December 18, 2016

Happy Holidays!

 It is that wonderful time of year! A season of Peace, as season of Giving. And a season of kvetching about how commercial Christmas has become, yadda yadda yadda.

I don't need to point out that this year is pretty scary for lots of folks too. Seems like Peace on Earth is farther away than ever in some places.

So here's a thought to take with you as go through our varied winter holidays.

Santa Claus. That jolly old elf. You know the guy, the one who lives at the North Pole and spends all year making toys (or getting them on Amazon these days most likely!)
Once a year he gets in his sleigh and rides across the globe delivering gifts to all the (good) children of the world.

 Hrmph, you say? I outgrew that belief YEARS ago thankyouverymuch. Bunch of nonsense. Not possible. Ridiculous.
 So I say....AHA! But your argument is simply one of logistics. Nobody argues that the idea of someone DOING what Santa does is impossible or ridiculous. We have known of people in our lifetimes for whom doing good for as many as possible was simply a logistics problem.

Stop and think about that.

If the technology existed tomorrow to make Santa's Christmas Eve ride possible, would someone do it? Absolutely. People already do within the limits of their technology.

THAT is the world we live in. A world where Santa absolutely exists, many times over, generation to generation. And perhaps someday children will laugh at the silly people who believed that he wasn't real!


December 5, 2016

Pearl-clutching Primate Politics

By Harry R. Hopps, (1869-1937) [Public domain], via Wikimedia Commons
Just read yet another article busily deconstructing the methods that the liberal left is utilizing to communicate with 'middle america' and assessing the effectiveness of various strategies in convincing those poor deluded folk that they are WRONG. Hence the pearl-clutching reference...

To be crystal clear here - I am a spittle-flinging lefty socialist from way back. So I am just as appalled as everyone else by the direction our nation has seemingly suddenly rotated, and suffering the same amount of disorientation and grief.


I also have a very good understanding that we are all pretty much just primates with cars and designer clothes who are not that far removed from the campfires and caves of our evolutionarily recent ancestors.
And when you strip away all the loaded language and the rationalizations what you see is pretty simple and clear. Divide and conquer is a very old and effective strategy. And our primate brains are very, very susceptible to that sort of manipulation because it goes along with how we see and interact with the world.
Using phrases like 'how we are wired' causes pain to those whose jobs involve both neurophysics and anthropology, but it is an easy shorthand to discuss the ways we classify and learn about the world and our place in it, based on how our brains have evolved over time. And our cultures reflect both the ways we are wired to think, and the strategies we have come up with to overcome a lot of those instincts in order to make living in large and often congested groups possible.

Part of that wiring is differentiating 'self' from 'other'. Most of us of a certain age can still sing the song 'One of these things is not like the other'. We classify and name things reflexively. We draw maps so that we can create imaginary lines to separate 'mine' from 'theirs'.
Using that to solidify your own position at the top of the tree by getting those below you fighting with each other to maintain their current position rather than eyeballing yours is a pretty basic and simple strategy.
And getting primates focused on easily identified differences in appearance to facilitate that unrest is not exactly rocket science either.
Which also explains why folks are willing to vote against their own apparent best interest.
Because they can always see someone down below them who they are higher than on the tree. And it is pretty easy to convince people that kicking the folks below them down if they try to climb up will ensure their place in the pecking order. Because the alternative of offering a hand up to those below is seen as a threat to the place at the top.
So you convince white men that they are threatened by everyone 'below' them. You convince white women that they are threatened by people of colour.
You convince people of colour that they are threatened by 'illegals' who shouldn't even BE here - so long as those illegals are brown-skinned of course.
And you convince everyone that they are threatened by 'Muslim terrorists' identified most easily as women in head scarves...
Most importantly, you convince everyone that they are far better off keeping the guys below them off their current branches and fighting to maintain their current position so everybody doesn't suddenly realize how much nicer the view would be way up on top.
In essence, you get the primates so busy fighting with each other that they fail to notice you packing up the silver and looting the vault.

So rather than wringing our hands about how we convince the other guy that they are WRONG, SO WRONG - how about we just point out that we should all be watching both Trump's hands and counting the spoons? And if we give each other a hand up, we can ensure there will be enough for everyone and not just the fat orange primate decorating the top of the tree?

November 11, 2016

Exceptionalism vs Inclusiveness

Being exposed to some very racist family members from an early age, I have had the opportunity to observe this sort of thinking in its natural environment, surrounded by others who either explicitly or tacitly supported it. Fortunately my parents saw this as an opportunity for education and discussion with us about why it was wrong, and I am grateful.

It wasn't just racism either. It was a deep-seated fear and distrust of anyone who fit into that huge box marked 'other'. Hippies were another huge bugaboo.

What I observed was fascinating. Because they had friends, neighbors, acquaintances, and later family members who fell into groups that inhabited that box. But the dissonance was solved by making exceptions. And it is a pattern I have seen my whole life when exposed to people who have internalized stereotypes for those they see as 'other'.

"Well my friend Bill is black, but he is different because he...
...has a good job and works hard." from here and talks like educated people."
...has a white parent so he isn't REALLY black."
...isn't, you know, URBAN."
...wears khakis and oxford shirts."
...has a degree and owns his home." married and his kids go to school with my kids."

"My sister is on disability but she is REALLY sick and isn't just faking it so she doesn't have to work. I mean, she has diseases x, y and z. And the doctors even say it is so much worse with her than anyone they have seen before."

"My nephew is in rehab right now. He isn't a junkie or anything! He got addicted to prescription pills. We need to do something about pharmaceutical companies that make those things"

"Bob's son is schizophrenic and living in the park right now. It is absolutely criminal the way all that money is spent on lazy homeless people who won't work when there are people who really NEED help and can't get it!"

"She is a woman but she is REALLY good. Thinks just like a man!"

"Maria from work is different because she... Mexican but she was BORN here.
...isn't Mexican, she is from Central America. Or South America...anyway.
...was born in Mexico but she is actually here legally.
...speaks perfect English. You can't even tell she is Mexican! from Mexico or South America somewhere down there. But she has green eyes and blonde hair! She doesn't look Mexican at all. Mexican but she only has one kid. And her husband is Mexican and he has a really good job too. 

"My daughter's friend is Native American. But he doesn't drink alcohol at all."

"My friend Joe is gay. But you can't TELL. He doesn't act like a fairy or anything."

You have heard it. You have probably said something like it about someone, somewhere sometime. You have definitely done it about yourself. We do it to rationalize our own behaviour all the time.

The reverse of this is inclusiveness. The realization that if this is happening to me or mine, friends and family, acquaintances, people I know...then it is may very well apply to others in the same boat.
We see it when the vocal opponent of marriage rights does an about-face when their child comes out as gay. Or the person who never had an interest in social activism becomes radicalized by the personal experience of someone close to them, or a personal issue.

Being aware of things like confirmation bias is very helpful here too. Realize that we will always file away the rare validation of or our prejudices, even in the face of a really impressive amount of evidence to the contrary.

This line of thought can also be applied to those of us reeling from the recent elections. Statistically, a lot of us know people who voted for the winning side. And we made exceptions for them, rather than considering they might represent a much larger group. Because they did not fit our stereotype.

I'll leave you with some photos of kids on Spring Break:

October 28, 2016

An Internet Quiz for You!

An Internet Quiz

In the scenarios below, what is the FIRST intervention required?

A person tells you they are hungry and have no food.

a) Assess for qualification for agency assistance programs.
b) Determine causes of current crisis, and assess for probable compliance with available programs.
c) Assess for resources available to hungry person.
d) Feed the hungry person.
e) Determine if the person is a danger to the public.
f) Sign the hungry person up for fishing lessons.

A person tells you they are cold and have no shelter.

a) Assess for qualification for agency assistance programs.
b) Determine causes of current crisis, and assess for probable compliance with available programs.
c) Assess for resources available to homeless person.
d) Shelter the homeless person.
e) Determine if the person is a danger to the public.
f) Sign the homeless person up for fishing lessons.

A person is in pain and/or medical distress.

a) Assess for qualification for agency assistance programs.
b) Determine causes of current crisis, and assess for probable compliance with available programs.
c) Assess for resources available to ill person.
d) Provide medical assistance to the ill person.
e) Determine if the person is a danger to the public.
f) Sign the ill person up for fishing lessons.

It's getting cold outside. Make sure you have your priorities in the right order.

October 13, 2016

Are Dead-Tree Books once again a measure of wealth?

Just to be clear, NOT where I grew up.

I grew up in a house full of books.
As an avid reader, this just seemed like a reasonable thing to me. As I grew to adulthood, I occasionally encountered houses that had few books - both my grandparent's homes were like that. It seemed odd, but since I was rarely staying long and usually travelled with my own stash, the lack never really impacted me much.

Not here either!
My house has always been full of bookcases overflowing, books piled on tables, next to the bed, even stacked on the back of the toilet.

Fast forward to the present. Just moved my mom in with us after my dad died in early September. We were in process of moving them both when he passed away pretty suddenly. He and Momma had been in the process of trying to sort through a lifetime of books to decide what was moved and what was donated. I now have a bedroom in this house filled to the ceiling with boxes, and a good number of those boxes are full of books. We moved four bookcases as well. Looking at the number of books and bookcases I am struck by the staggering amount of square footage that is consumed by printed books. Even in tall bookcases, it requires yard after yard of wallspace. Creatively arranging furnishings away from the walls into islands in the middle of the room to allow access to all those books.

Most places I have lived in recent years were far from the top of the list in price per square foot for housing, but it certainly is not near the bottom. If you live in a place with a healthy economy, chances are good you are dedicating a significant percentage of your income to floorspace to house you and your stuff. If you are like me, and on a limited income, then that floorspace becomes even more dear since there is less of it.
Just substitute the kids for dogs...

The advent of e-books have been a huge boon to bibliophiles like myself, they tend to be cheaper than dead-tree versions and they take up no floorspace! They lack the tactile satisfaction of a physical tome, and are generally pretty problematic for sharing, but you can keep your entire library on a pocket computer (They really should not be called smart phones since their telephonic function is generally a poorly executed afterthought. They are better at taking photos than at voice transmission.)

I suspect we are entering a time very soon when once again the library full of physical books will be a conspicuous luxury reserved for the wealthy and/or the eccentric. In the meantime, you will be able to find me buried under boxes of books trying to figure out where the heck to put them all!

The good news here is that libraries become even more relevant as we transition from buildings full of books to electronic archives of knowledge that will need to be curated, sorted, and maintained. And having a central repository that can be accessed remotely without the need for filling one's own electronic floorspace will also be in demand. Having those sorts of repositories that are not privately owned will be essential to ensure the continued free access to knowledge for everyone. Would love to hear from my librarian friends on whether I am completely off the beam here or not.

August 29, 2016

Is 2016 taking all our heroes?

It has been a tough year. It started early, and it seems every time we turn around another beloved public figure has passed away.
Baby boomers are at an age where a lot more of our idols are passing, and the modern world has produced a whole lot more beloved public figures as well.

All that said, every time I see another post of "screw you 2016" lamenting the accumulation of deaths I am reminded of a time when I was the beneficiary of some real perspective.

I started my first job as a hospice nurse on Sept 14, 2001. The management staff of the agency I had been hired at was stranded in another state due to the lockdown of all civilian air traffic. The remaining staff were in shock, trying to deal with everything that was going on while ensuring that patients were being seen and getting the support they needed.

My initial orientation involved going along on visits with various members of the team, and the chaplain was my first week. All anybody was talking about was the national trauma we were experiencing, including our chaplain. As we went on home visits, he was preparing himself to help families traumatized by the attacks on our country, in addition to their own loved one who was dying.

What we found was something that affected me profoundly, and informed how I approached my job ever after. When we entered a home, all that was happening and the only thing that was real in that home was the tragedy unfolding there. The immediate and real loss of a loved one. The events that were completely changing the world as we knew it outside those houses were background noise. People knew they should be concerned, but time and space work differently when you are in the liminal space created by the dying. 

In that space, the process of losing a loved one, the personal tragedy that is unfolding is all there is. Going through that door is entering an airlock, and on the inside there is a single focus. Other stuff exists, and has to be dealt with, but doesn't feel real. And as those who enter that space, we have to recognize and accept that THIS death, THIS loss overshadows anything else going on outside. And even if we have a connection to that person, it is not OUR loss.

So when I see yet another person who I admired has died, rather than adding them to some list of grievances I prefer to contemplate and grieve for those who are right now in that liminal space between the life that included that person and the life ahead
without them. And wish them peace and comfort going forward.

May 31, 2016

Who the Heck are You? A quick guide to medical care providers.

A visit to the doctor, to a clinic, nursing facility or hospital means talking to a dizzying number of people about medical issues. People ask for history, check your blood pressure and vital signs, take your blood, give you injections...who the heck are all these people?

Here is a quick guide to many of those letters you will see on the badges of the people you talk with.

MA or CMA - this is a medical assistant, most often seen in an outpatient clinic working with providers there. They work under the supervision of doctors and nurses. Their scope of practice in most states where they are regulated include clerical tasks, taking history, vital signs, assisting the provider during exams, taking specimens, and may be trained in phlebotomy (taking blood). Some states allow them to do additional simple procedures and operate equipment under the supervision of a physician, but they are never allowed to interpret results. What is a medical assistant?  They are usually the liaison between patients and their primary care providers, and may be mistakenly referred to as "nurse". Note that it is illegal for an MA or CNA to present themselves in such a manner. Calling yourself a nurse is a crime.

CNA - this is a Certified Nursing Assistant, most often seen in home health or inpatient facilities such as nursing homes or hospitals. CNAs work under the supervision and delegation of an RN, and provide hands-on bedside care such as taking vital signs, bathing and cleaning the patient, transferring the patient and assisting them with movement and self-care tasks like toileting and shaving. They also have the important responsibility of tracking bowel movements and skin condition in severely impaired patients, alerting the RN when changes are noted before much larger problems occur. They may also do dressing changes and daily wound care in some states. Both of the above require similar education, the primary difference is the location of their work and the tasks that are delegated to them. Both have differences in regulation and licensure (if any) varying by state. Differences between CNAs and MAs

LPN or LVN - this is a Licensed Practical Nurse or Licensed Vocational Nurse, terminology varies by state. An LPN *is* a nurse. They are licensed to provide nursing care, and are found in most places you will find doctors and nurses. They work under the supervision of a physician or RN and may have duties delegated by an RN. Limitations on practice by LPNs vs RNs are in areas that require clinical judgement, and in more advanced care settings. Many states limit the role of LPNs and do not allow them to administer IV medications or narcotics.  Working as an LPN .  LPNs are used to help keep healthcare costs down because it is much less expensive to have a group of LPNs working under the supervision of one RN than to employ RNs only.

RN - Registered Nurse. This is a nurse who has completed either an associates/certificate program or a bachelors degree in nursing, and passed the national licensure exam (NCLEX) as well. They perform all nursing tasks, supervise and may delegate to LPNS, MAs or CNAs, and may obtain advanced specialty training to increase their scope of practice in particular areas. While an RN has the broadest scope of practice of all the above listed, they also have the highest level of responsibility. The RN is responsible for not only their own scope, but they accept the responsibility of tasks that are delegated to them by physicians. An RN is responsible for ensuring the appropriateness of treatments, medications, etc that they have been ordered to give and is accountable along with the prescriber if the are wrong. Scope of practice is determined on a state-by-state basis, and requirements for continuing education vary. My specialty is Hospice and Palliative Care (CHPN). Some states allow me to pronounce a patient dead, some states require that I contact a physician to get that pronouncement, some states require the coroner to be notified, etc as an example of variations on scope of practice. As far as the other letters you will see after RN on a nurse's badge, they will generally designate their specialty certifications and may also include their education (MSN - masters of science in nursing, etc).

 APRN - Advanced practice RNs. These are RNs who have continued their education to a master's or doctorate in a particular specialty area and by doing so have increased their legal scope of practice. APRN  These providers practice medicine under their own licenses, and in most states do not require supervision of a physician to practice. The financial advantages of having a DNP versus an MD in roles that do not require the scope of practice of a physician are the same as those for hiring an LPN versus an RN. In the past, a Master's degree was the minimal educational requirement in most states for a Nurse Practitioner (APRN). Many states have changed that requirement to a doctorate, and there has been a push to make this a national requirement. So the Nurse Practitioner who sees you at the clinic may well be Doctor Nurse! This is similar to the change in requirements for pharmacists, who are now required to have a doctorate as well.

PA - Physician Assistant. PAs are masters degree trained medical providers who attend a specialized Physician Assistant program. PAs work under the supervision of a physician, and are frequently found in the same settings that you would find Nurse Practitioners. The primary difference between the two is that an NP can diagnose and treat without the supervision of a physician.

 DO - Doctor of Osteopathy. A Doctor of Osteopathy is a physician who has received their degree in medicine from a School of Osteopathic Medicine. They are licensed in each state as physicians and have the same scope of practice as MDs. DOs primarily see their practice as different from traditional medicine in the emphasis on a holistic patient-centered, versus disease-centered focus. An example: Oregon License Definitions Note that the scope of practice in Oregon is identical to that of an MD, with the addition of musculoskeletal manipulation.

MD - A licensed Doctor of Medicine, graduate of an accredited medical program and licensed by the state to practice medicine. May be found anywhere medicine is practiced. There are a vast number of specialties of medicine. A couple that regularly confuse people are Internist (a doctor with advanced training in Internal Medicine) and Intern (a medical doctor who is doing their clinical training for their licensure). Hospitalist - this is a fairly new specialty, physicians who specialize in treating patients who are hospitalized, coordinating all the specialties involved and ensuring that the patient is followed appropriately after discharge. Note that it is also illegal to impersonate a physician!

***Disclaimer: The above are the opinions and research of myself, a retired nurse. None of the above constitutes medical advice or definitive anything, is representative of the US, et cetera ad nauseum. Consult your local state medical board or nursing board for definitions, limitations, requirements and scope of practice.

NOT Nurse