Scatter my ashes here...

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

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.

Monday, April 15, 2019

Another Existential Crisis: The 24 Hour That Wasn't

I am so glad it's a new week. I had big plans for last week and everything sort of fell apart in one way or another. Nothing earthshattering, just a series of progressive and cumulative disappointments, but I ended the week on an upswing.
Bomb Cyclone

This time of year I usually plan a few days out of town to go to my favorite hot springs resort in the mountains to take a relaxing few days away from the grind and my inboxes, to get a massage or other spa treatments, and sit by the pool soaking up rays, listen to the creek and the breeze, and watch the clouds roll by the still-snowcapped mountaintops.
This year I asked my friend Crisann to join me and we drove up Monday morning, taking in the amazing scenery of Colorado's mountain banana belt. We went for a hike and sat by the pool in the spring-like weather, then later we went into town and had dinner at a fairly new Asian restaurant.
I had the best Panang curry of my entire life there- and we discovered a new favorite beer on tap- Soulcraft Coconut Milk Stout.

There was a storm expected to move in around mid-week. We planned to spend Wednesday in town and check out some of the shops, Crisann is a quilter so we were going to those shops and then wine tasting at my favorite winery down the road, and explore downtown. We figured we'd spend most of the day Tuesday at the pool, I scheduled a hot stone massage and scalp scrub in the afternoon, and the rest of the day I read a friend's new book that I've been meaning to finish. Tuesday was nice but it was getting cooler and windier by the hour.

We checked the weather forecast and as usual, since the news corporations can't sell "snowstorms" as well as they can sell "bomb cyclones" we had a bomb cyclone forecast, and it looked like it was going to hit the Front Range (where we live) around mid-day on Wednesday. Since we have to go over three mountain passes to get back home, we decided to leave first thing Wednesday morning and get home ahead of the storm. Turned out to be a good plan, because we arrived in Fort Collins around 10 am Wednesday, and it was already raining. By 1 pm it was dumping snow.

Circling the Drain

I was also scheduled to run the Palmer Lake 24 Hour run over the weekend, and the weather was looking sort of horrendous. I asked my friend Sasquatch, who is a real-life meteorologist, about his plans and he gave me the weather forecast. Last year it was nasty enough weather at Palmer Lake, but this year was shaping up to be way worse. I asked another friend, Sandee, who lives there, and she said expect 6 inches of snow on the course and that we'd need traction because of the mud if it thawed. I am not a fan of slipping and sliding for 24 hours and I sure as hell didn't want to wear my Kahtoolas that long. A nagging groin injury is not something I'd enjoy dealing with.

By Friday morning I decided I'm not going, and nearly all my friends who were planning to go had also backed out. I cancelled my hotel room, and decided I could put a few miles in over the weekend at home in better conditions. Saturday wasn't looking too great but Sunday was supposed to be a lot nicer. I'd planned to do 80 miles at Palmer Lake so I thought maybe, if all went well, I could pack 80 miles into two days at home.

Friday afternoon I found out that we didn't get the grant we applied for to expand my cancer survivor program at the nonprofit I'm working with, so that pretty much put a nail in the coffin of the entire week.

Flushing the Toilet

I decided that I would take it easy on Saturday and get maybe 20 miles in, and leave the rest of the miles for Sunday. I didn't get started until about 11 am on Saturday and went out to do my slow 20 on the Power Trail. It was cold and cloudy, which fit my mood perfectly. For the first 10 miles I had to work through my feelings about not getting the grant. It's not the end of the world, there are other grants to apply for, but it does slow my progress in developing the program and in the research I've been doing. This is my pet project, I've developed the program from scratch, it shows promise empirically, and despite the lack of interest from mainstream corporate healthcare, and now I have quantitative and qualitative data to back up its benefits. It's frustrating dealing with the slow pace of research and the academic world, as well as traditional healthcare, but I know it's making a difference in real people's lives, because they tell me it is.

But when I describe the program to dull-eyed executives their eyes light up with interest until they realize it's not a reimbursable service so they can't make money off of it. Anyway...who cares about that as long as I can keep doing what I'm doing. My purpose in life is not to enlighten their inflexible and shortsighted minds. I left the hospital because of that rigid and self-serving mindset, and I've had a lot of satisfaction doing my own thing. The thing that hurt the most was the message that you have nothing of value to offer us, we just want you to shut up and be our robot, stay in the lane we have designated for you. Sometimes it's enough to make you say, fuck it all, I'm taking my toys and going home. I'm used to this recurring theme in healthcare. But I'm not ready to retire yet. One of these days, I will be.

While I've mostly recovered from that, it can be very disappointing to have setbacks like this and I spent the first ten miles on the Power Trail Saturday morning purging my emotions, thankful that there weren't many other people on the bike path. By the second half of my day, I was over it. I met my friend Emma and she did six miles with me in the afternoon. I ended up with 20.2 miles for the day and felt good.

Dennis took me out for sushi, which further cheered me up.

The Sun Always Rises

I woke up way too early Sunday morning, around 3 am. I decided to make coffee and try to get out before dawn so I could have a shot at mega miles. Maybe 60 was still possible if I felt up to it, I thought. I knew it would take until late at night to finish, but I decided to see how I felt all day. Sasquatch was coming to my house at 9 so I figured I'd take a short break before meeting him there and we could do as many miles as he felt comfortable with, given that he's still recovering from his aortic valve replacement.
I started in the dark, going through the neighborhoods north of my house until I reached the north end of the Power Trail.. Light was starting to fill the horizon in the east, and when I got to Drake I turned east, facing into the sunrise. I stopped by the old barn and took some pictures, but saw something moving in the grass about 20 meters away. First I thought it was a cat. Then I saw the white stripe... I backed up as quietly as I could. That was close!
I continued down the hill and then up the hill on Ziegler as the sun was rising. That was enough to make the missed sleep worthwhile.

I headed back to the house, got some food and refilled my bottles, and waited for Sasquatch. I was feeling physically fine, but my motivation wasn't there. I felt a bit washed out. When Sasquatch arrived we did 6 miles by Warren Lake and then I had 20 when I got back to the house again. Sasquatch took off and I hung out for a while, thinking. I felt fine physically, my feet felt better than they did at the end of yesterday's 20, but I didn't have the drive. I decided to go out for another 10 and see how I felt. I ended up doing a little over 11 on the lower Power Trail and was feeling good, moving well, but I didn't have the desire- I just wanted to come home, drink a beer, and relax.

I finished up the day with 31.45 miles, a hair over 50K, and called it good. Before I went hoe I made a detour to the liquor store and bought a bottle of Coconut Milk Stout. I earned it.

I was in bed by 7 pm and was ready to go this morning, went to boxing class, and here I am. Ready to face another week. A better one. Gotta be.

Saturday, March 16, 2019

From Bomb Cyclones to White Ribbons

As I was headed west on my way back from my run, I saw this in the sky. Perfectly captures my thoughts today.

What does a white ribbon symbolize? It can mean peace, or nonviolence.

I'm not a fan of symbolism and especially not those multicolored ribbons that are used to signify different types of cancer. The simple explanation is, I find that symbols are too superficial and those who worship those symbols often forget what they really mean, which leads to a lot of hypocrisy, such as we have been seeing around our own flag in this country especially after September 2001 and again since the election of 2016.

I resent the use of the flag to claim that it only belongs to Christians or to white people or people of certain descendants, or those who fit into certain narrowly defined "acceptable" categories- deemed acceptable by some self-designated rulemaker of unspoken, unwritten rules to which the rest of us are not privy.

Likewise, those cancer ribbons piss me off because they symbolize "awareness", and too many people are superficially "aware" of cancer, when what they really do is wear a ribbon or slap one on their car. They know it exists, but they don't go any deeper than that to learn more. Appearance is it, they never examine what it really means to have cancer or actually support someone by doing something about it. Which is what I wrote a whole book about in 2018.

The other things I was thinking about were:

(1) the massacre in New Zealand, which, if you can forgive my snark, looks like Trump's attempt to balance the trade deficit by exporting violence, perhaps? But I truly am so disgusted by the violence and hate and bigotry and our so-called leader's response to it. Disgusting. I cannot wait until the day he is marched out of the White House in a jumpsuit to match his face.

(2) the invisibility of women, especially older ones, including in sport. But I'll do a whole separate post on that because I found an interesting blog from someone in the U.K. who also writes about this.

(3) violence in healthcare against nurses and physicians- which has become a serious and frequent problem- and how we need to change things, and

(4) yesterday I was going through my social media accounts and stumbled across a recent photo at the ACHE conference of three healthcare executives from my former place of employment which ties into all of the above points. I had to really restrain myself from posting a comment with a very snarky hashtag.

This week you probably heard the weather drama and disaster predictions about the "bomb cyclone" which was supposed to hit Colorado with a vengeance. It did, in some places, and I hear it was worse east of here, in the plains and midwest. But Fort Collins was spared- we only had about 24 hours of snowfall and maybe 8 inches total accumulation. The wind was what made it so nasty. But it wasn't as cold as it has been lately and just yesterday I saw these flowers popping out from the melting snow.

The temperatures have gotten warmer and over the past two days the sky has been blue again. It's brought me out of my crabby mood. And the appearance of the white ribbon in the sky, symbolic as it was, made me feel just a little better.

I'll be back with a post about my original idea, womens' visibility, along with the white ribbon symbol, soon. Bomb cyclone, be gone!