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.

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.

Healthcare Heretic Rants Again...

(Disclaimer: I don't speak for the concept or creators of Healthcare 3.0 but this is a stab at explaining what it might do for nurses, and we need to make sure nurses are included as this idea is fleshed out)

The other day as I was having a conversation over coffee with a local colleague who is a psychotherapist, our conversation shifted to healthcare. There's been a lot of talk about Healthcare 3.0 as an answer to the problems of our current escalating and unsustainable costs that aren't making a dent in our health as a society. As a nurse, I get asked on social media what healthcare 3.0 could do for nurses, who are understaffed, burned out, ready to burn their scrubs and walk out. Let's start at the top.

My colleague said something interesting about people who have executive jobs. Often they think it works for them, but the way they are functioning is not working well. They make a lot of money, they may have status in their communities and workplaces, but they are deeply unhappy. They are unable to connect with the underlying source of their unhappiness. So intently focused on what they think they have to do to maintain their status, money, and power, they can’t face how it affects other people around them: their spouses, children, community, or their own health and well-being.

In healthcare especially, people who have executive jobs often are fostering the climate of creating more work and finding justification for filling positions that contribute little to patient care and outcomes. They are contributing to the problem of the providers’ agony of having to spend more time in front of the computer than they can ever spend talking with their patients.

It’s disruptive to patient health and satisfaction, provider health and satisfaction, public and community health, the economic sustainability of our healthcare system, and our entire national economy as a whole. As healthcare costs have soared along with administrative costs, so has the distress in communities over healthcare access and availability, jobs and security.

We are all connected to the greater community. And when someone is sucking the resources away for their own benefit and not sharing, it hurts everyone.

Look deep into the eyes of a healthcare CEO. It’s been said that CEOs can be ruthless, sociopathic people. You might be able to tell in their eyes if they are truly sociopathic or just in deep denial of what their everyday decisions and actions are doing to those around them.

I believe many, if not most of them, are human beings who have taken to heart the myth that status, power, privilege, and money are what defines a person’s worth, especially for men, and while they might on some level know this is a myth, feel too entrenched in the status quo and fear the discomfort of change, believing that the price they might pay personally and professionally would be too steep.

Eventually they start to pay for it in their own health- mental, emotional, physical, and spiritual health. They might get sick, be depressed, get divorced. Or they might realize it when a family member has a serious illness.

It takes courage to take risks, to make change. They might think they are more comfortable sustaining their standard of living, with the vacation homes, the disposable income, sending the kids to college without financial strain. Their financial security is well-padded with the promise of a golden parachute.

On the other side of the fence in healthcare are nurses. Near the bottom of the totem pole in the direct patient care hierarchy, nurses do the heavy labor physically and mentally. Expected to function as well as machines, they are given the near impossible expectations of being able to safely care for a number of patients of varying acuities, safely administer medications and other interventions, and document everything that happens all day, with every patient.

Nurses have the most responsibility, the least power and authority, and often are abused, bullied, and disrespected, even by their own peers. They are not included in decisions made at the top of an organization that directly affect their working conditions and may pose a risk to their safety, their patients, and their licenses.

When more work is piled on nurses, if they complain, they are told they are not managing their time well, or can’t multitask. If they complain about unsafe conditions, they can be fired. When things get out of control, or a mistake is made, they are the first to be blamed.

The only reason nurses are in the position we are in today is because we’ve allowed ourselves to be lulled into a lie. We have never challenged the old guard of dinosaurs who live in the days when nurses couldn’t be married, never questioned the doctor and could only wear white caps, stockings and dresses.

The fact is, today, nurses need to stop making excuses that we can’t make change or speak up because we are powerless and we’ll get fired from the jobs we need. How badly do you need a job that leaves you insulin resistant, overweight, hypertensive, with back pain, foot pain, or headaches. A job that leaves you sleep deprived, grouchy, unable to spend quality time with your family, but spending a day or two each week uncompensated while you recover from your 12 hour endurance shifts?

Just for raising this point I’ve been attacked by nurses who get defensive, usually because, “I have kids. I’m a single mom. My spouse is unable to work, disabled, etc. I’m supporting my parents, my kid is in college, I’m in debt…” and so on.

We all have choices in life, and there are no guarantees! What if you got injured or sick? What if you got fired? What if the hospital burned down? What if you lost your job for some other reason? What would you do? You’d have to find another job, but what if you couldn’t? You would have to come up with some kind of contingency plan, right?

No one is saying you should give up your job and stop supporting your family. What I’m saying is, you shouldn’t have to be abused while you’re trying to do it. You shouldn’t have to fear for your job and be forced to do things that are not safe, that damage your health and well-being and compromise your own ethical standards just to keep your employment. You ARE NOT powerless, you can do something. The fact that people do make excuses for not speaking up is reason enough for making change. There is ALWAYS a way.

Nurses need to quit attacking each other and having turf battles in the workplace, social circles, on social media, and in the community. We are all connected. Again, we’re not powerless, but we need to be more courageous. True leadership moves us forward, is not regressive, and requires courage. We have to be willing to take risks, to put our ideas out there, expose our ideas to the light of day instead of hiding behind private conversations in quiet corners.

If we were allowed to do our real jobs: to advocate for the patient, educate the patient, and navigate so the patient and family could find and access the resources they need, in addition to providing basic but highly skilled nursing care, we’d be able to practice like the professionals we are, not as wait staff on roller skates. We could each be experts on our own patients and bring in specialized, available experts when needed. We’d have time to have conversations with the patient and identify issues so we can collaborate with physicians, who would get the full scoop on what we’ve seen in our assessment and concerns we have about the patient, resulting in better outcomes.

To lead this change, we need share our vision for nursing, establish we want to see, and make it happen, through policy changes, influencing public attitudes and understanding, and working together instead of at odds. Here’s a partial list of some of the things nurses would like to have:
•Safe staffing ratios that are not just marginally safe, that truly allow us to provide GOOD care.
•Time to think about what we are doing instead of rushing from task to task
•Time to collaborate- with nurses, other staff, physicians, managers, administrators
•Time to give attention to patients, to have conversations with them where we can listen
•Time to take breaks, lunches, vacations
•Adequate time to get our work done within the hours of our shift
•Getting paid for all the work we do
•Feeling safe in expressing concerns
•Not being rushed
•Having our needs acknowledged and addressed and met.
•Not facing bullying or disrespect from peers, other providers.
•Having access to decision making input
•Getting feedback
•Being communicated with
•Transparency from the administration in matters pertaining to our own jobs
•Support and time for professional development and growth and education
•Opportunities to lead, advance, contribute, change specialties or positions, or back down, cut or increase our hours when we want to or need to
•The ability to take time off when we are sick without being penalized
•The ability to work at a human pace without being replaced by robots
•The ability to use technology in the workplace that works for the patient’s best interest and supports our ability to do our jobs well, but doesn’t detract from the quality of our work with the patient.

What is leadership? Instead of an entitlement, it should be a privilege that is earned and kept through service to those you are charged with leading. Instead, many executives see themselves as entitled: to high salaries, nice perks, golden parachutes, and all sorts of other protections and padding.

Poor leadership consists of insecurity and fear of losing one’s job, the unwillingness to support others out of fear of exposure of one’s shortcomings. Instead of allowing people to shine, insecure leaders avoid creativity and keep the innovators out.

Toxic leaders poison the entire organization layer by layer. Morale drops, turnover goes up, and patients suffer. It’s not just a trickle-down effect throughout the organization, it’s a full stream raining down on their heads, like a burst sewer pipe upstairs from the hospital cafeteria.

Leading is not proselytizing, it is not enforcing the blind following and worship of a megalomaniac. It is not about overseeing a passive audience of yes men and women, or the intolerance of dissent. It requires independent, critical, and creative thinking that comes together to make improvements.

We need to clearly define what nursing would look like under 3.0. We must have a place at the table, as equals. Nursing is no less important than medicine. What is less important, is all the administration and extra fluff that does not improve relationships around the level of care.

Healthcare 3.0 would bring nurses fully into leadership, to an extent to which we have never been included or taken seriously before. Healthcare 3.0 is an idea that can be implemented and can save us from the impending healthcare Armageddon. There isn’t a single person who won’t be affected.

We need courage, we need everyone with a stake in this to face the fact that we are humans taking care of humans in healthcare. Outcomes matter, but we can’t lose sight of the real human condition that “outcomes” represent.

We cannot exist solely for the sake of constructs like technology, efficiency, or productivity. The relationships must drive these constructs, not the other way around. Those things can happen as a result of doing our one-on-one patient/provider relationships well. Let’s stop making constructs the holy grail and get back to focusing on relationships.

For more information on the Healthcare 3.0 concept, you can read Dave Chase's article here, or you can also watch ZDoggMD's rendition, Lose Yourself, below.

#unbreakhealthcare

Whirlwind in the Desert: BRA Day

I'm home, looking at the cool fall colors, after a week in Arizona. I managed to catch a nasty cold, probably on the flight down there, so I'm sniffling, hacking and snorting my way through the day, surrounded by piles of tissue and tea cups.

This blogpost isn't much about running, although I'm proud to announce that I have now been consistent with running most days of the week for the past 6 weeks. This coming week I'm sure I will cut back in order to get over this crud, but I feel like I've finally reached a point where the running is habitual again. I was up to nearly an hour and a half of running 4 or 5 days a week with some 2 hour runs thrown in there. Still no interest in ending my current hiatus from doing any running events, but we'll see how that goes...

I went down to Scottsdale to visit my dad and stepmom, and speak at an event in Tucson. Wednesday October 21 was BRA Day, Breast Reconstruction Awareness Day. It's intended to educate women about a full range of options for breast reconstruction following mastectomy.

Most women don't find out that they have a range of procedures to choose from that include using their own tissue to reconstruct breasts after a mastectomy, often they rush into immediate reconstruction with expanders and then implants, without being informed about all the possibilities because of microsurgical techniques that allow the patient's own fat and skin to be harvested and a blood supply established to create a more natural appearing breast.

More about that in a few... I flew down and the weather was un-Arizona-like. It rained like hell two nights in a row, a deluge of rain and hail in different parts of the valley. I ran early Monday morning with my running friend Chris and another friend of his on the canal, before the sun came up. It felt more Florida than Arizona with the humidity.

I hung out with my dad and stepmom, my dad is doing somewhat better and it appears that chemo is working. We won't go into the details of the possibility of relapse, which is fairly high, but he's feeling better and things are going well overall. Things are looking up now. It's great to see him getting his old energy back. Not quite himself, but he's improved dramatically.

I met with a social media expert while I was down there and will be using his services as I move forward with my business endeavors. I finished a big chunk of work before I left and now I'm switching gears from developing content to marketing.

Then it was time to go to Tucson for BRA Day. I met Terri online, now I can't even remember the exact circumstances of our connection but we started corresponding last summer and Terri wanted to make a BRA Day event happen in Tucson and she perservered along with the help of some nurses and social workers in Tucson who convinced the powers-that-be that it would be a worthwhile event to host.

Terri assembled a panel of speakers and the backing of local businesses to support the event and it came together despite many hiccups and speedbumps along the way. I agreed to help in any way I could despite being out of town.

We set it all up in the lobby of the U of A Cancer Center, which looks and feels remarkably similar to the Cancer Center we have here in Fort Collins. It was dumping rain as we carried all the supplies and donated gifts from Terri's car to the lobby of the Cancer Center.

We didn't have a room, podium, or formal presentation set-up, just some lobby furniture and a screen, and a microphone. But we did it, and it worked. One of the nursing staff members bought the refreshments herself. Local businesses donated prizes. Terri's son recorded all he could on the Periscope app on my phone. Of course my phone battery died even with the extra battery pack, so we didn't get to record most of the speakers. We have a learning curve with Periscope, which has some glitches itself.

I spoke on "Reconstructing Well-Being", about some of the overall wellness, prehabilitation and lifelong habits to adopt regardless of where a person might be with regards to cancer treatment and reconstruction decisions. Terri talked about her experience as a patient, there were nurses, social workers, tattoo artists, a plastic surgeon's PA and a breast surgeon there. Topics ranged from sexuality to surgical options to cosmetic appearance to more personal experiences from a patient who is also a nurse.

We had no idea how many people might show up for the event but we hoped it would be at least a couple of dozen. As it turned out we had a good 40-50 people in attendance. Afterwards we cleaned up and moved the furniture back to where it was, and it was time to party!

Afterwards four of us, the three nurses and Terri, went out to a Mexican restaurant for food and margaritas and got serenaded by a mariachi band, and decompressed. It is so amazing how every health system, nurses, cancer centers, and administration work the same everywhere.

This event only happened because of the work of Terri, a patient advocate, and her backing by a nurse and social worker who wanted to do something needed, useful, important, and meaningful for patients. It wouldn't have happened otherwise.

This is what it takes, people need to speak up and be vocal. Advocating for yourself as a patient, and for others who face similar experiences, as Terri does, and health care workers advocating for patients' needs and filling the gaps in information and care, all of that only happens at the grassroots level. With the corporatization of health care, the people up high are running a business. To use an overused term, there is a disconnect yes- I hate cliches too - between the business of health care and the service of health care. Service is what it needs to be about, otherwise we won't be serving anyone's best interest except the people who stand to profit.

The only way to make things work for the people who need the services is to do the footwork, be vocal, don't back down, and persist. It takes effort to make worthwhile things happen, and if at first it doesn't fit, make it fit.

Just like you have to move and make some effort to improve your health, changing the way the system works will take real effort toward movement. Sedentary habits won't create change.

The Pre-Nurses' Week Cancer Rant

Yesterday I had lunch with Wheaties Boy's mother-in-law, Faustine. I admire this woman in so many ways. We have a lot of interests in common, obviously health and fitness, but also cancer and healing. She has been a massage therapist for years, doing medical massage and has worked with many people with cancer.  She is also the epitome of vibrant and healthy aging. And gorgeous, she literally glows. 

We talked about my business ideas and where I'm moving with my online service development. We discussed the important components of empowering people to improve their own well-being after diagnosis and treatment for a serious illness, and moving beyond the sticking points. One of the things that I'm passionate about is getting people the answers to their questions that can't be addressed in a short doctor appointment, but not having to stress themselves financially in order to get the help they need. 

Medicine is becoming more of a product and not a service, and doctors are being squeezed for time and production...getting the patients in and out, and those short appointments don't leave room for explanation, education, or personalized attention. The rushed encounters-yes, they literally are referred to as "encounters" in the popular electronic health records...don't leave docs much time to have meaningful discussions with patients or teach them the finer points to empower them to manage their health.

Nurses can and often do fill many of the gaps in information and explanation, but they are under similar time and documentation constraints and in the rushed corporate health care environment, many of the details slip through the cracks as the robotic expectations of the organization for which they work supercede the desire to sit, educate, and empower.

This patient empowerment is a huge unaddressed need, especially in the time period after they get done with cancer treatment. Patients feel lost and abandoned in that transition from cancer patient to...not sure what they are afterward. Called survivors, they don't always feel like they survived. There are patronizing references made to what they feel after treatment. "The new normal" is one of those that makes me grind my teeth at night. 

Feeling like crap with nowhere to turn is not normal. It's not fair or humane to tell them, "well, we treated you for cancer, we poisoned you, burned you and cut out parts, so now you're supposed to go through life tired, sick and debilitated. Get used to it. It's your new normal." 

Not cool. 

People deserve to get information and help in restoring their health, in terms they can understand, and in ways that they can apply to their own lives. They need to do much of the work themselves, because only they can determine where they want to end up in terms of quality of life. But they need guidance, support, and attention getting there after enduring the rigors of cancer treatment and all of the associated emotional, social, financial, spiritual, psychological, and physical invasions in their lives. 

As Faustine and I discussed our ideas and experiences, I thought about my trip to Arizona, where I'll be talking with my dad and stepmom about what day are going through right now, trying to manage my dad's upheaval with chemo and all the fatigue that has stripped away his normal energetic life. Between naps and blood transfusions, he is able to carry on with some of the activities he enjoys, but I had to explain to him why it was not a good idea for him to call his personal trainer to come over for a workout the day after his blood transfusion...which is exactly what he did before I happened to call and catch him in this error that could have resulted in quite an unfavorable outcome. 

He's being treated at a world-renowned cancer facility yet no one explained to him why being severely anemic is not a good condition from which to exercise. Why? Because in medicine, they often don't think to ask about the daily habits of patients, their lifestyles, or what their normal activities are. And my dad doesn't have an education in exercise physiology or health care. They neither have time, nor the thought process in place to do so. It's just not how medicine thinks. 

Even if by chance someone did explain something to him, there is not adequate time for them to assess his full understanding of what they taught him. There is no time for "teach-back" or a way to ensure that the message they tried to convey was received, absorbed, and understood.

So it's just by chance that my dad as a cancer patient happens to have a daughter who is an oncology nurse and told him that not having enough oxygen in your blood to feed important organs like your heart and brain during exercise could result in you having a heart attack or passing out and falling and injuring yourself. And stopped him before it happened. 

People are not being given the attention they need and doctors are not referring them to appropriate resources for help, for their individual lifestyle needs. It happens during treatment and after completion of treatment. And that is what I want to address in a way that is affordable, accessible, understandable, and useful. 

Yet I can't get doctors to give me the time of day to let me explain them how I can help their patients. They're "too busy". So I go directly to the patients themselves. That's okay, but it would be much better if the doctors were aware of this service and could let their patients know. Sad reflection on the state of health care, isn't it? 

You can't make an addict stop the addictive behavior until they want to. You can't change dysfunction from within the system. So I do it from the outside. Meanwhile the doctors will continue to be unaware of these resources available to their patients. And they will do a disservice to their patients by omitting that important information that makes a difference in their healing and quality of life. 

Which is why I've been saying all along, health care is neither health nor care. 

We can do better. And I am. 

End of rant.