Monthly Archives: February 2013

Deadlines & Commitments: What to Leave In, What to Leave Out (Bob Segar)

I know one good reason why there is a statute of limitations, and it has nothing to do with the law.

It has to do with human nature. Apparently, most of us were born with a dominant procrastination gene that expresses itself at every opportunity. Given the option of infinity, how long do you think some people would wait to file a claim? Just count the number of times someone calls us and declares “the statute is tolling!” (i.e., the sky is falling).

Why is it tolling? Most often, the deadline is looming because the claimant waited until the last minute to find an attorney, or the attorney waited until the last minute to address merit, or the expert took too long to review the records and prepare an affidavit, or in general, life happened and it is human nature to save the hardest work for last.

We have a statute of limitations because someone had to take control of this gene.
We have final exams because without them, most students would study for the immediacy of one test rather than retain the data for a “final” test. Trust me on this; I have four children.

There is a time to punch the clock, a time beyond which we are tardy, an alarm clock that awakens us, and a snooze button that apologizes for waking us up.

I need deadlines. I do. I need goals and objectives because without them, I am at sea. If I find it difficult to prioritize work or decide what onerous task needs doing first, I can let deadlines be my guide. But I always know that what I am really doing is finding a rational reason to put off until tomorrow what I should have done yesterday.

I’ll take jurors for 100, Alex

Jurors are called upon to make incredibly important decisions, and while they may be instructed to “stick to the facts”, those facts can be difficult to parse out. Both sides will argue for their client, and they will use every weapon from accusation to rationalization to “make their case”.

A good trial attorney knows that keeping it simple is best; that is why they pick a “theme”, a central point around which to build their case, independent of how many people are being fingered for wrongdoing. The theme should be constant: “This man would be alive today but for the negligence of xyz in monitoring basic vital signs.”

Behind this simple statement is an extremely complex and highly developed game plan geared towards subtly asking jurors to apply their own sense of right and wrong to their decision. Once the facts are clearly laid out, and all has been presented to them, jurors are asked to make difficult choices independent of personal morality (but who can really do that?).

I have talked about clinical nurses serving as testifying expert witnesses, and legal nurse consultants working behind the scenes to analyze medical records and develop a case. In many states, there is a third way to become involved in the legal world of healthcare, and that is choosing to serve as a fact witness about your review of medical records.

In this role, you take what you know about a medical situation and explain it to the jurors in a way that makes sense to them. You are not testifying against another healthcare provider; you are merely relaying the information found in the record, and explaining the more complex medical issues to jurors as lay people. This sounds a lot like talking to family members in the hospital, and in a way it is.

You are not rendering an opinion; you are informing, and your information can help clear the fog of legal arguments in the minds of those oh-so important jurors.

Sleep is good. Work is good. Working without sleep…not so good

Sleep and work. We spend more time doing these two activities than anything else in life.

The need for a good night’s sleep is evident in the number of medications, therapies and sleep aids that promulgate the market. But we do not need advertising to tell us what we already know – a bad night’s sleep makes us miserable the next day, less efficient, moody and irritable. No sleep at all makes us dangerous at the wheel and to our patients.

For years I saw medical and surgical residents come through my ICU, sleep deprived, complete with bed-head and stumbling gait, reaching for a cup of coffee to jolt their nervous system. I never understood how being on call for 24-36 hours was a good thing for anyone but the attendings who were getting a good night’s sleep. It certainly wasn’t necessary to prepare students for being in private practice, and it occasionally put patients’ welfare in danger.

I could relate. I alternated between (3) shifts every two weeks. The coveted morning shift was bustling with activity, diagnostic studies, lab draws, ventilator weaning, PT, OT, breakfast and lunch. No way was I falling asleep on that shift. The afternoon shift was quieter, family more present, bedside and surgical procedures occurring when they could not wait until the next day, but never scheduled for 8pm. It was a time, with any luck, of relative respite for patients and staff.

But those night shifts. I well remember charting at 5am, standing up because I was trying to stay alert and literally sleeping on my feet. The circadian rhythm of my brain was not attuned to working at night. I could not sleep during the day for more than two hours, and felt like a zombie the rest of the time. Oh yes – I fell asleep at the morning wheel on more than one occasion. Thank goodness for that part of the brain that never truly sleeps.

“The stream of information (to the brain during sleep) is considerably reduced, but the brain is not fully disconnected from the environment. An inspection of the environment takes place to optimize safety during sleep. Stimuli…signaling danger are recognized, and may enter awareness, leading to a wake-up call, which allows the individual to react. This subconscious stimulus evaluation is regarded as having a guardian function for sleep.”

It’s no wonder that we spend so much time thinking about our work and worrying about our sleep. When either or both are out of balance, we are miserable and unable to enjoy everything that happens between these two activities – like family and friends, recreation and exercise.

Bones grow during sleep, brains recharge, and unless we have nightmares, a good night’s sleep cures many ills. Let sleeping dogs lie. Sleeping like a baby. Shhh! the baby (nurse, patient, doctor) is sleeping.