Re-name Old Crisis to get a Nifty New One

Wow! ‘Alarm Fatigue’. A new buzzword!

Did we need another buzzword, or would some boring old word describe this situation better…

WORCESTER, Mass. (AP) – UMass Memorial Medical Center in Worcester is stepping up efforts to prevent nurses from tuning out monitor warning alarms following the death of a patient whose alarms signaling a fast heart rate and potential breathing problems went unanswered for nearly an hour.

The patient who died was a sixty year old man. He should not have gone ten minutes without a nurse responding to his serious symptoms.

Why did an epidemic of ‘alarm fatigue’ break out in that hospital? Why so many alarms? To allow a stretched staff to monitor the maximum number of patients possible on an average shift, without reserve capacity for a bad shift where all the alarms are going off at once– that’s my guess.

When corporations brag about getting ‘lean and mean’, you better worry that things can get thin and nasty.

Alarms are dumb. They do not have the power of reason or any of the perception of a trained human being who comes to the bedside. They have their place, but are not a substitute for adequate staffing.

‘Understaffing’ is a boring old word we are tired of hearing, since nurses keep going on about it for decades of labor disputes and public lobbying. It’s hard to get a catchy headline going about understaffing. We’ve heard it all before.

But look at the obvious. When there’s constant screaming alarms and the staff is fatigued they need more staff.

5,000 Nurses in Ten Years

That’s the estimate of what Rhode Island will need for the health care work force. A new charter school is focused on vocational training…

PROVIDENCE –

They are the nurses of the future in a classroom setting that’s unique.

The Rhode Island Nurses Institute Middle College, a new charter school in Providence, opened Monday with a ribbon-cutting ceremony.

“A brand new model that creates a bridge from high school to college, and that’s a very exceptional thing,” said superintendent Robert Pilkington.

The school incorporates grades 10, 11, 12 and something called 12-plus.

“And during that fifth year of high school, the students are dually enrolled. They stay in the high school environment for safety and supportiveness, but they’re challenged with the college curriculum so that when they graduate from our 12-plus year, they’ll be college sophomores,” Pilkington said.

So many students sit in classrooms with no clear idea of how education translates into vocation. These students know that jobs are waiting for them, I wish we could say that to all our youth– give them a sense that they are wanted and needed.

There will inevitably be students who complete this program, and realize that nursing is not for them. What will they have to show for their five years? A solid grounding in math and biological sciences, a habit of thinking of how education can translate into skills that benefit society. They’ll have a head start on college.

I hope Nurses Institute makes time for some liberal arts. You don’t get through a nursing career without something to feed your soul.

Divorce, Alzheimer’s and Pat Robertson

So why is anything Pat Robertson says worth listening to? He has been spouting hateful nonsense for years– reliably blaming the latest natural disaster on the gays, the feminists, the pagans. He makes wack predictions about who is on God’s hit list, and the Lord continually fails to come through with tsunamis on the West Coast or nukes in Jerusalem. He has a worse track record than the Reverend Tillman Gandy Jr., who accurately predicted that we would all eventually die.

But unlike Rev.Gandy, who dressed to the nines as he exhorted on Westminster Mall in all seasons, Pat Robertson is a rich man and a political player. I regularly see his evil leprechaun face on the tube as I visit the elderly. His 700 Club mimics network news so closely that it is often indistinguishable from Fox– which is a paragon of journalistic excellence in comparison.

Robertson’s international meddling would be called out for what it is– pulling an end run around US diplomacy and playing with fire– except for one thing. He delivers the votes. He has a following.

Life is hard, unfair and complicated. You can deal with it in one of two ways. You can accept that we are all in the same boat and invested in bailing– or look for someone to blame until the Heavenly Coast Guard appears to rescue the worthy and drop a nuke on the floating sinners Left Behind. From my vantage point, as a provider of services to the disabled and elderly, Robertson’s simple narrative looks like a seductive con.

My clients and patients are those who are dealing with the very issues Robertson raised when he said that divorce would be an option for a man whose wife had Alzheimer’s disease. And my clients have shown me why Robertson is wrong on two counts. 1. Dementia is not death. 2. Divorce is not the answer.

I once worked in a nursing home where I cared for a woman who was unable to pick up a spoon to feed herself. I noticed her clear complexion and unlined face, the look of top-shelf plastic surgery. Someone told me she had been a Rockette. If not for dementia she would have been beautiful.

Every day her husband came in to feed her lunch. One day I heard him ask, “Do you know who I am?”
She struggled to remember.
“The handsome guy.”, she said.

Alzheimer’s is nothing to snark about– there’s no easy answers and we boomers are in the middle of this horrible epidemic. Some of us are seeing our parents fade away, others are suffering themselves, or watching their life partners lose their independence and abilities. William Saletan, at Slate.Com has a compassionate take on what Robertson really said, and meant, in his advice to the man whose wife was far advanced in dementia. I see Saletan’s point, but I don’t agree with Robertson’s advice.

Robertson, quoted by Saletan, says this–

I know it sounds cruel, but if he’s going to do something, he should divorce her and start all over again. But to make sure she has custodial care and somebody looking after her—

There’s the catch. Unless you are on a level with Robertson and his high-rollers you do not reach retirement age with the resources to support long-term care for a disabled spouse while starting a new marriage. You and your spouse are tied legally and financially, this illness is a financial disaster. Good traditional wives who stayed at home with their families depend on their husband’s Social Security and Medicare, or Medicaide if they are low-income. Divorce is not just cutting loose from a conjugal relationship, it’s cutting off financial support.

Another catch is that Alzheimers is a cruel and unpredictable disease. While it may be true, as Robertson says, that the affected spouse has suffered a kind of death, they are very much alive. They can suffer. They can have moments of happiness. They can unexpectedly clear and be whole for a time. They are still human.

I have seen many spouses, partners, relatives and friends faithfully visit their loved ones in nursing homes and I want to say this–it really matters. Sick is not dead. Even if it seems the visit is forgotten in minutes it was the bright spot in a day of confusion and lostness. Love is never wasted.

If everyone who had a spouse with dementia took Pat Robertson’s advice, it would be a lonelier world for people adrift in illness. It would also be a financial mess for our health care system. Who would pick up the slack if healthy people decided to separate their affairs from their disabled spouses? The government, of course. The couple are probably already on Medicare, but this would add to the burden on state Medicaide, and raise questions as to who would be the power of attorney for health decisions. The kids, if there are kids, will not take this well. They are trying to get their own children through young adulthood and are not looking to take responsibility for their sick Mom so that Dad can marry his girlfriend.

I have a reality-based alternative to Robertson’s advice to seek a divorce and re-marriage.

Stay married. You vowed to stay faithful through sickness and in health. There’s reasons for this and it’s not about romance. It’s about survival. As our gay friends have been trying to explain for the last few years, marriage is a legal contract that gives recognition and protection to the couple who take those vows. In the course of life, the best we can hope for is to survive our parents. Marriage is our way of making a family for the rest of our lives. For better or for worse, in sickness and in health. We need that commitment.

Secondly, a pagan word of advice. Commit adultery.

I have seen husbands and wives visit their spouse daily, sometimes several times a day, when the loved one was unable to converse, or to do anything except appreciate that they were in the presence of someone who cared about them. There was no hope of recovery, this was devotion in the long haul. The able partner faithfully gave what was needed.

I don’t think a person in a nursing home with Alzheimer’s needs their spouse to sit alone at night. They need them to visit during the day. That’s no small thing.

Robertson’s idea that it satisfies morality to cut loose from a disabled spouse so you can marry someone else doesn’t match up with reality. A disabled person in the medical system needs an advocate and defender. They need someone who has the authority to speak up for their interests. Again, this is one of the reasons gay people want the right to full legal marriage. Children, friends and social workers might care, but no one else has the power that a marriage partner has. Keeping faith may not be about sex anymore, but that connection is a lifeline, sometimes literally.

I don’t think that ‘handsome guy’, who was not young himself, was spending his evenings cruising for chicks. I hope he had old friends, family and companions to help him through the loss of his wife. It’s cruel when the loss is by inches. He probably needed some care, himself.

The forecast is that a silver tsunami is approaching, and these troubles will get worse. Retirement expectations have diminished with this bad economy, maintaining one household is going to be a challenge, never mind two. It’s a good idea to withhold judgement on how couples manage their changing relationships, and focus on the essentials. How they keep faith is an individual thing. But that they must keep faith is clear. There’s no one else to pick up the slack.

President Ruth Simmons

Brown University is a short walk away from my house, but unless I’m cutting across the quad, university business is not on my radar.

I can only name two Brown presidents– Vartan Gregorian and Ruth Simmons. I think it’s because both reached out to the greater community and all the students of Providence, and both were such warm and effective communicators.

Doctor Simmons gave Brown a running start into the 21st Century. Her defense of free speech, even at personal cost, her institution of need-blind admissions, and her straightforward confrontation of Brown’s legacy of slavery may stand longer than the buildings that rose during her tenure.

Good luck, Doctor Simmons in all you do.

ProJo.com has a timeline of Ruth Simmons’ tenure at Brown.

It’s All Obama’s Fault

Violent crime has shown large declines in the past two years..

Violent crime fell significantly last year in cities across the U.S., according to preliminary federal statistics, challenging the widely held belief that recessions drive up crime rates.

The incidence of violent crimes such as murder, rape and aggravated assault was down 5.5% from 2008, and 6.9% in big cities. It fell 2.4% in long-troubled Detroit and plunged 16.6% in Phoenix, despite a perception of rising crime that has fueled an immigration backlash.

The early figures, from the Federal Bureau of Investigation, indicate a third straight year of decreases, along with a sharply accelerating rate of decline.

And continues to fall.

This good news, of course, is due to multiple factors, though the Wall Street Journalarticle does mention that stimulus money helped keep police on the street. I wonder if the greying of America is part of the picture? You get old, mellow out, just don’t get into robbing banks the way you used to. Just a thought.

Free to Die

Economist Paul Krugman in today’s New York Times takes a closer look at Libertarian views about ‘freedom’. Millions of American children, for instance, make the ‘bad choice’ of being born to to poor parents– should taxpayers bail them out?

So would people on the right be willing to let those who are uninsured through no fault of their own die from lack of care? The answer, based on recent history, is a resounding “Yeah!”

Think, in particular, of the children.

The day after the debate, the Census Bureau released its latest estimates on income, poverty and health insurance. The overall picture was terrible: the weak economy continues to wreak havoc on American lives. One relatively bright spot, however, was health care for children: the percentage of children without health coverage was lower in 2010 than before the recession, largely thanks to the 2009 expansion of the State Children’s Health Insurance Program, or S-chip.

And the reason S-chip was expanded in 2009 but not earlier was, of course, that former President George W. Bush blocked earlier attempts to cover more children — to the cheers of many on the right. Did I mention that one in six children in Texas lacks health insurance, the second-highest rate in the nation?

This sounds like flaming partisanship but it is sober fact– such a shocking truth that we don’t want to face it. We have a highly developed system for dealing with acute health emergencies, but we are failing in preventive care. It makes no sense in terms of basic self-interest, never mind morality.

The unspoken assumption in the concept of ‘choice’ is that we are all born with a menu of choices before us, and some foolishly choose to be sick, or poor, or victims of discrimination. In real life, most of us choose as best we can from what seems possible. If health care is available and affordable to most, but out of reach for some, then individual choice is not the problem. The problem is justice and wise leadership.

It is the role of government to promote the public good, and especially the good of the next generation. We will all be older, most of us won’t be richer. What kind of nation do we want to be?

MORE: Echidne of the Snakes has a good explanation of why the current mess, which has disincentives for young people to buy health insurance or use preventive care, is economically dumb.

Get Ron Paul off Rt. 195

Really. I was driving over the I-way and there on the India Point Park pedestrian bridge was a banner–‘Ron Paul for President’.

Paul zealots are far from the only ones to use the interstate as free advertising, putting their stamp on public property, and I’ve seen this stunt many times, for many causes.

But if you must put a distracting nuisance in the way of drivers who should be concentrating on the traffic–

FOR THE LOVE OF GOD DON’T TIE IT TO THE OUTSIDE OF THE FENCE!

I know I must die sometime, but I don’t want to leave this world with a flying Ron Paul sheet covering my windshield.

Ron Paul says he is the candidate of personal responsibility. So who’s responsible for taking that sheet down when the elements reduce it to a frayed Sword of Damocles dangling over rush hour. Huh?