Patient Advocacy Didnt We Do Well: Fill & Download for Free

a few times come to mind over the ten years as a registered nurse . There are times I have politely disagreed with a doctor and entered into a discussion about and we have been able to both explain our side and reach an agreement. It is a fine line I suppose / as a student nurse I was trained to question and understand and to use my brain and conscience to advocate for my patient. So I certainly wouldn’t blindly follow any orders. But at the same time there may be a reason the doctor asks something that I don’t know about - which is where communication is so important and I have found most doctors happy to listen to my objections or concerns and explain their reasoning. Some times it’s a matter of weighing risks and it’s not an exact science. There’s been times I have disagreed and perhaps been in the wrong. There’s times I have done something reluctantly I felt was wrong , and times I followed an order and it still haunts me to this day as I feel I shouldn’t have. I haven’t thought about my nursing experience in a long time. One time I felt I wanted to write a book. But because of confidentiality and because I don’t want to scare people from getting help from nurses and doctors I was put off that idea. Doctors and nurses are human and yes there’s errors in judgement and there’s also times the law doesn’t allow for doing the right thing. But even though sometimes things happen that aren’t right , I believe there are people out there advocating for the patients and learning from the mistakes.there is much more good that happens than bad. But the bad tends to stick in my mind I suppose.Things are coming to mind as I write this that I felt I had forgotten. The one time I clearly remember refusing a doctor order It was a night shift and I was the senior nurse (I had been nursing approx two years and some of that was in aged care so I was not very experienced in acute care. ) we had an elderly gentleman with many problems. He had end stage bone cancer as well as dementia. He no longer spoke English and his family said even in his native language he didn’t make much sense. The patient had come in from an aged care facility. They had been forced to transfer him to the emergency room in the middle of the night as they had no palliative care orders or not for resus , and as his breathing deteriorated they had to call the ambulance as dictated by legislation at the time in that state.(This happened often in aged care. When I worked there the ambulance would arrive and shout at me for wasting time and resources with a clearly dying person. I agree with them the person would be better off with palliative care in their own bed and family around. But the law doesn’t allow a nurse to make that call. It’s a bad system. )This hospital did not permit nurses to have end of life or palliative discussions with patients or family. I watched a young Intern talk to the daughter of this man and say to her “well he’s pretty sick. You don’t want us to do anything for him right ?”The daughter had come from interstate hadn’t seen her father for weeks and wasn’t aware his deterioration or prognosis. She felt put on the spot and tried to ask for more information. The Intern told her “sometimes it’s better to let people go.” The daughter replied she and her father were catholic and valued life. The doctor said “You don’t want to send him to Intensive care and waste all those resources. I am catholic too but in my job I’ve seen much suffering it makes me in favour of euthanasia”. And the daughter after hearing the word euthanasia immediately insisted her father be treated fully.Being a new nurse I understand this intern not being able to properly have this talk he was likely nervous and it was overnight he may have been on call for days etc so I’m not making a judgement on him. But to the daughter this sounded cold. And soon as he used the word “euthanasia” - which was not what this case was about - it was about good palliative care - the daughter became anxious. She immediately replied they were catholic and she needed to talk to her priest. On Monday. This was Friday. No matter what treatment the man received he was unlikely to live until Monday. But the doctor walked away - leaving a very upset family member and no palliative orders. As the paperwork stood this man was for full active measures including resus and met calls. However he did have pain relief charted and as he was moaning and displaying other non verbal signs of discomfort I administered pain relief to him. His daughter was happy with this as she didn’t want him in pain. And I explained it may depress his respirations - but we weren’t giving it for that reason just to control his pain. And that with his other Illness his body may start to shut down. I was crossing a line saying even that as the policy at the hospital was doctors were to have all those conversations. But there was no doctor around and he botched the first attempt so I felt it appropriate to assure her that we were caring for her fathers pain and try to prepare her for the consequences.sure enough half hour or so later the patients resp rate and bp plummeted. We had a procedure at this facility on when to call the met team - including these two criteria the man now displayed as well as “any time a nurse feels worried for a patient”. While yes I felt this man was not long for the world , Calling the met team was really not In my patients best interest. I did it though -with hopes the doctors who arrived would see the situation and talk to the daughter and write some palliative orders. i explained I would call the team due to the deteriorating in breathing but because of the pain meds which he needed they would not likely be able to do anything and they would talk to her when they arrived about the options. the team arrived and assessed the patient and the file, the patient now had a high temp too and previously had been on oral antibiotics. The doctors gathered round talking to each other and asked me to give iv antibiotics as this was the daughters wish, while they debated about sending him to icu. Even though it wouldn’t do much for the man I didn’t feel it would hurt as he had iv access -and so I drew up the antibiotics. I wasn’t entirely comfortable with it but I felt maybe it was important for the daughter to see we were doing things to help her dad and I didn’t think it would hurt. As I was about to flush the iv with saline the patient - barely breathing and hadn’t spoken English for years - grabbed my wrist and said very clearly to me “lady ! Why you Do this ? Didn’t they tell you I am old man dying ! I don’t want this !” I know he had a fever and many other conditions and pain killers but that man looked into my eyes and I felt I knew his heart. It was my instinct already that he needed pain relief and comfort and dignity to say goodbye to his family.I put down the anti biotic and went to speak to the drs about what he said and that I hadn’t given the antibiotics. After a conversation with the daughter they maintained he was for full active resus and ordered not only the antibiotic but narcan. I was a new nurse in acute care. I was shy and lacked confidence. There were tears in my eyes as I shakily said no. I would not put the man through it. It would wipe all the analgesia from his system and he would be in agony and still dying from end stage cancer. And I strongly believed he didn’t want any more intervention. The doctor told me it wasn’t my call and my job was to obey. He told me “no one wants to waste time on this but it’s the law the family want it.” I felt sad for this man that he no longer had a say and I felt angry at this daughter. I contacted the nurse manager on call in the hospital and told her what was happening. She told me “if you don’t want to give it that’s fine let the dr give it.” I told her that may absolve me but it doesn’t help the patient and I hysterically asked her to come and intervene. She did. She had many years as a nurse manager dealing with situations but I could see she too was a bit hesitant to step on the doctors toes. I followed her into the patients room where two doctors were holding the man down trying to get blood gases from a femoral artery ! It astounded me they would traumatise a palliative patient like this. But again they had a job and per the paperwork and protocol this was what they had to do or risk being accused of killing patients. they had narcan on their trolley but not syringes or needles ( too bad if it was a real emergency !) and asked me for a needle and syringe. I said no. They asked for the key to the cupboard where the supplies were. I said I don’t have it. Which was a lie it was in my pocket. I felt so justified at the time but also a part of me was screaming what are you doing refusing to give a doctor supplies !!i was then kicked out of the room while (in front of the patient) the doctors and nurse manager argued ). I saw the daughter sitting crying and went to talk to her. I wasn’t sure what to say. It was my place to advocate for my patient and so I decided to Be frank with her. I explained that because there was a full active treatment order it meant any time we gave pain relief her dad may had effects like depressing his breathing. And due to the orders it meant a team like this had to come and focus on his breathing and bp and keeping him alive - as opposed to his comfort and dignity. i asked her if she knew her dads prognosis. She said she knew he would die very soon and was trying to make the right decisions for her dad and by her religious beliefs that life is sacred. She felt withdrawing these active measures was giving up on life. I talked to her a little about my own belief In God and why I wanted to be a nurse. It occurred to me she didn’t have the view point I had of seeing many palliative patients die in agony. She only knew she loved her father and the doctor Had made a comment about euthanasia and she then felt she had to stick up for her father and make sure he was treated. I told her that her fathers Illness would likely take his life soon - the choice she had was to make him comfortable and dignified and sit with him - or fight the illness and send him to intensive care with no pain relief and tests. I told her what he had said to me as I tried to flush the iv. He hadn’t spoken English in years and I wasn’t sure she would believe it. But she told me he used to call all the nurses at the nursing home “lady”. She had been made to feel that if she loved her dad she would fight for his life. But I helped her to see that his comfort and dignity and wishes mattered too. She had been made to feel that things like giving pain relief were because we were “trying to kill him quicker to save resources”. I explained what narcan would do and the pain he would be in and it would happen each time he had pain relief and breathing slowed. I explained to her that for me I felt there was a very big difference between euthanasia and actively ending someone’s life - and palliative care in a terminal case where life saving treatments are withdrawn and comfort given. She was very religious and felt she had to fight for life at all costs as her priest told her. I was a Christian at the time and I tried to explain my beliefs that sometimes medical intervention went too far. The treatments couldn’t help her father he would die very soon and she couldn’t change that. Only change the way the last days were. She felt she was killing him to give him pain killers. And I explained perhaps it may hasten his passing but it will make sure he is comfortable. Withholding pain killers and sending him to icu wouldn’t help him only hurt him and prolong the agony. She was silent for some time and I was scared I had spoken out of turn and over stepped. But she then asked me “why didn’t the doctor tell me this? He didn’t tell me that active treatment meant my dad couldn’t have pain killers? He didn’t explain it he just said he believed in euthanasia and was a catholic so it was ok for me to Not get my dad treatment. “In the interns defence he probably never had that talk with a patient family. And he maybe assumed she knew already. It’s easy to forget that many people don’t have the experience and knowledge of palliative care. Especially back then this was some years ago. The rest of the doctors who responded to the met call had been told “the daughter is a religious nut and wants full measures. Do it or we will be taken to court “. I found out later there had been a previous incident where the met team made a judgement not to take a palliative man to icu and the family took legal action. The family said the doctors pressured them to sign the forms etc. the case shook them and they were told follow the paperwork from now on. None of them tried to talk to the family as they had been told the family were “religious nuts “ and they Didnt want to be accused of pressuring them. They presumed the intern had a full talk and the family understood and wanted full treatment.After I had talked with the daughter she approached the met team and signed the pall care papers. Much to their relief. They didn’t want to be doing it to this man either. After a bit of drama I felt it was a good outcome for the patient and daughter and for all to staff too. Yet one of the met team approached me moments after and said he would report me for having the conversation with the daughter as end of life care etc should be discussed with a doctor. I was torn between feeling bad and feeling justified. He went on to say he would report me for refusing to give narcan or unlock the supply cupboard. The nurse manager came up behind me and told him “my nurse wouldn’t have to have that conversation if any one of you had bothered to do it hours ago. It would have spared this man and his family this pain. I’ll be Making a report too! I shouldn’t have to be called to the ward to sort this out when there are five doctors here. You are lucky she didn’t give you the keys because if you had given narcan to that patient I would make sure you lose your licence. The family would have a legal case against you as you didn’t inform the daughter the consequences of what you were doing. I understand there’s legal limitations to what you can do - but stop and look at the patient and talk to the family and then my nurses wouldn’t have to defy your orders.”I never heard a word about it afterwards. I asked the manager weeks later she said no one filed a complaint either way but that there was now mandatory training about how to talk to families in those situations as well as liaising with nursing homes about the importance of sorting this out before it gets to an acute situation. In some ways I understand the dr being angry as I defied his order and perhaps I could have done it differently but end of the day the patient was palliative and comfortable and the family was happy all the paperwork in order and yet he was angry as if he was saying it would be better if we gave narcan and took him to icu.Sadly this isn’t uncommon. Years later as I worked a shift in a nursing home I had an almost identical situation. A patient with terminal illness and dementia who fell and hit his head. Because of the dementia and the medications he took there wasn’t a reliable way to determine if his neurological state was deteriorating. Despite having end stage cancer which he was not having treatment for , there were no documented end of life wishes from him or his family. Being the middle of the night and an acute situation (as in if he was bleeding in his brain we couldn’t wait til morning if it was to be treated) there were little options. I called the next of kin — a son who lived nearby - and explained what happened - that he may or may not have a head injury - and we can keep him here and comfortable or send him for x rays etc which would be uncomfortable and due to his condition very likely nothing they could do that we weren’t doing here - keeping him comfortable etc. it’s a hard conversation to have especially over the phone in the middle of the night. and The son decided he didn’t nescessarily want his dad transferred to hospital but did want a doctor to see him. So we called the on call doctor who arrived a couple of hours later. Like us he wasn’t able to determine any neurological injury due to the patients condition - and he called the son to explain this - that if there was some injury there would not be anything the hospital could do. The son didn’t disagree but said he didn’t want the responsibility of signing the not for active treatment not for resus. If the man hadn’t hit his head he would have died shortly from his illness and having no “not for resus” puts the nursing home in a hard position. Legally you are supposed to attempt resus and call and ambulance -but atthe same time it’s a terminally ill patient where the doctors have written the prognosis is the patient will die soon and there is no treatment. anyways because of the paperwork the dr called an ambulance to cover himself , I may have done the same too if it were my call. I like to think I could stand for my patient and just pretend the fall never happened or pretend we found him too late and hope the family doesn’t sue us. But it’s so hard not just because the law isn’t on your side - because there’s a nagging voice in your own mind telling you that this is a person and a life and you have to do all you can for them. It’s one of the things that drove me out of nursing. It’s hard to know what the right thing is. Anyways the ambulance came and abused us for wasting time and for “torturing “ the patient. I don’t blame them I felt the same. I told them if you think it’s the wrong thing then you can refuse to take him. But they didn’t want to wear the legal consequences either. So they took him. He was in the emergency room for three hours and died there alone rather than in his bed in the home he lived for seven years with staff he knew and pain relief. That haunts me to this day what I could have done differently and why I didn’t stick up for that patient like I did the other man in the hospital. it’s not just the law that made me go along it’s something else hard to explain. We all just go along the doctor the ambulance the ed staff no one stands up and says this is wrong and I don’t know why I really don’t. I would have thought years later I would be more equipped to talk to the son or defy the dr but the years in the system somehow had the reverse effect and I let that man Down. The system did too. A terminal patient in a nursing home should have end of life orders documented and the family should know what to expect and what palliative care plans are in place. I can’t tell you the number of times I’ve called family or an ambulance in the middle of the night for a terminal patient who has no pain relief charted no instructions what to do no pall care order no not for resus. These things shouldn’t be decided in the middle of the night at the last minute.another time I refused a doctor was again in a nursing home we had a patient who was unresponsive. I called the on call (it was night shift ) and without looking at the patient he told me not to bother - she had alcoholic dementia per her chart - and it was expected. I explained this lady (in her early 50s) was very alert and active only half hour before and something was wrong and I wanted to transfer her to a hospital. He said “no don’t waste their resources , call her gp in the morning“. And he left. I called an ambulance after that and they came. They looked at the chart and saw the diagnosis and scoffed too “it’s a nursing home patient with alcohol related dementia she’s supposed to be out of it”. I explained the sudden dramatic change in her consciousness and the fact that aside from the dementia she had no other problems and insisted they take her. They did so - but warned me that I would be sorry for this , and that they would be back in twenty minutes when the dr discharges her. I felt stupid I have to say and started to question if it was nescescary to call an ambulance and defy the dr. Ten mins later I hear the helicopter over head and the patient is being transferred to the city hospital with acute renal failure. She was treated and then returned to the home happy and healthy and enjoying her quality of life. I shudder to think if I hadn’t called the ambulance. What was even more horrifying is the reason why the patient was in renal failure. She was vocal at night and one of the night staff had been giving her (non prescribed ) sedatives which lead to her being drowsy and not eating or drinking enough. This staff confessed it to me after I sent the patient to hospital and said she was so glad I did otherwise she would have a death on her conscience. I reported this and the nurse denied it - and nothing happened though the counted the sedatives a bit more closely after that.Another time I was an agency nurse in a dementia wing. I had worked a few shifts and knew the patients and one patient appeared to be in pain. He was non verbal and unable to walk he was full care. But he was grimacing and moaning -unusual for him - and he was vomiting. Something in his eyes was not right. He was a palliative patient and had no family , Sl I didn’t want to send him to hospital just some pain relief for him. This nursing home didn’t have a dr on call it was a locum in the community who was very irate at having to come to a dementia ward in the middle of the night. He went in and looked at the patient and came out saying “he’s not in pain.” I politely said I disagree and asked how he came to this conclusion. The dr said “he didn’t complain of pain when I asked him.” He hadn’t spoken for years so he wasn’t able to complain. I explained I knew this patient and he was not well and I felt he needed pain relief. The doctor said he didn’t think it’s needed and “shove a couple panadol suppositories In him if you really want to.” And walked off. Ashamed to say I just stood there. Another nurse was walking past and heard this and followed the dr out telling him “i hope when you’re dying some dr comes and shoves a suppository up your ….” He marched back to the desk and wrote a morphine order ,a small one, and stormed off. The nurses and I gave the pain relief but he was still in discomfort. His own gp came first thing in the morning and prescribed regular pain relief and he died shortly after. He had a major coronary event and would have been in a lot of pain. He got pain relief at the end but he spent that night in pain and it was so needless. Having said that his own doctor should have written prn orders as he knew the patient was terminal and likely to be in pain at some point. I asked the doctor about this and if there was legislation that prevented him writing prn orders for this purpose and he said there wasn’t any legislation but he preferred to be called when his patient was unwell or unstable to come see them and prescribe. That’s fair enough but the same gp won’t allow nursing homes to call overnight and a locum who doesn’t know the patient has to come and isn’t likely to want to write a prescription like that.The other time that springs to mind again in an aged care facility where there was a scabies outbreak. Not a big deal it happens and is easy to treat. For some reason the manager and the doctor of the facility wouldn’t address the problem. I would write notes documenting rashes and itching and the manager and doctor would come on the next day and say there was no rash and no itching. Staff began to get scabies and went to their own dr for medical certificates and went to the management and were told “you can get scabies anywhere you didn’t get it here .” It was so frustrating because the residents were ill and the last thing they needed was more discomfort. To this day I don’t understand why they denied the problem. We approached a skin specialist who assessed the staff and two of the patients who went to see him with their family and he diagnosed scabies and they were treated. He offered to come to the home to look at the others but the home refused and stated they had their own dr. Week after week this doctor would write absolute lies about no rash no iTching. We made a complaint to a higher authority who came in and spoke to the manager and doctor and left again without any action. The doctor wrote in several patient notes “this patient does not have scabies. Night staff are hysterically paranoid about scabies and imagining symptoms. I have examined the patient as has the nurse manager there is no scabies.” I was angry at the insult as well as the patients suffering and that night took photographs of the rash on each patient who had a rash , those who could talk I quoted their description of the problem in their notes. The doctor also wrote some of them had “heat rash “ because night staff were putting too many blankets on and that’s why the rash was only there at night. So we documented the room temperature the number of blankets what the patient was wearing etc, and a colleague on day shift did the same , taking photos of these rashes in the day shift to show it wasn’t night shift imagining it. We made another report to a different organisation. The nurse manager and doctor called me to the office next day to tell me “no one has scabies. But to get you nurses to stop freaking out we will treat everyone in the facility. But you have to take out the progress notes and photos you put in the patient notes. “ i knew several patient families had made complaints and asked for the patient notes - and I wanted to leave my notes there to support their complaint that nurses reported the problem and the management and dr did nothing. Besides it’s a legal document and my notes were the truth ! I refused as did other nurses who had done the same. The doctor finally ordered all patients treated (almost one year later ! Some of them passes away with horrible itching that was easy to treat !) but he wrote on every single order (patient doesn’t have scabies - just treating to please hysterical nurses ). The patients were treated (twice ) which involved staff from nurses to aids to cleaners and laundry staff volunteering extra time without pay to get it done. Everyone did so willingly because we had been fighting so long to get this treated. And there were suddenly no more rashes or itching. I know it seems a small thing a bit of itching -but we had a responsibility to provide care to those people and we failed. Again I look back and wonder what I could have done differently. After I refused to take my notes down or alter them I was told if I didn’t I would lose my job. I quit. I probably could have tried to fight it but I didn’t want to work there anymore. I felt bad leaving though as if all the people who speak up against things like this leave - who is left to speak for the patients ? Five staff left the same time I did all staff who were fighting for the patients to be treated. Later the home was investigated over the incident and the dr and manager convinced everyone there was no scabies just hysterics nurses who have now all left.I haven’t thought about nursing in a long time - suddenly things come back to me. When I was a very new nurse in a nursing home we had a patient with terminal cancer and very early Alzheimer’s. She was alert and oriented and knew where she was and who she was and very cognitively aware most of the time. She had back pain from metastatic cancer. Her family told her she had a back injury and put her into “respite “. They didn’t want her to know she was sick or dying as they felt she couldn’t understand due to her Alzheimer’s and it would confuse and upset her. As such the dr wrote in her notes that staff were not to discuss her diagnosis or prognosis with her per family request and dr order. This wasn’t a problem until the patient started asking me what was wrong with her. Why did she have so much pain. She felt her family were keeping things from her and she said to me “they don’t want to upset me but please tell me the truth”. I told her to talk to her family and then immediately contacted the manager about my concerns in keeping things from this patient who seemed very alert and oriented and was asking me very clearly things about her pain and prognosis. The manager said to go along with the doctor and family. So myself and another nurse approached the doctor about it - he said it’s what the family want and the patient is cognitively impaired so she can’t judge for herself if she can cope with the diagnosis. She had a history of depression and the family didn’t want her upset. I felt this was wrong but felt a bit stuck at the time. The next night the patient asked her family for a priest to say last rights. The family said no there’s no need you’re just here for respite. That really bothered me as this lady was very religious and last rights were important to her. She wasn’t silly she knew she was dying and that everyone was keeping it from her. She felt she could trust the nurses and asked us over and over if she was dying. Again I raised my concerns with the doctor and manager about calling the priest and that she had a right to the last rights. The doctor said fine to call the priest but no last rights. This made me more and more upset that the patient couldn’t have this ritual that was important to her or time to say goodbye to her family etc she was distressed and knew something was wrong and yet we were told in no uncertain terms we were not allowed to talk about her diagnosis or prognosis or last rights. Myself and another staff contacted an advocacy group for aged care patients with dementia and they were fantastic. They came in and spoke to the family - acknowledging their good intentions but trying to explain the patient was able to hear the truth and she was alert and oriented and knew what was happening. The doctor was furious that someone had come in telling him what to do and that nurses had gone over his head. He made no attempt to hide his anger about it. He was told to tell the patient the truth if she asked him. That day (a Friday) he wrote in the notes about the advocacy group meeting and that he would talk to the patient Monday and if she asked him and was alert he would discuss her diagnosis. He then left without seeing the patient. The family were upset too they felt they had been told off and disrespected so it wasn’t a nice situation at all. The lady died over the weekend - the dr knew she would likely not be around Monday or be too sick to talk about anything. She died confused and agitated. I called a priest and the family allowed him to come but not to acknowledge or talk about the fact she was dying. we left the room and I don’t know what happened in there but I like to think the priest was a better person than me and was able to be honest and give her some peace. After she passed away the family were distraught. Through the process I had been angry at them. But as they cried and asked me if they had done the wrong thing I could see they were doing what they felt best. They said the doctor thought it best and they didn’t want to upset their mum , but she asked them if she was dying and they felt bad they hadn’t been honest or allowed the priest to come or say goodbye. And I asked myself if I had ever tried to talk to them about it ? I argued with my manager and the doctor and reported it to advocacy groups as I felt the patient had no one to speak for her rights - but I hadn’t approached the family and asked them why they made that decision or if they felt things changed and they wanted to tell her the truth. I was so frustrated with them for the way this lady had died - but as I saw them crying I told them I knew they made the choice because they loved their mother and were doing what they felt best - and it didn’t matter now it just matters they were there in the end with her and she knew they loved her.Now I think on it I suppose there are more times I wish I had defied the doctor then times I actually did. Many times it’s not the doctor who is the problem it’s the system as a whole so I’m not trying to say doctors are terrible or anything. And these bad examples are only a few. There have been many amazing doctors I have worked with but the bad times haunt me I suppose and stick in my mind.

No, I do not believe in corporate welfare.Warning: Very long post. And parts are going to appear I'm drunk and waivering a bit off topic, and maybe I am, but I think it all ties into this head tax and the politics thereof. It's relative…Pertinent…A bit pent up.Disclosure: I have many “far left” political views. If that personally causes your conservative views or leanings adverse physical reactions, like seizures and vomiting, do not operate heavy equipment while reading, if you chose to proceed.Of course, you probably shouldn't be reading anything while operating any machinery. Brought to you by Darwin.Legend: Jeff Bezos = Wealthy CEOs and companies in his bracket. He's the face of what I'm advocating against in my statements below. He joins a healthy array of tuxedo clad cocktail party of others, but for simplicity sake I shall calls this phenomenon Bezos.Bezos could end world hunger tomorrow and still be a multi-billionare with more than enough money that he could still travel to outer space on a routine basis with things at his many homes quite nice and tidy for generations to come. That's the only way he could ever hope to spend his fortune in 3 life times. This is an excellent way to kick this baby off. Also, not conjecture. Run the numbers.However, here back on earth, where 30 odd people own more collective wealth than the rest of the combined planet, it appears we have some serious issues with psychopathy and obscene greed being the main symptom. Wouldn't ya say?If Amazon and other companies in that same financial bracket have to pay a little more towards fostering a more balanced planet that benefits more collective people instead of just a small handful, if only in the physical spaces they occupy than so be it. I do not lose sleep over the worries of what keeps psychopaths awake at night. Do you? Besides, who else is going to do it, the federal reserve?Do not worry now, wealthy CEOs will still get their obscene quarterly bonuses and that 7th vacation home in the countryside of southern France. So all is not lost for these unfortunate souls. We wouldn't want them feeling left out.The very fact that we don't have a minimum/liveable wage tied to actual inflation, and people walking around from all backgrounds, homeless on the streets, in crumbling infrastructure, and no meaningful mass shift towards renewable energy, which could create thousands of jobs, that could in turn feed the mouths of hungry children in our poorest communities, in the richest nation, giving an obscenely huge amounts to the military, to help wage wars on nations, wars no one was asking their tax money to go to, and have young men and women come back home into a profitized healthcare system, doesn't make me have much sympathy for billion dollar corporations who help steer this nation into much of these adverse realities, help pollute the planet on many levels, which conveniently somehow never have to feel any of the consequences thereof, as deregulations (also known as protections) melt away accountability. And that whole lack of empathy thing.The rich, got their coporate welfare by way of the recent tax cuts and deregulations and their military-industrial complex increase to help fuel the 76 wars we are involved in abroad right now. Bet you didn't know that one eh? Yet, they still cry about a head tax like a bunch of little indignant babies. I'm not buying it. I've raised kids. You dont give any human everything they want. Thats always been a recipe for disaster.Yet my ex can't go see a doctor with her medical conditions because she knows it will put her into dept. This leads to serious health issues. And who does those costs get transfered to? Amazon? No, me and the child we co-parent and if we can't pay those bills it's goes to you, the tax payer. Do you think my child in his 13 year old brain and heart wants to come to the realization that his mother is broken because of money?Hmm, I wonder if Alexa will send those medical bills to Bezos if I ask her nicely?Speaking more broadly about the military, because it hits home, let me remind everyone that WE ARE THE RICHEST and MOST MILITARIZED NATION ON EARTH. And yet the military constantly cries that it's so under funded. The chart below is a expenditure taken in 2014.Fun fact: Russia has more nuclear missiles than all other militarized nations including the United States. Yet, they only spend a quarter of their national GDP on their military. And even more peculiar they are able to provide their citizens with free healthcare. Damn him and his 13 Russian Facebook Meme Trolls.Just look at the blackness that occupies the cavities of their empty wittle KGB hearts. Awe.But again, don't you fret none, because now with this latest $717 billion increase in military spending new charts plotted at the end of 2018 are going to look even more, hmmm, what's the term, grossly imbalanced? I wonder what or perhaps whom could be driving this?For more context my eldest daughter is in special intel in the Army. Second from left.This is military training graduation. She's higher ranking now. I will leave out finer details as I'm sure her current military post would appreciate. Let's put it this way, we can't have a father to daughter conversation of her day to day activities in any detailed regard. Sort of cool in a James Bond sort of way, and yet equally disheartening and saddening as a parent. So my comments towards the military below don't come without personal internal conflict and consequence. I'm proud of how my daughter has worked.But I can't pretend I don't notice the ludicrous hold the military has on our government. It was not, and is not supposed to be this way set by our constitution.I have no anger for the soldiers, many of whom are young and believe in their hearts they are helping to make this world a more peaceful place. Of course, being a Doctor or EMT, or Firefighter or Animal Vet are pretty good choices too that don't involve blowing people to bits in the name of peace. But these kids are who they are and in that moment in their lives that's how they feel they could best offer themselves. I have and do respect that. It's part of personal growth.I also have no issue with what past soldiers have done in the total confusion and mind-F of combat. That’s not to say I like it or agree with it. Some of it is absolutely horrific, but a great deal of it reflects the madness of those head spaces, which is mental and emotional soup.I come from a long line of soldiers from the George Washington era (sorry we were actually King sympathizers) to modern times. I've heard the stories that aren't readily told in the media. If a solider doesn’t come back from intense warfare with PTSD you worry, because they ain't right in the head, they're missing emapthy, or are not connecting with it in a natural way. There are some traumas human beings are not equipped to handle. It takes considerable therapy to treat those kinds of internal wounds, if honestly even possible.The problem is the military at it’s uppermost chain of command uses these kids innocence and impressionability with the intent of making war a commodity. That's not debatable. Actions speak louder than words.76 wars in 2018 people. Think I'm exaggerating? I wish I were, but look it up, you will be horrified. At least you should be if you claim to follow the core principles of any major religion.We are the modern Rome. The modern Alexander the Great. The modern England. The modern Genghis Khan and Napolian and yes Hitler. We are the new occupiers and it aint for goodwill and peace. We are the most despised nation on this planet and we earned it. Occupation carries it's consequences. You won't feel it. But your children and their children will. So, there's that if “thou shall not kill” doesn't do it for ya.If you actually decide to do the research, if observant, you'll see the countries we are in wars with all have features in common. Did someone say oil reseves and lithium reserves? This translates as a quart of oil in your vehicle’s engine and an extra bar of juice on your smartphone is worth more then the entire quantity of blood in your child's veins in the eyes of the government at the behest of your military and corporations influencing laws in their own monetary interests.To my knowledge only one politican has sent their own child into war and that would be Joe Biden, who actually sadly lost his son in battle. I'm not making any political support statements towards Biden, I'm not a political fan, but I think it illustrates a succint point. Government enjoys free healthcare. Government doesn't send their own children into battle. How you doing?BTW, my daughter enlisted way before this 2018 increase for the military, she wasn't hurting financially in the slightest, which wraps up my point about the military.The above statement is not a factor of Republican or Democrat. If we're being honest with ourselves there’s really one political party which should be named the “Corporatists”.Is all this too Alex Jones for you? Well, I can't stand Alex Jones and I congratulate the quirky and courageous Seattlite that fed his mug a hot mug of our best on the street corner. Get the frack’n frick outta here. How's that for a cold morning Seattle Freeze? Alex seems pretty ready to guard expected aggressions. But I'm seeing a lot of bark and no bite here.Yet, we got nothing for the homeless right? Nothing to feed the hungry and aid the most vunerable in our own back yard besides uninsallated flammable tents with zero security propped up next to communities with children walking around.Blowing up innocent black and brown children to overthrow democratically chosen leaders of countries who are not interested in America's monied interests seems like a better idea instead. Or how about seperating them from their parents at the border?Fun Fact: Hillary Clinton was just awared the Radcliffe Medal last month for her “outstanding” advocacy for women and children.Yet she supported Totalitarian regimes like Saudi Arabia who systematically oppress woman, and publically execute gays, turned away several children from Hondorus seeking asylum, many who traveled alone, as well as the 100's of drone strikes that killed 90% of whom? If you said what is an evil terrorist bastard for $500 you are sadly incorrect. The correct answer is innocent women and children, mostly children. She wasn't alone.I suppose to her in the broader scheme of things perhaps women and children and the LGBTQ community only mean Americans. But in the eyes of a true humanitarian like Mother Theresa that meant every living soul. Mama T would have hacked that metal to help feed more babies in her ward. That's what a real hero is. Not someone who advocates and still stands by a sex offender husband who routinely degrades women and actually uses sexism as the very crux of her campaign. “I'm with Her”? How about “I'm with all of You”?Was Bin Laden taken out by a drone? Nope. Guess who ordered most of these air strikes? If you said what is an orange orangutan with a mysterious comb over that could be it's own form of life for $300, then you need remedial history classes.I'm not saying Trump is good, oh no, far, far, far from it. I shutter to think. It's to illustrate the point of how money corrupts our leaders from the local to the federal. And yet, we keep voting these muppets into office when we should be voting them into outer space to join Bezos. They all can have fun chasing their cocktail olives in zero gravity. Let them create their cesspool on the Mars colony, the ultimate player’s playground. If it doesn't work out is that like so bad? They can't come back, right?Come to think of it, Kermit the frog is a far better alternative to these crooks. “Hey Ho, I'm President Frog, your socially conscious and multi-generational hip green commander and chief, yaaaaaaaay!”Honestly, if I have to explain why all of the above (except Kermit) is heartless its time to head back to sunday school or whatever insitution teaching you how to be a good human being of your choice.Everyone should be reminded of the parable of the good Samaritan, or others like it. That is the only way we move forward as a species. This dog eat dog system clearly is not working for the bulk of society and it certainly didn't work in the past. We are mammals, but we are not dogs.I give two strong expletives about corporations being forced to be slightly more compassionate to the world around them. And I also refuse to join in on the Sawant witch hunt going on in the corporate-backed media and on social media. It's sickening to witness.The same thing seems to happen to all politicians who advocate on socially democratic policies, especially Sanders. He's like one of maybe 2 or 3 polticians actually advocating for the American people and it's just not somehow good enough? I don't know who you're expecting or what arbitrary and meaningless quality they must possess, but I hope you're a very patient person.Well, guess what, the American people didn't seem to mind it at all of FDR's 3 presidential terms. It pulled them out of a depression, which I might add was brought to this country by mass corporate greed, largely caused by deregulations in the banking system. How easy we forget history. Yet, a lot of that credit goes to this man. FDR did not share this man's level of dedication but they worked closely together.Henry A. Wallace. With dirt under his fingernails, the American middle and working class couldn't get enough of him. We're talking generating frenzied energized crowds (not in a Trumponian way) not too unlike that of another progressive man we know today. I wonder.Of course, to no huge suprise corporate America was “less thrilled”. But that sure didn't put a stop to prosperity, even for corporate America. It turns out when Americans make more money they like to go out and buy stuff. Novel concept. Trickle-down economics you say? Tell me, do robots buy stuff for themselves? Here comes that goose that lays them purty golden eggs boys! Get'her!Now all that being said, and what so many here have echoed, I do have some concerns about how effectively these funds will be appropriated. Seattle is a lot better concerning political social causes than other states, but we are not perfect, and our homeless issue is quite profound, if not the worst in the nation, in a predominately liberal city that's doing exceptionally better than most others in the nation. That warrants a degree of real concern. We should be looking more into whom is responsible is for appropirating these funds and then charting their major campaign contributors. Is that a purity test? Yes it is. You're talking about people’s lives, not a fashion show. Get serious.There's two models, punitive or long term rehabilition, like we see in other developed nations. I'm not sure where this country as a whole stands on this let alone Seattle. Building consensus on this seems like a very daunting task for our narrasistic culture. But I believe it can be done by proof of concept. Actions will always speak louder than words.Actually, there is a third model but it's more hidden. Inaction or ineffctiveness. I think that's what most of us are fearing here. Politicans make compromises on transparency so the bulk of the policy can pass, but that creates obvious inherent challenges and sloppy loopholes, by design. And then some government agencies just drop the ball all together logistically.Also, corporate dollars reach far into everyone's pockets and these funds could very well end up in places it was meant to avoid. I do not assume Bezos is going to just lay down and not work on blowing up the ears of their political channels and media pundits. As an informed American citizen you should understand this is how your government runs, local, state and federal. Any politician willing to be honest will tell you 80- 90% of their day consists of calling corporate donors for campaign “contributions”. In short, it's a racket and there's a lot of players in the mix.Ranked choice voting can help in this regard, and I seriously doubt if we had it in place any Republican would take another Presidency ever again. They only get elected when Democrat party leaders and canidates are not properly motivating their base to come out and vote. The lessor of evils strategy failed epically in 2016 and it's not going to cut it in 2020. You can leave the Russians out of it. But we have to actively fight for it. That being said, don't assume “Any blue will do” -Nina Turner. We have to stop being starstruck fools putting charisma before policy.Which man below is (was) a serial murderer?What are Oprah’s policies? The Rock’s? The West's? All these people are multi-millionaires. Have we learned nothing about the adversities of hiring celebrity Presidents?Obama, a very charismatic man and an excellent public speaker ran on hope and change. Yet couldn't pass single-payer in a majority blue senate and congress, because he didnt even bring it up for vote. He did some progressive things, but he also kept us in a unessecary illegal war in the middle east, launched an considerably aggressive drone war that had a 10% success rate and aggresively bartered trade deals that ultimately put obscene amounts of money into our wealthiest corporations pockets, not to mention help bail them out when the results of their greed went bust. It did very little for average Americans. That’s what untethered capitalism does. It pops every 10-20 years. So that's nice. The rich seem to walk away from these things unscathed. Funny that.Your citizenship gives you certain rights and freedoms. But that doesn't mean we get to sit back and assume some people won't seek to take them away from you. Saying to yourself, “They would never let that happen”. First, who the hell is they and what guarantees you they can't when we have secret courts? I can assure you it's been happening slowly for at least over the course of 40 years now. Democrat, Republican, it doesn't seem to matter. Greed is not a political party. Greed does not discriminate.I can also assure you George Washington ain't coming back any time soon in the flesh to give Trump a stern spanking. (Oh god, Trump may enjoy that) He gave you the keys to the car. But you have to drive it. Not only that, but there’s car theives around you. Reality. Freedom always comes at a price. But that price shouldn't be letting the insanely rich pillage you and your children financially. That just makes you an idiot or sadist.If I've upset someone here with my far left political views, which btw outside of the U.S. would be quite centrist, which would oddly make corporate/centrist Democrats like Jay Inslee exactly what now?We'll all just have to accept it and maybe schedule a lunch or agree to piss off from one another. I do not back down on things that challenge the unethical or unjust, nor break golden rules, and I do not wave party flags. And no, I'm not 23, I'm 45 who generally makes a 6 figure income. How else could I afford this area?I have no use for political parties. I want progressive policies that benefit all Americans and I will support any politician willing to fight that battle, even Inslee.I even support even lazy and worthless strung out homeless people that most of us disregard on the daily. I get it, a lot of them are bat shit crazy. You think that's how they became homeless in the first place? I guess people with mental disabilities aren't worth our time and resources. I mean they get into physical altercations with the bus. As in the bus itself. Pfff…Worthless.The homeless are more than that label, they are fellow human beings. Their situation doesn't define their humanity nor the entirety of their mind and certainly not their hearts. Shit, most of us are a couple paychecks and a savings account away from being on the street ourselves, especially with these living costs, so get off the pestastool, and have a little more compassion for the right player in this battle. It could be you, or your family members, God forbid.Bezos can see any top medical specialist from anywhere in the world with zero waiting list, can you say the same for you and your family? Most likely not. Why is Bezos more deserving of this than anyone else? Money? If money determines the value of a human life then we are definitely destined towards self extinction, no question. I'm sure there's an app for that. In fact, we might as well pull the plug right now to stop the needless suffering to come.Greed is a symptom of personality disorder, not that different from what triggers hoarding. We have to stop encouring and rewarding this mental imbalance while casting out others that exhibit other mental disabilities. We don't encourage hoarders when they cram pack their homes with worthless, useless material junk, instead we look down on them with disgust. But we don’t mind so much when the wealthy do the exact same thing, in albiet a more charming fashion. If their living room gets filled with crap, they just buy a new living room.Come on people, this is madness. We allowed this to infect our society and now 99% of us are paying for it's consequences. And guess who gets to suffer those consequences even more? Every new generation after us. You think this is going to heal itself? We have to turn this ship around now, not tomorrow. It starts by supporting this head tax and giving it a chance to see if it works. Bezos will be fine either way.We can question the homeless in their rise to fall but that doesn't lead to the help they need right now. Seattle took a stand in the right direction and I hope on all the holy muppet babies they follow through appropriately and succinctly so that the homeless get some help, and the American people can finally wake up and stop peddling this broken system that's only truly working for a handful of Americans. It's long term people. Climate, not weather. Understand the difference. If you want a decent future, you must understand the difference. I don't care how you arrive at it. Just arrive.I don't see many other cities making this poltical statement that more cities across this nation should be making in a time of mass deregulation.I'm quite shocked Sawant was able to get this passed in a largely centrist/corporate owned assembly who is routinely hostile to her and her supporters. I have no affiliations to her. I do support some of her progressives policies that advocate for average American citizens but other than that I don't follow her just as I don’t for most politicians. Trust is earned. They come to me as the voter.This was a middle finger to the establishment and it should be encouraged with reasonable skeptism because this is the kind of message it's going to take to corporate America that tells them that America is not for sale anymore. Every once an in awhile you have to tell a spoiled brat NO.Of course corporations are going to pout. You just took away that third slice of cake. Meanwhile, your aunt Elizeabeth refused to go back to the doctor for a follow up on her heart condition because that could mean bankruptcy, or get this, becoming homeless. Is this irony sinking in with anyone?I cannot support a system that would continue to enrich the 1% of this nation while the remaining 99% are left to suffer in the dark and cold. Not only is that incrediably heartless, it's dumb strategically. No insane. It's killing the goose to grab her golden eggs. Dumb and insane. Do you honestly think the super rich are going to affect their bottom line by risking pulling out of established markets for some extra pocket change? If they're pulling out, it isn't because of a head tax.If you are in the middle and working class and support corporate greed and the illusion of trickle-down economics you might as well rent a paint gun, go to the range and repeatedly shoot yourself in the foot, or maybe just nick a toe. Because that's what you're doing to yourself, your family and your fellow American, every time you go to bat for Bezos. You are slowly yet increasingly crippling your own economic dexterity and outlook. Why? So Bezos can get his jollies in outer space? He's going to do that with or without a head tax. And I guarantee Amazon headquarters stays in Seattle. Smokes a mirrors people. It's a political game to these people. They want to create an optical narrative.Can we please exhibit a semblance of order of priorities like human adults on this? Even if just for a moment to see what this head tax produces? Have your skepticism. It's a evoluntionary tool. But don’t let it completely drive your life. Give it a chance to prove or disprove itself. Learn from it's findings. Tweak it's mistakes. Keep fighting the good fight. Stay woke.