Scatter my ashes here...

Scatter my ashes here...
scatter my ashes in the desert...

Saturday, August 3, 2019

Nancy's 2019 Summer BlogHop Challenge


Every summer my blogging friend Nancy Stordahl poses a challenge to the cancer blogging community. This year she has offered 14 random questions for us to answer, and she will post links to everyone's blog who participates. I've done this for a couple of years now, I think.


It's always good to have someone give you a writing challenge, even if it's easy, just because it gets me off my ass to start writing again after being very quiet this summer. So here it goes, the 2019 Blogging Challenge courtesy of Nancy's Point.
This Year's 14 Random Questions

1. Who are you? If applicable, share anything you want about your cancer (type, stage, when diagnosed, whatever.) Share something about yourself such as where you live, the name of your blog and it's "mission", a challenge you have faced or are facing now, or whatever you want. I am Alene Nitzky... I live in Fort Collins, Colorado, and my blog is called Journey to Badwater http://alenegonebad.com The “mission” of my blog is to voice my opinion and perspective as a middle-aged woman who is an athlete, healthcare professional, business owner, author and writer, because in many of those spaces out in the world, we middle aged and older women are not heard from enough.

I think there is value in voicing your experiences and opinions because it helps other people to see that they are not alone and validates their feelings about their experiences. And we have a lot of wisdom that is often lost in the process of ignoring us in favor of the shiny objects. I write about all kinds of things, from running ultradistances to my experiences in healthcare to my take on politics and current events, and I definitely have an opinion!

On the topic of cancer, I have never had cancer, to my knowledge. I’ve been an oncology nurse for about ten years, after working in ICU for four years. I worked in a hospital infusion clinic giving chemotherapy and supportive medications, but I felt I could do more for people by getting out into the community and working with them where they really live, that is, not in a clinical setting.

I developed two programs, FIERCE and Cancer Harbors, both of which are primarily for people with breast cancer, during treatment and in the months to years following completion of primary treatment or with ongoing treatment for advanced cancer. I also wrote a book in 2018, Navigating the C, about my programs and about all the stakeholders in the healthcare system as it relates to cancer care, and how we can all do a better job of caring for people with cancer.

2. Have you ever participated in a blog hop before? Yes! and Nancy’s challenge several times.

3. What’s your favorite sort of blog post to write and/or read – personal story, informational, how to, controversial, political, opinion, rant or other? My favorite blogs to write are political/general social observation/rants, and my favorite topics are running, healthcare, and politics. I like to read about how other people see and perceive the world and ordinary/extraordinary events.

4. Describe yourself in three words. Yes, just three! Intense, creative, energetic

5. Name three of your favorite books from your youth (whatever age that means to you.) that had an impact on you. Nancy Drew books- made me want to be independent and adventurous and question things. Harriet the Spy- similar reasons, and like me, she wasn’t a girly girl. I also liked Green Eggs and Ham, don’t know why, maybe the rhyming, but I still have a copy.

6. What are you reading right now, or what’s on your to-read list for when you have time? I am currently not reading anything other than daily blogs and political briefings because it is summer, when I spend more time outside playing. But top on my list this fall are Becoming, by Michelle Obama; and Madeline Albright’s book, Fascism: A Warning

7. What’s your favorite dessert of all time? Our wedding cake. It was this chocolate cake that had the perfect texture, flavor, moisture, and we still talk about it after nearly 30 years.





8. Tell us about a special pet you have, had, or would like to have. (Never wanted a pet, that’s okay too.) I have had 5 dogs in my adult life: all female Australian Shepherds: Joanie, Iris, Isabelle, Velcro and Gypsy. Each one has/had their own unique personality and quirks, but they have all been very smart, funny, and sweet. Right now we have Velcro and Gypsy. Velcro is our first redhead- she’s a red tri, and all the others have been black tris.

Velcro and Iris have been the smiley-est: they smile at us all the time. Iris was the best hugger- she always gave hugs. Gypsy is Miss Sassypants- she won’t back down and she’ll let you know when she has something to say. Joanie was a Ninja- she was an incredible athlete and could walk through a pile of papers strewn across the floor without disturbing a single one. And Isabelle was the shyest and quietest of all our dogs, except when there was another dog behind a fence- she was a world champion fence fighter.

9. What’s something people don’t know about you and might be surprised to learn? I’m keeping THAT a secret. and... If I told you, I'd have to kill you. and... "You can't handle the truth!"

10. Do you believe healthcare is a privilege or a right? Neither. I don’t think it should be a privilege, but it’s not a right either. It’s a necessity. I do think it’s something we should strive to provide for all people. I only take issue with the word “right”- because it assumes that it’s a universal entitlement (I REALLY bristle when people start talking about gun “rights” or property “rights”) and some things are not always possible to provide for everyone, for a variety of reasons.

Some people make choices to live in extremely remote areas, where it’s not practical to provide access to care, for example. Some people may do other things that make it extremely difficult to provide adequate care to them- sabotaging their care, for example, abusing healthcare workers, or doing unreasonably risky things- though these instances are usually a result of a mental health condition and people need that kind of care at least as much as physical care.

But I think anyone who wants healthcare should be able to get it and have it reasonably accessible without being discriminated against or being given lower quality care than anyone else. And that includes both physical and mental health care, which are equally important. As a nurse, I have to say you really can’t have one without the other.

11. What’s your favorite thing about blogging and/or reading blogs? Learning about the people behind the blogs. They are, more often than not, interesting people with enlightening points of view with whom I’d love to have a beer.

12. What’s something you really suck at? Working in the corporate world (whether it’s academia, healthcare, or business). I think the corporate world purposely attracts and promotes mediocrity and people with poor social skills at best, sociopathy at worst. I can’t keep my mouth shut and my filter leaks like a sieve. When I see things being run poorly I point it out. That does not make people up high very happy. But I’ve always felt better after I left the job.

13. What’s something you’re pretty good at? Running. I love to run, I’ve been running for 35 years and I’ve been doing ultramarathons for almost as long. Roads, trails, tracks, deserts, mountains, I love being outdoors and covering distances on my feet. There’s so much to see on foot. And it’s great for my mental health.

14. How do you escape from cancer (or life in general) worries? Running, being outdoors, talking with my husband Dennis, hanging out with my dogs, and taking summers pretty much off. I recognize that I have the "healthy privilege" of being able to escape from cancer while the people I work with do not have that privilege. Being a support person, caregiver, healthcare provider, or any of those roles can wear on you over time and it is necessary to take time for self-care so you can come back and be thoroughly engaged in your work again. I'm a big believer in self-care for healthcare professionals and the patient suffers most when the providers/caregivers/supporters do not take care of themselves.

Sunday, July 28, 2019

Second Annual DIY 100K

So, this happened last Friday.

As usual, trying to find ways to occupy my time and prepare for upcoming events always takes a bit of creative genius. Felix and I decided to do this again, even after last year's not so great event. I think we were in Spanish conversation group when we decided to repeat it.

Last year was okay, but we did 50 miles and it was hot and I remember feeling like I couldn't get my head in the right place all day to really enjoy it.

This year was completely different. Our friends Mel, Brooke, and Rachel came out to do a few miles, and Crisann generously offered her front porch for an aid station area, and between Felix and Crisann's house- they are be neighbors-  we had bathrooms and refrigerators available as needed.

My intention was to stay out for the entire 100km, as long as it took me. I wanted to make myself run at least 6 hours of it, as I am building up my running time again after several years of doing way too much walking. Other than that, I just wanted to take it easy and have fun. It looked like it would be hot again, so I had plenty of ice and cold drinks in my coolers.

Crisann brought bagels for everyone who wanted them, and we set up my table on her porch with potato chips and other crap food, and we were set. Her house is centrally located on the course, and Felix's is right around the corner.

I was the lone hard core early starter. I got to Crisann's at about 3:50 am, set up my stuff, and was ready to start at precisely 4 am. I strung a section of toilet paper labeled "DIY 100K Start" in Sharpie across the entrance to her porch in the dark, and took off. It was still dark but soon the sun began to rise over I-25 and the Budweiser plant, and at some point Mel drove up and was ready to start by maybe 5 am, and we ran about 3 miles together before taking off on our own loops.

There are maybe 4 to 6 different loops that anyone can run on this course to keep it a little more interesting. A few have hills, but they are pretty tame, except after you do them ten or fifteen times you start to recognize them as hills. I keep track of my distance using paper, pen, and calculator, and GPS is my backup system.





The morning got progressively hotter and by 9 am I wanted ice on  my neck. That lasted until about 1 pm when it clouded up enough to seem less intense, and even cooled down a little. Instead of 93 degrees as forecast, them temperature hit maybe 88 or 89 and then cooled off into the low to mid 80s with cloud cover. That saved my butt.

I felt good all day. I distributed the running well over the entire time I was out there, and didn't walk super hard when I was walking.I didn't even use music until late in the afternoon- for the last 3 or 4 hours. Most of the day I ran alone, with occasional loops with Mel or Felix.

Mel originally wanted to do her first ultra, so she set her goal as 26.3 miles, but she felt so good that she ended up doing a full 50K. Her first ultra at the DIY.

After that, she went over to the pool and hung out with Felix, Brooke, and Rachel. Brooke did about 16 miles but she was running a half marathon the next day, and Rachel did her longest run ever, I think that's what I heard from Felix. At the pool they were drinking mimosas and who knows what else...








While they were out there I stopped by Felix's for an ice cream sandwich. The afternoon was pleasant and I had few issues- a tiny bit of chafing and I changed my socks once- but other than that, it was all easy.

Felix hung out at the pool until at least 3:00 and then he was way behind- but he wanted to do 100K and got back out there. I kept teasing him about his harem. As it turned out, he did finish around 12:48 am on Saturday- about 4 hours after I did- and I was long gone and asleep at home by that time.



The sunset was a bonus with the cloud cover. I finished my 6 hours of running by 6 pm and finished the entire distance at 8:41 pm. Crisann helped me put my stuff back into my car and I went home.

Not super exciting, but it served its purpose and I felt good running. I was able to still run the uphill sections even toward the end. I haven't felt that good running in a long time. It gives me hope that I might actually become a runner again. Just really looking forward to Across the Years this time.


Not much else to say-it was a good run, 62.2 miles in 16 hours and 41 minutes, nothing to get too excited about, but a decent training run on my feet and ready to take it up a notch as I go into the fall. Kind of a backward approach to marathon training. At least now I know I can run long enough to run a whole marathon.

Monday, June 10, 2019

Never Trust a Teflon Suit and Other Truths about Corporate Healthcare

Hi, my name is Alene and I’m in recovery from the U.S. corporate healthcare system, after another relapse.

The latest relapse was around my husband being forced out of his job where he's been working for twelve years. He did find another job, in a different line of work but still in healthcare, on his own terms, and our lives will be much improved for it, despite nearly a fifty percent cut in pay. But this see-through scheme is becoming all too common for people nearing retirement age.

With barely seven years to go until retirement, and 30 years of experience in the same line of work, and 18 with this particular company, he got the typical corporate healthcare tactics foisted upon him. This shit is so transparent it's a joke, I can't even believe they think these tricks will work anymore.

Side note: For those of you who aren't in healthcare, one new vocabulary word for you: HCAHPS. It means Hospital Consumer Assessment of Healthcare Providers and Systems) and it is THE HOLY GRAIL, the Pope's ring, the GOD of corporate healthcare executives. It is their raison d'etre. It is their data orgasm. It isn't everything, it's the ONLY thing. Also known as "patient satisfaction" scores. It's as if the currency used in the industry has been changed from dollars to HCAHPS. (All about the Benjamins, baby.)

You know, the one where they drop little hints about outsourcing if the HCAHPS (patient satisfaction) scores don't come up. Then the personal snide remarks, "You've changed". Then the one where they suddenly blindside you and kick you below the belt with all the things you're doing wrong, "Do you even know how to do your job?"

And they pretend like they are going to "help" you, via the "performance improvement plan". Which is a way to start gathering data to be used against you at the time it's convenient for them to fire you. But instead of following through, they leave you hanging- no specific timelines, measurable improvement points, or what exactly it is that you're doing wrong. When you try to pin them down, they squirm out of it with vague mumbles "four to six months".

Four to six months of what? Until they fire you? Or until they outsource the entire department? Or until they can find someone to take your place who isn't at the top of the pay scale?

They say they are going to "help" you, but when those meetings are supposed to occur, suddenly they become unimportant, forgotten, or pushed aside.

If you've been working in the same job and place for 12 years and no one has ever had a problem with your interviewing style and your hiring methods and your patient satisfaction scores and then all of a sudden they are- there is an ulterior motive. Especially when your past evaluations haven't reflected any of these things.

And then the barely 40-something snot-nosed, suck-up, little suited asshole who "worked" his way up the teflon corporate ladder-like an endoscope works its way up your colon- he can't even look at you in the eye, as he makes the decision to axe you.

And does it using the convenient excuse, the tool, of HCAPHS scores not high enough, that means smaller bonuses for the snot-nose and since he only makes more money in a year than you've made over the entire decade-plus duration of your time there, that would be really fucking traumatic for him. One less vacation home at a ski resort. The horror.

Infection control? Patient safety? People skills? Attention to detail in these things? No, not good enough for the snot-nose. You gotta have that arbitrary HCAHPS ranking. Why? Because HCAHPS data is GOD, so says the god of corporate healthcare.

Are the snot-noses really that important that they can throw away other people, on a whim, deciding someone has no value- basically saying they contribute no value to the organization and discard them like a piece of trash?

The feelings people experience when subjected to this sort of behavior- the dehumanization, the lack of kindness, appreciation, gratitude, empathy, or fairness, show that the corporation is a machine- as lightweight, yet profit-heavy, as possible.

Why can't executives be honest and straightforward, without eroding trust and someone’s self esteem. How about, “We appreciate that you’ve worked hard for us and sacrificed time with your family for ___ years. We have made some decisions that are going to result in us eliminating your position. Can we help you find another job?”

It's not THAT hard.

Secret Initiation Rites of Corporate Healthcare Executives (not including the handshake)

I am convinced that in the secret initiation rites of corporate healthcare executives, there is a test, and here's a sample question from that test:

Q. Just say, for example, it takes a certain amount of time for a chemical to do its job to thoroughly achieve its disinfection capacity, and the organization has chosen that chemical for the purpose of disinfection because there is evidence for its effectiveness, and is within the budget. The evidence came from research studies allowing the chemical to sit on a surface for a given amount of time. But that amount of time is longer than you are willing to allow staff to take to thoroughly clean a hospital room between patients, and since you, the snot-nosed executive, insist that they go faster and give them fewer staff to work with, then you have to choose between several options: (make sure you pick the right one!)

A. pay for more staff,
B. find a different, faster acting chemical if there is one within your budget,
C. shut the fuck up and let them do their job,
D. face the consequences of a higher infection rate, or
E. pressure the managers of all departments to make their nursing and support staff work harder and faster with fewer people and resources, expect the entire organization to turnover hospital beds faster than the amount of time it takes to thoroughly disinfect, and if anything goes wrong, blame junior management.

The correct answer is________. (fill in the blank)

There are some ugly truths in the corporate world and not only are they getting worse, they are being encouraged by a culture that ignores individual contributions in favor of monetary and tangible wealth-building units of currency. There’s a laser focus on whatever measure translates to more dollars and profit for the organization’s top tier. It is enforced by people hired as pitbulls, masters of deception, and compliant, robotic drones. No one is safe.

The worst thing about it, is that ultimately, it’s the healthcare “consumer”, the patient, who suffers, as well as all members of their community.

The people in a community who provide the labor for a healthcare organization, regardless of the level of skill or status in the healthcare system, are human beings first. They have lives, families, emotions, needs, and are connected to a community. As human beings, they also have basic rights, that seem to be getting encroached upon incrementally, as our democracy has declined into oligarchy and our wealth distribution has become more extremely unequal.

This has been a really hard post to write because my emotions have been so tangled up and so many feelings around past experiences of my own have been triggered by this.

I’ve worked in academia where there was a boys’ club. I’ve worked in the business world where there was sexual harassment. And I’ve worked in healthcare where there’s an insidious current favoring those who don’t question, simply comply, and sacrifice their entire lives until they are physically and/or mentally broken, then discarded.

I think they’re all reprehensible, but healthcare is completely out of control and it’s the industry that directly impacts whether people live or die.

None of this is a new discovery, these are things we’ve known and understood, and quite consciously, for a long time. We’ve been living in the United States our whole lives. It’s just that over time, things in the working world seem to have gotten a lot more ruthless and anti-human. There’s a complete lack of acknowledgement and appreciation of the value of individual human beings and what they bring to the workplace.

Two Things On My Mind

One is people’s basic needs, and another is human rights. I’m going to talk about Maslow’s hierarchy of needs and the Universal Declaration of Human Rights, not because these are perfect models or documents, but because most people are at least vaguely familiar with them, or have at least heard of them.

When I talk about human rights I am quite aware that no one is being coerced to work in these increasingly abusive situations, but there are very few alternatives if you want to work in nursing or the healthcare discipline in which you were educated and trained, and the mass exodus of nurses and ongoing nursing shortages are a direct consequence of this abusive behavior on the part of administrators. People do have a choice to leave, at great personal financial peril, but they can leave freely if they want to. But think about what people need in the U.S. to maintain a certain standard of living.

If you think about a visual model of Maslow’s Hierarchy of needs- there are three levels, all of which start from the bottom and build into a pyramid. Basic needs include the physiological safety and shelter needs, Psychological needs include belongingness & love and esteem, and at the top are self-fulfillment needs, also called self-actualization.

Look at the universal declaration of human rights and you will see throughout the document that there are multiple instances of violations here in the United States with regard to everyday life and especially in these healthcare workplaces. Look carefully at Articles 24, 25, 26, 29, 30. Then think about how corporations treat their employees. I think in the U.S. workplace we are coming dangerously close to practices, that in a setting without choice to freely leave, even in the face of financial ruin, would be called human rights violations.

Some of the language in the human rights declaration includes phrases such as:

  • act toward one another in a spirit of brotherhood,
  • no person shall be subject to...degrading treatment,
  • freedom of political or other opinion,
  • all are equal before the law and entitled without discrimination to equal protection of the law
  • Everyone has the right to freedom of peaceful assembly and association
  • Everyone has the right to economic, social and cultural rights indispensable for his dignity and the free development of his personality.
  • Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.

It seems that in this country, we’re toeing the line on human rights violations in many ways. Making a profit is not a basic human right, and really, if it means you have taken away from someone else’s ability to fulfill their basic human needs, that's not good. Not cool. No bueno.

I propose ending the declaration of human rights with something to the effect of: The right to profit should not supercede anyone’s basic needs, abuse their psychological well-being, or violate their human rights as stated above.

And we need to have a new code of ethics around business operations in this country. Because most corporations are ethically challenged to the point of being out of control.

Think about this, for example: in a healthcare organization, employees pay the same for their benefits whether they earn $12 an hour or $500 an hour, as CEOs do. That is not right, either. Since we don’t have universal healthcare and employers provide private insurance for many working people, they should also consider that there is a gap in affordability and apply a proportional deduction from paychecks. Then healthcare would be a real benefit, helping the lower paid employees avoid a poor tax on their health insurance.

A Few Solutions

So let’s look specifically at a few of the places we could make improvements. This is just a tiny list- my wish list is massive. Corporations and big business should:

1. Be good citizens-take responsibility for the communities they impact. Pay full taxes, nonprofit status is not allowed to be exploited. No more disguising profits as expenditures.  Stop outsourcing, cutting jobs without taking care of people they displace or push out, no matter how much they have given to the organization. Be mindful that these people have families who have also been impacted by the employees' sacrifices and will be impacted by the displaced workers' status.

2. Eliminate golden parachutes and "special" status for executives. If you leave for another job, you get your last paycheck from the old job, and then collect your first paycheck from the next job. No more padding in between. All benefits should be equally distributed and should not disproportionately cost lower paid workers more. No VIP treatment if the CEO or family members get sick. They get treated the same as any other patient. No picking their nurses, no special accommodations, no altered staffing ratios for that purpose.

3. Be transparent about the organization's plans and practices. No secret meetings or huddles, have representation of all levels of workers in decision making and on boards. No surprises for the masses.

4. Be banned from using money to influence the political arena- no more lobbying to protect self-interest and industry interest.  Stop union busting tactics, stop using deterrents to organized labor.

Some takeaways:

1. Old ideas of retirement and planning for it are no longer applicable. You need to assume you won’t live up to your full earning potential in the last 10-15 years before retirement, and most likely will be making less money at that time.

2. Don’t put up with abuse from your superiors at work. Fuck them. They have plenty of excuses and they’ll use every last one. Be brave, get out. If you live a "middle class" lifestyle, you can figure out a way to get by on less.

3. Their game is to pull in as much money as possible, cut costs and minimize risk to the organization, no matter what, even if it’s detrimental to patient and worker safety.

4. Healthcare is neither. In this profit-obsessed industry we have lost our humanity, and our ability to care. And that’s not healthy.

5. Your job is a job. It is a tool to bring you financial assistance in addition to contributing to society and furthering your own self- actualization/esteem. It is not something that should hurt your health or where you should sacrifice beyond a reasonable workday. And you should be compensated fairly for it. You should do the work of one person, staying reasonably busy for 8 or so hours a day. Not 12 hours. Not 7 days a week. Not for a period of time that does not allow you to do the basic things to take care of yourself and your health- eating, sleeping, seeing your family and caring for your own and their needs, rest time including mental rest. You should not feel threatened that you will lose the roof over your head or not be able to feed yourself. You shouldn’t be coerced into working more hours or taking on two or three people’s jobs.

6. I am unapologetic to those who somehow think the corrupt and distorted market can fix itself without regulation. Or to those who think that if you’re poor it’s your own fault and all the other lame excuses about pulling yourself up by your bootstraps.  I look at the rest of the world and the countries where they care for their people and don’t let them slip through the cracks, have socioeconomic safety nets, and provide universal healthcare. They have a better standard of living overall because they don’t have the wealth disparity that we do and people are cared for from birth until death and there isn’t the degree of extreme poverty as we have here.

7. No corporation should have the power to impact communities and individuals’ lives in this way. We need to get money out of politics. And we need a rebirth, reinforcement, and then actual enforcement, of antitrust laws.

8. We need to stop our addiction to wealth, fame, money, and power. We need to reform what’s become a national culture of shallow, lazy, self-absorbed, materially-obsessed, apathetic people. If something doesn't affect you directly, that's not a pass. You need to see yourself as a citizen of the community, your country, and the planet. What affects one person affects us all. When one person suffers injustice it impacts everyone. That bubble you want to keep living in, pretending like it's someone else's problem, is really the walls of your rectum. Get your head out of your ass. And once you pull it out, get off it and do something for the good of humankind.

9. Then, and only then, will our lives will be so much better and so much less stressful. And this country and world will be worth living in.

Friday, May 10, 2019

Nurses' Week: Moving Forward and Podcast with Lisbeth Overton

Ultrarunners understand RFMs- relentless forward motion. We often use our determination and mental strength to carry us forward through discomfort and difficult situations in our personal lives and work lives in addition to our athletic pursuits.

I had a conversation with my friend Lisbeth Overton yesterday in a podcast for Nurses' Week (listen here). We talked about the difference between moving forward one foot in front of the other in a way that breaks you down, versus moving forward intentionally with progress. I want to say more about that because right now, between healthcare and the crazy shit happening in our country, it can be easy to go to a place of despair.

I've found myself over the past month deteriorating into that place of despair and realized I need to get out and move more. I have been so bad about allowing myself to not go outdoors to run in the bad weather this winter. I need the fresh air and the brain break it gives me. Being a bit of a political news junkie and overthinker has not been working in my favor lately.

Lisbeth and I talked about how so many nurses are struggling and frustrated with the opportunities and working conditions their profession affords. They want to use their knowledge, talents, and skills to truly make a difference in patients’ lives, but often there is no place for that in the task-oriented, rushed and understaffed workplaces of healthcare facilities and hospitals.

Many nurses wish they could break out of the grind, find a better job that allows them to practice patient care they way they’d like to. They can feel stuck, which leads to despair, low morale, burnout, and health problems, none of which are good for taking care of sick people.

There are two ways you can move forward: one is to grind through, trudging with dread because you feel like you have no choice. The other way to move forward is by taking small steps, still moving forward, not any faster, but with intention and action, no matter how small those actions are, but doing something to move yourself toward better days.

The lesson, I think, that ultrarunners have learned, that sedentary people need, is that active leisure is such an important and undervalued part of our lives. It seems that so many people have forgotten how to play. Too busy chasing material objects, or buried in our electronic gadgets and devices, we end up sitting down as time flies past us.

The time focused on a screen takes away from the time we’re aware of our environment, using all our senses, learning, and appreciating what is in our world at arm’s length. Unaware of our surroundings, we could be moving and breathing, paying attention, burning calories, reducing our fatigue, circulating our blood, and boosting our mood and energy.

People who have not pushed themselves toward physical goals, who are not athletes, often miss out on the rich lessons that athletes learn, of pushing beyond prior achievements, and refusing to accept outwardly-imposed limits. We're always looking to go further, in distance, time, space, or experience.

Working with cancer patients, acutely ill people, and those with chronic disease, I've observed what being an athlete can do for a person in terms of mental and physical strength. Athletes who do get sick are at a big advantage, not just in terms of likelihood of recovery and regaining function and quality of life after an illness, but in coping with the physical and mental demands of an illness, even when there is a discouraging prognosis.

I used to say to my co-workers in the hospital, that it was easier to run a fifty miler than work a twelve hour shift. None of them believed me, but for me it was true. If you're going to be on your feet for 12 hours, you might as well be outside without crazy demands on you every second. Plus you can eat, drink, and pee whenever you want!

When it comes down to it, nursing is about public health, helping people (the public) get healthier, function more effectively, and live better lives. All of the major issues facing our country right now are connected to public health. Here is an incomplete list:

1. Income inequality- the greed, sociopathy and lack of empathy that leads us to a place where a few people have the overwhelming majority of wealth so that large numbers of people are unable to meet their own basic needs or access adequate services that allow them a decent opportunity at a decent standard of living and level of health. People who have to work two or more jobs to pay their bills are unable to take care of their own health.

2. The lack of mental health services, proper care and treatment of addiction, unaffordability of health insurance and prescription drugs, and near-monopolies that destroy competition and drive up prices, make decent healthcare out of reach even for those with health insurance.

3. Our stressful lifestyle- too many people are working too hard for too little compensation for things that are too expensive and often unnecessary. Poor community planning leads to overreliance on vehicles and commutes that are detrimental to our environment, people's health, and financial well-being. We don't have enough mental health services available and people don't demand them because of stigma associated with mental illness.

4. Obesity and metabolic disease are an epidemic, for many of the reasons cited above- community planning, mental health, low incomes, working several jobs, lack of education, feeling powerless, cycles of abuse...

5. The opioid crisis, a result of greed, poverty, lack of mental health services, lack of education, unemployment, family and social cycles of stress and despair.

6. The gun violence epidemic- children and teachers shouldn't be traumatized by the idea of being shot at school, and parents shouldn't be traumatized by dropping their kids off at school to get an education. We had another shooting this week in Colorado in Highlands Ranch. Our U.S. Senator Cory Gardner, big NRA money recipient, has blood on his hands. AGAIN. And again, nothing is being done legislatively to stop this.

I think if we could solve one of these problems I think income inequality and the factors that lead to it are the key. I think nurses need to make it our business to push for social change. And I don't think we've done nearly enough on that front, at least not in a publically vocal and visible way. Nurses care for other people regardless of who they are, their background, what they look like, or other characteristics. No matter how much the current sociopathic executive in chief wants to erode this.

Nurses could teach the public a lot about how to truly care for others and to see the humanity in everyone. I think it is something we've lost in our country- the idea of caring for others and considering others' needs before asserting one's privilege and "rights". If we cared for and about each other, we would be caring for ourselves, too.

Tuesday, May 7, 2019

Ode to the Zombies in the C-Suite

CEO pay is a problem. The administrative costs of running healthcare have increased because we’ve added so many layers of complexity and bureaucracy that have nothing to do with healthcare or outcomes.

The hospital and insurance industries are fighting against Medicare for all or any largely single payer system. They have stolen the money from the people who need healthcare. They use this loot to harness the power of lobbyists to write and promote legislation to keep their advantages and privileges away from the masses who might benefit from being able to afford medicine to stay alive.

How do they make so damn much money? They cut costs like crazy, and big costs like staffing are the first on the chopping block. CEOs are not considered healthcare staff. They don't contribute to health, or care. In fact, they operate against it. You don't need a heart, and certainly don't need empathy, to run a healthcare facility. All you need are pure, driven, focused, sociopathic tendencies. Just be a Zombie, and you'd make a perfect CEO.

On Nurses’ Week, let’s also remember the other people who do work in healthcare, including non-clinical workers. Understaffing is a widespread and dangerous practice, whether you work in direct patient care, take out the trash, provide security, or transport patients around the hospital. None of us can do our jobs without the others.

You cannot run a hospital without keeping it clean. You cannot run a hospital without people to move patients from one room to another or from their room to a procedure, changing lightbulbs, sterilizing equipment for surgeries, emptying sharps containers, and all the other things that are taken for granted but are crucial to safe and complete operation of a hospital. You can’t short staff the people who maintain the medical equipment or stock the supply shelves. You can’t short staff security, because there are actual and potentially violent individuals who enter the hospital.

You can’t even have short staffing for human resources, if you need to keep hiring people all the time due to your high turnover. Of course, you can try underpaying everyone, and in a low unemployment market, you can blame your inability to attract new employees on flaws of the existing staff. It certainly couldn't be the fault of anyone higher up.

By relying on as few staff as possible, you end up burning out the existing employees, who have to run at a faster pace, are more likely to miss details or make mistakes, or have to cut corners in order to get all of the work done in the time they are allotted. They can’t go on vacation because there’s no one to take their place. Doesn’t matter how much vacation time they’ve accrued, they can’t use it. And the shorter staffed they become, the more stressed the workers become, from the bottom up through consecutive layers of management.

Until you reach the C-suite- where they are somehow insulated- they can avoid and escape the chaotic and stressful everyday environment. And even if their worst stressors materialize- low patient satisfaction scores (gasp!)- they can apply pressure downward and no harm will come to them in their suits- they rack up bonuses and extra perks, and even if they are fired, they have a golden parachute coming, to keep them wealthy as they navigate the revolving door of the close-knit executive world.

Yet this is the model on which the executives expect the hospital to run. The mega-corporate near-monopolies have limited competition, driven prices up, and contributed to our plummeting outcomes and skyrocketing costs compared to every other industrialized country.

Blinded by data, the Suited Scourge wanders through the back hallways away from patient rooms, haunting management with blood-drenched HCAHPS printouts. Wide eyes bulging and bleeding from their sockets, insisting on hearing the magic “yes” to every demand. Keep downstaffing and don't stop until there is just one employee covering each floor, responsible for every patient, dust bunny, and soiled washcloth 24/7. Get those products patients in and out fast, to maximize revenue. Crank up the speed on the assembly line, the robots staff will have no choice but to keep up. If the products patients live long enough to beat up the robots staff, sue 'em for property damage to reduce the replacement cost.

Then, and only then, will the Zombies be satisfied, as long as the patient satisfaction surveys come back in the 90th percentile, and dripping with blood.

Monday, May 6, 2019

Strength and Vulnerability, A Two-Edged Sword

This is a tribute to our ultra friend Matt Watts, who died last Friday, and to my extended ultra family.

I’m writing this with love and concern, to clarify and remind, and to encourage everyone to keep on going. He left behind his partner in crime and wife Anne. She has always been at the events with him, a strong ultrarunner herself, and a great support not only to Matt, but a great friend and kind soul to everyone who knows her. I wish there was something, anything- that could comfort her right now.

Ultrarunning is that two-edged sword- at the same time as it makes us physically strong and mentally resilient, it can put us at risk. Especially as we get older.

Matt was a veteran ultrarunner. His sense of humor, spontaneously funny remarks, Cheshire Cat grin and “Matt in the Hat”, as I came to think of him, were a welcome fixture at so many ultras.

Matt used to sneak up behind me when he’d lap me at Across the Years and bark. LOUD. Scaring the crap out of me, even though I should have been expecting it.

Matt was trying to get 100 100 milers. He came very close- his 95th was his last.

Trying to explain what happened in plain English

People are asking me what happened. Since I wasn’t there, I don’t know exactly, I can only tell what I think I understood and try to piece a puzzle together. On Matt’s last ultra, apparently he fell and broke some ribs. I don’t even know if that’s what caused his quick demise.

I'm not sure if it was the broken ribs, a resulting pneumonia, or some other cause of the infection that eventually took him down, but Matt didn’t realize how sick he was. I don’t know if he had some underlying immune system issue, or another illness that had not been diagnosed, or if it was just his pain tolerance or willingness to endure discomfort past the point where he needed to seek help.

I do know that at age 62 our bodies don’t bounce back the way they used to at age 25 or 40. But that might not have been a major factor here. Maybe it was a complete fluke. Maybe he was just tired and worn down from consecutive ultras, or maybe his immune system was a bit weak from several years of running a lot of ultras. Maybe Matt had a blood cancer or another illness that weakened his immune system and he didn’t know it. Probably not, but we will never know. It doesn’t matter now.

I’ve seen it wrongly described as “he contracted sepsis”. No. I’ll try to explain the medical jargon in plain English. Sepsis is an advanced stage of infection, where the body’s ability to fight it off is less than the strength of the infectious process. It’s not something you can “catch”- it’s a consequence of an infectious process.

He had some kind of infection that progressed until it overwhelmed his immune system, resulting in sepsis. Sepsis has the ability to eat you alive from the inside, because it damages the most vulnerable organs- kidneys, gut, brain, heart, lungs. In Matt’s case it ate his heart valve. Sounds like they had no choice but to replace it. That’s a risky thing even in an otherwise healthy person, and with other complications it’s one of those life-or-death decisions.

Sepsis does funny things to your blood- it can cause little solid pieces of debris floating in the blood- septic emboli- that can travel to small blood vessels and clog them up- leading to death of the organ tissue. Or it can cause a state called DIC- disseminated intravascular coagulation- where your blood clots too much at the same time as it doesn’t clot enough, causing uncontrollable bleeding, or forming clots that travel to plug tiny vessels in organs just like the septic emboli do.

They replaced his heart valve to try to save his life- but the risk was that he could have a stroke or other organ damage. And that is exactly what happened in the days following, first a small stroke, then another huge one, from which he wasn’t coming back.

Again, I don't know the exact details but I am making an educated guess, to try to clarify for people who want to understand because it's part of their grieving process.

Now

Anne will need our support and while we need to respect her grief, we also need to remind her that we are here, and that we always will be here, and then follow through on that.

What I am saying here is not at all criticism of anything Matt did or didn’t do, he was living life fully and doing what he loved. I think that is the better route for all of us. But with advancing age and declining immune function, you are simply at a higher risk of something going wrong. It’s part of life.

I would have done the same- pursuing my goal, as he did. And I will continue to chase my own goals as I go forward.

What I wish to share with the running community is that our bodies are fragile, and more so as we age- we do need to remember that extreme endurance events can take their toll on us if we don’t allow ourselves to recover. We might feel okay, we might think we’re recovered, but unless we take a look inside our bodies at the cellular level (which is not really practical), and look at the components of our blood (which is pretty easy to do with a simple blood test called a CBC with differential), we can’t really know.

Just remember that we can’t take our health or our lives for granted. A good reason to keep on pursuing our goals, but also listening to our bodies. Sometimes our bodies don’t whisper loudly enough, or sometimes we forget how to listen.

Facing Death

Death truly is a part of life and all of us will die eventually. The best thing we can do is to live each day fully, work toward our dreams, have as much fun as possible, be a force for good and give as much love to others we possibly can.

Facing death is part of a healthy life- psychologically and emotionally, it doesn’t make it easier, but it does make you stronger and more resilient, and perhaps healthier overall. People who have a healthy attitude toward death tend to move through grief with fewer long-term physical and mental health consequences.

Facing death also means not forgetting those who were left behind, not avoiding them, letting them know you care and enjoying the memories when the time is right.

Avoiding death and emotion doesn’t mean you’re strong, in fact, just the opposite. Denying a universal reality does us no good. It’s coming for all of us. We do the best we can to live our best days, and then we need to step right up to it, look it in the eyes, run through the finish line without fear, realizing that it only means we will have arrived at the start of the next ultra.

And here's one thing you can do right now. Make your wishes known. Complete your advance directives- medical power of attorney, living will, and other documents- now. It's a gift to your loved ones to make things easier for them if they have to make decisions for you when you can't, in a time when they will surely be extremely distressed.

Moving forward

Matt’s sudden departure has made me re-think my own priorities and preparations, perhaps tweaking some things in my own advance directives that I could make more specific. And thinking about the real meaning of where I am in my life and what I’m doing. And what I hope is still ahead of me that I cannot take for granted. But mostly, to make sure I enrich my life to the fullest by strengthening my connections to the people I value most.

I'll miss Matt.

Wednesday, April 24, 2019

Tools for Nurses vs. Nurses as Tools

It's that time of year, we're approaching Nurses' Week, drawing the ire of millions of nurses across the U.S. May 6-12, to be exact. It's the week where we are reminded of the hand we're dealt, the King of Diamonds versus the Queen of Spades- the analogy is the rich mostly male executives wielding their power, watching over a mostly female workforce being forced into digging their own graves.

In 2015 on the TV show The View, the hosts mocked the Miss America contestant who was a nurse, asking why she had a "doctor's stethoscope". Apparently unaware that nurses are the ones who do physical assessments and actually use those tools more often than doctors, it came across as crass and uninformed to the large number of nurses who saw and heard the remarks. The good thing that came out of it was a flood of activism which resulted in formation of the group now known as Nurses Take DC, to fight for safe staffing and safe patient limits in the workplace.

Playing Cards

Skip ahead four years, and another uninformed comment from a prominent person got the whole nursing world riled up again. Washington State Senator Maureen Walsh made a comment about nurses playing cards most of the day, again inflaming nurses' collective frustration with the ignorance and disrespect with which nurses are treated, especially in the workplace by those decision makers around staffing. Chronic understaffing, overwork, burnout, moral injury, and unsafe conditions for adequate patient care plague the healthcare industry in its sociopathic pursuit of profit.

This time, in response to Senator Walsh's comment, and her weak, non-apology that is now becoming a whine-fest-she's complaining about all the mean comments she's received, nurses have mobilized again.

To Senator Walsh, sorry ma'am, but if you go into politics, you're a public figure and you're going to get public scrutiny. Next time watch what you say and if you screw up, offer a real heartfelt apology and start making amends.

I don't condone people being rude or disgusting. They should be harsh AND tactful at the same time- it IS possible.

First nurses depleted the supply of playing cards in Amazon's warehouse by sending her thousands of decks of cards in the mail. Then there was a petition circulating that gathered some half a million signatures.

Hung by our Stethoscopes

So my question is, if over half a million nurses can unite over a stupid comment by a politician, why can't they unite over the stupid actions of healthcare leadership, including organizations such as the archaic and hypocritical American Nurses Association, which claims to represent us but instead acts in the interest of hospital and healthcare executives in the healthcare corporatocracy? Here's the example in Senator Walsh's own state... supporting the pathetic "staffing committee" proposal to undermine and subvert the aims of safe nurse staffing.

Sure, there's plenty of money for the industry executives to lobby for their own interests but somehow they can't afford to staff safely for patient care? Where are the half million nurses when it comes to these types of decisions? Half a million nurses signed the petition to get Senator Walsh to follow a nurse for an entire 12 hour shift. Half a million nurses should be signing this petition for National Legislation.

Nurses are afraid to speak up in their communities and workplaces because they have no power and can easily be harassed or threatened, and they don't want to lose their jobs, licenses, and livelihoods. The tactics used by management are ugly. In the vast stretches of our anti-union, anti-labor plutocratic country, we have diminished workers' control over their working conditions and job security. And we are seeing more deterioration in the workplace, in the form of violent attacks against nurses.

Furthermore, with the consolidation of hospitals and healthcare facilities under bigger corporate umbrellas, near monopolies have been established, making it harder for nurses to find alternative companies to work for if they don't want to or can't relocate.

Stop the Bleeding

We need a giant set of hemostats to stop the hemorrhaging of nurses and their working conditions before healthcare implodes and completely collapses, resulting in more medical errors, more deaths, and more violence.

Executives use their excuses where they can to manipulate the workforce- using data like HCAHPS (patient satisfaction) scores as a cudgel to terrorize employees around their job security. They never count the human cost of abusive manipulation of employees and their families. These big corporate entities feel no responsibility toward the communities where they exist and employ people who live there, trying to make a living, and being worked harder with fewer staff and deteriorating compensation. It's a sociopathic system and there is no empathy- it takes a true sociopath to buy into the corporate data-pushing bullshit.

Here's are some small examples, and I mean small because they don't directly impact patients- wage theft by employers when nurses they have more work to do than they can finish in a 12 hour shift- by forcing them to clock out after 12 hours and work without pay. Also, when nurses don't get a break they are not allowed to charge for working straight through- they lose pay. And if they try to recoup those wages, nurses are subject to disciplinary action.

Healthcare is a human service, it cannot be run like a factory. Our lack of a human-oriented healthcare system is costing us more and delivering worse outcomes than other industrialized countries and it's not getting any better. Pissed off patients and families who come to expect "customer service" as if they were in a hotel or restaurant will act out aggressively when they are tired of waiting for overworked, rushed healthcare professionals without adequate support staff.

We can let it fall apart and pay an even higher price in the form of more morbidity, mortality, and trauma, or we can use that same fervor we unleashed against a politician's dumbass comment to unify ourselves, watch each others' backs, and take back our control and power over the situation. There are more of us than there are of them. But we need to be unified. We need to join together and speak in one loud strong voice.

I challenge every nurse to take a first step by joining a grassroots organization in taking back healthcare for everyone- especially for the good of the patients we are supposed to be caring for. (bonus: you don't have to pay dues) Don't be fooled by organizations that claim to represent you then backhand you when you're not looking. Sign the National Nurse Patient Ratios Petition.

I promise you, signing a petition like this and joining a group like Nurses Take DC will give you more satisfaction than your job has given you in years! Take back your power over your future in healthcare. Lives depend on it.