Trish’s Mental Health Resources Blog

De Paul University

Class: Law & Values

Teacher: Jack Morn, JD Spring 1991

Facts:     

In re Estate of Longeway, (Dorothy M.) Ill SupCourt, No. 67318, 11/13/89.

Mrs. Longeway was a 78-year-old, Naperville nursing home resident (The Community Convalescent Center). Longeway’s daughter, Bonnie Keiner, asked the court to allow tube feedings to be discontinued after her mother had several strokes. Longeway had been unconscious for 2 years and could not chew or swallow. She was not brain dead, nor comatose, but her prognosis was very poor. Mrs. Longeway did not have a Living Will or Power of Attorney for health care.

Issue:     

Whether the guardian of an incompetent, seriously ill patient may exercise a right to refuse artificial nutrition and hydration. And if so, how can this right be exercised? Whether a patient has a right to refuse this type of medical treatment.

Law:                

The court found the right to refuse life-sustaining treatment could be found in the state’s common law and in the Illinois Probate Act (Section 11a-17).

Reasoning:    

Other states that have allowed the removal of sustenance have labeled them as medical treatment (differing from spoon or bottle-feeding). Termination of these “intrusive” procedures will not be the cause of the patient’s death; their death was caused by the disease that left them unable to swallow or chew.  The court said that since they had no guidance from the U.S. Supreme Court, (Cruzan came 3 weeks later), they decided not to address the federal right to privacy, nor the privacy provision of their state constitution. The justices claim that a patient, under common state law, can refuse medical treatment, and under the right conditions nutrition & hydration. The Probate Act gives a guardian the right to refuse artificial sustenance on behalf of the ward. The agent may terminate sustenance if the patient had previously issued a power of attorney, under the Powers of Attorney Health Care Law. In the majority opinion by Justice H. Ryan, the court said, “Food and water are emotionally symbolic in that food and water are basic necessities of life, and the feeding of those who are unable to feed themselves is the most fundamental of all human relationships”. For patients who are not able to make decisions, tube feedings can be discontinued by a guardian of a terminally ill patient. They defined terminally ill as, “an incurable and irreversible condition, which is such that death is imminent, and the application of death-delaying procedures serves only to delay the dying process.”

Holding:

In a 4-2 decision, the justices said a guardian may exercise the right to refuse sustenance on behalf of an incompetent ward if certain conditions are followed:

         1.      The incompetent person must be considered terminally ill, in an irreversible coma or in a persistent vegetative state.

         2.      In addition to the attending physician, 2 other physicians must agree on the patient’s diagnosis.

Four state interests must then be considered:

         1.      The preservation of life

         2.      Protection of innocent 3rd parties

         3.      Prevention of suicide

         4.      Maintenance of the ethical integrity of the medical profession.

The next step is the determination of the patient’s wishes. The courts have used one of 2 theories:

Best interests – the surrogate decides which medical procedures are in the patient’s best interest. (The problem here is that one person is deciding on the quality of life for another which could end up undermining the very reason for self-determination and inviability of the person on which the right to refuse was intended). The court said cases must use:                      

Substituted judgment – the surrogate attempts to establish the decision that the patient would make if he were able, by either expressed intention or what seems to fit the patient’s value system.                              

Courts must use the clear & convincing evidence standard.

The final step is in determining the court’s role. They said that the majority don’t really need a court, but to withdraw sustenance they think it’s a good idea because:

Illinois has a strong public policy preserving life’s sanctity. The key element in the decision to refuse is the determination of the patient’s intent, requiring clear and convincing evidence. They also hope to guard

against the possibility of greed as a motive.

Dissent:

The right to refuse is dependent on and rooted in the patient’s capacity for making informed decisions which the incompetent patient cannot do. Justice J. Ward.  The issue should be studied fully by the legislature. Justice J. Clark.

———————————————————————————————–

Brief

Facts:     

In re Estate of Greenspan, Ill SupCourt, No 67903, 7-9-90.

-The wife, 2 daughters, an employee of and the rabbi of a 76-year-old man, who had been in a chronic vegetative state for 5 years, without reasonable hope to recover, sought to remove sustenance; they felt he would not have wanted to be maintained in such a way. There was no living will or health care power of attorney. 

-The public guardian’s petition (Cook County) was granted by the circuit court to appoint the patient’s plenary guardian. The public guardian then tried to discontinue the life support systems. A court-appointed guardian ad litem recommended that the public guardian’s petition be granted, but the trial judge said that the Living Will Act prevents withdrawal of sustenance if it would lead to death from starvation rather than the terminal disease.

-The guardian ad litem and the public guardian both sought Supreme Court intervention. The Americans United For Life Legal Defense Fund (AUL) presented opposing arguments. They claim that the public guardian was not acting in the best interests of the patient because     

stopping the feeding would result in death and how could that be in his best interest?

Issue:

AUL asked the court whether a guardian has the authority to order such removal from an incompetent. But instead of ordering the withdrawal of sustenance on the basis of any authority of his own, the public guardian tried to get the court to order withdrawal as the patient’s surrogate. The question initially stated by the AUL was whether that would be in conflict with the duties of the public guardian. 

In Longeway, artificial nutrition, according to the Illinois Living Will Act, was death-delaying treatment (even though the act prevents withdrawal if such withdrawal would result in death “solely” from the withdrawal

instead of the condition). Artificial nutrition and hydration are considered medical treatment under the Powers of Attorney for Health Care Law and may be discontinued. The Act nor the Law apply to this person because there is no living will or health care power of attorney. The fact that the statute’s referring to nutritional sustenance as medical treatment and not just as nourishment instructs the court on the issues here.

Law:                

Illinois Living Will Act.

Powers of Attorney for Health Care Law.

The 1975 Probate Act and common law.

Reasoning:    

The justices made analogies with Cruzan and Longeway’s decisions. In Cruzan, it was held that guardians lacked the authority to stop medical treatment. 

As in Longeway, when the patient can’t chew or swallow because of a terminal illness, the ultimate cause of death is the disease, not the withdrawal of feedings.

The Living Will Act doesn’t prevent the public guardian from having the feedings withdrawn. It does not apply to a patient without a living will. The Powers of Attorney for Health Care Law led to a public policy holding that discontinuance of tube feedings is allowable through a health care agency. If the person under the health care power has a living will, it will be mute, so long as the agent under power is able to act. The legislature recently amended the Living Will Act to say that a qualified patient, (one who is terminally and with a living will) should not be deprived of nutritional sustenance if that alone would be the cause of death.     

Holding:

Under section 2(h) of The Living Will Act, a terminal condition is one in which (1) death is imminent and (2) death-delaying treatments just prolong the dying process. For the purposes of defining terminal illness,   

“imminent death” must be judged as if the death-delaying treatments were absent; death would be imminent without the tube feedings. They allowed the feeding tube to be discontinued. Justice J. Stamos.

Dissent: 

The majority ignored the requirement that the incompetent patient must be terminally ill according to the Living Will Act which allows their withdrawal only when they are futile. They also disagree that the cause of death would be from the underlying disease. Justices Ward and J.J. Calvo. , (Dorothy M.) Ill SupCourt, No. 67318, 11/13/89.  Mrs. Longeway was a 78-year-old, Naperville nursing home resident (The Community Convalescent Center).

Longeway’s daughter, Bonnie Keiner, asked the court to allow tube feedings to be discontinued after her mother had several strokes. Longeway had been unconscious for 2 years and could not chew or swallow. She was not brain dead, nor comatose, but her prognosis was very poor. Mrs. Longeway did not have a Living Will or Power of Attorney for health care.

Issue:              

Whether the guardian of an incompetent, seriously ill patient may exercise a right to refuse artificial nutrition and hydration. And if so, how can this right be exercised?

Whether a patient has a right to refuse this type of Medical treatment.

Law:                

The court found the right to refuse life-sustaining treatment could be found in the state’s common law and in the Illinois Probate Act (Section 11a-17).

Reasoning:    

Other states that have allowed the removal of sustenance have labeled them as medical treatment (differing from spoon or bottle-feeding). Termination of these “intrusive” procedures will not be the cause of the patient’s death; their death was caused by the disease that left them unable to swallow or chew.  The court said that since they had no guidance from the U.S. Supreme Court, (Cruzan came 3 weeks later), they decided not to address the federal right to privacy, nor the privacy provision of their state constitution. The justices claim that a patient, under common state law, can refuse medical treatment, and under the right condition’s nutrition & hydration. The Probate Act gives a guardian the right to refuse artificial sustenance on behalf of the ward. The agent may terminate sustenance if the patient had previously issued a power of attorney, under the Powers of Attorney Health Care Law. In the majority opinion by Justice H. Ryan, the court said, “Food and water are emotionally symbolic in that food and water are basic necessities of life, and the feeding of those who are unable to feed themselves is the most fundamental of all human relationships”. For patients who are not able to make decisions, tube feedings can be discontinued by a guardian of a terminally ill patient. They defined terminally ill as, “an incurable and irreversible condition, which is such that death is imminent and the application of death-delaying procedures serves only to delay the dying process.”

Holding:

In a 4-2 decision, the justices said a guardian may exercise the right to       

refuse sustenance on behalf of an incompetent ward if certain conditions are followed:

         1.      The incompetent person must be considered terminally ill, in an irreversible coma or in a persistent vegetative state.

         2.      In addition to the attending physician, 2 other physicians must agree on the patient’s diagnosis.

Four state interests must then be considered:

         1.      The preservation of life

         2.      Protection of innocent 3rd parties

         3.      Prevention of suicide

         4.      Maintenance of the ethical integrity of the medical profession.

The next step is the determination of the patient’s wishes. The courts have used one of 2 theories:

Best interests – the surrogate decides which medical procedures are in the patient’s best interest. (The problem here is that one person is deciding on the quality of life for another which could end up undermining the very reason for self-determination and inviability of the person on which the right to refuse was intended). The court said cases must use:    

Substituted judgment – the surrogate attempts to establish the decision that the patient would make if he were able, by either expressed intention or what seems to fit the patient’s value system. Courts must use the clear & convincing evidence standard.

The final step is in determining the court’s role. They said that the majority don’t really need a court, but to withdraw sustenance they think it’s a good idea because:

Illinois has a strong public policy preserving life’s sanctity. The key element in the decision to refuse is the determination of the patient’s intent, requiring clear and convincing evidence. They also hope to guard against the possibility of greed as a motive.

Dissent: 

The right to refuse is dependent on and rooted in the patient’s capacity for making informed decisions which an incompetent patient cannot do. Justice J. Ward.  The issue should be studied fully by the legislature. Justice J. Clark.

———————————————————————————————–

Brief

Facts:     

In re Estate of Greenspan, Ill SupCourt, No 67903, 7-9-90.

-The wife, 2 daughters, an employee of and the rabbi of a 76-year-old man, who had been in a chronic vegetative state for 5 years, without reasonable hope to recover, sought to remove sustenance; they felt he would not have wanted to be maintained in such a way. There was no living will or health care power of attorney. 

-The public guardian’s petition (Cook County) was granted by the circuit court to appoint the patient’s plenary guardian. The public guardian then tried to discontinue the life support systems. A court-appointed guardian ad litem recommended that the public guardian’s petition be granted, but the trial judge said that the Living Will Act prevents withdrawal of sustenance if it would lead to death from starvation rather than the terminal disease.

-The guardian ad litem and the public guardian both sought Supreme Court intervention. The Americans United For Life Legal Defense Fund (AUL) presented opposing arguments. They claim that the public guardian was not acting in the best interests of the patient because stopping the feeding would result in death and how could that be in his best interest?

Issue:

AUL asked the court whether a guardian has the authority to order such removal from an incompetent. But instead of ordering the withdrawal of sustenance on the basis of any authority of his own, the public guardian tried to get the court to order withdrawal as the patient’s surrogate. The question initially stated by the AUL was whether that would be in conflict with the duties of the public guardian. 

In Longeway, artificial nutrition, according to the Illinois Living Will Act, was death-delaying treatment (even though the act prevents withdrawal if such withdrawal would result in death “solely” from the withdrawal instead of the condition). Artificial nutrition and hydration are considered medical treatment under the Powers of Attorney for Health Care Law and may be discontinued. The Act nor the Law apply to this person because there is no living will or health care power of attorney. The fact that the statute’s referring to nutritional sustenance as medical treatment and not just as nourishment instructs the court on the issues here.

Law:                

Illinois Living Will Act.

Powers of Attorney for Health Care Law.

The 1975 Probate Act and common law.

Reasoning:    

The justices made analogies with Cruzan and Longeway’s decisions. In Cruzan, it was held that guardians lacked the authority to stop medical treatment. 

As in Longeway, when the patient can’t chew or swallow because of a terminal illness, the ultimate cause of death is the disease, not withdrawal of feedings.

The Living Will Act doesn’t prevent the public guardian from having the feedings withdrawn. It does not apply to a patient without a living will.

The Powers of Attorney for Health Care Law led to a public policy holding that discontinuance of tube feedings is allowable through a health care agency. If the person under the health care power has a living will, it will be mute, so long as the agent under power is able to act. The legislature recently amended the Living Will Act to say that a qualified patient, (one who is terminally and with a living will) should not be deprived of nutritional sustenance if that alone would be the cause of death.     

Holding:

Under section 2(h) of The Living Will Act, a terminal condition is one in which (1) death is imminent and (2) death-delaying treatments just prolong the dying process. For the purposes of defining terminal illness, “imminent death” must be judged as if the death-delaying treatments were absent; death would be imminent without the tube feedings. They allowed the feeding tube to be discontinued. Justice J. Stamos.

Dissent: 

The majority ignored the requirement that the incompetent patient must be terminally ill according to the Living Will Act which allows their withdrawal only when they are futile. They also disagree that the cause of death would be from the underlying disease. Justices Ward and J.J. Calvo.

Taken From:

1983.  Givens, David B., Ph.D., Love Signals: How To Attract A Mate.  Pinnacle Books: New York.

Purdue University

Fundamentals of Speech (Public Speaking)

Com 114, November 1, 1988

Grade: 93%             

Teacher comments:  Good relationship with an audience, very nicely done

Flirting: An Anthropological Look

SPECIFIC PURPOSE STATEMENT

To inform the audience about courtship behaviors.

THESIS STATEMENT

Courtship behaviors are instinctive, initially nonverbal, and mandate conversation before touching.

BODY

I.       Courtship behaviors are instinctive.

         A.     Our brains are pre-wired with all the courtship cues that we need.

         B.      Thought and mating centers are on different neurological floors.

                  1.      Defies reason

                  2.      Nuclear physics and flirt

                  3.      Nonverbal cues better

         C.     Courtship is slow, cautious and gentle in all human groups. 

                  1.      Myth of caveman

                  2.      Wolf spider

II.  Courtship behaviors are initially nonverbal.

         A.     The main goal initially is to establish harmlessness.

                  1.      Stranger fear

                  2.      Shrug vs. military shoulders

                  3.      Head tilt

                  4.      Unfolding

                  5.      O.K. to scratch

                  6.      Casts

                  7.      Men armless and strong

         B.      There are signs we can look for to see if someone is attracted to us. 

                  1.      Pupil dilation and eye blink rate

                  2.      3 second gaze

                  3.      Forward lean

                  4.      Body alignment with reach out

                  5.      Smile closed or Jimmy Carter

                  6.      Female intuition

III.    Courtship behaviors mandate conversation before touching.

         A.     Conversation with a potential sex partner not only puts you on the line, it hangs you over the edge.

                  1.      Secret not to threaten

                  2.      Soft voice (cuddle response)

                  3.      Where is the bathroom

                  4.      Shared focus

                  5.      Share food (vulnerability)

                  6.      Be yourself

                  7.      Show meekness

         B.      Touching has deeper meaning than speech and leads to the end of courtship, which is intercourse.

                  1. First-touch accident

                  2.      Body extension

                  3.      Hugs (security and comfort)

                  4.      Females make love to get hugs and males give hugs to make love.

                  5.      Kissing childlike feelings

                  6.      Touch faces

                  7.      Prolonged kissing auto pilot

                  8.      Making love ends

Civil Rights: Similarities Between Blacks and Women

Fundamentals of Speech (Public Speaking)

Com 114, Fall 1988, December 6, 1988

Grade: 96%

Teacher comments: You improved more than you know

Outline

Civil Rights: Similarities Between Blacks and Women

Specific Purpose Statement 

My goal is to gain the audience’s empathy in regard to my strong feelings about civil rights

Thesis Statement

-I am in awe of the accomplishments of Dr. Martin Luther King Jr

-I feel a sense of shame for what blacks went through in our country

-I am thankful to Martin Luther King for his tenacity in fighting for civil rights

Introduction

-I first learned about civil rights as a 6- or 7-year-old who came home and said the word nigger; I had no idea what it meant. My dad promptly spanked me and forbade me to say the word. He gave two reasons: one, it hurt colored people and second, if said in the wrong place, could get you knifed. Dad went on to say that colored people were the same as pollocks; some were good, and some were bad. He ventured further to say that the blacker they were the nicer they were. This was his left-handed, Archie Bunker way of saying “All men are created equal.” Yes, Dad lacked eloquence, but he was able to get his message across. I feel ashamed for what whites did to blacks in our country, I am thankful to Martin Luther King for his tenacity in fighting for civil rights, and I empathize with the fact that blacks were compelled to fight for their freedom.

I.     I am in awe of the accomplishments of Dr. Martin Luther King Jr

         A.     He received his Ph.D. from Boston University in 1955

         B.      He was the founder and director of the Southern Christian Leadership Conference in 1957

         C.     He gained national attention when he organized a boycott of the buses in Montgomery, Alabama

         D.     He was an advocate of non-violence

                           1.      Accept blows without retaliation

                           2.      To create tension and force negotiation

                           3.      He was jailed 14 times

                           4.      In 1964 won Nobel Peace Prize

         E.     He presented an eloquent explanation of why he believed in nonviolent direct action

                     1.            He surely persuaded me that the city where his organization practiced was the only for blacks to demand an end to their oppression

                     2.            Injustice anywhere, is a threat to justice everywhere

II.     I feel a sense of shame for what blacks were forced to endure in our country

         A.     Slavery was a disgrace

         B.      The Klu Klux Klan should be abolished from the face of the earth

         C.  Poor blacks are still oppressed today, in our supposed free country

                     1.   Ghetto hospitals

                     2.   Patients are the same

         D.     He had defined just and unjust laws

                     1.   Just laws

                     2.   Unjust laws

         E.     He thought that the discontent that blacks felt was normal and healthy in their oppressed situation

                  1.      I empathize with their anger

                  2.      I empathize with their hurt

III.    I feel thankful that Martin Luther King continued his so-called civil disobedience to secure long-overdue civil rights

         A.     The Supreme Court banned segregation in public schools in 1954

         B.      It is impossible today to imagine a black person not being able to get a room in a hotel because he was black 

         C.     Martin Luther King is a true humanitarian that I did not appreciate until recently  

Conclusion

In conclusion, I am ashamed of what whites did to blacks in our country, I am thankful to Martin Luther King for his tenacity in fighting for civil rights, and I empathize with the fact that blacks were compelled to fight for their freedom. I hope I was able to share with you just how deeply I feel about human civil rights; I also feel that attitudes can be like unjust laws and be followed just because they are there without much thought about the profound effect on us. No human being should be trapped by attitudes that prevent him from seeking his dream.

========================================

Other aspects I liked …

         A.     It was only 25 years ago that Martin Luther King was compelled to engage in non-violent direct action to force the town of Birmingham to negotiate with blacks

                  1.      Signs designating colored or white

                  2.      Back of bus

                  3.      Hotels would not rent

                  4.      No amusement parks for colored kids

         B.      Martin Luther King was criticized by his fellow clergy 

                  1.   He broke the law  

                                    a.      Parading without a permit

                           b.     1st amendment right to assembly and protest

                           e.      Segregation

                           f.       Hitler’s Germany                                        

                  2.      Left his home to sit-in

                           b.     What affects one directly

                  3.      Wait for right time

                           a.      Justice too long delayed

                           b.     Justice denied

                           c.      ? right time

                           d.     Easy to say to wait

         C.     I doubt that any of us could imagine anyone these events of the past occurring today

II.     I am thankful to Martin Luther King for his tenacity in fighting for civil rights  

         A.     I like the idea of a society where we are all equal

                  1.      I for one feel that I am equal to anyone

                  2.      I see everyone as my equal too

         B.      The small world of my apartment complex could serve as a good example of successful integration

                  1.      Summer pool has all colors

                  2.      Ducks have civil rights

                  3.      Fantasize that the world could exist like this

         C.     Thank God Martin Luther King won the Nobel Peace Prize in 1964

                  1.      Had 4 years till his assassination to know the world appreciated what he did

                  2.      His death was a tragic loss

                  3.      I want blacks to share my joyous freedom

                  4.      Freedom leads to enormous human growth and potential

Written after reading Letter from Birmingham Jail, by Martin Luther King, Jr

Other aspects I liked …

                  3.      I want blacks to share my joyous freedom

                  4.      Freedom leads to enormous human growth and potential

Purdue University, English 105

Dr. Bolduc, Fall 1988      

Grade: (A)

                           Jet Lag: The Effects on Health                                                          

The entire universe operates via cyclic or rhythmic processes; from the galaxies rotating around their centers to the microscopic world of the atom. The cycle of day and night which lasts for 24 hours is caused by the earth’s rotation around its axis; the specific distance from the sun affects the amount of light and the amount of warmth present. The nucleus of an atom has electrons revolving around it which control it’s cyclic processes.

Man is also cyclic, his body clock or his physiological clock functions to tell him when to eat, sleep, be active, or when to play. Man’s rhythm is circadian. Circadian comes from the Latin word, circum which means “about”, and dies which means “day.” This biorhythm involves a period of 24 hours; also called the circadian cycle; this cycle controls our levels of wakefulness and sleep. “The cells of our bodies contain timers or “individual clocks” which in association with RNA (ribonucleic acid) process proteins in a cyclic 24-hour period.” 1 

So our actual chemical makeup contains our clock. The clock receives cues from several sources called Zeitgebers (a German word which means “time giver”). Some of these cues are external and some are internal. Light is an important zeitgeber in controlling our circadian rhythm; lighting cycles regulate endocrine function in our bodies. Our endocrine glands control the production of hormones such as adrenaline, cortisone, and thyroxin which all play a role in regulating our circadian rhythm; cortisol levels are high early in the am and low in late evening; cortisol levels rise to their highest an hour before the person awakes in the morning.                                                         

Neuroanatomists are now aware of a pathway from the eye to a spot in the hypothalamus called the suprachiasmatic nuclei which allows light to have an internal effect on the synchronization of our rhythm. These nuclei seem to be in control of our rhythms. Research has shown that if the connection between the retina and the suprachiasmatic nuclei is damaged, light can no longer reset the biological clock, in spite of the fact that the person can still see.

The pineal gland is also known to function in controlling our clock; in humans, it secretes large amounts of melatonin in young children; the greatest amounts are secreted at night during sleep. The level of melatonin declines towards puberty; melatonin also makes people sleepy; children with large amounts thus sleep more than adults. Studies with sparrows have shown that you can exchange a jet-lagged sparrow’s pineal gland with one from the new time zone and cure his jet lag. Removing the pineal gland in rodents allows the suprachiasmatic nuclei to rapidly adjust to a time zone change. The pineal gland is suppressed by some drugs used to treat mental illness; a widely used antidepressant has been found to reset biological rhythms in rodents.

An internal zeitgeber is a temperature; ordinarily, our body temperature (inside or core temperature, not on the skin) rises at midday to 37 degrees centigrade and falls at night to 36 degrees centigrade.  The temperature curve is an easily measurable indicator of our biological clock. The electrical activity of the brain shows distinct stages in the sleep-wakefulness cycles that can be measured via an electroencephalograph or EEG. 

The urinary system does most of its work during the day, the purpose being to allow undisturbed sleep; studies have shown that the byproducts of the hormones that control circadian rhythms can be found at corresponding appropriate times in the urine. Studies have shown that midday corresponds with the time that people are found to have the best ability to perform complex tasks; this correlates with the fact that most people like to be awake during the day.

Light and temperature act as cues to control our circadian rhythm, yet studies have shown that there are existent circadian rhythms even under experimental conditions with constant light and temperature; these are called free-running rhythms. Without light-dark cues the circadian cycle is said to be running in a free-running manner; it is following the natural internal timing of the body. “Sleep experiments have proved, however, that humans are capable of adapting to a slightly shorter or a slightly        

longer day.” 2 

We rarely exceed twenty to twenty-eight hours and are usually within an hour or two of twenty-four hours. Experiments attempting to change the circadian rhythm were unsuccessful. Young people placed in a cave-like environment with only artificial light agreed to go to bed when the clock said 11:45 PM and to get up when it said 7:45 AM. Though they did not know it the clock began normally, then gradually went faster till the day reached twenty-two hours. At the time the clock was at the twenty-three-hour part none of the participants had any trouble, but when it reached twenty-two hours only one person was able to keep up with the clock.          

After babies are born from a lightless uterus, they exhibit many alterations in their sleep/wake cycle during the first two to three months; the cue that tells them when to wake up is their hunger; the contractions of the stomach wake them up. It takes about three months for babies to develop enough to become curious about seeing the world and thus gradually become more light active. By nine months their body clocks are like that of adults.     

Jet lag is a disruption in this rhythm caused by traveling across a number of time zones; the traveler’s entire body functions are out of sync with those of the people at his destination. When we cross more than four-time zones we exceed our clock’s ability to reset itself. The symptoms of jet lag are many: sleepiness, headaches, alertness, and being hungry at times that are inappropriate. Intellectual functioning is affected; it is hard to learn new things, hard to concentrate, and hard to understand things when experiencing jet lag. Other symptoms are anxiety, nervousness, irritability, anger, depression, and inappropriate euphoria or depression. Usually, the return of intellectual and emotional functioning occurs in three to four days. It may take a week for sleep, appetite, and energy levels to return to normal; levels of serum electrolytes (sodium, potassium, and chloride) may take a few days longer; it may take two months for hormone functioning to return to pre-trip normals.

Examples of geographic time zones crossed are: coast to coast in the United States is four time zones, California to Scandinavia covers twelve, and from New York to New Delhi leads to a complete inversion of the sleep/wake cycle. This desynchronization causes a phase shift between the physiologic and the geographic cycle. Flying east causes things to advance and going west causes a delay in the day/night cycle. ” Most travelers adjust to a new circadian cycle at the rate of one hour per day.”  3 

The older we get the more sensitive we are to jet lag. There are very few people who are not affected much by jet lag. Some find it easier to adjust to eastbound, some to westbound flights; some say that it is easier to adjust on home turf because of the familiar surroundings. ” It turns out that your body cannot adjust to changing time zones much faster than two hour a day, as though your skin can travel at arbitrary speed but your insides are limited to about 100 miles an hour.” 4

An exhaustive study was done by Wegmann et al. in association with Stanford University School of Medicine and NASA (U.S. National Aeronautics and Space Administration) using B-747 aircrews operating regular passenger flights between Frankfort and the U.S. West Coast. The main purpose was to study sleep in aircrews exposed to time zone changes. They knew that multiple time zone transitions caused disruption in the circadian rhythm; their goal was to define changes in the twenty-four-hour fluctuations of selected variables. They studied sleep EEG and daytime sleep latency in the laboratory; they continuously recorded body temperature, and EEG and took frequent urine specimens. Additional measurements were conducted during pre-duty, during flight, and during a layover. In order to also check readjustment at home, the study continued for two days at home.

The design of the experiment was initiated because of their hypothesis: due to considerable time zone changes in the routes of the aircrews they would experience disruption of their circadian rhythms; they would then show sleep difficulties. According to their sleep log analysis, the surveys do not support the above hypothesis. The study showed that the pilots sleep much more on a layover and did not suffer from sleep loss when compared to their sleep at home. Results showed that time-zone transition did desynchronize their circadian rhythm, but with naps and staying awake for periods, and then sleeping long periods they were able to cope with the disruption. From personal conversations with the pilots, they found that they were very much aware of the potential difficulties and take serious measures to obtain enough sleep; the studies show that they are indeed successful. The study did find a difference with age; older pilots had to stay in bed longer to get enough sleep.

Another study was done by NASA in conjunction with an international research team; British, German, Japanese and U.S. research teams each associated with an international carrier along with support in their own country. The goal of this layover sleep study was the assessment of sleep changes encountered with multiple time zone changes; how sleep differ at home when compared to sleep during a trip; the subjects were long-haul flight crews. After baseline sleep EEG recordings, the crews underwent testing during nocturnal sleep followed by multiple sleep latency tests every two hours whenever they were awake and not trying to sleep; this provided objective information about the quality, and quantity of daytime sleepiness for comparison with the subjects’ own estimates.

The sleep recordings included EEG, electromyographic or EMG, and electro-oculographic or EOG activity. (EEG involves brain waves, EMG involves muscle activity and EOG records eye movements). Before each sleep recording the pilots completed a Stanford Sleepiness Scale or SSS, a mood assessment scale, and a self-report to check for adherence to standardization procedures. After awakening a questionnaire was completed involving self-reports about the quality and amount of sleep along with an SSS. Body temperature, heart rate, and urine were tested to clarify data about circadian rhythmicity. (Constant rectal temperature probes were used and all urine was collected to examine hormone levels).

NASA investigators found most crew members were able to get enough sleep during layover either by sleeping well at selected times or by sleeping less efficiently but staying in bed longer; sleep quality declined slightly in most cases; more so after eastward flights. Older (over 50 years) crew members got less total sleep and had poorer quality sleep. The human circadian rhythm is not only more disrupted by eastward flights, but also causes a longer resynchronization period. Sleep duration varies with the circadian temperature, the longer sleeps occur when the temperature is lower.

The study also showed that there is definite variance between individuals due to circadian type; some are morning and some are night people. Similarities were found in the baseline daytime sleep latency curves; all showed a gradual increase in sleepiness during the day with a maximum in the late afternoon followed by a gradual decrease in the evening; these sleepiness rhythms continued after the time zone shift when back to home base. It is possible that crews could predict the easiest times to fall asleep and thus develop good strategies for sleeping away from home. Data obtained after eastward flights showed that ” adhering to more structured sleep schedules and limiting initial post-flight sleep would appear to facilitate the acquisition of adequate sleep during the layover.” 5 

Jet lag is a psychological and physiological stress on the body; studies on stress have shown that the more stress in your life the higher your odds are of becoming ill. Studies on lab animals show that when their biological clocks are tampered with they are subject to higher death rates when exposed to toxic chemicals, alcohol, medications, and toxins from certain bacteria. Norman Cousins wrote about a serious illness he experienced after returning from a trip to Russia; he describes his perception of the illness in “Anatomy of an Illness” in New England Journal of Medicine, vol 295, Dec 23, 1976, pp. 1458-63; although Cousins did not say that jet lag was the cause, it is possible according to Dr. J. Greist and Dr. G. Greist. 6

The short and long-term effects of a single or a repeated experience with jet lag on our health have not been proven as yet; the type of studies that would be needed to prove the health effects would be very hard to do. Several factors are likely to be determining factors in how much we are affected by jet lag: the number of time zones crossed, the number of recent exposure to jet lag, and sleep loss. An interesting difference between the United States and the Soviet Union is that the Soviets assume that a change in the circadian rhythm would lead to deleterious effects; their cosmonauts maintain their earthly day/night cycles even while in orbit. The United States uses a variety of schedules; apparently, we expect flexibility in ourselves.

According to Dr. Strughold, Dr. R. F. Fitch, Chief of Internal Medicine at Wilford Hall USAF Medical Center, San Antonio, Texas, “the administration of hormone-containing drugs should simulate the natural circadian production pattern of the hormones, to avoid disturbing their role in running the physiological clock.” 7 

It has been reported that transplanted kidneys take about a year to get it together with their new body. Internal cardiac pacemakers automatically beat ten beats per minute slower at night.

The effects of jet lag can have serious meanings to those whose mission involves international political conferences; businessmen traveling abroad hoping to complete transactions involving large sums of money; Olympic athletes must do all they can to resynchronize themselves. There are numerous methods that have been suggested to help minimize the effects of jet lag:

Preflight adaptation is one; try to slowly adapt yourself to the time zone of your destination; if traveling east, go to bed and arise two or more hours earlier and gradually shift meal times so they are more in line with your destination. If traveling west, stay up later and get up later than usual. If possible plan to fly to your destination a couple of days ahead of time so you can become adjusted before your planned activity. President Eisenhower did this in 1955 before meeting Nikita Khrushchev in Geneva for a Summit meeting. 8  

Some companies have a rule that their executives are not to sign any contracts within the first two days after a transoceanic flight. If you are unable to take time ahead for adaptation be aware that the morning hours in the first few days after eastbound and the late afternoon after westbound are times to avoid signing contracts, making major decisions, or conducting affairs of state.

After arriving at your destination spend as much time as possible out in the sunlight, letting the sunlight help reset your clock. Joan Hamilton in Business Week magazine says that Czeisler, associate professor of medicine at Harvard, foresees that in the future airplanes may adjust their interior light to help reset our biological clocks. 9 

Socialize to stay awake and avoid daytime dozing. According to Joan Hamilton in Business Week magazine, frequent flyers get over jet lag sooner when they force themselves to socialize; she  quoted a pharmacologist at Florida A & M University as saying, “We know that extroverts seem to get over jet lag faster than introverts.” 10

Low humidity in airplanes can result in loss of water; this can lead to changes in electrolyte levels(sodium, potassium, and chloride); it is recommended that extra water is a good idea because dehydration can cause fatigue, sleep disturbances, and a reduced capacity to reset the biological clock.

Alcohol and caffeine should be taken only in extreme moderation; they have the ability to turn off the body’s antidiuretic hormone, which causes water loss which in turn will also dehydrate you. Also, the pressurized cabin at five to six thousand feet above sea level makes two drinks (of alcohol) have the same effect as three.         

The gastrointestinal system operates with rhythmic periods of high and low, so if you eat a big meal at a time when your stomach thinks it should be asleep you are just adding to the burden of time zone adjustment for your stomach. Gradually shift meal time to that of your destination. For this reason, eat lightly and at the correct time according to your destination. Increased altitude causes gas in your gastrointestinal tract to expand; carbonated beverages will thus have a worse effect than on the ground. 

It will help to make your transition easier if you rest at home before you leave; sleep or at least resting on a long flight will help, a short-acting sleeping pill may help also; Halcion and Restoril are two short-acting prescription products recommended. 11

“Intellectual function is often more noticeably affected than other biological functions”. 12 For this reason diplomats, business people and flight crews need to really take care. 

According to the editors of Discover and B. Bower in Science News magazines, researchers N. Mrosovsky and P. Salmon at the University of Toronto after experiments with hamsters think that exercise may help to speed up the resetting of our jet lagged clocks. Their study showed that active hamsters needed 1.5 days to adjust while lazy hamsters took up to 11 days. 13-14

People who work nights or periodically change shifts encounter symptoms very much like jet lag; in addition, police officers were shown to have high rates of alcoholism, sleeping pill use, accidents, and family disruptions. Lisa Bain says in Psychology Today, that neuroscientist, Charles Czeisler, of Harvard Medical School claims that “the problem is in the schedule, not the job.” 15 

Czeisler redesigned their schedule to better accommodate their circadian rhythm. There were three basic changes: one, instead of changing shifts every eight days, they changed every eighteen days; second, they changed shifts going from days to evenings and then to nights; third, Czeisler had the officers work only four days in a row so they could catch up on their sleep.   

The results after about a year were positive: The officers had less sleep problems and were generally more alert; car accidents were down by forty percent; alcohol and sleeping pill use were down fifty percent; the families felt five times better after the new schedule. Czeisler says that workers who have their circadian rhythms desynchronized frequently are functioning in an impaired state; public safety is thus a concern.

End Notes

1       T. Alexander, “Biological Rhythms,” Encyclopedia of Psychology, (New York: Wiley, 1984), vol 1 pp. 151.

2       Hubertus, Strughold, M.D., Your Body Clock (New York: Scribner, 1971), pp. 41.

3       Strughold, pp. 57. Dr. Strughold says that Dr. William Douglas, flight surgeon to the Project Mercury astronauts suggests this rule. 

4       Arthur, Winfree, The Timing Of Biological Clocks, (New York: Scientific American, 1987), pp. 4-5.

5       Graeber et al, “International Aircrew Sleep and Wakefulness After Multiple Time Zone Flights: A Cooperative Study,” Aviation, Space and Environmental Medicine, (Dec 1986, vol 57 (12, Sect II)), pp. 9.

6       John Greist, M.D., and Georgia Greist, Ph.D., Fearless Flying,  (Chicago: Nelson-Hall, 1981), pp. 71.

7       Strughold, pp. 32.

8       Strughold, pp. 61.

9       Joan Hamilton, “You Don’t Have to Give in to Jet Lag,”  Business Week, (Oct, 26, 1987) pp. 126.

10     Hamilton, pp. 126.

11     Editors of Changing Times, “Unsag From Jet Lag,” (May, 1988) pp. 104.

12     Greist, pp. 75.

13     Editors of Discover, “Overcoming Jet Lag: The Rodent Way,” (May 1988,) pp. 18.

14     B. Bower, “Hamster Jet Lag: Running it Off, Science News, (Dec 5, 1987 vol 132: no 23) pp. 358.      

15     Lisa Bain, “Night Beat”, Psychology Today, June 1988 vol 22, pp. 14-15.

Bibliography

Alexander, T.  “Biological Rhythms.”  Encyclopedia of Psychology.  New York: Wiley, 1984.  vol 1.       

Carlson, Bruce. “Pineal Gland.”  Encyclopedia Americana. ed.  Danbury: Grolier, 1986. 

“Circadian Rhythms in Metabolic Activity.”  Encyclopedia Britannica.  New York: U of Chicago P. 1988.  vol 25:487:2a.

Bain, Lisa.  “Night Beat.”  Psychology Today.  June 1988: vol 22.

Bower, B.  “Hamster Jet Lag: Running it Off.”  Science News.  Dec 5, 1987.  vol 132: no 23.

DuHamel, Meredith.  “Traveling Through Time.”  Woman’s Sport and Fitness.  Dec, 1987. vol 9: no 12

“Effects of Light on Biological Rhythms.”  Encyclopedia Britannica.  New York: U of Chicago P, 1988.  vol: 26: 519:2b.

Graeber, et al.  “International Aircrew Sleep and Wakefulness After Multiple Time Zone Flights: A Cooperative Study.”  Aviation, Space and Environmental Medicine.  Dec, 1986: vol 57 (12, Sect II).

Greist, John, M.D. and Greist, Georgia, Ph.D.  Fearless Flying.  Chicago: Nelson-Hall, 1981.           

Guyton, Arthur, M.D., “Circadian Rhythm of Glucocorticoid Secretion.”  The Textbook of Medical Physiology.  7th ed. Philadelphia: Saunders, 1986.

Hamilton, Joan.  “You Don’t Have to Give in to Jet Lag.”  Business Week.  Oct 26, 1987. 

Kalland, Gene.  “How to Reduce Jet Lag.”  USA Today.  June 1988.  vol 116: no 2517.

Kalat, James.  “Endogenous Circadian and Circannual Rhythms.”  Biological Psychology.  3rd ed.  Belmont: Wadsworth, 1988. 

Luce, Gay.  Body Time.  New York: Pantheon Books, 1971.

Morin, Lawrence.  “Biological Clock.”  Academic American.  Danbury: Grolier, 1987.  vol 3:264-265.

“Overcoming Jet Lag, the Rodent Way.”  Discover.  May 1988.

Sakmar, M.D., Gardner, M.D., and Peterson, M.D., Ph.D.  Health Guide For International Travelers.  Passport Books, 1984.            

Strughold, Hubertus, M.D.  Your Body Clock.  New York: Scribner, 1971.

“Time Dislocation: The Jet Syndrome.”  Encyclopedia Britannica.  New York: U of Chicago P.  vol 14: 641: 2b.

“Unsag From Jet Lag.”  Changing Times.  May 1988.        

Wegmann et al.  “Sleep, Sleepiness, and Circadian Rhythmicity in Aircrew Operations on Transatlantic Routes.”  Aviation, Space and Environmental Medicine.  Dec 1986.  vol 57 (12, Sect II).       

Winfree, Arthur.  The Timing of Biological Clocks.  New York: Scientific American, 1987.

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!

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.

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!                           

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.   

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. 

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? 

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.