Sunday, April 9, 2017

About dementia

Interesting thought this morning.
Dreamed last night that I was back in college and couldn't find my dorm room - kept mixing up the floors and ended up in a new dorm that was built after I graduated and that I've never even seen except in a picture. Was also worried about my senior examination that is usually done in the winter of senior year but it was already springtime in my dream and I hadn't heard anything about it yet - when and where - so I hadn't even studied. Anyway, my thoughts from the past and a bit of the present were all jumbled together and things made sense but they didn't, as they often do in dreams.
My father had dementia for many years and I often wondered what he was thinking - did he know where he was or not; did he know but couldn't express it; or was his connection to the present completely gone? Sometimes he seemed kind of with it, other times he seemed lost with bits of the past sprinkled in.
It occurred to me that's what it must be like to live with dementia - like being in a dream, where time and experience is jumbled and everything seems real and kind of makes sense, like in a dream, but you're actually awake. I can imagine myself walking around the kitchen muttering that I must get to my dorm, check my assignments, and prepare for my exam and my kids say to me, "Mom! It's okay. You're not in college, you're home. There's no exam." And what they're saying makes no dent on my thinking because my mind is in another time and place.
That must be what dementia is like: being in a dream but never waking up.

© 2017 Kvick Thoughts. All rights reserved.

Thursday, August 4, 2016

Clintons may be forced to become Democrats

Here’s the thing the Clintons and the Democratic Party don’t get, don’t want to get, or God knows what. Sure, a lot of Donald Trump supporters are just as loony as their candidate, but many mirror the same disenfranchisement felt by Bernie Sanders supporters, and Trump’s directness and plain speaking appeals to them, and they believe (wrongly) that he can or will try to help them.

It’s easy to scorn Trump supporters, but the Clintons have been running more or less neck and neck with Trump until recently. Despite all the money and campaigning, the Clintons’ numbers had not been moving much and roughly half the electorate preferred Trump over the Clintons. If Trump were to win, it would mean a majority (probably) of the American voting public preferred Trump over the Clintons.

Bearing in mind that Obama, a much-disparaged person of color, was elected twice with a comfortable margin, you have to ask what is happening. Has half the country suddenly become openly racist, misogynistic or homophobic? Not likely. At least some Trump supporters are angry, frustrated, and looking for answers, and they have not found them with the Democratic Party. If the Clintons want these votes, they’re going to have to stop pandering to moderate Republicans and deal head on with some bread-and-butter issues they’ve been avoiding, such as the Trans-Pacific Partnership.

Trump is a gift to the Clintons, but if he drops out as recent gossip suggests he might, and he is replaced by a saner conservative voice, the Clintons will be in trouble. They’ll have to start sounding like Democrats.

©2016 Kvick Thoughts. All rights reserved.

Wednesday, September 9, 2015

About the Black Lives Matter campaign

There has been criticism of the Black Lives Matter campaign that its focus on black lives only implies white lives don't matter. This is an obvious and probably intentional misreading of the Black Lives Matter message, but there is a context where the criticism may make sense.

In terms of police brutality, of course black lives matter and of course there is an experience of being black (or a person of color) in the U.S. that is unique and that many "white" people cannot understand because they have not experienced it and, if they are thoughtful people, find it hard to believe even happens because they cannot imagine people could be so nasty to each other, or that surely such violence does not happen without provocation.

But as we've seen over and over, there is racism in law enforcement (and elsewhere) and a campaign to highlight that is good, but not sufficient. We cannot change the attitudes of racist cops overnight. But we can demand for everyone's sake that cops who do as they please and violate civil rights be reined in. As a society we can say we will not tolerate out-of-control law enforcement for anyone. This does not end racism, of course, but it does help protect people of color who bear the brunt of such behavior as well as "white" people who are also subject to such abuse albeit less often and not as deliberately.

In 1974, my husband, who is white, was travelling with some friends in the U.S. in a green car with Michigan license plates. They were in southern California and a green car with Michigan plates had been involved in a robbery in the area. The police pulled them over and forced everyone to the ground at gunpoint screaming obscenities the entire time. At one point, my husband who is Swedish was going to reach for his passport to prove his identity but, thankfully, did not. When it was clear they had the wrong car, the police simply drove away. No apology.

I understand the potential danger to the police, and the odds of two green cars with Michigan plates in that part of California at the same time is low, but coincidences do happen. And to approach it with such a macho attitude only increases fear and tension. To leave with no apology is inexcusable. There is no doubt in my mind if my husband had reached for his passport, a natural thing to do if you are in a foreign country and/or unfamiliar with possible police attitudes, he would be dead today.

While not deliberate victimization by racist cops, it was nonetheless a shocking and frightening experience for my husband and his friends and did nothing to increase their overall trust in U.S. law enforcement.

So keep up the "Black Lives Matter" campaign to build awareness of racism in law enforcement and elsewhere, but for pragmatic results that indirectly curb the behavior of racist cops and that benefit everyone, we should demand loudly and unequivocally that aggressive, out-of-control cops be removed from their jobs.

© 2015 Kvick Thoughts. All rights reserved.

Sunday, March 30, 2014

Self-projection

For years my college catalog carried a black and white photo of two people "traying" down a hill in the winter snow. (Do students still do this – slide down hills on serving trays?) In the picture, snow is flying and you can almost hear the students’ glee as they skid wildly down the slope.

Every time I saw that picture I felt envy and anger. How could those people be so happy and be having such a good time? My college years were not especially happy. And when did those students find time to get outside?  I went traying only once in college.  
 
It’s not that college was so awful; more like bittersweet. There were some good moments, but also a lot of anguish and self-realization. But mostly my college years were a lot of hard work and worry. Campus life was intense, and I did not adapt well to work hard, play hard living. Perhaps it was a lack of self-confidence and uncertainty that I could handle the academic and social challenges that came my way.

When I walked past the campus common and saw people playing Frisbee, or stared out the library window at a chaotic game of softball in the field below, I felt like an outsider. Why couldn’t I abandon the books and cut loose for a while? Why did I find it so hard to balance work and play, and how did these people do it so effortlessly? A PE teacher once told us the best thing to do when we felt like a nap was to take a walk. I knew she was right, but I couldn’t bring myself to waste an hour wandering around the campus arboretum.

By my senior year, pre-exam stress and tremendous self-doubt were taking their toll. I had no choice but to take the PE teacher’s advice. I started walking and swimming as regularly as I could, and in a fit of anxiety, decided to go for broke on my seniors' exam, i.e. show evidence of thought rather than regurgitate what I knew. I was scared, but the strategy worked. I got honors on the exam. By spring, when I knew I would graduate, I began to relax a little and even took courses that were out of character for me.  One of them became one of my favorite courses.

So despite my self-doubts, college did its job. I learned to respect emotional well-being, honor the balance between body and mind, and enjoy learning for learning’s sake.

As I look back, my biggest regret is that I’m such a slow learner. Several years after graduation while I was digging through some boxes, I ran across the college catalog and stared at that picture for the umpteenth time still puzzling over how those people knew what it took me so long to realize. Suddenly I noticed something. One of the jackets looked familiar…and I think I once had mittens like those.

The lead person on the tray was me.

© 2014 Kvick Thoughts. All rights reserved. 

Tuesday, December 10, 2013

Nätverksbyggande med förhinder

Som introvert är jag inte bra på småprat. Jag skulle göra nästan vad som helst än att vara med på ett av alla dessa mingel- eller nätverksbyggarmöten. Men eftersom ”kontakter” är så viktiga för företagare fortsätter jag att delta. Men det kunde genom några få enkla åtgärder från arrangörerna bli mycket lättare för oss lite blyga:

Namnskyltar
Man kan hata eller älska dem, men de fyller sitt syfte. De är både en påminnelse om syftet med mötet och en enkel samtalsöppning för den som från början känner få av deltagarna. Dessutom gör de det lättare att komma ihåg namn. De fungerar. Använd dem.

Hjälp nykomlingar känna sig välkomna
Utse vid luncher eller middagar en ”bordsvärd”, som kan identifiera och välkomna nykomlingar till gruppen. Ge varje ny medlem en ”kompis” för att hjälpa till att introducera dem de 4-5 första gångerna. Eller fråga nykomlingar vid anmälan till en aktivitet om de vill någon äldre medlem som ”kompis”. Arrangörerna borde också planera någon form av strukturerad aktivitet där alla deltagare presenterar sig för varandra. Det kräver eftertanke och planering att få människor att känna sig välkomna. Lämna det inte till slumpen.

Stå eller sitta?
Visst är det besvärligt att skaka hand och samtidigt hålla en tallrik med små mat och en drink. Men syftet med nätverksmöten är att få nya bekanta, inte att smörja skrovet. Och det är lättare att mingla stående än sittande. En tumregel kan vara att inte ha stolar till alla. Det får deltagarna att byta platser och flytta runt under aktiviteten – det vill säja mingla. Vill du sitta ned och äta med dina vänner - gå till en restaurang.

Det personliga är lättare att minnas
Kom ihåg att det är ett maraton, inte ett sprinterlopp. Målet är inte ha få så många visitkort som möjligt, utan att få så bra kontakt med 2-3 personer att ni kommer ihåg varandra nästa gång ni träffas. Det är vetenskapligt bevisat att vuxna lär sig genom att associering, inte genom inlärning. Nästa gång du träffar någon i affärslivet, utbyt affärselementa, men också lite personlig information som hjälper er att minnas varandra. Förresten, när någon ställer frågar om dig, glöm inte att fråga tillbaka. Det handlar om god ton.

Nytta eller nöje
En avslappnad stämning är bra för framgångsrikt kontaktskapande. Men jag var nyligen på ett arrangemang där höga bakgrundsmusiken gjorde det nästan omöjligt att samtala. Det är populärt i Sverige att blanda arbete och nöje. Men resultatet är blandat. Kontaktskapande möten skall vara strukturerade, meningsfulla och ganska korta. Ett party är – tja, ett party. Låt kontaktskapande vara kontaktskapande och fester vara fester (med respektive eller vänner). Blanda inte ihop dem.

Framgångsrikt nätverksbyggande uppstår inte av sig självt. Det kräver planering av alla arrangemangets delar. Och paradoxalt nog känns aktiviteten mer spontan och avslappnande ju bättre planerad den är.

Publicerades av VLT (Västmanlands Läns Tidning), 15 augusti 2008. För att läsa artikeln på engelska, klicka här.

Networking 101

As an introvert, I’m not big on small talk. In fact, I’d rather go to Hell and back – actually, I’ve been there; it’s a small town in Norway just east of Trondheim – than attend a business mingle or networking event. But in the business world, “contacts” are everything; so I endure. Yet organizers of networking events can do a few simple things to make them a little less painful for us shy types.

Name tags
Love ’em or hate ’em, they serve a purpose. They are both a visual reminder to everyone about the purpose of the gathering and an instant conversation starter for the odd-person-out who’s trying to break into a cozy two- or threesome to introduce her or himself. (Not to mention they help people remember each other’s names.) They work. Use them.

Help newcomers feel welcome
Designate a host for each table (if it’s a luncheon or dinner event) to identify and welcome newcomers to the group. Or assign new members a “buddy” to facilitate introductions for the first 4 or 5 events the newcomer attends. Or ask newcomers if they would like a buddy when they sign up for the event. In addition, event organizers should plan some kind of structured activity that forces attendees to introduce themselves to each other. Helping people feel welcome takes forethought and planning. Don’t leave it to chance.

Sit or stand?
Sure it’s hard to shake hands while juggling a plateful of snacks and a drink. But the purpose of networking is to meet new people, not chow down. And it’s easier to mingle while standing than sitting. One rule of thumb I’ve heard is provide seating for only part of the group. This forces people to switch places and move around during the event, i.e. mingle. If you want to sit down and eat with your friends, go to a restaurant.

Something personal is something memorable
Remember – it’s a marathon, not a sprint. The goal is not to collect as many business cards as possible, but to genuinely connect with two or three people on a personal level so that you remember each other the next time you meet. It’s a scientific fact that adults learn through association, not memorization. The next time you meet someone at a business function, exchange your business vitals and a little personal information to help you remember each other. By the way, when someone asks you about yourself, but sure you ask about them in return. That’s just good manners.

Business or pleasure?
A relaxed atmosphere can be conducive to successful networking. But I recently attended a networking event where the rumble of the boat engine and loud background music made conversation almost impossible. It’s popular in Sweden to mix business with pleasure. But this leads to mixed success. Networking events should be structured, purposeful, and relatively short. And a party is – well, a party! Let networking be networking and a party a party (with spouses, partners, or friends, please). Don’t mix the two.

Successful networking events do not happen magically. Every aspect of the event requires serious planning. But the paradox is, the better the planning, the more spontaneous and effortless the event will be for all participants.

© 2013 Kvick Thoughts. All rights reserved. This article was also published in the Swedish newspaper VLT on August 15, 2008. To read the article in Swedish, click here.

Saturday, October 12, 2013

A toss of the genetic coin

My brother is dead. His body was found in his residence on May 12 and cremated shortly thereafter. But we just found out. That’s because my brother had a mental illness and lived on the margin of society. He was 59 years-old.

I heard the news from a sister, who heard it from our other brother, who heard it from our mother, who heard it from a stranger on the phone who had called to say they were sending a death certificate. My brother had been dead for a while before his body was found - it was mummified. There was no information about family among his possessions so it had taken time to track us down. But I guess that’s how it is when you die poor and alone. There’s no hurry to inform anyone because there’s no one to inform.

My brother was diagnosed with schizophrenia in the 1970s. This was the same time that states began discharging people who posed no threat to themselves or others from state hospitals. This was not a bad thing – there was talk of sheltered employment and new housing alternatives for former hospital residents. But sufficient services never materialized, and many of these people ended up on the streets.

One Christmas shortly after he had completed college my brother came home to visit. But he was not himself.  He had a major breakdown. Following hospitalization and many months in therapeutic and supportive work programs, and medication, his condition was stable. It was now time to get a job. But what kind of work, and where? Or more precisely, who was going to hire a bright young man who walked and talked like a zombie? He had completed the available programs but there was nowhere for him to go. Yet he still had hope for himself. He thought his chances would be better elsewhere so he returned to where he had been. We never saw him again.

Why, you may wonder, did my family not encourage him to stay and assume responsibility for him? The answer to that is long and complicated but familiar to any family that has lived with an adult with mental illness. Let's just say the structure of U.S. health insurance, social service and public assistance programs do not make it easy, and many families lack the financial resources and emotional stamina to make such a commitment – providing for all material and medical needs, coping with erratic behavior, running interference with the law, assuaging other peoples’ fears, monitoring medication, and more. It can be a full-time job depending on the type and severity of the illness. Ultimately, their life becomes your life, and no one in my family was willing to give up their life for his. We cut him loose. Why no one stayed in touch with my brother is another matter, but can probably be best summed up as benign neglect.

But one person’s well-being should not require the preemption of someone else’s. We live in very punitive and selfish times: If you don’t succeed in life it’s your own fault, and don’t expect government to bail you out! I understand when unemployment is high, budgets are strained, and families are stressed, people hang on tighter than ever to what they have for fear of losing it. They are afraid and don’t know how to protect themselves. So they become defensive.

But you would think uncertainty and worry would make them more, rather than less, willing to support reasonable taxes, health care for all, and public programs that help us support each other. After all, in times of misfortune, these same programs will protect and preserve their families, too. Yet, there is not only widespread unwillingness to help other people, but denigration and outright contempt for those down on their luck. It’s a way of thinking and an ungenerous spirit I don’t understand, and one that will haunt them when trouble lands on their doorstep, as it inevitably will.

A childhood friend of mine wrote upon learning of my brother’s death: “I remember hanging out in his room, without you, looking at his fossil collection with him…There was something really peaceful about him that made me comfortable. It's too bad the toss of the genetic coin robs us of our essential nature.”

It’s important to remember: There, but for chance, go I.

© 2013 Kvick Thoughts. All rights reserved.

Wednesday, November 7, 2012

Obama rhymes with Ohana

As my daughter read on Twitter, à la "Lilo and Stitch":
"Obama rhymes with Ohana. Ohana means family, and family means no one gets left behind."

Sunday, November 4, 2012

Define “poor”

A couple months ago, Fox “News” pundits pooh-poohed a survey about poverty in the United States, expressing amazement that, according to the survey, something like 90% of all poor people own a refrigerator. Fox’s rationale? If someone owns a refrigerator, how can they be poor?

A couple days ago, conservatives were at it again: Romney economic adviser Kevin Hassett in a Wall Street Journal article questioned how someone can be poor if they own a microwave oven (Daily Kos).

When I was ten, my family visited Puerto Rico. Several times during our stay we drove a causeway in San Juan over a shantytown on stilts along the banks of a dirty, marshy river. My father explained that people lived there because they couldn’t afford a house on land. Each time we took that highway, I stared at the houses and people below. I knew they were poor, yet they were fat and wore nice clothes. I was puzzled. This didn’t square with my picture of poverty. When you are poor, you're supposed to be starving and dressed in rags.

When my eldest daughter was 14, she went with a small group to Bangladesh through a project sponsored by her school. While they were there, they visited a slum in Dhaka. When she came home and talked about the visit to the slum, she was surprised that even though the people who lived there owned almost nothing, most of them had a cell phone.

I can’t tell if Fox News and Hassett are being deliberately obtuse or just disingenuous. Do conservatives really need to be told that how things look are not necessarily how things are? As a child, I didn’t know that cheap, high carbohydrate rice and beans were an Island staple and that clothing can be cheap or expensive. And things once deemed luxuries are inexpensive today, and to some people, necessities: Dhaka slum dwellers may live in shacks but they all have cell phones. Does this mean they’re not poor?

Poverty is not about the things people have. It’s about things and opportunities they don’t – nutritious food, appropriate clothing, decent housing, safety, education, and the ability to acquire these things for oneself and one’s family.

My message to Fox and Hassett?

Grow up!

© 2012 Kvick Thoughts. All rights reserved.

Tuesday, October 23, 2012

Age of selfishness (or getting my way – what I want, when I want, how I want)

I was making dinner and handed the onion chopper to my teenage daughter who was sitting at the table doing schoolwork. “Would you chop this, please?”

She accepted the chopper. “What are we having?”

“Lasagna,” I said, aware that that she doesn’t like it.

She suddenly stopped chopping. “I can’t support that.”

I laughed. Her reply epitomized the current political and social culture of the United States, if not the world: If you don’t like the outcome, don’t support the process! But as a parent, I was also a little irked: It’s one thing to express an opinion; it’s another not to cooperate because she doesn’t like the menu. As the designated cook for the family that night, I needed her help whether she liked it or not.

In an online article, “Why We Fight for Economic Freedom,” Charles Koch of the infamous Koch brothers tries to equate government intervention in American business with central planning in the former Soviet Union by listing a series of platitudes that warn about the danger of big government and power with no acknowledgment that American and Soviet economics evolved from completely different systems of government, and that, most tellingly, in the United States, “‘the government’” is you, me, and even Charles Koch. The irony, as any first-year economics student can tell you, is that unfettered economic freedom inevitably leads to oligarchy and monopoly, either public or private. “Nations with the greatest degree of economic freedom [read: limited government] tend to have citizens who are much better off in every way,” writes Koch. Not necessarily, Charles, unless you mean we’re all better off if we do what you tell us.

Harold Simmons, one of the biggest contributors to Republican candidates and causes during this election, also believes his business acumen justifies a certain derring-do. Charles Homans writes in The New Republic (May 10, 2012) that in 1993, Simmons used the pension fund of one of his companies to take over another company, a move the U.S. government deemed unduly risky. When he found himself in court, Simmons justified his action by claiming the deal was a prudent investment, but the judge ruled against him anyway. “‘That’s when I started contributing to politicians with free-market and antiregulation [sic] agendas,’ he later told [The Wall Street Journal]. ‘If the Labor Department hadn’t sued, that pension would be as rich as me.’” So in Simmons world, the ends justify the means? And what if he had been allowed to proceed and had been wrong? Bernie Madoff?

Democracy allows everyone an equal say in how they are governed in accordance with principles that permit them to live free from oppression or coercion by others. (Thanks, Wikipedia.) It does not mean getting your own way. Nor does it guarantee efficiency. Democracy is about helping as many people as possible get their own way while protecting us all from individuals and groups who would impose their will on everyone else if they could. When it comes to democracy, Koch and Simmons thrive because of government, not in spite of it. I guess they missed that day in civics class.

As I told my daughter, “If you don’t like what I’m making, don’t eat it.” But it's my job to make dinner for everyone, and as a member of the family, she's expected to help - even if she doesn’t like lasagna.

© 2012 Kvick Thoughts. All rights reserved.

(See related post Corporate give and take.)

Friday, July 6, 2012

Winning an election vote by vote

When you read about the ridiculous amounts of money being channeled by PACs and billionaires into the 2012 election – all sanctioned by the Citizens United Supreme Court decision – it’s easy to feel overwhelmed and discouraged.  How can a candidate without big money ever hope to win an election?

Then I think about Quaide Williams.

Quaide is a U.S. citizen who lives in Germany. Two years ago, Quaide, inspired by Republican Sarah Palin and her campaign bus, started planning a 6-week, trans-Europe voter registration bus tour to register Americans who live in Europe for absentee ballots in the 2012 election.

U.S. citizens who vote from abroad are an overlooked but increasingly important block of voters. In the 2008 U.S. senate race in Minnesota, for example, Al Franken won the seat by 312 votes. This is fewer than the total number of absentee ballots received in Minnesota during that election. And according to an article in The Huffington Post, if the number of U.S. citizens who live aboard were a state, it would be the 18th largest in the U.S.

Although the tour was organized in cooperation with Democrats Abroad, Quaide and his fellow passengers, Americans who live elsewhere in Europe and who join him for a few days at a time, will help register any U.S. citizen who wants to vote regardless of party affiliation. Why?  Probably because they, like me, believe voting is essential for a healthy robust democracy. Of course, they would prefer to register more Democrats than Republicans, but they understand that the act of voting is important in itself.

The bus tour is essentially self-financed, and driver and riders rely on members of Democrats Abroad to house and feed them as they travel from city to city. Last Saturday, following a busy afternoon in Stockholm, Quaide and his “roadies” made a quick stop in Västerås, a city near me. I greeted them with coffee – this is Sweden after all – and a canister of homemade peanut butter cookies while they went into action. We received local media coverage and even registered a couple of voters.  An hour and a half later, at 6:00 PM, Quaide and his team hit the road again for a 5½-hour drive to Oslo. The bus tour will visit 27 cities in 13 countries.

Unless the PACs and deep pocket donors are literally buying votes, it’s still flesh and blood individuals – I can’t say “people” for legal reasons – who will decide this election.  And it’s important to remember that the biggest spender doesn't always win.

How do you counter the influence of big money in an election? Vote by vote, with dedicated volunteers and an occasional homemade cookie.

© 2012 Kvick Thoughts. All rights reserved.

Thursday, May 24, 2012

Letting go - parents and kids

I was cleaning the other day and ran across two journals I had started when my children were young. I had intended to write down memorable things they said and did as they grew up, but I didn’t get very far. Not surprisingly, “life” intervened and I had made only a few entries in each notebook. But one item caught my eye. My eldest daughter had told me, “I want to be poor when I grow up so I can live with you.”

I’m flattered she had loved me so much.  Out of curiosity, I decided to test her to see how she felt about this today. But I posed the question a little differently. “If I’m poor when I retire,” I asked, “how would you feel if I lived with you?” “Well,” she hesitated, “if you absolutely have nowhere else to go, I suppose you’d have to.”

What happened to my loving, trusting little girl? What a difference a few years make!

When kids are young, they can’t imagine life without their parents. When I was young, I thought children died when their parents did. I obviously hadn’t thought this through, but that didn’t matter.  I had no concept of myself independent of them. We were completely symbiotic: if they die, I die. It did occur to me that, by this logic, if they died “tomorrow,” I would never grow up. This puzzled but did not worry me. I thought that’s just how things are.

But my parents did not die, hence my ability to write this post! It’s the paradox of parenting:  you want your children to love you, and to some extent, need you, but it’s your job to teach them to live without you. The truest act of love is to drive your children away! Maybe that’s why my parents gave each of their children a suitcase as a high school graduation gift.

As my daughter intrinsically knew, parents and adult children in Sweden and in the United States do not live together unless they have to. So she needed the excuse of poverty to continue to live with me as an adult. She did not yet know she can have both self-reliance and a live-in mom, if she wants.

But now she does, and she’s no longer as keen on the mom part. Paradoxically, the better I do my job as a parent, the less my children need me. Yet, the more I need them.

I’ll miss her when she moves on. But maybe she’ll miss me, just a little, too.

© 2012 Kvick Thoughts. All rights reserved. 

Thursday, May 10, 2012

I feel vindicated!

It's official: Västmanland county (landstinget Västmanland) has the highest number of patient complaints of all counties in Sweden. Go, Västmanland!

Read more in VLT.

Monday, April 2, 2012

Läkare är inte ofelbara

(To read this article in English, click Doctors never make mistakes.)

I december fick jag dagskirurgi (inne på morgonen och hemma på eftermiddagen) för att förbättra ett ärr som jag fick på grund av bortopererande av livmodern för två år sedan. Innan den senaste operationen ringde jag till Socialstyrelsen för att kolla om det fanns prickningar mot läkaren som skulle utföra operationen. Den som svarade förklarade att en patient hade anmält enheten, inklusive den aktuella läkaren, men att efter en undersökning blev beslutet att inga fel hade gjorts.

Inga fel gjordes. Men det önskade resultat för patienten som anmälde enheten hade inte uppnåtts på grund av beslut som fattades av dem som jobbade där.

Något gick fel, men ändå hade ingen gjort fel. Det påminde mig om min första operation när kirurgen klippt bort urinledaren under bortopererande av livmodern och man behövde fästa om urinledaren. Uppmanad av personalen och som rutin anmälde jag operationen hos Landstingens Ömsesidiga Försäkringsbolag (LÖF) för kompensation för några av de besvär som följde på grund av operationen. Men anmälan avslogs med hänvisning till att läkaren inte hade gjort fel.

Inget fel? Hur kan det vara så? Skall man skada urinledaren under bortopererande av livmodern?

Jag förstår att medicin är en konst - att det inte finns några garantier. Man kan inte alltid förutse resultatet. Ibland kan det dyka upp oväntade problem och att resultatet kan variera beroende på omdöme, skicklighet, och erfarenhet hos personen som utför operationen. Men där ligger problemet: läkare är människor, och människor gör misstag. Det är bara mänskligt. Frågan är egentligen om läkaren borde ha vetat bättre eller handlat bättre? Fattade läkaren ett beslut eller gjorde något som andra läkare i samma situation skulle anse som orimligt? Var läkaren försumlig?

När Socialstyrelsen och LÖF påstår att läkaren inte gjorde fel menar de egentligen att läkaren fattade rimliga beslut under givna villkor, trots oönskade resultat eller medföljande skador. Men det finns problem med att läkaren och andra använder förskönande omskrivningar som ”komplikation” istället för ordet ”misstag.” Det förklarar problemet med oförutsedda omständigheter eller krafter som läkaren inte kan kontrollera och frikänner därför läkaren från direkt ansvar för sina åtgärder och sina beslut. Men urinledningen klippte inte sig själv. Någon klippte av den.

Jag förstår att min situation var besvärlig och att det faktiskt inte är ovanligt att urinledningen klipps av under bortopererande av livmodern. Men det var tveklöst ett misstag. Att då inte erkänna detta gör att myten om den ofelbara läkaren bevaras.  Det hjälper inga.

Läkare lär sig aldrig ödmjukhet – för det finns inget mer ödmjukande än att titta någon i ögon och säga, ”Jag gjorde mitt bästa men jag gjorde fel. Jag ber om ursäkt.” Det får heller inte människor att acceptera att trots att man försökt göra sitt bästa händer misstag, ibland tyvärr med förfärliga konsekventer.

Jag förstår att om en läkare, mer så dock i USA, medger ett misstag är det att öppna för en stämning eller en rättegång. Men även i Sverige, där patienter inte direkt kan stämma en läkare, finns det samma motvilja hos läkare och myndigheter att oförbehållsamt erkänna och diskutera misstag i sjukvården. När jag ringde till LÖF för att kolla läkaren var kvinnan som pratade med mig lite misstänksam när jag ställde frågor. Då frågade jag henne, ”Varför är du så defensiv? Jag ställer frågor om läkaren på grund av att det inte finns ett annat sätt för att få informationen om honom.” Då kopplade om henne lite och sade, ”Ja, men några människor…,” utan att avsluta meningen.

Så snart som vi tar ned läkarna från piedestalen eller de klättrar ner själva kan vi prata lugnare om mänsklig ofullkomlighet och om patientens förväntningar, liksom om skillnaden mellan förklarliga misstag och försumlighet. Ett fel beroende på omständigheterna? Litet skadestånd. Försumlighet? Stort problem.

Det är dags att sluta låtsas att läkare aldrig klantar sig. Människor kan vara överraskande förstående när man bemöter med dem med ärlighet och respekt.

© 2012 Kvick Thoughts. All rights reserved.

(See related posts "We are not Dr. God" and Name game.)

Tuesday, March 27, 2012

"We clean ears on Thursday only."

"We clean ears on Thursday only." Children on Tuesday. Bones on Monday. Joints on Wednesday. Fevers on Friday, but only until 15.00. If your problem does not fall on the scheduled day, fuck off. Or go to the ER.


Västmanland health care at its finest.

Sunday, March 11, 2012

Facebook face-off

With the recent IPO of Facebook shares and construction of a Facebook data center in northern Sweden, it looks as if Facebook is here to stay. But I can’t say I’m staying with Facebook. It’s getting too commercial and too intrusive for my taste.

As an American who lives abroad, it’s a great way to stay in touch with far-flung family and friends. I enjoy my daily dose of friendly chatter. But Facebook is losing its charming folksiness.

My first beef is Facebook assumes a lot about me based on my age and gender, which are required information to open an account. My wall, or excuse me, “timeline” (I’m a resister) is filled with ads for arthritis medicine, weight loss products, and large-size bras even though Facebook doesn’t know my health status or weight (or so I think). But stereotyping has never stopped advertisers in the past, so why start now?

A couple months ago, I tried to update my profile. But I could no longer write what I wanted about my hobbies and interests. Everything was preset, and I could only click on icons to list my favorite books, movies, and music. I couldn’t write any free-standing information. Not wanting to be connected to these pages, I chose nothing.

But most upsetting is the meshing of personal and professional information. I recently saw a job announcement where the only way to apply for the position was through a Facebook or Google account, which automatically reveals the applicant’s age, gender, and looks (depending on the account picture). Nor did the announcement provide an email or traditional address where applicants could send documents to bypass a Facebook or Google login. For kicks, I decided to see if I could apply yet block access to potentially discriminatory information. If there was a way to do it, I couldn't figure it out.
  
I understand Facebook is a business and needs to make money. But it has gone too far. It’s sacrificing its reason for being to commercial interests, and I don’t know how long or how far I’m willing to cooperate. I know people who never have and never will open a Facebook account. I hope they can hold out.

I wanna talk to my peeps without worrying who’s listening in. It’s enough to drive me back to email and anonymous ads for penis enlargers.

Wednesday, January 25, 2012

Name game

I recently switched health clinics. Yesterday I visited my new clinic for the first time. On a wall in the waiting room were the happy, smiling faces of the staff, identified by first name – “Jakob,” “Kristine,” “Marie,” “Samir,” “Erik”, etc. – and job title – doctor, administrative assistant, doctor, doctor, nurse, etc.

Self-reference by first name only is supposed to convey friendliness and feel less intimidating for patients, I assume. But I think it conveys a lack of gravitas I find distressing when it comes to my health. I appreciate friendliness and service with a smile; but both a first and a last name convey a professionalism I find reassuring. When a doctor or nurse uses his full name when introducing himself I feel like he's giving me his complete attention and putting his entire reputation on the line for me. This person is saying “I’m completely committed to your care.”

Although my former doctor put a perfunctory “Dr.” before his first name, i.e. “Dr. Harold,” when he phoned with test results or treatment options, this didn’t cut it either. It’s the way someone talks to children or how people refer to doctors on radio or TV talk shows: I am not seven years old and you are not a media personality. I want to be approached as an adult peer, and I want my medical practitioner to present herself using her first and last name as in any professional relationship: “This is Claris Parnell from the City Health Clinic. I’m calling about….” Or, more traditionally, “This is Dr. Parnell from the City Health Clinic.”

But don’t try and be my “buddy.”  It’s supposed to feel friendly, but I find it forced and phony, and presumptuous. Given a choice, who would you trust: Dr. Hibbert or Dr. Nick?

© 2012 Kvick Thoughts. All rights reserved.


Tuesday, January 17, 2012

Doctors never make mistakes

(To read this article in Swedish, click Läkare är inte ofelbara.)

I had day surgery (in and out the same day) in December to repair a scar from a hysterectomy
about two years ago. Before this most recent surgery, I called Socialstyrelsen (National Board of Health and Welfare) to check the record of the doctor who would be doing the operation. I was told there had been a patient complaint against staff in his unit, including him, but that the complaint had been investigated and it had been determined no mistakes had been made.

No mistakes were made. Yet the desired outcome for the patient who filed the complaint had not been achieved as a consequence of their decisions. Something had gone wrong, but no errors had occurred. It reminded me of my first operation two years ago when the surgeon cut a ureter during the hysterectomy and it had to be reattached. As a matter of routine, I filed an insurance claim with Landstingens Ömsesidiga Försäkringsbolag, LÖF (patient insurance bureau) for financial compensation for some of the ensuing difficulties. But my claim was denied because the doctor had done nothing wrong.

Done nothing wrong? How can this be? Are you supposed to damage the patient’s urinary tract during a hysterectomy?

I know medicine is an art – nothing is guaranteed, outcomes are not always predictable, difficult, unforeseen circumstances are possible, and results can vary depending on the judgment, skill, and experience of the individual practitioner. But there's the rub: doctors are people, and people make mistakes. That’s the human condition. The real question is: should the doctor have known or done better? Did the doctor make a decision or do something other doctors in the same situation would consider unreasonable? Was the doctor negligent?

When Socialstyrelsen and LÖF say the doctor did not make a mistake, what they really mean is the doctor followed a reasonable course of action under the circumstances despite a negative outcome or collateral damage. But the problem is when doctors and others use euphemisms like “complication” instead of the word “mistake,” it ascribes the outcome to unforeseen circumstances or forces over which the doctor had no control and thereby absolves the doctor from direct responsibility for her actions. My ureter did not cut itself. Someone cut it for me.

I’m aware that in my case the circumstances were difficult and that, in fact, to slice a ureter during a hysterectomy is not uncommon. Nevertheless, a mistake was made and by not acknowledging that, we perpetuate the myth that doctors don’t make mistakes when they obviously do. This is a disservice for everyone. It fails to teach doctors humility – there’s nothing more humbling than looking someone in the eye and saying “I did my best, but I made a mistake. I’m sorry.” And it does nothing to help people accept the fact that despite a doctor’s best efforts, mistakes do happen, sometimes, unfortunately, with dire consequences.

I realize that especially in the United States for a doctor to admit a mistake is, for many reasons, to invite a lawsuit. But even in Sweden, where patients cannot sue doctors directly, you see the same reluctance in doctors and regulatory authorities to openly acknowledge and discuss mistakes in medical treatment. When I called Socialstyrelsen to check the record of my most recent surgeon, the woman I spoke with was vaguely hostile and I flat out asked her, “Why are you so defensive? I’m just asking about this doctor and there is no other way to get information.” She relaxed a little and said, “Well, some people…” and trailed off.

The sooner we take doctors off their pedestal, or they climb down themselves, the sooner we can talk more calmly about human fallibility and patient expectations, and the difference between understandable mistakes and negligence. Circumstantial mistake? Small penalty. Negligence? Big problem.

But let’s stop pretending doctors never flub up. People can be surprisingly understanding when talked to honestly and respectfully.

© 2012 Kvick Thoughts. All rights reserved.

(See related posts "We are not Dr. God" and Name game.)


Tuesday, October 18, 2011

Roman holiday

We were on vacation in Rome this past weekend. The hotel clerk suggested if we were planning any daytrips, Saturday would be a good time to get out of town. A demonstration had been planned and travel within the city would be chaotic because of blocked off streets. “What are they protesting?” I asked. Berlusconi, banks, and the general economic situation, he replied. “Berlusconi?” I thought. “Count me in!”

I’ve been casually following the Occupy Wall Street movement and was aware that sister demonstrations had been planned for October. But I didn’t know when. This sounded like one of them. But even if it wasn’t, a chance to demonstrate against Berlusconi, a disgusting man who had survived yet again another vote of confidence that same day, was reason enough to show up.

We arrived at the designated starting point at the designated time and saw a few hundred people milling about. I was disappointed. Where was everyone? I’m angry and I don’t even live in Italy! We saw banners for what appeared to be political parties, unions, and other organized groups. That was okay, but I wanted to see everyday, unaffiliated people protesting – ordinary individuals who are fed up with the Berlusconi government and the general state of affairs in Italy.

We scanned the crowd and saw a middle-aged woman and a middle-aged man sitting on the edge of a large fountain with homemade signs around their necks. I approached the woman – I hoped she spoke English – and asked her what her sign said. For a better Italy, she answered and directed my attention to a newspaper she was holding with a similar headline. She explained she was a secretary from northern Italy near Berlusconi’s home town. She was a temporary worker who could not find a permanent job and this was the third year she had demonstrated in Rome.

I asked my perennial question: if people dislike Berlusconi, why does he keep getting elected? Because the politicians are too vested and have too much to lose if they don’t back him, she said. [This may explain parliamentary behavior, but it doesn’t explain why voters continue to support this outcome.]  I asked her about the various groups and what other homemade signs said. My favorite, held by a man, read “I’m here for my daughter.” I went over to talk with him and get his picture, but the crowd started moving so we joined the flow.

As we inched along, I noticed a little girl holding a sign. I asked her presumed dad what it said: "I vote, you vote. They say we’re a democracy but we’re not."  Along the periphery, I occasionally noticed one or two people wearing hoodies and black bandanas across their faces. I wondered who they were. A couple of them climbed a lamppost and I wondered what they were up to.

We soon entered a large public square and the march stopped. It was warm, and people chugged beer and chain-smoked. (After all, this was Italy!) The crowd soon became dense and we realized we were in the middle of it. I wanted to be closer to the edge so we pushed our way out to a side street. By now my youngest daughter had had enough – it was hot, her back hurt, and she was nauseous from cigarette smoke. She and my husband left, but my eldest daughter and I stayed.  

I spied three people with homemade signs and went to investigate. One of them explained they worked with public services and were protesting cuts to service programs. She herself worked with family planning.   

Half an hour later, the crowd seemed to be moving again and we eased our way down a main thoroughfare. Occasionally we heard sirens but I didn’t think much about it. Sirens are a way of life in Rome. We had progressed several blocks when suddenly people became very agitated and started shouting. I looked to my left and saw a group of maybe fifty hoodies. People backed away and hollered at them as they cut through the crowd. Several of the hoodies wore helmets.

I looked for someone who could explain. “It’s the Black Bloc!” a man sputtered indignantly.  Who are they? I turned to someone else. He spoke better English. “They’re troublemakers,” he said. “They just want to fight. I was yelling, ‘Show your face!’” We started walking together. “No one knows who they are. When you see them, you know there’s going to be trouble. Some people think they’re policemen.” I thought maybe fascists or neo-Nazis. But whoever they are, the man and I both agreed that in a democracy, people who protest in good faith have no need for masks.

I asked about his job. He worked for the foreign ministry. He was protesting because he was worried about Italy’s future. We discussed the Euro and the country’s financial state. He talked about Italy’s industrial decline. “The country had lost its steel and milk industries. All that’s left is tourism and design.” He also contended that education money is being channeled to private schools and that public schools are being bled dry. A few minutes later, he saw some friends and we parted.

About an hour after we left the public square, we came upon a dismaying scene. Five or six cars had been burned. The fires were out but an astringent odor hung in the air. We saw a store whose windows were smashed. It was named Élite. Several windows of a bank were cracked, along with those of a couple other stores.

We had now been marching for three hours. We had not reached the end of the route but my daughter and I had to leave. It was 5:00 p.m. About a quarter of the route, or an hour of walking, remained. We rejoined the family at the hotel and started chatting with a man who told us there was now rioting at the demonstration.  We turned on the TV and saw cars burning and windows being smashed. It looked very violent. But on closer inspection, I saw it was the cars and windows we had passed earlier in the afternoon. The perpetrators were the Black Bloc. It made for impressive TV but it was nothing like the demonstration we had just attended, although this may have been the reason for the sirens we had heard earlier.

We saw few, if any, shots of the crowd, which numbered according to subsequent estimates from 100,000 to more than 200,000 people. We also realized we were watching one of Berlusconi’s television stations, whose incentive was to downplay the crowd size and overplay the violence, although later in the evening I saw new TV reports that at the end of the route there had been nasty confrontations between the police and Block Bloc rioters with substantial property damage and one serious injury.

In the past when I have seen news reports of demonstrations that turned violent, I assumed an overzealous faction of the demonstrators was responsible for the mayhem. Now I know better: it may well be hooligans just out to make trouble. The danger, of course, is their actions undermine the right of peaceful assembly. It is a worrisome problem.

One Swedish newspaper I read today, Monday, reported that according to witnesses, a group that had partially masked themselves with hoods was behind most of the violence. This is not correct. I contend they were responsible for ALL the violence. When you come to a peaceful demonstration wearing a mask and a helmet, your intentions are not honorable. (See related story here.) The protesters I walked with were frustrated but ordinary, everyday people, like you and me.


© 2011 Kvick Thoughts. All rights reserved.

Wednesday, October 12, 2011

The "invisible" kids

It was getting toward the end of lunch and I wanted ice cream. But I decided against it. I was eager to get out of the lunchroom and out on the playground before “they” came.

They usually came down after everyone else had eaten and we usually didn’t see them, but sometimes we did because we were sixth graders and the last group to eat. Although we tried not to, we stared in morbid fascination as they went through the serving line. There was the dark-haired girl with the very large head and very large body. There was a boy with a lopsided face that looked as if part of it had collapsed. Another boy had a large round body and a very small head. But the worst was the girl with the purple face: half her face was the color of blueberries and she walked with two crutches to support her mature but disproportionate torso.
  
In fact, they all had adult bodies but we didn’t know why. To us they were kids because they went to our school. But no one ever talked about them. They just appeared at lunchtime and disappeared after. They may well have been a classmate or neighbor’s sister or brother, or more likely, aunt or uncle, but no one I knew claimed to know them and no one talked about them. We kids certainly didn't, even among ourselves. We just pretended they didn’t exist, and were secretly grateful not to be one of them.

One day my teacher asked me to deliver a note to "Mrs. Smith." I didn't know Mrs. Smith so I asked where I was supposed to go. Her room was just around the corner and down the hall from ours.

I went and knocked on Mrs. Smith's door. When she opened it, I was amazed to see the boy with the small head and the girl with the purple face. They and the others were sitting at desks. There was writing on the blackboard and books and papers on tables and shelves. Special equipment was lined up against the walls but it was definitely a classroom, and Mrs. Smith was their teacher.

Who were these "kids"?

Sadly, no one ever told us, and we never dared ask.