April, 2006 Archive

April 30, 2006, 3:51 pm

When Every Word is a Struggle – Blogging Against Disabilism

roundish.jpgShe was born ten days late.

Nearly two feet long and almost nine pounds.

In retrospect, I’m sorta glad she was a C-section!

And she was perfect.

Except that she looked like an orangutan, according to her grandmother.

Her soft blond hair stood straight up until she was eleven months old.

Good thing afros were the style back then, because I think she was the only white baby I’ve ever seen with one.

She walked at nine months.

She could point out the individual Bee Gees by name at 18 months (hey, I have my parental priorities!).

Healthy, beautiful (don’t believe what her grandmother said) and the smartest baby in the world. Not that I was partial or anything.

My daughter, Lillian, is now 25 years old.My regular readers will remember her as the child who presented me with my dermoid cyst grandchildren, Barry and Bridget a few months ago.She is tall, blond, model-thin and gorgeous (I’m still not biased, as you can see.) She works in public relations for the city of Portland, Oregon.

She works with the public everyday, talking on the telephone, greeting office visitors, arranging sales, working with her managers.

She even interviewed for a job that would mean coordinating conventions and meetings for the city, providing even more opportunities for working with the public.

And she has stuttered continually since she was two-and-a-half years old.

Stuttering, or dysfluency as it is also known, is rare in females. The ratio of males to females is 4:1. There is no known causation (although theories abound) and there is no cure.

Water.That was the first word.When Lillian would say it, it came out as “wa-wa-water”.

No biggie. It isn’t unusual for toddlers to go through a period of what appears to be stuttering when they first learn to talk. It’s harmless. It’s transient.

For Lillian, it never stopped.

“Oh, she’ll grow out of it”, her pediatrician told me. Visit after visit. Year after year. “She’ll grow out of it.” Grandparents expressed concern. Aunts and uncles expressed concern. “Oh, she’ll grow out of it, that’s what the doctor said!”, I reassured them.

She still stutters.

She has lived with taunts and laughter, like when we were on a cruise and she tried to order a hamburger. The waiters laughed at her and mocked her speech. When she answers the phone, it sometimes takes her 10-15 seconds to say a single word. People would hang up thinking there was no one on the line. She could not say her name without going through facial contortions and repetitive syllables.

Speaking in front of the class was torture. And this was in a supportive, Catholic grammar school and high school with kids who had known her since she was five and where ridicule was not tolerated under any circumstances.

Public school would have eaten her alive.

When evaluated at the age of seven at the Speech and Learning Center of the Children’s Hospital, Oakland, they asked her to draw a picture of herself.

She drew a crying clown. At the age of seven her self image was already taking the brunt of the stuttering backlash.

Oh, we did speech therapy, off and on. Lillian hated it and hard a hard time complying with the exercises. All speech therapy can do is give you tools to use and she felt even the tools made her talk differently.

All she wanted was to be able to talk.


She has used the new earpiece device that gives feedback as you speak (actually works with the developer of the device), which helps with fluency. It’s better, but not a cure.

Lillian gave me permission to blog about her experiences with stuttering.

I wish I could have asked her to “guest blog” how debilitating this was and is for her. I’m feel I’m not getting across how the inability to communicate normally can be so devastating to a life and a person’s self esteem.

Like it was when she was seven, externally Lillian seems like she has a charmed life. She graduated from college (with honors), has never had a dearth of boyfriends (who never seemed to mind the stuttering), and ironically, works as intimately with the public as you can!

But she never knows if she loses a job interview, if it was her speech that held her back. If she’ll be fluent or not each time she answers the phone.

Every time she opens her mouth to speak, she doesn’t know.

And it hurts.


Lillian has a speech disability.It’s not visible.She doesn’t need special equipment to walk or move. Or a disabled placard.

But it is a disability just the same.

She says no one really understands how disabiling stuttering is, despite her high-profile job.

I understand.

Who knows if she has even experienced discrimination, no one tells you they aren’t hiring you because you stutter. She could have easily taken a job in a back corner and hidden herself from the world and the need to communicate.

Instead, she has tackled life head-on and puts herself out in public every day. Stuggling with what the rest of us take for granted: communication.

Does that make her a hero?

You’re damned right.

People with diabilities do it everyday of their lives.

She is an inspiration.

And I am extremely proud of her.

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1:11 pm

Diversion Aversion

chest x-ray

“Oh yes, doctor. That is so much better! You see, Billy is so ugly that we couldn’t possibly have put a picture of his face in the yearbook! This picture of his ribcage is much more appealing! Thank you so much!”

Billy: “Yeah, wait until the guys get a load of my widened mediastinum! That’ll show them!”

It looks like they had three-dimensional chest x-rays back then!

If x-rays were that good, even I, one of the radiologically challenged, would be able to read them!

Trust me, if I can see something wrong on your x-ray, you are really sick!

Ambulance diversion.Does it really help emergency department overload?

In the counties I have worked, the emergency departments are allowed to go on “ambulance diversion” status.

This means that anytime the ED cannot safely handle any additional patients, based on specific criteria, they are able to divert ambulance traffic to other area hospitals.

That “specific criteria” usually means one of two things:

  • You have no monitoring capabilities as you have every monitor tied up with a patient who requires it.
  • You ED has maxed out its resources and cannot safely handle another patient. For example, your ED has monitors available, but you have three critical patients in cardiogenic shock and all available staff are required to care for these patients until they can be transferred to the unit.

Lack of staff and/or lack of critical care beds are not, for example, criteria for diverting ambulance traffic.

The status of any particular ED is visible on a county-wide monitoring system; a computer resides in each ED.

(You can also signal the county if your CT scanner is down: patients with head injuries and possible strokes will automatically be diverted.)

Some counties have restrictions on how many hours you are allowed to be on divert in a 24 hour period, some have limits on how many consecutive hours are allowed.

Others have no restrictions, but keep track of the different hospitals and evaluate how much time they spend on diversion.

Too much time on diversion is a no-no.

But what exactly does it accomplish?

  • Well, it might keep elderly, altered and septic patients from nursing homes from arriving by ambulance.
  • It will keep the ambulance-for-the-stubbed-toe folks from arriving.

And that is about it.

  • If you are in cardiac arrest, you go to the nearest hospital, period! Diversion means nothing at this point. Even if you don’t have a monitor and have to perform resuscitation in the hallway, that patient is coming and you will find the means to deal with it.
  • If the paramedics are going Code 3 (red lights and siren) they will come to your hospital. You don’t question the medic’s decision – it is their call. And it should be. You must accept Code 3 traffic at all times. It means the patient is critical.
  • On both sides of the San Francisco Bay, there are hospitals 5-15 minutes apart all down the highways. If two hospitals in a row are on diversion, then neither of them are on diversion, because it would mean passing up two hospitals for care.
  • Diversion does not stop:
    • the walk in MIs
    • the patients with pulmonary edema
    • the decompensating asthmatics
    • the suicidal overdoses
    • the trauma patients laying in the back of their friend’s truck
    • the patient with the CVA whose family managed to get them into the car despite the paralysis of their entire left side.

You get the picture. In addition:

  • Patients who have an HMO plan and are transported to non-HMO hospitals because of diversion have to deal with extra paperwork to make sure their hospitalization is covered or have to deal with the extra trauma of being transferred for admission to the hospital that was diverting at the time of their call to EMS.
  • Some hospitals in our area are well known for certain specialties and patients often request facilities for that reason; requests that cannot be accomodated if the facility is on divert.
  • A patient may be diverted to a facility where their regular doctor does not have admitting privledges, especially distressing if the doctor was planning on meeting the patient at their usual hosptial.

Some of my worst shifts have resulted not from ambulance traffic, but by the acuity and number of walk-in patients to the department.

So while it may be psychologically comforting (and it is) to think that you will not be receiving ambulance traffic, diversion can cause distress to patients, put pressure on the medics in the field and you can never really be sure that the Code 3 ring-down isn’t just a second away.

Ambulance diversion just gives the illusion of control, something that you never get in emergency departments.

It’s the nature of the beast.

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April 28, 2006, 3:34 pm

The Office of National Nurse



A national spokesperson for the nursing profession,to be created by the United States Congress.

A Registered Nurse in an offical government position to represent nursing to the public, deliver weekly speeches promoting health education and the nursing perspective while focusing national attention on the nursing profession.


Volunteer National Nurse teams responding in times of crisis, or helping to deliver health education to the public.

You may not have to imagine for much longer.

What started as an op/ed piece in the New York Times written by Teri Mills, an RN and Nurse Educator from Portland, Oregon has turned into H.R. 4903, a bill to create an Office of the National Nurse.

Let’s add our voices to the many who have already supported this new representation of our profession.

Visit the National Nurse web site for information.

And check out the totally cool “store” where your purchase can help fund the passage of this bill (do I sound like I live with a teenager or what?). Teri makes it easy by giving you easy access to your representatives and ideas on how to facilitate the ongoing efforts to pass this bill.

Keep up with the latest by subscribing to the free email updates put out by the National Nurse team.

Is your representative in support of H.R. 4903?

Now please excuse me while I take my own advice and go show my support….

Read »

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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