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On a recent episode of the podcast Public Intellectual, Jessa Crispin interviewed the artist and writer Johanna Hedva about some of the differences between health care in Germany and health care in the US. Hedva is a Los Angeles native who moved to Berlin after marrying a German. Hedva already had longstanding health issues when they moved countries and left their support network, including their family, behind.

That’s a big loss, but one thing Hedva gained was affordable health care. In Berlin, Hedva got immediate access to a team of professionals that included a social worker. The team started by seeing Hedva monthly, “just to get to know them,” because Hedva had multiple health concerns.

One of the first things the German providers wanted to know about was Hedva’s “care network.” Who was in their support system? Friends, family, and others?

This was not a box that Hedva’s doctor ticked just once. The care network was a central project that the team revisited monthly, with every appointment. Together, they mapped and brainstormed about how to build out a circle of care, using a whiteboard and also a paper copy kept on file.

So that got me thinking about what my care network might look like. I haven’t moved countries, but I did move pretty recently, and mentally reviewing my own circles revealed gaps. The kind that internet friends, of whom we all have many, can’t fill.

If we imagine our social network, it’s probably a much bigger circle than the core group of people we can turn to—and that can turn to us—in a real crisis. Or even a mini-crisis. Those are the key people in our circle.

We all need to know some of our neighbors. We all need people we can leave a house key with, who can pick up a prescription for us, and who can sit with us while we wait for news. These are the people who need us, too.

As we talked about last month, the time to nurture your network is before your hour of need. If your care network could use a little work, you can do as Johanna did and begin a diagram. If it includes some blank spaces, you’ll have a picture of what needs to be built, and where the supports need to be shored up.

Make it a living document, and review it every so often. Ask, how strong is my network? How strong are the individuals in it? And: What have I done for them lately? What could I do to support them?

If you belong to a close-knit family or a thriving religious community, where reciprocity is naturally present, these questions may sound a bit transactional.

But if your family is remote, or you’ve just undergone a move or changed jobs, or your friends are scattered, or the folks in your network are all affected by a shared crisis, well, you might need to jump-start the reciprocity, and pour some love in there. When you do, everyone wins.


Image:  Quilt, British, 1820-1850, Metropolitan Museum of Art, Purchase, Gift of Adele Pharo Azar, in memory of her late husband, Jemile Wehby Azar, by exchange, 1987. Used with permission.

About The Author

Max Daniels is a research-based life coach whose weekly emails make us laugh with recognition and rethink everything we thought we knew. Her new book is Meals at Mealtimes. What a concept!


  • Interesting article, we rarely plan our care networks until a crisis occurs and then the gaps are glaringly obvious as are the people who drop everything and come to our help. It made me decide to discuss with close friends and family not just how they could help me in a crisis but also whatI could do to assist them if the need arises. I was made aware of my care network recently when I was admitted to hospital as an emergency and my daughter and close friends and neighbours stepped in to feed and care for the animals and me and also when I was discharged but still to ill to be completely independent.(I was even too ill to knit!) Would love to share this article on Facebook but not sure how to.

    • I think you just select the “f” on the left of the article for FaceBook. It’s one of the four icons there. Good luck.

  • Helpful in formation…deb

  • Last year, I went to the hospital in an ambulance. I was sick! Once in the emergency room, I asked my husband to call our friend, Jennifer, and ask if she could take care of the dog until we got home. She and then others gladly came to our house and took the dog for walks while I recuperated. Likewise, my chicken friends took care of the chickens. My gardening friends watered my vegetable gardens. Friends were looking for ways to help, so I asked them to bring lunch and stay for a visit. Those visits were so memorable- my vulnerability made me open up and in return they opened up. Our conversations deepened our relationship. That period of recovery has become a happy memory. I learned new ways to be helpful to others. I learned I had a care network (although I didn’t realize that group had a name!). Since then I’ve been much more open with those friends and don’t wait so long to ask for help. It’s a good thing.

  • As usual, something to think about!
    I have a wonderful care group here and now, but ya’ never know.

  • Interesting article, thank you for sharing.

  • I recently moved from the close-knit community where friends and acquaintances automatically came to help when our living situation simply became more than we could manage because of our poor health. I can certainly vouch for the importance of a care network (though I never called it that: it was just our community). Now in a new city closer to the health care we need, developing that community again has become critical — but it’s so hard when we don’t have a workplace to go to or any other “easy” way to make new friends. There isn’t even a yarn store in the area! I’ll keep looking….

  • This kind of “care network” whether across the street or cross-town is important to consider and bring attention to today; given the virtual immediate network so many of us have. thanks Max

  • I don’t have a particularly large or close circle, but you’re right; it does sound transactional.

    • I am thinking about this and wondering whether all of human society, in which people support and are in turn supported by others, is transactional by this definition. Is that a bad thing, to recognize our need for each other and act accordingly? To me, “transactional,” as a pejorative, refers to things that are done not for the sake of principle or to support the relationship between two entities, as a quid pro quo. I will do this specific thing for you because I want this specific thing from you, and that is the end of it. The network I want is one where, over the arc of our lives, people reciprocate care out of a sense of affection, connection, and mutual support. That seems like a good idea to me.

      • I agree Kay. When I offer to help someone, it is transactional but not in a pejorative way. I’m offering to help because I love you and you’re my friend (sister, work buddy, step-son). But I’m also hoping my help will be like a bank deposit on which I can draw when I need to. Sometimes I think our independence makes us feel like we have to do everything on our own. Asking for help is a talent to develop. I’m working on it, and it’s really hard sometimes.

      • That’s what I want, too, Kay–a network where over the arc of our lives, people reciprocate care out of a sense of affection, connection and mutual support–I’m typing this up and posting it where I can see it. I find these circles of care, of community, have expanded and contracted over the course of my life. In times of contraction, I have to ask the questions: Where do I have to invest more in order to strengthen my community? Where do I have to explore more in order to expand and deepen my community?

  • I have been asked twice since I began Medicare if I have people who can help me in a crisis. The doctor also asked if I had enough money to buy the foods I want. I thought both of those questions were a step forward in our health care system. I knew the baby boomers would change aging by the sheer volume of them. Good article. I look forward to your shadings.

    • Sharings!

  • The assumption that we all have many internet friends is erroneous. I have very few if any internet friends, as I would define a friend. Most, if not all, the people I “know” across the internet are people I know in person – close friends and family that I connect with occasionally on the internet because it is convenient.

    I also regularly see them in person, talk to them, and frequently feed and host them.

  • No friends, terrible family. What is a person supposed to do about that? I live in a place where a therapist literally told me I would never have friends.

    • Emma-where do you live? If it’s anywhere near Washington state, let’s plan to meet?

    • I’m in the same situation as you Emma. And I have tried, it’s not easy to just find a network. So I send you hugs as one of those who is alone.

      • pj & emma, I am one who fully understands. I believe we are not the only ones. I’m not a shy person and start conversations in stores I frequent but someone on their cell or on computers scream ” leave me alone I’m busy”. Not easy these days to even connect with people.
        There are others out in society like us ,we just haven’t found each other.

    • Don’t allow another person to define you. Write a list of 5 ideas that make you a good friend and get yourself going! Look for friend making opportunities – coffee shops, library book clubs . . .

  • This post is great, and has reactivated my concern about an important issue. I like the idea of creating a diagram or worksheet to revisit as I work on creating a supportive and sustaining network.

  • My daughter lives in Berlin and had her first child a year ago. What struck me about he prenatal care, other than the respect for midwives, is the care circle for her for when the baby was born. I live in Canada and thought we had great healthcare. What the US and Canada needs is the will to support preventative care and care that sees the human and all our parts instead of the medical condition

  • This conversation or something very close to it is part of the kidney transplant evaluation process for both potential recipients and living donor candidates. Which is fantastic and important but I wish it started sooner, for everyone.

    • I used to regard a circle of care as something I did for others. As a do-er at a high level (it’s integral to my career as well as my friendships), I didn’t realize the holes in mine until my partner was disabled, which caused to sell our beloved home, and then my mom and my favorite aunt died all in the same year. That was two years ago and I am still sorting out my grief and re-establishing my self confidence. The experience put a white hot spotlight on my circle of care.
      Does anyone have an idea of what a circle of care diagram looks like? Is there any way to see what the German medical team was referencing with Hedva when they helped her develop a care network? It would help me to better understand how to move forward for myself.

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