Day: February 29, 2016

“If we could know the future our jobs would be a lot easier.”

A detailed and exhausting account of one nurse’s twelve-hour shift on a hospital’s hematology/oncology floor. Medical memoirs are a favorite genre of mine and I enjoyed it!

If I sound the alarm and the patient is OK, then I over-reacted and have untrustworthy clinical judgment. If I don’t call in the calvary when it’s needed, then I’m negligent and unsafe for patients. You don’t always know because what goes on inside human bodies can be hidden and subtle. This job would be easier if there weren’t such a narrow divide between being the canary in the coal mine and Chicken Little.

Over the twelve-hour shift, Brown is responsible for four patients. Four patients don’t sound like many at first, but the stakes are high and there are multiple tasks to juggle per patient. Her patients are immunocompromised, so a number of extra precautions have to be taken during each task to keep them safe from invisible dangers. We spend time with these four patients:
• Dorothy – A woman in her 50s with a positive attitude. She is being treated for leukemia and is waiting for her lab work to return to normal so she can be discharged after a six-week stay.
• Richard – A fragile lymphoma patient in his late 70s, who has just been prescribed an extremely toxic chemo drug that demands constant supervision while being administered.
• Sheila – A woman in her mid-40s with antiphospholipid antibody syndrome, a blood clotting disorder. She is experiencing mysterious abdominal pain.
• Candace – A difficult (or empowered, depending on your perspective) cancer patient in her early-40s, who is scheduled to receive a transplant of her own cells.
In the book’s disclaimer the author notes that while these stories are true, specific details have been changed to protect patient and staff confidentiality. In some cases, composites are used. While she is unable to give us updates on patients after they leave the hospital, we do get enough of a conclusion for the aforementioned patients.

I watch the intern walk down the hall, slightly stopped, as if he bears the weight of the world on his shoulders. But it is I who will give Mr. Hampton his Rituxan, who will monitor him for serious changes in blood pressure, heart rate, and breathing, who will need to call this intern, or his replacement, if the treatment intended to heal ends up hurting instead. The intern doesn’t know this drug as well as I do. The intern won’t be the person hooking it up to Mr. Hampton’s IV, watching it run down the plastic tubing directly into his vein, knowing that if things go badly, it will be result of the work of my own hands.

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The more patients an individual nurse cares for, the smaller amount of TLC per patient. More significantly, research on staffing levels has made it pretty clear that the more patients a nurse has above a certain number (the number itself depends on the patient population and how sick the patients are), the larger the likelihood a patient will die who wouldn’t have otherwise. In other words, nurse-to-patient ratios aren’t just about patients feeling cared for; they’re also about fragile people staying alive.

Besides the patients, my favorite parts were Theresa Brown’s insights into problems with the way care is managed at hospitals. I wish there was more time spent on these topics. Theresa airs her frustrations with a system that doesn’t allow her to spend as much time with a patient as she would like. She always wanted to do more for them, but time constraints and the hospital’s bottom line didn’t allow it most of the time. She addresses the lack of emotional care for patients, hospital hierarchy, practitioner fatigue, the overcomplicating of processes in the name of safety and excessive workload. Though she gets frustrated, Brown loves her job and shows remarkable empathy for her patients and colleagues. In one chapter, she notices that she treats the escort in a way that she complained about a doctor treating her earlier. She realizes that everyone has a lot to do and maybe they are all doing the best they can to get through the day and keep their patients alive.

As force from the syringe makes blood swirl into the saline I stop and watch it billow like silk. Red. Beautiful. I never gave blood too much though before I took this job, but now I revere it. Blood is the liquid of life. Red cells give oxygen, platelets form clots, and white cells protect us from infection. Without healthy blood humans cannot live.

Because the author was an English major before changing careers, the language occasionally becomes poetic. This leads to some distracting figurative language and excessive literary references. (“Changing the bandages on his dying toes caused a shadow of pain to fall over his face, like the moon covering the sun during an eclipse.”) While it did make the work feel more human, it was jarring to shift from routine, “day-in-the-life” language to emotional language.

I had doubts that the author could maintain my interest with such a tight focus, but I enjoyed the whole book. We are all likely to be patients at some point, so this is a useful read for everyone. “There will come a time when each of us will need a clean, well lighted place that stays open all day and night, offering shelter from life’s storms.” It certainly will make me more patient! If you liked this book, you might also like The Real Doctor Will See You Shortly: A Physician’s First Year.

In all the hurly-burly, I’d forgotten, but now I remember: The most important thing of all is that everyone’s alive at the end of the day.

2.5 Stars, 3 for the first half and 2 for the second half. Entertaining, but superficial exploration of public shaming in the age of social media. I was expecting fluffy, but this was fluffier than most of the popular social science books I’ve read. It is as much about the author and the process of writing this book, as it is about public shaming. One of my biggest book pet peeves is when an author keeps mentioning the book in the book (also see: [book:Yes Please|20910157]), so that heavily colors my perspective!

A life had been ruined. What was it for: just some social media drama? I think our natural disposition as humans is to plod along until we get old and stop. But with social media, we’ve created a stage for constant artificial high drama. Every day a new person emerges as a magnificent hero or a sickening villain. It’s all very sweeping, and not the way we actually are as people. What rush was overpowering us at times like this? What were we getting out of it?

I was interested in this book because internet shaming sessions always make me so uncomfortable! They are so counterproductive and self-serving. (“We express our opinion that Justine Sacco is a monster. We are instantly congratulated for this—for basically being Rosa Parks. We make the on-the-spot decision to carry on believing it.“) Many times a person’s words are interpreted in the least charitable way so that they can become the latest poster child for everything wrong with the world. Death threats and a persistent pile-on that continues until someone is professionally destroyed seem excessive for many of these conceptual crimes.

We became keenly watchful for transgressions. After a while, it wasn’t just transgressions we were keenly watchful for. It was misspeakings. Fury at the terribleness of other people had started to consume us a lot. And the rage that swirled around seemed increasingly in disproportion to whatever stupid thing some celebrity had said. It felt different to satire or journalism or criticism. It felt like punishment. In fact, it felt weird and empty when there wasn’t anyone to be furious about. The days between shamings felt like days picking at fingernails, treading water.

I was surprised at how many of the cases in the book I recognized. That probably means I should spend less time on the Internet! A few of the cases discussed in this book: (The Sacco and Stone links are articles by Jon Ronson)
• Jonah Lehrer – Pop-science author who got caught plagiarizing and fabricating quotes. He gave a self-serving public apology that didn’t go so well.
• Justine Sacco – Tweeted “Going to Africa. Hope I don’t get AIDS. Just kidding. I’m white!” before flying off to South Africa. By the time she landed, she had became infamous and was fired from her PR job.
• Lindsay Stone – The woman photographed flipping the bird and pretending to shout obscenities next to a “Silence and Respect” sign at Arlington National Cemetery. She lost her job as a caretaker for people with learning disabilities.
• Donglegate – Woman (Adria Richards) at professional conference overhears two men joking about “dongles” and tweets their photo to the world. One of the men (Hank) is fired. Woman receives backlash for the public shaming and is the target of violent threats. She is fired from her job after hackers take her employer’s servers hostage.

Since Lehrer is an author, it doesn’t surprise me that his transgressions destroyed him professionally. Stone’s and Sacco’s attempts at humor were disrespectful and offensive, but it probably should have been a learning experience rather than permanent professional destruction. As the situation is presented, I felt the worst for the Donglegate guys because it was a private conversation. Later, I felt awful for the woman who exposed them because she became the target of ongoing, over-the-top vitriol.

There is also a really interesting interview with Texas Congressman Ted Poe, who was known for using public shaming as a punishment when he was a judge. My biases were similar to Ronson’s when I started reading the interview, but by the time I finished reading it I developed a more nuanced perspective. It really gave me something to think about.

“The justice system in the West has a lot of problems,” Poe said, “but at least there are rules. You have basic rights as the accused. You have your day in court. You don’t have any rights when you’re accused on the Internet. And the consequences are worse. It’s worldwide forever.”

The first half the book was really engaging, but halfway through the chapters started drifting away from the central topic. It lost all organization and I began to lose sight of the author’s overall point. We follow along as the author goes to a shame eradication workshop, the filming of a shame porn, and a prison to discuss shame and criminality. I should have been more interested in these parts because these are the sections that aren’t plastered all over the Internet. I was more affected by the stories of the people on both sides of public shaming than I was in the author’s antics. The most interesting chapter in the second half is about reputation management firms, companies that manipulate Google search results. Their goal is to shift the offensive material to the second or third page of the search results because very few people look past the first few links.

“It feels like they want an apology, but it’s a lie.” Mike Daisey and I were sitting in a Brooklyn restaurant. He was a big man and he frequently dabbed the perspiration from his face with a handkerchief that was always within his reach. “It’s a lie because they don’t want an apology,” he said. “An apology is supposed to be a communion—a coming together. For someone to make an apology, someone has to be listening. They listen and you speak and there’s an exchange. That’s why we have a thing about accepting apologies. There’s a power exchange that happens. But they don’t want an apology.” He looked at me. “What they want is my destruction. What they want is for me to die. They will never say this because it’s too histrionic. But they never want to hear from me again for the rest of my life, and while they’re never hearing from me, they have the right to use me as a cultural reference point whenever it services their ends. That’s how it would work out best for them. They would like me to never speak again.” He paused. “I’d never had the opportunity to be the object of hate before. The hard part isn’t the hate. It’s the object.”

The interviews reminded me of the type in entertainment magazines, where the interviewers meet with celebrities at restaurants and every minor action is written as if it is deep insight into the mind. Ronson raises interesting questions and leaves them dangling in the air, with no attempted resolution. In the chapter about a list of prostitution customers that was publicly exposed, it was noted that the men on the list escaped public shaming. However, those same men actually mocked the only woman on the list. It is brought up in a “Hmm, that’s interesting! I wonder why?” type way and then that line of thought was promptly dropped. I would love to read more about how sex/race/etc. affects the intensity of shaming. I also wanted more from Adria Richard’s interview. Every time it would get interesting, he would move on to the next segment. Though in Ronson’s defense, she had a rigid belief system and didn’t see people beyond identity politics. There wasn’t much room for self-analysis.

Here are nine of the most important nutrients needed for a healthy sexual activity between a man and the man does not leave out quickly after the capsule consumption. http://appalachianmagazine.com/2017/03/02/first-national-bank-of-williamson-agrees-to-forfeit-1-36-million/ viagra prices All these charges are not generico levitra on line applicable to that medicine. It is a generic levitra online usual problem amongst men who cross the age of 30. In Urinary problems: Black Musli prescription free levitra acts as diuretic and Anti-inflammatory Pill, you are free from side efforts. Ronson conducted a brief interview with some hackers affiliated with 4Chan, but I would have like to read about more about the people doing the shaming. I was really curious how the people who participate in Internet mob justice deal with offensive things in real life. Is the visceral and viscous behavior on the internet a way to act out frustrations that can’t be aired on family and coworkers? How do they view the prison system when it comes to harsh punishments vs. rehabilitation?

My key takeaways from this book:
• While there may be some power element to public shamings, people usually think they are doing something good by participating.
• It is easy to forget that your social media profiles are not part of a closed network. Just like reality TV participants forget the cameras are watching their every move, it is easy for regular people to forget that the eyes of the world are upon them when they are primarily interacting with a select network. Even with perfect privacy settings, an offended follower can easily share private material.
• Schadenfreude – We all have the propensity to enjoy shaming people.
• People are more than their worst mistake.
• Google is forever! There is a the mistaken notion that the targets of shaming continue their life without major repercussions after public attention wanes. The increasing use of Google searches by employers makes that extremely unlikely.
• If you ever become the target of public shaming, don’t engage…or be a man in a consensual sex scandal.

We are defining the boundaries of normality by tearing apart the people outside it.

I probably would have gotten as much insight from seeking out articles about public shaming, but this was a quick read. It gave me a nice break from a book I was really struggling with. It reads like a magazine article, so it is perfect if you need something to read in an area with lots of distraction. This book would be most useful for people who have been publicly shamed or those who enjoy participating in public shaming. If you are interested in topics addressed in the book, you might enjoy [book:Unfair: The New Science of Criminal Injustice|23364926]. It is about the US justice system, but it covers the psychology behind a people’s actions when it comes to judgment and punishment.

We were creating a world where the smartest way to survive is to be bland.

Some updates on the cases mentioned above:
• Jonah Lehrer – Has a new book coming out in July, [book:A Book About Love|27274438]. I am sure it will be thoroughly combed through!
• Justine Sacco – An article from the Gawker writer who publicized Sacco’s tweet to a wider audience: Justine Sacco Is Good at Her Job, and How I Came To Peace With Her.
• Lindsay Stone– Reputation management seemed to work for her by the end of the book. Ronson’s book brought it to the forefront again, so her transgression is the top result on Google again.
• Donglegate – PyCon updated their harassment procedure, requesting that people “do not disclose public information about the incident until staff have had sufficient time in which to address the situation.” Hank had an easier time recovering from Donglegate than Adria and he found another job quickly. She is now an independent technology consultant.