Thursday, November 29, 2007

The Nurse Dilemma and Parenthood

At the family Thanksgiving (last weekend, thanks to the many family members in jobs that don't shut down for holidays), one of my nieces, a NICU nurse on track to become a Nurse-Practitioner, was talking about health care and other topics. (NICU, neonatal intensive care, "preemie" babies, babies born with other severe problems, heartbreak kids, all; hospital stays are long and survival rates are not high -- but most of those those babies had slim chances to none at all thirty years ago)

"We need universal health care," she said, "Like all the other civilized countries."
I made polite noises and lifted an eyebrow quizzically; I don't enjoy arguments. I did point out that government health care doesn't work so very well, to which she responded, "They pay a set amount per procedure, no matter the outcome! And they keep reducing the things they do cover."

She noticed the implied contradiction; she's no fool.

In further conversation, it came out that it tears her up to not be able to help; to send kids back to homes without power, without proper care, without parents who can or will do what it takes to care for them.

The easy, bumper-sticker libertarian question is, how much of my tax money do you want to mitigate your angst? Yeah, simple, neat, isn't it. I'm not asking it.

Here's a more difficult question: neo-natal nursing is high-stress work. The pay's decent money but they're not getting rich. What they are doing is working through tears, working with gut-churning emotional conflict, keeping little vegetables alive while Mums and Daddy dither, putting in endless hours with babies who will make it but whose parents never show up until the day the baby is sent home. They try to save the baby the rich teen-ager gave birth to on the toilet and left there, the baby whose new grandmother, on calling 911 and being told what to do, replied, "I'm not reaching in there after that." They work with utter-jerk surgeons, nasty cold men people hate, unfeeling guys who, on hearing the baby they worked on for eight hours has died after a struggle, drive in from an hour away, walk right to the NICU, tenderly lift the tiny corpse from the nurse's arms, look down and say softly, "We tried, buddy, we tried," hand the baby back and stride savagely out of the hospital, never making eye contact with another human being.

So the question is: what's it worth to keep these people from burning out?

I don't have an answer.

Maybe we're better off leaving the decision to bean-counters -- just as long as we don't run out of nurses who'll take on the job.

One thing we'd better do is get better at prevention. A significant proportion of the babies that end up in NICUs are born to drug-addicted mothers, to mothers who were malnourished, to teenagers who denied and hid their pregnancy. There's no law that'll stop that, no government program that can fix it but it can be slowed, one mother at a time. To the extent any of us can personally lend a hand to help on an individual basis, we should. And for pity's sake, we've got to try to change the trend of people seeing children, their own children, as an inconvenience.

Margaret Sanger, a figure both admired and loathed (and with good reason for both opinions), often stated her goal as trying to "ensure every child was a wanted child." So put, it's a good goal and one that can be just as easily done by helping (even glorifying) parents as by preventing pregnancies or worse yet, terminating them; and since all three are options available in a free society, there's probably at least one of them you can lend a hand to. (Not to pile yet another soapbox on the heap but it usually does more good and more directly affects individuals in a positive way to work for a positive goal. It's a lot easier to get people to try a new thing than to stop them doing something they're already doing).

Politics can be fun but bumper-sticker politics is full of pitfalls. There's no digging out of most of them from an ivory tower or even a blog; if we want a better, more free society, if we hope to roll back the growth of Mommy/Daddy Government, it's up to us to roll up our sleeves, pick up a shovel and use it to dig a path out rather than slinging mud. Sure, you're just one person; maybe you'll only ever be able to help one other person. But you'll have made that much change.

Wave signs, get on the evening news -- or help a scared and lonely girl? Which one will you look back on with the most pride?

Which one will help keep nurses -- nurses whose help we may someday need for our own families -- from burning out?

Which one will do the most to slow the demand for socialized medical care?

[It seems I have been a bit unclear. I'm not talking about "charity," I'm talking about doing what you can, within your own ethical framework, to push the younger critters within your easy reach a bit closer towards civilized behavior anent reproduction. This is rife with self-interest: if we end up with a huge bunch of barbarians and their preventably-hard-started offspring, it's going to make our "golden years" a lot less nice than they'd otherwise be and in a huge number of ways. Among other considerations, I'd as soon not be having to shoot the worst of them on a weekly basis when I'm greyhaired and rocking on the porch. Hollowpoints are expensive! YMMV.]


phlegmfatale said...

me mum manages the billing office for a prominent group of neonatologists in my city, and I've done a fair bit of work there re-organizing their office, and let me tell you, it's dazzling to me how the emotional types wax sympathetic for the babies and give no consideration to what a bleak morass billing personnel have to wade through to get a fraction of the billed amount re-imbursed from the gubmint programs that are purported to pay for these services for sick babies, many of them foreign babies whose mothers never went to clinics for pre-natal care to ensure a healthy baby (I suspect for fear of being deported before dropping anchor).

[gawd, what a crappy, eternal sentence that was. Emotional much? About this topic: yes.] I'm about to start a class in a minute, but I'll come back here and rant more. If any nurse is in doubt about what a gordian knot our government bureaucracy has made of health care billing, I strongly encourage them to talk to the people who take care of the business end of the business and find what their perception is of how the government handles things. In two words: they suck.

Roberta X said...

--Have I mentioned yet just how much I love the blogosphere for exactly the kind of cross-pollinating perspective you have brought to bear?

Darn right such programs suck; it stymies my how folks can imagine that making them all-encompassing will cause them do anything but suck even worse.

Less said...

The problem that is with prevention is that it implies that someone knows what they are preventing.

Knowing what you are preventing takes personal responsibility and that is an anathema to a large portion of the masses these days. We live in the instant gratification, me-me-me, it's not my problem generation where parenting, personal responsibility (hell personal Hygenie!) are not taught/learned by an ever increasing proportion of the population.

My sister in law is married to an illegal mexican who is almost always out of work. (Not all of 'em are like that. He really is...) and their solution was to keep having kids - Illinois gives 'em free dental, pediatric, food stamps, etc... Why would those "looters" even think of changing their ways? More over, what are their kids learing by example from them?

At some point the joyride will end because the majority will become people that'll think, "Why bother? The state will provide..." and the system will bankrupt. I think that prospect is far colder and crueller than asking a pointed question like "How much of my tax money will mitigate your angst."

As for rolling up your sleves and stuff I'll leave a quote and a qualifier:

"My views on charity are very simple. I do not consider it a major virtue and, above all, I do not consider it a moral duty. There is nothing wrong in helping other people, if and when they are worthy of the help and you can afford to help them. I regard charity as a marginal issue. What I am fighting is the idea that charity is a moral duty and a primary virtue."
-Ayn Rand

I started a company 2 years ago... From nothing, my company has gainfully employed 3 people (I can still afford a house, schooling for the wife, ammo, and 5 dogs and 5 cats). We hope to expand and employ another 10 sooner than later... I think those prospects are far better than almost any charity I could donate my already spread-thin time to.

Less said...

Very offtopic, but thanks for adding me, your "colorful protoplasm", to your blog roll!


phlegmfatale said...

Yup, cross-polination, indeed. It's good to know that we have the most efficient means ever of disseminating information.

True story - a pair of doctors (physicians - trained medical professionals wot am PhDs & stuff) from Mexico City came to my town to offload their high-risk baby. They got here just in time for her to give birth, because they knew the child would likely die in a Mexican hospital without top-flight med care. Guess what? They filed medicaid for that baby and didn't pay a dime for health/hospital - nada. People of means. Wealthy people. It's not just the indigent third-worlders who are raping our healthcare system and tapping resources intended for dire domestic need. When I think of examples like that and the thought that someone wants us to bend over a little farther and spread 'em a lot wider, well, I've got a problem with that.

I'm sorry that nurse-practitioner has the perception that the doctors don't care - I do think nurses are often stuck in the middle and they do most of the hands-on care of patients for a relatively low rate-of-pay. Guess what? Them's the breaks. Life's not fair. Still, I'd say a job is a pretty damned good one if a single woman can raise her bairns herself and put them all through college - I know several nurses who have. Besides that, it's a growth industry. Dealing with these sick babies would come with more emotional wear-and-tear than the average job, but again, that's why there are higher pay scales for those specializations. Rather than being angry at the doctors who breeze in and out (probably terrified of anything resembling personable conversation resulting in resentments/lawsuits, I'd bet), I'd focus my rancor on the crack-head mothers and ignernt bitches pounding out infants like rapid gunfire. Let's be honest - most profoundly ill newborns are in such a state due to the mothers' neglect.

And while we're at it, how about putting a limit on things. How about neutering crackhead baby mommas AND daddies? I'd call that a fair exchange for the toll the rest of society will pay for the folly of these individuals.

*Whew* Told ya I was gonna rant. Sorry I made such a sloppy mess of your nice, purty blog.

It's good to know Tam's got twins running around - she's the coolest chick ever.

Roberta X said...

Plegmme, you flatter me! --Keep it up; I think the very world of Tam and hope to qualify as a "cousin," at least. Anyway, it's an aspiration an' she's an inspiration.

Have another look at the "uncaring doctor" refernece. No few of them behave like SOBs to keep from breakin' down. That's a good thing; if a person takes a scalpel to me or mine, I'd as soon they weren't teary-eyed. But it takes its toll.

Less: A) you're already doing the sort of thing to which I was attempting to point.
B) Very pleased to list you on my blogroll.

Welshman said...

An excellent essay, Roberta! I will link to it tomorrow on The Liberty Sphere.


Larry G said...
This comment has been removed by the author.
Larry said...

A good friend's wife works in the PEdiatric Oncology ward at OHSU.

I could never do that.

Larry said...

Oh, and my local hosptial, SW Med Center in Vancouver Washington, which is several hours drive from the Canadian border, has an entire section of their finance department dedicated to dealing with Canaadian checks.

Wonder why that might be...

Anonymous said...

I should like to reinforce what I see is at least in part your point. To whit: the gratuitous insertion of the state into medical matters is not a solution, but an aggravating factor.

It is only because there is as much private entrepreneurial commercialism in the medical field as there is that a NICU is even POSSIBLE in this world. Certainly, government finance would never have gotten us here.

Mark Alger

phlegmfatale said...

brilliant point, that last one is.

Yar, you're on my blogroll now, RX!

comatus said...

Thanks for that, and expect more links as it makes the rounds, as it's one of the best new-humanist accounts I've read. Like the half-a-tear I once saw in Ayn Rand's eye, it plays up the amount of heart and gut it takes to burnish your glistening obsidian edge.

The enlightened-egoism addendum is particularly touching, as before the saccharine shower the sixties brought us, it was the no-duh standard rationale for deciding how to "help." If we survive mandatory voluntarism, it could catch on again.

Incisive furthermores from phlegmfatale, too, especially if you consider what she's putting her poor feet through as she writes. Like a hairshirt for the metatarsals.

Roberta X said...

Aw, Comatus, you old softie! ;) --Also spellchecker. (For which, public thanks!)

...My Nurse-Niece is more than mildly critical of mothers who shirk their care while carrying and even more so about the ones who are uncaring or inept once the child is born.

"Enlightened self-interest" has always made sense to me.

Anonymous said...

Huh-yeah, the only trouble with "Enlightened self-interest" is that everyone I meet who's 'self-interested' also passionately believes he's 'self-enlightened'!

Roberta X said...

It's okay to enlighten yourself, Comatus (though, N.B., so doing in the alley behind the bar is considered declasse'), just as long as you do not then proceed to forcibly light a fire under other folks who were minding their own business.

--Doping out when to butt out and when to lend a hand -- or a swift kick -- is the rub. It's what keeps philosophers, preachers and judges in business. At best, it's more of what you might call a goal; and at our best, we keep working towards it even as Xeno snickers at the way we keep closing half the remaining distance but never touch the target.

Anonymous said...

Zeno's not welcome at my range any more. Those endless strong-9 groups just weren't cutting it. (That's Aristotle's joke, and yep, I stole it.)

Why does the line from "Who shall rule?" to "Who is John Galt?" so often pass through "Who moved my cheese?"