"It's a life panel..."

More here.

Update: I also blogged about this general issue last August, here.

Memorial Monday - Christof Probst

November 6, 1919 - February 22, 1943

Christoph Probst was one of the leaders of the "White Rose," an anti-Nazi resistance movement among German students in Munich. Along with friends Hans and Sophie Scholl and Alexander Schmorell (q.v.), Probst wrote and distributed leaflets condemning the Nazi regime and calling for sabotage against the war effort. After the Scholls were caught distributing the leaflets in public, they and Probst were interrogated by the Gestapo and tried by the notorious Nazi People's Court. Found guilty, they were executed on Feb. 22, 1943, in Munich's Stadelheim Prison.

from Find a Grave

photo added by M.Altinsoy

h/t Daniel Gilbert

It's actually pretty comforting

Yup, this must be the place...

I was using Google Maps the other day to locate a residential hospice. The address on file included Street View, so I zoomed in for a closer look.

A bunch of theories

The correct answer is "nine."

I’m very much looking forward to a couple of upcoming events – specifically the AAHPM/HPNA Annual Assembly in Boston, and my next online grad school course.

I’m only attending the Assembly on Friday, but it promises to be an active day with an early start, a late finish, and a chosen emphasis on the intersection of end of life care/nursing education with social networking technology.

With regard to my next online course, I’m not sure if I’ll be signing up to start in early April or early May. But it’ll be on theories and conceptual models. I like that kind of head work, and am completely up for it.

I’ve been attracted to several models and theories over the years, and have incorporated them into my evolving practice with varying degrees of success. The course will be an opportunity to explore them in greater depth, as well as a chance to learn about others.

The following theories and models resonate with me for different reasons, and they appear in no particular order:

Robert Altemeyer’s work on authoritarianism is a useful way to examine and understand the motivations and behaviors of people and groups. Altemeyer has identified the characteristics of people who need to be told what to do, and who approach life’s challenges in very stark, explicitly black/white terms. Rules are not just important for such people, who he describes as ‘authoritarian followers,’ they’re essential. Altemeyer also looks at those who exploit these followers, calling them ‘authoritarian leaders.’

Robert Hare’s work on psychopathy is as chilling as you might imagine. Psychopaths aren’t nice people, but unfortunately they’re out here in the real world, and they’re out here in surprisingly large numbers.

I’ll spend more time applying the work of both to the nursing profession. At best, I believe it’s important to understand the extremes, if only to better understand the milder pathological forms we encounter. That said, my professional path has most certainly crossed with colleagues whose actions and attitudes more closely fit Altemeyer’s and Hare’s prototypes.

A professor of nursing at a local undergraduate program has done work on the hostile workplace and bullying behavior in nurses. That’s another topic of great personal interest, and this professor’s publications have directed me to several theorists whose works form a good foundation for exploring the phenomenon. For starters, I’ve just ordered Behind the Mask, by Dana Crowley Jack a book that explores violence and aggression in women.

This focus also leads me to the broader field of feminist theory, and to Jo Ann Ashley, author of Hospitals, Paternalism, and the Role of the Nurse.

I think Richard Schwartz’s Internal Family Systems model is a useful framework for understanding our own psychodynamics. I think it also has value for approaching and developing relationships with colleagues and patients.

I recently stumbled upon the Tidal Model developed by Poppy Buchanan-Barker and Phillip Barker. Wow. I’ll be poking around with this one for quite some time.

Finally, in a post here last November I pointed to Human Relationships at the End of Life: An Ethical Ontology for Practice by David Wright, Susan Brajtman, and Vasiliki Bitzas. Their basic message is useful without further explanation, namely that we can be confident of having a sound ethical foundation for our decision making if we engage with patients on the basis of a compassionate relationship. But I welcome the chance to dig more deeply into this thought.

Not just about a fish

John McPhee is one of my favorite writers. His latest piece in the New Yorker's February 8th issue has already been archived, so if you don't have a subscription you'll need to snag the copy at your local library.

Here, he writes about the pickerel, a fierce freshwater fish that I also used to catch at the small pond in Hudson, New Hampshire where my uncle had a camp. I didn't like eating fish much as a kid - except for hot, greasy chunks of deep fried battered haddock.

Catching fish was another story, and I'd go after all of them with enthusiasm.

Pickerel aren't very active in the summer, when we usually fished at night for horned pout. But we always caught pickerel on the tip-ups we set in holes dug through the ice.

McPhee weaves his recollections about fishing for pickerel with those of his father's death from a stroke. The elder McPhee was a physician, and the author writes of the family's first encounter at the hospital bedside:

I was startled by the candor of the doctor. He said the patient did not have many days to live, and he described cerebral events in language only the patient, among those present, was equipped to understand. But the patient did not understand: "He can't comprehend anything, his eyes follow nothing, he is finished," the doctor said, and we should prepare ourselves.

Wordlessly, I said to him, "You fucking bastard." My father may not have been comprehending, but my mother was right there before him, and his words, like everything else in those hours, were falling upon her and dripping away like rain. Nor did he stop. There was more of the same, until he finally excused himself to continue on his rounds.

About that paper...

OK, so it came down to using either this image, or one featuring that unfunny cable-guy redneck comedian dude. Call me elitist.

Anywhoozle, with regards to the APA-formatted research paper that I've groused about a couple of times - I finally got the freakin' thing done.

It's about blogging. If you read it, you'll learn the origin of the term innertoobz, and be introduced to my unified theory of blogging.

Powerful stuff.

Someone's story - The man on the bench by the sea

Seaside bench

from johngpson's photostream at flickr

The first continuing education program on palliative care that I ever attended was held at the Beth Israel Medical Center in Boston, in 2003. I don't remember how I heard about it, but it was a day-long program, and there was no cost for me to attend other than $20 or so to park my car. I even got lunch.

Most of the people there worked at BI, or at one of the other nearby hospitals. I think I was the only man, and one of the few there who didn't work in oncology. I was doing outpatient hemodialysis at the time, and it was that clinical experience that really sparked my interest in end of life care. I've always thought of hemodialysis as the ultimate form of palliative care - it doesn't cure end stage renal disease, it just addresses the consequences and the symptoms of that fatal illness.

I don't recall making very good connections with those colleagues at the time, but I don't know if it was due to my being a stranger among people who knew each other professionally more closely, or my own social awkwardness.

The following year, I signed up for the first Art and Science of Palliative Nursing course developed through the Harvard Medical School's Center for Palliative Care, which has been offered annually ever since. That was when I knew that I had found a group of like-minded colleagues, and when I knew I wanted to work and learn among them. I haven't looked back since.

There's just something about the character of nurses who've chosen this work that resonates with me. Maybe it's the level of maturity, or the shared acknowledgement and acceptance of our mortality. I've found that nurses in this field don't have the kind of need to prove themselves, or to outshine or even put down their colleagues, in ways that nurses in other settings can sometimes display and sadly act upon. It's like everybody working in end of life has finally figured out what's really important. I don't know.

But there you have it.

One of the things I like about this work is the role narrative plays in end of life care. Everyone who works in it seems to not only have a huge collection of stories, but also the eagerness to share them, and the ability to recount them so compellingly.

Here's a story told to me by a nurse who manages a residential hospice and home hospice service in an oceanside community:

The nurse had come to speak about bereavement to a church group, and while there several people told her that one of their members had recently lost his wife. They said that he had become very withdrawn, and had resisted all of their attempts to reach out to him. He spent many hours of every day simply sitting on a bench across from the church, looking out at the sea. She saw that he was sitting there even as they spoke. They asked the nurse if she could go over and talk with him.

She didn't think that was a very good idea, and instead soon placed a call to one of her agency's social workers. She described the situation to her colleague, and gave her the location.

The following day, the social worker happened to be walking her dog in that area. The man was sitting on the bench. The social worker stopped for a minute, sat on the bench to re-tie her shoes, and resumed her walk.

Since she needed to walk her dog at the same time every day, she continued to use the route that brought her by the bench. Each day the man was there. Sometimes she stopped, and sometimes she didn't. Sometimes she sat for a moment, at other times not. She always looked towards the man, and when their eyes met she silently acknowledged him. A week or two passed.

Finally, one day she sat at the other end of the bench, looked over to the man, and said hello. "It's a beautiful view from here, isn't it?" she asked him. "Yes, I like it," the man replied.

"I often see you here when I'm walking my dog," the social worker continued. The man said nothing, and they both sat silently for several minutes before she got up and continued her walk.

This continued for several more days, with the man and the social worker simply exchanging nods or brief greetings when they met.

One day while sitting together in this way, the man reached over and patted the dog. He then began to talk about his wife, and how they would often walk together along the ocean-edge path. He told the social worker that be missed his wife very much.

It's not my story, but I know it's true.