"Columbus Circle, 4:30 P.M"

Please feel free to surf on over to my fiction blog, "Fiction, Prose & Ephemera", to read my latest short story, "Columbus Circle, 4:30 P.M."

Wikio Ratings

Just a quick note to let my readers know that Digital Doorway is currently rated #65 of the top 100 health blogs on the Web (according to Wikio), and rumor has it that my ranking may improve more in the coming weeks. I am humbled and grateful, and hope that I can continue to be worthy of such ranking in the future!

Collaboration and Relationships

In my current position as a Public Health Nurse, I am seeing so clearly how the building of collaborative relationships is the key to success. Whether I am creating wellness programs for municipal employees, writing town-sponsored blogs, developing emergency preparedness protocols, fostering communication with other town health departments, or working with the local university and colleges, my work revolves around positive relationships and a collaborative spirit of cooperation and mutual benefit.

As I delve deeper into the areas for which I am responsible, there is precious little that I can satisfactorily accomplish without some form of collaboration. If I want employees of the town to exercise, then I have to develop positive relationships in order to motivate employees to take part in my programs. If I want to move forward with our emergency preparedness plans, then I have to work closely with town officials and school department personnel in order to conduct surveys of potential emergency shelter sites and Emergency Dispensing Sites. When there's a case of tuberculosis or salmonella in town, I have to use my contacts at the state Department of Public Health to fully undertake my investigation.

Every step I take here in my work is collaborative on some level. Every initiative I undertake suggests a way in which I might get the "buy in" of a key individual or group of individuals. With each idea I have or new program I wish to launch, some connections must be made, relationships must be fostered, and alliances forged.

This position of mine is not one in which I can thrive as a lone agent. Sure, I could act on my own, burning bridges as I run rough-shod over my colleagues and other innocent bystanders. But in order to truly create public health programs and initiatives of any intrinsic and lasting value, collaboration and relationship building is key.

I am building such alliances every day, feeding relationships, fostering connection, finding common ground, and building confidence within and without. I am gathering my forces and lining up my allies. And with these elements in place, success is assured.

Obama Administration and Congress Invest in Nurses

Several major American nursing organizations are applauding the support demonstrated by Congress and the Obama administration for the nursing profession, with newly allocated funding that should have a profound impact on every aspect of nursing, including the central focuses of education, practice, retention and recruitment.

As part of the American Recovery and Reinvestment Act (H.R. 1), $300 million were awarded to the National Health Service Corps and $200 million will be divided between the Nursing Workforce Development Programs (Title VIII of the Public Health Service Act) and the Health Professions Training Programs (Title VII). $10 billion will also be allocated for the National Institutes of Health, with $7.4 billion distributed to various Institutes, including the National Institute of Nursing Research, further demonstrating that nursing's contributions to both the clinical and research worlds is indeed taken seriously.

The provisions in H.R. 1 allow for money to be distributed directly to nursing students and schools of nursing, with allocations for Title VII programs like Scholarships for Disadvantaged Students and the Faculty Loan Repayment Program.

Additionally, the monies allocated for the National Health Service Corps will fund scholarships and loans to nurse practitioners, certified nurse-midwives, primary care physicians, dentists, mental and behavioral health professionals, physician assistants and dental hygienists.

In blog posts leading up to President Obama's inauguration, I voiced cautious optimism (and some considerable doubt) that an Obama administration would pay close enough attention to the nursing shortage, addressing not only the need for increased scholarships and education funding for nursing students, but also funding to address the lack of qualified nursing professors available to educate new nurses. Seemingly, multiple levels of the nursing profession have been addressed under the auspices of these new programs, and the money allocated will not only provide scholarships for nursing students, but will also offer loan repayment programs for those nurses who might wish to teach but would likely be dissuaded by the relatively low salaries offered to nursing professors.

I am heartened by this news, and foresee a blossoming of the nursing profession at a time when a universal nursing shortage (and an economy in apparent free fall) inform the overarching zeitgeist that currently casts a pall over the entire health care industry. Yes, most nursing schools are filled to capacity, yet that capacity is generally hobbled by a profound shortage of professors, a reality which very well may be addressed as these funds become available.

These are difficult economic times for many Americans, and as President Obama's economic recovery plan is actualized, we will begin to see the ways in which the plan may succeed and fail. Over all, I feel optimistic that, in terms of the nursing profession and the profound shortage therein,we will sense a discernible sea change if the allocated funds are targeted and distributed as proposed. While I have not seen the fine print (and we all know that the large print can giveth and the small print taketh away), my hope is that the fine print will in no way diminish the potential impact of such an historically and economically significant investment in the future of nursing.

Despite the dire warnings and the hand wringing occuring nationwide as the unemployment roles grow, perhaps some optimism, positive movement and job growth within the nursing profession will have a ripple effect throughout the health care industry. And for this we can only hope.

Return

Well, dear Readers, I'm back from a brief three-day Mid-Atlantic sojourn, visiting my aging parents, helping my mom, and making the rounds.

Being without Internet access for almost three days felt like an eternity, the electronic umbilical cord tugging at my nearly constant desire to email, blog, hop onto Twitter, update my Facebook page, and otherwise connect with the myriad people with whom I have a strictly electronic relationship.

As Digital Doorway has surpassed its fourth birthday, I realize how very important a venue it is for my self-expression. This space serves as a touchstone for me, and I indeed appreciate those of you who visit, comment, and make this blog come alive.

Stay tuned for continued adventures, and thanks again for your generous readership!

---Keith

A Valentine Change of Shift

Please surf over to This Crazy Miracle Called Life to peruse the newest edition of Change of Shift, everyone's favorite nursing blog carnival.

What We Take for Granted

Listening to a guided meditation today, I was struck by a statement reminding me about what happens each morning when we wake up. Every morning of our lives, we open our eyes and completely take for granted that our heart is still beating, our lungs are breathing without a second thought from us, our kidneys are churning out urine, and the blood and lymph and other vital fluids of our body are busily going about their work as we rub our eyes and set feet to the floor.

I, for one, am so often lost in the daily deluge of email, phone calls, papers, appointments and "things to do" that I completely forget what's happening right here inside my little envelope of skin. How can this be?

My wife often reminds me to be sure to feel, express and contemplate gratitude every day. Gratitude for what? For breathing, for another day, for our home, our dog, our son, our health, the money we have in the bank, the jobs that we're so very lucky to have. Gratitude, she says, for everything and anything, is what's most important to contemplate every day.

So, how do we remember to do this? How do we remember to feel grateful every day? Do we put Post-It notes on every surface, reminding us to be grateful? Perhaps. Do we tattoo "Remember to be grateful" backwards on our foreheads so that we remember every time we look in a mirror? (Perhaps a little extreme, but if you try it, please send me a photo!)

I admit that I am as guilty as the next person, and I am more likely to forget than to remember. Luckily, I have my own "Gratitude Guru" in my life, and I am reminded to be grateful more often than I would sometimes like! Still, I appreciate the effort, and am slowly making strides.

So, dear Reader, how do you remember to be grateful? Do you feel gratitude from time to time? What happens when your feet hit the floor each morning?

Health Care Without Harm

Imagine hospitals and other facilities built without cancer-causing materials. Picture a hospital that supports local sustainable agriculture and organic growing practices. Imagine health care facilities that offer full disclosure of materials used in the delivery of care that might be harmful to consumer health, and fragrance-free environments that do not harm patients with environmental sensitivities.

Health Care Without Harm (HCWH) is "an international coalition of hospitals and health care systems, medical professionals, community groups, health-affected constituencies, labor unions, environmental and environmental health organizations and religious groups" whose mission is "to transform the health care sector worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment."

While this may seem like a tall order---or perhaps a pipe dream---HCWH is indeed a growing global coalition looking closely at health issues surrounding mercury, biomedical waste, green purchasing practices, healthy building practices, pesticides and fragrances, and the widespread toxicity of materials used in the delivery of health care.

The stated goals of HCWH are:

1. Create markets and policies for safer products, materials and chemicals in health care. Promote safer substitutes, including products that avoid mercury, polyvinyl chloride (PVC) plastic and brominated flame retardants.

2. Eliminate incineration of medical waste, minimize the amount and toxicity of all waste generated and promote safer waste treatment practices.

3. Transform the design, construction and operations of health care facilities to minimize environmental impacts and foster healthy, healing environments.

4. Encourage food purchasing systems that support sustainable food production and distribution, and provide healthy food on-site at health care facilities.

5. Secure a safe and healthy workplace for all health care workers.

6. Ensure patients, workers and communities have full access to information about chemicals used in health care and can participate in decisions about exposures to chemicals.

7. Promote human rights and environmental justice for communities impacted by the health care sector, while assuring that problems are not displaced from one community or country to another.

Here on Digital Doorway, I will be following HCWH's development and reporting on issues raised through the various campaigns already underway. The health care industry is not immune from the reverberations of its own environmental effects, and I am very grateful to have discovered this robust international campaign with a goal of reducing the toxicity created by the health care industry while increasing sustainability and responsibility in the health care arena.

A Valentine Treat

Here's a collage that I made for Mary as a Christmas gift a few years ago. I thought it would be a nice image to share with my readers on Valentine's Day. Enjoy!

The One and Only Campaign

Just today I learned of the newly launched "One and Only Campaign", the mission of which is to create zero tolerance for poor infection control practices in health care facilities.

Apparently, thousands of infections are caused by the inexcusable reuse of syringes by health care providers across the country, and many of these infections do indeed lead to unnecessary illness and death. In fact, in February of 2008, over 40,000 patients were exposed to potentially deadly bloodborne diseases at an endoscopy center in Las Vegas, Nevada due to the reuse of syringes that should have only been used for one patient and then properly disposed of.

According to the One and Only Campaign website, "the goal of the One & Only Campaign is to improve safe injection practices across healthcare settings. The practices within an organization are highly influenced by its culture or are an expression of its culture. Through education, outreach, and grassroots initiatives, the One & Only Campaign will seek to influence the culture of patient safety."

The description continues: "The One & Only Campaign is an education and awareness campaign aimed at both healthcare providers and the public to increase proper adherence to safe injection practices to prevent disease transmission from the misuse of needles, syringes, and medication vials in outpatient settings. While the campaign will be initially rolled out in targeted locations, the vision is to develop a concept that can be replicated nationwide."

At this late date, I am honestly personally shocked that there are still U.S. health care facilities who reuse medical equipment and disposable injection devices that are truly meant for one-time use. While nosocomial infections do indeed occur on a daily basis in health care facilities the world over, we are, after all, more than 25 years into the Age of AIDS, and I have apparently been mistakenly naive to think that health care facilities in the United States have all learned their lessons from the days before Universal Precautions were the norm of medical practice.

Let's hope that The One and Only Campaign is effective, and that health care providers and facilities learn from the thousands of grave errors that have been made, often with deadly results. And remember that, as a patient and health care consumer, you have a right to ask your health care facilities about their infection control practices prior to agreeing to treatment.

Does Emergency Preparedness Make Sense?

Yesterday, I spent eight hours with folks from the Centers for Disease Control, learning about how to communicate with the public and the media during public health emergencies. While this stuff can indeed be pretty dry, I must say I was quite impressed with the way the CDC puts these trainings together. The presenters kept it lively and interactive, and group exercises broke up the day nicely.

Although these trainings do indeed seem to focus on potential scenarios involving anthrax or other terrorist activity (something which I see as highly unlikely), having public health officials who know how to communicate with the public doesn't seem like such a bad idea, really.

While people don't generally want to think or talk about preparing for unknown dangers which may or may not happen some time in the future, I'm beginning to get a sense of the larger picture and how the government is striving to create a coordinated system in which metropolitan areas, small towns, and even rural areas are accounted for in emergency preparedness.

Billions of taxpayer dollars have been spent in order to create the Strategic National Stockpile (SNS), the Cities Readiness Initiative, and other very complex and, ultimately costly, programs. Many people would question whether this money would have been more well spent on creating jobs, improving infrastructure, green technologies and other important issues of the day. From my perspective, this would be an excellent question to pose, however the emergency preparedness train is fully out of the station since 9/11/01, and there's simply no way to reign this one in, for better or for worse.

So, taxpayers of America, be advised that, yes, there are huge warehouses of medications at strategic points throughout the country, ready to bring antibiotics and antivirals to your town in case they're needed in a hurry. There are also thousands of people like myself constantly undergoing training in order to be able to bring those medications to you in a real emergency.

Taking into consideration the likelihood of a terrorist attack, an influenza pandemic, or another scenario in which these assets would indeed be deployed, one might be led to wonder why so much money has been sunk into these efforts of preparing for that which may never occur.

These are good questions to ask and valid points to consider. The fact is, however, that the behometh of emergency preparedness is a beast with a life (and a budget) of its own, and even though I sometimes question the amount of money being set aside for such efforts at a time of economic turmoil, as a public health official I must fulfill my mandated mission of taking these tasks seriously as I increase my knowledge of such a new and complicated world.

Emergency Preparedness Day

Today was a day focused on emergency preparedness. At work, a colleague who is an emergency preparedness consultant went with me to three town schools in order to survey the buildings' potential to serve as Emergency Dispensing Sites (EDS).

An EDS is a facility designated to be the operations center wherein a town accesses emergency medications from the Strategic National Stockpile (SNS), a national repository of medications designed for a swift response to terrorism, epidemics, and other public health emergencies. The EDS can be a school, a community center or any building that can accommodate large crowds as they're shepherded through for triage and treatment in an orderly manner.

It was an eye-opening experience, and I came away with a much more robust understanding of what it means to set up an EDS in my town, and which buildings are more appropriate that others.

This evening, following a long day of work, I attended a training on Psychological First Aid, a key to helping people in the immediate aftermath of various types of disaster.

My baptism into the world of emergency preparedness continues, and it will only become deeper as I delve further into my (seemingly growing) responsibilities.

Change of Shift: Welcome to The Fishbowl

In the days leading up to hosting this edition of Change of Shift, I gave a great deal of thought to the phenomena of the internet, blogging, Twitter, iPhones, Facebook, and the many technological advances that now keep us all connected and communicating.

That said, as much as I love these manifestations of our Digital Age, I also see these forums as proverbial fish bowls in which we all stew ourselves in the waters of public communication, often rendering ourselves vulnerable and naked as the observing masses watch our every move.



Over on Twitter, many of us now communicate in a "micro-blogging" format, using 140-word posts to get our message across to our myriad "followers". Twitter is, for all intents and purposes the newest digital fish bowl, and as more and more of us jump into the water, the pool sure does get crowded!

But before Twitter and many other manifestations of Web 2.0 emerged from the depths of the collective technological consciousness (bear with me here, folks), blogging arose as the newest form of armchair journalism, rendering many of us health care professionals suddenly able to make our voices heard, singularly and collectively. Nurses, doctors, pharmacists and others suddenly found a venue in which their experiences, feelings and expertise could be readily shared with hundreds, perhaps even thousands of readers hungry for their fresh perspective. And for this opportunity, we are thankful, and we take full advantage of the digital soap box that blogging provides on a daily basis.

So, dear friends, welcome one and all to our Change of Shift Fishbowl, and thanks to Kim at Emergiblog for making it all possible. Feel free to swim with the school, make some new friends, and bask in the rich and teeming waters of the blogosphere.



Swimming over to the mental health section of the fishbowl, our favorite Therapy Doc bemoans the post-modern illness, Internet Asperger's Syndrome. Oh the irony of it all!

Speaking of mental health, my Twittering friend Strong One delivers two posts for this week's Change of Shift, the first being very wise advice for new grads and new nurses trying to care for themselves in the stressful world of health care delivery, the second being further advice for those same new nurses to avoid the trap of being a Know-It-All or its absolute opposite.




Meanwhile, Travel Nursing Blogs reminds us (for better or worse!) that tax time is here, and those ever-so-lucky traveling health care professionals can take advantage of significant tax benefits if they do their homework.

And as far from taxes as one could get, Miss-Elaine-ious regales us with the moving story of how an example of true caring makes her want to be the best nurse she can be.

Eschewing the written word, Robert Fraser of Nursing Ideas shares a video interview with a nurse who also advocates for environmental issues. Thanks for the multimedia post, Rob!




Lists seem to be a frequent theme in blog posts these days, and submissions to Change of Shift are no exception. So, for those of you who like their recommendations enumerated, swim over to the other side of our tempest in a teapot to peruse what's on offer:

A second submission from Travel Nursing Blogs gives us the Top 5 Reasons to become a travel nurse. What are we waiting for, especially in light of the aforementioned tax benefits!

USPharmD informs us of the Top 50 Genetics Blogs on the Internet.

And since iPhones are all the rage, Radiography Schools graces us with a list of 20 iPhone apps that can help you to improve your health.

Speaking of iPhones, there just seems to be no escaping their cultural domination, as Phlebotomy Technician Schools regales us with 20 iPhone apps for overwhelmed students.



Swimming on, we find Ultrasound Technician Schools discussing how the benefits of ultrasound far outweigh the potential negative effects.

And using laser therapy to help patients quit smoking is submitted for your consideration by Health and Nutrition Facts.

In terms of heart health in the face of menopause, Heartstrong shares the results of a new study that is certainly food for thought, as well as a second post outlining guidelines for preventing heart disease in women.

Dean Moyer of The Back Pain Blog offers up a two-for-one deal this week with his latest post entitled Health Care Reform and Sciatica Recovery. In Part One he covers what he (as a consumer) would like to see included in a national health care plan. Part Two is the continuation of an ongoing effort to answer reader questions about sciatic nerve pain.




Over at RehabRN, we are treated to a heartfelt post about the travails of nursing, of succumbing to winter illnesses, and the adaptation involved in order to be able to still love nursing at the end of the day.

Nearby, Nerdy (not-quite) nurse shares some very sage advice for women of all ages based on her experiences working in a OB/GYN office.

A guest blogger on NurseConnect discusses the stress faced by patients when they are transferred from one unit to another, especially in the ICU, a place that can certainly feel like a fishbowl.

And another guest blogger on NurseConnect discusses the ins and outs of writing letters of complaint to businesses that deserve them, as well as letters of satisfaction when all is well. This advice is well suited to experiences in health care facilities, so watch out!

The third offering from NurseConnect challenges us to assess the level of assertiveness practiced in our workplace. Are you ready to assert yourself with the big fish in your facility?


Meanwhile, over at Online Nursing Degrees, my blogger friend Jen wonders whether something fishy is going on, asking why there are so many hiring freezes when the nursing shortage is so dire.

Over near the coral, an interesting and thought-provoking post is offered by VP Medical News concerning medical providers who are reprimanded---or worse---for offering to pray with patients.

And on a very different subject, BookScoutLookOut brings us the story of being a first responder to the home of an overdosed heroin addict.



For myself, your host, I've been thinking and blogging about many subjects these days. On a personal level, my struggles with my health and recently chronic insomnia has been a preoccupation, ad nauseum.

On the macro scale, a recent Pentagon ruling to exclude veterans diagnosed with PTSD from being awarded the Purple Heart certainly raised my hackles, and the independent film "Ballast" brought my post-inaugural attention back to the plight of the rural poor in America.


So, my friends, it's abundantly clear to me that our blogging fishbowl is simply awash with talent, curiosity, compassion, and professionalism. These myriad forums for the sharing of information and opinion truly enhance our lives, and as long as we don't allow technology to usurp our humanity and our ability to connect face to face in the real world, we can hope to continue to benefit from this veritable flood of information for years to come.

Thank you for paying a visit to this edition of Change of Shift, and remember that there is life both inside and outside the fishbowl. So when the waters get too murky and visibility isn't so good, remember to draw a hot bath, take a walk, make a cup of tea, hug a friend, and jump back in when you've been refreshed. We'll all still be here, ready to welcome you back for a swim.



Note: The next Change of Shift will be hosted at This Crazy Miracle Called Life on February 19th. You can submit direct to the host or via Blog Carnival.


(All photos by NurseKeith)

Change of Shift at Digital Doorway, February 5th

I will be hosting Change of Shift, the premier nursing blog carnival, here on Digital Doorway on February 5th.

There is no specific theme for this next edition of CoS, and I welcome submissions from any blogger, as long as the post has something to do with nursing, medicine, health, health policy, health care, health care reform, disabilities, social justice, human services, human relations, or the human condition in general. (So narrow, I know.....)

Anyway, feel free to email me directly (my email is available through my Blogger profile), or submit via Blog Carnival, the user-friendly website for all things carnival. All submissions are due by noon on February 4th. Any submissions received after that time may or may not be included, depending on my mood, workload, and level of insomnia.

Thank you, and I look forward to hosting Change of Shift this Thursday, February 5th.

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 NCHMinteractivemedia@CDC.gov to let them know you plan to attend.

Thanks!

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

Ballast

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

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

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.....

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)

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 Alensa.com, and everything I write on DD feeds directly to my author page on Wellsphere.com. 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 BlackDoctor.org, 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,

Keith

(c) 2009 NurseKeith

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.

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.

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