Strength, intelligence, and sheer determination combined with creative thinking sprinkled with empathy.  These are some of the most admirable traits of Marvel’s famous “Avengers.”  Comprised of those with sketchy criminal backgrounds combined with physical size and physical ability extremes, they work together to battle an unjust system to promote peace. 

However other, less famous professionals work together to battle a fragmented system embracing special populations with similar physical extremes.  These compassionate professionals creatively plan for those with similar interpersonal challenges.  Those superheroes call themselves another name; those superheroes call themselves case managers.

While superheroes are born of untimely misfortunes and accidents, case managers are remarkably similar in their evolution.  From childhood encounters with hospitals to those thrust into caring for aging family members, ill pets, and farm animals, their upbringing plunges them into healthcare.  Others simply manifest a passion to help those in need and become driven to find their niche in the human services industry.  Their educational backgrounds vary from multiple advanced degreed social workers to similarly highly degreed registered nurses.  Their individual skill sets make them creatively resourceful, highly skilled, and irreplaceable.  Experience is one of their most valued and hard-earned assets to ensure success and longevity in the profession.

One of the most challenging settings these case manager superheroes sharpen their swords is the unplanned destination called the acute care hospital.   Some patients that arrive here experience a celestial departure; others stay for long periods.  Unfortunately too many are recognized as being frequent aviators in this land.  This is a part of the galaxy where a human’s ability to walk and eat is frequently a topic of discussion.  Most inhabitants arrive un-expectantly and unprepared for the journey they are about to partake in.  The superhero is present to help guide their way but the suggestions case managers pose can be unpopular.  While they are masters of presenting a choice, not all choices are pleasing and delightful nor are the discharge choices entirely appeasing to patients and their families.  This is a world where treatments and medications must be tried and failed, tolerance to therapy must be as high as 3 hours a day, and a world where DME does not stand for discouraging mental exhaustion; although that exists here too.  MOON notices and Important Messages are abundant in this land and are discussed with inhabitants daily.  Seeking solutions to replace nonexistent services for the uninsured, underinsured, or un-insurable are some of the most frequently encountered dilemmas for the superhero case manager.

While the circumstances encountered here are hard-fought, emotionally charged, and filled with ethical challenges, there are numerous gratifying moments here too.  While less abundant, they are certainly motivating and inspiring.  One such heartwarming example of heroism is the warrior case manager that collaborates with her colleagues to find a former hairdresser turned respiratory therapist to cut the hair of the 80+ day hospitalized patient.  A small gesture but a thoughtful display of empathy and compassion that makes a big difference in the life of that one patient and his family.  

These same case managers ‘difference makers,’ sometimes encounter situations where their own loved one is hospitalized in the same organization they themselves are employed within.  This can create an emotional tug of war between their employers’ motives and the case managers’ intrinsic interests.  Knowing the rules and applying them unconditionally to those we care about is difficult, especially knowing that the plan to leave the hospital, rehab facility or Geri-psych placement must occur in a timely manner.  These nimble and highly educated advocates understand the delicate balance between the length of stay and successful disposition but unlike others, they also understand the rights and responsibilities of the institutions they work for and collaborate with.  

From time to time, all good superheroes have their destiny interrupted. Enter the despised villain also known as COVID-19; weakening human body systems, claiming lives, creating separation in a nation that thrives on human contact then making healthcare supplies unattainable.  But the villain didn’t claim the resiliency that the case manager possesses.   The villain, however, did provide temporary relief to the dreaded 3-midnight curse that cripples the case manager’s intentions.  The case managers’ selfless compassion and sheer determination were tested but have prevailed through the most troubling of times.    

While other superheroes become weak when faced with adversity, the case manager is dependable, steadfast, and a relentless advocate.  One such example of perseverance is the case manager that conducts weekly family meetings to propel a patient towards discharge.  Week after week, the case manager assembles a team of professionals to help propel the discharge in a feasible direction.  Week after week, a clearly volatile family dynamic is witnessed.  The case manager tirelessly continues to display professionalism in the form of collaboration, discussion, and interpersonal support.  Discharge options are carefully investigated and reviewed extensively.  Finally, after weeks of meetings, a plan for discharge is agreed upon.  When the decision is made to withdraw life-sustaining care, the case manager is the warrior present to provide support and resources for bereavement. 

When the case manager superhero retires, they certainly leave a lasting impression on their peers, their leaders, and their health system.  They enter retirement with an abundance of unique knowledge that allows them to continue to successfully advocate for their own healthcare journey.  Those that are fortunate enough to call themselves case managers have certainly placed themselves in one of the most exciting yet challenging careers in healthcare.  A place where superhero = case manager.

Carrie Browning, MS, BSN, RN, CCM worked for 12 years for Stormont Vail hospital starting on UR then moving to a case manager and 3 years ago promoted to nurse manager over Case Management. Prior to case management, I worked on dialysis.