Friday, January 25, 2008

the politics of malpractice

a friend o'mine was concerned about the fact that homebirth midwives do not have malpractice liability insurance. we talked about the financial barriers--most insurance companies refuse to cover midwives or at astronomically unaffordable rates. and i later wrote this to her:

i read this article about malpractice in southwest magazine (i think. pregnancy brain.) a couple of years ago about malpractice and accountability/ethics. the point of having malpractice insurance is in case you get sued. the ethical part of the question comes in when you look at why or when people sue. so the article was saying that its not just having an undesired outcome that makes people sue, but that the majority of malpractice lawsuits occur when they have an undesired outcome and they are dis-informed or ignored by their care provider afterwards when the patient/family try to understand why/what happened and get closure (usually because the care provider is afraid of getting sued, they don't trust their patient, they clam up usually and this is a fairly universal hospital policy/protocol too). the lack of accountability and violation of their trust rightly infuriates people and they sue to get access to the information not primarily for money nor to "reverse" the outcome. they see the monetary damages as a way to teach the hospital/doctor that it should give the information/closure to patients in the first place. and so now, a few hospitals are now trying a new mediating approach where care providers talk to the families after an undesired outcome, give them what information they have, and admit any mistakes and apologize if necessary. the result--the family gets closure & does not pursue a malpractice lawsuit.

from my perspective, insurance in general is designed to financially protect your assets (whether life, car or home); malpractice insurance is really a way for the medical establishment to avoid accountability and to protect their financial assets. its sort of a moot point for most midwives because of the mutual trust building, the ethics of empowering the client/family particularly with information, and accountability to the client. if midwives had to get malpractice insurance, they would go out of business b/c of the expense & barriers. and if they got sued (regardless of insurance or no), they would go out of business. and that's also one of the reasons why many hospitals are reluctant to grant midwives hospital privileges b/c the hospital would be liable in the event of a lawsuit. what makes it moot is that because of the empowerment, trust and relationship, midwives aren't as likely to be in a situation where a family feels like its only recourse to getting closure about an undesired outcome is to sue. really overwhelmingly midwives are sued/persecuted with criminal charges by doctors and hospitals more than you see midwives sued by clients. so that's the larger context. and from my experience, when my niece died at birth last year, the nurse midwife (similar to CNMs in the East Bay, had hospital privileges) came and talked to my sister soon after. and my sister got the closure she needed around how Anabelle died. it didn't change the outcome or her grief, but she understood why/how it happened even as she disagreed with the standard medical procedure to resuscitate.

malpractice insurance doesn't prevent undesired outcomes. that's a part of the package when we choose to have a homebirth. we are informed about risk, outcomes and prevention and empowered to make choices. and thats part of the very small risk we accept to have a normal and safe birth.

malpractice insurance doesnt protect the patient; it protects the doctor.

Tuesday, January 22, 2008

the hormones made me do it!


since i cant imbibe, this is the next best way to decompress after work. you cannot hear the soundtrack. i am laughing uncontrollably the whole time while T. shakes his head.

isnt that the cutest romper? (thanks Trang!) wait until i get me some newborn cloth diapers! hmmm... what other baby items can i practice using?






Beatrix Potter ain't got nothin on TýTý Kitty.

after i let go, she houdini'ed out of this in 30 seconds flat. i think T. managed to get two photos in of her hightailing it for the hills. and that's with a professional camera.








rồngtý "special needs" kitty was very much calmer. he likes the attention.









as you can imagine, the cats are eagerly anticipating the day that they are no longer the direct recipients of my maternal instincts.

Monday, January 14, 2008

co-workers say the darndest things!

i try not to blog about work because in general, i like my workplace and i like my co-workers. and being friendly means that some of them may read my blog. so i keep it to friendly.

that said, i work in a small office with 7 other people, mostly women. we share a kitchenette. like many offices and collective spaces, kitchen sharing is a fraught issue dependent on collective and individual responsibility. in an office of just eight people, it is immediately obvious when someone slacks on their dishwashing duties. and in an office of just 8, it is not that hard to narrow down the likely dirty dish culprits using deductive logic, inductive reasoning, or just plain common sense.

now, to be fair, everyone flakes every once in a while. eat then run to a meeting or to meet a deadline. however, it's the consistent flakers that have created an unfair situation for the rest of us. we're talking fly infestation here. flies don't discriminate between thems who wash dishes and thems who don't; they come callin' to everybody. flies drowned in my coffee. flies in the dead in the honey. flies around your face. flies when you're trying to have lunch. and we work above a chinese restaurant, so i leave to your imagination the potential for future, larger vermin.

now the rest of us are fairly aggravated, disgusted by the flies, and too busy to track the dish-offenders on a semi-daily basis. and though we all kind of have a sense of who the most consistent, most persistent offenders are (um, there are only 8 it's not that hard to figure out especially when the sink is always clean when certain folks are on vacation or out of the office), as polite well-socialized professionals, we like to give them the benefit of the doubt and really, who wants to be their parole officer checking in with them constantly? so we resort to general emails.

weo, the two people in question either don't check email because they are too busy to read generally directed emails much less wash their own dishes or because they don't think it applies to them since dirty dishes are clearly their blindspot. i'm not sure which, but the end result is the same. the dirty dishes accumulate and fester vermin, communicable diseases, bacteria, and the unsavory remainders of their leftovers which they also could not be bothered to scrape into the trash before dumping their dish in the sink/bucket for days on end.

so email reminders weren't working. then came the notes. which also did not work because the amount of dishes in the sink actually *increased* immediately after the notes were posted. go figure. granted this is all passive-aggressive ways of dealing, but if you don't have evidence of guilt, how can you go and question the two most likely suspects without them feeling "targeted" (standard defensive response)?

so as the general office manager-type person (along with my other two job descriptions), i pleaded via email for people to take responsibility and not to force it to a staff level discussion through their lack of action. to no avail. yup. it was an agenda item on the full staff meeting. yes, it took 15 minutes of precious time (overage time mind you b/c our staff meetings are always overly packed and have unrealistic time frames) to discuss. and yes, it was absolutely ludicrous.

now, i tried to forgo my usual tough love, frank style of approach (which obviously wasn't working) in favor of a diplomatic, facilitative, coaching approach because making people feel bad is not the best way to change their behavior--"okay everyone, there's a problem and how can we go about changing the situation for the positive? what do folks need?" i was able to maintain that for about halfway through the discussion until the sheer audacity of response brought about my natural attitude and my "i ain't yo mama. i don't want to be anybody's mama. do your dishes" tirade held in check only by my neighbor on the left who does do his own dishes rightly laughing at the irony of my mama-hood statement which reminded me i was trying to be more diplomatic. "i don't want to be mama for anyone at work" i amended.

okay, reality check though. why is it that the two people who most consistently do NOT do their own dishes (and who are btw self-proclaimed, obsessive neat freaks) had the most to say on the matter? and why is it that their "helpful" proposals on the matter involved everyone else on staff who already do their own dishes taking on responsibility for those who do NOT do their own dishes? heaven preserve me from folks who deflect their own personal responsibility/culpability to the group.

so the one leave-the-dishes-in-a-bucket staff member (because somehow leaving it in a bucket of stagnant water for several days makes it okay) who shall remain nameless suggested that everyone sign a pledge of good behavior (she called it "self-determination" and it included sundry organizational practice topics such as email subject headings and server file management in addition to cleaning up after oneself) ; the pledge could then be laminated and displayed prominently on the wall and then used as the basis for evaluation/self-evaluation. ... really?! i mean, reaaaally? let me get this straight, so you are not in the habit of washing your own dishes in a timely manner, and you want the rest of the organization who does wash their own dishes in a timely manner to sign a pledge that you will author with everyone's input of course, a pledge that everyone will do their own dishes, and this is a matter of organizational culture that will take four weeks to go through an organization-held proposal process, rather than this being your own personal responsibility from the minute you use a dish?! riiiiiiiiight. i wash my own dishes. i don't need to sign no fucking pledge to wash my own dishes. and really a "Drug-Free Zone" sign or "motivational" posters just tells me that there's some shady business up in the hood and is that really the message we want to convey to outsiders?

th'other leave-the-dishes-and-trash-on-the-table staff member who also shall remain nameless acknowledged, to her credit, that she was one of the messier ones, that signing a piece of paper wasn't going to change her behavior, and that the passive aggressive notes/emails weren't going to make her do her dishes either. she also noted that the larger organizational pattern of indirect confrontation was unhealthy dynamic. then she asked that everyone else be responsible for directly reminding her to do her dishes as i had done when her kid left his in the sink for 2 days. this is when i started to diatribe a little. "that only works when i know it's your dishes. if i don't know whose dishes it is, why does it become my responsibility to come around to each person and ask, are those your dishes? no? okay, are those *your* dishes? no? okay are those *your* dishes? yes? wash your dishes." then came the "i ain't yo mama" bit already mentioned above.

within the fifteen wasted overage minutes, a couple of other people who actually wash their own dishes had suggestions for those who do not, about how to create a proactive checking habit at the end of the day or change one's mental paradigm around washing one's own dishes as a part of lunchtime. very concrete, very individual responsibility-focused. why do i get the feeling that the ones who needed it, didn't get it? mine own suggestion was if you don't got the time to wash, leave it at your desk. it may be an OSHA violation but at least you have to deal with your mess instead of putting it on everyone else to deal with your mess. so we left it at the suggestions and a check in on progress (roll-the-eyes) at the next staff meeting.

if i wasn't so aggravated, had more presence of mind and was trying a little less to be a diplomatic facilitator against my nature, i would have pointed out the irony & contradiction that thems that do not wash their own dishes wanted everyone else to be responsible for thems washing their own damn dishes.

i bear no ill will and yet, sometimes the ridiculousness of the situation is like a bunion. you can ignore it, but it will get worse and there it is cramping your toes. really, there's an easier way. and sometimes, in blogs one can say things that aren't quite um, professional shall we say, in staff meetings. Like the rest of my mentally censored diatribe "this ain't about organizational culture. this ain't about organizational dynamics. it ain't about everybody else who already do their dishes. this is about individual responsibility. this is about you. are you a grown-ass woman? wash your own fucking dishes. period."

dear co-worker if you happen to be reading this, yeah, i'm clowning you. if the shoe fits...

bottomline: wash your own dishes.

sigh, just 17 more days til i go on maternity leave...

Tuesday, January 8, 2008

brain-to-mouth filter

i've been known from time to time to put my foot in my mouth. especially when i'm tired. and especially when i'm tired and had an alcoholic beverage (sigh, miss that) sometimes it's both feet in the mouth. now that i'm obligated to be sober samurai, i've discovered this precious truism:
grown-ups say the darndest things!
take this conversation for example. i had gone out with my girlfriend Chanda on friday evening (hot date night, but t. was sick) to see 10's husband's band perform at Maxwell's--an upscale (for Oakland) dinner & show venue. after both sets, getting on towards 11pm, Chanda & i got ready to leave because i was tiiiiiiired. so i made my rounds bidding adieu to 10 & friends. here is the last person i talked to before leaving. i shall call her X.
friend X : something about huge belly and the due date getting closer or some such

me [a couple of incoherent response attempts. full-on pregnancy brain]: yah t. & i were talking and we realized we're going to have a baby in 6 to 8 weeks. can you believe that?

friend X: or sooner if you have a premature baby. hahaha.

me [what the ??? too tired/polite to give the person the swift kick in the shin she deserved]: uhm. yeah. thanks, X. for that uh "blessing". X. it's real--. hmmm. that's reeaaalll uh. nice. wow.

friend X [apparently still self-convinced she's in her right mind and being witty, and is clearly not deciphering the sarcasm]: don't worry, you have all of us to support you.

me: yeah. right. that's uh comforting. well. uh. bye.

friend X: oh hey, don't forget my offer to host the space for your baby shower.
yeeeeeah. now i should say this dear friend is severely allergic to alcohol, was out on a date with a new guy, and so had unwisely chosen to consume three sips of some murky-colored, maraschino cherry-laden cocktail making her quite tipsy. there's some on goddess' green earth that weren't meant to drink. (X, if you are reading this and were not so drunk that you don't remember this lovely verbal interchange, i say this as your friend who cares about you, please i urge you, don't drink and talk. it's just hazardous.)

as verbal diarrhea/social faux pas go, this is about on par with another friend o' mine who is, i assume, sober (though i shouldn't assume) and regularly likes to refer to my baby-in-the-womb as a "fetus" for reasons incomprehensible to me since she blithely refers to my cats as my babies. what's the logic for humanization here?

brain-to-mouth filter. brain-to-mouth filter. at least kids have innocence and charm. i guess my response should be "hey, y'know you're far more endearing when i'm drunk."

could we as polite society develop some sort of brain-to-mouth-filter breathalyzer for people before they try to engage in conversation?

if childless people wonder why their pregnant/childfull friends don't come to them for advice or support or meaningful conversation anymore, this is why. and that goes for all you people who like to tell personal/second- or third-hand gory, blood-soaked birth stories too. you should really have a license before attempting to be a motivational speaker.

holidays



i thought the photo of her reaching up to squeeze my right breast in tentative amazement was way funnier. ah to be 5 again...





scenes from the "baby loves disco" shower my sis & phamily threw for us.


do Bruce Lee and Disco Dave really require explanation?



in case you didn't realize, my phamily is fun. here are three of my aunties & mom playing twister (after boogeying with the DDR contest).



and what's a disco party without a deathstar--uh, i mean disco ball pinata


my favoritest custard fruit tart on phyllo dough which can now only be found in San Gabriel and which my big bro obligingly fetches for me. it's nice to pregnant with my phamily.

and this is neither here nor there
aren't they precious?

Wednesday, January 2, 2008

silly games to whilst away

when i was just a little girl, my sis, cousines & i would make up satirical skits and perform them for the phamily or just for ourselves, especially the ones with foul language. A-S-S. oh and "slut makeup." think judy blume meets wierd al yankovic meets saturday night live.

this propensity to parody manifested in my successful, albeit brief moonlight run as a playwright in high school. my one act, tongue-in-cheek comedy "on the side" was a hit at the high school variety show and made it as far as the citywide performances. it had a lifespan briefer than my thespianism (i have a Best Actress "Oscar" to show for that though. actually my mom does. along with all my diplomas and report cards.)

last night, wakeful from one on my wee hour weez, i thought up a fun parody for a PSA and thought it'd be just the thing to fill up space. see if you can guess which commercial i plagiarized. the first person to guess wins a Sock Blocker(TM)--a draft preventing sock filled with that awful dry-supposedly-jasmine-but-really-long-grain-brown-rice-that-i-didn't-like-the-taste-of-but-have-20-lbs-of mixed with lavender. mmm.

SCENE 1
A pregnant woman late in her third trimester sits on the pottery barn couch next to her dude. They are the picture of suburban domestic bliss. She is watching a TV offscreen.
PREGNANT LADY: (pensively) hmmm... i want something... savory...
At this, DUDE promptly gets up and dons a baseball cap. He is a man on a quest. He pauses as she adds additional descriptors of her whimsical cravings.
PREGGO: and salty... and juicy.
He pauses on cue and waits for her tone of finality before valiantly heading off into the night.

Cut to DUDE getting behind the wheel of his car when his cell phone rings. He answers.
PREGGO: and meaty.
DUDE groans perplexed. Cut to DUDE happily getting his card back from the worker at a counter and carrying away a bag of goodies.

Cut to PREGGO opening the bag and pulling out a stack of bestseller books--mystery, thrillers, literature.

Cut to title
Think Inside the Book