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Friday, October 14, 2011

Take Time to Thrive - Hiking Team Meetings!!!


In Clinical Operations we like to do activities together to help us stay connected.  We participate in charity work and awareness walks.  We have walking team meetings and morning meeting hikes whenever possible.  We take time to celebrate each other.  What do you do to strengthen your team and encourage each other to thrive?

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This tree was our landmark to tell us how to get back up the trail we blazed.






















Remember to take plenty of time outs

Thursday, October 13, 2011

I Swear I'm Not Spying


Today I went to see my doctor for what turned out to be another case of bronchitis. While I was using the check-in kiosk to avoid the long line, I noticed the Department Administrator staring at me. He stopped me and said, "I know who you are. You're here to see if we are doing our POE stuff." I laughed and said "Nope. I'm actually just sick."

Considering the fact that I was dressed in my "I feel like crap and don't really care" clothes, I was a bit surprised that he even recognized me. He told me that they had just spent the last week retraining his staff on standard workflows and was glad to see me. He asked that I be honest with his staff and my observations. So... while I promise I'm not spying, I do like to make observations :-)

One thing I always appreciate about going to see my doctor is that the Glendale clinic is great about rooming patient's on time. The tough part for me because of my role with POE, is that I can't have a visit without answering questions or doing some on the spot training. Not that I mind, I love to take advantage of every opportunity to teach our staff and set their minds at ease. As much as I would like to ignore the little things like not doing things in proper order to increase efficiency or bypassing a care gap prompt to complete the asthma screening questionnaire (especially when the patient presenting has shortness of breath and coughing spasms) - it's almost impossible for me to stay quite. Mostly because I find it extremely frustrating to see our staff working hard instead of smart. What's interesting to me is that some of our clinics have really strong support staff and physician's whose strengths are in being a physician (computer skills lacking), some of our clinics have the opposite with really strong physician's and well intentioned, but not so computer savvy support, and their are clinics that have the best of both worlds. My doctor's support person is a little slower with the intake process and struggles a bit with POE workflows, but my PCP is not only the best primary care physician ever, she is also a computer super star. Some would argue that maybe this works for them so there is nothing to fix, but I can't help but wonder if we could do more.

Couple more positive notes...
  • The Glendale clinic pharmacy is one of my favorites because it is always well stocked and they get you in and out fast.
  • I was pleasantly surprised to find one of our Domestic Violence Silent Witness displays in the pharmacy waiting room.
  • They also had a flu shot clinic that was booming with patient's.
  • 
Nice job Glendale!
Silent Witness Display.jpg

Tuesday, October 4, 2011

Her Silent Plea - Domestic Violence Awareness



I can feel my heart pounding lightly in my chest as I think about the story I want to share with you.  The story of a young lady I know who had her voice, hope, pride, sense of value, confidence, and strength taken from her by someone she loved and trusted.  I can still recall the overwhelming emotions I felt as I helped her find herself again when she did finally make it out of that situation.  Fortunately, this story does have a happy ending, which is not always the case for the one of four women victimized by domestic violence.

By one estimate, one in four women experiences intimate partner violence in her lifetime—twice as many women as are affected by breast cancer

She was a 21 year old girl working as a waitress at a restaurant where he was a busboy.  She spoke English, he spoke only Spanish.  Still... they found a connection in one another.  She learned to speak Spanish so they could dump their friend who came along on dates to translate.  They loved each other and, one day on a whim, they decided to run off to Las Vegas to get married.   A month later, even though they were using protection, she got pregnant and soon after something changed in him.  It started with words meant to sting. "You are getting fat", he would say, even though she only weighed 103 lbs.  Nothing she ever did was good enough for him.   The cans in the kitchen cupboards weren't lined up perfectly with the labels facing straight, there was a tiny piece of paper that she missed behind the toilet when sweeping, his shoelaces were dirty, shoes weren't shined to perfection, and her cooking was never to his liking.  She knew she had made a mistake in marrying him, but didn't have the courage to tell her family she needed help getting out.  She was embarrassed and ashamed.  Words  became demands...  he would not allow her to do things with her friends or family.  One night, when she was 5 months pregnant, there was a holiday party for work and he said he didn't want to go, so she went without him.  When she came home, she was faced with anger and rage.  He knocked her to the ground.  Kicked her over and over again and then wrapped his hands around her neck.  Right when she thought he was going to kill her, he released his grasp and walked away like nothing happened.  Leaving her lying curled in a ball on the floor... arms still protectively wrapped around her belly. 

She wanted to leave, but had been told that she was "nothing" and "nobody would want you" for so long that she didn't think she would have any place to go.  So she tried to work things out, making excuses for his abusive behavior.  When the baby was born, the threats changed to "if you ever try to leave me, I'll take her to Tijuana and you will never see her again."  So every time they went to visit his family in Tijuana, she would desperately try to record every street name possible... just in case.   She remembers one night sleeping on the floor at her sister in laws house in Tijuana. The baby woke in the middle of the night crying. She tried to calm her quickly, but it wasn't fast enough. He awoke in a fit of anger and slammed his fist into her back, knocking all of her wind out, and yelled at her to "shut the baby up". The next day, her sister in law saw the shame on her face and hugged her, as if to say, "I know what you're going through, but our role is what it is." 


Oh that boy was good.  He stayed away from her face so her sister wouldn't see the bruises and reminded her every day that her life and the life of her daughter could be taken from her in an instant.  She learned to cover the scars with long sleeves and make up accidents for the more serious stuff like when he broke her wrist when she blocked one of his punches. If she had to go to the doctor, he would accompany her and tell her exactly what she was allowed to say, then act lovingly in the exam room as he stayed by her side.  She often wondered how those doctors couldn't see the desperation in her eyes... the hope that someone would save her. Her co-workers and sister has suspicions too, but refused to believe it could be true. Her sister even made a comment one day "I've never seen you be so subservient to someone. Where did the old you go".  The fact was that girl of their childhood had been transformed in to one who lived in fear, doubt, and distrust. 

At home, she wasn't allowed to use the telephone and she learned to sleep with her car keys in her shoes... in case she needed to run in the middle of the night.  She remembers going to bed each night wondering if that would be the night he would kill her.   She recalls one night when things were really bad.  He attacked her and had her pinned to the floor, again with his hands around her throat.  She could feel her life started to fade when their 1 and a half year old climbed on his back, crying "No... Poppi No".   It's like her daughter snapped him out of his rage.  He got up.  Kicked her in the ribs, and walked away.

That night changed her life.  She knew she couldn't raise her baby girl in this world of rage.  She knew she needed to stop wondering if she was going to die and instead find a way to live.  She set aside a little money each week... just enough so he wouldn't notice.  She wasn't sure how she was going to make her escape, but was determined to find enough strength to save her daughter.  To save herself. 

It wasn't always bad between them.  After each episode, he would be kind and gentle.  It was almost as if he didn't even know the scars he created the night before.  She discovered he was having an affair, and actually felt relieved because he left her alone.  Then one spring evening, something set him off again.  She came home from work after picking up their daughter from the sitters to find him already home and angry that nothing was ready for dinner.  She quickly made something for him to eat.  He took a bite and said it was crap then threw his food in her face.  She could tell that it wasn't going to be a good night.  She put their baby girl to bed early and waited for the storm.  His anger was like no other.  This time, he chased her through their apartment complex.  When he caught her, he drug her back to their apartment by her hair.  She heard a voice call out from the apartment nearby, "do you want me to call the police?"  "Yes!" was all she could get out before he threw her back in to their apartment and knocked her out cold. 

The police came just in time and that night the boy went to jail.  Her family, who had been in the dark to her situation for over two years, was now rallying by her side.  As a "first" offender, her husband only went to jail for 3 days, but those three days were enough to find a place to live in a building with security, file a restraining order, and set a divorce in motion.  She had to reach deep inside herself to find the girl she knew from childhood who had strength beyond measure.  She fought through the feelings of shame and embarrassment and slowly, over time, learned to love herself again.  Determined to give her daughter the best life possible, she moved forward... one step at a time.  She discovered how confident and strong she could be.  There were times when she had to work three jobs to make ends meet, but she did it.  A few years later, she met a man who had full custody of his own daughter who was able to brake down her walls and teach her and her daughter how to trust and love again.  He made her feel safe, secure, and happy. 

Be courageous enough to speak up
over the silence which drowns the screaming
Sometimes, I think of that girl from so long ago and my heart breaks a little for everything she went through.  She taught me to be compassionate of others, to be aware of signs and signals, and to be courageous enough to speak up over the silence which drowns the screaming.  Some times, I look at the woman staring back in the mirror, take a deep breath and smile... knowing the one behind is a survivor.

Kaiser Permanente has done a lot of work to raise awareness on the topic of Domestic Violence.  In Southern California we have a new Domestic Violence Prevention websitewith information and reference specific to SCAL.   We have displays up in our restrooms and an emotional Silent Witness display that share stories of domestic violence survivors.  


For more information and resources, please see the links below.