Perspective

I wanted to write something clever.  Work has been increasingly stressful lately, and I had an idea to illustrate my frustrations by juxtaposing what I’ve been going through with a scene from a war movie that resonates within me.  But after reviewing that particular scene, a scene I’ve watched so many times…after witnessing the horror, the terror, and inhumanity of what happened on that beach in Normandy, the hell that those men went through…well, let’s just say that my stresses paled with the comparison, and I found my perspective…

 

The scene takes place in the midst of the opening sequence of “Saving Private Ryan.”  Soldiers…brave and terrified young men are being slaughtered on the sand, in the water, and even before they have a chance to get off the landing craft.  Carnage, explosions, bullets pinging off the metal beach obstacles like hail on a tin roof.  For we, the viewers, that opening sequence is the most uber intense twenty or so minutes in film history.  When I originally viewed it, when I see it again, each and every time, my body tenses with the terror and horror of it all; I have to remind myself to breathe at times, unaware that I’ve been holding it.  I cannot even imagine how it must have been for the real soldiers on those beaches, slogging through the blood and the mix of broken bodies and equipment…

 

The scene I was remembering is, in the midst of all this chaos, a young medic works feverishly to save the life of a wounded soldier, kneeling in the sand over him, even pulling the body of another soldier close, to shield the dying one, only to see his efforts ultimately fail when a bullet strikes the wounded soldier in the head, killing him instantly.  The medic cries out his frustration to the German guns mowing down the men around him, as he fulminates a foaming mouthed string of obscenities directed at the German soldiers behind those guns: "Just give us a fucking chance you son of a bitch, you son of a fucking cocksucker!"  That was the scene that resonated with me, the utter frustration of being laden with more burden than it was possible to carry, that’s what I wanted to convey...

 

At first, I figured I would offer the caveat, homage to those soldiers, to all combat veterans, that in no way would I mean to compare what they go through, with the threat of imminent and horrific death all around them...to my experience rendering care to elderly folk in a nursing home...but after reviewing that scene, I felt chagrined at even conceiving a parallel... 

 

Yes, I am more familiar with death than I ever wanted to be; I’ve held dying people in my arms, watched them suffer, sometimes for only a short time, other times, for far, far too long.  I’ve hugged and tried to comfort the scared ones, the abandoned ones, held their hands, stroked their foreheads, hugged and kissed them and tried to assuage their fears, and tears.  I’ve hugged the loved ones who come to witness their dying moments, tried to offer words of profundity to soothe their loss, knowing that there are no such words.  I’ve watched the slow decline, the withering, the loss of color to flesh, the dimming light in eyes.  I’ve been surprised how some linger, unable to achieve their death, suffering all the while.  I’ve been surprised as well at the unexpected, sudden deaths.  Those we send out to the hospital for a seemingly minor illness, only to never come back to us.  The “younger” ones who suddenly “arrest.”  The man who aspirated on his own vomit. The woman who was breathing as I rolled her one way in bed, but who’d ceased breathing when I rolled her back.  The ones where you go into their room, only to discover that they’re “gone.”  Just gone.  Then there are the countless souls who never recover after suffering a fall.  I’ve watched them sent out with a broken hip, to have some surgeon “practice” their technique, fixing the broken joint with rods and screws, before shipping them back to us to “recover,” only to witness their rapid decline until they die a few months or weeks later.  People on the outside don’t realize how critical a simple fall can be to the elderly; people on the inside know this all too well.

 

It’s not only the death though.  There are the poor “jumpers” who climb repeatedly out of bed and wheelchairs, setting off beeping alarms to alert us so we can safely guide them back down before they fall, and maybe break a hip.  There are the “wanderers” who shuffle their feet along the floor, propelling their wheelchairs all over the building, sometimes intruding into the rooms of other residents who are not too happy to have them visit.  Wandering the halls, wailing out their dementia, crying out the names of their loved ones, the only connection their addled minds have to any semblance of reality.  There are of course also, the sufferers.  Half blind, half deaf people, sitting in their rooms with only dark silence until maybe one of us aides or nurses takes the time to lean in close and offer our muffled voice into their ears, touch their shoulders, hold their hands, hug them.  There are the “behaviorals” too, those who are not as physically bad off as the others but who through loneliness and depression and childlike “neediness,” are compelled to incessantly ring their call bells, or seek us out, or follow us around to the rooms of other residents, or scream our names from the other end of our unit, demanding attention for all manner of silly assistance.  “Can you fix my TV?” they might ask, and for the umpteenth time you push the same single button on their remote to affect that “fix.”  “Can you open that window?  Just a crack, no, that’s not enough, no, that’s too much, no...” Then five minutes later you’re answering their light again: “Can you pull that curtain a little? No, that’s too much, no that’s not enough, no a little more, no...” 

 

And all the while, you’re juggling similar requests from three other residents, (this one wants water, that one wants the head of her bed raised, the other wants...well, he just wants...) along with the man who’s a fall risk sitting forever on the toilet whom you’re not supposed to leave but the bitchy nurse you have to work with that shift just demanded you go get that other resident up for supper so you gamble and leave the toilet sitting one to go make the nurse happy and meanwhile one of the more sentient residents is screaming at a “wanderer” to “get the hell outta my room or I’ll break your nose with my fist!”

 

What compelled me to ruminate, and then write about all this is because more and more it seems, the long-term care unit where I work is being laden with an endless stream of “hard cases.”  I’m reminded of that inscription at the base of the Statue of Liberty: "Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore...”  We seem to take in the ones that no other facilities want to handle.  Our own rehab unit purges their beds of the difficult cases and ships them down to our end of the facility, the long-term care unit, last stop on the train ride to nowhere... 

 

So more and more my nights, my shifts seem to be overrun with chaos and insanity; screaming, crying, angry, combative residents who require far more care than we can provide with our limited staff.  Everything happens at once on these nights.  Residents falling, residents trying to beat on each other, or us, residents demanding our attention, despite the emergency situation happening down the hallway...all at the same damn time!  I sometimes want to fulminate my own foamy mouthed frustration and scream, “Give us a fucking chance!”

 

But then I remember, there are no bullets flying overhead.  I am not witnessing limbs blown off with explosions.  I’m not awash in blood and viscera and my people, and myself,  are not in peril of imminent death...

 

I watched that opening sequence of “Saving Private Ryan” again before I sat down to write this blog...and I found my perspective.  I realized that my debt to such men is so enormous that I can never repay it.  And that my burden is not so great that I cannot carry on.  Like the elder Private Ryan at the close of the movie, standing over the gravesite of Captain Miller, tears in his eyes, asking his wife if he’s been a “good man,” I realize that what matters, what truly matters, is that I do my best and try to earn and live the life that has been given to me, and at least pay down the debt owed.  And if that means I have to endure the suffering and death around me, and the helpless feeling I sometimes get, the feeling that none of what I do really makes a difference, then I too can soldier on.  And maybe someday, when my “tour of duty” has come to an end, I will know that I have done my part, that I have served...that I have been a good person...

Frag

At my place of employ I work for a Nazi with a Napoleon complex.  I call him Frag. 

 

In the military, there’s a long tradition of handling superior officers or members of one’s unit who are ineffective leaders to the point where they endanger the unit as a whole.  Wikipedia defines it thusly: “Fragging,” assassination of an unpopular member of one's own fighting unit, occasionally using a fragmentation grenade.  While it might sound a bit harsh and extreme to have to resort to killing one’s own leader, sometimes it’s necessary to preserve the fighting integrity, and especially the safety of the unit. 

 

The object of the fragging is often an imperious, officious, prick who believes leadership is all about rules and regs, and especially domination of one’s subordinates, at the expense of respect and dignity, and especially attention to the real nuts and bolts of what makes up a fighting unit.  They try to rule by intimidation and waste too much time and energy on spit and polish, at the expense of both learning, and teaching the craft of warfare.

 

There’s a TV mini-series that I have on DVD, and watch at least once a year, that I think illustrates this perfectly.  I think it should be mandatory viewing in every organization as a training tool for both effective…and especially, ineffective leadership.  “Band of Brothers” is a multi-part series about a company of paratroopers in the 101^st Airborne during WWII.  In it, we see two officers exhibiting each of these leadership styles. 

 

Captain Sobel, played with exquisite foppishness by David Schwimmer, is a prime example of ineffective leadership.  He is a also a prime example of just the sort of officer who would have been “fragged” at first opportunity by his men, before he had the chance to “lead” them to slaughter in battle.  Captain Sobel rants and bellows, belittles his men, embarrasses his junior officers and non-coms in front of the men, punishes them all by cancelling leave for minor infractions of buttons on uniforms and scuffed boots, and relentlessly forces them on marches up Mt. Currahee.  In one scene, he deviously “rewards” the men with a nice dinner of spaghetti and meatballs, before interrupting the meal and demanding the now pasta engorged men run up that mountain yet again, hoping that the ensuing agony and mass vomiting will bend them to his will.  To the men’s credit, they rally together against their common foe, and instead the hapless Captain Sobel is only made to feel foolish before them. 

 

In England, while preparing for the D-Day invasion, where the paratroopers are to make a  drop behind enemy lines the night before, Sobel further exposes himself as a feckless military commander, getting lost and confused while trying to lead his company to rendezvous points.  The troops are so horrified by his ineptitude that they actually risk court-martial to mutiny against him in order to not be lead to inevitable slaughter when the real battle begins.

 

A subordinate officer, Lieutenant Winters, is ordered to take command of the company on short notice and what we witness through the remainder of the movie is how he evolves as a true leader, gaining and building on the respect of his men to the point where they will follow him into and through the most hellish battles imaginable. 

 

The difference between Winters and Sobel is that Winters leads by example.  He is only forceful when he needs to be, but he is always fair.  He does not ask his men to do what he could or would not do himself.  He never treats them as inferior beings and is always instructing and drilling on the aspects of soldiering that have real practical application.  And always, always, he looks out for his men and tries to keep them as safe and cohesive as possible.  By the end of the campaign, he has risen to the rank of Major and battalion commander.

 

I’ve worked for too many Captain Sobel’s, especially it seems, in this business of health-care and nursing where I’m at today.  My current Sobel is without question the worst Sobel I’ve ever encountered.  Sometimes I call him the Wizard, because like the phony “man behind the curtain” in Oz, he rarely comes out of his office or from his position behind the computer screen on his desk.  He’s been in his position as Director of Nursing Services at our facility for 3 months and yet not once has he taken it upon himself to circulate amongst the staff and get to “know his people.”  Despite being utterly clueless, or caring, of what happens on the long-term unit I work on, he delegates reprimands and discipline to his underlings to execute on us based on what the personnel files show on his computer screen.  Worse, he seems to actually enjoy pulling people into his office to belittle and demean and even threaten them.  People have been told: “you’re worthless,” or, “you should look for another profession.”  He told one aide, a 62yr old Filipino woman, not even five feet tall, who shows up every day, never calls out and does her job to the best of her ability, that he had to cut her overtime hours because apparently she was too “tired” to do her job properly.  Then in the next breath he inquired as to her financial situation, asking her if she had money troubles, insinuating that as the reason for her picking up so many OT hours.  Seriously, never mind the inappropriateness, and grossly unprofessional tone of such a remark, or the fact that her financial situation is none of his damn business, is he aware that she still has family in the Philippines, and that they’re still reeling from the devastation of the typhoon?!

 

So what has Frag wrought with his campaign of bullying intimidation of nurses and aides?  What does he think his open contempt of LPN’s (he’s stated that he considers them inferior to RN’s) and his obvious disdain for the frontline grunt LNA’s who do the bulk of actual care for our residents, what does this he think his “leadership” style will cultivate?  The answer is obvious; the answer is the same for those men on Currahee.  And I can tell you it is not one of reverence or respect.  Intimidation, in any situation, breeds only resentment.  Those oppressed will only do what they need to do to make the whippings stop.  Only escape, and/or mutiny are the true byproducts of this methodology of managing people.  It is so blatantly counterproductive to actually urging the best from your charges.  Yet so many, so damn many people in “leadership” positions, resort to this style.  It is lazy.  It is ignorant.  And it is utterly ineffective. 

 

The problem here is that positions of management, of leadership, of “power over people” too often attract only those Sobels who are least suited or qualified to perform the task.  Real leaders, almost always have leadership thrust upon them.  And the best ones often come from a background of remembering what it’s like to be a subordinate, an underling, a frontline grunt.  And those who don’t, at least have a sense of compassion and respect for those who do the heavy lifting.  They remember that we are all humans, first and foremost. And that respect and credibility are two things you must first earn from the people you are charged with leading, lest you turn around mid-way up that hill of Currahee, or worse yet, in a fox-hole in battle, surrounded by the enemy, and find yourself alone with no one to either lead...or save your ass!

 

Frag will get his in the end.  They all do eventually.  It is only distressing that so many good people will go down before him; like Custer’s men, scalped and defiled, all in the name of his own vanity, this Sobel will only lead his “troops” to inevitable slaughter.  And worse yet, in a business that’s supposed to be about caring and compassion, the most vulnerable in this whole scenario, the elderly and infirm people that we are supposed to be providing care, will suffer the most...