Tag: Health care

A Conversation with Noah Fey

SKID ROAD
SKID ROAD
A Conversation with Noah Fey
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On June 24, 2022, I sat down with Noah Fey, director of the Downtown Emergency Service Center (DESC) Housing Programs, at the DESC building in Pioneer Square. We discussed his work, first as a volunteer at DESC, then as an outreach worker, and now in DESC administration overseeing all of their varied housing programs. That morning, I had walked past tent encampments on the sidewalk just north of DESC. Noah talked about his nuanced views of encampment clearances (sweeps), encampments that grew exponentially in Seattle during the COVID-19 pandemic. Noah said, “I am not a fan of sweeps, but I am not a fan of simply saying, ‘We need to leave people where they are and leave them be.’ Neither of those are good alternatives and neither of those are informed by what we know works for people. Sweeps on their own are highly disruptive for people. (…) There’s already such a feeling of insecurity when you don’t have a place to live. Losing it time and time again is inherently pretty traumatic. (…) But I also think we’re shortsighted (…) if we are just adamantly saying, ‘No sweeps,’ and not saying what should come instead.”

Various cities around the country, including the Seattle area Burien, enforce stricter “anti-camping” bans, allowing more encampment sweeps and legal fines for unsheltered people. Many people and advocacy groups, including the National Health Care for the Homeless Council, point to the mounting evidence that sweeps harm people experiencing homelessness. Other groups like the National Homelessness Law Center have the campaign, “housing not handcuffs,” highlighting the fact that encampment sweeps are a form of criminalizing homelessness and poverty.

This past Monday, April 22, I conducted a workshop on homelessness in a large medium-security correctional facility in a rural area of Washington. The forty-five men who attended wanted to discuss the just-opened Supreme Court case, City of Grants Pass, Oregon v. Johnson, which will decide whether laws regulating camping on public property constitute ‘cruel and unusual punishment’ prohibited by the Eighth Amendment. Many of the men had experienced homelessness and had family members still living on the streets. Obviously, they were in prison for other crimes, but homelessness had complicated their lives. They asked me for resources on re-entry programs for when they are released from prison to reduce their chances of becoming homeless and churning through the homelessness, jail, and prison pipeline. Through the librarians at the facility, I was able to provide some of these resources. The Central Library of Seattle Public Library has a list of re-entry services, as does the Emerald City Resource Guide from Real Change. Seattle University’s Homeless Rights Advocacy Project, which advocates for legal and policy changes to prevent homeless people from entering the criminal justice system, also has a list of sources. My experience with the men at the prison made me even more grateful for the dedicated work of people like Noah Fey in providing compassionate, evidence-based housing and support services in our region.

Skid Road

SKID ROAD
SKID ROAD
Skid Road
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In this first episode of my Skid Road podcast, I introduce listeners to the situation of health and homelessness in my hometown of Seattle.

Nurse Bullying is Real

From the Radical Nurses Group/Royal College of Nursing Archive, Edinburgh

In my almost 40 years of nursing, I have heard about, read about, and taught about nurse bullying, but I had never experienced it directly—until yesterday while working as a Covid vaccinator in a hospital setting.

The American Nurses Association (ANA) defines nurse bullying as “repeated, unwanted harmful actions intended to humiliate, offend, and cause distress in the recipient.” As I write that, I wonder why they include “unwanted” in the definition. Who in their right mind would want to be bullied? And even if that were the case, it would not make bullying okay. The ANA includes bullying in its statement on workplace violence. They point out that nurse bullying threatens patient safety, diminishes quality of care, and contributes to nurse burnout/staff turnover. Nurses who are bullied suffer a host of physical and emotional repercussions, including higher rates of depression and suicide.

“Nurses eating their young” is an oft-repeated phrase when referring to nurse bullying. I imagine that Florence Nightingale was quite the nurse bully. It seems to be ingrained in our profession and treated almost like a necessary rite of passage. Nurse bullying can begin in nursing school, with students being subjected to humiliation and intimidation by professors, clinical instructors, and school administrators. In some studies (see references below), over half of graduating nursing students report having witnessed (bystander) or been the recipient of nurse-on-nurse bullying in clinical rotations. The vast majority of nurse bullying happens in hospital settings, perhaps perpetuated by the high stress, high stakes clinical outcomes, heavy workloads, and low job autonomy of nursing within the rigidly hierarchical hospital setting.

I know that many frontline hospital nurses across our country and in other countries hard hit by the pandemic are burned out and angry after over a year of treating patients with COVID-19 and seeing so many of them die. Many nurses are tired of being portrayed as “angels on earth.” And, of course, the pandemic is far from over despite the rollout of safe and effective vaccines. Perhaps the vaccine clinic nurse manager yesterday is one of those burned out, pissed off nurses. It doesn’t excuse the bullying behavior she threw my way (I’ll spare you the details but it went way past incivility) and to a patient who, post-vaccination, asked to use the restroom (located next to the clinic) and she told him curtly that he had to wait the full 15 minutes of post-vaccine observation. Seriously, a patient is a person who has the right to use the restroom. I’d had enough and escorted the patient to the bathroom, waited outside to make sure he was okay, and then excused myself from the presence of that nurse bully. And reported her behavior in the hopes that she will be removed from that specific role and offered professional coaching of some sort. But I’m not going back to that setting, at least not as a clinician. I’ll find a better place to volunteer as a nurse vaccinator.

I’m attempting to turn this distressing experience into a teachable moment, for myself, and for students I teach. I now know from direct experience that nurse bullying is real.

References:

Theresa Brown, “When the Nurse is a Bully,” NYT Well blog, February 11, 2010.

Cole Edmonson and Caroline Zelonka, “Our Own Worst Enemies: The Nurse Bullying Epidemic,” NURS ADMIN Q. 2019, vol 43(3):274-279.

Note: I received this message in response to this post:

“As I’m sure you know, workplace violence is a critical issue affecting not
only nurses, but patients and their quality of care. That’s why ANA
launched #EndNurseAbuse – a nationwide initiative to eliminate physical and
verbal abuse, sexual harassment, and bullying in the workplace.
#EndNurseAbuse galvanizes nurses, health care stakeholders, and consumers
across the nation to reduce violence and harassment against nurses. Visit the
#EndNurseAbuse resource center to see the video that brings to life actual
accounts from real nurses who have experienced various forms of violence and
abuse on the job. While you’re there, please take a minute to sign the #ENA
pledge and share!

Here’s the link to ANA’s official statement:
https://www.nursingworld.org/news/news-releases/2021/ana-applauds-passage-of-workplace-violence-prevention-legislation/

ANA Applauds Passage of Workplace Violence Prevention Legislation by U.S. House of RepresentativesMEDIA CONTACTS: Keziah Proctor. 301-628-5197 keziah.proctor@ana.org . Silver Spring, MD – Today, the American Nurses Association (ANA) applauds the U.S. House of Representatives for passing the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1195).This legislation, approved by a vote of 254-166, will help to better protect all health care professionals and …www.nursingworld.org

Dr. Ben Danielson: Standing Up to Institutional Racism

Dr. Ben Danielson, photo by Josephine Ensign, 2015

The new year brought hope for a better year ahead. Also, it brought sorrow and anger in Seattle at the news that a beloved physician and community advocate, Dr. Ben Danielson, recently resigned as medical director of the Odessa Brown Children’s Clinic. Odessa Brown Children’s Clinic is a pediatric clinic run by Seattle Children’s Hospital. It began in the late 1960s in the traditionally Black Seattle neighborhood (because of redlining/racial restrictive covenants) of the Central District. It began from a combination of the Model Cities Program and community calls for improved healthcare access and quality for marginalized urban communities, including communities of color. Seattle Children’s Hospital was—and still is—located in the upscale, mostly gated and white neighborhood of Laurelhurst. Then, as now, there were accusations that the powers that be at Seattle Children’s Hospital were racist, that children and families of color were subjected to racist treatment–as were nurses, physicians, and other healthcare staff members of color. (Also, Seattle Children’s Hospital has been accused of not supporting LGBTQ staff and patients; see my posts on the suicide of nurse Kim Hyatt who was openly gay and who was treated poorly by administrative staff. This showed up clearly in the redacted hospital personnel files I reviewed and in conversations with her friends and co-workers who contacted me.)

According to the independent newspaper, Crosscut, which broke the news of Dr. Danielson’s resignation after twenty years as medical director, “Danielson felt marginalized and alone as the rare Black voice in a position of authority…He said Seattle Children’s would gladly place Odessa Brown, which serves mostly low-income and people of color, on a pedestal to raise money, but would not show that same level of interest when it came to daily care”

I worked alongside Dr. Danielson in the early 2000s when I was a nurse practitioner at the ‘sister’ community clinic, Carolyn Downs Family Medical Clinic. Carolyn Downs is one of our country’s longest surviving clinic begun by the Black Panthers. As a nurse practitioner who had worked at a majority Black community clinic in East Baltimore, I knew about sickle cell anemia in terms of crisis management but not longterm, chronic management. One of my teenage patients at Carolyn Downs had sickle cell anemia and Dr. Danielson helped me manage his care more effectively. Subsequently, when working on my Skid Road oral history project for my forthcoming book, Skid Road: On the Frontier of Health and Homelessness in an American City, I had the please of completing an oral history interview with Dr. Danielson. An edited version of my interview with him is available here. (The audio quality on this one is much better than the video since I wrestled with the equipment that day.)

At the end of my oral history interview with Dr. Danielson, stated, “Diversity and cultural humility and improving the lot of people who are marginalized, that happens when you do it intentionally. Waiting for people to just do it out of generosity, or out of some sense of enlightenment all of a sudden that hasn’t been there for 20 or 30 years, that won’t cut it. We have to be intentional, and we have to be creative, and we have to work hard.” He spoke of being energized and having renewed hope because of the work of young people in the Black Lives Matter movement and because of the social justice work locally of the people of El Centro de la Raza. “You’re reminded that people stepped up. They occupied. They talked about oppression and racism, and they stood up to it and made a difference.”

The Long View

This, unfortunately, is the season for despair for far too many people in our country. We have the recent health policy and population health news that, for the third year in a row, life expectancy in the United States is going down. Our overall life expectancy began to stagnate in the 1980s, then decline for certain groups, and more recently to decline more broadly. (see: “‘There’s something terribly wrong’: Americans are dying young at alarming rates” by Joel Achenbach, The Washington Post, November 26, 2019)

And, as researchers point out, this decline cannot be blamed solely on the opioid epidemic. Neither can it be blamed on Democrats or Republicans. Diseases and deaths of despair in our country are something we are all responsible for, what we all can do something about.

History teaches us to take a long view. History training, in the words of one of my favorite contemporary British historians, David Hitchcock, is also “empathy training among other things.”

Recently, I have had the pleasure of immersing myself in the oral history interviews I have conducted with a variety of people working and living at the intersection of homelessness and health in Seattle-King County. You can view the names and photographs of the people I have interviewed so far for my Skid Road project, as well as a few videos, here.

As an antidote to despair, I offer you an excerpt from my interview with one of my mentors, the social worker and civic engagement teacher Nancy Amidei. This interview was conducted on June 16, 2015 at Jack Straw Cultural Center in Seattle. This was her response to my question of what gives her hope for the future:

“I’m old enough to be able to say that when I graduated from college, there was no Medicare, there was no Medicaid, there was no Head Start, there was no WIC [Women, Infants, and Children] program. Food stamps was a pilot demonstration project in seven counties. What else? Oh, school lunch was only in the schools that could afford it, only the rich schools. There was no senior nutrition program. There was no American with Disabilities Act. There was no Civil Rights Act. There was no Voting Rights Act. Oh, there were no women in professional sports because there was no Title IX.

So, if I had to guess, I think all of those things passed within maybe twenty years from when I graduated. Well, if you had lived through that kind of change and you’ve seen that happen–and most of that is stuff that helps people who are not rich, who are not powerful. Food stamp recipients are not rich and powerful. Welfare moms are not rich and powerful. We can do things in this country, and you don’t have to be rich and powerful to make it happen. But you do have to vote, and you do have to pay attention to who’s in office. You do have to pay attention to the candidates. And you do have to speak up.”

Stories Matter

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“Stories matter. Many stories matter,” states author Chimamanda Ngozi Adichie in her powerful TED talk “The Danger of the Single Story.”  Adichie points out that listening and clinging to a single story—about a person, a place, a situation—creates stereotypes, and, in her words, “the problem with stereotypes is not that they are untrue, but that they are incomplete. They make one story become the only story.” She goes on to say, “The consequence of the single story is this: it robs people of dignity; it makes our recognition of our common humanity difficult; it emphasizes how we are different rather than how we are similar.”

I thought about Adichie’s wise words earlier this week as I moderated a hospital-based panel discussion on service provision and community advocacy to end commercial sexual exploitation and sex trafficking. The panel and the day-long training for health care providers included personal stories of survivors of sexual exploitation. None of the survivors remotely resembled Julia Roberts in the “modern Cinderella story” movie Pretty Woman, which reinforces the common stereotype of the high-class and empowered hooker. Instead, the survivors told stories of trauma and violence which both preceded and accompanied sexual exploitation.

In my introductory talk about why this topic matters, I linked to an important storytelling video geared towards healthcare providers on The Life Story website, “Medical Emergency.”  I appreciate how this particular video weaves together the stories of women in their own voices. Advocacy is not about speaking for those less fortunate, less powerful, but of using our own power and privilege to amplify their voices, their stories. Our job as healthcare providers, as compassionate citizens, is to step back and listen respectfully.

Another powerful story came to me today via a colleague who sent me the link to this NYT Op-Docs Season 6 video “We Became Fragments” directed by Luisa Conlon, Hanna Miller, and Lacy Jane Roberts. Through their video, they step back, listen, and then amplify the voice and words of Ibraheem Sarhan, a young Syrian refugee now living in Canada. I love how this short video highlights the importance of competent and compassionate, trauma-informed teachers and healthcare providers. When one of Ibraheem’s teachers gives an in-class assignment to write about their family, the teacher gently points out to Ibraheem that he doesn’t have to write about his family if it is too painful a topic. The teacher must know that a bomb in Syria killed Ibraheem’s mother and siblings and left him with a shattered leg. Ibraheem tells us that when people ask him about his visible leg injury, “they don’t know how much my heart burns when I tell my story.”

Stories matter to the teller and to the listener. What we need more of in this world is for all of us to increase our capacity to listen to a multiplicity of stories and within those stories to recognize our common humanity.

 

 

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).

Homeless Feet Come Full Circle

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Josephine Ensign/ foot care at Cross-Over Clinic, Fall 1986, from Freedom House brochure.

“I did a lot of foot care at the clinic… Of course, it had its Biblical roots, but there was something about foot washing that most people found comforting and even pampering…I knew that having your feet cared for could somehow make you feel better all over…Almost all the homeless patients I saw had foot problems. They had to walk around town to get to different agencies, meal sites, and day-labor pools. They walked in the rain and the snow and the heat, usually in ill-fitting, secondhand shoes with dirty, holey socks, and carrying heavy backpacks.”~ from my book Catching Homelessness: A Nurses Story of Falling Through the Safety Net, pp 86-87.

In this excerpt, I was referring to homeless patients I cared for when I worked as a nurse practitioner at the CrossOver Clinic in my hometown of Richmond, Virginia in the mid to late 1980s—over thirty years ago. But I could be (and indeed, am now) writing about currently homeless people and foot care here in my adopted hometown of Seattle, Washington.

There is this brief part of a haibun (prose mixed with haiku) reflection I wrote after helping with a foot clinic at ROOTS Young Adult Shelter in the University District near where I work: “Tonight in the homeless shelter a 19-year-old man from Georgia says, ‘My momma always told me not to go barefoot and I didn’t listen. That’s why my feets so bad. And I have to walk everywhere on them now.’ He reaches down and gently rubs his brown gnarled feet soaking in a white plastic basin. His feet are darkly scarred and calloused: the feet of an old man.

walking barefoot/we find our way/though cruel paths scar”

(From Soul Stories: Voices from the Margins, in the haibun/chapter titled “Where the Homeless Go”).

Kendra and Ani1.jpg

And there is this description of a foot care clinic I helped with at Mary’s Place, a downtown Seattle women and children’s homeless drop-in center: “The most delightful—and tender—foot clinic patient we had that morning was the petite three-year-old daughter of a young North African immigrant mother. The child pushed around a pink plastic toy shopping cart from the shelter’s playroom, and she wore a dress, bright striped tights, black Mary Janes, and a huge pink feather boa around her neck. She came and sat on a metal folding chair while one of the students washed her mother’s feet. The little girl wanted her own feet to be given the same attention, so her mother removed her shoes and tights. Baby toes! So cute!… I wanted to scoop her up and protect her from the traumas, the abuses of the world. But, of course, I knew I couldn’t do that. It made me sad to watch her toes curl up in delight as she splashed her feet in the basin of soapy water.”

(From Soul Stories: Voices from the Margins, in a chapter titled “Walk in My Shoes.”

IMG_0678And finally there is this King5 TV news report on the University of Washington School of Nursing foot clinic I helped with a few days ago (“UW Nursing Students Host Tent City Welcome Party” by Heather Graf, January 13, 2017). Rusty, the homeless resident of nearby Tent City 3 (currently on the UW campus), told the nursing student working with him that he had never felt so pampered. Small things go a long way. They always have and always will.

On (Not) Letting Go

imageHaving read, and liked, Jonathan Kozol’s previous books Rachel and Her Children and Amazing Grace, I looked forward to reading his recent medical memoir The Theft of Memory: Losing My Father One Day at a Time (New York: Broadway Books, 2015).

While there were parts of the book that I appreciated, including Kozol’s candidness about the relative loneliness of his life and his reasons for wanting to extend his father’s life as long as possible even after Alzheimer’s disease had ravaged his father’s mind and body, overall the book was frustrating to read. It felt as if it had been written in a hurry and not edited carefully. For instance, there were frequent awkward and overly long (as in six to seven lines in length) sentences that detracted from the story. And I really did not care at all about the long sections of the book pertaining to Eugene O’Neill and his family and personal dramas. It felt more than unethical for Kozol to have mined his psychiatrist father’s notes pertaining to his patients, including O’Neill.

Kozol comes across in this book as an overly-privileged and entitled man who blames all of his father’s doctors for under and mis-treatment of his father’s health conditions. He does on occasion show some self-insight, as in this passage: “At some level, I think I was aware that selfish motivations of my own might very likely be at stake in the decisions I was making. …As nonresponsive as he often was, and physically enfeebled as he had becomes, I could not escape the crazy thought that I still needed him.” p. 151. That part of the book, a look inside the decision-making process for a family member such as Kozol who defies medical advice and staunchly fights for his father’s life to be medically extended as long as possible, made it a worthwhile read. That is a mindset that I do not understand, both as a medical provider and as a family member. Having read this book, I do have greater insight and compassion for people who hang on to their loved one’s lives far past what would appear to be prudent.

My Homeless Shadow

IMG_1542“Most of us live homeless, in the neighborhood of our true selves.”
—Rachel Naomi Remen

__________________________

A few years ago, while working with Public Health– Seattle & King County on a medical respite project for homeless youth, my own homeless shadow resurfaced. I was in downtown Seattle at the YWCA women’s shelter, waiting inside the front lobby for the rest of our group to arrive. We were scheduled to have a tour of the facility to see how they ran their medical respite program. I’d taken the city bus and had purposefully dressed down in jeans, a sweater, and a raincoat. It was late afternoon, raining out- side, and I saw soliciting, pimping, prostituting, and drug dealing happening on the sidewalk in front of the shelter. The members of my medical respite group were buzzed in the front door. At the same time, a homeless woman resident walked up to me and asked, “Did you stay at a hotel last night on Aurora instead of here again?” Aurora Avenue is one of Seattle’s main prostitution areas. I looked up at her in alarm. “I’m sorry. You must have me mixed up with someone else. I’m not staying here, I’m just visiting.”

The people in my group overheard this interchange. Later, they teased me about it, saying how preposterous it was. I was a university professor, for God’s sake! There was no way I could be homeless, much less a homeless prostitute. But I couldn’t shake the feeling that my cover had been blown, that I’d been found out, that my homeless shadow was showing. You were homeless—why? What was wrong with you? Those are the questions people ask me—or want to ask me—whenever they discover I was homeless. Coming out of the closet about my own homelessness was never an option for me. It could derail my career, hurt my family, and marginalize me even more. It was largely why I had moved across the country to Seattle, to escape the memories of having been homeless in my hometown of Richmond, Virginia. But standing there in the YWCA shelter, I recognized the irony—and the hypocrisy—embedded in my reaction to the woman’s question. Here I was an outspoken advocate for people who were homeless, while secretly judging them, and by extension, judging myself.

Homelessness is exhausting and soul sucking. Homelessness has marked me. Like the star-shaped surgery scars on my belly, the body harbors secrets. Homelessness is a type of deep illness, a term coined by sociologist Arthur Frank for an illness that leaves you feeling dislocated, an illness that casts a shadow over your life. That shadow never completely goes away. At some point it was time to acknowledge my homeless shadow, time to remember.

Note: This is an excerpt from my recently published medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (Berkeley: SheWrites Press, August 9, 2016).