Social Desirabilty and the ethical imperative.

I know – it has been a long time since I wrote – sort of an expected phenomenon when involved in the #PhDLife :/

I am currently in the midst of an ethics course, and we were assigned to read the Brittany Maynard case.  It caused me to reflect a little: how different is this case from the outcry that existed for assisted suicide in the past? California recently passed legislation that allows assisted suicide.   Did seeing the articulate, attractive, intelligent young woman discuss her reasons for wanting death with dignity resonate more with the general public, and then in turn with the lawmakers?

I really don’t know the answer to that question, but it made me reflect back 30 years to when the AIDS crisis was sweeping the nation.  Not only was there confusion and fear regarding the devastation of the disease, but prejudice was rampant due to the nature of its earliest victims.  Then a young, fresh-faced teen named Ryan White contracted the disease and was kicked out of school.  The public and the lawmakers paid more attention to the disease after that, and changes were made.

As a nurse who has worked through both events, I can be glad that Brittany and Ryan both raised awareness of their respective plights; these were both issues that needed careful examination without regard to previously determined stigma.  However, my soul aches a little because in both cases stigma existed.  Consideration of ethical healthcare issues should not be dependent upon the social desirability of the people afflicted.

I am just pondering here – as I have no true solutions for this dilemma, but I wanted to acknowledge my awareness of the issue and not just forget that it is a discussion that needs to continue. It might become too easy for me to become immersed in theoretical contemplation of ethics and measurement, and not contribute to the real work.  I hope that my family and friends will help me to remember that is my real goal – not some degree.


No one ever went into healthcare to take care of gunshot children

I see the news of the latest shooting in Roswell New Mexico and my heart goes out to the victims and families – how could it not?  But my heart also goes out to the first responders, EMS, and hospital providers caring for those children.

It has been almost 26 years, but I still remember working in the ED that day in May 1988 of the Laurie Dann shootings in Illinois.  I remember getting ready in case we had to take the overflow of the injured children.  I was working at a Level II Trauma Center at the time, and the Level I center was deciding if they needed to send some of the less critical children to us.  As we were getting prepared – I had fleeting thoughts of relief that my daughter was in 1/2 day kindergarten and safely home at the babysitter at that time. But had to fight my impulse to call and check on her.  In our quiet little north suburban area, this shooting was so surreal that no one truly knew what to feel – and in 1988, shootings in a school just was unfathomable. That was long before such things as Wiki Pages for School Shooting existed.

Our ED did not get the shooting victims that day – just some scared kids that parents brought in to be checked out.  Although there was some relief of that, there was also some weird form of survivor guilt.  When you are an ED nurse, you take care of children who have been through horrible traumas, so you understand what your peers at other institutions are looking at physically.  When you are taking care of even one child with non-accidental trauma, you are sickened and need to box up your anger and sadness in order to provide the best care for that wounded child (I  should say that is what the hidden curriculum taught us at that time).  So those of us not at the affected hospital have some understanding and fear of what it must feel like emotionally to box up the anger, sadness, and despair that comes with caring for multiple children who were intentionally hurt.

Back in the late 1980’s we had a focus on Critical Incident Stress Debriefing.  So a team came in after it was all over to let us all vent that box of toxic emotions and suggest ways to cope.  What I wish for the current generation is that someone comes in  and does some form of mindfulness training BEFORE incidents like this happen.  In some ways to prepare the providers for the feelings that they will have.  Someone who can say: it’s okay to be worried about your children and then to go home and watch them breathe for hours, it’s okay to be supremely pissed off at the perpetrator and whatever system issues you think contributed, and so many other things that I don’t know that I am the best person to articulate them all.  It is okay to acknowledge and/or verbalize all those feelings before you deal with the crisis at hand. I am encouraged by movements such as Com-passion for Care which encourage health care providers not just to have compassion for their patients, but also for themselves – to remember that we are also human.

Later in my ED career I worked with a nurse whose brother was shot in the chest that fateful day in May – he later lobbied for gun control and now works teaching hostage crisis negotiation.  The nurse’s bedroom was where Laurie Dann actually shot herself – she told me once that her brother was her inspiration for getting her life back to normal and for eventually going into nursing.  The two of them are just a small example of the wounded who became healers and/or heroes.  But like most of us in healthcare, I am sure they hoped never to NEED to take care of gunshot children.

So my heart goes out to all the providers of care to these children and the other tragedies.  My thanks goes out to you for being there when they most needed you.  My apologies to you and perhaps forgiveness to myself that I wasn’t able to be there to help you.

The NATO summit… my own perspective

The NATO summit begins Sunday in Chicago – this is the first time that an American city other than DC has hosted the summit.  As residents and people who work in the city, we are given updates on traffic closures and other potential impacts.

It has been an interesting experience sitting on both sides of the fence of an academic medial center: university and hospital.  On the university side, there is the same information about road closures, parking changes, and travel alternatives.  There is also information about journalism students covering the event and discussions regarding the political events and ramifications.  The university also advises students on safety precautions such as carrying a charged phone and awareness of groups and surroundings. The university suggested that those staff and faculty who could work from home on Monday might want to do so due to traffic and logistical concerns with getting into the downtown campus.  Even on Friday – there are far fewer people on that campus than normal.

On the hospital side of the street has it were – things are much different.  They also advise their staff of traffic and travel concerns, but instead of suggesting people work at home, they are asking for extra staff, and preparing for ways to house staff if travel is logistically impossible. There are ORs being on standby for trauma victims, the ED is ready to treat chemical exposures, and the hospital has extra supplies ready in case of mass casualty events.

As an ED veteran of almost 30 years, I understand the disaster preparedness mode.  I also know that there are so many ED nurses married to police officers, firefighters, and paramedics who are working extra shifts in order to maintain safety for the protesters and community members. I know these nurses worry about the safety of their spouses and they make sacrifices to make sure that there is adequate staffing in case of emergency – including missing family events.  I can’t say it better than a quote from one of the nurses:

Not looking forward to working the next two days with NATO. But especially because it means I am missing my daughter’s preschool graduation tonight and feel terrible. Protestors I am here bc of you, so please keep the peace…

I remember the fear post 9/11 and going into high gear for any mass casualty type events – knowing that we could never prevent terrorist attacks, just be prepared to deal with them when they happen.

Protests are NOT the same thing as terrorists, but there is still some need to be prepared.

It was important for me to acknowledge the ghost remnants of fear, and that being prepared for disasters helps control the fear.

It is also nice to maintain perspective and remember that protesters have important messages they feel should be heard.  Interestingly, the first official protest this weekend comes from a group of nurses.   Having a group of nurses enabled me to step back outside the ED, and see the protesters and the NATO officials not just as potential threats, but as humans.  It helped me to remember that there are opinions and workings of the NATO officials, of groups and individuals who oppose those views, AND of those who are prepared to keep the peace and maintain the safety of our community.

I think that police superintendent Garry McCarthy summed it up nicely when he said:

“Come, feel free to express your First Amendment right to free speech. We are going to provide a safe environment to make sure that happens,” McCarthy said. “We are going to provide a safe environment for the protesters, and the people who live in this city. And we are going to be intolerant of criminal behavior at the same time.”

So my hope is that everyone does have an opportunity to express their opinions freely – within a safe and respectful environment.

Mother’s Day – a tribute.

Read more of this post

A profound reminder of the importance of compassion

As part of my visit to Amsterdam – I went to the Anne Frank Huis today.  I remember reading the book as a schoolgirl, and knew that I couldn’t possibly come to the city without visiting the house where Anne wrote her diary.

It had such an impact on me when I was young.  I am not Jewish – so I can’t understand that kind of persecution, but something about the way she examined her life in the context of knowing how very precious each moment might be resonated down to my core.

The house itself was so much less than what I expected – especially in terms of light and space.  I can respect Otto Frank’s decision to leave it empty, as it was when he came home.  But that emptiness meant that the emotional impact of the house on me was so much more than I ever thought it could be.  The lives of eight people who lived in fear, then were betrayed, and most of them lost were keenly obvious in the barren small rooms.  Anne’s diary made all of those people real for millions of readers.  The photo of Otto Frank standing in an empty attic is too poignant for expression – the art of the camera captures the grief and the angst far more powerfully than words

At the end of the tour – there is an exhibit that tells stories of other types of persecution: homophobia, race issues, and so many more.  It is not about just religious persecution – it is a stand to fight against all types of hate crimes and prejudice.  It made me recall some current events: a young African American boy in a hoodie, a woman in a hijab, and too many others to mention.  I am glad that this exhibit asks the questions – and tries in its own way to stop the discrimination.

It made me glad that I will be going to #TEDxMaastricht – where we look to the future of health, the importance of patients as partners, and protecting the dignity of the human spirit.  It mad me grateful for people like Salmaan Sana, who gave a talk today and at TEDxMaastricht last year about #Compassion4care.  It is so important to teach compassion to our future and current healthcare providers – and give them tools to overcome old prejudices and hidden curricula.

The most acute awareness was that it is not just doctors and nurses who need these lessons – we need to teach the next generation how to have compassion.

When my daughter was very little, there was a song that we sang together that was one of her favorite lullabies.  I now sing it to my grandson – and he smiles at me because it is one of his songs.  It may not change the entire world, but as the little guy starts to sing the words – I have faith they will imprinted on his heart.

What Color is God’s Skin

Here are the lyrics – although in my daughter’s case – we changed “my little son” for my little one, and said tell me “Mommy” what color is God’s skin – hey single mother’s prerogative ;)

What Color is god’s skin? (Colwell Brothers)
“Good Night” I said to my little son
So tired out when the day was done
Then he said, as I tucked him in
“Tell me, Daddy- What Color is God’s Skin?”

What color is God’s skin?  What color is God’s Skin”
I said it’s black, brown, it’s yellow… it is red, it is white
Every man’s the same in the good Lord’s sight.

He looked at me with his shining eyes
And then I knew I could tell know lies
He asked “Daddy, why do the different races fight
If we’re the same in the good Lord’s sight?”


“Son, that’s part of our suffering past
But the whole human race is learning at last
The thing we missed on the road we trod
Is walking as the daughters and the sons of God”.


(This verse was deleted in 1970 to be more universal, but I include it here for authenticity)
These words to America a man once hurled
God’s last chance to make a world
The different races are meant to be
Our strength and glory from sea to sea.

Just a postscript. I have friends from many religions: Christians of all flavors, Jews, Muslims, Buddhists, some atheists, several agnostics,  and even a wiccan or two ;)   The song is not really about any deity, it is about tolerance and compassion for your fellow human beings.

So at the end of the day, I sat by the multi-colored flowers of the Bloemenmarket and was hopeful for the future. Image

Health Professions Education – First Semester

My first PhD semester studying Health Professions Education was very promising.  At first, I was concerned because after 27 years of speaking nursing/clinical/medical jargon – I had to learn curriculum jargon.  I actually now can use hegemony or epistemology in a sentence without choking – much ;)

The greatest impact on my professional and personal philosophies from my studies has been in how I think about health professions education curriculum. My experience thus far with curriculum has been mostly focused on curriculum development; strongly following the four steps of the Tyler Rationale.  The Rationale has a place in medical education, since clinical competence is not only a strongly desired outcome, but can best be measured by observable behavior.   Yes, there are right answers needed for some clinical questions and performances.  However, there are even more opportunities for understanding meaning when it comes to critical issues such as patient education.  Clinicians educate patients all the time, we are giving rudimentary classes in communication.  Hearing faculty talk about meaning to the students reminded me that we should strive for the same focus on meaning to the patient. The health literacy of the patients should be understood in terms of their race, gender, and socioeconomic status for overall patient education, medicine and diet teaching, and discharge instructions.

In Dewey’s model, curriculum should begin with the learner interest and previous experience, and be facilitated by educators who have discipline specific knowledge and can collaboratively create learning experiences.  I think that this model would also be useful in guiding patient education: start with the patients understanding and experience of their disease or wellness and build upon that knowledge.  I see two opportunities for research and growth: curriculum for providers (RN/MD) in how to best educate patients and curriculum for faculty to educate the providers.

In a much broader sense, I have was able to draw analogies between curriculum studies and the provision of healthcare.  There is much talk about healthcare reform, but again it seems as if there is much effort still focused on finding the right model.  Perhaps thehealthcare field instead needs reconceptualization. Curriculum reconceptualists focus on phenomenology or the lived experience of the student.  Shouldn’t healthcare be the ultimate autobiographical experience if we are to provide truly patient-centric care?  Curriculum studies researchers have questioned disparities in curriculum related to race (Watkins, Martin), gender(Lathar, Morales) and socio-economic status. Such research and rethinking of healthcare disparities should be used to inform reconstruction of the system.  If these issues are not addressed, then it will function in the same manner that education did by reproducing the status quo.

The one in which I learn a lesson from my glasses

Starting reading this morning for my curriculum course – huge 1143 page book, but I am really intrigued so far.  I like the fact that google books gives me a cloud when I looked at the review, so that I had a preview of the contents – intrigued me in a way the chapter titles probably wouldn’t.

I needed my age-appropriate-vanity-limited-no-line-bifocals to begin the reading.  The interesting thing about these glasses is that while I am able to focus on the text if I use the lower portion, or distance if I use the upper portion – the glasses limit my peripheral vision.  So in order to have clarity, I sacrifice some of the periphery.

Scanning topics  regarding political influences, hermeneutics, and feminist theory – it made me realize that I have done the same thing with life/career.  I get so focused sometimes on clinical education.  I love my job; teaching healthcare providers, developing faculty to be better mentors, and mentoring younger nursing grad students.  However #meded is a very different breed of education.  Some of the challenges we face our not the same as my grad school colleagues, and some of the social and political influences that challenge them don’t touch me in the same way.  In specializing so much, I have sacrificed my peripheral vision and awareness of what is happening in other academic arenas.

I know that this is probably a little inevitable when you get to a certain level of higher education.  However, I am now very grateful for the opportunity to study with these other educators.  To feel that there is a time and place for that focus on my specialty areas, but there is also a time to tolerate a little peripheral fuzziness in order to have my horizons expanded.


Get every new post delivered to your Inbox.