By Michael L. Millenson

Here’s a greeting card conundrum. What exactly do you say to an 82-year old man who, emailing you about a joint project you were working on, notes that he has just survived  “a 12-foot backward fall into a jagged confined space. Result at least 6 smashed cervical and thoracic vertebrae. [But] no paralysis! In a halo and off full duty for a while, but eager to rejoin the hunt.”

“Get well soon” seems so pallid a reply.

Paul Ellwood, who survived this most recent harrowing accident, is best known as the man who originated the term health maintenance organization and then got the federal government to support the concept. He was also one of the first policy thinkers to push vigorously for patient-centered measures of care quality, through his Jackson Hole Group and, since the mid-1990s, on his own.

He’s also one tough hombre.

In 1998, he was bucked from a young horse at his Bondurant, WY ranch
and broke his neck. He very, very carefully dragged himself inside,
called for help and laid flat on his back for aid to arrive. The
experience, he said, showed him the limits of patient empowerment.

Although Ellwood was trained as a pediatric neurologist, he had
difficulty even when fully conscious getting doctors and nurses to
listen to him. There was, for example, the nurse who didn’t know how to
put back his protective collar, which had fallen off and had been used
to immobilize his head.

Before that accident, Ellwood liked to explain that his response to
doctors’ poor track record in following the medical evidence was to
constantly carry around his own aspirin and beta blocker in a small
container, ready to self-administer in case of a heart attack.

Ellwood’s latest near-death experience came when he “fell from a
newly constructed ship’s ladder-like stairs in our about-to-be
completed home” on the ranch. He explains that “in your 80’s
proprioception is an early victim.” (Hey — look it up the same way I
had to.)

Paul, our thoughts, prayers and — OK — grudging admiration are with you.