My Plan From Here

[ed note: Jim Dowd, as many of you know, was diagnosed with a Grade IV Gioblastoma last August. He recently entered hospice care at home and is as peaceful as one Jim Dowd can possibly be. He hates condolences. His amazing wife Bo transcribed this for him. – KT]

 

Carbon has a half life of approximately three and a half thousand years.

Right now, I’m basically a big bag of grass clippings.

That grass specifically having been corn processed into the “ITO” family of products.

 

Fritos

Doritos

Tostitos

 

 

In about 3000 years the protons and neutrons and electrons from these carbon atoms will probably get picked up by the solar winds.

They’ll fly around the solar system just as they did the first dozen billion years out from the big bang. I imagine it as a carefree time.

 

 

As I am mostly carbon I imagine there is lots of useful material I could be incorporated into. Maybe structures or even potentially living things of the microbial variety.

So, if you are looking for me, you’ll most likely find me at the bottom of a yogurt in the chunky stuff.

 

I’ll try to remember to smile as I pass through.

Okay, we found a stonecutter.

Okay, we did it. Turns out Friend of the Clam Stephen Voltz is not just a renowned scientist, he’s also a freelance digital stonecutter. So with our modern tools (did you know weed is legal in Massachusetts now?), a party of intrepid Clamunauts went into the woods of wild Dogtown to update the Babson Boulders for modern times.

We think that his work was well worth it. The maps will be hopefully updated soon, though without Historic Register status and funding it may be a little while. Enjoy the search until then.

Babson Boulders for a new era

We’ve noticed here at the Clam a great deal of discussion about Dogtown in recent months. We think that Dogtown belongs on the Historic Register, and that will help keep it protected from development while also making it somewhat more accessible as a part of our history.

But we realized that the Babson Boulders, one of the noteworthy features of the site, seem a tad dated for today’s world. So we consulted with the Clam braintrust in our super secret Underground Lair, and came up with a few ideas that can be placed as soon as we find a stonecutter who will work cheap and can chisel in Comic Sans. But until then, we’ll share them with you.

“Get Consent”

“Vivaaaaaaaa”

“Back up your data”

“If this is the high tide line, you’re screwed”

“Vaccinate your kids”

“Carry in/Carry out”

“Take off every zig”

“Han shot first”

“I went to that old parochial school on the Rotary; what happened with that?”

“Fight the Power”

“Never vote Republican”

“Delete your browser history”

“Suck It, Ravenswood”

“Fluoridate Public Water”

”Check Snopes”

Question 1: Forcing us all to suddenly become nurse/patient staffing ratio experts somehow?

Clam Nation, Question 1 is the November 2018 ballot question which has caused the most consternation among your Clamrades, who are pretty much split down the middle or undecided regarding the vote.

Short answer: vote yes because it will keep more people alive.

Question 1, also known as the Patient Safety Act, would mandate specific patient staffing ratios at hospitals around Massachusetts. There’s a lot of uncertainty, speculation, and rumor surrounding Question 1.

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Because we haven’t had enough of that yet, ffs

Here’s our analysis: Nurses are the front line of healthcare. For instance, if you wind up in a neuro ICU because an undiagnosed tumor in your brain just made you have full-on seizure including chewing on your tongue like a fruit roll-up, the people doing the actual work of keeping you alive (putting in lines and tubes, ordering tests, giving meds, all the actual action), will be done by nurses, not doctors.  

The pressure we currently put on nurses burns them out and they quit, especially floor nurses. Therefore: less burnout = more skilled nurses coming back to the bedside. And staffing more skilled nurses = less patient death overall because a skilled nurse is often the thing between a live patient and one stepping into a lighted tunnel going, “Granddad, you lost weight!”  

The outcome of the vote could change quite a few things around the highly-influential and science-y neighborhood that is the Massachusetts Health Care Industrial Complex, which regularly treats the sickest people in the world and gets penalized because of it (people come here literally from all over the world because they are really sick for treatment, some of them die, and we look like we’re not doing a good job).

So we would like to dissect the issue. Because that’s what nerds do. Also, we eat a lot of Fritos (unrelated). 

The Mass Nurses’ Association (MNA), our state’s most powerful nursing union, spearheaded this ballot initiative because of staffing concerns in hospitals throughout Massachusetts. There have been disagreements, even among nurses. Some are comfortable leaving things the way they are and say “This proposal undermines the flexibility and decision-making authority of nurses and puts rigid mandates above patient safety, clinical nurse input, nurse manager’s discretion, and every other consideration in a hospital.”

For hospital administrators and management staff who actually listen to floor nurses, this is great. However, would you believe some hospital administrations are more focused on the bottom line than they should be in our for-profit healthcare system? Shock, no? nursing unions exist for this reason, and we guarantee someone you love is alive because of them.

Looking at the hundred-year history of the MNA, it’s pretty interesting. And then, in 1994, it gets REALLY interesting.  With the introduction of managed care, health care systems in Massachusetts became more corporatized and, by design, pushed to get more for less. The nursing union pushed back because I mean, have you ever worked a 12-hour shift without going to the bathroom while being required to help everyone around you go to the bathroom, and then OMG there’s also a literal ream of paperwork you need to finish before you go home? That is some real Kafkaesque shit right there.

Not to mention being punched in the face, verbally abused, or possibly stabbed.

Meanwhile, in 1999, California passed AB 394, a benchmark safe staffing law similar to the one on the ballot here. In 2004, AB 394 was implemented. There isn’t anything else like AB 394 in the entire United States, so we don’t have much of a basis for comparison.

If you look at the “No on 1” website, they claim the effectiveness of mandated staffing ratios is “not scientifically proven” (right up there at the top of the page). ORLY?  Well, thank goodness after AB 394 was passed, a whole bunch of highly-credentialed folks including nurses, doctors, and policy wonks decided to study the outcomes of mandated ratios over several years.

While only 1/50 states have anything this comprehensive on the books, California is basically a country of 40 million people with a massive health care system. A quick Google search will take you to several publications touting the effectiveness of the mandated staffing ratio they implemented, even if only a little more effective than being without one. Your Google experience may vary – and always check your sources. Some hospital systems have published findings skewed in their favor.

Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality” There are lots of equations and deltas and variables here, and right off the bat, the authors stipulate more research is needed. However, they found evidence that the incidences of things like falls and pressure ulcers (both of which kill people) lessen when there are more nurses on staff.

References to a study by Linda Aiken, Ph.D. RN, comparing staffing, staff satisfaction and patient outcomes in California to those in New Jersey and Pennsylvania:  
DPE Fact Sheet
UPenn’s LDI Issue Brief
Lower burnout rates = better employee longevity = more experienced nurses taking care of us over a longer period of time.

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Newark, probably

 

Some emergency room nurses are actually afraid the hospitals will make them turn patients away if this mandate is passed, which is why they’re voting no. What is particularly shocking to us is that hospital administrations would continue to spread this rumor, putting the burden of responsibility on their staff. Thankfully, since 1986, it’s been illegal for hospitals to turn people away as long as those hospitals take Medicare. Though to be fair, that requirement combined with ratios does create a potential conflict. But the law does give wiggle room for a crisis

“Question 1 would remove real-time decision-making power from nurses and caregiving teams and put it in the hands of a rigid government mandate.”

No. Just No.  Nurses exhibit real-time decision-making power all the time. Nurses need to think about notifying doctors of one person’s critical labs as they wade through blood and shit and are berated and harassed. Having fewer patients to focus on will give them more time they need to make decisions and advocate. Again, put yourself or your loved one in that bed and ask, “How much time should the nurse be given to review the critical lab results before they have to go deal with changing the fluid bag in room 5?”

If you have misgivings about government oversight of staffing, think about day care centers. Sure, a daycare provider would get more bang for her buck by having a 12:1 ratio. But would you really want to leave your kid for 10 hours with someone who has 11 other children to watch? Nah. Neither did other people, which is why Massachusetts imposed staffing regulations on licensed day care centers.

To be real, nobody in Massachusetts really knows what the health care climate here will be like if people vote in favor of mandating nursing staffing ratios. But if you end up in the hospital, do you want the nurse who hasn’t eaten in 12 hours, or the one who isn’t going into hypoglycemia as she takes your blood pressure? From this writer’s perspective (and the experience of the entire fucking state of California), more nurses = less death.

The politics behind this one are weird. The MNA fought for years to try and get some measures taken to protect their members through the legislative process, only to be outmaneuvered the whole way. So finally, they took Every. Single. Thing. on their wishlist and got it into a ballot question. If this had managed to go through the Legislature (where good ideas go to die at the hands of Speaker DeLeo) we’d probably have a common-sense system now, and not an incredibly expensive, divisive ballot question. Thanks, spineless legislature!

For a mostly balanced perspective on this topic, head over to WGBH’s take on the matter.

Last note: The final claim is regional hospitals will have to close because of mandated ratios. We can’t believe this is even an argument. Charitably, it’s the “You have to let us keep coal mines unsafe, otherwise you won’t have any coal,” line always made by billionaire coal-mine owners. Uncharitably, it’s what the passenger representative says to the press from the wing with a Kalashnikov in her back. “Just give the guys holding the plane what they want and they won’t kill us…or at least all of us.” It’s a hostage-taker argument. It’s obscene that it’s being made. We’re the richest country in the world. We can have safe regional hospitals and nurses not so exhausted they’re guaranteed to make critical mistakes. The end.

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Threatening us with death: not the foundation of a productive discussion

Your Helpful 2018 Ballot Question Clamsplainer: Question 3

TLDR: Vote YES because we are not monsters

In 2016, after much drama, the MA Legislature passed a law giving the same basic protections to transgender individuals that are provided to most other groups. It’s a really short law (https://malegislature.gov/Bills/189/Senate/S2407/) and it basically says that if you’re a place that has segregated facilities based on sex, that people who have the appropriate gender identity can use them. Like, humans can use bathrooms and stuff. This is not hard.

That’s it. So let’s say, for argument’s sake, that you’re a transgender female (born male, but perhaps at a midway point in the transition). Let’s also say, inelegantly, but we’re trying to be as clear AF here, you still have your junk. You can still pee standing up.

This law allows said transgender person to go and use a women’s bathroom, where they can then go sit in a stall like the rest of the ladies would. Or in the case of the opposite, a person born female who is transitioning genders, they could go into a men’s bathroom (where they would also likely use a stall).

I oversimplify, of course, because we are the Clam, and we like to break things down this basically, and often we’ve had a couple of beers when we’re writing these things. Gender is, we now know, far more fluid that this simple example, and trans people are on a continuum. It’s about far, far more than where your junk is.

Well, there’s a certain ultra conservative minority out there who thinks that being transgender is an abomination unto the Flying Spaghetti Monster or something. And they are seizing on the natural fear and squickishness most of us feel about bodily issues and sexuality to raise FUD on this. They call it “the bathroom bill” to minimalize it, and they try and raise the specter of hairy, bearded, clearly male people wearing dresses so they can hang out in women’s bathrooms and commit unspeakable violations.

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You can go through the actual Bible to see how wrong these people are or, you know, take your cues from their website design skills. Heck, it may not even be up at any given time.

I’m a politician, so I’m not going to say what I want to about that premise, but it’s total B*$%&@#(!!. Period. Men are not going to use this to make criminal behavior legal. It’s also not going to affect very many people at all – but those it affects gain a massively positive benefit. It basically legalizes them in public.

On a personal side, I know a number of people who are transgender. On both sides. You wouldn’t know it looking at most of them. Heck, you probably wouldn’t know it about any of them unless they told you. One of my friends was born female and began to transition a couple of years ago. He now looks more badass than I do, and has a better beard. I may be a bit jealous. His wife is someone he met and married when he was physically female, and she is a wonderful person who has stood with her wife (and now husband) throughout – because sexual orientation may be one thing, but plumbing is just plumbing. Love is bigger than that.

This message of tolerance brought to you by the good people at Love Plumbing & HVAC, LLC

So in other words, I’m proudly voting “yes” on Question 3 in order to preserve the protections that a small class of people in this Commonwealth need in order for them to safely survive in our increasingly crazy-ass society. If you are so heartless as to want people who look like women but don’t yet have 100% of the plumbing (or, conversely, people who look like badass men but need to pee sitting down – and forcing them into the ladies’ room) hooked up to have to use a men’s bathroom, well, first of all you’re not someone I want to know. Secondly, take a good look in the mirror. And then vote “yes”. Because the only way this ballot question could be clearer is if there was a checkbox for “Duh”.