Toad in the Hole

August 13, 2006

Personal History

Scene-setting: I worked as an LVN after getting my license via a government-sponsored employment-training program (CETA, which no longer exists) in, oh, 1975 or '76. I spent most of the years between then and late 1983 working part-time (because everyone should work "part"-time!) at Children's Hospital in Oakland.

One minor story from my checkered past in medical practice:

We, like many professionals, had to take continuing-education classes to keep our licenses current. The hospital ran some of those, some for RNs and LVNs together; one I took was an ethics short-course. This would have been about 1979.

During the class, the inevitable burning question arose, especially from those of us who worked in the Intensive Care Nursery. Technically, I was a "floater," but I'd evidently shown some competence so I was in the ICN most of the time. Come to think of it, that's where I was when they'd first hired me away from the registry. The question: We're spending upwards of a million dollars on some of these babies, and so many of the problems that brought them here are preventable. Why on earth doesn't society spend a tenth of when we spend here on simpler things like real education, more available good nutrition, ways for girls to escape bad family situations? (It seemed that rather a lot of our patients had the same person as father and maternal grandfather, and/or were premature because of violence done to their mothers.) The government ends up paying for a lot of what we do here anyway, of course; it's way beyond most people's means and insurance, whatever their class. Why can't we spend a fraction of that in prevention?

Well, I thought about that over the lunch break, and when discussion arose that afternoon I ventured a speculative answer. One thing, I said, might be economies of scale. The equipment and supplies we used were outrageously expensive, and would be more so if they couldn’t be sorta-mass-produced and marketed. Also, education and shelters and distribution of good food wouldn’t add so much to the Gross National Product as all the hefty salaries and supply purchases that came out of the way things actually were being done. So, in a sense, those sick ghetto babies were filler, or a kind of contemporaneous guinea pig, for the babies of other classes who would need our services at unpredictable rates and times.

I didn’t get shouted down for that exactly, though of course there was vigorous discussion… Hmm, actually I remember shocked silence and then a general switch of topics, and then vigorous discussion of the new item.

But some of the nurses there, RNs who had evidently pushed to hire me a few years before and told me they felt good and reassured when I was on-shift and who I’d considered good friends, who’d lent me rides home when I didn’t have a car and to Siggy’s annual Christmas parties and shared lunches and gone out for a post-shift drinks – some of them stopped speaking to me after that. Believe me, in such an atmosphere of stress and crisis and general pain, that hurt. One needs social support to bear it. And, typically, it took me forever to figure out what was going on. I’ve always been remarkably slow on certain social cues.

Bear in mind that I hadn’t said "you"; I’d always said "us" because that was the way I saw it. I didn’t see us as dupes, but as people doing damned well under circumstances we hadn’t made. And I’m not blaming them either, really. While some of us shared annoyance with certain colleagues who seemed always to behave as though they were on one of those medical-hero TV shows – I’d said something once about almost being able to hear the theme from "Medical Center" leaking out of someone’s ears as she worked, and I got appreciative laughs for that; I’d articulated what was bugging her co-workers about her – we all needed to feel heroic sometimes or we’d collapse in a heap. Hospital medicine is run to a great extent on the numbing and energizing effects of internally generated epinephrine. How can you do that stuff for weeks, months, years on end without convincing yourself at least sometimes that you’re being a hero?

And of course you are one, at least some of the time. What I was trying to say, the idea I hadn’t yet fully formed or communicated, was that our heroism was being as used-up as the kids’ unnecessary suffering. But the idea that it wasn’t all really necessary or inevitable, that we were being jointly betrayed by people and the structures they’d built out of short-sightedness or greed or whatever inertial process makes societies, was too corrosive to bear. I think I understand it, but man, it hurt.

As I recall, it was pretty soon after that that I took a six-month hiatus so Joe and I could drive around the country chasing birds. When I returned, I was on a different shift, and assigned to a different floor. I still floated to the ICN sometimes, because no one else on the floor was willing to and they’d ask me to when that came up, and I was fine with it. I don’t recall being made to feel unwelcome there either, so I guess half a year was time enough to forgive and/or forget.

Posted at August 13, 2006 04:22 PM


I tried commenting on this the other day but had trouble. Now of course I can't remember what I was going to say. I'm certain it was very pithy. :)

I wonder if those people stopped talking to you because they thought you were right or because they thought you were wrong?! People are funny.

Posted by: Rurality at August 17, 2006 12:16 AM

i really love CHO. was a volunteer there in about 1983 -- i'd go play or read or hold kids. and my own kids spent a few stints in ER for various emergency injuries, and my son's asthma. and -- this was where my adopted nephew was treated so well as he struggled with brain cancer.

i think you were right about prevention, then and now. i hope things have moved more in that direction, but am not confident they have moved much in 30 plus years -- just don't know.

i do know that social changes benefitting poor people happen slowly, and in fits and starts, and they don't happen at all without many, many people standing up and telling the truth. that is what you did.

things like incest, malnutrition, familial violence, desperate poverty -- huge risk factors, with outcomes ranging from premature birth, to serious mental impairments, to involvement in the criminal justice system -- are factors that can be ameliorated if not prevented by decent policies and some resources. nobody can seriously think otherwise.

there don't seem to be enough ways to patch together solutions. places and people who could make a real difference to many people -- they just somehow don't get the attention and the funding and the seal of approval that would let them do some of what needs to be done.

and sometimes even brainstorming possible solutions is too threatening. i think that's what happened to you.

in discouraging times, it is all the more important for real voices to be heard.

Posted by: kathy a at August 17, 2006 02:37 AM

Well, the way I put it, more or less as I've put it here, was pretty cynical I guess. Not that I'm saying I was wrong or anything. Still, I have friends with whom I have profound political disagreements, and it wouldn't occur to me to shun them over a statement that general. It's not as if I were saying anybody was categorically evil or subhuman or anything.

Ah well, live and learn, personal politics included.

Posted by: Ron at August 17, 2006 04:08 AM