Patients or Standards?

“I think there's more to this hobbit than meets the eye” ~ Gandalf, The Grey

My daughter “HD” is known to her friends as ‘hildow’ or to me as my ‘Hobbit Diva’. She always has a way of bringing things home for me. She has challenged my career decisions ever since I left the ICU bedside. To her what I do ‘now’ is nebulous and meaningless. For her saving real lives is what matters. I can recount the many times she has asked me if “indirectly helping people with activities of daily living is as significant as direct intervention/life saving measures? “ I can’t answer that question. My passion has and always will be direct intervention; however, keeping people safe at home abates the inevitable direct interventions.

Yesterday while chauffeuring HD to one of her many activities, she asked one of her profoundly dreaded questions; “What are you most passionate about, people or standards?” I didn’t answer her; I had to think about that for awhile.

The College of Nurses of Ontario (CNO) assists nurses in providing safe, effective and ethical care by developing and setting standards for the profession. Those regulated Standards of Practice legislated through the Nursing Act 1991 http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_91n32_e.htm and the RHPA 1991 http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_91r18_e.htm have guided my professional life. I have always practised safe effective ethical care according to the CNO practice standards and guidelines and applicable legislations. So HD even while I was in direct care delivery I practiced according to standards.

On the other hand Accreditation Canada's sector and service-based standards help organizations assess quality at the point of service delivery. They are based upon five key elements of service excellence: clinical leadership, people, process, information, and performance. While my current work focuses on these serviced-based standards, my patient outcome goals remain steadfast...SAFE, EFFECTIVE and ETHICAL care.

So HD, patients or standards? Without standards, safe patient care is inexistent. "Would I rather enforce compliance to standards or feel the pulse of a patient?" I think you know my answer. I’d rather nurture my patient but for now I’m doing that by ensuring that standards are adhered to and patient care outcomes are met. Believe it or not, it’s another way of saving lives. It will never replace the feel of a pulse, breath or smile. Thanks for reminding me why I do what I do.

So Long Kiefer (1962-2009)

“No one ever dies unless they are forgotten.”...Ojibwa legend

I learned years ago that in Ojibwa there is no word for “goodbye”. I think that very premise is what drew my fascination towards Ojibwa culture, history and rituals in the first place. Six weeks ago our beloved Kiefer went to meet his “Maker”. Cancer kicked him down too young and left the rest of us wondering why...

As rituals go, surrounded by friends and family, I paid my respect to him that weekend. Kief and my husband were best friends for over 40 years; I had the privilege to share in that friendship for the past 20 years. Unfortunately I’ve been in a phrenic work state of mind these past few months and failed to pause long enough to honour a friendship that selflessly taught and nurtured us.

Kief’s birthday was this week; he wasn’t here to celebrate it. Kief was known as our noble “Kraut”. Tomorrow marks the start of Oktoberfest and Thanksgiving weekend, Kitchener Civic Square will be bustling with pomp and ceremony, music and dancing. As the fanfare of trumpeters sound off the official opening of the 41st annual Kitchener-Waterloo Oktoberfest, and the mayor taps the keg and says “Willkommen to Oktoberfest”...I promise Kiefer that I won’t say “now go home”.

Our memories of you are precious and hidden deep in our hearts. We miss you. Happy Birthday! As we give thanks this weekend, we will remember everything you have given and shared in our lives.

As the Irish blessing goes, “May God hold you in the hallow of his hand until we meet again”. Love you always and forever...meet you on the rainbow bridge and we’ll do the chicken dance...

"And here I am - knocking at your door with expectations of my own.
Knock
Knock
Knock"...Ojibwa legend

Cheers ;-)

“In Queue” Etiquette a la Madeline

"In an old house in Paris that was covered in vines
Lived twelve little girls in two straight lines
They smile at the good, and frown at the bad
and sometimes they are Very sad
In 12 straight Lines they break their bread
Brush their teeth and go to bed.
They leave the house at half past nine, in two straight lines.
The smallest one is MADELINE!”... Ludwig Bemelmans

I have a pet peeve that has been driving me nuts and into a “Rick Mercer” rant for years. My rant is all about queuing etiquette. “Queue “means to form a line, and to wait for services.

When I was young my mother read me the “Madeline” book series; when I was able, I read them myself; I read them to my daughter; when she was able, she read them herself. Not surprisingly, the key lessons for me all had to do with structure and formation especially when “something is not quite right “such as forming proper line-ups.

I learned early on through Miss Clavel and my kindergarten teacher how and why line-ups/queues are formed. The rules are as follows:

1. Get in line
2. No jumping, butting, budging, skipping, ditching, breaking, shorting, or pushing in at any position other than the end of the line.
3. Sometimes you can "back cut" – if you have permission to enter behind the person who was asked. This is only considered fair if each person behind the one being "cut" allows it.
4. You can “cut in line” if someone is saving your place in line and you are both conducting one transaction.
5. You can leave the queue to use the bathroom and then return to your original place without having to ask permission.
6. You must respectfully allow pregnant women, adults accompanying small children, and the physically disabled to be serviced prior to everyone else.

These are fair rules that have served me well since my early “Madeline” days. However, something changed in the 90’s. I have not been able to ascertain if these changes are reflective of the dot com era or the Ritalin Generation. I can only state that I don’t like the change.

When I started my working life at McDonalds, I worked the “window”, which was teller. This was long before the drive-thru days. Patrons came into the restaurant, got in line and placed their orders. When I was going through Nursing I worked at Eaton’s...same thing, customers got in line at a cash register and waited to be served. This linear queue sequence is dependent on the structure of 2 or more cashiers. This linear queue sequence provides equal opportunity to all as well as fairness to the customers due to a slow cashier and/or customer clog. Then...the dot com and/or Ritalin Generation went parallel which lead to the cattle herding lines and merges waiting for the call out of “can I help the next customer”. This is the sequence that drives me nuts. I only accept the linear queue sequence as it supports semblance of societal order.

Recently I followed suit and lined up behind a patron who was in linear queue formation at the LCBO, when a clueless gentleman walked by and somehow managed to time his arrival at the exact moment the cashier at asked “May I help whose next.” Of course, he’s somehow next by the magic of the Gods at power (parallel line up). Normally I would say something and make sure that I was indeed next, but I figured that’s ok I’ll be nice today. He was abiding by the parallel line up theory. Patiently I waited for another cashier to say the magic words; unfortunately two university students walked by and somehow swooped in at the sound of those magic words by an unsuspecting cashier. This is when I decided civil justice must prevail. From my sentry I announced that indeed they were not next, and that I was. I continued to explain the linear queue sequence theory and mentioned that by listening in school they would have known such earth shattering mathematical concepts. Of course as expected they looked at me like I was from some other planet. Needless to say, I got my Little Penguin before the stupid university students got their beer.

Unless you see a “please form line here” sign or a cattle herder barricade, just pick a line and get it in. No jumping, butting, budging, skipping, ditching, breaking, shorting, or pushing in at any position other than the end of the line.

So Madeline, let’s form the world in two straight lines. One line with an appendix and one line without. Somehow that would be quite right. Muuah girl…and Maddie if we fail...We’ll call Rick Mercer to rant for us.

Peace Dudes

“I do not want the peace which passeth understanding, I want the understanding which bringeth peace.”...Helen Keller

What is peace? “Peace” conjures different images for people. It can mean the absence of hostility, healed relationships, social justice, economic equality, but by and large it is the sense of safety we all seek in our lives. I prefer to think of peace as “Shalom” as its meaning includes safety, welfare, prosperity, security, fortune and friendliness.

Shalom is more personalized as it describes relationships between people characterized by respect, justice and goodwill. For me “Shalom” also conjures the image of the safety of home. For the past month I’ve been travelling throughout Ontario preparing locations for our accreditation survey next week. I also lost a friend last weekend to cancer. It’s been a long journey. When I got home Friday night I was pooched.

Saturday was a family day to celebrate my nephew Adam’s 2nd birthday. My “Shalom” happened on the back deck...Duke, Fish and I just chatting. We weren’t chatting about anything of importance. We were just enjoying each other, referencing what to eat in Venice, where to go in Ephesus, and what life expectations lay ahead for each of us. It was a safe place, unconditional and filled with goodness. I was home, safe and sound where I belong.

I was reminded of our conquered battles and how together we can do anything. Duke and Fish have been my rocks and my pillars and have never failed me. I wouldn't be where I am today without them. It’s always been “all for one and one for all” and it felt good to be home. Thank you Duke and Fish for always being there...I’m always by your side. We’ve got mountains to climb; unfortunately for you my competitive side prevails...I’ll beat you both to the summit eh! Mwah xoxo

My Deet

"Each friend represents a world in us, a world possibly not born until they arrive, and it is only by this meeting that a new world is born." - Anais Nin

When I travel for work I tend to recollect significant memories that take me to the places that I call “home”. This week I travelled 2500 km conducting pre-accreditation survey prep visits. Each town I rolled through generated old memories. As I passed the US border near Gananoque ON I recounted the memories of vacation days in the Eastern States with my friend Deet in her “baby poop” coloured Benz singing along to John Denver songs.

Our friendship adventure began while working in the Intensive Care Unit at Grand River Hospital in 1987. We had our “rounds”, loved to shop, do lunch and just talk about life and all therein. We vacationed together. Our favourite place was Boston Massive-two-tits... I can still remember “Perry’s Motel”, the flea bag hole in New Hampshire. We registered and discovered bed bugs and left. As we drove away Perry waved. I can still hear Deet saying “Perry is waving and thinking...they’ll be back”. Sure enough we couldn’t find alternate lodging and “we went back”.

Later we worked together at Mount Sinai Hospital in Toronto. We both lived on Elm Street, she on the 3rd floor and myself on the 5th. That complex was a nightmare of sorts. We had adventures at the Eaton’s Lancôme make up bar as it was critical that we purchased what was required to look like Isabella Rossellini. Dinners at Bemelmans, movies in Yorkville, hair products from the Toronto Barber Shop, too many bra purchases, hairstyle upon hairstyle and many late nights talking over wine and Cheesies joined us at the hip.

Divorce, marriage/remarriage, births, death of parents and a spouse and “we’re still standing”. Cheesecake bakeoffs and late night Soirees are forefront in my mind. Deet holds the record for the best leg of lamb. Our cheesecakes are tied; however, she taught me how to bake them so she takes the cake there too.

Well today is Deet’s birthday. I can still remember when she turned 30...but who’s counting? I’m happy she has found love again and will be remarrying this September, most of all I’m grateful for our many years of friendship.

Just a few quotes for Deet that only she and I can appreciate...

“What do you mean my kidneys don’t work?” ....ICU Pt.

“I’m hungrier than hell” ....Karen C

“Those shorts and white Cotton Ginny T can stand in the corner on their own” ...Moi

Happy Birthday Deet! Love Ya Pouge xoxo

http://www.youtube.com/watch?v=Y8hd5M9Z73g&feature=related

Dear Dad

“Old as she was, she still missed her daddy sometimes.”.... Gloria Naylor

When I got married my father gave me away, officiated and read his letter to me entitled “To My Daughter on Her Wedding Day” I’m not going to share that letter here. It’s reserved for those who attended and is very close to my heart.

Father’s Day is the hardest day of the year for me. My father was my hero and best friend. I decided after 18 years it was my turn to write a letter back to him:

Dear Dad,

You always lead by example. You taught me strength, perseverance, and tolerance. I can recall the day I had to go to that evil dentist in Montreal...you were going to deck him. I still hate dentists. I had a passion for “cut out dolls and clothes”. Every time I bumped my head or fell, you would bring a cut out kit home for me. In particular I recall the time I fell down the steps at our house on Chemin de Chambly. I bumped my head so bad....You brought me the biggest and best cut out doll and clothes ever.

We moved to Perth after that. I can still see the green bike with the metallic banana seat that you bought me. I remember when you took off the training wheels and I freely sailed down Clyde Street. I can still hear your speech after I told B. Hewitt to “F-Off “...Not sure who taught me that phrase either...lol but it felt good to spit it out. When Auntie Georgette went back to France, I was devastated. You held me and reassured me that I would see her again. I haven’t yet, but she’s back in Canada and I will see her again soon.

I loved our fishing trips. I can hook any worm. I still refuse to fillet the fish. You always accepted my friends as family. I love you for that. You never accepted my boyfriends... For the record my first love was “Rick” not Ralph and the other was Wayne not “Wolf-fang”. I know you always loved and accepted Steve and we have survived 18 years.

I can recall when my first patient died. I was a wreck. Yet you drove me out to Memory Gardens to say "good bye". Ironically you rest only a few yards from her now. The best memory of all was my birthday in 1983. I was doing my medical unit placement on the med/surg unit at St. Mary’s Hospital. Sister Theresa paged me; she had an oatmeal/choc chip muffin from Norris’ Bakery, with a white candle in it. I looked at her and said “how do you know it’s my birthday”...She replied “It’s from your Dad”. That was the best gift I ever received.

I could go on and no...You should see your grandkids. While you’re with Belle in heaven, you need to know that Caitlin, Erinn, Hilary, James, and Adam are amazing. You would bust with pride to know them.

Be proud...your kids are a cool and your grandkids rock!

Happy Father’s Day Golden Eagle...

Love always and forever,

Falling Rock
xoxox

My van Gogh Girl

“You can't be at the pole and the equator at the same time. You must choose your own line, as I hope to do, and it will probably be color.” Vincent van Gogh

I remember 2 years ago when my daughter indicated that she wanted to apply to The Integrated Arts Program at Eastwood C.I. I emphatically said “no”. I didn’t relish the idea of her travelling across 2 cities for school. Reluctantly I agreed to attend the information night with the intention of making an “informed no” decision. As it went I was awestruck by the incredible talent of the art students and the dedication and passion of the teachers. As I observed Hilary, I was intrigued by how she was inhaling their enthusiasm and by her desire to “find her art”. I knew that night, that she belonged there. She applied, auditioned, was accepted and started the program last fall.

Something about “finding her art”, has given her wings to soar. She has had her poetry published, won English awards, been “Rebel of the week” 5 times and she can’t stop herself. Last week she was awarded the best “Overall Visual Artist Award" for the entire Arts Program grades 9-12. That is impressive when you’re just a shiner niner. While she is confident and determined, she is humble and often I learn about her achievements after the fact and in passing like the time when my sister-in-law emailed to inform me that Hilary’s art and poetry had been published.

That happened again yesterday. Hilary indicated that she had to attend the opening of the GEEE! In Genomes Art Exhibit at the Waterloo Regional Children’s Museum. Fifty-four Eastwood artists created 58 works which are currently on display alongside the Natural History Museums interactive displays based on the concept of Genome which runs until September. She hadn’t bothered to tell us that she was chosen as the Student Art Director or that her “Genome Teapot” is on exhibit. Furthermore she had to give an opening address. As her teacher introduced Hilary to the crowd she stated that Hilary is the most passionate art student she has taught in her 20 years of teaching. Usually when she performs, my mother instinct comes out and I feel that umbilical pain of watching her, knowing that with each performance there is a certain level of anxiety. I didn’t feel that anxiety yesterday. As she started her speech, it flowed, perfectly crafted and delivered. She was outstanding. It was my proudest moment.

Talk about Genomes...While she is a perfectionist and driven like me, she did not get her art talent from me. She got her talent from my dad, who she never knew. Yesterday as she delivered her speech like a perfect 3-point sermon I saw him living in her. It’s all in the DNA. Keep colouring the world girl!