Safety Is Not in Numbers

So as I've said I work in a large inner city trauma center. We see about 83,000 patients a year in the ED. That's a lot. Not sure how many come in as trauma patients are sudden death but a fair number I'd imagine. Many of those are ones that I am directly responsible for in terms of providing family support. Lots of times, due to cultural reasons, every single relative and friend of the patient comes to the hospital. Frequently, this leads to a virtual wake happening in the family rooms of the ED. There is anger, falling on the floor, screaming, pulling of hair and gnashing of teeth. Sometimes it is managable, often it is not and becomes a safety issue.

I have found that I am less and less tolerant of out of control behavior. I respect culture, hell, I seek it out and find it interesting and enlightening. I gotta say though, is it really appropriate to disrupt an entire department by screaming and rolling around on the floor? I mean, I get it, I'm sorry for the loss, I am sure their heart is breaking but it scares other people, it escalates other family members, it often makes patients of family members. It makes it difficult to provide comfort. I also understand and respect that family wants to see their loved one, wants to be with other family members. I just wonder if it really needs to happen in the ED. We aren't equipped to handle 20-30 grieving family members whether they are in or out of control. We have two rooms, they aren't huge. They are far away from security and other staff, they are somewhat enclosed. We really have no idea who it is that we are allowing back into that area and what their intent might be. Our ED is in the inner city. We have gang members, we have many, many violent deaths. Often I am the only one down there with these people. I am not six feet tall. I am not muscular. My own children do not find me alarming even when I am mad. I am assertive but that is not going to matter to someone who is pissed off and wants revenge or has manufactured some sort of vendetta to avenge his father's death.

I bring my concerns to security who does not see an issue. This makes me so mad I could scream. We are not a rural hospital set in Amish country. Somebody did not get killed by being run over by a horse. They were murdered. They committed a violent suicide. They are part of the underserved population who may not have gotten appropriate medical care. They died at a young age, for a variety of reasons. Their families are pissed. Their families are shocked, they are at a loss, they are not very often in their right mind. Some families are okay to deal with. they cry, they may yell or scream, they may collapse but they do not adversely affect other patients or staff members.

A study was done at New Jersey hospitals using incident reports between 1992 to 2001 and it was found that 100% of the 50 hospitals in the study reported violent events in their ED's. 61% of employees reported threats, verbal abuse was reported by 90% of workers and almost one third reported assaults. Of assaults that occurred verbal or physical, 72% were not reported through an incident report. A survey of over 1000 ED nurses in PA indicated that during their careers 97% experienced verbal abuse, 94% had physical threats, and 66% had been physically assaulted. More than a quarter of psychiatric nurses believe that violence is to be expected in their line of work. So, really, I am not talking out of my ass. I value my life. I am the mother of three children who need me. I am not willing to risk my own health and safety because other people who do not do my job refuse to accept that allowing unrestrained numbers of people in an enclosed area is a safety issue.

Suffering is Over

A ten year old died today. It got me on so many levels. He was between the ages of my girls, he had blonde hair, he was cute, he had a terrible disability with many many surgeries ahead of him and multiple hospitalizations. He was apparently the life of the party, he was brave, he was the center of his extended family's life. He no longer has to suffer. It's possible that he is now standing and running on his own, he can eat by himself, he can breathe. I am hoping.

I cried right along his mother, I felt the despair of his father, I know his family will miss him terribly. I made them hand and footprints of his poor feet, his limp and white hands. The feet that never walked, the hands that weren't able to grip but were so loved, so treasured. His grandfather took the prints with love, he hugged me and kissed my cheek, he was so grateful for this small memory of his grandson's life. I was so honored to have made them, to have been able to be a part of this beautiful family for a short time, to have taken part in their grief and stepped over with this little guy from this world to the next.

More Facts

So reportedly the US is the richest country in the world. Supposedly. Let's see what that means. The US is ranked behind Cuba, Denmark, Israel, Germany, Norway, France and Sweden in infant mortality. So out of 1000 babies, 6.30 will die before age 1. We are ranked behind the same countries except for Cuba in life expectancy. We can expect to die at age 78.14 while France enjoys wine and cheese until age 80.87. That's totally unfair. 16 percent of out gross domestic product is spent on health care. The UK spends about 8.3 percent, and despite copious cigar smoking in Cuba, they only spend 7.6 percent. To break that down even further, approximately $6700 is spent annually on each American for health care. Now wait, I thought I was the one that spent that on co-pays and premiums. I had no idea the government contributed! Apparently that includes the 47 million folks that are uninsured as well. The projected expenditure for Medicaid and Medicare for the year 2017 is 1.26 trillion dollars. That's up from 559 billion dollars spent on those two programs in 2007.

Now what's kind sad is the fact that in 1945 President Truman had a plan for a national health program. Unfortunately for us the American Medical Association and the House of Representatives shot it down as a "communist plot." However, as early as the 1910's reformers had a national conference on social insurance and earlier than that, lumber, mining and railroad companies recognized the need for good health among their workers and offered it to their workers to keep up with production.

Let's look at some other statistics now. In my state, which is one of the wealthiest in the nation boasts a population of 283,000 that are food insecure throughout the year. 25% of those that visit food banks are working families. Our state food banks service 350,000 people per year. That's a lot. In 2007, 7.9% of people in my state were living below the poverty level. Guess what the definition of poverty level is? For a family of four you can't make more than $18,100 per year to get some state benefits. Um, that's pretty low. The median value of a home in my state is around $157k which equates to about a $1,265 mortgage payment per month which according to stats is unaffordable for about 60% of the state's population. So, even if you have a shitty apartment in a shitty neighborhood and are food insecure, but you make say, $18,300, you may not qualify for any state benefits because you are too rich. Makes sense doesn't it?

There is a great site called www.nationalpriorities.org. A pretty eye opening website I think. For example, my town contributed something like $168.2 million to the Iraq war effort. This amount of money could have provided health care for 55,577 people. You can put in your town and see what the trade off is for what has been spent on the war so far. Very interesting.

So we are heading into the cold season and oil is at an all time high. I worry about these families, hell, I worry about my own family. Food or heat, medicine or food, clothing or gas to get to work, its pretty scary and I have a good job. I've already hit up people in my department for old coats and shoes for the homeless closet, because God knows, we are going to need it.

Help Wanted

I just saw a sign advertising a job for a garbage truck driver. It can't be that hard can it? I mean, you just drive a truck around and pick up folks garbage with a mechanical device. I also hear they pay well. I could sit there, listen to music, enjoy the fall foliage on my run, wear a t-shirt and jeans (well, maternity jeans but still), not have to speak to another human being for hours at a time. It sounds really wonderful. I'm having them fax me an application. If I get the job perhaps my rants will be about other types of "garbage." (har de har har har)

Facts

At any given time there are over 4000 homeless in my state (in New England).
Last year shelter workers had to turn away 30,000 in need of shelter for lack of room.
2000 people, including 400 children are in shelters everyday.
One January night in 2007 when the temperature was 20 degrees, a count all around our state was taken. There were found to be 3,325 households homeless. Of these, there were 392 families and 797 children. 10 percent of these families were found sleeping on the street or in places unsuitable for habitation.
With heating oil, food prices and other commodities at an all time high this year, I can only imagine what January will look like this year. I have stocked up my homeless closet with hats, scarves, mittens, socks and sweatshirts and coats. It won't be enough. I have many packets of information at the ready for those who need shelter. I don't know if it will help.
Why is this so prevalent in this country when so many have so much?
I hate this time of year..............I feel so helpless.

Until Death

He wants to give up but is worried. He feels he hasn't told his family everything. He worries about his wife, will she be okay? Will his sons take care of her? Will his daughter stay with her awhile? It's been 60 years together. He has so much to say but breathing is so hard. His wifes eyes fill with tears. "It's okay hon. It's okay. Rest now" He does rest, and he holds her hand and caresses it, the hand that he pledged his love to so many years ago. She kisses him and smoothes his hair. She pulls up his blanket that covers his emaciated frame, the frame that swung their children in the air, the frame that provided her the comfort of his embrace. And they sit there together, no words are needed after years of learning each others looks, body language and sighs. She is there when he passes to the other side, she closes his eyes, she folds his hands, she kisses him, sighs and goes to meet their children.

Feelings, nothing more than feelings..........

OH, MY, GOD! She's crying. Quick get kleenex, stat! Send in the militia of social work and pastoral care, bring in a carton of kleenex, particularly the scratchy, millimeter thin kind that shreds with one blow. She's crying, for God's sake because she is overwhelmed. Her father is in the room dying, they have just made the decision for a DNR/DNI order, he is getting meds to make him comfortable. She has a right to be upset. She has the right to cry and sending in a militia of "caring people" isn't going to make the situation any less upsetting. Truth is, she has been up all night, has been thinking about this decision for weeks, she hasn't had breakfast and barely ate dinner last night. She is thirsty, she feels grungy after being up all night and really would appreciate a hot washcloth and some coffee, maybe a muffin and some orange juice. These are readily had around here and so I bring them. She really has made peace with her decision, she is just glad that he won't suffer anymore, she understands the ramifications, she wants Dad to pass with the dignity that he held throughout his life.

Some folks really don't want to talk. Some folks prefer being alone in their pain. Some just want some nice ice cold water. Some want to talk to their loved one alone. Some wail, some sniffle, some yell. Some love to talk and talk. It's cathartic to talk about their loved one's life. He was a teacher, an artist, an architect, a bus driver. She was a nasty old biddie but I loved her. He was a dirty old man but a fabulous painter. They just need time. They need their feelings, they need to cry, and sometimes, they need to cry alone.