Dear Flo: What Nurses Week Means to Me

IMG_4737Happy National Nurses Week to all you dedicated, compassionate, hard-working nurses out there! While you’re enjoying your free cinnamon bun and coffee, I hope you will pause to reflect on your work and on what truly fuels your continued passion for nursing (or where the heck that passion has gotten to if you have lost it).

And if you have time to read more than patients’ chart notes or community outreach notes, I hope you will pick up and read a “real” book written by nurse authors. We may be a small group compared with the vast number of physician authors, but we are growing in strength. I am proud to be a nurse and I am proud to be a nurse author in the company of some amazing, inspiring people.

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As far as living nurses go, there are many who inspire, innovate, and influence me. One of these is Ruth Watson Lubic, the nurse-midwife, MacArthur “genius” award winner, and founder of the Family Health and Birth Center, located in one of the poorest neighborhoods in Washington, DC. She walks the talk of what nursing can and should do well, to “treat everyone like a human being,” to create a community-based health center where “everyone who walks in that door feels love.” Plus, she has combined direct nursing service with upstream policy work as succinctly depicted in this brief video. (And she is a way cool elder who has her own Hip Hop Saves Lives song and video!)

The American Nurses Association Ethics and Human Rights Statement of 2017 states that “Nursing is committed to both the welfare of the sick, injured, and vulnerable in society and to social justice.” It goes on to proclaim that “Nurses must always stress human rights protections with particular attention to preserving the human rights of vulnerable groups, such as the poor, the homeless, the elderly, the mentally ill, prisoners, refugees, women, children, and socially stigmatized groups.”

I am a proud nurse educator and (most days) count among my blessings, the opportunity to work with the amazing, smart, creative, and compassionate future nurses. Like the students yesterday at the Nurses Week event at Shoreline Community College. And like these University of Washington School of Nursing students at our Doorway Project pop-up community cafe who spent a sunny Sunday afternoon washing the feet of homeless young people. Dear Florence Nightingale, happy birthday and happy Nurses Week! As Florence Nightingale nurse scholar Tony Paterniti, PhD, RN states, Nightingale wasn’t only the lady with the lamp, she was also a “woman with a mission.” (Check out Dr. Paterniti’s fascinating digital archive collection on Florence Nightingale through Texas Woman’s University.)

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Life in the Swamp: Float, Don’t Flail

P1020499Community-engaged scholarship is mucky business. It takes a high tolerance for—and even delight in—ambiguity, lack of clear paths, no solid ground, simultaneous decay and incubation, annoyingly loud squawking ducks, tail-thwacking beavers stirring the mud, and skunk cabbage. Oh yes, the putrid smell of skunk cabbage. Skunk cabbage reminds me of the people who seriously pluck my nerves, who irritate me, yet somehow must serve a useful purpose (for instance, as food for bears coming out of hibernation in the case of skunk cabbage).

Community-engaged scholarship is not for the faint of heart or the fastidious or the unprepared. I’ve learned and re-learned these lessons many times over my thirty-plus years of such work. There always comes a point of crisis, with the inevitable interpersonal and inter-agency power plays coming to a head. In these times, (which I am in the midst of currently with the particularly complicated Doorway Project) when my default mode is to fight back against the stealthy, submerged weeds of the swampland territory of this work.

But then I remember my Red Cross swimming safety instruction as a teenager. When swimming in swampy rivers and the underwater fingers of submerged plants begin to grasp your limbs, threatening to pull you under—instead of fighting them (thus tightening their hold), you are instructed to relax and float. The threatening underwater plants will then release you to the surface where you can gently scull your way back to the safety of shore. Float, don’t flail.

It is useful to have wetlands and swampy areas near at hand to visit and remember these sorts of lessons for life and for community work. (Not to mention, of course, the myriad positive environmental aspects of wetlands.)  I’m fortunate to have Yesler Creek in my (literal) backyard and Yesler Swamp (where the creek empties into Lake Washington) only a mile from my home. Yesler Swamp has undergone a restoration process (ongoing) spearheaded by a campus-community group (Friends of Yesler Swamp and University of Washington Botanic Gardens) and is now a refuge for wildlife—and for humans who need a respite from the bustle and hassle and skunk smells of academic and city life.

Swamps are terrific metaphors for community-engaged scholarship, especially scholarship that deals with wicked problems such as homelessness. I return time and time again to the wise words of Donald Schon, author of The Reflective Practitioner: How Professionals Think in Action (Basic Books, 1984) among many other important works:

….The research university is an institution built around a particular view of knowledge, as the following dilemma helps to make clear:

The dilemma of rigor or relevance.  In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution.  The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.  The practitioner is confronted with a choice. Shall he remain on the high ground where he can solve relatively unimportant problems according to his standards of rigor, or shall he descend to the swamp of important problems where he cannot be rigorous in any way he knows how to describe.

Nearly all professional practitioners experience a version of the dilemma of rigor or relevance, and they respond to it in one of several ways. Some of them choose the swampy lowland, deliberately immersing themselves in confusing but critically important situations. When they are asked to describe their methods of inquiry, they speak of experience, trial and error, intuition, or muddling through. When teachers, social workers, or planners operate in this vein, they tend to be afflicted with a nagging sense of inferiority in relation to those who present themselves as models of technical rigor.  When physicists or engineers do so, they tend to be troubled by the discrepancy between the technical rigor of the “hard” zones of their practice and the apparent sloppiness of the “soft” ones.

People tend to feel the dilemma  of rigor or relevance with particular intensity when they reach the age of about 45. At this point, they ask themselves, “Am I going to continue to do the thing I was trained for, on which I base my claims to technical rigor and academic respectability? Or am I going to work on the problems — ill formed, vague, and messy — that I have discovered to be real around here?”  And depending on how people make this choice, their lives unfold differently. (Donald Schon, “Knowing-in-action: The new scholarship requires a new epistemology,” 1995, Change, November/December, 27-34.)

Here is to all of the swamplands and swamp workers of the world. Let’s keep mucking around together and remember: when things get particularly tough—float, don’t flail.

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Listening to Skid Road

IMG_4007Listening to Skid Road: Join us for a lunchtime panel discussion on the intersections of health, homelessness, and racism in King County, as well as explorations of the moral responsibilities of the University of Washington in addressing these issues. Hear from panelists who participated in the oral history collection for the Skid Road project, currently on display in the University of Washington Odegaard Library. Panelists include Krystal Koop, MSW; Nancy Amidei, MSW; Sinan Demirel, PhD; Rebekah Demirel (author of the memoir Nothing’s for Nothing: Transformation through Trauma) and Eric Seitz, RN; with Josephine Ensign (PI of the Skid Road project) as moderator.

Date: Tuesday February 6, 2018
Time: 11:30am-1:30pm
Place: University of Washington Odegaard Library, Room 220
Light lunch and beverages provided
Open to the Public

4culture_colorSpecial thanks to public historian Lorraine McConaghy, PhD for her support and mentorship throughout this project.

This project was supported, in part, by an award from 4Culture. Additional support for the audio portion of the DS videos comes from Jack Straw Cultural Center. My Skid Road project was also funded, in part, by the University of Washington Simpson Center for the Humanities, the University of Washington College of Arts and Sciences, the National Endowment for the Humanities, and Humanities Washington.

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Solastalgia: Homesickness and Climate Change

BC642845-1D42-466F-870C-CC1456A62A08Population health effects from climate change are established scientific facts. Like anti-vaxxers (anti-vaccinators), climate change deniers are not only wrong-headed, they are dangerous to everyone’s health (and to planetary health). Case in point: beware of the pets of anti-vaxxers since many seem to be refusing rabies vaccinations for their cats and dogs/ see “Anti-vaxxers now refuse to vaccinate pets” by Nick Thieme, Slate, August 3, 2017; at the same time, global warming is increasing the spread of rabies among animal hosts such as foxes in Alaska/ see “Ecological niche modeling of rabies in the changing Arctic of Alaska” by Huettman, Magnuson, and Hueffer, Acta Veterinaria Scandinavica, March 20, 2017. And as a reminder, rabies in humans is almost 100% fatal (source: CDC).

The Centers for Disease Control has developed an excellent graphic depiction of the impact of climate change on human health, shown here:

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Of special note in this graphic is the fact that mental health impacts are shown twice, associated with both severe weather and with environmental degradation.

A recent (November 25, 2017) NYT article illustrates the mental health effects from climate change for people who live in Rigolet, Labrador. As Livia Albeck-Ripka states in the article “Why Lost Ice Means Lost Hope for an Inuit Village” there are increases in depression, substance abuse, domestic violence, and suicide related to the disorienting environmental changes and increased isolation for villagers. “An unpredictable environment means disempowerment,” she writes and links this with the stirring up of the intergenerational trauma of colonization for indigenous people. But she also points out that mental health effects from climate change and environmental degradation affect us all. She quotes Australian philosopher Glenn Albrecht as stating, “We weren’t around when the asteroid wiped out dinosaurs, but now we have humans in the 21st century who are trying to deal with a change to the world which is unprecedented.” Albrecht coined the term Solastalgia: “a form of homesickness one experiences when one is still at home.”

But what can we individually and collectively do about climate change and about the health effects of climate change? Perhaps the most important action is to become better informed and more civically engaged in respect to these topics. The Lancet has a good website: Tracking the Connections Between Public Health and Climate Change which includes a synthesis of scientific evidence in The 2017 Report of The Lancet Countdown. In the US reliable sources of information include the CDC (resources linked above) and the American Public Health Association (APHA). The APHA graphic “How Climate Change Affects Your Health” (included below) is a bit overly-busy and heavy on the gloom and doom (and curiously does not include mental health), yet could spur helpful discussion in certain settings:

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Another great resource that is geared towards a young adult audience is the Seattle-based environmental news site Grist, with the vision of working for “a planet that doesn’t burn and a future that doesn’t suck.” Their funny and informative (a good combination) “Ask Umbra” eco-advice column is worth following. Take a look at Umbra’s “21-day Apathy Detox” for great ideas on brushing up on civic engagement related to environmental justice and climate change. My two favorites are “Day 5: Read More Than Dead White Men” and Day 20: Art Brings Life to Social Movements.” 

Get involved. Do what you can to beautify and “green” the places where you work, live, and play. Work upstream for social and environmental justice. Bloom where you are planted. Those are some of the thoughts I’ve had this fall as I’ve been involved with this year’s University of Washington Health Sciences Common Book Changing Climate, Changing Health: How the Climate Crisis Threatens Our Health and What We Can Do about It by Paul R. Epstein and Dan Ferber (University of California Press, 2011).

In order to emphasize the what we can do about it, I’ve been part of a team attempting to green the ugly weed-filled concrete planters in the main courtyard at the University of Washington Health Sciences—a courtyard with entrances to the Schools of Nursing, Medicine, Dentistry, the UW Health Sciences Library, as well as the UW Medical Center. The photos at the beginning of this post show the planters in their current (dismal, depressing) state, along with my tiny (art project!) protest sign next to a fake flower “blooming” in a pot. Our team wanted to plant spring bulbs and a healing garden full of water-wise herbs like rosemary and lavender, as well as indigenous healing herbs and native wildflowers. We have had a seemingly endless series of meetings with people from the medical center, the health sciences schools, the building and grounds folks, and the UW Sustainability group. Something that would appear to be easy to do is not. As I understand it, the (ugly concrete/example of Brutalist “raw concrete” architecture) Health Sciences building where this courtyard is located, is crumbling and leaking inside, including in the rare books collection of the library. We have been told that we can’t plant anything until the courtyard infrastructure and water membranes are replaced, which would cost millions of dollars ($7.5 million to quote one reliable estimate).

This is a somewhat trivial problem when compared with other environmental issues affecting our most vulnerable populations, but it is a daily reminder of the negative mental health effects of environmental degradation—including from poor choices for our built environment and health institutions.

Fight Hate

img_1244I grew up in rural Virginia surrounded by White supremacists and the KKK. I went to school with—and received direct threats from—the son of the Grand Dragon of the KKK. Hate groups are, unfortunately, alive and all too ‘well’ today as they were then, and according to the wise folks at the Southern Poverty Law Center, they are proliferating in number. Hate groups are not confined to the South but they do seem particularly prevalent there, especially White supremacist hate groups, for obvious historical reasons. It is both disingenuous and dangerous for Virginia politicians, including Governor Terry McAuliffe and Mayor of Charlottesville Michael Signer to claim that the White supremacists at this past weekend’s hate rally were “not from here.” Of course, they likely represented almost every state and dark, dismal corner of our country. But of course, they were born and bred Virginians as well. It is dangerous for us to deny that hate starts at home, that hate is present where we all live, in each and every community. Fight hate. Here are ten ways to fight hate in your community, brought to you by the Southern Poverty Law Center.

Hate crimes are a public health issue, recognized as such by the American College of Physicians in a recent statement, by the American Public Health Association, the American Psychological Association, the American Nurses Association, and by a growing number of other professional associations.

And, because the memory of the following experience was brought back for me over the past few days, here is my story of my first run-in with the KKK. I was ten years old. Oh yes, and when I was back in Virginia this past fall right before the November election, on the exact farm where this KKK rally occurred, there were huge signs for both Trump and a White supremacist/nationalist group.

One late summer day I was riding in our VW bug, my mother driving on back roads from the airport, within view of downtown Richmond, not far from Oakwood Cemetery. We had just dropped off a camp counselor who was flying back to college. I was ten, sitting in the backseat, slumped against the right side window, reading a book, vaguely registering the countryside and farms we were passing, when my mother slammed on the brakes.

“Damn!” I never heard my mother curse, so I looked up quickly.

“What?” I asked.

“Keep your head down and stay quiet,” she said, adding more softly as she turned off the engine, “It’ll be OK.”  I could see her leaning forwards, both hands tightly clutching the top of the steering wheel. I slumped down in the seat while quickly peering out the side window to see what had stopped us, to see what would be OK, to see what she didn’t want me to see. I figured it was a bad car accident and she didn’t want me to see the dead or injured people.

It was approaching dusk, the witching magic hour for the waning sun. The field next to us glowed golden, with large rectangular hay bales strewn about the field of wheat stalk stubble. Hovering over the field, suspended in the thick damp evening air were shining motes of hay bits, effervescent like Fourth-of-July sparklers. With our car engine turned off, the sound of cicadas and crickets created a curtain of white noise, as mesmerizing as the floating hay.

“ Evening, ma’am. Don’t mean no trouble. I gotta’ stop you here awhile. There’s a meeting that’s passing through, that’s all. You can get going in a minute or so,” a man’s voice, polite, official-sounding, with crisp words stuck in a slow Southern drawl, came in my mother’s open window. I looked between the seats and saw a spotless white-gloved hand cupped over the doorsill. Behind that was blazing white with a thin, trickling, blood-red cross, above the cross was no face within a white mask, pale thin lips moving within an elliptical cutout area. From the words spoken and the weight of the voice, I expected to see the uniform of a policeman. When I first saw the white mask, I felt disoriented and had to remind myself it wasn’t Halloween. I stayed quiet, huddled down behind the seats. As the man walked away, I looked out the front windshield to see where he was going. Up ahead, perhaps fifty feet away, was a swarm of ghostly pointed-hat masked figures swirling around a huge bonfire. It took a moment for me to see that inside the bonfire was a ten-foot dark wooden cross.

“What’s that and why are they wearing those weird costumes?” I asked.

“Shhhhh—I’ll tell you later. Stay down and stay quiet,” my mother said.

Absorbing the fear in my mother’s voice, I sank deeper in the seat, but moved over in the middle so I could see out the front windshield at the fire and the figures. Several of the white-clad men reached into the fire with long wooden sticks and withdrew flaming torches. Then en masse, with fluid amoeboid movement, the group came toward us, sucking in lone figures as it streamed forward. I heard deep-voiced chanting, words indecipherable as a foreign language. They grew louder, surrounding our car, lighting the inside with their glowing whiteness and lit torches, gently rocking the car as they brushed past it, moving across the road, then thinning to double file down a dirt path that cut through the next field. The comforting, familiar smell of wood smoke followed them.

I didn’t hear my mother start the car. We were speeding away, screeching around bends in the road. Reflected in the rearview mirror, I saw my mother’s face set hard as stone, etched with the fierce anger I seldom saw. I was more afraid of her anger than I had been of the men we had seen. I stayed quiet, huddled down in the back seat, bracing myself for the rough ride. When we got home she disappeared into her bedroom, talking quietly with my father—so quietly that I couldn’t make out what they were saying, even with my ear pressed against the rough stucco wall between our bedrooms.

At the dinner table that night, my father told me we had been in the middle of a Klu Klux Klan meeting. “They’re racist white men who wear those costumes to look like ghosts of Confederate soldiers to scare black people, and to scare white people who don’t agree with them, like it scared your mother.” As I slowly chewed a mouthful of food, I considered this information. The ghostly man who had stopped us seemed polite, a Southern gentleman. Being in the midst of the KKK meeting had been exotic, dreamlike, seductive—almost beautiful. I knew that what I had seen, the way I had seen it, was not something to discuss. I swallowed the dissonance between my mother’s reaction and my own experience of the encounter.

The dissonance remains. It took living out of and looking back at the South to understand that ghosts becoming part of the landscape are something not to relax into. The landscape of my childhood is a landscape of half-buried violence, covered with violets, punctuated by deep, abandoned wells. The roads leading back to it are as twisted as the country roads I grew up on. Within the accretive layers of nostalgia lies the sludge of orange dust tasting of blood. I both fear and yearn for the complexity, the offbeat rhythm of the South that has formed me.

From the chapter “First Families” included in my medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net.

Stealing Stories

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Kris W. “Wall of Distraction” Photograph on canvas. 2011—Youth in Focus/ On display at the UW School of Social Work, Seattle

The commodification and co-optation of stories—of individuals and communities—is something I have been thinking about lately at both a personal and professional level. Personal, as I reflect on the various critiques of my medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (Berkeley: She Writes Press, 2016). And professional, as I walk through the medical center where I work and notice the larger-than-life patient testimonials (read: advertisements) for the medical care they have received—and read the various gut-wrenching personal stories of people who will be adversely affected by the current Republican-led efforts to “reform” our healthcare system.

In addition, I am thinking about this issue as I finish final writing and editing of my next book manuscript, Soul Stories: Voices from the Margins. The following is an excerpt from the chapter/essay “The Body Remembers”:

“Telling the story of trauma—of survival—may have the capacity for at least aiding in healing at the individual level, but then there is the added danger, once shared, of it being appropriated and misused by more powerful political or fundraising causes. Stories can be stolen. Arthur Frank calls these hijacked narratives. “Telling one’s own story is good, but it is never inherently good, and the story is never entirely one’s own.”

An intriguing example of a stolen story is the one included in Rebecca Skloot’s narrative nonfiction book The Immortal Life of Henrietta Lacks, which tells the story of the “stolen” cervical cancer cells from an impoverished and poorly educated black woman in Baltimore in the 1950s—cells that scientists at Johns Hopkins University Hospital subsequently profited from through the culturing and selling of HeLa cells—cells which killed Henrietta Lacks and cells which neither she nor her family members consented to being used and profited from. Skloot, a highly educated white woman, has profited from the use of the Lacks’ family story, although she has set up a scholarship fund for the Lacks’ family members. I am reminded of the proverb that Vanessa Northington Gamble shares in her moving essay, “Subcutaneous Scars,” about her experience of racism as a black physician. Dr. Gamble’s grandmother, a poor black woman in Philadelphia, used to admonish her, “The three most important things that you own in this world are your name, your word, and your story. Be careful who you tell your story to.”  (From “Subcutaneous Scars” Narrative Matters, Health Affairs, 2000, 19(1):164-169.)

  • See also my previous blog post “The Commodification and Co-optation of Patient Narratives” from February 11, 2011. Re-reading this blog post, I remembered that it was deemed too controversial and critical by a university librarian to include on our narrative medicine university-sponsored blog site (now inactive—the library blog, not the librarian).

Health Care as Political Weapon

Version 2Access to affordable, quality, basic health care is a basic human right. Basic, as in fundamental and essential. In a civil society, in a democracy, health care should not be used as a political weapon—as it is being used by the current U.S. government administration. Using health care as a political weapon is sick. That it is being used as a weapon by powerful, affluent (mostly men) with the best health care and most comprehensive health insurance in the country—against those of our society who have the least power and resources, is despicable.

Repealing the ACA, which all health policy experts agree has had far-reaching positive effects on our health care system and on millions of people’s access to care, is senseless and mean-spirited.

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For a brilliant critique of the current heartless rhetoric of the leaders of the ACA dismantling, please read Nicholas Kristof’s NYT op-ed piece, “And Jesus Said Unto Paul of Ryan…” (3-16-17).