July 2, 2018

Dateline: Blacksburg, Virginia-

After thinking about various options for travel today, I opted to head down the Shenandoah valley and up into the mountains of West Virginia. It seemed like a good idea, until the thundershowers arrived and you could barely see five feet. Fortunately, there was a nearby rest area so I pulled off until things got a bit better. For whatever reason, I was feeling a bit on the tired side today so I opted not to go as far as I might have otherwise and stopped for the night at the home of Virginia Tech. Seems to be like all small college towns every where. As I am not due in South Carolina until the day after tomorrow and I’m not all that far away, I’m going to take an extra day in the mountains and maybe take some of the back roads which can be such fun to drive.

I’ve gotten into bed early and am watching some bad movies and starting my next MNM column which I should have completed in the next day or two. It hasn’t been a terribly exciting day but a slower pace after two weeks of Manhattan is probably good for me.

Many of you know that I have spent a lot of time in the mountains of West Virginia and Kentucky over the last couple of decades. It ‘s another one of those serendipitous things that seems to happen to me. This one came about as part of my original hire at UAB. I was hired there originally, specifically to help strengthen the outpatient geriatrics clinic. Given the structure of Medicare, ambulatory practice does not generate enough money to both run a clinic and pay providers so it was necessary for me to have a couple of other sources for salary. One of these was a contract that UAB had with the United Mine Workers Funds geriatric care management program which had started with a demonstration project in Walker County Alabama and Mercer and McDowell Counties in southern West Virginia. The UMWF is an organization that administers union guaranteed benefits to individuals whose coal companies are no longer in business. One of those benefits was lifetime health benefits for miners, their spouses, and dependent adult children. As the miners (and more often their widows) aged, they were not necessarily being well served by their local health providers and the GCM provided nursing oversight in the home long term to these frail and usually impoverished rural elders.

I had had experience in case management programs in California and so GCM was entrusted to me when I got to UAB. I started with training and working with the Alabama nurses and it went so well, I was asked to do the same thing with the West Virginia nurses. This necessitated my heading off to the metropolis of Welch, West Virginia. The first time I went, I flew. By the time you took two flights, landed at the only airport in WV which is at the opposite end of the state, rented a car, and got to where I was going, it was a 10-11 hour process. This compared to a 9 hour drive from Birmingham so ever after, I drove up once a quarter or so to teach, review cases and lend my expertise to the program. Over the years, the program expanded to additional WV counties and then into eastern KY and I just kept adding more and more nurses and patients to my purview. I got to know the roads between Alabama and the heart of coal country very well.

I made fifty or sixty trips up there over the 17 years I was affiliated with the program, ending my tenure in 2015 when the UMWF had to retrench its finances and could no longer pay for the contract with UAB. I got smarter about the drives over the years, or I just got older. Originally, I would drive up the afternoon before a meeting, spend the night in a hotel, have eight hours of meetings, then immediately drive back to Birmingham getting in about 2 AM. (Steve was sick during this period and I didn’t want to leave home for too long a time). Later I got smart and refused to do the drive and meetings on the same day.

There’s not a lot to do in small town Appalachia so Ellen Peach, the program’s NP, and I explored pretty much every decent place to eat in Princeton WV, Beckley WV, and Pikeville KY. The list isn’t long. There was also the memorable Veteran’s Day parade in downtown Welch in 2001. It was just two months after 9/11 and we both nearly lost it when the zaftig high schooler dressed as lady liberty proudly rode by on the back of a flat bed Ford chained to a model of an ICBM. That one was incorporated into an MNM column.