Stanley Gray is an award-winning writer who creates exciting stories with flawed characters. Traits of Darkness, the first in its series, is available on Amazon. He lives in beautiful Oregon, and loves spending time with his cat, Calypso.
Bonus Content: 4 Reasons to Be Afraid of New Amazon Rules for Authors
Do you hate cheaters? Most of us do. And rightly so. When there are fair, transparent rules meant to level the playing field, it is precisely those rules that can create a framework for people to flourish under. Yet, just like in the popular board game Monopoly, many of us have encountered people who might try to bend the rules in an attempt to gain some perceived advantage. Friendships can be ruined, trust can be broken in those moments. It is easy to feel as if something tangible has been taken from you, when someone uses unfair advantages to acquire a temporary advantage. Even if you beat the cheater, the damage has already been done: you know they don’t always abide by the rules.
Three Reasons Donald Trump is Wrong About LeBron James
Allow me to begin by being up-front about something: I am not a LeBron James fan. Born and raised in the Indianapolis area, I grew up idolizing Reggie Miller, Rik Smits, Dale Davis, Jermaine O’Neal, et cetera. As the game of basketball evolved, the names and people I rooted for changed, but the team did not. There were many years when LeBron James almost single-handedly delivered the fatal blows to my Indiana Pacers’ championship ambitions. His years of dominance in the Eastern Conference are thankfully over, and I confess I did not feel a single moment of sadness at watching him depart for Los Angeles.
Need a Great Summer Read? This Epic Fantasy Novel Is It
Chaos reigns. In a remote island kingdom, a tyrannical king indulges his basest desires. He murders for pleasure and terrorizes the peasants who have built his empire with their backs. Yet, the king’s madness may be preferred to the horrible cruelty of his son and heir to the throne. As the callow prince and his mother the queen conspire to commit the ultimate form of treason, the people of Norteras clamor for justice and talk openly in the cobbled streets on a revolution. A dragon has been prophesied to come to the land to save the oppressed and vanquish the nefarious overlords.
A Healthcare Crisis Defined
Can you imagine someone hurting Santa? While that may sound preposterous at first, in January 2017, that is exactly what happened. It wasn’t malicious, nor was it necessarily intentional, but the pain was still very real as it kept him awake in his uncomfortable hospital bed in Springfield, Oregon, listening to the sounds of the machines working to sustain him as he anxiously tried to will the nurses away from him. Unfortunately, what happened to Santa is an all-too-common occurrence in America, and may serve as an apt metaphor for a broken system dominating a political system in crisis. If it’s hard or uncomfortable to believe that the people we trust to help us in a medical crisis may not always be able to do so, consider the following: in 2007, the famous actor Dennis Quaid had his two twin newborns given massive overdoses of medication that nearly killed them. Millions of people suffer TODAY from prescription drug addictions; most have actual prescriptions for drugs known to be toxically habit-forming. In March of this year, a man brought to a Chicago-area hospital BY POLICE was allowed to walk free after a multi-jurisdictional car chase and multiple felonies, simply because overworked nurses and other staff didn’t effectively communicate. Ken Major is my girlfriend’s dad. As part of his severance package from the Lane County Sheriff’s Department, where he worked for decades as a jail deputy, Ken contracted MRSA. This dangerous and lifelong infection usually does not impede the man’s life or living, and it did not interfere with his job as the mall Santa at the second largest mall in Oregon, Valley River Center. An active member in the community, affectionately known by many for his flowing white beard and genuine kindness, Ken has a lot to be thankful for. Unlike many, he has decent healthcare coverage. He earned it the hard way, working for well over a decade monitoring jail inmates, serving them meals and transporting them, making sure they didn’t harm themselves or each other. Nonetheless, despite the generous health coverage afforded by his former employer, Santa is not a wealthy man. Providing for himself and his wife, as well as his five growing grandchildren, is not easy to do on a retirement payment of around 2000 dollars a month. Especially since he has a number of health-related issues stemming from his former job. Because of his jocular temperament and fondness for children, as well as an unusual blend of physical traits that give him a genuine similarity to the famed charitable man from the north, Ken decided to supplement his income by acting as Santa. The hidden costs of providing memories and smiles to countless children over the busy holiday season are myriad. One must sit in a bulky, thick suit for hours without regular access to bathrooms or fluids, all while kids, and sometimes pets, of all shapes and sizes bounce around on your lap. For an older gentleman that survived prostate cancer, the task is physically and mentally demanding. Couple this with 12+ hour days, and it can be downright exhausting. Just after his rigorous stint as Santa had ended for the year, Ken fell ill. When his fever reached a dangerous point, his wife forced him to go to the hospital. One leg was red and inflamed, and Ken experienced a horrible pain in his good shoulder. Ken leaves his bedroom window open for his wife’s cats, and he initially thought he may have been shivering too hard in the cold, and had dislocated the joint. He clearly told a number of staff at McKenzie-Willamette Medical Center about the pain jolting through his shoulder. Santa was given NSAID medications to alleviate the discomfort. Despite the fact that the man many kids know as Santa groaned when someone got close to the shoulder, and reiterated the pain at every new intake questionnaire, nurses continued to take the affected arm and use it for vitals. They used the arm to draw blood. More than once, nurses came it and pulled on the arm, eliciting reactions of pure pain from a man at the nadir of his dignity, to get yet another pulse reading. Once admitted to the hospital from the E.R., nurses finally wrote on a dry erase board located at the foot of the man’s bed not to use Ken’s left arm. Ken was scheduled for surgery on his shoulder, and there were orders for him not to be fed as a result of this. Nurses knew about the surgery, as they verbally communicated the need to avoid food to me and my partner because of it. Yet this continued up to and even after the surgery, and it took a desperate daughter verbally complaining to a nursing supervisor to end the senseless and completely preventable pain. Switching gears, according to Dennis Tsilimingras, Director of Patient Safety and a respected professor from Wayne State University and Florida State University, close to 400,000 people die each year due to “Adverse Preventable Events.” A 2013 Journal for Patient Safety article agrees with that estimate, disputing some of the findings from an earlier Institute of Medicine Report, widely relied on by the government, which concluded the number of deaths is merely 44-98,000 each year. In the 1999 Institute of Medicine report, entitled “To Err is Human,” it was estimated Adverse Preventable Events cost hospitals 17-29 billion dollars annually. That’s billions, with a b. As mentioned earlier, Dennis Quaid, a famous U.S. actor, experienced the trauma of an adverse preventable episode first-hand. At Cedars-Sinai in L.A., a premiere medical facility respected throughout the world for its dedication to service, his newborn twins were given 1000 times the appropriate does of the drug Heparin after they developed an infection. According to Rick Shapiro of The Virginia Beach Legal Examiner, Baxter, the manufacturer of this and a similar drug, knew that it labeled the two different drugs in a way that would make them easily confusable. The company even sent out warnings to hospitals throughout the country after three children, much like Quaid’s, except they were not rich, died in Indianapolis under virtually identical circumstances. The New York Post, People Magazine, and a host of other mainstream media sources reported on the large settlement Quaid reached with the hospital. Despite the expensive insurance that hospitals and doctors have, and the various regulations which sometimes make it more difficult to file lawsuits against healthcare providers, many high-profile lawsuits are filed against these well-intentioned people and organizations each year. An ABC News online article from 2010 estimates that every single doctor in the U.S. will face at least one legal action in their career. Nearly 20,000 malpractice suits are filed each year, and this is just one area for possible litigation. According to Diederich Healthcare’s 2013 Medical Malpractice Payout Analysis, a malpractice payout occurred every 43 minutes. 3.6 BILLION dollars were paid out for malpractice in 2012, the emphasis of this study. And that constituted a significant reduction in payouts compared to previous studies. 93% of claims were eventually settled, and nearly a third involved death. Another 40 percent involved “significant,” or “major,” lifetime injuries, or becoming a quadriplegic (Becoming a quadriplegic in this study was not major or significant, oddly enough). Each one of these legal claims requires hours of attention by not just lawyers, but also the healthcare providers they are lodged against. Discovery, the process of gathering and providing evidence to the other side of a lawsuit, is an intensive process that is often treated as a negotiation. In many cases, more money is spent trying to delay revealing evidence of wrongdoing than acknowledging the problem and attempting to get better. During this process, doctors understandably become less aggressive in treating problems, and lose some focus on the patients they by all accounts really want to help. Studies rarely take into account these hidden costs, but they are nonetheless very real. And, unfortunately, they can be as harmful as actual errors. One reason American healthcare became known throughout the world is its ability to be flexible and creative in responding to dynamic medical needs. Germs and bacteria adapt to us and our attempts to neutralize them, and humans are notorious for their ability to find new ways to destroy themselves. Cancer does not understand careful disclaimers and hesitancy. Going back to Santa, we see that his plight is horrifically common, and the worst part is that these deaths and injuries can be prevented. While it is important to discuss the political and fiscal realities of healthcare, what is often lost in news reports is the very human element of the people involved. Close to half a million people a year, according to experts, die because nurses don’t communicate effectively. Those that don’t die, which are the majority, according to Tsilimingras, impose burdensome costs on a strained hospital system. Families that lose loved ones in APEs become cynical towards their healthcare providers, according to a source at Lane Community College. They become less likely to go in and ask for care when they feel a mistrust of the system, and this complicates their own possible health risks. People like Ken Major exit the hospital in significant pain, saddled with a huge bill and a sense of helplessness. According to the American Nursing Association’s Standards of Practice, nurses must “communicate effectively in a variety of formats in all areas of practice.” This, according to professional standards of conduct, includes: “conveying information to healthcare consumers, families, the interprofessional team, and others in communication formats that promote accuracy.” Communication is so important in the medical field that the state of Oregon created a Emergency Department Information Exchange, which is supposed to serve as a further clearinghouse for information exchanges between providers. It may be ironic that the motivation behind finally developing this exchange was money. Area hospitals wanted to seek ways to reduce costs. It seems giving proper care the first time they encounter a patient didn’t fully enter their calculus. A 2013 scientific American article hints at the critical role communication plays in Adverse Preventable Events. The Institute of Medicine report that Tsilimingras says “ignited,” the patient safety movement, explicitly discusses how easy it is for overworked nurses to inadvertently harm patients through a lack of communication. Several of the recommendations made to ameliorate this problem focused on this point. In the opening paragraphs of the Journal for Patient Safety article, authored by Dr. John T. James, readers will be confronted with the fact that communication lapses cause almost a 400,000 people to die each year. James cites evidence that transparency and limited accountability further complicate the issue. In layman’s terms, that means MORE than 400,000 people could be dying as a result of negligence. The Scientific American article claims that, if true, APEs constitute the third-leading cause of death in America. To put this in context, according to Hannah Nichols of medicalnewstoday.com, the leading cause of death in America is heart disease, which caused 600,000+ deaths in 2014. Cancer received the infamous distinction of winning silver in the dark Olympics, with 591,000 deaths attributed to it. Chronic lower respiratory disease is the official third-leading cause of death, according to this article. It killed 147,000 people in 2014. A quarter million more people died as a result of adverse preventable episodes than the third leading cause of death. And it could be WORSE. One slightly comical example of how miscommunication can have a significant impact on not just people, but communities reads like a fictional tale. In March 2017, according to abc7chicago.com and the Chicago Tribune, after a man was forcefully subdued by Kane County law enforcement officials, he was taken to a hospital with the passenger in the car he crashed while attempting to elude police. Billy Cole arrived at the hospital under armed escort by police, in police custody. By committing multiple alleged felonies and leading cops on a high-speed chase through heavily populated areas, the man had violated his conditional release from jail…pending attempted murder charges. No one is willing to publicly say why or how this man, historically dangerous and wanted by police, was able to simply walk out of the hospital a short time after his admission. But a reasonable assumption is that shift change happened, and people forget to mention to the new crew that the banged up guy in room 203 (the room number is arbitrarily created for narrative purposes) was brought in under police escort, and he shouldn’t be allowed to leave. Moving on, the hospital in which Ken Major stayed for nearly a week in 2017 was the subject of investigation after healthcare violations were reported by the Centers for Medicare and Medicaid Services. In 2011, there were violations tied to medical record services. According to the Association of Health Care Journalists, there were patients discharged without any discharge date in their records, surgery patients with scratched-out and unauthenticated entries, there were unsigned consent documents. This is in addition over four separate incidents of surgery data being rendered indecipherable due to data being scribbled over by anonymous sources. In 2012, McKenzie-Willamette hospital violated CMS standards by failing to maintain proper quality improvement activities. This included, according to the ACHJ, giving duplicate doses of medicine to patients. In addition, it included shelving in the Intensive Care Unit with multiple unmarked medications. According to usnews.com, the latest available data show that 32,273 visited the emergency room at McKenzie-Willamette. At the last census, the city of Springfield, a suburb of Eugene, Oregon, had a population of 59,403. More than half of the population in a city served by this hospital had at some point entrusted it with their care. A nurse working at the hospital confirmed that it is hard to maintain effective communication when so many things are happening simultaneously. Perhaps the feeling that staff are not properly paid exacerbates the problem; in 2014, unionized McKenzie-Willamette workers planned a three-day strike to protest HR-disputes. Whatever the root of the problem, it is abundantly clear not every patient gets the benefit of nurses that adhere to proper standards of care. In February 2017, when I asked for some feedback on area hospitals on social media, I was inundated with complaints from former patients who felt harmed by an impersonal and inefficient system. Magdalena Dice, a Eugene resident, reported feeling violated by her experiences during a hospital stay. Several others expressed intimate details about their struggles, obviously affected even years later by what they perceived as poor care. What nursing professionals told me was confirmed by this surprising outpouring of poignant personal narratives. Experiencing a medical emergency is a stressful, emotionally traumatic thing. Often, getting to a healthcare provider requires a team effort, whether that team includes family or emergency medical technicians or both. If one is cognizant of their surroundings, they are subjected to a litany of questionnaires and surveys, pokes and palpations AFTER getting in to see someone about their problem. Hospitals are noisy, uncomfortable places where everyone feels the burdens of their own mortality acutely. Nonetheless, we implicitly trust that the people at the hospital can and will take care of us. The system’s foundation is not insurance or laws, but our continued trust as a people that the medical professionals know our bodies and the invisible things afflicting them better than we do. And we HAVE to believe, because the alternative is dark, indeed. Few want to explore the issue of weaknesses in the healthcare system, because, at a very deep and disturbing personal level, this means we, as individuals, could be at risk. And, on the other hand, there probably isn’t a quick and easy fix. It may be time to introduce a new element into the healthcare discussion. A human element. Because what not many people talk about is the very human characters delivering healthcare, or the people damaged when negligence happens. It is not necessarily the fault of nurses, when they are not able to communicate effectively in a complex and fluid emergency situation where a life may be on the line. There are recognized structural issues that seem to be lost in the slush pile. At a time when nearly everyone is reading the latest news about the Affordable Care Act on their mobile devices, is it inconceivable that we ask for better and faster reporting in the healthcare fields? If we are constantly talking about reducing healthcare costs, might the estimated billions lost due to APEs be a place to start? If people want to focus on quality of care, should we talk about the human element in that process? Ken Major spent the majority of his life trying to help protect the members of his community. In his retirement, he is Santa, bringing smiles to so many families during the stressful holiday season. He is also a statistic. Just one of the hundreds of thousands of patients affected by preventable harms. Who is going to protect him? What always haunted me was the fact that Santa has decent insurance. He has a good family willing to be proactive in advocating for him when he cannot. What happens to the people without insurance? To those without family or friends nearby to speak when they are forced to remain silent? If Santa can be hurt when there is a clear sign by his bed telling nurses how not to hurt him, can’t that happen to anybody? In the current divisive political climate, it is often hard for people to understand that each party possesses a fundamentally decent desire to help hurting people. The question often can be reduced to how, versus who or why. A lot of attention is, understandably, paid by politicians living in the world of 24 cable news and soundbites to statements on healthcare. A significant chunk of people that regularly vote also experience medical issues at higher rates. But sounding tough in carefully crafted speeches designed to say little does not help save the person likely to experience a preventable harm in the hospital. By the time you are done reading this, at least one more person will be misdiagnosed or given the wrong medications. Another person will receive a large settlement for malpractice. And five politicians will give a public statement about healthcare that effectively does nothing to help solve the problem. Addressing and solving the healthcare crisis in America requires people to communicate with each other. Not just talk at or to each other, but communicate. In a sense, the problem of adverse preventable events is eerily similar to the contemporary political climate of toxicity and divisions. One of the most significant fixes is also potentially one of the cheapest and easiest: listen to each other and communicate effectively. All of those surveys they make us take before we even see a doctor are there for a reason. Simply looking over this information and conveying it to other specialists in different offices can be the difference between treatment and torts. Similarly, long before any bill is introduced, by any party or congressional member, regardless of party or ideology, the health of the proposal is assessed though countless interminable surveys. Communicating with the man down the hall, who may not be privy to these surveys or their results, is the only way to diagnose a disease. Medical professionals have specialties because it is virtually impossible to develop the necessary expertise on every aspect of the human body. Politicians have specialties because it is virtually impossible to develop expertise on every aspect of the human condition. It is only by working together that these diverse groups can diagnose a problem. And it is only by diagnosing a problem that one can begin to form an effective treatment plan for combatting it. As we can see from Santa’s case, as described throughout this article, the problem is clear. Dennis Tsilimingras and other respected experts have given a name to the issue. Adopting the idea of triage, we can see that the emergency should be a priority, since it poses a significant risk of death to the entire modern healthcare system. Some of the government’s own experts suggest more people die each year from preventable errors in hospitals than car accidents and respiratory issues combined. Hospitals cannot possibly deliver more affordable care to everyone while spending billions on errors they could have prevented in the first place. Politicians that consistently claim to value life and equality need to come together to begin assessing treatment options for this disease. Hospital administrators and doctors, as well as lawyers and advocacy groups need to begin communicating with the various specialists and stakeholders, with an aim towards reducing these errors. Everyone needs to be able to accept that they made mistakes, without this being an admission of defeat. People need to be willing to seek solutions, even if this might mean short-term diminution of profitability. There are some conversations that lead one to more questions than answers, and this may be one of them. But it is time to start asking them. Because the system is flawed, and the flaws are causing hundreds of thousands of people to die each year. THAT is the real injustice.
We knew when she stumbled in at 5 AM that she would be trouble. With an unruly mop of curly brown hair that declared open war on conventional notions of hygiene, a sallow face, and the attire of someone more likely to be a guest of a nearby condemned house, she did not possess the appearance of a normal guest. She, however, had a reservation, and that was the most relevant factor. While the normal guest at the Hilton-branded hotel would be in a dress shirt or a chic dress, money, not fashion reigned supreme. Front desk agents aren’t judges of character or arbiters of sartorial splendor. And Eugene is an odd enclave of artistic self-reproach. Barb was one of the reasons we played a game behind the desk, where we guessed whether someone was a business owner or a homeless person. You just never knew.
Freedom on Alcatraz Island
The once-familiar sounds of doors clanging shut did not make me cringe or dredge up suppressed memories. Instead, they had the curious effect of bringing me a sense of peace. Integrating a difficult past into a present inextricably intertwined with a single impulsive action committed long ago can be hard. Many people that have been to prison allow their imprisonment to become their identity; you become known as a felon when convicted. Yet the process of reintegration after a long stretch of incarceration often means reconciling the two. And it was this reconciliation that took place during my recent trip to Alcatraz.