The Business of Caring

St. Vincent’s Is the Lehman Brothers of Hospitals
Its demise was only the beginning. An alarming number of New York’s major medical institutions are teetering on the financial edge.
By Mark Levine from "New York" Magazine

An astute blow-by-blow description of St. Vincent’s demise. I don’t think of HHC hospitals as safety nets, because all hospitals are safety nets. Once you walk into an E.R., whether you can pay or not, you will receive care.

“They often come into the hospital through emergency rooms, which are required by law to treat anyone regardless of ability to pay and where the cost of care is much higher than it is in other settings. New York hospital patients tend to stay in the hospital longer than others; the city’s average of 6.6 days per hospital stay is more than a day longer than the national average (older people can’t be sent home to walk-ups until they’re capable, non-English speakers require translators to provide discharge instructions, and so on.”

Spurred on by Joint Commission, there’s a new focus on length of stay. An anecdotal example: Families who reside in the U.S. bring their family member from their native countries to the hospital straight from the airport because he or she is sick. The patient stays in the hospital for the work-up and cannot be discharged because diagnostic tests cannot be done outpatient due to lack of insurance. What happens to length of stay?

There’s a comment about salaries in the article, but no one seems to say outright that the taxes from the salaries pay for the uninsured. To put it differently, I’m paying for you to be cared by me – I’m paying myself to work. And I get your attitude on top of that? Sorry, but I did not get myself to a nunnery.

New York City expects all of its hospitals to be charity wards and not in the business of flipping beds. I’m all for benevolence and indiscriminate caring. However, the business of caring as we know now does not make room for charity. As the article puts it, “In New York hospitals, it helps to be smart, but it helps, above all, not to cater to the poor.”

Teabonics

I was told to look it up and I did.

For maximum smarts, run it on slideshow and spot the grammatic errors as fast as you can.

For more: Teabonics

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:

Out of Cash, St. Vincent’s Is Set to Close

By ANEMONA HARTOCOLLIS

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.

VIP

You know there's a VIP in the building when news vans are parked in front ...

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.

Grades

First day of school for this term.
Already 6 chapters behind.
Cue the circus music ... and the juggling begins.

Coincidentally, from The NY Times:

The Choice: A Tougher ‘A’ at Princeton Has Students on Edge
By JACQUES STEINBERG
Published: February 1, 2010
Some 'Type-A' students on an Ivy League campus worry that the job market may punish them for grades lower than at other institutions.

I can vouch for my school (non-Ivy)-
That those who come to expect an easy A
Are sorely mistaken.
A few classmates from another private university, nonmatriculated,
Took Physics during the summer in my school -
Because they thought our Physics would be easier than their school's Physics.
Also it would increase their GPA at the other university - if they earn that A.
An underestimation on their part. (Not to mention that laws in Physics do not differ from school to school.)
And this was a prerequisite class for med school!

I am Type A.
Grades matter to me.
Up to a point.
An easy A is a waste of time if I learned not a whit.

Pantone

The dress served as the sole suspense in yesterday's Inauguration.
Upon spotting Michelle Obama’s dress, Pantone came to mind. Think of that purple dress she wore during the campaign – a speck away from Blue Iris, Pantone’s Color of the Year for 2008. And now, a golden gown to usher Pantone’s Color of the Year for 2009: Mimosa, which “embodies hopefulness and reassurance in a climate of change.” Is she a trendsetter? Or trend seller?

Hmmm. Nancy Drew sniffs a money trail …

Layaway

With "layaway" now resurrected in modern usage comes other ideas for thrifty living.
This lives up to that word:

Recycle Your Romances
The joys (and savings) of sex with your ex.
By Em & Lo
From: New York Magazine
Published Nov 2, 2008

Normal dates—with the requisite mani-pedis, barbershop shaves, drinks, and movie tickets—can easily add up to more than $200. But just because you’re single and can’t afford big nights out doesn’t mean you need to forgo sex altogether. Just sleep with your ex. Booty-calling an ex, at least one you’re on good terms with, is a low-risk, high-yield investment. You’re familiar with each other’s flaws already, so no need to mask them with pricey beautification or elaborate mating rituals. Just order in Chinese—or better yet, nuke some Ramen, then get busy. Bonus perk: Your ex knows his or her way around your body, and vice versa, which means a guaranteed good time for all.

Annual Savings: $2,400
(Compared with twelve $200 dates.)

Hoover

Overheard at the arena before Janet Jackson's concert:
"Which artists do you think are recession-proof?"

Since the economic woes, "We'd Like to Thank You, Herbert Hoover" from ANNIE keeps popping up on my iPod.
Also brings to mind STEEL PIER. Could a dance marathon be around the corner?

Lyrics to "We'd Like to Thank You, Herbert Hoover":

ALL
Today we're living in a shanty
Today we're scrounging for a meal

SOPHIE
Today I'm stealing coal for fires
Who knew I could steal?

MEN
I used to winter in the tropics

WOMEN
I spent my summers at the shore

FRED
I used to throw away the paper--

ALL
He don't anymore!
We'd like to thank you, Herbert Hoover
For really showing us the way
We'd like to thank you, Herbert Hoover
You made us what we are today

Prosperity was 'round the corner
A cozy cottage built for two
In this blue heaven
That you gave us
Yes!
We're turning blue!

They offered us Al Smith and Hoover
We paid attention and we chose
Not only did we pay attention
We paid through the nose.

In ev'ry pot he said "a chicken"
But Herbert Hoover he forgot
Not only don't we have the chicken
We ain't got the pot!
Hey Herbie

WOMEN
You left behind a greatful nation

ALL
So, Herb, our hats are off to you
We're up to here with admiration

SOPHIE
Come down and have a little stew

ALL
Come down and share some Christmas dinner
Be sure to bring the missus too
We got no turkey for our stuffing
Why don't we stuff you
We'd like to thank you, Herbert Hoover
For really showing us the way
You dirty rat, you Bureaucrat, you
Made us what we are today
Come and get it, Herb!

Con

Confidence.
A word often heard these days.
Bandied about like a hacky sack by pundits on the air.
"Boost consumer confidence," "investor confidence."
Think twice.
Do not get played.
They are not called "con men" for nothing.

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:

Bed

Bed sharing 'drains men's brains'
From BBC News
Bed sharing disturbed sleep quality.
Sharing a bed with someone could temporarily reduce your brain power - at least if you are a man - Austrian scientists suggest.

Is the claim true for gay men since the study sample only included hetero couples?
Am I getting dumber? Is my BF getting dumber?
Is that why I find Professor Layton's puzzles harder now more than ever?
Maybe they had it right in the old movies and TV shows when couples slept in separate beds.
However, I don't doubt this statement from the article:

"Bed sharing also affected dream recall. Women remembered more after sleeping alone and men recalled best after sex."

Band-aid Your Empty Lives With These

It’s No Boo-Boo: Bandages as Fashion Accessories
By KAYLEEN SCHAEFER
Published: August 7, 2008, NY Times
Since the adhesive strip has been upgraded by designers or studded with Swarovski crystals, some adults have begun to view it as any other accessory.

So ridiculous that I have to share this from the Thursday funny pages, otherwise known as Thursday Style Section of the NY Times. They wear band-aids for no apparent reason except to be hip. My favorite part's at the end of the article:

Patricia Graf, a designer in Aachen, Germany, wears Mr. Seibert’s designs as a ring, on a foot or under an eye as a sparkly version of a football player’s greasy black stripe. Somebody once offered to buy her bandage from her at a party.

“Gross,” Ms. Graf told this reporter. “It was used.”

As for Mr. Brown, he’s worried his supply is running low (he bought only six boxes, after all) and plans to use them sparingly from now on. New York Fashion Week is just four weeks away, and for that, he said, “I definitely have to be rocking a bandage somewhere visible.”

Can't wait for patients asking for designer bandages in the hospital soon. "Would you like the Swarovski or the Tiffany duoderm on your pressure ulcer?"

Beijing Opening

DVR-ed the 4 hour ceremony since I was at work. Watched the "artistic portion" and sped through the Parade of Nations to the lighting of the Olympic flame.

Curious about what Zhang Yimou would do with live spectacle compared to his cinematic spectacles. (I like his quieter movies: "Not One Less" and "The Road Home.") Marveled at the technology he used: the LED screens on the floor and top rim of the stadium. The flying and wire work got a little tired. More amazed at the low-tech undulating printing blocks that formed Chinese characters, drops of water, and the Great Wall - a segment at the end of which I found myself applauding. The sphere with performers traveling around it was cool until Sarah Brightman pierced my ear drums. I don't know but there's something so "Triump of Will" about the whole ceremony that I can't help Zhang Yimou may be the next Leni Riefenstahl.


The spectacle confirms that poorer countries would never be able to host the Olympics in the future. When will the IOC let an African country host the first Olympics in that continent? It is the only continent in the 5 Olympic rings to never host one.

Now, onto the swimsuit competition -er - the swimming competition.
The games I will most likely watch for sportsmanship: Beach volleyball and gymnastics.
The games I will most likely watch for hotness: Swimming, Soccer, Water Polo, Basketball.

The Next Filipino Import

Douche: "What do you do?"
Me: "I'm a nurse"
Douche: "Of course, you are. You're Filipino."
I'm a stereotype in so many ways. (But let me be the first to make fun of myself.)
So imagine my relief to hear that pretty soon, we'll be importing teachers in addition to nurses.

Lessons Far From Home
by Phuong Ly from The Washington Post
At a Forestville elementary school, Mabel Ventura learns what it will take to give her family in the Philippines a better life

The bleak side of the story is that Baltimore can kill you (Sorry, John Waters.):

Pinoy Teacher Driven to Suicide in Baltimore
By Rodney J. Jaleco
ABS-CBN North America News Bureau

Spray On!

My Quest? Build A Better Condom
By Callie Lefevre
TIME, 7/31/08

Jan Vinzenz Krause, inventor, 30

German entrepreneur and sex educator who designed a spray-on condom made of liquid latex

There are lots of reasons scientists are looking for ways to make condoms more appealing--and safer--to use. TIME's Callie Lefevre asked Jan Vinzenz Krause about his efforts to make a spray-on condom.

How did you get this idea? I went to get my car washed. In Germany, you drive through a tunnel, and there's water coming from all sides. I was sitting in my car, and I said, "Yes! This is the idea! I will try this with a condom." So I went to a hardware store--I felt a little like MacGyver--and I bought a tube, put some holes in it, attached these nozzles and connected them to a box of liquid latex. The latex sprays out of the nozzles.

What's the advantage? The condom fits 100% perfectly, so the safety is much higher than a standard condom's, and it feels more natural.

Did product testers worry that spraying on latex protection would ruin the mood? Yes, that was mentioned. The prototype takes a few minutes to dry. For people to buy it, it needs to be ready in five to 10 seconds.

Any other hesitations? They were a little bit afraid to use the tube.

Are you waiting for someone to come up with a better latex formula? Right now, I have to focus on things I think will be successful in the immediate future.

So what's your latest project? A condom brand in six sizes. We developed this brand for the Web. Men on the Web--they are very honest.

Could you imagine kids getting a hold of this? The way I got a hold of my parents' condoms when I was in grade school. I thought the condoms were balloons, but my aunts insisted they weren't. So I demanded to know what they were. Being conservative, they didn't explain it further. Believing they were balloons, I blew them up and took it outside in the street to play, much to my aunts' mortification. They weren't good balloons to play with. They popped after they landed on a blade of grass.

So, what if a kid gets a hold of a spray on condom and sprays it on his schoolmates? He'll probably just think it's silly string.

"I'm a Bleedin' Romantic"

"What's your blood type?" How's that for a pickup line? It's not as weird as you might think.

My friend started talking about blood type as a sign of romantic compatibility. I simply thought she was wacky. But upon trawling the net for some research, the idea that blood types can be a matchmaker, much like how others believe that astrological signs can indicate compatibility, is an idea that's been around for a long time. And researched, too, by a Japanese scientist. It reminded me about the four humours the Greeks assigned to bodily fluids.

From Elle Canada:
Romantic chemistry is in your blood
Astrology aside, your blood type works as the new matchmaker.
By Steve Burgess

So, here's the breakdown and see if it's true to your type:

Type O: Type O’s are outgoing, and very social. They are initiators, although they don’t always finish what they start. Creative and popular, they love to be the center of attention and appear very self confident. Worst Traits: Vain, careless, ruthless. O is most compatible with O, and AB.

Type A: While outwardly calm, they have such high standards (perfectionists) that they tend to be balls of nerves on the inside. Type A’s are the most artistic of the blood groups. They can be shy, are conscientious, trustworthy, and sensitive. Worst Traits: Fastidious, over earnest. A is most compatible with A and AB.

Type B: Goal oriented and strong minded, type B’s will start a task and continue it until completed, and completed well. Type B’s are the individualists of the blood group categories and find their own way in life. Worst Traits: Selfish, irresponsible, arrogant. B is most compatible with B and AB.

Type AB: Type AB’s are the split personalities of the blood groups. They can be both outgoing and shy, confident and timid. While responsible, too much responsibility will cause a problem. They are trustworthy and like to help others. Worst Traits: Critical, indecisive. AB is most compatible with AB, B, A and O.

(Source: http://www.falloutcentral.com/news/2008/06/01/bleeding-love/)

Let's see how many of you know your own blood type.

When Patients Attack!

From NY Times:

Nurses Step Up Efforts to Protect Against Attacks

By DAVID TULLER

Published: July 8, 2008

Advocates for nurses are lobbying for increased penalties for violent patients and urging that all incidents be reported.
(Click HERE to read more.)

We were just discussing about this at work because one of our patients became verbally and physically abusive to one of the nurses. My co-worker asked, "How come we can't do anyting when they try to hit us?" She meant file charges or at least file a complaint. My answer basically was that it comes with the job. I expected patients to be like that, since I've grown up hearing my mom's tales of when patients attack. Now, I have my stories, too. One is of a 90-year old lady trying to take a swing at me. My other question to my co-worker: Can a patient be responsible for his/her actions when they are confused (whether from psych or physical reasons)? I don't really have an answer. Different hospitals deal with that in some way, I'm sure. Hasn't come up for me yet, so I haven't investigated.

Spurred by the article, I tried to see if NY was doing anything along those lines. In NY state, NYSNA is lobbying for Bill A06186. The bill would make assault on nurses a class C or D felony, equal to assaulting a police officer. However, the bill seems very specific in only being applied to emergency situations, as in first aid, or in ER cases. What happens to nurses in inpatient med/surg units? Maybe I should just work with babies. They don't hit you at all. The OR maybe? They're too knocked out to even lift a finger. Bill AO6186 is currently referred to the Codes Committee.

See, that Nursing and Society class actually paid off.

Fall Fashion

Women from Texas polygamous sect launch clothing line

Wed Jul 2, 7:50 AM ET

WASHINGTON (AFP) - The raid by Texas authorities on a reclusive polygamous sect in April and their seizure of 400 children amid allegations of abuse has had an unexpected consequence -- the launch of a new clothing line.

From: Yahoo! News.

Guess what my costume will be come Halloween?
I'm gonna have to lose some weight to fit in the Teen Princess Dress (See Below).