Road Trip

We just completed another memorable family adventure. It was every bit as harrowing as bungee jumping into a burning vat of ravenous rattlesnakes. We took a trip to Chicago.

A normal family would fly to Chicago or take a train or drive any of the hundreds of modern expressways. A normal family might forego Chicago and go to anywhere else on the planet. We are not that normal family.

After extensive research consisting of watching “Chicago Fire” and a musical named after the city, I decided we’d save 3 or 4 dollars staying in the camper in Indiana and driving to the city. We’d get the city experience and wind down in the pastoral countryside. That sounds almost sane, doesn’t it? Wait, there’s more.

To make this a perfectly memorable trip, why not forget the Interstate and drive up old US 41? We did just that. I know now why they made interstates.

It takes a while just to get to Highway 41, as we all know. In the southern part of Indiana, it’s a good 4-lane on which you can make pretty good time if you make it through all of the 8,000 traffic lights some sadist installed. After Terre Haute there aren’t any more stop lights for a long time because the road turns into a 2 lane winding goat trail laid out by a drunk. Dragging a 6,000 pound trailer around tree infested hairpin turns makes this an especially remarkable experience.

Eventually the 4-lane unrolls again and you’re off to the next red light, and the next, and on and on.
Our destination of Cedar Lake scrolled past before we knew it. I had the pleasure of turning into a dead end alley and backing a trailer between a light pole and a covey of gang-bangers so we could turn around. After some swearing and screeching brakes we got on the right track until we got lost again.

Our RV Park claimed to be on 137th Avenue, which didn’t really exist. I later learned the address was implied and everyone else knew exactly how to translate the address to English.

While I’m thinking about it, no self respecting town needs 137 streets. Ten numbered streets are quite enough. If you exceed 10 streets, you need to make it another town. I can say Bob lives in the same town as Bill, but if they live 15 miles apart that’s not really true. They live in different places. If your town is that big, and you say “I’m going to the store in town” and you disappear, nobody will know which store you went to. Keep towns small. It’s safer.

So after 5 phone calls and 3 threats by other drivers, we found our designated RV spot. It was nice, so it was worth the effort getting there.
Not having learned anything the previous day, we continued up Highway 41 to Chicago the next morning. Without the trailer, how hard could it be?
Being an old road, 41 takes a lot of turns but is well marked every once in a while. Somewhere on the South side, a sign is missing. I didn’t know that at first but I figured it out.

I learned a sign was missing and I’d missed a turn after about an hour on 87th Street. To the uninitiated, that is a bad South-side street. The neighborhood got exponentially worse as we drove. I wasn’t sure where I was at. I could have gotten my bearings from the sun but it was hiding due to the bad neighborhood. My wife turned on the GPS but it just kept saying “You’re an idiot”. The thousands of people on the street looked angrier and more dangerous the more I drove. I think some of them were zombies hungry for my meager brains.

We finally asked directions which directed us to drive in circles for a while. After seeing the same gang graffiti on a wall over the same wino 14 times we turned against directions and eventually found a major road. The GPS said, “That was luck” and then directed us to downtown where we got lost in a much better neighborhood.

We decided to go to the Navy Pier because we couldn’t find any of the other attractions. We found a parking garage too small for a truck but paid $43 to park there anyway.

The rest of the adventure wasn’t nearly as exciting or dangerous. We learned to be as rude as the natives and managed finding the truck at the end of the day. The sun frequented the area of the city we were in, so we found our way back to the RV on the mystery avenue. It ended up being a good trip.

The next time, I think we’ll try Route 66. Want to come along?

I Forgot to Remember

By Charlie Melton

I sit down on the loveseat and turn on the TV for some midday viewing. I notice the seat doesn’t feel right.

I turn the loveseat over and see a spring is broken. I can fix that with some wire. I think I have some in the junk drawer in the kitchen.
I go into the kitchen and open the drawer. What a mess. I start digging through it hoping to find some wire.

I start emptying the disaster of a drawer. I toss nasty wooden skewers in the trash. Odd paperwork goes into a zip-lock. Odd change goes in the piggy bank. I scrape the hundreds of screws and bolts into a jar, and I’m done. The drawer looks fabulous. I make a sandwich and go back to the living room.

Wait, the loveseat is upside down. What happened in here? Then I remember I went in the kitchen to get wire to use in a repair. It’s a good thing I’m home alone. Nobody will ever know that I forgot what I was doing.

A faulty memory is a scary thing. Every lapse brings a little thought that this is the sign that we’re losing our minds. For me, it’s a harbinger of eventual inability to control my mind. I picture myself wandering aimlessly around town in my bathrobe unable to remember where I live.

Have I told you this before? I don’t remember.

I don’t know about anybody else, but the eventual loss of control of my faculties scares the heck out of me. I’m a well documented control freak and I often say I won’t ride a roller coaster because they won’t let me drive. Control issues also have made my work life what you could call “chaotic”. It’s the same issue with impending memory problems. They mean I won’t have control.

I really became concerned when I overheard an Alzheimer’s patient doing an oral test to determine his level of dementia. He was asked several basic questions about the year, where he was, the name of the President, and other simple things. He got a higher score than I did.

Being a control freak with a big fear of not being able to control my mind or memory I work to overcome or delay impending dementia. The internet is full of techniques to improve mental agility and memory. I’ve probably tried them all at one time or another.

First up is nutrition. Reportedly if you eat certain things your memory will stay and even get better.

Certain oils like olive oil, coconut oil, and fish oil helps the brain. I didn’t notice my memory getting better when I ate the oils, but my bowels noticed the oil intake and kept me well informed.

If you eat lots of berries, nuts, and seeds your memory will improve. Those worked well because I definitely remember they were very tasty in the cakes and pies I put them in.

Certain foods reportedly harm memory. Two of these are coffee and sugar. Let’s just forget about them.

Next, mental exercise is supposed to help the brain. This method is more to my liking.

Reading is good for you. I kind of dig reading, so I do all I can get away with. Recently, I even started reading instruction manuals for items I buy. It helps my brain and keeps me from breaking any more new appliances.

Puzzles and games are good for your mental agility. Crossword puzzles and Sudoku are good. Chess is a good game you can get for free and play on a computer or smart phone. It helps you think systematically. In chess you have to think several moves ahead, which for me is the mental equivalent of running a marathon.

My wife plays those games where you have to find microscopic things in a hodge-podge of unrelated scenery. She’s very good at it, and it must help. She remembers everything I ever did to make her mad.

I try to stave off the imminent loss of faculties, but what if it sneaks up on me? I work in a nursing home. To be honest, I think I work in a nursing home. I could be a resident in a nursing home. I learned a little technique from a family member. It helps me know the difference.

Every day when I get ready to leave work I check to see if I have my car keys in my pocket. If they are, I work there. If they’re not, I no longer drive because I’m a resident. This works for me, except for the day I left my keys on my desk. I had a few minutes of panic until I located them, but I’m good now.

Oh, and don’t ask to borrow my keys. You’re not getting them. I will play chess with you, though.

Fly Your Flag

It may not seem like a big deal. In the aftermath of the shootings in South Carolina almost everyone wants their flag, which is the Confederate battle flag, gone. When the issue first came up, I thought it was a non-issue. It’s the flag of a losing side in a long-ago war. It’s the flag of people that wanted to keep slaves. Since the war, the flag has served racist organizations and “good old boys”. I could care less about having a Confederate flag.

The entire Confederate flag issue is far removed from us, and has no real affect on our lives. Am I correct in that thought? No, I’m not correct.
Then, as I thought about it, how can we dictate another person’s symbols? To some, the Confederate flag stands for the sanctity of the state over the federal government. For others, it’s a sign of Southern pride that they seem to have plenty of. Others see the Confederate flag as a “Dukes of Hazard” type of redneck independence. You may have one because you like the pretty colors and really dig stars and bars.

I’m seeing the Confederate flag as a freedom of speech issue. I have the right to say what I want. You don’t have to like it. I make a statement by what symbols I choose, and that is my right. With the state being made of individuals, if enough want the flag to be their state flag, then it should be so. If you don’t like my speech, or my symbols you can ignore them or go away. It’s your choice.

So major retailers have jumped on the wagon and will no longer sell that flag. We can choose who we buy from, and what we buy. If we feel strongly enough about the issue, we can stop giving our money to businesses that oppose our views.

With all of that being said, it gets tiresome that groups try to dictate what everyone does. It gets tiresome that the thought police have to impose the current political correctness on us. They really do believe that they know what is best, and we are too stupid to make even the most mundane decisions on our own.

The attack on symbols is an attack on people. We are the people under attack.
Most of us hold the American flag dear. It is also under attack. Our favorite activist Louis Farrakhan has already started attacking the stars and stripes. He says that the flag must be “put down” because people have suffered under it even more than they’ve suffered under the Confederate flag.

Some neighborhoods try to restrict the American flag because someone may be offended. Even our local Walmart carries very few of our flags, and usually hides them in the corner in the bowels of the store.

With most of us being Christian, we have a deep reverence for the cross. It has been under attack for as long as I can remember. The people that regulate the rest of us have a pretty good record of limiting cross displays. It’s well documented that every aspect of Christianity is under attack, and that attack on the symbol is just part of it. Even Bibles are forbidden in some venues.

By attacking a person’s symbols, you attempt to outlaw the person. By outlawing symbols you outlaw a certain way of thinking and acting. By outlawing a way of life you eliminate the people that live that way.

I had a sociology professor that taught that when we brought Chinese over to build our railroads, they brought their way of life and their opium. When we finished with them, they were still here and we didn’t like it. We outlawed opium to outlaw Chinese. The same thought processes apply to many of us today. We are slowly being outlawed.

Here’s how I think it should go. Suppose my daughter brings home a guy in a leather jacket with a big swastika tattoo on his neck. I don’t like him on a great number of levels. I tell him I’m offended by him but I don’t hold him down and try to remove his tattoo. He may think I’m a jerk but he doesn’t expect me to learn to like his tattoo. It’s his right to have the tattoo, and my right not to like it. We hopefully go our separate ways and that’s the end of it.

We have to quit giving up our way of life and its symbols. We have a right to be. They have a right to be. As my least favorite son-in-law once told me, “I’m a grown man. You can’t tell me what to do.” He was right, and I admitted it even after I chased him out of my door.
Clint Eastwood nailed it in the movie “Gran Torino” when he said “Get off my lawn”.

The Challenges of Healthcare, Part III

The Challenges of Healthcare, Part III

By Charlie Melton

We were talking about the problems in health care. I pointed out that I believe nurses have to spend entirely too much time charting. They have less time to care for patients because of it. We all get less care and nurses can’t give all of the care they wish to give.

We were discussing why so much documentation is required of nurses. Some even have to chart that they washed their hands and put on gloves.
Nurses do acknowledge the need to document patient care that contributes to patient management and treatment. This communication between caregivers is essential. We’re not talking about the necessary charting. We’re talking about excessive charting.

We went through the belief that the threat of lawsuits is the driving factor for excessive charting. I said that malpractice suits are brought by people that feel they’ve been wronged or are looking for money, or both.

Why are people suing due to being wronged or looking for a payday?

The answer is that the state allows, and even encourages it. The state is complicit in excessive paperwork by nurses. In Illinois, the limits on malpractice suits are mostly non-existent. The caps enacted were ruled unconstitutional so there is really no limit on how much you can be awarded. This in itself is very enticing and very dangerous for nurses. It should be noted that states that have limits on malpractice awards have fewer lawsuits. I do not know if this equates to less charting by nurses.

Illinois also lets you sue in counties other than where the incidents occurred. Many cases end up in St. Clair, Madison, and Cook Counties because the counties give out more money.

Against my best efforts I ended up on a malpractice jury in St. Clair County when I lived in that county. The medical practice and the home of the injured party were in Monroe County. The attorney followed the money, and expected an enormous amount of it. After the longest 2 weeks of my life, we gave the person and his attorney absolutely nothing. That case, which should have been in the home county, was the exception. Most juries gave huge awards in that courthouse.

Lawyers are part of the cause of nurses being under fire. Greedy clients are part of the problem. The state itself is at fault as well. With all things being equal, I think the state limiting money available in malpractice suits will reduce a lot of the fear of lawsuits that causes excessive documentation by nurses.

I spoke to an attorney about my concerns. He doesn’t see a problem with nurses documenting so much information. His opinion is that as a professional you document. He relayed that he spends a lot of time documenting his actions. I thought it was funny that part of the reason is to protect himself from being sued by a client.

In my unqualified mind I think the medical establishment is to blame as well. Medical organizations are notoriously top-down. They give instructions and mandate actions often without input from any staff members affected by the mandates. Leaders make sweeping policies and have no patience with any dissenting opinions.

The issue of nurses’ reduced opportunities to care for patients is “standard practice” and taken for granted. It doesn’t have to be. Other industries have developed and embraced all sorts of process improvement techniques. Systems like “Lean”, “Six- Sigma”, and other methods have saved entire industries from oblivion. Some medical corporations have embraced process improvement, but not to the extent they’re needed. Leaders have to give up power to embrace the changes needed to free up nurses to do what they’re supposed to be doing. Leaders must learn that decisions need to be made at the lowest level possible.

We’ve talked a long time about excessive charting being required of nurses. We should be concerned because we want better care and more expedient care. Nurses are concerned because they want to care for people and heal. They know, and we know, that paperwork never healed anyone.
This is an opportunity for us to improve our lives. This is an issue to bring to legislators. This is an issue to bring to your medical providers.

I want to urge the state to enact limits on lawsuits. I want cases to be tried in the appropriate county. I want to get the care I need. I want to go home without waiting on a ton of paperwork. I hope you want the same thing and help achieve it.

The Challenges of Healthcare, Part 2

We were talking about the problems in health care. I pointed out that I believe nurses have to spend entirely too much time charting. They have less time to care for patients because of it. We all get less care and nurses can’t give all of the care they wish to.

The National Institutes of Health commissioned a time and motion study of 767 nurses at 36 hospitals. The study found that nurses spent the vast majority of their time (35.3%) in documentation, med pass (17.2%), and care coordination (20.6%) for a total of 73.1%. Only 19.3% of their time is spent on patient care and 7.2% of their time on patient assessment.

I brought this concern to nurses, and they believe they have to chart excessively because of the danger of lawsuits.

Is there a real threat of lawsuits against nurses?

Historically we think of malpractice lawsuits as being against doctors or institutions. That is no longer the case. Nurses are frequently named in malpractice suits. Multi-million dollar awards from malpractice suits aren’t unheard of. One source claims that Illinois malpractice case fees collected by attorneys exceed $200 million a year. This amount is only a portion of the total money awarded. Nurses are often part of those lawsuits.

The threat of lawsuits is a real danger to nurses. The professional nursing associations encourage nurses to carry malpractice insurance. The fear of lawsuits may influence how they have to perform their jobs. Because institutions fear lawsuits, they may demand an ever increasing amount of documentation to protect from lawsuits.

What is the root cause of excessive charting? As I’ve stated, I lean towards lawyers causing this disruption. I approached one of my former professors from SIU. He’s the most analytical and methodical person I know. He never makes assumptions and always follows the data to its conclusion. He’s not convinced that this is the root cause of excessive documentation by nurses. When I announced to him that I’d identified the cause, he asked how I determined that the threat of lawsuits causes excessive documentation by nurses. He teaches to repeatedly ask why until you run out of “whys”. At that point you’ll be closer to the answer.

In this case, why is there a threat of lawsuits? There is a threat of lawsuits because people want to sue. Why do people want to sue? Because either they have been wronged or are looking for a payday, or both.

It should be noted that lawyers only do what the client allows them to do.

I know that some people sue to make money. There was just a story on the news about a policeman that was getting free coffee at a business and was burned by that free coffee. He sued. We all know similar stories. Some people sue because they can. It’s further verified by the fact that when the Illinois economy goes down, malpractice suits go up. It appears that you can supplement a lowered income with the proceeds of a lawsuit.

I’ve pointed out what I see as a problem. I’ve tried to start a discussion that someday may contribute to a solution.
How bad is it anyway? Is excessive time charting enough of an issue to even care about? Are there novel solutions to the problem?
Next week in my final installment I want to look at the results of all this paperwork. Has it really protected nurses? What is the impact on the patient? What can we do, and what can nurses do?

Illinois Healthcare- Nursing part 1

The Challenges of Healthcare, Part 1

By Charlie Melton

Everybody talks about how healthcare is a mess. Too many of us have no insurance or insufficient insurance. Too many of us have to choose between food or rent or medicine.

I don’t understand all of the aspects of healthcare. I understand very little. What I do understand is that health resources often go to the wrong place for the wrong reason.
If you’ve ever been to an emergency room you know the drill. You appear, wait, get assessed, wait for the doctor, and wait some more. The nurse tells you that you can go home and then you wait more. You end up concerned, then irritated, then border on furious.

You look out of the exam room you’re interred in and see nurses sitting at their station. They’re either peering into a computer monitor or writing on paper at length. If you stroll around and spy on the nurses they’re not writing a love letter or playing Angry Birds. The nurses are charting. They’re writing down every interaction with the patient, every observation, and every action taken or not taken.

While charting is an essential part of healthcare, to the uninitiated it seems to be excessive. With that concern I asked several professionals about charting.

I’m friends with several nurses on Facebook. I messaged them individually and asked each the same question. “My perception is that nurses spend most of their time on paperwork. What do you see as the biggest factor that makes this necessary?” About 10 nurses responded with almost identical observations.

Heather Tille is a self described “Ninja Nurse”. She works in a large hospital as an ICU nurse and she is a nursing instructor at a local college. She’s currently working on her master’s degree. She says that the amount of time charting varies according to the type of unit the nurse works in, but it ultimately takes away from direct patient care. Mrs. Tille says that nurses and their employers fear being sued and that influences the charting they do. She decries the fact that attorneys go for every conceivable person involved in patient care when suing for malpractice. She says this system makes fear and the quest for money the dominate factors in how a medical provider does business. Patient care suffers.

My good friend Brandie Walters is a RN. Brandie says, “If you’re involved in a lawsuit, if you didn’t write it down it didn’t happen. I even have to chart that I washed my hands and wore gloves. It’s a waste of time. I also have to chart the same information every time I see a particular patient. How about I spend that time taking care of someone? It’s the biggest thing I hate in my career. Charting is about money any way you put it.”

What I gleaned from nurses is that nurses, doctors, and companies fear lawsuits. Their perception is that they could do a better job for patients if the fear of attorneys wasn’t so pervasive.

Is that a rational fear? Do nurses really get named in malpractice suits? Does charting have a purpose other than to protect the individual care giver?

Am I naïve when I say that nurses are dedicated and caring professionals and the very idea of suing one is reprehensible?

Over the next couple of weeks I hope to explore what nurses do. Is the paperwork your nurse has to do excessive? Does it reduce the amount of care you receive? I’m not skilled enough to rewrite standard practices, but maybe we can start a discussion that will ultimately benefit us all. Please tell me what you think by emailing me at chasmelton@gmail.com or write me at P.O. Box 378, Norris City, Il 62869.

Road Rage

Sometimes things aren’t what they seem to be. Our experiences taint our perceptions. Our view of ourselves and others affects how we see things. I think this gives order to our world. It can also make us very wrong when we deal with circumstances.

Last week I was late to work because I had a certain view of the world. If I held a different view I would have been early enough for a cup of coffee and a few words with the girls before I clocked in. I had a good excuse for being late, but ultimately it was my view of the world that betrayed me and made me late.

I’m tooling to Enfield at my regular “look at the scenery” clip. I just achieve the speed limit North of Norris City when a car passes me and the driver starts tapping the brakes. I figure I must have taken his turn at the 4 way like a lot of us have the habit of doing. I salute in apology and slow way down to show I’m sorry.

He hits the brakes and slows down. I must have cut him off without realizing it because he really seems upset. I slow down even more to increase the distance between us and placate him. He speeds up and the situation seems over.
In a short time the other driver starts his antics again. Okay, this is getting ridiculous. I start mouthing oaths in his general direction. I find I still have all of the vocabulary I honed in my years in the military. Even though he can’t hear me, he senses my attitude. The situation just escalated.

My nemesis slows way down. I press the issue and get dangerously close to his bumper. He slows even more. I get a testosterone surge, and get ready for battle. He continues to slow.

The car’s turn signals come on and the driver points out of the window to a turn off. He turns in and so do I. He opens his door and I open mine. It’s time for battle.

“Something flew out of your truck back by Norris City”, he yells. “I thought you might need it.” I take a moment to process his words. “Thanks”, I respond. I continue to process the change in the circumstances. He gets back in the car and proceeds towards Enfield. I sit for a second and head back to Norris City to pick up my missing cargo. What just happened? How did I get this so wrong? Even if it was road rage, why would I get involved at my age?

I think my interpretation of the situation came from my experiences in life. I’ve lived in cities where a certain behavior facilitates survival. Some of my neighborhoods weren’t the best, and projecting a willingness to fight ensures continued breathing. Even my career rewarded aggressiveness and punished the timid. Experience may be the best teacher, but it’s still possible to get the lesson wrong like I did.
The point I’m trying to make is don’t make assumptions, and don’t jump to conclusion. A wise person I know says to think before speaking. I’d extend that to think before reacting. Something may have fallen off of your truck.