I don’t understand…

This post on the Atlantic web site by Olga Khazan is insightful, though perhaps not the way she planned it.

Olga’s surely a liberal. But even the blind squirrel finds the occasional acorn. Her lede is that most uninsured folks don’t understand the Affordable Care Act. Her conclusion, based on such a stunning observation, is that we should work ever harder to convince them how supercalifragilisticexpialidocious it is.

I’d suggest approaching the issue from a different angle. Let’s suppose for a moment that the clearer and less ambiguous a law is, all else being equal, the more likely it is to be effective once enacted. In other words, those affected by it have a better idea of the benefits and risks it presents to them, they can make more reliable decisions on how to act, and the collective acts of the populace are more accurately predictable—allowing the framers of the law to tell ahead of time whether it will achieve its intended outcomes.

The ACA clearly fails this test. As one who spent numerous weeks in many of my MHA courses facing assignments focusing on one or another of its endless provisions, I can attest that leafing through it (assuming you can hold it in your hands) is akin to opening Forrest Gump’s box of chocolates. Progressives dumped a boatload of old favorites into the bill, took a single-state experiment (that, on further review, is a blazing failure) and took it national, added a generous dollop of “The Secretary shall“s, and larded it with goodies like the Cornhusker Kickback and the Louisiana Purchase to get it through the Senate. No wonder people can’t understand it!

My take, in general, is that an act of such complexity stands a good chance of being a bad law. That is a generality, ignoring right vs. left or other distinctions. But I believe it to have plenty of validity. It is distressing, by the way, that acts of Congress are becoming increasingly obtuse over time, regardless of who’s minding the House, the Senate, or the White House. We’re better off with slimmer, simpler statutes that are easily understandable by those of us who aren’t policy wonks in our specialty field (or lawyers…).

To paraphrase a remark I saw on Facebook today, where the object of comparison was not the ACA but the case being brought by Hobby Lobby to the Supreme Court on behalf of religious liberty, if you know who got kicked off DWTS but have no clue about Obamacare, you deserve the continued removal of your rights.

Now that’s clear and concise.

Posted in Uncategorized

Family pet visitation: 20 years later

I am inspired to post the below on reading in the December American Journal of Nursing today, and encountering on my Facebook news feed, a fascinating article about family pet visitation. I commend the article for your review. Without further ado, here is an exemplar I submitted to the American Association of Critical-Care Nurses approximately twenty years ago, recounting a real-life experience that I will never forget. As far as I know, it was never published. Enjoy!

“I know you probably won’t approve of it, but I would like to ask one favor of you. . . . ”
R.R.’s wife came to me with these words about midway through my twelve-hour shift in the cardiac ICU. And at this point, I was ready to grant her just about any favor.
R.R., who had undergone coronary artery bypass surgery only a month before, seemed very close to death. After returning home from his surgery, his mitral valve decided to go on strike and R.R., in his seventies but otherwise in good health, went into severe heart failure.
For ten days we had worked to get him off the ventilator and normalize his cardiac output, but we had been unsuccessful. The previous day, his attending physician discontinued all his medications, ordered comfort measures only, and set up a meeting with the hospital’s ethicist and attorneys to discuss disconnecting the ventilator.
On this day, while mentally preparing myself to assist in terminal weaning, I noticed that R.R. appeared slightly more alert, and that his vital signs were fairly stable even without being pumped full of inotropes and diuretics. Even so, I knew his prognosis, and my goal for the day was to provide whatever solace I could to him and his family.
Although I had only worked in the ICU setting for five months, I was feeling more comfortable about my critical care skills. Before taking this position, which allowed me to “flex” between the cardiac ICU and stepdown units, I had worked on a medical-surgical intermediate care unit for more than two years. Clients’ acuities were high, and so was the nurse’s workload–but it was a wonderful place to learn nursing. Even though I had been an orderly and nursing assistant in hospitals for six years before graduating from nursing school (not to mention a nursing home orderly for too many years before), that was important to me. So on this day in late March, I was getting better at keeping the high technology, tubes, and wires from overshadowing what my clients and their families really needed.
“We have Benji out in the car. I wondered if you could let us bring him in to see Dad one last time.”
At once I realized not only that it could be done, but that it had to be done. The hospital had recently implemented a pet visitation policy, despite some initial objections from infectious disease doctors and others. And I was aware that if there was ever a right time for a pet visit, this was it.
Of course, the policy had to be followed to the letter. But I had no idea what kinds of hoops I would have to jump through to make Benji’s visit happen. I had to obtain a veterinarian’s OK, a clean bill of health for the dog. And though R.R.’s wife had vaccination papers with her, I needed to phone the vet and confirm that Benji was disease-free.
I called security, to let them know there would be an animal entering the lobby, and to have them reserve us a service elevator. And when the patient representative got wind of what was happening, he questioned me to make sure that a visit was appropriate–fortunately, with all private rooms on the unit, there would be no roommate to object.
With all the arrangements I was making, I felt more like a politician’s press secretary than a nurse. But I had a suspicion that this work would not be in vain.
Almost three hours after R.R.’s wife approached me with her request, I met her and Benji in the lobby. I examined the overweight but otherwise healthy-looking Cairn Terrier for fleas, wrapped him in a sheet, and escorted him to the ICU.
As soon as we entered the room, I sensed that something therapeutic was happening. R.R. instantly recognized the twenty-pound dust mop on his lap, and vice versa. Benji’s only problem was that the endotracheal tube hindered easy access to his master’s face; and it scared him when the extra abdominal pressure caused R.R. to cough, and the ventilator responded by alarming in disapproval.
The visit itself was a total, unqualified success, and what followed was even more remarkable. Pleasantly surprised at R.R.’s mental status half an hour after Benji’s visit, the pulmonologist decided to try weaning him once more, this time without cardiac drugs. And, incredibly enough, we succeeded; he was extubated less than 48 hours later. His DNR status was reviewed, medications were resumed, and within a few days he was transferred to a general floor. And most significantly, R.R. was able to return home and reunite with Benji and the rest of his family.
Of course, skeptics will say that pet visitation, and my role in facilitating it, had nothing to do with this man’s recovery. While that is possible, I do not believe it. The literature is starting to show examples of the therapeutic benefits of pet therapy, and I am convinced that it played a role in R.R.’s healing process. Even if he had not survived, a visit from his beloved dog would have helped to brighten his last days and raise his family’s spirits.
This incident has earned me a certain amount of notoriety, especially after we re-enacted it for a feature story on a local television station’s evening news. And it seems that if any of my colleagues in the Heart Center has a question about pet therapy or visitation, they come to me first as a resource person. But the most important feeling I retain from this experience is that I helped make a difference, that I went the extra mile, and that perhaps as a result, Benji is perched on R.R.’s lap right now as I remember them from not so long ago. And as for my own dogs at home, I hope that, if I am ever critically ill, my nurses will allow Bentley, Gertie, Bucky, Ali, Stormy, and Demi to visit me as well.

The only postscript I’ll add is that the above-named canine family members, of course, have all crossed the rainbow bridge since 1994. So I’ll just mentally substitute for them Jinx, Zora, and Visa.

Posted in Dogs

Bleeding edge

I knew I couldn’t hold out for long. Having some time available this evening, I went ahead and updated the laptop to Windows 8.1. Up to now I have spent as little time as possible in the Metro/Modern UI. Will see if 8.1 improves my experience any. The jury is out. Really annoying big black and orange boxes commanding me to use gestures even though I do not have a touchscreen, obscuring large swaths of the screen. I think I was able to banish them, at least for the moment. Several important browser add-ons show as incompatible with IE 11, especially Evernote. Looks like it’s back to Firefox for me. Also a Citrix file called pnamain.exe does not seem to like 8.1. Getting on to HPM and Epic from Citrix may be a challenge.

Desktop will have to wait. It is almost five years old and came from Dell with Vista on it. It is definitely time to do a clean install. In any event, I can’t get to the Windows Store since a month or two back when I got a bad infection with Sirefef. I was fortunately able to clean the Trojan off the machine, but ever since then, the Store and all of its apps fail to communicate through Windows Firewall. I have not been able to figure out how to fix that. No other way, it seems, to download Windows 8.1. (Not to mention the Weather app being frozen in time….)

Tagged with:
Posted in Uncategorized

Back to the blog

Well, it’s official. At least the grades are posted. I have completed my Master of Health Administration program, and sometime early next year will get the diploma to go with it. Lots and lots of work writing papers and participating in group projects. Due in part to my Type A nature, I would agree with the university’s estimate at the outset of an average of 15-20 hours per week dedicated to course work.

Now that it is done, I pledge to be more regular here and on the Twitter feed; while I perhaps could have kept them up in some limited fashion, the last two years have been all about simplifying what I could. Simple is still good, but I feel like I can unleash my voice a little more now. (Readers can judge whether that’s a good thing….)

There’s plenty of grist for the mill these days. The health insurance exchanges are proving to be a major dud, and there is no shortage of worry in my business. Buckle up with me for the challenging ride!

Posted in Uncategorized

Rights and Wrongs

Lately, much that’s in the news causes the observant to wonder how long our treasured rights, as allegedly guaranteed in the first ten amendments of the Constitution, will be available to us to exercise. My current reading is the eye-opening exposé by John Whitehead, A Government of Wolves: The Emerging American Police State. It documents how, slowly but surely, we the sheople are being preyed on by our exalted rulers with lethal force.

I am really prompted to compose this post today, though, by a semi-amusing story on the Huffington Post site, showing how an enterprising county fair game proprietor found notoriety by using President Obama’s face as a dart board target. Now, in today’s polarized atmosphere, reaction is sure to range from attaboys to calls for hate crime prosecution. But let’s look at it in the larger picture.

Does the vendor have a right to do this? Absolutely. He is protected by the First Amendment’s freedom of speech clause, which he did not overstep by infringing on anyone else’s rights. Fairgoers are free to play, or not to play, his game. And certainly Mr. Obama was not injured by the display.

Did he exercise good judgment? Probably not. He made a political statement distasteful to many, and that could harm his business as well as that of the fair he was at. It’s not a charitable idea in general to impute any approbation to children, who have been known to be quite numerous at county fair midways, in the matter of throwing a dart at the likeness of a person’s head. (Yeah, leave that to the adults….)

Interesting, though, that many current complainers would have been fine, eight years ago, if the visage were that of George W. Bush. Same right, same exercise of judgment. Why would some view it differently?

Does it in fact make any difference that it’s a president’s face at all? I would argue that it should not. One unfortunate reality of the last couple of centuries in this country is that the office has been raised far above the station intended for it by the Founders. As the character Joe Pesci played in the 1994 movie With Honors put it,

The President isn’t an elected King, no matter how many bombs he can drop, because the crude Constitution doesn’t trust him. He’s a servant of the people. He’s a bum, okay Mr. Pitkannan? He’s just a bum.

Indeed. Any President, any Congress critter, any supreme, superior, or inferior court judge, any bureaucrat or IRS lackey needs to remember that WE THE PEOPLE are their boss, and they serve at our pleasure. A president deserves the respect due any citizen of these United States. No more, no less.

And yes, I have specifically said CITIZEN. That will disqualify me from being a public servant in the city of Seattle, which is spending its time less in good governance than in policing the dictionary.

That leads into the topic of my previous “leisure” (i.e., other than work or degree program) reading, Walter Block’s provocative The Case for Discrimination. If you want a thoroughgoing libertarian’s perspective on the topic, this is it. You can download the e-book from Barnes & Noble for the princely sum of three dollars. Well worth it!


Posted in Uncategorized

Hit job

First off, welcome to the first post on my new (to me) platform on WordPress.com. I started Critical Condition almost four years ago on Posterous, which appealed due to its “drop-dead easy” approach. Well, they lived up to the first part of it this week. After selling out to Twitter last year, they discontinued their blog service as of yesterday. Fortunately they provided a way for me to export my several years of blog posts and import them into WordPress. So here I am. Though you likely know it already if you’re reading this, my semi-random musings can now be found here at http://InfoTechRN.com (end technical prolegomenon)

There are several things going on these days that merit the title of this post, not all of which I can elaborate on today. I’ll confine this entry to the radical animal activist campaign, thinly disguised as investigative journalism, with which the NBC Today show soiled itself this morning. I will leave it to the reader to do his own review of the severe agenda, and misleading use of donations from pet lovers, of the Humane Society of the United States. (Just do a search on HSUS scam if you are not already familiar with this outfit’s thuggish tactics.) For a supposedly reputable news organization like NBC (wait, I contradict myself there) to feed us canned HSUS propaganda to denigrate an organization, the American Kennel Club, that actually is committed to the strengthening of bonds between people and their dogs—their piece today was thoroughly disgusting.

Granted, I don’t think the AKC spokeswoman who was interviewed made the best case for her organization. I know there are bad breeders out there, and likely as not they hide behind the AKC shield. It is very likely the AKC’s inspection efforts need upgraded, since they have only nine inspectors to cover the country, and there are hundreds of thousands of breeders who surely never get inspected. Sadly, ramping up that work would cause AKC’s fees to those registering pure-bred dogs to rise markedly, in order to cover the costs involved.

I am not sure that is the right path. AKC just needs to acknowledge that while they do what they can with regard to inspection, it does not have the resources to catch every malevolent breeder. Obviously the HSUS found one of them, and today their activist accomplices at NBC milked it for all it’s worth. Which is, not much.

Tagged with:
Posted in Uncategorized

Fecal cliff

Others have previously posted attempts to put the federal fiscal morass, with its incomprehensible numbers in the billions and trillions and gazillions, into household budget terms we should be able to understand. Here’s my take at putting last night’s Senate-passed plan into that perspective, using the following facts:

National debt: 16.4 trillion dollars, now at the debt ceiling which by law must be raised in the next two months
Federal spending: 3.54 trillion dollars annually
Federal revenue: 2.45 trillion dollars annually
Budget deficit: 1.09 trillion dollars annually
Spending cuts passed overnight by the Senate: 15 billion dollars over 10 years (1.5 billion per year), to forestall the 109 billion dollar sequester for 60 days during which the next Congress will allegedly come up with a “grand bargain”
Revenue hikes passed overnight by the Senate: 620 billion dollars over 10 years (62 billion dollars per year)

What this picture translates to, for a typical middle-class family (the factual numbers above are all adjusted by a factor of 0.00000003):

A spendthrift couple named Red and Blue—both have been spending in an entirely uncontrolled fashion, though Blue has lately held the credit cards and accelerated the pace—survey the state of their finances. Last year they earned net income of $73,500. They spent $106,200. Their total current debt is now $492,000, and all their credit cards and lines of credit are maxed out.

Here’s their plan for 2013. One of them will find a second job, very part-time, to bring in added net income of $1,860 during the year. They cannot yet agree on how they can possibly spend that much less (meaning, $1,860) in 2013. So, for the next two months, while they figure it out, they will plan to spend $45 per year less than they did last year. Meanwhile, Red and Blue continue to blame each other for their sorry state.

Suppose you are this couple’s debt counselor. What do you think of their plan???

Today, the U.S. House of Representatives is effectively filling the role of the nation’s debt counselor. What should the House do with the bill that has been presented to it???

It has been noted by some wags, by the way, that this type of comparison is faulty because the government can print its own money, basically paying its bills via IOUs. Maybe that works for a while, but do you think China will take our IOUs indefinitely? And, for those retiring in 10 to 20 years, would you like your Social Security checks to be replaced by IOUs? This is all pretty simple arithmetic, and unfortunately the geniuses in DC failed the lessons on addition and subtraction.

Those of us who have climbed out of debt know the job is really hard, and making large cuts in spending seriously hurts. Our elected legislators and executive officers have shied away from every tough decision they can. How long can they continue to kick the can down the road? The implement that comes to mind is a shovel, a very large shovel….

Tagged with:
Posted in Uncategorized

Thrill of victory, and the agony of the feet

We’re back from today’s Ann Arbor Kennel Club dog show near Monroe. It was a long day for everyone, Zora included, but we came away with a Beginner Novice obedience title, grabbing the third and final qualifying leg.

It wasn’t easy.

We left home around 5:30 AM to ensure getting a good parking spot and prime crate space in the show building. At least it had some measure of air conditioning, unlike our last venue in New Castle.

Even so, the brutal heat was a factor. Barely had the National Anthem been sung and the announcement made over the P.A. system to remind us to keep ourselves and our dogs cool and hydrated, when a Great Dane collapsed in the building, overcome by the weather. Fortunately he got plenty of help and revived, though it was rather scary.

My first run with Zora in obedience was a real puzzle. She just seemed out of sorts, lagging through the heeling and figure eight exercises, tail down. Then, to top it off, on the recall exercise she did not want to budge from her sit and come to Dad. Honestly! That never happens. Well, never until today. So, another first for us: an NQ. For those not into the show lingo, that means a Non-Qualifying score. Ouch!

We put Zora back in her crate to rest up for her rally appearance. But she still didn’t seem quite right. For a bit, we were concerned the temperature was getting to her. But Rita finally figured it out when she took her out. Zora did not want to bear weight on one of her hind legs, and Rita spied a drop or two of blood on the floor. Somehow, the bitch had torn a toenail, and it was really bothering her.

Rita did go ahead and take her in rally, and she placed fourth with 89 points under an insanely picky judge. All in all, we felt pretty good about that.

That’s not the end of the story, though. The club held both morning and afternoon trials today, and we had Zora entered in both obedience and rally for both trials. So, Rita spent the lunch break getting a little styptic powder from a vendor, applying it to Zora’s tender toe (news flash: dogs do NOT like that!), toweling her down to cool her off, and basically helping her to chill in more ways than one.

We decided to forgo the second rally event. There was nothing at stake, after all, except another ribbon or two. And we wanted Zora to have enough gas in the tank for the obedience exercises; this time around, the events were in different rings, and Zora would have been due in rally just a few minutes before obedience.

Back in the obedience ring, now. Good start, she’s not lagging much on the heeling exercise. Still didn’t want to sit at the end. (It’s upsetting why she does it so well when practicing, but not so much in the ring when it counts.) The figure eight wasn’t her best, as she did lag a bit, but at least she sat when she needed to. S-l-o-w-l-y, but she did. No issues on the sit for exam or the sit stay. Now, for a drum roll. The recall.

“Zora, come!” Not a muscle moves. I re-establish eye contact.

“Zora, come!!!!!”

Ever so gingerly, she decides to make our day. After what seemed like an hour, though it wasn’t more than ten seconds, Zora ended up in front of me, with an expression on her face like, “Are we done yet???”

Indeed we were. 188.5 points out of 200, second place in the class, and our first obedience title – all rode on that recall. Even the stifling 102-degree heat that hit us as we exited the show building did not deter us. And by the time we got back home, after a nap in the crate on the way, Zora was back to normal, terrorizing Jinx like nothing had gone on earlier in the day. But we knew better.

At some point, when we get Zora working more reliably off leash, it will be time to reach for that Novice title, the Companion Dog (CD) credential. But for now, we celebrate the Beginner Novice title, even if, as a Facebook friend suggested, the name is a bit redundant.

Tagged with:
Posted in Uncategorized

Study Break

Yes, once again an inordinate amount of time has passed since my last blog post. Between work and school, there is so much going on that social networking and blogging are way, way down the list. I just don’t have mental room for them now.

I know not to go into too much detail on what is happening at work. Let’s just say that right now I am application lead for two huge strategic projects plus a major software upgrade. Both projects have executive level visibility and very tight timelines. In fact, both of them really should be spread out over three or more times what we need to get them done in. And, of course, there are all the other projects and assignments that the parties involved with them *think* are major. Need to stop there.

On the academic front, my thoughts at the moment are mixed. Just to keep everyone up to date, I started in January on my online Master of Health Administration program at Ohio University. As of tomorrow my cohort of 25 students will be halfway through the first of eight quarter-length modules. Each module is basically two four-quarter-hour graduate level courses. This module is called “Context of Leadership in the US Health System.”

On the bright side, so far my grades are very good. Individual assignments have gotten very high scores. Now that is with a certain amount of my Type A personality perfectionism, spending the time needed to get everything just so before submitting. There may be opportunity to figure out what lesser amount of time it may take to submit work that is still A quality, maybe not quite so stellar.

An interesting sidebar. I think back to my first undergraduate experience, where there was also lots of paper writing. I marvel at how much easier it is today. (Part of me also marvels at the difference in the grades.) Maybe it has to do with the bazillion e-mails I have had to craft at work in the intervening time. They have forced me to get specific and to the point. That’s a good thing.

But then there are the group assignments. Again, the right amount of effort vs. reward comes into play, perhaps even more so. The first one yielded my mates and me a score in the A- range, though below both the mean and median for the class. I was an average contributor, to be honest. My contributions were good, but I did not get as critical about my colleagues’ contributions as I might have. Now, we’re about to ramp up for the big group project for the quarter. The group members are different this time. We’ll see where it leads. All I know is, I’ll be plenty busy. Don’t expect to see many blog posts in the immediate future.

Posted in Uncategorized

Happy Thanksgiving!

Although Thanksgiving Day is a federal holiday with definite secular elements in its origin (e.g., rejoicing at the end of the harvest), people of faith understand intuitively that this is a day to praise and give thanks to our Creator for the many blessings bestowed upon us.

We are, every one of us, truly better than we deserve, and today we recognize and celebrate that.

We give thanks for our families, our friends and neighbors, and our God-given talents and abilities. We give thanks that we still live in a place that leaves us free to leverage those talents and abilities to improve our earthly station, provide for our families, and worship without state interference. We give thanks that we can heed God’s call to share our blessings voluntarily with those who are materially less fortunate than we. For those of us (myself included) who work for non-profit entities, we give thanks that every day we do our job, we assist in providing tangible benefit to the communities we serve. We give thanks to those who safeguard our liberty, often at a great price paid by them and their own families.

So when we bow our heads today before diving into the holiday feast, let’s be so very thankful for all that we have and all that we are. And let’s remember the source of our blessings.

Happy Thanksgiving!

Posted in Uncategorized