Scatter my ashes here...

Scatter my ashes here...
scatter my ashes in the desert...

Friday, May 10, 2019

Nurses' Week: Moving Forward and Podcast with Lisbeth Overton

Ultrarunners understand RFMs- relentless forward motion. We often use our determination and mental strength to carry us forward through discomfort and difficult situations in our personal lives and work lives in addition to our athletic pursuits.

I had a conversation with my friend Lisbeth Overton yesterday in a podcast for Nurses' Week (listen here). We talked about the difference between moving forward one foot in front of the other in a way that breaks you down, versus moving forward intentionally with progress. I want to say more about that because right now, between healthcare and the crazy shit happening in our country, it can be easy to go to a place of despair.

I've found myself over the past month deteriorating into that place of despair and realized I need to get out and move more. I have been so bad about allowing myself to not go outdoors to run in the bad weather this winter. I need the fresh air and the brain break it gives me. Being a bit of a political news junkie and overthinker has not been working in my favor lately.

Lisbeth and I talked about how so many nurses are struggling and frustrated with the opportunities and working conditions their profession affords. They want to use their knowledge, talents, and skills to truly make a difference in patients’ lives, but often there is no place for that in the task-oriented, rushed and understaffed workplaces of healthcare facilities and hospitals.

Many nurses wish they could break out of the grind, find a better job that allows them to practice patient care they way they’d like to. They can feel stuck, which leads to despair, low morale, burnout, and health problems, none of which are good for taking care of sick people.

There are two ways you can move forward: one is to grind through, trudging with dread because you feel like you have no choice. The other way to move forward is by taking small steps, still moving forward, not any faster, but with intention and action, no matter how small those actions are, but doing something to move yourself toward better days.

The lesson, I think, that ultrarunners have learned, that sedentary people need, is that active leisure is such an important and undervalued part of our lives. It seems that so many people have forgotten how to play. Too busy chasing material objects, or buried in our electronic gadgets and devices, we end up sitting down as time flies past us.

The time focused on a screen takes away from the time we’re aware of our environment, using all our senses, learning, and appreciating what is in our world at arm’s length. Unaware of our surroundings, we could be moving and breathing, paying attention, burning calories, reducing our fatigue, circulating our blood, and boosting our mood and energy.

People who have not pushed themselves toward physical goals, who are not athletes, often miss out on the rich lessons that athletes learn, of pushing beyond prior achievements, and refusing to accept outwardly-imposed limits. We're always looking to go further, in distance, time, space, or experience.

Working with cancer patients, acutely ill people, and those with chronic disease, I've observed what being an athlete can do for a person in terms of mental and physical strength. Athletes who do get sick are at a big advantage, not just in terms of likelihood of recovery and regaining function and quality of life after an illness, but in coping with the physical and mental demands of an illness, even when there is a discouraging prognosis.

I used to say to my co-workers in the hospital, that it was easier to run a fifty miler than work a twelve hour shift. None of them believed me, but for me it was true. If you're going to be on your feet for 12 hours, you might as well be outside without crazy demands on you every second. Plus you can eat, drink, and pee whenever you want!

When it comes down to it, nursing is about public health, helping people (the public) get healthier, function more effectively, and live better lives. All of the major issues facing our country right now are connected to public health. Here is an incomplete list:

1. Income inequality- the greed, sociopathy and lack of empathy that leads us to a place where a few people have the overwhelming majority of wealth so that large numbers of people are unable to meet their own basic needs or access adequate services that allow them a decent opportunity at a decent standard of living and level of health. People who have to work two or more jobs to pay their bills are unable to take care of their own health.

2. The lack of mental health services, proper care and treatment of addiction, unaffordability of health insurance and prescription drugs, and near-monopolies that destroy competition and drive up prices, make decent healthcare out of reach even for those with health insurance.

3. Our stressful lifestyle- too many people are working too hard for too little compensation for things that are too expensive and often unnecessary. Poor community planning leads to overreliance on vehicles and commutes that are detrimental to our environment, people's health, and financial well-being. We don't have enough mental health services available and people don't demand them because of stigma associated with mental illness.

4. Obesity and metabolic disease are an epidemic, for many of the reasons cited above- community planning, mental health, low incomes, working several jobs, lack of education, feeling powerless, cycles of abuse...

5. The opioid crisis, a result of greed, poverty, lack of mental health services, lack of education, unemployment, family and social cycles of stress and despair.

6. The gun violence epidemic- children and teachers shouldn't be traumatized by the idea of being shot at school, and parents shouldn't be traumatized by dropping their kids off at school to get an education. We had another shooting this week in Colorado in Highlands Ranch. Our U.S. Senator Cory Gardner, big NRA money recipient, has blood on his hands. AGAIN. And again, nothing is being done legislatively to stop this.

I think if we could solve one of these problems I think income inequality and the factors that lead to it are the key. I think nurses need to make it our business to push for social change. And I don't think we've done nearly enough on that front, at least not in a publically vocal and visible way. Nurses care for other people regardless of who they are, their background, what they look like, or other characteristics. No matter how much the current sociopathic executive in chief wants to erode this.

Nurses could teach the public a lot about how to truly care for others and to see the humanity in everyone. I think it is something we've lost in our country- the idea of caring for others and considering others' needs before asserting one's privilege and "rights". If we cared for and about each other, we would be caring for ourselves, too.

Tuesday, May 7, 2019

Ode to the Zombies in the C-Suite

CEO pay is a problem. The administrative costs of running healthcare have increased because we’ve added so many layers of complexity and bureaucracy that have nothing to do with healthcare or outcomes.

The hospital and insurance industries are fighting against Medicare for all or any largely single payer system. They have stolen the money from the people who need healthcare. They use this loot to harness the power of lobbyists to write and promote legislation to keep their advantages and privileges away from the masses who might benefit from being able to afford medicine to stay alive.

How do they make so damn much money? They cut costs like crazy, and big costs like staffing are the first on the chopping block. CEOs are not considered healthcare staff. They don't contribute to health, or care. In fact, they operate against it. You don't need a heart, and certainly don't need empathy, to run a healthcare facility. All you need are pure, driven, focused, sociopathic tendencies. Just be a Zombie, and you'd make a perfect CEO.

On Nurses’ Week, let’s also remember the other people who do work in healthcare, including non-clinical workers. Understaffing is a widespread and dangerous practice, whether you work in direct patient care, take out the trash, provide security, or transport patients around the hospital. None of us can do our jobs without the others.

You cannot run a hospital without keeping it clean. You cannot run a hospital without people to move patients from one room to another or from their room to a procedure, changing lightbulbs, sterilizing equipment for surgeries, emptying sharps containers, and all the other things that are taken for granted but are crucial to safe and complete operation of a hospital. You can’t short staff the people who maintain the medical equipment or stock the supply shelves. You can’t short staff security, because there are actual and potentially violent individuals who enter the hospital.

You can’t even have short staffing for human resources, if you need to keep hiring people all the time due to your high turnover. Of course, you can try underpaying everyone, and in a low unemployment market, you can blame your inability to attract new employees on flaws of the existing staff. It certainly couldn't be the fault of anyone higher up.

By relying on as few staff as possible, you end up burning out the existing employees, who have to run at a faster pace, are more likely to miss details or make mistakes, or have to cut corners in order to get all of the work done in the time they are allotted. They can’t go on vacation because there’s no one to take their place. Doesn’t matter how much vacation time they’ve accrued, they can’t use it. And the shorter staffed they become, the more stressed the workers become, from the bottom up through consecutive layers of management.

Until you reach the C-suite- where they are somehow insulated- they can avoid and escape the chaotic and stressful everyday environment. And even if their worst stressors materialize- low patient satisfaction scores (gasp!)- they can apply pressure downward and no harm will come to them in their suits- they rack up bonuses and extra perks, and even if they are fired, they have a golden parachute coming, to keep them wealthy as they navigate the revolving door of the close-knit executive world.

Yet this is the model on which the executives expect the hospital to run. The mega-corporate near-monopolies have limited competition, driven prices up, and contributed to our plummeting outcomes and skyrocketing costs compared to every other industrialized country.

Blinded by data, the Suited Scourge wanders through the back hallways away from patient rooms, haunting management with blood-drenched HCAHPS printouts. Wide eyes bulging and bleeding from their sockets, insisting on hearing the magic “yes” to every demand. Keep downstaffing and don't stop until there is just one employee covering each floor, responsible for every patient, dust bunny, and soiled washcloth 24/7. Get those products patients in and out fast, to maximize revenue. Crank up the speed on the assembly line, the robots staff will have no choice but to keep up. If the products patients live long enough to beat up the robots staff, sue 'em for property damage to reduce the replacement cost.

Then, and only then, will the Zombies be satisfied, as long as the patient satisfaction surveys come back in the 90th percentile, and dripping with blood.

Monday, May 6, 2019

Strength and Vulnerability, A Two-Edged Sword

This is a tribute to our ultra friend Matt Watts, who died last Friday, and to my extended ultra family.

I’m writing this with love and concern, to clarify and remind, and to encourage everyone to keep on going. He left behind his partner in crime and wife Anne. She has always been at the events with him, a strong ultrarunner herself, and a great support not only to Matt, but a great friend and kind soul to everyone who knows her. I wish there was something, anything- that could comfort her right now.

Ultrarunning is that two-edged sword- at the same time as it makes us physically strong and mentally resilient, it can put us at risk. Especially as we get older.

Matt was a veteran ultrarunner. His sense of humor, spontaneously funny remarks, Cheshire Cat grin and “Matt in the Hat”, as I came to think of him, were a welcome fixture at so many ultras.

Matt used to sneak up behind me when he’d lap me at Across the Years and bark. LOUD. Scaring the crap out of me, even though I should have been expecting it.

Matt was trying to get 100 100 milers. He came very close- his 95th was his last.

Trying to explain what happened in plain English

People are asking me what happened. Since I wasn’t there, I don’t know exactly, I can only tell what I think I understood and try to piece a puzzle together. On Matt’s last ultra, apparently he fell and broke some ribs. I don’t even know if that’s what caused his quick demise.

I'm not sure if it was the broken ribs, a resulting pneumonia, or some other cause of the infection that eventually took him down, but Matt didn’t realize how sick he was. I don’t know if he had some underlying immune system issue, or another illness that had not been diagnosed, or if it was just his pain tolerance or willingness to endure discomfort past the point where he needed to seek help.

I do know that at age 62 our bodies don’t bounce back the way they used to at age 25 or 40. But that might not have been a major factor here. Maybe it was a complete fluke. Maybe he was just tired and worn down from consecutive ultras, or maybe his immune system was a bit weak from several years of running a lot of ultras. Maybe Matt had a blood cancer or another illness that weakened his immune system and he didn’t know it. Probably not, but we will never know. It doesn’t matter now.

I’ve seen it wrongly described as “he contracted sepsis”. No. I’ll try to explain the medical jargon in plain English. Sepsis is an advanced stage of infection, where the body’s ability to fight it off is less than the strength of the infectious process. It’s not something you can “catch”- it’s a consequence of an infectious process.

He had some kind of infection that progressed until it overwhelmed his immune system, resulting in sepsis. Sepsis has the ability to eat you alive from the inside, because it damages the most vulnerable organs- kidneys, gut, brain, heart, lungs. In Matt’s case it ate his heart valve. Sounds like they had no choice but to replace it. That’s a risky thing even in an otherwise healthy person, and with other complications it’s one of those life-or-death decisions.

Sepsis does funny things to your blood- it can cause little solid pieces of debris floating in the blood- septic emboli- that can travel to small blood vessels and clog them up- leading to death of the organ tissue. Or it can cause a state called DIC- disseminated intravascular coagulation- where your blood clots too much at the same time as it doesn’t clot enough, causing uncontrollable bleeding, or forming clots that travel to plug tiny vessels in organs just like the septic emboli do.

They replaced his heart valve to try to save his life- but the risk was that he could have a stroke or other organ damage. And that is exactly what happened in the days following, first a small stroke, then another huge one, from which he wasn’t coming back.

Again, I don't know the exact details but I am making an educated guess, to try to clarify for people who want to understand because it's part of their grieving process.


Anne will need our support and while we need to respect her grief, we also need to remind her that we are here, and that we always will be here, and then follow through on that.

What I am saying here is not at all criticism of anything Matt did or didn’t do, he was living life fully and doing what he loved. I think that is the better route for all of us. But with advancing age and declining immune function, you are simply at a higher risk of something going wrong. It’s part of life.

I would have done the same- pursuing my goal, as he did. And I will continue to chase my own goals as I go forward.

What I wish to share with the running community is that our bodies are fragile, and more so as we age- we do need to remember that extreme endurance events can take their toll on us if we don’t allow ourselves to recover. We might feel okay, we might think we’re recovered, but unless we take a look inside our bodies at the cellular level (which is not really practical), and look at the components of our blood (which is pretty easy to do with a simple blood test called a CBC with differential), we can’t really know.

Just remember that we can’t take our health or our lives for granted. A good reason to keep on pursuing our goals, but also listening to our bodies. Sometimes our bodies don’t whisper loudly enough, or sometimes we forget how to listen.

Facing Death

Death truly is a part of life and all of us will die eventually. The best thing we can do is to live each day fully, work toward our dreams, have as much fun as possible, be a force for good and give as much love to others we possibly can.

Facing death is part of a healthy life- psychologically and emotionally, it doesn’t make it easier, but it does make you stronger and more resilient, and perhaps healthier overall. People who have a healthy attitude toward death tend to move through grief with fewer long-term physical and mental health consequences.

Facing death also means not forgetting those who were left behind, not avoiding them, letting them know you care and enjoying the memories when the time is right.

Avoiding death and emotion doesn’t mean you’re strong, in fact, just the opposite. Denying a universal reality does us no good. It’s coming for all of us. We do the best we can to live our best days, and then we need to step right up to it, look it in the eyes, run through the finish line without fear, realizing that it only means we will have arrived at the start of the next ultra.

And here's one thing you can do right now. Make your wishes known. Complete your advance directives- medical power of attorney, living will, and other documents- now. It's a gift to your loved ones to make things easier for them if they have to make decisions for you when you can't, in a time when they will surely be extremely distressed.

Moving forward

Matt’s sudden departure has made me re-think my own priorities and preparations, perhaps tweaking some things in my own advance directives that I could make more specific. And thinking about the real meaning of where I am in my life and what I’m doing. And what I hope is still ahead of me that I cannot take for granted. But mostly, to make sure I enrich my life to the fullest by strengthening my connections to the people I value most.

I'll miss Matt.