Cancer, Revisited

Earlier this week,  I attended the first annual Kay Johnson Memorial Lecture. Kay was a Hampshire faculty member who died in 2019. I knew her really well because our sons were best friends from birth to the age of 5.

Kay died from metastatic breast cancer. In honor of Kay, I am reposting a piece from 2009.  At that time, my Uncle Norm had a diagnosis of lung cancer. He died a few weeks later. 12 years later, we have still not made enough progress in the fight against cancer. Hopefully once President Biden gets COVID and the economy under control, he can turn his attention to defeating cancer.

Cancer  12/16/2009

As part of my research for my new book, I have been reading short stories from various eras of Harper’s Magazine. One written in 1949, “The Lady Walks,” by Jean Powell, deals with a faculty wife who has breast cancer. Although my original interest in the story was because of the faculty wife character, Ravita, as a nurse I found the description of the cancer treatment clinic she goes to unsettling. The description did not seem that different from clinics I have worked at various times in the past fifteen years.

After reading the story, I have concluded that things have not changed as much as we might think or like in the area of treatment of cancer. Today I participated in a Cancer Care teleconference, “The Latest Developments Reported at the 32nd Annual San Antonio Breast Cancer Symposium.”  It was very interesting; there are new drugs that might prevent bone loss in cancer patients as well possibly prevent the re-ocurrence of cancer.  However, treatment for certain kinds of breast cancer is a five-year process, which seems extraordinary long.

Around Thanksgiving, I read a story in the New York Times about a recreational lounge for cancer patients at Memorial Sloan-Kettering, a hospital in New York City. One of the patients is Seun Adebiyi, a young Nigerian immigrant and a Yale Law School graduate. He has lymphoblastic lymphoma and stem-cell leukemia and needs a bone marrow transplant. He is also trying to be the first Nigerian to compete in the Winter Olympics in skeleton. His goal is 2014. I have participated in a bone marrow drive but I have never received a call to donate.

I have had friends who have died from ovarian cancer and relatives who have experienced lung cancer. Although we may not have made as much progress in the last sixty years as we would have liked, let us hope that we can make significant progress against cancer in the coming days.

 

Busy Week

This past week I was very busy. As I wrote last week, Saturday was the first night of Passover. We had  a great time with my sons and daughter-in-law. Next year I hope we can have even more family attend our seder.

Passover is one of my favorite holidays ,but eating just matzah for a week is tough. The change in diet gave me some minor health issues, primarily the stomach kind. Regularity begets regularity, if you get what I mean.

Because at the end of last week, I was getting ready for Passover, I fell behind on some routine tasks, such as mail, email (the bane of my existence) and bills. This week I had to play catch up.

As a result, I spent most of the week not actually writing anything. I did finish reading and taking notes on two books that had to go back to the library.  Although I didn’t write much, I had writing experiences due to the two groups I am involved with.

This was week was the first meeting of a new ten week session from Nerissa Nields’ Writing It Up in the Garden. I switched from her group that meets Wednesday evenings back to the group I was in last year, Tuesday midday. I like the people and I got good feedback on some pages I read from the chapter I am currently working on.

One of the people in the group read something about ALS, which was hard for me to listen to. I have known several people, including my brother Fred, who have died from that terrible disease and my first cousin, Lowell, is living with it.

The other writing  experience involved the year long Pioneer Valley Writers Workshop Creative Nonfiction Group that I am participating in. The first meeting was at the beginning of last month. One part of the program is having a different accountability buddy each month. I really enjoyed my first buddy, Jennifer. We have a lot in common and are working on similar topics. It was great to talk about my book to a fellow historian.

Although the week had hard parts and was busy, I did do some enjoyable things. Last week  was the World Figure Skating Championships. I couldn’t watch them in real time so, starting this past Monday, I watched repeats of all the events. It ended last night with the ice dancing. It was a pleasure to watch the superb skating of all the athletes. I love skating and, in fact, I am going skating today. The week is ending on a good note.

 

 

 

COVID Vaccines

Me getting my first shot.

 

Earlier today I got my second dose of the Moderna vaccine. So far, I feel okay. The nurse who gave me the shot said the side effects kick in around the ten hour mark. If that is true, I will feel fine at skating but not so well this evening and into tomorrow. She thought I would be fine by Sunday when I go skating again.

I have been volunteering at Amherst clinics, inoculating people and also acting as the scribe for the inoculator. The  Massachusetts rollout of the vaccine has been abysmal. People have faced long waits to get an appointment and the enrollment process is apparently very confusing.

Last week  the Governor announced that people who were 65 or older or had two comorbidities were now eligible to receive the vaccine. People still had a tremendous amount of trouble getting appointments. The list of comorbidities also made little sense. If you  smoke and have asthma you are eligible but if you have high blood pressure, that doesn’t count.

The other thing the Baker administration announced last week was that they were shifting distribution of the vaccines away from doctors offices and hospitals to mass vaccination sites. At that time, the  closest site was at least fifteen miles away from Amherst and not necessarily on a bus route.

Our state representatives, Mindy Domb and Jo Comerford, along with others, worked very hard to get both Amherst and Northampton designated as regional vaccination sites. Starting Monday, Amherst will have clinics in the Bangs Center located in downtown Amherst. If you need more information you can click here. If you need more help, you can call 2-1-1.

Around here, everyone I know is desperate to get vaccinated and is willing to go to great lengths to achieve that goal. I think that is probably true of many people across the country. I did speak to someone I know who lives in Florida; she and her husband have decided, upon reflection and study, to skip  getting the vaccine. She feels they have been careful,are in good health, and therefore, if they were to get COVID, they would get a mild case.

I don’t know how she came to that conclusion. My cousin was very careful and wore a mask wherever he went; he still got COVId and spent five days in the hospital. Now his wife has it.

Everything I have read says that getting the vaccine is preferable to getting COVID. If you have read things that convinced you not to get vaccinated, I would love to know more about that. My advice is, if you can get vaccinated, please do that. More people getting vaccinated will bring herd immunity more quickly.

Proof I got both shots.

Sepsis

On January 5, news broke that the actress Tanya Roberts died from sepsis following a urinary tract infection. Roberts was sixty-five; she had been both a Bond girl and a Charlie’s Angel. She collapsed on December 25th, 2020. Roberts was hospitalized and put on a ventilator. Before her collapse she had not appeared ill.

Over thirty percent of UTIs lead to sepsis; this is 2.8-9.8 million cases in the United States and Europe. These result in as many as 1.6 million fatalities. Sepsis occurs when the immune system, in response to a perceived threat in one’s blood stream, goes into overdrive and starts attacking the body.

UTI’s are usually contained within the bladder and antibiotics easily cure them. If a UTI goes untreated, it can progress to a kidney infection which in turn can became sepsis. Tanya Roberts death resonated with me for two different reasons. The first is that my paternal grandfather, Frank, died in 1937, following a sinus infection. Antibiotics were not widely available; his infection went unchecked and he died. My father was eighteen; his older brother twenty and his younger brother eleven.

The other reason I felt deeply about Roberts’ death was that I had a similar, although obviously not fatal, experience. From December 2011 to the beginning of January 2012, I had a urinary tract infection that went untreated for as long as four weeks. (The reasons for my lack of treatment is another story for another day).

By January 2, 2012, I had a very high fever, was chilled to the bone, and was ashen in color. I had a raging kidney infection and my doctor sent me to the hospital. One of the ER nurses said my white blood cell count was the highest she had ever seen. If the infection had continued to go untreated, it is likely I would have developed sepsis. Once sepsis sets in, there is a very high rate of mortality.

As women age, they are more susceptible to UTIs and often the infection does not generate any symptoms. That certainly could have been true for Roberts since she did not seem ill before she collapsed. As with most illnesses that occur more frequently for women, the progression from a urinary tract infection to sepsis is not well studied.

Tanya Roberts’ story is very sad, and I wish she could have received treatment before she became septic. My kidney infection was the sickest I have ever been but I am glad that I did get treated and did not become septic.

 

Visiting Brooklyn During the Pandemic

Last Friday, my son got married in Brooklyn. It was a beautiful wedding, but as Arlo Guthrie might say, that is not what I came here to talk about. Being in Brooklyn from Thursday afternoon until Friday afternoon was very unnerving, because of COVID-19.

We drove down on Thursday. It was the longest car ride we have taken since some time in February. We parked the car in a garage about three blocks away from our hotel. Walking on the streets of Williamsburg, Brooklyn, we saw everything. There were a lot of people, many more than we have seen during the five months of the pandemic. Some were wearing masks, but some were not. It wasn’t very easy to keep six feet of social distance on city sidewalks.

The hotel, itself, felt safe; we didn’t really see many people. Thursday, we met my two sons and my daughter-in-law for dinner. Again, we had to walk on sidewalks with lots of people, masked and unmasked. We ate outside and tried to keep on our masks when we weren’t eating.

Friday morning, we walked toa bakery to get something to eat for breakfast. The store did have social distancing measures in place. Only one patron was allowed in at a time and the line outside was spaced six feet apart.

These experiences of the pandemic in a big city made me realize how fortunate I have been to sit out the pandemic in Western Massachusetts. We have not eaten at a restaurant at home; we have just gotten takeout. We can walk at home not wearing masks and often we don’t see anyone else.

Being in Brooklyn made me realize the enormity of COVID-19 and the fear and anxiety I have lived with for over five months. I do not want to get sick and I do not want anyone I love to get the virus either. I wish no one else would ever get sick from Corona. My heart goes out to anyone who has gotten the virus and all the families affected by the disease.

Florence Nightingale, Part 3

This is part three of my three part post of a paper I wrote in 1994 about Florence Nightingale. You can read part one here and part two here. I had a good time revisiting this paper from almost thirty years ago.

Amy Mittelman ©2020, Professional Nursing I,                                                           Fall 1994

FLORENCE NIGHTINGALE

Lauren Smith used the Nightingale concept of management to frame her discussion of clinical nurse specialist (CNS) managed care for the chronically ill child.  In myelomeningocele clinics in Ohio, clinical nurse specialists provide case management.  Smith argues that this case management has provided early identification and intervention, continuity of care, increased parental advocacy skills, improved social and development skills for the children as well as professional growth and interdisciplinary collegiality for the nurses. She feels this work has carried out Nightingale’s directive of knowing that “what you do when you are there shall be done when you are not there.”[1]

Smith’s article was part of two in a recent issue of Clinical Nurse Specialist presented under the heading “Florence Nightingale: A CNS Role Model.”[2] The other article, “CNS Roles in Implementation of a Differentiated Case Management Model,” did not mention Nightingale.[3]

In doing research for this paper, I found many references to Nightingale, particularly in Japanese nursing literature. I disagree with the opinion expressed a few weeks ago that modern nursing views Nightingale as outdated. She remains a starting point for many nurse scholars and many nurses are eager to link their work with hers.  This may explain why that article appeared under the rubric “Florence Nightingale: A CNS Role Model” even though it did not mention Nightingale. Other examples of this are an article in Nurse Educator that is a letter by a nursing student to Nightingale and a response written by a Nightingale scholar, an article by Elise Gropper that claims Nightingale as “Nursing’s First Environmental Theorist,” and the work by Giger, Davidhizar and Miller that links Roy and Nightingale.[4]

Smith is an example of clinical use of an aspect of Nightingale’s theory. However, there are not that many explicit clinical examples because many of her themes – particularly asepsis – are an integral and unquestioned part of nursing today.  A Nightingale nurse caring for an ill hospitalized patient would not focus on the medical aspects of the patient’s condition. Nightingale did not consider that part of the nurse’s domain. As a Nightingale nurse you would assess the environment of the patient, paying particular attention to sanitary issues. You would draw your diagnoses from those functional health patterns that are environmentally oriented including Activity-Exercise, Sleep-Rest, Role-Relationship and Nutritional. Decreased Cardiac Output would not be an appropriate Nightingale diagnosis, but Impaired Physical Mobility or Impaired Skin Integrity would be. Your goals for the patient would focus on preventing illness from environmental conditions. Thus, your interventions would involve repositioning if the patient was bedridden, providing a restful, clean atmosphere and keeping the patient’s skin clean and dry to prevent skin breakdown.

Florence Nightingale had a tremendous impact on the history and development of nursing as a profession. I found it interesting and informative to read her work.  Many of her practical suggestions are still applicable today. Perhaps her claim that “observation, ingenuity and perseverance … really constitute the nurse” says it all.[5]

[1] Smith, Lauren D. 1994. Continuity of care through nursing: Case management of the chronically ill child. Clinical Nurse Specialist 8 (2), p. 68.

[2] Sparacino, Patricia S.A. 1994. Florence Nightingale: A CNS role model. Clinical Nurse Specialist 8 (2): 64.

[3] Brubakken, Karen, Wendy R. Janssen, and Diane L. Ruppel. 1994. CNS roles in implementation of a differentiated case management model. Clinical Nurse Specialist 8 (2): 69-73.

[4] Decker, Bernita, and Joanne K. Farley. 1991. What would Nightingale say? Nurse Educator 16 (May/June): 12-13; Gropper, Elise I. 1990. Florence Nightingale: Nursing’s first environmental theorist. Nursing Forum 25: 30-33; Giger, Joyce N., Ruth Davidhizar, and Scott Wilson Miller. 1990. Nightingale and Roy: A comparison of nursing models. Today’s OR Nurse (April): 25-30.

[5] Nightingale, Florence. 1860. Notes on nursing. New York: D. Appleton and Company, p. 65.

 

 

 

Florence Nightingale, Part 2

This is part two of my three part post of a paper I wrote in 1994 while in nursing school. You can read part one here. Nightingale’s advice on sanitary practices, especially frequent hand washing, seems very relevant.

Amy Mittelman ©2020,                                                                                   Professional Nursing I, Fall 1994

FLORENCE NIGHTINGALE

In Nightingale’s view the environment was also nature centered and physically based; it was the nurse’s responsibility to manipulate it to provide sanitary conditions. Her emphasis was one of prevention. “True nursing ignores infection, except to prevent it.  Cleanliness and fresh air from open windows, with unremitting attentions to the patient, are the only defense a true nurse either asks or needs”[1] Giger, Davidhizar and Miller have found Nightingale’s focus on the environment to be similar to Sister Callista Roy’s adaptation nursing theory.[2]

In 1860 the germ theory of disease was not a part of scientific discourse.  As it became prevalent, Nightingale refused to believe it.[3] Because Nightingale believed that disease was a reparative process, external forces such as dirt, odors, and poor diet had to cause it. She would not accept that a person could get sick in sanitary conditions.  Nightingale did not believe that medicine was a “curative process . . . nature alone cures.”[4] Health was a state of nature; illness was a response to a disruption in that state.

Although Nightingale rejected the germ theory of disease which is a cornerstone of modern medicine and nursing, many of her opinions on sanitary practices are still appropriate. She emphasized frequent hand washing, the value of fresh air, the evils of dirty carpets, the importance of modulating the stimulus a patient receives, and the importance of maintaining a patient’s spirits. These all remain critical aspects of caring for a patient and effecting recovery.

Nightingale believed that the same guidelines of sanitation applied to the healthy as well as the sick. The person was a subject of nature and had the responsibility to observe nature’s law in such a manner (sanitary) as to avoid infection and illness.  Again, the emphasis was prevention.[5]

To Nightingale, the nurse’s role in the reparative process was “to put the patient in the best condition for nature to act upon him” She felt that nursing should “signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper administration of diet – all at the least expense of vital power to the patient.”[6]

Nightingale advocated a patient centered nursing. She stressed the importance of “sound observation” for “the sake of saving life and increasing health and comfort.” Although Nightingale emphasized the high level of attention that the nurse must undertake, she also pointed out the importance of delegating responsibility as a way of knowing that “what you do when you are there, shall be done when you are not there.”[7]

 

[1] Nightingale, Florence. 1860. Notes on nursing. New York: D. Appleton and Company, p. 34.

[2] Giger, Joyce N., Ruth Davidhizar, and Scott Wilson Miller. 1990. Nightingale and Roy: A comparison of nursing models. Today’s OR Nurse (April): 25-30.

[3] Vicinus, Martha, and Bea Nergaard. 1990. Ever yours, Florence Nightingale. Cambridge, Massachusetts: Harvard University Press.

[4] Nightingale, Notes, p.133.

[5] Ibid.

[6] Nightingale, Notes, p. 133, 8.

[7] Nightingale, Notes, p. 125, 35

The Liquor Industry and COVID-19

At the beginning of the year, thing were looking pretty good for all segments of the brewing industry. Local and state municipalities see craft beer as an important economic driver, That’s why a tax cut was part of Trump’s disastrous tax bill and why this year the industry got an one year extension for that tax reduction. Then COVID-19 happened.

Most states have closed bars and prevented restaurants from providing in house service. They are allowed to provide grab and go service. How has this affected brewers and distillers?

Here is a roundup of articles about how the liquor industry is faring during the pandemic. Like everything else in our society, regulations surrounding certain practices are being  loosened or abandoned. When this is over, many thing will be different.

Deschutes Brewery has laid off  over 300 workers and is not presently offering any to-go services.

The governor of Rhode Island  issued an executive order  that allows limited sale of beer and wine when people are getting takeout from restaurants.

Last Saturday, some Milwaukee brewers had a pop-up  brewery drive-through in a parking lot.

Before the virus, only  twelve states allowed  delivery of all  kinds of liquor while thirty-one states allowed  delivery of beer and wine. This article is arguing for a permanent change in these regulations.

Reminiscent of Prohibition, distilleries are producing hand sanitizer. The relief bill passed last week allows distilleries to do this without having to pay the excise tax.

I hope everyone is safe and stays well.

Life Lessons

As you may have noticed, last week I didn’t post anything. On Tuesday I was getting ready to go to New York City on Wednesday for a legal matter pertaining to a relative. Once again, as has been happening all year, life intervened to prevent my blogging.

My relative is a single person and has not designated anyone to be their power of attorney. They also do not have a will. A health care proxy is in place. This legal matter has made me realize how important it is to proactively plan for your old age and eventual demise.

People in sound mind and body may be reluctant to grant authority over either their financial or health concerns to someone else. However enunciating your wishes when you can will save both time and money later. A lawyer told me that she tells clients “spend $700 now to avoid $10,000 later.”

It is also prudent to plan for your funeral and burial. Buying a plot or deciding to be cremated as well as stating where you would like your funeral to be held will make everything easier for your grieving relatives. Everyone should designate a power of attorney and execute both a health care proxy and will.

 

Sleep Hypnosis

As I have mentioned before, I often have insomnia. Recently I have been a sleep therapist who has taught me self hypnosis. I wanted to try hypnosis for my sleeping problems since I felt I had tried everything else.

Before the first visit, I thought that she would put me under, give me a command and then I would automatically go to bed and  fall asleep. It doesn’t really work like that.

The therapist gave me tools to use to focus sufficiently so I could fall asleep. The idea is to put yourself in a trance through counting down, visualizing going downstairs while counting from ten to one, using a mantra with deep breathing and other techniques.

The cognitive behavior aspects of insomnia also comes into play. Being on a set sleep schedule is key as is avoiding devices for a period of time before you go to bed. To me, the hypnosis feels close to guided meditation with the purpose being a successful night of sleep.