Barstool Thoughts

A perfect pour

A perfect pour

Sometimes you read a line in a book or hear a piece of dialogue in a movie or play that speaks to you. It hits your brain and then rattles around like a bullet, careening off memories, bouncing off preconceived notions, and generally making a mess of your thoughts. For me, the sources of these are varied. I’ve spent months, years even, pondering the magic behind words from movies that went straight to DVD and books that no one has ever heard of. They don’t resonate in my brain because the words are elegantly strung together. They resonate because they hit me where I live, wherever that is at the moment I hear them.

Last summer I read Gillian Flynn‘s “Gone Girl.” Two lines have stuck with me and continue to plague me on a regular basis. Protagonist Nick Dunne, bar owner and adult child of an alcoholic father says “There’s no app for a bourbon buzz on a warm day in a cool, dark bar. The world will always want a drink.”

In some ways, I feel like I’m one of the last generations to enjoy alcohol before societal pressure and Mothers Against Drunk Driving made the idea of demon rum reality. Home movies of my mother during her pregnancies show her drinking cocktails.  When I was pregnant, it was suggested pregnant woman should minimize alcohol. Now a pregnant woman drinking alcohol faces public scorn and possible child abuse charges if the fetus-is-a-person-with-rights movement gets its way.

Driving drunk used to be against the law, but in small towns the cops would have you park your car and then drive you home rather than take you to jail and book you.  Groups didn’t apear at bars with a designated or sober driver. Whoever was the least drunk at the end of the night took the keys.

Bars used to be serve people until they fell off their bar stools or passed out. Now they cut you off if you slur a word or stumble over someone’s foot. When’s the last time a bar had 2 for 1 specials? I remember bars where beers were 4 for a 1 and they’d put a case on ice on the table to keep the drinks flowing.

Giving babies brandy, wine, even whiskey for teething used to be an acceptable parental decision.  As children aged, parent sponsored alcohol use  included purchasing kegs for  end of season football parties or graduation. The host parents made sure everyone hung around and slept it off.  Now any drinking at a house party, whether the parent provides it knowingly or not, results in criminal charges against the parents.

And don’t get me wrong. I don’t bring up the past to make excuses for what used to be acceptable behavior.  It’s just that was the way it was and it will never be that way again.

Are we better off now than we were then? Statistics and government agencies say we are. But if you’ve never spent a quiet afternoon in a dim bar where the television volume is low and the bartender asks if you want another drink with gestures rather than words, I think you’re missing something.

 

Beauty Contests and Cancer

Miss America contestant plans double mastectomy after competition

The above headline hit me hard. To see a beautiful woman, fearful of cancer, planning a double mastectomy AFTER the competition only reinforced my healthy distrust of beauty contests. The take away message seemed that having a double mastectomy would ruin your chances of winning a beauty contest.  Of course they couldn’t discriminate against someone with breast cancer genes, but perhaps there was some obscure rule about reconstructed breasts via “natural” breasts or a prohibition against prosthetic breasts.  I didn’t know for sure,  but in my quick view of her world, this young lady didn’t dare get a mastectomy until after she had been judged with her breasts intact. My prejudice against these contests demanded that I find the facts.

I surfed the Miss America site to get some insight into what was, and wasn’t considered beautiful by pageant officials. At first glance, their requirements looked fairly innocuous:

To compete you must

  • Be between the ages of 17 and 24.
  • Be a United States citizen.
  • Meet residency requirements for competing in a certain town or state.
  • Meet character criteria as set forth by the Miss America Organization.
  • Be in reasonably good health to meet the job requirements.
  • Be able to meet the time commitment and job responsibilities as set forth by the local program in which you compete. (source)

So perhaps putting off the mastectomy was driven more by the need to be “in reasonably good health to meet job requirements” than needing breasts to compete. Certainly surgery, a hospitalization, and recovery would impact the contestant’s availability.  My suspicion that there was more to the pageant requirements was driven by the lack of a weight and height requirement in the rules.  Since the armed forces and other positions, such as smoke jumpers, must meet  height and weight requirements, I thought  Miss American might.  I dug a little further, went to the New Hampshire web page, and found more requirements for contestants:

(Q) A contestant must be and always have been a female.

(R) Contestants must not now be and never have been married.

(S) Contestants are not now pregnant, and have never been pregnant. She is not the adoptive parent of any child.

(T) Contestants must be of good moral character and never been involved at any time in any act of moral turpitude.

(U) Other than minor or petty offenses, contestants must never have been convicted of any criminal offense and there are no criminal charges presently pending against the contestant.

(V) Contestants must never have performed any act or engaged in any activity or employment that is or could reasonably be characterized as dishonest, immoral, or indecent.

(W) Contestants must be in good health, and can, to best of their knowledge, participate fully and without limitation in any Program activities. Contestants must not use or consume any illegal controlled dangerous substances or abuse the use of alcohol or other dangerous substances.  (source)

Whoa! We’ve all heard of contestants being stripped of their titles due to moral turpitude clauses, legal violations, and drug and alcohol abuse.  I can understand those, but to ask contestants to certify that they “are not now pregnant and have never been pregnant”?  Obviously the pageant is against abortion, adoption, and single parenthood (because they’ve nixed marriage, too).  Is this to impart an air of virginity and chastity to the contestants or to preclude unsightly stretch marks?  Why not disqualify them if they’ve had a sexually transmitted disease as it is as much an indicator of sexual activity as pregnancy.

Still, no clause stating a contestant can’t have plastic surgery. Miss Universe/Miss USA rules come right out and say they don’t prohibit plastic surgery because of the difficulty in enforcing the rule.  Though I suppose they could require contestants to sign a blanket medical release and go trolling through their medical records and health insurance bills looking for surgery. You know, if it’s that important to the pageant.

And then I started thinking of how important the pageant must be to women willing to sign off on the requirements because if  the Miss America pageant was  a job interview, the questions on marital status and pregnancy would be against the law. To the women who enter these, putting aside marriage, children, and college parties to be a contestant is likely considered a reasonable trade off. I don’t understand their desire to participate in a beauty pageant, but it’s a decision I don’t get to make. It’s theirs, as is either having or delaying cancer risk reduction surgery to pursue a dream.

When all is said and done, I wish Miss America contestant Allyn Rose  the best of luck in the pageant and in her decisions regarding her genetic risk of cancer. I’ll never be a fan of pageants, but as long as women enter and people watch, they’ll go on.

Colonel Russell Frasz, 89th Airlift Wing vice ...

Colonel Russell Frasz, 89th Airlift Wing vice commander, poses with the 51 Miss America 2004 contestants and Miss America 2003 on the Andrews flight line as part of their tour of Andrews AFB, Md. (Photo credit: Wikipedia)

Let’s Call A Dick A Dick

English: "No Swearing" sign along At...

English: “No Swearing” sign along Atlantic Avenue in Virginia Beach, Virginia. (Photo credit: Wikipedia)

For me, fall is a time of reflection and contemplation. I don’t know why fall has such an effect on me, but nine out of twelve job changes have occurred during the fall. While dusting off my resume recently, I looked back and thought about how lucky I am that I can count the number of disruptive physicians I’ve worked with on one hand.

Disruptive physician is code for doctors who are dicks. Whether it’s the surgeon who picked up a nurse manager and put her down in a sink or the neurosurgeon who had to be removed from the Operating Room by the police after flipping out when his request to use unsterilized instruments on a patient was ignored. Some doctors believe they can act in ways that would get them punched or arrested in the real world, but in the hospital, they can do no wrong.

The problem is so pervasive that in 2009  The Joint Commission, a voluntary accreditation agency for hospitals, started requiring hospitals to have standards in place and procedures to deal with disruptive behavior, including physician disruptive behavior.

Unfortunately, some physicians believe there is an ulterior motive to disruptive behavior policies. In 2008  American Medical News.com has these two quotes:

“If somebody’s not a ‘team player,’ individuals will try to remove them from the team, and the disruptive physician policy is one mechanism by which that can be done,” said Dr. Gregory, a general surgeon and trustee at the Muskogee Regional Medical Center in Oklahoma

Interesting perspective. I’ve just never worked in a hospital that targets well-mannered, kind, respectful physicians who aren’t team players.  Oh, unless not being a team player is a code word for a doctor who’s a dick.

During my nursing career, I’ve had a surgeon approach me in the nurse’s station and loudly yell that it was my job to fill out the preoperative consent and, when I refused, accused me of doing it for the other surgeon.  He thought the nurses played favorites.  Luckily that was at a hospital where our policy was to laugh at dicks in person and hang up on them when they called. Really.

I’ve also had a specialist scream at me in a hallway because no one told him I would be observing in the clinic he worked in that day. He (not the owner of the clinic, just another hospital employee) didn’t think anyone should be allowed in the clinic without his permission. Every time I tried to (politely) interrupt, he yelled louder until I walked away.

Did these doctors suffer any ill consequences from their dickish actions? No. Most hospitals will forgive physicians who bring in business. Sort of like your top used car salesman. If he sexually harasses the secretary, do you really want to lose him to keep her?

Instead of trying to get rid of disruptive physicians, most hospital administrators would rather keep the doctor. Even when there are multiple complaints. Even in the face of staff turnover. Even when patients get hurt because of the doctor’s behavior.

When doctors whine, yell, threaten and bully other healthcare workers with questions or concerns, those questions and concerns are going to dry up. Pretty soon no one’s going to be calling them in the middle of the night to deal with a rapidly deteriorating patient because no one wants to take the verbal abuse. Rapid response teams were formulated because too many patients died while physicians blew off concerned hospital staff and family members.  That’s why in a hospital with three wrong side brain surgeries, no neurosurgeons lost their jobs. Instead the nurses were told not to give the scalpel to the surgeon until he verified he was on the right side or the nurse would be punished. When that didn’t work, they hired staff to go into operating rooms and monitor that doctors were properly identifying the correct side.

There is a price to be paid for healthcare’s refusal to address the problem of disruptive physician behavior and the price is paid every day by patients as well as by the people who leave healthcare careers. I think that calling the problem what it is might be a step in the right direction.

Let’s call a dick a dick.

Jane, You Ignorant Slut, A Vaccine Doesn’t Cause Promiscuity

Sexually transmitted disease

Sexually transmitted disease (Photo credit: Wikipedia)

What if an immunization existed that made young girls become sexually active? Sounds like a horror story that I might write one day. Realistically, though, no pharmaceutical company would be interested in developing a vaccine that made young girls sexually active. Vaccines are developed to prevent disease, not to promote unwanted behaviors.

In June 2006 a vaccine for HPV (Human Papilloma Virus) was licensed. The vaccine information statement provided by the CDC has this to say about HPV:

Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. About 20 million Americans are currently infected, and about 6 million more get infected each year. HPV is usually spread through sexual contact.”

Sounds like a disease one would wish to avoid.

“Most HPV infections don’t cause any symptoms, and go away on their own. But HPV can cause cervical cancer in women. Cervical cancer is the 2nd leading cause of cancer deaths among women around the world. In the United States, about 12,000 women get cervical cancer every year and about 4,000 are expected to die from it.”

Cervical cancer bad, right? Minimizing the chances of getting it would be good. I mean, children are vaccinated against diseases like hepatitis B, polio, and flu. Protecting them from a virus that causes cancer should be a no-brainer.

So why did so many parents opt out of HPV vaccination when it was first introduced? And why did so many states battle to make sure it wasn’t required?

Maybe because HPV is a sexually transmitted disease aka STD and you can’t catch STD’s if you are abstinent. Abstinence education believes that “the only 100% effective protection from the physical, emotional, mental, and social consequences of sexual activity is to save all forms of sexual activity for marriage” (source: http://www.ampartnership.org/) If children are abstinent, they have no risk factors for HPV and don’t need the vaccine. Further inflaming the abstinence educators was the recommendation that HPV vaccine be given to girls age 11 and up. Obviously giving them a vaccine to prevent STD’s at that age would send a tacit message that they were expected to have sex.

Really. Like if you get a Hepatitis A vaccine you’d lick watermelons bathed in raw sewage because you’d be protected against a disease spread by infected bowel movements. Or if you have a tetanus vaccine you’d start jumping on rusty, dirt covered nails because you wouldn’t be worried about a disease spread through cuts or wounds. If the above were true, clearly immunization against HPV would encourage young girls to have casual sex with multiple partners.

In reality, giving the vaccine to children before they are sexually active gives the best bang for the buck. The vaccine only works against HPV types the person has not been exposed to.

Sexual contact = potential HPV exposure = less effective vaccine.

Simple. Give it to people who haven’t had sex and, if they wish to remain abstinent until marriage, they’ll be protected then. You know, in case their spouse carries the HPV virus.

Unfortunately logic didn’t stop the outcry that allowing a child to have the vaccine gave approval for the recipient to have sexual activity and lulled the (now) sexually active child into believing they were impervious to STD’s.  Parents, legislators, and religious leaders all loudly railed against this vaccine.

Recently a three year study published in Pediatrics journal concluded that girls who received the HPV vaccine showed no increase in pregnancy rates, STD rates, or contraceptive use when compared to girls who didn’t receive the HPV vaccine. In other words, vaccination did not turn the girls into sluts. Instead it protected them from infections with HPV types 16 and 18, the cause of  approximately 70 percent of cervical and anal cancers.

And, as the years go by and research continues, there should come a time where  there is a clear difference in cervical cancer rates between those vaccinated with, and those who didn’t get, the HPV vaccine.  When that time comes, I think it will be damn hard to explain to your child that you didn’t protect them against a deadly disease because you misinterpreted cancer prevention as an assault on your child’s virtue.