Published monthly for CC employees by Clinical Center Communications April 1998 First ethics rounds focus on DNR issues The breast cancer quilt and its art |
Down, but not out Tree number 154 may be down, but it won't soon be forgotten. Tree's destiny an historic oneThe 200-year-old oak tree removed from the future site of the Clinical Research Center was destined to make history. The 80-foot tree, known to many as number 154, based on a system to track the trees along the perimeter of the construction site, was one of more than 250 to be either permanently removed or relocated on campus. Saving the trees threatened the construction of the research facility addition after several community sources protested their removal. NIH and the National Capital Planning Commission determined that major alterations to the construction plans would not be feasible. Instead, NIH made several modifications to the perimeter of the site. "Through a regrading process, where the edges of the proposed construction area were carefully reviewed and revised, at least 60 percent of the trees along the edge of the construction area that were set to be removed were spared," said Yong-Duk Chyun, project director, NIH Division of Engineering Services. Although tree number 154 was not one of those saved, the 14-ton trunk of the giant was donated to the U.S. Navy for restoration of the U.S.S. Constitution, the world's oldest commissioned warship, dating back to 1797. "Old Ironsides," as the ship is known, set sail last year for the first time in 116 years. Docked in Massachusetts Bay, it serves as a national monument. In spite of the controversy involving the removal of tree 154, another portion of it will go down in history. After the tree was felled, a slice was sent for preservation and will become a permanent exhibit detailing NIH historical milestones. A younger oak tree also removed was donated to Pierce Mill in Rock Creek Park to renovate its mill waterwheel shaft and blades. (by LaTonya Kittles) index |
First ethics rounds focus on DNR issuesA patient signs an order requesting not to be resuscitated should a crisis arise during a surgical procedure. While in surgery, the patient is inadvertently given too much morphine. Another patient signs a similar order, and during that surgery has an allergic reaction, leading to cardiorespiratory arrest. Should the doctors ignore the DNR (do not resuscitate) order and administer life-saving procedures when easily reversed errors occur? Or should such an act be viewed as an infringement on the patient's right to self determination? Scenarios such as these were addressed last month during the first ever CC Ethics Grand Rounds, "DNR in the OR." Dr. Robert Wittes, NCI, moderated the session. Dr. Richard Alexander, NCI, presented a case study, and Dr. Bob Truog, M.D., Children's Hospital in Boston, was the guest discussant. According to Dr. Truog, DNR orders have evolved significantly in the past several decades, encompassing areas in the hospital other than wards and intensive care units. As a result, said Dr. Truog, the American College of Surgeons, among others, has said that DNR in the operating room is acceptable. He stressed the need for a shift toward discussions of patients' personal goals and needs rather than a checklist-type procedure where patients decide the specific circumstances under which they want to be resuscitated. "Negotiating around goals and values is much more likely to work than negotiating around procedures," said Dr. Truog. Since some DNR requests, according to Dr. Truog, are a result of patients' concerns that they might leave the operating room in a worse condition than when they arrived, he emphasized the need for doctors to understand the issues surrounding a patient's DNR wishes. He encouraged more dialogue among the medical team, including the anesthesiologist, the surgeons, and their patients, to help establish what is in the patients' best interest. Participants also discussed several issues that the medical team must address when faced with a DNR request, such as: Why would someone going into surgery sign a DNR order? What was their emotional status at the time of their decision? Did they fully understand the implications of their decision for surgery? Could an alternative, less-risky medical procedure be conducted? During the session, attendees agreed that there should be a group approach to the request process, including the medical team, the patient, and their family. On May 6th the next Ethics Grand Rounds will address the issue of informed consent for research with cognitively impaired persons. The guest discussant will be Paul Applebaum, M.D., with the University of Massachusetts Medical Center. (by LaTonya Kittles) index index |
To gain control, take time to learn how to do itMy day is out of control. What now? Ever had one of those days where you're trying to handle a ton of things all at once? You're on the highway with portable phone in hand, writing notes to yourself. You get to work only to discover that the parking lot is full, so you drive around some more. And now you find a space. To avoid being late for work, you run into your office, open the door and discover that two people are holding for you on the phone. One call is from your daughter's school (let your imagination wander here) and the other is from your fellow NIH staff member who needs a report from you in 10 minutes. When you've completed these phone conversations, you turn on your computer, only to discover that there are already twenty e-mail messages for you. You say to yourself, "My day is already out of control. What now?" If you can relate to this or a similar start to your day, you may find the following five tips useful:
(Michael Scott, president of Empowerment Unlimited, Inc. Scott was a speaker for a work/life presentation held at the Clinical Center this past December. Scott's articles on improving your work life will be featured in upcoming issues of the CC News. To suggest a story idea, call us at 6-2563.) index
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Workers who volunteer help ease patients' worries | ||
Ina Ifrim, an NHLBI biologist who works at the CC, uses her language skills to help patients feel more at home. |
After spending much of the morning viewing cells that cause cholesterol-blockages in the arteries, Ina Ifrim, NHLBI biologist, takes a break. However, she doesn't head for the B1 cafeteria or the lounge. Instead, she makes a bee-line to the admissions desk, as she has done for the past five years, to meet her "friends for a few." Ifrim is one of more than 65 employees who volunteer to translate for patients who come to the Clinical Center for protocols. Although Ifrim's languages of choice are Spanish and French, the group combined also translates Urdu, Norwegian, Arabic, Mandarin, Hebrew, Japanese, and Russian, among others. Born in Romania and raised in other countries around the world, Ifrim empathizes with the feelings of patients who speak no English. "They must feel completely lost and out of their culture," she said. "I've been through it too, and it's hard. It gives me satisfaction to help them feel more at home." While assisting patients, volunteers help them through the admissions process, meet with them and their medical staff to assure that they understand the procedures, and discuss the pros and cons of the pending treatment. They are also required to attend training sessions that hone core competencies and set boundaries and standards. Many departments are grateful for the service, which they see as an integral part of patient care. Although the program requests advanced notice from departments needing the service, employee volunteers are sometimes called at the last minute, requiring the assistance of others to cover job duties. "These volunteers and their supervisors should be applauded for their role in providing these services to the patients," said Andrea Rander, director of volunteer and language interpreter services. "The interpreters are an important part of the CC volunteer program, said Rander. "Their interpreting skills, as well as their familiarity with NIH procedures, help staff better assist patients, and also help family members adjust to an unfamiliar environment." Volunteers will be honored at an awards ceremony on April 21 at 11:30 a.m. in Lipsett Amphitheater. National Volunteer Week will be observed from April 19-25.CC family among dedicated cadre. Editor's note: The Clinical Center is well represented in the list of NIH employees who volunteer their time and services to help patients. They include: Kim Bui, CC Pharmacy ;Yung Chan, CC Clinical Pathology ;Marie Charles, CC Social Work ;Quyen Chau, CC Pharmacy ;Irene Chu, CC Clinical Pathology ; Hae Cin Chun, CC Transfusion Medicine; Vickie Chung, CC Clinical Pathology; Anna Ferreira, CC Nursing; Simone Guerami, CC Surgery; Nadia Guirgus, CC Pharmacy; Mohammed Hussein, CC Pharmacy; Chau-Ha Huynh, CC Transfusion Medicine; Tina Levin, CC Social Work; Laura Musse, CC Nursing; Alice Pau, CC Pharmacy; Chung-He Row, CC Clinical Pathology; De Tan, CC Transfusion Medicine; Chi Vu, CC Clinical Pathology; Judith Williams, CC Social Work; and Jeannie Wu, CC Pharmacy. index |
News briefs:Recognition program for volunteers set
Nursing ceremony planned
Possible retirement system error
Circus success
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