My Life is in Your Hands

screen-shot-2016-10-28-at-8-43-57-amI have always had a bit of a control problem though I do manage it much better than I did when I was younger. I am sure the fact that I was put “in charge” at a very young age,  has influenced that attitude.

Sometimes this can be for the good. I can take charge  if I have to.  I was able to be a leader in the health care field, and can manage some pretty complicated areas of our personal health.  But truly, I just have to give in and realize that most things are not in my control. You know the prayer ” God, grant me the serenity to accept the things I cannot change, Courage to change the things I can, And wisdom to know the difference”.   I am not sure I am following that little prayer at all these days.

My husband, as chronicled in past posts, has quite  a few health problems and just when life seems to be going fairly smoothly, our world crashed again.  In late summer, our fall  plans were derailed.  Hubby suddenly was very ill with what was diagnosed as a septicemia (whole body blood infection). After two ambulance rides and two days sitting waiting for a bed in Regina Emergency Department, I spent a few days watching an incoherent and drowsy man who essentially slept nearly 24 hrs a day.  It was difficult for  me to sit beside him watching others control the medications and care. In these situations, my mind goes overtime, trying to solve the problems and control what I can.  (I am not sure  the staff love a patient’s wife who is an “old nurse”, but the nurses were kind and looked after both of us well)

It was hard to leave at night, but for my sanity, I know I had to. I don’t do well without a decent sleep. One early Wednesday morning they called to tell me he was bleeding. The nurses didn’t seem very upset so I somehow went back to sleep. I returned  early in the morning to find a situation I could not control –  He was having  a lot of bleeding and his blood pressure  was dropping, while we waited helplessly for him to have  a scope to look for the cause.  Finally, with a blood pressure number that I can only whisper to those who know what it means, he went to the Endoscopy room, the scopes happened and his ulcer was fixed.  He was stable again.  Texts to family and friends were slow that day as I sat in fear, praying for his life to be spared and helping the nurses  to keep the chaos of a gastrointestinal bleed in check. When I was able to take the time for texts, the crisis was over. So foolish that when I need support the most, I didn’t call my family for help !! I must say that despite my lack of communication, family and pastoral care were right there for us.

Control you say?? I have it bad.

Since discharge from hospital, life has been rough. He didn’t recover in my allotted time and all things in my power did not seem to help him. I struggled to seek what might be holding him back and came up with a couple of possible reasons, which our doctor acted on. My waking hours ( while closing up the cabin and canning my garden supply) were spent  trying to fix and control a difficult  situation. This wasn’t very easy on my patient.  It also took a toll on my sleep and my well being

One Sunday in church, in the midst of all this,  I realized that the problem is not that I cannot control this, but that I am not giving the control up to God. As we sang a moving chorus called  “Trust it all” I realized that  trusting God for everything in my future  is difficult for me, and I needed to give it all over.

I also started to see a strange  pattern of irrational thinking…  that if I could do something that I hadn’t done  before,- something I always left for hubby to do,  then it would prove that I could control the uncontrollable!  I have had to learn a lot of ” blue chores” that I would gladly give up.  In 2007, during one of hubby’s darkest times in hospital I looked at our “to be painted” computer room, and patched areas  in our main bathroom , and decided that if I could prove to be able to paint those ( when I had never really handled a paint brush and don’t do well on ladders) , then I would be “Okay”. So I painted that computer room (not the best job but done).  That day, as I lay exhausted on my bed I heard a loud voice tell me that ” YOU will be all right.”

Now you may truly believe that I just might be crazy to think that in today’s world God does talk to us in huge voices !  That was the only time that God chose to do that until the day hubby got ill this time. I was at the lake cabin and he was at home.  I was trying to sleep in  and was suddenly convinced I should  check on him even though he should be safe at his dialysis appointment. Yes, again in a  voice loud enough to wake me!

Our plans this summer included a bunk bed  basement guest room/sewing room. As changes go, that meant looking at the old carpet, and ordering a replacement and looking at faded, marked old white walls.  So it seemed necessary for me to use those painting “skills” again (now strengthened a bit with my accessory role in lake renovations) so I painted the room.  Sweat (literally)and a few tears went into that painting job. No voices from heaven, no assurances of all being well.

The Sunday after that, God told me clearly that “my life is in His hands” and I needed to give up control and trust Him. The tears that just wouldn’t come before flowed freely, as I let go.  Hard for a control person. But the message was clear, and the need was real.

After that , our daily life had  with some very down days and more and more up days (for both of us).  As time passes, with some changes in treatment, we are learning to live with another new reality.  Hubby has made huge progress and I am finding myself more patient and less anxious.  You will see us out walking Walmart and the Mall to gain leg strength.

I am learning what I need to “control” as there are things that have to be planned, done and advocated about.  But through it I remember that I do not need to be in  control, for
God has my back. No matter what life gives us, I will learn to trust Him in all things.

But I know that giving up control still will be a  lifetime struggle – Some things just aren’t easy!

.** check the link Here  to read the full lyrics of Trust it All

 

 

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Posted in Faith, Health crisis, healthy living, Living life, musing, Skin Care, healthy living, trust | 5 Comments

Enjoying an online presence

Facebook friends (1)Sometimes its scary isn’t it ? Knowing that people can find out “stuff” about you from just googling your name. If you haven’t tried it, I recommend you do so. See what people can find about you. Getting rid of something you have posted or uploaded can be simple or darn right hard, so it is advisable to think before you post !

Many employers do a google search of potential employees, look up their Facebook page and just see generally what type of online presence the potential employee has. Many a politician or potential politician has been brought down by something he/she posted ( sometimes many years ago )

So lets talk Facebook. Many of the precautions I will outline will be useful for all the others but to try to outline them all makes a confusing blog post.

  1. Know what is Public and what is more private.
    1. Your name will always be searchable.  Facebook frowns upon phony names, but some teachers, counsellors, social workers may not want their name to be easily searched so a first and middle name, first and initial or nickname  will be acceptable. Personally, I leave my full name, due to wanting people to find me for business and social purposes.
    2. Your profile picture is always public. I think the best is a good headshot of you. Or a picture that, if you want someone to find you, is easily recognizable. Just remember this is the first impression someone searching you sees. ( so it may be a flower, a pet or a picture of a place you love.)  Pictures of you under the influence, kissing someone, or doing silly expressions can give a negative impression to those finding you.
    3. Your Cover photo is also always public. Again, remember that others will see your children, grandchildren etc so if you are making your cover photo of an event, it may be wise to check with the people in the picture if that is okay. I used to put a lot of family there – but now stick to scenery and pretty pictures.
    4. Your ” INTRO” ( used to be About page ), your previous work, schooling, pictures, and friends list is all set by you.  Make it as public and private as you wish.
    5. Your posts can be set to a wide variety of audiences.
  2. Control the audience of the posts on your timeline:
    1. How much of your news feed is shown is controlled by your settings – go to your settings and explore your options.  You can control who sees what on your timeline ( to a degree ). You can control which pictures you are ” tagged” in.
    2. When you post, you can choose  whether you make a post public or just for Friends ( but that can include friends of friends ).
      1. You can customize your friends list by making some Acquaintances  ( or belong to a certain group like Family, a school etc ) and then post to exclude some of those people from seeing your posts or for only certain people to see your post. This is found in the drop down box to the right of the post.
    3. When you tag someone in a post, it is displayed to all of their friends too. This can be great or not so great.
    4. Liking something on Facebook can tell your Facebook friends all about that person and what they said. Be careful about this, as it can tell things about you, and spread things about the other person. This is still a bit of a mystery – as it is run by an algorithm  that Facebook constantly changes.
  3. Commenting on some posts can be commenting to a webpage not just a friends timeline.  Watch that as some of what you say can be meant only for your friends audience and can end up on the local papers’ or pages like Huffington Post.
  4. Know when to rant and when to just keep quiet. Your Facebook presence can tell a lot about you and as noted by many famous people, can surface at an inopportune time.
  5. Know the difference between a private message and posting to a timeline. Unless a person has posting to their timeline setting set to private, your message of ” how are you” or “when are you coming to visit” can put a very private conversation on the timelines of all your friends pages !  Your timeline can be a good or a poor place to carry on a conversation.
  6. Be careful of “check in’s ” or posts about vacations as this can advertise that your house is empty. Posting vacations can be fun and informative to many of your friends, so many do it, but just be aware of that risk.
  7. Watch your language, the type of pictures you post, and other things that can give people a wrong idea.  Watch what you post while “under the influence.” It may not be the time you make your wisest choices !
  8. Remove posts that may have offended or cause a conflict. It is not worth losing friends over something you may have said in haste or may offend.
  9. You can block or unfriend any Facebook friends whose posts annoy your or are against your beliefs.  Facebook can be a pleasure or enhance your rage depending on what you allow. You can just block a post if it is offensive to you.  You can tell Facebook why, or not depending on what you choose.
  10. You can choose what you want to see more of or less of by altering your timeline preferences.
  11. Choose your Facebook  friends wisely – if you don’t know someone who wants to be your friend:
    1. Check out mutual friends – none ? probably unwise to accept.
    2. Watch for messages from people who are trying to scam you or think you are beautiful.
    3. You can make some very nice friends you have never met – perhaps relatives of a good friend or friend of a friend or those that share a common interest ( business, hobby, or common background.)  Don’t be afraid of it.. you can always unfriend them !
  12. You can edit your posts and comments. If you say something that people misinterpret, or spell something wrong ( auto-correct can be dreadful !) just click on the little arrow on the right of the post, click edit and change it.  You can remove any posts or comments as well with the same little arrow.
  13. Explore your settings and news feed preferences. ( on the right hand side under the little arrow ) Do this on a regular basis – as Facebook changes things as well as you change in how you wish the world to see you or see the world.

The bottom line – these social media places are here to stay. They can also be big time wasters. But they can also  be sources of enjoyment, of sharing accomplishments, fears, sorrows, and joys.  They can keep you in touch with old friends and relatives. They can be a source of entertainment and knowledge ( watch that though.. what is posted on Facebook is not always true ! ) Share and see what you are comfortable with. Own your preferences.

And me ?? I am a known addict – but I do control what I post and see. I am a bit of an open book. But lately I have helped to network people together in the neatest way, and have me a lot of people, and learned more about some people and this has added a lot to my enjoyment. Enjoy along with me !

 

 

 

 

Posted in Skin Care, healthy living | 4 Comments

Exercising Caution in an Electronic World

ID-10093855I have a variety of friends who have varied views on how visible they should be online. Some avoid it at all costs – using both emailing and internet searches sparingly. In fact, some of my age group don’t even own a computer.

Others cautiously create a Facebook page, and perhaps even an Instagram account, but mostly to look at other people’s posts.  And some, like me, embrace this new way of communicating, staying in touch, and putting the fun and not so fun life events out in front of their online friends. Those of us with home based businesses know the value of Facebook and other social media sites to connect and sell.

It can be  a scary thought to imagine how many electronic footprints we have out in that world. Recently I googled what sights to see on our planned trip to Vegas, and said to my hubby – Watch how quickly the sponsored ads on Facebook start advertising that tour  – it was immediate !! So “big brother” or internet cookies are a fact of life – it is how to make your browsing and posting a bit safer that recently has been a focus of mine.

Perhaps some say –  But Terry you are not very cautious with your comments/likes etc. But that is where you might be mistaken. I try to learn what is real and what is not but sometime get caught !!!  I am often behind the scenes cautioning friends as to what to watch for and what to do if certain breeches happen.

Some of those scenarios could be :

Duplicate Facebook page :  You see a friend request and you wonder “am I not friends with them already” but being a good friend you click YES to their friend request. Not a good idea. If that was a true duplicate request, some scammer has now your information and how much you share.. That may be your whole friends list.

  • Instead – check your friends list first, click DELETE REQUEST  and then report this as spam – follow the links and it gives you the opportunity to send a message to your friend to tell her she has been duplicated.
  • If this is you – find the page click on the three dots after message  report as spam – say it is impersonating you .. and follow the links. Again the sooner the better.

Screen Shot 2016-08-12 at 2.04.11 PM

2. Click Bait :  There are many sites on the internet that exaggerate truth and distort information behind a story, just to get you to click on the link and visit their website. This is referred to as clickbait.
To help you understand what clickbait is, here are three examples from my source.  They are:

  • “When She Looked Under Her Couch Cushion And Saw THIS…I Was SHOCKED!”
  • “He Put Garlic In His Shoes Before Going To Bed And What Happens Next Is Hard To Believe”
  • “The Dog Barked At The Deliveryman And His Reaction Was Priceless”
  • A most recent one is the stories re Melissa McCarthy that lead you to a weight loss supplement ( are you kidding me ?? )

Try to avoid clicking on ClickBait – they are collecting your information. Facebook is putting in some stops of this nonsense but some will get by them.

3. Facebook “Like Farming ” Scams:

  • Click on the picture, type _____  and see what happens ( hint: nothing will but the poster now has your Facebook information )
  • Can you name an animal without a certain letter in the name ( or variations)
  • Click Amen ( or like or pray for )  for this poor little child with cancer /deformity/born prematurely ( these people are using someone’s real picture to draw you in and will use your information in some way.  The picture is stolen and some innocent family has been stolen from – what an added stress  to someone who really does have a sick child.
  • Sometimes it is a Fan page – perhaps a child with Downs syndrome doesn’t think she is beautiful and she needs ” likes’.. your friend likes it, you see it, you like it and on it goes. When the page gets a few thousand likes, they turn it into a business page ( or worse ) and you are now liking that page and getting it on your feed. It may be something you have never and would never endorse or even a porn page.
  • Pages  put out by others on behalf of a celebrity – the most recent one is our young olympic swimmer – someone put out a page to support her. Many jumped on board to like the page and comment – SPAM !! Even Swim Canada noted that in the comments. The hint here is if it is not the athlete’s page, is created fairly recently, and claims with message that seem to come from the celebrity. IF there is something not quite right.. move on !!

4. GIVEAWAYS 

  • $100 Walmart card, Costco card, airline tickets  etc – no it is not very likely that everyone who goes thru their song and dance ( message 10 people, put it on your page, share etc etc etc ) is going to get $100.00 gift card.. so just don’t go for it.
  • They are also not giving away laptops, macs, ipads, etc etc etc. Again a Like Farming Scheme
  • What appear to be companies giving a way a LARGE TICKET item. Yesterday I saw a Coach ( motor home bus ) worth close to $1,000,000 to win by a company with no address listed and who started their page on August 8th. They have gained 29,000 likes since then – perhaps you and I. If you liked this page, I would recommending ” un-liking ” it as they are either selling the likes or mining your information and your friends

5.   I am going to add this one to the list. Curtesy of Jan Miller ( TheGrommet.com)

Anytime someone sends you a Facebook item with instructions “copy & paste” instead of share”, please stop and ask yourself “why not share?” The reason usually is that, hidden within the text message, there is a nasty bit of hacking code that cannot be spread by “sharing” ( which is why Facebook created “sharing” in the first place).
REMEMBER: hackers are like vampires…they can’t come in unless you INVITE them. When you “copy & paste”, you bypass Facebook’s security and not only invite hackers, but you also infect your friends.

This briefly explains some of the pitfalls we might  fall into and how  to avoid them.

I would also add:  if it is too good to be true it probably is, if you don’t know the person who originated a ” like” or “pray” for story – don’t like it or say amen or  pass it on.  Before clicking on a link from Facebook, always remember to check the address bar, which should always display “www.facebook.com/” and nothing else like “www.facebook33.tk” or “www.facebook1.php”, etc. which is a giveaway of a phisher. It can steal your e-mail and password, as well as post spam links to your friends’ walls.

If you think you clicked a page in error or you have liking regret you can go to your Activity log ( see pix ) and unlike it,  remove it or mark it as scam.

Screen Shot 2016-08-12 at 2.49.28 PMYou can also go to your profile ( the one with your name on it ) and check ” Pages I have liked ” for any that you don’t remember liking or never in a million years would have – Simply unlike.. it is one click and done.  Or if something is coming across your feed you would rather not see, click on the right of the post, click unlike and move on.  Report only if it is a post NOBODY should see.

I have been cleaning out my ” likes” and have come across pages like this one.  Guaranteed I never liked a page not even in English, but me and 499,000 others have – so this was probably a give away.

Screen Shot 2016-08-13 at 11.48.56 AMThere are other ways ( settings, picture posting and tagging etc)  that can help keep you safe.. I will save that for another post.

 

 

picture credit to Freedigitalphotos.com

Posted in Electronic safety, Facebook, Healthy LIving | 3 Comments

Partisan Politics or Provincial Power?

organ donorLast  week our government defeated a bill that could change the lives of many.  Did they do it as some articles say  for “partisan ” reasons ? Or do they really have other plans and much money put into provincial donor registries ?

This bill was defeated by the governing party, the Liberals being the majority of the Nays.   The bill was a ” private members bill” from MP of Edmonton Manning, Alberta Ziad Aboultaif   (Members Bill, C-223) which was to  introduce legislation to establish the Canadian Organ Donor Registry and to coordinate and promote organ donation throughout Canada.

The purpose of this Bill was threefold:

  1. To establish the Canadian Organ Donor Registry, a compilation of information on organ donors and recipients and a system that links to compilations held by third parties.
  2. To develop a national strategy to promote organ donation in Canada and facilitate the exchange of information on organ donation between provinces. Canada is the only developed country without national organ donation legislation, such as the 1984 U.S. National Organ Transplant Act.
  3. To mandate an annual report.

This to me the important part of this is having a compiled list of those that wish to donate upon death that can be accessed in case the need arises. There is much work in my opinion to be done for efficiencies in the transplant programs, but that is another subject.

In Canada, deceased donor kidney transplants are distributed provincially, but other organs from deceased donors are distributed nationally and that registry works very well.  A national registry for those with high antibodies needing a kidney transplant was established in  2014- again a good move.

I believe a nationwide donor registry is can and will help to save lives.  Canada has a dismal rate of  transplants  at 23 per million, (this compares to the USA  at  34 per million, or 50 per cent higher.)  According to  Dr. Phillip Halloran, professor of medicine at the University of Alberta and editor emeritus of American Journal of Transplantation and chair of the Swiss-based Roche Organ Transplantation Research Foundation, Canada is in the lower third of all developed countries, certainly below 50 per cent, of donation activity per population.

So why is this ? First of all since our health care is provincial in jurisdiction ( with some federal mandates ), each province can decide how to register their potential donors and a different system of procurement. This bill would not have changed the living donor rate or system ( though would have brought more awareness to that possibility) but would impact that deceased donor program and a national donor registry could change the face of transplants in Canada.

Lets just walk through a potential deceased donor scenario. First of all, to give a “solid organ” ( kidney, heart, liver lungs ) the potential donor has to be “brain-dead” – and yet have a  beating heart and functioning organs. These are usually victims of a car accident or brain bleed or stroke, who arrive to the Emergency department on time to have been placed on a ventilator, as their brain is not telling them to breathe.  At that time, or hours or days later, brain function is determined and if “no perceptible brain function” is determined, the patient is considered “brain-dead.” At this point, a nurse or transplant coordinator will approach the family and discuss organ donation.  Usually, the wallet with the driver’s licence that may or may not display the patient’s wishes is not readily available or in the hands of a very distressed family member. This means the nurse or coordinator is starting from scratch – ” The very difficult discussion begins with ” do you know if your loved one ever expressed a wish to have their organs donated?”  Fortunately (or unfortunately ) most families are not like ours –  have discussed their wishes due to a personal relationship to a transplant. If the loved one has never discussed this, the decision must come from a very bereaved and distressed next of kin ( spouse, mother, father, daughter, son, sister brother). How difficult is that !!

Take a second scenario, same circumstances,  but the nurse/coordinator can access a quick online registry, see that the patient has registered his wishes, and the conversation can begin from a different focus – ” I see that your loved one has placed himself on the donor registry, I am here to help you fulfil those wishes. The family may /will have some say yet, but rests easier knowing the wishes of their loved ones will be fulfilled. It becomes less of their decision and more of the person who will donate.  I have heard many stories of those put in this tragic situation and knowing their loved one’s wishes made all the difference in how comfortable they were  of the decision. Family rivalries decrease as the donor is dictating their wishes.

Other organs can be procured after death regardless of cause of death ( corneas to help someone see for example ). There are so many missed opportunities here. Again, the conversation can start from the donors wishes.

Our Federal Health Minister in her remarks to the defeated bill glibly stated that anyone can just go and register – so I tried to do that – HERE .There you can see that each province has a different way /route. Some like SK just have a voluntary paper ( and stickie that sometimes stays there ) that goes with your driver’s licence, others sign up with health care card, and some nothing.  And if one of those residents happens to be in an accident in another province, there is no access to that persons’ wishes. If you click on Saskatchewan’s link you will see this:

Screen Shot 2016-06-17 at 9.19.37 AM

I have a two very personal reasons for wishing a better way for this process to take place.

One being that my husband has spent 12 yrs on dialysis and we know the potential freedom a transplant would make.  He was fortunate to receive a transplanted kidney in 2006 from a deceased donor. What an exciting and conflicting day that was. To know that someone died to give several people the gift of life was humbling and very emotional. Unfortunately the kidney my husband got was destroyed by a common virus and a  high count of antibodies and other health concerns has made another transplant a poor option for him right now.

The other being my experience as an ICU nurse – where decisions like this were made, mostly in the transfer to a larger centre who did the actual conversation, but at times, we as nurses had to start the process with the doctor. I know opportunities are missed for both solid organs and other tissues.

The outcome of this vote  was discussed in an article in Huffington Post  which shows how much education needs to be done in regards to organ transplant procurement and donation. It appears that our MP’s missed the whole point of the registry.  If 64 million dollars have been spent since 2008 on a national system – then where is it ??

This has been called ” petty politics” to defeat this bill and I am afraid it is. This bill could have been sent to committee for further discussion. Our Federal Health minister didn’t do the simple google I was able to do to stand informed. Shame on her ! Her comments were less than helpful.

I am upset – upset that we can change the words to our national anthem because a dying man requests it but cannot work toward something that can prevent many from dying.

The nature of a private members bill is that this member can only present one each elected term, so this will be a done deal for now. I guess the best we can do is express our opinion, hope for the government to present its own bill ( which it appears has been in the works since 2008 an 8 yr process !! )  Or to begin to see if our provincial legislation can be changed.

A start … enough ? I don’t think so but one must start.

 

organ donor

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Sliding down a slippery slope

hands

 

Do we have the right to die in the way we want, when we want and how we want ? The Supreme Court gave our parliament until June 6, 2016 to pass a law allowing physician assisted dying.  As a nurse, wife, mother, Christian  and Canadian citizen, I am at two minds about this legislation.  However, our Canadian policy makers seemed to have put together a decent bill with some safeguards in it.

First let’s look at this bill

Who can access this “right “? A person must have:

  • an incurable illness or disability 
  • An advanced state of irreversible decline
  • be in intolerable suffering
  • natural death must be “reasonably foreseeable”

So what does this actually mean ? It means that this law is actually for the “dying patient”. It is not for those who are suffering and wish their life over, and  where death is not an inevitability in the near future.   As predicting how long someone has left in their life is a very non scientific, and sometimes a guessing game, the fact that the arbitrary 6 months to live or other parameters were not put in this bill can be troubling for some, it makes sense to me.  The person must also  be in “intolerable suffering” – which really can only be judged by the dying person themselves, yet will have to be decided by two physicians. That may be problematic.  Irreversible decline – tells me that the health status must be worsening and death is the only outcome. Incurable is easy to define in most circumstances.

What other safeguards are in this law ?

  • The person must request this in writing (can use acceptable methods of consent that is in place in all medical procedures if they cannot sign themselves)
  • The person must be able to express their own wishes  – this cannot be a family or friends’s request.
  • There is a 15 day waiting period after consent
  • They must take the medication themselves
  • They must have Canadian Healthcare ( no tourism for this ! )

The bill addresses some of my concerns – but leaves some unknowns in the minds of those looking at it.

  • Can a person declare in advance their wishes should they become in this state and be unable to say what they wish ?  Most provinces have an Advance Directive law.
  • Can a person have a mental illness that fits these criteria ? ( I think not )
  • As our health care is provincially administrated, will access be different in various Provinces in our country.
  • Some say that the 15 day rule can be problematic, but in my experience, I have seen patients demand to die when in intractable pain, yet more settled in the dying process when pain and symptom measures are in place. Would we have robbed that person of some very important final goodbyes if requests could have an immediate effect. To me, as a health care professional, this safeguard is quite vital

I have seen irrational thoughts when someone is in horrible pain, and those thoughts dissipate when pain is relieved.  Heck, when a friend was in labour she threatened to jump out the window to  stop the pain. Right to die legislations must never come before good palliative care.  Good palliative care assists a person in their dying process with the aim of pain and symptom management  with clarity of mind. Sometimes a hard balance, but most times it can be done.

The fifteen day window may cause concern for some. I think it provides a good safeguard, but will eliminate some from being eligible. Sometimes it is the last week or two of life that are more painful and troubling.  I think it is a good start. Good research following this becoming law would be important- so we can know if indeed this is a good clause.

Right to die legislation is not new. Switzerland, the Netherlands, Belgium and Luxembourg in Europe,  and several states in the USA have these legislations.  Some date as far back as 1949. Most US states with legislation says there has not been abuse of this law. In most of those countries/states, the number of patients enacting this right is rising steadily. Some statistics say that many more ask than actually  enact the decision in their lives.

I was asked as a member of the Saskatchewan Registered Nurses Association to fill in a survey re our concerns as nurses. I had to say that good policy development and education for all that may have to know and enact this law and wonder how to deal with it. I also have a great fear of our equality mentality that will bring someone who feels that they cannot ( due to moral or religious grounds ) assist a person to commit suicide.  As we read the International Nurses Pledge at our reunion banquet recently, I thought of what we were pledging and how that fit. Can I pledge to “refrain from any action which might endanger life or health” and still follow this law ? Physicians would have a similar dilemma, having sworn their own oath.   I hope that the law makers and the law enforcers will remember that some of us came from the era where our oaths and pledges meant so much to us.

I do fear that we are going down a slippery slope but one that we have been sliding on for some time. Change is hard and I am really not sure where I sit with this new law. There are a lot of worries of what will come next, and sometimes I don’t think we need to “go there.” The law will soon be in effect, so lets try to live within it.

For now, I will watch and wait and hope that for those that are dying, we look to pain and  symptom management while supporting families in good hospice settings or hospice like settings, helping people to understand the process, and helping them to accept  the dying – and to say goodbye. I will hope that pain medications will never be spared, and doses titrated up to ones that may seem astronomical but are needed. I will hope that anxiety will be relieved, and restlessness settled. I will hope that nurses will educate themselves on palliative medications as some drugs used in palliative care are frowned upon. I will also hope that they will have a good nurse to hold their hand – who because she/he believes in and loves palliative care,  stops in her/his busy day to remember the reason she/he is there.

And if someone asks for the tools to quicken that process, that the policies and education and safeguards are known, that the decision is discussed, counselled and supported so that this death can have the same caring at the end as those that die in a more ” natural way.”

I will also try to remember that as they say ” there are no atheists in foxholes” and we cannot know until confronted with our own inevitable death  what we might want or do. Knowing this, and knowing that I agree with withdrawal of life support when that becomes burdensome or a body is brain dead or end of life, puts me in that ” two sides of the fence” type of thinking on this law.

I look forward to your thoughts !

 

Posted in healthy living, Living life, musing, registered nurse retired | Tagged , , , | 5 Comments

What the LEAN is going on ?

It’s an Election!  I like a good debate, but I am not a fan of a negative campaign. Not long out of the election gate, “Lean” was on the chopping block for one political party, and perhaps to be scaled down some by the ruling party.

Though never a “Lean Leader” I have seen enough to have an educated opinion of the Lean journey. Our Health Region was first out of the block to explore this way of looking at systems, processes and change and some very good changes have come out of that system. After a few years of this region doing some Lean initiatives, the Saskatchewan government rolled it out big time, with timelines set ( ? realistic ?)  and other Health Regions began their own programs.  There are some parts of it that are great, some good and there could be some that don’t “add value” to our health care system.

In my career, health care has gone from Quality Assurance  (essentially tracking safety performance but never really thinking out of the box) to Quality Improvement ( random ideas on how to improve but often without staff input and accountability) to the latest adoption of Lean Methodology and Kaizen Promotion Teams. To me this is the most effective of all the programs I have participated in. There is always something to improve in a system that is so diverse and full of potential risk.

So what is all the criticism and is it true ? Were the staff paid  to speak Japanese and fly airplanes ? Did millions of dollars go down the drain without any effect on quality ?

TRUE:  All staff were obligated to attend a ½ day session to learn the jargon that goes with Lean and to understand some of the processes and innovations that were to come.  In most workshops one attends there is usually some kind of a game to illustrate the learning, and the paper airplanes did help us to see how teamwork and buy in could make a difference.  Did all buy in ? Of course not, but it was a good way for us to understand some of the basics of the program.

TRUE: Fancy Japanese names and processes? Let me explain simply …

3S – This is basically “everything in its place and a place for everything”.  Nurses love to hoard. We hide linen away and supplies away “just in case”.  It is like we all grew up in the Great Depression. Hence, cupboards get full, people decide on a new place to house important equipment – and the chase goes on. “Where are we keeping the dressing supplies now?” or “where did the lift slings go to?” are common time wasters in a health care staff’s day. Everyone has a better idea on storage, and if they find spare time, get to sorting and cleaning and moving thing around. Imagine if equipment and supplies  had a home, and it was clear where they  went and everyone agreed that it was a good place. What if we checked periodically that something didn’t go rogue?  A good thing and it seems like common sense but in all the places I have worked as a nurse in 45 yrs standard storing of supplies has been a concern. Oh how many steps I have travelled to find an item gone rogue.

Kanban: This is simply described as a push system instead of a pull.  Staff in health care spend several hours every week ( and sometimes more often ) to count inventory and send a requisition to “Stores”to refill their supplies. Imagine ( and actually see !! ) a system where instead of ordering and counting, there is a line in the sand where the supplies are too low, and the supply department fills it from just looking at what is at the low. ( Of course buildings not within the hospital still have to order, but the line is clear where new supply is needed)  Our new hospital has an amazing storage system where supplies are kept in the room and accessible from both sides. Filled from the outside, used from both sides.  That was created through Lean processes.

3P – The process where people ( executive leaders, doctors, nurses, housekeeping staff, dietary staff and even patient representatives get together and look at potential flow, potential room size, and generally every area of the hospital. For example,  the pediatric ward, a mother of a child who had been in hospital was on the team.  Was the process perfect ? no far from it . But with this process, people began to compromise, brainstorm and work together to solve problems that exist and might exist. As with every project, this can have some fails. Ours was the 2nd 3P project in the province ( the other one being the Children’s Hospital ) so we are in a brave new world.

Several Lean processes are put into place to evaluate a “Kaizen Event” ( or improvement process )  Lean looks at a process from beginning to end and all the tasks and people involved in it.   Work is measured. If one knows the average time it takes to do a task, we can figure out what things prevent that timing from happening, and we can standardize the work.  ( something like the timing estimates on your favourite recipes.)  Then we can “load level” to patient demand – meaning if I am overly busy, there will be a system to flag that I need help. Think of a line up at grocery store.. when it gets to 5-6 at a till, someone calls for a till to be opened, and things move quicker). Health care can do the same kind of things and will continue to improve processes until they feel they are doing just that.

Kaizan projects look at problems and work to find solutions. Solutions come from staff that have never worked your department in consultation with staff that do. These take up a lot of time, so choosing a project is vital to having a successful Kaizan project.   It isn’t a manager telling staff  a process has to change, it is staff brainstorming with the leaders and coming up with the best way – which then becomes standard work. The other blessing is sometimes we wait till the perfect time to change something – and that never comes. With these projects the question is “how can we make that happen today?” And the change begins.

Procedures become Standard Work – more than just a name change. Everyone knowing what has to be done, in what order and no “individualizing of procedures”. Nursing in the past has often been a “but I do it this way” kind of system.  Not with lean.

Mistake proofing looks at high risk procedures and making sure mistakes don’t happen.

So if  done right Lean makes sense, and saves waste ( of time, materials and workload). But sometimes, when we think of different ways to do things, the solution isn’t right.. and  that is where the team goes back to the “table” and looks at other solutions. Sometimes no improvement is seen. And sometimes the changes are not an improvement.. but overall the process works.

Consultation with Lean consultants has made the Lean process in our region a well oiled machine. What are the results?   Shortened surgical  wait times, better pre op assessment,  increased services in mental health, shortened wait for assessment for long term care and home care, better scheduling, processes to ensure the right patient gets the right procedure, foolproof  identification  of patients ( are you tired of giving out your birthdate yet ?) are just a few.  And if you look beyond the hype and criticism you will see that we now have a hospital to be very proud of.

Shortened wait times you say ? What about our Emergency department – well sitting in a crowded waiting room or a room in the emergency for 4-6 hours is certainly distressful, and I have been there – but both times we had to go to Emergency  since the new hospital opened,   we got immediate and competent attention.

Long wait times are a problem all across the country. One of my most difficult decisions is deciding when Emergency is the right place to go to. I agonized over this as I am sure many reading this do as well.

Emergency departments are often used because of poor access to walk in clinics and for those who work and can’t take time off during the day to look into minor health concerns. Many times the waiting room becomes a social time for family and friends to visit while waiting, in areas not designed for this.  In a perfect world, waits would not happen, people would have better access to non urgent care and time off work to access it and everyone visiting the Emergency department would be seen in ½ an hour. In Canada, Saskatchewan,  and in Moose Jaw  we just are not there yet.

My experiences in hospitals both working, being a patient, and being a family member have not always been positive, and I believe  that using  Lean we are  looking at solutions for concerns. Recently when I expressed a concern, I saw those Lean processes go into play and a willingness on the part of the manager to try a different way of doing business.

Our health system is far from perfect but staff and management are working together to solve the problems. I think to throw out Lean is to throw out the baby with the bath water.

I believe  that the 3P process gave us a wonderful building we can be all proud of, and I believe that when staff and managers get more used to their totally new environment and processes, there will be great things to come.  When a concern is taken to the Quality Care Coordinator, people  are ready and willing  to find a solution. I know.. I have been on both sides of having a problem taken to them.

Have I made this more clear ?  I hope so !

 

Posted in lean health care, Lean Methodology, musing, registered nurse retired | Leave a comment

Because I knew you – I’ve been changed for good

caractyreA Calgary golf course social room, a beautiful view of the foothills, a sea of Tommy Bahama shirts and sundresses,  laughs and tears and memories.  Sounds like a description of a party, and it was a party that  Cliff would have approved of – right down to the smoked salmon sandwiches. This was not a party that any of us wished to be privileged to attend – this was a Celebration of Life of my brother in law who died of Colon cancer just after his 66th birthday.  This sad event was so well orchestrated by my sister, and her children, who knew that a way to honour this “larger than life” man would be to do it well, using the best,  and asking people to do  “All Things Cliff.”

My sister and brother in law were married 45 years, having met as teenagers at their summer jobs at Colombia Ice Fields (waitress and bombardier driver) – he from Halifax and she from Calgary (Moose Jaw originally). My dad loved him immediately and spent many hours talking investments and businesses with him.  Through life’s challenges, I always admired Lorna and Cliff  for living life with gusto, gathering and keeping  thousands of friends from every place they worked, lived or holidayed.

Travel was vital to Cliff’s lifestyle, there were a lot of his favourite places to visit – most hot and near an ocean.  Sometimes Lorna would say ” I just want to stay home for a bit ” but soon they were planning their next place to go – Hawaii, Spain, Rome, England, San Jose del Cabo, Caribbean, Turkey to name only a few. Gord and I were so  lucky to enjoy the fun of Cabo for a week with Cliff and Lorna and I had a couple of weeks at his Phoenix home. Never ate so well ! (should we mention the Margarita’s from Mexico limes as well ?)  He booked a last trip to Phoenix and Hawaii for January, that they, unfortunately, were not able to take.  My daughter and son in law took a small palm tree and some Hawaii treats to him in the hospital, and that just had to do. That was a dream that was hard for him to let go of for he was determined to have these last trips for three years – and he wasn’t ready to stop avoiding the snow.

He was  always ready for a new adventure, a new  investment, new oil seeking and he was constantly learning.  He took on Spanish lessons while in Cabo, and became a great friend of his teacher. Those lessons continued via Skype twice a week for several years and only ended a couple of weeks before his passing. His Spanish speaking hospice nurse was quite amazed at the articulate Spanish he spoke.

A story about Cliff would not be complete without some funny stories and his memorial party was full of them.  He loved being a red head, and had a bit of a temper that went with that mop of red. I remember the time he got angry at some driver and ended up with his car up on a median because he cut the turn too fast. That was an expensive rim and tire replacement.  Or colourful language when he tried to fix things around the house – for all his wonderful skills this was not one of them.  My most unforgettable temper story was at a family dinner when I accidentally knocked over one of his  expensive wine glasses and it broke. Although we can laugh about it now, I still choose the shortest wine glass  and always placed it WAY out of reach. At his house there were never “cheap wine glasses” like at my house.. for his shopping trips usually just took him to look for ” the best.”

Cliff was known for his moustache – big bold and red.  He cut his moustache off a couple of years ago, after a new barber trimmed it down to what Lorna describes as a “Hitler moustache” so it had to come off.. and he decided it could stay off. It took a long time to get used to that !! His red hair  never turned grey… just this beautiful shade of blond – but he never stopped reminding us (and our daughter) that red heads were still the best.

Lorna always answered the phone at their homes and to be honest, I am not sure Cliff really knew how to say much more than “Hello Terry- Lorna’s not home” on the phone. Talking in person was far more rewarding, as he always offered conversation  with a twinkle in his eye.. with a trace of Nova Scotia and that characteristic Jeffrey family pause. In early January, I was pleasantly surprised to find that despite a load of narcotics, he could still talk politics, food and finances.

Cliff’s style was distinctive.  He wore whatever he wanted and owned a closet full of bright, flowery Tommy Bahama wear.  He would travel in his Tommy bathing suit even when leaving Calgary at 40 below. There are stories about some of his very colourful shirts, including one ( pink, orange, green in splendid stripes) that gained quite the reputation.

He loved all genres of music, read all varieties of books, and was probably the best cook you could encounter. His secret – a pound of butter and a quart of cream – and maybe a few jalapeño peppers. He researched restaurants as soon as someone said ” lets eat out’ , and knew where to eat on each holiday. He was rarely wrong. When Lorna and I went to Florida together, we decided to just choose restaurants randomly and see if we could find good restaurants without a day of research (boycotting one of the “all things Cliff).  We didn’t dare tell Cliff of this unscientific process – but we found good food!

His collection of cookbooks was impressive, but you knew that even a famous chef’s recipe probably had a “Cliff variation”. He was always ready to teach. He wasn’t afraid to tell me (the time my oven failed and my thanksgiving turkey was sitting raw at 1 pm) , that my turkey would cook – after all “you always cook them too long anyways” and I could always count on advice (yes even on the phone) on any recipe (or actually on any financial matter as well.)

I learned from Cliff to know immediately when the french fries in a restaurant are frozen rather than fresh cut  but I do not necessarily ask the “question” when I order fries . Maybe I will take that lesson from him now from now on. Boycotting frozen french fries is certainly a cause that Cliff would want us to continue.

He was more than just an uncle to my three children, he was special. He  agreed to have two of them live with them when they needed a place to stay and hosted the other even when he even brought a flock of friends with him for a weekend.  He always engaged them in his passions and knew how to draw them out. Politics could get my oldest son and him on a long discussion.

Cliff’s diagnosis of incurable cancer came three years ago and it shocked us all.  How could cancer hit this always healthy, exercise addicted, fit man? This was just  at the beginning  of their retirement years, in the midst of their travelling days, and while they were getting used to being grandparents and enjoying seeing their two children successful and happy.

Cliff accepted  his diagnosis and pushed through fear and lived life to the fullest this last three years. Between biweekly chemo treatments he would travel back and forth to Phoenix, their cabin in Invermere, their son’s Ironman competitions, Cabo and even Hawaii. It was a whirlwind of travel, doctors appointments and treatments and we almost imagined that he could actually beat this disease.  In June, was the big and final blow, when they were told that the chemo was no longer was working. A last ditch experiment was tried, but that too, failed to stop those wicked cells from gathering and multiplying.  His time with oncology was done, palliative care would begin.

So he planned more trips – a family trip to Disneyland, and Halifax and back to Phoenix twice. During this time, he saw his son meet a wonderful girl and choose a small family wedding to ensure his dad could attend. His last trip to Phoenix, he even golfed more holes than most healthy men golf, then was able to fly home to Calgary alone in late November, staying a bit longer than his wife. Days later, by the first week in December though, his health went downhill, with two months of pain, an increasingly weakened body, and finally one week in Palliative Care, and one week in Hospice. Despite that, he was able to manage the wedding day, and enjoy his grandchildren’s antics at Christmas.

His last two weeks were spent with more challenges with pain control but true to his nature, he, with tears, confirmed his love for the people who surrounded him. This man who spent his life as a successful geologist and larger than life personality, ended it with tenderness, and love and a legacy to remember.

There were some very wonderful nature displays on Monday that assure us that Cliff will be “all right” in the life after this. I believe that  right now is in Heaven where there is no pain, no sorrow and where cream and butter doesn’t contain calories. Monday  just as the singer was singing the beautiful Rankin Family song, “Fare Thee Well” a large flock of geese gracefully flew by the huge picture windows – and then circled to come back as the song ended. Later, a sunset the colour of his flaming red hair could be seen in the sky as we ended our family time together.  Great visuals, that I believe were sent by a loving God to reassure mourners that Cliff was at peace.

These are only a few of the thoughts I have of this man, there are so many more, and our photo albums journal each wild moustache, each hair style change, and many wild outfits, but mostly precious times with his wife, son and daughter, grandchildren and with all of us who shared a piece of his life.

I will close with words from Glinda from Wicked.

“It well may be

That we will never meet again

In this lifetime.

So, let me say before we part:

So much of me

Is made of what I learned from you.

You’ll be with me

Like a handprint on my heart.

And now whatever way our stories end

I know you have rewritten mine

By being my friend.

Because I knew you…

I have been changed for good.

” For Good” Idina Menzel

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