Maslow's Hierarchy of Disease

     

      I'm going to preface this by saying, I am not a front line nurse.   I've been a recovery room RN for 21 years and I'm in a fairly low risk sector of healthcare right now.  I work in an ambulatory surgery center and as a clinical instructor for a local college.  However, I have family members on the front line and I have colleagues I care for deeply on the front line.  In April, at the height of wave 1 I traveled to New York and cared for a friend who had a lung transplant 2/29.  Instead of going to a rehab center and risking Covid, she came home and I was her rehab nurse.  I was the traffic cop at the door for the repairmen making structural changes to her home to accommodate her needs--sanitizing the heck out of everything constantly.  I was the meal prepper, wound care, PT nagger--and miraculously my friend is doing great now.   I've been following the science, and am involved with screening patients prior to surgery.   So now you know the background it brings me to our subject-- Maslow. 

     Have you heard of Maslow's Hierarchy of Needs?  Twenty -six years ago in my first day of nursing school I sat in a lecture hall learning of this concept for the first time.  We all know it instinctively.  We know a kid cannot go to school and accomplish any meaningful learning on an empty stomach--so we say, "Breakfast is the most important meal of the day", and as a society many schools have even made provision for students to get their bellies full before they dive into the books.  Makes sense, right? 

    When  I stared at Maslow's triangle for the first time, I never imagined how much it would guide some critical practice decisions--but here we are.  The blue zone--the basic stuff we all need first in order to accomplish anything else is a safe place to live, food, shelter, clothing.  Advancing career, education, innovation, creativity, family connection--all of it gets put on hold until those things are accomplished.  

 

     As we are today, the US is sitting at about 100,000 new Covid cases daily and climbing. We are approaching critical mass of exponential growth of cases.  I saw a map today that was all red, bar one lonely Midwest state doomed to be swallowed up soon.  There's a new doctor in the Whitehouse-- Dr. Scott Atlas, a neuroradiologist.  That's great if you have had a stroke and need someone to read your MRI--but he is not an expert on viruses and infectious disease.  That's why we have Tony--but apparently they have a muzzle on him these days.  But I digress, having a neuroradiologist from Fox news at the upper echelon of the pandemic response is like having gynecologist intubate you.  They may have read about it in medical school and tried it on a manikin,  but they are not experts on the subject and really have no business dabbling.  That's the other thing I learned the first day of nursing school--know what you don't know.  Otherwise you are dangerous--which is why we consult experts.  

     Most of my life I have generally voted Republican, fairly conservative with a strong Independent streak.  But this year is different.  My fellow Americans----we will be stuck in the blue zone until this virus is under control and contrary to White House tweets we are not rounding the bend.  We are ballooning the curve.  You may think it's just a flu.  You may even think masks are a government conspiracy to take away your freedom.  That's for another blog.  However, there are 220,000 dead Americans in 8 months so we don't get to have nice things like normal school, normal work, low unemployment, unhindered weddings, family gatherings without the consideration of illness, and a multitude of other things until we have a handle on this.  

     Other countries have done it but we missed our chance.  We should have emerged from lockdown with national mask guidance and we didn't.  We had all summer to get it right but there were too many people on rabbit trails of conspiracy and infringement of rights to realize we all just want this to be done.  No one wants it to be done more than the front line workers, especially frontline workers who are now having to homeschool or remote school their children.  They are tired and they are fighting two battles.  The first is the daily battle to care for the ill.  The second is the uncooperative public who suddenly has become an expert on Hydroxychloroquine from a Facebook course they took on the subject. The mass dismissal for basic science is boggling. 

     So how does a life long Republican/ Independent voter suddenly feel compelled to write a blog about voting for Biden?  Maslow's Hierarchy--we have an unmet need for safety as long as this pandemic is spiraling out of control.  Who will listen to experts?  Who is humble enough and collaborative enough to build consensus and have a plan?  Right now we have 50 separate plans with states competing for PPE.  This is a national problem.  There has not been a coordinated national response.  If your house was on fire you would not instruct each of your children to just figure out how to get to safety on their own.  The stakes are too high and safety is involved.  No--you make a coordinated, and clear plan from the top so everyone would be as safe as possible. Our current administration doesn't even recognize there is a problem--never mind have a plan to get us out.  This week news from the White House bragged about Covid being under control on a day when a new case total record was announced. The unmasked Trump rally train and the continual tweets of disinformation underscore the man does not have a grasp on this.  Meanwhile every reputable infectious disease doctor is desperate for him to just listen to the experts.  The arrogance is deadly.  

     I want my young adult children to be able to get on with their schooling and career plans which have been put on hold.  I want normal family gatherings and restaurant dates.  I miss vacations.  I miss normal. But what I miss even more is respect for science and those who dedicate their life to medicine and caring for others.  Those who have the most disdain may very well find in the coming months they are in need of an expert.  All I can say is I hope you don't have to get intubated by a gynecologist because the surge is coming and we do not have infinite resources.

     On Tuesday, vote like your family's health depends on it because it likely does.  Oh, and mask up, wash your hands and take care of each other--and pray.  It's the only way we are getting out of this mess. 

                                                                    Kimberly Mihelich RN BSN CPAN, MSN Student                                                                 

Of Olives, Pandemics, and Purpose and Making Good Salad Dressing

     It's been awhile since I've written.  All my life I have used writing to work out emotions. Most of it is archived in a hard drive somewhere never to be accessed again--the act of writing it accomplished the purpose.   Some people bake and knead dough to press their fear and frustration into kinetic energy.  I type.
     So here we are in our own little corners at a time like none other, as a pandemic sweeps across our big beautiful world.  Overnight some have lost jobs and become homeschool parents.  Others with pre-existing medical conditions have recoiled in fear knowing their risk is higher and they are more vulnerable.  Unfortunately other people are having play dates and hoarding toilet paper.
     The underlying current for shutting down an education system and an economy is really ….human.  As a nation we are trying to protect our vulnerable, elderly, and immunocompromised.  Now individually we are not all buying in.  I see you...the rule breakers.  But as a matter of national  policy for at least this brief time we have taken decisive action that our most vulnerable, fragile, elderly, and sick citizens are precious to us.  And that my friends, gives me hope.
     I find it ironic during this time I was charged by my women's group at church to develop a lesson on "Suffering Prayerfully".  You know if you take on a lesson like that you're going to have to do the homework...so here I am doing my due diligence.  One of the aspects of my lesson discusses Jesus in the Garden of Gethsamane.  ( I don't want to give it all away lest I get the chance to really teach this).  I'm not very vocal or open with my faith....I'm more a live it out in silent action type--so here I am awkwardly sharing what is nagging me.
     Gethsamane was a beautiful garden at the base of a hill where an expansive olive grove was.  This garden would serve as the central collecting area where the olives would be pressed into oil. You see-- here is the thing my friends-- One does not have access to that precious, nutritious, tasty oil without the essential application of pressure.  When we had a chance to visit France last year I got to see the olive groves as we traveled. There were miles of manicured slopes of olive trees, soaking up the sun of southern France.  I even got to go to an olive oil tasting.  I was pleasantly surprised at the many different kinds of olive oil which I tasted right off the spoon, unadulterated by bread or anything else.  Sometimes they mix the older and younger fruit--allowing the olives to stay on the vine at different levels of maturity until they are pressed. They utilize different kinds of olives.  The vine tender in his wisdom and discretion cultivates, gathers, and presses the olives according to his good pleasure for different purposes. Some olives produce oil that is good for cooking.  Other oil is used for dipping bread or making vinaigrettes.  Each purpose has a different process and the vine tender knows them all.  But they all get pressed before their vital promise is released. Those little fruits don't get out of this life without getting pressed if they are to become a useful oil.
     Have you been pressed this week?  Are you living in fear because you know you are about to be pressed and you don't know how long or how painful the pressing will be?  I know I am.  But I rest in this......God, my vine tender has me.  He knows me and my family and He loves us all.  He loves you too.  You are safe in the Vine Tender's hands. When He presses you it is to release the vital riches that otherwise would not be available. He has a purpose in mind.  You are not a random olive bouncing against the millstone.  Your particular process of pressing was hand picked just for you.  This is not the first time I've been pressed and I can tell you as I approach a major decade birthday--with each pressing a new aspect of faith and character is revealed and tended.  It's not fun by any means but I see it as a necessary journey, one I've yielded to.  I've yielded to the press and ask myself these days what is it I am supposed to reap from this exercise.  When I come through this what does God want from my life?
     Tonight at dinner my oldest son sat to my right.  He was supposed to leave for school in Vermont to start studying a new trade in mid March.  He had already quit his job based on the date he was scheduled to leave--then he got the word school entry was delayed at least one month.  He's 21, frustrated, itchy to hang with friends, and uncertain about his future.  Across from me sat our middle son whose hours at work went from greater than 25 a week to 6 or less.  All of his classes are online now and he is uncertain as he studies to be a high school history teacher and a lot of his hands on practical education classes have dramatically changed.  Our youngest son is overwhelmed.  Normally a high honor student he is juggling a barrage of online material, emails, and assignments.  He misses his friends and his running buddies who were all preparing for track season.  Even my job as a nurse is uncertain as vital surgical supplies are not readily available and being diverted to other sectors of healthcare. I was to be caring for a friend in NY right now as she is one month post lung transplant--but all plans are on hold as she is in the epicenter of this pandemic and neither of us knows what tomorrow holds.  We are all being pressed in ways we never imagined, sometimes beyond comprehension and comfort on all sides.
     But there is blessing in the pressing. It's personal and it's different for each of us.  It may be momentary snippets and gems of faith but it is there. It is the painful but beautiful process that gets us to our purpose.  We only see the blessing if we are looking...and look we must.
      Around our table---all five of us gathered.  It's been a few years since we've done that regularly.  The older two boys have worked evenings, attended classes, and there were sports and meetings and work obligations.  But here we were--gathered in together socially distancing together.   There was laughter and brothers chiding each other and an overwhelming gratitude that for right now we are healthy and together.  This. Just one of the blessings in the pressing.
     Once the olives are pressed they become valuable---oh so much more valuable then when they sat in their original state.  Nothing more is added to them to increase their value.  It is the application of pressure and the time and attention of the Vine Tender that makes them valuable and useful and makes the oil available. Before the pressing that vital potential is locked away and unattainable. And so it is with us.  We reveal our best, when pressed.
     Don't despair if you are being pressed.  The way I see it is that God is just getting you ready for your true purpose.  This is not the end.  This is just a new beginning.  This moment can define you--with a Devine view of your future.
     Be safe.  Be well.  Be humble and kind but most of all....... be looking for the blessing in this pressing.