Cynthia Stock

An amazing author for your soul!

Thanksgiving 2014

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The media seems to think ratings depend on peppering our lives with a plethora of bad news: wars on multiple fronts, religious conflict, the collapse of the armor that shielded professional athletes from public scrutiny, politics, and, of course, Ebola.   In response to these purveyors of doom, I challenged myself to list ten things to be thankful for this Thanksgiving.

To my surprise I filled my list in just a few minutes. While some things may sound simplistic or insignificant in the context of a world view embellished by mass communications, I find them reassuring and filled with hope for the future.

 

I am thankful that:

 

After forty-one years of nursing at the bedside, I still learn something new every day. I have changed from being the new nurse to being the seasoned nurse. Rather than having a “work husband,” I have a “work daughter,” who I try to teach, nurture, and share wisdom with, without being too motherly. Yesterday I managed yet another new device used in critical care. And despite having to deal with a machine, I picked up on subtle changes in the most important element of the health care system, the all-too-human patient.

 

Fifteen years into our marriage, my husband and I still hold hands when we walk or sit on the sofa. I told him on our first date I was “that sort of girl,” that I liked the connection born of such a simple gesture. I watched my parents do the same during their marriage. He holds my hand, and I am confident he is listening and present.

 

Cancer entered my life. How can I be thankful for that? Anyone who has faced cancer knows it brings out either the best or the worst in people. In my family, it opened a hot-line of support and established a depth of communication we didn’t enjoy before the cancer intruded. We became a phone network of love, shared information, and reassurance. We relived treasured moments and brought to life my father, who died decades ago. Our differences melted away; the reality of how very much alike we were allowed us a closeness I quite possibly would have missed had it not been for the cancer.

 

My mother sold her house and is moving closer to family. The perfect role model for young women, she was one of the first who labored to “have it all” before anyone coined the phrase. She worked. She went back to school after she had a family. She competed. She coped with the loss of two husbands and survived. As a widow she established a new life and a rigorous sense of independence. Yet she was willing and has chosen to face change again. The family will come full circle.

 

Ebola appeared in this country through my city. Why be thankful for that? The presence of Ebola would have blind-sided almost any city. Entering the flu season in a culturally diverse place like Dallas, how many would have suspected Ebola? Americans have enjoyed the myth of impenetrability. We seem to think major crises and conflicts all happen someplace else. Because of Ebola, Americans must acknowledge the problems of the world and recognize the shrinking global community. Unfortunately we do not live “under the dome.” But the Dallas crisis opened our eyes and our minds and made us better prepared for the next challenge.

 

There are books like Joyce Carol Oates’ Carthage. She uses words to make the ordinary extraordinary: “—then the flowing-white hair, a testament to masculine vanity so refined as to approach abnegation, obscured the old, bitter hurt like a caress.” I want to journey in her mind. Or The Storied Life of A.J. Fikry by Gabrielle Zevin which has been described by one critic as a “slim novel.” I found it deliciously “plump” with deeply layered characters and convoluted story lines that converge and provide the satisfaction of a favorite wine.

 

I heard from my son. Sometimes children go missing. They haven’t been kidnapped, been in an accident, or deployed overseas. Sometimes they disappear into a space where they can mature and establish an identity unencumbered by the accouterments of family. My son drifts in and out of my life. Without warning or logic, he calls. I hear about his work and his health. Then I hear about his music, his true love. He gives me enough to last me until the next time he calls. But he has invited me in, in a way, and I feel I can call him if I want. We both seem to be growing in our fragile roles as son and mother.

 

I still love to write. On my very darkest days, if I sit and write just one sentence, I am lifted. I say the words out loud to hear their melody. I reread my work to see if I communicated the action and the images that wouldn’t let me go back to sleep at 2:30 in the morning. I look for passion, beauty, the ugly, the tragic, the joyous, and a moment in words that transcends the mundane. Memoir pieces placate my demons; fiction allows me happier endings. The haiku demands me to simplify. The written word pleasures all my days.

 

I am still able to work and work out. The miraculous machine, my body, has yet to betray me. I still can work three 12-hour shifts in a row. Today I worked out 75 minutes at the gym. My paresthesias stop me from hand sewing and needlepoint, but I type faster than most of my colleagues. I am in better shape than many of my cardiac patients who are years younger. They inspire me to keep going.

 

For some reason Mom’s Pumpkin Pie made the list. For years I followed what I thought was her recipe. Mine never tasted as good. I thought it had everything to do with the fact that hers was made under the penumbra of our nuclear family. On Thanksgiving Day, I watched Mom use her hand grinder to prepare the turkey liver and gizzard for the dressing. I sympathized when her eyes watered when she cut up the onions. I marveled how she carefully heated the juice from the can without the peas in it so the peas wouldn’t collapse when cooked. She allowed us to set the table with cloth napkins and sterling silverware. Sometimes we would eat by candlelight, forest green tapers with flames that flickered and beckoned like fingers. The light enclosed the four of us in a golden cave. My family. No wonder the pie was special. I asked her what I was doing wrong, why mine tasted different.

 

Mom told me her secret. “Don’t bother using half white and half brown sugar. Use all brown.”

I did as she advised. But she was wrong. The taste, just like giving thanks, is all about family.

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Ebola: Its Impact on the American Mind Set

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With the same shock and speed as the planes that destroyed the Twin Towers, the Ebola virus razed the last bastion of the American Myth: the Ivory Tower of impenetrability. Americans have long enjoyed the belief that being surrounded by two oceans distanced them from the diseases, political turmoil, and wars rampant in other countries. Thanks to Thomas Duncan, we now know the truth. For that I am thankful. Just as we gave up many personal liberties after the 2001 assault on our country, protocols for community health and safety will change the way we live in a post-Ebola environment.

Criticism abounds in Dallas’ handling of the health threat. I commend the response and wonder what would have happened had Mr. Duncan chosen a less populated area without the same health care and security resources to respond as quickly as Dallas did. Responsible citizens must be prepared to give some more for the sake of community health and safety. The CDC recommends using facilities with practiced expertise in the care of infectious patients. This follows the logic used to quash the polio epidemic. This type of care requires special training, equipment, and mental toughness.

Our national security depends on us being ready to handle crises regardless of their nature. Weapons of mass destruction take on new meaning. While attempting to master the arms race, what attention has been paid to that which we have least control: biological weapons? Our enemies seem enchanted with brutality and the horror inspired by genocide and butchery. However men who are intelligent enough to assume power over large groups will see the potential in wielding weapons that are poorly secured and understood. This is no time to be cavalier or lax. Aggressive and proactive measures must be instituted to control and manage Ebola.

Health care professionals, defense specialists, and the NSA must collaborate with the full support of Congress and the White House to insure the safety of the American people.

 

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Beware: Death Panel Paranoia on the Horizon

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I predict a resurgence in “death panel” panic thanks to an article first appearing in The New York Times and picked up by The Dallas Morning News. Beginning next year, end-of-life-decision discussions may be covered by Medicare. Without thinking it through, the euphemistic question will arise: “Will the medical community arbitrarily ‘pull the plug’ to cut costs and conserve resources regardless of what the patient and/or the patient’s family wants?”

During my career, I have been involved with many families forced and unprepared to make decisions about a dying relative. Tears, anger, guilt, and regret overwhelm those involved in the process. The time for such discussion and choices is not when death is imminent, but when rationale thought balances conflicting emotions.

If Medicare were to cover the cost of time spent for these discussions, choices bound by reason and compassion as opposed to fear, fatigue, and stress, could be made. As a nurse at the bedside for forty years, I see this as proactive, an activity that advocates self-determination for the patient.

Who should represent medicine in this decision making process? The cardio-thoracic surgical specialist who knows the specifics of the patient’s cardiac problems, who has seen what some believe is the site of the soul, the heart, while the chest is open? The anesthesiologist who does a cursory history by phone to assess the essentials of a national risk scale for patients receiving anesthesia? The nephrologist who tinkers with meds, fluids, and diet to keep the kidneys functioning at acceptable levels? Each specialist focuses on a slice of the human pie. The surgeon is invested in the heart, surgical statistics, and hospital length of stay. The anesthesiologist is like one of the tea cups at Disneyland. He spins through the patient’s life with a brief interface when the patient is awake, administers anesthesia, and then is gone. The nephrologist looks at the BUN, creatinine, and daily weights. Who looks at the total patient? Who looks at, talks to, and delves into the history of the bio-psycho-social being who makes up the whole pie?

I think of my Mom who just lost her extraordinary PCP. He spent almost an hour with her each time she visited. He knew not just her physical history, but her social history. He supported her desire to maintain the highest level of wellness so she could continue to live independently. He asked per permission to pray with her. He LISTENED to her. And when she self-diagnosed an acute myocardial infarction, he personally drove her to the hospital in her car, because she wouldn’t leave it at his office. This physician extended himself in what I perceive as a gesture of love and respect and grace, not just as a doctor dealing with a patient. If my Mom needed someone with whom she could discuss how she wanted to die, I would want it to be with someone who knew how she lived. And that would be her PCP.

Any discussion of end-of-life/death meets several obstacles.

Thanks to technology things considered impossible before have become possible. AIDS transformed from being a death sentence to a chronic disease. Organ transplantation evolved from being a great experiment to a process that extends the life of organ recipients and is limited only by organ availability. Minimally invasive surgeries have allowed procedures to be successfully performed on people who previously would have been turned away because of their co-morbidities. The blessing of technology is the extension of meaningful human life. The curse of exponential growth and change in medicine is two-fold.

First, medical therapy can extend life without factoring in risks of potential outcomes and the quality of the life extended. How often I have seen patients survive perfectly executed surgeries while failing to recover their previous level of functioning. The surgery succeeds; the patient fails and endures an emotionally draining and physically tortuous life.

Second, death is seen as a weakness or a failure. America is a country that evolved through ingenuity, innovation, and hard work. Many people think these qualities and access to health care empower them to elude death. Of course this isn’t possible. Nor is it a failure to succumb to the natural, end result of having lived. Death is the “elephant in the room.” It is something we don’t want to believe happens, especially to those we love, admire, and draw strength from. Quite simply it is much easier to talk about life than about death.

Television has further complicated real understanding of disease and death. Just as Law and Order or CSI has generated an unrealistic expectation of crime-solving and justice to occur within an hour, so House and ER have created a false sense of rapid diagnosis, treatment, and recovery, leaving little room for death and the discussions surrounding it.

Advertising inundates viewers with quick pharmaceutical fixes for everything from depression to fibromyalgia, from diabetes to Crohn’s disease. Bariatric surgery is touted as the be-all-end-all solution for weight control. Just as the drug ads list a plethora of warnings and exceptions, every surgical consent has fine print. Success with bariatric surgery requires a life style change, not just a surgical intervention.

How do families open the necessary discussion about death? From the time I was old enough to participate in adult conversation, my parents discussed quality of life. When my father developed a brain tumor, there was no question in my mind what he would want done, or not done. My courageous mother asserted my Father’s wishes against a medical construct that in the mid-1970s still leaned toward patriarchy. My sister and I fully supported her. We were three of the lucky few who discussed such things before they happened.

When my husband and I prepared wills, we also prepared Living Wills/Advanced Directives. What better time to think about end-of-life as when documenting your history by distributing what you leave behind, no matter how insignificant those things may be? Our daughter became involved as she has Medical Power of Attorney if something happens to both of us together. Hopefully this role opened a discussion between her and her husband. Experience has surprised me when I count the number of patients I have taken care of who don’t have a basic will.

Perhaps when families are together, enjoying the grace engendered by love and connection, when relatives are savoring all that has come before and all that has yet to come, a discussion of how each family member hopes to leave this world can be part of the experience. I don’t find this macabre; it is part of the human experience. I have things I will leave behind and have a hope about how I will be remembered. I want people to remember the love I had for them, how I loved to read and write, how I could never sit still, how I flew with white knuckles and fled an MRI because of my loathing for small spaces, how I loved my cats, attended patients’ funerals, and balked at mastery of the cell phone. I don’t want to be remembered inert, unthinking, in a swamp of my body’s own making. In the warmth of a gathering of friends or family, what better place to share these thoughts, these concerns?

Politicians seeking a photo-op will misrepresent this subject. They will suggest, without hands on experience, that the decision to stop or withdraw extraordinary care equals stopping care. To the contrary, I explain to families that the plan of care merely changes from one of aggressive, often traumatic therapy, to care, support, and comfort. Death may be imminent, but time is not a certainty and death may not be immediate. To the health care team, the caring never stops.

I hope Medicare begins to cover time spent with patients and families discussing these matters. The American Association of Critical Care Nurses has reported that families in crisis situations involving a dying patient need 1:1 care as much as any patient in an acute physical crisis. Addressing these needs in all patients can’t help but improve quality of care for both patients and families. Rather than “pulling the plug,” these discussions will give patients a voice and a choice in the direction of their care. And so it should be.

 

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Human Touch in an Ailing System

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Bruce Springsteen asks in his song Human Touch: …in a world without pity Do you think what I’m askin’s too much…I just want something to hold on to…And a little of that human touch.

The words resonate with anyone who has teetered at the black abyss of depression or psychosis, with anyone who has experienced a moment when he felt alone and anonymous in a bustling, too-busy-surviving world. How therapeutic for one person to reach for the lonely, to touch an arm, drape an arm over a shoulder, and pull a soul back from the darkness. Most people have lived through such moments and know the void of which I speak.

A friend of mine who works in a psychiatric facility told me she planned to quit her job. She had been reprimanded for hugging her patients. Although she is the type of therapist who radiates an aura of genuine concern, a professional who patients request for their care, she was told that hugging was not appropriate. Not appropriate? The touch between two people, a gesture validating existence and humanity. These are not full body hugs. They are not sexual hugs between men and women. They are connections between patient and therapist executed in a day room perhaps, in a hallway, anywhere.

In my clinical setting, I sense when a patient or a family member needs a hug. I prevented a woman from falling to the ground in grief because I hugged her shoulders to brace her for the news. I did not hug, sensed the need for tactile restraint, but stood shoulder to shoulder as a man watched the resuscitation of his wife. I guided a wife, my hand in the small of her back, to seat her by the bed of her husband as he slipped from this Earth. At one point she squeezed my hand. I see people so diminished by grief I touch them and hope that touch provides a conduit to share the abundance of energy I have provided by the love I have for my profession. Is this inappropriate?

Conversely to my surprise, a man who was going back to his home in another city, who knew he would never see me again because his cousin was dying, hugged me and wrapped me in profound gratitude, not only by his words, but also by this one unexpected gesture from someone who had seemed distant and restrained. I haven’t collected a paycheck able to match the value of this act. The wife of a patient hugged me and told me how much my care meant, not just to her husband, but to the entire family.

For brief moments when people are most vulnerable, the nurse I am becomes an extended family member. Because recovery from illness is never straight-forward, because it is filled with days of five steps forward and three steps back, I earn the trust and wrath of family members. I share the joy, bear the brunt of frustration. I praise success and illuminate the smallest shard of progress. I awaken at 2:30 in the morning and wonder if I have done everything I should have; if I could have done something more or better or more quickly. That is the nature of my nursing practice. It is the nature of humanity.

I imagine some patients will notice my friend’s absence. In the bigger picture of corporate health care, someone will fill her position and the institution will go on without pause.

Decades ago my favorite nursing instructor challenged me to maintain a “Ma and Pa” quality to bedside care in corporate world. I took her to mean: Keep it individualized and personal. I talk books to those who read. I read bean futures to those who farm. I find church services on Sunday for those who worship. I share funny stories from my own family to take a patient’s mind off the humiliation of incontinence, the shame felt by some for being weak. I wash feet, endure court TV, and answer a daily barrage of the same question quite like a child’s “Are we there yet?” “Is he better?” “When can he go home?” “Is he gonna make it?”

I once hugged a man whose son ultimately died, a victim of a drunk driver. He told me that at the time, “Life sucked. It (the hug) picked me up. I knew someone really cared.”

Springsteen tells it right: “You might need somethin’ to hold on to When all the answers, they don’t amount to much Somebody that you can just talk to…a little of that human touch.”

In your new job, my friend, keep hugging.

 

 

 

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The road to self-publishing

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My Book Baby

 

I never dreamed of being a writer, but I have always been one. I “journaled” for many years. Back then I called them diaries and included graphic drawings, a pressed daffodil, retrieved from our front yard after a tornado, and a desiccated silverfish that squeezed between the pages and died amid the purples and pinks of my colored pens. As an adult, I took creative writing classes, read, and read some more. My first novel started as a short story and developed into my second child. Members of my small writer’s workshop told me my main character, an eight year old boy who experienced life with a perspective enhanced by circumstance, not age, needed to tell his story in a bigger world.

Any parent knows it is a job that requires twenty-four seven vigilance. It was no different with my book baby. I suffered sleepless nights when the boy wouldn’t leave me alone. I’d awaken and see him squinty-faced in overalls, a single ray of sunshine lighting his presence at the side of my bed. He never spoke, but I heard him. Somehow he communicated what part of his story I needed to tell next. I sat for hours at the computer and created scenes where my character grew. I submitted chapters to workshops and cried when I had to excise parts to make the exposition tighter. I eliminated unnecessary, beautiful words, the kind that roll over your tongue and come out a physical sensation. I agonized over the constructive criticism of a professional editor. When I finished the rewrite, I felt satisfied, almost ready to call myself “author.” Think again. In a talk about creativity and art, Phillip Glass said he didn’t feel his music was complete until it had been heard. I understood. I wanted my child to be seen and read.

The second part of the author’s journey began. I was ready for anything with one limitation: I wanted my book in print before I turned sixty-three.

In the course of my writing education, I took classes from a community writing organization and a local university. The university instructors provided a glimpse of the publishing process: acquisition of an agent, sale of the book by an agent, purchasing of the book by an established house, and marketing, printing, and distribution driven by that house. Finding an agent seemed as important as finding the right babysitter. I needed someone I could trust with my book baby, who would nurture it, love it, and market it with care.

My parents raised me with the mantra: if you worked hard, you would succeed. For me it had been true. In competitive swimming, I practiced twice a day and secured a scholarship enabling me to go to an out of state university. In school I studied and graduated with honors. In my professional life, I secured every job for which I applied. After two years creating a life, I knew someone would want to publish my little boy’s story.

The university provided select authors an opportunity to go to New York and meet with agents of well-known publishing houses. I flew to this experience with high hopes, belief in the quality of my work, and not the faintest idea of how to sell myself. I blogged about Moneyball, the movie in which a GM takes a chance on questionable talent in MLB. I researched editors, rehearsed my synopsis and sell, and made myself sick from the stress. Silly me. For sixty years I depended on the reward-for-hard-work myth. A mandatory paradigm shift blind-sided me and rattled my confidence. Was I a worthy parent, a real writer?

Every agent but one was young enough to be my daughter. Generation shock. I stuttered and mumbled to relative novices at life how the story of a man who killed his wife, lost his son, and lived with the nightmares from a prolonged childhood hospitalization alluded to the story of Job. In ten minutes, I couldn’t make them love my boy-man. In New York I received one request for my full manuscript, one for a partial, and very cordial rejection e-mails. Living with rejection came with a huge BUT. But you haven’t read the whole thing.

Sylvia Plath said “The greatest enemy of creativity is self-doubt.” I taped her words to my computer.

I began the unsolicited submission process. I only sent to agents open to unsolicited material. The others: They didn’t know what they were missing. I started a folder of which agents I submitted to, what I sent, and if I got a response. Hand-written rejections were touted by instructors to be an exceptional compliment. So it’s better to be back-handed in cursive. Most came as form letters. My list of rejections grew. I became more skilled at matching agents with my genre, sharpening my synopsis, and mass producing packets of cover letters, the synopsis, and the first fifty pages of my manuscript. A sort of baby bundle. I took solace knowing the author of The Help received almost sixty rejections. Dr. Seuss garnered over four hundred. I juggled this second job between stretches of twelve hour shifts, strained my marriage, and gained thirty pounds. I thickened my skin to tolerate what felt like bullying and refused to let disappointment keep my child from taking its place in the world.

I never lost faith, but I chose a new approach: self-publishing. With my sixty-third birthday less than a year away, what did I have to lose but my husband, my sanity, and my health?

Self-publishing services amounted to a smorgasbord of choices. Another writer-friend had already self-published. She shared her experience; I followed her lead. I searched company web sites, publishing packages, and, of course, cost. Teasers came with every package. Until I began to shop, I didn’t realize I’d be a decision maker and marketer of my product. A career in professional nursing hardly prepared me for such an undertaking. The very nature of nursing mandates that people seek your service. I never had to sell myself. Even in a high stress area like critical care, all I had to do was appear at the bedside and be a consummate, compassionate, knowledgeable, decision-making professional. A piece of cake. I dedicated myself completely to my work, just as my parents had taught me.

I finally bought a mid-priced package. The company made the process remarkably pain free. From the beginning, contact people helped me format my manuscript to company standards, provided me with thorough editorial comment and recommendations, suggested reasonable time frames for task accomplishments, and updated me frequently about processes out of my hands. But I had the final say with my story, my baby.

I selected my book cover from a small pool of photographs. To my amazement, I found my boy in a symbolic pose of the quest I created. A shadow in the penumbra of a brilliant sun, my protagonist climbed a mountain representing his life of adversity. It was a picture I had found on the internet two years before I finished my first draft. It felt like a new life inside kicking for the first time. I took it as a sign.

A few days after selecting my cover, a package arrived in the mail while I was at work. My husband placed it on a shelf in the foyer. He thought it was just another book I had ordered. On my next day off, a representative from the company called and asked my opinion. “Of what?” I asked. With the phone in one hand, I found the package and opened it. My hands shook when I held the precious thing, not unlike the first time I held my son. I didn’t need to say anything to the rep. My voice spoke the language of joy. I allowed myself a half-scream. The rep laughed. I held my novel in its hard proof copy. Five years of work took tangible shape. All the files of chapters in their original and rewritten forms, all the on-line saved documents, all the time spent molding the world and characters of the novel came together. Despite the beautiful cover, the artistic design of chapter pages, and the presentation of the jacket biography, reality hit when I found the ISBN and Library of Congress numbers. Like a footprint on a birth certificate. I was a real author of a published novel.

I want my novel to be read by those who love the written word. It would be nice if it were a best seller. I have already cast the stars to play my protagonist in the different stages of his life on screen. I have received my invitation to the Oscars for which it received a “Best Screen Adaptation” nomination. In reality I deserve to celebrate my part in two accomplishments: the writing and the publishing. Creation. On this day that is more than enough: I just found out I sold my first book.

 

 

 

 

Why does ED happen

Service versus being a servant

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In forty years of nursing, I fought for respect and autonomy in my profession. I pursued a graduate degree and believed a higher level of education would not only enhance my clinical practice, but would also earn colleague status with doctors wherever I worked. For the most part, this has been true.

In the critical care setting, my specialty, adaptation to change, continuing education, and the ability to make sound clinical decisions has been instrumental in the practice of nursing. A four year degree has become the expected entry level education. Certification in this specialty and the pursuit of a higher degree is becoming more commonplace. Both are encouraged and economically supported by health care institutions. This sounds like nursing is advancing as a profession.

Enter the new ad campaign by a large health care conglomerate that praises the “servant” who cleans up messes and changes the sheets. The ads devalue the educational requirements, both basic and ongoing, the responsibilities assumed, and the commitment to best patient outcomes manifested by consummate professionals. The portrayal of health care providers as servants discomfited me.

As a nurse, I have been a witness to and caregiver in the most deadly epidemic in modern times. I have watched women infiltrate medicine and men infiltrate nursing. I have lived a history in which critical care grew from the MASH units on the front lines of war into the technology driven units in tertiary care facilities. I have watched drugs come and go, so-called best practices be replaced by better practices, and health care become a right. I recognize my profession is one of service. I know that without the patient I am nothing. Without the trust of someone who allows me into his or her life at a most vulnerable time, I cannot do what I am trained to do. But I am not a servant.

Conversely, when I come into the hospital, I want an educated professional familiar with the latest technology, the newest drugs, the best treatments, and the dedication of someone who is prepared for his job. I neither want, nor expect a servant.

I am a professional nurse. I empty trash, clean the floor, clean up excrement, and turnover a room. I have successfully resuscitated a patient before the doctor could arrive. I started an IV when a patient was bleeding to death as the doctor stood over me and told me I had to find a vein. I have made countless decisions in treatment plans, made critical notifications, participate in interdisciplinary collaboration to devise the best plan of care, wept with families, attended funerals, and shared the pain and joy of loss and recovery. I am and will always be in service to my patients. However I am not a servant.

 

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Where are the cell phones?

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Finally the media is addressing the silence of over two hundred passengers and their cell phones. A CNN expert suggested that the plane was too high for the towers to reach the phones. If that’s true, then why is the FAA considering the issue of allowing use of cell phones in flight? In response to people recalling the plane that went down in Pa. and last minute communications, he stated that those calls were made via “air phones” on the back of the seats that required the caller to swipe a credit card before calling. Really? Wasn’t that plane low enough for cell phones to pick up tower signals?  And yesterday another expert stated the plane was flying low in an attempt to avoid being detected by radar. If just one of the passengers were alive, wouldn’t he have called someone? To the untrained ear, the inconsistency in reporting smacks of cover-up and subverts any confidence in the media. To date, there are far more questions than answers, more doubts than reassurances.

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The Way of the World, the End of the 2014 Games

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The Way of the World

For some there is logic in the separation of church and state. In the vicarious excitement I experience when I watch the Olympics, the same logic follows: there should be a separation of politics and sports. I don’t care how these athletes vote (if they live in a place that has voting), who they sleep with, or the ideology of their home country.  It is breathtaking and inspiring to watch athletes who have trained for years, sacrificed in all aspects of their lives, and reduced the measure of all their commitment to one competition and the acquisition of an Olympic medal. As with all things logical, there is a caveat.

I gasp when I witness the flight of skiers and snowboarders. I marvel at their lack of fear. When the skaters spin and leap and lift, I feel dizzy from their speed and height. I love the wild helmets, the beauty of the designer costumes, and the almost alien looking accouterments of the hockey players. Olympic competition represents a celebration of athleticism, work ethic, health, and the global community. Unfortunately at the end of the competition, there are other channels, other conduits. I see and vicariously experience the devastation of Syria, oppression and death in the Ukraine. Appreciation of stellar athletes becomes moot.

As the Olympics close, these thoughts plague me. The press covers the adoption of homeless dogs by an athlete while Syrian refugees starve and wonder where to go for safety. A Canadian journalist, as well as a competitor, complain about judging known to be subjective for years, while citizens in Kiev are judged and shot to death in the street. A team that has practiced with another for two years charges their coach with favoritism, conveniently not apparent until the pair gets into the national spotlight. A snowboarder nurses his failure to win a medal by touring with his band. In the aftermath of this great sporting event, what are we missing? So many questions arise. What will be left behind when all the athletes are gone? What social and environmental detritus will the Olympics of Sochi have generated? Considering all the money, energy, talent, and resources invested into the sports events, is the world a better place? Is there less domestic violence? Is there fresh water for all the people in Africa? Is the nuclear clock any less close to striking the time for Armageddon? The Olympics brings the world together in a microcosm of competition and comradeship on a stage in such isolation that it does little to bring the rest of us to a peaceful co-existence where all become good stewards of the earth and its people.

All complaints and hubris aside, it IS just a sporting event. And it IS time to move on.

 

Why does ED happen

Wake-up Call

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I confess. I called myself a feminist in the early 70s. The focus of that label centered on equal rights, sexual freedom, access to birth control, and abortion. In college I met a fellow who told me if I wanted to date him I needed to be on the Pill. I didn’t see that as sexual freedom at all, just another Y-chromosome telling me what to do with my body. I moved on, got an IUD, and rallied in support of Roe v. Wade.

Today I look at the insidious movement to turn back time and shudder with amazement and fear. Amazement that young women today seem unconcerned about forces at work seeking to take control of their most private, personal decisions. Fear that so many people are verbal and passionate and self-righteous about doing so.

 Then I picked up When She Woke, by Hillary Jordan, and amped up my anxiety. I believe more people need to read this novel today. Jordan creates a world in which radical conservatives rule the country. The laws of the land are extreme end-results of the trend I see in modern attitudes. Hannah Payne aborts the child conceived during her affair with a well-known, married leader of a megachurch. When her act is discovered, she is sentenced to sixteen years of “chroming,” a process which turns her skin red. The Scarlet Letter in the extreme. All criminals are subject to such punishment with crimes being color coded. There is no need for imprisonment when the color of your skin defines who you are and what you have done.

When She Woke allows the reader to accompany Hannah on her quest to find a new life and redefine herself as a woman. Raised in a fundamentalist home, she must reconcile her faith with the cruelty and prejudice she encounters as a Red. Even more difficult is her break from the traditions of a rigid social upbringing. She learns to take control, make her own decisions, and not judge herself as she escapes the oppression of her family and community. How relieved was I to reassure myself Hannah’s life occurred in a fictitious world? Not much.

Enter the 21st century and a “Perspective” published in the Jan. 16, 2014 New England Journal of Medicine called “Physicians and the (Woman’s) Body Politic,” by Alta Charo, J.D. The essay sites numerous cases in which the law supports the incarceration, admission to mental institutions, or forced medical/surgical therapies of pregnant women claiming protection of the unborn as justification. State laws targeting abortion providers have burdened them with restrictions deemed “unwarranted and unjustified” by the American Congress of Obstetricians and Gynecologists. And then there is the transvaginal ultrasound, mandated in an effort to keep women from choosing abortion. Invasive, dehumanizing, it is a diagnostic test that should be decided upon by the patient with the physician. A legislator in a state, or the nation’s, capitol cannot know the circumstance of every pregnant woman. It is ludicrous to pass general legislation for health care that is driven by the individual patient. Would there ever be a law mandating someone engaged in high risk social behavior be tested for Hepatitis B or HIV? A law regulating eating and BMI?

In When She Woke, the Novembrists are members of a group of rebel-activists helping Hannah escape a community where she will be ostracized and abused. When asked why they do what they do, the spontaneous response is: “It’s personal.”  Sexuality, pregnancy, and child-bearing. Personal choices. Not to be influenced, regulated, and interfered with by outside forces. When She Woke is a wake-up call, a warning about the possibilities of what could happen in the atmosphere of today’s politics and voter distraction.

Why does ED happen

A Matter of Life, Death, and Miracles

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In the weeks since the cardiac arrest and the declaration of death for Jahi McMath and brain death for Marlise Munoz, the media has conducted a discourse with ethicists, an elementary school class, the grieving family, and medical professionals. Maybe I missed it, but nowhere have I heard anyone speak with health care professionals, specifically nurses, assigned to care for either of these patients. In this group of care providers, a continuum of emotions and opinions about what is ethical and humane would abound.

After forty years of nursing, I still find most disturbing the provision of care to those who have no chance of a meaningful recovery. I have cared for a patient who was declared dead. The Harvard criteria for brain death includes: unresponsiveness, apnea (no respiratory effort), absence of movement, no reflexes, a flat electroencephalogram, no central nervous depressants in the body, and a core body temperature greater than 32 degrees. The beside nurse observes more subtleties. There is a vacancy in the eyes, an emptiness, and a lack of recognition of the outer world. Many times I have sensed an absence well before the body declared itself done with this life. No one can verify if the spirit transcends the body, but in my experience it seems that way. And it feels that way. Does this change the type of care I, or any professional, provides? No. I still talk to the person as if I’ll get a response, and I handle the body with the upmost tenderness and respect. This doesn’t change the lack of reciprocity in the human connection between this nurse and the specific patient.

Part of the conundrum with end-of-life decisions stems from the failure to differentiate life from living. In the cases of Ms. McMath and Ms. Munoz, a heartbeat defines life. But when she was alive, Ms. Munoz defined living by her ability to do certain things. She did not want life maintained by mechanical means. Each individual defines living differently. For many people, work and certain activities define who they are. For me, I am a nurse, a fitness nut, a reader, a writer, a wife, a homebody, a thinker. I am not sure which roles I could give up, which things I could stop doing, and still feel life had enough value for me to want to live. For me a heartbeat is not enough of an existence to justify the consumption of finite resources that would better serve another human being. These things I have discussed with my husband, my attorney, and have set down in an Advance Directive.

“What about miracles?” you might ask. Have I seen them? Yes. I still cry when I remember walking down the hall with a patient who suffered a catastrophic brain injury. When I saw his father’s face morph with the recognition it was his son coming down the hall, I knew I had been privy to something divine. I can give you all the scientific rationale for why the boy got better: his youth, perfect timing, a tenacious, committed doctor and team of nurses. I can only speculate about a force present, not prescribed by any medical practice. My question to you is this: “If it truly was a miracle, would it have happened had we done nothing?”

When Jahi McMath’s family prays and talks about God’s miracles, I wonder if they could surrender to their faith, remove all life support, and wait for God’s intervention? At a time when they were most vulnerable, experiencing the worst grief parents can endure, the media spotlighted decisions of the most delicate, private nature. I wonder where the reporters will be six months from now. And I wonder if the family will rethink their decision once they have begun to deal with, not only what they have lost, but also with what they have begun.

You may say: “It’s easy for you to say, you haven’t ever been there.” But then you don’t know me or the kind of nurse I am. I remember the first patient I “lost” on my first Christmas Day on the job. I remember my father, my husband’s son, my neighbor, saying they were ready to go when the quality of their lives became intolerable, all for very different reasons.  My mouth went dry and I felt embarrassed and sad when I read an article in the newspaper about my own challenged grand-daughter who suffered a brain injury at age six weeks. She is seventeen years old, requires total care, and has never uttered a word. She receives tube feedings, never to enjoy the delightful taste of chocolate or grapes or a well-cooked steak. She passes urine, stool, and has gone through adolescence. Someone must attend to all of her bodily functions.  I believe all of us have “been there” at some time and bear the wound of loss deep within us.

Perhaps that is the point of this discussion. These situations are so personal, so private, that people calling the hospital to get information must have a security code. Then how has it come to pass that the law, bureaucrats, and outsiders, who have no knowledge of the people involved, impose decisions on virtual strangers about life and death.

Each person’s definition of living or quality of life determines the path he chooses to its end. I demand this as a sanctified, inviolate right for myself and exclude input from all other external sources. Life, death, and miracles, all very private concerns.

Why does ED happen