Closer Than a Brother

As I look out my hotel window in Nashville and have country music songs running through my head, I feel very refreshed by the past 36 hours.

I'm here for the 15th Annual NACLNC conference, held at the Gaylord Opryland Hotel www.gaylordhotels.com/gaylord-opryland. For my first time in Nashville, I have experienced some great things while here. Meeting fellow Certified Legal Nurse Consultants from around the United States has been great, but the highlight thus far was spending about 9 precious hours yesterday with David and Heidi Casey, two dear friends of ours from the past (Caseys pictured above with their two dogs. And what's with the Ohio State sweatshirt? Come on, man!).

I first met David and Heidi at the University of Nebraska-Lincoln in 1993. I was a lonely freshman and David was working on his Master's degree at the time. David and some close friends spent a great deal of time with me...treating me like a close friend and brother and teaching me things from the Scriptures that changed the course of my life in the fall of 1993.

Michelle and I became good friends with the Caseys as they turned out to be great mentors of ours from 1993 to 1999. David moved away (from Sioux Falls, South Dakota) in 1997 to finish his Master's and PhD and eventually returned in 1999 and helped perform our wedding ceremony in Sioux Falls.

We touched base with each other in 2000 and then 10 years passed until I found out that the Caseys lived just a stone's throw away from Nashville (in Hendersonville-actually, 20 miles away is quite a throw).

Proverbs 18:24 says that "A man of many companions may come to ruin, but there is a friend who sticks closer than a brother." (NIV)

Even though 10 years have passed, spending 9 hours with the Caseys was just as good as old times. Just like the Caseys took care of me when I had $14 dollars to my name and no where to live for a short while in 1995, they treated me like a king yesterday by greeting me at the gate at the airport, introducing me to many of their close friends, buying me lunch, and showing me around downtown Nashville. I hope Michelle isn't jealous, but they even took me to the world famous country bar, Tootsie's http://www.tootsies.net/.

Thanks, David (and Heidi) for being that friend that "sticks closer than a brother." Even though 10 years have passed since we last communicated, it sure didn't feel like it!

By Brian Brandser, RN, BSN, CCRN, CLNC

Q and A with LaDonna S. Brown

"Justice cannot be brought about if two parties cannot communicate effectively..."

From the classroom to the courtroom, from the doctor's office to the home, communication is vital. And communication can be difficult enough when two people speak the same language.

Whether in the courtroom or in a hospital setting, interpreters/translators are a great tool when two people do not speak the same language.

Here is my "Question and Answer" interview with LaDonna S. Brown, a Spanish interpreter/translator who resides in the Seattle area. I wanted to hear firsthand from an interpreter on what it is like to help individuals/professionals in the legal and health care fields.

Q (Brandser): How are you currently using your skills as a Spanish interpreter/translator?

A (Brown): "I work at Nintendo as a Spanish Consumer Tech Specialist. Each day I must interpret the Nintendo material from English to Spanish and vice versa in order to help the consumer troubleshoot his/her game, console, etc."

Q (Brandser): What experience do you have in assisting health care professionals?

A (Brown): "Interpreting at Detroit Children's Hospital was a great, hands-on, up close experience being in different environments each day to assist nurses and doctors perform their duties better through the communication gap I was able to fill. Each day I was in a different wing of the hospital: this kept things fresh and exciting as I grew and learned more about the world of communication and interpretation in the hospital environment. Through this I was able to learn how to comfort my patients when their child was having surgery or facing other difficulties."

Q (Brandser): In what ways have you assisted our justice system?

A (Brown): "As a Spanish interpreter I was assigned to court cases in Flint, Michigan. For those who are familiar with Flint, MI, it is not a place with the best reputation. I was an interpreter for small claims court as well as misdemeanors. Within the justice system, the judge was unable to communicate in the target language, which in this case was Spanish. Therefore, with my interpretation skills, I was able to assist in justice being brought about through communication that would not have been possible without an interpreter being present. The judge was very happy with my interpretation skills, and in fact commented on it on one occasion in the middle of court, saying, 'This is the best interpreter that has ever been in my court room!' I smiled and went on interpreting. Justice cannot be brought about if two parties cannot communicate effectively...that is where I come in."

Q (Brandser): Briefly describe your experience studying in Spain.

A (Brown): "My experience studying in Spain was paramount. I studied with Spaniards at one of the oldest and prestigious universities in Spain (Universidad de Salamanca). Being able to study with Spaniards put me in a position where I could really experience how it is to be a student in Europe. To see how other educational institutions function was eye opening. It helped me to appreciate the different ways to get the same point across. This has helped me work more effectively in different environments and with people from all walks of life, and growing to appreciate diversity. The experience studying abroad also helped me to grow as a person and as a woman."

Q (Brandser): How can health care professionals benefit from the services you offer?

A (Brown): "Health care professionals will benefit from the services because I am extremely professional and good at what I do. Sincerely, I love interpretation, it is a gift from God. I do simultaneous and consecutive interpretation, which gives those who I interpret for an option and more control of how they want the flow of the interpretation to go. Overall, I enjoy my work and the nature of what I am able to do through interpreting-bridging the gap of communication through interpretation and translation so that certain services can be yielded. Through my experience in the hospital, I am familiar with medical terminology from different branches of the hospital (including but not limited to): neurology, genetics and EKG/cardiology are just some of the departments that I was an interpreter for."

Q (Brandser): How can legal professionals (attorneys, paralegals, legal nurse consultants) benefit from your assistance?

A (Brown): "Legal professionals can benefit from my experience because I have previous experience interpreting in the legal environment. I have interpreted in the court room and jail holding cells. I understand the importance of staying calm, cool and collected, along with following court room procedures and speaking with respect to the judge, as an interpreter. In addition to this, I am familiar with legal terminology and am capable of simultaneous and consecutive interpretation."

If you are an attorney or health care consultant that is in need of an interpreter, here is LaDonna's contact information:

LaDonna S. Brown, M.A. (Spanish Language & Culture), B.A. (Hispanic Studies: Spanish)

Email: brown.ladonna@ymail.com

Mobile: (248) 556-1553

By Brian Brandser, RN, BSN, CCRN, CLNC

Lost in hospital translation?

One issue that adds to the healthcare reform debate is that of hospitals and translators. According to Adam Gurvitch, director of health advocacy at the New York Immigration Coalition," most hospitals will likely rely on volunteers, bilingual staff and telephone translation agencies..." when it comes to meeting state rules regarding the use of translators. New York is an example of a state that has laws set in place for all hospitals to require "skilled" translators for its non-English speaking patients. www.msnbc.msn.com/id/14838695/.

I recently reviewed a medical record of a patient that was non-English speaking. The patient was about to undergo a procedure in the past, but started complaining to staff and appeared to be in a lot of pain. Finally, after the hospital staff spent a considerable amount of time treating the patient's perceived pain, a family member arrived, translated, and relayed to the staff that the patient "wanted a Pepsi" to drink. Fortunately, in that situation, the family member was a reliable source.

But take the case of an 18-year-old man in Florida, told by Mara Youdelman of the National Health Law Program. www.npr.org/templates/story/story.php?storyId=111066555. Unfortunately, his girlfriend or mother didn't speak English. It's too bad that the Spanish word for nauseated is "intoxicado". The man went on to receive 36 hours of unnecessary treatment for a suspected drug overdose. Staff thought the man was intoxicated or "high on drugs."

I received my bachelor's degree in Spanish in 1998. 11 years have gone by. Speaking as a Registered Nurse, a hospital employee, legal nurse consultant, husband and father, I have issues with going to translate when called upon to do so at my hospital/employer. I have close friends that I speak Spanish with on a regular basis. I have traveled to Chile, Argentina and Uruguay, and spoke some Spanish there. I have translated for a number of patients in an emergency room, a labor and deliver unit, and multiple acute/critical care units. I recently used some Spanish when consulting with an attorney on a health-related case. Despite the degree, the practice with friends, the experience in the hospital and with the attorney, am I "skilled"? Sometimes I feel like I am. Then I think of the time I translated for an anesthesiologist who was placing an epidural for a lady in labor. I think I got most of the dialogue correct, but I sure felt a little uneasy after leaving the birthing suite. The woman was in intense pain, moaning and grunting just like my wife did when she was going through labor. The moaning and the grunting made it difficult to understand all her words. Thank God that the anesthesiologist placed the epidural line successfully.

It's great that New York put forth a plan for "skilled" translators a couple years ago. I think a lot of hospitals and states would have many different definitions for "skilled", however.

Most facilities will agree that patient safety comes first. The challenge lies in relying on family members, volunteer staff, telephone interpreters vs. "skilled" full-time interpreters. Then there's the whole issue of who pays for these "skilled" interpreters.

Until we figure this out, I'll keep practicing my Spanish.

By Brian Brandser, RN, BSN, CCRN, CLNC

A 10-year heart check-up

August 20th, 1999 (10 years ago today). This was the 6th day of our amazing honeymoon.
We were enjoying the hot weather and the view from our balcony in Tucson, Arizona. In a couple hours, we would be on our way for reception #2 in New Mexico.
10 year ago today, my father, James Russell Brandser, died of a Myocardial Infarction (heart attack) at the age of 49. He had just began his work day in Fargo, North Dakota. Apparently, he collapsed on the job in the early morning hours. 911 was called. Paramedics tried to revive him. He died at a downtown hospital a couple miles away.

According to the American Heart Association, www.americanheart.org/presenter.jhtml?identifier=4591, coronary heart disease (CHD) accounted for 445, 687 deaths in the United States in 2005 (about 1 of every 5 deaths).

We arrived at the ranch near Church Rock, New Mexico, in the early evening hours 10 years ago. The first thing my mother-in-law, Pamela, told me was to call my mom. Strange, I thought. I had never given my mom my in-laws' phone number. Somehow, she got ahold of it.

My mother told me the news. I was shocked. Many tears flowed that night and during the days that followed.

Within the next week, I examined the details of my dad's short trip in the ambulance. Apparently, he was in Ventricular Fibrillation www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=745 when the medics found him. Called V fib for short, this is a life-threatening condition in which the heart's electrical activity becomes disordered. When this occurs, the heart's lower (pumping) chambers contract in a rapid, unsynchronized manner. (The ventricles "flutter" rather than beat.) The heart pumps little to no blood.

My dad's death was unfortunate. Everyone talked about how "young he was" and how it "happened unexpectedly." In some ways, I agreed. However, my dad had told me years before that my grandfather (his dad) died at age 50. Another relative had told me that "most of the men" on my dads' side of the family died around that age.

When dad died, I was working in a cardiac unit at Avera Mckennan Hospital www.mckennan.org/amck/index.aspx in Sioux Falls, South Dakota. I was getting ready to start my 2nd semester of nursing school. I had a desire to work with heart patients due to my family history. My dad's death fueled that passion all the more when he died.

For the last 8 years, my greatest passion at Northwest Hospital & Medical Center www.nwhospital.org/ has been working with heart surgery patients and heart attack survivors. I often wonder what it would be like to see my dad walk out of the hospital alive and well. He never had that chance. But it brings joy to my heart to see heart surgery patients and heart attack survivors go home with their spouses and to their families.

Dad, thanks for the memories.

(Picture above: James Brandser [right] with wife Linda)

By Brian Brandser, RN, BSN, CCRN, CLNC

In Loving Memory of Barbara Ann Morgan

I never like taking my wife, Michelle, to the airport.
However, today I not only dropped off Michelle, but also my 1-year old son and my mother Linda as well. I don't have any regrets about this trip, however. Michelle is currently on a flight from Seattle to Phoenix, then on to her home state of New Mexico. Michelle's cousin, Barbara Ann Morgan, died Friday, August 14, 2009, and the family is having a funeral for her this Wednesday. Yep, another victim of Endometrial (uterine)cancer. cdc.gov/cancer/uterine/index.htm
According to the Center for Disease Control and Prevention, uterine cancer typically strikes women over 50. Unfortunately, Barb didn't live to see her 50th birthday.
Barb, a resident of Olympia, Washington, for the past several years, was diagnosed last year with the disease.
Other than remembering that celebrity Fran Drescher copingmag.com/cwc/index.php/celebrities/celebrity_article/fran_drescher battled the disease, my only experience with uterine cancer was a patient I took care of at a hospital in the midwest during my final weeks of nursing school. I remember her quite well, especially the Morphine I was giving her every hour...and that was barely relieving her pain.
Every trip we made from Everett to Olympia to visit her was worth it. From the time she had a melon-shaped tumor removed from her abdominal area, to the moments we spent listening to her late-night gasps for air and grunts while walking to her bathroom at her home in Olympia, it's encouraging to know that her battle is over. The cancer had not only spread to her stomach, but to her kidneys and spine. Eventually, it slowly collapsed both of her lungs as well.
Though we weren't in Phoenix on the 14th to witness her death, it is comforting to know that Barb was surrounded by many loving family members in her last moments on earth.
Barb has a supportive family that lives miles away in Arizona. Despite the distance, either her father, mother or sisters were with her every step of her battle since January of this year. The family fought hard to pull her away from the beautiful state of Washington, and won.
Barb: thanks for the laughs. Thanks for your fighter's spirit. Though I don't know all the battles that you were fighting inside, I never heard you complain once.
With love, Brian.
(Picture: Barb, at left, with cousin Michelle Brandser)

By Brian Brandser, RN, BSN, CCRN, CLNC

The Mom I Know

I received the call in the spring of 1998 from my mother Linda and I remember everything so vividly. I shut the door, sat down at the desk in my dorm room and listened carefully because something sounded different with mom this time.
The tone of mom’s voice kept me patiently waiting. Maybe a family member back in North Dakota was sick or had suddenly died, I thought.
“Brian,” she said, “My doctor has diagnosed me with Parkinson’s disease.”
Being a pre-nursing student at the time, I had heard of Parkinson’s, but I didn’t know much about it. I knew it involved the brain and I knew that Michael J. Fox had the disease, but that’s about it.
Mom was only 45 years old at the time. Medical literature told me that people aren’t typically diagnosed with Parkinson’s until their 60s.
Mom quickly joined a support group and was doing fine, she would tell me. She was good at taking her medications as ordered. The only thing I noticed when I went back home to visit was my mom’s gait disturbance, which is common in Parkinson’s. Typically, mom would shuffle her feet and take short steps, having to grab on to things if needed. I was relieved to see that mom didn’t develop any major tremors or battle with severe pain.
Time passed. I got into nursing school. I would keep up with mom over the phone and made sure I asked how she was getting along. Mom was strong, just like I thought she would be. She managed to keep working. Grandmother Nona always had good things to say about mom’s willpower and perseverance. I gave ample amount of credit to the medications mom was taking, because they seemed to be helping her. Mom had Parkinson’s, but it didn’t have her, I would tell myself.
In 2000, things changed with mom, and I wasn’t quite sure what was happening. Mom told me she was on the same medications. Her walking seemed to be more of a challenge. She was now dealing with tremors. The thing that worried me most, however, was my mom’s state of mind. She seemed to be depressed when I would talk with her. She just didn’t seem the same. I received letters throughout the year from her sisters claiming that mom was now asking the family for money to support a possible gambling addiction. “Mom is gambling? No way,” I thought. This is not the mom I know. Mom eventually asked me for money, too.
Mom, however, did admit that she had been gambling, but was getting help for it through Gamblers Anonymous (GA). Then the phone call from Aunt Kathy came in the fall of 2002. Kathy thought it would be a good idea for me to fly back home so I could see mom. She had reached an all-time low. Her debts were increasing. She had just been bailed out of jail.
It wasn’t until 2004 that David Tullar, PA, realized that mom had been experiencing one of the rare side effects of Mirapex, the drug she had been on for 6 years. Tullar discontinued the drug due to mom’s compulsive gambling. Mom stayed committed to her GA weekly meetings.
I have taken care of many patients with Parkinson’s disease in the hospital, many of whom take Mirapex. I may never know how the drug has affected or will affect them. But one thing is certain: since being taken off of Mirapex, mom has remained strong and no longer gambles.
The mom I know is back and that comforts me.

By Brian Brandser, RN, BSN, CCRN, CLNC

A career in journalism?

That's the question I asked myself when I was sitting next to the sports editor at The Forum http://www.inforum.com/ in Fargo, North Dakota, back in 1993.
I was a senior in high school and my journalism instructor, Robert Hendricks, had landed me an internship/job as a sports reporter with the "big guys" in the sports department at The Forum.
At the time, I was the co-editor of our high school newspaper, The Sudhian. I was grateful to have "my foot in the door" before I headed off to journalism school at the University of Nebraska-Lincoln in Lincoln.
However, this night changed my life and career path for years to come. I was sitting next to the editor, taking commands as I usually did. "Yes, sir." "You bet...no problem," were usually my replies. Phone calls were coming in left and right and I was trying to keep up with all the latest scores and comments from local coaches. I hadn't had a bathroom break the entire evening.
I tried to keep to myself at The Forum, do my job, not step on any toes and hopefully get out by 12:00 or 1:00 a.m. so that I could manage to get a couple hours of sleep before going back to school the next day.
The shift was coming to a close. The paper had just finished its first run on the press. I was dreaming of my bed. I wasn't a fan of the second hand smoke coming from one of our news editors (who I will call "Jim" for privacy purposes). I think "Jim" had been there going on 30 years. I don't think he had moved all night either. No wonder he was about 300 pounds, I thought. He seemed pretty unhappy, too. He had been cursing most of the night. If I didn't have a clear view of him, I would have thought he was talking to a fellow reporter...but I was the closest one to him with no one else in sight.
I always had my eye on the clock. But for the last part of the shift, I lost all sense of time. I thought about Jim. "Do I want to be like him 20 years from now?"
To this day, I am thankful for Jim, Robert Hendricks, and those late nights at The Forum for sending me in a different direction and on a different career path.
I have been a critical care Registered Nurse for 8 years now and I love nursing. On top of the excitement of critical care nursing is legal nurse consulting, which I have been doing for a little over a year.
I like responding to instructions from a doctor or lawyer much better. I also get to take bathroom breaks as needed. Thanks to today's age, I now enjoy breathing fresh air as well. And yes, nurses do walk a lot, so the exercise is better than being planted in a chair for 8 hours.
Thanks again, Jim.

By Brian Brandser, RN, BSN, CCRN, CLNC