Aw hell no, Sergeant Major

My first annual training (AT) in the reserves, after spending 4 years active duty, was an Educational Experience.

The reserves are about as much like active duty as Fredricksburg is like Germany – not very. But I quickly found that I much preferred the reserves. There was a lot less focus on formality and image and a lot more focus on getting the job done. Maybe because you’re always trying to figure out how to run a unit and train your soldiers in a ridiculously compressed time frame. Less energy left over for bullshit. And everyone’s role was bigger and more integrated than in active duty, where we had each been relegated to one small piece of the puzzle with very little collaboration.

I was an E5 when we rolled into Fort Hood for that AT, just a squad leader, not really in charge of much and still figuring out how it all worked. We set up our SCIF and the GP medium that served as our quarters and began 24x7 operations.

Three days later we got orders to move. We packed it all up and relocated.

And then did it again.

And again.

Moving a SCIF is no small feat. The setup was three 577’s parked side-by-side with vestibules extended, a GP small guard shack, a perimeter of three courses of razor wire, and camo netting spread over all. Only after the MPs approved the set-up could the radios be turned on and communications re-established. Communications is the whole point, since the raison d’etre of the SCIF is gather, analyze, and disseminate information. And of course, we did it all in 100-degree heat with cactus needles piercing our uniforms and razor wire ripping our gloves and scorpions, fire ants, and blister beetles bringing their own form of biological warfare.

As the exercise concluded, it became obvious that we had aced it. Located all the “enemy” units. Maintained OPSEC. Met all of our training objectives. We were feeling pretty chuffed and starting to relax a little and wind things down when the Sergeant Major walked in. A couple of folks were stripped down to their tee-shirts. Somebody was sitting on an upturned ammo box, pulling cactus spines out of his boots. I guess our casual demeanor offended his refined sensibilities, because he started to harangue us “smart-assed, card-playing, cigar-smoking college kids with bad attitudes.”

This was too much for our NCOIC.

“No, Sergeant Major, you don’t get to walk in here and talk to these hard-working soldiers that way. They just aced this exercise. They did a fine job. They’re the best team I’ve ever trained or worked with!” she yelled at him.

“At ease, Sergeant! You’re out of order!” he yelled back.

“Get out!” she snarled. “Leave my soldiers alone and get the hell out of my SCIF! If you have a problem, take it up with the commander!”

He got out.

The next day, we were relaxing in our GP medium after dinner. In our tee-shirts. The 577s were packed up and ready to load up for the trip back to Austin in the morning. In honor of our newly minted “smart ass” status, we were sitting on the ends of our cots, playing hearts and smoking cheap cigarillos. The Sergeant Major walked in.

“Hey Sergeant Major!” I called. “Pull up a cot and we’ll deal you in!”

He stood there for a moment, silent, radiating rage, then he spun on his heels and left the tent without a word.

Power is derived from the consent of the governed. Even in the army.

I’m still a smart-ass and I still play cards, but it’s been a long time since I smoked a cigar. There was that Cuban cigar I smoked on the white marble steps of the Houston Junior League, but that’s another story.

Healthcare's dirty little secret

In college, I worked for a year as a nurse’s aide in a for-profit nursing home. Basically if you were physically capable and didn’t have a criminal record, they’d hire you. If you made it through their two-week training course, you had a job caring for the sick, elderly, and disabled for minimum wage. You had to buy your own uniforms and stethoscope. Lifting belt and thermometers were provided.

I wasn’t a CNA. CNA is a state certification and my training/experience was insufficient for that. But there was no requirement for the nursing home to hire CNAs. Most of those with certification worked for a health staffing agency and earned well over minimum wage. So the nursing home trained their own, and only called the staffing agency when they were short-handed and needed to augment staffing for a shift. Which didn’t happen often, because most of the aides were happy to work a double shift when they could, to earn the extra pay. Since I was a full-time college student with the GI Bill, I usually only worked three 8-hour evening shifts a week.

My evening shift usually went like this:

• Get the patients who ate in the dining room up, dressed, and moved to the dining room for dinner. Since there were only 2-3 aides on a hallway of about 20 double occupancy rooms, this took a while, so the first patients I prepped got to sit in the lobby or dining room for an hour or more before dinner.
• Assist a table during dinner, which meant getting drinks and helping the patients who couldn’t feed themselves. The tables were semi-circular so that a single aide could sit in the middle and assist several patients at once.
• Take my patients back to their rooms after dinner.
• ­­­Take the patients who were due for a shower to the shower room and wash them. There were separate shower rooms for male and female patients, but the gender of the aide didn’t matter, and the shower rooms afforded no individual privacy for patients.
• Return all of my patients to bed.
• Check vital signs.
• Change bedding and clean patients who had soiled themselves as needed.
• Empty urinary drain bags and record quantities as needed.
• Provide hair care and tooth/denture cleaning as needed.
• Assist the nurse as needed.
• Respond to patient call lights as needed.

Since mine was a “skilled nursing hall,” almost all of my patients had significant impairment. Advanced dementia. Advanced multiple sclerosis. Multiple amputations. Infectious disease. Aphasia. Incontinence. It would have been difficult for 4 aides to provide sufficient care on that hall. When I started the job, we were usually staffed at 3. That meant that when any lifting of a patient needed to be done, we would have to take it in turns to help each other. Then, as part of a cost-savings effort, staffing was reduced to 2. Two aides, working solo, each caring for approximately 20 high-need patients. It wasn’t possible to always wait for a teammate to help with a patient, and as a result, injuries increased.

In addition to the lack of aides, there was little physical or occupational therapy provided, no entertainment or socialization outside of meal times, and no outdoor areas where patients might feel the sun or see a tree. The nurses rolled their carts down the halls, dispensed medication, and attended to such duties as could not be done by aides, such as catheterization or tube feeding. 

The available equipment was very shoddy as well. The shower chairs were made of PVC pipe and sometimes they came apart. One patient wound up on the floor of the shower room when her chair crumbled beneath her. She died a week later. I’m sure her family was never told anything except maybe “she took a fall.” The patient with chronic bedsores finally got a special therapeutic bed. She began to show significant improvement. Her wounds started to granulate and close. But insurance would only pay for the special bed for 6 weeks. Within a week after it was removed, her wounds were back to their original status or worse. In some places you could see her bones where the flesh had rotted off. 

The work was heart-breaking, and it was exhausting. I was 23 years old and Army-fit, but at the end of a shift I could barely stand. Technically speaking, we were supposed to have one 30-minute meal and two 15-minute breaks each shift. We seldom got to take that much time. I usually found time to grab a quick bite, but I never got any other break except for a quick pee.

Then came the day I showed up for my shift and found out that I was the only aide on the hall. The other aide had called in.

“This is insane. I can’t work this hall by myself,” I told the charge nurse.

“You’ll have to. We’re short-handed,” she replied.

“We have to call the agency and get a temp,” I said. “It’s not physically possible to care for this many patients single-handedly.”
“We’re not using the agency any more,” she told me. “It’s too expensive.”

“Okay then. I quit.”

“You can’t quit now. You have to work your shift.”

“No I don’t. I quit. Right now. So you go ahead and call the agency, because you don’t have anyone to work the hall now.”

I pocketed my stethoscope, walked down the hall, clocked out, got in my car, and went home. And that was the end of my medical career. A week later, I got a job with U.S. PIRG.

Make no mistake, those who run American health care are in it for the money. Understaffed, under-equipped facilities are responsible for many injuries and deaths, of patients and of care-givers. Nursing homes are the most chronically understaffed, but it's a problem across all medical facilities, and it is a huge contributor to the burnout that causes medical professionals to leave the profession. Attrition of RNs runs about 17%. Attrition of CNA’s is about 28%. I lasted 10 months.

The Roaring 20s

I’ve spent a little time on Linkedin this week, browsing through the endless flow of pandemic-related posts. They fall into a few predictable categories.

• How to stay positive, upbeat, and productive during a global crisis!
• How to manage your team to keep them positive, upbeat, and productive during a global crisis!
• Give me money for tools and tips to stay positive, upbeat, and productive during a global crisis!
• You can exploit this crisis to make more money!
• I just lost my job due to a global crisis!

Even in the best of times, Linkedin is mostly useless pablum, but during a pandemic, it becomes painfully obvious that the business world runs on positivity porn and intellectual dishonesty. It’s a dangerous bubble, disconnected from reality. Here’s an example that really made my hair stand on end:  “The Spanish flu epidemic of 1918 was followed by the boom years of the Roaring 20s! We’ll bounce back just like that! Stay positive!”

Where do I even start? Let’s talk about the Roaring 20s, shall we?

We’ll start with the utterly useless or destructive presidencies of the 20s. There was Harding's corrupt presidential administration, noted for the Teapot Dome scandal where the Secretary of the Interior accepted bribes to lease Navy petroleum reserves to private oil companies at low rates with no competitive bidding.

Then there was the ineffectual Coolidge administration. Coolidge was a conservative who advocated isolationism and ignored the agricultural depression which was the precursor to the Great Depression, preaching self-sufficiency and limited government while he himself did almost nothing as the country’s figurehead.

The president who actually presided during the stock market crash and onset of the subsequent economic misery was Herbert Hoover, a mining engineer who decided that the best way to fight the economic downturn was to impose tariffs on foreign goods, thus increasing America’s isolation and reducing the demand for American products overseas.

The 20s also saw the rise of organized crime thanks to the puritanical and ill-fated experiment with Prohibition. Closing down the production and distribution of alcohol threw a lot of people out of work and opened the door to widespread smuggling and its cousin, bribery. Only 5% of illicit alcohol was actually seized by law enforcement, and alcohol poisoning rose 400% as people turned to unregulated or homemade product.

Then there was the common acceptance of eugenics as a practical approach to improving the human race. One of the outcomes of the pseudo-scientific eugenics movement was the forced sterilization of people deemed “unfit” to breed, which resulted in over 60,000 Americans being involuntarily sterilized. American eugenics inspired Hitler in his quest for racial purity in Nazi Germany.

Racism and racial violence ran rampant in the 1920s, with the KKK re-emerging as a national force with 6 million members across the country. There were incidents of mass violence like the Tulsa riot where at least 200 black Americans were murdered and their community destroyed. During the decade there were about 300 known lynchings of black Americans.

And lastly, there’s the unfortunate truth that the fabled prosperity of the 20s was enjoyed by only a few Americans. The majority, 60%, lived below the poverty level. Farmers, immigrants, minorities, and rural Americans were almost totally excluded from the glittering consumerism popularly associated with the 20s.

So no, I don’t want a repeat of the booming 20s, thank you very much.

Americans need a lot less happy talk and nostalgia and a lot more reality. Some people are using the pandemic as an opportunity to talk about and work towards a more equitable, healthy, and sustainable society. Some people are using it as an opportunity to exploit the market and scoop up undervalued assets in a downturn. And some are using it as an opportunity to push destructive agendas such as racism, isolationism, and environmental exploitation.

Which kind of person are you?