Please Join Me (A Letter To My Readers Regarding the Impending Government Shutdown)

Dear Readers of Kathy’s Musings:

Good Morning. I wanted to write a little humor piece next, but am waking up disgusted and nervous about the impending government shutdown.

I just wrote a letter to my Representative; I have supported my Representative with my votes for a long time. I wrote that instead of focusing on my disgust, if there is something I can do to help avoid this shutdown, and keep people working so they can pay their rents and mortgages and buy groceries, and not make the kids touring our nation’s capital burst into tears because they can’t see the moon rocks at the National Air and Space Museum after selling who knows how many candy bars to get there, and continue to let prospective home owners acquire loans, and keep this nation from becoming a laughing stock in the eyes of the world, and prevent a downhill slide in the local, national, and global economies, then I will do it.

I have joined others in signing online petitions to register my deep concerns. I wrote a letter to the Editor of my local newspaper, although it wasn’t published. And now I sent a letter to my Representative, and even suggested we make public the names of the job positions that may be furloughed come Tuesday. Please join me in contacting your Representatives as well. Shutting down the government of the United States of America impacts all of us.

Thank you.

Kathy Galgano

September 29, 2013 

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My Daughter’s College Town (Part 2 in the Series on Traveling to See Loved Ones)

The “Duck Tour” ended. We felt cool and relaxed in the middle of the Potomac with a gentle breeze blowing across our faces. But as the amphibious truck motored to the shore, drove up the landing and back to the official assembly area, the triple digit heat and near triple digit humidity smacked us hard. I searched for an air conditioned place within a short walk before we collapsed.

We were touring the city my daughter had chosen for her college experience. The museums beckoned, and while we each had expressed interest in several exhibits, they did not fall within the now self-imposed five minute maximum walk. There was this one option in view that we had not considered and we headed there. Walking in that miserable heat, I couldn’t help but ponder that with only one day to tour our nation’s capital, we were choosing our experience based on convenience. It reminded me of a humorous sign that once beckoned customers in front of a local restaurant: “Let’s eat here before we both starve.”  

When I was a kid I tried my hand at stamp-collecting. I had watched my older brother soak stamps in a tub of water in the kitchen sink to pull the thumb-sized rectangles and squares off envelopes. When dried, my brother flipped through the pages of a large important book with imprinted images of hundreds of stamps in it. I remember he used these little folded clear sticky tabs to affix the stamp to just the right spot on just the right page. The stamps would not be glued against the page because of the folded tab; instead, they would be mounted a tiny bit off the page. As an adult, I knew that people also collected sheets of stamps as a hobby, but my knowledge of philately was weak.

The National Postal Museum was a good choice. It was close by and air conditioned. What we hadn’t expected was the level of enjoyment; these displays and activities held our attention for hours. One particular exhibit surprised us because we would have expected it in a different museum; it was beautifully and sensitively designed for an audience of children. To explain the Holocaust, the postal museum offered a series of letters written by a family attempting to flee to the United States. It wasn’t just the youngest visitors who were captivated by the story in these letters. And another poignant exhibit showcased the postal service amidst the September 11 tragedy. There were postal artifacts from the World Trade Center found in the wreckage, and mail retrieved from the crash of United Airlines flight 93 in Pennsylvania. Then there was the history of the letter carrying trade, and the dangers to the early riders on horseback who delivered the mail. Of course, there were stamps. These included many themed exhibits, and this one table in the open that was covered with them. As we watched people sort through hundreds of U.S. and international canceled stamps, the docents invited us to participate. We were given cards and each encouraged to make a personal collection. People floated their picks in the nearest bowl of water to soften the adhesive and peel the stamps from envelopes. I felt like a kid back in the kitchen with my big brother, culling vivid flowers and famous faces and works of art.

Having stayed in hotels near my daughter’s university, I felt confident moving around by foot and using the transit system. When I inquired which supermarket was closest to my hotel so I could plan my route, one local’s response was, “Social Safeway.” Social Safeway? My daughter may have been the one in college, but I was in for quite an education. The woman I spoke with took a minute to explain Washington’s supermarket nomenclature, and later that afternoon, my daughter and her friends confirmed it. Social Safeway is “where all the singles in Georgetown go to look cute, and buy booze for their parties and pick people up.” Now I don’t know if the “pick people up” part is accurate, but there were plenty of surprisingly well-dressed college and graduate students and young professionals buying groceries and beer in line while I stocked up on Diet Coke, shampoo, granola bars, boxes of tea and other staples on my college kid’s list. But that’s not all. Near my daughter’s university in D.C.’s Tenleytown neighborhood is the store referred to as Secret Safeway, so named because it’s not visible from the main road. Then there’s the Not-So-Safeway in a tougher and undisclosed neighborhood, and my apologetically favorite — Soviet Safeway near Dupont Circle. Why Soviet Safeway? Usually the shelves are empty and the lines are long. 

It seems that many of my visits to D.C. include beating the scorching heat on summer days. On one such toasty morning we headed to the Metro station, rode down the deep escalator well and boarded a train for Old Town Alexandria. A long-time friend of mine had enjoyed living there years before and suggested we check out her old stomping ground. The kids and I strolled down the street and chose a quaint eatery for lunch. The historical restaurant’s walls were brick-lined and beautiful. Afterwards, we ambled in the shops, and then toured one of the many private historic homes turned museum. We were in a history buff’s paradise. To cap off our outing we popped into a cupcake shop and feasted. Instead of taking the Metro back, we bought tickets for the water taxi. It’s brilliant. For twenty minutes we rode on the Potomac to Georgetown, this time without the duck calls. Some people nodded off while others took in the passing sights from the seats and railing, everyone looking quite comfortable with the light breeze blowing across the water. My daughter and I moved around the vessel, photographing the bridges and buildings and other boats, and pointing things out to my son as he relaxed, all the while listening to the narrated tour. It was a memorable day.

I enjoy attending live sporting events. I have seen the Capitals play ice hockey in the Verizon Center, and the Washington Nationals play baseball at Washington Park. One huge thrill was when my daughter, a member of her college women’s ice hockey team, played an annual game against a rival collegiate team in the Verizon Center, and I was in town. I was staying with her and her two college apartment mates. As she prepared her gear for the big game, my daughter explained that a teammate would be picking her and several other teammates up in one of the dedicated vans the sports teams use at school. She reluctantly warned me that there may not be room for me in the van, and if need be, could I get to the Center by myself? “No worries,” I told her. I could either hail a taxi, or walk down the street and hop on the Metro that would take me right to the Verizon Center. Easy. Besides, it was still a few hours before the game so I had loads of time.

The van arrived and I was informed there was room for an extra person. On the drive downtown, one of the girls casually said that she had a bit of a headache and wished she had taken a Tylenol before leaving her apartment. I opened my purse, grabbed the little bottle and handed it over. She took two tabs with a gulp from her water bottle. A minute later another player said she wished she had had time to eat as she was getting hungry. I opened my purse, found the granola bars and handed them over. The girls were chuckling, thinking that having a mom in the van wasn’t such a bad thing. A few minutes later a third player said she craved an orange. Yes, I even had citrus in my purse. I took out the sandwich bag holding two tangerines and handed it over. Now I was chuckling; we moms live for this kind of thing.

We parked in the vacant underground garage and even met the opposing team there; everyone smiled and greeted each other. It was a nice start. Team members had explained to me that security would be tight and authorities may not let me in with the team. I could wait at the outside entrance for other family members and fans, and we would be allowed into the arena at a given time. “Okay,” I said. I made a snap decision. “Girls, give me your sticks.” So I carried a large bundle of tall hockey sticks (players carry more than one stick) through the garage to the outside door where the team would enter. Allow me to interject here that while hockey players carry a lot of gear in that big bag of theirs, unless they are little kids with parents helping to lug the equipment, players each carry their bag with one hand and grab their sticks with the other hand.

An NHL practice for that evening’s game was running a bit late. Nobody seemed to mind waiting outside; it was a beautiful cool autumn afternoon with a bright warming sun. Finally, the door opened and the team streamed into the building. We waited in a small area while the girls were asked to unzip their hockey bags. Uniformed security guards peered inside them. Then, they led the girls to their locker room, and I just grabbed all the sticks and followed. Nobody said anything to me and nobody tried to stop me. Success! With multiple locker rooms in this large professional facility, the college teams weren’t assigned the space designed for the Capitals or their NHL rivals, but still, I was there with my daughter and her teammates at the Verizon Center. I can’t tell you how excited I was! We entered the locker room, I handed the sticks back to their owners, wished my daughter and the team luck, and was personally escorted through the building to the section where the teams’ fans were taking their seats, getting a little tour along the way.

The two college women’s hockey teams were announced, player by player, by the booming voice of the announcer. The large score board lit up. I sat in the lowest section, the one next to the Plexiglas where you can see the players’ faces and hear what they are saying, and I cheered for my daughter and her friends. Some parents wore college team jerseys with their daughter’s name printed on the back of them. Throughout the game, I texted updates to my husband and son at home. There was a row of guys in this section from my daughter’s school who stood and yelled enthusiastically, waving signs and providing much amusement to both teams and all the fans.

Frankly, I don’t remember the score or who won. I do remember the thrill. My daughter took up the sport in college, so I hadn’t spent time driving her to the rink and carrying her gear and lacing her skates and trying to stay warm with a thermos of coffee when she was little. Here I was, 3,000 miles away from home, living a dream I never knew I would have. My daughter played college hockey on NHL ice in our nation’s capital. You can’t beat that! See what happens when you travel to visit friends and family?

Kathy Galgano

September 28, 2013

When Your Best Friend Moves, TRAVEL!

When a family member or friend moves away, saying goodbye can be heartbreaking. However, there is one positive piece to take away from the teary experience; a new vacation prospect emerges. Suffice it to say, I have taken full advantage of these opportunities over the years to reunite with loved ones, and to tour, tour, tour. I hope you enjoy reading the vignettes that follow, each one capturing a different aspect of travel and sight-seeing.

We were in the Green Mountain State for a wedding, and which chocoholic can waive an invitation for the Ben & Jerry’s ice cream factory tour? There were two highlights on that hot summer’s day: Savoring my luscious ice cream flavor that was only available there at the factory, and delighting when another chocoholic, someone considerably younger, valiantly struggled in the “battle of the drips.” In this case, the chocolate cone was winning but the little girl was all smiles as she worked on it. Grabbing my camera, I asked the mother for permission to photograph this happy child. She consented. As I pressed the camera to my eye, the mom pulled a tissue from her purse and wiped her child’s face clean. I don’t know who was more crestfallen, the little girl or I. I didn’t want to show disappointment, so I smiled, took the photo, thanked them both, and walked back in line as the tour began.

With family in Southern California, the La Brea Tar Pits and Page Museum quickly earned a spot on the “Must See” list. I’ve toured this gallery of Ice Age fossils several times, and the grounds and museum always strike me as other worldly. If you’re not impressed by the million-plus fossils like the mammoth and saber-toothed cat in their collection, then I suggest you take a walk around the perimeter of the building. To this day, “tar” or asphalt bubbles and oozes to the surface of what is now Wilshire Boulevard in the heart of downtown Los Angeles. It’s a working excavation site. These animals lived in Los Angeles!

There have been trips to Europe when friends and family lived there. I could list marvel after marvel, the castles and cathedrals and ancient ruins and museums, but what leaps to the forefront of my memory are specific vistas and tastes. On a crisp but sunny January day in the mountainous area of my Italian forebears, the sight of an old man as he collected firewood from the steep grassy and tree-lined incline comes to my mind’s eye. This man gathered sticks and small branches and arranged them on a pack that dropped to the sides of his donkey. Sheep and goats kept the grassy hill sheared. Most hikers would have found this trek rigorous. There were no power lines, no buildings, no billboards, nothing but this man and his work beast, the hills and trees and grass and brilliant sky and an occasional hand-fashioned hay bale.

Also on that same trip to visit Italian family, my cousins roasted a steak on the open hearth in their kitchen. The Italian tile floor near the hearth had been charred from years of extending the coals closer to the table. This was my first time tasting goat, and it was an animal my family had raised. It took very little pressure on my knife to cut through the perfectly cooked piece of steak that had been placed on my plate with a flourish. It was warm, juicy, melted in my mouth, and was the most delicious and memorable morsel I had ever tasted. What made it even more memorable was that when my father translated the conversation building up to this moment, relaying to me that this was “goat” steak, I thought he meant it was lamb or mutton. The only way I could resolve the mix-up I caused was to mimic the calls of sheep, only to be told “No” by my cousins’ shaking heads. This was not the product of a “Baaaa Baaaa.” So I tried my best goat call. “Mehhh-eh-eh-eh-eh.”  Laughing, everyone nodded their heads in agreement, repeating “Si! Capra”! “Yes! Goat”!

When my daughter completed her semester abroad, I headed south of the equator, to Santiago, Chile to see her and meet her host family. There were two things on my agenda, one playful and one serious. First, I had to check if the water drained clockwise in the southern hemisphere, so I opened the tap in the hotel bathroom, put a little water in the basin and drained it. Of course then I couldn’t remember which direction it was supposed to drain and so came to no conclusions. Good thing, because I have learned since that while the Coriolis force is real, it does not impact the direction of water draining in sinks. So with that fun non-experiment out of the way, I turned my eyes to the heavens. Literally.  On a tour originating in the Elqui Valley, we drove to an observatory in the mountains. Most Chilean observatories are research facilities and closed to the public, so this was a gift. Being that Santiago is such a large city, the lights make for a lovely vista from the nearby mountain communities. However, it also means it is difficult to go star-gazing from the city proper. But there on this cold cloudless night at the observatory, my dream came true. I couldn’t stop staring at the Magellanic Clouds, the irregular galaxies that really do look like clouds in the sky. These dwarf spiral galaxies just aren’t visible to us in the northern hemisphere. They are neighbors to our Milky Way, and since reading about them years ago, I have yearned to see them. A docent took us on a “star tour” using a laser pointer, and described the constellations of the Southern hemisphere. Then we looked through the telescope at different heavenly bodies. It was thrilling. But tilting my head back and just staring at constellations and the Clouds I had not seen before was the best part.

My cousins in Florida took me to their nearby state park in Homosassa and I grew more excited by the minute. Once there, you couldn’t budge me from my perch. Here were the manatees, those giant gray and brown water mammals that dwell in the Floridian rivers, estuaries and coasts. Some may find it difficult to call them “beautiful,” but I had no trouble doing so.  I knew that manatees are cousins to the elephant, but still was surprised to see that same wrinkly skin. These creatures fascinated me. They have an interesting tail that is shaped like a paddle. One docent I spoke to told me that people call them “sea cows.” These slow swimmers are endangered, and this park is a rehabilitation and refuge center for injured manatees; boat propellers are the main reason for their endangerment. Unlike seeing animals in facsimile habitats in zoos and parks thousands of miles away from their home, we were in the midst of their natural habitat.

En route to family and friends in New Mexico, an unplanned roadside stop led to a discovery so profound that I have cherished that moment ever since. Needing to stretch my legs, I noticed a small sign on the highway and turned down the unpaved drive, parked the car, and walked several yards on a trail. I didn’t expect the enormity of what lay before me. Boulders and cliffs surrounding a field provided a treasure trove of rock carvings created by ancient people. There were a few other interested folks there, walking, studying the carvings, stretching their legs, photographing and reflecting in this large, quiet area. I was impelled to see more. In a recent visit to the state, I toured the Petroglyph National Monument in Albuquerque. As it was summer, monsoon rains and a lightning storm had turned back all visitors the previous day. The weather cleared overnight and we tried again. This time the parking lot was full and crowds of history buffs, tourists, hikers, and people looking for something to do on a nice Sunday afternoon took to the trails. The National Park Service provided maps to the petroglyphs that also explained the many carved symbols.  With other people walking up the trail behind me, I tried not to linger too long at any one petroglyph while studying and photographing it. Once we arrived at the top of this large hill, the views of Albuquerque in warm sunlight were remarkable. So many people were clicking their camera shutters to capture the city from this vantage point. A few times, however, I found myself reminiscing about that roadside “find” years back, when hundreds of petroglyphs came into view, and I wandered through the field in solitude.

Next week, I will explore the memories of one city, one place, where I never expected to visit more than a few times. However, once again, a family member moved there.  While it offers a wealth of things to do, it will be the link to loved ones and history and culture and isolated everyday moments that I will describe. I am looking forward to continuing my journey and hope you accompany me by reading along. See you next week.

Kathy Galgano

 

I Used To Clean Penguin Poo

I used to clean penguin poo. Willingly. I performed heavy physical labor, moving and hosing and scrubbing large mats and rocks, carrying buckets of fish, swabbing floors, siphoning debris out of the water, and washing Plexiglas. I shoveled and carried buckets of sand and power-washed more mats.

I always looked my very best when working at the aquarium. I knew I was representing the organization and I frequently was in the public’s eye, so I never left the house without lipstick. I wore my special short-sleeved aquarium shirt with “Volunteer” woven on it; I coveted those bleach-stained shirts. These weren’t my only “aquarium wear”; I also wore either my special zippered fleece sweatshirt or my black zippered jacket, both sporting the spiffy aquarium logo. One day each week I arrived early in the morning for my shift wearing my uniform: the “aquarium wear,” dark pants or jeans, closed-toe sturdy shoes, and my smile.

There is something very special about entering the aquarium through the employee gate and walking through the not-yet-open-to-the-public building and exhibits. I cherish these memories. Strolling past tanks and exhibits, I quietly wished fish and birds, “Good Morning.” The rays in the touch pool were ready for breakfast. During the numerous times I have toured this aquarium as a visitor, only once or twice have I ever managed to touch a ray. These critters either stayed away completely from the beckoning hands and their splashing, wriggling fingers, or cleverly swam just near enough to entice the excited crowd, but disappoint those who splashed so eagerly. But first thing in the morning, the rays are sweet and respond when I tickle the water with a few fingers. I don’t have breakfast for them, but I know their meal is coming very soon, so I don’t feel too guilty about asking them to visit for a few moments. As they swim under my outstretched fingers, I can feel their smooth, and a bit spongy, shapes go by. What a way to start a day!

My jobs changed from week to week. When it was my day to clean the penguin enclosure, I would cover my jeans with a pair of overhauls and step into high-calf rain boots. Sometimes the boots would fit pretty well, but other times the medium sizes were taken, so I grabbed the mens’ sized-large boots. No matter. There was work to do. I picked up my scrub brushes and hose, put on my goggles, stepped into a foot bath and entered. One week, a penguin decided to make the entry way his domain, so he pecked at each member of the morning team. How is it that this penguin knew just where the boot line ended? Even with jeans and overalls for protection, being nipped behind the knee sure smarts!

Penguins are beautiful, and they are the bosses in their domain. I could be crouching down, scrubbing rocks, and a penguin just might peck me in the you-know-where. Yes. I’ve been bitten in the backside. Once when I needed to scrub with a larger brush, I made the switch dropping the little brush I no longer wanted by my knee. The next thing I knew, one of these entertaining beauties had stolen it! Our team leader and staff professional quickly retrieved my brush, and I never put a brush or any piece of equipment down again. These birds are fast! And I learned fairly quickly to cover my ears when the penguins started communicating. What the public cannot hear behind the Plexiglas is how loud they are.

Sometimes my family would catch a glimpse of me next to “my penguins” by checking the aquarium’s web-camera. Every week I would come home with a new story. One day there were whales in the Bay. Another time I was asked to help re-band a few birds. Then, I had to conquer my fear of handling some live bait because I sometimes prepared other birds’ meals.

Even picking up squirmy bait with my thick gloves made me happy in that I knew I was there for the birds.  Whether washing the many containers needed to hold food, or just scrubbing, this was a job in a million, and I loved it and always found the humor in it. My dream job remained just that, no matter how sweaty I became, or how much I reeked of fish when I drove home, or how uncomfortable I felt when I tripped over a log while siphoning the pool. As I started to tip over, the cold water poured over the bib of my cumbersome waders designed to keep my dry. And my friends listened to every word I told them, just as long as I had showered and changed first.

So why am I not there? I sure do miss my little critters. Well, I learned during my tenure at the aquarium that it takes more than enthusiasm and a love of animals to work there. It also takes a very strong back to perform the duties well, and so I look forward to finding another job that lets me be near my buddies, but perhaps not tidy up after them.

Is Communication a Big Problem in Health Care?

When people in different parts of the country relate personal experiences to me, and a common theme emerges, my brain kicks into motion. Perhaps I’m on to something here. I try to identify the various threads in the common theme, wondering if there is a relationship between them. With so many people experiencing X and Y, what’s causing this to happen? And I ask myself, if, in all these varied episodes, the issues that leap out at me are actually about the same thing, are they rooted in the same cause, or similar causes? If I answer my own questions with an affirmative, my brain shifts into overdrive, creating different scenarios that could potentially explain these occurrences. I pull my explanations and scenarios from all sorts of referential material in my brain’s personal repository. And on a number of occasions, I’ve been happy with my explanations, only to read them in print in some point in the future, or hear others more “expert” relay them as truth. Of course for me, it’s anecdotal and non-scientific research, but patterns are significant and worthy of exploration. It’s my way of striving to understand a piece of what is going on around me.

Or perhaps I’m not on to anything at all. Perhaps my brain needs to focus on a new predicament because this one is merely a series of coincidences. That remains to be seen. Suffice it to say, I have been in brain-whirling mode recently.

My questioning pertains to hospitalizations, or procedures performed in hospitals. I’ve chosen a few episodes and I am confident they are accurately represented. These illustrate a common theme with various threads. Please note I am not going to talk about bad medicine, incompetent doctors, or medical malpractice. In fact, a common thread in each of these non-fictional scenarios is the consistency of sound medical practice. I will offer a story and identify the thread, because I think I am on to something here. At the very least, we can appreciate the complexities of patient care, and ask ourselves a final question: How can the underlying situation be changed to make it better? Please let me know what you think; I welcome your comments and ideas.

I once visited a pediatric patient in the hospital. I sat in the large waiting area while a doctor was with the patient. I was thumbing through a nature magazine when a young mom came into the large room, pulling her little toddler-aged girl in a red wagon. The kids preferred the wagons over wheelchairs I was told; they can cuddle up in nice blanket and have room for their favorite stuffed animals. The little girl’s IV pole was attached to the wagon. This wagon looked like a clever way to offer a diversion to a sick kid.

This little girl was out of sorts, though. She was whining and crying and hanging onto her mother. The young mother looked exhausted, and patiently, she tried everything she could think of to help settle her young one down. I struck up a conversation with the mom; the three of us were the only ones in the room. I started turning the pages of the magazine and showing the toddler pictures, and made up a few little stories about some of the flowers in an ad. I used my calmest “Mom” voice. There was a picture of a waterfall, and so I told her about Yosemite National Park and the waterfalls there.  After a minute or two, the little girl started to become less agitated. I offered her the magazine, which she took, and even smiled a bit. The mother looked at me and also smiled.

“Yesterday,” the mother told me, “my daughter was scheduled for heart surgery.” I invited her to sit down. She explained to me that the child had been born with a heart defect. So she and her daughter had traveled from out-of-state for this “last chance” operation. At home, cardiac specialists had performed other procedures on her daughter, and still the problem remained. According to the mother, this operation was the final thing that could be done to help. Without the operation, the child would die. The mother watched her child for a minute.

She continued on with the story. Early yesterday morning, the little girl was prepared for surgery. The morning appointment time came and went, and nobody from the operating room came to escort her daughter to surgery. Minutes passed. Then a half hour passed. Then an hour passed, and still no one came to accompany the girl. Hours passed and still there was no word from the surgical staff. The mother said she was frantic. She wondered if they had forgotten that her daughter was on the schedule. The unit nurses had no information. The floor nurse was finally able to speak to someone in the operating room. The mother was told that, after a final consultation with the pediatric cardiac team, it was determined that this surgery proved to be too risky, too dangerous, and it was not medically advisable to proceed. The surgical team then proceeded with the next patient on the list. But they never called to explain this to the mother.

The mother smiled as she watched her little girl making up stories about the pictures in the magazine. The child was in a better mood, relaxed. This was the way her daughter usually acted, she told me. The toddler was adorable, and wanted to move to the next window. They were both smiling now, and the mom pulled her in the wagon to their next stop to play.

The medicine was not the issue here. Teams of doctors at this university hospital did everything they could to help the child, including deciding not to operate. Communication was the issue. Was there no one on this team of medical specialists responsible for providing information to the family in a situation like this? In most hospitals, there is a system in place for providing information to families when the loved one is in surgery. This is true for patients already admitted to the hospital, and patients who arrive from home on the day of surgery. There are waiting rooms for family and friends. In some hospitals, information from the surgical team is called down to staff members in these waiting areas, and the staff updates status boards. The system is based on confidentiality; patients are represented by numbers. They can tell whether their family member is in surgery or post-operative care. Usually, there are phones in this room so surgeons or nurses can speak to family members before, during or after a procedure, if that is warranted. However, our young patient was never brought to surgery. The doctors moved on to the next patient. What happened?

Two summers ago I had surgery on my spine. “Serious” surgery, people called it. So afterwards, and for the next three days, I told my nurses that I was seeing double. I wasn’t seeing double every moment I lay on my hospital bed; the double vision was intermittent. It was a new experience for me, and sometimes the second version was a bit blurred around the edges, so I could tell which was the object and which was the facsimile. As a team of experts had just spent hours tugging at, operating on, checking and scanning my spinal column and surrounding area, and knowing that I had been given a fair amount of anesthesia, I figured this vision anomaly was significant. I mentioned it to the nurses when they came to check on me, or to give me my meds, or to answer my call button. And as no one seemed to pay much attention to it, I began to think that perhaps it wasn’t an unusual experience. One nurse did ask me a follow-up question about it after describing it again, after I don’t know how many times; she even seemed a bit surprised to hear it.

In mid-morning of day three, my surgeon purposefully strides into my room wearing scrubs, and holds up an index finger in front of my face. “How many fingers?” he asks. Not even a “Good Morning;” This was serious business. Finally! He performed an examination and ordered the appropriate tests. But why had it taken so long?

I don’t know if my double vision was documented before that particular nurse acknowledged my observation. If it had been charted earlier, then why hadn’t it been flagged? Perhaps I wasn’t heard each time I mentioned this occurrence; I was taking medications that could slur my speech. No one had asked me to repeat things, however, so I don’t believe this was the case. Or perhaps nurses didn’t consider it noteworthy, but I find that difficult to believe. It could be that one or more nurses had made a mental note to chart it, but had forgotten to do so. What I do know is that no person acknowledged my report of double vision until that one nurse offered a follow-up question. So communication is critical and again, there is a break-down in the response system, either for a lack of hearing/listening, charting, offering follow-up, or questioning.

During that same week-long hospital stay, there was one medication the doctor prescribed that I considered important, but not critical. It assisted with the healing, but it did not lessen pain or fight infection, for example.  After a couple days of experiencing discomfort, the staff narrowed down the culprit to this small colorful pill; one of its side effects is itchiness. The doctor ordered a new medication that performed the same function, and I had no further problems. One afternoon when a nurse handed me that little paper cup of meds, I immediately recognized that bright pill. I told the nurse that this drug made me itchy and my prescription had changed. She insisted that this was my medicine. I explained again. She was certain. I could see that she wasn’t going to walk down the hallway and back to the desk to check the chart after I suggested she do so; she was 100% sure this was the correct med. I gave it some more thought. I knew this dosage wasn’t going to harm me, and in fact, would help me, despite an unpleasant side effect. After several give and takes, I took the darned pill and figured I would just get a little itchy and get on with it. I said to myself, Choose your battles! Had it been a critical med, I would have held my ground. Plus, I needed my other meds; my medicine for pain was rapidly wearing off and other prescriptions were also time critical. Days later, when recuperating at home, I carefully documented these things on the patient comment card, plus other experiences, including some very positive ones I had encountered. Weeks later I received a personal, non-form letter from the hospital thanking me for my comments and learned that the hospital addressed some of my issues, specifically delineating the changes they were enacting. I do not know if the double vision or this particular medication incidents were discussed, but I was satisfied that the hospital took my remarks seriously.

In the communication theme, listening, acknowledging, questioning, and double checking are the threads. Why had the nurse not re-checked my chart at my request? Was she so far behind in her work schedule that she couldn’t afford the time to walk down the long hall and possibly get way-laid into doing something else that would put her further behind schedule? Had it been her experience that patients generally get confused about their medications? Or perhaps she and another nurse had already double-checked the meds against my chart, and my chart now documented this bright pill as my medication again?

Recently, a friend working in concert with her medical team, elected to participate in a clinical trial to treat an invasive condition at a university teaching and research hospital. She considered the treatment that would be administered without placebo, and after agreeing that this was indeed the right course of action for her, received a detailed daily schedule for administration of the particular drugs in the trial. It was a complicated schedule, which included the dispensing of a combination of drugs on different days. My friend had lined-up family and friends to accompany her to these treatments.

Three days before beginning the trial, she received a phone call stating that there had been a change to the treatment schedule. The time for the follow-up appointment with her doctor had changed and she would start treatment the same day. When asked for an explanation, the scheduler did not have an answer. She told my friend that the trial coordinator or the doctor’s nurse would call within an hour to discuss the change. Five hours later, my friend received a call from the trial coordinator. She was told that a medication that she had previously taken for an unrelated issue disqualified her from participating in the study. She was now on a new daily schedule for a different course of treatment. When the patient requested the trial coordinator to contact the doctor to call her, the coordinator was hesitant to oblige. My friend insisted she speak to her doctor before agreeing to the new treatment. Finally, a satisfying call from the doctor came. The doctor explained why the changes were made and why she no longer qualified for the clinical trial. Apparently, a previous medication would have an adverse effect with the new trial drug. The doctor also offered a sincere apology. Together, patient and doctors discussed the new regimen and schedule, and the doctor answered questions thoughtfully and in great detail. Based on this information, the patient agreed to the plan.

Had the patient been notified by the trial coordinator of the changes prior to receiving a call from a scheduler, undue stress, fear, and disappointment could have been avoided. It was not the responsibility of the scheduler to offer an explanation for a change of treatment. Again, the line of communication was broken.

When a hospital representative contacts a patient, there are multiple facets to the telephone call besides the pertinent information being delivered. How a person communicates this information is significant. Through the inflexion of the voice, the phrasing of words and the tone, a listener can distinguish if the person placing the call is hurried, stressed and in a bad mood, or smiling and relaxed. All hospital employees, the medical professionals and technical assistants as well as office personnel and housekeeping staff must realize that they are representatives of an organization designed to help sick people. Patients dealing with complex medical issues and their loved ones are already stressed. It’s difficult enough when patients do not receive pertinent information in a timely fashion. Patients want to know that their health, their lives are respected and valued. When the hospital representative is distracted or hurried, patients feel increased stress; they need to know that the hospital has their best interests at heart. Patients need to know that they can trust the hospital to make the proper call with regard to their health. Communication is a matter of instilling confidence.

One hospital I know of has invested considerable resources to ensure that patients feel satisfied with their hospital experience. Research indicated that while patients highly approved of the health care delivered during their stay, they were less satisfied in other areas, notably, communications. As a result, the hospital embraced a series of changes for all departments. Survey results now indicate a significantly improved experience for patients. To illustrate, every director and person on this task force personally visits a patient each day and inquires how the patient is doing, asking if there is anything that can be done to make that patient’s hospital stay better. Then, they see to it that something is done to help the patient. This takes a chunk of time out of each participating individual’s day, to be sure. But the results are worth it. Can you imagine lying in your hospital bed and the CEO of the hospital walks in to say hello? Of course this team is listening!  A second change that has produced huge results is that every single person is directed to smile when they answer the phone. Yes, Smile! It’s working.

In the final example, a friend had so much pain in her hip that she couldn’t sit all afternoon. Her condition worsened and by night she could not move. After hours in the emergency room, a hospital bed became vacant and she was admitted. Despite combined efforts of a qualified medical team, she could not move her leg and the pain was fierce. Doctors worked for days to help alleviate symptoms and get to the root of the problem. They took her history, performed exams, ordered tests, conducted scans, awaited results, administered drugs and consulted with each other and with the patient. They decided she was not a candidate for surgery.

Hospitalizations can be difficult. Hospitals are noisy, busy places and frequently, it’s hard to sleep. Nurses must attain patient information, or “vitals,” such as blood pressures and temperatures, many times a day, and frequently, in the middle of the night. Blood draws can occur at 4:00 in the morning. Your hospital roommate might have a bad night and require a team of people talking and working around the patient with just a curtain to shield the activity and sounds from you. The IV monitors chime or beep, what seems like, all the time. The patient is uncomfortable, or in pain, or nauseous, or delirious from meds, or all of it. The patient can be nervous or scared. Patients press their call buttons but nurses or aides may not be able to answer the call right away. The patient waits for the doctor, who can arrive at any time, even when the patient is barely awake, and the patient might not recall quickly the questions to ask, or may not remember the physician’s responses. And patients worry about getting sicker in the hospital. There is a lot of stress.

At this point my friend has been in the hospital for a week without being able to move her leg. The pain continues and there is no diagnosis yet. Physical therapists have attempted to work with the patient, but as she is unable to move her leg, they have stopped coming daily.

Enter the rules and regulations of the health insurance company. A hospital staff member tells my friend she must be discharged because the hospital has performed all necessary and prescribed tests, and cannot justify extending her stay to the insurance company. It’s the weekend and the insurance office is closed, so the staff person, a hospital liaison, cannot petition the company for an extension. The liaison told my friend that not only would she have to be discharged, but that if she opted to stay in the hospital, the patient would have to incur the costs personally.

Instead of concentrating on getting better, staying calm and resting, my friend is now spending considerable energy and time trying to find someone who would listen to her. How can she be discharged without any arrangement for home health care since she cannot manage on her own? She felt that nobody was listening. Finally, a physical therapist stopped by to see if the patient was somewhat more mobile, listened to the patient and intervened, successfully advocating on my friend’s behalf. Knowing that a specialist was expected to examine the patient the next day, and concerned the insurance company might not pay for any future time in the hospital, the therapist personally contacted the doctor and explained the predicament. The specialist physician consented to a rare Sunday evening consult. In a visit that lasted two hours, he took a full and detailed medical history, examined the patient, studied the test results and scans, and asked many questions. This doctor diagnosed the condition as one pertaining to his specialty. With a diagnosis, and a course of action charted, the hospital worked with the insurance company to extend the patient’s stay.

One would think that with a firm diagnosis and treatment schedule in hand, the patient could begin to relax. After two more days in the hospital that included new tests, medicines delivered intravenously, and physical therapy, the patient was told she would be released to a skilled nursing facility. While she could not drive and return to work, she could at least move her hip, sit, and was starting to use a walker. There was progress. My friend was asked to choose a rehab facility that afternoon. It had to have a good physical therapy department staffed seven days a week, and be covered by insurance. The hospital liaison merely handed the patient a list of facilities and refused to assist my friend in finding an appropriate and available placement. For a hospital patient who must take many medications, and who has not slept well in over a week, this was a daunting task. She was supposed to negotiate Web sites, make inquiries, engage in detailed conversations and make an informed decision. My friend said that once again, she talked to people in the hospital, but no one was listening.

After several fruitless conversations, my friend insisted that she speak with the liaison’s manager. A more experienced liaison then visited with my friend, and at this meeting, the staff member apologized. She said that the other liaison had less experience, and while sometimes it is enough to offer basic assistance, such as in the way of a list of names of rehab facilities, it is not always the best way to help a patient. Many patients do not always have a network to help them negotiate these difficult decisions. This liaison helped my friend by finding a vacancy in a rehab hospital that offered physical therapy and was covered by insurance.

I did a little research. According to statistics reported on March 27, 2012 during a PBS NEWSHOUR broadcast,* more than 50 percent of adults in the United States are single. Compare that to 1950, when 22 percent of American adults were single. As of 2012, 31 million people, or about one out of every seven, live alone, making up 28 percent of all households in the United States. In the 1950 statistics, four million adults lived alone which accounted for 9 percent of all households in this country. Clearly, our health care system must be able to accommodate all people in a rapidly changing demographic.

Communication and listening issues prevail. Also, acknowledgement remains an issue. Self-advocating patients are frustrated that their requests are not noted, and that their destiny hinges on somebody working without the proper tools and skills, and without their best interests in mind. Nurses and doctors understand the emotional and human aspects of health; getting sick is scary. Your whole life is turned upside down. Sometimes, you can’t do the most basic things, like sit or stand or walk. Your independence is gone. Moving may be difficult, but one thing that remains is the ability to reason and plan for your own wellness. But even that can be compromised due to the nature of the condition; medications or exhaustion, for example, can cause the most active people to tire quickly. So hospital representatives need to understand that patients may have very little control over their lives at that moment, and the one thing the representatives can provide is a sense of calm and order. Their work, their acknowledgement and follow-through shows patients there is a rational and proven process in place to help patients attain the very best information and treatments possible. Hospital representatives should see themselves as having all the tools necessary for all patients. It’s an art. These representatives can skillfully select and provide patients with the information, policies and schedules necessary. They can make requests on behalf of and advocate for the patient and, in doing so, gain the patient’s confidence and respect. I am guessing that studies have determined that patients in a positive frame of mind heal more quickly than stressed patients. I don’t know this for a fact, and perhaps I can blog about that sometime. I do know that it’s hard to concentrate on getting well when you are in the bed, feeling sick, unable to move, and wondering why nobody is listening to what you have to say.

Listening and communication skills are paramount in any organization, and especially in medicine. Considering that people are sick, or experiencing unknown symptoms, it can be difficult enough just to stay calm. Yet in all instances, and in many more that I have been told, the patients have to work hard to be heard, and have to determine if the battle is worth it. Can it be that there have been so many staff cuts, so many reductions in force, that there are not enough people left working in the hospitals to handle all that must be done?

Also, medicine is now a collaborative process; hospitals participate in team care. In fact, in one local pediatric hospital which includes a hospital school, the head of the school accompanies doctors and health specialists on rounds, addressing each individual patient’s education issues with families. The school specialist understands which medications affect memory, for example, and can explain to parents how certain lessons may have to be re-visited at some point in the future. With so many facets of patient care considered, however, do medical professionals become so expert in their areas of specialty, that working beyond their specific area is not considered because another specialist is there to cover that part of the patient’s care?

This is not to speculate that people don’t care. On the contrary, most people care a great deal. But there are so many specific items that must be completed, that must be documented for each aspect of a patient’s health care program, and I wonder if there is enough time to address everything. Health care practitioners must document so much in accordance with hospital and federal, state and local regulations that it seems that they have to be able to continually choose which pieces of information to report. And do they report items that are not in their specialty?

Team health care is a very positive thing. Think of the extensive training, research, experience and talent a group of dedicated medical specialists offer patients. However, when something doesn’t fit in the usual pattern or structure protocol, who intervenes? Who remembers to call the parent of a child to tell her the surgery will not be performed? It seems to me there is a way to offer the best information to all patients and loved ones, even if the procedure is atypical.

Without proper training and expertise, hospital staff may not know that they can do more than their training provides. More importantly, young and inexperienced representatives may not know that their inability to handle a situation well causes great stress for the patient. Supervisors are busy, too, but surely someone can provide additional information. Or maybe not. Is the system so strained because of regulations and loss of staff that questions are not welcomed? Asking too many questions may be seen as a hindrance. They take a great deal of time to answer, and so while one person is receiving information, something else is left unfinished. Is it the patient’s responsibility, and is it in the best interests of that patient to have to ask, again and again for results? I don’t think so.

So I have answered Yes to my original questions; there is a common thread to these scenarios. It is communication, and listening crops up the most, as patients experience a mounting frustration because their health care representatives do not listen. Patients want hospital employees to help them, not hold them back as they jockey for the best care possible.

Now, what can be done about it?

*Author and sociologist Eric Klinenberg stated:  … At the same time, especially as our society ages and the boomer generation begins to age alone, we will find that our housing is not quite up to the challenge of giving people what they want, which is a place of their own, if they can’t have the right partner, but also connection to other people and to all kinds of care and support. We have a long ways to go there.

PBS NEWSHOUR, March 27, 2012 – Conversation with Ray Suarez and Eric Klinenberg, a sociologist at New York University and author of Going Solo: The Extraordinary Rise and Surprising Appeal of Going Alone. Please see: http://www.pbs.org/newshour/bb/social_issues/jan-june12/goingsolo_03-27.html

Baseball Memories

His voice was gravelly, not particularly low in pitch, and strident. You could hear him clearly from his stance behind the catcher at home plate to the top row of the filled large grandstand and beyond, to the parking lot. This resounding voice was one that I emulated.

I don’t even know the name of my childhood hero. My dad knew his name, though. I went to the American Legion baseball games downtown on summer evenings with my dad and younger brother. My older siblings probably were busy with their friends, and my mother didn’t go to the games, either. She was always interested in sports; in fact, she particularly loved basketball. But I suspect she was happy to have a little peace and quiet after a busy day with the four of us “monsters,” as my dad referred to us kids. “Hi, Carl,” a friend of my dad might say. “Are these two your youngest?” “Yea!” my dad would affirm. “I have four monsters.” We weren’t really monsters. I liked it when Dad called us that, though. The way he said it, it sounded like he was serious and funny at the same time. On the nights when our home team played out of town, my dad, two brothers and I would toss around a baseball in the backyard. Sometimes Dad or my older brother would pitch a wiffle ball to us for a little batting practice, but usually, we just grabbed our mitts and threw a hardball.

My dad always would sit in the same section of the grandstand with other men he knew; down the middle aisle a few rows, and then to the right. I don’t recall other kids sitting in the group, but there may have been. These were special times. I knew my way around the park, but I rarely left my spot on the bleachers. Baseball was serious business. I knew all the players by sight and by uniform number. I knew which positions they played. I knew if they were right- or left-handed batters and pitchers. I knew if they were good hitters. I knew which players were most likely to hit foul tips, pitch after pitch after pitch. I remember when the team started hitting with aluminum bats, with that high-pitched dink echoing in the park, and thinking that I much preferred the crack of a wooden bat. I frequently pondered why I had never seen a ball sail over the center field fence, and one time when I mentioned it to my dad, he told me that the center field was so deep, I probably would never see a home run hit there.

During this time, I remember going to Yankee Stadium with my dad and uncle and cousin and younger brother. It was a thrill, but the playing field actually disappointed me. My hometown ballpark’s outfield was at least as big, bigger, actually. But one thing we didn’t have at home was this crew of guys in uniform unrolling and then later rolling tarps over the infield. It was like watching a precision drill team. In seconds they were done. And unlike my hometown’s park, this stadium held thousands of fans, and we sat in real seats, not bleachers. The usher showing you to your seat dusted it off with this big mitt he wore on his hand. It was a very hot day, and my dad and uncle bought us sodas to drink. Cokes. What a treat. Carrying large trays of soda cans, these guys would run through the stadium, going up and down the stairs, yelling with a strong New York accent, “Soda Here! Get your iced-cold soda here!” Then, dad or my uncle would call the guy over, and pay a dollar for each soda they bought. That was a lot of money. The guy positioned a metal opener with his thumb on top of it and punched a circular row of triangular cuts through the top of the can. He was fast! Punch. Turn. Punch. Turn. Punch. Turn. Then he would drain the entire can at once, upside down, into a large paper cup, hand it to you, and repeat the process, rapidly filling cups until the order was complete. Throughout the game there was so much to see. People held signs. “Yankees eat Tiger meat!” was one I’ll never forget. The baseball was great, the crowd was loud, we clapped to the stadium’s organ music, cheered for double plays and stood and yelled for home runs. What a day!

This was major league baseball. I couldn’t believe how many different baseballs the umpire had handed to the catchers. We saw some famous players on the field that day. These were people I had read about in the sports pages and watched on TV. But I just couldn’t get over a couple of things. I didn’t want to complain to my dad and uncle; I had been taught that you just don’t do that. Yet this feeling, this thing, gnawed at me. For starters, how come our hometown field was larger than the professional field? That just seemed wrong. Weren’t the major league fields huge? And in the eyes of this little kid, something was off with the umpire. He called the strikes with a quick punch of his right fist and yelled “Strike” loudly and briskly. He did a fine job calling the game. I don’t remember any plays that angered the crowd. We never saw players brawl, and no one was tossed out of the game. Yet, we had driven all this way and this was supposed to be professional. What was it?

And sitting in the back seat of the long drive home, something in me crystallized. I decided then and there that someday, when I grew up, I was going to be the first American League woman umpire. I had never seen a woman umpire at any of the high school games or American Legion games we watched. I had not seen women umps at Little League games in town. And I certainly had never seen one on televised games. But why not? I knew I could do this. I loved baseball. I went to games. I studied the pitches as they came over the plate, and though I was always on the first base line at the local ballpark, the calls that I made in my head were usually good. I compared them with what the umpire called, and also with how my dad and his friends described them. I watched baseball on television; there the camera angle was great and it was fun calling the game with my dad and brothers. I figured I had what it takes. I read, watched, listened, and practiced. I practiced hard.

Back in town, every time the hometown umpire called a strike, I reiterated the call in the stands, just as loud, and with as much gusto, complete with arm movements. He’d yell, “Stir-RIIIKE,” in two syllables, accent on the second, elongated syllable. I yelled, “Stir- RIIIKE!” He would pump his fist and right arm, swinging back to front at the elbow and back again, many times, while yelling “Stir- RIIIKE.” I pumped my right fisted arm back to front many times. He put a lot of energy in his fist and arm pumps. I put a lot of energy in mine. I practiced his call for “balls”, but this wasn’t as dramatic as the strikes call, so that wasn’t my main focus. This umpire was the best! And someday, I would be just like him. This was the thing that bothered me ever since going to Yankee Stadium; that umpire had fallen short in my eyes. He was not as good, as compelling as my idol behind the plate at the American Legion games.

One Saturday afternoon I heard my mother and father talking at home. I was breezing through the house on my way outside to play. I heard my dad say the word “baseball.” I had to listen; they were talking about the most important thing in the world. Dad told my mother how I would sit in the stands and emulate the umpire’s calls. Every single one! I think I even heard the word “embarrassing” once when he described my behavior at the park. But I never heard another word about it. I actually forgot about it for a long time. My dad didn’t mention it to me. My mom never pulled me aside to ask me to stop practicing at the park, or at least not to yell so loudly. They never said, “Stop screaming ‘Stir-RIIIKE’ all the time!” At some point that summer I told Dad my plans to be the first American League woman umpire. He never laughed. He just kept playing catch with us after dinner, and taking us to the games.

I see now I had two heroes.