Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts

12 June 2020

Pride 2020: Episode 1 - The Gay Plague

The following is a transcript of a podcast that aired only inside my head.



June is bustin' out all over!


She's not the only one bustin' out. Protesters all over the too are bustin' out of quarantine.


In celebration of June, the month of pride, we'll discuss movies of the LGBT persuasion.


For the first entry, we’ll cover the following movies: “5B,” “We Were Here,” and “How to Survive a Plague.” We traveled back in time to the early days of the AIDS epidemic.


Way to go, picking a depressing theme. AIDS? Really?


Thought of Larry Kramer since he died last month.


Rest in peace. We hava a lot to thank him for.


I think it’s only appropriate. With Larry Kramer's death and the COVID-19 pandemic, it feels like that time of the AIDS crisis speaks to now. 


We started with “5B.”



Nurses as healthcare heroes!


See? It’s relevant already.

We stayed in San Francisco again with “We Were Here.”



San Francisco was the place to go then. And they had a lot of sex. You know that book, “The Immortalists”? The four siblings are told how and when they will die. I didn’t know how the other three would die, but once the gay one runs away to 1970s San Francisco, I knew how he would die.


This doctor I know told me that if he had stayed in San Francisco he would be dead by now. A lot of his friends are dead.


“How to Survive a Plague” takes us back to 1980s New York.



Larry Kramer was mad!


See them protest, chanting “The whole world is watching!”


Just like now. Black Lives Matter!


AIDS defined our gay generation.


Speak for yourself. Not my generation. 


I went to see “Rent” when the movie came out in 2005 with my friends who were born a generation after me. They didn’t know what AZT was. They asked, “Did everyone have AIDS in the 90s?” These were future nurses, mind you. How quickly the country forgets.


What’s “Rent”?


It’s what “Team America: World Police” called “Lease.”


The AIDS song!



This year’s Pride should rightfully honor Larry Kramer.


All three movies are documentaries. 


Watching them does feel like bearing witness. Listening to those who were there. “We Were Here” is definitely like that. Talking heads. 


To tell the stories of those who are not here.


But “5B” and “How to Survive a Plague” are crafted well. “5B” has genuine narrative surprises, right up to the end. Did you think that doctor was married to that man? Of course, some things made sense after you knew that. It casts nurses as both heroes and villains in one subplot. 


Why does the Filipina nurse have to be a villain? I think she’s Bisaya.


Let’s face it. There are homophobic nurses.


Is it because she was married to that fat bigot?


That’s part of the mystery.


For a documentary, “How to Survive a Plague” feels like a thriller. It plunges you in the middle of an ACT UP meeting and never lets up. Like “Man on a Wire” or those Matt Damon Bourne movies. Makes you feel the thrill of protest and resistance.


Dr. Anthony Fauci looked so young. He links both plagues. Our link to then and now.


The same fears arise.  In “5B,” there were nurses in San Francisco General who sued to fight for wearing more PPE when caring for AIDS patients. However, this had the hint of homophobia, not just plain contagion.


Nurses as frontline workers!


Then and now. But those healthcare professionals didn’t get “clappy hour” for their services.


An argument for these movies, I suppose. These movies exist so you can’t forget.


So much of that time echoes to now. So much of that time changed medical practice: patient confidentiality, needle safety, re-defining what “family” at the bedside means.


And so many deaths.


Never forget a number is a life.


Numbers can be so sterile.


That’s why that front page of the Sunday New York Times during Memorial Day weekend featuring the names of those who died from COVID-19 is so moving. There’s a certain power to reading names.


A kind of bearing witness.


That front page is like that book of name in “5B.” The ward’s retired nurse manager opens a book where the staff wrote down names of the patients who died in the ward. The book is now fragile and seems to be preserved by a library. She has to use gloves to turn the pages. White gloves. The Mickey Mouse kind.


Ironic because the ward tried not to use gloves as much as possible.


She notes the increasing number of deaths per year. When she reads the names out loud, the numbers gain more meaning. “We Were Here” shows pages and pages of the Bay Area Reporter when it ran the pictures and names of those who died of AIDS in one year. I don’t know any of those people, but seeing those names made the toll overwhelming.


The same way Maya Lin’s Vietnam memorial gets you. 


You could argue that some deaths were avoidable. 

I thought the COVID-19 virus would be an equal opportunity infector. Instead, it highlights health disparities. Minorities take on a bigger burden. Blacks and hispanics are disproportionately affected by COVID-19 because the government acted slowly.


The gay community were disproportionately affected by AIDS because the government acted slowly. 


Part of me was looking for a sense of how this pandemic will end. And none of the movies really offer the kind of reassurance I was hoping to find. It took approximately 15 years for HIV medications to be tolerable AND effective. There’s no HIV vaccine yet. We’ve only managed to control it well.


And two cures. The Berlin patient and the London patient.


Those treatments are high risk. I said the same thing when it was used for sickle cell. When the benefit outweighs the risk, go for it.


Can’t be as bad as those early AIDS clinical trials. That man from “We Were Here” was the only survivor of that clinical trial because he wimped out from the side effects.  


That’s a lasting effect of ACT UP. Their protests changed the FDA and NIH. “How to Survive a Plague” showed how they teamed up with breast cancer patients. Protests can bring meaningful change. 


Pride began with a riot. Watching these movies offers some hope that ALL of this too shall pass.


At a cost. There’ll be burn out and survivor’s guilt. The next crisis will be a mental health crisis among healthcare workers post-pandemic. Like the caregivers in “5B” and “We Were Here” burning out. Survivor’s guilt among patients are apparent in all three movies. In a grotesque way, part of the suspense of watching “How to Survive a Plague” is seeing who does survive. And there’s a cost to those who do.


As mentioned before, depressing.


My tear ducts got a workout. A lot, especially from “5B.” I felt nostalgic for old New York watching “How to Survive a Plague.” So bittersweet to see St. Vincent’s Hospital and St. Clare’s Hospital.


Spoiler alert: they didn’t survive.


I’ve been missing theatre since the lockdown. I didn’t see it before, but it’s clear now that ACT UP protests were forms of theatre. I mean, Larry Kramer was a playwright! They knew how to put on a show. So many of the activists were artists. Probably what made them effective was the art. The propaganda used then has since become iconic: Silence = Death with the pink triangle, Keith Haring’s drawings.


The red ribbon!





Millenials won't know what it means. I was handing it out in nursing school to raise awareness and this young woman thought that if you wear it that means you have it.


That's what the politicians in "5B" wanted. An easy mark for them to know you have the virus.


And what about that giant condom over Senator Jesse Helms' house? It's like a Christo artwork.


He just died. Undisclosed causes. 


We won’t speculate. Not like the old days.


Those activists were tastemakers.


But I was most moved by the sense of community that formed during the AIDS crisis. You also see that now with an uptick in volunteerism during the pandemic. You saw that in 5B’s staff and volunteers. In ACT UP members. “We Were Here” especially reminded you about the lesbians who were there for the gays. There’s one thing I plan to do: thank the lesbians for being there.


Thank you, lesbians!


08 November 2010

Rated A, B, or C

Again, it amazes me that NYC has always been receptive to health-related changes - even if those changes border on over-regulation, e.g. the smoking ban on restaurants, visible displays of food calories.

Starting in July 2010, New York City is requiring restaurants to post letter grades that correspond to scores that it receives from its sanitary inspection. An inspection score of 0-13 is an A, 14-27 points is a B, and 28 or more points is a C. Grade cards must be posted where they can easily be seen by people passing by.

Started noticing the posted grades this weekend. Below a C means they must be shut down.
Would I still walk into a place I frequented with a C by the door?
Probably.
Old habits die hard.

02 November 2010

Live! Nude! Models!

3 years of bedside nursing and I finally got to see a normal vagina:
on a live human model for a GYN exam in Advanced Health Assessment class.

Still not sexy to me.

15 October 2010

BMTs

Personally, I find allogeneic BMTs frightening for its upsetting side effects. GVHD has horrendous clinical manifestations. But I have to let that go because it is what the patients want. T. Brown, RN on the NY Times' Well blog felt the same distress, but who are we to take that hope away? Below is a feel-good piece that re-affirms why I do what I do. I applaud those who are on the registry. I know of one who's on the registry who worries they might call him one day. Take heart, "walking funny for a week" and some pain seem to be the only unpleasant complaints for a donor post-collection.


The Gift of a Lifetime
How a Woman Who Died in April 1999 and an Infant Diagnosed With Leukemia Became Connected by an Act of Kindness
from "CBS Sunday Morning"

13 October 2010

PE, cont'd

Wouldn't you know it? My teacher brought up the Stanford 25 (previous post) in class because Dr. Verghese was profiled in in the NY Times. I was ahead of the curve.


Physician Revives a Dying Art: The Physical
By DENISE GRADY
Published: October 11, 2010
At Stanford, Dr. Abraham Verghese is on a mission to bring back something he considers a lost art: the physical exam.
I volunteered that I had read this two weeks ago and brought up the limitations chimed in by other MDs in BMJ. She seemed put off by that. I agreed with her though that RNs beat PA's and MD's when it comes to "touch"-ing a patient. Because we're a touchy profession.

11 October 2010

PE

On "The Fading Art of the Physical Exam," by Richard Knox from NPR.org

I'm not for going back to the days of Dr. Quinn, Medicine Woman or even Dr. Kildare.
Since I will be a “mini-doc,” as my Advanced Health Assessment prof put it, the Stanford 25 seems like a standard to look up to as a program objective. (There are limitations/criticisms.) Nurses are trained to do a physical exam (PE). Yes, we learned these PE skills in nursing school, but do not keep it up. Depends on where we practice. In a hospital setting, MDs and diagnotic machines are within easy reach, so nurses' PE skills rust. Upon review, not many of my nursing preceptors emphasized PE skills in practice when I was a student. Many of my colleagues do not carry a stethoscope around, so I can bet they don’t listen to breath sounds or bowel sounds and are only forced to use it when they have to take a BP manually.

10 March 2010

National Colorectal Cancer Awareness Month

Only hospitals can circulate this kind of memo:
That I should tune in to watch Harry Smith's colonoscopy live on TV while Katie Couric holds his hand.
And in case I missed it on TV early this morning, they sent another memo linking to it:




As an oncology nurse, I'm proud of it.
Will this make my Dad schedule one?
We'll see.

09 March 2010

And The Winners Are ...

Losing my touch.
Scored only 60% correct on my Oscar predictions.
Honestly, no one saw that Argentinian movie winning.
I'll cop to my screenplay picks belonging in the "should" column and not the "will win" column.

In other news:



So naive of me. Only thought it was a power button symbol until the filthy comment writers on New York magazine pointed out it could be other things: "This is like when IT people have sex, on a wrapper."

01 March 2010

St. Vincent's


Photo: My union dues at work.

Saw a line of red-capped NYSNA members streaming into the main entrance of St. Vincent's. They carried laminated signs that said "Save St. Vincent's."

A little background from the NY Times:

Published: February 6, 2010
The Greenwich Village institution, which is $700 million in debt and in danger of bankruptcy, has not found a partner and has stopped admitting some patients.

I find this beyond the union's purview. If the hospital stops serving the needs of the immediate community, then it won't survive. It has served Greenwich Village well when the AIDS crisis hit the neighborhood hard. Between it and Bellevue, they were at the forefront of that modern plague. My soft spot for St. Vincent's stems from that. The nuns during those times must have felt like their predecessors centuries ago, tending to victims of ancient plagues. I'm sure the hospital's nurses must have felt that as well. This is a guess: but the hospital has been riding that goodwill for a long time. The population who bestowed them all that good will are dwindling. The community has changed. Its new residents are moneyed and younger and their first choice for primary care and non-emergent surgery is probably not St. Vincent's. Being a Catholic hospital may have something to do with it as well. Do consumers choose which hospital to go to based on its strong religious affiliation? Maybe. And the hospital's heart, its duty to provide the underserved and survive in an urban economy, is part of its undoing. New York has "safety net" providers and St. Vincent's is not one of them. It thinks it is, but it isn't.

I am for saving St. Vincent's. That area of Manhattan needs a hospital. Without it, the nearest E.R. would be all the way on the East Side, all the way downtown, or St. Luke's Roosevelt in the upper 50s. To save itself, St. Vincent's needs to engage the community boards in its neighborhood and assess what they need. March with time and enhance the quality of care (I would emphasize technology here or add specialties - e.g. be a Stroke Center). The other solution is for HHC to swallow it up and become a full-fledged "safety net" provider. We're helping to bail them out, anyway.

15 February 2010

Let's Vote, NYC!

This is the Gotham Awards in the category of Best Condom Wrapper Design.

Health Department Unveils Five Finalists in NYC Condom Package Design Contest

After assessing hundreds of possible package designs for a special limited-edition NYC Condom, a panel of judges has selected five finalists. The Health Department has received nearly 600 entries since December 15, when it invited New Yorkers to design a wrapper that would “capture the city’s
distinctive culture while promoting safer sex.” Designs have flooded in from all five boroughs, and as far away as Perm, Russia. New Yorkers can vote for their favorites starting Thursday, February 11 through Sunday, February 28.








To vote, click
HERE.

07 February 2010

Scotland (cont'd)

P.S. to yesterday's post.
While they're at it, maybe they could make the bottles less breakable, too.

From: Coatbridge Journal
For Scots, a Scourge Unleashed by a Bottle
By SARAH LYALL
Published: February 4, 2010
Buckfast Tonic Wine is a symbol of Scotland’s drinking problems at a time when it is debating how to address them.

06 February 2010

"Glassing"

How's this for Health Promotion?
From The Associated Press:
British Toast New Shatterproof Pint Glass
Half of all violent assaults in Britain are alcohol-related and drinkers are known to smash glasses and use them as weapons. British leaders say the country will save billions in health care costs by coming up with a glass that doesn't double as a lethal weapon.
Reminds me of the "British coal-gas story" in decreasing suicide.
(Although that was accidental).
Will they clink like real glass?

Some choice quotes:
"Glass feels good in the hand, it feels cold. Plastic is warm."
".... plastic glasses are an insult to beer drinkers everywhere ... "

24 November 2009

"The Cost of Dying"

"We don't ration rationally."


Watch CBS News Videos Online


A naive reductionist phrase: "Pulling the plug on grandma."
A question with a too-often unknown answer, "What did grandma want?"
"Do Not Resuscitate" does NOT mean "Do Not Treat."
Less aggressive treatments at end of life yield better outcomes across the board:
Palliation, quality of life, less moral distress, and yes, less cost.

01 October 2009

Mandate

Get pricked or get fired. Unless you have a demonstrable allergy to eggs.

New York state issued a mandate for all health care workers to be immunized with this year's flu vaccine and the H1N1 vaccine when it's available.

When you tell people they HAVE to do something, it stirs people to the verge of mutiny.
"While we encourage nurses to be immunized for the flu, we do not agree that nurses should be required to be immunized every year as a condition of employment.The seasonal flu vaccine is not 100% effective and sometimes is highly ineffective, as it was in 2005 and 2007. There is no guarantee that in any given year, the public will benefit from mandatory immunization of healthcare providers." -New York State Nurses Association
Give me this year's flu shot, but don't give me the H1N1 shot.
The swine flu vaccine is a rushed product. It's considered safe based on studies from a small limited sample. My tin foil hat senses government-corporate conspiracy when the new vaccine falls under the PREP Act. That means the vaccine manufacturer(s) has immunity from lawsuits related to the vaccine. So, those who will develop Guillain-Barre, Steven-Johnsons, or anaphylaxis are simply trading one illness for another.

Uncertainty fans fear and I'm throwing in some kindling here. But for a health care model that values patient autonomy, none can be found in this situation. Of course, the state and our employers don't see us as patients, even though we are the receiving end of that needle. They see us as workers and vaccination is like insurance for them. Human subjects in research are lucky. They have informed consent. I don't and I feel like a guinea pig in this process.

04 May 2009

H1N1


Traveling in the subway yesterday, I was paranoid about every sniffle and cough I made. Will other people flee from me? Or will my fellow passengers kick me out of the car? Luckily the cough drop worked and I was inconspicuous. Can you blame me for the paranoia? There's a panic-demic going on. A friend told me how his company purchased masks in bulk so the employees in the office can wear them. How about staying home from work? (I know, it's a luxury not everyone can do.)

The NY Times ran the above chart and left out the current Influenza A/H1N1 outbreak. The scapegoats this time are Mexicans. No kerosene baths for them this time (See Typhus Outbreak.) But the dowsing they get from TV viewers calling in or e-mailing to news shows are as scabrous. Mexicans did not bring the swine flu to the U.S. by sneaking across the border! The first cases stateside were from U.S. tourists.

From New York Magazine: Swine Flu Is Turning Us Against Each Other

04 February 2009

World Cancer Day

PSA: In brief, the message is fat kids will get cancer. So tell them to eat right and play.
Wednesday, 4 February 2009, is World Cancer Day!

On World Cancer Day, the International Union Against Cancer (UICC) will launch “I love my healthy active childhood”, the second full-year theme in our “Today’s children, tomorrow’s world” cancer prevention campaign.

The prevalence of overweight and obesity is rising dramatically among adults and children around the world.

According to the World Health Organization, 1 billion adults are overweight, and at least 300 million of these are clinically obese.

The International Obesity Taskforce estimates that one out of every ten school-age children is overweight. Of these, around 30-45 million children, that is 2-3% of children aged 5-17, are obese.

Being overweight or obese has been shown to increase the risk of cancer among adults.

World Cancer Day 2009 marks the start of a year-long campaign, where UICC will work with parents, teachers and decision-makers around the world to encourage kids to eat a healthy diet, be physically active and maintain a healthy body weight.

For more information about World Cancer Day and the World Cancer Campaign, contact the UICC.

01 December 2008

Red

For community health clinical as a nursing student, my section set up camp outside of the school's cafeteria taking blood pressures, giving out free condoms and lube, and handing out literature to fellow college students much like the Jesus people handing out their tracts to heathens. We warned about having too much fun in college: drinking, having sex. Or about not having fun at all: depression.

During one of those weeks, I created an educational poster to highlight HIV/AIDS. I thought it would be cool to hand out red ribbons to raise awareness. I found myself explaining what the ribbon is for more than what HIV/AIDS was about to the "younger" generation. That gap, of seven or eight years between me and "them," felt wide. To them, "Rent" is a period piece, as old as "La Boheme." Not even a whiff of the menace the disease once felt like, the anger of those early times only a cooling ember.

This one young woman asked me, "Wearing the ribbon means you have AIDS?"
If not for the fact that I was being graded, I would've laughed at her stupidity.
I hope she's learning some other things in school.

22 November 2008

Better




Where do I fall under the bell curve?
If I knew I ranked average, would I throw in the towel?
Probably not. I would strive to be better.
I asked myself this throughout orientation: "How can I do it better the next
time?"
Thought I'd stop asking that at some point. I haven't yet.

Aiming to be a positive deviant by following Gawande's suggestions:

1. Ask an unscripted question.
2. Don't complain.
3. Count something.
4. Write something.
5. Change.

-Atul Gawande, Better: A Surgeon's Notes on Performance (2007)
I promise I will Apgar something for my P(ile)h(igh)D(eep).

Put the funds on performance, he writes.
Implement "evidence-based practice."
Agreed.

23 October 2008

Smoke

"We didn't know that it was bad for us."
Because Big Tobacco brainwashed you with these ads!
These relics are hilarious. From an exhibition Not a Cough in a Carload: Images from the Tobacco Industry Campaign to Hide the Hazards of Smoking.
Plenty more to browse on their website.
Seemed like everyone endorsed cigarettes: movie stars, babies, nurses, dentists, physicians, athletes ...

Below is the US Post Office's new stamp to commemorate BD. The portrait is from ALL ABOUT EVE. What's missing between her fingers?

23 September 2008

P.S. to Arsenic and Donne

Appending previous posts.

"Arsenic":
Who knew? Arsenic still fills the beauty counter according to the article below.

Ancient, but How Safe?
By ABBY ELLIN
Published: NY Times, September 18, 2008
The health industry has questions about metals like lead, mercury or arsenic being found in ayurvedic supplements.

"My First Code":
I mentioned "Wit," Margaret Edson's play, on that post. My lit profs in high school lobbed that John Donne poem "Death Be Not Proud" at us every semester. (On one hand, I'm fed up with it, but on the other, I thank them for it because a Donne poem actually appeared in the essay section of the AP Lit Exam. I now wish I had written how the man loved his commas.) No escape from that poem. Dame Eileen Atkins' lecture from the "Wit" movie breaks it down for you: