube).

wish you all a great holiday week and I wish me the ability to write a similar
column next year. But I take nothing for granted any more.

my Dad was alive he used to say he would wake up every morning and put his
hands next to his ears and push out. If he didn’t feel wood pushing back he
knew he was still alive. The great Duke basketball forward, cancer survivor,
and Houston resident Ken Dennard said to me many times, “every day above ground
is a good one.”

am just grateful for all the pain and pleasure of 2014.  With luck, another year above ground.

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