There is a movie review in this blog.

Print journalism has been so good these past months that felt like years. Remember back in 2012, that gleeful feeling you got when you read Pete Wells’ review of the Guy Fieri superfund site in Times Square? Well, I just re-read it and it is a mere amuse bouche for the righteousness served daily by journalists at the Washington Post, New York Times, and smaller dailies in Detroit, Cincinnati, so on. Oh, lord, ProPublica’s piping hot Pulitzer-prize winning online investigative journalism. Just as you might “a plate of pale, unsalted squid rings next to a dish of sweet mayonnaise with a distant rumor of spice,” choke down this justice!

All of this is to say that print journalism is being the kind of excellent that one can only imagine was motivated by a prior laziness, a willful misinterpretation of equal coverage, a cowardice so big it created a universe of language to explain a phenomenon where one word would do (lie); all contributing to the rise of the a leader that in brief, is frickin’ dangerous.

SO! What I mean to say is now is the time to hug your journalist. And, if you like me think human lives are fascinating and the people that spend theirs writing about others even more cause they are themselves fascinating in super intelligent, hard to get along with, quirky beyond all reason ways, please watch the documentary Obit.

Somewhere buried in the documentary the writers address the “isn’t it sad to write about dead people all day” question. I couldn’t agree more with the answer, which is: not at all. They get to write about a life that, likely if it makes The New York Times, is full and brilliant, meaningful, left a legacy, and often lasted a long time.

I feel the same way about taking care of people at end-of-life. Is it sad? Not usually. Not really. No.

I regret even starting with the Guy Fieri stuff. I’ve lost my appetite.

 

 

 

 

 

 

Why gun violence research has been shut down for 20 years – The Washington Post

Lamenting the absence of studies has been a part of our post-massacre what-can-be-done for a number of years and a larger number of mass shootings. But what could research do to get us out of these dire straits?

Scientists, lab coat-ed spreadsheet fillers, create the data that uncovers the truth. I’m not sure if you’ve heard yet but truth is a powerful thing. Evidence is the pointy triangle on which change is leveraged.

Traffic deaths, often sited by gun lobby as even with gun deaths, get a healthy amount of study. The Federal Transit Administration gave out 7 million in grants to advance transportation safety.  Research is done, evidence is collected, and regulations (seat belts, which I find sexy) are put into place. The auto industry isn’t going to make those crumple zones, laminate that glass, put in that little switch that turns your passenger airbag on and off so a tiny seat occupant is not killed by its deployment, out of the goodness of its heart.

To make industry safer, we need regulations. To make regulations, we need evidence. To make evidence, we need research.

The gun industry has put an impressive chill on learning anything about the safety of firearms. The 1996 Dickey Amendment, legislating that no research may advocate gun control, has been reauthorized every year by Congress. Data quoted in the aftermath of mass shootings is culled from CDC databases that collect cause of death information. CDC numbers tell us that guns are killing people in epic numbers. But epidemiological data alone does not a policy make.

Source: Why gun violence research has been shut down for 20 years – The Washington Post

No more free birth control, says President

That’s right. I was pretty stoked about the Affordable Care Act requirement that birth control to be 100% covered by all insurance plans. What a great thing! To not have to pay more for health care simply because you have a uterus! To make accessible the means of controlling when you will have children, thereby increasing your chances of advancing your education and career, making you, a uterus-haver, more able to pursue the dream of being an independent and self-sufficient citizen-contributor.

Allegedly the pres. wants to put a stop to abortions. Presumably the fewer abortions the better?  Since free birth control provided by the ACA became available the number of abortions per capital dropped to its lowest level since data collection began at Roe v. Wade.

MAKE UP YOUR MIND.

This is abysmal health policy. Terrible public policy. Bad economic policy. And its perfectly in tune with the administration’s regard for women. NONE.

American guns and public health and hope.

America is not a hostage to itself in the battle over how to handle guns. We are able to change. The evening after another massacre, the word weary for being trotted out month over month, I’ll make an appeal.

With the will, we can get better.

Our current president dismissed the Surgeon General Vivek Murthy, the first in the position to declare gun violence a public health issue. Like HIV/AIDS in the 1980s and tobacco in the 1960s, the Surgeon General can be the first political officer to acknowledge a public health disaster. This should not be a controversial position…I’ll quote from Healthcare Triage, which has a very worthwhile primer on gun death stats:

guns hctraige

There is evidence to show that a gun-loving nation can be made less violent. You may know the history of our fellow former colony (and the only place where you can make a grittier western than home) Australia, and it’s remarkable policy-driven turn around addressing gun violence. Through compulsory buy-backs, stricter regulations, and cutting off the flow of new guns among other measures, the country responded to a harrowing mass shooting with sweeping policy change that turned their gun violence trajectory upside down. Sure, they are more than ten times smaller than the US. But in most all measures they are our closest comparator. There is no reason that their success could not be seeded here.

No reason not counting money and gun makers and, most important, political will. All of this is just to say we’re selling ourselves short with thoughts and prayers and other things offered in the face of hopelessness. We can get better.

 

 

 

 

Friendly neighborhood sick person weighs in on health care debate.

When I used to freak out about losing my health insurance/access to care, not being able to afford medicine, I always pictured my parents losing their house to pay my medical bills. It was the greatest loss imaginable. In the past months my catastrophizing has changed. Now, my mother won’t sell her home, cash out her retirement. I fantasize about dying from lack of care. If my cancer comes back, if I can’t keep my job, if I lose my insurance and I can’t afford to get treatment–I won’t seek care. I’ll die of my illness.

If anyone every told you I’m stubborn they weren’t lying. I indulge this fantasy of martyrdom to my hard-hearted country.

I need to express the psychic weight that the debate over who deserves what coverage burdens me with. Watching the monetary value of my continued American existence up for debate just a few miles from where I live. I cost healthy people too much. My debility or poverty disqualifies me, abdicates rights I thought were mine… life, liberty, something else… but yea, life. Not that.

In my hospital we have special education high school students working as volunteer helpers. Not everyone welcomes them. They are different people and require a slight adjustment in communication. They require accommodation.

They came to the hospital to work with assistance of a career coach and the support of our unit manager. They are kind and interesting, alike to most young people. Tremendously helpful, alike to most young people. Restocking supplies, lending a hand to grab a wheelchair or a drink for a patient, going to the waiting room to track down someone’s elderly family member who won’t answer a cell phone. They complete tasks that keep everyone in the unit moving forward. Days that I’m swamped, they keep me afloat.

The myth of the productive citizen baffles me. I’ve met a lot of people. Strangers coming out of anesthesia tell me dark secrets. No one conforms, not all the time. We are a big interdependent mess. To define productive and make it the measure of value is a terrible effing idea. This ideal of a completely independent working class American is at the core of the repulsive rhetoric I see daily.

What we are capable of is influenced by what we are told we are capable of. The political dialogue, a demoralizing debate over who is worthy of access to care, corrodes the potential of the precise people that have renewed American greatness again and again. The striving poor, immigrant, person of color, victim of circumstance. The young. Mounting arguments to deny the very poorest, the sickest, the youngest among us the scant safety net of Medicaid and strip us of legal protection to not be discriminated against due to sex and preexisting conditions, is undeniably passing judgement on who deserves healthcare. These groups of people, my people, have no chance to acquire health insurance without the protections set in place by Medicaid and the Affordable Care Act. To be without insurance is to be without access to care. The message is this: you are uncared for. To be perfectly clear, you are left for dead.

The health care debate is deeply personal. The abandonment of my cause, my cause being the pursuit of a productive and healthy life, by so many of my fellow Americans. My president, my representatives.

Since my diagnosis at age seventeen I kept my lupus a secret from most. A learned behavior from my father who shared the same diagnosis. He came of age in this country, a sick person in a time before the Americans with Disabilities Act. The fear of being found out, losing out on educational opportunities, jobs, insurance.

I lied on my college applications. I lied on my job applications. I’m not sure if you’ve noticed, but there is a box to check for “I may require reasonable accommodations” i.e.–I have a disability. NOPE. Nope. Per dad’s advice, cross that bridge if you come to it. You don’t need accommodation. You can pass. I can pass for healthy. I’ve never had trouble getting a job.

But I was ashamed. Sneaking around in the shadows will do that to a body. Fearful of being judged as burdensome. A waste of the world’s resources.

To experience the birth of the Affordable Care Act and its protections after a labor so long and fraught was elation. Immense validation. I was hearing from the highest office in the land that my worth, my potential, was not degraded by chronic illness. It’s no coincidence that it was in those heady days I returned to school and became a nurse. I chose a challenging career in a field of service. I was pushed, encouraged to dedicate myself to progress personal and political. In no small part because of the leaders of my country put all the chips on the table to codify the belief that health care is a human right.

Since the ACA passed, I’ve checked the “accommodations” box. When I go to an appointment, I don’t lie. My coworkers no longer think I am hitting the dentist’s office monthly. I can pass, but I need everyone to know what a disability looks like. Which is, in my opinion, human. The messages that came from President Obama, from my representation, from advocacy groups all over the land made me feel like it was okay to exist as I am.

Permission to exist is a powerful thing. It isn’t hyperbole to say that the Affordable Care Act is my own civil rights legislation.

It despairs me to hang on as the pendulum swings against it. But hold on, it matters. Keep saying it, no matter how ridiculous it feels to say, children and women and the sick and the elderly all deserve equal protection under the law. Our nation, and me, well… our lives depend on it.

PS- Somebody make me a bumper sticker that says “KEEP YOUR HANDS OFF MY OBAMACARE”

St. Elizabeths Asylum, Washington, DC.

Lo, I did write thee a splendid piece on my visit to the National Building Museum exhibit on Washington, DC’s great Asylum hospital, St. Elizabeths (no apostrophe). But ay I did it waiting for a surgery to close, needing something to do something with my nervous energy. The patient, when asked the standard pre-surgical question “Why are you here with us today?” (assesses orientation, assures that the patient is informed, confirms procedure), answered “I am dying.” Always believe the patient who says they are dying.

Crash cart at my side, fellow nurse and I finished planning our I-hope-this-doesn’t-turn-into-a-code, I typed out a gem. And upon finishing, ran off to do a thing and lost it.

Instead, here is an excerpt of a letter written by Dr. Charles Nichols, superintendent, to Dorthea Dix (nurse, hero) the greatest advocate for mental health that ever lived whose actions led to the establishment of the hospital, on the selection of a site.

The moral treatment of the insane, with reference to their cure, consists mainly in eliciting an exercise of the attention with things rational, agreeable, and foreign to the subject of delusion; and the more constant and absorbing is such exercise, the more rapid and effectual will be the recovery; but many unbroken hours must elapse each day, during which it is on every account impracticable to make any direct active effort to engage and occupy the patients’ minds. Now, nothing gratifies the taste, and spontaneously enlists the attention, of so large a class of persons, as combinations of beautiful natural scenery, varied and enriched by the hand of man; and it may be asserted with much confidence, that the expenditure of a thousand dollars each year, directed to the single object of promoting the healthy mental occupation of one hundred insane persons, with either amusements or labor, would not be so effectual in recalling reason to its throne, as will the grand panorama of nature and of art, which the peculiar position of the site chosen happily commands. The shifting incidents of the navigation of the Potomac, the flight of railroad cars to and from the city, the operations at the Navy Yard, &c., will continually renew and vary the interest of the scene.

It lifts my iron anchor of a heart to read about this period in time, the asylum movement. Started by Quakers and somehow collecting political support for the mission to create a place, tranquil and serene, to house and heal vulnerable, imprisoned, and cast away persons suffering from mental illness. Public funding! Our government and the people it represents setting aside money to better provide for its poorliest members. Acknowledgement that all people have dignity and value.

**I know you’re thinking asylum? You mean those places where people are locked up and tortured and experimented on? Yes, terrible. But I’ll refer you to the many, many atrocities committed against those walking free: people of colorindigent people seeking care at public hospitals. Medical ethics has an awful lot to answer for. It’s my speculation that we pin it all so easily on asylums, place all our unquiet ghosts there, because of the fear and stigma bound to mental illness. Chew on that. I digress.

Asylums were conceived in goodness. Every pure-hearted reformer may know exactly where the road paved with their good intentions will end up, but I’m glad that they’re trying. We keep trying. We should always be trying.

PS- As Dr. Nichols states, I’m in favor of doing anything that “recalls reason to it’s throne.” Especially in this nuthouse town.

Last week in health care

As far as health news for Americans last week was, much like a circus fire, INTENSE. Here in the Capital “Thunder” Dome there was the braying of donkeys, the stampeding of elephants, the crunching sound of every member of the health care community beating their skulls against the walls, and the immense heat of electronic devices tripping breakers over and over as the grid (and I, via bourbon) experienced rolling blackouts.

I stayed up late and got up early and skipped all my meals in an attempt to stay current, but unlike our president I will not make assertions that that means I’m functioning. Hm, maybe he’s just tired and cranky?

Things of importance from this week:

#1 Healthcare Triage short video on understanding the AHCA. You can see that Aaron Carroll is about 85% of the way to his breaking point here. And good god there were still two more days to go in the week.

#2 Paul Ryan shows he’s a bit shaky on what insurance is (we all pay for fire insurance so that if you have the terrible fortune of your house catching on fire, you are not financially devastated). BUT MR. RYAN WHY SHOULD I BUY FIRE INSURANCE WHEN MY HOUSE IS NOT AT PRESENT ON FIRE?

#2 Emma Sandoe, quickly becoming my favorite voice on the internet, expert in Medicaid, with this tweet (Poor people were once human people like me? No…)

https://twitter.com/emma_sandoe/status/839877905882759168

#3 In response to the question: what mandates do the Republicans object to? “Men paying for prenatal care.” Buh..uh..wha..wait. Since no man has ever been born or engaged in an act that might conceive a child.

#4 The AMA, ANA, AHA, and any lobbying association representing direct patient care declare the American Health Care Act to be one hot unsustainable mess. For the uninitiated, this is lions laying with lambs stuff. The orgs are not friends, and we seem to be arguing into a void at this point.

#5 The Washington Post editorial section posts a satire that would make Alexander Pope holler “SWEET BURN” in his grave. Per the Dems response to the AHCA:

“Mr. Gorbachev,” as Reagan so stirringly said, “This wall desperately needs revision.”

#6 Our collective desire to continue living is affirmed by a BBC Asia expert in his home office in Korea when his children pull back that hollow-core door veneer that keeps us believing that what we say and do is suit-and-tie worthy and crucial to the survival of humanity. From his IDAF toddler in her you’re-not-going-to-miss-this-dance yellow shirt to the younger sibling in the most successful comedy vehicle since the American Pie movies. It had to be the mom, btw. That was a woman bolting off the toilet to save her family.

Cheers to this week! Hope you’re well rested.

 

Thank you for marching. Love, Me.

I knew by last Wednesday I wouldn’t make it to the march. My six-year-old had had a fever for 3 days, I was calling out of work and trying to get him to the doctor, and my nursing work schedule included non-negotiable 12 hour shifts on Friday and Sunday.

I was desperately sad when I woke up on Saturday and, like every normal human, pulled my phone from under my pillow and started scrolling twitter. All these beautiful women I love and admire, my friends! Together on The National Mall with their children. Arms linked, posters cutting, experiencing history’s counterpoint to Friday’s stiff and depressing presidential inauguration. And here I was in my PJs. A bad mom for not bringing my son to the momentous even, a bad woman for skipping the rising up of the sisterhood.

But wait, forget that guilt. You marched for me. I’m a single parent of a young child. I struggle with being a mom without a partner or adequate child support, a professional with no job flexibility to accommodate my role as parent, and due to the unaffordable nature of childcare lean on the support of my own mother to help raise my child. Also, I’m a cancer survivor and the ACA keeps me covered with health insurance and free from the fear of medical bankruptcy. Last, I am fortunate in this time of health professional shortages to work with a diversity of talented professionals from all over the world. I worry that through fear mongering or bad policy I will lose these irreplaceable nurse, tech, and doctor colleagues caring for our sick and elderly.

So to everyone who marched–I couldn’t be there on Saturday to show my support. I am forever grateful to you for marching.

Virginia Gov: Health Commissioner gives standing orders for residents to receive opioid reversal drug

Virginia responds to opioid crisis with standing orders written by State Health Commissioner Dr. Marissa J. Levine allowing residents to obtain opioid reversal drug naloxone from pharmacies. Has anyone seen a set of standing orders used in this way during a public health crisis? I’m thinking bold moves. Which is what I wholeheartedly support.

Governor McAuliffe:
“The overdose rates in Virginia have led me to agree with Dr. Levine that we are indeed experiencing a public health emergency. This declaration helps us respond in a nimble way to a rapidly changing threat, while the Naloxone standing order from Dr. Levine broadens our ability to get life-saving medication into Virginians’ hands.”

Source: Governor – Newsroom

BUT WHAT ABOUT

From Medline:
You will probably be unable to treat yourself if you experience an opiate overdose. You should make sure that your family members, caregivers, or the people who spend time with you know how to tell if you are experiencing an overdose, how to use naloxone injection, and what to do until emergency medical help arrives.

Who will do the educating? Public health campaign to instruct people on what a opioid habit looks like so they know to be prepared with the reversal drug? Pharmacists to educate on how/when to use it? What’s the plan, where’s the funding, how are we going to implement, and in what way will we measure success.

Also, check out: http://vaaware.com/treatment-recovery/