Haven House

Haven House is the only homeless shelter in Southern Indiana to serve fourteen counties. It is set up to house around sixty-five people, men, women, and children, per night, but rarely is it not over capacity. Most nights there are eighty-five people sheltered and often as many as one-hundred and ten. Thirty percent of the residents are from across the Ohio River in Louisville, KY. The average stay is 26 days.

Haven House, established in 1985, has been in its current location at 1727 D. L. Motley Jr. Way in Jeffersonville, IN since 1999. The facility is a rehabbed church building which you see in the photo below.

Besides meals and lodging residents of Haven House are provided clinical care by four volunteer Registered Nurses. These volunteers do minor treatments, monitor prescriptions, triage medical needs and maintain necessary records of treatment and health maintenance which is provided by Life Spring Health System that has a grant to care for the homeless. Once per week a van transports residents to the healthcare facility.

Residents are expected to pay for lodging ($5/night) and meals which run from $1.20 for breakfast to $1.60 for dinner. If residents have no money to pay a tab is kept and they are expected to pay when they have obtained a job. Volunteers assist residents with job applications and interviews.

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Information in this post was gathered in an interview with Haven House Executive Director, Barbara Anderson on May 3, 2019. Haven House has a Board made up of six members who meet quarterly. There are five full-time employees and all other work is performed by volunteers.

Barbara Anderson

 

For additional information on the Haven House see: https://crookedcreek.live/2019/04/02/people-are-good/

 

NOTE: These are my observations and opinions. I do not represent nor speak for Haven House. 

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The Ritz

Recollections of Travel 

One of my favorite places to stay during my travels was the Ritz-Carlton Pentagon City in Arlington, VA just outside Washington, DC. It was right on the Metro (subway) line and even attached to a first rate shopping mall, not that I had much time to shop while working. I was supposed to be at this venue on 9/11/2001, but two days before I canceled my plans for reasons I do not recall. Others who attended that meeting spent several days getting home because all flights were grounded for days. One of my associates got back home to Florida via train. While I would have been in no danger, I am glad I was not so close to the horrendous disasters of that day.

Before you think I’m bragging about staying at the Ritz-Carlton, I will hasten to add I also stayed at Holiday Inns, La Quinta Suites and once at what must have been a truck stop motel in Bluefield, WV. So West Virginians don’t become offended, let me clarify it was many years ago and I know from a current Google search Bluefield has many nice hotels today. I was in Bluefield briefly to observe an eye operation at the Ophthalmic Center of Excellence. Back to the Ritz story. I was attending a conference, I believe it was sponsored by the North American Transplant Coordinators Organization (NATCO), a group to which I belonged. In the middle of the night before the conference was to begin the next day the fire alarm jolted me out of bed. I grabbed my robe and room key and followed the emergency exit lights. Down many flights of stairs, as the alarm continued to scream, I finally arrived at a door that surprisingly led me straight into the kitchen. Several people who appeared to be employees did not seem in a hurry to evacuate, but the sight that will always remain in my mind is chicken and a few other food items scattered about the floor. Pieces of fried chicken and I distinctly remember kicking a piece aside as I made my way to another door opening into the main lobby.

As I looked about the lobby I saw people looking dazed, some women were wearing fur coats, others were tightly clutching purses and a couple of men had brought their luggage down with them. I felt a bit underdressed, but I was proud of the fact I had followed emergency procedures and left valuables in the room, exiting quickly. Never mind I was wearing terry cloth, had a severely broken nail from the stair rail and no shoes. I wish I could tell you what was on fire, but I do not recall. Obviously, it was nothing significant because the firefighters soon allowed us to return to our rooms. I will never know why I did not encounter other guests on all those flights of stairs or why I ended up in the kitchen with the chicken.

Winding Up

It is time to wind up my recollections of business travel. If only I could remember more details, i.e., dates and exact locations, I don’t think I would ever run out of true stories to share. Of course some, because of confidentiality or intellectual property rights cannot be told. During those twenty-plus years, I visited over one-half of the states in the US and went to Canada three or four times.

The Transplant World

In those many cities, I worked with a diverse collection of people. There were transplant professionals, contract specialists, hospital administrators, lawyers, government and military officials and on very rare occasions a patient or family member. It was a humbling experience because each person had personal gifts, amazing intellect, and made contributions that helped to build not only a strong transplant network but a better and safer approach to life-saving procedures.

When I began my own journey in the transplant world, after a few years developing the immediate care centers, I found each day intriguing whether in the office in Louisville or in some distant city. When the first living liver donor transplant was done in the US, I was present at the hospital where the baby girl received part of her Mom’s liver. Years later, they looked me up and I was so privileged to see this young woman, healthy and ready to enter college. Her donor, (mother), was equally as healthy. Contracts were a challenge, but real people were the inspiration.

Kidney transplants from living donors were first performed in the 1950s and it was about eight years before kidneys from deceased (cadaveric) donors were viable. I became involved at the time heart transplants were first reimbursed by Medicare in the 1980s and one by one other solid organs and even double organs, e.g. heart-lung, were successful particularly after the development of anti-rejection drugs. Bone marrow and stem cell transplantation as better matching has been developed between donor and recipient have developed rapidly as well. I will always find transplantation fascinating. I was never in a clinical transplant role, my expertise in this field was administering benefits , contracting for services and third party reimbursement.

If you would like to know more about solid organ transplantation or becoming an organ donor see the United Network of Organ Sharing (UNOS) at https://www.unos.org

Information regarding bone marrow transplants can be obtained through the National Marrow Donor Program (NMDP) at https://bethematch.org which matches patients and donors internationally.

And, here’s a bonus site for those who love technology. The so-called “heart in a box” is a development by TransMedics, Inc. Check it out here to see a video (<3min.) of the device with a cadaveric heart actually beating prior to being transplanted into the recipient. http://www.transmedics.com/wt/page/ocsheart-improve-tx_med

The company has also developed a similar device for lungs and livers which can allow donor organs to be transported further as well as tested and treated prior to transplantation. There is little doubt that these technologies will extend and improve life for many.    http://www.transmedics.com/wt/page/organ_care

The future is truly now. 

Thank you for following along with me in my Recollections of Travel. 

 

Photos by Pixabay

 

Deep South

Recollections of Travel 

Traveling in the South was a real treat for many reasons including the soft accents and colloquialisms. I will never forget being in an elevator in Montgomery, AL when a smartly dressed woman walked through the door and requested I “mash 6” for her. I’m sure my mouth was agape while I figured out she wanted me to push the button for the sixth floor! 

Being a Kentuckian, I’ve always wondered why we are considered “southern.” We are far from Montgomery, New Orleans and other southern towns where honeyed accents prevail. In fact, we are squarely in the middle of the Eastern one-third of the US. I know I have an accent, but in my opinion, it is not Southern, but country. I hear it, I’ve been reminded of it and even teased when traveling to cities to the North or out West. I must admit when I was teased I often became, even more country, sprinkling “Y’all” liberally throughout the dialogue. Accents are intriguing.

Charleston, SC

A long time ago a business colleague and I spent a week in Charleston, SC, training staff at one of the ambulatory care centers slated soon to open. It was going to be a demanding schedule which was a shame because by all accounts Charleston was a beautiful historic city. We knew we would have little time for anything other than work but two things were obvious. We had to have a place to stay and we had to eat, so we optimized both requirements. We chose an extra nice hotel situated on the beach and planned to sample the local cuisine at the finest places. 

While I don’t remember every detail of that week, some things do stand out. One was sleeping with the sliding glass doors open to the balcony so I could hear the ocean. The pounding of the waves was magically relaxing after long days of teaching and orienting nurses, doctors, radiology and lab technicians as well as clerical staff. They were experienced professionals but needed to learn the policies and procedures established by our company. 

Seafood

Our treat for the week became the wonderful restaurants, especially those specializing in seafood. Each evening we would choose a different place and linger over dinner while reviewing the events of the day. We were never disappointed in the meals nor the southern hospitality. We tried many types of food, but I kept going back to my favorite, shrimp. I ate shrimp as appetizers and in main courses prepared in various ways. I did not tire of these plump, juicy crustaceans night after night. 

On Thursday night sleep came quickly while I listened to the sounds from the beach. Approximately an hour later, I awoke to severe abdominal pain. It was intense as I sat up and turned on the bedside lamp. Within seconds I was aware of itching of my arms and trunk. The itching intensified to the point that the abdominal pain was almost forgotten. As I called my colleague, Gale, whose room was just down the hall, I saw I had red hives, some as big as my hand, quickly advancing over my trunk and limbs. By the time she got to my room, I was tearing at my skin, unable to control the itching or accompanying panic. Thank goodness, Gale was not only intelligent, she was a “take charge” type who also had Benadryl in her room. I probably owe her my life. She forced me to swallow two capsules of 25 mg. each while she shouted demanding I stop scratching. That was impossible for me as the more vascular areas swelled and throbbed with an itch I didn’t know was possible. 

Hospital

In the city hospital emergency department (ED) those accents I had been enjoying all week, became so pronounced I could barely make out was being said to me. Perhaps it was my state of fear and agitation, but the only person I could understand was the doctor who was from Vietnam! As my lips, tongue, and throat continued to swell I could not believe how chatty he became. He did all the right things obviously because I survived anaphylactic shock, but when he had learned the company I worked for and that I was from Louisville he found those facts far more remarkable than my precarious medical situation. 

You see, this was during the time that the Jarvik 7, an artificial heart engineered to replace an ailing human heart, was being implanted in Louisville, KY.  The surgeon who performed the first such procedure in Utah had moved to Louisville to perform his second and subsequent surgeries at one of the hospitals owned by my employer. The Vietnamese ED physician kept asking questions about that famous surgeon. Did I know him? What was he like? What did the Louisville medical community think of this procedure? If he had known I was recently a nurse manager at the same hospital where this device was being implanted, I doubt he would have been able to focus on his patient at all, i.e., ME! 

Thanks to quick thinking on the part of my colleague and in spite of the ED doctor’s infatuation with the artificial heart surgeon I survived to work another day in Charleston even though it was without sleep. After returning to Louisville tests confirmed I was allergic to crustaceans, e.g. shrimp, lobster, and crabs. I have not eaten shrimp, or any other crustacean, since that trip to lovely South Carolina.

For years I grieved the loss of shrimp and lobster. I also went through a stage of blaming myself (called “personalization” by Sheryl Sandberg in her book Option B) for overindulging and thereby becoming sensitized. Finally, I was able to not only accept, but be a little grateful as my research revealed a close kinship between shrimp and certain bugs (arthropods.)

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NOTE: Allergy to crustaceans is not the same as a shellfish allergy. Oysters, clams, and mussels, for instance, are not crustaceans. For simplification I refer to crustaceans as the ones with antennae. 

Photos by Pixabay

Taken for a Ride

Recollections of Travel 

Houston

In Houston, the taxi driver taking me to MD Anderson Cancer Center was gigantic. He had a Jamaican-sounding accent and wore an enormous cowboy hat.  His remarks were friendly at first as he discussed the need for health care reform obviously assuming that I was interested in his opinions. He progressed to make disparaging remarks about “foreigners who take jobs from native Americans.” It was obvious that he considered himself to be one of the latter in spite of his very black skin, so I wondered if I was wrong about his being from Jamaica. I said something about American Indians being actual “Native Americans” and he postulated “they were not really here first,” he’d seen a documentary on PBS. I did not debate that issue with him.

During the ride, he talked cloyingly nonstop and I became rather uncomfortable as his comments grew more inappropriate in content as well as tone. At the time Ann Richards was running for governor of Texas and the driver declared that he did not want her to win, because “women should not be at the forefront.” It was hard to not debate that point, but I again managed to refrain. At that point, he asked me where I was from, not an unusual question for a driver picking up at the airport. When I said, “Louisville,” he asked about horse racing, again appropriate. I replied that the Breeder’s Cup was taking place there in a few days and his response was “I hope you breed something good down there.” Okay, so now I thought he had embarrassed both of us to the extent possible with words, but I was wrong. Suddenly he began to laugh when a female driver slowed and motioned him into the traffic flow. I thought I had missed something because it seemed simply a polite, not humorous, gesture. He spoke loudly in the car’s direction saying, “Thank You!” and then to me, “I’ll have to do something nice for a woman tonight! I’m glad that I have never impregnated a woman.” It was with considerable relief that I saw my destination up ahead. 

Baltimore

Out of all those years of travel that cab ride in Houston, TX was the most bizarre, but two others stand out as slightly concerning.  One night, after entering a cab at the Baltimore Airport and asking the brooding driver to take me to my hotel near Johns Hopkins the entire city suddenly turned black. To me, it was an ominous sign, especially that it occurred the exact moment that I stepped into the cab. He drove silently block after block, underneath unlit traffic lights, in front of darkened buildings and deadened street lights, not saying a word that acknowledged he had even noticed the blackness surrounding us. Apparently, he was a seasoned driver, because within about a half hour he pulled in front of the looming darkened hotel. He popped the trunk to get my luggage and Baltimore was immediately illuminated with a brilliance that stung my eyes!

Kansas City

Very late on another night I arrived at the airport in Kansas City and gave the driver the address of my hotel. About forty minutes later I was beginning to worry a little and then I suddenly saw that we were passing the US Federal Penitentiary at Leavenworth! Much later I safely arrived at my destination and paid a $65 (in 1994 dollars!) tab which of course was an item of interest when I turned in my expense account. 

Photos by Pixabay

Fashion on the Road

Recollections of Travel

While trying to work in the Delta lounge during a long layover, I was distracted by the TV. It was not loud, in fact, the voice I heard droning on was barely a murmur. Perhaps that is why I could not resist listening to his descriptions of the perfect and perfectly beautiful models sliding onto the show runway. Their hair, flawless, shiny, and straight flowed spontaneously. The make-up was subtle in its goal of looking natural. His sensitive voice was fluid and sophisticated as he described the women. He talked about the models wearing fabrics “sort of blue, sort of yellow and sort of print.” The non-colors were equivocal, there or not there, whatever you wanted. As he proceeded to detail the faces with terms like “the non-lip,” the gaunt women walked up and down, staring into nowhere with eyes that weren’t. 

Later in the week while attending a medical conference at UCLA, I was listening to a distinguished bone marrow transplant physician, world-renowned for his pioneering work with stem cells. As he spoke, the room became absolutely silent while over one-hundred (100) attendees listened in awe to this brilliant scholar describe his latest techniques and accomplishments. 

It was impossible to not notice a movement in the back of the silent room as a woman, too polite to make a distracting click, clack noise with her four-inch heels, walked the full length of the conference room on her tip toes. As she began the trek she looked back and forth, apologetically, at those who observed her progress. She hunched over to appear smaller and assumed an awkward gait resembling a person crippled by some congenital deformity. 

The beautiful woman, hobbled by her stilettos, had broken the mood of academics absorbing knowledge and now we were simply enjoying the show.  

Photos by Pixabay

Flights Home

Recollections of Travel 

From 1984 through 2005 I traveled nearly every week for work. At first, it was to train clinical staff and open ambulatory care centers (frequently called “Docs in a Box”) in eighteen states. Later, I began Centers of Excellence network development for the same company. Among other things, I contracted for marrow and solid organ transplant services. This position took me to even more destinations including a few times to Canada. In 1997, I incorporated a consulting company still working with transplant centers coast to coast until I reluctantly retired. I believe that I am finally over airport withdrawal but it did take a while. 

During those years of planes, taxis, subways and airports, I made many observations of fellow travelers and others I encountered along the way. I will share some of those recollections that, for some reason, I recall after all these years. Some were intriguing, many more mundane. I’ll let you consider why these memories persisted when so many critical medical and technical facts from those years have evaporated. 

Tampa

While sitting in the airport in Tampa one Friday afternoon, I looked around and noted that almost without exception travelers were either holding or working with a similar small book. Some of these were wire bound, others looked like leather and they came in various sizes. How we loved our Day-Timers back in that day. They were badges of our busy lives and demanding careers. One could clearly see that we had a lot to keep up with, places to go and people with which to network. Perhaps few other 20th-century icons made a more important business statement. At that time some kids were using pagers, drug dealers even had mobile phones, but we were reluctant to transition to that digital age back in the 80s, so we proudly carried our Day-Timers everywhere, placed them lovingly into our briefcases and at intervals made critical notes. As I think back to that era, I wish I had saved at least one that recorded a year’s meetings, flights, and appointments. Today we use our smartphones to carry calendars, do banking, prepare and store documents, keep up with e-mail and social media, even monitor or control our homes, but I still recall the small paper pages that functioned on a much more limited basis but seemed equally important at the time.

A man sitting across from me in the waiting area had been dozing off and on. He was dressed in a very finely tailored suit, but the effect was minimized by his splayed legs and occasional snort. One hand was cupped over that bulge between his legs. Was he afraid that someone might steal it if it was not shielded in this manner? When he moved around for a more comfortable position, he changed hands but remained protective. Finally, the flight was called and he awakened, folded his Wall Street Journal and gathered up his leather attache. Standing, he straightened slowly and slightly shook one leg, then the other. Apparently unsuccessful,
he quickly removed the troubling wedgie with a snatch before proceeding down the jetway.

Atlanta

After a transfer in Atlanta, I’m was finally on the way to Louisville in a much smaller commuter plane. The one busy flight attendant informed us that she was from Columbia and judging from her accent, I assumed that she did not mean South Carolina. Her pre-takeoff instructions included the fact that in an emergency we were to “pull the red liver” to open the door. As we approached Standiford Field (currently Louisville International Airport) for landing the flight attendant’s voice over the speaker gave the following instruction: “If you are enjoying a beverage please pass it to a flight attendant at this time.” So, what do I do if I am not “enjoying” it, but I am simply thirsty, do I keep the cup? I am way too literal to follow instructions tonight.

Home at Last 

 

Photos by Pixabay

Death – Decisions

Decisions

It is understood that family units are all different and may be made up of biological or chosen family, spouses or partners, relatives or close friends. We will use the term “family” for those closest to you. These differences may dictate what, exactly, you need to do to from a practical standpoint to prepare for your death, but regardless, the first step should be honest family discussion. We’ll call it “The Talk.”

The Talk

It doesn’t have to be a formal meeting. If you and your family are open to the discussion of death “The Talk” can be in increments and flow from normal conversations. When discussing the death of an acquaintance it is a natural time to say, “When I die, I prefer . .” Since such discussions may not include everyone who needs to hear, having your wishes in writing, leaves no doubt or confusion. So, what do you need to talk about and how will you document it?

Living Will

Legal agreements can be our guides. Let’s start with those things usually addressed in a Living Will. If you are diagnosed as terminal and are no longer able to make your own decisions, because you are permanently unconscious or otherwise unable to express your wishes:

1. Do you want treatment withdrawn except for pain control?
2. Does that include withdrawal of food, water?
3. What about a DNR (do not resuscitate) order?
4. Do you wish to participate in anatomical donation?

Decisions for #1-#3 can be very difficult for a family member. You may have no doubt that these life prolonging actions are inappropriate or undesirable for you, but to your loved one it is not that clear. To them it may feel as they are hastening your death, while you are more likely to feel that such measures would prolong suffering. If this has been discussed and documented ahead of time, there is less anxiety when the decisions must be put into practice. Physicians, emergency personnel and hospitals must provide every means available to save a life if they have not been given the legal right to withhold those interventions. Resuscitation (CPR) will be initiated, regardless of the patient’s prognosis, unless there is an order in place for DNR.

Number four (#4) involves whether you would like to donate organs for transplantation or all of your body to science. If donating the entire body is your desire, besides documenting, it is best to make logistical arrangements in advance. Most such donations are made through a university or medical school.

Organ donation decisions are often made long before formal end of life planning. In most states one can designate the wish to be an organ donor while obtaining or renewing a driver’s license. Organ donation more specifically is addressed in the Living Will. If you have explicit wishes, maybe you are willing to donate corneas, but not hands for example, this needs to be legally documented. On this subject people often think first of heart or kidney, organs which dramatically save lives. In fact, donations may be made of tissues such as skin which is used as dressings for severely burned patients or bone for spinal surgery. There may be personal or practical reasons for specifying exactly which organs/tissues you are willing to donate and these can be itemized in your Living Will.

Consider Donation of Organs or Tissue

Transplantation is a subject that I feel strongly about, having worked in that field for many years. I find it unfortunate that after over sixty years of successful transplantation, only 52% in the US choose to donate. If you have not already made your decision, please give some consideration to it now. There is no lack of information available to answer any questions you may have. I recommend calling your local/state donor affiliate or researching Online.

The United Network of Organ Sharing (UNOS) is the national organization which governs transplant facilities and Organ Procurement Organizations (OPO) in the United States. Their website probably contains more information than you would ever need: https://www.unos.org

Cornea transplantation differs in some ways from other donation and a good site for more information is https://www.donatelife.net/types-of-donation/cornea-donation/

Bone marrow and stem cell transplantation is still in the experimental phase for cadaveric donation, but is showing promise. If you are interested you may find information at the National Marrow Donor Program: https://bethematch.org

Your Surrogate

A Living Will allows one to record legally, exactly what one wants and does not want. Or, with this document you can authorize a HEALTH CARE SURROGATE, sometime referred to as a proxy or Medical Power of Attorney (POA), to make these determinations for you at the time of need.

Choosing a Health Care Surrogate is a very critical decision. First, of course, is that it be a person you trust. Your designated surrogate should be geographically close if at all possible and should know your wishes before accepting this responsibility. A few of the subjects included in a legal Surrogate Designation are:

1. Access to your medical record
2. Right to choose your health care providers and long term facilities
3. Withdrawal of life-prolonging treatment

This legal document names your surrogate and an alternate surrogate in the event the first person designated is unable or unwilling to serve at the time she/he is needed.

Update and Storage of Documents

Sometimes we change our minds about the directions we’ve given and the Living Will and/or Surrogate Designation may require legal revision. These documents need to be reviewed on a regular basis. If our wishes remain the same, it is probably advisable to initial and date each page to show that they remain current. Having your Living Will on file at your hospital can make it difficult to keep current. I would trust a photocopy carried by my surrogate (and in my car’s glove box) more than the hospital’s computer system. It goes without saying that original documents need to be stored in a locked fireproof box and that your surrogate and/or POA has access.

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“It seems to me most strange that men should fear; Seeing that death, a necessary end,  Will come when it will come”  Shakespeare in Julius Caesar