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When Your Employer Won’t Take No For an Answer

English: This is CDC Clinic Chief Nurse Lee An...

English: This is CDC Clinic Chief Nurse Lee Ann Jean-Louis extracting Influenza Virus Vaccine, Fluzone® from a 5 ml. vial. (Photo credit: Wikipedia) You go, girl!

The recent firing of 8 healthcare workers who refused to get a flu vaccination at Goshen Hospital in Indiana is not surprising. As influenza season kicks into hyper-drive, hospitals unleash the latest public relations strategy in making patients believe they are safer – mandatory flu vaccination for healthcare workers. The reasoning is that hospital inpatients are already vulnerable to infection and preventing healthcare workers from infecting them, because the healthcare worker has immunity due to the flu vaccine,  will save lives.  This mindset has a few flaws.

First, the flu vaccine is not 100% effective. That’s not to say I don’t get one myself, but, as the Centers for Disease Control (CDC) website points out:

“The effectiveness of influenza vaccines varies from season to season, and depends upon a number of factors. One factor is how well the vaccine strains match the viruses that actually circulate during the season. In addition, vaccine effectiveness is affected by the recipient’s age, immunocompetence, and previous exposure to influenza viruses.”

No 100% guarantee there.  In fact the CDC notes,  “Recent RCTs (Randomized Control Trials) of inactivated influenza vaccine among adults under 65 years of age have estimated 50-70% efficacy during seasons in which the vaccines’ influenza A strains were well-matched to circulating influenza A viruses,” “a study of Dutch community dwelling people aged 60 years of age and older reported a vaccine efficacy of 58%” and “study among 92 healthy adults aged 18–41 years, the efficacy of inactivated and live attenuated influenza vaccines in preventing laboratory-confirmed influenza was 71% and 85%, respectively.”

With the average age of registered nurses at 46 and doctors at 51, I’d guess the vaccination effectiveness is in the 50-70% range. Oh, and did I mention if you’re going to get immunity,  it can take up to 2 weeks after the shot to get immunity?

Even if it did confer immunity to 100% of the healthcare workers who received it, they are not the only carriers of influenza. Since the infected are able to infect others one day BEFORE getting symptoms and up to seven days AFTER getting sick, think of all of the other traffic in a hospital including visitors, admitted patients, and vendors. Are they all vaccinated against flu? Who knows. Can hospitals require them to receive vaccination? I’m guessing the answer is no. This means in a perfect world, with every healthcare worker not only immunized but also immune, there would still be potential flu carriers wandering the halls every single day. Since the flu can be spread to others up to six feet away, a vendor or visitor at the nurses station can infect a patient who is walking nearby for physical therapy. Unless hospitals go into lock-down at the start of flu season, a strategy of mandatory vaccination leaves plenty of room for infection.

Forcing people to get immunized for flu or lose their job is easy. In my book, proving that it is the best and most effective option to save patient lives is a little bit harder. Having worked in a number of healthcare institutions, I know most healthcare workers work sick for a number of reasons including managers who penalize them and co-workers who resent working short-handed. I also know that hand hygiene, considered the baseline measure to prevent the spread of disease, is nowhere near 100% in organizations. Instead of picking the low hanging fruit of vaccination, organizations should look toward preventing all healthcare acquired infections. I’d love to see someone fired for not washing their hands.

Instead, Goshen Hospital fires 8 out of 1300 people who refuse vaccination. It makes me wonder about the 1292 workers who didn’t get the vaccination, but were allowed to keep their job. Maybe the excuse was they don’t provide direct patient care. Maybe the hospital couldn’t take the financial hit of losing certain positions, such as doctors, surgeons, and top administrators.  Firing front line staff, such as nurses, therapists, housekeepers and food service workers,  has always been easier than the politics of firing the rainmakers of healthcare.

Perhaps this is just the first salvo organizations will fire in the crusade to show their commitment to patient safety. Imagine a hospital website proclaiming, “100% flu vaccination rate” instead of “71% rate of compliance with washing hands between patients.”  The illusion of safety provided by mandatory immunization shouldn’t be confused with the reality of 1.7 million hospital-acquired infections and 99,000 associated deaths each year.

For now, firing a few employees for show will have to do. I know I feel safer.

Fired red stamp

Fired red stamp (Photo credit: Wikipedia)

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Plumbing the Depths of Grief

american somme cemetary Bony

american somme cemetary Bony (Photo credit: Wikipedia)

The death of a loved one is an impossibly agonizing, soul-crushing experience that never completely heals and only lessened by time. When my brother died in a car accident at the age of 25, I thought my tears would never stop.  From the moment I first heard the news, until the moment we lowered his body into the ground, I cried with a ferocity and singleness of purpose I didn’t know I possessed.  All the awful details of death, going to the hospital to get his personal possessions, cleaning out his apartment, picking out a coffin and the clothes he was to be buried in, were done with eyes blurred by tears and a voice hoarse from crying.  The procession of people bearing food and flowers seemed never ending, but I only hungered for alcohol and cigarettes.

After he was buried, the dreams started. Dreams of the two of us on a subterranean train system, the only illumination strobes of light that made him and the other passengers appear and disappear to the background sound of a speeding train racing over wooden tracks.  I was the only one who spoke in the dreams. He sat quietly, attentively, listening. I started out by speaking slowly, normally, and as the train raced along my words hastened to match its speed. I’d talk faster and faster, cognizant in my dream that the time to talk was soon coming to an end, and then he’d disappear.

I’d wake up crying, thinking I would pay any price for him to still be alive. Eventually my grief ebbed to where I could say his name without crying, and then to where I could look at his picture without my eyes growing teary, and now I survive without him. Still, 28 years later, I mist up whenever I hear the lines from “White Christmas” that promise “I’ll be home for Christmas, if only in my dreams”  because my dreams are the only place I can hope to see him.

Was I depressed during the grieving period? Yes. Did my doctor put me on antidepressants to numb the pain of my loss? No, and I’m glad he didn’t. My brother’s death was something I had to work through and plumbing the depths of my grief informed how I have dealt with the deaths of all of the loved ones that have followed him.

The American Psychiatric Manual has traditionally warned against diagnosing depression during bereavement, but now psychiatrists with ties to drug companies have helped to remove that warning and the makers of antidepressants stand to benefit from the change. If grief equals depression, grief is a treatable condition. A treatable condition is billable and amenable to interventions, in this case, prescription medications. Instead of providing a shoulder to cry on, doctors will provide a prescription pad to write on. And where does that leave the patient? Once again a normal part of life is medicalized, this time because drug companies want to take advantage of a market that increases every day, with every death.

Recently I heard the story of a mother who stood up at her son’s funeral and apologized because she had nothing to say to eulogize her son. She stood dry-eyed, unable to cry, and said she was on too many medications to feel anything but numb.  I wonder about her now, many  months after her son’s death, and whether she’s allowed herself to experience the pain of grief in all of its snot-drenching messiness. I hope so. I can’t imagine any crueler prison than not being able to let go of that pain.

In mourning death, we open our heart and let it bleed. Even though a scab may form, for a long time every memory rips it open and starts the bleeding again. It’s an unpleasant, unpredictable process, but as Henry Rollins says, “Scar tissue is stronger than regular tissue. Realize the strength; move on.”

The grieving process helps us to do that far more than any chemical ever will.

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Toilet Paper and the Not Quite Empty Nest

English: Toilet paper, orientation "over&...

English: Toilet paper, orientation “over” (Photo credit: Wikipedia) Correct placement of roll.

The Christmas holiday has bestowed the gift of my adult children at home for a week as well as two additional dogs and a cat. Yes, it’s a little chaotic and crazy here.

My mother always says that fish and house guests stink after three days. I’m unsure if it is a cautionary tale meant to keep your house cold or to ensure there’s adequate Febreeze, but so far the stench has been minimal. Other than discovering one of my dogs is allergic to one of my daughter’s dogs and that when everyone in my family is in front of the wood stove for a picture, the wood stove pipe will spontaneously disconnect from the chimney, things have been surprisingly pleasant.

Except for the toilet paper.

English: Toilet paper, orientation "under...

English: Toilet paper, orientation “under” (Photo credit: Wikipedia). So incorrect it hurts me to look at it.

There is a right way to put on the toilet paper roll and a wrong way. You would think these two children that I raised would know this. In our house, the toilet paper roll has always unfurled on the front. Always. Trust me, anytime a visitor or passing toilet user has made the mistake of loading it backwards, I’ve promptly remedied the mistake. My lifelong dedication to this principle is unwavering.

Why then, does my youngest daughter replace the toilet paper backwards? Why would she think that dangling the end of the roll down the back of the holder is acceptable? Has she learned nothing from me all these years?

Of course my mother always told me to never go outside with wet hair or I’d catch a cold, and I do that all the time.  She also cautioned me against putting ice in red wine, but damn it, I like my red wine chilled.  My grandmother told me never to put hot meat on a cold plate or it would be shocked into toughness. I ignore that on a regular basis, too. But all of their recommendations were based on superstition, and the correct way to hang toilet paper is based on common sense and science.

Isn’t it?

And, not only that, but I forgive my children for so many other things. I don’t mind when they don’t squeegee the shower walls after bathing. I clean the hairbrushes without complaint (though wonder which one of them left gray hairs in there). I cringe inside, but shut my mouth, about the half filled beverage glasses left on side tables and the carelessly kicked-off shoes that create a mine field near the front door. I forgive so much, but, toilet paper? I suspect even Jesus would have a problem with that.

In case you’re curious, let me assure you, as a hostess, I am top notch. Their favorite meals (three bean chili, my special turkey stuffing, bread bowls) are consumed with satisfaction. The house is kept tidy and clean, in spite of four dogs and a cat. My television remains tuned to shows I would never watch (Jersey Shore, My Big Fat Gypsy American Wedding, and Catfish to name a few). I provide adequate outlets for their myriad electronic appliances. My car? Please, take it. It’s clean, maintained, and full of gas. All that I provide seems sufficient to ensure a guest would have no problem complying with my one, small request to put the damn toilet paper in the holder correctly!

Let me take one deep breath to center myself.

Okay. In their defense, they have shoveled snow, washed clothes, rinsed dishes, and even fed my allergic dog the 18 pills he must now take daily. The fact that one daughter, in an attempt to entice my dog to chew his fish oil gel cap, bit into the capsule herself and ended up with a face full of fish oil is a Christmas memory I’ll savor. Their thoughtful Christmas gifts (including an Ipod adapter for my car and a hot spot for the houseboat) illustrated how well they know me and my needs. Waking up to them shuffling around the house like zombies as they prepare their morning cups of coffee brings back memories of college breaks and the remembered happiness of having them here, tempered with the relief of knowing they would leave.

And, even though fish and house guests may stink after three days, the emptiness of my children’s leaving will last for many more. For a week, we dance around trying to get this new relationship right. We bicker, and pick at each other, and roll our eyes. We form and reform alliances over movies and music. We hide our resentment and disappointment. Then we hug it out and whisper i love you’s and i miss you’s and i wish you didn’t have to leave so soon. But, that’s what happens when children grow up.

Someday they’ll have families of their own. They’ll create their own holiday traditions and, I hope, I’ll have a place in them. Each holiday reminds me that this will always be their childhood home, but it isn’t the place they call home.  It reminds me that my time for making their rules has ended and now they make their own, and if that includes putting the toilet paper in backwards, there’s nothing I can do about it because I can’t turn back time. I can only turn around the toilet paper.

Empty Nests

Empty Nests (Photo credit: Sterlic)

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Facing Your Fears

English: Ocean Beach Pier at sunset.

English: Ocean Beach Pier at sunset. (Photo credit: Wikipedia)

 

The End of the World (yes, it feels right to capitalize it) provokes two distinctly different feelings in me. On one hand, I tend toward hunkering down with a year’s worth of food and my Kindle (and yes, I’ve a plan to keep that powered after the world ends). On the other hand, I wonder whether this isn’t the best time to cast off my fears and head out to parts unknown.

 

Fear keeps me sitting here at the keyboard.

 

My theory is that the longer you live, the more you fear. As a child, before we’re taught what and when to fear, the world must be a magical place, full of possibility. Then along comes mom and dad and everyone else to introduce the words “no” and “don’t.”  Don’t touch this, do this, eat this, lick this, pat this – the list of things children have to learn not to do is overwhelming. When my younger daughter was five, she put her entire hand on the stove top because it was red and she wanted to touch it. Her bad mother hadn’t remembered to tell her don’t touch the stove. In her early teens, she filled the dishwasher with liquid dish soap because we were out of dishwasher powder. Yep. Once again, I’d neglected to tell her that was a big no. My favorite, expensive vacuum cleaner died as she attempted to vacuum up the suds that covered the kitchen. Oops.

 

My children are not stupid or lacking in common sense. Their only crime was to think that I’d covered all of the important information in life’s owner’s manual and I hadn’t.

 

As they grew older, my incessant instructions led to my receiving the family nickname of “Master of the Obvious.” Even so, they continued to push boundaries, explore new activities, and generally leave me with a sick feeling in my stomach as I swallowed my fear and let them make their own mistakes.

 

For the record, sleeping in a public park in Europe is something you don’t share with your mother until after you’re safely back in the States.

 

The braver they got, the more scared I became. My comfort zones shrunk. My willingness to drive in big cities vanished. My ability to make decisions as simple as buying a new air purifier became mired in the obsessive reading of Consumer Reports and Amazon reviews. I questioned every decision.

 

I noticed the same thing with my older relatives and patients. They worry about icy sidewalks and driving at night and vague aches and pains. The world becomes a dangerous place, full of vandals and disease. No matter where they look, there is danger out there.

 

And so they retreat into the cocoon of their home and huddle fearfully under blankets. The television hisses with malevolent news in the background while they eat bland foods and wait for death to come. Fearful.

 

The end of the world, the end of the year, or the end of the work week are all arbitrary measures we employ as our lives slip away, but we can choose to constrict or we can choose to expand.  Give in to fear or give in to the possibility that whatever is out there is wondrous rather than terrifying. And if it’s terrifying, well, like roller coasters and natural childbirth and getting married, there can be wonder in terror.

 

When faced by an endless onslaught of demons, Angel, vampire with a soul, explains his big plan as “I kinda wanna slay the dragon.”

Career coach and author Tama Kieves says “It doesn’t matter where you enter the stream. It doesn’t matter how you begin. Just jump in.”

 

Here’s to doing the things we fear. I’ll let you know if there be monsters out there.

 

Angel_5x22_001

 

 

 

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A Magic Pill

Pills

Pills (Photo credit: madcowIV)

 

Pills (white rabbit)

Pills (white rabbit) (Photo credit: erix!)

 

 

At least twice a week someone tells me about a magic pill. They discovered it on Dr. Phil or Dr. Oz, an infomercial or a magazine, from the recommendation of a friend or with the help of an alternative healer. No matter what the magic pill cures/heals/improves, it never requires the taker to do anything except remember to take the pill.

 

I’m always a little skeptical. Most things in life, to me at least, require some effort.

 

And it’s not like the people who believe in a magic pill are dumb. Incredibly intelligent people look me straight in the eye and tell me about the latest one. On some level, we all desperately want to believe there’s a shortcut to our dreams or a work around to our pain. But that’s not the case.

 

Life isn’t easy, it isn’t fair, it’s full of pain. If a magic pill could cure that, wouldn’t we all take one?

 

Except there’s something to be said for fighting the good fight and emerging successful. Whether it’s losing fifty pounds, marrying the man of your dreams, or conquering an addiction, the journey is the part that helps us to grow. The magic pill takes that away from us. It makes us believe in trickery.

 

It’s time we value the work of improving ourselves and our lives more than we value the magic pill. Yes, working through our problems is hard, but it is only when we fully accept and embrace the tough times and the difficult choices that we move forward.

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If Women Can Shut Down Rape, Can Men?

English: A television news program simulation ...

English: A television news program simulation image. (Photo credit: Wikipedia)

I avoid watching the news on television. The days of objective journalism are long gone and if I want to watch someone with an axe to grind, I can turn to my community television channel and watch a City Council meeting.

Newspapers are no better. I can read the Upper Valley paper which portrays my working-class town as drug-addicted, uneducated idiots or read the local papers where religious zealots explain that homosexuality is a sin and that abortion shouldn’t be an option because you should “pay to play.” Really.

Usually I can get through google news and learn a little about what is going on in the world without becoming overwhelmed with the idea that the zombie apocalypse might not be a bad thing. Until today.

Zombies as portrayed in the movie Night of the...

Zombies as portrayed in the movie Night of the Living Dead (Photo credit: Wikipedia)

Today even google news pissed me off.  Superior Court Judge Derek Johnson‘s on why he didn’t think a woman in his courtroom was physically damaged enough to prove she was raped.

“I’m not a gynecologist, but I can tell you something: If someone doesn’t want to have sexual intercourse, the body shuts down. The body will not permit that to happen unless a lot of damage is inflicted, and we heard nothing about that in this case,” Johnson said.

Is 2012 the year of men equating women’s vaginas to Fort Knox or an armored truck? Are there panic alarms that sound when women are sexually assaulted? Do large steel gates descend from our vaginal walls and lock out intruders or do razor-sharp teeth erupt, ready to mutilate any penis that enters without an engraved invitation? Do I have a small pistol hidden up there that I can shoot at will? This year, I’ve had to ponder those questions and ask, is this crap taught in sex ed classes or in the back pages of porn magazines?

new favorite magazine

new favorite magazine (Photo credit: cloois)

As the mother of two daughters and aunt to two nieces, I despair that I live in an age where information is so readily available, yet men cling to idiotic, unsupported-by-reality ideas about women’s bodies. And, if women have these magical superpowers, what about men?

Is it possible to rape a man or will his body “shut down” and prevent entry. The only way to tell would be to send Judge Johnson, Todd Akin, and a few others with similar beliefs to a men’s prison for a week and see what happens.

Please, don’t get me wrong. I don’t think anyone who is sent to prison deserves to be physically or sexually assaulted. The fact that an estimated 9.6% of former state prison inmates report being the victim of sexual assault one or more times is sickening.  But, if being sexually victimized in prison helped to change the hearts and minds of idiots who blame woman for either “asking” to be raped or “not fighting hard enough” to prevent a rape, I could live with it.

Not politically correct, I know, but that’s how I feel.

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