Working At A Nursing Home Part II

June 20th, 2009

In Part I, we looked at the trauma surrounding being in a nursing home from the patient’s point of view. But what’s it like for the staff at a nursing home? They’re dealing with people traumatized by the effects of aging, injury, and illness. These people are not happy about suddenly being in a dormitory-type setting with a bunch of other people with whom they have little in common except misery. You may be glad you’re alive but it’s not easy to be optimistic in that setting!

It isn’t easy on the staff either. They don’t have the immediate glory of saving a life quickly or seeing results on the spot. (Although I do work at nursing homes that post the number of annual successful discharges, which is optimistic and rewarding to both staff and patients.) But by and large, working at a nursing home means long hours, constant messes to clean up, constant medical treatment to be given, and everything that goes along with managing a large building full of very cranky people who are not particularly grateful that life put them there.

Imagine trying to handle keeping a large building clean, laundry restocked, meals prepared, etc., and at the same time that building is full of people who needs medicine administered, blood tested, physical therapy provided, baths and showers and changing of diapers and bandages on a regular basis, I could go on and on. But the point is, as we saw in Part I, those are people! Real human beings with all the complex emotions and behaviors they had before they got into this situation. This complicates the logistics and problems enormously!

All old and/or sick people are not alike. There are many possible ways a person can cope with aging and illness. Dealing with the shock, grief, and trauma that brought you here is just part of the situation. Finding the courage to take new steps is difficult when all about is already unfamiliar. Personality issues you haven’t resolved may resurface or become worse. Activities and hobbies are not passion; they don’t necessarily contain or encourage zest, an all-consuming interest, or motivation to continue

Repetition is not a substitute for motivation. Following someone else’s schedule is not the same as having a real life. Understanding and a sense of having choices is important to healing. Cognitive limitations and personality issues may interfere with this ability. Patients may keep up a front or drop masks entirely. They may be active or withdraw completely. They may try to consolidate the old and wish to explore new and unconventional behaviors. They may be feisty or stern or always cheerful. In short, you never know how someone will behave.

Worse yet, disturbing traits are likely to be exacerbated by stress, illness, and old age. The mean get meaner, the fearful get more afraid, and the apathetic sink into near paralysis.

But it denigrates their humanness to exempt the old and the ill from personal responsibility. They are not moral eunuchs. They can still do harm, and they can still atone. They are still capable of cruelty and greed and assorted misdeeds.

The good news is that, as human beings, we are never a finished product. We can refine and rearrange and reverse and improve. Change is inevitable, but it is up to us to use what choices we make to adapt to change with grace and dignity.

How can staff help these larger issues? By seeing their patients as the human beings they are. By knowing their names and respecting their humanity. By accepting that the patient didn’t ask to be in this situation. By keeping their focus on the larger goal, and not getting lost in the messy details. In a thousand tiny ways, everyday, nursing home staff can make healing more likely.

Remember that out of Chaos, through encouragement and initiative, can come Creation and Renewal.

Everybody who works at a nursing home (by whatever name it’s called!) has a vital role to play in the healing process. Because of all the differences among facilities, I’d leave somebody out if I tried to list all the jobs. It isn’t just Medical Doctors and Primary Care Physicians. There are Certified Nurse Assistants as well as Registered Nurses. There are Social Workers and Case Managers and Psychologists. There are Psychiatrists and PPN’s who function as psychiatrists. There are Physical Therapists and Occupational Therapists, Speech Therapists and Recreational Therapists.

That’s a partial list and it leaves out Administration, who have to make sure that the whole team and the whole building functions smoothly, because lives are at stake. Don’t make fun of bureaucracies because even those who never see a patient are making sure there are clean bandages, needed medicine, accessible medical records, and all the other things essential to the survival of the patients under their care.

Yes, I know there are nursing homes that get it wrong and lose sight of the very patients they are supposed to be helping. But before we can even discuss them, it helps to understand what an enormous job it is to begin with. I’m always amazed at the number of facilities that mostly get it right! I applaud the ones whose staff maintain their respect for the humanity of patients, who encourage healing and growth, and who, even when exhausted and trying to do the work of ten, remember to smile at a patient and greet him or her by name.

I ask for reform in many areas, and healthcare is a major one. But I always acknowledge the work of people who do do their jobs well, even under the most adverse conditions. Because they prove it can be done well! And I do work for understanding between different perspectives.
In this case, as with so many others, it’s very clear that both sides have a difficult job because of the very nature of the situation. There’s no magic pill or simple solution, not even throwing money at the problem. It’s going to take thought and creativity and personal responsibility, as well as a clear understanding of our priorities as a society.

Why Is “Nursing Home” a Scary Phrase? Part I

June 20th, 2009

The reality is that most people equate going into a nursing home with a fate far worse than death or zombiehood. And what’s even sadder is that most people who work in nursing homes feel they are dealing with the most difficult patients in the world. Both of them have reasons for the way they feel. So in this two-part series, I’ll try to explain the problem from both sides.

Remember that nobody goes to a nursing home because they wanted to. Call it a Rehab Center, or a Sub-Acute or Skilled Nursing Facility, the fact is that people are there because something terrible happened to them! They had a terrible injury, a life-threatening illness, or a disability beyond their ability to cope. Or they just got old and didn’t have the financial, physical, or mental capacities to handle everyday life itself. None of these are pleasant things. All of them pull the rug out from under you and knock you flat on your rear!

It can make you pretty depressed, anxious, angry, and just plain unsocial for a while.

First of all, getting old has some real disadvantages. Earlier aspects of your life do not remain the main purpose of your life. You may have retired from your career, lost your spouse through death or divorce, and your children are grown and have their own lives now. Nothing is the same, and that can feel very unsettling.

Then there is the nearness of death itself. If you were born, the only thing I can guarantee is that someday you will die. Proverbs to the contrary, death is more certain than taxes! If you have lived a long life already, death feels a lot closer. If you have just come from a life-threatening crisis at the hospital, it feels pretty close no matter what age you are. How do we prepare for contentment and peace when life ends? It’s not an easy task, even if it is a necessary one.

If the physical strength or beauty that you possessed, and the joys of the senses were among life’s greatest values, what do you do when they ebb away?

Besides, you’re still the person you always were inside. In fact, you’re likely to get more so as you age. The down side is that unresolved problems can become intensified, and some patterns of behavior that were only mildly maladaptive before are now making you dysfunctional.

I can quote from Greek, Chinese, even Ancient Egyptian sources, and show you that people have always recognized this. Did you think you would escape the fate of being mortal? Sorry, but we move from the familiarity, safety, and security of the life we’ve built to the uncertainty and vulnerability of another. And we have no other choice! No wonder we feel pain and grief.

Being in a medical care facility, whether hospital, nursing home, or rehab center just adds to the burden. 1) All of the burdens cited above are intensified. 2) The loss of independence, self-respect, and dignity are all exacerbated when we are struck down by physical illness. 3) We must trust our very being to the care of total strangers. 4) We loss all privacy, all choices, and have very little control over anything.

Yes, I know it’s being done to save your life. But when it happens to you, it feels more like life has been taken away. In a sense, it has.

Human beings are simple, like a piece of furniture. We are composed of many aspects, and all of them are affected by age and illness. Nothing is “all in your mind” because the last time I looked, your mind and your body lived in the same place! And they are always interacting. In fact, when I think of the human, I have to add the heart and the spirit into the mix, because human beings are feeling many more things besides just thinking and physical sensations.

Actually, you can use any schema or worldview you want. Just be sure it includes all the complexities of being human. Bear with me while I try to explain it in my fashion:

The Body is deteriorating and weakening. It is now fragile and easily sickened. It may lose control of unmentionable things like peeing, shitting, or bleeding. This is not only hard to comprehend when it happens to you, it is also terrifying!

The Mind finds that its memory and attention span are decreasing. As things become difficult, our own expectations of ourself can become negative and self-defeating.

The Heart is grieving. Many friends have died or moved. We’re in a place where the surroundings, the environment, even the language of people around us may be un familiar. Grief and loss predominate in our immediate feelings.

The Spirit may know that the need to move to an inner life is normal at this stage. Some cultures even have a description or place in life’s stages for it. But that inner life must be enriched and it must be supplemented by a full outer life.

The deepest misery comes from those who feel they are doing nothing. Patients may feel that their potential is locked up by their illness, their physical limitations, or just by being in a medical facility.

A dear, dear friend, mentor, and colleague of mine gave me the solution. Dr. Roy P. Fairfield, educator, historian, author man of almost unlimited interests and talents, is now 90. And he, in his firm New England way, decided that this nonsense wasn’t for him. Re-Firement, not retirement became his motto. And so, with his permission, I share it with you.

Re-Firement is the way to avoid getting stale and cranky. The delight of self-discovery is always available to us. This is also a time when you can become more authentic and find your own identity. Exercise and movement slow physical aging and help heal illness. And even more important, activities done with real passion and a social life that isn’t superficial slow down the other aspects of aging and help the soul heal itself.

The future can always be happier! How much time it contains doesn’t matter as much as how happy it is.

In the second part of this article, I’ll talk about the other side of the situation: some of the cautions and concerns involved, and the problems nursing home staffs face in dealing with them.

Pluralism is the Strength of Our County!

June 20th, 2009

I keep getting myself in trouble at social dinners for the simple statement that I am mixed blood. I simply refuse to self-identify as “white”, a meaningless term with lots of baggage that does disservice to my family’s wonderfully rich background. (Obviously I am turning into a somewhat controversial guest to have at dinner, albeit inadvertently.)

For one thing the word “white” has no meaning and no real definition. As one young dinner guest pointed out recently, “I thought white was just what everybody aspired to be?”  That’s not an unfair summary of U.S. history. I still have a sign from Boston dated 1918 that says “No Irish Need Apply!” In some post-Civil War southern states hiring the :shanty” Irish was considered an nearly-acceptable alternative to owning the African-American slaves who no longer existed as slaves. Leasing convicts was about the only other option available.

And I’m used to hearing “Canuck” applied in various tones of voice to other branches of my family tree. And then there’s my great-great-grandmother, the Algonkin who married a French merchant in Quebec City, Canada. Not only did she gives up her native tongue when she married, she wore French clothes and spoke only French ‘til the day she died. How do I know? Because I was lucky enough to meet some of my great-parents when I was a child and heard stories told with some pride in her sacrifice but more embarrassment over her heritage. Only one picture (a portrait, a daguereotype?)
Existed of her because, as the family said in hushed tones, “She was a bit dark skinned, you know.”

In Canada today, which has First Nations terms not used in the U.S., I would be considered “Metis”. (Someday I’ll talk about Louis Real and the great Metis Uprising that actually got the Canadian Pacific Railroad the government funding it needed for compleion so the Royal Mounties could be speedily swept to central Canada to quell these uppity “savages.” The word Metis itself literally means mixed, but I was brought up to deck anyone who called me a “half-breed.”

And then there’s my grandfather Nikolai. I didn’t even find out his name until my father lie on his deathbed in 1995. You see, grandfather Nikolai had died in the War To End All Wars (WWI) and his memory was preserved by denying his heritage and pretending he was “Polish.” But when I worked in Poland in the 1980’s and tried to trace my family tree, my Polish friends sadly informed me that his last name was not Polish and most likely Russian. (And possibly not a “true” Russian, but a gypsy or worse yet, a Jew!) He had apparently passed for Polish when he immigrated to the U.S. because of all the languages he spoke. Lost in a semi-safe crowd at the height of the Cold War, he disappeared from family respect.

When I describe my childhood, I explain it was somewhat like the United Nations backstage, with everybody squabbling or ignoring each other in a multitude of mutually-unintelligible languages. God help the poor victim who married into the family from another background and was subject to the hostility vented on the “outsider.” My favorite maternal aunt was shunned from almost the whole family because she had the nerve to marry an “Eye-talian” whom she loved. Fortunately, he had a large family who took her in with adoration, she learned to be a great Italian cook, and they lived happily with their children for decades.

My poor mother was Irish & French-Canadian (both suspect) and was never considered to belong. Since the big goal of every immigrant to this country was to pass for Anglo-British, she bleached my fine baby hair to straw with undiluted peroxide, pinned it into painful Shirley Temple curls, and harshly slapped me or washed my mouth with soap if I dared picked up a word of the many languages spoken around me. I had to pass for “white”, as in WASP, which left a bad taste in my mouth forever after.

I was half-raised by my grandmother Mary Katherine Lynch from County Claire in Ireland, and thank God for her intervention and that of her large brood of my mother’s siblings. My ancestors sit beside me at every dinner table and I wouldn’t desecrate their lives by labeling myself “white” a bland and vague word associated with white supremacy, the KKK, terror, and a general, overwhelming assumption of superiority and power, especially if they are male to boot!

In my teens I was “adopted” by Matchwaya Rom in New York City, and treated and taught as a daughter. I lived in Hawai’I and saw true pluralism in everyday life. I was befriended by a Japanese family who had lived through WWII, and knew how close they were to being interred in a U.S. concentration camp as an not-white enemy. In Nepal and India I was given a name and a caste (Matwali that of Sherpas and foreign anthropologists) to bring me into the group, and in Haiti, my friends introduced me as their cousine and insisted joyfully that I must be part African.

I could go on and on, but the bottom line is that I have been naïve enough to be believe that E Pluribus Unum actually means from the many to One. I believe we are humans, and cannot see each other in groups of us versus them.

And the saddest thing to me is that we as a country cannot see Mr. Obama as our first truly mixed president because way too many people are so obsessed with just one strain of the many rich traditions and bloodlines that make him what he is: a man with just as rich a heritage as most of us have, more truly representative perhaps than any before him of the real population of this United States!

Working At A Nursing Home Part II

May 25th, 2009

In Part I, we looked at the trauma surrounding being in a nursing home from the patient’s point of view. But what’s it like for the staff at a nursing home? They’re dealing with people traumatized by the effects of aging, injury, and illness. These people are not happy about suddenly being in a dormitory-type setting with a bunch of other people with whom they have little in common except misery. You may be glad you’re alive but it’s not easy to be optimistic in that setting!

It isn’t easy on the staff either. They don’t have the immediate glory of saving a life quickly or seeing results on the spot. (Although I do work at nursing homes that post the number of annual successful discharges, which is optimistic and rewarding to both staff and patients.) But by and large, working at a nursing home means long hours, constant messes to clean up, constant medical treatment to be given, and everything that goes along with managing a large building full of very cranky people who are not particularly grateful that life put them there.

Imagine trying to handle keeping a large building clean, laundry restocked, meals prepared, etc., and at the same time that building is full of people who needs medicine administered, blood tested, physical therapy provided, baths and showers and changing of diapers and bandages on a regular basis… I could go on and on. But the point is, as we saw in Part I, those are people! Real human beings with all the complex emotions and behaviors they had before they got into this situation. This complicates the logistics and problems enormously!

All old and/or sick people are not alike. There are many possible ways a person can cope with aging and illness. Dealing with the shock, grief, and trauma that brought you here is just part of the situation. Finding the courage to take new steps is difficult when all about is already unfamiliar. Personality issues you haven’t resolved may resurface or become worse. “Activities” and hobbies are not passion; they don’t necessarily contain or encourage zest, an all-consuming interest, or motivation to continue

Repetition is not a substitute for motivation. Following someone else’s schedule is not the same as having a real life. Understanding and a sense of having choices is important to healing. Cognitive limitations and personality issues may interfere with this ability. Patients may keep up a front or drop masks entirely. They may be active or withdraw completely. They may try to consolidate the old and wish to explore new and unconventional behaviors. They may be feisty or stern or always cheerful. In short, you never know how someone will behave.

Worse yet, disturbing traits are likely to be exacerbated by stress, illness, and old age. The mean get meaner, the fearful get more afraid, and the apathetic sink into near paralysis.

But it denigrates their humanness to exempt the old and the ill from personal responsibility. They are not moral eunuchs. They can still do harm, and they can still atone. They are still capable of cruelty and greed and assorted misdeeds.

The good news is that, as human beings, we are never a finished product. We can refine and rearrange and reverse and improve. Change is inevitable, but it is up to us to use what choices we make to adapt to change with grace and dignity.

How can staff help these larger issues? By seeing their patients as the human beings they are. By knowing their names and respecting their humanity. By accepting that the patient didn’t ask to be in this situation. By keeping their focus on the larger goal, and not getting lost in the messy details. In a thousand tiny ways, everyday, nursing home staff can make healing more likely.

Remember that out of Chaos, through encouragement and initiative, can come Creation and Renewal.

Everybody who works at a nursing home (by whatever name it’s called!) has a vital role to play in the healing process. Because of all the differences among facilities, I’d leave somebody out if I tried to list all the jobs. It isn’t just Medical Doctors and Primary Care Physicians. There are Certified Nurse Assistants as well as Registered Nurses. There are Social Workers and Case Managers and Psychologists. There are Psychiatrists and PPN’s who function as psychiatrists. There are Physical Therapists and Occupational Therapists, Speech Therapists and Recreational Therapists.

That’s a partial list and it leaves out Administration, who have to make sure that the whole team and the whole building functions smoothly, because lives are at stake. Don’t make fun of bureaucracies because even those who never see a patient are making sure there are clean bandages, needed medicine, accessible medical records, and all the other things essential to the survival of the patients under their care.

Yes, I know there are nursing homes that get it wrong and lose sight of the very patients they are supposed to be helping. But before we can even discuss them, it helps to understand what an enormous job it is to begin with. I’m always amazed at the number of facilities that mostly get it right! I applaud the ones whose staff maintain their respect for the humanity of patients, who encourage healing and growth, and who, even when exhausted and trying to do the work of ten, remember to smile at a patient and greet him or her by name.

I ask for reform in many areas, and healthcare is a major one. But I always acknowledge the work of people who do do their jobs well, even under the most adverse conditions. Because they prove it can be done well! And I do work for understanding between different perspectives.
In this case, as with so many others, it’s very clear that both sides have a difficult job because of the very nature of the situation. There’s no magic pill or simple solution, not even throwing money at the problem. It’s going to take thought and creativity and personal responsibility, as well as a clear understanding of our priorities as a society.

Why Is “Nursing Home” a Scary Word? Part I

May 15th, 2009

The reality is that most people equate “going into a nursing home” with a fate far worse than death or zombiehood. And what’s even sadder is that most people who work in nursing homes feel they are dealing with the most difficult patients in the world. Both of them have reasons for the way they feel. So in this two-part series, I’ll try to explain the problem from both sides.

Remember that nobody goes to a nursing home because they wanted to. Call it a Rehab Center, or a Sub-Acute or Skilled Nursing Facility, the fact is that people are there because something terrible happened to them! They had a terrible injury, a life-threatening illness, or a disability beyond their ability to cope. Or they just got old and didn’t have the financial, physical, or mental capacities to handle everyday life itself. None of these are pleasant things. All of them pull the rug out from under you and knock you flat on your rear!

It can make you pretty depressed, anxious, angry, and just plain unsocial for a while.

First of all, getting old has some real disadvantages. Earlier aspects of your life do not remain the main purpose of your life. You may have retired from your career, lost your spouse through death or divorce, and your children are grown and have their own lives now. Nothing is the same, and that can feel very unsettling.

Then there is the nearness of death itself. If you were born, the only thing I can guarantee is that someday you will die. Proverbs to the contrary, death is more certain than taxes! If you have lived a long life already, death feels a lot closer. If you have just come from a life-threatening crisis at the hospital, it feels pretty close no matter what age you are. How do we prepare for contentment and peace when life ends? It’s not an easy task, even if it is a necessary one.

If the physical strength or beauty that you possessed, and the joys of the senses were among life’s greatest values, what do you do when they ebb away?

Besides, you’re still the person you always were inside. In fact, you’re likely to get more so as you age. The down side is that unresolved problems can become intensified, and some patterns of behavior that were only mildly maladaptive before are now making you dysfunctional.

I can quote from Greek, Chinese, even Ancient Egyptian sources, and show you that people have always recognized this. Did you think you would escape the fate of being mortal? Sorry, but we move from the familiarity, safety, and security of the life we’ve built to the uncertainty and vulnerability of another. And we have no other choice! No wonder we feel pain and grief.

Being in a medical care facilyt, whether hospital, nursing home, or rehab center just adds to the burden. 1) All of the burdens cited above are intensified. 2) The loss of independence, self-respect, and dignity are all exacerbated when we are struck down by physical illness. 3) We must trust our very being to the care of total strangers. 4) We loss all privacy, all choices, and have very little control over anything.

Yes, I know it’s being done to save your life. But when it happens to you, it feels more like life has been taken away. In a sense, it has.

Human beings are simple, like a piece of furniture. We are composed of many aspects, and all of them are affected by age and illness. Nothing is “all in your mind” because the last time I looked, your mind and your body lived in the same place! And they are always interacting. In fact, when I think of the human, I have to add the heart and the spirit into the mix, because human beings are feeling many more things besides just thinking and physical sensations.

Actually, you can use any schema or worldview you want. Just be sure it includes all the complexities of being human. Bear with me while I try to explain it in my fashion:

The Body is deteriorating and weakening. It is now fragile and easily sickened. It may lose control of unmentionable things like peeing, shitting, or bleeding. This is not only hard to comprehend when it happens to you, it is also terrifying!

The Mind finds that its memory and attention span are decreasing. As things become difficult, our own expectations of ourself can become negative and self-defeating.

The Heart is grieving. Many friends have died or moved. We’re in a place where the surroundings, the environment, even the language of people around us may be un familiar. Grief and loss predominate in our immediate feelings.

The Spirit may know that the need to move to an inner life is normal at this stage. Some cultures even have a description or place in life’s stages for it. But that inner life must be enriched and it must be supplemented by a full outer life.

The deepest misery comes from those who feel they are doing nothing. Patients may feel that their potential is locked up – by their illness, their physical limitations, or just by being in a medical facility.

A dear, dear friend, mentor, and colleague of mine gave me the solution. Dr. Roy P. Fairfield, educator, historian, author man of almost unlimited interests and talents, is now 90. And he, in his firm New England way, decided that this nonsense wasn’t for him. “Re-Firement, not retirement” became his motto. And so, with his permission, I share it with you.

Re-Firement is the way to avoid getting stale and cranky. The delight os self-discovery is always available to us. This is also a time when you can become more authentic and find your own identity. Exercise and movement slow physical aging and help heal illness. And even more important, activities done with real passion and a social life that isn’t superficial slow down the other aspects of aging and help the soul heal itself.

The future can always be happier! How much time it contains doesn’t matter as much as how happy it is.

In the second part of this article, I’ll talk about the other side of the situation: some of the cautions and concerns involved, and the problems nursing home staffs face in dealing with them.

What I’ve Been Up To!

May 7th, 2009

If you have noticed some erratic behavior on the part of this site, it’s because so much has been happening! With the book published in December 2008, and the ordeal nearing an end, I knew I wanted to be in an area with far more resources than I’d been in the last five years. So on the 1st of March, 2009, I closed my office doors in Butte County and moved to San Jose, California, in what is basically considered the South Bay area of San Francisco. It’s been 2 months and I admit to living out of a suitcase for 3 weeks, but with the help of my sons, life is finally beginning to settle down. There are far more medical facilities here for me to work at. I have a private office and a rapidly growing practice, both in clinical therapy and in forensics.

Many universities abound in the area, and in Palo Alto is the Stanford Center on Interdisciplinary Policy, Education, and Research, where I hope to be able to pursue my interests in making this a safer world for all of us. I’ve been nominated to the American Board of Intelligence Analysts, and I look forward to serving Homeland Security interests in a humane and valuable way.

Meanwhile, I still pursue legal system and healthcare system reform, and have found many more resources and opportunities than have been available in other locations. In addition, I get to do more publicity regarding the sad state of affairs in legal corruption in California. It wasn’t safe to publicize the book until April10th, 2009, so I’ve finally been able to push hard to get the story out. A number of organizations are helping to get the word out, and I look forward to talks and book-signings across the area soon.

There are volunteer activities, and museums and libraries to explore, and I’m in heaven with all the doors that are opening. The welcome that I’ve received in the area has exceeded every expectation that I had, and I am delighted with a rapidly growing support system of friends and colleagues. I’m working on at least two papers fro presentation, and another (more positive!) book to be published by the end of the year.

And not to forget the spiritual side of life, I have to admit that the wealth of interdenominational dialogues here has been a source of joy and comfort. I know we have to co-exist on this world and in this country, with respect, kindness, and personal responsibility to each other. I seem to be receiving a multitude of chances to do so, and I am so grateful.

I admit it! Despite all the agony of relocation, being here in the Greater San Jose Area is balm to my soul, and therapy for my mind and body. Those who have read Surviving Human Venom will understand how incredibly healing my new life here is.

Wish me well and make prayers for me in whatever way suits you best; I welcome all your good wishes and give thanks to Creator daily!

Is It Possible to Reform Health Care?

April 22nd, 2009

Sometimes a topic is just so big that I find myself gathering data until the pile is enormous but unable to write about it until a specific incident triggers an outpouring of all the information I’ve stored! Healthcare is a good example of this. Since I’m right in the middle of the maelstrom of controversy, I find myself almost overwhelmed by it all. Not that incidents don’t occur almost daily that should act as triggers. But where do I begin?

There are patients who’ve never seen their actual M.D.’s, or only seen them for a total of 15 minutes over the course of a year. Multitudes of people are multiple medications, with no idea of which is for what symptoms or of the side-effects or drug interactions. There are patients who need to change life-style or unhealthy habits who can’t get a 30-minute consultation with their primary care physician. Well, the M.D. just doesn’t have time! He or she has to see too many patients just to pay his administrative costs, which have risen over 25 % in recent years.

I didn’t even mention paying off school loans for the arduous process of becoming an M.D., or of rising malpractice fees. I’m sympathetic to the realities of practice. As a psychologist, my own time spent on paperwork and non-patient time has risen to the point where I have to pay someone else to fill out forms, code procedures, follow up on billings and payments, etc. etc. etc. No wonder there’s a shortage of family physicians in the U.S.

And if you have Medicare or MediCal or worse yet, no insurance, it’s often difficult to even find a doctor who will accept you as a client. A government survey done in 2007, quoted by the AARP, states that the more than 1.3 million people on Medicare have difficulty finding a doctor. And since seeing a specialist often requires the referral of a primary care physician, you’re out of luck even if you have a clear idea of what you problem is.

With economic conditions getting worse, and people losing their coverage or cutting back, the situation is just getting worse. I found this out after my serious auto accident in 2004, as described in my recent book Surviving Human Venom. Even recommended treatments can be delayed or not covered, and the insurance company can cut those treatments off or raise your premiums beyond your ability to pay for reasons that often make no sense to the poor patient. I’ve seen Workers Comp patients have treatment delayed for years, while their condition worsened, because the insurance company argued with the need.

And despite the high cost of medical care, assuming you can afford appropriate treatment on a timely basis, the U.S still has much lower positive outcomes than many other developed countries. We’ve got over 46 million Americans without health insurance, and we spend over $8000 per year per capita on all Americans, but we have lower life expectancies, a higher rate of preventable deaths, and higher child mortality rates than many Western countries.

I haven’t even mentioned quality of life issues yet! Billions are spent on advertising to convince us that some magic pill will solve all our problems. But chronic conditions and chronic pain persist, and the suffering from depression and anxiety continue to escalate. To really put patients first, psychologists and other behavioral specialists should be part of every treatment team. But more often they’re relegated to the last resort of a frustrated and busy physician, who dooms you to failure by saying, “It’s all in your head! Go see a shrink!” That hardly sets up a positive expectation of success.

I hate to keep harping on personal responsibility. But it always gets back to that, doesn’t it? LBJ brought up the idea of healthcare “regionalism,” where every doctor, clinic, and hospital was affiliated with a regional medical educational center. But instead of thinking “teamwork and collaboration,” when the idea is brought up, most doctors think “oversight and supervision” and panic. Is this just ego?

Many doctors are afraid of any program that is designed to reward efficient, high-quality services because they are afraid they don’t want measures of provider effectiveness applied to them. Insecurity and a sheer meanness of spirit make them resist being accountable for the quality of their care. Integrated care approaches help cut costs while improving services, but that would mean sharing the “golden halo” with other specialists on the team. The most difficult patients often require the most care, but even they have an improved prognosis when evidence-based treatment models and a multi-person team that includes mental health professionals, nutritionists, and other specialists are used to really treat all aspects of the patient.

Putting the patient first should be the first characteristic of healing. And if that means evaluating what you’re doing, consulting with colleagues, working with emotions and thoughts and other intangibles, then so be it! Taking better care of all patients, not just the wealthy ones, should be the goal of any reform plan. Not just splinting the bone or bandaging the wound, but actually educating, reassuring, and motivating the patient, something you can’t do in a 10-15 minutes office visit!

The major psychological organizations are busy coming up with ways to integrate psychologists into interdisciplinary teams, to ensure quality in mental health practice, and to encourage support, consultation, and collaboration among providers. Let’s see that extended to all areas of medical care.

Since I’m more familiar with sub-acute and skilled nursing homes, I’ll put my thoughts into an article or two that should help both professionals and lay persons understand how these ideas of teamwork can be put into effect. Look for them next week or so, because I’ll try to explain all the parts of being human that need care if we’re actually going to heal anybody!.

Pluralism is the Strength of Our County!

April 12th, 2009

I keep getting myself in trouble at social dinners for the simple statement that I am mixed blood. I simply refuse to self-identify as “white”, a meaningless term with lots of baggage that does disservice to my family’s wonderfully rich background. (Obviously I am turning into a somewhat controversial guest to have at dinner, albeit inadvertently.)

For one thing the word “white” has no meaning and no real definition. As one young dinner guest pointed out recently, “I thought white was just what everybody aspired to be?”  That’s not an unfair summary of U.S. history. I still have a sign from Boston dated 1918 that says “No Irish Need Apply!” In some post-Civil War southern states hiring the :shanty” Irish was considered an nearly-acceptable alternative to owning the African-American slaves who no longer existed as slaves. Leasing convicts was about the only other option available.

And I’m used to hearing “Canuck” applied in various tones of voice to other branches of my family tree. And then there’s my great-great-grandmother, the Algonkin who married a French merchant in Quebec City, Canada. Not only did she gives up her native tongue when she married, she wore French clothes and spoke only French ‘til the day she died. How do I know? Because I was lucky enough to meet some of my great-parents when I was a child and heard stories told with some pride in her sacrifice but more embarrassment over her heritage. Only one picture (a portrait, a daguereotype?)
Existed of her because, as the family said in hushed tones, “She was a bit dark skinned, you know.”

In Canada today, which has First Nations terms not used in the U.S., I would be considered “Metis”. (Someday I’ll talk about Louis Real and the great Metis Uprising that actually got the Canadian Pacific Railroad the government funding it needed for compleion so the Royal Mounties could be speedily swept to central Canada to quell these uppity “savages.” The word Metis itself literally means mixed, but I was brought up to deck anyone who called me a “half-breed.”

And then there’s my grandfather Nikolai. I didn’t even find out his name until my father lie on his deathbed in 1995. You see, grandfather Nikolai had died in the War To End All Wars (WWI) and his memory was preserved by denying his heritage and pretending he was “Polish.” But when I worked in Poland in the 1980’s and tried to trace my family tree, my Polish friends sadly informed me that his last name was not Polish and most likely Russian. (And possibly not a “true” Russian, but a gypsy or worse yet, a Jew!) He had apparently passed for Polish when he immigrated to the U.S. because of all the languages he spoke. Lost in a semi-safe crowd at the height of the Cold War, he disappeared from family respect.

When I describe my childhood, I explain it was somewhat like the United Nations backstage, with everybody squabbling or ignoring each other in a multitude of mutually-unintelligible languages. God help the poor victim who married into the family from another background and was subject to the hostility vented on the “outsider.” My favorite maternal aunt was shunned from almost the whole family because she had the nerve to marry an “Eye-talian” whom she loved. Fortunately, he had a large family who took her in with adoration, she learned to be a great Italian cook, and they lived happily with their children for decades.

My poor mother was Irish & French-Canadian (both suspect) and was never considered to belong. Since the big goal of every immigrant to this country was to pass for Anglo-British, she bleached my fine baby hair to straw with undiluted peroxide, pinned it into painful Shirley Temple curls, and harshly slapped me or washed my mouth with soap if I dared picked up a word of the many languages spoken around me. I had to pass for “white”, as in WASP, which left a bad taste in my mouth forever after.

I was half-raised by my grandmother Mary Katherine Lynch from County Claire in Ireland, and thank God for her intervention and that of her large brood of my mother’s siblings. My ancestors sit beside me at every dinner table and I wouldn’t desecrate their lives by labeling myself “white,” a bland and vague word associated with white supremacy, the KKK, terror, and a general, overwhelming assumption of superiority and power, especially if they are male to boot!

In my teens I was “adopted” by Matchwaya Rom in New York City, and treated and taught as a daughter. I lived in Hawai’I and saw true pluralism in everyday life. I was befriended by a Japanese family who had lived through WWII, and knew how close they were to being interred in a U.S. concentration camp as an “not-white enemy.” In Nepal and India I was given a name and a caste (Matwali –that of Sherpas and foreign anthropologists) to bring me into the group, and in Haiti, my friends introduced me as their “cousine” and insisted joyfully that I must be part African.

I could go on and on, but the bottom line is that I have been naïve enough to be believe that E Pluribus Unum actually means “from the many to One”. I believe we are humans, and cannot see each other in groups of “us versus them.”

And the saddest thing to me is that we as a country cannot see Mr. Obama as our first truly “mixed” president because way too many people are so obsessed with just one strain of the many rich traditions and bloodlines that make him what he is: a man with just as rich a heritage as most of us have, more truly representative perhaps than any before him of the real population of this United States!

Does One Small Voice Really Matter?

April 5th, 2009

I was at a disturbing dinner table conversation with a group of young people the other day. (“Young,” in this case, meaning 20’s through 30’s.) The topic came up of whether one person’s voice speaking out was of any value. And the shocking consensus of the young people at that table was a resounding “no!”

I admit to being an idealist. I admit to having a vested interest in the topic since I tend to risk my job, welfare, or life speaking out against what is wrong. The latest book I wrote is just a recent example. But to hear these young people dismiss even the voices of Gandhi or Martin Luther King or JFK as meaningless! I was overwhelmed.

One of them even said “There were others saying the same thing. Gandhi just added to his voice to theirs.” That may be true, I acknowledged. But what if he hadn’t spoken? What if Martin Luther King hadn’t spoken? Would the course of history have been the same? At sixty years old, I’ve heard these people speak or seen the direct effect of their voices. It made a tremendous difference to my heart, soul, and mind. How could they be dismissed so casually?

One of the people at the table had recently passed the Bar Exam and was looking forward to working for Legal Aid. I asked her directly if she wouldn’t be one small voice speaking out for those who couldn’t speak for themselves. “Of course not” was her reply. I wondered how many real courtrooms she had been in, when the accused was too overwhelmed or scared or uneducated to speak for themselves. What happens when your lawyer disparages the very role of being that one voice who will speak for you?

At one point I had to go outside for some fresh air. The truth was that there were tears in my eyes, and I didn’t want to spoil an otherwise social evening. But I was terribly bothered. If you don’t speak up when there is an injustice, how do you know someone else will? What if there are other minds thinking the same thing, but afraid to speak their thoughts out loud?

Should I demean the achievements of President Obama because he only said what other people had said? Or should I applaud him for taking a strong public stance and trying for the chance to do something about what he thought was wrong? I believe that “Yes we can!” echoed the sentiments of many people but I’m still going to give credit to the man who said those words out loud and often enough that something changed. I don’t know yet how much he can accomplish in respecting what’s right about this country and fixing what’s broken, but I hope everybody begins to say to themselves “Yes I can!” when faced with something that needs repair.

I don’t want to think that “one small voice” doesn’t matter because my experience has taught me that it does!

Do I wish I had a louder voice or a bigger audience? Of course I do! I don’t have the money or the celebrity status to automatically be heard. And approaches to Attorney Generals, Grand Juries, and state representatives have just resulted in form letters saying “we don’t investigate individual cases.” I don’t understand that. If you don’t start by investigating one case, then how do you ever find the pattern of wrongdoing? But I’m not going to stop whistleblowing. To be silent in the face of venom would be worse.

I think the problems I’m working to call attention to are serious ones. They require resources and power to fix that I just don’t have by myself. So I do what I can, speak up whenever I can, and try to find the resources that can (and have the guts to!) investigate and fix a broken system.

By the way, I have no grandiose illusions of being Gandhi or any of the inspiring people I mentioned. But they are my heroes and they taught me that the worst sin of all is to be silent when you see what is broken or wrong. Those who don’t speak up become accomplices in the evil, whether it happens in Nazi Germany or your local street. One small voice it may be but I’d rather be small than silent!

The Masks of Hypocrisy or: What Planet is Cheney Living On, Anyway?

February 8th, 2009

How dare ex-VP Cheney even use the phrase the “civil rights of U.S. citizens.” I got really angry when I heard his hypocrisy this week! It’s people with his attitude of entitlement that have led to the mess the United States is in! Having just finished an entire book detailing the violation of rights by local government officials, I couldn’t help wondering where the hell he has been lately! 

And I’m going to use his individual name throughout this article because I don’t want to fall into the trap of labeling and then assuming everybody in that category is bad. This isn’t about political affiliation, gender, ethnicity, or religion. It is about a type of pathology. Whatever your background or characteristics, grabbing for power and money at other people’s expense is wrong! Period! Wrong! 

True patriotism means working to keep this country living up to its stated ideals of human dignity, fair play, and civil rights. Walk your talk, Cheney! Because I don’t see you doing anything to help improve the widespread violation of human rights committed on everyday citizens. 

This isn’t about Gitmo. It’s about you and me! I don’t see any evidence that Cheney or his cronies encouraged an atmosphere of “to serve and protect” the U.S. public. In fact, quite the opposite! Corruption and destruction of the average citizen has run rampant. Just look at the headlines! And it’s because of the lies, hypocrisy, and attitude of ‘”I’m always right; you’re always wrong.” 

What rights do U.S. citizens still have? The Attorney General, the SED, the FDA –all government bureaucracies don’t investigate “individual cases” of misconduct. That way they don’t have to discover or face a pattern of widespread malfeasance! It took ten years for the whistleblower on Madoff’s case to even be heard!  

How are you and I, the average citizens, supposed to have the resources or information to prove a “pattern of misconduct” when we don’t even have the resources to understand our individual case?!!! So people die of salmonella, lose their life savings, send their kids to battlefields, and are shot, tortured, or destroyed by their own government officials.  

In the minds of people like Cheney, it appears to be all right to bully and lie to U.S. citizens.  As long as he had money and power, he turns away from the “trivial” concerns of ordinary citizens. Under the guise of “national security” he has helped to undermine the very foundations of American ideals. I guess he thinks we’re too stupid to understand the facts. I guess he thinks that our concerns about paying bills, living in a safe and clean neighborhood, and being treated equitably by our legal system are too small for people like him to worry about.  

I have two sons in the Army. I’ve worked with law enforcement, and with the Army. I thought we were all defending the principle of human dignity and the sanctity of human life. Is Cheney the kind of person who thinks that just pasting a label on someone gives you the right to ignore due process and humane behavior?   

He reminds me of the callous people who invented a particularly dumb slogan back in the 60’s. They’d say “America: love it or leave it!” What happened to the idea that loving your country meant staying to correct injustice.  Jack Kennedy and Martin Luther King didn’t just give up and leave. Neither did Gandhi. Why then should we even consider not helping to improve the country we love? What can you do for your country? Improve it!  

I’m trying to do psychotherapy to help people make better choices, live happier and healthier, and maintain caring connections with others. I help them to not feel helpless and victimized. I want people in positions of authority should be better role models. Is that too much to ask? I’m tired of false patriotism masquerading with hypocrisy and lies. I’m against corruption. I think that makes me more patriotic, not less. 

If one of my patients was paranoid and greedy, lied to his family, and ignored all rational values, we’d consider him mentally disordered. If a family ignored budget constraints and insulted and assaulted their neighbors, if they spent their neighbors’ money on their own bad behavior, we’d consider them disgraceful. Why then do so many bureaucracies get to behave this badly? 

It’s hard not to feel discouraged. But each of us, with our individual actions and individual voices, can add up to a powerful force. We must. Because change and repair are necessary, and constructive disagreement is the only way we are going to have a future. But let’s put a time limit on the discussions, and get some positive actions started. Please? Soon?