“Let me tell you what I really, really want.” Don Berwick talks about learning to skate ski. “It is the closest I have ever felt to flying.” He talks about a beautiful, secluded skate skiing trail in the mountains that leads across a stream and up a hill to a stand of young birch trees. “I don’t know any lovelier spot in the whole world. If you are lucky . . . you can stop there and . . . in the silence, you can watch a busy red squirrel and feel totally at peace.”
He describes a problem in his right knee. “The problem is osteoarthritis, it comes from medical error, from botched surgery when I was a medical student, aggravated by years of jogging. In December 2004, in very bad knee pain, I was scheduled to have a total knee replacement. But at the very last minute, a few days before my surgery, an orthopedist, a third opinion actually, suggested trying a steroid injection in my knee. My surgeon agreed to try, and here I am.”
“It’s five years later, and just one more steroid shot later, and I’m limping a little, I’m almost pain free, and I have my own knee still in place. It’s not a perfect knee. I can’t jog even a single step. I have to wear special orthotics. When I hike I have to use poles to take some weight. But here’s the important point. I can skate ski. I can skate ski all I want. With a metal knee I probably couldn’t, because a metal knee can’t take the torque. . .”
“Next weekend I will be up there quiet [on the trail] leaning on my ski poles and watching a little red squirrel watching me. What health care do I want? Well, of course what I want is safe, effective, evidence-based health care for my knee. What do I really want? I want to skate ski on that knee. What I really, really want is five minutes on a sun-filled blue sky 20-degree February afternoon in total silence leaning on my ski poles in that little stand of birches watching one busy red squirrel. Now, I’m not saying I won’t need a metal knee some day, I probably will, but just not yet, not yet. Health care wanted to give me a metal knee. It was very ready to move, on a dime, and I wanted to visit a squirrel. My care was dignified, it was professional, but it missed the point.”
Don Berwick, plenary speech “Squirrel,” IHI’s 21st National Forum, 08 December 2009.