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
