As I walked up the stairs I thought about the history of the building I was about to enter. Although the foundation was the same, almost everything else had changed. The hallways were updated. The patient rooms decked out with comfortable furniture and fancy televisions. I even marveled at the bathroom as I answered nature’s calling. I could have been in a fancy hotel.

Yes. Things were different than when I started as medical director. Back then, no one doubted upon walking into the entrance that they were in a nursing home. The five senses exploded with unwanted stimuli. The moans and groans, the smell, and the faded, run down facade.

They were “the good old days.” Hindered by appearances, we felt we had to provide excellence beyond compare. The patients were old, demented, and psychotic. But they were ours. The names rolled off our tongues with an ethnic flavor. We took care of our neighbors. Before the boundaries blurred. We were part of the community

There was something about being the red headed step child, the underdog. It created a strange sense of identity. We knew who we were.

***

With an infusion of money, the construction trucks trampled in. The act of breaking ground was an affirmation of survival. But it was also the beginning of a new era.

Staff changed. Our patients changed. No longer constrained by second hand clothes the facility attracted a new clientele. We didn’t need the support of our community, we expanded against it.

I looked at my patient roster. So many names were holdouts from a time long passed. But there were also new names. New responsibilities.

It was time for me to say goodbye. I was no longer captain of this boat. My ship had sailed and I didn’t belong. It was as if it was I, and not the building that was antiquated.

***

We are entering a new era of healthcare. Old ways are being replaced at a staggering pace. The cracked and crumbling facade of our institutions has given way to the technological marvels of modern day society.

But sometimes I feel like a lonely ship floating in the ocean. As I struggle against the seismic change of tides, I wonder whether I will drift along with the waves or be swallowed whole.

We have changed our outsides. We have slapped lipstick on the pig. But on the inside are we really any different?

Can we, as physicians, survive the new world that is being foist upon us?

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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