A bit of this and that ...

Well, here we are again with an update on a recent sojourn to the local hospital. I had started this article several weeks ago, but then all hell broke loose in Buffalo, Uvalde and Tulsa and my attention was drawn to the gun control issue. This was the focus of the previous article that I shared with you a week or so ago.

It was about a month ago that we went to the Emergency Room around 4:30 in the morning. After about a two hour wait, we were taken back to one of the curtained-off bays in the ER. I had been having excruciating pain in my lower left abdomen and after x-rays and further examination, it was determined that I had a kidney stone that was causing blockage into the kidneys. Emergency surgery was performed, and the surgeon put in a stent to bypass the blockage. The stone remained and was removed when I went back for additional surgery. This was the sixth time I had been hospitalized over about an 18-month period. I have been quite critical about my past experiences at the local hospital, but on this occasion, I cannot say enough about the care and attention that all the medical staff gave me. The ER physician continued to check on me, the nurses and technicians were very attentive and professional in their care, and I want to convey my appreciation. It is important to give credit where credit is due just as it is important to be critical when that is appropriate. Following the surgery, the pain abated, and I remained in the hospital for four days during which time the focus was on getting my blood numbers stabilized. I have been back home for several weeks and have been free of any pain or complications. I can only wish that my current condition will continue to be the norm.

Let me change my focus. It is my belief that the following case example is the epitome of self-serving hypocrisy by an individual immersed in faction of the political spectrum which has minimal regard for the needs of others. From 2011 until 2017, Robert Bentley was the governor of Alabama. Prior to Bentley assuming the governorship, the Affordable Care Act was passed and signed into law by President Obama in 2010. A primary component of this new law was the opportunity for states to expand Medicaid coverage to those who were not currently covered. Either these folks worked in a job that did not provide medical coverage or their salary was too high, thus making them ineligible for Medicaid coverage. The Federal match in the first few years following the new law, was 90-10 meaning that the Federal government would put up 90 percent of the cost and the respective state would be liable for 10 percent. In ensuing years that match would change with the states assuming more of the monetary responsibility. Even though the state must participate at a higher percentage, the revenues generated by the expansion would more than offset the increase for the state. By providing for coverage under Medicaid, eligible individuals would have more spendable income and would be paying more in taxes to the various branches of government. Similarly, the income generated to health care professionals would also be taxed and these dollars would contribute to the state’s overall revenues. In Alabama it was estimated that with the expansion of Medicaid, as provided for in the Affordable Care Act, 300,000 individuals would be covered.

Let me go back to Bentley in his role as the state’s governor. He was adamantly against the expansion of Medicaid throughout the time he served as the state’s governor. He claimed that the state could not afford to pick up the additional costs in ensuing years and refused to accept the facts that additional revenue would be coming to the state because of the expansion. As a result of his intransigence about expanding Medicaid coverage for more Alabama residents, the state remains as one of twelve states that have refused to expand Medicaid.

Bentley was forced to resign as governor in 2017, following legal issues that surfaced while he was governor, including having a questionable sexual relationship with a staff member. Following his removal from office, he returned to Tuscaloosa and resumed his Dermatologist medical practice. In a recent article that was published by AL.com, Bentley comes out in support of expanding Medicaid and, he argues, the failure to do so leaves a substantial number of Alabama residents without medical coverage. This is a bit hypocritical. While in a position, as governor, to promote expansion, he chose not to support the expansion. Now that he is back in private practice, he is taking the opposite position. Is he taking this “newfound” enlightened position because he could expand his own practice? That is a question that only he can answer.

 Medicaid should be expanded. The arguments against doing so pale in comparison to the good that would come from expansion. There are too many individuals who are adversely impacted by the state’s failure to affirmatively act on expanding Medicaid. Indeed, even as Bentley has stated, there are many who do not have the coverage that they deserve. Will the state ever join the thirty-eight states and the District of Columbia that have expanded Medicaid coverage, or will they continue to be one of the twelve who have refused? The likelihood of effective change is, at best, remote and that is the tragic reality. The case example that featured Alabama, could be replicated in eleven other states and this perpetuates the tragedy of the “haves and the have-nots.” 

Political insanity ....

As I strive to put my thoughts down on paper, I find myself being ambivalent about the ever-growing problem of gun violence in our country. The genesis of my ambivalence grows out of the pessimistic belief that nothing of any substance will lead to meaningful change so why address the problem. As President Biden stated the other night, why does the magnitude of such violence not resonate in other countries. The United States stands alone as the alleged civilized country with the highest rate of gun violence. Tragically, many of the victims of these careless and horrific acts are children—those least likely to defend themselves. Over and over children are being killed while they sit in a car, lie in their bed, play in their yard, walk down the sidewalk in their neighborhood, or sit in a classroom in their school. Yet, it is not just children that are savagely killed by senseless use of a gun, as evident in the recent massacre at the Buffalo, New York food market. Most of these victims were older adults who just happened to be in the wrong place at the wrong time. Similarly, those killed in Tulsa were all older adults. The bullets being shot by a deranged individual have no age-related markings; therefore, anyone in the path of the bullet is a target.

Are there answers to the ongoing mass violence that we are experiencing throughout the country? Are there meaningful and enforceable policies, procedures and practices that can be followed to address the problem? Indeed, as gun proponents are wanton to say, “guns don’t kill, people kill,” This is a truism that does have merit, but we cannot lose sight of the fact that in the absence of a gun being so readily available, the death of another person would not be the outcome. Guns do kill. Guns in the hands of disturbed individuals can be and are lethal. Yes, those who have been diagnosed or viewed as having mental health issues need to get the interventions that are needed to, hopefully, stave off any tragic behaviors leading to the death of another. While mental health deficiencies can be improved, it has also become a shibboleth for those advocating for loose to non-existent controls. The Webster definition of shibboleth is “a word or saying used by adherents of a party, sect, or belief and usually regarded by others as empty of real meaning.”   To advocate for advancing the availability of mental health services is credible, but it is not a cure-all for the problems we are witnessing. Nevertheless, the “gun rights adherents” will inevitably go to the mental health issue as the real problem. It is not the real problem. Yes, it may well be a contributing factor, but the real problem is the availability of guns and assault weapons to anyone who has the dollars to pay.

Similarly, many of the adherents to which I refer, will hide behind the second amendment which provides for individuals to own and bear arms. As I have noted in a previous blog, the meaning inherent in the second amendment was based on a point in-time when there was an absence of enforcement agencies. State militias were seen as the vehicle for enforcement of laws or regulations. We no longer have state militias. It is my belief that this amendment needs to be viewed in the context of the times and is not an absolute. It must be subject to reconsideration and interpretation considering a different cultural and societal context. The second amendment does not provide license for every individual to own and bear arms and use them at their discretion.

Will any substantive action be taken by the politicians in Washington? Sadly, but realistically, there may be some “window-dressing” palliatives growing out of a bipartisan attempt at placating the populace. It should be noted that most Americans believe in, and support reasonable controls related to gun ownership. Even though the argument for banning assault weapons is, in my judgment, a no brainer, it will not be included in any legislation. Raising the age to twenty-one to purchase such a weapon will be cut from any “new” legislation. The National Rifle Association (NRA) has donated over one hundred million dollars to the political careers of Republican representatives and senators. Mitch McConnell alone has received over twelve million dollars from the NRA, and more than thirty million dollars was contributed to the ill-fated Trump campaign in 2016. In Alabama, more than $300,000 was given to Republicans running for representative or senator. These politicians are beholden to the NRA and like-minded organizations and; therefore, will not make any decisions that counter the skewed message of this powerful lobbying entity.

The insanity of the political arena is what will keep meaningful change from occurring. Yes, there may well be legislation that comes from this latest barrage of mass shootings. Red flag laws will be given some support and states will be encouraged to enact these. Mental health services will be given tacit attention, but not at a level that will have significant or substantive impact. School safety will be a priority, but you cannot make the schools an impenetrable fortress so kids can be safe. Adequate and pertinent training of police and security personnel may be given some attention as well. Each of the above could be beneficial; however, the primary and real problem still exists. Guns are too readily available for anyone to be able to purchase one. Laws that broaden this “right” such as no controls on carrying a concealed weapon, are not the answer. I recall talking to a former student who told me that she carried a gun in her purse. In discussing this with her, I mentioned that having it available to you means that you could use it—is that what you want? There was not an answer to that question.

If we are ever going to get anywhere in controlling these mass shootings it will only be when there is a political environment of caring. As a society we must get beyond the belief that all this is inevitable. The answers to this growing problem are not partisan and it behooves all Americans to support reasonable and defensible controls. Background checks should be a given to identify any individual who could be, potentially, harmful to others or themself. Waiting periods must be addressed to limit the impulsive purchase and use of a gun. The age for purchasing a long rifle, such as an AK-47, must mirror the Federal restriction on the purchase of a handgun. The age for such a purchase should be raised to twenty-one for the purchase of any gun. Efforts to control the sale of guns at gun shows and through private dealings must be addressed. As a civilized society, we can no longer tolerate or accept that mass shootings will be an ongoing reality. A poll of Democrats, Independents and Republicans found that 44 percent of the Republicans believed that mass shootings were a reality of a free society. Further another study found that after three days from a mass shooting, the general population tends to forget and lessen any demands for effective change. We cannot lose sight of the fact that according to the Gun Violence Archive, through May 2022 there have been over two hundred mass shootings in the United States. (A mass shooting is defined as four or more individuals being killed or wounded in a single incident) This is unconscionable. Is this what we have come to—a return to the wild, wild west!

Busted in rehab ...

For several years I have been going to the Cardio/Pulmonary Rehab unit at the local hospital.  I try to get there each Monday, Wednesday and Friday, if I have no scheduling conflicts.  Over the time I have been involved with the unit, I have become friends with some of the other folks who have also been “long-timers” vis a vis their participation.  Some of them have a pass that allows them to enter from the parking deck to the actual floor where the Rehab Unit is located.  Recently, I have been scheduling my time to arrive when one of the other guys is there so I can enter with them.  It has proven to be quite convenient and when we’re done, we can go back to the parking deck to our parked cars.

Now comes the day that one of my newfound friends and I get “busted in rehab”.  We are not supposed to enter the building until 7:00 AM, but on this day we entered at about 6:50 AM and thus became fugitives of justice by virtue of our errant behavior.  Upon reaching the floor, which also houses the Wound Unit Treatment Program, the receptionist for this unit made a telephone call to security to come and escort my friend and I from the confines of the waiting room for the Wound Unit.  She stated that she could not be liable for us and that we did not belong there until the bewitching hour of 7:00 AM.  Her concern about liability is interesting given that my friend is 87 and I’m 82; therefore, not sure what we could have done that would have been a liability. She directed us to leave the waiting room and go out the door and wait.  My friend just kept walking back toward the Rehab Unit and refused to acknowledge her commands.  I told her I was going to return to my car and began slowly walking that direction.  About the time we reached the doors to the Rehab Unit, a staff member opened the door, and we went into the room to sign in, and begin our workout regime. 

While we were both on a respective treadmill, in comes security searching for the wayward culprits who had committed such a dastardly act as to enter 10 minutes early and sit in an empty waiting room.  When the receptionist pointed us out to the security officer, the officer began talking to us about our devious actions and warned us that it better not happen again.  As she talked and took notes with her pen and notebook in hand, it reminded me of an episode of Dragnet—the TV show of years gone by-- when Joe Friday, “just wanted the facts and nothing but the facts”.  As we continued walking on the treadmill, expecting to be cuffed and shackled at any moment and “per-ped walked” out of the unit down the hallway, the saga continued.  I played a bit dumb, (not hard for me to do) and let my friend” take the heart” with security.  In his rambling attempt to put some semblance of an explanation to what we had done, my friend invoked our other friend into the conversation, stating he would talk to him and have him intervene with the hospital’s upper management.  The third person amongst the “Three Amigos” is a retired physician, thus it was assumed that he had connections that could be beneficial to our subsequent release, should we be detained for what we had done. 

 When our doctor friend arrived, my friend attempted to bring him into our fold, but he would not agree and stated that we should just follow the rules.  So much for invoking the ire of upper management.  Well, when all was said and done, we promised that we would be good and follow the rules and since that fateful day, the three of us have been nothing but compliant about when we enter the building. 

History is made ...

On Thursday, April 7, 2022, history was made with the confirmation of Judge Ketanji Brown Jackson as the first African American woman to become an Associate Justice of the United States Supreme Court. Whatever one’s politics, this was certainly a momentous outcome for the advancement of some measure of balance on the “court of last resort.”  The process that led to the final counting of the votes, was fraught with a great deal of character assassination, the malignment of Judge Jackson, and a number of Republican senators showing just how low they could go to try and derail the nomination. Through it all Judge Jackson displayed a measure of grace under the intense pressure and innuendos caste about and to her. A lesser person might well have buckled under the unfounded and baseless attacks on her judicial record and her personal integrity.

A glaring example of the level of hypocrisy that several senators stooped to was best displayed by Ted Cruz the Senator from Texas and the grandest hypocrite of all the hypocrites. He who chastised anyone who deserted a state during a time of crisis. Obviously, this did not apply to him. Subsequently, he flew his daughters to Cancun, Mexico during one of the most crippling crises experienced by the State of Texas. During the “inquisition” of Judge Jackson by some of these senators, Cruz spent a great deal of time questioning her about Critical Race Theory and held up a book that was used at a Georgetown private school in Washington. Not only did the Judge and her husband send their daughters to the school, but the Judge was also on the board of the school. Cruz was relentless in his accusations about what the book described from a racial perspective. During the questioning, Judge Jackson stated that she was not familiar with all the books being used at the school and could not address some of the innuendos being thrown about by the senator. An interesting side bar to this matter is that the private school Cruz and his wife send their children to in Houston, St. Johns, uses the same book that he was so adamantly bothered by and, in fact, St. Johns, is much more public with its position on diversity and inclusion when compared with the Georgetown school. What Critical Race Theory has to do with her qualifications as a judge will always remain a mystery.

Similarly, the Republican Senator from Tennessee, Marsha Blackburn, seemed to be on another wave- length than would be expected in an inquiry as to Judge Jackson’s judicial qualifications. Blackburn focused on asking the nominee how she would define a woman and the nominee declined to answer. Again, one must question, the significance of this question. What could be the reasoning behind the question other than to try to find a way to “trip up” the nominee. Subsequently, several Republican legislators were asked the same question and to a person they had a difficult time trying to produce a definition of “what is a woman”.   The definition included in the Merriam-Webster dictionary is “an adult female person.”  This really does not delineate the unique differences between an adult male person and an adult female person. Oh well, just one more example of the inane position some senators took during their time to question the nominee.

There was also a great deal of attention given to the nominee’s judicial decisions, specifically in child pornography cases. Even though some of her decisions might be questioned, in the main she adhered to the federal guidelines which provides a measure of discretion and latitude for judges to hand down sentences. As was stated on several occasions, her record for such decisions mirrored the actions of other judges and she was not out on the limb of leniency any more than might be expected of any judge in a comparable situation. Senators Graham, Hawley, and Cotton were particularly focused on this issue and were doggedly relentless in their attacks of her. On another note, Cotton, the senator from Arkansas, even stooped to the lowest of low when he suggested that Judge Jackson would probably have defended a Nazi during the Nuremberg Trials. He was also quoted as saying that she was friendly in helping terrorists, such as Nazis. How low is low?

The confirmation of Judge Jackson was based on a fifty-three for and forty-seven against vote and the president’s hope for bipartisan support of the nomination was met. As we know, three Republican Senators, Collins of Maine, Murkowski of Alaska, and Romney of Utah voted in favor of her confirmation. Based on their comments, they reached their decisions based on the judge’s qualifications and not on her politics and they are to be commended for taking this action. One of the more confusing and perplexing positions was that of Blunt, the retiring senator from Missouri. He had nothing but high praise for Judge Jackson and believed that she was immensely qualified to sit on the Supreme Court, yet stated that he would vote, no, for her confirmation. Why?

Throughout the process, Judge Jackson remained in control of her emotions and dealt with the onslaught in a remarkable manner. Others might have “folded their tent” and determined that it was all not worth the intense and crazy attacks on her, as her family, husband, and children sat behind her listening to it all. That she “hung in there” is a tremendous achievement on her part and for that she should be commended. In my judgement, those who chose to wage the attack, could best be described as “piss ants.”  This is a phrase that a colleague used with some frequency in describing others. By the Oxford definition, a piss ant is “an insignificant contemptuous person or thing” - how best to characterize these senators. Their behavior certainly met the essence of the definition.

What I have included is my personal position. Obviously, I feel quite adamant about what I have included. What has been included is based on the written record of the hearing proceedings and the commentary of those who witnessed the process. I am aware that everyone who might read what I have included will not agree, and that is OK. In closing, I do think that the forty-seven senators who voted against Judge Jackson’s confirmation should step back and reflect on their position. If their decision was based on differences in judicial philosophy, that is defensible; however, if their decision was based on politics, in my judgment, that is not defensible.

Questionable medical treatment....

 LYING ON A GURNEY IN THE HALLWAY OF THE EMERGENCY DEPARTMENT AT THE LOCAL REGIONAL MEDICAL CENTER!  A couple of weeks ago I had to be admitted to the DCH Medical Center and thus began my journey to and through hell for those 40 plus hours.  It is not my intent to find fault with the care provided by the medical staff, especially the nurses.  They are working under what is obvious adverse conditions with what also appears to be little to no appreciation or recognition.  The hospital is losing nurses day after day, and many are going to work at other hospitals for double the pay and fewer patients.  Once I left ICU for a room on the sixth floor, I recall a conversation that my doctor had with the attending nurse.  She stated that earlier in the week, six nurses left to go work at a hospital in Montgomery for double the salary and a smaller patient to nurse ratio.  Similar stories abound with nurses leaving for better working conditions and more money in Birmingham and other cities throughout the state.  Where is the Board of Directors in all of this?  You cannot sit idly by and not be concerned with what is happening, yet little seems to change.  I recall one of the nurses caring for me mentioning that a travel nurse, doing the same job as she is doing, will earn up to triple the pay, but she is expected to ‘suck it up “and not complain.  Her comment was that it doesn’t do much to make you feel appreciated.

 If other hospitals can siphon off these nurses, why can DCH not do what is necessary to keep trained staff?  What responsibility and accountability does the administrators of the hospital have for what is going on and how do they continue to keep their employment?  The CEO has been in that position for several years and during this time there has been obvious deterioration, especially with staff morale.  While lying in the dialysis unit I overheard one of the nurses mention to a small group of technicians that the nurses would have left if it were not for them stepping in and helping.  Over and over, you hear the same stories.  Who, if anyone is listening?  Based on what is seen, the board seems to be impervious to an obvious sign of a problem—high turnover.  It is not a mystery that individuals leave one position for another for several reasons.  Better working conditions and more pay are the most prevalent reasons given for moving to a new position.  Apparently, that is what is happening at DCH, and action must be taken to bring some semblance of order to what has become a chaotic environment.  

 I mentioned to a friend, who is a physician, that I felt like I was a patient in the MASH sitcom and his response was , you would hope you would get that level of care.  Although the pandemic has certainly impacted the local medical facility, it is not the basis for the problems with the hospital.  Over three years ago, long before Covid, my wife spent several days as a patient at DCH and should have been in a private room, but remained in a two-person room for most of her stay.  Rooms were available, but as I experienced, there were not sufficient staff to make the rooms available.  She wrote a letter to the members of the Board of Directors expressing her concern for the conditions at the hospital.  Being a nursing educator, she often had students in clinical rotation during the better days so she is aware of how it should and can be.  The response from the CEO to her letter was the same old crap and boiled down to “we’re trying our best”. 

Often the doctors expressed dismay for the conditions they are working in due to the shortage of staff, hence patients languish in the ED for days.  I am aware of a friend’s mother who at age 88 laid in the ED for over four days before being assigned a room.  This is unconscionable and mirrors what might be found in some of the third world countries.  There are frequent accolades strewn about that brag on the outstanding medical facilities that exist in this country, yet this does not compute for the local facility.  Recent statistics indicated that it was common for bed occupancy to be around 60% plus; therefore, 40% plus percent of the beds are not being utilized.  The beds are there, the staff are not there. 

Not only are staff shortages contributing to the problems in the local facility, but there is also the increase in the number of hospitalizations of those with Covid.  Less than 50% of the adult population in the state have been fully vaccinated.  The overwhelming number of admissions for Covid patients are due to the unvaccinated coming down with the virus.  It is no mystery that Alabama is one of the states that has a substantial number of anit-vaxers and much of this revolves around politics.  Witness the current barrage of political ads.  One candidate strives to outdo the others with anti-masking, anti-mandates, and promoting individual rights at the expense of others.  The real frustration is that the vaccines do prevent individuals from coming down with the virus or if they do it is not as severe and does not, typically, lead to hospitalization or death.  Certainly, there are some unknowns, but the same people who will “chow down on a hot dog or a baloney sandwich, question what’s in the vaccine.  What’s in a hot dog?  What’s in in a slice of baloney?  Anyone who has had to decide about whether to take a drug to offset the symptoms of some malady is aware of potential side effects.  One must weigh the pros and the cons and do what seems to provide the best odds.  The vaccines provide, overwhelmingly, the best odds.  The number of people in this country who have died from COVID or experienced deadly consequences because of the virus are legion, and it did not have to be what it has become.  The politics of it all lead to some degree of cynicism.  We have all done things in our life that were not very smart, but to avoid death by taking some action seems to be a no brainer.  Guess that’s not true for everyone!

I have addressed this issue in previous blogs, but when it “hits close to home” it begins to have a bit of a different impact.  While lying in the hospital for ten days, I had a good amount of time to think about my own mortality.  Around the time I entered, a good friend who I have known for 40 plus years died.  She was in her early 80’s and had lived a good and full life, but it led me to give pause to the inevitable reality.  Just before I was being taken for emergency dialysis, I had to answer the question about the use of life-saving actions.  I had never been asked this, directly.  There is always the question about a living will and we have those, but the nurse asked if I wanted to be resuscitation and I said yes, but as he lingered a moment I recanted and stated that I did not want that to be done.  While I was in ICU my bed faced the wall with a white board that was there for notes to be written and at the bottom were the initials “DNR”.  Sort of gives one a bit of that reality check.  “Life is but a vapor”.