or at least a medium blue to a rehab facility. At least not when that is the color of the scrubs worn by all the personnel working there. Never mind that they are all – without exception wearing pants. Never mind that each and everyone has both the facility name and their role embroidered in large white letter on their top. My showing up today in a dark blue Columbia skirt, t-shirt and long sleeve over shirt tied at the waist caused confusion.

Correcting fellow visitors is fine as long as I point them to, or get them to the person who can give directions.  But causing confusion in one of the patients at dinner had me feeling completely horrible. The reassurance by the staff member on duty that that special patient wasn’t particularly oriented to time or place with almost absent short term memory didn’t help.

It was something, the clothing color, that I noticed yesterday but didn’t take into consideration when I got dressed this morning. I was just thinking the weather was going to be nicer and I could leave my last pair of leggings for tomorrow’s flight home.  Now I know better, but hopefully once my friend is out of there, I won’t ever have to worry about this particular “uniform” again.

The following thoughts also apply to OZ, original EU countries. There are two serious sides to health care delivery in the Developed World. The first is supply of adequate numbers of trained providers at all levels to meet the increasing acuity, demand and complexity of First World medical standards and regulations. The second is the impact on those countries which provide a large number of the above mentioned health care staff.

This struck me once again as I hang out with Carmen as she wends her way through the system. Adventist Hospital visibly does not discriminate in employment that I can see. Race, color, creed, religion, gender, country of origin, religion make absolutely no difference.  What they are looking for is expertise, care for patients and a willingness to work hard. That is not to say that there are not going to be hiccups in the system (not enough staff on is always an issue with nurses in every hospital in which I have worked) but that this is not a hospital that looks like the kind in which I trained (Minnesota in the 70s). 

But there are serious issues facing the US health care system: we simply don’t train enough native born individuals irrespective of ethnic origin to fill the number of personnel needed. Not by any means. The same is true in the UK which draws on both the Commonwealth and the EU (up to now) to fill its ranks. The situation in Scandinavia (working off 5 year old memory now) is that the Eastern European EU countries have filled many of their needed slots. We have an aging population in the US, the same as many of the original EU countries. Population is at replacement level or below except in the immigrant/refugee population. All countries in the west are becoming more diverse whether they want to or not. And it is not just the acute care system that needs medical personnel, an aging population, one that lives long enough to develop many of the challenges of extreme age (read 95+) requires personnel for nursing homes, rehab facilities, visiting health nurses and respite.

Over the last two days, I have had the wonderful opportunity to talk with numerous staff. Many were immigrants as teens or children when their parent/s came as refugees/immigrants to the US. A few others were trained outside the US and moved here for further training. Or to use the skills they had learned from books but had no opportunity to use at home due to lack of facilities/equipment.  And here is where the moral/ethical considerations come into play. Countries that can barely afford basic health care, in fact generally not able to provide much of anything due to lack of funds/infrastructure/political will can not afford to train individuals who then leave to practice elsewhere. Or can they? There are those countries which actively produce excess providers knowing they will go overseas and send their salaries home to family remaining in country. The classic example with which we are all familiar is the Philippines which has citizens working everywhere else in the world in hospitals to ships in order to make more than at home.

Where are they from? Africa, the Caribbean, Indian subcontinent, Central America. All well qualified, all feeling like they are actively contributing. With rare exception, they couldn’t do this level of work at home (see comment about lack of everything above). Would they go home? Maybe. If there wasn’t civil unrest, if there was a chance to practice high acuity medicine, if there was family to go back to, if there were excellent schools for their children, if they weren’t looking at massive overcrowding and primitive living conditions.

Can we [US] continue to deliver the standard of care that we except to receive as patients without immigrants? Obviously not in some areas of the country, perhaps not in most. Maybe so in others where there are bountiful training opportunities and young people who want to stay locally (see San Francisco).  Can we do something in return for those countries which are loaning us health care professionals? Probably, and not just the Gates Foundation or those Universities which have research projects or limited partnerships.  All of what could be done is well above my paygrade as the old saying goes. But these are things to think about. And to seriously understand what is going to be the US future if we seriously curtail immigration.

It is Wednesday, with Friday the 13th arriving in the middle of the week. I am sitting in the infusion room at the SFVA. My break is over and I am back to hanging out with other vets and the infusion nurses.

I’ve finished the main run of chemo and am now shifting over to maintenance therapy. No promises but the best guess is that returning for regular infusions (immunotherapy) will prolong remission and I am all for that. Never any promises, but we will see.

So it was up at a really early time this morning, dropping Dani off at work before parking at BART and heading to SF. In a long, round about way, I managed to make my way to the SFVA via the #38 Bus on Geary.  I arrived about 10 seconds too late to catch the usual MetroLink bus. This particular driver is overly prompt and doesn’t stop or wait for anyone (unlike the drivers on the previous Bauer Contract). Just after I was leaning disgustedly on the wall, preparing to wait 40 minutes for the next bus another person bound for the VA. In a flash of really dumb thoughts, we decided to head over to Geary and catch the 38R. Said bus, of course, didn’t come along. After waiting a while we grabbed the second 38 and wound up dropped in front of the VA just about the same time as if we had waited for the free shuttle.

None the less, the ride was fun as it was just about only VA staff + a couple of vets by the time that we arrived at 42nd street.

The clinic hasn’t changed but there has been considerable nursing staff turnover since I was here 90 days ago. I was able to give away the bag of lemons I brought and get a latte even before I started my appointments.

It is going to be a long day – I have dental after I finish at the infusion center. But I should be done in time to catch the Metrolink home. By that time, George ought to be home!

of just about all poisons but one. By mutual consent (my doc and me) we dropped the Vincristine this time around. I was just starting to get some symptoms that could be attributed to side effects. Or – I was willing to admit that I was having side effects from the drug and there was no good reason for me to risk them getting any worse.

It was a long day – George bailed me out and we stopped for supper on the way home. I was glad there wasn’t a home game tonight. OTOH, well the As are not exactly operating at the top of their abilities. On the rare time they win… oh never mind.

And what did I do while hanging out at the infusion center?

worked more on my fractal but forgot to take pictures….