Operating Nurse Quotes

What was she thinking?” muttered Alexander, closing his eyes and imagining his Tania. “She was determined. It was like some kind of a personal crusade with her,” Ina said. “She gave the doctor a liter of blood for you—” “Where did she get it from?” “Herself, of course.” Ina smiled. “Lucky for you, Major, our Nurse Metanova is a universal donor.” Of course she is, thought Alexander, keeping his eyes tightly shut. Ina continued. “The doctor told her she couldn’t give any more, and she said a liter wasn’t enough, and he said, ‘Yes, but you don’t have more to give,’ and she said, ‘I’ll make more,’ and he said, ‘No,’ and she said, ‘Yes,’ and in four hours, she gave him another half-liter of blood.” Alexander lay on his stomach and listened intently while Ina wrapped fresh gauze on his wound. He was barely breathing. “The doctor told her, ‘Tania, you’re wasting your time. Look at his burn. It’s going to get infected.’ There wasn’t enough penicillin to give to you, especially since your blood count was so low.” Alexander heard Ina chuckle in disbelief. “So I’m making my rounds late that night, and who do I find next to your bed? Tatiana. She’s sitting with a syringe in her arm, hooked up to a catheter, and I watch her, and I swear to God, you won’t believe it when I tell you, Major, but I see that the catheter is attached to the entry drip in your IV.” Ina’s eyes bulged. “I watch her draining blood from the radial artery in her arm into your IV. I ran in and said, ‘Are you crazy? Are you out of your mind? You’re siphoning blood from yourself into him?’ She said to me in her calm, I-won’t-stand-for-any-argument voice, ‘Ina, if I don’t, he will die.’ I yelled at her. I said, ‘There are thirty soldiers in the critical wing who need sutures and bandages and their wounds cleaned. Why don’t you take care of them and let God take care of the dead?’ And she said, ‘He’s not dead. He is still alive, and while he is alive, he is mine.’ Can you believe it, Major? But that’s what she said. ‘Oh, for God’s sake,’ I said to her. ‘Fine, die yourself. I don’t care.’ But the next morning I went to complain to Dr. Sayers that she wasn’t following procedure, told him what she had done, and he ran to yell at her.” Ina lowered her voice to a sibilant, incredulous whisper. “We found her unconscious on the floor by your bed. She was in a dead faint, but you had taken a turn for the better. All your vital signs were up. And Tatiana got up from the floor, white as death itself, and said to the doctor coldly, ‘Maybe now you can give him the penicillin he needs?’ I could see the doctor was stunned. But he did. Gave you penicillin and more plasma and extra morphine. Then he operated on you, to get bits of the shell fragment out of you, and saved your kidney. And stitched you. And all that time she never left his side, or yours. He told her your bandages needed to be changed every three hours to help with drainage, to prevent infection. We had only two nurses in the terminal wing, me and her. I had to take care of all the other patients, while all she did was take care of you. For fifteen days and nights she unwrapped you and cleaned you and changed your dressings. Every three hours. She was a ghost by the end. But you made it. That’s when we moved you to critical care. I said to her, ‘Tania, this man ought to marry you for what you did for him,’ and she said, ‘You think so?’ ” Ina tutted again. Paused. “Are you all right, Major? Why are you crying?

Waiting for the operation, there was a gentle tap on the door. In came a strapping nurse. 'Good morning', she shrilled, whipped back the bedclothes, upped with his nightshirt, grabbed his willy, lathered furiously around it till it looked like the Eddystone Lighthouse in a storm, then shaved the whole area till it looked like an oven-ready chicken. 'Excuse me, nurse', said Looney, 'why did you knock?

And - as a woman reconciled in her own body - I feel I can argue with anyone's god about my right to end a pregnancy. My first conception - wanted so badly - ended in miscarriage, three days before my wedding. A kind nurse removed my wedding manicure with nail-polish remover, in order to fit a finger-thermometer for the subsequent D&C operation. I wept as I went in to the operating theatre, and wept as I came out. In that instance, my body had decided that the baby was not to be and had ended it. This time, it was my mind that has decided that this baby was not to be. I don't believe one's decision is more valid than the other. They both know me. They are both equally capable of deciding what is right.

I almost died. Fortunately, my mother was a nurse. She gave me a shot of something, and things turned out brilliantly.” Lucky me, I thought. Why couldn't his mother have been a telephone operator?

We walked into my mother's house at 10:30 in the morning at the end of February 1992. I had been gone for three weeks. She had been so desperate about us - she, too, looked thin and haggard. She was stunned to see me walk in, filthy and crawling with lice, with a huge crowd of starving people. We ate and drank clean water; then, before we even washed, I put Marian in a taxi with me and told the driver to go to Nairobi Hospital. We had no money left and I knew Nairobi Hospital was expensive; it was where I had been operated on when the ma'alim broke my skull. But I also knew that there they would help us first and ask to pay later. Saving the baby's life had become the only thing that mattered to me. At the reception desk I announced, "This baby is going to die," and the nurse's eyes went wide with horror. She took him and put a drip in his arm, and very slowly, this tiny shape seemed to uncrumple slightly. After a little while, his eyes opened. The nurse said, "The child will live," and told us to deal with the bill at the cash desk. I asked her who her director was, and found him, and told this middle-aged Indian doctor the whole story. I said I couldn't pay the bill. He took it and tore it up. He said it didn't matter. Then he told me how to look after the baby, and where to get rehydration salts, and we took a taxi home. Ma paid for the taxi and looked at me, her eyes round with respect. "Well done," she said. It was a rare compliment. In the next few days the baby began filling out, growing from a crumpled horror-movie image into a real baby, watchful, alive.

After three hours, I come back to the waiting room. It is a cosmetic surgery office, so a little like a hotel lobby, underheated and expensively decorated, with candy in little dishes, emerald-green plush chairs, and upscale fashion magazines artfully displayed against the wall. A young woman comes in, frantic to get a pimple "zapped" before she sees her family over the holidays. An older woman comes in with her daughter for a follow-up visit to a face-lift. She is wearing a scarf and dark glasses. The nurse examines her bruises right out in the waiting room. And you are in the operating room having your body and your gender legally altered. I feel like laughing, but I know it makes me sound like a lunatic.

Their task was to film the work of the Allied women. More than 20,000 American women served overseas during the war—10,000 as nurses in the army and navy and a few thousand under the auspices of the Red Cross, the YMCA, and the Salvation Army. Several hundred women were telephone operators with the Army Signal Corps and still others served as doctors, entertainers, canteen workers, interpreters, dentists, therapists, decoders, and in a myriad of other roles. Most of the one thousand professional entertainers who joined the war effort were connected to either the Overseas Theater League or the YMCA and over half were women.

In its basic form, nursing can be seen as a duty, but beyond the incessant operational activities that lay the foundation of our daily work, the profession is all about grace. Helping people is a noble calling. It is a privilege to serve my fellow human beings. Fifteen years has seen many ups and downs at the workplace, but I have enjoyed serving the many patients who come into my care, and have prayed for the souls of those who were on the brink of death.

Surgical Talk As we look at the insides of humans, We find the inside of ourselves And each other. What lies beneath us? What do we believe About the world and our place in it? We cut down layer upon layer And dissect the inner life.

It was the day that I said, “do whatever it takes to keep me alive.” With the nurse’s words changing everything and giving me a fresh viewpoint, I felt stronger. The fact that I was one of the very few people in the world to have survived was a wonder.

White Fang received the nursing. Judge Scott's suggestion of a trained nurse was indignantly clamoured down by the girls, who themselves undertook the task. And White Fang won out on the one chance in ten thousand denied him by the surgeon. The latter was not to be censured for his misjudgement. All his life he had tended and operated on the soft humans of civilization, who live sheltered lives and had descended out of many sheltered generations. Compared with White Fang, they were frail and flabby, and clutched life without any strength in their grip. White Fang had come straight from the Wild, where the weak perish early and shelter is vouchsafed to none. In neither his father nor his mother was there any weakness, nor in the generations before them. A constitution of iron and vitality of the Wild were White Fang's inheritance, and he clung to life, the whole of him and every part of him, in spirit and in flesh, with the tenacity that of old belonged to all creatures.

The executive’s time tends to belong to everybody else. If one attempted to define an “executive” operationally (that is, through his activities) one would have to define him as a captive of the organization. Everybody can move in on his time, and everybody does. There seems to be very little any one executive can do about it. He cannot, as a rule, like the physician, stick his head out the door and say to the nurse, “I won’t see anybody for the next half hour.” Just at this moment, the executive’s telephone rings, and he has to speak to the company’s best customer or to a high official in the city administration or to his boss—and the next half hour is already gone.*

[My mother] related a childhood anecdote about one of her sisters who had an appendix operation and afterwards had been given a beautiful purse by another sister. My mother was fourteen at the time. Oh, how she yearned to have an exquisitely beaded purse like her sister's, but she dared not open her mouth. So guess what? She feigned a pain in her side and went the whole way with her story. Her family took her to several doctors. They were unable to produce a diagnosis and so opted for exploratory surgery. It had been a bold gamble on my mother's part, but it worked--she was given an identical little purse! When she received the coveted purse, my mother was elated despite being in physical agony from the surgery. Two nurses came in and one stuck a thermometer in her mouth. My mother said, 'Ummm, ummm,' to show the purse to the second nurse, who answered, 'Oh, for me? Why, thank you!' and took the purse! My mother was at a loss, and never figured out how to say, 'I didn't mean to give it to you. Please return it to me.' Her story poignantly reveals how painful it can be when people don't openly acknowledge their needs.

the Signal Corps recruited U.S. switchboard operators who were bilingual in English and French and loaded them into ships bound for Europe. Known as the “Hello Girls,” these were the first American women other than nurses to be sent by the U.S. military into harm’s way. The officers whose calls they connected often prefaced their conversations by saying, “Thank Heaven you’re here!

It was history’s first co-operative international scientific venture, and almost everywhere it ran into problems. Many observers were waylaid by war, sickness or shipwreck. Others made their destinations but opened their crates to find equipment broken or warped by tropical heat. Once again the French seemed fated to provide the most memorably unlucky participants. Jean Chappe spent months travelling to Siberia by coach, boat and sleigh, nursing his delicate instruments over every perilous bump, only to find the last vital stretch blocked by swollen rivers, the result of unusually heavy spring rains, which the locals were swift to blame on him after they saw him pointing strange instruments at the sky. Chappe managed to escape with his life, but with no useful measurements. Unluckier

Mummie, however, fretted in the nursing-home. She longed for her lost comforts, her maid Julia, and the food she had been accustomed to. The operation was performed, and she was not strong enough to stand it, as her sons had feared. She died with her arms around them both, on the anniversary of her wedding to Kicky just fifty-one years before. She was buried beside him in the grave in the Hampstead churchyard.

The orchestra musician’s plight caught the interest of Harvard researcher Richard Hackman, who was studying the job satisfaction of workers employed in a variety of industries. Orchestral musicians were near the bottom, scoring lower in job satisfaction and overall happiness than airline flight attendants, mental health treatment teams, beer salesmen, government economic analysts, and even federal prison guards. Only operating room nurses and semiconductor fabrication teams scored lower than these musicians.

In airplane crashes and chemical industry accidents, in the infrequent but serious nuclear plant accidents, in the NASA Challenger and Columbia disasters, and in the British Petroleum gulf spill, a common finding is that lower-ranking employees had information that would have prevented or lessened the consequences of the accident, but either it was not passed up to higher levels, or it was ignored, or it was overridden. When I talk to senior managers, they always assure me that they are open, that they want to hear from their subordinates, and that they take the information seriously. However, when I talk to the subordinates in those same organizations, they tell me either they do not feel safe bringing bad news to their bosses or they’ve tried but never got any response or even acknowledgment, so they concluded that their input wasn’t welcome and gave up. Shockingly often, they settled for risky alternatives rather than upset their bosses with potentially bad news. When I look at what goes on in hospitals, in operating rooms, and in the health care system generally, I find the same problems of communication exist and that patients frequently pay the price. Nurses and technicians do not feel safe bringing negative information to doctors or correcting a doctor who is about to make a mistake. Doctors will argue that if the others were “professionals” they would speak up, but in many a hospital the nurses will tell you that doctors feel free to yell at nurses in a punishing way, which creates a climate where nurses will certainly not speak up. Doctors engage patients in one-way conversations in which they ask only enough questions to make a diagnosis and sometimes make misdiagnoses because they don’t ask enough questions before they begin to tell patients what they should do.

Oncology wards, more than maybe anywhere on earth, are musicless places. Instead of flowing melody, there’s incessant beeping. During the day, the halls clamor with a constant medical call-and-response loop: nurses hollering to one another; patients calling, sometimes screaming, for morphine; nurses scrambling to find doctors; visitors searching frantically for nurses. But in some ways, those noises—however annoying—are a welcome distraction, a reminder that the hospital “machine” is in healthy operation. It is the quiet hours after dark, the hollow sounds of silent suffering, that are most frightening.

In the early 1970s, racial and gender discrimination was still prevalent. The easy camaraderie prevailing in the operating room evaporated at the completion of surgical procedures. There was an unspoken pecking order of seating arrangements at lunch among my fellow physicians. At the top were the white male 'primary producers' in prestigious surgical specialties. They were followed by the internists. Next came the general practitioners. Last on the list were the hospital-based physicians: the radiologists, pathologists and anaesthesiologists - especially non-white, female ones like me. Apart from colour, we were shunned because we did not bring in patients ourselves but, like vultures, lived off the patients generated by other doctors. We were also resented because being hospital-based and not having to rent office space or hire nursing staff, we had low overheads. Since a physician's number of admissions to the hospital and referral pattern determined the degree of attention and regard accorded by colleagues, it was safe for our peers to ignore us and target those in position to send over income-producing referrals. This attitude was mirrored from the board of directors all the way down to the orderlies.

The savage knows nothing of 'the law of Christ.' He will bear no other's burden. The sick must die; the wounded must perish; the feeble must go to the wall. Only the mightiest and most muscular survive and produce another generation. 'The law of Christ' ends all that. The luggage of life must be distributed. The sick must be nursed; the wounded must be tended; the frail must be cherished. These, too, must be permitted to play their part in the shaping of human destiny. They also may love and wed, and become fathers and mothers. The weaknesses of each are taken back into the blood of the race. The frailty of each becomes part of the common heritage. And, in the last result, if our men are not all Apollos, and if our women do not all resemble Venus de Medici, it is largely because we have millions with us who, but for 'the law of Christ/ operating on rational ideals, would have had no existence at all. In a Christian land, under Christian laws, we bear each other's burdens, we carry each other's luggage. It is the law of Christ, the law of the cross, a sacrificial law. The difference between savagery and civilization is simply this, that we have learned, in our very flesh and blood, to bear each other's burdens and so fulfil the law of Christ.

But I can cite ten other reasons for not being a father." "First of all, I don't like motherhood," said Jakub, and he broke off pensively. "Our century has already unmasked all myths. Childhood has long ceased to be an age of innocence. Freud discovered infant sexuality and told us all about Oedipus. Only Jocasta remains untouchable; no one dares tear off her veil. Motherhood is the last and greatest taboo, the one that harbors the most grievous curse. There is no stronger bond than the one that shackles mother to child. This bond cripples the child's soul forever and prepares for the mother, when her son has grown up, the most cruel of all the griefs of love. I say that motherhood is a curse, and I refuse to contribute to it." "Another reason I don't want to add to the number of mothers," said Jakub with some embarrassment, "is that I love the female body, and I am disgusted by the thought of my beloved's breast becoming a milk-bag." "The doctor here will certainly confirm that physicians and nurses treat women hospitalized after an aborted pregnancy more harshly than those who have given birth, and show some contempt toward them even though they themselves will, at least once in their lives, need a similar operation. But for them it's a reflex stronger than any kind of thought, because the cult of procreation is an imperative of nature. That's why it's useless to look for the slightest rational argument in natalist propaganda. Do you perhaps think it's the voice of Jesus you're hearing in the natalist morality of the church? Do you think it's the voice of Marx you're hearing in the natalist propaganda of the Communist state? Impelled merely by the desire to perpetuate the species, mankind will end up smothering itself on its small planet. But the natalist propaganda mill grinds on, and the public is moved to tears by pictures of nursing mothers and infants making faces. It disgusts me. It chills me to think that, along with millions of other enthusiasts, I could be bending over a cradle with a silly smile." "And of course I also have to ask myself what sort of world I'd be sending my child into. School soon takes him away to stuff his head with the falsehoods I've fought in vain against all my life. Should I see my son become a conformist fool? Or should I instill my own ideas into him and see him suffer because he'll be dragged into the same conflicts I was?" "And of course I also have to think of myself. In this country children pay for their parents' disobedience, and parents for their children's disobedience. How many young people have been denied education because their parents fell into disgrace? And how many parents have chosen permanent cowardice for the sole purpose of preventing harm to their children? Anyone who wants to preserve at least some freedom here shouldn't have children," Jakub said, and fell into silence. "The last reason carries so much weight that it counts for five," said Jakub. "Having a child is to show an absolute accord with mankind. If I have a child, it's as though I'm saying: I was born and have tasted life and declare it so good that it merits being duplicated." "And you have not found life to be good?" asked Bertlef. Jakub tried to be precise, and said cautiously: "All I know is that I could never say with complete conviction: Man is a wonderful being and I want to reproduce him.

Finally it was time to go into the operating room, and the nurse came to wheel her away from me. My heart tightened. To ease her fears, the pediatric nurses gathered around her and created a “bubble parade,” blowing little soap bubbles as they went into the operating room. To create this fairy-tale experience, they used a wand. Specifically, a bubble wand. All the worry and fear melted from my daughter’s face as she was captivated by the magical moment. As a parent, I felt a great deal of gratitude for this small but meaningful touch. As a marketer, I was awed. I’d just witnessed my daughter’s customer experience switch from anxiety to anticipation in less than ten seconds.

And that evening too, as I looked at her arm, into which was flowing a life that was no longer anything but sickness and torment, I asked myself why? At the nursing home I did not have time to go into it... But when I reached home, all the sadness and horror of these last days dropped upon me with all its weight. And I too had a cancer eating into me—remorse. “Don’t let them operate on her.” And I had not prevented anything. Often, hearing of sick people undergoing a long martyrdom, I had felt indignant at the apathy of their relatives. “For my part, I should kill him.” At the first trial I had given in: beaten by the ethics of society, I had abjured my own. “No,” Sartre said to me. “You were beaten by technique: and that was fatal.” Indeed it was. One is caught up in the wheels and dragged along, powerless in the face of specialists’ diagnoses, their forecasts, their decisions. The patient becomes their property: get him away from them if you can! There were only two things to choose between on that Wednesday—operating or euthanasia. Maman, vigorously resuscitated, and having a strong heart, would have stood out against intestinal stoppage for a long while and she would have lived through hell, for the doctors would have refused euthanasia… A race had begun between death and torture. I asked myself how one manages to go on living when someone you love has called out to you “Have pity on me” in vain.

Nurses on transplant wards often remarked that male transplant patients show renewed interest in sex. One reported that a patient asked her to wear something other than "that shapeless scrub" so he could see her breasts. A post-op who had been impotent for seven years before the operation was found holding his penis and demonstrating an erection. Another nurse spoke of a man who left the fly of his pajamas unfastened to show her his penis. Conclude Tabler and Frierson, "this irrational but common belief that the recipient will somehow develop characteristics of the donor is generally transitory but may alter sexual patterns.' Let us hope that the man with the chicken heart was blessed with a patient and open-minded spouse.

Consider this scenario: A man gets a stomachache after each meal. To “treat” this problem, he takes (either by prescription or by self-medication) some antacid or other nostrum. Then he gets a headache (which may or may not be a side effect of the stomach medication); to “treat” the headache he takes aspirin, which further irritates his stomach. Three years later he develops an ulcer, for which he takes another medication, plus large amounts of milk and cream (although an outmoded treatment, it is still being used today). Meanwhile, he is still taking antacids for his indigestion and eating the same way he always had. Eventually, he has an operation to remove his ulcer. He continues with his high-dairy diet. Soon thereafter he develops arteriosclerosis and high blood pressure and begins to take antihypertensive medication. The side effects of the latter include headaches, dizziness, drowsiness, diarrhea, slow heart rate, mental confusion, hallucinations, weight gain, and impotence. When his wife leaves him for a younger man, he takes antidepressants and sleeping pills. He has a heart attack and undergoes an operation to repair a heart valve. Painkillers keep him going as he slowly recuperates. A year or two later, he finds himself with an irreversible neurological disease such as ALS or Alzheimer’s, and he wonders what could have gone wrong. All that’s left for him to do is wait to die, which he can do in a nursing home, drugged into complaisance and painlessness.

Code Blue! We’re losing him!” The EMTs hustled the gurney containing Erik Dawson’s broken body into the operating room where the surgical team waited. The nursing staff literally ripped his clothes off as they worked to stabilize him. “What do we have here?” the lead surgeon asked. His assistant didn’t bother to look up as she answered, “Auto accident. An eighteen- wheeler smashed his car into a guardrail.” The lead surgeon whistled through his teeth. “It’s a miracle he’s still breathing. Let’s keep him that way.” As the surgical team moved into action with skill born of practice, Erik drifted on the fringes of consciousness. Erik’s thoughts raced. What? Where? Anesthesia put him under, but as the doctors began their work and his parents prayed fervently in the waiting room, Erik spasmed and stopped breathing. Family Matters, from Home Again

Another common practice, the reps told us, was to take fancy meals to the entire doctor’s office (one of the perks of being a nurse or receptionist, I suppose). One doctor’s office even required alternating days of steak and lobster for lunch if the reps wanted access to the doctors. Even more shocking, we found out that physicians sometimes called the reps into the examination room (as an “expert”) to directly inform patients about the way certain drugs work. Hearing stories from the reps who sold medical devices was even more disturbing. We learned that it’s common practice for device reps to peddle their medical devices in the operating room in real time and while a surgery is under way. Janet and I were surprised at how well the pharmaceutical reps understood classic psychological persuasion strategies and how they employed them in a sophisticated and intuitive manner.

If subjective confidence is not to be trusted, how can we evaluate the probable validity of an intuitive judgment? When do judgments reflect true expertise? When do they display an illusion of validity? The answer comes from the two basic conditions for acquiring a skill: an environment that is sufficiently regular to be predictable an opportunity to learn these regularities through prolonged practice When both these conditions are satisfied, intuitions are likely to be skilled. Chess is an extreme example of a regular environment, but bridge and poker also provide robust statistical regularities that can support skill. Physicians, nurses, athletes, and firefighters also face complex but fundamentally orderly situations. The accurate intuitions that Gary Klein has described are due to highly valid cues that the expert’s System 1 has learned to use, even if System 2 has not learned to name them. In contrast, stock pickers and political scientists who make long-term forecasts operate in a zero-validity environment. Their failures reflect the basic unpredictability of the events that they try to forecast.

Last night I decided that it is totally nuts to believe in Christ, that it is every bit as crazy as being a Scientologist or a Jehovah’s Witness. But a priest friend said solemnly, “Scientologists and Mormons and Jehovah’s Witnesses are crazier than they have to be.” Then something truly amazing happened. A man from church showed up at our front door, smiling and waving to me and Sam, and I went to let him in. He is a white man named Gordon, fiftyish, married to our associate pastor, and after exchanging pleasantries he said, “Margaret and I wanted to do something for you and the baby. So what I want to ask is, What if a fairy appeared on your doorstep and said that he or she would do any favor for you at all, anything you wanted around the house that you felt too exhausted to do by yourself and too ashamed to ask anyone else to help you with?” “I can’t even say,” I said. “It’s too horrible.” But he finally convinced me to tell him, and I said it would be to clean the bathroom, and he ended up spending an hour scrubbing the bathtub and toilet and sink with Ajax and lots of hot water. I sat on the couch while he worked, watching TV, feeling vaguely guilty and nursing Sam to sleep. But it made me feel sure of Christ again, of that kind of love. This, a man scrubbing a new mother’s bathtub, is what Jesus means to me. As Bill Rankin, my priest friend, once said, spare me the earnest Christians.

Eight Bells: Robert J. Kane ‘55D died June 3, 2017, in Palm Harbor, Florida. He came to MMA by way of Boston College. Bob or “Killer,” as he was affectionately known, was an independent and eccentric soul, enjoying the freedom of life. After a career at sea as an Officer in the U.S. Navy and in the Merchant Marine he retired to an adventurous single life living with his two dogs in a mobile home, which had originally been a “Yellow School Bus.” He loved watching the races at Daytona, Florida, telling stories about his interesting deeds about flying groceries to exotic Caribbean Islands, and misdeeds with mysterious ladies he had known. For years he spent his summers touring Canada and his winters appreciating the more temperate weather at Fort De Soto in St. Petersburg, Florida…. Enjoying life in the shadow of the Sunshine Bridge, Bob had an artistic flare, a positive attitude and a quick sense of humor. Not having a family, few people were aware that he became crippled by a hip replacement operation gone bad at the Bay Pines VA Hospital. His condition became so bad that he could hardly get around, but he remained in good spirits until he suffered a totally debilitating stroke. For the past 6 years Bob spent his time at various Florida Assisted Living Facilities, Nursing Homes and Palliative Care Hospitals. His end came when he finally wound up as a terminal patient at the Hospice Facility in Palm Harbor, Florida. Bob was 86 years old when he passed. He will be missed….

In short the only fully rational world would be the world of wishing-caps, the world of telepathy, where every desire is fulfilled instanter, without having to consider or placate surrounding or intermediate powers. This is the Absolute's own world. He calls upon the phenomenal world to be, and it IS, exactly as he calls for it, no other condition being required. In our world, the wishes of the individual are only one condition. Other individuals are there with other wishes and they must be propitiated first. So Being grows under all sorts of resistances in this world of the many, and, from compromise to compromise, only gets organized gradually into what may be called secondarily rational shape. We approach the wishing-cap type of organization only in a few departments of life. We want water and we turn a faucet. We want a kodak-picture and we press a button. We want information and we telephone. We want to travel and we buy a ticket. In these and similar cases, we hardly need to do more than the wishing—the world is rationally organized to do the rest. But this talk of rationality is a parenthesis and a digression. What we were discussing was the idea of a world growing not integrally but piecemeal by the contributions of its several parts. Take the hypothesis seriously and as a live one. Suppose that the world's author put the case to you before creation, saying: "I am going to make a world not certain to be saved, a world the perfection of which shall be conditional merely, the condition being that each several agent does its own 'level best.' I offer you the chance of taking part in such a world. Its safety, you see, is unwarranted. It is a real adventure, with real danger, yet it may win through. It is a social scheme of co-operative work genuinely to be done. Will you join the procession? Will you trust yourself and trust the other agents enough to face the risk?" Should you in all seriousness, if participation in such a world were proposed to you, feel bound to reject it as not safe enough? Would you say that, rather than be part and parcel of so fundamentally pluralistic and irrational a universe, you preferred to relapse into the slumber of nonentity from which you had been momentarily aroused by the tempter's voice? Of course if you are normally constituted, you would do nothing of the sort. There is a healthy- minded buoyancy in most of us which such a universe would exactly fit. We would therefore accept the offer—"Top! und schlag auf schlag!" It would be just like the world we practically live in; and loyalty to our old nurse Nature would forbid us to say no. The world proposed would seem 'rational' to us in the most living way. Most of us, I say, would therefore welcome the proposition and add our fiat to the fiat of the creator. Yet perhaps some would not; for there are morbid minds in every human collection, and to them the prospect of a universe with only a fighting chance of safety would probably make no appeal. There are moments of discouragement in us all, when we are sick of self and tired of vainly striving. Our own life breaks down, and we fall into the attitude of the prodigal son. We mistrust the chances of things. We want a universe where we can just give up, fall on our father's neck, and be absorbed into the absolute life as a drop of water melts into the river or the sea. The peace and rest, the security desiderated at such moments is security against the bewildering accidents of so much finite experience. Nirvana means safety from this everlasting round of adventures of which the world of sense consists. The hindoo and the buddhist, for this is essentially their attitude, are simply afraid, afraid of more experience, afraid of life. And to men of this complexion, religious monism comes with its consoling words: "All is needed and essential—even you with your sick soul and heart. All are one

Rennie looked again and his hand attached itself to his arm, which was part of him. He wasn’t very far away. She fell in love with him because he was the first thing she saw after her life had been saved. This was the only explanation she could think of. She wished, later, when she was no longer feeling dizzy but was sitting up, trying to ignore the little sucking tubes that were coming out of her and the constant ache, that it had been a potted begonia or a stuffed rabbit, some safe bedside object. Jake sent her roses but by then it was too late. I imprinted on him, she thought; like a duckling, like a baby chick. She knew about imprinting; once, when she was hard up for cash, she’d done a profile for Owl Magazine of a man who believed geese should be used as safe and loyal substitute for watchdogs. It was best to be there yourself when the goslings came out of the eggs, he said. Then they’d follow you to the ends of the earth. Rennie had smirked because that man seemed to think that being followed to the ends of the earth by a flock of adoring geese was both desirable and romantic, but she’d written it all down in his own words. Now she was behaving like a goose, and the whole thing put her on foul temper. It was inappropriate to have fallen in love with Daniel, who had no distinguishing features that Rennie could see. She hardly even knew what he looked like, since, during the examinations before the operation, she hadn’t bothered to look at him. One did not look at doctors; they were functionaries, they were what your mother one hoped you would marry, they were fifties, they were passe. It wasn’t only inappropriate, it was ridiculous. It was expected. Falling in love with your doctor was something middle-aged married women did, women in soaps, women in nurse novels and sex-and-scalpel epics with titles like Surgery and nurse with big tits and doctors who looked like Dr. Kildare on the covers. It was the sort of thing Toronto Life did stories about, soft-core gossip masquerading as hard-nosed research expose. Rennie could not stand being guilty of such a banality.

Sylphid was beginning to play professionally, and she was subbing as second harpist in the orchestra at Radio City Music Hall. She was called pretty regularly, once or twice a week, and she’d also got a job playing at a fancy restaurant in the East Sixties on Friday night. Ira would drive her from the Village up to the restaurant with her harp and then go and pick her and the harp up when she finished. He had the station wagon, and he’d pull up in front of the house and go inside and have to carry it down the stairs. The harp is in its felt cover, and Ira puts one hand on the column and one hand in the sound hole at the back and he lifts it up, lays the harp on a mattress they keep in the station wagon, and drives Sylphid and the harp uptown to the restaurant. At the restaurant he takes the harp out of the car and, big radio star that he is, he carries it inside. At ten-thirty, when the restaurant is finished serving dinner and Sylphid’s ready to come back to the Village, he goes around to pick her up and the whole operation is repeated. Every Friday. He hated the physical imposition that it was—those things weigh about eighty pounds—but he did it. I remember that in the hospital, when he had cracked up, he said to me, ‘She married me to carry her daughter’s harp! That’s why the woman married me! To haul that fucking harp!’ “On those Friday night trips, Ira found he could talk to Sylphid in ways he couldn’t when Eve was around. He’d ask her about being a movie star’s child. He’d say to her, ‘When you were a little girl, when did it dawn on you that something was up, that this wasn’t the way everyone grew up?’ She told him it was when the tour buses went up and down their street in Beverly Hills. She said she never saw her parents’ movies until she was a teenager. Her parents were trying to keep her normal and so they downplayed those movies around the house. Even the rich kid’s life in Beverly Hills with the other movie stars’ kids seemed normal enough until the tour buses stopped in front of her house and she could hear the tour guide saying, ‘This is Carlton Pennington’s house, where he lives with his wife, Eve Frame.’ “She told him about the production that birthday parties were for the movie stars’ kids—clowns, magicians, ponies, puppet shows, and every child attended by a nanny in a white nurse’s uniform. At the dining table, behind every child would be a nanny. The Penningtons had their own screening room and they ran movies. Kids would come over. Fifteen, twenty kids.

a guitar. A hammock is swung near the table. It is three o'clock in the afternoon of a cloudy day. MARINA, a quiet, grey-haired, little old woman, is sitting at the table knitting a stocking. ASTROFF is walking up and down near her. MARINA. [Pouring some tea into a glass] Take a little tea, my son. ASTROFF. [Takes the glass from her unwillingly] Somehow, I don't seem to want any. MARINA. Then will you have a little vodka instead? ASTROFF. No, I don't drink vodka every day, and besides, it is too hot now. [A pause] Tell me, nurse, how long have we known each other? MARINA. [Thoughtfully] Let me see, how long is it? Lord—help me to remember. You first came here, into our parts—let me think—when was it? Sonia's mother was still alive—it was two winters before she died; that was eleven years ago—[thoughtfully] perhaps more. ASTROFF. Have I changed much since then? MARINA. Oh, yes. You were handsome and young then, and now you are an old man and not handsome any more. You drink, too. ASTROFF. Yes, ten years have made me another man. And why? Because I am overworked. Nurse, I am on my feet from dawn till dusk. I know no rest; at night I tremble under my blankets for fear of being dragged out to visit some one who is sick; I have toiled without repose or a day's freedom since I have known you; could I help growing old? And then, existence is tedious, anyway; it is a senseless, dirty business, this life, and goes heavily. Every one about here is silly, and after living with them for two or three years one grows silly oneself. It is inevitable. [Twisting his moustache] See what a long moustache I have grown. A foolish, long moustache. Yes, I am as silly as the rest, nurse, but not as stupid; no, I have not grown stupid. Thank God, my brain is not addled yet, though my feelings have grown numb. I ask nothing, I need nothing, I love no one, unless it is yourself alone. [He kisses her head] I had a nurse just like you when I was a child. MARINA. Don't you want a bite of something to eat? ASTROFF. No. During the third week of Lent I went to the epidemic at Malitskoi. It was eruptive typhoid. The peasants were all lying side by side in their huts, and the calves and pigs were running about the floor among the sick. Such dirt there was, and smoke! Unspeakable! I slaved among those people all day, not a crumb passed my lips, but when I got home there was still no rest for me; a switchman was carried in from the railroad; I laid him on the operating table and he went and died in my arms under chloroform, and then my feelings that should have been deadened awoke

It’s not always so easy, it turns out, to identify your core personal projects. And it can be especially tough for introverts, who have spent so much of their lives conforming to extroverted norms that by the time they choose a career, or a calling, it feels perfectly normal to ignore their own preferences. They may be uncomfortable in law school or nursing school or in the marketing department, but no more so than they were back in middle school or summer camp. I, too, was once in this position. I enjoyed practicing corporate law, and for a while I convinced myself that I was an attorney at heart. I badly wanted to believe it, since I had already invested years in law school and on-the-job training, and much about Wall Street law was alluring. My colleagues were intellectual, kind, and considerate (mostly). I made a good living. I had an office on the forty-second floor of a skyscraper with views of the Statue of Liberty. I enjoyed the idea that I could flourish in such a high-powered environment. And I was pretty good at asking the “but” and “what if” questions that are central to the thought processes of most lawyers. It took me almost a decade to understand that the law was never my personal project, not even close. Today I can tell you unhesitatingly what is: my husband and sons; writing; promoting the values of this book. Once I realized this, I had to make a change. I look back on my years as a Wall Street lawyer as time spent in a foreign country. It was absorbing, it was exciting, and I got to meet a lot of interesting people whom I never would have known otherwise. But I was always an expatriate. Having spent so much time navigating my own career transition and counseling others through theirs, I have found that there are three key steps to identifying your own core personal projects. First, think back to what you loved to do when you were a child. How did you answer the question of what you wanted to be when you grew up? The specific answer you gave may have been off the mark, but the underlying impulse was not. If you wanted to be a fireman, what did a fireman mean to you? A good man who rescued people in distress? A daredevil? Or the simple pleasure of operating a truck? If you wanted to be a dancer, was it because you got to wear a costume, or because you craved applause, or was it the pure joy of twirling around at lightning speed? You may have known more about who you were then than you do now. Second, pay attention to the work you gravitate to. At my law firm I never once volunteered to take on an extra corporate legal assignment, but I did spend a lot of time doing pro bono work for a nonprofit women’s leadership organization. I also sat on several law firm committees dedicated to mentoring, training, and personal development for young lawyers in the firm. Now, as you can probably tell from this book, I am not the committee type. But the goals of those committees lit me up, so that’s what I did. Finally, pay attention to what you envy. Jealousy is an ugly emotion, but it tells the truth. You mostly envy those who have what you desire. I met my own envy after some of my former law school classmates got together and compared notes on alumni career tracks. They spoke with admiration and, yes, jealousy, of a classmate who argued regularly before the Supreme Court. At first I felt critical. More power to that classmate! I thought, congratulating myself on my magnanimity. Then I realized that my largesse came cheap, because I didn’t aspire to argue a case before the Supreme Court, or to any of the other accolades of lawyering. When I asked myself whom I did envy, the answer came back instantly. My college classmates who’d grown up to be writers or psychologists. Today I’m pursuing my own version of both those roles.

As I was wheeled into the operating room one of the nurses said, “Hey, it’s Hillary Clinton!” and I answered by barfing all over her. Full circle.

Despite all this bad news, there is real-world evidence that groups do confront bullies as a group—and it works! A shining example is the “Code Pink” technique used by surgical nurses. These highly skilled professionals are often berated and belittled by pompous surgeons, both men and women. In some hospitals, whenever a bullying surgeon steps over the line into mistreatment, “Code Pink” is called by the targeted nurse. Immediately, supportive nurses form a circle around the physician. Together, they declare their unwillingness to assist that person with current and future patients, if an apology is not given with a promise to behave in a civil manner. The interdependent nature of surgery makes the surgeon powerless without the help of the team in the operating room. All work stops and the physician is accountable for her or his bullying. It is the physician who is responsible for the patient’s life. “Code Pink” is the group displaying its power to the bully, demanding cooperation instead of controlling games.

Today, Mihir stopped a bomb from killing the Tahitian President but not from shattering his own collar bone. So, he is now in the operating chamber, undergoing his 250th reconstruction. The nurses have tied a balloon to his bed that says, “Don’t make it to 251!

Back in Portland, Oregon, Diehl realized that another fundamental problem involved communication. Engineer Mendenhall had spotted the fuel problem. He had given a number of hints to the captain and, as the situation became serious, made direct references to the dwindling reserves. Diehl, listening back to the voice recorder, noted alterations in the intonation of the engineer. As the dangers spiraled he became ever more desperate to alert McBroom, but he couldn’t bring himself to challenge his boss directly. This is now a well-studied aspect of psychology. Social hierarchies inhibit assertiveness. We talk to those in authority in what is called “mitigated language.” You wouldn’t say to your boss: “It’s imperative we have a meeting on Monday morning.” But you might say: “Don’t worry if you’re busy, but it might be helpful if you could spare half an hour on Monday.”5 This deference makes sense in many situations, but it can be fatal when a 90-ton airplane is running out of fuel above a major city. The same hierarchy gradient also exists in operating theaters. Jane, the nurse, could see the solution. She had fetched the tracheotomy kit. Should she have spoken up more loudly? Didn’t she care enough? That is precisely the wrong way to think about failure in safety-critical situations. Remember that Engineer Mendenhall paid for his reticence with his life. The problem was not a lack of diligence or motivation, but a system insensitive to the limitations of human psychology.

At MGM, Arthur Freed and Vincente Minnelli made their last musical together, Bells Are Ringing (1960), reunited with Comden and Green. Dean Martin joined the Broadway package, replacing Sydney Chaplin, Charlie’s eldest son.13 Adding Martin’s star persona to the Judy Holliday vehicle produced another close match of movie star to musical role. As Jeff Moss, a Broadway playwright who’s been hitting the bottle harder than the typewriter, Martin fit the public perception of his romance with the grape. Even those who don’t care for the liquid Martin style find him charming in this musical.14 The vivacious answering-service operator Holliday nurses him back to sobriety and success, and the laid back, breezy Martin hoofs with Holliday in casual soft-shoe duets like “Just in Time.” In “Drop that Name,” Minnelli’s eye adds stylish brilliance to a satire of New York’s pretentious social elite, a Black-and-White Ball of burlesques and grotesques in answer to An American in Paris. Though Bells Are Ringing is neither vintage Freed nor vintage Minnelli—cramped by a middle-class present, a CinemaScope frame imprisoned in stageset interiors, and self-conscious disguises for Holliday’s shape—it is pleasant enough Holliday and Martin.

The problem was a crazy problem. It wasn’t going to have a non-crazy solution. Still, she’d sort of shocked herself. She’d never had the slightest interest in business. But if she wanted to save the country, she’d need to become an entrepreneur, and create a company—though in business, she quickly learned, she couldn’t talk like that. When she said she wanted to build a tool “to save the country,” people just smiled and thought she was goofy in the head. But when she said things like “I’m going to create a data-based tool for disease prevention that companies can use to secure their supply chains,” serious business types nodded. “Five smart people have replied with confusion when I said the company was to save the world and protect our country,” said Charity, after her first attempts to explain her vague idea. “Then when I said, ‘We’re going to do private government operations, like Blackwater,’ their eyes lit up and they said, ‘Oh wow, you could take over the world.’ ” She’d entered the private sector with the bizarre ambition to use it to create an institution that might be used by the public sector. She’d already hired twenty people, among them public-health nurses and some of the team at the Chan Zuckerberg Biohub responsible for genomic sequencing, including Josh Batson and David Dynerman. Joe DeRisi had signed on as an adviser; Carter Mecher was about to. She’d raised millions of dollars in capital. Venrock, a leading health care venture capitalist, had taken a stake in the new company. As a local health officer, she hadn’t been able to get the tens of thousands of dollars she needed for some new disease-stopping machine. In the private sector, people would throw tens of millions at an idea: if she failed, it wouldn’t be because investors wouldn’t give her the money to try. The Public Health Company, she’d called it.

The Germans found out where the camp of our partisan unit was. They cordoned off the forest and the approaches to it on all sides. We hid in the wild thickets, we were saved by the swamps where the punitive forces didn’t go. A quagmire. It sucked in equipment and people for good. For days, for weeks, we stood up to our necks in water. Our radio operator was a woman who had recently given birth. The baby was hungry…It had to be nursed…But the mother herself was hungry and had no milk. The baby cried. The punitive forces were close…With dogs…If the dogs heard it, we’d all be killed. The whole group—thirty of us…You understand? The commander makes a decision… Nobody can bring himself to give the mother his order, but she figures it out herself. She lowers the swaddled baby into the water and holds it there for a long time…The baby doesn’t cry anymore…Not a sound…And we can’t raise our eyes. Neither to the mother nor to each other…

Page 7: (H)e (Darwin) supposed that man, before he even emerged from apedom, was already a social being, living in small scattered communities. Evolution in his eyes was carried out mainly as a struggle between communities - team against team, tribe against tribe. Inside each team or tribe, the 'ethical cosmos' [the dual code of Amity and Enmity] was at work, forging and strengthening the social bonds which made the members of such a team a co-operative whole. … Thus, in the early stages of human evolution we find competition and co-operation as constituent elements of the evolutionary process … Co-operation and unity give strength to a team or tribe; but why did neighboring tribes refuse so stubbornly to amalgamate? If united, they would have got rid of competition and struggle. Why do human tribes instinctively repel every thought of amalgamation, and prize above all things independence, the control of their destiny, their sovereignty? Here we have to look beneath the surface of things and formulate a theory to explain tribal behavior. How does a tribe fulfill an evolutionary purpose? A tribe is a 'corporate body,' which Nature has entrusted with an assortment of human seed or genes, the assortment differing in some degree from that entrusted to every other tribe. If the genes are to work out their evolutionary effects, then it is necessary that the tribe or corporation should maintain its integrity through an infinity of generations. If a tribe loses its integrity by a slackening of social bonds, or by disintegration of the parental instincts, or by lack of courage or of skill to defend itself from the aggression of neighboring tribes, or by free interbreeding with neighbors and thus scattering its genes, then that tribe as an evolutionary venture has come to an untimely end. For evolutionary purposes it has proved a failure. Page 25: Tribalism was Nature's method in bringing about the evolution of man. I have already explained what a tribe really is - a corporation of human beings entrusted with a certain capital of genes. The business of such a corporation is to nurse and develop its stock of genes - to bring them to an evolutionary fruition. To reach such an end a tribal corporation had to comply with two conditions: (1) it had to endure for a long age; (2) it had to remain intact and separate from all neighboring and competing tribes. Human nature was fashioned or evolved just to secure these two conditions - continuity through time and separation in space. Hence the duality of man's nature - the good, social, or virtuous traits serving intratribal economy; the evil, vicious, or antisocial qualities serving the intertribal economy and the policy of keeping its genes apart. Human nature is the basal part of the machinery used for the evolution of man. When you know the history of our basal mentality - one fitted for tribal life - do you wonder at the disorder and turmoil which now afflict the detribalized part of the world?

In 1984, a psychologist named Roger Ulrich studied patients recuperating from gallbladder surgery at a Pennsylvania hospital. Some patients were assigned to a room overlooking a small strand of deciduous trees. Others were assigned to rooms that overlooked a brick wall. Urlich describes the results: “Patients with the natural window view had shorter post-operative hospital stays, had fewer negative comments in nurses’ notes . . . and tended to have lower scores for minor post-surgical complications such as persistent headache or nausea requiring medication. Moreover, the wall-view patients required many more injections of potent painkillers.” The implications of this obscure study are enormous. Proximity to nature doesn’t just give us a warm, fuzzy feeling. It affects our physiology in real, measurable ways. It’s not a giant leap to conclude that proximity to nature makes us happier. That’s why even the most no-nonsense office building includes a park or atrium (in the belief, no doubt, that a happy worker is a productive one).

I kept thinking how grateful I felt to have been part of this magnificent team. For five months we had been one unit, all specialists and all tackling the same problem together. The staff at the pediatric ICU and the consultants in the children's center reacted spectacularly. They rallied behind us and spent countless hours without charge, working to make this operation successful. As pessimistic as I was about the eventual outcome of the surgery, I still felt a glow of pride in being able to work side by side with the best men and women in the medical field. And the end of the surgery wasn't the end of our teamwork. The postoperative care was as spectacular as the surgery. Everything in the weeks following the surgery confirmed again our togetherness. It seemed as if everyone from ward clerks to orderlies to nurses had become personally involved in this historic event. We were a team--a wonderful, marvelous team.

What homeless people with wheelchairs were supposed to do when all that was available to them were inaccessible shelters was never discussed. Were they supposed to continue to live on the street? Most did; they could find neither housing nor homeless shelters they could get into in their wheelchairs. If they were really bad off, they'd go to the emergency room, and from there to a nursing home, where they were kept  -- the nursing home operator getting upwards of $100,000 a year in public money for keeping them there.

But maybe his father was right. Maybe what had happened in 1918 could never happen again. "U.S. Reveals Detailed Flu Disaster Plans." Cole decided to make this the topic for his research report. Plans for manufacturing and distributing vaccines and other medications. Plans to quarantine the sick and to call up extra doctors and nurses and to replace absent workers with retired workers so that businesses wouldn't have to shut down. Plans to keep public transportation and electricity and telecommunications and other vital services operating and food and water and other necessities from running out. Plans to mobilize troops (for Cole this was the only exciting part) in the event of mass panic or violence. One day he would ask Pastor Wyatt why, despite all these plans, everything had gone so wrong. "Son, that is just the thing. That is what people did not--and still do not--get. There is no way you can count on the government, even if it's a very good government. The government isn't going to save you, it isn't going to save anyone. There's no way you can count on other people in a situation like we had. People afraid of losing their lives--or, Lord knows, even just their toys--they'll panic. Even fine, decent Christian folk--you can never know for sure what they'll do next. So I say, love your neighbor, help your fellow man all you can, but don't ever count on any other human being. Count on God." What Cole didn't know was that most of the plans he read about that night would have been sufficient only for an emergency lasting a few weeks.

In the US, there are apparently more than 2 million cases of elder abuse each year in nursing homes; one in ten old people will experience some form of abuse. People with dementia are much more likely to be abused than those without it. What's more, elder abuse is probably the most under-reported form of violence in the country. It's the same depressing story in the UK, where the care system is under severe pressure, with many experts saying it is disintegrating; home-care workers are paid paltry amounts of money to spend tiny amounts of time in the homes of the old and vulnerable. There have been over 23,000 allegations of home-care abuse in the last three years - which means there must be more, because often the people who are being abused can't tell tales (which, of course, is partly why they are being abused). Many care homes are understaffed and operating within a punitive, impossible budget; the tens of thousands of allegations of abuse over the last three years include, neglect, physical abuse, psychological abuse and sexual abuse. All over the world, in poor countries and rich ones, hundreds and thousands of old and vulnerable people live the last part of their life in fear and distress, in loneliness and in sorrow.

Consider Johnson & Johnson. It has the corporate world’s single most eloquent statement of purpose—its “credo,” which hasn’t changed since J&J’s legendary chair Robert Wood Johnson created it in 1943. Here it is, in abbreviated form: We believe our first responsibility is to the doctors, nurses, and patients, to mothers and fathers and all others who use our products and services.… We are responsible to our employees, the men and women who work with us throughout the world.… We are responsible to the communities in which we live and work and to the world community as well.… Our final responsibility is to our stockholders.… When we operate according to these principles, the stockholders should realize a fair return. The credo bluntly spells out the pecking order: customers come first, and shareholders last. However, J&J has confidence that when customer satisfaction is at the top of the list, shareholders will do just fine.

As healthcare became a business, hospitals could have spent their operating surpluses on raising pay for nurses and orderlies, or reducing list prices for patients. But there was not much commercial incentive to do that.

Alternating Pressure Therapy or Anti-Decubitus Air Mattress & Pump System is used to heal and prevent bedsores, pressure sores, and decubitus ulcers. The alternating pressure system plays a positive role in preventing and curing bed sores caused due to long illness like paralysis, burns, fracture, recovering from an operation or for person who is permanently confined to bed due to old age. An air pump provides sequential inflation and deflation of the air cells throughout the mattress forming an air channel up and down in the mattress to redistribute pressure. Mattress has micro holes which can, via air loss, allow air to pass through and ventilate the patient’s back. The air pump is heavy duty for long life which operates quietly, vibration-free and energy-efficient. The mattress can be placed over top an existing mattress. It is light weight, portable and easy for transportation. It is ideal for use in home healthcare or nursing homes.

moment.’ She smiled. ‘How old are you, Ned?’ ‘Nineteen.’ ‘You risked your life for me.’ She stood on tiptoe and kissed him on the lips briefly but tenderly. ‘Thank you,’ she said. Then she left the room. * MOST PEOPLE BATHED twice a year, in spring and autumn, but princesses were fastidious, and Elizabeth bathed more often. It was a major operation, with maidservants carrying big two-handled laundry tubs of hot water from the kitchen fire to her bedchamber, hurrying up the stairs before the water cooled. She took a bath the day after Swithin’s visit, as if to wash away her disgust. She had said no more about Swithin, after kissing Ned, but Ned thought he had won her trust. Ned knew he had made an enemy of a powerful earl, but he hoped it would not last: Swithin was quick-tempered and vengeful but, Ned thought, he had a short attention span. With luck he would nurse his grudge against Ned only until a better one came along. Sir William Cecil had arrived shortly after Swithin left, and next morning he got down to work with Ned. Cecil’s office was in the same wing as Elizabeth’s private suite. He sent Ned to Tom Parry’s office to fetch a ledger of expenditure for another house Elizabeth owned. Coming back with the heavy book in his hand, Ned walked along Elizabeth’s corridor, where the floorboards were puddled with water spilled by the maids. As he passed her suite, he saw that the door was open, and – stupidly – he glanced in. Elizabeth had just got out of her bath. The tub itself was screened off, but she had stepped across the room to pick up a large white linen sheet with which to dry herself. There should have been a maid waiting beside the tub holding

antibiotics—but absolutely no methods for increasing resistance, so that antibiotics won’t be necessary. Fantastic operations—but when it comes to teaching people the way of going through life without having to be chopped up, absolutely nothing. And it’s the same all along the line. Alpha Plus for patching you up when you’ve started to fall apart; but Delta Minus for keeping you healthy. Apart from sewerage systems and synthetic vitamins, you don’t seem to do anything at all about prevention. And yet you’ve got a proverb: prevention is better than cure.” “But cure,” said Will, “is so much more dramatic than prevention. And for the doctors it’s also a lot more profitable.” “Maybe for your doctors,” said the little nurse. “Not for ours. Ours get paid for keeping people well.” “How is it to be done?” “We’ve been asking that question for a hundred years, and we’ve found a lot of answers. Chemical answers, psychological answers, answers in terms of what you eat, how you make love, what you see and hear, how you feel about being who you are in this kind of world.” “And which are the best answers?” “None of them is best without the others.

In 1984, a psychologist named Roger Ulrich studied patients recuperating from gallbladder surgery at a Pennsylvania hospital. Some patients were assigned to a room overlooking a small strand of deciduous trees. Others were assigned to rooms that overlooked a brick wall. Urlich describes the results: “Patients with the natural window view had shorter post-operative hospital stays, had fewer negative comments in nurses’ notes . . . and tended to have lower scores for minor post-surgical complications such as persistent headache or nausea requiring medication. Moreover, the wall-view patients required many more injections of potent painkillers.

Discussion Questions 1. An institution for people with disabilities, the Willowbrook State School opened in 1947 on Staten Island, New York, and remained in operation until 1987. Despite having a maximum capacity of 4,000 people, by 1965 it housed over 6,000 intellectually and physically disabled children and adults, becoming the largest state-run mental institution of its kind in the United States. Due to staff and money shortages, there was only one nurse per ward, one or two attendants per 35 to 125 residents, and more than 200 residents living in houses built for fewer than 100. An estimated 12,000 residents died at Willowbrook from 1950 to 1980, approximately 400 a year, due to neglect, violence, lack of nutrition, and medical mismanagement or experimentation. What was your awareness of Willowbrook State School before reading The Lost Girls of

There wasn’t much more to it. But getting teams to stop and use the checklist—to make it their habit—was clearly tricky. A couple of check boxes weren’t going to do much all by themselves. So the surgical director gave some lectures to the nurses, anesthesiologists, and surgeons explaining what this checklist thing was all about. He also did something curious: he designed a little metal tent stenciled with the phrase Cleared for Takeoff and arranged for it to be placed in the surgical instrument kits. The metal tent was six inches long, just long enough to cover a scalpel, and the nurses were asked to set it over the scalpel when laying out the instruments before a case. This served as a reminder to run the checklist before making the incision. Just as important, it also made clear that the surgeon could not start the operation until the nurse gave the okay and removed the tent, a subtle cultural shift. Even a modest checklist had the effect of distributing power. The surgical director measured the effect on care. After three months, 89 percent of appendicitis patients got the right antibiotic at the right time. After ten months, 100 percent did. The checklist had become habitual—and it had also become clear that team members could hold up an operation until the necessary steps were completed.

I’m Jay Powers, the circulating nurse”; “I’m Zhi Xiong, the anesthesiologist”—that sort of thing. It felt kind of hokey to me, and I wondered how much difference this step could really make. But it turned out to have been carefully devised. There have been psychology studies in various fields backing up what should have been self-evident—people who don’t know one another’s names don’t work together nearly as well as those who do. And Brian Sexton, the Johns Hopkins psychologist, had done studies showing the same in operating rooms. In one, he and his research team buttonholed surgical staff members outside their operating rooms and asked them two questions: how would they rate the level of communications during the operation they had just finished and what were the names of the other staff members on the team? The researchers learned that about half the time the staff did not know one another’s names. When they did, however, the communications ratings jumped significantly. The investigators at Johns Hopkins and elsewhere had also observed that when nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an “activation phenomenon.” Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up. These were limited studies and hardly definitive. But the initial results were enticing. Nothing had ever been shown to improve the ability of surgeons to broadly reduce harm to patients aside from experience and specialized training. Yet here, in three separate cities, teams had tried out these unusual checklists, and each had found a positive effect. At Johns Hopkins, researchers specifically measured their checklist’s effect on teamwork. Eleven surgeons had agreed to try it in their cases—seven general surgeons, two plastic surgeons, and two neurosurgeons. After three months, the number of team members in their operations reporting that they “functioned as a well-coordinated team” leapt from 68 percent to 92 percent. At the Kaiser hospitals in Southern California, researchers had tested their checklist for six months in thirty-five hundred operations. During that time, they found that their staff’s average rating of the teamwork climate improved from “good” to “outstanding.” Employee satisfaction rose 19 percent. The rate of OR nurse turnover—the proportion leaving their jobs each year—dropped from 23 percent to 7 percent. And the checklist appeared to have caught numerous near errors. In

I had full knowledge of the fact that my body had just stopped living. I could hear lots of commotion in the operating room (even though I was completely sedated and with no heartbeat). The nurses that were assisting were quite frantic.

Pervitin became a sensation,” one psychologist reported. “It soon gained acceptance in a very wide range of circles; students used it as a survival strategy for the exertions of exams; telephone switchboard operators and nurses swallowed it to get through the night shift, and people doing difficult physical or mental labor used it to improve their performance.

Do you suppose that the other animals,” he asked, “have no love or heroism or patience—or, which is the more important, no co-operative affection? The love-lives of ravens, the heroism of a pack of weasels, the patience of small birds nursing a cuckoo, the co-operative love of bees—all these things are shewn much more perfectly on every side in nature, than they have ever been shewn in man.

Most people think they know pain. Everyone's done something: broken a limb, been stung by a wasp, recovered from an operation or rammed a baby through their birth canal. But chronic pain is different. It isn't just pain that lingers; it's pain that dominates. It swaddles you in its gloom and slips blinkers on you until everything you see, and everything you experience, is filtered through that pea soup of pain. The vast majority of chronic pain conditions are not only incurable but also untreatable. They don't respond to drugs, and science hasn't -- yet -- located a central fuse box to repair. So people with chronic pain not only live with pain; they're told that this is it until death they do part. It is a diagnosis that dehumanises your body as much as it eviscerates your spirit. And it's made worse because, if there's no obvious physical explanation for it -- as is the case with most types of chronic pain (diseases like arthritis aside) -- people think, consciously or not, that you're making it up. Three GPs, eight consultants, three physiotherapists, one nurse and two psychologists had tried to rout my pain in the first year of its existence. All had failed, though each had laid their failure at my door, not theirs. There's no physical reason for it, they said; or there's kind of a physical reason but not enough of a physical reason to correspond to your level of pain. Maybe, some of them ventured, possibly, do you think... could it be in your head?

Most people will call Emergency medical helpline/Ambulance service only a few times during their lifetimes. Having the necessary information before calling Emergency Ambulance helpline will help them in sending you the appropriate help say first aid responder, ambulance service, doctor, nurse quickly. It can be a frightening moment, but few prior precautions that might help you to run the process smoothly for both, you and the operator. If you are ever in a life-threatening medical emergency, it is important to have the emergency medical helpline number of your area memorized. Being composed and prepared to assist could save the victim life. Don’t Panic: Obviously, when you are calling the emergency medical helpline, you are in an emergency. But, Panic does not help, it may obstruct your speech (talking too fast, too slow, begin stuttering). Make sure you are far enough away from the emergency to be safe. Call your local ambulance helpline: Call your local ambulance helpline say in Bangalore, Emergency helpline number is 080 67335555 or 108. Be aware that, sometimes, it takes time for the phone to connect to the correct answering point. Do not disconnect the call if you do not connect immediately!! Know what you will be asked from the emergency operator. Make sure you are aware of the following queries: Where is the emergency location? Location is the first question asked by all emergency responders to provide & send the help. Give the dispatcher your name and address. Be aware of emergency location & where you are. Nature/Type of the emergency? Be aware of the type of emergency that you are in & the type of assistance that you want. The assistance includes medical professionals, ambulance service, firefighters or other professionals. A detailed, yet concise, description: Be aware of what happened? What should have the most importance? And why & what type of assistance you need. Have your phone number memorised: The dispatcher may need to call back for further information or to provide some useful instructions or to know where you are. 4. Listen to the dispatcher & be prepared to assist: Listen to the dispatcher & follow their instructions. The faster & better you follow their instructions, the higher the rate of survival will be. The operator/first responder might explain how to do CPR, if the victim is unconscious, while help is on arrival. For example, he can instruct you first aid, or how to help a choking victim guide you on how to stop nose bleeding. 5. Know your local medical emergency number: The emergency number depends on the country that you are living in. So you should know the local emergency number memorised. The Emergency Ambulance number in Bangalore, India is 080 67335555 & 108. 6. Ask for the type of ambulance that you are looking for: The operator wants to know the type of ambulance that you need. The type of ambulance includes Advanced Life support, Air ambulance Service, and Basic life support depending upon the type of emergency. In this case, make it clear about the type of emergency condition or explain the emergency, the victim is suffering from. Call Blood for sure helpline number 080 67335555 immediately for any life-threatening medical Emergency & ambulance services. These include chest pain, choking, car crash or any vehicle accident, difficulty speaking, drowning, numbness, sudden intense pain, severe burns and other serious medical problems.

Robertson was in the operating room and no word on his condition was coming out. A bloody-handed nurse, who’d taken him in, stood washing her hands, and when Lucas asked, she said, “I’ve seen worse who lived. But then, I’ve seen better who died.” No help there.

Teamwork may just be hard in certain lines of work. Under conditions of extreme complexity, we inevitably rely on a division of tasks and expertise—in the operating room, for example, there is the surgeon, the surgical assistant, the scrub nurse, the circulating nurse, the anesthesiologist, and so on. They can each be technical masters at what they do. That’s what we train them to be, and that alone can take years. But the evidence suggests we need them to see their job not just as performing their isolated set of tasks well but also as helping the group get the best possible results. This requires finding a way to ensure that the group lets nothing fall between the cracks and also adapts as a team to whatever problems might arise.

massacre at the Alexandra military hospital. Three hundred and twenty-three patients, doctors and nurses were systematically murdered in the shadow of the Red Cross that was meant to protect them. The invaders actually bayoneted some of the patients on the operating table. When I read

The day-to-day running of the Empire State Building fell to the building’s manager, Chapin L. Brown, who operated as if he were the mayor of a small town. Brown supervised about 350 service employees (full tenancy would have called for one thousand), including fire and sanitation departments and a police force, as well as elevator operators and mechanics, engineers, plumbers and pipe fitters, electricians, painters, cabinetmakers, a house smith, and a staff for the general welfare of the workers, which included a nurse.

had to volunteer. Thought I couldn’t wait to get there. Arrived at Stotsenberg at nightfall. The hospital was bedlam—amputations, dressings, intravenouses, blood transfusions, shock, death … Worked all night, hopped over banisters and slid under the hospital during raids. It was remarkable to see the medical staff at work. One doctor, a flight surgeon, had a head injury, but during the night he got up and went to the operating room to help with the other patients.

Architect-poet Buckminster Fuller sums it all up in one, fine, unforgettable paradox: “Everything we see,” he says, “is inside our own heads. ” That is, we do not see with our eyes, but with our brain-plus-eyes working as a unit. Thus, if a person has been blind and has his sight restored by an operation, he will not see what we see. He will see a whirling chaos, and it will probably frighten him; it is only gradually, over a period of months, that he will learn, through coaching by his doctors and nurses, to see what we see. We will not regale the reader with the neurological theories that attempt to explain why an LSD trip sets the experimenter into this same whirling chaos. Needless to say, we also hear with brain-plus-ears, taste with brain-plus-tongue and, in general, know everything only through its registration inside our heads on what William S. Burroughs calls “the soft machinery” of our brain tissue.

Before long, something unexpected happened to test my newfound faith. Mom had to go in for a simple, twenty-minute surgery. I went with Dad to the hospital, and we waited while she was in the operating room. Forty-five minutes went by, and no one came out to tell us anything. Then a nurse came out, and one look at her face told me the news was not good. “Look, there’s a problem,” she said. “We haven’t been able to wake her up. She’s gone into a coma. We have a machine breathing for her, and we think she’s going to be okay, but she needs to wake up.” Dad looked at me, his face white and his eyes big and scared. We had no idea what was going on, but we knew it was bad. Really bad. He grabbed my shoulder and said through tears, “We’re fixin’ to pray for your mom right now.” I’d never heard him pray as fervently. He was frantic and telling God about how much we needed Mom in our family. We knew her life was at stake, and we both were scared she would never wake up. The rest of the family came to the hospital, and we gathered, praying our hearts out. We finally got in to see her, and the sight of Mom on a respirator, her chest rising and falling with the help of the machine, freaked us all out. Eventually, we found out what had happened. There had been a mistake, and Mom had been given too much anesthetic, sending her into a serious coma. Two days later, after many tears and huddles with family and desperate prayers, Mom came out of it, woke up, and started breathing on her own. I knew deep in my heart that she could have died, but God had chosen to answer our prayers, and that really built my faith. I was such a new Christian that I’m not sure how I would have reacted if something would have happened to my mom. I also felt like it drew me closer to my dad, as we had been the first ones to hear the news and to pray for her together. I saw a side of him I didn’t see very often, how much he loved and needed my mom and how much he trusted God to help him in a very bad situation. No matter whose fault it was, we were just relieved Mom made it out alive. She recovered from the experience, and with her cooking during those months, my appetite came back, and I gained fifty pounds. I even got a little chunky, so I started working out so I could look and feel better. Those three months of house arrest were probably the best days of my life. My thinking had changed, my heart’s desires were back on track, and I had hope for the future.

Last Comforts” was born when one nagging question kept arising early in my journey as a hospice volunteer. Why were people coming into hospice care so late in the course of their illness? That question led to many others that rippled out beyond hospice care. Are there better alternatives to conventional skilled nursing home operations? How are physicians and nurses educated about advanced illness and end-of-life care? What are more effective ways of providing dementia care? What are the unique challenges of minority and LGBT people? What is the role of popular media in our death-denying culture? What has been the impact of public policy decisions about palliative and hospice care? The book is part memoir of lessons learned throughout my experiences with patients and families as a hospice volunteer; part spotlight on the remarkable pathfinders and innovative programs in palliative and late-life care; and part call to action. I encourage readers – particularly my fellow baby boomers -- not only to make their wishes and goals clear to friends and family, but also to become advocates for better care in the broader community.

In 1900 there were 500,000 women office workers—in 1870 there had been 19,000. Women were switchboard operators, store workers, nurses. Half a million were teachers. The teachers formed a Teachers League that fought against the automatic firing of women who became pregnant. The following “Rules for Female Teachers” were posted by the school board of one town in Massachusetts: Do not get married. Do not leave town at any time without permission of the school board. Do not keep company with men. Be home between the hours of 8 P.M. and 6 A.M. Do not loiter downtown in ice cream stores. Do not smoke. Do not get into a carriage with any man except your father or brother. Do not dress in bright colors. Do not dye your hair. Do not wear any dress more than two inches above the ankle. The

In Tulsa, Oklahoma, two pediatric nurses—Donna Wong and her colleague, Connie Baker—sought a way of assessing pain in children who had trouble describing what they felt. Wong was incorrectly diagnosed with leukemia as a child, and subjected to painful operations without the aid of analgesics. She became a nurse. In the 1980s, with the smiley face fad in recent memory, the women devised a series of six faces a child could point to. The chart begins with a smiling face and ends with a tearful, grimacing face. The Wong-Baker FACES scale is now a standard in gauging pain in children. There are other versions for adults. Patients are asked to quantify their pain according to a scale—numbered from 0 to 10, 10 being worst. These scales were highly subjective, but they were about the only pain-measurement tools medicine had to offer.

The infant gave up its little arm to the operator without suspicion or fear. But when it felt the puncture, which must have been sharp, no words can express the astonishment and grief that followed. I could not have thought the mouth could have been distended so widely as it continued, till the nurse’s soothing restored her usual calmness. What an illustration is this of the impatient feelings we are often apt to experience, and sometimes even to express, when suffering from the dispensations of a Being, whose wisdom we profess to believe to be unerring, whose kindness we know to be unfailing, whose truth also is sure, and who has declared to us, that all things shall work together for good to them that love Him, and that the object of His inflictions is to make us partakers of His holiness.