BEST patient comment EVER!!!!

So one day I went to visit a patient in a care facility. I had been told that the patient had health problems that made him pretty confused at times, and also he tended to sleep a lot. I went into the room and his wife was visiting also and said it was fine to say hello to him. The patient was dozing. I walked up to his bed and said, "Hello, Mr. X." He opened his eyes, looked right at me, and said, "YOU'RE A SCOUNDREL!" His wife looked a little horrified, not knowing me. I was delighted. "I am," I said. "How did you figure that out so fast? You're really GOOD." He gave me a knowing, mischievous smile that had a bit of a swagger to it. And went back to sleep.

Tangled Web of Rambling

I spend a lot of idle time in the blogosphere, because I enjoy good writing and because the actual lives of people have always fascinated me. I read a tweet from someone whose writing I enjoy and respect, that directed me into the drama of a mother in TN whose son died a bit over a year ago of a drug overdose. The mother is a well-known blogger and she has a lot of internet supporters, and a lot of support is what any parent needs at the death of a child. Somehow I can't let the drama go, probably because a lot of it is about addiction, and the impact of addiction on families, and that is a topic about which I have far more first-hand knowledge than I would wish. Drugs and alcohol contributed to the early death of both of my parents. I was raised in a house of addiction. And so I project into this situation, and I react with rage, frustration, bafflement, compassion, every emotion in the book.

A summary, hopefully fair: the young man in question was 19. His parents became aware of early drug use when he was, I believe, 14. Eventually he was sent to two residential rehabilitation programs that combined treatment with education so that he could continue high school work. He left rehab when, at 18, he attained legal majority, and returned home, where, within a matter of weeks, he was using once again. From this point he used harder and harder substances, developing an addiction to opiates. I believe I am correct in saying that in the last weeks of his life he was injecting opiates, selling as well as buying drugs, and also selling sex for drugs. He was 19 when he died, having been found in the home of two people who, his parents believe, sold him lethal doses of methadone, were prostituting him and other young men, and failed to call for help for several hours while he was in extremis in their home. At some point before being found in that home, their son was involved in a drug deal gone bad that left him beaten.

Their son was taken to hospital where, his parents believe, he was found to have anoxic brain injury from drug overdose as well as from beating injuries. He appeared to recover some limited functionality but eventually succumbed to complications from his brain injury.

The blogging mom and many others believe this young man was murdered, based on statutes that allow for those who illegally provide fatal doses of drugs to be charged with murder. They believe that the criminal justice system has failed them and their son by declining to perform an intensive criminal investigation into the circumstances of their son's death, to include the injuries he sustained in the drug deal gone bad, the provision of methadone allegedly at the hands of those in whose house he died, and the failure of those persons to render aid. Further, they believe the criminal justice system has failed to take action on credible evidence (statements their son made while in hospital) about a prostitution ring the couple was allegedly running from their home. The parents have filed a civil suit against those in whose home he died, as well as a methadone clinic from which the methadone allegedly was obtained. Currently, the mother is also attempting to draw attention to alleged improprieties in the medical examiner's office which performed her son's autopsy, an autopsy which, it is alleged, failed to find any evidence of the serious beating injuries the parents believe their son sustained along with a lethal drug overdose. One hardly knows what to think. Could it be true that every single person in the justice system that has encountered this family has been utterly incompetent and unprofessional at best, and complicit in large-scale criminal activities in the city and county? Could the family be the victims of a draconian plot? Perhaps, I suppose--I don't know the county involved and certainly its medical examiner function has been heavily criticized and problematic for years before the death of the young man in question. Perhaps this grieving mother will end up doing good if there is widespread incompetence and she is able to bring about a cultural change in law enforcement.

I don't know how much any of the mom's effort at finding justice will help the family, though, and that's the rub for me. (By the way, google "Justice for Henry" to read the mom's own accounting and opinions.) I find myself by turns fascinated, appalled, and irate over the family's view of their son and his addictive disease, and fascinated, appalled, and irate over the information that is out there and accessible that seemingly they never, ever had.

One aspect that, I have to admit, sticks in my craw a bit, is that the mom describes her son, over and over, as "fighting a brave struggle against drugs." That phrasing, or similar, appeared in his obit and factors into every aspect of her war for "justice" for her son, and I have to say that I am so utterly ordinary that, if it sticks in my craw, chances are it sticks in other craws as well. Although I acknowledge that I don't know everything about her son's life, what I do know from what she has posted leads me to a far different conclusion: that her son was not, in fact, fighting any kind of struggle against drugs at all. I see a young man who attended treatment programs only as long as he could legally be compelled to do so. I see someone who made no attempt to alter his life for sobriety once home and who, within weeks, was abusing drugs perhaps more severely than he had before leaving for treatment, and who, within months, was on a downward spiral where death was becoming more likely with each passing day. I see, from his mother's own account, a man who resisted even the suggestion of treatment for his addiction to the very end of his life. In short, I see an addict who manifested, in terms of behavior, absolutely no intention whatsoever to change his life, other than talking about hating his addiction. I see also a man who manipulated his family to obtain a place to sleep, food, and a cell phone, and I can imagine him using talk of how much he wanted to change to keep alive the hope that led a family member to keep providing him with those basic needs. I see a man whose untreated addictive disease was not only killing him but destroying the family who loved him and believed in him. And I see a family who continues to hold onto their image of their clearly gifted, charismatic, artistic son as "bravely struggling" in ways that do not allow them to get, on an emotional level, the ways in which he participated in his own illness and, eventually, in his own death.

The family seemed never to be aware of the types of danger that awaited their son once out of rehab. Mind-bendingly, they seemed never to know how lethal the opioids were that flowed freely in their community and all over the country. Nationwide publicity about, for instance, oxycontin notwithstanding, they seem to have had no idea that their son had easy access to substances that could and did kill him. They seem to look back with nostalgia to the 60's and to their own youthful years as times when young people could use drugs as more or less a rite of passage, safely, and emerge on the other side better and stronger from the experience. They seem, and their supporters seem, appallingly ignorant of the deaths that have occurred since long before the 60's from addiction to alcohol and drugs. Thus ignorant, they seem to feel that their adult son (this point I do wish to make and make strongly--he was not a minor child) was failed by a social network including a criminal justice system that allowed terrible drug pushers access to lethal drugs and young people in a new and unique manner.

The mother and her supporters seem also woefully ignorant about addiction itself, about how addicts behave and about the huge mortality and morbidity associated with alcohol and drug addiction. Would that the same programs which offered to rehabilitate their son, no doubt at staggering expense, have demanded that the parents enroll forthwith in Al-Anon or Narconon, that they might begin to understand what demon gripped their son and how eager that demon was to demolish him and everyone around him. Would that they have been given the agonizing knowledge that neither they nor any other human being or human system would be able to impact their son's life in such a way that he would stop using, no matter what they did. Would that those programs, while working with their son, also told his parents what so many families living with addiction know: that you cannot and must not trust any word that comes out of the mouth of a person who is using drugs--that the beloved person is in fact possessed by a force they cannot control, and that the force of addiction renders the beloved person utterly unreliable and untrustworthy. Would that they have had some preparation for the horrific but not, in the larger scope of the world of addiction, surprising outcome to their son's disease, given their son's refusal until the bitter end to treat his addiction.

If I could have offered one piece of knowledge to this family in the last weeks before their son's fatal overdose, it would have been this: Your son is dying. Your son is dying as surely as if he were in a hospital bed riddled with cancer. Whether it happens quickly or slowly, your son is on the path to death, and there is nothing you or anyone else can do. Take the rose-tinted glasses off, look clearly at what he is doing and who he is doing it with. He is not "bravely struggling." It is not "just a matter of waiting until he turns around." You can hope, but his situation is beyond bad. It doesn't matter what you do, or what anyone else does except him; you are helpless in the face of almost certain death. Be prepared.

That wouldn't have changed a thing, I know it wouldn't. But, if they could have heard that, perhaps from other parents, they could have had people to walk with them through the truth of those days, to help them understand the law enforcement view, the depth of the injury, the devastatingly poor prognosis. The awful phone call his mother got would still have been awful, but would have been part of a context rather than a lightning bolt out of left field. They would have been able to see the fullness of their son's life--the enormous and real promise, and the enormous and real destruction--rather than holding the promise and understanding the destruction as something temporary which would eventually pass. It has seemed to me that, as the mother grieves over the idea that her son is not seen completely but only as "an addict," she too fails to see him completely. She sees the innocent youth, duped by older evil people into things he would not have done otherwise, rather than, yes, the addict, the man of immense promise whose life had been handed to a demon, a demon with which he, at the end of the day, did not choose to engage. When people say these sorts of things to the mom, she hears us saying he "deserved to die" and "deserved to die a terrible death." That is not what I am saying, really--no one "deserves to die a terrible death," but people with addiction die terrible deaths every day in every city, and it really does not matter whether law enforcement is impeccable or not, whether drug overdoses are prosecuted or not, etc. It is human tragedy and evil at its most immediate and painful. And the roots of addiction are complex and multifactorial and some people die even if and after they choose treatment for themselves, because the disease is so godawful powerful.

I tell families of persons dying of consequences of addiction that, if I had a magic wand and the capability to eliminate one disease from the planet, I would choose addiction without a second's hesitation. I have no time for libertarian talk about how anyone should have the freedom to consume any substance they like, on grounds that the harm is done solely to the user. That viewpoint is self-centered and utterly naive. Families, friendships, communities, cultures, economies are ravaged by addiction, and it is at this point impossible to predict who might be able to use something "safely" and who might not.

There are no easy answers and no simple places to put blame. I wish this family some measure of peace, and I wish that none of their other family members ends up in the same evil situation. I wish I thought for one moment that the success of their lawsuit would vindicate either them or their dead son, or even that I thought for one moment that their suit could or would prevail. Their lives are utterly and unalterably changed by their loss and it is always thus. I wish them more fullness of knowledge and vision even though I know it may bring more pain. And I wish there WAS an easy answer to what they are going through.

Ah, the Royal Wedding

It has been a rough couple of weeks. Owing to an act of colossal stupidity (mine, of course) I wrecked my car... this was awful in every way and I am slowly climbing out of the pit of that. My second (now only) car has been skillfully resurrected by a VW mechanic who (a) does not work for the VW dealer and (b) knows what he is doing. (Could this be a coincidence?) Hopefully the wolfhounds will fit, one at a time at least, in the back of the VW. The tiny dog will fit anywhere in the VW but will of course wish to drive it. I doubt she can manage the clutch, however.

Meanwhile, I find what innocent enjoyment I can in contemplation of the Royal Wedding. Now, most people around me find it irrelevant if not utterly boring, but although I am otherwise as unromantic as a cement block, I am vulnerable to the fantasy of Royal Weddings. After all, I did get up at oh-dark-hundred to watch Diana marry Charles, although it was plain as the nose on anyone's face that expecting a 19-year-old virgin and a 32-year-old well-traveled male to have much of anything at all in common was utter lunacy. Fat lot of good it did THEM, my getting up so early.

There is after all something archetypal about royal weddings, that's why they hold any fascination at all. One (or even I) project something shining and gold on a royal couple, and the wedding, itself an archetype, holds the weight of great hope and promise. And at least this time the couple are of similar age, met at university, have known one another for more than a month or two, and apparently are able to converse for more than a sentence or so. These factors lend one (or me, even) to hope for better times for them than for the unfortunate Charles and the late Diana, who seem to have been even more appallingly mismatched than I imagined in my wildest dreams.

I want them to be happy, William and Catherine, and I want their relationship to be genuine and not a sham, and I want their dreams of spending their lives together to be richly fulfilled. Marriage is at best a sacred calling, a true sacrament, in which ordinary daily experience is infused with the presence of the Divine. I wish that for this young couple, as I wish it for everyone I know who chooses a partner and takes that courage step into life together.

And I want to see the dress, and her hair, and whether she wears a tiara, and whether they get to stay on in their rented farmhouse, and whether he loses all his hair by 35, and whether they have babies, and on and on and on. Incurably nosy, that's what I am, especially about lives that mine has never, and will never, resemble. I always have been curious about royal families. I always have wondered what it would be like to grow up in a palace and to have "what you will be when you grow up" decided for you even before you were born. Life in a royal family seems such an odd combo of freedom (from worry about money, especially) and restriction (one cannot plausibly run off and join the circus, really, if one is royalty--Princess Stephanie of Monaco tried it, which says it all actually). I used to think, why would anyone NOT want to be a prince, or princess, or whatever, but now I think of the fellow I once heard of who worked for a Buick dealer and was very successful as a salesman because he believed, truly believed, that Buick was the best car in the world. He refused to check out the competition because he was afraid he might find out that Buick was really no better than Chevrolet, and then where would he be? As a royal one would simply have to believe one was relevant, because if not, how could one bear it? And, as the relevancy of royalty comes under increasing question, maintaining the belief would become tougher and tougher, and of course what about the poor soul born a Crown Prince who is, sadly, a person who yearns to be steamfitter, or a priest, or a phlebotomist, or anything at all really, other than a future King. Like most youthful fantasies, thoughts of royalty become tempered by experience of reality over the years.

I still, though, look forward to the wedding. I hope the dress is magnificent, and the day is sunny, and the horses shiny and perfectly groomed, and the vows said without a hitch (let us not forget that Diana, by mixing up two of her husband's names, took Prince Philip in marriage... ) and the balcony kiss enough to make the world swoon. It will be grand.

What on earth?????

So there are days at the end of which only two options seem valid, the first being a stop at the local hock shop to see what's available in the way of a .38 snubbie and the other being the implementation of a rigorous quality testing program upon one's supply of Adult Beverages.

Today has been such a day.

Actually, all of the last week has fallen into the same unfortunate category. Sadly, at the end of each day, I have lacked the energy to visit the local hock shop(s) and my level of fatigue has gotten in the way of the attention to detail required for proper quality analysis.

This is not fun.

There are many things that have annoyed me lately, and about the only one I can discuss without fear of legal ramification is the proliferation of what are properly called Medical Marijuana Dispensaries but more accurately called "dope shops."

Mind you, I do think medical marijuana has its place. And I do think people who need it oughtta be able to get it without engaging in clandestine drive-by purchases in questionable parts of town or setting up elaborate systems of artificial lighting in the closets of their guest rooms. But really there are limits--limits on need, appropriateness, and good taste for mercy's sake--and my state has sadly left all of those limits so far in the dust they may as well have fallen off the edge of the earth.

How many dope shops does any stretch of city street really NEED to have anyway? I live a few blocks from one of the more dope-shop-intensive streets in town and I can tell you that however many there are right now? Is too many. Waaaayyyyy too many. Honestly I wouldn't mind them nearly so much if it weren't for the AWFUL!!! decor. If I were to pick a color that would subtly allow the customer looking for this business profile to identify same, I would not have picked the sort of sickly greenish-chartreuse that is practically ubiquitous. And, if I were bound by some apparently unpublished dope-shop code of ethics that required I use that color, I would use it in small bits. I would NOT PAINT THE WHOLE FRONT OF MY BUILDING IN A COLOR THAT LOOKS LIKE THE CONTENTS OF A BABY'S USED DIAPER. Honestly. Some shops use a combo of awful green, awful brown, and awful yellow that makes me think of patients with particularly bad end-stage liver disease. Perhaps that is called Foreshadowing, or perhaps the goal is to make the building so depressing to look at that all its neighbors will be compelled to become customers in order to reach some state of hazy equanimity. And let me tell you, the universal Red Cross symbol of Medical Help that appears on a lot of the shops looks particularly disgusting against a sickly yellow background.

And oh my God the NAMES!!! The names of the businesses!!! It is difficult to keep track as there is some, shall I say, turnover, but "A Cut Above?" I would have guessed a hair salon, but ooooh no, not unless there is more than one business under the roof. "Bonnie and Clydes Caring Cannabis?" Do you WANT to advertise a connection to crime? "Chronic Wellness???" From smoking marijuana? Listen, I talked to a doc about a year ago who said, with the fervor of a man who sees a pulmonology residency in his future, that in 30 years all the patrons of these businesses will have lung disease worse than those who use tobacco. Because if you are smoking the stuff, unless you're more sophisticated than many, you're rolling it up in ZigZags with NO FILTERS. And if you want to know how good that is for you, look at the inside of someone's water pipe sometime, and think of your lungs. Anyhow, back to the names. How about the Ganja Gourmet Medical Marijuana MMJ Restaurant Dispensary? You can view a menu online. Honest. Which is one of the fascinating things about the Medical Marijuana MMJ business (sorry, couldn't help it) -- you have a Full Range of Products from Which to Choose. Not just leaves and buds, oh no. And no need to bake your own Medical Marijuana MMJ brownies anymore either, you can buy 'em premade (be sure the kiddies don't pick up the wrong batch for birthdays at school, just saying). At the Ganja Gourmet one can buy Medical Marijuana MMJ-infused pizza!!! and beef pot pie (pun intended I am sure)!!!! and rice krispy treats!!!! and double-fudge cookie with hint of espresso (what's the point of THAT, I want to know???) and, yes, "Stoney Road" ice cream.

Back to names after the brief gustative diversion: A number of these sickly green businesses include words like "natural," "kind," and "healing" in their business names. I suppose these names are meant to contrast the businesses with purveyors of allopathic health care which is not really fair. I mean, if you are having a big fat heart attack and you are being resuscitated, your immediate concern (if you are perfusing well enough to have one, that is) is less about "kindness" than about the forcefulness of the compressions being applied to restart your ticker. Your concern about "kindess" comes the next day, when you are supposed to start waking up, broken ribs notwithstanding. Maybe sickly green isn't so disgusting then, I dunno. I am beginning to ramble here, but do go back up a paragraph or so and ponder what I said about "lung disease," and think about that in relationship to "kindness." Take your time.

There is purportedly a Medical Marijuana MMJ business (I canNOT help it, the redundancy is simply too much) named Releaf. Do they recycle, too, I wonder? And the Rocky Mountain Farmacy. Cute. By far my favorite though is the SweetLeaf Compassion and Wellness Center (italics mine). What the hell? "Good afternoon. I need to purchase some compassion. Also wellness. Do you have a price list?"

Which brings me in a somewhat befogged way back to the beginning of my post. I probably do need to purchase or otherwise obtain some compassion, if only for the poor souls that have to write ad copy like the following (for The Giving Tree MMJ Dispensary): "...An established licensed Denver medical marijuana dispensary providing premium compassionate caregiver services and products..." Anyone who has to spend their days writing that kind of purple prose to describe premium products otherwise known as "Afghooey," "Northern Lights," or "Green Crack Medical Marijuana," and probably writing said purple prose while sitting in a sickly-greenish room deserves at least a pound of compassion, SweetLeaf or otherwise. Or perhaps a double-fudge Medical Marijuana MMJ-infused cookie with hint of espresso. Balance in all things, indeed.

I don't know about you, dear reader, but I am feeling much better indeed after this little rant about the Medical Marijuana MMJ business. It may be that I can forego the rigors of quality assurance for another day and the .38 snubbie for two or even three. It is good to feel gratitude, even though the quality analysis of a tiny bottle of peppermint schnapps is, if done well, a task worth doing.

("Green Crack Medical Marijuana???????????????????????")

Stuff, maybe nonsense

So I have been finding myself more easily angered lately; certainly grief resulting from the death of my friend J a week before Thanksgiving is a huge factor but perhaps there is more to it. I attended a couple of presentations lately where it seemed that large topics were oversimplified and where the speakers' own point of view was presented as fact. This is the sort of thing that can (and did) make me totally nuts. One is reminded that, when the only tool one has is a hammer, then everything tends to look a hell of a lot like a nail. It is so easy not to notice that one has only a hammer.

There is much to annoy in current health care discourse and sometimes it seems the job of chaplain brings me to notice those things acutely. At present there is an enormous focus on how patients need to change their lives so as to improve health, with an underlying sense of judgment applied to folks who are perceived as using "more than their share" of health care resources. Consider smokers. You cannot read an H and P (history and physical) about a patient who has smoked or is smoking without that fact being noted, no matter what the reason for the patient's visit to a health facility. Some health professionals are openly scornful of smokers feeling that they have brought some health issues upon themselves and should have known and done better. Which in an abstract sense is true--the dangers of smoking have certainly been widely published and an informed consumer certainly can find the information that suggests quitting would be a Good Thing. I don't know, though, if we understand what it is we ask folks to do when we keep harping on the topic. If I live in a family where everyone smokes, and I work with smokers, and my friends smoke, and indeed some of my social contacts come from "smoke breaks" at work, say, then is it really an individual thing that I can simply stop? Will I not have to do something about my environment if I am taking the dangers of smoke seriously? That's a lot harder than slapping a nicotine patch on and fighting cravings, which is hard enough on its own.

I begin to wonder why we don't get as righteous when we deal with people who have a lifetime of participating in sports, from jogging on up, and now are needing joint replacements, physical therapy, etc., related to wear and tear from athletic activity. Are such people not also taking "more than their share?" But hospitals, far from scorning the Boomers with blown knees, are building fancy new orthopedics units and buying fancy new robots for surgeries and competing like mad to get the business. Maybe joint replacements, being procedures, are reimbursed at a more reasonable rate compared to obstructive pulmonary disease, which can involve repeated hospital stays and is ultimately not curable. I don't know--but health care is not neutral in its views of its consumers. I have heard folks blame returns to hospital (that is, patient is discharged but only maintains in the home or nursing home for a day or so and comes right back) on patients' failure to adhere to discharge instructions. I suppose this accounts for some, but the ones I've seen happen with medically complex patients who are discharged because their insurer demands that they move to a lower level of care in a certain number of days. The guidelines for length of stay depend on the main problem for which the patient is being treated. Which is probably highly appropriate and cost-effective for patients whose condition is relatively straightforward, but for patients with underlying health issues may be kind of nuts. Thus we see patients discharged from the hospital on Day X after some procedure, when something may be brewing but it's too early to know, and a day or so after they get to a rehab facility or home, there's a full-blown infection somewhere and back to the hospital they go. That certainly cannot be blamed on patient failure. So better patient education is not going to be the big fix for this problem. The fact is, hospitals discharge patients earlier and sicker than once was the case, and not all patients have the support in the home to recover well, and care facilities are getting sicker patients without in many cases the staffing to care for these patients. No simple fix here, so when I hear a speaker talk about how repeat admissions must be fixed by patients being more responsible I am annoyed to put it mildly.

It seems to me that the huge push to reduce employee expenses in aid of controlling costs is nuts. First off, the more people get put out of work, the wider the gap becomes between rich and poor. Also, when people are not working, they are not able to consume the products and services being offered so "efficiently." Cutting numbers of workers has been disastrous in a number of areas--I'd say health care is one. Robots, scanners, protocols can only do so much. At some point none of these can substitute for a set of skilled human eyes that can assess a patient and understand when to use, and when not to use, the tools at hand. I'd also say that food production is an activity that should be more labor-intensive. Perhaps there would be less food-borne illness if more eyes and hands were on the job, and more care taken for quality. Perhaps food production could happen in more sustainable ways if the entities doing it were less concerned with "efficiency--" I don't know.

Last night I remember fragments of a dream--I was in a place where there was a fair bit of land and there were gates where I could let my dogs into fenced areas. Somehow a mother bear and two cubs got into the area where the dogs were and I was terrified. I wanted to get the dogs in and away from the bears, but one bear cub got into the house for awhile. Eventually the bears were on a neighboring golf course, and I called the authorities. The authorities could hear the bears but couldn't find them. Eventually they told me I was simply going to have to work on dealing with the bears, finding ways to keep the dogs safe knowing the bears were around. Not the news I wanted by a long shot. Puzzling.

Weird times, these are, in the inner as well as outer life. That's all for now--need sleep.

back again

It has been tough to figure out how to blog given the responsibility to refrain from posting anything that might allow identification of a specific person or facility. Which I understand, because when your job involves Seeing Dead People it is important not to do anything that causes any more pain to the living people who surround said Dead People.

So I will be self-involved and blog about MEEEEEEEEEE!!!!!

It has been a rough month or two. Jobs that involve death and dying hold an inherent level of stress and loss, that is if one plans to be actually present to the work. There are lots of ways to avoid doing so, but I think people who are facing loss need human connection more than they need most anything else, so there you have it: an inherent level of stress and loss.

If there is one thing I am NOT, it is romantic. When I become more weary I become LESS romantic, less convinced that "things happen for a reason" or that "the right thing happens in the end." I become more likely to be pissy about what has gone wrong or firm about the existence of sin, yes SIN, and evil in the world and in the big systems that surround us.

We had a workshop on the environment at work. The worldview behind the presentation is that people are inherently good and need education about what needs to be done. Once educated, people will feel "empowered" to make the right decisions and do the simple things that will change culture and save the planet. The notion is that an industrialized model that relies on continued growth in production and consumption has put the planet and its people in danger (I actually agree with this and have been saying it in one form or another for some time). There is, however, a certain irony in listening to this message from a man wearing a Ralph Lauren shirt. A kinder soul than I suggested maybe he bought the shirt used from a thrift shop, but I think not. The presentation involved some video segments of folks in beautifully and expensively decorated offices. I was in a rage at the romanticism of it all by the end. Would that anything were so simple. Would that we could just make one change that wouldn't hurt ANYONE. Would that everything about indigenous societies was so praise-worthy and possible to implement that the world could simply turn the clock back.

I know I am not enlightened. I know I don't do my best every single time. I know I could do better at conservation and recycling and the like. I know in that vein I sin. I also would guess I am not alone. I also would guess that it is very hard to discern what the best choice is in most situations. Out here we don't have water to spare. Is it really better to stop using disposables and use water to wash dishes, cups, towels, the like? Is it better to compost? What IS the best choice? I am tired of romantically smug folks who are SURE they are doing right things and aren't able to see complexity. I am tired of people who are unwilling to confront the fact that evil exists. You work in systems, it is easy to see evil. It is harder to see our own. Am I willing to keep my thermostat set lower in winter? Am I willing to spend more time cooking? What really IS required?

I have a much lower anthropology than most people it seems. Maybe because I know myself better, know my own ability to let myself off the hook for things. The presentation was supposed to be enlightening and uplifting. It was not--it made me despair. "Education" sure has worked well for racism and sexism, hasn't it? It sure has worked well for efforts for peace, right?

Here's where a doctrine of sin CAN bring comfort: it allows me to say, I am no better than you, and you no better than I. We have a problem. And we already know we will resist fixing it, because that is how we are. How can we work together to find out what to do and sustain one another to do what we can, even if that involves sacrifices we already know we will resist making? How can we help ourselves be accountable? How can we broaden our view and face uncomfortable things?

Eh. Enough for today. I am mourning the loss of a good friend who died just over two weeks ago. I am sad for some tough deaths at work and for times of low census that have stressed teams to the max and for tough circumstances faced by friends. I am glad for big furry dogs and a tiny hot-water-bottle of a dog who make me laugh a thousand times in a day. I am glad for holiday lights and evergreen smells and the gorgeous music of the season and new friends at church. And I hope next week's presentation at work doesn't make me mad...

AmbulanceFAIL

So I heard this one from a nurse who heard it from a member of the family involved: The family had needed a "non-emergent transport" to take a member for some specialized care. As the family member was basically comatose an ambulance transport was called for. The ambulance arrived and pulled up in the driveway. The two medics jumped down from the cab, went to the back, opened the doors, and found... no stretcher. OOPS. They use those big yellow ruggedized pram things and you wouldn't THINK you could overlook one, especially since at the end of the prior run they put it BACK IN THE AMBULANCE, but I suppose one could get busy and forget. Anyhow the ambulance had to return to base and get a stretcher. There is a certain slight swagger that goes with being an EMT or paramedic, but I imagine that was lacking the second time they arrived at the house.

There is a time for stupendous silliness in hospice work as I have mentioned before. Some days are beyond stressful for any number of reasons, and a good belly laugh is the best way to release some of that. I was sitting at a nurses' station calling a mortuary to arrange a pickup on one such day, late in the afternoon. The somewhat disinterested answering service operator was droning throught the necessary questions. As she asked, "Name of the pronouncing doc?" I heard a sound and looked up to behold exactly that doc, white coat and all, being rolled past the nursing station in a wheeled Geri-chair (a kind of recliner) by one of the nurses. The doc was reclined back, gazing straight ahead, legs extended and feet crossed at the ankle. I am sure that the answering service operator wondered why I snorted in such an undignified way before answering the question; it was all I could do not to laugh out loud. The nurse had been rolling the chair to put it away, and the doc had apparently popped into it; this nurse, who has a marvelous deadpan, simply kept on going.