Monthly Archives: October 2011

Advice for nurses about anger and patience – from the Buddha

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Imagine Health care with no nurses???

A few years back I was attending a national meeting of the American Nurses Association, which is the most successful advocacy group for health care in the history of the Republic. And the president of ANA started her talk with “Imagine if there were no nurses when you got health care.” It was a moving speech, serving to remind everyone there of the value of what they do.  It was a call to action.

Wherever you are, your main job as a nurse is to humanize the medical process for those persons involved in it.  People are not simply biological organisms undergoing a scientific process as if they were laboratory rats. A person dealing with a health crisis can have fear, anxiety, anger, confusion, despair and other emotions.  Nurses offer hope, teaching, reassurance, and compassion.

Patience

One of the hardest things for a nurse to address is anger. Anger, patience and forgiveness are three concepts that are intertwined in Buddhist practice.  This makes me contemplate the idea that I could make this into an ongoing thread – maybe I will.

For now, though, I want to share a parable about anger, that I read  on the internet – behold:

Once upon a time there was a little boy with a bad temper. His father gave him a bag of nails and told him that every time he lost his temper, he should hammer a nail in the fence. The first day the boy had driven 37 nails into the fence. But gradually, the number of daily nails dwindled down. He discovered it was easier to hold his temper than to drive those nails into the fence.

Finally the first day came when the boy didn’t lose his temper at all. He proudly told his father about it and the father suggested that the boy now pull out one nail for each day that he was able to hold his temper. The days passed and the young boy was finally able to tell his father that all the nails were gone. The father took his son by the hand and led him to the fence. 


“You have done well, my son, but look at the holes in the fence. The fence will never be the same. When you say things in anger, they leave a scar just like this one. You can put a knife in a man and draw it out, it won’t matter how many times you say ‘I’m sorry’, the wound is still there.”

If you as a nurse are around angry people all the time, there is a point where you need to do some self-care, just as the fence in the parable needed repair. Anger can fester, and longterm exposure is injurious to the human spirit just as surely as if it were a deadly  carcinogen.

Toxicity

What is your exposure to this toxic poison? We can all contemplate this phenomenon, and meditate on the hope that wisdom may come, even after a while, to those who can not control their anger.

That same website has a section on rational choices to deal with anger, giving a list of eleven antidotes.

Peace Out

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The Way – Oct 22 2011 – summer 2012 plans?

So the deal was, let’s go see The Way.

It’s about the pilgrimage to Campostella through the Pyrenees and into Spain.

Europe in summer 2012?

A faculty colleague, Estelle Codier, has done this pilgrimage three times, has wonderful stories and photos. Her husband is a minister and they have the summers off, of course. I had spoken with her about this, since I have been thinking of whether it is time to got Europe and hike there. Last year I even bought a guide book to the Pilgrimage, it was fun to read about and to daydream.

Estelle and I have schedules that seem to be exactly opposite, so it’s unusual for me to see her  in Webster Hall at the same time.  I’d been on the look out for her… so when I saw her in the elevator it was funny that we both blurted out the same thing – ” have you heard about the Campostello movie????”

Trendy and anti-trendy

I told her that now the pilgrimage would be ruined, it would be overflowing with trendy types and maybe I would not want to go. ;-(

“Joe, it’s been trendy for fifteen hundred years” she said. then after a short pause “and are you trying to say that going to Nepal isn’t trendy? don’t you go to Nepal because it’s cool?”

okay, she had a point. Yes, I go to Nepal, and yes, i know it’s wicked-ass cool. But once I am there I try to do the anti-trendy thing. I don’t stay in Thamel with the rock jocks, I go for long periods of time without seeing the tourists,  only hang out with NGO -types in Jawalekhel, make my out-of-the-Valley trips to the Terai as opposed to Everest Base Camp….. but yes, I have an internal meter that gauges how cool it is.

Moving right along….. any way yesterday was the first day the movie showed in Honolulu and there I was, in the theater. with popcorn.

The Solitude of the trail?

Any body who takes a long journey on foot, or who goes on an expedition of some kind,  knows that solitude is not what it’s about, not really. Not for most people. Oh, you have to learn to be happy being with yourself, and happy walking, but the big memories are more likely to be from the people you meet and the relationships that form. You can make lifetime bonds with people you share this kind of experience with, events take on a vividness that makes home life seem boring and colorless. Before any such trip I always used the say ” I know that epic things will happen. I just don’t happen to presently know what they will be.”

Guava Boy and Gummi Bear, summer 2000

I remember doing the Hundred Mile Wilderness with my fifteen year old daughter a dozen years ago. During the day, we hiked our own pace, just walking alone for long sections. That waswhat she expected. In the evenings, the hikers arrive at a lean-to, a designated shelter spot with water supply and privy, these are all on the map. When you get the last twenty yards, you come around the corner to find up to a dozen complete strangers who have each done the same thing all day. They will be your sleeping companions.  Now you are in a hugger-mugger social situation, sleeping like sardines in a can at times. My companion on that long-ago hike was nicknamed Gummy Bear, and she was astounded at the social scene, I realize now that I initiated her into a cult of which she longed to be a member. In the evenings, if there is a campfire, a sort of “hail fellow well met” camaraderie develops, throwback to an earlier time when storytelling and sharing was more the norm. If you are headed in the same direction, you rendezvous with the same crowd every evening for awhile. The setting amplifies the attributes of the participants so that even the quietest person takes on attributes of a colorful personality.

Long Trail Inn

The same is true for any expedition, in which the team dynamics play an outsized role in the events. we all crave the opportunity to run with a pack of Big Dogs, and form a surrogate family. In Vermont in 2010, even though I was a slowpoke, I found myself travelling in the same direction as about a dozen people and we seemed to leapfrog for a hundred miles. ( Idid my first eighteen-mile day of the summer, in Vermont, in the rain…) I got to the Long Trail Inn and shared beer and dinner with the travelling cohort, and we were able to discuss long distance hiking strategy of the previous hundred and twenty miles. It was great, and when they were doing  this in the movie, I thought they captured it.

During the day, you do have time to reflect. You may be on a marked path but your mind is free to wander in any direction it pleases. Thoughts churn. Over time, the thoughts disappear and you learn to stop thinking and just be.

The Way

I guess I’d have to say the movie was – “nice.” Light escapism. Lots of scenery. snippets of the actual activities, such as what the hostels look like, the activity in the mornings, and the rolling hills. Scenes where the little group sleeps outside a barn, where they meet a sketchy eccentric hostel owner, and the towns along the way, such as Pamplona and Burgos, made famous by Hemingway. Yeah, I guess it has been trendy for a few years…… the pilgrims in the movie looked older than say, the A.T. crowd.

World Heritage Experience

The main character stumbles into three traveling companions, each one colorful. A bit of a descent into stereotype takes place here, as the screenwriter was attempting to draw each person with sharp lines, and make you fall in love with their endearing charms. the movie compresses a two month trip into a hundred minutes, and so we skip major sections of walking, portrayed periodically by updating the map like a   travelogue.  Despite the need to highlight the eccentricities of each character,  I thought this was okay.  There were some crowd scenes, such as coming upon a group dining al fresco where the Europeans derisively sing the Star Spangled Banner, that conveyed the perspective of travel in a cosmopolitan setting such as this. And of course, the Martin Sheen character ends up relying on his mates, this boundary is overcoming in believable fashion.

There are touching scenes along the way, harbingers of which are revealed very early in the film. The main guy decides to complete the pilgrimage his son started, and at times he sees his son, out of the corner of his eye, as if he was alongside during the events, just for a second. I could relate to this. In 2010 my 475-mile hike on the Appalachian Trail was mostly for the purpose of getting in good enough shape to hike with my daughter, now travelling under the assumed name of Whoopie Pie. We spent a week hiking through New Jersey, the culmination of months of effort, and a surprisingly fun section of the Trail. During the run-up, my daughter was an imaginary travelling companion.  The mind plays tricks with you on such a journey. The things that well up in your consciousness are the things you long for, and if your mind becomes trained, you can conjure them up almost as if they were real, in front of you and tangible.

Roma, not some other name….

My favorite scene in The Way, of course, took place in the Roma neighborhood. I have had some travel experiences in Nepal that were just like that, and I cherish those.

The only thing that I found annoying was a group of four people who sat right behind me. Evidently they had made this pilgrimage, and they felt the need to comment “yes, I remember that” every now and again. It reminds me that I too can be insufferable when reminiscing about past adventures.

All in all,  an okay movie.

Summer 2012

I will soon be thinking of plans for summer 2012. If you have gotten this far in the reading, I invite you to submit ideas.

My summer break goes from May 18th or so, to August 10th or so.

My nephew “Doc” gets married, in Texas, June 3rd. I will be there.

Plan A – Nepal. Summer 2011 was a hoot, lots of fun. meaningful contribution. Would love to expand on that work.If I go to Nepal, it won’t be for as long as last summer. disadvantage – the cost of airfare.

Plan B – Hiking again maybe the Appalachian Trail starting at Springer; maybe the John Muir Trail and then north through the Sierras; the idea is to cut down on air travel, and once I get to the mainland, to stay there.  I think if I did it right, I could bite off about six hundred miles of the Trail  during that time.

I have also always wanted to canoe the Boundary Waters Region or the Temagami region of Ontario. why not?

Plan C  – Europe once I am on the mainland of USA, europe is not that far…. Compostela?  Jerusalem? the U.K.?

I will get more serious about these ideas in the next three months…..

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simplest coffee maker ever devised Oct 16 2011

Nice thing about my apartment is the lanai – an open air patio that looks to the east. the alarm goes off at 0500 every morning, and as I listen to NPR I make coffee, contemplating the view of L.A. over the horizon, a tenuous connection to the mainland. Lots of folks here follow L.A. sports teams – for me, I have always detested the Lakers and UCLA for that matter ( being a Cal alumnus). 

In one cabinet I have three broken coffee makers, and last week I went shopping to see about getting a fourth one. Looked at a Keurig – nope, can’t get Starbucks. Thoughts about a new espresso maker – hmm….. not for $150 I won’t.

  Then I said to heck with it. I will use the system I now have,  the one I relied upon while backpacking, the same system they use to make Chiya in Nepal. SOme call this the Hobo method for coffee – I recall seeing this in a campground in Oregon in 1978 while driving crosscountry with a woman I knew at the time. It is an unexpected pleasure to come across well-prepared food in such a location.

  A simple mesh filter. Portable. Unbreakable. In Nepal, when they make chiya they boil the tea, milk and spices together, then strain it through this. Nepal is not a coffee-drinking country, in the east they have many tea plantations, in Ilam district. I want to visit there someday. Nepali chiya is sort of the predecessor to “Chai” – a trendy drink sweeping the countercultural nation.
 
  The system works like this. Water is boiled in a kettle. Get the ground coffee out of the freezer compartment, I spoon it out in to a plastic heat-tolerant measuring cup. Add boiling water and let it steep. stir it a couple of times. Then I strain it through the filter into the drinking cup.
 
I bought the filter for about $1.50 at the grocery store, then sawed the handle off when I went backpacking on the Appalachian Trail last year. A long time ago I was on a gourmet-food-while-backpacking mode, last year I managed to simplify things considerably, but I never gave up having real coffee in the mornings. It’s easier to dispose of used grounds, in the woods. In my apartment I put them in a separate trash container, since they will clog up the garbage disposal.
 
  And of course, I have a favorite mug. This one I got at a tag sale when I first moved here, there is a nice heft to it. The red-checkered tablecloth on the lanai table adds a festive touch. I am thinking of getting Christmas lights to string along the railing, since there is no built-in light on the lanai. Most of the time, though, it’s nice to be out there with just the lights of the nearby urban landscape. If I ever do get such lights, I will share a photo or two.
 
 

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Movie review of “Contagion”

Contagion

Not much of a date movie. As we left the theater the military guys behind us were talking about where to get hand sanitizer.  

 Gwenyth Paltrow

Okay okay there’s more to life than trying to unwind from the work week. I wanted to see Contagion partly because it has Gwenyth Paltrow in it, and I now realize that she and the other stars (Matt Damon, Lawrence Fishburn, Kate Winslet, Sanjay Gupta) probably got signed on for the express purpose of luring their fans into the theater. It worked in my case. The movie was also recommended by Willie Marshall, a public health nursing faculty at UH. 

 Heroism is not always glamorous

Public health, the part that deals with epidemics, is heroic in it’s own quiet way, but not “sexy.” There is no glamor to be found, no countdown to a victory celebration at the end.  Every schoolchild grows up hearing about polio, small pox, plague (“the Black Death”), Spanish Flu, Malaria, yellow fever and the like, but western  society has insulated all of us from close contact with infectious diseases, and I greatly prefer to deal with illnesses that can be packaged and treated within the confines of a hospital building. I feel secure that way. We all do. Let’s keep the wild viruses in a zoo as if they were lions and tigers…..

 The Dark Ages

For those of us in health care, there is a certain medieval quality to the idea that these things are out there and can kill you, that they have literally been a plague since the dawn of time. And that humanity is also a “herd” governed by the same rules that apply to the cattle business.  Just because these diseases are old-fashioned does not mean they have gone out of style, and we get these jarring reminders now and again.  And these threats have  not gone away just because we now have pennicillin and DNA sequencing. 

 Memories of past adventures

Allow me to reminisce in an unsentimental way. Over my whole career, taken in it’s entirety, I have been in the presence of just about everything. AIDS was not named until 1981 or so, but I know that I took care of Intravenous narcotic abusers with broken-down immune systems at Boston City Hospital in 1977 in my very first RN job. (“Heroin does funny things to the immune system” we used to say in those days)  At UCSF the neuro-ICU  was the site of inpatient care for a study they were doing on infectious encephalitis while I was there, I remember calling for one particular specialist consult, then meeting UCSF’s  Fellow in Infectious Diseases (I.D.). It was a small department in those days, with a shining history dating back to the days of Pasteur.  The I.D. Fellow wore horn-rimmed glasses and was a bit tweedy. “Don’t run away. I may need you,the first rule is not to panic.” he said. This will be interesting, I thought. I.D. has always been a specialty for thoughtful nerdy doctors, with a sort of Clark Kent quality, and an air of the Mad Scientist about them.   Whenever a doctor prefaces his remarks by saying “don’t run away,’ I have learned that something really really interesting is about to happen. 

 Q Fever

While at UCSF,  the half-dozen or so Q fever victims of the now-infamous Q fever mini-epidemic were admitted to Neuro-ICU, my workplace. ( Infamous because it later became a poster child for the impetus to revise federal rules on use of laboratory animals in academic medical centers).

 ANA-Maine

While President of ANA-Maine, part of the American Nurses Association (ANA), I was editor of their statewide quarterly newspaper mailed to every RN in Maine. In that role I got to know people  from the public health infrastructure of Maine, and gained a new respect for the great care taken in efforts  to present accurate public health info.  Do you remember the anthrax threat after 9-11? Or that national debate about smallpox vaccination? I sure do. I remember coming back from an ANA national meeting in  DC with a box of the first smallpox brochures, hot off the press, wondering how to best share the info with people in my home state.  Maine State Public Health also sponsored an annual workshop on public health, a must-go-to event, and one year  the featured speakers were the  leaders of the Toronto SARS response.  All the key players in Maine  got a jaw-dropping inside look at the true story behind that the response to that event. Health workers died in Toronto. The speakers conveyed the gravity of the “oh shit” moments, times when  the Toronto Public Health authorities realized it was getting away from them.

 (First rule of public health – don’t alarm the public.)  

 And of course, Nepal. Read my book. :-)

 Somewhere previous, http://joeniemczura.wordpress.com/2011/05/03/reprint-of-2008-meningococcal-meningitis-episode/ I described the single most gut-wrenching inadvertent exposure I ever was involved in, and it unfolded on a hot afternoon in Tansen in 2008 (I survived to tell the tale, just the smell of peach soap is enough to remind me of that day). Nepal remains a  simmering stewpot  of infectious diseases I hope we never see here in the USA – kala-azar, leprosy, tetanus, malaria, Japanese encephalitis, TB, brucellosis, hepatitis, meningococcal meningitis. A long list – what I am I forgetting???? 

Oh – add cholera, typhoid, plain ol’ infectious diarrhea, helminths of all types, snakebites,  HIV,  pneumonia and meningitis…… 

Worms and snakes *do* belong on that list.

 I am happy to report that I have never caught anything major during that whole thirty two years. Oh, I got rotavirus (“cruise ship virus”) one time at a hospital, along with a dozen others, but I take comfort in the fact that I was the one who said “hey, something fishy here that we are all getting sick.” So, some good came of it.

 Handwashing

The secret? I always wash my hands, always. That is still the number one rule at work. On the home front,  I never got a tattoo, visited Haiti, drank unpasteurized milk, or had skanky sex. (TMI perhaps, but true). 

 Movie Review, here, finally

Back to the movie. The challenge for the moviemakers was to dramatize and personalize something that unfolds over time and which requires a bureaucratic response with hundreds of players. Also, quite frankly, to compete with fictional action-adventure movies. In a fictional outbreak, the disease can be exaggerated so that the audience is gripped by  an immediate horror, satisfying the thrillseeking entertainment value of the genre, and allowing the pace to be  faster. In real life, we are programmed so that an illness of this nature causes disgust and revulsion, not quite the kind of “thrill” that pulls people in to a movie theater.  There is a slow-motion aspect caused by the incubation period, a seeming randomness to the victims that is maddening to uncover, and an element of quiet suffering, as the victims go down, one by one, laying quietly in a heap for awhile before they pass away.

 These scenes were accurately depicted in Contagion. Whenever I see a movie in which a person dies, it’s ruined unless the details are plausible and realistic to the T.

Shakespeare in Love

(The autopsy scene was truthful but I prefer to remember Gwenyth as Viola De Lesseps, flowery incandescent youthful glory of her Oscar-winning role…..isn’t that how we all prefer to remember our loved ones?)

 Death by Committee

To convey the drama of a worldwide pandemic, the movie was forced  to include various committee meetings where the protagonists were educating elected officials or each other, a sneaky way to clue in the audience  as to the relevant science. They tried to keep the lectures short, but it still had the feel of being lectured or taught about the action.  The geography also played a role – switching from rural China to Atlanta, Minnesota, and San Francisco (and yes, I recognized all the San Francisco scenes since most were in the neighborhood of UCSF where I used to live,  Parnassus Heights and on the UCSF campus. My alma mater).

 Anyway, I think the movie did the best possible job to depict  the phenomenon, given these constraints. At times it had the feel of a documentary, since there was an obvious educational component to it (here is what the Red Cross does, here is the National Guard. A very poignant moment in which a Roman Catholic nun appears. Go get ’em, Sister!)  and of course, when we finally get the next pandemic I wonder if any body will be left around to tell the tale in a similar way.  For those persons who have not been involved in this line of work, I can tell you  it does mirror real life, people making decisions based on incomplete knowledge. 

 In summary – worth seeing, a thought-provoking effort to educate the general public about a little-known part of the medical establishment.

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