What's is Like to Be You?

For a standing room only crowd at the National Museum of Mexican Art last night, a group of fiesty Chicanas unveiled their new book, Chicanas of 18th Street, and spoke of their more than forty years of activism in the Chicago Hispanic community. There were cheers and tears in the audience, spontaneous expressions of heartfelt appreciation from a number of men (!), and an embarrassing shortage of tamales for a turnout that was three times what had been expected. The authors' overriding theme was that the "struggles" (this word was used often) continue and these women write and speak to teach and inspire the generations that follow.

But the previous day one of the most thoughtful, dedicated, and articulate Hispanic advocates I know posted an essay on Facebook raising the question of why the Hispanic community in Chicago seems to have lost momentum in its activist movement. He teaches at a local college where most of the students are of Mexican heritage, and asked this question of two of his classes. The response was that they were unwilling to give up the twenty or thirty dollars they would earn working in order to attend a demonstration or other activist activity. Is the issue money, the author/teacher wondered? Or fear? Or something else? He invited comments; as of this morning there has been only one.

He is asking the wrong question.

The Chicanas inspired an overwhelming turnout. Young women rose from the audience to ask tearfully what they could do to help, how they could become more involved. Discussion was halted after two hours or the crowd might still be there this morning. In fact, they may indeed yet be there! I briefly perused a couple of poster displays while consuming my one lonely tamal, signed up for the mailing list, picked my way through the milling crowd that clearly was going nowhere soon, and took my leave in order to go home to dogs much in need of walks. Who knows what time the museum finally emptied of that crowd?

Hispanic activism clearly is alive and well in Chicago, indeed, in the very same barrio where turnout had been so poor for a demonstration two short weeks ago. How is the difference to be explained?

The easy question to ask always is, "Why don't others do what I believe they should?" Why don't they march in the streets for a good cause, why don't they take their medicine, watch their diets, keep their medical appointments, exercise regularly, turn off the TV or computer and read a book, sit down as a family for dinner at night, and make love, not war?

But the question that yields meaningful answers and suggests where discussion and action need to begin if behavior change is to be inspired is, "What are they doing instead of what I believe they should?" Because it is in actions that values and priorities are reflected, and until a recommended behavior change serves those values and priorities as well as or better than current practices and habits, change won't happen. Jack Glidewell, a professor with whom I studied at the University of Chicago years ago, used to emphasize that when seeking to make change in any organization or group it is imperative to remember that any behavior or practice that has persisted for a long period of time has done so for a reason, and unless that reason is understood and continues to be satisfied, the proposed change will not be embraced.

So, if workers have functioned for years in a punitive environment where mistakes were punished instead of corrected and order was maintained with threats rather than reason and discourse, sudden introduction of a new manager or, worse!, "consultant" who announces that an "open door policy" and shared governance now are the order of the day is likely to meet with mute disregard and heightened suspicion. If the Sunday School class followed by the worship service followed by the church supper for decades has been the anchor and highlight of an old woman's week, counsel that she must take a "water pill" that will require her to run to the restroom every twenty minutes or have" accidents," and that she may not eat the foods served at the supper because they contain too much salt, fat, and sugar is likely to cause cognitive dissonance at best, and almost certainly to be ignored over time. Understanding the historic context of the work setting and the values and needs served by longstanding personal habits are key to improving both the workplace and personal health. Any anything else.

I don't know why the Pilsen community packed an auditorium last night but did not appear for a march two weeks ago. I don't know why "Mr. Brown" missed his doctor's appointment last week. I don't know precisely why any one of millions of Americans will overeat and make unwise food choices this holiday season. But I do know that asking why they don't do something other than they do will not give me the answers I need to inspire them to make different choices. Instead I need to ask, "Where were you the day of the demonstration? What were you doing? What was that like for you; how was it important? Did you know about the demonstration; how does/doesn't it matter to you?" and "What happened last week, Mr. Brown? Where were you and what were you doing the day of your doctor's appointment? How was that important to you? How do you feel about going to the doctor? What makes it easy/hard for you to go?" and "Tell me about your holidays. What do you do and with whom? What are your fondest memories? To what do you look forward? What is most special to you, and what do you most enjoy? Are there aspects of holidays that are difficult for you, and, if so, how do you manage that?"

Knowing that one is comfortable sitting in an auditorium but not marching in the streets, or that the comfort of the church community and of longstanding habits is greater than the discomfort of any exacerbated health problem, or that mindless consumption of cherished traditional foods in the company of too-rarely seen loved ones and a good televised football game brings greater joy than seeing a two pound weight loss on the scale the next morning tells me where to begin if I hope to bring change.

When we were divorcing many years ago my soon-to-be-ex husband looked at me with pained eyes and asked, "Why can't you be who I want you to be?" My answer might have been, "For the same reason that you can't love me for who I am." Just as a marriage based on projecting a fantasy onto one's partner is not likely to succeed, so efforts to bring behavior change, whether by inspiring a community or a single patient, are likely to be sorely misguided when they proceed from the question, "Why don't you do/be/think as I want?" Instead may the question always be,

"What's It Like to Be You?"

Mouse-Eared Princess Brides

Walt Disney World didn't seem an ideal venue for a professional symposium last month. Throughout every phase of managing my travel, the Disneyites referred to my trip as a "vacation," which hardly seemed appropriate as I hauled my jet-lagged backside to obscenely early meetings and lectures. Further complicating the jet-lag was the irksome practice of ending every day with a late night parade, complete with rousing renditions of patriotic music that certainly left one wanting to march to the beat . . . except when one wanted to clamp a pillow tighter over one's ears instead. Unless short-order fast food seemed appealing, breakfast was a boat-ride away. This entailed extracting one's bleary-eyed, post-nocturnal parade self from between the sheets at an ungodly hour, in order to hike to the dock and wait in the cold - and at that hour of the morning central Florida was cold in March! - for the boat, and then shiver in gratitude for the fly-back-to-Chicago clothes which, although not quite warm enough, surely were salvation from what felt like threatening frostbite as morning winds whipped over the open vessel making its way across the lake. I never had attended a professional meeting in jeans and fleece before, but, hey, Disney is good for nothing if not new experiences! Even if the mercury pushed its way into the seventies by mid-afternoon, there's no way my decorous skirts and blouses with coordinating light sweaters, were going to cut it on that boat!

Then there was the matter of timing: early to mid-March. Read: Spring break. Disney World no doubt is a magnet for children and families any time, but with many schools and colleges out of session for break, that week the place was a veritable wasp's nest of youthful revelers, everywhere, every hour, day and night. And Disney World is all about the children. A nap by the pool was punctuated by enthusiastic loud-speaker entreaties to join in a hula hoop contest. Every meal in every restaurant had a make-believe theme. Staff often were in costume, and those who weren't wore uniforms that looked like costumes. And wherever one turned, the landscape was ripe for acting out some fantasy. Indeed, each of the Disney World resorts has a theme, and expressions of that theme and opportunities for immersion in it and for absorbing play are everywhere. There are subtle and not-so-subtle suggestions and props at every turn, and everything a child would need to become the adventurer of his or her dreams.

And become adventurers and act out their fantasies they did. At about age three, "Pocohontas" stood next to me on Main Street of the Magic Kingdom, calmly taking in stride the sudden halt of a trolley-like vehicle, from which emerged colorful Victorian-era performers singing and dancing . . . even when one of them left the revue, danced up to little Pocohontas, greeted her by name, and engaged her in conversation. And although wide-eyed and a bit shy, Pocohontas not only did not back away from the attention, but instead gradually allowed herself to be drawn into it. Disney World is a safe place to be a child. And childhood is embraced, understood, and celebrated there.

A number of times I noticed a variation of the same ironic being: A little girl, with the trademark skull cap and mouse ears that characterize Disney, but also sporting a tiara in front of the cap, and a bridal veil behind it and down her back. Yes indeed: A mouse-eared princess bride. Princess costumes were everywhere, and mouse ears of course were ubiquitous. Interesting combinations of regalia from various Disney characters and individualized versions thereof popped up all around. But the mouse-eared princess brides were my favorite. And judging from the looks on the faces under this headgear, this look was the be-all and end-all for them, too. Such happy little girls!

In fact, the entire place was brimming with happy, happy children. I witnessed a rare, mild, fatigue-induced fuss now and then, but no tantrums, no whining, no aggression or violence, . . . only an extraordinary degree of patience, wonder, and sheer delight. Hundreds and hundreds of over-excited children in a strange place with their daily routines turned topsy-turvy, and little other than a large measure of happiness to show for it. And never once did I hear anyone tell a mouse-eared princess bride that she, in fact, could not be a mouse, or a princess, and certainly not all three, that she might not ever be, or actually want to be a bride, or that the other two options were out of the question entirely, thanks to immutable biology and heritage. No, if a little girl wanted to be a mouse-eared princess bride, then a mouse-eared princess bride she was, with the essential trappings provided and nothing but unassuming acceptance all around.

There's a lesson here. I have lived the better part of six decades, and have yet to encounter an adult who thought she was or wanted to be a mouse-eared princess bride. Maybe, just maybe, it isn't necessary, or desirable, to help children understand that their fantasies aren't real, to tell them that some dreams won't come true, or to admonish them to be realistic and grow up. And maybe the Disneyites have it right: If children are encouraged and supported in their creativity, they will tend to be happy, content children . . . and perhaps continue to create, begin to ask "what if?" and "why not?", and experiment and understand the world around them in ways that we in our paradigms, protocols, and evidence-based obsessions would never consider. Confident and brave, instead of doubtful and neurotic, perhaps these children can grow into adults who see ways out of the complicated mires previous generations have left them, and they might even be kind and generous enough to look kindly on their feeble and misguided elders, and protect us from ourselves.

Children don't need to be taught or told to grow up; it happens naturally (although we do have the wherewithal to make the process smooth or miserable). I suspect dreams and fantasies do the same: Supported, and then left to her own devices, the mouse-eared princess bride evolves into a new version of her dream, and then another, and another. Each one fits the circumstances of the child's life and level of maturity at the time, and if we try to mold, correct, or guide them, we produce only a damaged child and a lifeless dream with nowhere to grow and no empowering spirit.

Walt Disney World seemed a poor choice for a professional symposium, where experts from around the world would come together to understand and explore what is to be done to halt the epidemic of cardiovascular disease raging through our society and worsening alarmingly every year . . . while a giant, over-the-top, perpetual birthday party raged outside the meeting room doors. It seemed a poor choice, until I met the smiling, shining-eyed mouse-eared princess brides. And until I saw that if a little girl dreamed of being Mickey or Minnie Mouse, a princess living in Cinderella's castle, and a beautiful bride who would grow up to be just like Mommy, altogether, all at once, then she could do it, she could be it, with acceptance, support, and everyone around her eager to join in the game. Maybe, just maybe, we would solve the problems of cardiovascular disease, and poverty, and obesity, and cancer, and bad hair days, and all the rest, much more easily, much more creatively, much more effectively, and much less expensively, if we were allowed and encouraged to dream, to assume for awhile that the impossible is possible after all, and to ask "what if" and then act out the answers. Maybe our science would be better, and we would be a tad more effectively human, if we began our days with a boat ride to breakfast, lived our days in the spell of magical castles where anything is possible, expected people to pop out of vehicles on Main Street and break into song and dance, and never went to bed without a parade to celebrate all the good that the day had wrought.

I came home, in my fly-back-to-Chicago clothes, with a suitcase full of reports and samples, a bit of sunburn, and a wistfulness about the lack of a parade that night, and about there being no boat ride on the agenda for the next morning. Walt Disney World had not afforded me many quiet corners to have intense conversations about Important Matters with colleagues from across the country, and I was a bit sleep-deprived and overstimulated by days of being surrounded by throngs of excited children. I still haven't sorted through all those papers in my suitcase, and the volume of email generated from that conference is daunting. I'm worried about the toll to be exacted by the epidemic of "cardiodiabesity" that is upon us, and rue the lack of immediate answers. But I have a sneaking, smiling suspicion that even as we conference attendees go back to our laboratories, classrooms, and clinics and do our best to help those we serve and to advance the science that will help that process, the best ideas and most profound solutions may yet come a bit farther along in the future, from eager, insightful, creative, and confident clinicians and scientists who today are fortunate to be embraced and encouraged to be who they are and become who they will, beginning right now as

mouse-eared princess brides.

Gra'nanny Bed

Gra'nanny nurse come today.
And den Gra'nanny got a bed.
Gra'nanny ain't never had no bed befo'.
Gra'nanny sleep on the flo'.
Sometime I sleep dere with her,
when my bed full,
or I watch TV,
or it thunder.
But now Gra'nanny got a bed.
It go up an' down.
It set Gra'nanny right up, like in a chair,
only she still be in da bed.
It got bars she hold on.

How dat bed get here?
It be big. It be a whole bed.
Dem elevators broke.
Dey always broke.
Don't think dat bed fly upstairs
an' come in a winda'.
But it here.

Gra'nanny nurse come today.
The POlice brung her.
I was scared at first,
but he nice.
He show me his star,
and he play with me.
Gra'nanny nurse, she got needles
and stuff dat smell funny.
But Mr. POlice tell me stories.
He strong.
He pick me up when we play.
He help Momma.
He say the POlice got a summer camp
for kids like me.
I don't know about dat.
The POlice, dey got guns,
an' dey lock you up.
I know dat.

Gra'nanny nurse come today.
An' Gra'nanny got a bed now.
The POlice brung da nurse,
an' I might go to camp!
Some day I gonna be strong like da POlice
and carry beds upstairs,
so nobody Gra'nanny
never sleep on da flo' no mo'.

We'll Talk Later

Unlike just two or three years ago, no one in my personal circle seems to be feeling financially comfortable and confident right now. Payrolls have been "downsized," either by eliminating jobs entirely or cutting pay, companies are struggling, and I am newly aware of an undercurrent that must pervade much of otherwise happy family lives, as breadwinners wonder how much longer they will be able to pay the bills, or what threats may lurk around the next corner. An educator friend is giving me inside looks at the protests ongoing in Wisconsin, as the governor and allied lawmakers attempt to eliminate public employees' right to bargain collectively, a sobering and scary prospect. Many of my elderly clients, who worked and saved responsibly throughout their lives, barely can make ends meet now, and any unforeseen additional expense has the potential to pull them under. And I can't quite imagine how the bright but socioeconomically "at risk" student I tutor will pay for high school (yes, high school!) next year.

So far, my home is warm, my larder full, and my overindulged dogs content. But with clients who pay late and then only partially, or who are not-for-profit entities whose survival by no means is assured, or whose programs are faltering, there can be no assumption that next month's provisions are secure. And I am one of the lucky ones.

The temptation to succumb to fear is real, but the stronger that temptation grows, the more dangerous it grows as well.

Yesterday I lunched with representatives of a large company that would like to hire me . . . for approximately half the salary I made in my previous work. Not addressing the money for the moment, I explained that because I represent more than one client, it is essential that I remain an independent entity and that my role and relationship with each client is clear. There can be no appearance of using a relationship with one client to give a competitive advantage to another, and the ethics of representing an organization as an employee while simultaneously representing another client independently to the same market, are muddy at best. My luncheon companions understood.

I offered the option of their company procuring my services through my own company, Cima Services, in which case my independence and objectivity would be preserved, with my advocacy for and representation of all of my clients clearly defined, and no conflicts of interest apparent or extant.

The response? "We don't contract with nurses. We only contract with therapists." And my reply, "We'll talk another time."

There is little doubt that should that company want my services badly enough, they will enter into a business relationship with Cima Services without regard of its being owned by a nurse instead of a therapist; that reality may or may not ever come to pass. But the truth today is that the position of my luncheon companions' company can be taken liberally right now . . . because nurses permit it.

I walked away from that lunch with handshakes and smiles, and we will talk later . . . so that I can drive home my point with focus and clarity apart from the hubbub of the restaurant and the messiness of mutually feeling our way through a new relationship. But I walked away without a contract because too many other nurses do not walk away at all. Even as they complain about a "nursing shortage" and expect nurses to carry workloads dangerous to themselves and to their patients, employers in healthcare by and large continue to operate on the assumption that there always are more nurses to be found who will accept the abuse and its attendant risks. So it is not necessary to pay more, to redefine roles and responsibilities, or to enter into contractual relationships with independent nursing professionals. Nope, there's always another sucker out there who's worried about paying the rent, educating the children, and helping out the grandparents, and so who will drive 200 miles to make home visits to ten patients in one day, or work back-to-back double shifts day after day, or accept a low wage simply because it is offered, and it is a job.

Contrast this with another luncheon meeting last year, with the owners of another large company eager to hire me away from my previous employer. Never mind that the honchos didn't seem to have a job in mind that they wanted me to do, and seemed more eager to undercut my old boss by decimating his team than to build a quality operation of their own, but note their comment in passing that they simply were unable to recruit Physical Therapists. "They all have their own companies," lamented the honchos, "and when we have to contract with them we don't have the control that we would with our own employees. They tell us who they will see and who they won't, and they are considerably more expensive than our own personnel would be."

Hats off to our colleagues in Physical Therapy! They know their own worth, and have assumed control of their own practice. Many are personal friends, and I know they see patients on weekends, do paperwork at night, and drop what they're doing and head off to evaluate a new, high risk patient on a moment's notice . . . hard work, and less-then-ideal circumstances. But done on the therapists' terms, with the therapists having the power to accept or decline referrals, and to set their prices. Certainly if they are not competitive or not readily available their practices will suffer, but the decisions and control are theirs.

And then there is the nurse, often (albeit not always) with a broader scope of responsibility, more education, and more experience, who makes less money and is told, "You're on call because your employer determined you would be, you must accept this assignment, no matter if it's excessive, unsafe, you're tired, or if doing so would put you, us, and the patient at risk." The nurse grumbles, but acquiesces.

My word to my colleagues is, "You must stop." You are compromising your professionalism and integrity, you are placing yourself and those in your charge at risk, and you are enabling healthcare employers to continue to underpay and overwork nurses. You are enabling them to say, "We don't contract with nurses. We contract only with therapists." You are giving away your power. You are modeling passivity and a herd mentality for your children, despite the excellence of your professional skill.

Stop. When you tell that employer that you will drive fifty miles to see five patients, but not 200 to see ten, and stand your ground, that employer can choose between losing the revenue from all ten patients, if you walk away, or losing the revenue from only five, in which case there would be work left over for your nurse colleagues. Is this less lucrative for your employer? You bet! The CEO may have to give up one of his Mercedes or forego one of his luxury vacations . . . and it will be the fault of professional nurses who insisted on reasonable workloads and fair compensation. Reasonable workloads and fair compensation will not destroy the employer, no matter how much the employer wants everyone to believe otherwise. But insisting on these will constitute a much-needed step towards reducing that huge gulf between America's richest and poorest citizens.

Such a deal, my fellow nurses: More money, more power and control over your own practice, better patient care, a sane life, the opportunity to work independently if you wish, and doing your patriotic duty to boot, by taking some of the fat out of the executives and stockholders' wallets and seeing that it is reinvested in workers and in real work.

But it takes some courage: Courage to walk away with smiles and handshakes instead of employment contracts. Our colleagues in Wisconsin are talking, saying an unequivocal "No" to unilateral, top-down determination of their salaries, working conditions, and benefits, and insisting on having a respected place at the table, with a voice, a vote, and self-determination. Our colleagues in Physical Therapy have said "yes" to being their own bosses, and "no" to dictatorial employers. Historically it has been the workers who have prevailed to gain reasonable workweeks, benefits, safe condtions, fair compensation, and a measure of security. Nurses, no matter how scary the prospect and no matter how uncertain the times, whether we bargain collectively, or stand alone, it is time to do the same. It is time to explain what we offer and its price, to insist on a place at the table, rather than on the menu, and to leave with our values and dignity intact, knowing that regardless of the outcome,

We'll Talk Later.