Get Behind Me, Cowbell!

I used to suffer a recurring anxiety dream that I want to share with you. The great writer Henry James once said, “Have a dream, lose a reader.” But please, bear with me. 

Imagine being atop a green hillside looking down upon a peaceful valley vivid in the fixtures of late spring (okay, I don’t dream in color, but go with it…) with magnificent pink heads of wildflowers growing out of the land and the trees of the mountains, the pines and aspens and birches, all comfortable in their renewed fullness.

And animals are everywhere here too, no doubt feeling even more acutely this transformation, this sloughing-off the barren skeleton of winter, with its crunchy ocean of snow, absent livestock, dormant trees locked in deadness. A fox scuttles across the glade.

Everything is lined in promise. Cows walk along the mild slope and get into the alpine lake and drink with their cartoonish tongues. At a distance they seem quite dapper, stately, even regal. I’ve never had much admiration for cows but in the dream I go straight to the heart of their impressiveness. When they walk out of the water, the sun pools on their wet haunches and brawny chests. They eat grass with contentment. Life seems quite profound, very resonant. I feel tapped in to deep feeling, the way some might perhaps when smoking an expensive cigar.

But because I am facing only one side of the hill there is of course an unlooked-upon expanse at my back, outside the immediate perception. It sneaks up on me and has that awful weight of anxiety like the he obsession of misplaced keys or the delusion of the front door being open in the middle of the night—that kind of restless irrational fixation that finds its home in something eerily particular.

Then a bell clangs. I turn around to discover a rogue cow audibly sucking a diabolically large grass blade, the bell on its fat neck tolling at the slightest tilt of the strange head. Behind it the landscape is, incredibly, in winter. It confronts me with this hostility I interpret as a wish to disturb the fondness I just felt at viewing the other side of the hill. It implies I am not entitled to that transformation.

I awake sweaty and perturbed.

I typically suffer this troubled nighttime experience during some kind of personal or professional tumult when I am choosing to leave an old conduct for a newer yet foreign one. The cow I see as representative of the world I am necessarily leaving but which is still in some odd way an element of the one I am pursuing. It wants me to remain in its obsolescence and the anxiety is spawned from the unknowns of the future. But I know I must transform as much as the seasons must change.

In healthcare, choosing the resplendent hillside means deserting the closed-loop systems and paper-heavy processes of the old world that may be convenient with respect to office operations, as transforming requires a bit of elbow grease, but do not represent what patients have come to expect from healthcare. A fully transformed experience for the patient means access to remote care, predictive analytics, patient portals and personalized care: this is the green hillside.

And patients have become terrifyingly informed about the incredible technology out there thanks to the all-seeing Internet. They know what they want and know how to say it and this should be a hefty motivation to compel every provider to tailor care to such informed desires.

It frightens you to have a cow appear at your back, signaling do not for forsake me, but we must slip out of the stranglehold of antiquated seasons for vital renewals or else play winter to someone else’s spring. 

Do not embrace the obsolete cow. Its bell tolls for a dead world.