The Fireside

After much hoopla and publicity, the Stinkwater Mountain Hospital is opening next week!

Does anyone but me have any reservations about this?

Doesn't anyone remember 5 years ago, when the Mary Fisher Clinic was expanded with two fully equipped trauma rooms so that Stinkwater could have a 24/7 Urgent Care? I know most of the people who now live in Stinkwater weren't living here 5 years ago, but it's not too hard to find out the history. What happened then? They couldn't fund it, and they couldn't staff it, and that building has been sitting empty since then.

Can they now fund and staff an 11 bed acute care hospital in addition to a full-fledged Emergency Department when they could not even keep the Urgent Care afloat?

I am an RN. Like many local health care professionals, I sent in a letter of interest and C.V. to the new CEO back in August, when they first started seeking applications. I heard absolutely nothing for months, not even a postcard to say that my application was received and I would be contacted soon. You must understand that nursing today is an extremely competitive field. I generally take short-term contracts in various facilities throughout the Southwest, and I am very experienced in Acute Care, Critical Care, and Emergency Medicine. When I finish a contract, I generally take some time off, and then, when I'm ready, I contact one or two hospitals, and I always hear back from them, not within days, but within hours, and a new contract is signed within days. The Stinkwater Mountain Hospital, while actively seeking applications since August, did not contact me until December, almost 3 months later! Any hospital, but especially a new one, must realize that attracting good, experienced nurses today takes a proactive stance. Ignoring a resume for three months is not proactive!

When I did get a phone call from the newly hired Director of Nursing (DON), I was told how they intended to staff the facility, and I was stunned. They are only going to hire 2 RN's per shift to care for 11 acute care patients and EVERYONE who comes in through the Emergency Department. Safe staffing ratios in acute care settings are generally 4 patients to 1 RN, or, in a pinch, 5 patients to 1 RN. To expect 2 RN's to care for 11 beds is already exceeding safe standards, but to then expect those RN's to see and treat everyone who comes in to the ER on top of it is outrageous. Not only that, but she told me that they were not going to hire any part time or fill-in nurses. This means that the nurses they do hire will be expected to work overtime on a regular basis, and that if one calls in sick, they will be even more short-staffed. A nurse who agrees to work in such circumstances is putting her license at risk, because she cannot provide safe care to that many patients alone.

I have worked in ER's in towns that are similarly sized to Stinkwater. Those ER's generally staff with a minimum of 1 doctor and 2 or 3 nurses 24/7, in addition to ancillary staff, unit clerks, etc. They need to, because of the high volumes of patient visits. The ER in Alamosa, for example, sees on average 60 patients a day! Why would Stinkwater be any different?

Part of the problem, as I see it, is that the new DON does not have any hospital experience, nor does she have any Emergency experience. She has worked in a nursing home for the past 5-6 years, and before that, she worked for the military as an OB delivery room nurse for babies born to military wives. She told me that they were not expecting the ER to be very busy, because the ambulance in Stinkwater is not very busy.

But you can't judge by that! You have to understand the demographics of exactly who uses an Emergency Room. It's not like you see on TV, where it's one true life-threatening situation after another, with the staff constantly saving lives. Far from it.

Since a certified ER must see, examine, and treat everyone who walks in the door, regardless of their ability to pay, the number of times they have visited already for the same complaint, or the nature of the complaint. This means that the vast majority of ER visits are made by people who are not experiencing an emergency. This includes people who are mildly sick but cannot get in to see their doctor, people who are mildly sick but can't AFFORD to go see a doctor, people with mosquito bites that are red and itchy, people who called in sick to work in order to have a day off to go skiing and now need an excuse for their employer, people who want narcotic pain medications but their doctors won't give them to them, people who are lonely (or psychotic) and just want somebody to pay attention to them. Sore throats, ingrown toenails, and mosquito bites are much more commonly seen than heart attacks. That's the way it is. The "real emergencies", people with serious injuries, heart attacks, and other things that require immediate interventions, are few and far between, in every emergency room in this country. It will be no different here.

Newspaper articles quote the CEO as saying that the budget will be very lean at first, and there will be no room for extra expenses. The same article tells us that "injured people" have been entering the construction site, thinking the hospital is already open. The handwriting is on the wall for those who care to read it.

I think we all agree that we need a hospital here in Stinkwater, and it's high time that we got one. Nobody likes to go all the way to Durango for our hospitalization and emergency care. Yet, can we afford another effort that fails due to inadequate funds and unsafe staffing? Do we want another building to sit empty for years until the Board decides to try it again?

If they staff adequately for patient safety, employee retention and a quality and profitable hospital can surely benefit our community. I hope that they do, for if they do not, it is bound to be a disaster, and we have seen enough of those in our community lately.

Recently, we had a major snow storm in Stinkwater. Our county in particular does not have a great infrastructure, and when it gets windy, or rains, or snows, we generally have power outages. Since these weather conditions occur frequently, we have frequent power outages.

Most of the residents who have been around for a while realize this, and prepare. We have woodstoves, and piles of wood in the garage, on our decks, and/or in the backyard. We have food stored up that will last us through a bad storm. Some of us have generators that will at least give us light for a few hours if we need it. We use propane as well as electricity to hedge our dependence on the electric company.

Now, however, Stinkwater is composed of people from elsewhere who have no history and no comprehension of preparedness. Fifty-eight percent of the homeowners in the county have primary residences somewhere else. My neighborhood has had a building boom in the last five years which has tripled the number of homes, and the cost of those homes. Most of those people have been there less than 5 years, and have moved from warm climates, from big cities in Texas, New Mexico, Arizona, and California.

What happened during this recent storm?

I wasn't at home. I'm still out of town for a few more weeks, working this nursing contract. The morning after the storm and power failure, I get a message on my voicemail from a neighbor up the street saying that they were cold, and were going to go over to my house to get some of my wood. Hmmm... I called her the next morning, and yes, she had sent her son over to get some of my wood. I couldn't believe anyone could possibly not have ANY wood available for emergencies like this. She just said, "Well, we just never got around to getting any." What? That is a necessity if you want to live here!

Not only that, but her son is a very troubled young man who has been arrested for burning down building in the area. I was not exactly thrilled that he had been sent to my home alone, by his mother, to help himself to some of my wood. What message does that send to an already confused boy? "If you need something and someone else has plenty, it's OK if you go and take what they have, since they probably wouldn't mind."

Later that day, the older people who are watching my house, told me that my gate had been left open, and with the continuing snow, they couldn't get it closed.

I called my neighbor back, and informed her that her son had left my gate open. Her response? "Oh, yeah, I noticed that when I drove by!" I asked, "Were you planning to go and dig out the snow so that the gate can be shut and latched, as it was prior to your son going over there?" She seemed shocked that I would ask such a thing. She said that she was really busy right now looking for cat food for her daughter's cat. I asked her to please make sure that the gate was dug out, and then shut and latched, since more snow was coming and it would be much easier to dig it out now than with another 2 feet on the ground the next day." She said she would try.

Later, she called and left a message that she had gone to shut the gate. It was now closed and latched, and she had put some of the wood back. "Thanks, anyway," she said, "but your wood was mostly too wet to burn so I put it back. We got power back on an hour after we went to get the wood anyway." Hello! Yes, wood in the backyard is generally wet during a big storm cycle like this one. That's why we keep some in the garage and in the house and cycle the wet wood inside to dry out as the older wood burns and heats up the house.

Is this not common sense?

I could not help but think of Jesus' parable of the 10 virgins. While I realize the message of the parable was not about earthly preparedness, but to be prepared for the Son of God, the Bridegroom, to return. Yet, those five foolish virgins went out to meet the Bridegroom without any oil for their lamps. Did they not really believe He was going to come, and that this was just a drill? Did they think that they could depend upon the preparedness of others in case He did, taking from others what they themselves would need?

His coming was promised and was sure to happen. We too have the same promise, and it is sure to happen, just like snow and power failures in Stinkwater. We just don't know exactly when.

Our preparedness for snow and cold is something we can do (or choose not to do), and from which we benefit when the event occurs (or suffer if we have not prepared).

Yet, our preparedness for the Bridegroom is something we cannot really do. Thanks be to God that the Bridegroom Himself prepares us, gives us the "oil" we need, which is our faith in Him, through our baptisms and through hearing the Word and partaking of the Sacrament of Holy Communion on a regular basis.

Let us all be "ready" when that time comes.

I recently read a book about immigrants to the US back in the 1930's. One couple had just had a baby in the hospital, and the man described how he took the time to speak with the nurses and smile with them. He treated them with respect, knowing that by getting to know them, and them him, that they would take good care of his baby.

Today's nurses are very highly skilled professionals, much more so than back then. Quite literally, we hold the lives of their patients in their hands. Nurse today know how the conduction system of the heart works, and we know how different medications effect that system. We know what Murphy's sign, Babinski's sign, and Homan's sign are and we know how to assess them. We know the Creb's cycle and it's implications for cellular metabolism. We know how to resuscitate a patient in cardiac arrest with sophisticated drugs and procedures (not just CPR) and bring him back to life. We also generally work 12- to 13-hour shifts and usually do not get to stop even for a lunch break because we are too busy trying to care for our patients' medical and personal needs.

Yet, family members of patients in the hospital, for the most part, do not treat nurses with respect, and indeed are generally quite rude and disrespectful toward nurses. Why is that?

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After a few moments of confusion early in my Christian life, I discovered that Christians number the ten commandments differently than we Jews do, and thus the two tables are configured differently. For Christians, the first commandment begins in Exodus 20:3 – “You shall have no other gods before me!” Subsequently, all the following commandments were also “off” in their numbering, and it took a little while to understand certain references, which at first didn’t make much sense.

For Jews, of course, Exodus 20:3 is the second commandment. In Judaism, the first commandment of the Decalogue is Exodus 20:2, which reads, “I am the LORD your God, who brought you out of the land of Egypt, out of the house of slavery.” While this may not sound like a commandment to Western ears, to Semitic ears it clearly says, “I am your God. I have demonstrated this fact to you by miraculously bringing you out of Egypt, and now you must believe in Me.”

What difference does that make? First of all, Exodus 20:2 is an explicit commandment to believe, which effectively turns a “belief” into an “action”. In Judaism, what you do is more important that what you believe. A commandment to believe in God, and to know that He exists, is necessary before one can even begin to understand why you should not worship any other God, or take His name in vain! It also implies that you can will yourself to believe, whereas we know, as Christians, that our faith in God is, indeed, a gift from God, and we cannot make ourselves believe, or love God, on our own.

The second part of this Jewish first commandment is something I’ve never heard discussed in Christian circles, but one that is prominent in Jewish theology, and that is the significance of Egypt in this commandment. “I am the LORD your God, who brought you out of the land of Egypt, out of the house of slavery.”

And make no mistake, we were slaves in Egypt for 400 years. And God brought us out of Egypt in a miraculous way. If he had not done so, we would most likely still be there today. But why does God continually remind us of this fact, throughout the Books of Moses, especially in sections dealing with the Levitical law, but also the rest of the Old Testament as well? Being slaves for centuries is really not something that we would really think of as the high point in our history. Yet, it is prominent displayed for all the world to see, in the Bible, as well as in the worship life of Judaism. In the Siddur, the prayer book of Judaism, there are also many prayers and references to Egypt as well. When something is remembered so often, in God’s Word and also in our heart and prayers, you know it must be important.

Just as the first Passover points to Christ as our Redeemer and Lamb of God, so also does the constant reference to the reminder that God took us out of Egypt in the Hebrew scriptures.

The Hebrew word for Egypt is “Mitzrayim”. Translated literally, this means “the narrow place”. This is fitting for a place like ancient Egypt. Egyptian civilization was focused along the Nile River, thus creating the impression of a long, lush, narrow place, surrounded by dry, wilderness areas. In those days, too, there was no understanding of man-made borders, and nations were not clearly defined by their borders as they are today. For the most part, borders as they existed were generally quite fluid, depending on nomadic tribalism, and the almost daily changes due to conquest and loss. The civilization in Egypt, the narrow place, would have been more static because of the reliable water source, and consequently, a more permanent civilization emerged, of which we still see evidence today.

So, the Lord took us out of the narrow place, where we were in slavery. He reminds us of this almost constantly in His Word. God shows us his mercy by rescuing us from slavery in the days of Moses, but you may wonder how this points so clearly to Christ today.

Knowing a little Hebrew helps a lot in understanding this significance here. The Hebrew word, Mitzrayim, refers to any narrow place, including the very significant one that is the shape of our own human physical bodies. How are we enslaved in Mitzrayim, the narrow place of our own bodies, today? Obviously, it is by our sinful wants, thoughts, and actions.

In Judaism, where belief is secondary to action, it is thought that we can free ourselves from our own personal Mitzrayim, that by our actions of performing enough mitzvaot we can overcome our sinful desires, redeeming not only ourselves, but repairing the world at the same time.

Yet we know, as Christians that, like the Israelites of Moses’ day, we are unable to free ourselves from our own captivity in Mitzrayim, and God stepped in to free us. In the case of the Israelites, who were forgiven, redeemed, and given the great gift of the Law, the Ten Commandments, we all were also redeemed from the Mitzrayim of our own flesh when Christ stepped in to free us from the bondage of our own sin. He brought us out of the land of Mitzrayim, out of the house of slavery, through living a perfect, sinless life, and by dying for us for the forgiveness of all of our sins.

The next time you read the many narratives in the Old Testament, notice how many times you read the phrase, “I am the Lord your God, who brought you out of the land of Egypt”, and then remember the great promise that is included in those words, and Jesus the Messiah who has come and fulfilled it, and who has saved us and brought us out from Mitzrayim.

If there are any die-hards out there who still check my blog every once in a while, I'm sure you have noticed that I have removed all the former posts regarding LC-MS issues, nor am I posting any new comments, nor am I writing any new articles regarding those issues for publishing elsewhere.

I have been off the blog for over a year, due to my own personal reasons. I intend to begin posting again, but be advised that the character of the blog will be changing to reflect other issues of interest, such as local mountain community issues, thoughts on vocation, life and death issues (I work in an Emergency Room!), yet still from the perspective of a confessional Lutheran.

However, as far as the LC-MS is concerned, I have nothing further to say on the issue. I watched the debacle of the 2007 convention, read the first meeting minutes of the Board of Directors, and it must now be completely obvious to the most casual oberver that the bus that once was the LC-MS is in the ditch. In spite of many efforts by some valiant people to dig it out, it is stuck fast and there is nothing more that can be done.

Yet, I grieve for the tragedy that has befallen the Synod in which I was first brought to faith in Christ. In spite of the fact that, like suicide, this tragedy comes at the hands of those at the helm of the Synod itself, this is no less a tragedy, for the LC-MS could have remained a strong Confessional Lutheran body in our communities and in our country, yet it has freely chosen to leave that path of righteousness, leaving a very small group of faithful individuals, who still do remain confessional, to carry on in solitude, much like the 7000 Israelites of Elijah's day who refused to bend the knee to Baal. Of course, our current Baal is the contemporary society, social gospel, and post-modern relativism, which we see reflected and embraced in the LC-MS of today.

While I'm sure there is much that remains to be discussed about the state of the LC-MS, that discussion will no longer happen on this blog.

I say this for myself primarily, but also for others who feel as I do. And that is, that we must keep in mind that, although the Synod has betrayed us, Christ and His gospel, His love, and His forgiveness, never will.

Kyrie Eleison.

Last week I was attacked by two large dogs while I was riding my bicycle in my neighborhood. One dog was more vicious than the other, and bit me repeatedly and deeply on both legs, as I screamed in vain for help. The owners were not home, apparently, nor was anyone in the few other houses in the area.

I continued to try to protect myself from the dog by using my bicycle as a shield between me and the biting dog, who continued to charge toward me and try to get around the bicycle. It seemed like hours, screaming for help, knowing that I could not hold the dog off indefinitely, nor could I escape since both dogs were blocking my way and I couldn't move away.

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I got back home a few weeks ago from a short term nursing contract in another state. I have to say it was the most difficult position I've ever held. Barriers to good nursing care were everywhere, and nobody in administration seemed interested in hearing about them or doing anything about them.

Every morning I went in to work looking forward to taking care of patients, their medical as well as their emotional needs. But, at least half of the shifts I worked, I left in tears, thinking that this one had been the worse so far.

What does a Christian do when her sacred vocation is a nightmare?

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by Julie Martinez, as published by The Alliance of Evangelical Lutheran Lay People

After my own congregation went through the devastating destruction and prolonged aftermath of an unconscionable attack on our pastor, I found that the many books and other resources available indicate that this antagonistic behavior is not new to the Christian Church, and is endemic in the LC-MS at this time. Why would this be?

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Back in January, I had a reminder of how fragile life can be with a close-up brush with my own mortality. I went in to see my doctor for a routine exam, as I have dozens of times before. While palpating my abdomen, I saw a “different” look come across her face. She felt around a little more, and finally, carefully, told me that she could feel a lump on one of my ovaries. I needed to go to Durango right away for an ultrasound to see if it was a cyst or cancer.

Well, “right away” turned out to be a few days, which gave me more time than I really wanted to think and worry about it! On the other hand, it gave me some time to begin to prepare for the worst. I started thinking seriously about my own mortality. Death as an abstract concept is not that hard to grasp. We all know intellectually that we will die “sometime”. But death knocking on your front door is a different matter. I wasn’t ready to face that yet!

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Paul writes in this text, For I am convinced that neither death, nor life, nor angels, nor principalities, nor things present, nor things to come, nor powers, or height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord. Romans 8:38-39 NASB

I have had questions about the translation of this verse, and in particular the Greek word translated here as “principalities”. First of all, what exactly is a “principality”?

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