Technological Solutions

Purdue University

English Composition II – Eng 105

Fall 1988, Dr. Bolduc

Grade:  (A)                                                     

Technological Solutions

Modern medical technology saves lives. Technology is here, but solutions to the social problems it creates are still unsolved. These social problems are legal, ethical, financial, and maintenance in nature.

If you’re not a medical person you may be amazed to know what some of the technology can do. If your lungs don’t work air can be forced into them with respirators; they can be adjusted to keep oxygen and carbon dioxide levels perfectly balanced. Nonfunctioning hearts can be maintained in many ways: drugs can make it contract stronger, beat slower or faster, and open or close blood vessels leading to the heart. Pumps can be used to do the heart’s pumping job for it and let it rest. There are plastic total replacement hearts now in use. If you are too sick to eat, nourishment can be totally supplied and balanced by infusing it through your veins or infusing it through a tube in your stomach.  No kidneys – no problem, we have machines that can filter your blood. If you combine the different types of technology (which happens frequently) you can keep a person with “total body failure” alive for indeterminant periods of time; goody goody.

In the United States, all men are created equal so all men should have equal access to this wondrous lifesaving technology. All living wills (written requests not to receive heroic life support if terminally ill) should be banned. Anyone who would write such a request must be considered “off” mentally anyway because who would not want their life saved?

This would simplify things for all involved. No family would be asked to make judgments about whether to put their 97-year-old grandmother on a respirator; no parent would have to decide whether to feed their infant born without a cranium (the bone that covers the brain). What a comfort it will be to relieve loved ones of these tortuous decisions. Healthcare professionals won’t have to make decisions about whether to use or how much technology to use on a particular patient; they will simply use all available technology on every patient.

Now that we have solved the legal and ethical problems we can deal with the financial aspects. Many hospitals are going bankrupt due to cuts in Medicare\Medicaid reimbursements; the government surely won’t pay for increased use of technology for the aged and poor. The patient and family are the ones benefiting from the technology so they must pay for it. They need to become open-minded in regard to fundraising schemes; cocaine sales are quite profitable and at least would be for a good cause. The United States Defense Department is known for having an unlimited and inflated budget; loans could surely be obtained directly from them; patients could bid for loans and the defense department could decide who is the worthiest.

There is a nationwide nursing shortage so they can’t take care of these patients. Closed boarded-up steel mills and other bankrupt factories could be turned into warehouses for the “almost dead” people being kept alive. Men out of work from these factories could be trained as maintenance men for the life support systems. “Really dead people” (like decapitation victims) could be used to provide replacement parts for the “almost dead”. We could call it Human Recycling.

No one can now say that we have technology without equitable means to deal with its results.

GOOD!

Persuasive Paper

Purdue University

English Composition II – Eng 105

Fall 1988, Dr. Bolduc

Grade: (A-)

Persuasive Paper

My dad, a clone of Archie Bunker, would be 72 years old now if he were still alive. I can imagine him cringing in his grave at the thought of my buying a foreign car. This is a futile attempt to convince Dad, but possibly a fruitful attempt to convince you that it is not only OK to buy a foreign car, but it is a smart thing to do.

Dad never knew that in May 1978 the Department of Transportation recalled all 1971-1976 Ford Pintos due to a flaw in the gas tanks; the gas tanks would ignite instantly upon impact; many people were either critically burned or killed as a result. This was the most expensive recall in automotive history.   

The worst part of this recall is that Ford Motor Company owned the patent on a new, safe, saddle-type gas tank before 1971. Ford plants were already tooled to manufacture the ignitable gas tanks; the company’s “cost-benefit analysis” said it was not economically wise to go through the enormous expense of retooling, even though it would have saved many lives.

Through personal experience, I learned why Consumer Reports magazine (April 1986) said that the Chevrolet Cavalier built in 1984 was the worst used car to buy. Before 40,000 miles I had replaced the following in my 1984 Cavalier:

         Brakes

         Muffler

         Alternator

         Battery (twice)

         Starter (twice).

In addition, from the time it was brand new, the butterfly flange would close in cold weather (it then causes the car to flood),; I was told by the Chevy dealer and several other mechanics that this could not be fixed, these cars just do that. This meant that I had to get out of my car, pop the hood, and stick my rat-tail comb in the flange before my car would start in weather below 32 degrees. The car was also recalled for faulty emission control mechanisms.

And now for the real joy, at about 44,000 miles the engine blew up. Chevrolet said sorry lady, but you have to pay the $1300 to replace the engine; you must also pay for the rent a car you will need for 3 weeks to get to work. Only through obnoxious assertiveness did I get Chevy to pay for all but $100 for the new engine.

Being a college student, I then decided to do my homework before buying a new car. I spent 4-5 hours in the library researching Consumer Reports about small cars. The Toyota Corolla that I bought had the highest ratings in its class in almost everything:

         Least repairs needed

         Easiest to repair and do routine maintenance on

         Seating comfort

         Gas mileage

         And safety in engineering ie Brakes etc.

I have never heard of a Toyota recall. I have had my Corolla for 3 years now and have never had to fix ANYTHING; my car has 67,000 miles on it! All I have done is routine biyearly maintenance checks and oil changes every 3-4,00 miles. My average gas mileage is 37 miles per gallon. Two different mechanics and a salesman at a tire store, recently told me that my tires looked like they had 15,000 miles on them and asked why I was even thinking about replacing the tires.

I consider myself patriotic; I get teary-eyed at the sound of the National Anthem. However, loving your country and a good car but don’t necessarily go hand in hand. Our system of capitalism breeds competition; the Toyota Corolla has won.

Japan has strived to make reliable, affordable cars; they have perfected their technology and used quality materials; they have earned and proven worthy of my faith in their products. Chevy must agree because their Nova and Spectrum are made as a joint effort with Japan.

Pain Medicines

Purdue University

English Composition II – Eng 105

Fall 1988, Dr. Bolduc

Grade: (B+)    

Pain Medicines

I occasionally give patients more pain medicine than ordered by their doctors; I do this when I think the dose is ridiculously small; I document giving the ordered amount. Only God and I know or will ever know the difference. As shocking as this sounds, my consciousness is always at ease; in fact, it actually relieves my consciousness to ease my patient’s pain. Experience with patients in pain has given me gut instincts about their need for pain medicine. Nurses spend most of their time at a patient’s bedside; doctors order doses according to drug manuals and then walk away. An example of a situation in which I would give more than the prescribed amount would be a man who just had his lung removed weighed 200 pounds, and was screaming, “Let me die!” The order said to give 8 mg of morphine; even a textbook would say I could give 15 mg; I gave him 10 mg.

I attended a seminar about pain relief. The nurse who gave it was a dolarologist (pain specialist). She had done enormous clinical research on pain relief. She also worked as a consultant to doctors and pharmacists all over the country; she guided them in relieving their patient’s pain. Her research documented what I knew through experience; patients need much more pain medicine than we are giving them and much more pain medicine can be given safely; pain is not good for your patient’s health.

To illustrate the vast disparity in what doctors order and what patients need I will use this example:

                  Doctors orders: Morphine 6-8mg every 3-4 hours

                  Patients need: Morphine 360mg in 1 hour.

I am talking about major discrepancies!

The seminar also dispelled myths about using narcotics to relieve pain:

         MYTH: We must be stingy with pain medicine because patients might become addicts. People may lie about having pain just to get narcotics.

         TRUTH: The number of patients that would lie about pain or become addicted when taking needed pain medicine is so small that it should not even be considered. Nurses are now taught to believe the patient about his pain. Surgical patients are not even remotely thinking about becoming addicts; cancer patients do not want to be taking narcotics.

         MYTH: Narcotics depress respirations and may make the patient stop breathing.

         TRUTH: The use of pain medicine must be individualized; it should be titrated to the patient’s relief, not by drug book usual doses. When patients have pain their pain receptors use up the narcotic and do not allow the drug to depress respirations.

         MYTH: As long as the textbook doses of pain medicine are given the responsibility of the health care professional is ended.

         TRUTH: Relieving pain is just as important as giving a diabetic his insulin. Unless you relieve pain in a surgical patient he will not cough well and may get pneumonia; without relief, he will not move around well and may develop blood clots. So, by relieving the pain you are preventing complications that could kill the patient.

         MYTH: I should not take pain medicine, especially narcotics.

         TRUTH: Most patients feel guilty about asking for pain medicine; they have been socialized not to take drugs; they associate narcotics with drug addicts. To relieve their guilt ask the patient, “If you did not have pain would you want to take this medicine?” Of course, they answer no. They are then greatly relieved.

Patients can sense the health professional’s attitude about relieving their pain. It is psychologically painful and frightening to think that your nurse or doctor does not believe you about your pain. Health professionals should make their patients feel “OK” about taking needed pain medicine; they should even point out the health benefits associated with being comfortable such as fewer complications with their illness.

By relieving patients of their chronic pain, we allow them to be intellectually involved in their own care; when you are in constant pain you cannot think. Chronic pain makes people feel that they have no control over their lives; with relief, they have control back. Dying patients are allowed to live in comfort until they die with adequate pain relief.

Even though research has given us new data about pain control, this data is not universally used in health care. Many seasoned doctors and nurses are not aware of this new knowledge; many have heard it but are unable to accept the new knowledge and attitudes about pain relief. It will take time for these new attitudes and knowledge to become accepted and trusted. Until then I feel compelled to use my new proven knowledge when faced with a patient in pain who has a doctor from the old school.

Consumers beware: the knowledge and attitude of your healthcare professional can literally hurt you!                           

Nursing Shortage

Purdue University

English Composition II – Eng 105

Fall 1988, Dr. Bolduc

Grade: (B+)

Nursing Shortage

There is a severe nationwide nursing shortage today. Staffing is so poor in critical care units that patients’ lives are at risk. Hospitals have had to resort to using nurses from temporary agencies; they have to pay about four times a staff nurse’s salary for an agency nurse; the agency nurse gets one and a half to two times what a staff nurse gets. At Loyola university hospital, for example, it would not be unusual to find one staff nurse and 6 agency nurses in a critical care unit.

A nationwide survey done by RN magazine showed that 90% of nurses think their patient’s lives are at risk and are dissatisfied with the care they are able to give – all due to the shortage.

Nursing school enrollments are down drastically across the country; Northwestern University closed its nursing program due to a lack of enrollments; the University of Illinois had only eight students starting out this September. A college freshman today could earn more money majoring in almost any other field, so why get a bachelor’s in nursing? This leaves the immediate future without much hope for new nurses. For the short term, there will not be any more nurses.

In the past (and present) hospitals have treated nurses like assembly line workers; they see them as easy to replace, quite dispensable, and pay them the least they can. They see nurses as easily manipulated females and take advantage of the fact that most nurses care about and are dedicated to their patients. Hospitals slowly but steadily decreased staffing budgets and thought it would be more cost-effective to only call-in help when things got desperate; this may have been cost-effective in the short term, but in the long term it is costing them a fortune; more and more nurses are working for agencies. Their thinking is as long as I must work my ass off, I may as well make the most money I can.

Nursing lacks strong leadership and unity. Nurses are very non-supportive to one another; whether this is a coping mechanism to deal with their stress and anger is up for debate. If the individual nurses on a unit are at each other’s throats, how can they unite and become a powerful constructive force to get what they want for their patients and themselves?

Nursing salaries are insulting when measured against the awesome responsibilities they have. There are no rewards for giving TLC (tender loving care), it is expected that a nurse gets into a patient’s room and does only what she has to do so she can get on to the next one. This so-called efficiency will keep them from getting in trouble for running into overtime.

Hospitals have salary ceilings. It does not pay for a nurse to stay at a hospital for more than 5 years because she will only get cost of living raises after that time. A nurse must change jobs to get more money for the experience gained. This makes retention difficult and gets in the way of a nurse accumulating benefits.

I see two possible solutions, the first one being that nurses should run nursing. I mean total control, even the budget!  Each nursing unit should decide how many nurses are needed to give safe care; the unit should then decide what if any ancillary help is needed. Nurses should obtain equipment and supplies that only they are experts on. Nurses should be involved in designing construction and reconstruction so they can set things up to fit practical needs. The nurses should at the end of the year split the profits among themselves. I am aware of a pilot study done at Lutheran General using these ideas; at the end of the first year, each nurse got a profit check for $5,000.00. The unit’s morale was up, they gladly worked overtime and helped one another. They learned (or should I say showed) how to give safe cost-effective care. The nurses and the patients won.

Since I doubt most hospitals would ever relinquish control to nurses, I think nurses should stop working for hospitals in mass. For example, all the critical care nurses in Chicago quit their hospitals and form a corporation; they hire themselves out to hospitals at a fee they set themselves. They refuse assignments that are unsafe. They are real professionals using their judgments. They split all profits equally and can write off expenses like other professional business corporations.   

Language

Purdue University

English Composition II – Eng 105

Fall 1988, Dr. Bolduc

Grade:  (A)     

Language

I disagree with Orwell. I do not think our language is in a bad way just because there are some who abuse it. There will always be people who make a mockery of the creative beauty our language possesses. Twisting words can have many causes; to say these causes are only political or economic are absurd.

I think that people who use big words and worn-out phrases are merely exhibiting their lack of language skills or being pretentious. My personal favorite authors are Isaac Asimov, Andrew Greeley, and Mike Royko; they all use common words and are quite successful at getting their messages across. In fact, I see their simplicity as their very genius.

Orwell says the political language is designed to make lies sound truthful, murder respected, and give an appearance of solidity to pure wind. His message is clear, but it goes too far. I agree that politicians attempt to remain vague, avoid direct answers, and twist words to argue their points. But because Orwell goes too far with his criticism I do not take his argument seriously. He sounds like an old fuddy-dud professor who would not be pleased by anything that did not meet his rigid standards.

Language can pose a barrier between people if it is not shared. I think that global community relations could be enhanced if we had more people speaking and writing multiple languages. Between the approximate ages of 2-14 years, children are in what psychologists call a “sensitive period”; during this time their minds are sponge-like in regard to learning languages. I think that we should take advantage of this innate biological ability and teach foreign languages in the nursery, grade, and junior high schools. Imagine a future United Nations conference with most of the countries able to speak to one another because we have taken advantage of our kid’s learning abilities. By giving the next generation increased language and communication skills we would be doing something positive for world relations. I love language. I see it as a creative tool to express an array of feelings, thoughts, and ideas. With language, we are free to create, either verbally or in writing, anything that we can imagine. I can turn thoughts into something we can see and hear. Language gives our thoughts a new tangible dimension. I love learning new words; all the more words to think with. 

Head Nurse

Purdue University

English Composition II – Eng 105

Fall 1988, Dr. Bolduc – (B)      

Head Nurse

Linda has been an R.N. for seven years now; she worked two years on a general medical-surgical floor and five years in an intensive care unit. She has a bachelor’s degree in nursing and is going for her Master’s in Nursing Management. She’s very bright, assertive and cares deeply for her critically ill patients.

She’s now near the completion of her master’s degree and her Director offered her a position as the Nurse Manager of the Coronary Intensive Care Unit. She’s enthused about the opportunity to use her newly obtained knowledge in participatory management. She’s learned that psychologists have studied management styles and found that people are more likely to comply with and feel invested in decisions that they helped to make. With this management style, the best leader doesn’t lead at all; she facilitates group solutions to problems and fosters the development of leadership within each group member.

On an individual basis, she makes herself aware of the special and unique contributions made by each staff member. She compliments these contributions and encourages each person to share them with the unit. For instance, one may be a good organizer of supplies, one may be good in bolstering morale, and one may be especially skilled with inter-department communication.

Through her intensive care experience, she’s also a role model. She shares her expertise in the technical aspects of critical care. She’s supportive of new nurses who are overwhelmed by the stressful situations that serve as their learning labs; she tells them “Yes, you can!”

The Administrator of the hospital has a Ph.D. in Hospital Administration. He has served as an administrator at 2 other hospitals (thus with a total of 10 years of experience). He has also worked in the accounting field and is especially skilled at corporate budgeting. He knows how to balance a budget and in a hospital, he knows where to cut spending: nursing, nursing, and nursing support services. He’s an opportunist and uses what he’s learned about nurses against them. Nurses are by majority dedicated to giving good care to their patients. They are generally passive with much less than optimum self-esteem. They don’t see themselves as having the power to improve their working conditions or salaries.

His abusive attitude allows him to take advantage of the nurse’s dedication and lack of self-esteem. He cuts the budget for the intensive care unit leads to unsafe conditions.

Federal law mandates that one nurse can only care for two patients in a critical care unit; Linda’s staff routinely care for three patients; many non-nursing tasks were also added due to the cut in nursing support services. This dangerous situation is occurring nationwide. Mr. Administrator may be qualified to administer, balance budgets and collect a 6-figure income, but he is not qualified to run the nursing aspects of a hospital. He does not know what nurses really need to do or how precious what they do is to their critically ill patients. Hasn’t Mr. Administrator heard of participatory management? 

The Catholic Church

Purdue University

English Composition II – Eng 105

Fall 1988, Dr. Bolduc – (B)

The Catholic Church

The Catholic Church discriminates against women. A woman is barred from becoming a priest and is not allowed to read the gospel during mass.

I recall a sermon about vocations. The priest was trying to recruit clergy. It was obvious to me that he was only interested in recruiting males to be priests; I was not surprised. I was surprised when my 6-year-old daughter asked me, “Why can’t I become a priest when I grow up?” after hearing the sermon. Having to tell my daughter that she could not become a priest made me realize what an unfair practice it is for the church to discriminate against women. The church represents God; how can the church tell little girls that they are not as good as little boys? How dare the church tell little boys that they are better than little girls!

The church, being one of this country’s major institutions, has a responsibility to serve as a role model with “equal” (male and female) Christianity. Children are developing their sexual identities, what is conveyed to them from God through the church affects our future society; the church is oppressing women.

Since the church is trying to recruit clergy, why not place an ad in the Sun-Times Job Mart:

HELP WANTED

         Young people sought who love God and have the ability to pocket their sexuality. The following are mandatory:

         1.      Penis and testicles

         2.      Absence of enlarged mammary glands

         3.      Facial hair

         4.      Voice with low decibel level

         5.      Ability to lift a prescribed dumbbell weight Modern employment applications now have questions such as sex, age, or marital status listed as optional; employers can get in trouble if they discriminate against applicants. Is it the separation of church and state that allows the church to continue this discrimination? Has it been proven that the five mandatory prerequisites listed in the ad are necessary to say mass, give sacraments, comfort the sick, teach theology, and collect donations? I see no logic to its discrimination. Unless I somehow become miraculously enlightened about what disqualifies a woman, I cannot see any logic in keeping women from serving God in an equal manner as men. I cannot imagine that God would be offended if I stood up in mass (without the previously mentioned qualifications) and read the gospel.  

Medical Technology:  What’s the Problem?

Purdue University

Medical Sociology, SOC 491C

Winter 1987

Grade – 10\10

Teacher’s comments: Excellent and sensitive discussion of a complex topic

Medical Technology: What’s the Problem?

Medical technology has not gone too far; the way in which we use that technology is the problem. There is a lag involved between scientific technology and the ethics involved in its humanistic use. We can physically keep a person alive with life support systems, but society has not yet provided a moral code for doing so; there are no norms or guidelines for medical practitioners to go by.

The science involved with the technology is actually the easy part; whether you’re talking about an antibiotic to kill a germ or a machine to force air into motionless lungs, the principles are concrete and appear to be quite humanistic. The ethics that become involved with science is very complex and very controversial.

Another major problem is the fact that the doctors who order this technology are no further advanced (and possibly further behind) than the rest of society. Medical school does not prepare doctors to deal with these delicate issues. Doctors become nomophobic (an irrational fear of the law) in medical school; they make decisions about the use of technology from a standpoint of fearing a lawsuit. This leads to the problem of medical technology going too far; doctors end up over-treating dying patients simply to avoid litigation. Technology should be used to help a patient.

By practicing defensive medicine doctors see the law as primary and ethics secondary. Legal thinking is to protect themselves; their goal, however, is to benefit the patient. Ethics goes beyond the law; many of us are not trained in ethics as a part of our education, but the fact that doctors aren’t is hard for me as a nurse to cope with.

The American Heart Association has said that CPR’s use on a terminal patient is a violation of his/her right to die with dignity.

The Vatican has spoken to this issue in its 1980 “Declaration on Euthanasia”. Roughly quoted the Vatican said: No one need to undergo treatment when its use would only secure a precarious and burdensome prolongation of life. If treatment doesn’t offer a reasonable hope of success if it only prolongs dying, it is worse than useless; it is an indignity against our humanity.

I can think of an example that will illustrate a case where interventions became intrusive. I was a new graduate nurse in an intensive care unit; I was assigned to a patient who had been in the unit for a month now with metastatic cancer. He weighed 72 pounds, was respirator-dependent, was being fed through a needle in his vein, and was in constant, excruciating pain. I had been aware of this patient’s case, but this was the first time that he had been my patient. I was afraid to have him as a patient because I feared that I could not ethically refrain from being honest with the family. When I first went in the room to care for him his blood pressure was 50\0; he was already on drugs to force him to have blood pressure. I called his wife and told her that he did not have enough blood pressure to maintain his life and the medications were at their maximum. I asked her if anyone had discussed emergency measures with her. She said no, but that she was too upset to bring the subject up herself; she begged me not to do anything to make him live any longer in this horrible way. I told her that she had to sign a paper to prevent his being resuscitated.    

I feared the loss of my job for doing what the experienced nurses and none of the doctors had done; I was honest about what we could do with our technology and what we couldn’t do to help this patient. I called the respiratory specialist (MD) to tell him that the wife was on her way to sign a DNR (do not resuscitate) for her husband. He said, “Gee, thanks, I’m glad someone finally took care of that”. I had prepared myself for being told that I’m just a nurse and had no right, to be honest with the wife. I then called the family doctor to let him know and he said, “Boy, I’m glad you took care of this; you know I’m not trained in these matters”.

Can you imagine the doctor’s defense if the wife were to sue for unnecessary cruelty to her husband? The doctors would say that they used the technology even though it would not help the patient and would prolong his suffering because they feared being sued for not using them – what a flimsy defense! I believe that doing what is ethically appropriate and goes along with the patient’s wishes is not only humane but serves as the best defense.

I think that interventions are intrusive whenever the patient is not fully informed and in charge of his/her care. I have seen many little old women from nursing homes come to my CCU saying that they don’t want all this stuff done to them. Their families tell the doctors that they want everything done to save Grandma. (They don’t know what “everything” means). It is assumed that grandma is senile, (even though my neurological assessment tells me otherwise) and they proceed to treat the patient telling her that they are only doing what is best for her. They (the family and the doctors) make Grandma feel guilty for not cooperating with all this generosity.

I recall a recent occasion when I acted as a patient advocate for an older woman and was able to elicit the assistance of a resident to see that we respected her demands. I was reprimanded by my head nurse; how dare I rock the boat and deprive this hospital of the funds collected for grandma’s care and for the opportunity for the doctors to practice their skills on her.

The manner in which DNR subjects are brought up to the patients and the families leaves a great deal to be desired. For one thing, we usually bring up an extremely difficult subject with people who are experiencing a major life crisis; the loss of their own life or that of someone whom they love. If you ask a family, “If your mother’s heart stops beating do you want us to help her”? could only elicit a response of “yes”. On the other hand, if you explain the terminal prognosis and that no technology can make the patient better and then ask, “What do you think she would want us to do for her?” The family will more than likely say to make her comfortable in her last days.

Some families may misperceive a DNR order as meaning no care; an order called, “comfort measures only” may be more psychologically palatable.

I think that health professionals have a duty to decrease the power disparity between the patient and staff and use their knowledge and experience to better meet the PATIENT’S needs; we should think in terms of the goals of the patient NOT those of the staff which may be to cure cure cure. The patient’s need may be to obtain support and comfort to cope with their death; I think we should be non-judgmental in assisting our patients.

Patients should be made aware of all their rights and options involved in their care; professionals should be held liable to respect their wishes.

The solutions to these very controversial issues are many as I see them. I once worked in an oncology unit where the subject of death and treatment choices were discussed on admission by the nurses. This worked well because the nurses had the support of the doctors in regard to putting patients in charge of their care. The nurse would document in her notes a patient’s wishes; the chart IS a legal document so it can be referred to later for reference if the patient becomes unable to direct his/her care; the family can fall back on the patient’s wishes without guilt and the staff can feel free of liability.

Because nurses spend more time with patients and are more educated in the social and psychological sciences, I think they are the natural ones to deal closely with these matters. Patients frequently feel free to talk to nurses; I have had many intimate relationships with my patients because they felt free to discuss difficult subjects with me.

Nurses are in an excellent position to do research on these issues, and I think they should do so and go public with their findings. There are literally no issues that aren’t discussed on TV, why not the issues involved with technology and its proper use.

Being honest and using language that a patient can understand cannot be overemphasized; frequently doctors leave the room, and a patient will say, “What did he/she say?” Education of doctors is definitely lacking in training to enable them to deal with humans and communicate compassion. I recently heard on TV that a leading medical school was changing its entrance requirements to include an assessment of qualities relating to the ability to show concern to patients. I found this very promising.      

Living Wills are not fully understood by doctors; they don’t seem to feel secure in feeling protected from liability with them. I have had patients with living wills prepared; they come to the hospital at death’s door, unable to speak for themselves and the family says they want all the technology used; the docs go ahead and use the technology.

At a seminar on this subject that I recently attended, the speaker recommended appointing a representative who would speak on your behalf if you were too ill to do so. You could discuss ahead of time the various issues in current technology. The speaker specifically and emphatically recommended NOT using a lawyer to fulfill this role; he said you could even spare your family by using a friend. This spokesman and you will prepare a legally binding document to be used if it ever becomes appropriate.

Twenty states now have N. D. A.’s (Natural Death Acts); these are a collection of legal documents recognized as a way for a competent person to express their wishes in advance. These documents guard against civil or criminal liability of health professionals; they also hold the doctor liable if he does not comply or transfer to a doctor who will comply with the patient’s wishes.

Recently, nurses are becoming involved in many areas of health care which involve non-traditional; they review charts to check DRGs and audit billing. Why not have nurses specialize in discussing and implementing a patient’s wishes regarding technology?

Of course, doctors need to become comfortable with death; this will be a major feat. The acceptance of death as a part of life is not a simple teachable concept; it would probably need to be filtered into all their education. 

Ideology and Myths: The Fuel of Woman Abuse

Patricia J. Anderson

Indiana University Northwest

Social Problems, Soc 163, Winter 1983

Grade: A (in class also)

Ideology and Myths: The Fuel of Woman Abuse

Wife abuse was first seen as a social problem by feminists in the late 1960s and early 1970s. By sharing their research and experience in helping battered women they are trying to pull society’s head out of the sand so that they can see what a devastating problem it is. In more than 14 years, these feminists have not yet succeeded in making wife abuse a commonly known and understood problem.

The problem affects Battered women, the batterers, their children and extended families, the police, (called in, in cases called domestic violence), the judicial system (offers little or no help to alleviate the problem), the clergy (who usually are confided in and in turn send the battered wife back to the batterer), and human liberation in general.

“A battered woman is one who is repeatedly subjected to any forceful physical or psychological behavior by a man in order to coerce her to do something he wants her to do without any concern for her rights. To be classified as such, a couple must go through the battering cycle at least twice”.  1     

“It is estimated that 50-60% of all women will be battered victims at some point in their lives”.  1, 2  

“The problem includes physical and psychological abuse; both types of violence exist in battering couples and cannot be separated”.  1 

Myths

Many myths function that keeps wife abuse from being dealt with in a positive and helpful way by society; a few of the most common ones are:

ONLY A SMALL PERCENTAGE  OF THE POPULATION IS AFFECTED.

Like rape it is an unreported crime; it usually takes place at night, in the home, without witnesses. It is estimated that only 1/10 of cases are reported. Of 500 divorce suits filed in New York in 1976 – 57.4% listed physical abuse as the cause.

BATTERING OCCURS MORE OFTEN IN LOW-CLASS OR MINORITY WOMEN.

All socioeconomic classes, educational levels, income levels, cultures, and races are victims of wife abuse. Middle- and upper-class women are less likely to report it for fear of embarrassment and exposure of their batterer, who is a “pillar of the community”. A study in England revealed a high incidence among police, doctors, and service professionals (lawyers, executives, college professors, and elected officials).

BATTERED WOMEN ARE MASOCHISTIC OR DESIRE TO BE BEATEN.  

Case histories show no provocation in the majority of cases at all, or the precipitating factor may be something like a dinner served 5 minutes late. Batterers lose control because of their own internal reasons; this myth robs responsibility from the male. Out of thousands of women’s stories not one showed any signs of masochism.

BATTERED WOMEN CAN ALWAYS LEAVE.

They do not have the freedom to leave; she knows that her man is capable of gross violence; he makes chillingly frightening threats about what he will do to her friends or family if she leaves – she believes him!  Frequently she knows no one who will believe her. He keeps her isolated a great deal so that her sphere of helpers is minimal – usually she has nowhere to go.

Characteristics

Common characteristics of battered women and their batterers are quite revealing:

1.      SHE: Has low self-esteem.                        

HE: Has low self-esteem.

2.      SHE: Believes myths about wife abuse. 

HE: Believes in myths about wife abuse.

3.      SHE: Is a traditionalist, who strongly believes in family unity, and prescribed feminine stereotyped role in the family.

         HE: Is a traditionalist, and believes in male supremacy and the stereotyped masculine role in the family.

4.      SHE: Accepts responsibility for his actions.

         HE:   Blames others for his actions.

5.      SHE: Suffers from guilt yet denies the terror and rage that she feels.

         HE:   Is pathologically jealous.

6.      SHE: Presents a passive face to the world but has the strength to manipulate her environment enough to prevent increased violence and/or being killed.  

         HE:   Presents a dual personality.

7.      SHE: Has severe stress reactions, with psycho-physiological complaints.

         HE:   Has severe stress reactions, during which he uses wife battering to cope.

8.      SHE: Uses sex to establish intimacy.

         HE:   Frequently uses sex as an act of aggression to enhance self-esteem in view of waning virility. May be bisexual.

9.      SHE: Believes that no one will be able to help her resolve her problem except herself.

         HE: Does not believe his violent behavior should have any negative consequence.

Some battered women grew up witnessing their mothers abused by their fathers; some were treated like fragile dolls by their fathers; these pampering fathers taught their daughters that they were incompetent and had to be dependent on a man – sex role stereotyping.

An overwhelming majority (if not all) of batterers were their father’s apprentices; fathers showed them how to beat up mom, and some even let their son get a few licks in early on mom too – for practice. Definitely a learned behavior.

The core of the problem lies in the ideology perpetuated by the traditional attitudes shared by the wife, the batterer, and society (police, courts, and clergy). He MUST dominate and keep his wife in line; she sees him as her ruler who has superhuman abilities.

During hospitalizations for fractured ribs or jaws (or both), she thinks to herself that he may have gone a little overboard, but the dinner WAS served 10 minutes late. The batterer dotes over his wife after the beating brings flowers and candy, tells her how much he loves her, and begs forgiveness.

The husband is not sanctioned for his violence by his wife or society. If police are called to an acute battering episode, they don’t see it as a crime, they merely tell him to calm down; they see domestic violence as a nuisance, but they don’t arrest the batterer or report it as a crime. The wife is too terrified of what would happen if she pressed charges: they usually have enormous trouble in proving it and judges are not interested in sticking their noses in either.

His wife forgives him although during the acute battering incident he does not stop even when she is obviously severely injured. The wife has no legal action with any teeth in it to prevent another beating; police will not remove him from the house, so she must leave if she wants to get away from him.

I went to Haven House, a battered women’s shelter, in Hammond, In. The psychologist who runs it is Joan Cmar who was happy to share information with me because one of the solutions to help battered women is to spread understanding of the problem through as many people as possible.

Joan doesn’t hold much hope for the problem in Indiana. Since Reagan took office the federal funds that support the shelter have been cut drastically and she fears may be cut altogether. Donations are not enough to keep it open.

Right now Indiana offers no legal recourse or protection for the wife. The woman who manages to get out and get to the shelter can only bring what she can carry. The police will not go with her so that she may get her belongings. She faces starting life all over without clothes, money, or a place to live, (the head of the household all the money). 5

There is a bill now pending in the Indiana legislature that would allow women to press charges on their word alone and have the batterer arrested. A similar bill, when passed in Illinois, immediately brought out 1600 cases filed; only 2 batterers were prosecuted. 5 

She says the police do respond quickly if a batterer attempts to cause trouble at the shelter, so she feels safe.  5

The police and officials of the courts are mostly male, they frequently share some of the traditional ideas about a man’s right to dominate his wife; they help support the problem by turning their heads and blaming the victim – why doesn’t she just get divorced? 5

When I asked Joan about the clergy’s helpfulness (all denominations) she became quite angry. She says they are the worst! Most priests and ministers are also male (churches are quite traditional and sexist). They instruct battered women to return home, be better women and keep the family together at all costs. An extremely high percentage of batterers also engage in incest and child abuse toward their daughters. The clergy still think the family should stay together!  5  

She says there are no counselors in Northwest Indiana who are either knowledgeable about or trained to help violent men and their families. So even if the couple, by miracle, get into marriage counseling they have almost no possibility of ever having a violence-free relationship. Even in other parts of the country with expert counselors, almost no progress toward violence-free relationships – divorce is the only answer. If counseling were to work, the husband would need to give up a great deal of power, which is very unlikely. Also, unless the wife gets assertiveness training, she’s likely to marry another batterer.  5

A personal acquaintance of mine recently revealed that she is a battered wife. I was shocked because they own a very successful business and seem to be very nice people. She was beaten by her mother as a child; her husband and four of his brothers beat their wives just like their fathers did. This was my friend’s third abusive relationship.

I personally know a female anesthesiologist who is a victim of a battering husband. She had three babies in 30 months! Batterers don’t allow their wives to use birth control. The doctor lost her job because when she was called out on an emergency case the husband would sit at the nurse’s station in surgery and wait for her – he didn’t believe that some cases could take as long as they did. He ran into surgery one day to see if she left by the back door; this behavior let her secret out of the bag and the hospital couldn’t have him doing that again.

Society loses these women because they must gear every waking moment to seeing that life goes smoothly for their husbands so that they can avoid them getting upset and beating them again. Even if she works, he usually picks her up and takes her there; he doesn’t allow social relations with her coworkers. Most of the case histories that I have read reveal that whenever possible the men take their wives to work with them. (My personal acquaintance says that not only does she go to the business with him, but she can’t even grocery shop without him. To the outsider it looks like they are just so cozy).

Society as a whole is held captive to this pervasive ideology as long as it continues to invade the minds of the violent family’s children, thus ensuring another generation of oppressive batterers and their victims.

A great deal of money is spent and time wasted by the police having to go to “calm down” domestic violence.

Society loses these women because they must gear every waking moment to seeing that life goes smoothly for their husbands so that they can avoid them getting upset and beating them again. Even if she works, he usually picks her up and takes her there; he doesn’t allow social relations with her coworkers. Most of the case histories that I have read reveal that whenever possible the men take their wives to work with them. (My personal acquaintance says that not only does she go to the business with him, but she can’t even grocery shop without him. To the outsider it looks like they are just so cozy).

Solutions

-Continued and increased federal support for shelters.

-Laws to make wife abuse a crime. Mandatory 48-hour incarceration of batterers who have obviously beaten up their wives. This would involve police education and a change in attitudes to the problem. The batterer must be negatively sanctioned. Mandatory psychiatric help to those known to beat their wives.

-Hotlines for batterers, their children, and battered women. 2

-Educate educators about the problem and discuss its existence in schools; drug abuse is now taught in public schools. 2 

-Nurses and doctors should be taught to ask suspected cases if someone did this to them; this may very well open the subject to the victim, and it tells her that you would believe her and take it seriously. Records could be used later in court to prosecute batterers. 2

-The clergy need an educational overhaul to bring the problem to light with them.

-Movies about the realities can be enlightening. An increase in men’s liberation would help. Hopefully, awareness could be stimulated to encourage men to express their feelings more openly. Machoism really hurts and traps them too, with the traditional stereotypes.

-We could teach our children to be more expressive, especially boys – let them cry! Children are taught about why the clouds do what they do – why not teach them the psychology of why people do what they do?

-I would like to see more men like Rosie Greer in the public eye.

-Radical feminism is not the answer. The equal rights amendment will not change people’s minds or hearts. Women will not be free until men are too. I hope to see a new social movement for Human Liberation; men will be allowed to knit and cry, and women will be elected president or become pipefitters if they choose.

While researching this subject I learned about myself – I am a feminist, but I think the ones that are too radical have discouraged its real growth.

Bibliography 

1.      Walker, Lenore E. (1979). The Battered Women. Harper & Row.      

2.      Davidson, Terry. (1978). Conjugal Crime. Hawthorn.

3.      Roy, Maria. (1977). (Ed). Battered Women: A Psycho/sociological Study of Domestic Violence. Van Nostrand. 

4.      Personal acquaintance.

5.      Cmar, Joan. Counselor – Haven House, Hammond, IN.

6.      Personal friend, volunteer – Haven House, Hammond, IN.

Research Design: Touch and the Power to Heal

Indiana University

Principles of Sociology Soc 161, Fall 1982

Grade: Full Credit, 11 Points, “Good Paper”

A in Class; A Hypothesis

Physical contact (hugs, pats, shoulder squeezing, hand holding, etc.) affects the body in a positive manner both physically and psychologically; lack of physical contact has a negative effect on the body physically and psychologically.     

Observations

Football players are quite demonstrative with their physical contact. Anyone who has watched them get ready just before game time knows this to be true. These big tough macho men (who would be arrested for such behavior in any other circumstances) hug, squeeze, hold, hit, and embrace each other in groups of fifty or more. This physical contact with one another psyches up each individual and adds to team unity; their adrenaline is released which prepares them physically for rigorous activity.  1. During the game the physical contact continues with pats on the rear and hand slapping to keep spirits up, share the joy of a touchdown and stimulate another burst of adrenaline.

On the other hand, patients suffering from depression are not psyched up for life and are physically lethargic. Having worked with depressed patients, I have observed that they lack the ability to reach out to be touched; they lack receptiveness to others’ physical advances too. Depressed people seem unable to gather enough physical or psychological energy to respond. They isolate themselves because they feel isolated.

                                                     Test 1 

I would love to see what would happen if on a given Sunday half of the NFL teams refrained from all physical contact, other than what is needed to tackle and get the ball through their opponent’s defense. The opposing team would be allowed their usual pre-game physical bombardment of one another before the game.

Comparisons could then be drawn as to how the players felt about playing without their physical contact: were they as psyched up? Did they physically play as well? Were there more injuries than usual (compare statistics from previous play)? Do they feel that they should have beaten the team that they played? How much did they play up to their potential?

To ensure a spontaneous response from the team being tested they would not be told of the test procedure until arrived at the stadium prior to the game. After the game, the players would be questioned as to the differences that they observed with the elimination of the normal pre-game physicalness.

Statistics could be compared as to points scored, the number of fumbles, and the general effectiveness of the testing team. Hopefully, we could learn whether their physical contact really aids the team physically and psychologically.

                                                     Test 2  

I recommend doing touch histories on patients with depression. Family members and significant others who bring them to the hospital could be asked about the usual touching patterns in the families’ or patients’ life. Are they a family or a couple that is physically close? How do they touch? When? For how long? Is touching in a marital relationship only for sexual purposes? Have them make out a usual day-touching itinerary.

The patient could be questioned too. Comparisons here between what family members reported and what the patient reported may also be enlightening.

Ask the patient how his family was regarding touching during his childhood. Did he feel free to jump up on a parent’s lap? Perhaps one parent and not the other? Was there physical contact in the form of a pat on the head or maybe a bear hug? How would they like to be touched? Is it important for them to be touched? Was there a drastic change in their recent past (last 1-2 years) regarding their physical contact? Death divorce or other physical separation could decrease one’s physical contact behavior. Was there a substantial change in the amount of touching that was comfortable for the patient?

One true example a recall was a woman of 47 who had been married 26 years, had five children and described her family as quite physically expressive in their love: both parents hugged the children daily and the children frequently were seen with their arms around one another. When she had a radical mastectomy her husband and children were so frightened that they were unable to touch her as usual. The woman committed suicide before any help could be obtained for her and her family.

                                                     Test 3  

Psychiatrists and psychologists treating depressed patients could do a different study. One group of depressed patients could be given conventional therapy; the other group should be purposefully given physical contact along with conventional therapy. The counselors would need to decide how comfortable they felt with each type of physical contact and use it appropriately. A patient should be able to perceive it as sincere or the results would be tainted to say the least.

A sincere handshake could be initiated before the therapy session. The counselors should be positioned so that physical contact can be comfortably made during the discussion; squeezing of the shoulder, patting hand or knee and if possible a strong hug before leaving would serve well.

The two groups can be compared as to: did the touched patients show any signs of being more psyched up for life than the untouched? Can it initiate some adrenaline for them and thus increase their physical activity? As time goes on, the touched patient has the ability to respond to human contact. Can a team spirit feeling be generated in those without this feeling by having physical contact with them? Can we take a cue from football and use it to help the depressed patient?

                                                Hypothesis 

(Agree or Disagree)

I’m sure that without their usual touching behavior, the football teams could not function anywhere near their best. I’m sure that less team spirit could be assessed from them; without the team spirit and the adrenaline stimulation of their physical contact, they would win fewer games and have more injuries.

I think there would be a high correlation between the onset of depression and the lack of physical contact in depressed patients.

I don’t doubt that with proper controls and with therapists that felt ok about touching their patients, the patients who were purposely touched during the study would do better than those treated conventionally.  

                                                  Analysis 

If my research design were ever carried out, I hope that it would show in black and white just how important physical contact is. I hope people would THINK about how, why, when, and whom they touch. They may use it more often to express themselves at times when at a loss for sensitive enough words. Perhaps we could become more inclined to ASK for physical contact when we need it, realizing what it can do for us.

If fifty macho men (football players) can all hug one another why not encourage other groups to do the same? There are many groups that could attain cohesiveness with physical contact: a class of students studying for a big exam, a local chapter of Parents Without Partners, residents of a senior citizen home (staff could also join in), and any other group who could benefit from gaining a team spirit and increasing physical ability.

We know that newborns die without soft warm contact; the depressed patient’s situation would illustrate one of the things that can happen to adults with a lack of soft warm contact. If lack of soft warm contact can have such a drastic effect on the youngest of our species, then it MUST also affect even the oldest in some negative way.

Notes

1       Adrenaline – a neurotransmitter (chemical substance released at the neuromuscular junction) released in response to stimulation of the sympathetic nervous system. This is also sometimes referred to as the fight or flight response. This is a protective mechanism of the body that is elicited in conditions that are other than basal.

The physical contact displayed by football players serves to elicit a sympathetic response which results in the release of adrenaline. Adrenaline serves to prepare muscles to run, jump, tackle, and in being generally ready to play. It does this by elevating blood pressure, pulse, respiration, and general metabolism which brings more blood and more oxygen to the muscles that they need to increase activity. If this was not done and the muscles were not ready with extra blood and oxygen, I’m sure that they would be more inclined to injury.