I went to bed last night inconsolable, and woke up in the middle of the night feeling the same. I had gotten some news that threw a wrench in everything that we've been working towards and had meetings with people on the front lines that just made me feel like we were preparing people to go quietly to their unnecessary deaths. Pretty heavy stuff.
I woke up somewhat refreshed and checked my email. A few folks I've been interacting with had sent me some positive feedback and information. It perked me up a bit. I was ready to move forward with another day on the battlefield of COVID-19. I spoke to my colleague and friend (and boss for that matter, for one of my only paid positions). I found out that he too had been similarly inconsolable. In his despair, he had reached out to our State Senator and made a statement that I might have made, and for which he would normally have admonished me and told me to tone down. His email got a response, and by noon we were on the phone with our State Senator and his staff.
We continue to push forward in sharing our thoughts and ideas. The day ended with a Board of Directors emergency meeting to pass a resolution that can now be used by our State Senator to push the solutions that we know to be possible. Now we'll wait and see.
Oh yes, my Skype interview with CBS National News from last week was on tv this morning! CBS Morning news.
https://www.youtube.com/watch?v=bZ7u4gowT5g&feature=youtu.be
Tuesday, March 31, 2020
Monday, March 30, 2020
One Step Further From Helping
I worry that the entrenched interests are going to win out. Nobody really seems to care what happens to a bunch of old nursing home residents. The Confluence of ageism and greed, combined with a deadly virus, will lead to the deaths of the most vulnerable members of our society.
It really hurts when you spend your life trying to help a group of people, and in the end, society don't really care.
That's all for tonight.
It really hurts when you spend your life trying to help a group of people, and in the end, society don't really care.
That's all for tonight.
Sunday, March 29, 2020
One Step Closer to the Governor
That's what I spent the latter part of my day doing.
The rest was spent arranging for expert panels to help physicians across the country.
And, I actually turned off all of my electronics for 2 hours.
The rest was spent arranging for expert panels to help physicians across the country.
And, I actually turned off all of my electronics for 2 hours.
Saturday, March 28, 2020
Facebook Surreal Post
Two days ago, I posted the following on Facebook. It's worth copying here. It's got a lot of nice responses.
It's been nearly four weeks since I heard about the Coronavirus impacting a nursing home in Washington. For the last three weeks, my life has been surreal. Because I'm a geriatrician, I've been focused on the impact of this nasty virus on vulnerable older adults. This has resulted in me speaking, texting and emailing my colleagues across the country. Because of those interactions, I've been privy to information about what's happening often before the news media. That's not the hard part. Two weeks ago, my colleagues were "holding down the fort" and trying to do their best in keeping their patients safe from the virus. Geriatricians care deeply about older adults. Over the past week, I've been privy to the despair and frustration that these incredible physicians have felt as this lethal virus has broken out. They're trying to contain it and keep their other patients safe, but it's a huge challenge. This being my specialty, I've been trying to help support them. From the moment I wake up in the morning to the time I go to sleep at night, I've been immersed in COVID19. I've been speaking to reporters and have been quoted in NBC News, the L.A. Times, and Skilled Nursing News. I did a Skype interview with CBS News today, though not sure if it aired. I've been speaking with the state government and some elected officials I know what's happening in the ICU's and the hard decisions that doctors and patients and their families are having to make. I'm seeing #Ageism combine with this virus to result in some very discouraging results. Yesterday, the Governor of New York instructed nursing homes to accept patients with COVID19, a decision not based on science or medicine. In fact, the California Association of Long Term Care Medicine, of which I am President, has said that doing this puts the lives of all nursing home residents at risk. I've come to wonder how much our elected officials care about the people that I have spent my career caring for and protecting. They are not protected now, they are vulnerable. Older adults are being isolated in assisted living facilities, nursing homes and in their own homes. I can only pray that God will step in and change the course of this virus, but that's not how it works. We are supposed to be learning something from this pandemic. I hope that we end up learning that we care about each other, that we are all one people and one country. By and large, that's what I've seen. I consider the machinations in Washington to be an aberration, I think that most Americans are better than that. I've had my moments of discouragement and have certainly had plenty of ups and downs in the past week. I'm blessed to have a wonderful family to support me and friends and colleagues around the country to draw strength from. They are my heroes. #WeArePALTC#Geriatrics
It's been nearly four weeks since I heard about the Coronavirus impacting a nursing home in Washington. For the last three weeks, my life has been surreal. Because I'm a geriatrician, I've been focused on the impact of this nasty virus on vulnerable older adults. This has resulted in me speaking, texting and emailing my colleagues across the country. Because of those interactions, I've been privy to information about what's happening often before the news media. That's not the hard part. Two weeks ago, my colleagues were "holding down the fort" and trying to do their best in keeping their patients safe from the virus. Geriatricians care deeply about older adults. Over the past week, I've been privy to the despair and frustration that these incredible physicians have felt as this lethal virus has broken out. They're trying to contain it and keep their other patients safe, but it's a huge challenge. This being my specialty, I've been trying to help support them. From the moment I wake up in the morning to the time I go to sleep at night, I've been immersed in COVID19. I've been speaking to reporters and have been quoted in NBC News, the L.A. Times, and Skilled Nursing News. I did a Skype interview with CBS News today, though not sure if it aired. I've been speaking with the state government and some elected officials I know what's happening in the ICU's and the hard decisions that doctors and patients and their families are having to make. I'm seeing #Ageism combine with this virus to result in some very discouraging results. Yesterday, the Governor of New York instructed nursing homes to accept patients with COVID19, a decision not based on science or medicine. In fact, the California Association of Long Term Care Medicine, of which I am President, has said that doing this puts the lives of all nursing home residents at risk. I've come to wonder how much our elected officials care about the people that I have spent my career caring for and protecting. They are not protected now, they are vulnerable. Older adults are being isolated in assisted living facilities, nursing homes and in their own homes. I can only pray that God will step in and change the course of this virus, but that's not how it works. We are supposed to be learning something from this pandemic. I hope that we end up learning that we care about each other, that we are all one people and one country. By and large, that's what I've seen. I consider the machinations in Washington to be an aberration, I think that most Americans are better than that. I've had my moments of discouragement and have certainly had plenty of ups and downs in the past week. I'm blessed to have a wonderful family to support me and friends and colleagues around the country to draw strength from. They are my heroes. #WeArePALTC#Geriatrics
Friday, March 27, 2020
Thursday, March 26, 2020
Four Weeks
It's been nearly four weeks since I heard about the Coronavirus impacting a nursing home in Washington. For the last three weeks, my life has been surreal. Because I'm a geriatrician, I've been focused on the impact of this nasty virus on vulnerable older adults. This has resulted in me speaking, texting and emailing my colleagues across the country. Because of those interactions, I've been privy to information about what's happening often before the news media. That's not the hard part. Two weeks ago, my colleagues were "holding down the fort" and trying to do their best in keeping their patients safe from the virus. Geriatricians care deeply about older adults. Over the past week, I've been privy to the despair and frustration that these incredible physicians have felt as this lethal virus has broken out. They're trying to contain it and keep their other patients safe, but it's a huge challenge. This being my specialty, I've been trying to help support them. From the moment I wake up in the morning to the time I go to sleep at night, I've been immersed in COVID19. I've been speaking to reporters and have been quoted in NBC News, the L.A. Times, and Skilled Nursing News. I did a Skype interview with CBS News today, though not sure if it aired. I've been speaking with the state government and some elected officials I know what's happening in the ICU's and the hard decisions that doctors and patients and their families are having to make. I'm seeing #Ageism combine with this virus to result in some very discouraging results. Yesterday, the Governor of New York instructed nursing homes to accept patients with COVID19, a decision not based on science or medicine. In fact, the California Association of Long Term Care Medicine, of which I am President, has said that doing this puts the lives of all nursing home residents at risk. I've come to wonder how much our elected officials care about the people that I have spent my career caring for and protecting. They are not protected now, they are vulnerable. Older adults are being isolated in assisted living facilities, nursing homes and in their own homes. I can only pray that God will step in and change the course of this virus, but that's not how it works. We are supposed to be learning something from this pandemic. I hope that we end up learning that we care about each other, that we are all one people and one country. By and large, that's what I've seen. I consider the machinations in Washington to be an aberration, I think that most Americans are better than that. I've had my moments of discouragement and have certainly had plenty of ups and downs in the past week. I'm blessed to have a wonderful family to support me and friends and colleagues around the country to draw strength from. They are my heroes. #WeArePALTC#Geriatrics
Wednesday, March 25, 2020
Surreal
I'm in the L.A. Times. I'm talking to reporters. I'm speaking to colleagues around the country. I've got elected officials calling me. I'm interacting with people one step away from the Governor. None of that matters. People are dying. My friends and colleagues are in despair. Governmental officials are suggesting that older adult sacrifice themselves for the good of the economy. Governors are making decisions without all of the facts. This is surreal.
Tuesday, March 24, 2020
Monday, March 23, 2020
A Better Day
I was going to entitle this blog "A Good Day," but that's really true under our present circumstances, so I chose, "A Better Day." I finally talked to a number of people that I'd been reaching out to. Hopefully, we'll see some differences made because of my discussions. Who knows? Not a long blog today, but a lot accomplished. Time to go to bed.
Sunday, March 22, 2020
No More Blogging Left in Me Today
Started my day around 6:30am. It's 9:30pm and I'm done:). Putting my computer down.
Saturday, March 21, 2020
Harnessing My Passion
I lost it today. I was speaking to someone, and I lost it. I also got in the circular "listen to me" argument. Anytime I was trying to say anything, even a few clarifying words, I got "listen to me." I've encountered this a number of times over the years, typically with bullies. I can't think of one time that I've ever had to tell someone that, even if they're the one doing all the talking. So, I lost it. I lost my temper.
Fortunately, I've been in these situations before. The best thing to do is apologize and then let the other person talk. That's what I did. The worst part about losing ones temper is that it's just not healthy. I didn't feel good afterwards, and these days you don't want to do anything that makes you feel physically uncomfortable.
I've always struggled with harnessing my passion. It's a lifelong challenge. Fortunately, that same passion has been very effective for getting people who believe in what I'm advocating for to follow me. On the other hand, if someone doesn't believe in what I'm saying, that passion can be very off putting.
Sweet and sour. Yin and yang. Two sides of a coin. Passion can bring both. The challenge continues. Let's see what tomorrow brings, this is something I'll continue to write about and ponder.
Fortunately, I've been in these situations before. The best thing to do is apologize and then let the other person talk. That's what I did. The worst part about losing ones temper is that it's just not healthy. I didn't feel good afterwards, and these days you don't want to do anything that makes you feel physically uncomfortable.
I've always struggled with harnessing my passion. It's a lifelong challenge. Fortunately, that same passion has been very effective for getting people who believe in what I'm advocating for to follow me. On the other hand, if someone doesn't believe in what I'm saying, that passion can be very off putting.
Sweet and sour. Yin and yang. Two sides of a coin. Passion can bring both. The challenge continues. Let's see what tomorrow brings, this is something I'll continue to write about and ponder.
Friday, March 20, 2020
A Silent Assassin
COVID-19 can be a silent assassin when it comes to frail older adults. The Washington nursing home which became ground zero for the virus in the United States, "had patients who, within an hour's time, show no symptoms to going to acute symptoms and being transferred to the hospital...die relatively quickly under those circumstances." There's been talk in the last day of the possibility of using some old fashioned medications, hydroxychloroquine and azithromycin, to treat COVID-19. That would be great if it works. As a geriatrician, the first question that I pose is, does it work in older adults the same way it works in younger adults? Granted, if it works in younger adults, that would be fantastic. My concern, however, is that the presentation of the illness in older adults appears to be quite varied, and also can kill quickly.
A silent assassin attacks quickly and you don't see it coming. This is one of the presentations of COVID-19 infection in frail older adults. What was seen in the Washington nursing home was probably not an aberration. In fact, when we finally have time to look back at this pandemic, I expect to see a sudden rise in mortality for unknown reasons in the two to three weeks prior to outbreaks in assisted living facilities and nursing homes. This creates treatment challenges.
Geriatricians are used to the fact that older adults may present differently than younger people when it comes to many illnesses. Infections are not unique for this, where older adults might not demonstrate a fever in the face of blood borne bacterial infections. I've already heard a report of an assisted living resident who went to the emergency room for falls, was sent back, only to return a couple of days later with clinical signs of COVID-19. If there was ever a time to not only mobilize geriatricians, but utilize our knowledge and expertise in the fight against COVID-19, that time is now.
For frail older adults in particular, COVID-19 can be a silent assassin. As we look at possible treatment methodologies, this must be taken into account. We can not be complacent if we manage to find successful treatments soon. There might be a tendency to relax, loosen quarantines and physical distancing recommendations. Haste in this regard could lead to more deaths among frail older adults, who will fall before we even know that they have the infection. While, to most, COVID-19 infection seems easy to diagnose, to the most vulnerable, and those are the ones dying from this disease, we might not see it coming quickly enough to effectively treat.
A silent assassin attacks quickly and you don't see it coming. This is one of the presentations of COVID-19 infection in frail older adults. What was seen in the Washington nursing home was probably not an aberration. In fact, when we finally have time to look back at this pandemic, I expect to see a sudden rise in mortality for unknown reasons in the two to three weeks prior to outbreaks in assisted living facilities and nursing homes. This creates treatment challenges.
Geriatricians are used to the fact that older adults may present differently than younger people when it comes to many illnesses. Infections are not unique for this, where older adults might not demonstrate a fever in the face of blood borne bacterial infections. I've already heard a report of an assisted living resident who went to the emergency room for falls, was sent back, only to return a couple of days later with clinical signs of COVID-19. If there was ever a time to not only mobilize geriatricians, but utilize our knowledge and expertise in the fight against COVID-19, that time is now.
For frail older adults in particular, COVID-19 can be a silent assassin. As we look at possible treatment methodologies, this must be taken into account. We can not be complacent if we manage to find successful treatments soon. There might be a tendency to relax, loosen quarantines and physical distancing recommendations. Haste in this regard could lead to more deaths among frail older adults, who will fall before we even know that they have the infection. While, to most, COVID-19 infection seems easy to diagnose, to the most vulnerable, and those are the ones dying from this disease, we might not see it coming quickly enough to effectively treat.
Seventeen Hour Day
No blog, I've written enough, and done enough today. I'll save part 2 of yesterday's post for tomorrow.
Wednesday, March 18, 2020
The Geriatrician Who Hopefully Cried Wolf, But Unfortunately Didn't, Part 1
It's literally been 20 days since I first read about the nursing home resident in Washington state who had the Covid-19 virus. The Geriatrician and former nursing home chain CEO in me immediately reacted. I knew two things. This virus is lethal to frail older adults, and nursing homes are a particular setting where they would be at heightened risk. Falling back on the side of me that wrote a letter to President Johnson in the 60's asking him to end the war in Vietnam (yes, I was nine), President Carter and Menachem Begin in the 70's and 80's with ideas for bringing peace to the Middle East, and countless other Don Quixote-like adventures, I sprung into action. Why? I took an oath. I take that oath seriously, it's why I became a physician to begin with. And, I just can't help myself. It's in my DNA to try to make a difference in the world. I'm not looking for fame or fortune, I just want to help older adults. Might be hard for some to believe, but if you know me, it's the obvious truth.
The first week and a half was focused on writing op-ed's and trying to get them published. No luck. I finally went to my fall back position and reached out to one of the Long Term Care News Outlets, McKnight's. They agreed to publish my article. It took a few days, but it was published one week ago. https://www.mcknights.com/blogs/a-mantra-in-wake-of-coronavirus-stay-home-and-save-a-life/
I've actually been able to use this article to message people on social media. It will always be a reminder of why I'm so passionate about what I'm trying to do. In the meantime, I managed to get interviewed by NBC News, and actually provided the tag line for a story. https://www.nbcnews.com/health/health-news/coronavirus-nursing-homes-greatest-threat-years-here-s-what-they-n1153181 This article was actually published the day prior to my McKnight's article. I've subsequently been interviewed by a couple of other reporters.
About two weeks ago, I also began to realize the full scope of what was in front of us. As I followed the news and tracked the data, my concerns grew. I tried to reach out to people I knew at the CDC. I reached out to the people I knew at the nursing home trade association in California. I emailed the head of the California Department of Health. At first, I had the idea of offering to have my organization (a non-profit clinically oriented organization) provide leadership training that I felt was needed during this crisis. That didn't go anywhere. So, I sat back, took a deep breath, and asked myself, what is the most important message to get across right now. I immediately knew the answer. It was based on my experience and those of other experts in long term care.
Every nursing home has a person designated as an Infection Preventionist (IP). When I was at Rockport, as CEO, I convened a leadership retreat with all of the leaders in our organization, about three months into my tenure. One of the things we brainstormed on was how to help the IP have time to do their job! Looking back, it appears quite prescient. IP's are typically overburdened with multiple tasks outside the scope of their infection prevention and control duties. Knowing the full impact of what was about to confront us, I sat back and tried to think of one thing. The one thing that nursing homes could do in order to make a difference. In a crisis, focus is key. You can't try to implement 12 things. You can't even implement five. You need to focus on one or two. I immediately knew that the issue that I had found important over two years ago, was still the greatest priority. If every nursing home in the state of California (and the rest of the country for that matter) gave their IP full-time status, and empowered them to do their jobs, we might be able to impact change in facilities.
Having run a large nursing home chain, I am intimately aware of the operational challenges that most nursing homes face. Under a crisis like this, unless there is one person tasked and dedicated, infection control and prevention will ultimately succumb under the weight of all of the other fires that are needed to be put out on a daily basis. I reached out to the heads of the California nursing home facility organization and the State health department and made my suggestion. It went over like a lead balloon. I've since tried to message this to anyone or everyone who might listen.
CALTCM (the California Association of Long Term Care Medicine), of which I'm President, put on a webinar 9 days ago that spelled out the importance of the IP and the need to empower them. I've reached out to nursing home chains that I have a good relationship with, and made my pitch. I'm not sure what traction, if any, we've gained, but it's not for lack of trying. The forces that are aligned against this are great, as I found out today, even at the highest levels of our government.
The first week and a half was focused on writing op-ed's and trying to get them published. No luck. I finally went to my fall back position and reached out to one of the Long Term Care News Outlets, McKnight's. They agreed to publish my article. It took a few days, but it was published one week ago. https://www.mcknights.com/blogs/a-mantra-in-wake-of-coronavirus-stay-home-and-save-a-life/
I've actually been able to use this article to message people on social media. It will always be a reminder of why I'm so passionate about what I'm trying to do. In the meantime, I managed to get interviewed by NBC News, and actually provided the tag line for a story. https://www.nbcnews.com/health/health-news/coronavirus-nursing-homes-greatest-threat-years-here-s-what-they-n1153181 This article was actually published the day prior to my McKnight's article. I've subsequently been interviewed by a couple of other reporters.
About two weeks ago, I also began to realize the full scope of what was in front of us. As I followed the news and tracked the data, my concerns grew. I tried to reach out to people I knew at the CDC. I reached out to the people I knew at the nursing home trade association in California. I emailed the head of the California Department of Health. At first, I had the idea of offering to have my organization (a non-profit clinically oriented organization) provide leadership training that I felt was needed during this crisis. That didn't go anywhere. So, I sat back, took a deep breath, and asked myself, what is the most important message to get across right now. I immediately knew the answer. It was based on my experience and those of other experts in long term care.
Every nursing home has a person designated as an Infection Preventionist (IP). When I was at Rockport, as CEO, I convened a leadership retreat with all of the leaders in our organization, about three months into my tenure. One of the things we brainstormed on was how to help the IP have time to do their job! Looking back, it appears quite prescient. IP's are typically overburdened with multiple tasks outside the scope of their infection prevention and control duties. Knowing the full impact of what was about to confront us, I sat back and tried to think of one thing. The one thing that nursing homes could do in order to make a difference. In a crisis, focus is key. You can't try to implement 12 things. You can't even implement five. You need to focus on one or two. I immediately knew that the issue that I had found important over two years ago, was still the greatest priority. If every nursing home in the state of California (and the rest of the country for that matter) gave their IP full-time status, and empowered them to do their jobs, we might be able to impact change in facilities.
Having run a large nursing home chain, I am intimately aware of the operational challenges that most nursing homes face. Under a crisis like this, unless there is one person tasked and dedicated, infection control and prevention will ultimately succumb under the weight of all of the other fires that are needed to be put out on a daily basis. I reached out to the heads of the California nursing home facility organization and the State health department and made my suggestion. It went over like a lead balloon. I've since tried to message this to anyone or everyone who might listen.
CALTCM (the California Association of Long Term Care Medicine), of which I'm President, put on a webinar 9 days ago that spelled out the importance of the IP and the need to empower them. I've reached out to nursing home chains that I have a good relationship with, and made my pitch. I'm not sure what traction, if any, we've gained, but it's not for lack of trying. The forces that are aligned against this are great, as I found out today, even at the highest levels of our government.
Tuesday, March 17, 2020
Getting it Right
I've spent a good part of the last year connecting the dots between the delivery of care in nursing homes and the real estate behind it. As I read social media posts today, what are the biggest concerns everyone has? Having enough food and paying the rent! If you're a business and you provide non-essential services or goods, and you have to shut your doors, what do you do about the rent? If you work in an industry that provides non-essential services or goods, you worry about not getting paid. Why? Because you need to buy food and pay the rent.
I've literally been ranting (everyone who knows me is aware of this) for the past year about how real estate drives poor quality in nursing homes. Now, all of a sudden, one of the greatest fears everyone has right now is how to pay the mortgage or the rent. It seems to me that there is a solution to this problem. It's a solution that was missed in the housing crisis of 2008. The government bailed out the banks at the time, but didn't bail out the people who lived in the homes that were ultimately foreclosed upon. This time our government has an opportunity to get it right.
I've worked with wonderful people in the nursing home industry who taught me that the most important thing is doing the right thing. Our country needs to do the right thing. Now.
I've spent the last 2 1/2 weeks focused on the health and well being of older adults in our society. I'm a geriatrician. That's what I do. But I'm also a businessman and entrepreneur. We all need to take a deep breath and relax. We need to focus on what is essential. We need food, clothing and shelter. We live in a country that has an abundance of all of these things. There is no reason to panic. There is every reason to focus on keeping the most vulnerable members of our society safe from this virus.
What would happen if we didn't have to pay our mortgage or our rent? What would happen if we could go to the grocery stores and get the food and supplies we needed? The people who own the real estate are in the same boat. We all need food and shelter. Most of us have food and shelter, except for the homeless, whom we must help during this crisis. We can survive for a few months without being transactional. It may be hard for capitalists like myself to comprehend, but we can survive for a few months without money. We already have what we need. And, we have each other. Let's get it right!
I've literally been ranting (everyone who knows me is aware of this) for the past year about how real estate drives poor quality in nursing homes. Now, all of a sudden, one of the greatest fears everyone has right now is how to pay the mortgage or the rent. It seems to me that there is a solution to this problem. It's a solution that was missed in the housing crisis of 2008. The government bailed out the banks at the time, but didn't bail out the people who lived in the homes that were ultimately foreclosed upon. This time our government has an opportunity to get it right.
I've worked with wonderful people in the nursing home industry who taught me that the most important thing is doing the right thing. Our country needs to do the right thing. Now.
I've spent the last 2 1/2 weeks focused on the health and well being of older adults in our society. I'm a geriatrician. That's what I do. But I'm also a businessman and entrepreneur. We all need to take a deep breath and relax. We need to focus on what is essential. We need food, clothing and shelter. We live in a country that has an abundance of all of these things. There is no reason to panic. There is every reason to focus on keeping the most vulnerable members of our society safe from this virus.
What would happen if we didn't have to pay our mortgage or our rent? What would happen if we could go to the grocery stores and get the food and supplies we needed? The people who own the real estate are in the same boat. We all need food and shelter. Most of us have food and shelter, except for the homeless, whom we must help during this crisis. We can survive for a few months without being transactional. It may be hard for capitalists like myself to comprehend, but we can survive for a few months without money. We already have what we need. And, we have each other. Let's get it right!
Monday, March 16, 2020
Educating is Gratifying
I've spent most of my waking hours over the past 18 days completely focused on educating others. Prior to that, I was talking to my wife about how much I enjoyed educating people. One of the things that I've realized during this recent journey is that it's the act of educating that is gratifying. What others do with the information that they learn is up to them. There's the rub! I've always been someone who wants to teach people things. For most of my life, however, I believe that I've attached the need for results to education. Expecting results ultimately creates stress and conflict. Resting on the enjoyment of the educational process brings joy and satisfaction. I think that I've not only seen that in the past couple of weeks, but have felt it.
It's human nature to what to accomplish something. Unfortunately, achieving a goal is not always easy to do. There are often things beyond our control that keep us from our expected outcome. When we're teaching others and hoping for them to achieve a goal or outcome, all bets are off. We can not be responsible for the outcome that others attempt to achieve. All we can do is our best when it comes to educating. Of course, if we don't do a good job, we might have some culpability. But, what's a good job? The best teacher doesn't have a class of perfect students.
When I talk of education, it's not in the traditional sense of the word. I'm not teaching a class. I'm trying to impart knowledge on others so that they might benefit from that knowledge. For the last 18 days, that's what I've been doing. I feel really good about it. I've had some positive results, but I realize that's not what makes me feel good. What makes me feel good is that people appreciate receiving the knowledge. That's the best part of educating. That's what's gratifying.
It's human nature to what to accomplish something. Unfortunately, achieving a goal is not always easy to do. There are often things beyond our control that keep us from our expected outcome. When we're teaching others and hoping for them to achieve a goal or outcome, all bets are off. We can not be responsible for the outcome that others attempt to achieve. All we can do is our best when it comes to educating. Of course, if we don't do a good job, we might have some culpability. But, what's a good job? The best teacher doesn't have a class of perfect students.
When I talk of education, it's not in the traditional sense of the word. I'm not teaching a class. I'm trying to impart knowledge on others so that they might benefit from that knowledge. For the last 18 days, that's what I've been doing. I feel really good about it. I've had some positive results, but I realize that's not what makes me feel good. What makes me feel good is that people appreciate receiving the knowledge. That's the best part of educating. That's what's gratifying.
Sunday, March 15, 2020
My Facebook Post to Calm People Down
Here's what I posted on FB tonight:
I'm proud to be an American. We are a great nation. Being a specialist in Geriatric Medicine, I can unequivocally state that this virus is deadly to older adults. Many of our largest companies have realized it's not good business to worsen a pandemic. Many of our scientists and leaders have found ways of sharing their expertise with local and state governments. The American people have figured out what to do. Journalists have helped share information. Social media, for the most part, has been responsible. Let's all follow social distancing protocols, practice mindfulness (scientifically proven to strengthen our immune system), Skype/Face Time our parents, grandparents and great grandparents, and most of all, be thankful that we are blessed to be living in this incredible country!
I'm proud to be an American. We are a great nation. Being a specialist in Geriatric Medicine, I can unequivocally state that this virus is deadly to older adults. Many of our largest companies have realized it's not good business to worsen a pandemic. Many of our scientists and leaders have found ways of sharing their expertise with local and state governments. The American people have figured out what to do. Journalists have helped share information. Social media, for the most part, has been responsible. Let's all follow social distancing protocols, practice mindfulness (scientifically proven to strengthen our immune system), Skype/Face Time our parents, grandparents and great grandparents, and most of all, be thankful that we are blessed to be living in this incredible country!
A Break From Blogging Today
I'm dedicated to blogging daily, but I've been writing all day, articles, etc., so no additional blogging today. I deserve the break:)
Saturday, March 14, 2020
Ironman Levity
With all the seriousness going on in the world, I figured it was time for some Ironman levity. It's been nearly 10 years since I completed my first Ironman, but that race and many of the others after didn't come with varying degrees of adversity, as well as meteorologic and other challenges. As I write this, I have to wonder whether I'm a little snake bit when it comes to signing up for an Ironman. My first race was in St. George in 2010. I signed up the year before, and now that I think of it, what happened nearly six months prior might have been a sign of things to come. At the Long Course World Championships in Perth Australia in October of 2009, I crashed about a half mile into the bike. Despite fracturing my clavicle and hip socket, I completed the bike and walked 3.5 miles before going to the hospital. Six months later, I completed Ironman St. George, despite 52 degree water temperatures that caused many participants to become hypothermic. Hmmm. A trend was starting. A year later I completed another Ironman St. George, this one with temperatures soaring into the mid 90's. A challenge, but relatively tame compared to what transpired at Ironman St. George in 2012, where 50 mph winds created 5 foot swells for the swim and challenges on the bike. WTC chose to cancel future races in St. George, so I signed up for Ironman Lake Tahoe in 2013. It literally snowed on the course the day before! I scraped ice off my bike in transition. My gloves and socks were soaking wet, so I went without them on the bike.
By this time, I was wondering if I was jinxed, and I got a reprieve in 2014 at Ironman New Zealand, which was uneventful from a weather perspective. Boulder, on the other hand, in addition to the challenge of altitude, was pretty hot. Fewer than 100 athletes ran under 4 hours that day. Enough said. Then came Lake Tahoe 2014, which was cancelled due to fires as I put my toes into the water at the start. Hmmm, was it just me? Did signing up for an Ironman portend something? I was wondering. I skirted the jinx the following week by immediately transferring my entry to the first Ironman Chattanooga. That race turned out to be my PR to this day. Maybe signing up a week in advance keeps the Ironman Gods from wreaking havoc on my race?
That brought on 2015. I signed up for three races, Couer d'alane, Boulder and Maryland. I injured my back prior to Couer d'alate and didn't start it, missing temperatures up to 108 degrees. I was officially signed up, so that one goes on the list of races I paid to enter that encountered severe circumstances! I managed to complete Ironman Boulder in 2015, again with high temperatures, but on the scale of everything I'd done, not too bad. I'd had a relative reprieve. Then came Ironman Maryland. As my plane landed in Baltimore, I found out that the race had been postponed due to a hurricane! I got back on the plane and flew home. Two of the Ironman's I'd signed up for had now been either cancelled or postponed. Most of the others had extreme weather or fires. Was I jinxed?
I did two more races in 2016, bringing me closer to my Legacy requirement of 12. Boulder was hot once again, though I was well prepared and managed to persevere. Similarly, Ironman Chattanooga in 2016 had temperatures reaching 104 degrees. Again, my experience and preparation got me through it. In fact, many of the races that I've done (or signed up for and didn't start in the car of Couer d'Alene) have had the highest DNF (Did Not Finish) rates. Enough said.
I managed to get through Ironman Boulder in 2017 before completing my Legacy qualifying 12th race in Santa Rosa. No weather issues, but this time I came down with a cold three days before the start of the race. Having a cold feels miserable, so I got to feel miserable during that race. Fortunately, I also got to feel great knowing that I'd reached my Legacy qualifying status. My thirteenth Ironman, validating my Legacy spot, was in Santa Rosa again, and yet again, I got a cold about 10 days before the race. Needless to say, that one was a slog, but I finished. I did Boulder again in 2019, because I wanted to, not because I had to, and had a good race. Boulder is always hard, but I'll always love that race (which has also been cancelled). That's another thing, I raced the inaugural St. George, Lake Tahoe and Boulder, all of which were subsequently cancelled. I've already written about Kona, so I won't delve into that here.
Which brings me back to the beginning. When they announced last year that they were bringing back Ironman St. George in 2020, the glutton for punishment in me immediately signed up. I wonder if I had managed to trigger the Ironman Gods again? I didn't think about this until recently. After Kona, I decided that I was done with Ironman. Two weeks ago, I changed my mind and began considering competing at St. George this year. And now we have a pandemic sweeping the world and the United States. Coincidence? Probably. But, I've got to wonder. Maybe this is the universe telling me that my Ironman days are over. Maybe not? Time will tell.
By this time, I was wondering if I was jinxed, and I got a reprieve in 2014 at Ironman New Zealand, which was uneventful from a weather perspective. Boulder, on the other hand, in addition to the challenge of altitude, was pretty hot. Fewer than 100 athletes ran under 4 hours that day. Enough said. Then came Lake Tahoe 2014, which was cancelled due to fires as I put my toes into the water at the start. Hmmm, was it just me? Did signing up for an Ironman portend something? I was wondering. I skirted the jinx the following week by immediately transferring my entry to the first Ironman Chattanooga. That race turned out to be my PR to this day. Maybe signing up a week in advance keeps the Ironman Gods from wreaking havoc on my race?
That brought on 2015. I signed up for three races, Couer d'alane, Boulder and Maryland. I injured my back prior to Couer d'alate and didn't start it, missing temperatures up to 108 degrees. I was officially signed up, so that one goes on the list of races I paid to enter that encountered severe circumstances! I managed to complete Ironman Boulder in 2015, again with high temperatures, but on the scale of everything I'd done, not too bad. I'd had a relative reprieve. Then came Ironman Maryland. As my plane landed in Baltimore, I found out that the race had been postponed due to a hurricane! I got back on the plane and flew home. Two of the Ironman's I'd signed up for had now been either cancelled or postponed. Most of the others had extreme weather or fires. Was I jinxed?
I did two more races in 2016, bringing me closer to my Legacy requirement of 12. Boulder was hot once again, though I was well prepared and managed to persevere. Similarly, Ironman Chattanooga in 2016 had temperatures reaching 104 degrees. Again, my experience and preparation got me through it. In fact, many of the races that I've done (or signed up for and didn't start in the car of Couer d'Alene) have had the highest DNF (Did Not Finish) rates. Enough said.
I managed to get through Ironman Boulder in 2017 before completing my Legacy qualifying 12th race in Santa Rosa. No weather issues, but this time I came down with a cold three days before the start of the race. Having a cold feels miserable, so I got to feel miserable during that race. Fortunately, I also got to feel great knowing that I'd reached my Legacy qualifying status. My thirteenth Ironman, validating my Legacy spot, was in Santa Rosa again, and yet again, I got a cold about 10 days before the race. Needless to say, that one was a slog, but I finished. I did Boulder again in 2019, because I wanted to, not because I had to, and had a good race. Boulder is always hard, but I'll always love that race (which has also been cancelled). That's another thing, I raced the inaugural St. George, Lake Tahoe and Boulder, all of which were subsequently cancelled. I've already written about Kona, so I won't delve into that here.
Which brings me back to the beginning. When they announced last year that they were bringing back Ironman St. George in 2020, the glutton for punishment in me immediately signed up. I wonder if I had managed to trigger the Ironman Gods again? I didn't think about this until recently. After Kona, I decided that I was done with Ironman. Two weeks ago, I changed my mind and began considering competing at St. George this year. And now we have a pandemic sweeping the world and the United States. Coincidence? Probably. But, I've got to wonder. Maybe this is the universe telling me that my Ironman days are over. Maybe not? Time will tell.
Friday, March 13, 2020
A Mindfulness Opportunity
I realized that the opportunity for everyone in the United States to take a four week vacation is an opportunity to practice mindfulness. There certainly won't be any sporting events to watch on television! It's a great time to read, and a great time to practice mindfulness. There is actually a 2003 study, "Alterations in Brain and Immune Function Produced by Mindfulness Meditation," by Richard Davidson et al, that shows that practicing daily mindfulness can improve the immune system. They looked at the response to influenza vaccine and found an increased antibody response!
There's no question that practicing mindfulness is helpful to our overall health and well being. We live in a world today with constant instantaneous messaging and responses. It's hard to get away from it. The COVID-19 crisis only serves to heighten those stimuli. How many people will sit at home glued to their television sets, listening to and watching news about the virus from the time they wake up to the time they go to bed? Is it necessary? Of course not. Find a way to stay abreast of the important news and use the newfound time to read a book, and of course, practice mindfulness.
There's no question that practicing mindfulness is helpful to our overall health and well being. We live in a world today with constant instantaneous messaging and responses. It's hard to get away from it. The COVID-19 crisis only serves to heighten those stimuli. How many people will sit at home glued to their television sets, listening to and watching news about the virus from the time they wake up to the time they go to bed? Is it necessary? Of course not. Find a way to stay abreast of the important news and use the newfound time to read a book, and of course, practice mindfulness.
Thursday, March 12, 2020
Plausible Deniability
I could have sworn that I'd written a blog about plausible deniability, but I can't find it. So, I guess that's my topic. I was looking for what I thought was a previous blog for a reason. I wrote yesterday's blog with the intention of copying it onto LinkedIn today and sharing it via social media. I was pretty busy today and just never had the time to make that decision. Yesterday's blog calls a number of folks out, and in some ways I wanted to give them more time to respond. I'm pretty fed up with the way some organizations work. Having been taken advantage of in the past, I'm ok with sucking it up if it's for the greater good, but at some point one has to stand up and fight back.
We're in a crisis. I'm reminded of all of the times I've heard nursing home owners and leaders say that they had told everyone to "do the right thing." Yet behind the scenes, they tied the hands of people in one way or another, so that they could not actually be effective in getting things done. That also seems to be going on in Washington right now. We hear some public officials acting as if they're doing everything possible, or that they've given edicts to do everything possible. Yet nothing is happening. Leaders have to own results. That's something that I've always been proud of. Whenever I've been in a leadership role, if things don't work out, I'll own it. Regardless of how much responsibility I had, I'll still own it. That's what leaders should do.
The concept of plausible deniability is one that we should all be aware of. It's a cloak to hide behind. It's an excuse for both incompetence on one hand, and immorality on the other. If you really support something, you should be demonstrating it with actions and deeds. Only then can you take full responsibility for what happens. Only then can others let you off the hook if things were clearly out of your control. That's the irony of this viral pandemic. If people thought that everything that could be done was being done, they would let our leader off the hook if things don't turn out well. However, when we see other countries making things happen that we've been unable to do, one has to pause. We are the greatest country in the world. At least we were. South Korea appears to be making an attempt to claim that mantle. Their response to COVID-19 has been textbook, while we've been stumbling around with Dick and Jane meet the Coronavirus. But, we'll hear our leaders say that they're doing everything possible. That's plausible deniability.
We're in a crisis. I'm reminded of all of the times I've heard nursing home owners and leaders say that they had told everyone to "do the right thing." Yet behind the scenes, they tied the hands of people in one way or another, so that they could not actually be effective in getting things done. That also seems to be going on in Washington right now. We hear some public officials acting as if they're doing everything possible, or that they've given edicts to do everything possible. Yet nothing is happening. Leaders have to own results. That's something that I've always been proud of. Whenever I've been in a leadership role, if things don't work out, I'll own it. Regardless of how much responsibility I had, I'll still own it. That's what leaders should do.
The concept of plausible deniability is one that we should all be aware of. It's a cloak to hide behind. It's an excuse for both incompetence on one hand, and immorality on the other. If you really support something, you should be demonstrating it with actions and deeds. Only then can you take full responsibility for what happens. Only then can others let you off the hook if things were clearly out of your control. That's the irony of this viral pandemic. If people thought that everything that could be done was being done, they would let our leader off the hook if things don't turn out well. However, when we see other countries making things happen that we've been unable to do, one has to pause. We are the greatest country in the world. At least we were. South Korea appears to be making an attempt to claim that mantle. Their response to COVID-19 has been textbook, while we've been stumbling around with Dick and Jane meet the Coronavirus. But, we'll hear our leaders say that they're doing everything possible. That's plausible deniability.
Wednesday, March 11, 2020
Excuse My Cynicism
16 months ago I quit my job running a company that oversaw the largest nursing home chain in California. There were a lot of complex reasons for my leaving, not the least of which was the greater understanding that I had gained regarding how the nursing home industry operates. I've spent most of my time since then reflecting on what I learned. Being both a geriatrician and a businessman, my lens is unique. I have been trying to share my knowledge and expertise over the last several months. I have tried to reach out to my legislators. I've tried sharing my knowledge with anyone in government whom I could access. I've written articles. I've written op-ed's that no one wants to publish. And then it happened. Less than two weeks ago, we heard about the first person to die from COVID-19 in the United States. It was not a coincidence that this person was a resident of a nursing home. The bells immediately went off in my head. COVID-19 was going to unmask all of the underlying problems that exist in the nursing home industry.
I reached out to the State Health Department. I reached out to the State's Nursing Facility Association. I attempted to get another Op-Ed published. I tweeted. I posted on Facebook and LinkedIn. Fortunately, I am medical director of a nursing facility that is part of an incredible organization that cares more deeply about older adults than I do, the Los Angeles Jewish Home. I have learned new things daily from the incredible individuals who are acting quickly and responsibly to this rapidly developing crisis. I am part of the California Association of Long Term Care Medicine (CALTCM). We gathered experts and put together a very informative webinar on "What Nursing Homes Need to Know (https://www.caltcm.org/covid-19)." I wrote another article that McKnight's agreed to publish (https://www.mcknights.com/blogs/a-mantra-in-wake-of-coronavirus-stay-home-and-save-a-life/). The article described why this virus scares me so much. It's not just the virus itself, it's how it will interact with the nursing home industry.
Here we are. Will the realization that all nursing homes should have at least one full-time Infection Preventionist actually take hold? Will the industry finally recognize the true value of the CNA's who do the majority of direct care? Will they receive full pay even if they need to be off for two or more weeks? Will the nursing home medical director be appreciated for their clinical expertise instead of whether they bring in new admissions? Will having adequate staffing levels and delivering quality care become the industry's priority? Excuse my cynicism, but my experience informs me that greed and ageism are a combination that is dangerous to nursing home residents.
There is an army that is prepared and ready to help. The army is made of up geriatricians, geriatric nurse practitioners, physician assistants, geriatric pharmacists, nurses and social workers. Only a small number of nursing home medical directors are Certified Medical Directors (CMD). They stand at the ready to engage and help fight the effects of COVID-19. It's time for Federal, State and Local government agencies to engage experts for WHAT they know, rather than WHO they know. It's also time for all of us with expertise to be willing to SPEAK TRUTH TO POWER. It won't always work, which I can attest to based on my personal experience. But, we can't bring about change if we don't TRY. Cynicism shouldn't keep us from trying. It certainly won't keep me.
I reached out to the State Health Department. I reached out to the State's Nursing Facility Association. I attempted to get another Op-Ed published. I tweeted. I posted on Facebook and LinkedIn. Fortunately, I am medical director of a nursing facility that is part of an incredible organization that cares more deeply about older adults than I do, the Los Angeles Jewish Home. I have learned new things daily from the incredible individuals who are acting quickly and responsibly to this rapidly developing crisis. I am part of the California Association of Long Term Care Medicine (CALTCM). We gathered experts and put together a very informative webinar on "What Nursing Homes Need to Know (https://www.caltcm.org/covid-19)." I wrote another article that McKnight's agreed to publish (https://www.mcknights.com/blogs/a-mantra-in-wake-of-coronavirus-stay-home-and-save-a-life/). The article described why this virus scares me so much. It's not just the virus itself, it's how it will interact with the nursing home industry.
Here we are. Will the realization that all nursing homes should have at least one full-time Infection Preventionist actually take hold? Will the industry finally recognize the true value of the CNA's who do the majority of direct care? Will they receive full pay even if they need to be off for two or more weeks? Will the nursing home medical director be appreciated for their clinical expertise instead of whether they bring in new admissions? Will having adequate staffing levels and delivering quality care become the industry's priority? Excuse my cynicism, but my experience informs me that greed and ageism are a combination that is dangerous to nursing home residents.
There is an army that is prepared and ready to help. The army is made of up geriatricians, geriatric nurse practitioners, physician assistants, geriatric pharmacists, nurses and social workers. Only a small number of nursing home medical directors are Certified Medical Directors (CMD). They stand at the ready to engage and help fight the effects of COVID-19. It's time for Federal, State and Local government agencies to engage experts for WHAT they know, rather than WHO they know. It's also time for all of us with expertise to be willing to SPEAK TRUTH TO POWER. It won't always work, which I can attest to based on my personal experience. But, we can't bring about change if we don't TRY. Cynicism shouldn't keep us from trying. It certainly won't keep me.
Tuesday, March 10, 2020
Giving Credit, Not Taking Credit
About four years ago I interviewed for a job where the person who interviewed me was clearly worried about me having too much experience. He literally told me that I intimidated him. I knew that rather than intimidate him, I could have helped him be more successful. I didn't want his job. I'd one his job and that wasn't what mattered to me anymore. Fortunately, I didn't get the job. In the end, I took a job where I was blessed with an incredible team of people. They made me look good. I hope that I gave them the opportunity to shine, and I worked hard to make sure that they got all of the credit that they deserved. When I subsequently took a job overseeing a large organization, I was once again fortunate to have another group of incredible people working for me. It was truly easy to give them credit for all the great work that they did.
My wife asked me today if I was always like this. When I was younger, I often looked for opportunities to take credit for thing that I had accomplished. The means towards the end was that these accomplishments would help me to advance my career. As I became more successful, I think (and hope) that I looked for opportunities to build up those around me. One person can only do so much. A team can accomplish a lot more. Besides, I'm a conceptual thinker. I need people around me who actually do the hard work to get things done. The people who make things happen are the ones who deserve to get the credit.
Last week, I had an idea. Ideas are great, but without people who can turn those ideas into action, they're just ideas. I was very fortunate, as I've often been, to work with others who know how to get things done. They deserve all of the credit. One of the things that I've learned in the past few years is that reaching the top of the mountain only means something if what you achieve makes a difference for others. There's really no true value from a personal perspective. There's a lot of credit to give, and it always feels better to give that credit to those who deserve it!
My wife asked me today if I was always like this. When I was younger, I often looked for opportunities to take credit for thing that I had accomplished. The means towards the end was that these accomplishments would help me to advance my career. As I became more successful, I think (and hope) that I looked for opportunities to build up those around me. One person can only do so much. A team can accomplish a lot more. Besides, I'm a conceptual thinker. I need people around me who actually do the hard work to get things done. The people who make things happen are the ones who deserve to get the credit.
Last week, I had an idea. Ideas are great, but without people who can turn those ideas into action, they're just ideas. I was very fortunate, as I've often been, to work with others who know how to get things done. They deserve all of the credit. One of the things that I've learned in the past few years is that reaching the top of the mountain only means something if what you achieve makes a difference for others. There's really no true value from a personal perspective. There's a lot of credit to give, and it always feels better to give that credit to those who deserve it!
Monday, March 9, 2020
Getting Things Done
It's been awhile since I was truly in Getting Things Done mode. It really started a week and a half ago when I heard about the death from COVID-19 in a nursing home. That got my attention. On Friday, I realized that something more needed to get done. That's when I pulled my team together. If there's one thing I've learned in the past few years, it really does take a team. For many reasons, including the fact that when I get into this mode by myself, I'm just going to ultimately bury myself. It's hard enough even when you have a team. Delegation is critical.
Remarkably, in just a few day, our team got it done. The final result had one glitch, but that's technology for you, kicking you in the butt every time. Nevertheless, the result was a huge success. It's now a template for future efforts. I also remembered how the adrenaline turns on when I'm in Getting Things Done mode. Today was that kind of day, when I realized this morning that I needed to go into the nursing home for a meeting. I could have done the meeting by phone, but under the circumstances that are happening, it's just not the same. When given a choice, I'll always take the most effective route. Upon returning home, it was, let's get ready for the webinar time, and before I knew it, it was time for the webinar. Nine straight hours of work.
My wife was hungry because we had no food in the house, so I went shopping, all the while continuing my text and twitter followup from our webinar. I finally managed to eat dinner when I got home and caught up on emails. I even turned my phone off. However, I had some work on the textbook I'm overseeing, and didn't want that work to wait another day. More emails. I've been my own assistant for everything as of late, which makes sense for someone who is semi-retired like myself.
The day is now 13 hours old and I figured that writing my blog was a good way to close out the day before chilling for an hour and going to bed. I'll have to blog about the positives and negatives of Getting Things Done another day. Tonight, I'll just rest on the fact that I accomplished a ton today, so did a bunch of other folks, and hopefully we did something good for the world.
Remarkably, in just a few day, our team got it done. The final result had one glitch, but that's technology for you, kicking you in the butt every time. Nevertheless, the result was a huge success. It's now a template for future efforts. I also remembered how the adrenaline turns on when I'm in Getting Things Done mode. Today was that kind of day, when I realized this morning that I needed to go into the nursing home for a meeting. I could have done the meeting by phone, but under the circumstances that are happening, it's just not the same. When given a choice, I'll always take the most effective route. Upon returning home, it was, let's get ready for the webinar time, and before I knew it, it was time for the webinar. Nine straight hours of work.
My wife was hungry because we had no food in the house, so I went shopping, all the while continuing my text and twitter followup from our webinar. I finally managed to eat dinner when I got home and caught up on emails. I even turned my phone off. However, I had some work on the textbook I'm overseeing, and didn't want that work to wait another day. More emails. I've been my own assistant for everything as of late, which makes sense for someone who is semi-retired like myself.
The day is now 13 hours old and I figured that writing my blog was a good way to close out the day before chilling for an hour and going to bed. I'll have to blog about the positives and negatives of Getting Things Done another day. Tonight, I'll just rest on the fact that I accomplished a ton today, so did a bunch of other folks, and hopefully we did something good for the world.
Sunday, March 8, 2020
Making a Difference
It's been a little over a week since it was reported that a nursing home resident in Washington state had died from COVID-19. It moment I read this, I knew. I knew that the COVID-19 virus was deadly for frail older adults. How did I know? Years of experience as a geriatrician, combined with the growing knowledge of the virus had suggested that this was not a virus that killed kids, but that older adults were more prone to bad outcomes. The fact that the first U.S. death occurred in a nursing home scared the daylights out of me for many reasons. First, I know the milieu that are nursing homes. Second, I understand the staff and the challenges that they face every day. Third, I know the nursing home environment and the pressures that facility leadership faces in making decisions.
I knew that I had to do something. My alarms were ringing all over the place. The first thing that I did was reach out to the administrator at the facility where I'm the medical director. I told her my concerns. Fortunately, the facility has great and caring leadership. They were already on top of things. I'm not sure that I added much, except for one thing. Knowing the fact that nursing home front line staff rarely earn a living wage and often live paycheck to paycheck, my immediate concern was one that I felt that most clinicians, including medical directors, would not think about. That was the fact that these wonderful people might go to work despite having symptoms of being sick, out of fear of losing wages.
I often talk about the need for healthcare leaders to have a better clinical understanding, and in the case where that care involves older adults, the need is even greater for leadership to have a full understanding of the geriatrics approach to care. Somehow, the fact that the first death in the U.S. was in a nursing home set off all the bells and whistles in my head. It was one thing making sure that my nursing facility was instituting the necessary policies and procedures, it was another to try to expand this knowledge to facilities throughout California. I reached out to the state health department with a proposal for leadership and management training. I probably should have known that such a proposal would be overwhelming to them. Too much, too big, too soon. They suggested that we put together a webinar. Why not?
Starting on Friday I reached out to the person I respect the most when it comes to infection control in nursing homes. We brainstormed the key elements that we wanted to get across to nursing homes and were in complete agreement on what those were. By Saturday we had a presentation prepared. Now, we just needed to set up the webinar. Fortunately, having a great project director to call upon in our organization paid dividends. The webinar is set up for Monday afternoon. We'll see how many people listen in, but at least the information will be available for anyone who is interested. Instead of focusing on what and why, we're going to focus on the key things that MUST happen in every nursing home to prevent this from getting completely out of hand. It's wonderful to be part of a team of caring people, let's hope that our message gets out and that we can truly make a difference.
I knew that I had to do something. My alarms were ringing all over the place. The first thing that I did was reach out to the administrator at the facility where I'm the medical director. I told her my concerns. Fortunately, the facility has great and caring leadership. They were already on top of things. I'm not sure that I added much, except for one thing. Knowing the fact that nursing home front line staff rarely earn a living wage and often live paycheck to paycheck, my immediate concern was one that I felt that most clinicians, including medical directors, would not think about. That was the fact that these wonderful people might go to work despite having symptoms of being sick, out of fear of losing wages.
I often talk about the need for healthcare leaders to have a better clinical understanding, and in the case where that care involves older adults, the need is even greater for leadership to have a full understanding of the geriatrics approach to care. Somehow, the fact that the first death in the U.S. was in a nursing home set off all the bells and whistles in my head. It was one thing making sure that my nursing facility was instituting the necessary policies and procedures, it was another to try to expand this knowledge to facilities throughout California. I reached out to the state health department with a proposal for leadership and management training. I probably should have known that such a proposal would be overwhelming to them. Too much, too big, too soon. They suggested that we put together a webinar. Why not?
Starting on Friday I reached out to the person I respect the most when it comes to infection control in nursing homes. We brainstormed the key elements that we wanted to get across to nursing homes and were in complete agreement on what those were. By Saturday we had a presentation prepared. Now, we just needed to set up the webinar. Fortunately, having a great project director to call upon in our organization paid dividends. The webinar is set up for Monday afternoon. We'll see how many people listen in, but at least the information will be available for anyone who is interested. Instead of focusing on what and why, we're going to focus on the key things that MUST happen in every nursing home to prevent this from getting completely out of hand. It's wonderful to be part of a team of caring people, let's hope that our message gets out and that we can truly make a difference.
Saturday, March 7, 2020
Mr. Rogers and Mindfulness
We finally watched A Beautiful Day in the Neighborhood today. Wow! I imagine this is one of those movies that everyone takes something different from. For me, it was mindfulness. Fred Rogers struck me as the epitome of mindfulness. He also came across as someone who cared deeply for other people. The combination was incredibly powerful. I'm someone whose mind is always going a mile a minute, and so it's easy to be thinking about something else while I'm still trying to focus on the conversation or task at hand. This movie provided the impetus to think about staying mindful and in the moment whenever I'm speaking to another human being. No thinking ahead. No thinking about something that I need to get done that day. No thinking about politics, God forbid! Just stay in the moment.
When I think of staying in the moment, my mind immediately goes to Sand Hollow Reservoir, May of 2012 and the Ironman. The moment that I briefly worried about dying, but instead switched over to staying in the moment, is indelibly etched in my memory. It will always be the moment for which I appreciate mindfulness the most. Putting one arm in front of the other, breathing, moving forward, not thinking about "what if I die," although I did allow my mind to think "I hope no one else dies today," was the ultimate in being in the moment. It got me through the swim that day. In fact, I'm pretty sure that I was mindful and in the moment for the entire race.
In a lot of ways, Kona was the same for me. As I biked out of town and onto the Queen K Highway my brain wanted me to quit. I knew that's what my body was telling my mind. The reality was that I took less than a second to acknowledge the thought, and in the spirit of mindfulness, I let it go, to drift into the sky and onto the lava fields that I was riding through. I appreciated every moment of that very long and arduous bike ride, except for those few moments when I was scared to death from the crosswinds. But even during those moments, I let them go, and didn't allow them to cloud my appreciation of the day.
My proudest mindful moment from Kona was my joy for the 75 year old man who finished just ahead of me. Despite my long journey to get there, for a literal bucket list experience, I believe my joy and happiness to see a 75 year old man finish in front of me defines who I am. I don't know if any of us can actually be Mr. Rogers, but the movie inspired me to keep trying!
When I think of staying in the moment, my mind immediately goes to Sand Hollow Reservoir, May of 2012 and the Ironman. The moment that I briefly worried about dying, but instead switched over to staying in the moment, is indelibly etched in my memory. It will always be the moment for which I appreciate mindfulness the most. Putting one arm in front of the other, breathing, moving forward, not thinking about "what if I die," although I did allow my mind to think "I hope no one else dies today," was the ultimate in being in the moment. It got me through the swim that day. In fact, I'm pretty sure that I was mindful and in the moment for the entire race.
In a lot of ways, Kona was the same for me. As I biked out of town and onto the Queen K Highway my brain wanted me to quit. I knew that's what my body was telling my mind. The reality was that I took less than a second to acknowledge the thought, and in the spirit of mindfulness, I let it go, to drift into the sky and onto the lava fields that I was riding through. I appreciated every moment of that very long and arduous bike ride, except for those few moments when I was scared to death from the crosswinds. But even during those moments, I let them go, and didn't allow them to cloud my appreciation of the day.
My proudest mindful moment from Kona was my joy for the 75 year old man who finished just ahead of me. Despite my long journey to get there, for a literal bucket list experience, I believe my joy and happiness to see a 75 year old man finish in front of me defines who I am. I don't know if any of us can actually be Mr. Rogers, but the movie inspired me to keep trying!
Friday, March 6, 2020
Why do I care so much?
It's times like this that I'm reminded of my greatest challenge. I care too much. What do I mean by that? I'm concerned about the Coronavirus. Not for myself or my family, but for older adults living in nursing homes (and assisted living facilities). As best I can tell thus far, Covid-19 kills frail older adults. It seems to bypass kids and doesn't have much effect on most younger and middle age people, so long as the are not immunocompromised. That puts it in my wheelhouse, the older adult population. I'm especially concerned about nursing homes. Why? Because I know too much about how nursing homes function and operate. Thus, I feel like I have an obligation to do something. Am I the only person that can do something? Of course not. On the other hand, with all the challenges in healthcare affecting (and in this case infecting) older adults, we still have huge problems. While one person won't change everything, and while I can't and shouldn't be taking that responsibility on my shoulders, I can also make a point that change won't happen without people like myself who feel so strongly about advocating for older adults.
With all that said, I should also think about myself. The emotional, and ultimately physical, investment is not minimal. Which is why I keep coming back to looking at focusing on the things most near and dear to me, which is educating people about Geriatrics and the needs of older adults. If I focus on the basic things that I can easily do, it doesn't necessarily make sense to distract myself with more pie in the sky types of things. Caring matters, but it won't do me a lot of good if it buries me. I certainly find that I'm less productive when I overextend myself. Paying attention to what makes the most sense to focus on and spend my time doing will allow me to gain the maximum gratification and pleasure from those things, while reducing the added stress of trying to do too many things at once.
When I think about it, I don't want to let go of caring, but I don't have to spread that caring around so much. It spreads me too thin. Interesting realization. My caring will always be there. It's not going away. It's not more or less than it ever was. On the other hand, the things that I get involved with related to what I care about are things that I can manage better. I guess it's ok to care so much!
With all that said, I should also think about myself. The emotional, and ultimately physical, investment is not minimal. Which is why I keep coming back to looking at focusing on the things most near and dear to me, which is educating people about Geriatrics and the needs of older adults. If I focus on the basic things that I can easily do, it doesn't necessarily make sense to distract myself with more pie in the sky types of things. Caring matters, but it won't do me a lot of good if it buries me. I certainly find that I'm less productive when I overextend myself. Paying attention to what makes the most sense to focus on and spend my time doing will allow me to gain the maximum gratification and pleasure from those things, while reducing the added stress of trying to do too many things at once.
When I think about it, I don't want to let go of caring, but I don't have to spread that caring around so much. It spreads me too thin. Interesting realization. My caring will always be there. It's not going away. It's not more or less than it ever was. On the other hand, the things that I get involved with related to what I care about are things that I can manage better. I guess it's ok to care so much!
Thursday, March 5, 2020
I've Got That Running Feeling!
I felt like running today. Wasn't sure what the run would be like. My legs were a little sore, probably from my squats and lunges yesterday, but not bad. I just started like I usually do, running down the hill in front of my house and then starting my one mile climb immediately. Lately, I've been just running up the hill easy and comfortably, and that was my intention today, but I immediately realized that I was in store for something else today!
As I ran the lower portion of the climb, I realized that I was running faster than normal, though my effort wasn't quite as hard. I seemed to want to really run. I didn't throttle back, nor did I push harder. Instead, I just kept focused on my leg turnover and the feeling of running. I wasn't sure what would happen next, though as I hit flatter segments, I was able to keep a nice pace. Surprisingly, when I started hitting some greater pitches in elevation, I still felt good, and still felt fast. In fact, I glanced down at my watch and saw myself maintaining a pace of around 8:30. When I hit the steepest part of the climb, at the end, I pushed. Not too hard, albeit, it was definitely hard, but not extreme. My pace dropped closer to 10:30 pace as I neared the end. Lately, if I'm doing this run comfortably, my pace will get closer to 13-14 minutes per mile at this point. I was doing something right.
When I got to the top of the hill, I slowed to a walk. Ultimately, I ran this uphill mile at around 9:10 pace. Not my fastest, but I wasn't trying to run it as fast as I could, I was just trying to stay comfortable and fast. I'm not sure where this came from, although it may be a combination of my training and my state of mind. I walked a couple of minutes before pushing the next downhill portion of the run. On the flatter portion, I started out around 8:30 pace, and then pushed on the rest of the downhill, actually getting my pace down closer to 6 minute pace for a little while. After walking another couple of minutes, I hit the third mile comfortably hard, keeping my pace right around 8 minutes per mile. I finished with a few 200m sprints which were close to 6 minute pace. I've got that running feeling!
As I ran the lower portion of the climb, I realized that I was running faster than normal, though my effort wasn't quite as hard. I seemed to want to really run. I didn't throttle back, nor did I push harder. Instead, I just kept focused on my leg turnover and the feeling of running. I wasn't sure what would happen next, though as I hit flatter segments, I was able to keep a nice pace. Surprisingly, when I started hitting some greater pitches in elevation, I still felt good, and still felt fast. In fact, I glanced down at my watch and saw myself maintaining a pace of around 8:30. When I hit the steepest part of the climb, at the end, I pushed. Not too hard, albeit, it was definitely hard, but not extreme. My pace dropped closer to 10:30 pace as I neared the end. Lately, if I'm doing this run comfortably, my pace will get closer to 13-14 minutes per mile at this point. I was doing something right.
When I got to the top of the hill, I slowed to a walk. Ultimately, I ran this uphill mile at around 9:10 pace. Not my fastest, but I wasn't trying to run it as fast as I could, I was just trying to stay comfortable and fast. I'm not sure where this came from, although it may be a combination of my training and my state of mind. I walked a couple of minutes before pushing the next downhill portion of the run. On the flatter portion, I started out around 8:30 pace, and then pushed on the rest of the downhill, actually getting my pace down closer to 6 minute pace for a little while. After walking another couple of minutes, I hit the third mile comfortably hard, keeping my pace right around 8 minutes per mile. I finished with a few 200m sprints which were close to 6 minute pace. I've got that running feeling!
Wednesday, March 4, 2020
Going by Feel
I had a pretty full day of work today, but managed to stop at the pool on the way home. This is the fun part of my training life. I had no planned workout, initially I'd thought of swimming at least a half hour straight, if not an hour, like I did last week. When I actually jumped in the pool, I made the decision to do a series of 100 yard intervals. Last week, I swam an hour straight at a pace of 2 minutes for every 100 yards. That's about 8-10 seconds slower per 100 than when I was fully prepared for Kona. Not too bad, considering I literally hadn't swam since! Swimming non-stop is relaxing, but I can do that anytime. I'm sure I'll do it again. But today I didn't feel like swimming at that pace, so I set a target of swimming at a 1:40/100yd pace. That's what I did, doing the next interval at the 2 minute mark, so essentially getting in the same volume in the same time, just training my body to swim faster in order to do it. After about 10 of these, I switched to 50 yard efforts at about the same pace. And restarting each of these every minute. After 36 minutes of swimming, I started to slow down a tad, so I figured that was time to stop.
Swimming is all about feel. It's always interesting how easy and free I swim initially. Today, my first few 100 yard efforts were done literally with minimal effort, with fewer strokes and obviously more at ease. As I progressed, the number of strokes that I needed to maintain the same pace increased. I'm going to have to think about that next time. Do I allow myself to go slower in order to use fewer strokes? Do I focus on the increasing my effort while maintaining the easy feeling of swimming with the fewest amount of strokes? Swimming is fascinating.
The other thing that I enjoy about going by feel is the natural way it feels. My return to ironman-like training is about feeling the joy of the workouts. Going by feel is purely a joyful experience, as is doing the same on a run or during a bike ride. That's what it's all about!
Swimming is all about feel. It's always interesting how easy and free I swim initially. Today, my first few 100 yard efforts were done literally with minimal effort, with fewer strokes and obviously more at ease. As I progressed, the number of strokes that I needed to maintain the same pace increased. I'm going to have to think about that next time. Do I allow myself to go slower in order to use fewer strokes? Do I focus on the increasing my effort while maintaining the easy feeling of swimming with the fewest amount of strokes? Swimming is fascinating.
The other thing that I enjoy about going by feel is the natural way it feels. My return to ironman-like training is about feeling the joy of the workouts. Going by feel is purely a joyful experience, as is doing the same on a run or during a bike ride. That's what it's all about!
Tuesday, March 3, 2020
Bring America's Greatness to Everyone
James Clyburn, an iconic figure in both the civil rights movement and Congress, made a great point during an interview. It's not a matter of making America great, America is already great. It's a matter of bringing America's greatness to everyone in the country. I couldn't agree more. I'm often asking taxi drivers, now Uber drivers, from foreign countries, what they think about America. For many years, and up until now, they often tell me that they wouldn't go back to their country of origin. They believe that the United States is the best country in the world. Are we perfect? Of course not. Can we do better? Always. One thing that conservatives, liberals and everyone in between should be able to agree upon is that the Founders of our country were on to something. Our Constitution attempts to frame the type of country that we have. It attempts to frame the freedom's that we treasure. When our country was founded, these self evident truths were not extended to all who lived in our country. We've come a long way since then, but we're not done. Congressman Clyburn is absolutely right. America is great. Let's bring the greatness to all Americans.
I really do believe in the concept that America is already a great country. When I look around the world, the degree of corruption and political craziness abounds. I often feel that our political process is purposefully set up to avoid major instantaneous changes. Our separation of powers, being severely tested by trump, is unique amongst the countries of the world and generally works to provide checks and balances. Again, it's to perfect, but the concept is good. The wealthy and the middle class in our country are blessed with good lives. We generally have food, shelter, clean water, and usually clean air. On the other hand, our poor do struggle, though generally not to the same degree as the poor in other countries (with the exception of the very poor and our homeless population). This isn't an excuse or an attempt to gloss over these issues. It's a starting point. We shouldn't have a homeless population. Our poorer communities should have good schools and clean water. We know that not to be necessarily true.
I agree with James Clyburn. We don't need to blow up the country. We don't need to blow up our system. We are a great country. We just need to bring that greatness to all Americans.
I really do believe in the concept that America is already a great country. When I look around the world, the degree of corruption and political craziness abounds. I often feel that our political process is purposefully set up to avoid major instantaneous changes. Our separation of powers, being severely tested by trump, is unique amongst the countries of the world and generally works to provide checks and balances. Again, it's to perfect, but the concept is good. The wealthy and the middle class in our country are blessed with good lives. We generally have food, shelter, clean water, and usually clean air. On the other hand, our poor do struggle, though generally not to the same degree as the poor in other countries (with the exception of the very poor and our homeless population). This isn't an excuse or an attempt to gloss over these issues. It's a starting point. We shouldn't have a homeless population. Our poorer communities should have good schools and clean water. We know that not to be necessarily true.
I agree with James Clyburn. We don't need to blow up the country. We don't need to blow up our system. We are a great country. We just need to bring that greatness to all Americans.
Monday, March 2, 2020
Will the Real Democratic Party Please Stand Up
We may be finally seeing the Democratic party pulling together for a greater good. Time will tell, but in the last couple of days we're seeing politicians do things for the greater good, and not for themselves. Pete Buttigieg and Amy Klobuchar realized that they had a less than 1 percent chance of winning the nomination. They also realized that Bernie Sanders is not the person who should be the nominee. I understand that, because I believe that a Bernie Sanders nomination is the true existential threat to the United States of America. Why? First, I'm not sure a self described socialist can actually win the election versus the embodiment of capitalistic greed. Second, I think for similar reasons, the Republicans keep control of the Senate. Third, because, a wave of red voters might actually return control of the House to the Republicans. An already emboldened trump would then become even more dangerous than he is now. Bernie Sanders can not be the nominee. I think that Tom Steyer, Pete Buttigieg and Amy Klobuchar came to the same conclusion. They made a decision for the greater good. I am impressed, plus I feel that this bodes well for the future of the Democratic party.
The irony of all of this is the situation with Sanders and Elizabeth Warren. Warren clearly is taking votes away from Sanders, but she refuses to give up or give in. She seems to be focused on staying in until the bitter end. Sanders himself is interesting. He seems to feel like he has a God given right to the nomination, regardless of whether he has 50 percent of the delegates going into the convention. He sounds like he's the only one who can speak up for the American people, and he certainly does a great job speaking up. He's just never gotten anything done.
Last, but not least is Mike Bloomberg. He got into the race thinking that Biden was losing ground and there was no clear nominee. Suddenly, things have changed. Biden is looking stronger. Tomorrow is Super Tuesday. Bloomberg will get votes, and he'll get delegates. Depending upon how many delegates he gets, we'll have to see how he responds. It strikes me that if Biden becomes the clear leader, Bloomberg would drop out. It also strikes me that if Bloomberg is really trying to defeat trump, he'll recognize when it's time to support Biden as the others have done. We'll see soon enough why Bloomberg is running. Is he running for the Democratic party or for himself. I hope he's running for the party.
The irony of all of this is the situation with Sanders and Elizabeth Warren. Warren clearly is taking votes away from Sanders, but she refuses to give up or give in. She seems to be focused on staying in until the bitter end. Sanders himself is interesting. He seems to feel like he has a God given right to the nomination, regardless of whether he has 50 percent of the delegates going into the convention. He sounds like he's the only one who can speak up for the American people, and he certainly does a great job speaking up. He's just never gotten anything done.
Last, but not least is Mike Bloomberg. He got into the race thinking that Biden was losing ground and there was no clear nominee. Suddenly, things have changed. Biden is looking stronger. Tomorrow is Super Tuesday. Bloomberg will get votes, and he'll get delegates. Depending upon how many delegates he gets, we'll have to see how he responds. It strikes me that if Biden becomes the clear leader, Bloomberg would drop out. It also strikes me that if Bloomberg is really trying to defeat trump, he'll recognize when it's time to support Biden as the others have done. We'll see soon enough why Bloomberg is running. Is he running for the Democratic party or for himself. I hope he's running for the party.
Sunday, March 1, 2020
The "Ironman Legs" Feeling
I've put in a solid week of running, and backed it up yesterday with 3 1/2 hours on the bike. My legs weren't sore today (can't say the same for my butt!), but they were on the dead side. It's what I call the Ironman Legs feeling. I can't believe how much I've missed that feeling. The last several days have been a revelation to me. I really do enjoy the feeling of running on tired legs. I'm not sure why, except that it's always a bit surprising to see how the body adapts and manages to perform despite some level of fatigue. Of course, there's always a balance, but today was just fine. In fact, I ran at a comfortable, but solid, effort. Not too easy, and not too hard. For me, that has me breathing every 4th step. In heart rate vernacular, that usually puts me in Zone 2. That's where most of my training should probably be.
Surprisingly, my pace today was as good as it's been on the hilly 6 mile route I take from my house. After a very short downhill, I get going on a long one mile climb that is especially a challenge at the top, where the incline gets up to 9%. As of late, I've not needed to walk that section, and today was no exception. My heart rate also didn't shoot up, hence, no reason to walk. Once at the top, I was able to settle into a comfortable pace for the remainder of the run, before getting to the same hill on the way back, which is my downhill mile. Running downhill has it's own challenges, and today my focus was on running fast, but not pushing too hard. Running fast downhill on tired legs is a bit of a challenge, but I maintained my breathing at every 4th step, albeit the breathing effort was increased from the rest of my run. I managed to run the steeper portion of the descent at close to 7 minute pace, and as the mile flattened out, my pace for the mile ended up closer to 7:30 pace. Mission accomplished. That provided my legs with several minutes of solid downhill leg training, which is ultimately critical for getting stronger, especially when there are hills involved.
I finished up the week with just over 30 miles of running. I haven't done that since my Ironman training last year. In fact, over the years, 30 miles has generally been my target for a week of running. I really like the way this week panned out, with three 6 mile runs and a longer run to boot. My legs feel fine, albeit a little tired, but fine nevertheless. More important, I feel like I'm back home, as I alluded to yesterday. I really do like running (and swimming and biking). For too long I've come up with health related excuses for the time I spend in this endeavor. No more. I'm going to embrace the feeling of Ironman Legs, and embrace the lifestyle that seems to fit my mind and body so well. It feels right.
Surprisingly, my pace today was as good as it's been on the hilly 6 mile route I take from my house. After a very short downhill, I get going on a long one mile climb that is especially a challenge at the top, where the incline gets up to 9%. As of late, I've not needed to walk that section, and today was no exception. My heart rate also didn't shoot up, hence, no reason to walk. Once at the top, I was able to settle into a comfortable pace for the remainder of the run, before getting to the same hill on the way back, which is my downhill mile. Running downhill has it's own challenges, and today my focus was on running fast, but not pushing too hard. Running fast downhill on tired legs is a bit of a challenge, but I maintained my breathing at every 4th step, albeit the breathing effort was increased from the rest of my run. I managed to run the steeper portion of the descent at close to 7 minute pace, and as the mile flattened out, my pace for the mile ended up closer to 7:30 pace. Mission accomplished. That provided my legs with several minutes of solid downhill leg training, which is ultimately critical for getting stronger, especially when there are hills involved.
I finished up the week with just over 30 miles of running. I haven't done that since my Ironman training last year. In fact, over the years, 30 miles has generally been my target for a week of running. I really like the way this week panned out, with three 6 mile runs and a longer run to boot. My legs feel fine, albeit a little tired, but fine nevertheless. More important, I feel like I'm back home, as I alluded to yesterday. I really do like running (and swimming and biking). For too long I've come up with health related excuses for the time I spend in this endeavor. No more. I'm going to embrace the feeling of Ironman Legs, and embrace the lifestyle that seems to fit my mind and body so well. It feels right.
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