Sunday Scribblings #24 - Hospitals

Yo ho ho.
Hospitals make me laugh.
Not a joyful laugh,
but a cynical "can-you-believe-the-gall" laugh.
From the inside there's lots to see.
Layered with waste.
Much talk with little action.
Lots of ego and minimal consciousness about the incompetence.
(If you at least know you're incompetent, that's a step in the right direction!).

The "marriage" happened in 1998.
Not a love marriage, but an arranged hospital marriage.
An amalgamation that swallowed our autonomy.
"Saving money" meant creating more layers.
More management.
Endless cab rides from one site to another.
Costing tax-payers, not to mention the environment.

I've since seen hospitals go through "divorces", taking back their independence.
We never got that far.
We just got trapped in a bad marriage.
Helpless, and unable to leave.

S.M.A.R.T. goals

Specific
Measureable
Acheiveable
Realistic
Time-bound

We are having our 3rd day-long workshop about how to make a goal SMART.
There are work groups that study and present this.
Don't get me wrong, I think it's important, because then we can measure our effectiveness.

The hospital has spent about $20k to teach us this stuff
(it's not really that difficult of a concept to grasp, but some of the therapists are a little resistant to change).
Even though they've dropped 20 grand into SMART goal training they won't pay the $1680 to teach us all CPR.
We have to pay out of pocket for that.

We work in a rehab hospital, for god's sake. Where people are sick likely to need CPR.
It is a requirement of our jobs that we have it. But they won't pay for it.
And they won't let us have CPR drills either, yet we have fire drills practically once a week.
Let the place burn down - we'll know what to do.
But god forbid you need CPR at our hospital.
Thank the lord I have malpractice insurance, cuz you never know when someone is going to pass out in the middle of a speech-therapy session.

I'm sitting at our weekly "team meeting".
Our agenda says that we're going to talk about the bulletin board in the lobby.
But that's the last agenda item, so I assume that means it's the least important.

I see "Waiting List" near the top of the agenda, and am anxious to talk about how we're going to tackle our mammoth ever-growing wait-list. It's been multiplying since those two therapists went on parental leave and they weren't replaced.
Bitching about what is allowed to be posted on the bulletin board and who is going to police it seems less important than figuring out how we're going to schedule new patients.
Wrong.
For 45 minutes, a bulletin board debate ensues.
Nonsense like "what goes on the board must be in line with our core values", and "what kind of stamp-of-approval" will go on posted items?" is spurted across the table.
We never do end up making a decision.

So now, there's no time to talk about the waiting list.
Out of this comes a "work group" whose job it is to figure this issue out.
They will meet, come back with recommendations, and the whole team will then debate and likely disagree with their recommendations.
That or the action plan will be veto'ed by the higher ups.
Waste.

A hospital is a business.
With something to prove.
It still surprises me that they compete with one another
to be recognized as "the best".
There are score cards, things to measure up to.
Tracks to cover.
T's to cross and I's to dot.
Things to write down on paper and later forget about.

Every day we keep stats.
Stats about who we've seen, what we've been doing.
Stats that account for every minute of our day.
How much face to face time we're spending with patients.
How much "non-patient-care" time we log.
Good things to know.
Useful information.
Although it's a pain, I think it's a good idea to keep stats.

But then one day I learn that NO ONE looks at them.
That's right, they never get looked at.
We spend all this time meticulously recording our every move, and NO ONE uses this information.
Decades of data are ignored.
I thought our funding or salaries or capital budgets were calculated by our stats.
Nope.
Seems it's all arbitrary.

2004.
No recycling at my rehab hospital.
I take my paper and recyclables home by the armful.
2007.
Still no recycling.
Still no recycling.
Plastic water bottles (distributed because of the lead in
the pipes).
THROWN IN THE GARBAGE.
Tons. LIterally tons of landfill.
Created by
the
hospital.

Hospitals.
Ha.
I know too much.
This omniscient institution with too much yang pumping through it's infrastructure is a little messed up.

But the pension plan is pretty good... : )

Sunday Scribblings #23 - My first act as Queen of the world would be...

...to admit that I don't have a clue how to run the world.

But what I could do is create a pretty savvy, forward-thinking, and progressive group to take care of straightening things out.
I'd need to hand pick a team of consultants.
You know, a group of experts on things like the environment, disability rights, equal opportunity, trade relations, the economy, anti-racism/sexism/genderism/ageism, etc.
I'd screen them scrupulously to make sure they held common values.

Our goal would be: to cultivate harmony by removing barriers that prevent loving kindness.

These consultants wouldn't be paid unwarranted salaries.
In fact, these would be voluntary positions.
The world's gratitude and their relative autonomy would be reward enough.
It wouldn't be cult-like. No crazy pep-talks or strange routines to keep people going.
Our group would be task-oriented, talking about AND doing things.

Oh, and there'd be no palaces or gated properties in my queen-dom either.

Would all this work? Who the hell knows.
All of this is just pretend shit anyhow.
Sometimes I'm a bit of an idealist,
hoping that we could all just live in truth,
recognizing that we are all no different from one another.

PACE

Sunday Scribblings #22 - First, Worst and Dream Jobs

First Job:

Starways flyer delivery girl, 1985, 12 years old.

Yup, you know those annoying circulars that practically no one reads and everyone throws away (that is, if they don't get blown away or rained on first)? That junk mail that drives some of us batty? That's what I delivered. I earned 1/4 of a penny for each flyer I delivered. I had to deliver to 4 houses to make 1 cent. Can you imagine? I hated that job. It took me about 2 hours to deliver all 250 papers and earn 62 cents. The smell and feel of the newspaper made me nauseous, and I felt like such a geek.

The only reason I took the job was to try to keep up with my twin sister who had a REAL paper route. She delivered the Toronto Star. She earned roughly 13 cents per paper, a full 420% more than I did. What's more, she had the help of my step-dad who drove her around the neighbourhood with the Saturday papers in the trunk.

Soon enough I realized that I was losing the earning competition, and that my time was worth more than 31 cents per hour. My solution? When the second delivery day came around, I left the papers in the green garbage bag they were delivered to me in. I walked over to the back of our local plaza, where the store owners left their garbage, and added my bag to the collection.

At the time, I thought this was quite clever; I was saving my time and preventing my neighbour's frustration at having to deal with junk mail. In the meantime, I went and got myself a job walking a little girl to and from school. The human interaction was nice and it made me feel needed.

This sweet deal lasted only for about a month, at which time I had a fight with my sister, and she spilled the beans. During a particularly nasty girl fight, she told my mom what I was up to. I can still remember standing at the side door as Kim yelled out to my mom "Jennifer is throwing out her flyers instead of delivering them".

So ended my broken contract with Starways Carrier, Inc. My mom had me pay back the money I had been padding my bank account with. I think she was more humiliated by her daughter's fraudulent behaviour than I myself was.

Funny, that. Thinking about it now, It seemed that by throwing away those flyers was like being on some sort of a strike. It's my earliest memory of standing up for my rights and making a point. Mind you, I might have just quit the job altogether, but a 12 year old is not cognitively sophisticated enough to make that call.


Worst Job:

Speech-Language Pathologist, Riverdale Hospital, Toronto, Inpatient Neuro Rehab and Progressive Neurological Unit
1998, aged 25.


My first professional job was also my worst job. An overzealous, type A perfectionist, I was particularly vulnerable to neglecting self care. I worked a 12-15 hour day 5 days a week to try to be everything to everyone. First to arrive, last to leave.

My job was to provide communication and swallowing services to 2 groups of patients. I was to spend 70% of my time with folks who were recovering from acute strokes and traumatic brain injuries. The other 30% of my time was devoted to those with all kinds of progressive neurological disorders: Multiple Sclerosis, Parkinson's Disease, Huntington's Disease, Progressive Supranuclear Palsy, ALS (Lou Gehrig's disease).

I couldn't maintain the 70/30 split for the guilt it caused. There was more to do on the progressive neuro unit than the 30% of my time allowed. My 40 hour work week ballooned into 60-70 hours and I still couldn't do enough. I was being paid big money to deal with lives, and I felt particularly responsible for things beyond my control. While the people with the acute injuries had spontaneous recovery on their sides and were making slow and steady improvements, the ones with the progressive neuro disorders were declining. Often daily.

This is why this was the worst job. Grad school didn't prepare me to deal with deterioration. I was under the illusion that my job was to "fix" people. Of course I thought this - my training followed the medical model. Rationalizing that this was unrealistic meant challenging my sense of self and my human limitations. Worse, justifying my lack of super-powers to desperate family members was soul wrenching.

And the swallowing. My god. Talk about culpability.

Picture this: A cognitively disordered Tamil-speaking daughter force-feeding her mother who is in the late stages of Huntington's disease. This poor mom is so neurologically impaired that she is UNABLE to swallow. It's not even that the swallow is delayed or that there is some tongue or jaw weakness messing around with her swallow function. Nope. Much more serious. SHE IS UNABLE TO SWALLOW. Period. But the daughter, innocently wanting to nurture her mom, continues pushing food into her mom's mouth. Eventually, mom's mouth fills with food and then it starts to pour into her trachea, down her airway, into her lungs. Recipe for death due to choking or aspiration pneumonia.

I didn't sign up for this. All I ever wanted to do was help people to communicate better. My head and neck anatomy training landed me in this role as a "swallowing specialist".

Back to the woman with Huntington's Disease. I have no way to communicate the danger to the mom or daughter. I don a hospital gown and gloves, and watch as the daughter feeds her mom. I move in to try to feel for laryngeal elevation. In the meantime, mom sputters up the pureed veggies that are trickling into her lungs, and I get a nice facial spray of the food she's unable to eat. Oops, forgot to wear that mask.

Fast forward 2 days. Mom is dead, and I am bawling in the hallway. Her death really had nothing to do with me, but I bore the responsibility nonetheless.

That seals the deal. I quit after only 4 months.


Dream Job:

Nia Instructor, 2006, age 33.

Movement, music and magic.
The Joy of Movement.
Form and Freedom.
Yin and Yang.
East meets West.
The pleasure principle.
This is Nia.
Dance, martial arts and healing arts.
Nia.
"With Purpose" in Swahili.
Nia.
Neuromuscular Integrative Action. Nia.

I discovered Nia through a boss about 7 years ago, at the age of 27. At first I didn't understand it. Because it involved taking off my shoes to exercise. And it didn't involve barking commands or repetitive, jarring exercises. The instructor encouraged us to feel good in our bodies, and there was none of this "no pain, no gain" kind of talk. I guess I found it foreign to actually be in my body and to feel pleasure while exercising.

It took about 6 years to decondition my belief that "harder is better", "more pain = more progress", "physical punishment and pain" and "faster, further, harder is better". It took awhile.

From Dragon Boat Coaches who encouraged us to "Paddle til you puke" and Boot Camp Instructors who said "Doesn't it feel good to work out so hard that you lose your hearing?!", I had a lot to unlearn. It took a lot of effort to change the automatic self-talk tapes in my head that told me to "work it harder".

But now I have Nia. I teach 6-8 classes per week and live so fully in my body now. I sweat, I dance, I have fun!

Dream job. Taking care.

Nia

Now
I
Am
.......free
Now
I
Am
.....alive
Now
I
Am
....in control

Sunday Scribblings #21 - Sorry

"Oh, sorry"

Not my fault, but still,

"I'm sorry"

Weakness of character, failure, act of wrongdoing.

Rushing through the kitchen, I brush past the corner of the fridge,

"Sorry", then a laugh.

Talking to my mom, I tell her I'm a little down.

"I'm sorry honey". That's taking responsibility to the extreme. Unreasonable.

Over-used, watered down, becoming meaningless.

"Spare some change?"

"Sorry". But I'm NOT sorry. There's so much more to it than that.

"Sorry for living!". What self-bashing shame that expression taught us!

Taking care of myself by saying "no", followed by

"I'm sorry" links selfishness and guilt to self-care.

"You're not sorry, you're just sorry you got caught".

A disciplinary check on my conscience growing up.

Yeah, I learned to repent, to be remorseful.

I was born to be sorry.

Sorry for the original "sin" (the sin of thinking for oneself).

How many hours dd I spend up there at that mercy seat crying my eyes out,
being "sorry" and pathetically unsatisfactory to everyone around me?

What a waste of emotional well-being and a sabotage to my self esteem.

Cause-and-effect

Act, then explain

Sorry

Sorry

Sorry

Sorry!

A hallmark Parker Brother's board game,
an apology for bumping opponents back to the start.

I'm Canadian.

inherently

I AM SORRY.