Category Archives: nurses

PACIFIC BEACH: An unforgettable year (Part III)

Something surprising happened in January.  Months before, I’d applied to work at the San Diego Legal Aid Society, but I’d never heard back.  Now I got a phone call asking me to come downtown for an interview. When I met with the program director, Steve H, I was visibly pregnant, but Steve liked my background working in Legal Services as a lawyer for low-income clients, and he decided to hire me part-time. 

I was thrilled.  I’d completed teaching Poverty Law at USD at the end of the fall term, reading final exams and papers and handing in my grades.  Starting a great new part-time job right now would work out perfectly.  Steve loved introducing me to everyone in the office, practically beaming because he, a steadfast liberal, had hired a pregnant woman.

I discovered that I could take a convenient bus downtown.  But when I met my officemates, one of them offered to give me a ride. Mike W, a single lawyer about my age, lived near me and picked me up on a corner close to my apartment. 

Mike W was a smart guy but totally unaware of how pregnancy worked.  Almost every time he gave me a ride, he fretted that I’d give birth in his car.  I had to keep reassuring him that first babies are never born that fast.  And of course mine wasn’t.

Working in the downtown office turned out to be a terrific experience.  I enjoyed my Legal Services work, interviewing clients and doing research at the downtown city library.  During lunchtime strolls, I was also able to explore downtown San Diego.  I discovered a great used book store and still own a vintage copy of Robert Burns’s poetry I found there. 

I also browsed at the big downtown department store, Walker Scott.  It reminded me of old-line department stores in other cities, like Chicago’s Marshall Field’s.  I remember the store was at that time promoting the forthcoming film, “The Great Gatsby,” featuring life-size photos of Robert Redford and Mia Farrow on full display.

One lunchtime, I entered Walker Scott feeling a bit tired, and I happily discovered a women’s lounge where I could put my feet up.  I returned there often.  One day I noticed a new mother nursing her baby, and I remember smiling and telling her how much I admired her.  At the time, I was busily reading up on how to nurse my own baby, and it was reassuring to see a new mother handling it so well.

Before I reluctantly went on leave from my job at Legal Aid (I’ll explain why below), the women in my office surprised me with a baby shower!  It was a true surprise because I never expected any of them to spend their precious time and money on me.  I think there was one other woman lawyer, whom I barely saw because she was so busy.  The other women were either administrative staff or secretaries, and most of them didn’t appear to have an extra dollar to spend this way.  It was a joyous event, and I treasured receiving gifts from these ultra-kind women.  A stuffed teddy bear from Mari became our baby’s first toy, landing in her bassinet as soon as she arrived home.  Another gift was a baby blanket, especially endearing because it had a noticeable flaw that identified it as a remainder purchased at a bargain store.  Buying even that was probably a stretch for my beautiful co-worker, and I loved her for it.

In March, I got some bad news.  A routine urine test revealed a high number for glucose.  I had to follow up with another, more serious, glucose test, requiring that I drink a revolting liquid.  The result was a shocker:  I was diagnosed with a complication of pregnancy, “gestational diabetes.”  

I didn’t even know that this complication existed.  It was NOT a complication described in my well-thumbed paperback copy of “Pregnancy and Childbirth,” written by the noted NYC ob-gyn Alan Guttmacher.  His book listed a whole lot of complications, but nowhere did Dr. G mention gestational diabetes.  (I do remember his advice for dealing with constipation:  Just relax on the toilet with a cigarette.  Oh, yes, his book gave that advice.  Luckily, I never needed to follow it.)

Dr. Blank sent me to a local specialist, an MD who was an expert on diabetes.  This man turned out to be a horrible practitioner of the medical profession. I had no problem with modifying my diet. That was no big deal.  But this MD also ordered that I begin having insulin shots once a day, and he arrogantly announced that I had to enter a hospital overnight to learn how to give myself injections.  Further, instead of trying to cheer me up, reassuring me that everything would go well, he warned me forebodingly:  “We’ve had some losses….”  What a miserable thing to say to a vulnerable pregnant patient.

My friends Lyn and Ted once again came to my rescue, dismissing the idea of my going to the hospital.  Instead, in their dining room, they taught me how to give myself insulin shots, using an orange as the substitute for my arm.  Former nurse Lyn told me that was how nurses learned to give shots.  I felt incredibly lucky to have Lyn on my side.

Marv lovingly took over giving me my needed shots.  But I was nevertheless depressed by the prospect of six more weeks of them.  Marv tried valiantly to make me feel better by reminding me of the biggest news story of the day:  Patty Hearst’s abduction in Berkeley six weeks earlier.  The shocking story had dominated local TV news.  “The time since then has gone fast, hasn’t it?” Marv asked me.  I had to admit that he was right.  Those six weeks had flown by.  I could survive six weeks of shots.

I had become and would always be a “high-risk primapara.”  Once I learned the meaning of “primapara,” a woman giving birth for the first time, I thought about writing a journal titled “Diary of a High-Risk Primapara.”  But I never got myself organized enough to do it.

Celebrating my birthday at the end of March became a wonderful break from our worries.  My nausea had lessened a great deal by that time, so Marv and I drove to Tijuana, where we had a scrumptious Mexican lunch and shopped at the outdoor vendors’ stalls.  Marv bought me a beautiful white crocheted shawl that I cherish to this day.  We then drove back to San Diego, where we devoured a delicious dinner at a fancy rooftop restaurant, Mister A’s.  (It’s still in business.)

Marv and I didn’t want to tempt the evil eye, so we put off shopping for baby clothes and furniture until just before my due date in early May.  But we anticipated needing a rocking chair for our new baby.  In a store near our apartment, we found a great Scandinavian-designed rocking chair, made with teak wood like the rest of our good furniture.  I later used it to rock my new baby, just as we planned.  I still own and treasure it.

In April, my diabetes diagnosis compelled me to take a leave of absence from my Legal Aid job.  The reason was borderline disgusting.  Please forgive me for describing it, and feel free to skip the following paragraph.

My doctors demanded that I collect my urine for 24 hours every day so it could be analyzed for a certain substance in it.  I was given giant glass jug-like bottles in which to save the urine, and I kept them in a bathtub in our apartment.  I was so dutiful in my collecting that whenever I left home, I would carry smaller bottles in which to collect smaller amounts, later adding them to the giant bottle. Usually accompanied by Marv, I would then drive to the UCSD hospital downtown to drop off the big bottles.  The whole process was exceedingly disheartening, but the final blow came when I began to lift a completely-filled bottle out of my bathtub, and the bottom fell out, spilling an entire day-long collection.  I sadly watched it all go down the drain.

At that point, I knew that I couldn’t keep up with both my job and all the medical demands on me, and it was the job that had to go.  My desire to give birth to a healthy baby overpowered everything else.  So I said goodbye to my Legal Aid office, assuring everyone that my leave was only temporary and that I planned to see all of them again after the birth of my baby.

Although my diagnosis of gestational diabetes was disheartening, and we couldn’t be certain of the outcome of my pregnancy, I felt pretty sure that the fetus growing inside me would put up a good fight.  This baby had to be strong.  It had survived all of my energetic dives into the hotel pool we’d shared with our friend Arlyn in Westwood.  (I’ve always believed that a weaker fetus might not have survived my vigorous diving.) 

The gap in my work-life balance was soon filled by another part-time job, one I could work on at home.  I’d already begun my leave of absence from my job at Legal Aid when I was recruited to bolster the Legal Writing program at USD law school.  I’d successfully completed teaching Poverty Law at USD at the end of the fall term, reading final exams and papers and handing in my grades.  Now a faculty member eagerly recruited me for this new job.  He brought me a big pile of student papers to review and grade by the end of the spring term.  I was happy to use my experience as a Legal Writing instructor at the University of Michigan Law School, a job I’d completed just before we left Ann Arbor for San Diego.  I dug into the USD student papers with relish, marking them up with my trusty red pen.  My hope, of course, was that my revisions and comments would help these students become better lawyers.

Meanwhile, Marv and I went back and forth, trying to choose a name for our hoped-for baby.  Picking a name for a boy was easy:  Marv’s and my father had both been named David.  But a girl’s name was much more challenging.  Almost every one that I liked Marv would veto.  While we continued to consider possible names, my friend Lyn gave me some useful advice:  Choose a name your baby will like.  She confided that she and Ted had named their son Ira Robert, but he was incessantly teased by other kids:  “I’m a rabbit, I’m a rabbit.”  They finally legally changed his name to Robert Ira.

                                                To be continued….

Waiting for a Vaccine

 

While the world, in the midst of a deadly pandemic, turns to science and medicine to find a vaccine that would make us all safe, I can’t help remembering a long-ago time in my life when the world faced another deadly disease.

And I vividly remember how a vaccine, the result of years of dedicated research, led to the triumphant defeat of that disease.

Covid-19 poses a special threat.  The U.S. has just surpassed one million cases, according to The Washington Post.  It’s a new and unknown virus that has baffled medical researchers, and those of us who wake up every day feeling OK are left wondering whether we’re asymptomatic carriers of the virus or just damned lucky.  So far.

Testing of the entire population is essential, as is the development of effective therapies for treating those who are diagnosed as positive.  But our ultimate salvation will come with the development of a vaccine.

Overwhelming everything else right now is an oppressive feeling of fear.  Fear that the slightest contact with the virus can cause a horrible assault on one’s body, possibly leading to a gruesome hospitalization and, finally, death.

I recognize that feeling of fear.  Anyone growing up in America in the late 1940s and the early 1950s will recognize it.

Those of us who were conscious at that time remember the scourge of polio.  Some may have memories of that time that are as vivid as mine.  Others may have suppressed the ugly memories associated with the fear of polio.  And although the fear caused by Covid-19 today is infinitely worse, the fear of polio was in many ways the same.

People were aware of the disease called polio—the common name for poliomyelitis (originally and mistakenly called infantile paralysis; it didn’t affect only the young) — for a long time.  It was noted as early as the 19th century, and in 1908 two scientists identified a virus as its cause.

Before polio vaccines were available,  outbreaks in the U.S. caused more than 15,000 cases of paralysis every year.  In the late 1940s, these outbreaks increased in frequency and size, resulting in an average of 35,000 victims of paralysis each year.  Parents feared letting their children go outside, especially in the summer, when the virus seemed to peak, and some public health official imposed quarantines.

Polio appeared in several different forms.  About 95% of the cases were asymptomatic.  Others were mild, causing ordinary virus-like symptoms, and most people recovered quickly.  But some victims contracted a more serious form of the disease.  They suffered temporary or permanent paralysis and even death.  Many survivors were disabled for life, and they became a visible reminder of the enormous toll polio took on children’s lives.

The polio virus is highly infectious, spreading through contact between people, generally entering the body through the mouth.  A cure for it has never been found, so the ultimate goal has always been prevention via a vaccine.  Thanks to the vaccine first developed in the 1950s by Jonas Salk, polio was eventually eliminated from the Western Hemisphere in 1994.  It continues to circulate in a few countries elsewhere in the world, where vaccination programs aim to eliminate these last pockets because there is always a risk that it can spread within non-vaccinated populations.

[When HIV-AIDS first appeared, it created the same sort of fear.  It was a new disease with an unknown cause, and this led to widespread fear.  There is still no vaccine, although research efforts continue.  Notably, Jonas Salk spent the last years of his life searching for a vaccine against AIDS.  Until there is a vaccine, the development of life-saving drugs has lessened fear of the disease.]

When I was growing up, polio was an omnipresent and very scary disease.  Every year, children and their parents received warnings from public health officials, especially in the summer.  We were warned against going to communal swimming pools and large gatherings where the virus might spread.

We saw images on TV of polio’s unlucky victims.  Even though TV images back then were in black and white, they were clear enough to show kids my age who were suddenly trapped inside a huge piece of machinery called an iron lung, watched over by nurses who attended to their basic needs while they struggled to breathe.  Then there were the images of young people valiantly trying to walk on crutches, as well as those confined to wheelchairs.  They were the lucky ones.  Because we knew that the disease also killed a lot of people.

So every summer, I worried about catching polio, and when colder weather returned each fall, I was grateful that I had survived one more summer without catching it.

I was too young to remember President Franklin D. Roosevelt, but I later learned that he had contracted polio in 1921 at the age of 39.  He had a serious case, causing paralysis, and although he was open about having had polio, he has been criticized for concealing how extensive his disability really was.

Roosevelt founded the National Foundation for Infantile Paralysis, and it soon became a charity called the March of Dimes.  The catch phrase “march of dimes” was coined by popular actor/comedian/singer Eddie Cantor, who worked vigorously on the campaign to raise funds for research.  Using a name like that of the well-known newsreel The March of Time, Cantor announced on a 1938 radio program that the March of Dimes would begin collecting dimes to support research into polio, as well as to help victims who survived the disease. (Because polio ultimately succumbed to a vaccine, the March of Dimes has evolved into an ongoing charity focused on the health of mothers and babies, specifically on preventing birth defects.)

Yes, polio was defeated by a vaccine.  For years, the March of Dimes funded medical research aimed at a vaccine, and one of the recipients of its funds was a young physician at the University Of Pittsburgh School Of Medicine named Jonas Salk.

Salk became a superhero when he announced on April 12, 1955, that his research had led to the creation of a vaccine that was “safe, effective, and potent.”

Salk had worked toward the goal of a vaccine for years, especially after 1947, when he was recruited to be the director of the school’s Virus Research Laboratory.  There he created a vaccine composed of “killed” polio virus.  He first administered it to volunteers who included himself, his wife, and their children.  All of them developed anti-polio antibodies and experienced no negative reactions to the vaccine. Then, in 1954, a massive field trial tested the vaccine on over one million children between six and nine, allowing Salk to make his astonishing announcement in 1955.

I remember the day I first learned about the Salk vaccine. It was earthshaking.  It changed everything.  It represented a tremendous scientific breakthrough that, over time, relieved the anxiety of millions of American children and their parents.

But it wasn’t immediately available.  It took about two years before enough of the vaccine was produced to make it available to everyone, and the number of polio cases during those two years averaged 45,000.

Because we couldn’t get injections of the vaccine for some time, the fear of polio lingered.  Before I could get my own injection, I recall sitting in my school gym one day, looking around at the other students, and wondering whether I might still catch it from one of them.

My reaction was eerily like John Kerry’s demand when he testified before a Senate committee in 1971:  “How do you ask a man to be the last man to die in Vietnam?”  I remember thinking how terrible it would be to be one of the last kids to catch polio when the vaccine already existed but I hadn’t been able to get it yet.

I eventually got my injection, and life changed irreversibly.  Never again would I live in fear of contracting polio.

In 1962, the Salk vaccine was replaced by Dr. Albert Sabin’s live attenuated vaccine, an orally-administered vaccine that was both easier to give and less expensive, and I soon received that as well.

(By the way, neither Salk nor Sabin patented their discoveries or earned any profits from them, preferring that their vaccines be made widely available at a low price rather than exploited by commercial entities like pharmaceutical companies.)

Today, confronting the Covid-19 virus, no thinking person can avoid the fear of becoming one of its victims.  But as scientists and medical doctors continue to search for a vaccine, I’m reminded of how long those of us who were children in the 1950s waited for that to happen.

Because the whole world is confronting this new and terrible virus, valiant efforts, much like those of Jonas Salk, are aimed at creating a “safe, effective and potent” vaccine.  And there are encouraging signs coming from different directions.  Scientists at Oxford University in the UK were already working on a vaccine to defeat another form of the coronavirus when Covid-19 reared its ugly head, and they have pivoted toward developing a possible vaccine to defeat the new threat.  Clinical trials may take place within the next few months.

Similarly, some Harvard researchers haven’t taken a day off since early January, working hard to develop a vaccine.  Along with the Center for Virology and Vaccine Research at the Beth Israel Deaconess Medical Center, this group plans to launch clinical trials in the fall.

While the world waits, let’s hope that a life-saving vaccine will appear much more quickly than the polio vaccine did.  With today’s improved technology, and a by-now long and successful history of creating vaccines to kill deadly viruses, maybe we can reach that goal very soon.  Only then, when we are all able to receive the benefits of an effective vaccine, will our lives truly begin to return to anything resembling “normal.”

A new book you may want to know about

There’s one thing we can all agree on:  Trying to stay healthy.

That’s why you may want to know about a new book, Killer diseases, modern-day epidemics:  Keys to stopping heart disease, diabetes, cancer, and obesity in their tracks, by Swarna Moldanado, PhD, MPH, and Alex Moldanado, MD.

In this extraordinary book, the authors have pulled together an invaluable compendium of both evidence and advice on how to stop the “killer diseases” they call “modern-day epidemics.”

First, using their accumulated wisdom and experience in public health, nursing science, and family medical practice, Swarna and Alex Moldanado offer the reader a wide array of scientific evidence.  Next, they present their well-thought-out conclusions on how this evidence supports their theories of how to combat the killer diseases that plague us today.

Their most compelling conclusion:  Lifestyle choices have an overwhelming impact on our health.  So although some individuals may suffer from diseases that are unavoidable, evidence points to the tremendous importance of lifestyle choices.

Specifically, the authors note that evidence “points to the fact that some of the most lethal cancers are attributable to lifestyle choices.”  Choosing to smoke tobacco or consume alcohol in excess are examples of the sort of risky lifestyle choices that can lead to this killer disease.

Similarly, cardiovascular diseases–diseases of the heart and blood vessels–share many common risk factors.  Clear evidence demonstrates that eating an unhealthy diet, a diet that includes too many saturated fats—fatty meats, baked goods, and certain dairy products—is a critical factor in the development of cardiovascular disease. The increasing size of food portions in our diet is another risk factor many people may not be aware of.

On the other hand, most of us are aware of the dangers of physical inactivity.  But knowledge of these dangers is not enough.  Many of us must change our lifestyle choices.  Those of us in sedentary careers, for example, must become much more physically active than our lifestyles lend themselves to.

Yes, the basics of this information appear frequently in the media.  But the Moldanados reveal a great deal of scientific evidence you might not know about.

Even more importantly, in Chapter 8, “Making and Keeping the Right Lifestyle Choices,” the authors step up to the plate in a big way.  Here they clearly and forcefully state their specific recommendations for succeeding in the fight against killer diseases.

Following these recommendations could lead all of us to a healthier and brighter outcome.

Kudos to the authors for collecting an enormous volume of evidence, clearly presenting it to us, and concluding with their invaluable recommendations.

No more excuses!  Let’s resolve to follow their advice and move in the right direction to help ensure our good health.

 

 

 

 

Rudeness: A Rude Awakening

Rudeness seems to be on the rise.  Why?

Being rude rarely makes anyone feel better.  I’ve often wondered why people in professions where they meet the public, like servers in a restaurant, decide to act rudely, when greeting the public with a more cheerful demeanor probably would make everyone feel better.

Pressure undoubtedly plays a huge role.  Pressure to perform at work and pressure to get everywhere as fast as possible.  Pressure can create a high degree of stress–the kind of stress that leads to unfortunate results.

Let’s be specific about “getting everywhere.”  I blame a lot of rude behavior on the incessantly increasing traffic many of us are forced to confront.  It makes life difficult, even scary, for pedestrians as well as drivers.

How many times have you, as a pedestrian in a crosswalk, been nearly swiped by the car of a driver turning way too fast?

How many times have you, as a driver, been cut off by arrogant drivers who aggressively push their way in front of your car, often violating the rules of the road?  The extreme end of this spectrum:  “road rage.”

All of these instances of rudeness can, and sometimes do, lead to fatal consequences.  But I just came across several studies documenting far more worrisome results from rude behavior:  serious errors made by doctors and nurses as a result of rudeness.

The medical profession is apparently concerned about rude behavior within its ranks, and conducting these studies reflects that concern.

One of the studies was reported on April 12 in The Wall Street Journal, which concluded that “rudeness [by physicians and nurses] can cost lives.”  In this simulated-crisis study, researchers in Israel analyzed 24 teams of physicians and nurses who were providing neonatal intensive care.  In a training exercise to diagnose and treat a very sick premature newborn, one team would hear a statement by an American MD who was observing them that he was “not impressed with the quality of medicine in Israel” and that Israeli medical staff “wouldn’t last a week” in his department. The other teams received neutral comments about their work.

Result?  The teams exposed to incivility made significantly more errors in diagnosis and treatment.  The members of these teams collaborated and communicated with each other less, and that led to their inferior performance.

The professor of medicine at UCSF who reviewed this study for The Journal, Dr. Gurpreet Dhallwal, asked himself:  How can snide comments sabotage experienced clinicians?  The answer offered by the authors of the study:  Rudeness interferes with working memory, the part of the cognitive system where “most planning, analysis and management” takes place.

So, as Dr. Dhallwal notes, being “tough” in this kind of situation “sounds great, but it isn’t the psychological reality—even for those who think they are immune” to criticism.  “The cloud of negativity will sap resources in their subconscious, even if their self-affirming conscious mind tells them otherwise.”

According to a researcher in the Israeli study, many of the physicians weren’t even aware that someone had been rude.  “It was very mild incivility that people experience all the time in every workplace.”  But the result was that “cognitive resources” were drawn away from what they needed to focus on.

There’s even more evidence of the damage rudeness can cause.  Dr. Perri Klass, who writes a column on health care for The New York Times, has recently reviewed studies of rudeness in a medical setting.  Dr. Klass, a well-known pediatrician and writer, looked at what happened to medical teams when parents of sick children were rude to doctors.  This study, which also used simulated patient-emergencies, found that doctors and nurses (also working in teams in a neonatal ICU) were less effective–in teamwork, communication, and diagnostic and technical skills–after an actor playing a parent made a rude remark.

In this study, the “mother” said, “I knew we should have gone to a better hospital where they don’t practice Third World medicine.”  Klass noted that even this “mild unpleasantness” was enough to affect the doctors’ and nurses’ medical skills.

Klass was bothered by these results because even though she had always known that parents are sometimes rude, and that rudeness can be upsetting, she didn’t think that “it would actually affect my medical skills or decision making.”  But in light of these two studies, she had to question whether her own skills and decisions may have been affected by rudeness.

She noted still other studies of rudeness.  In a 2015 British study, “rude, dismissive and aggressive communication” between doctors affected 31 percent of them.  And studies of rudeness toward medical students by attending physicians, residents, and nurses also appeared to be a frequent problem.  Her wise conclusion:  “In almost any setting, rudeness… [tends] to beget rudeness.”  In a medical setting, it also “gets in the way of healing.”

Summing up:  Rudeness is out there in every part of our lives, and I think we’d all agree that rudeness is annoying.  But it’s too easy to view it as merely annoying.  Research shows that it can lead to serious errors in judgment.

In a medical setting, on a busy highway, even on city streets, it can cost lives.

We all need to find ways to reduce the stress in our daily lives.  Less stress equals less rudeness equals fewer errors in judgment that cost lives.