No Hostage to Fear

The massacre in Las Vegas is a horrible tragic event. I mourn the senseless loss of innocent lives taken by a nobody. Thousands of lives will forever be affected by the events which transpired at the Route 91 Harvest Festival.

I’m speaking at the AAMCN conference at Mandalay Bay in three weeks. But you know what? I never considered not fulfilling my agreement. I will not change my plans to attend and speak at this event.

I will not live my life in fear of a nobody schlump who “just snapped” for no reason or a zealously crazed terrorist. None of us should ever bow to the insanity that happens all too often these days. None of us should become desensitized to murderous violence. When we do, we lose our own sense of humanity and become collateral victims of it.

Stand up and do something to honor the lives lost and affected by this tragedy. My very small part is to refuse to change my plans to speak at this event.

Do your part and refuse to be held hostage by fear or the nobody schlumps and crazed terrorists win.

This is still America!

We are human beings you know!!! When will someone be human to us???

(This was written over two years ago in the aftermath of a family emergency. Being on the other side of the health care service delivery equation was more stressful than anything in recent memory because we were not treated as people…. we were patient and caregiver. Labels used to identify people in the health care system instead of using their actual names. How about this… dispense with the labels. Maybe then health care will be both healthy and caring.  What I know is, something needs to change.).

What I know.

I love. I feel. I express best through words. I create. I carefully consider but am prone to making decisions based solely on intuition. As intensely as if bearing down to obtain the most vivid tone and hue, I feel. I hurt.

Not wishing to focus on the negative, but it is through I must proceed. So let’s start with this – I’m not looking for validation. I don’t care to hear the reasons why something I feel isn’t true – from anyone else’s point of view. Everything I feel is my truth. What emerge are tones, shades of me at various points in time. Intensity is transient and frequency variable. Regardless, it is truth – mine.


Perhaps never as before, I felt very alone and cold on March 2nd 2014.

A thud represented the reality in which I found myself. A thud and a weak cry for help. What I found was a man oddly propped against a wall, hanging between life and not.

Instinct took over…
Lie him down….
Run downstairs…
Find a phone…
Unlock the front door…
Run back upstairs…
Tell fingers to press the numbers 9-1-1…
Speak… say something…
Help us…

Help me up.
No hon, stay there.
I’ll help you.
No honey, stay where you are… you are having a stroke.

That was the first time I said it. Stroke.

9-1-1 Operator. What is your emergency?
My husband is having a stroke.
Yes, he is conscious.
His right side isn’t moving…. He has a facial droop… speech slurred.
Lying on the floor
Oh yes… our address is…
We are upstairs… the door is unlocked…

I remember Skooch sat next to his head the whole time.
It was as if she knew the problem was happening in his head.
She just sat there until I put her in the closet when the rescue team arrived… and upstairs they came
to help.

They were nice… and took care of you… and took you outside to the ambulance… and to the hospital and away from me…

I called Mom…

Meet me at the emergency room.
Dave is having a stroke.
I have to go.

I can’t really remember this part. I got dressed. I let the cat out of the closet… or the bathroom. I got into my car… and started to drive. I realized I beyond frantic so I dialed another number. What time was it? No idea.

I phoned a friend…

Dave is having a stroke.
I’m going to drive off the road if I don’t calm down.
I can’t breathe.
I can’t believe this.
I need to calm down or I’ll be in the ED bed next to him.
Ok… I’m at the hospital. I’m going in now.
Thank you…
I’ll let you know.

Walking in to the ED…

Where is my husband?
He isn’t in the system yet?
So he doesn’t exist.
Oh, there he is.
We’ll let you back soon.

Sitting… waiting
Come with me.

Doctor speaks clearly… slowly
Simply but not condescendingly
This is good but all I hear is
Too late for clotbuster
Wait and see
Blah, blah, blah
Too late for clotbuster
Blah, blah, blah
Blah, blah, blah
Too late for clotbuster
Blah, blah, blah
Too late for clotbuster
Too late for clotbuster
Wait and see
Blah, blah, blah
Blah, blah, blah
Blah, blah, blah
Blah, blah, blah
Blah, blah, blah

Entering a big room
Feels like a cave
In the middle of it all
A stretcher
Tubes and wires
Milling around
No one explains a thing
Do they think I already know this stuff?
Barely a hello… from anyone
We are human beings you know!!!
Will someone be human to us???

Sorry hon
He sounds funny but I understand him
Half smiling
What a mess I made of things
It’s ok… we’ll get through this together
I love you… love you too.

Mom comes in
More family arrives… how did they know?
Baby carriage
More family arrives… in and out
Off to CT

When did you have your first stroke, sir?
Huh? I didn’t.
Oh, but you did.

Back to ED.
Admitting for a few days
Up to room
Hooked up
Tubes in
Tubes out

Ice chips, please
He’s been waiting hours
Well ok.
Have to wait for admitting doctor for more

So we waited hours and hours and hours

This is ridiculous, where is the admitting doc?
He needs something to keep his mouth moist at least
We are human beings you know!!!

When will someone be human to us???

Family arrives… stays a while… leaves.
Kills some time where we aren’t just sitting and waiting for

Finally – alert the media
THE DOCTOR arrives
Actually, a pack arrives
Resident, medical students… in lock step
A bio mass
Blah, blah, blah
Blah, blah, blah
Blah, blah, blah
No idea who we are talking to
We are human beings you know!!!
Will someone be human to us???

I’m staying
I don’t care
Afraid to leave him alone in the hospital
There seems to be no one around
No one watching him
No one talking to him
Can’t you see he is afraid
No one cared
What happened to caring care?
A relic… like a rusted out caddy at some roadside exhibit in the dessert deadlands.
It can’t be… but it was
That day

No one asked why I was there
No one asked me to leave
Was it a relief that there was one fewer person to have to watch?

It felt like people simply headed off to their lives
Thankful that they could walk away
That this was not their life that just exploded

It was sometime in the middle of that first time when were both awake and clinging to each other… and crying… and sorry
Sorry I did this to us
It’s ok… we’ll get through this together
I love you… love you too.

I hate March 2nd

SOLD OUT! A report from the 2016 CMSA Annual Conference

The CMSA Annual Conference took place in Long Beach, California this past week.  It was the first time in years that I attended the full week of conference events and I was excited to participate. The general mood was extremely uplifting and positive. People were happy to be there and fully engaged in both entertainment and educational offerings. I thrived on the fabulous networking and the atmosphere of collegiality. International attendees who I met represented South Africa, Germany, China, and Singapore. That says a lot about how important professional case management has become around the globe, not just in the United States.

A couple highlights worth mentioning…

My dear friends and trusted colleagues Ellen Fink-Samnick and Hussein Tahan were honored with the CMSA Award of Service Excellence and the Lifetime Achievement Award, respectively. I cannot think of more deserving recipients and was honored to have witnessed the presentations at the Gala Recognition Reception.  On top of that, the Case Management Society of New England was recognized with a Chapter Excellence Award. CMSNE raises its own bar year after year.  When good friends and my home chapter are recognized for their fabulous contributions to professional case management, it doesn’t get much better!

Wolters Kluwer’s booth was hopping busy with both a scheduled and an impromptu book signing. COLLABORATE for Professional Case Management sold out, as did the newest edition to the professional case manager’s reference library, The CMSA Core Curriculum for Case Management, 3rd ed.  Although sold out, orders were still being taken at Friday’s post-conference session, Setting the Standard Through Application of the New CMSA Core Curriculum. The all-star panel of presenters were both honored and humbled by the reaction of the capacity crowd.  It was a great launch for the new Core Curriculum text. Although advanced copies were made available at the conference, pre-publication orders are being taken at the WK website. Just follow the link provided above.

Next year’s annual conference is being held in Austin, Texas. Hope to see you there!


Soon to be released! The CMSA Core Curriculum for Case Management (3rd ed.)

My esteemed co-editor/author Dr Hussein Tahan and I just wrapped up the last bit of work – the Index – this past week!  So much has gone into re-working the third edition but none of it would have been possible without the foresight of case management pioneer, Suzanne K. Powell. Suzanne had the vision and assembled the first edition published in 2000 (with Donna Ignatavicius) and carried through as she led the second edition in 2008 (with Hussein Tahan).

The latest edition advances professional case management practice even further, “This comprehensive, expertly-written guide provides those directly or indirectly involved in case management with information about best practices, descriptions of key terms, essential skills, and tools that fulfill the current Case Management Society of America’s (CMSA) standards and requirements. Addressing the full spectrum of  healthcare professional roles and environments, this is both a crucial certification study guide and vital clinical resource for the case management professionals in all specialty areas, from students to veteran case managers” (Wolters Kluwer, 2016). Highlights of the new edition include:

  • NEW text boxes highlighting key information and vital practices in each chapter
  • NEW and updated Standards of Practice implications in each chapter
  • NEW and updated content on transitions of care, community-based care, care coordination, Value-Based Purchasing, ethics and social media, the impacts of health care reform, and digital technology
  • NEW and updated content on accreditation in case management
  • NEW chapter that lists key additional resources, by topic

This official publication of the Case Management Society of America, embeds the CMSA Standards of Practice for Case Management directly within each chapter to demonstrate the applicability of the standards across the entire care continuum.


The 3rd edition will be available through Wolters Kluwer, Amazon, and other fine book sellers in August. If you wish to register for publication updates, feel free to visit Amazon’s page, here.

A limited number of advance print copies will be available at the CMSA Annual Conference and Expo held at the Long Beach Convention Center in Los Angeles from June 21 – 23. There is a special post-con session the morning of June 24th from 8am-12pm to discuss the book and its importance in today’s high-stakes healthcare environment. Visit the CMSA Conference page for registration details. Hope to see you there!


Reviews on Amazon

Ellen Fink-Samnick and I are humbled by the response to COLLABORATE for Professional Case Management: A Universal Competency-Based Paradigm. These are just three examples of the feedback we are receiving about …

“Case management and interprofessional collaboration and cooperation have recently become integral to care delivery regardless of the healthcare setting. These have proven to add value to the consumer of healthcare services and to the professionals responsible for care provision. despite the popularity of case management, involved care providers continue to learn what case management is on-the-job. The authors of COLLABORATE have done an excellent job in sharing their collective practical knowledge, wisdom, and experience in an easy to read and apply textbook that can be used by the diverse healthcare and case management professionals. This textbook highlights the essential aspects of the fundamental structure, processes, and outcomes characteristics of case management practice; its history and roots; and its relationships to care coordination and transitions of care. COLLABORATE also provides a competency-based approach to the development of the case manager’s role; a topic that is not commonly deliberated in the literature. The list of competencies addressed in COLLABORATE is comprehensive and the practical tools shared on each competency makes their applicability in practice easily manageable.

COLLABORATE succeeds in offering a “go to” guide to case managers and other healthcare professionals interested in or are struggling with the practice. The value of this textbook is broad; it is essential for academic programs which aim to prepare future case managers. It also is equally important in the practice settings – use for orientation of those new to the role, in that it assists case managers in acquiring necessary knowledge, skills and competencies for better patient care outcomes. Additionally, it is a MUST read for case management leaders who may be struggling in transforming or advancing their programs. Without a doubt COLLABORATE supports the professional practice of case managers and their colleagues – the various members of the interprofessional healthcare teams. Congratulations to these trusted and credible authors for delivering a textbook that is a MUST HAVE for any case manager for years to come!”

Hussein M. Tahan, PhD, RN
Case Management Author, Researcher, Evaluator, and Consultant

“The collaboration between Teresa and Ellen to provide us with such a tremendous framework for case management structure is the best I have had the privilege to be exposed to and read.

This is a wonderful book to hand someone when they approach you and ask, “Now exactly what is Case Management and how does it work?”

Joint communication and decision-making processes with the goal of satisfying the health care needs of a target population is true collaboration. Our health care system is finally coming to the realization that better quality patient care and desired outcomes are achieved by the contribution and collaboration of the entire team within a patient’s healthcare circle.

All healthcare providers, whether they are physicians, specialists, therapists, social workers, clinic nurses, home health nurses, IP facility nurses, case managers or our BH providers, are learning that there should not be any hierarchy within our collaborative team for the member to succeed and meet their goals. We are all equally accountable for our patients to meet their desirable outcomes.

This book is an excellent guide/resource for new case managers learning about there challenging new roles or for the mature case manager that is tasked with growing their knowledge of the every changing healthcare system we have today.
This book is not only for individuals but for markets that are building a case management department. That is how detailed the information and resources are in this book.”

Amazon Customer

“This is an amazing book for case management professionals and especially for case management leaders. There is an excellent review of the history of case management and a deep analysis of the many aspects of case management. There are abundant references and case scenarios throughout each chapter.

For those starting in case management, this book may be a bit too in depth but as one’s experience increases with increasing responsibilities and leadership roles, this book must be read.”

Amazon Customer