McCleary MRSA Prevention

Our TV drones on day after day with more and more outrageous stuff from Washington DC.  He said , she said, he lies, she forgets, he says one thing, she says another.  What is the cure for all that?

My Country calls me.  It is time for this old retired RN to come out of retirement and to serve our country.   I must do this while I still have hair on my head.  Pulling  hair out of my own head is a daily thing now.

Here are some excellent nursing measures I can use when I go to DC.

 

 

 

 

1.”I didn’t hear that” seems to be a pretty regular response to Senate, Congressional and FBI questioning. I can do a mean ear irrigation.   Things are said, some things much saltier than others, and crass and gross.  I always hear that stuff.  I don’t have difficulty hearing it when it is around me, and I am darned near 70!   So, if those Secretaries, and Senators and Congressmen, and aids cant hear,  I have a nursing measure.  I will bring a large irrigating syringe, an ophthamoscope, some peroxide and basins and I will irrigate those ears so they are sparkly clean and clear.  Wax be gone!  If that doesn’t work, they I will get them  hearing consults and hearing aids.

 

 

 

 

 

 

2. “I don’t recall that“  This is the top response to questioning in DC. Is there something in the air or water down there.  Is there an outbreak of selective dementia?  Every one of those respondents who say that should get a memory assessment…I can do that.   I don’t have a nursing cure for selective memory loss ,except maybe putting your cell phone on record, so your defective collective memories don’t have to be intact.  Unfortunately, there is no irrigation to clear the fog between your brain synapses.

 

 

 

 

 

 

 

3. “He/she didn’t say that”  Lies are another thing altogether!  Lying is bad and it gets us nowhere. It hurts the liar and it hurts the listener.   The only cure for lying is an opposing truth.  Tell the truth.  The American people deserve it and that is who you work for.  If telling the truth will lose you your job, that is pathetic.  Is it worth it for you to lie (sell your soul) to keep a job?   Another cure for lying is starting an IV and injecting so called  “Truth serum”.  I can do that.

 

 

 

 

 

 

 

 

4. Smut talk, like S hole, S house, F this and that.  My mother and the generation before that had a cure for this kind of talk.  Potty Mouths got their mouths washed out with soap.  A newer trend is eating laundry pods.  Either way, mouth soaping may be a reminder to our leaders, who should be an example for all of us, including our children, to keep the language respectable and clean.   Please note that this is not a recognized nursing procedure.

 

 

 

 

 

 

 

 

 

5. FOS.   Old nurses remember HHH enemas. I can do those!!!   “High Hot and Hell of a lot” enemas could clean out the fullest, most impacted bowels.  We mixed up a soapy solution with steaming hot water, hung a bag full of it on a pole, hooked up and inserted a lubricated tube.  Let loose…to let it loose.  After we were done, the recipient was no longer FOS.  That doesn’t mean it is clean enough to kiss or to crawl up in there and to lose your own perspective.   I think this may be the most important nursing measure we could use in DC…because there seems to be way too much S floating around, figuratively, and in important discussions about the future of immigrants and all of us in this country.

 

 

 

 

 

 

 

6. Immunizations.  Inoculating our leaders for contagious and infectious diseases may be another way to stop the rampant widespread lying, deafness, forgetfulness, and foul stinky language.  I’m not sure there is a vaccination for that, but certainly we can call on the CDC to help develop one.   I can give 49 or 50 shots an hour…  Yes, I can do that.

Just line em up.  I promise to be gentle.  This old nurse is ready to use her skills and get our leaders in tip top shape.  We need them that way to help us to move forward.

 

I am both a retired RN and a healthcare consumer.  I have attended dozens of meetings about Hospital and Healthcare associated infections, or HAIs. I do this because I think it is essential that healthcare consumers (simpler term is PATIENTS) should have a voice in the decisions surrounding HAI prevention, transparency, reports and policy, and over the past decade, the State and Federal governments came around to believing the same thing.  I am an official member of the State of Maine CDC HAI collaborative and I represent consumers.   A few days ago there was a member of the public in our meeting  I tried to listen to the conversation through her  ears.

This is what happened.   Right off the bat, acronyms were used that she, and possibly others in the group do not understand.  Beyond that, some of those acronyms are used in public reports.

It isn’t intentional when professional infection prevention professionals speak in complicated lingo, it is their everyday language.  But, when consumers are part of the conversation, the very least that could be offered is a printed glossary of terms for newcomers, and for some of the people around the table who do not do this work every day, like me and a few others.  I know for a fact that other regular members of our collaborative don’t understand all of those acronyms or terms that are tossed about during our meetings. .

So, what exactly is an SIR?  It is an acronym for “Standard Infection Ratio“. It is a way that the CDC, both State and national, reports infection rates.  The SIR is a risk adjusted number that is reported that includes the number of expected infections,  by facility or by State, or Nationally.  For example, if a big trauma center that accepts the most complicated patients has a higher number of “expected” infections, that is somehow formulated into their SIR. There is also a risk adjustment for teaching hospitals.   WHAT???!!!!   The actual number of infections is not reported when using an SIR.  The mean is the number 1, and anything under 1 like .48 is on the better side of 1 and anything above 1 , like 1.4,  is on the worse side.  Under 1 means fewer infections, and over 1 means more infections. Contrary to most reports, a higher score does not mean a better score.   So, is that now as clear as mud?   After all my years of these meetings, I’m still not 100% sure this explanation is totally accurate, but it is close enough.

So, what does having an SIR in an infection report mean?.  Well, one thing that it means is that Hospitals (or entire States)  can actually HAVE an expected number of infections and that is figured into their SIR report.  That is how the final reported SIR numbers are risk adjusted.   REALLY??  It seems to me  that expected number of infections should always be ZERO….always.   Zero expected infections is exactly what I and I assume all patients expect from any Hospital, so why can they have anything above that as an expectation, no matter what or who their patient population is.  I know this will stir up some discussion and anger from the larger hospitals that claim they care for all the most complex patients, but they also have the resources, the staff (we hope!), and the experts that smaller facilities do not.  And, it is their job although challenging, to keep all of their patients infection free. Nobody ever said elimination of infections would be easy.

This incomprehensible methodology is routinely used to create public reports on infections.  Then the experts who create these muddy reports have the nerve to say that patients do not understand infection reports.  Of course they don’t. A lot of doctors and nurses don’t understand them either.  They don’t know what an SIR is.  Creating a report that even some professionals don’t understand is a disservice to patients and consumers.  How about this approach for a change?  Report actual numbers, not SIRs.  For example,  report the number of hysterectomies the hospital performs every year, and the number of those patients who get a surgical site infection (SSI) as a result.   Hospital A does 1500 hysterectomies (all varieties) every year, and 3 patients get an SSI.  Or, Hospital B performs 50 such surgeries and 3 patients get an SSI. Even with my limited mathematical skills, I can figure out which hospital generally gets the best results regarding infections.   This type of report is useful in two ways.  It gives the volume of procedures done, and it also gives the number of infections that occur, both very important pieces of information for patients.  As a patient, I don’t particularly appreciate or understand “risk adjustments” that help hospitals have a better infection report, I just want to know exactly what my personal risk is with a particular facility, doctor or surgeon.

If Hospitals and entire States are going to publicly report infections, as they absolutely should, make the report useful to everyone, not just to infection prevention professionals and other savvy experts, who actually understand these wonky reports.  Consumers will use that public information to make choices that could very well affect their lives and pocketbooks.   Preventable infections cause horrible suffering and sometimes death,  and they can tack on a huge amount to an already high hospital bill.  We want clear, accurate and easy to understand information about infections.  Creating a public report that only infection professionals can decipher is not really a public service.  It only serves the experts who can understand it.

This has been my brief but spectacular explanation of and opinion about the SIR!

http://www.maine.gov/dhhs/mecdc/infectious-disease/hai/documents/2016-hai-annual-report-maine.pdf.pdf

http://www.comparemaine.org/

http://www.leapfroggroup.org/hospitals/search/list/states/Maine

https://www.cdc.gov/hai/surveillance/progress-report/faq.html

https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/nhsn-sir-guide.pdf

 

I have been a nurse for almost 50 years.  I trained in a  Catholic school. My training was similar to the military in that you start out very low on the totem pole and gradually build up.   I was very proud of my work and accomplishments.  Nursing school was no easy task.

I learned a lot from a nun that was an instructor.  I loved this very smart and tolerant woman.  She did not believe in birth control except for rhythm.  But, she gave out information about other forms of birth control.  Because of her dedication to Jesus and her beliefs, she couldn’t in good conscience teach us details, but certainly as nurses we should know the basics. Every patient deserved the care of a well educated and non judgemental RN.   Other things I learned as a student nurse were that regardless of race, religion, nationality or background, we were to treat everyone equally and with respect and regard.  We were given the privilege of holding the lives of human beings in our hands and caring for them.   Why can’t that simple concept play out in our current healthcare discussions?

When people say they don’t want to pay for anyone else’s healthcare, most especially people who are fat, or who smoke, or immigrants, or drug addicts, it makes me cringe.  Who would be the gate keeper for such discrimination?

Consider this.  I worked as triage nurse in an ER for many years.  Of course in an ER, nobody is turned away (which is exactly as it should be).   What if I had to sit at triage of the entire healthcare system.

#1 Patient.  60 year old male, overweight, short of breath, cyanotic.   High blood pressure, rapid pulse.  He recently quit smoking, was until recently  employed in a challenging paper mill job, and is on his second marriage with young chldren at home.  Because he lost his job, he and his family are currently without health insurance coverage.  Going by the rules of haters, I would have to deny this man healthcare because “someone else would have to pay for it”.   And he would not be able to ever get insurance again, at a decent price because he is now a “preexisting condition”.

#2 Patient.  12 year old female.  High fever, flushed face, rapid pulse.  Lethargic.  Not responding to commands appropriately.  Parents recently immigrated, and do not have insurance. Although this child is obviously very ill and may have sepsis, I have to turn her away because “someone else would have to pay for it”

#3 Patient. 30 year old female, 34 weeks pregnant, no insurance, no Medicaid because of recent cuts, no prenatal care. Very high blood pressure, and headache.  Fetal heart strong.  I would have to turn this pregnant lady (and her viable fetus) away  because “someone else would have to pay for it”   Her pre eclmapsia may kill both her and her baby.

#4 Patient  24 year old male, recently ODed on heroin.  He was saved on the street by a cop using Narcan.  He knows he has hit rock bottom and he seriously wants to go through a rehabilitation program and get clean.  Nope, he can’t come in because “someone else would have to pay for it”

#5 Patient.  92 year old woman, who has dementia. Recently kicked out of her assisted living facility because her money ran out.  Because her Governor refused to expand Medicaid and her President pushed for a plan to cap, block grant and reduce it, she has no coverage for her needed Dementia care.  Her routine and her care  is disrupted.   She is confused and agitated, because that is what happens when a dementia patient’s routine and surroundings are changed.     I wouldn’t turn her away, because she is my mother and my husband and  I would have to pay for it and do the best I could to care for her ourselves.   This rolls the cost of care rock downhill because we will spend our savings on her care. Good luck to us when our time comes.

#6 Patient.  55 year old male, pimple on his butt and runny nose.  Wants immediate care.   Great insurance coverage, and tons of money.  Come on in!

The thoughts of ANY patient being refused care are very upsetting to me.  It is against the nature of a well trained nurse or any well trained healthcare provider.  We didn’t go into our line of work to reject human beings from the “system”.

Exactly how many people would suffer, get sicker or even die if we started turning away very sick patients who are under or uninsured.  We are human beings for crying out loud.  We as part of the human race should be looking out for each other and taking care of each other.  I truly believe that everyone in this country deserves  healthcare benefits and access to quality affordable healthcare.   Our taxes would be better invested in human beings than in Wall Street.  Rather than sending billions  or trillions of dollars,, skimmed off the top for healthcare profiteers, we should be investing in the health  and care of Americans.  With proper governmental regulation, and oversight, and kicking corruption and profiteering to the curb, we can do this.

It’s time to turn our healthcare back to an everybody in and nobody out human service.

Medicare for all.  Healthcare is a human right.

addendum:  All except one of the above “patients” are fictitious, and they could have benefited from regular care in a doctors office rather than reaching a healthcare crisis.

If you are a nurse and you are paying attention, you have seen the video of Alex Wubbels RN, super nurse hero, getting assaulted and handcuffed by a bully cop.  Now I don’t hate cops.  In fact I have loved a number of them in my lifetime.  I had a favorite uncle who was a cop.  I had cops help me when I worked as an ER nurse.  Cops have stopped at traffic accidents that I have stopped at and helped tremendously.  Cops do dangerous and difficult work on a daily basis, but it does not put them on a pedestal.   They are not allowed to make up the law as they go along and they cannot harass and assault innocent citizens “just because”.  The cop in this video was a bully and a jerk.   If he had half the professionalism that Alex Wubbels had, this would not have happened.

What have we learned from what happened to Alex?

1. Nurses MUST know their hospital policy about patient’s rights to safety and privacy.  Without that, you don’t have a leg to stand on.  You can’t just say NO because something doesn’t feel right.   Patients, when you are alert and able, you should also know your rights.

2. If you are being assaulted by ANYONE, yell and scream and object loudly.   Not that this did Alex any good at all. I think her coworkers and the hospital security in this video were dumbfounded and maybe did not dare to step in.  I’m giving them a lot of credit here, because I think they should have stood around their coworker while someone called administration AND the police chief.  Of course I wasn’t’ there, and I am just a distant observer.   I have to ask…would that cop have done this to a man?  (makes the cop even more of a jerk in my eyes)

3. Keep saying  “I have done nothing wrong”.  She did this and she was right.

4. Make sure your administration has your back.  NEVER EVER face off with a cop especially one that is like the one in the video, on  your own.  Have your administrative back up right there, not on a speaker phone.  Just as when facing a violent patient, a cop can turn.  This cop turned.

5. Allow the aftermath process to take it’s course.  Alex is doing that. She is incredibly wise and patient.  She has accepted the apologies of the Salt Lake City mayor and police chief.  There is an internal and a criminal investigation now.  She will not say she wants that cop fired (like I have said repeatedly to anyone who will listen to me).   She is waiting until the process is finished, and in the meantime she has left all of her personal options on the table, like legal action.  She is a very smart and generous person.  I want her for my nurse if I am ever sick in SLC.

6. She is using her personal and traumatic experience to help teach other nurses and police about the rights of patients and and about the hospitals policies regarding that.  Alex has a lot to teach them.

7. Nurses are like protective mothers in the wild guarding their young…don’t threaten a vulnerable, and in this case unconscious patient on their watch, because they can and will take you down (unless all the proper paperwork and policies are in order of course).

8. Nurses stick together and they will fight as a pack against injustices and bullies.  Nurses will generally come out on top, because they know what they are doing and they are by in large very responsible and respectable people.  Alex has every staff nurse in the country (who has seen this video) on her side.   My bet is that this exact issue will be reviewed in every hospital in the country.

9. Stay calm in the face of craziness….Alex did this. She never raised her voice (until she was assaulted).  She was respectful and organized.  She presented the necessary policies verbally and in writing. to the cop in writing.  She got her supervisor on the phone (although he should have been there beside her). She did not disrespect anyone.  She rightfully protected her unknowing, unconscious patient by being his voice and advocate.   She didn’t expect anything from anyone other than mutual respect.

10. Alex taught us what herosim is.  She is an excellent example of nurse strength and courage.

Nurses encounter crazy business every day they go to work.It can come out of the blue, just like this cop did.  It can come from a patient, a visitor, a doctor, a boss, or another coworker.  Nobody expects it to come from a public servant, like a cop.

Appreciate your nurses because they will always have your back.  As patients, we should all be so lucky as to have a nurse like Alex Wubbels.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Our Louie is almost 15 years old. He is truly a geriatric dog.  He still has a puppy face, and many people are shocked to learn his age.  But look closer.  He has arthritic joints, a sway back, rheumy eyes, a small growth on his left lower eyelid and a lipoma on his chest. He is also very deaf.  His front legs have been badly bowed since he was very young.  It was a birth defect that we didn’t notice when he was just 12 weeks old, when we got him.   He looked perfect to us, and he was.  Those crazy front legs served him very well all this time.  Now when he walks, especially after lying down for a long time, he staggers, and sometimes one back arthritic leg, or the other just slips out from under him.   But, he recovers quickly and keeps on walking.  Sometimes his puppy persona takes over and he is downright frisky, jumping and running about.  That burst of puppiness doesn’t last long these days.

Seeing signs of aging in our beautiful pup is so hard.  We all remember his crazy wild puppy play.  He would run in circles or chase a ball forever. If nobody was paying attention he would nudge his ball into our pool and stand at the edge and bark until he engaged someone in his game.  He would get so worked up he would ram into furniture, bounce off and keep going.  He could jump 3 feet off the floor for the right treat.  He had a high pitched bark or yip, and he used it often. He jumped up on furniture to watch out the window and guard our house.  He was a ‘never fail’ alarm for incoming guests.  And, oh, did he love to travel.  We have taken him on countless camping trips.  He is a real camping trooper, except that he is scared to death of campfires.  And, he is petrified of fireworks and thunder, except for now, because he is deaf.

A few months ago, I watched my patient son and husband separate and rescue entangled squirrels. I knew about Mike’s tenderness toward animanls.   Every day I watch my husband go off with Louie, for a short walk, and now he pulls a red foldable wagon.   Louie doesn’t/can’t walk all the way around our block anymore.  He goes far enough to do his business, and Mike pulls him in his wagon the rest of the way.  He loves it.  Louie that is.  Mike was a little self conscious when he first started using the wagon for his crippled buddy, but not anymore.  I believe they have become well known in the neighborhood.  It is such a heart warming sight to see my boys coming up the street, Mike pulling the wagon, and Louie riding in it.

I asked Mike recently, “will you take such good care of me if I need it”   My younger son immediately said “I doubt it”.   Mike has the patience of a saint with Louie and it is something special to witness that.  I worry about him when Louie has to go over the rainbow.  There will come a day when he won’t be able to stand on his wobbly legs.  Will that be the time?  Or will Mike get Louie a doggie wheelchair?   It could go either way, but if Louie is suffering, I know we will both agree on what is best for him.

We voluntarily bring these sweet animals into our lives.  Then we fall in love, just like when we have our human babies.   They become part of us, our days and our home.  They mark their space in every possible way.  Louie knows he rules the roost. He communicates with Mike and Mike responds.  Sometimes I think Mike understands dog speak better than human speak.  Louie’s yip, whine, sneeze, cough, or cry elicits almost immediate response from Mike, whereas, my yelp, whine, or complaint many times falls on deaf ears.

I love all of my boys…Mike, Louie and my sons, but the special relationship between Louie and Mike is something to behold.  There is a love and codependency like no other.  I wish it would never end.

 

 

This is a story about two men in my family and a squirrel family.  I have been married to Mike Day, for 45 years this year.  He is a quiet gentle man who  has the patience of a saint.  He has stuck it out with me and that speaks for itself!  My son Andrew Day is my youngest and he is also a special and big hearted man.  None of us expected notoriety for their patience and kindness but then last Sunday a weird thing happened.

Andrew was visiting us at our Pearl Street home in Bangor and he was about to leave when he looked out our front window.  He said, “Uhoh, there is some cat/squirrel action out there”.   At the end of the driveway across the street, there was a big old orange cat, stalking what we thought was a single squirrel on our side of the street.  We thought we were seeing an injured adult squirrel.  He went outside to find FOUR baby squirrels, all joined together at the tail by a weird ball of debris.  Oh no, what to do!!!  They couldn’t walk or run because they would all pull in different directions.  They couldn’t climb a tree because one or two of them would weigh the others down.  Mother squirrel was on the side of a tree across the street and she was frantically screaming and crying for her babies.  The babies all huddled in a crevice at the base of one our maple trees.

Andrew called for the Bangor, ME animal control.  The dispatch told him they weren’t available on a Sunday, so they put in a call for us to the Game Warden service.  We knew these babies were in jeopardy.  The Game warden called back and he couldn’t come right away, because he was at a remote pond.  When we described our predicament, he said he would just use his pocket knife to cut away the debris, and he would need our help to do it.  So, based on that, my men decided they could do this themselves.

They gathered up some rudimentary tools.  We got a large plastic rake, a soil cultivator tool,  3 foot deep box, scissors, long leather gloves (no bites or scratches for them!), some branch trimmers, and a grabber which is used by handicapped people to pick things up or reach things.  Mike got the rake under the squirrels and Andrew used the claw like cultivator to gently help them into the box.  The little buggers had picked up a number of long branches during their excursion, and Mike cut away all of those.  Andrew then spent almost an hour and a half cutting, trimming and picking away at the ball of stuff that cemented the babies together.   At the end of this operation, they used some Dawn detergent to lubricate and condition the remaining small tangles and then they were separated.  Whew!

The tails were tattered and skinny for lack of hair, but they were intact.  The little guys were stressed and tired, and they curled up around each other and rested under an old blanket while I called the warden.  We couldn’t see the mother squirrel anywhere and were uncertain about the next step.  He told me that their only chance for life was with their mother, and to let them out of the box.  We did.  They ran off immediately, and separately, for the first time I think!   Two went up the tree where their nest was, and the two others went in different directions.

About an hour later, we saw Mamma squirrel nudging one of the babies up the tree.  We were all happy and relieved that the little family was back together.  Andrew’s friend Peg dropped by to support Andrew and a couple of neighbors stopped to satisfy their curiosity.  We were all pretty triumphant that these little guys would make it.

THEN! Andrew posted his video of the babies, before they were separated, on YouTube.  A friend of a friend who writes for the Bangor Daily News asked to do a story for the newspaper. http://actoutwithaislinn.bangordailynews.com/2017/05/22/recreation/four-baby-squirrels-with-tails-tangled-together-rescued-by-bangor-men/

WLBZ Channel 2 news asked for an interview.  http://www.wlbz2.com/life/a-tale-of-4-squirrels/442317489

Mike’s and Andrew’s big hearted heroism had spread far beyond our family, a friend and a couple of neighbors. In fact, the story went viral and so did the video.  After only 3 days, there are almost 150,000 hits on his video and numerous media reports.

I love this story and telling it, because it just plain warms my heart.  But, both Mike and Andrew are a little embarrassed by all of the attention.  Neither of them think they did something heroic.  I beg to differ!

 

 

 

 

May 8, 2017

All last weekend, I was in the company of some of the smartest, most compassionate people I know.  The Lown Annual conference corrals some of the brightest and best activists,  advocates and scholars in healthcare. This year it was in Quincy, MA.  We learned, laughed,  cried, and we networked.  It was absolutely amazing.  I have faith, in all of them, and in our determination that compassionate and excellent healthcare will thrive and improve, even with the existing odds.

Then this……

My team mate, friend, confidante and colleague, Poppy Arford took a nasty tumble while jogging alone early in the morning.  She stepped into a pothole and her left leg was bent at an unnatural angle and she twisted and fell on her left shoulder, and bumped her head.  She was in the middle of the road and couldn’t get up, so a wonderful Uber driver stopped, picked her up from the ground,  and drove her up the hill to our hotel.   At 62, Poppy is in excellent physical condition because she loves exercise and the great outdoors.  She can move like a teen and bend herself into pretzel like forms.   But, she has grown to distrust the healthcare system in general because of things that have happened to her family and her in the past.  She was literally petrified of going to the ER.  She was away from home,without her family, she didn’t know the area providers, and her fear was compounded by all of that.   She couldn’t walk and she was in terrific pain, but she did not want to go to the hospital.  She was in a roomful of doctors and friends, but they couldn’t convince her. Right there in that room with the kindest people in the world is where I found my friend Sunday morning, in a wheelchair, with her arm in a sling, and her leg propped up on very nice hotel pillows.  Ice had been applied and gentle kind people had brought her some scrambled eggs.

Our mutual Maine friend  Kim H, met me in the lobby outside the conference room to tell me that Poppy had been injured.  I had no idea.  I asked why she hadn’t gone to the ER. She said that a roomful of doctors couldn’t convince her to go.  I basically said, she is going.   I shifted into my mean and controlling nurse self.  I can do it…I really can, when the situation calls for it and when I know it is for the benefit of my friend.  Warning, watch out when I switch into this mode.

Poppy told me that when I said “We are going to the ER” she was able to move past the fear as she knew, she trusted, that I would be her “right care“ advocate at the hospital. Yet she still refused an ambulance. That was  a very good decision, because they probably would not have taken us to the hospital that was recommended to us. Sometimes by policy, they have to go to the closest facility.  We were advised by Boston doctors at the conference to go to Brigham and Womens Hospital. Dr. Andy L, Poppy’s friend from one of the organization’s councils gently supported and guided Poppy’s painful leg (there was no leg support on her hotel wheelchair) while we slowly and very carefully wheeled her to our volunteer drivers car.  We packed her and fluffed her up in the back seat of the car.   A contingent of conference attendees and friends came to wish her well, and a hotel employee swung into action to help  Kim gather her bags and other things. Some of us exchanged phone numbers and advice and information….all for our friend Poppy.   Dr Marlene H drove us to the hospital in Boston.  Because I have found humor to be a great salve for stress, we had some pretty silly conversations on the way into the hospital…I hope we didn’t scare our new friend Marlene.

Just before we left, the Right Care Alliance introduced,  from the stage of the conference,  the names of the members of their new steering committee.  Poppy is honored to be on that committee and she spoke into her microphone and told the whole room who she was, and that she had hurt herself badly that morning.  Her voice was shaky and she admitted her crippling fear of being harmed when she went to the ER. She said it shouldn’t be that way.  She is a very wise woman.  I promised I wouldn’t let anyone hurt her.

On arrival at the hospital, I asked the security guard for help.  They gently helped us get Poppy into a wheelchair.  Then a very patient admissions clerk took her information.  We wheeled right into nurse Triage after that and then she was immediately taken to an exam room.  There were no waits and Poppy got compassionate care from the door to her exam bed.  We were assigned a sweet nurse named Christina, and an ER tech named Justin.  She was gently examined by 2 medical residents, the ER attending and an orthopedic resident.  These young doctors treated her with the greatest patience, respect and compassion.  They gave her every bit of information she needed and eased her fears. They fluffed her pillows up and comforted her,  gave her necessary information and  helped her with her needs. We laughed together  and we all learned about each other.  But most importantly they eased her fears and pain,  and they cared for my friend.  She had great care in that ER and both of us were so incredibly relieved.

After she had x rays, we found out that Poppy broke  her rt collarbone and her left lower leg (tibial plateau).  She was given a painful  injection of Lidocaine below her knee so the resident could do a thorough exam of her fracture, and determine if it was stable or not.  He felt that it was stable. When I left her yesterday, she was planning to go home.  The attending orthopedist had a different opinion.  He recognized the importance of Poppys active lifestyle.  He told her that if she wanted to continue to be this active and not develop arthritis, it would be best to fortify the bone with a plate and screws.  These devices can stay in or she can opt to have them removed down the road.   He said that surgery would be her best option.  Poppy agreed to have the surgery.

I left Poppy yesterday afternoon in the competent hands of the B&W ER staff and her beautiful daughter Libby. Husband Loren was on his way.  When he arrived in Boston in the B & W ER, and learned the plan, he drove back to Maine to prepare a downstairs bed for Poppy. Later when he learned that she will spend some weeks in a wheelchair, he and a couple of friends built her a ramp.   When I spoke with her this morning, she told me she has very little pain, and she was very pleased with her night nurse.  She is awaiting the surgical stabilization of her fracture.  She is confident, comfortable and she has a great attitude.  My friend is very courageous.

Late this afternoon, I got a message from Loren that Poppy was out of surgery and all went well.  What wonderful relief. She has a struggle ahead, but I am very confident that she will work hard and have a full recovery.  The human body is an amazing vessel and Poppy has taken excellent care of hers.

Poppy and I have teamed up on a number of presentations and campaigns.  Our friends at the Right Care alliance have affectionately named us the Lucy and Ethel of the RCA.  What an adventure L and R had yesterday.   And, next year at the Lown, what a story we will have to tell, to teach others how to be safe and engaged patients.   I have bold printed the people who helped Poppy just in one day, and there are many more now.  It’s amazing how a large group of  mostly unacquainted caring people pulled together to help my  friend Poppy.  We can never underestimate the goodness of people in times of need.

My opinion is that we found some of the finest in healthcare at the B & W ER  and a great example for the work we are doing.  However, we both went to the weekend conference expecting to help reform the heathcare system, not to experience it!

Addendum.  Poppy never stops working, and when we were in the ER she and I may have even managed to recruit the ER attending and the ER RN to the Right Care Alliance.  I left my card.

To be continued…….

May 10, 2017

Poppy was discharged from Brigham Women’s this afternoon in a wheel chair. Once her clavicle has healed sufficiently, she will begin using crutches to walk with no weight bearing on her injured leg for ten weeks. This will be a struggle, but if anybody can beat this, it is Poppy.  She is grateful to everyone along the way who helped and cared about her.

 

 

 

Oxford Living Dictionary  Definition of CARE

Noun:

The provision of what is necessary for the health, welfare, maintenance, and protection of someone or something.

Serious attention or consideration applied to doing something correctly or to avoid damage or risk

Verb:

Feel concern or interest; attach importance to something.

Look after and provide for the needs of.

 

 

I need to get something off my chest.   Health Insurance is not Healthcare.  When people ask, “Do you have Healthcare?”, we should not  think insurance.  Insurance is an  expensive profitable commodity, that has been marketed as care, but it is not care.  It is a negotiating service.  Let’s call it Medical Negotiators.   Insurance companies do not “care” for us or about us, even though some of their employees may be very nice and helpful.    Insurance corporations “are people too” but they do not touch us, or render care.  They care about their profits and their stock holders.  They negotiate insurance coverage for us with providers of care, like hospitals, doctors, dialysis centers, etc.  The only people left out of the negotiations are us, the people who pay for it.  We do not get to negotiate our payments to the insurance company or to the provider.  And some people are unable to have any insurance at all, even with all of its  imperfections.

Our families “care” for and love  us.  Healthcare workers and professionals “care” for us and sometimes they love us.  The professionals spend a lot of time and money to learn the proper care and handling of human beings and their health.  Doctors generally spend about a full decade getting educated.  Nurses can become licensed in 2 to 4 years, and some choose to continue on to become nurse practitioners.  There are many levels and kinds of professional caregivers . We can’t leave out the people who do abbreviated training like CNAs, PCAs, and such.  All of them learn to care for real live people. Real Health care is a challenging but noble career calling to answer.

I can only speak from the nursing end of things because that is my experience.  I was a wide eyed naive 18 year old girl when I entered nursing school at St Elizabeths Hospital School of Nursing in Brighton, Massachusetts in 1967..  St E’s was a 3 year Catholic Nurses training program.  I had no idea what I was getting into.  Our first half year and some of the second half we studied all the sciences.  Chemistry, Anatomy, Physiology, Nutrition, …argh!  That first year we also started on the fundamentals of nursing, which is how to give great hands on daily care to our patients.   First we learned about making a bed and how to do tight neat bed corners.  There were no fitted sheets when I was in school.  I was really good at that and I still am.  Next, we learned to give a bedbath and give backrubs and skin care.  This is the first time we really learned how to touch the bodies of strangers, so thank goodness we practiced on dummies.   Our instructors were exemplary professionals, and they taught us to be the same.  It was all very serious stuff for a goofy 18 year old. (Unfortunately now I hear from patients that their sheets were rarely changed and they never had a bath the whole time they were hospitalized. Back rubs and skin care??  Patients have never heard of that! Time isn’t allowed for such frills).     Soon we launched into more serious procedures like giving injections,  catheterizations, IV  insertion, sterile technique and dressing changes.  We learned Pharmacology (that was a tough one) and nursing specialties like maternal and child health, operating room nursing, psych nursing, pediatrics, medical surgical nursing and ICU.  We spent at least 2 months, sometimes 3 months at each specialty.  I had to live in a dirty dorm at Boston State Hospital for 3 months to learn psychiatric nursing.  My brother, who is also an RN spent 3 days at a psychiatric facility for his psych training.

I remember my trepidation when we first went onto the hospital floors.  What the hell was I doing there? I had never even worked as a candy striper, so I knew nothing of hospitals except as a visitor.  This was all of a sudden very serious business and it scared the bejesus out of me.  Between our in hospital time and our classes, there was not much time for anything else.  Off hours were spent studying.  Our weekends were when we let our hair down.

Caring is either in you or not.  I remember a few of my classmates who I doubted really cared about patients.  I can’t really pinpoint why I sensed that, other than the fact that they cheated in class on exams.  If they really cared, they would have taken the learning more seriously.   Someone who skated dishonestly through really difficult classes was not someone I would want caring for me.  Could I trust them to really care?

I didn’t have to learn to care, but I had to learn how to give hands on professional care.  Prescribed steps had to be followed for certain procedures.  If I skipped a step, I could endanger my patients.  Let’s take getting a medication ready.  We followed the 5 rights rule, but there was more.  The 5 rights were  Right Patient, Right medicine, Right dose, Right Route, and Right time.   Then of course there were the steps to keep medicine safe, like appropriate storage, keeping multi dose vials uncontaminated, using sterile needles and syringes and not contaminating them, prepping the skin for an injection the right way, putting pressure on and gentle massage of an injection site.   And after a medicine was given, we had to watch for appropriate effects and possible side effects.  Yes, all of this is part of giving an injection, and most of this is also followed when giving what seems like  a simple pill.  One slip up and there can be serious consequences for the patient.   All of it takes time.

When I was a student, I was under the tutelage of excellent and strict clinical instructors.  We were observed and corrected if we missed a step.  We did things in order, and efficiently.  We only had assignments that we could handle.  It was all very detailed and orchestrated so we could learn to be excellent nurses.  When I graduated, I felt like I had the world by the tail and I could take on anything.

After school I went to work in a small town operating room.  I took my nursing boards exam while I was sick with strep throat, but passed my nursing boards first time around!  My parents were so excited and so was I.  And then…..

I didn’t have my instructors to guide and protect me anymore.  I didn’t have the luxury of time anymore.  Most days, our OR schedule was reasonable, but I remember a visiting surgeon who was demanding and in a hurry to finish.  He put demands on the staff that were impossible to handle.  He wanted his patients lined up at the door of the OR so he could get out of there as soon as possible. Think widgets on an assembly line.  I found myself in charge of the OR one day (not my usual position) when he was there.  The surgical tech on with me and I decided that we were going to take our usual cleaning steps between cases whether the surgeon liked it or not.  It was our job to care about cleanliness and the patients.  He reported me because he was forced to wait between cases.  I stood up for us and our meticulous work, and that was that.  The Director of Nursing stood by me.  It could have gone either way.

Eventually I ended up working in a busy ER in Bangor.  Most days, it was controlled craziness, and then it would become uncontrolled craziness.  patients with very serious problems were forced to wait in the hallways.  If I was on triage, I was responsible for some of  those patients in the hallway. When I asked the ER administrator about short staffing and how we could remedy that, I was told “you just do the best you can with what you have”.  I recommended some kind of call in for especially busy days, so every patient got the attention they needed.  It never happened.

I worked in 4 ERs over my career.  2 were small community ERs and 2 were city ERs.  I learned that in order to survive, I had to take short cuts.  Some shifts I felt like an automaton, or a machine.  I had so many patients that it could be confusing, and I never felt like I was doing any of them justice.  I remember asking a patient to take his pants off to have a hemorrhoid checked.    He asked me “why, I’m only here for sore throat!”  He misheard me when I called the patient’s name. This is a good example of how easily mistakes can be made.  Caring for sick and injured people should not be this chaotic, and there should always be enough nurses so that one nurse is not caring for more patients than they can manage safely and efficiently at one time.

My last hospital job was in the hosptial Walk in Care doing 12 hour shifts.  I took this job because the patients were not as acutely ill and required less skilled care.  I was in my 50s and I was ready for this level of care.  I worked with one aide and a registrar.  I was responsible for all of the triage, and other RN duties like assessments, medications, treatments, orders, charting, etc.  I thought…”piece of cake”.   NOT.  After being told  a several times  that I would not have an aide to help me with the workload, and I was facing 12 hours with no relief or breaks, it was not a piece of cake.  After I worked with an LPN who just walked off to take her breaks in the middle of craziness,  without asking if it was a good time to do so, it was not a piece of cake.  After triaging dozens of patients and facing a dozen more in the waiting room staring at me and wanting immediate service, it was not a piece of cake. Eventually, I refused to work alone anymore in Walk in Care.  I would only work the part of the shift that I had help.  On a couple of occasions, my supervisor had to relieve me when the aide was leaving for the day.  This new staffing decision left the department with just an RN for the last 4 hours that WIC was open.  She came to relieve me and as soon as I left, she called for one of the ER aides to come and help her. So, the supervisor could get herself some help, but the other RNs and I were never given that option.

My hospital jobs forced me to learn to take shortcuts in care.  They were not harmful shortcuts, but the steps were there to assure safety of patients.  Lack of support and inadequate staffing forces all nurses to do this.  An example is handwashing.  We all know that handwashing is perhaps the most essential step a nurse can take to prevent infections.  If done appropriately and often enough, patients are safer.  But handwashing compliance is never 100% and often times is as low as 40%.   Nurses are considered whiners if they complain about their work load.  Middle management and upper management nurses are not managing by walking around, they are managing by looking at and calculating numbers on a piece of paper.  Bean counters at the top are budgeting to the bone and telling middle management that there is no more money for safe staffing levels.

In later  years, after struggling with short staffing time and time again, I became a union organizer in a small Maine Hospital.  When nurses cannot reason with their managers and directors, this is what they do.  We won our organizing effort and nurses are represented by the union now.  Great strides in patient safety and nurse staffing have been made because of the union.

I always cared about my patients.  But, I found myself asking.  WHO cares about me?  If we don’t care about the people giving the care to patients, and we don’t listen to them when they have needs, like some help with their workload,  we will beat them down, force them to take shortcuts, and everyone suffers.  Eventually I got beaten down…and the joy of nursing just wasn’t in me anymore.  I retired early.

When I went into nursing in 1967, young women were just starting to assert themselves in careers other than nursing, teaching or secretarial work.  My high school guidance councilor basically steered all of us to those 3 careers.  And it was not uncommon for 18 year olds to get married right out of high school and start families.  It is very different now.  We are facing having our very first female president, or so I hope!  Young women look at that and think there is no limit on what they can do with their lives.  Will young women consider nursing, particularly if it stays the way it is??  What about young men?   It is a tough profession, but if done correctly and by the right caring people, it is an honorable and inspiring profession.  We learn the professional skills and the patients teach us about everything else.    And, if done right, patients love you as much as you love them.

Nursing is an honorable and rewarding profession Nurses are the most trusted professionals and our patients need us.  My hope is that the industry sees the light and stops beating down nurses and other caregivers.  Patients need our care, not the care of insurance companies.

 

 

 

 

At 345am on November 9, 2016, my alarm went off.  I am retired but I volunteer work on Patient Safety and other healthcare issues.  That morning I was headed to New Orleans to a conference on cost and quality.  The night  before, I had watched  all that I could stomach of the presidential votes being counted on TV.

Mike, my husband confirmed it.  Hillary had conceded to T.

Mike and I voted early.  The tension and vitriol during this presidential campaign was causing both of us way too much stress.  I just can’t stomach that much hatred and negativity.   We already knew how we would vote and we thought that we could allay some tension if we took care of our voting business.  NOPE, it didn’t work.  TV coverage and constant horrifying and disgusting stuff surfaced every day.  What was happening to my country?

About 10 years ago, a sexual predator, in the form of an uncle, scared a cousin of my granddaughter. He lured her into going for a ride with him in his shiny new truck.  She had just turned 16 and had a newly printed drivers license.  He directed her onto roads that she was unfamiliar with and then he began a sickening sexually explicit trash talk with her describing what he would like to do to her, and bragging about what he had done to other young girls.  She was such an innocent that she didn’t understand half of what he described.   She was scared, and lost.  She didn’t know how to get back home, so she just kept driving.  She was from a beautiful Christian family and on most occasions she didn’t go with boys unless she was chaperoned. This was her trusted uncle!  One can only imagine her fear.  She didn’t stop the truck and fortunately she eventually found her way home.  He did not touch her and thank God for that.  That uncle was my only grandchild’s other grandfather.  And he lived in the same house as her.  She was just 13 at the time.   On the advice of police, her father (my son) and I worked to get him away from her.  We did it to protect her and her young friends from a sexual predator.  That was the beginning of the end of our relationship with my granddaughter.  Her loyalty was to her “other” side, including the sexual predator grandfather.  We had cared for our sweet girl for many years in our home.   She spent entire summers here and most holidays.  She had her own room and things here.  We love her deeply.  And now she barely speaks to us. We haven’t seen  her for over 7 years.  She is now 24 years old.  We were not invited to any events in her life, like her high school graduation with honors or her college graduation.  She has shared one photo of herself in all those years.  I have books full of them from our time with her.

When a family gets behind a sexual predator and dives into denial, it is impossible to penetrate that.  The disgusting perpetrator  we knew 10 years ago has a “devout Catholic” wife who immediately took him to her priest.  He lied to the priest, after telling the police the truth.  The small minded wife stuck by him and defended him.  She told her daughters and son and their families “we will never speak of this again”.  Her doe eyed denial saved  face, but destroyed very close and loving relationships all through her very large extended family, and it separated my family from our beloved girl.

There is great impenetrable strength in denial and undeserved loyalty.

This example of my painful separation from my sweet granddaughter is a microcosm of the vast harm a disgusting small man with those sickening tendencies can bring to those around him.  When they get away with their appalling behavior repeatedly, over many years,  it empowers them to be even more disgusting.   I have never written about this part of my life before.  It is very painful and something that I have not shared with a lot of people, but it is true, it is my reality and it is time for me to share it.

Almost 50% of American voters got behind a sexual predator for president and now he is going to live in the White House. That is a huge portion of our citizens that turned a blind eye to his predatory behavior, that was confirmed by his own words,  a number of women,and even by prior wives.   I can only imagine what kind of harm he can do to all of us, when a single creepy sexual predator uncle/grandfather could wreak such havoc in his own family and as a result, in mine.  Even before his election, T has left a path of destroyed lives and emotionally battered women.

I am horrified over this election and I will grieve it until T is finished.

God help us all.

 

 

Last Monday October 17, my husband Mike and I packed up our camper and went to Freeport, ME.  The weather was predicted to be unseasonably warm and dry.  Also, it is the peak foliage season.  This couldn’t get any better, could it?

The reason for our trip was twofold.  We are early senior citizens (67 and 68) we feel the need to do what we can while we can still do it.  Camping has been a big part of our lives and we would love keep it up.  It is a great way to travel, and to do it cheaply and mostly in comfort.  Our traveling nest offers this.  And we get to take Louie.

 

 

 

 

 

 

 

 

 

 

We settled that afternoon on the edge of a field at Recompence Shores Campground.  Then we found a vacant ocean front camping lot and stared at the gorgeous views and foliage.   It’s pretty simple stuff, but stuff that we love.

On Tuesday morning, I drove some hilly beautiful roads to Brunswick Maine to meet up with Poppy Arford, my colleague in Healthcare transformation.  We would host a listening booth table as part of Right Care Action Week at the Brunswick Senior Expo, in the Cooks Corner Mall.   Poppy had information sheets and beautiful posters printed up for our display, and we each carried clip boards to write on.  We introduced ourselves to about 100 seniors and other exhibitors, and asked the question “What worries you most about healthcare?”  and if they had no worries, “What do you like about your healthcare?”  http://rightcarealliance.org/right-care-action-week/

 

 

 

 

 

 

 

 

I have always loved working with seniors.  They/we are generally sharp, engaged and straight forward in their responses.  This was exactly the case on Tuesday.

Let me tell you about a few of the people I met that morning.

1. A tiny white haired 80ish lady with a walker approached.  When I spoke to her, she said it was hard to see me because of the bright light behind my head, and could we switch positions.  So we did.  She told me she is legally blind.  She uses the walker because if she bumps into something, the walker takes the hit instead of her.  Her greatest worry was getting alzheimers.  She said she doesn’t have it, but if she got it, she has no one to help her.  She has no family or support people.  Her worry touched me personally because of my own mother and her dementia.  This lady also expressed her exasperation with the Maine DHHS and how they lack coordination, efficiency and effectiveness.  She struggles with poverty and when they mess up her EBT card, she is in trouble.  She said she never gets the same case worker twice, and that they take care of complaint forms in bunches instead of as they come in.  The services are slow and uncoordinated and it affects her a great deal.

2. A sweet couple, married 59 years shared that they have a 45 year old ‘girl’ and a 54 year old ‘boy’.  The girl is a nurse and she told her Dad to take his hands out of his pockets because if he falls, he would not be able to break the fall.  I told them they have  a wise daughter.  They were generally happy with their healthcare.  They were patients at Martins Point in Brunswick and their Medicare Advantage plan is through them as well.

 

 

 

 

 

 

 

 

3. A man, estimated to be 80 or so, talked about his late wife’s costs for medicine.  He said that with insurance, a 90 day supply of 2 liquid nebulizer medicines was $900, and without insurance it would have been $9000 for 90 day supply.  He talked about his beloved wife and her struggles at the end of life, and also about the expenses for her medicines.  He felt that he was healthy and liked the care that he received at the VA.

4. A younger senior, maybe a little younger than me, was running a display table on Reiki, an alternative treatment for many health issues.  She was enthusiastic and bright and when I told her about the Right Care Alliance, she got very excited.  I invited her to join our movement.  When I told her about the Lown Institute annual conference, she said she could envision herself there, offering Reiki to the attendees in a central lobby!  WOW, what a great idea. He concern is that too much medicine is prescribed to mask symptoms of illness.  (yeah, my kind of gal!)  She said the goal should be to eliminate the symptoms, not mask them or drive them deeper.  I hope she joins our group.

It was a very busy and productive day.  I loved meeting, and talking to these awesome seniors about their healthcare.  We will take their comments and concerns to the Right Care Alliance staff and they will create a data base.  My guess is that costs issues will rise to the top, so I wonder if the question should have been a little different.  People associate the term “healthcare” with insurance and that can muddy the waters and center the conversation around coverage/cost.  I think perhaps I should have asked more about their actual hands on provider and perhaps hospital care.

Mike and I stayed one extra day at the campground, and it was a beauty.  On October 19, the temperature was 77 degrees at Old Orchard Beach, Maine.  Imagine that.  We had a great seafood lunch outside at a picnic table and then we went to the beach and watched the high waves crashing on the almost empty beach.  After we got back to our camper, we got a can of cold beer and took our chairs to the waterfront again and stared at the beauty of the place we were at.  Amazing.  Life is good.