Thursday, June 24, 2010

SORRY, FAITHFUL READERS: A Blogspot program glitch, now fixed, prevented me from posting normally for a few days. A more recent post, "Hospital Chow, Then and Now," appears AFTER this one with the wrong date. "Chow" really was posted about 2 p.m. on July 5. No problem if you want to add comments in the usual way.
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Out and Out

Are there any Americans who don’t want to bring our young men and women home from Iraq and Afghanistan? Unfortunately, yes.

Despite what they say publicly, many generals and admirals who gain power, promotions, and places in history during wartime don't really want to end major conflicts. They prosper when battles rage, yet are careful to stay safe and snug in their war rooms. When’s the last time we lost a general in combat?

Despite what they may say publicly, many corporate leaders whose firms are enriched by profits from producing guns, bombs, aircraft, tanks and other implements of war do not want wars to end. It doesn’t take long to replenish the arsenal in peacetime, and a full storehouse of armaments significantly diminishes bottom lines of companies making the weapons of war.

The two groups comprise the American military-industrial complex. Isn’t that the very complex Dwight D. Eisenhower, a fairly experienced military man, warned us to beware of when he left the office of President? It is. History now verifies the wisdom of his warning. Our nation is in a precarious financial position because of the huge cost of two wars, yet no one except members of the complex and those duped by them wants to be engaged in those wars.

Some suggest we should simply quit and go home, because neither war can possibly result in benefits worth even a fraction of the costs. Some maintain we must stay as long as necessary to establish democracies, which somehow will promote stability in the volatile Middle East.

Some, like me, think the two wars are distinctly different. We ought to get out of both, but for different reasons and in different ways. A rereading of The Future of Freedom: Illiberal Democracy at Home and Abroad, by Fareed Zakaria, a bestseller in 2003-2004, supports some of my beliefs, although the expert and I disagree on a few important points.

A big-time political analyst, Zakaria is considered a liberal by many conservatives because of his dark skin and foreign-sounding name and a conservative by many liberals because of what he says. Born and reared in India, Zakaria seems best categorized as a pragmatist. He proposes real-life pathways to establishing, developing, and nurturing democracies, based on his own experiences and rigorous study of history and political science.

Briefly, Zakaria thinks it foolhardy to defeat the bad guys in a country militarily, get the residents to hold elections as soon as possible, and declare that democracy has been established and the citizens will henceforth enjoy the benefits of freedom. Instead, he suggests a much slower process is realistic, with American-style democracy finally arriving thanks mainly to the efforts of the locals, not outsiders. The first steps are to develop basic institutions, especially establishing the rule of law. Then capitalism can begin to flourish, helping the citizens to attain a reasonable standard of living. What Zakaria calls liberal democracy, featuring personal freedoms, guaranteed rights, and citizen participation, then has a good chance to develop.

Zakaria thinks invading Iraq to oust Saddam Hussein was justified because of his evil repression of his own people—no government that followed the tyrant could be as bad. I disagree.

There was no good justification for invading Iraq. With very effective no-fly zones, occasionally effective economic sanctions, and a large segment of world opinion against him, Saddam posed absolutely no threat to us. Nasty as he was within his own borders, he was under control as far as our interests went.

Saddam had destroyed his weapons of mass destruction to protect himself. His secular government was an effective check on theocratic Iran, ruled by some pretty evil guys in their own right who really are a threat to us and some of our allies. He also kept the unruly Kurds in the north occupied with fending his forces off, which probably pleased our Turkish allies. His presence helped stabilize the Middle East far more than his absence has.

That said, there is a chance for democracy to succeed in Iraq, despite horrendous bungling by the U.S. government seemingly designed more to destabilize than stabilize the country. Iraq did have established institutions and rule of law (even repressive law offers a measure of security for the general public). A strong military enforced the rules before we took over and dismantled the most fundamental institutional needs. Rebuilding essential institutions has taken a long time and a huge amount of our taxpayer money, but that part of the task of establishing viable government finally is enjoying some success.

Before and during Saddam’s reign, unlike most Arab countries, Iraq had a large cadre of literate and educated citizens, and was allowing some participation by women and minorities in politics and professional fields. Many of these people fled during the civil war that followed our invasion, but some are back, and educational institutions again are functioning. Much business, except for the vital oil industry, follows western-style capitalism and free enterprise principles. A secular state headed toward classic democracy has a chance there.

We ought to get out of Iraq—soon, but not next week. We ought to do it just about the way we recently started to do it, by setting some dates for major withdrawal events (which the Iraqis demanded). It was to our advantage to do that to motivate the Iraqis to get serious about running their own affairs. We need to stick with the final date—out by the end of 2011. And we need to make sure that is a true “out,” not just a point at which to negotiate extensions.

Once we leave, the Iraqis will resolve their differences either peacefully or by fighting it out, and any outcome will be more beneficial to us than squandering further lives and dollars with a never-ending adventure that should not have begun in the first place. We gain nothing by staying in Iraq any longer than another 18 months.

To my chagrin, the war I enthusiastically supported (I opposed invading Iraq from the moment the idea arose) has turned out to be the bigger bummer. As part of a majority of Americans, I strongly backed President George W. Bush when he ordered our military forces, with as many NATO allies as he could round up, to attack Afghanistan and topple its government. I believed the radical Islamic state that trained and harbored terrorists deserved the strongest possible retaliation for the dastardly 9/11 attack on our country.

Our military did a great job in Afghanistan, just as it did in Iraq. Our government didn’t make nearly the number of blunders in post-war Afghanistan as it did in Iraq, but as things have turned out the overall strategy imposed on our military was faulty, and our latest strategy adjustment is not working.

Just as we have so long ignored the sound advice of that old leader Dwight Eisenhower, we ignored the counsel of a more recent outstanding military commander, Colin Powell. Powell’s philosophy is that successful military ventures must have a carefully defined and limited mission, including an exit strategy.

We broke Taliban control of the Afghan government and tossed most of them out of the country pretty easily. Then we made the big mistake. We stuck around, hell-bent on killing or civilizing the rest of the Taliban, and finding and prosecuting Osama Bin Laden.

Americans like to personalize their collective enemies. In fact, one man restricted to moving from cave to cave by the threat of a multi-million-dollar reward for his capture is not much of a threat to the United States of America. The reward, plus launching a missile at a cave occasionally, would have been sufficient actions on our part to render him ineffective. And, as for the Taliban, they just melt back into the populace when our forces take some territory and return when we leave.

Afghanistan bears little similarity to Iraq. It consists of a whole lot of illiterate tribal people who could care less who rules in Kabul as long as they are relatively secure, free to cultivate their poppy cash crops, and able to collect pay from whatever rebel force is fending off foreign invaders or battling the central government at any particular time. There never has been a coherent system of national institutions. Evidence is scant any could be developed in the foreseeable future.

We should have gone into Afghanistan as we did. We should have punished the Taliban for their sponsorship of terrorism as we did. We should have put a large price on Bin Laden’s head and made a diligent search for him, as we did. Then we should have brought our people out, leaving the Taliban with a clear message that we’d be right back to kick hell out of them if they sponsored anything that even barely resembled an attack on us or our allies.

Now, we need to put silly politics aside and do what is in our national interest. George W. Bush and company made a major blunder by invading Iraq. Barack Obama and company decided that a troop “surge” coupled with a new territory holding strategy was just the thing needed to triumph in Afghanistan. A surge was a factor in improving the situation in Iraq. It hasn’t worked in Afghanistan, reinforcing the idea that the two wars are radically different. Both Presidents have blundered; these are equal opportunity wars for our top politicians to screw up. Unfortunately, Bush’s blunder cannot be corrected. Obama’s can.

Instead of sticking around for many more years until we can make a phony declaration of victory, we should get out of Afghanistan as soon as possible. Next Wednesday would not be soon enough. Of course, a little more time than that will be needed to arrange an excuse for withdrawal and plan to get our forces out safely.

A withdrawal excuse is at hand. Officially, we are part of a NATO military mission. We should meet with leaders of our allies, many of whom already are withdrawing, for an up or down vote on total withdrawal. The outcome is assured. We can claim we had no choice but to accept the verdict of our NATO allies and “reluctantly’ leave Afghanistan’s corrupt leaders to search for a new group of outsiders from whom to extort cash. When we go, Afghanistan will return to the dark ages, a regrettable situation for women’s rights and any prospects for religious and other freedoms there, but that is a price we must pay.

There was no hope of establishing a viable national government of any kind in Afghanistan when the British left the feudal country many years ago. There was no hope when the old Soviet Union withdrew massive forces not long ago. There is no hope now, at least not in this century. Staying there is just a waste of lives and cash that is badly needed to protect civilized people from terrorists, to reduce our national debt, and for other useful purposes.

Let’s bring our young heroes home, and soon.

Wednesday, June 23, 2010

Hospital Chow, Then and Now

Anyone who said in 1950 the food at Sacred Heart Hospital in Tomahawk, Wisconsin, was just fine would have been viewed with suspicion.

Anyone in 2010 who said the food at Borgess Medical Center in Kalamazoo, Michigan, was not very good probably was there for a mental health adjustment.

Patient meal service at both hospitals was neat, orderly, and sanitary. There the similarities pretty much end. Except for those with a special diet need, all Sacred Heart patients got a standard meal three times a day. Breakfast arrived at an ungodly early hour, and everybody was abruptly awakened from slumber when it arrived. Many complained about that. Almost everyone said the food at all meals was “bland” or “tasteless” and few or no condiments were provided to make it tastier.

Lots of patients I visited toyed with chunks of plain Jell-O or small mounds of unappealing steamed veggies. I don’t remember seeing anyone eat everything on a tray. Trays were sectioned, as they were in those days in school cafeterias and the U. S. Army. Patients who weighed 97 pounds got the same portions as those who weighed 307 pounds. The bigger people complained, loudly sometimes, that they were hungry much of the time. Sometimes those complaints brought portion adjustments, sometimes not.

Complaints about hospital food were widespread. Sacred Heart was a well-run hospital and patient care was good. Meals appeared to be balanced nutritionally. In the 50s, just about everybody who had been hospitalized anywhere complained about the food. Across America, the hospital food service systems were much different than what I encountered at Borgess recently.

Meals at Borgess are customized for every patient, as they probably are nowadays at many other hospitals. The menu resembles a condensed Applebee’s list of offerings. With 11 entrees for lunch or dinner and an array of pastas, salads, desserts, and other individual items to choose from, it is possible to construct a five-course meal akin to those served on cruise ships. The Borgess food is not as elegant as that served on the better cruise liners we’ve sailed on, but it’s as good as some we’ve enjoyed on the lower cost ships.

As at Applebee’s, symbols indicate the healthier items on the Borgess menu. But you can get a cheeseburger, pizza, hotdog, or other fast-food favorites that are contributing to obesity in America. That is, you can, if the medical staff has not put a restriction on your diet that your order would violate.

I had a salt restriction during my Borgess stay. So, when I picked up the phone to order any meal, the order taker tapped into a computer program that automatically matched anything I ordered to the amount of salt I was allowed to have. Once, I ordered a Caesar salad, but I couldn’t have Caesar dressing because that put me over the total allowable salt level for my meal. The order taker suggested alternative dressings with less salt, or other salads. We worked it out to my and the computer’s satisfaction. The computer program might also have been calculating calories, but I never ran into that kind of limit.

One might think the order takers would try to exert a lot of pressure on patients to select the healthier menu choices, but they didn’t. As part of a lifelong battle against excess blubber, I seldom eat desserts. As I was about to order my last Borgess meal, a personal care associate recommended a dessert that sounded healthy to me, so I went for it. The order taker asked, “Aren’t you going to have some ice cream with that?” I succumbed to the temptation. There was nothing low-fat or low-cal about the generous portion of vanilla that arrived with lunch. But it sure was good.

Breakfast at Borgess is served at a reasonable time. Patients have about an hour-long window to order it and other meals, and delivery is within 45 minutes. Caregivers can, and do, order full meals or special snacks for patients outside the standard ordering times.

Meals are delivered by cafeteria personnel in snappy black-and-white uniforms. They announce “Room Service,” not “Dinner” or “Lunch,” a nice touch. It’s the kind of delivery you would expect in a good hotel, and the food is as good as or better than typical hotel fare brought to rooms.

Several caregivers told me people with no connection to the hospital often visit the Borgess cafeteria for lunch. Some are regulars. And quality and variety are the attractions, not the prices. I was told prices are reasonable, but higher than at some other Kalamazoo eateries.

I joked about it with the nurse who was checking me out, but secretly wished for a couple of hours delay in my discharge from Borgess . . . so I could have one more dinner there.

Thursday, June 17, 2010

The Penguins are Gone

Dr. P. Tatineni expressed surprise when he learned I’d lived three-quarters of a century without spending a single day as a patient in a hospital. So were several nurses and other caregivers at Borgess Medical Center in Kalamazoo after my health winning streak ended on June 9.

One nurse suggested I might be forgetting something, perhaps intentionally. “Oh, you must have been born in a hospital,” she said. Not so, I was born at home with Dr. William McCormick presiding. He and other doctors routinely made house calls 75 years ago. Dr. McCormick was said to have delivered a good share of the population in northern Lincoln County, Wisconsin, during a long career. He went where he was needed, to a farm, a home, or to the delivery room at Sacred Heart Hospital.

Dr. Tatineni mused about changes in hospital care during our brief conversation. He said he was a student of the history of medicine in the United States. He pointed out that hospital use has come full cycle. Early in hospital history, almost no one was born or died in them. Those two important events most often occurred at home. Now, a great many Americans are born and die in hospitals, although the cycle may be heading in the other direction lately as ancient birthing practices and hospice care become more popular.

I would not have had the pleasure of talking with Dr. Tatineni, or the displeasure of an unscheduled visit to his workplace, had June 9 been routine for me. It started normally. A little computer work and play was followed by some light yard work helping wife Sandy with a landscaping project. The day was hot and humid, but I took frequent breaks. Nonetheless, I felt more tired than usual in the evening, and went to bed early.

A few hours later, I awoke with a little problem. I was struggling to breathe. Breathing is fairly fundamental to the human condition. I thought my visit to earth was about to end. I felt the way we felt as kids at the end of a sprint when we needed a rest period to “catch” our breath. My trouble the evening of June 9 was I couldn’t catch it, and it felt like I never would.

Sandy and son Lee and his fiancée Karen were my first caregivers. They rushed me to the nearest emergency room five miles from our place very quickly. We arrived at 11:30 p.m., and a nurse had me connected to an oxygen supply within minutes.

After two hours of tests and treatments, the presiding doc decided I needed a hospital stay. He gave me a choice of two in Kalamazoo, about 15 miles away. I picked Borgess Medical Center because Sandy had good experiences there earlier. The nurse made some calls and I soon was strapped to a gurney and on the way, monitored closely by two paramedics.

The paramedics said it was their fourth consecutive trip to Borgess in what had been a long day. A nurse at the hospital said such trips cost $1,500 each (when the bill came weeks later, it was slightly more than $1,000). In a big country like ours, the sheer distance between facilities contributes to high health care costs, a factor seldom mentioned when we discuss the quality of care versus the expense.

I roomed at Borgess for three days. The experience included many revelations for a first-time hospital resident. I intend to describe some of them, here and later. Now, before you click to another site after observing that this neophyte is going to babble about a lot of stuff we already know, or any boob can discover by watching medical shows on the boob tube (I watch “House,” one of the few entertainment shows we bother tuning in on), let me elaborate. I’ll try to compare important, but not dramatic, situations you usually don’t observe on the TV shows with my recollections of hospital activities 60 years ago.

Whoa. How can this instant hospital expert know anything about conditions 60 years ago? He never was a patient. Well, I have a few qualifications in that regard.

As a younger man, I became very familiar with how things were done at Sacred Heart Hospital in Tomahawk, Wisconsin, my hometown. I visited many times to see friends and family members. My grandmother, father, and mother were among the patients I spent time with. Also, my family was very much in tune with medical practices in those days. One aunt spent her entire working life as a sort of business manager and general helper in the offices of Doctors Baker and McCormick, serving three of the four doctors who practiced in the city during most of her lifetime. An addition, members of the Baker and McCormick families were good friends of ours.

Sacred Heart and Borgess have a common heritage. Both were founded by nuns. Hospitals thus created have been one of the great voluntary contributions to American society. Andrew Carnegie built libraries to nurture our minds; Roman Catholic (and Episcolal) nuns established hospitals to minister to our bodies. Both types of institutions were open to everyone; most were from the start, all became so as racial segregation diminished in America.

As irreverent youths, we referred to nuns as “penguins,” but only at a discrete distance. The Tomahawk variety wore uniform, cumbersome, black habits. The more portly sisters tended to waddle a bit, and the net effect indeed was a certain resemblance to the Antarctic birds. The flight of these wonderful “birds of mercy” at Sacred Heart and Borgess over the years roughly parallels the changes in what is most important to every patient—the nature of the caregivers and how they deliver their services.

At Sacred Heart in the 1950s, nuns handled almost all the nursing and administrative duties. They wore their habits at all times on the job, and everywhere else in public. A few “civilians” staffed kitchen and maintenance positions and performed some aspects of patient care. The latter, as I recall, all wore white uniforms. The nuns were in full command of hospital activities. That was very clear. Three doctors performed surgeries, prescribed treatments, and made rounds at the hospital. I remember seeing them attired in business suits, often with vests, during routine visits to patients.

It seems reasonable to assume staff composition, appearance, and duties were similar at Borgess years ago, although the scale of things was much different. Sacred Heart had 25 beds. Borgess, serving a much larger population, has hundreds today and probably always was larger. It is likely, however, at both places most nuns were extremely dedicated to their vocation. At Sacred Heart, they lived together in a building right next door to the hospital. Running that hospital was their major mission in life, and they had only to walk a few yards from their home to their workplace to get on with their daily business.

The hospital nuns mirrored what my Catholic friends said nuns as a group were like in the 50s. A few were cheerful and jolly. More tended to be reserved and severe, especially in dealing with youths. Discipline had high priority. Visiting hours at Sacred Heart were strictly enforced. Visitors and patients were expected to quietly follow all rules. Borgess in 2010 has the same “general visiting hours” and lots of suggestions about behavior in a guidebook, but nurses were willing to arrange all sorts of exceptions and nobody seemed a bit concerned about minor rules violations, unless they interfered with patient care.

Sacred Heart had no guidebook. The nuns told you what the rules were, or assumed you knew. In the 50s hospital, it was somewhat difficult to get answers to questions, including reliable reports on patient condition. The whole area of communications has changed greatly in hospitals. I paid attention to that at Borgess; communications has been my vocation.

Like television, hospital uniforms progressed from black and white to full color in 60 years. The black habits and all-white outfits have disappeared, with very few exceptions. Medical programs on TV show that, usually by treating us to views of heroic surgeons wearing colorful caps. But you have to spend a little time in a modern hospital to appreciate the full spectrum of costume color.

Personnel even are color-coded. The Borgess guidebook devotes a full-page chart to the codes. As examples, volunteers wear purple, occupational therapists dress in burgundy, and housekeepers wear light green. Only doctors have become more uniform, they all wear white lab coats nowadays, rather than business suits. I didn’t worry much about who was wearing what during my stay, but the color diversity added some welcome pizzazz to the place.

A more important kind of diversity contributes much to the ambience at Borgess. In the old days at my hometown hospital, every staff member was Caucasian. A few of the nuns spoke with pronounced accents, I think German in all cases, indicating they were immigrants. Other than that, there was no ethnic or racial diversity. All the doctors were men.

There were virtually no opportunities for Sacred Heart to have any staff diversity. The small city’s population included only one African-American family, and its members had good jobs with the railroad company. None of the Native Americans in the area lived within the city limits; as far as I know, none worked at the hospital. The commute from where they lived would have presented problems in those days, when not everybody had a car.

Sixty years ago the population in the Kalamazoo area no doubt was not nearly as diverse as it is today; it has diversified gradually. It’s safe to say the Borgess staff followed suit. Dr. Tatineni emigrated to the U.S. from India. A no-nonsense respiratory disease expert, a female African-American doctor, popped in to check on me in the middle of my first night at Borgess. One of my caregivers was an Asian-America, a young lady who was super-efficient and sported a perpetual smile. Many registered nurses (RNs) and other staff members appeared to be African-Americans, but they came in so many shades of color that heritage was not always apparent.

The difference in hospital staff competency between the 50s and now is vast. The early nuns probably got almost all of their training in convents or on-the-job. Older sisters taught and showed the younger ones how things were done. The “civilian” nurses’ aids I knew about also had little or no formal training. My aunt, with no medical training whatsoever, did things like taking x-rays and giving injections when she worked in a doctor’s office. The doctors taught her. We can assume that sort of thing occurred in hospitals as well.

However, I doubt the doctors who practiced at Sacred Heart had much time to devote to teaching nuns or anyone else about medical techniques. They had demanding schedules. A separate post will focus on that in the weeks ahead.

The Sacred Heart doctors in the 50s all had medical degrees. All were general practitioners; specialization just occurred over time. The townspeople had some opinions on that score. If you wanted excellent attention during pregnancies and at baby deliveries, or diagnosis by a doc with a kindly bedside manner, you went to Dr. McCormick. Dr. George Baker was your man for serious surgery. His son, Dr. Rowe Baker, was more of a jack of all trades. He was very efficient, and when urgency was important, he was the go-to guy. After Dr. George retired, before I got to know him other than by reputation, Dr. Rowe took over the complete Baker practice.

Some sophisticated procedures simply could not be done at Sacred Heart. At Borgess, staff doctors have special advanced training in caring for hospital patients, and many advanced procedures feature highly trained specialists. Borgess has a brain and spine institute and a heart treatment center, among other things, on its campus. A whole lot more medical brain power is available than in the old days.

I was around long enough for numerous shift changes to often bring new caregivers to my bedside. Shifts changed daily and once again with different people on the one weekend day I was there. Every RN I talked with had a four-year college degree. Every Personal Care Associate (PCA) who appeared in my room had a two-year degree. Every specialist (a respiratory therapist was available to me at all times) had at least a two-year degree. Several types of specialists were part of the staff. The day before I was released, an occupational therapist spent a solid hour running me through some tests and giving lots of good advice on how to cope with breathing problems in the future.

You might think with all that education the Borgess caregivers would be somewhat of a hoity-toity bunch. Not true at all. With one exception, to some degree all exhibited friendliness and good cheer almost all the time. The most mundane questions were answered, a few jokes were told, and a little time was taken for general chitchat, although all obviously had busy schedules. I think the level of dedication to their work was at least equal to that of the nuns in the 1950s.

The sole disappointment for me was a PCA who seemed somewhat too detached from her work and showed minimal interest in caring for me or my roommate (he was a soft-spoken gentleman who had been in the hospital for three weeks recovering from major surgery). Perhaps the PCA merely was having an off day. Or, perhaps she might find a different line of work more pleasant and rewarding. No organization is perfect. Generally, the Borgess people were terrific.

Despite the high levels of education the Borgess staffers had attained, they wanted more. I think this is another major difference between them and the Sacred Heart personnel in the 50s.

The Sacred Heart nuns were not known for personal ambition. After all, except for those who might aspire to becoming administrators, they had reached their career goal the day they dedicated themselves to their vocation. Other staff had high school educations, or less, and seemed content with their status in life. Going on to college was not considered as important in those days as it is today. The doctors were firmly established in the community as family physicians; they were highly respected and fairly wealthy citizens. They had no particular motivation to complicate their busy lives with advanced training.

It’s altogether different at Borgess. One RN was completing a master’s degree and intended to pursue a PhD so she could operate a high-level business in the future. Most of the PCAs I talked with were working on four-year degrees, or expressed a strong desire to do so. A nice young man doing housekeeping work was earning cash to help him along the way as he studied at a local college.

A whole lot of Borgess staff members I met were interested in higher education as a key to their personal advancement, and not just the youngsters. Several taking courses had ten or more years experience as caregivers. Incidentally, that attitude of valuing education permeates the Kalamazoo community to a remarkable degree. Some think much of it is motivated by “The Kalamazoo Promise” to public school students. I promise to write some about The Promise at a future date; it’s an unusual, unique actually, financial assistance program that has national implications for community improvement. If this aside arouses your curiosity and you don’t want to wait, check out The Promise with a web search.

Put a flock of intelligent, highly educated, ambitious and culturally diverse people together in often-stressful situations and interpersonal conflict is likely. Yet, I never heard any sniping at colleagues or back-biting during my stay at Borgess. Things got a little tense once in a while, but the RNs stepped out of their role as friendly consultants into an order-giving capacity, and when the crisis was over the whole crew returned to normal. Normal seemed to be friendly coexistence.

The closest thing to competitiveness was a comment by one of the PCAs who talked with me several times because she was finishing up a college writing course, learned I dabble in discourse, and wanted to compare notes. With a mischievous grin, Amy said she would be pleased to answer some of my questions about her work at the hospital, but only if I agreed to write, “Amy was the coolest PCA.”

Amy was finishing the last writing assignment in her English course; she was happy about that. We agreed that writing is not a particularly easy chore. But if she could concentrate on it in her limited spare time, I can make a little extra effort, too. I intend to tackle at least six topics related to my hospital stay and earlier experiences in my hometown. One, dear to every patient’s heart, will be the food. Others will be staff communication networks, effects of computerization, patient-staff communication, caregiver pay, and suggestion systems.

One future topic has some political importance in these parts. The question is about the merits of expensive duplicate services when two major hospitals coexist in the same area. My stay at Borgess completely changed my mind about that. Other things interest me, so the duplication discussion and the other hospital stories will be interspersed with other items on this Blog.

But if you want a chance to agree or disagree with the views of one mature adult about hospital care, past and present, check in here once in a while and see what’s posted. I hope a nun or two will read this, and do that. I want to conclude this piece of the picture with a little message for all of them.

The last time I visited Sacred Heart Hospital, when my mother was a patient there during her final days, I saw only one nun. She was in modern, attractive attire, not wearing a habit in the traditional sense. She was not working as a nurse or personal care provider.

There may be more than one nun on staff at Borgess Medical Center now, but all those I talked with could name only one off-hand. She is not serving as a nurse. Her coworkers admired her good work as a spiritual counselor and patient confidant.

Sacred Heart Hospital is no more. Labor costs as the number of nuns available to staff it declined surely were a factor in its closing. What now is Borgess Medical Center overcame that and other obstacles to grow and prosper as part of Borgess Health, a huge health-care organization in southwestern Michigan. Although very few nuns work in day-to-day Borgess operations, the Sisters of St. Joseph continue their involvement as sponsors.

The penguins have flown away. Hospital care is in the hands of the Amys of the world and their associates. And they are pretty cool. But those nuns gave a great gift to many hometowns across America, whether the hospitals they founded ultimately died or flourished in other forms.

The nuns I’ve encountered over the years were rather secure people. They didn’t really need morale boosts to keep them going—especially from a fairly impious Lutheran who was raised as a Christian Scientist and has been told his name is on the rolls in a Mormon mountain vault whether he wants it there or not. But they deserve great amounts of appreciation, whatever the source.

Bless you all, hospital sisters, wherever you may be.

Sunday, June 13, 2010

A Wowser of a Ritual

Normally, I wouldn’t walk across the street to attend a high school graduation ceremony. Tuesday I gladly would have, but I couldn’t.

President Barack Obama came to nearby Kalamazoo as promised to speak at the ceremony honoring 282 graduating seniors from Kalamazoo Central High School. Central won the presidential visit in a contest to recognize the best school improvement program in the nation. No tickets were available to the general public.

The lead story in the Kalamazoo Gazette’s eight-page special section the next day said it this way: “Best. Commencement. Ever.” The section backed that claim with numerous photos of students, faculty, friends, and dignitaries, all laughing, clapping, or cheering wildly. One reporter said the students were “joyful and jubilant.” Actually, just about everyone involved was.

I did the next best thing to being here. I watched  on one of two regional TV stations that aired the two-hour proceedings.

As expected, Obama gave a masterful speech, urging the grads to take personal responsibility for their future success. He wowed the audience with humor, no-nonsense advice, and many local shoutouts, talking to students by name and mentioning area institutions.

Somewhat unexpectedly, the students stole the show. The Gazette quoted a graduate who summed that up: “I thought it was going to be about Obama, but it turned out to be about us.” The kids wowed me. They made it one of the most interesting programs I’ve seen on the tube in a long time.

One young lady, after receiving her diploma and an Obama handshake, asked for and got a presidential hug. That touched off a series of hugs, pats on the back, and personal comments from the President as the graduates filed by. He shook all 282 hands, some twice because he dropped in on a gathering of the seniors unannounced before the ceremony started and smoozed with them for 15 minutes.

The band had been practicing “Hail to the Chief” for nearly a week before the conductor was advised that only the U.S. Marine Corps Band was permitted to play that music when a President enters a room. The Central bandmaster said his group would switch to a customized version of “Pomp and Circumstance.” What I heard sounded suspiciously like a customized “Hail to the Chief” when Obama arrived. He looked just a tad startled.

The class valedictorian, a South Korean immigrant, struggled a little with a few parts of her talk. But she earned a standing ovation with a punch line punctuated by a huge grin and raised arms: “Less than four years ago I came to Kalamazoo and to America for the first time. Just look where I am now!”

The salutatorian, at 18 a speaker nearly as polished as Obama, said his goal was to be elected President of the United States. After Obama took the podium he told the young man, “I’m glad that, according to the Constitution, you can’t run until you’re 35. So I’ll be long gone by then.”

The observation in my May 13 post (Hey, Look Them Over) that many Americans are eager to see and hear a sitting President in person was verified. Despite a move to a 5,000-seat venue, there was no way for me to get a ticket. Administrators allocated all the tickets to seniors at the three district high schools, some other students, and a limited number of family and friends of the graduates.

The level of interest in the community was amazing. Every seat in three school auditoriums and a church viewing area was filled by individuals viewing the event on big-screen video. One lady drove from Decatur, Illinois, just to experience the togetherness of watching with a group, although she had no chance at a ticket to the actual ceremony.

No nastiness marred the occasion. Two small groups, one lobbying for an end to war and one for immigration reform, held rallies away from the Western Michigan University campus where the President spoke. Both were peaceful. Area Tea Party adherents, a group that might be expected to provide hecklers for an Obama appearance, declined to show up. A Gazette reporter quoted a spokesman as saying, “This shouldn’t be a political event on his part or ours. It’s the kids’ day and the families’ day, and they should be able to enjoy it without interference.”

Amen. After seeing those thrilled young people, I don’t regret for a moment missing what probably was my last chance to see and hear a sitting President in person. Those students earned their thrill of a lifetime, and they have many more years than I to enjoy the memory.

Sandy and I got one little thrill, though. About 9:15 p.m. huge sound waves drew our full attention as big helicopters roared directly over your house, something that never happened before. We figured the squadron escorting Mr. Obama would have left Kalamazoo about that time, so one of them might be Marine One. Marine One would be carrying the President of the United States to Grand Rapids where he was to board Air Force One for his return flight to Washington.

I got off my best recollection of what a snappy salute ought to be as the choppers passed over us. Heck, I thought, even if it wasn’t the commander-in-chief overhead, saluting some standout Marines was something I was proud to do.

News reports confirmed that Marine One was sighted leaving Kalamazoo minutes before 9:15 and heading north right toward our home. At least I now can claim to have saluted a President in person, even if I still haven’t seen one.

Thursday, June 03, 2010

Absolute Lunacy

As we developed our master plan for moving from Utah to Michigan we kept coming up with two cars and only one driver for the final journey. So we solved the problem by selling the clunker of the two machines at a garage sale. Having done that, we decided to try life with one vehicle for a while to see how it went.

I told Sandy, “Well, we’ll get one little benefit even if it only lasts until we replace the second car. Our insurance costs will drop when I take one auto off our policy.”

The company increased our premium when I called to report that we now needed coverage for only one car. Flabbergasted, I phoned again to get another representative to confirm that decision. It was true—the company charged more to insure one car than two. It seemed a trifle illogical that one vehicle ran more risk of being involved in an accident than two. The representatives explained it all by stating that we no longer qualified for a “two-car discount.”

We had been with the company, a major national firm, for more than ten years. We had filed only a single claim for less that $200 in all that time. Our premium payment record was spotless.

The company was one of those that advertise significant percentage savings by switching to them. With profit-making strategies like the “one costs 10 percent more than two” plan, it’s no wonder they can make that sort of claim.

We promptly relieved the company of 100 percent of our business.