History is made ...

On Thursday, April 7, 2022, history was made with the confirmation of Judge Ketanji Brown Jackson as the first African American woman to become an Associate Justice of the United States Supreme Court. Whatever one’s politics, this was certainly a momentous outcome for the advancement of some measure of balance on the “court of last resort.”  The process that led to the final counting of the votes, was fraught with a great deal of character assassination, the malignment of Judge Jackson, and a number of Republican senators showing just how low they could go to try and derail the nomination. Through it all Judge Jackson displayed a measure of grace under the intense pressure and innuendos caste about and to her. A lesser person might well have buckled under the unfounded and baseless attacks on her judicial record and her personal integrity.

A glaring example of the level of hypocrisy that several senators stooped to was best displayed by Ted Cruz the Senator from Texas and the grandest hypocrite of all the hypocrites. He who chastised anyone who deserted a state during a time of crisis. Obviously, this did not apply to him. Subsequently, he flew his daughters to Cancun, Mexico during one of the most crippling crises experienced by the State of Texas. During the “inquisition” of Judge Jackson by some of these senators, Cruz spent a great deal of time questioning her about Critical Race Theory and held up a book that was used at a Georgetown private school in Washington. Not only did the Judge and her husband send their daughters to the school, but the Judge was also on the board of the school. Cruz was relentless in his accusations about what the book described from a racial perspective. During the questioning, Judge Jackson stated that she was not familiar with all the books being used at the school and could not address some of the innuendos being thrown about by the senator. An interesting side bar to this matter is that the private school Cruz and his wife send their children to in Houston, St. Johns, uses the same book that he was so adamantly bothered by and, in fact, St. Johns, is much more public with its position on diversity and inclusion when compared with the Georgetown school. What Critical Race Theory has to do with her qualifications as a judge will always remain a mystery.

Similarly, the Republican Senator from Tennessee, Marsha Blackburn, seemed to be on another wave- length than would be expected in an inquiry as to Judge Jackson’s judicial qualifications. Blackburn focused on asking the nominee how she would define a woman and the nominee declined to answer. Again, one must question, the significance of this question. What could be the reasoning behind the question other than to try to find a way to “trip up” the nominee. Subsequently, several Republican legislators were asked the same question and to a person they had a difficult time trying to produce a definition of “what is a woman”.   The definition included in the Merriam-Webster dictionary is “an adult female person.”  This really does not delineate the unique differences between an adult male person and an adult female person. Oh well, just one more example of the inane position some senators took during their time to question the nominee.

There was also a great deal of attention given to the nominee’s judicial decisions, specifically in child pornography cases. Even though some of her decisions might be questioned, in the main she adhered to the federal guidelines which provides a measure of discretion and latitude for judges to hand down sentences. As was stated on several occasions, her record for such decisions mirrored the actions of other judges and she was not out on the limb of leniency any more than might be expected of any judge in a comparable situation. Senators Graham, Hawley, and Cotton were particularly focused on this issue and were doggedly relentless in their attacks of her. On another note, Cotton, the senator from Arkansas, even stooped to the lowest of low when he suggested that Judge Jackson would probably have defended a Nazi during the Nuremberg Trials. He was also quoted as saying that she was friendly in helping terrorists, such as Nazis. How low is low?

The confirmation of Judge Jackson was based on a fifty-three for and forty-seven against vote and the president’s hope for bipartisan support of the nomination was met. As we know, three Republican Senators, Collins of Maine, Murkowski of Alaska, and Romney of Utah voted in favor of her confirmation. Based on their comments, they reached their decisions based on the judge’s qualifications and not on her politics and they are to be commended for taking this action. One of the more confusing and perplexing positions was that of Blunt, the retiring senator from Missouri. He had nothing but high praise for Judge Jackson and believed that she was immensely qualified to sit on the Supreme Court, yet stated that he would vote, no, for her confirmation. Why?

Throughout the process, Judge Jackson remained in control of her emotions and dealt with the onslaught in a remarkable manner. Others might have “folded their tent” and determined that it was all not worth the intense and crazy attacks on her, as her family, husband, and children sat behind her listening to it all. That she “hung in there” is a tremendous achievement on her part and for that she should be commended. In my judgement, those who chose to wage the attack, could best be described as “piss ants.”  This is a phrase that a colleague used with some frequency in describing others. By the Oxford definition, a piss ant is “an insignificant contemptuous person or thing” - how best to characterize these senators. Their behavior certainly met the essence of the definition.

What I have included is my personal position. Obviously, I feel quite adamant about what I have included. What has been included is based on the written record of the hearing proceedings and the commentary of those who witnessed the process. I am aware that everyone who might read what I have included will not agree, and that is OK. In closing, I do think that the forty-seven senators who voted against Judge Jackson’s confirmation should step back and reflect on their position. If their decision was based on differences in judicial philosophy, that is defensible; however, if their decision was based on politics, in my judgment, that is not defensible.

Questionable medical treatment....

 LYING ON A GURNEY IN THE HALLWAY OF THE EMERGENCY DEPARTMENT AT THE LOCAL REGIONAL MEDICAL CENTER!  A couple of weeks ago I had to be admitted to the DCH Medical Center and thus began my journey to and through hell for those 40 plus hours.  It is not my intent to find fault with the care provided by the medical staff, especially the nurses.  They are working under what is obvious adverse conditions with what also appears to be little to no appreciation or recognition.  The hospital is losing nurses day after day, and many are going to work at other hospitals for double the pay and fewer patients.  Once I left ICU for a room on the sixth floor, I recall a conversation that my doctor had with the attending nurse.  She stated that earlier in the week, six nurses left to go work at a hospital in Montgomery for double the salary and a smaller patient to nurse ratio.  Similar stories abound with nurses leaving for better working conditions and more money in Birmingham and other cities throughout the state.  Where is the Board of Directors in all of this?  You cannot sit idly by and not be concerned with what is happening, yet little seems to change.  I recall one of the nurses caring for me mentioning that a travel nurse, doing the same job as she is doing, will earn up to triple the pay, but she is expected to ‘suck it up “and not complain.  Her comment was that it doesn’t do much to make you feel appreciated.

 If other hospitals can siphon off these nurses, why can DCH not do what is necessary to keep trained staff?  What responsibility and accountability does the administrators of the hospital have for what is going on and how do they continue to keep their employment?  The CEO has been in that position for several years and during this time there has been obvious deterioration, especially with staff morale.  While lying in the dialysis unit I overheard one of the nurses mention to a small group of technicians that the nurses would have left if it were not for them stepping in and helping.  Over and over, you hear the same stories.  Who, if anyone is listening?  Based on what is seen, the board seems to be impervious to an obvious sign of a problem—high turnover.  It is not a mystery that individuals leave one position for another for several reasons.  Better working conditions and more pay are the most prevalent reasons given for moving to a new position.  Apparently, that is what is happening at DCH, and action must be taken to bring some semblance of order to what has become a chaotic environment.  

 I mentioned to a friend, who is a physician, that I felt like I was a patient in the MASH sitcom and his response was , you would hope you would get that level of care.  Although the pandemic has certainly impacted the local medical facility, it is not the basis for the problems with the hospital.  Over three years ago, long before Covid, my wife spent several days as a patient at DCH and should have been in a private room, but remained in a two-person room for most of her stay.  Rooms were available, but as I experienced, there were not sufficient staff to make the rooms available.  She wrote a letter to the members of the Board of Directors expressing her concern for the conditions at the hospital.  Being a nursing educator, she often had students in clinical rotation during the better days so she is aware of how it should and can be.  The response from the CEO to her letter was the same old crap and boiled down to “we’re trying our best”. 

Often the doctors expressed dismay for the conditions they are working in due to the shortage of staff, hence patients languish in the ED for days.  I am aware of a friend’s mother who at age 88 laid in the ED for over four days before being assigned a room.  This is unconscionable and mirrors what might be found in some of the third world countries.  There are frequent accolades strewn about that brag on the outstanding medical facilities that exist in this country, yet this does not compute for the local facility.  Recent statistics indicated that it was common for bed occupancy to be around 60% plus; therefore, 40% plus percent of the beds are not being utilized.  The beds are there, the staff are not there. 

Not only are staff shortages contributing to the problems in the local facility, but there is also the increase in the number of hospitalizations of those with Covid.  Less than 50% of the adult population in the state have been fully vaccinated.  The overwhelming number of admissions for Covid patients are due to the unvaccinated coming down with the virus.  It is no mystery that Alabama is one of the states that has a substantial number of anit-vaxers and much of this revolves around politics.  Witness the current barrage of political ads.  One candidate strives to outdo the others with anti-masking, anti-mandates, and promoting individual rights at the expense of others.  The real frustration is that the vaccines do prevent individuals from coming down with the virus or if they do it is not as severe and does not, typically, lead to hospitalization or death.  Certainly, there are some unknowns, but the same people who will “chow down on a hot dog or a baloney sandwich, question what’s in the vaccine.  What’s in a hot dog?  What’s in in a slice of baloney?  Anyone who has had to decide about whether to take a drug to offset the symptoms of some malady is aware of potential side effects.  One must weigh the pros and the cons and do what seems to provide the best odds.  The vaccines provide, overwhelmingly, the best odds.  The number of people in this country who have died from COVID or experienced deadly consequences because of the virus are legion, and it did not have to be what it has become.  The politics of it all lead to some degree of cynicism.  We have all done things in our life that were not very smart, but to avoid death by taking some action seems to be a no brainer.  Guess that’s not true for everyone!

I have addressed this issue in previous blogs, but when it “hits close to home” it begins to have a bit of a different impact.  While lying in the hospital for ten days, I had a good amount of time to think about my own mortality.  Around the time I entered, a good friend who I have known for 40 plus years died.  She was in her early 80’s and had lived a good and full life, but it led me to give pause to the inevitable reality.  Just before I was being taken for emergency dialysis, I had to answer the question about the use of life-saving actions.  I had never been asked this, directly.  There is always the question about a living will and we have those, but the nurse asked if I wanted to be resuscitation and I said yes, but as he lingered a moment I recanted and stated that I did not want that to be done.  While I was in ICU my bed faced the wall with a white board that was there for notes to be written and at the bottom were the initials “DNR”.  Sort of gives one a bit of that reality check.  “Life is but a vapor”.   

The next year 2022...

Today is January 6, 2020, a January date that will live in infamy. I will not dwell on the ramifications of what occurred on that day in 2021, but it does bear mentioning that our nation has become much more politicized and divided since this date. It is certainly a mystery to try and understand how anyone can watch the videos and television coverage and not draw consistent conclusions. There is no doubt that the seat of our democratic government was breached on that day. It is no mystery that people died because of what took place on the date and numerous people were injured and continue to bear the scars due to what they were confronted with by the invaders. It is no mystery that property was destroyed and defaced. It is no mystery that chants of “hang Mike Pence” were heard as the rioters sought him out. It is no mystery that politicians of every stripe huddled in fear as individuals milled about the capitol building wreaking havoc at every turn. Given all of this, what conclusion can be drawn other than this was a calculated and blatant assault on our government and the orderly transfer of power?

As we embark on 2022, there lies before us a myriad of challenges starting with the ever-present virus that has altered our world and more, specifically, our society. While the Omicron variant has replaced the Delta variant, there is another variant that has been found in France, the IOU. Will it be less lethal than Omicron which has been less lethal than Delta? The answer is not known, but the host virus will constantly foster additional variants; therefore, we may need to be prepared for our lifestyles being changed for some time to come. We may not have the luxury of meeting in large groups, shoulder-to-shoulder in inside auditoriums. We may not have the opportunity to travel at will to destinations that have their own restrictions as to who can come and go. Children may not have in-person classes on a regular basis and flexibility in teaching and learning may become the norm rather than the exception. Prior to the ascendency of Omicron, many of us were beginning to breath a measure of relief that this was all behind us only to realize this was not the case, 

During 2022 we will also be bombarded with political campaigns complete with lies and innuendo. Buzz words and phrases will become common place on the television and radio announcements. Racial slurs will be embedded in the denouncements of Critical Race theory which is becoming one of the rallying points for conservative leaning candidates. Mandates is another one of the buzz words that raises the ire of those who espouse that such governmental intrusions are undermining our freedoms. Parenthetically, mandates are a given in our daily life. Kids cannot be enrolled in school unless they have been immunized. Drivers run the risk of being ticketed if they do not wear a seat belt. The examples of mandates being passed down by governmental entities are well ingrained in the American way of life. The political rhetoric, particularly here in the south, will be characterized by who can “out-Christian” the other candidate. Pandering to the religious community will become common place from now until the election in November.

Another realistic reality will be the every-present hypocrisy that characterizes the behavior of so many. The very nature of our democratic way of life is fraught with hypocritical comments and behavior. Hypocrisy is “the practice of engaging in the same behavior or activity for which one criticizes another or the practice of claiming to have moral standards or beliefs to which one’s own behavior does not conform to.”  As one reflects on this definition, it is obvious that for many in the political arenas from local to state to federal chambers, such behavior is commonplace. Let me provide an example. Back in November of 2021 Congress passed a limited bill that focused on infrastructure issues such as roads, bridges, broadband access in rural areas, etc. An Alabama Congressman, Gary Palmer, voted against the bill, yet publicly praised the $369 million that he secured for a highway in the Birmingham area. Further, Palmer is a member of the House Freedom Caucus that seeks to punish the 13 Republican Congresspersons who voted for the bill. Such inconsistent and blatant comments and behavior is much too commonplace within the political community. It is not limited to one party over another but has become much too acceptable during and since the previous administration. Such hypocrisy has also been evident in how the previous administration flaunted the belief and practice of law and order. It became very apparent that only the laws, rules, and regulations that they wanted to follow were going to be followed. Those that did not conform to their wishes would be ignored or outright violated. The repeated violations of the provisions of the Hatch Act are a case in point. This Act came into existence as an attempt to limit the political involvement of government workers, yet numerous individuals associated with the previous administration refused to abide by these provisions.

Let me continue with the hypocrisy evident amongst many in the political arena. A number of state leaders, primarily in the south and portions of the Midwest, are quick to point out that the Federal Government is too often trying to wield its power over the states. A common rallying cry is invoking the mantra of “states’ rights.”  Indeed, the U. S. Constitution makes it clear that there is a separation between the Federal Government and the states, including their respective roles. Historically, when it has become evident that a state is not respecting the provisions of the Constitution, courts and Congress have stepped in. The rights of the respective state are certainly important but do understand that for many states the intrusion of the Federal Government has kept the state afloat. The use of federal dollars to fund a variety of projects and services is substantive to the fiscal survival of the state. Let me share a brief example to make this point. In West Virginia for every dollar, they pay in taxes they receive $3.74 in Federal funds; Mississippi receives $3.40 for every dollar paid; Alabama receives $2.46 for every dollar paid; Kentucky receives $2.05 for every dollar paid, just to highlight some of the southern states. Comparatively, contrast what some of the non-southern states receive. Ohio receives $.90 for every Federal dollar paid; New York receives $0.93 for every dollar paid; Illinois $0.94 for every dollar paid; New Jersey $0.78 for every dollar paid, and California receives $1.00 for every dollar paid. It is quite apparent that there is a significant disparity amongst the states relative to the amount of Federal dollars received and the amount that is paid in. When the percent of Federal money as a part of the state’s budget is reviewed, this discrepancy is even more obvious. The above figures were taken from an analysis completed by Moneygeek. It is difficult to accept the argument that as a state we need to “float on our own bottom” and then take all the Federal money that comes along. How hypocritical. There is a need for a symbiotic relationship between states and the Federal Government and this is not readily apparent in the current fabric pf the political arena. It seems as if there is more of an adversarial relationship as evident by the number of lawsuits filed by states against some of the public health mandates from the Federal Government.

The coming year holds some measure of promise, but it also has some very practical challenges. It seems to be commonly accepted that the House of Representatives will become controlled by the Republicans and that raises some concerns for me. Recently, there was an article that quoted Senator Ted Cruz stating that if the Republicans took control of the House, then there would be impeachment proceedings against President Biden whether it was warranted or not. This statement is the most salient example of hard and fast partisanship at its ugliest, it would be great to believe that reason will prevail, but such has not been a hallmark of the current congress, nor does such an expectation hold much promise for the next Congress. When given the opportunity to hold the past president accountable, nary a Senator and only a handful of Republicans in the House supported the second impeachment proceedings. This is but one example of the intransigence and stagnation of a deeply divided and partisan-driven Congress. We have the hand we have been delt and we will see how it all plays out.

Just Because

JUST BECAUSE we want to maintain contact and some interaction with each other, we meet each Wednesday afternoon at the home of our friend who is house bound as he continues to deal with medical issues which limit his mobility. There are four of us who try to keep open the “sacred” Wednesday gathering. Each of us have various medical issues whether it is cancer, kidney and diabetic issues or complications following eye surgery—the list never seems to end. Invariably, each of us give a “weekly” medical report, focusing on our respective maladies.  Our fifth “compadre” has been closely confined to home although we do try to keep in touch by email and phone.  Additionally, during these “gatherings” we are bound to rehash the latest adventure of the Alabama football team, making claims of superior knowledge of what should have been done that was not evident during the game. Basketball is now beginning to creep into the conversation as the season looms closer. Critiquing the athletic exploits of Alabama does consume a measure of our time together. We tend to meet for about an hour or until our “host” informs us that it is time for him to get down to the business of eating his dinner. Off we go until the next Wednesday rolls around!

Prior to the ravishes of COVID, there were five of us that met daily at a local pub for drinks as we brought another day closer to closure. It was and has been JUST BECAUSE we had a mutual respect and interest in one another that kept our time together habitual. Each of us come from quite diverse backgrounds and life experiences. Four of us are retired Professors at The University of Alabama and one is a retired Director of a county department of Human Resources. Among the four of us who left the university, one was from English, another from Mechanical Engineering, another from Geography and I had been on the faculty of the School of Social Work. While we have varied political orientations, the one coalescing factor was a mutual disdain for the previous president and his bombastic behaviors. I know there was a time when my wife was asked about our “little tradition” and she supported it as something that allowed me to have some time with friends and to an extent, like-minded individuals. Friendship is ever so important as we travel through the journey of life. In most cases, family will always be there to support, cajole, and prod us to do what we should and need to be doing. Friends, on the other hand, may come and go, but those that remain are critically important as the waning years continue to build up. Of the original group of five, two of us are in our early 80’s and the others are in there mid to late 70’s. At some point in the not-too- distant future, the bell of lifer is going to ring; therefore, clinging to the friendships that we currently enjoy allows us to have some measure of stability and saneness. JUST BECAUSE that is what friends are for and what friends provide without any imposition of conditions.

As we get older, I believe, it allows us to spend some time reflecting on where we have been and what we have accomplished. Further, it allows us to reflect on those relationships that have been important throughout life’s challenging times as well as the good times. It has been some of those relationships that have been there to sustain us and keep us moving forward. As the years move one, we find ourselves holding on to those relationships that are still available. How many of past relationships are no longer possible because the other person is no longer with us. Keep your friends and, yes, your family, close and let others know how important they are to and for you.  JUST BECAUSE!

Potential crisis in healthcare....

A recent article in The New York Times stated: “Covid-stricken Alabama had more deaths than births last year, a first in its recorded history.”  This is an oft-repeated reality throughout the country, but especially in the southern states. It is also a draconian realization that these are the same states that have the lowest vaccination rates and the largest numbers of anti-vaxxers. It does not take the wisdom of Solomon to find a direct correlation between the number of deaths and the failure to be vaccinated. As I noted in an earlier article, the rallying cry by the unvaccinated is that they have the right as an individual to make that decision. There is a modicum of truth to such a position, but it falls into the realm of indefensible when it impinges on and affects others.

A substantial number of the unvaccinated proclaim that they have an inalienable right to decide whether to be vaccinated. They often bring the Constitution into the flimsiness of their position, yet fail to recognize or admit that in the Preamble to the document to which they refer, it states: “We the People of the United States in order to form a more perfect Union…promote the general welfare…”  It does not state to promote one’s induvial welfare. There have been a chorus of outcries since the president’s recent Executive Order mandating vaccination or testing for employers of one hundred employees or more. These same individuals claim that it is an overreach by the president and an impingement on individual’s right to decide yay or nay. It undermines one’s freedom of choice and that is not within the purview of what the role of the government should be. Well, does such a mandate not promote the general welfare? There is a myriad of examples which support the promotion of the general welfare of all the people. We all must abide by various laws, rules and regulations which have been established to foster a more perfect union. Whether they be behavioral expectations relative to operating a motor vehicle, signing a contract, holding another accountable, determining paternity, entering marriage, being vaccinated against specific diseases, etc., most people abide by the law, rule, or regulation. Only then, is there a semblance of a “more perfect union.” 

With the recent surge brought on by the Delta variant, the number of people being hospitalized has increased to problematic proportions. ICU beds are fully occupied, hospitals are overwhelmed with the numbers, ambulances cannot discharge patients, the problem just continues to get worse and worse, and people are dying because there is no room for them in a hospital. A recent headline of an article in the Montgomery Advertiser read: “After 43 hospitals turn away Alabama man who needed ICU bed, obituary urges COVID vaccines”. What a sad indictment on our country’s lack of preparedness for dealing with this pandemic. How could our healthcare system get to such a state that a person is turned away by over forty hospitals in three states and dies in a hospital over two hundred miles from his home? We have gotten here, in large part, because of the millions of Americans who refuse to be vaccinated, then come down with the virus, and then become hospitalized. Again, the problem is more acute in the southern states. States have turned to triaging admissions and making decisions based on best potential outcomes. Undoubtedly, more individuals will die because of the lack of space or lack of staff. Those non COVID patients who need a bed are being turned away because the beds are often occupied by those who contracted the virus and refused the vaccine. Let me note some of the headlines in recent articles in The Washington Post: “Four patients, two dialysis machines: Rationing medical care becomes a reality in hospitals overwhelmed with covid patients,” “Unvaccinated covid patients are straining hospitals like mine, where I had to turn a cancer patient away,” “I was supposed to have life-saving surgery. Tennessee’s covid-19 surge cost me a hospital bed”. These are just a few of the articles that point to the crisis that exists in our hospitals. This reality begs the question, do those who refuse to be vaccinated deserve to be treated at the expense of non-COVID patients.? Do they deserve to take one of the finite ICU beds in hospitals throughout the country?

 In an article in TIME magazine, titled “In desperate need of more hospital beds,” the author makes the case for an increase in bed-capacity in the nation’s hospitals. Often the availability of beds is not the problem, but the lack of trained staff, especially Registered Nurses. The nursing shortage is a grim reality of this pandemic for a variety of reasons. The overwhelming issue for many nurses is simply being burned out from the onslaught of cases day in and day out with little or no relief in sight. ICU nurses who typically care for two to three patients are expected to care for ten. Undoubtedly, the quality of care can be compromised. The use of traveling nurses has created another major hurdle for hospital administrators as they attempt to staff their hospitals. The cost of a traveling nurse can be astronomical and reach up to $250 per hour being paid to the organization that has the contract to provide the nurses. A small rural hospital does not have the budgetary capacity to absorb such costs. The problem is not limited to just the small rural hospital, but also to those facilities in urban areas. One health care system has four hundred openings for bedside nurses that have gone unfilled. In the State of Mississippi there are 2,000 fewer Registered Nurses than there were prior to the pandemic.

 Another piece to the reality is seeing those who refuse the vaccine being caviler in their behavior. Packed stadiums, concerts, bars, and restaurants bring to the fore the very real potential for additional surges and drains on the healthcare systems. Those working in these systems see friends, neighbors, family members putting them in danger as they continue to care for those who come down with the virus. Considering this, many are leaving the healthcare and allied professions and taking different career paths. The following articles bring this into focus: “US public health workers leaving in droves amid pandemic burnout,” included in the Guardian; “COVID-19 creates dire US shortage of teachers, school staff”, an AP News article; and numerous sources referencing shortages of medical and non-medical staff throughout the fabric of the healthcare system because of the recent Delta surge. Shortages are real. “When hospitals are understaffed, people die,” a warning included in an article in The New York Times.

 Due to the number of hospitalizations, scheduled medical procedures are not being done or postponed, i.e., mammograms, colonoscopies, cancer treatments, etc. What will be the ramifications of these conditions going untreated or undetected? Will more people die from inattention? Will mental health concerns begin to surface more frequently such as depression anxiety, and even suicide? The health care system is a finite system and has the capacity to only go so far and do so much. This reality should not be lost in the current climate.

 The perplexing frustration is that there is an answer to this ever-growing problem. If individuals who are unvaccinated would become vaccinated, then we could begin to get some control over the chaos that seems so prevalent in today’s healthcare. Such chaos has been exacerbated by the substantial number of unvaccinated individuals. As the public continues to get more comfortable with not wearing a mask or social distancing and avoiding the vaccine, the numbers will continue to spike and at some point, could well lead to the system imploding. Let us not let it get to that outcome. No none wins in such a scenario.