While in college, I worked as an orderly in a local nursing home during the summer months. Although certainly not a glamorous job, this opportunity to serve the elderly influenced my future decision to pursue a career in medicine.

I met many unique individuals, including a man who had been on the Titanic as a child. Most nursing home residents were disappointed by the final phase of their lives. Some felt abandoned by their families. All had lost their ability to function independently, which frequently left them despondent or angry.

Despite these challenging circumstances, a few people I met faced their circumstances with a positive attitude. Olga was in her early 90s and suffered from advanced macular degeneration, congestive heart failure, and severe arthritis. She was a retired teacher whose children had taken the little money she had saved and dropped her off at the nursing home. Even so, Olga never complained during the time I knew her. Instead, she focused on how wonderful her life was and tried to figure out how she could assist others. I was deeply moved when she pushed residents to the lunchroom in their wheelchairs when she probably needed a wheelchair more than they did. She constantly offered words of encouragement to others and almost never asked for help.

I was drawn to Olga’s compassion, rosy outlook on life, and inner strength. I was brought to tears when she gave me an afghan that she had crocheted for me despite being legally blind. I prize the afghan for its mistakes; they are a testament to her love and effort.

Over the years, I returned to the nursing home from college and medical school for the sole purpose of visiting Olga. She taught me the power of perseverance and the importance of maintaining a positive attitude. Amazingly, a woman in her 90s had a huge impact on a teenager. Hers was a life that mattered!

Today, we doctors are losing some of our power to decide how to care for patients. The reimbursement of both surgical and medical care is declining, yet the costs of capital equipment, disposable instruments, clinical supplies, and medication are rising at an alarming rate. These financial challenges force us to increase the number of patients we see and our surgical loads just to cover overhead expenses. Meanwhile, patients’ expectations are high, and they sometimes demand care at no cost to themselves. This issue of Glaucoma Today addresses some of the business challenges of clinical practice.

Each of us makes decisions everyday that affect others. Will we embrace the responsibility? If we do, we can move the needle for our staff, our colleagues, and our patients. We can exert a positive influence just as Olga did for me! n

Steven D. Vold, MD, Chief Medical Editor