The Missoulian - Example for Others

Recently, at a small dinner in New York with health care researchers, someone asked why I live in Missoula, "of all places". I usually respond to such questions by talking about the beauty of Montana and about the quality of life here. On this evening, a colleague who has been here and loves Missoula, pitched in, "When the plane lands in Missoula, the captain announces there's been a time change and suggests that passengers reset their watches to 1955." I had to grin and bear ribbing about living in Mayberry, replete with images of Aunt Bea's lemonade, porch swings and bandshell concerts.

Timing is everything. Once the chuckles subsided, I pointed out that life in the Garden City is better than the bucolic image of 1955. Besides porch swings, the Carousel, Farmers Market and Out to Lunch, we have reliable air service (well mostly), cable and satellite TV and, of course, the Internet. Missoulians are active nationally and internationally. My colleagues' big-city smugness visibly dampened. But I wasn't finished yet.

By the time our salads arrived, the conversation had turned to our collective worry about the future of American health care. Major social and demographic trends are already resulting in a tidal wave of caregiving need. As the baby boomers age, for the first time there will be more older people than younger people on the planet. Half of everyone who has ever lived to be 65 years old is alive today! Adding to the challenge is chronic illness, "an invention" of the latter half of the 20^th Century. Medicine enables people to live for years with diseases that formerly caused death abruptly, but also precipitates unprecedented social dilemmas.

The mood during our main course was somber as we realized that every one of us was currently dealing with a grandparent, parent or in-law who either needs care at present, or is frail, perhaps at risk of falling, or otherwise soon to be in need of home health or residential care.

We Americans are finding it hard to adequately care for the people we love. Many of us are part of two-job couples and live a great distance from our parents. We all want our mothers and fathers to have "the best care possible," but even those of us who are doctors and nurses are frustrated by how hard it is to access basic services. Many of us are in the "sandwich generation," not finished with child rearing but inexorably drawn into parent care. Our siblings and friends help when they can, but peoples' time and capacity are limited.

These social problems are being played out in every community. Indeed, how we will care for the soaring numbers of ill, infirm and advanced elderly among us will be the central social and moral questions confronting the baby boom generation.

Dessert arrived and we began to focus on hopeful strategies. I pointed out that people who live in Missoula are also dealing with these problems. But Missoula is unique in one respect. As a community we are confronting these issues head-on. Hundreds of Missoulians have built the Missoula Demonstration Project to be a community-based vehicle with which to grapple with these profound challenges.

Under the auspices of the Missoula Demonstration Project, people from many walks of life are working to improve the quality of life's end. Task forces are raising awareness and skills related to pain management and advance care planning. Others are exploring how best to integrate the realities of dying, caregiving and grief within the life our faith communities, workplace communities, schools, clubs and neighborhoods. The Project=s Life Stories task force has given rise to StoryKeepers, Inc. a new community-based, non-profit organization dedicated to helping people review and record their personal histories. Through the Arts task force Missoulians have learned to create memorials for loved ones who have died.

The Missoula Demonstration Project doesn't come with a fixed vision or set of answers. The more we learn, the clearer it becomes that we will have to live out our collective response to the challenges of dying, caregiving and grieving. The Project can, however, offer its research to foster quality improvement on a community-wide basis. We can align what we value and hope for with how we care for and support one another. The opportunities are limited only by our imagination and commitment.

"You're really doing all that in Missoula?", one colleague, now wide-eyed inquired. We really are. Of course, there are cynics who roll their eyes and scoff at this pie-in-the-sky notion. It is, afterall, So Missoula!

Yes it is. Our willingness to live in community B rather than merely in proximity B with one another enriches the quality of life here, just as much as our mountains and streams. Missoulians are the main beneficiaries, but our community's efforts will also shed light on what communities elsewhere can do. Even the most skeptical of locals will benefit from these efforts. Missoula may not be Mayberry but together we are making it an ever-better place to grow up, grow old and grow on.

By the time the bill arrived, several colleagues who had poked fun at the notion of living in Missoula asked me when they might come for a visit. In the process of caring for ourselves, we are already setting an example from which others can learn.

Ira Byock, MD, is the co-founder and principal investigator for the
Missoula Demonstration Project.