Saturday, January 31, 2009

Salmonella Outbreak Widens and Continues

As the nationwide salmonella outbreak related to peanut butter increases in its scope, the CDC, the FDA, and regional and local public health officials are doing their best to contain the epidemic and remove potentially tainted products from the shelf.

As a public health nurse, I'm frequently updating a blog which I publish for local online consumption, and I'm sincerely surprised that I haven't received a single telephone call from worried citizens seeking more information. Either people aren't overly concerned, or the information being disseminated by the feds is assuaging people's fears.

For the bloggers out there who would like to be more involved, the CDC and FDA are holding a webinar on Tuesday, February 3rd, 2:30-3:30 pm EST. To log in, call 1-800-857-9824 and dial pass code 1234, and visit this link. Please also email to let them know you plan to attend.


Friday, January 30, 2009

Purple Hearts and PTSD

It was recently announced that the United States Armed Forces have decided that war veterans suffering from Post-Traumatic Stress Disorder (PTSD) cannot be awarded the Purple Heart due to the fact that their injuries are non-physical in nature and difficult to diagnose. While it is true that the Purple Heart was originally created to honor combat veterans who had shed blood on the battlefield or suffered some other injury to their physical body, we must now acknowledge that the nature of warfare has changed, as has our knowledge of what constitutes an injury.

When a soldier loses a limb or experiences physical trauma related to gunfire or ordinance, it is readily clear that that individual has suffered an injury, an event that warrants special recognition by the country whom that soldier serves. However, I believe that the psychological trauma of combat can be just as devastating as the physical insults endured by the body, and the rehabilitation and recovery from such psychic wounds can be an arduous and lifelong process.

If the Pentagon is concerned about the difficulty of diagnosing PTSD, perhaps they should closely review the process through which veterans are screened for psychological damage as a result of warfare, as well as establish strict guidelines for their psychiatric teams who perform such assessments. Granted, the diagnosis of PTSD and other mental disorders is not necessarily as cut and dry as the diagnosis of a broken leg or a collapsed lung, but there are standards, protocols and various tools available for the assessment of individuals suffering from the effects of psychological trauma, and it would not be a difficult matter to operationalize such standards among the mental health professionals who work for the Armed Forces and perform such reviews.

It is my feeling that the Pentagon's misguided decision is based on the very American notion that mental illness and psychological problems are less than acceptable, and that those who experience them are somehow weak. But in the 21st century, we should finally be sophisticated enough to recognize that prior notions of mental illness as a sign of personal weakness or moral failing are as erroneous as ever, and those who suffer from such conditions are as deserving of compassion and accommodation as individuals with a physical illness or condition.

Apparently, the Pentagon is still uncomfortable with the notion of PTSD as a true injury of war, even when approximately one-third of veterans experience significant symptoms of depression or combat stress. In its decision, the Pentagon has clearly communicated---both to the public and to the men and woman of the Armed Forces---that PTSD is simply not a significant enough injury to warrant recogntion that that individual's sacrifice is worthy of our compassion and gratitude.

This unfortunate ruling sends a clear message to those who have put themselves in harm's way while serving their country, and it dishonors members of the Armed Forces who have suffered psychological injuries as a result of their service. I am very disturbed by the Pentagon's decision, and I hope that the outcry in response to such a narrow-minded definition of injury will cause a reversal of this ruling.

Psychological inuries are real, and their impact on quality of life and individual well-being is well-documented. Perhaps the Pentagon needs a thorough education about the enormous impact of PTSD and how disabling it can truly be. While a limb can be replaced with a prosthesis and rehabilitated with intensive physical therapy, damage to the brain and the psyche can be devastatingly difficult to recover from, and members of the Armed Forces who suffer such condtion as a result of combat should be properly recognized for the sacrifices they have made and the very real injuries that they have sustained, injuries which may very well last a lifetime.

(c) 2009 NurseKeith

Wednesday, January 28, 2009

Confessions of a Reluctant Insomniac

It's 2am. Do you know where your insomniac is?

It's been a few weeks since my diurnal nature has come into question. Wikipedia confirms that diurnal animals are indeed active during the day and rest during the night, and my personal experience confirms that, yes, I was once a diurnal creature myself. For the time being, at least, that seems to have changed, much to my chagrin.

So, what does a fatigued nurse do when the going gets tough at 2am? The trusty laptop is always a nice distraction, but if my mind is reluctant to be engaged, soft music or desultory attempts at meditation sometimes manage to keep my mind at bay. And then there's always TV, every insomniac's potential best friend, infomercials and all.

My sleeping patterns are apparently in flux, and as I navigate the beginning of my third week without pharmaceutical antidepressants, I assume that my nocturnal discombombulation is a direct result of that most apparent physiological and chemical change.

The acupuncturist/naturopath who is guiding me through my current health crises has been working diligently to cut through to the essence of my symptoms, focusing in on pain and depression as the issues most in need of immediate succor, an assessment with which I am in full agreement. Whereas no provider has been able to pinpoint a physical cause of my chronic pain, we are led to believe that the pain is indeed of psychoemotional origins, and no combination of narcotics and physical manipulations is going to assuage it.

Battling unseen demons has become somewhat of a personal habit, and these wars being raged in my body and psyche have apparently led to the taking of prisoners, and my ability to waltz with Morpheus appears to have been first on the list of casualties. My hope is that, through acupuncture, herbs and emotional inquiry, we will get to the bottom of the pain, knock the depression on its head, and (finally) help me to move beyond this current state of sleeplessness.

I understand from my recent readings that Barack Obama is a night owl, frequently burning the midnight oil at a time of day when he does his best thinking and ruminating. I'm glad to have such stellar company, although I certainly do not have the weight of the world on my tired shoulders.

Perhaps in a few weeks I'll be able to look back on this period of disrupted sleep with equanimity, hindshight, and greater self-understanding. But for now, I'll continue to entertain and distract myself as well as I can during these lonely wee hours of the night. There are blog posts to write, Twitter to catch up on, French to study (my newest endeavor in self-improvement), and a plethora of infomercials to avoid as I surf the channels of television purgatory. If you happen to be up, send me an email (see my Blogger profile) and we can have a late-night chat about the weather or the news of the day. Til then, enjoy your own sleep, treasure those uninterrupted hours of rest, and say a prayer for those of us whose circadian rhythms are hopelessly askew.

As was once so aptly stated, "to sleep, perchance to dream."

(c) 2009 NurseKeith

Sunday, January 25, 2009


Seeing the new independent film "Ballast" several days after Barack Obama's inauguration was a stark reminder that, once the party is over, economic and social change will be hard won.

According to Merriam-Webster's online dictionary, ballast represents "a heavy substance placed in such a way as to improve stability and control" or "something that gives stability (as in character or conduct)".

If ballast is indeed what this country needs in order to lift those who live in abject poverty out of their plight, then it will take a lot more than hundreds of billions of dollars thrown at banks and car manufacturers to accomplish what looks to be, at best, a Herculean task.

In many rural, urban, and---let's face it---suburban American homes, putting food on the table and into the stomachs of our children hasn't been so difficult in a generation. When it comes to making mortgage payments or keeping up with rent, that is a task made even more challenging by the scores of jobs being slashed each week as prices rise and families struggle to keep up. People with Master's degrees are applying at Wal-Mart and Starbucks, and retirees eke out their survival by joining the ranks of the unemployed at job fairs.

In the deep South, in California, in Harlem and Detroit, most everyone is waiting to see how the new economic recovery plan will create jobs, stimulate the economy, and bring some sorely needed ballast to a nation afloat in uncertainty.

Just as we all need stability and accountability in our personal relationships and communities, we also expect the same from our government and our leaders. With a new leader wielding the power and speaking from Teddy Roosevelt's proverbial "bully pulpit", all eyes are turned towards Barack Obama and his stated desire to reverse the course of trickle-down economics, creating instead a trickle-up economy that first feeds those in most dire need of an infusion of hope and hard currency.

I am personally waiting on the edge of my seat, hoping with all my heart that whatever is undertaken will accomplish what needs to be done. There are vulnerable people among us who need the succor of the state and a way out of their economic plight. May the tears and hopes of last week's celebrations give way to the hard work and clear decisions that lead us to where we truly need to be.

(c) 2009, NurseKeith

Wednesday, January 21, 2009

Crisis, Opportunity, and a New Reflection

There are ground-breaking changes afoot in Washington, DC. Hopes---and tensions---are high as the Obama Administration takes wing, and we all take a collective breath as the transition of power becomes complete.

As much as I am listening to the accolades being strewn across the land, I am also aware that walls of opposition will rise as soon as change comes into play, and the cynics will surely raise their voices high at every opportunity. Yes, the country is in crisis, with a dysfunctional health care system and a crippled economy collectively hobbling us at this moment in time. But a crisis is also an opportunity, and we can only hope that this opportunity for rebirth will lead to great things.

These past eight years have been, for me, a time of much consternation and despair, politically speaking. Several months after 9/11, my best friend was murdered by the police in a small New England town under questionable and egregious circumstances, and the abuses of power---both small and large---seemed to ripple out in ever-widening circles from that day forward. My friend was erroneously perceived to be a threat to others, just as those non-existent weapons of mass destruction posed a threat that eventually was proved to be groundless. We all chase phantoms at some point in our lives, and many a phantom has been hounded in these first years of a new century.

So, here we are, with the nation poised for change, and the rest of the world on tenterhooks, expectantly watching our every move.

Despite my own cynicism throughout most of the presidential race, I feel a responsibility as a citizen---and as a new local public health official---to see how I can play a part in the changes that are now underway. I have never felt such a feeling of truly wanting to be a part of something so large, so far beyond the personal. Perhaps this is what some felt when the New Deal was created in order to invigorate a nation on its knees, or when the country pulled together in the face of a world war that came on the heels of the Great Depression.

As I see the faces of the new administration---the women, the diverse ethnicities, and the diversity of the Obama extended family itself---I am enthralled to see that there is a new reflection when America looks into the Reflecting Pool on the Washington Mall. I feel a stirring of hope and a potential for greatness, all of which is mitigated by a guarded sense of optimism and a memory of how hopes can be dashed, especially when those hopes are placed in the unreliable hands of the political and legislative processes.

Still, despite the voices born of worry, cynicism and concern, I am the most hopeful that I have ever been as a politically aware adult American, and that in itself is a feeling worth celebrating.

(c) 2009 NurseKeith

Tuesday, January 20, 2009

Inauguration Day: Walking Forward

On this Inauguration Day, there were so many smiles, so many tears shed, such an outpouring of hope. We rejoiced with hundreds of others in our local independent movie theater, watching a live video feed of the day's proceedings on the silver screen.

Even as the naysayers begin to rev the engines of opposition, I am simply stunned that an African American man of such stature and eloquence now holds this most powerful office. And a beautiful African American family now begins their residence in the White House on this very evening, two young star-struck schoolgirls tucked into unfamiliar beds, perhaps only realizing how their lives have truly changed.

Personally, I am ready to give what I can, to volunteer my time, to share my thoughts, and to sacrifice when sacrifice is needed. It is an ebullient time, a hopeful time, and a time of tremulousness and uncertainty. I have frequently volunteered throughout my adult life, and will certainly volunteer more if I am called and inspired to do so. No matter the doubts that some of us may have about whether the wrongs can be righted and the crooked made straight. This is an unmistakable moment of opportunity for the entire world, and I am certain that this opportunity will not be squandered.

As a writer, I was moved by the poem written and read by Elizabeth Alexander this afternoon, a poem that celebrated the mundane even while it exalted the highest power of love. I am moved to share a transcript of that poem here with you, and to leave you with the notion that, no matter your political persuasion or civic affiliation, there is much to praise on this day, and much room for hope tomorrow.

Praise Song for the Day, by Elizabeth Alexander

Each day we go about our business,
walking past each other, catching each other’s
eyes or not, about to speak or speaking.

All about us is noise. All about us is
noise and bramble, thorn and din, each
one of our ancestors on our tongues.

Someone is stitching up a hem, darning
a hole in a uniform, patching a tire,
repairing the things in need of repair.

Someone is trying to make music somewhere,
with a pair of wooden spoons on an oil drum,
with cello, boom box, harmonica, voice.

A woman and her son wait for the bus.
A farmer considers the changing sky.
A teacher says, Take out your pencils. Begin.

We encounter each other in words, words
spiny or smooth, whispered or declaimed,
words to consider, reconsider.

We cross dirt roads and highways that mark
the will of some one and then others, who said
I need to see what’s on the other side.

I know there’s something better down the road.
We need to find a place where we are safe.
We walk into that which we cannot yet see.

Say it plain: that many have died for this day.
Sing the names of the dead who brought us here,
who laid the train tracks, raised the bridges,

picked the cotton and the lettuce, built
brick by brick the glittering edifices
they would then keep clean and work inside of.

Praise song for struggle, praise song for the day.
Praise song for every hand-lettered sign,
the figuring-it-out at kitchen tables.

Some live by love thy neighbor as thyself,
others by first do no harm or take no more
than you need. What if the mightiest word is love?

Love beyond marital, filial, national,
love that casts a widening pool of light,
love with no need to pre-empt grievance.

In today’s sharp sparkle, this winter air,
any thing can be made, any sentence begun.
On the brink, on the brim, on the cusp,

praise song for walking forward in that light.

Healthcare Reform and Grand Rounds

An Inauguration Day edition of Grand Rounds, the medical blog carnival for everyone, is up and running at MedPageToday. Health care reform is the main theme, and there is plenty of rich writing for you to digest at your leisure. Please do slide on by if you can.....

Monday, January 19, 2009

Building a Peaceful World

We will not build a peaceful world by following a negative path.
It is not enough to say we must not wage war. It is necessary
to love peace and sacrifice for it. We must concentrate not merely
on the negative expulsion of war but on the positive affirmation
of peace. We must see that peace represents a sweeter music,
a cosmic melody, that is far superior to the discords of war.

Somehow, we must transform the dynamics of the world power
struggle from the negative nuclear arms race, which no one can
win, to a positive contest to harness humanity's creative genius
for the purpose of making peace and prosperity a reality for all the
nations of the world.

In short, we must shift the arms race into a peace race. If we have
a will - and determination - to mount such a peace offensive, we
will unlock hitherto tightly sealed doors of hope and transform our
imminent cosmic elegy into a psalm of creative fulfillment.

-- Martin Luther King, Jr. (1929-1968)

Sunday, January 18, 2009

Digital Doorway Celebrates 4 Years!

Well, time flies in the blogging world, my friends, and today Digital Doorway turns four years old! Born in January of 2005 at the suggestion of my ever-supportive older brother, it's hard to believe that this blog has been in existence for so many years, with an average of 250 posts per year.

While this blog has centered mostly around thoughts on nursing, medicine, health care, and my professional experiences in nursing, I have also tried to imbue it with some philosophy, spirituality, notes on American culture, and stories of my own personal life and world. I always hope that the multifaceted nature of my posts is interesting enough for my readers, and although many nurses appear to read Digital Doorway, I also seem to have readers who are not directly connected to medicine or nursing.

Looking back, Digital Doorway has certainly provided me with a wonderful forum for honing my craft of writing, and has actually garnered enough attention to receive several award nominations specifically for bloggers, an honor that I do not take for granted.

Beyond awards, blogging here has indeed brought me paid work as a writer, both online and in print, as well as opportunities to feed this blog to other popular websites. Another version of Digital Doorway runs over at, and everything I write on DD feeds directly to my author page on My online presence as a nurse blogger has also brought me the opportunity to be published in two recent books of non-fiction by nurses recently released by Kaplan Publishing: "Reflections on Doctors" and "Final Moments". Most recently, I am now contributing content as an "Expert Blogger" for, as well. I am also quite content to regularly be included in two venerable and respected blog carnivals of nursing and medicine, Change of Shift and Grand Rounds.

Over all, blogging has been an exhilarating, gratifying and tremendously worthwhile experience. Digital Doorway has taken on a life of its own, and I am personally pleased with its current state of being. While I would love to have more comments and active give and take with readers, I understand that people are very busy, overwhelmed with the amount of information at their fingertips, and I am extremely gratified that anyone at all takes the time to read what I have to say.

Whether you are a regular reader, a first-time visitor, or a reader who wanders by from time to time, I thank you sincerely for visiting Digital Doorway, and I have no doubt that this blog will see many more birthdays as it continues to develop, satisfying both my need to write and (hopefully) your desire to read. It is an honor to blog about my life, work, and place in the world, and I am grateful for all of the company I have had---and will have---along the way.

With gratitude,


(c) 2009 NurseKeith

Saturday, January 17, 2009

Fiction, Prose and Ephemera

Dear Readers,

Just a reminder that my newest blog, "Fiction, Prose and Ephemera", is available for your reading pleasure. It is updated approximately once per week, and allows me a venue for posting fiction, poetry, and other writings that simply don't fit with the purpose of Digital Doorway, If you'd like, please pay "F, P, and E" a visit.

Friday, January 16, 2009

The United States of Tara

I am very dubious about the new Showtime Network comedy, "The United States of Tara", which is premiering on January 18th. Since I don't get Showtime at home, I probably won't even see the show until it comes out on DVD in a year or two, but that doesn't stop me from feeling queasy about a television comedy that will use Dissociative Identity Disorder (previously known as Multiple Personality Disorder) as a vehicle for laughs.

The premise of the show revolves around the life of Tara, a housewife and mother who has four distinct sub-personalities. Since the pilot was written by Diablo Cody, the trendy and popular author of the hit movie Juno, "The United States of Tara" is sure to get a great deal of (justifiable) media attention as it hits small screens across America.

Now, I'm not one to say that movies and television can't use illness, mental disorders or other human conditions as means to entertain and educate. Thinking of "Rain Man", for instance, I can remember a high-quality film that portrayed a character who was outside the norm of human behavior without dehumanization or belittlement. Dustin Hoffman's portrayal of Raymond Babbit fit this bill very well, and although Tom Cruise's character did indeed try to take advantage of Raymond's gifts for purely monetary gain, that part of the story was what, in the end, humanized Cruise's character in the face of his own misplaced anger.

My concern about "The United States of Tara" is that her multiple personalities will be used as nothing more than a gimmick to elicit laughs, and the public will be (as usual) misinformed and perpetually uneducated regarding the truth of Dissociative Identity Disorder, also known as "DID". Just as the public still sees schizophrenia as a form of multiple personality disorder (remember Ian Hunter's poorly named 70's-era album, "You're Never Alone With a Schizophrenic"?), the television-viewing public will most likely walk away from "Tara" with no more understanding of the actual disorder than they had before tuning in.

Television and film can do a great deal to advance the cause of a particular disease or condition, and certain films can absolutely break open a viewer's heart when faced with the suffering of another human being. "The Diving Bell and the Butterfly" was one such film that brought the viewer directly into the world of the afflicted character, fully realizing that individual's humanity. Comedy is, of course, another story, and I assume that my worst fears will be realized when "Tara" makes her debut on American television next week. Perhaps I'm mistaken, but this is most likely yet another example of television doing what it usually does best: entertaining the masses without provoking compassion or thought. And this would surely be yet another golden opportunity squandered.

(c) 2009 NurseKeith

Wednesday, January 14, 2009

Grand Rounds, Vol. 5, No. 17

The latest edition of Grand Rounds is up at In Sickness and In Health, and this edition's science fiction theme is entertaining while being informative.

By the way, In Sickness and In Health is a wonderful blog for couples who are dealing with illness, serving as a resource and as a place for advice, stories, and support.

Sunday, January 11, 2009

Pain, the Unwanted Passenger

Pain sits in the passenger seat, contentedly sipping a soda through a straw, watching the scenery go by.

"Do you want some?", Pain asks, shoving the soda in my face, briefly obscuring my vision.

I look over at the passenger seat, glaring. "No," I reply angrily, "I don't want anything from you."

Looking forlorn, my unwanted passenger pouts and changes the channel on the radio to a Top 40's station.

"Hey! I was listening to NPR, and you know how I hate Top 40!" I push a button, returning to "Morning Edition".

Pain replies, "Y'know, listening to the news will only make you feel worse. Listen to some of that depressing music you like so much instead."

"You're really getting on my nerves today," I reply. "Who invited you on this trip anyway?"

I shove a CD in the console: Conor Oberst. Maybe Pain is right. There are several emotionally devastating songs on this CD, but I listen to it over and over again. Am I a glutton for punishment?

We're both quiet for a while, listening to the music. It's like reading a tragic novel. It's cathartic to hear about someone else's pain, putting one's own struggles into perspective.

Suddenly, Pain interrupts the music, shouting over the guitars and vocals. "I know you don't want me to go away. You think you do, but you're so goddamed identified with me, you wouldn't know what the fuck to do if I was gone." He opens the window and throws his empty soda bottle onto the shoulder.

"Hey! Littering's against the law, and it's dangerous to throw things out of a car moving at 60 miles per hour!" I glare at him.

"Don't be such a fuss-budget," he spits back. "Maybe if you weren't so worried about everything, you wouldn't need me around. Just relax, man. You waste so much time on worry, and then you wonder why you feel like shit most of the time."

"We need gas," I say as I pull off the highway and into a service station.

"I've gotta piss like a race horse," Pain says, opening the passenger door and trotting off to the men's room. Looking back, he yells, "Want anything? Tylenol? Advil? Maybe a beer?"

Grimacing, I give him the finger and start pumping gas into the tank. He emerges from the men's room and is now inside the little convenience store, amiably chatting with the clerk, buying candy and soda. He waves to me through the window. I glare back and give him the finger again. He feigns hurt feelings and touches his hand to his heart, rolling his eyes up into his head.

I finish pumping the gas and consider what would happen if I hopped back in the car and sped off, leaving him stranded here in the middle of some American suburban purgatory. Then I reconsider. I guess I'm not done with him yet.

He opens the passenger door and sits down with a sigh, noisily rummaging through a plastic bag filled with candy bars, several cans of Red Bull, and a trashy magazine.

"Y'know," Pain says, looking at me squarely, "while I was standing in line waiting to pay the cashier, I honestly wondered whether you had the balls to drive away and leave me."

He continues to look at me and I have to look away. It's too painful to face the truth. He is so much a part of me, a piece of my identity----like depression. It's harder to let go than I thought.

"I knew it!" he laughs maniacally, slapping the dashboard several times. "You were thinking about it, and you knew you couldn't do it!" He laughs again and pops open a can of Red Bull. "It's a good thing I got some extra caffeine. We have a long day ahead of us!"

I stare straight ahead at the road, gripping the steering wheel until my knuckles are white, and I wonder what I ever did to invite such a passenger into my life, and what I need to do to let him go. I look over at him and I'm disgusted. He's slurping on hyper-caffeinated soda, eating junk food, reading a shitty magazine and just changed the radio to that horrible Top 40's station again. He looks back at me like a petulant child and I shake my head in disbelief that I would ever allow such behavior in my car. He sticks out his tongue, laughs, and turns the music louder.

This is of my own making, I tell myself. I invited him in and I can ask him to leave.

Maybe tomorrow. Maybe tomorrow.

(c) 2009 NurseKeith

Saturday, January 10, 2009

CRZEGRL Hosts Change of Shift

CRZEGRL, a venerable blogger and courageous flight nurse, is hosting this week's Change of Shift, the blog carnival of all things nursing. It's certainly worth a perusal, even if you only have time to read one or two entries. Blog carnivals are an amazing phenomenon, in that they are online magazines bursting with content and connections to blogs you might otherwise never find on your own (at least not all at the same time).

Wednesday, January 07, 2009

Reaching Out To the Margins

Yesterday, I received a call from a young college student with an interest in Public Health who wants to volunteer at our health department. After a telephone conversation and a string of emails, I gleaned that she is from Cape Verde, speaks Cape Verdean Creole (Portuguese married with African dialects) as her first language, and also speaks and understands some Spanish. Thinking quickly, I realized that this is a golden opportunity to utilize this individual's language and cultural knowledge to reach out to the Cape Verdean community in our town. While not as sizeable as our Chinese, Tibetan, Cambodian, and Latino communities, I know for a fact that a pocket of Cape Verdeans are scattered amongst the population, and this young woman may be the key to doing some important outreach to a marginalized segment of our municipality.

The director of our health department is dedicated to issues of racial justice and social equality, and a significant multi-year social justice grant has given our department just the push it needed to bring to life her much appreciated vision. With a part-time worker devoted to fulfilling the social justice grant and a Cambodian outreach worker dedicated to the Khmer community in our area, we are well aware that there are ethnic and racial groups that also deserve our attention.

While public health does indeed involve immunizations and infectious disease surveillance, the 21st century has brought the very enlightened awareness that the control of chronic disease is where we should be focusing in the wake of the 20th century's successes vis-a-vis the virtual eradication of vaccine-preventable diseases such as polio and measles. However, to control chronic diseases and improve quality of life and lifespan, we must also ascertain why and how health disparities occur amongst various ethnic, racial and socioeconomic groups, subsequently taking concerted action to assuage those disparities. From infant mortality to rates of diabetes, people of color are more burdened than their caucasian counterparts. While some genetic differences may account for a small portion of these differences, it has been demonstrated time and again that socioeconomics and the very stress of living in a racist society can indeed have a significant impact on health outcomes. Of this we are now certain, although some are still not convinced.

So, enter my new, young and earnest Cape Verdean volunteer, who is excited that I even know anything at all about her language and culture. When health care professionals and agencies take pains to make contact with marginalized and vulnerable segments of the population, everyone benefits. Gathering data on sub-populations and ethnic groups is a useful and intelligent undertaking which, as a bridge-building exercise, encourages dialogue, communication, and the building of trust. Vulnerable citizens with poor English-language skills and discomfort with American culture are more likely to reach out for assistance and utilize existing services if they feel seen and understood. While a well-meaning white outreach worker without appropriate language skills can make some inroads, a worker who is a native of the target population's country and who speaks the language fluently can make significantly more progress within a community that may feel collectively invisible.

My town may still be white by a vast majority, but our segments of Latino, Caribbean, and Asian citizens is apparently growing by the month. Cambodians, Tibetans, Cape Verdeans, Central Americans---these communities are all growing, and even as their children learn English and quickly become Americanized translators of culture and language for their elders, reaching out to those elders who are less comfortable with the transition to American life is key. I will use this new volunteer energy to my benefit, and to the benefit of our town, our department, and the people who we serve.

Reaching out to the margins is crucial, and as bridges are built, those living on the edges become significantly less marginalized. The margins make us see that we are all more similar than we are disparate, and taking culturally sensitive action in order to serve those who are most vulnerable improves the quality of life for all concerned. The reach of the human heart and its compassion is without measure, and I have seen for myself how magic can happen when our arms are opened wide enough to embrace those who lack our cultural, economic, and social privilege. Our community's diversity is an enormous strength, and our ability to welcome all into the heart of the community speaks volumes about our singular and collective humanity.

(c) 2009 NurseKeith

Tuesday, January 06, 2009

Grand Rounds: Profit in Medicine

The newest edition of Grand Rounds, the best medical blog carnival on the web, is available for reading over at Dr. Edwin Leap's excellent blog. Please pay the good doctor a visit.

Monday, January 05, 2009

Edwin Leap, M.D.

In my bloggish wanderings, I have discovered a doctor who writes about medicine like a poet. Edwin Leap, M.D. has some wonderfully insightful things to say, and one of his most recent posts, "What I Love in Medicine", is music to this nurse's ears. It is beautiful, poignant, meaningful, rife with compassion, and simply perfect.

Please pay him a visit and give thanks that doctors like Edwin walk this troubled earth.

Loss and Bereavement

Loss and bereavement can remind you sharply of what can happen when in life you do not show your love and appreciation, or ask for forgiveness, and so make you far more sensitive to your loved ones.

Elisabeth Kubler-Ross said: ‘What I try to teach people is to live in such a way that you say those things while the other person can still hear it.” And Raymond Moody, after his life’s work in near-death research, wrote: “I have begun to realize how near to death we all are in our daily lives. More than ever now I am very careful to let each person I love know how I feel.”

---Sogyal Rinpoche

Sunday, January 04, 2009

Of Depression, Statistics and Labels

According to the website of the National Institute of Mental Health, depression is the leading cause of disability among Americans between the ages of 15 and 44. Further statistics show that 6.7 % of the U.S. population (14.8 million adults) are affected by Major Depression in any particular calendar year. And at least in the U.S., more women are diagnosed with depression than men, with the median age of onset being 32 for both genders.

When reading these numbers, please bear in mind that this reflects only the statistics vis-a-vis Major Depression, and does not include significant data concerning Dysthymic Disorder and Bipolar Disorder, as well as the myriad anxiety and personality disorders, phobias, PTSD, and other mental illnesses.

Extrapolating the data to include all mental disorders, the numbers of astounding. It is estimated that 26.2 % of all Americans 18 and older (more than 57 million adults) suffer from a diagnosable mental disorder, however only 6-7 % have a serious mental illness.

Here on Digital Doorway, I have disclosed a number of times that I have lived with Major Depression for many years, dating back at least to adolescence, but most likely into early childhood. Having suffered Post-Traumatic Stress Disorder (PTSD) in late 2001 following the murder (by police) of a close friend, my struggles with my mood disorder have been even more challenging. With chronic pain also on board, my life has certainly become significantly challenging in my 40's, the aches and pains of middle age supplanted by the daily punishment of pain that is (so far) untreatable, often occurring in concert with stultifying depression.

We are all statistics in one way or another. We can all be catalogued, categorized, compartmentalized, boxed, packaged, and graphed. Be it our gender, race, income level, tax bracket, profession, educational level, marital status, gender identity, or any other label-ready identifier, we can all be lumped into a veritable mosh-pit of humanity and stirred into the statistical melting pot.

So, yes, I do indeed identify as being a person who lives with chronic pain and depression. At times, I actually identify as being a person living with a mental illness, and I have occasionally played with actually saying that I am mentally ill. These labels that we give ourselves or allow others to give us have power, and I am often admittedly ambivalent about them. It's always easy to say that someone else is mentally ill, or that someone else has this or that disorder. But when we look at our ourselves, placing that very same stamp on our own forehead can be another issue altogether.

Many public figures have come out of the mental illness closet to talk publicly about their lives. Legislators, actors, musicians, writers---they cut through the stigma by normalizing depression and mental illness, serving as beacons to those who fear betrayal, judgment and real discrimination.

As a person with multiple chronic illnesses and disabilities, I am seeing more and more clearly that I need to be increasingly outspoken about my own experiences, to use my writing and communication skills to help to normalize this very universal experience. I hope that my writing about my own life can serve even one person in making sense of their own struggles. Whether I am ever aware of that effect is beside the point. As a blogger and writer, I am indeed a public figure, and I want to use this soap box for more than my own aggrandizement.

If you are one of those people who suffer in silence, know that your suffering---while apparently solitary---is shared by many, and I encourage you to reach out in any way that feels comfortable to you, breaking the isolation that can feel so crushingly impervious. If there are indeed so many of us, then we are certainly not alone, and it's up to us to be more than a statistic on a graph. We are individuals with lives of importance and meaning, and no diagnosis or label can take that away.

(c) 2009 NurseKeith

Thursday, January 01, 2009

Welcoming 2009 With Compassion

Well, here we are looking 2009 square in the face, with our hopes, dreams, prayers and aspirations floating up into the ethers.

For myself, on a very personal level, I am wishing for an end to my chronic pain, a complete remission from depression, regular exercise, stable weight, improved sleep, and more connection with others. I plan to be proactive about my health, reach out socially and professionally, and embrace the challenges and opportunities afforded me by my new job as a Public Health Nurse. In terms of writing, Digital Doorway will very soon celebrate its fourth birthday, and I plan to continue to seek out opportunities to have my work published both online and in print.

As for this world of ours, I am hopeful that Barack Obama's rise to power will lead to some startlingly refreshing changes here in the United States and abroad. For one, I hope that 2009 will see us moving towards some form of universal health care, allowing those 40 million uninsured Americans to have access to what I see as a basic human right. Yes, providing health care for every American citizen will be expensive, but as our population ages, the cost of untreated chronic disease will have costs beyond our wildest dreams.

In terms of violence around the world, I find it difficult to hope that all violence, slavery, ethnic cleansing, terrorism and war will cease to be. Considering the track record of homo sapiens sapiens, this is an unrealistic expectation, however I still hold out hope that we will see some changes as the U.S. itself undergoes a makeover of sorts.

Over all, if there was going to be more of anything on this old earth of ours, I would like to see more compassion. Breaking it all down, stripping away the hurt, the pain, the violence, the greed, the errant passions that consume us as a species, I feel that a scarcity of compassion can lead humans to act in ways that are damaging to self, to others, and to humanity as a whole. As for Mr. Obama, he would be wise to create a new cabinet-level position---The Secretary of Compassion---whose grave responsibility would be to remind us as a people that compassion is the energy that must be injected into every situation, into every circumstance, and into every relationship.

Compassion is the seed of non-violence, and the lack of compassion is the very germ that leads to the growth of hatred, violence, and all of the negative emotions and energies that seem to so deeply infect and haunt the human race.

While cultivating compassion is indeed a very personal action that begins from within, compassion can also be developed by nations, by world leaders, and by societies themselves. If I were to wish for any particular theme for 2009, the widespread cultivation of compassion on a global scale would be my greatest wish for humanity. Perhaps, if we each plant the seed of a growing seedling of compassion that comes to fruition within each of our hearts in the coming year, that seedling will sprout into a worldwide blossoming of compassion that can only have positive ramifications for the entire world.

As I have written before, The Charter for Compassion is a worldwide movement striving to bring compassion into the consciousness of humankind. Its mission is global, and the work of cultivating a worldwide movement of compassion is indeed in process as I write. From their website:

"The Charter for Compassion is a collaborative effort to build a peaceful and harmonious global community. Bringing together the voices of people from all religions, the Charter seeks to remind the world that while all faiths are not the same, they all share the core principle of compassion and the Golden Rule. The Charter will change the tenor of the conversation around religion. It will be a clarion call to the world."

I, for one, embrace compassion as the global theme for 2009. Perhaps you, dear Reader, will join me in this movement so we can work to bring compassion to the forefront of human consciousness in 2009.

(c) 2009 NurseKeith