As the Norwegian Gem departed the port of San Juan, I leaned against the rails on the aft deck and marveled at the beauty of the Puerto Rican coastline. The shoreline and the mountainous rainforest beyond were dramatically lit by the setting sun. The sight put me in a reflective mood. And not just me. I had an enjoyable and lengthy conversation with Edwin, a middle-aged Puerto Rican man who has lived for the past seven years in New York City. He told me about his native land and some of its struggles. But, perhaps because of the setting, he turned to larger issues – particularly his personal struggle with faith.

In the presence of such humbling beauty, it was difficult for him to deny God. There was pain in his reflection – regrets, loss, and loneliness. His cruise, one he was on alone, was very different from mine.

He shared that, just this year, three people in his building were found dead. They were discovered not by friends or relatives, but by passersby who noticed the smell coming from their apartments. Edwin was shaken by this, and he shuddered when he noted that the same thing happened all over the city in all cities. I suspect that he fears that this may someday be his fate.

The Christmas season is often tough for people. I suppose those who have no loved ones also have no need of seasonal movies like Home Alone to underscore the value of family. No, that message is for those who lack patience for their crazy cousins, wacky aunts, or neurotic in-laws. Being annoyed is one thing. Missing people is another.

Being alone not only hurts. It can be dangerous, not for only the infirm (or 10-year-olds fighting off burglars), but for anyone. I had a recent discussion about the dynamics of the medical industry in a business meeting. My clients pointed out that one of the major challenges in healthcare is patient adherence with regard to properly taking meds. Here are some of the ill effects of non-compliance (for more, here is the source blog):

• In the United States, avoidable healthcare costs add up to $213 billion, of which $105 billion is due to medication non-adherence, according to the Express Scripts 2013 Drug Trend Report.
• Non-adherence causes 30-50% of treatment failures and 125,000 deaths annually.
• 64% of readmissions within 30 days are due to medication issues, according to HIN’s 2010 Benchmarks in Improving Medication Adherence.
• Medications are not continued as prescribed in about 50% of cases, according to a 2013 Centers for Disease Control and Prevention (CDC) presentation.
• Non-adherent patients are 17% more likely to be hospitalized than adherent patients, with a cost that exceeds that of an adherent patient by $3,575.
• For some classes of medication, up to 30% of prescriptions are never filled by the patient, according to the Network for Excellence in Health Innovation (NEHI).

My clients reported that a primary reason for non-adherence is that patients often have nobody to help them stay on track. Health care providers are actually developing nursing services to address this need, but they are no substitute for a loved one who lives with the patient.

Of course, many who live alone are just fine. They may even prefer it. I know people like this, and I don’t worry about them. Last week I heard a friend invite another friend who lives alone for Christmas Eve dinner. I’m sure that he appreciates that, and I also suspect that this Christmas will be a little brighter for both of them.

Generally speaking, we are not meant to be alone. What is the worst punishment in our penal system? It isn’t death, but solitary confinement. I haven’t researched it, but it’s not hard to imagine that people find themselves alone for a variety of reasons. I don’t wish to be critical or judgmental about those who find themselves on that path. I have lived alone before, but I’ve never been without family and friends. So I don’t pretend to know what it’s like.

I do believe that the two major success habits, 1) continually add value to those around us, and 2) continually learn and grow, produce many benefits. A reduction of our chances of ending up alone is one of them.

My thoughts and prayers are with Edwin and others who, for one reason or another, find themselves alone for the holidays. Though I believe we are all blessed beyond imagining, it must be difficult to feel it in isolation, while all around you so many others seemingly live Norman Rockwell Christmases. My prayer is that they find peace and joy – that they recognize their gifts and find ways to give them to others.