Recently, a friend of mine who has been a nurse less than a year, was involved in an unsuccessful resuscitation attempt. There is nothing so difficult in our profession as to feel that our efforts didn't make a difference. Below is a letter I wrote to this nurse after hearing that she was disturbed by the code. I realized after I wrote it that it says as much about nursing, in general, as it does about her specific quandary.
I was both happy and sad to hear that you experienced a code the other night. Happy because you need that experience (because it will happen again), and sad because codes aren't fun and can be emotionally trying and exhausting, especially when there are good reasons to save the patient other than the patient--I heard that a relative, a young boy, was present.
I hate to have a professional philosophy based upon a television show, but I remember an episode of M*A*S*H* in which Colonel Blake consoles one of the doctors after a soldier's death. I'll paraphrase. Blake says, there are two rules he's learned about the health care profession. Rule number one is, people die. Rule number two is, doctors and nurses can't change rule number one.
Despite the fatalism, remembering these rules can make the difference between despair and acceptance. People in pain, people with problems, come to us and ask for help. More often than not, we're able. Sometimes our help has positive outcomes, but not always, and sometimes not in predictable ways. There are some problems too complicated or too far gone for us to do much about. Recognizing this is not the same as failing to try.
And that's what you did, you tried. You tried against great odds. Unfortunately, this time the outcome wasn't what everyone hoped for and everybody lost. That's a real drag, but then, the rules are a drag.
As I heard somebody say recently, "We're living in a rented world," and saving lives is a game of odds. Sometimes you win (and your patient wins) and sometimes you don't. But no one lives forever, so for every patient, there has to be a time when you lose. It's a drag to be there when that time comes, but, because you never know when that will be, being there is the only opportunity you have to attempt to delay that time. You'll never eventually prevent it, but then, that isn't your job.
You (and nurses in general) are there when a lot of other people aren't. Between that and doing the best you can when you are there, that should make you feel good, and proud, and provide some solace. I'm sure the patient, his family, and your co-workers appreciated your presence.
That said, don't be afraid to talk about your experience and your feelings. Debriefing is a valuable process. Like with so many other strong, emotional experiences, talking about your feelings is a good way to exorcise the more damaging aspects of pent up emotions, frustrations, etc. We all have these after a code, successful or unsuccessful, and it never gets any easier. We just get a little thicker each time. That might not be something to look forward to but it'll happen, incipiently, sooner or later.
Emergency nursing is both a difficult physical and emotional occupation. Some events underscore this fact more than others.
Sunday, March 29, 2009
Monday, July 7, 2008
Popular Misnomers
Not that you need to know but I just returned from a long, much needed vacation. A month away from work yet paid, barbaric in its paucity by European standards, does a wage-laborer good.
I mention Europe only because that's where I went, traveling among a couple of the heathen national health countries of the U.K.--you know, the one's that have greater life expectancy than the U.S. and a greater percentage of the population with access to quality health care.
But let's not pick nits (unless you have lice...)
And what did I get for my travels? Pneumonia.
But since I'm still up and about, the popular term would be walking pneumonia, as if the infiltrate in my left lower lobe has sprouted legs and become a peripatetic infection!
No, it's just pneumonia. Probably been living too high. What are vacations for?
I mention Europe only because that's where I went, traveling among a couple of the heathen national health countries of the U.K.--you know, the one's that have greater life expectancy than the U.S. and a greater percentage of the population with access to quality health care.
But let's not pick nits (unless you have lice...)
And what did I get for my travels? Pneumonia.
But since I'm still up and about, the popular term would be walking pneumonia, as if the infiltrate in my left lower lobe has sprouted legs and become a peripatetic infection!
No, it's just pneumonia. Probably been living too high. What are vacations for?
Saturday, June 7, 2008
None of This Has Anything to Do with Nursing
The hospital at which I work is much more than just a building. It is a bureaucratic organization of interrelated statuses and roles stratified upon a hierarchy of authority and power coordinated to provide health care to our community. Most members of the community only see the end result. When they are sick or injured, they come to us and we care for them.
What the community doesn't see or see often is the corporate culture embraced by some elements of the organization. This culture is characterized by all the slap and tickle, buzzwords, and managerial guru crap popular in corporate culture these days. Some at my hospital are completely ga-ga for it.
Take for instance their newest corporate embrace, a program supposedly designed to "hardwire excellence," whatever that means. (Don't ask them, unless you want to be drowned in a sea of corporate cliches, 7 habits, and all those cool folks you're supposed to meet in heaven!)
The program is the infamous source of the low-middle-high performance assessment tool. And what a handy tool it is...for determining not so much the worth of employees as their allegiance to corporate authority and their willingness to agree with and align their own interests with managers and administration, even against their own ethics and best interests.
Fully 75% of the assessment tool in this program is subjective! Questions like, how much does this employee accept and support the decisions of his/her managers? How comfortable do I (the boss) feel when this employee is on shift? What is the attitude of the employee toward his/her workplace, manager, administration?
Now, if ours was a totalitarian organization, I could see where these questions might truly reflect the value of an employee. Or at least ferret out those who need to be eliminated. But, let's be honest, these questions have very little to do with how well an employee does his/her job!
Objective questions could do that, and would be easier to defend as a true performance assessment, while keeping the subjectivity of like and dislike out of it. Why wouldn't a health care organization that wants to provide quality nursing services be more interested in how well nurses perform rather than how well they mouth the words of the corporate line (for they really don't want nurses to say anything)?
One reason is that an assessment tool of objective criteria of nursing performance is harder to devise than one based on subjectivity. You can't really get it out of a guru's book, and I'm not sure that they are smart enough to do it themselves.
A second reason has more to do with the manner in which the subjective assessment tool can strike fear into the workplace of those who have it used capriciously against them (see the most recent two entries). No objective criteria to tell me I'm a bad nurse? Just tell me I have a negative attitude! That's a great reason to fire a good nurse, despite this era of nursing shortages.
Of course, as I mentioned in the last entry, the low-middle-high assessment tool is a one way street: those at the top evaluate those underneath them, and never have to be evaluated by them. That means, the top dog is the one whose attitude and belief system is what everyone else in the organization has to agree with or at least espouse, at least at work. But the top dog isn't the pope, doesn't wear a funny hate, and isn't infallible. Excellence hardwired doesn't seem to account much for that fact.
And, if you're not the top dog, don't go mentioning it; you'll be labeled a low-performer.
What the community doesn't see or see often is the corporate culture embraced by some elements of the organization. This culture is characterized by all the slap and tickle, buzzwords, and managerial guru crap popular in corporate culture these days. Some at my hospital are completely ga-ga for it.
Take for instance their newest corporate embrace, a program supposedly designed to "hardwire excellence," whatever that means. (Don't ask them, unless you want to be drowned in a sea of corporate cliches, 7 habits, and all those cool folks you're supposed to meet in heaven!)
The program is the infamous source of the low-middle-high performance assessment tool. And what a handy tool it is...for determining not so much the worth of employees as their allegiance to corporate authority and their willingness to agree with and align their own interests with managers and administration, even against their own ethics and best interests.
Fully 75% of the assessment tool in this program is subjective! Questions like, how much does this employee accept and support the decisions of his/her managers? How comfortable do I (the boss) feel when this employee is on shift? What is the attitude of the employee toward his/her workplace, manager, administration?
Now, if ours was a totalitarian organization, I could see where these questions might truly reflect the value of an employee. Or at least ferret out those who need to be eliminated. But, let's be honest, these questions have very little to do with how well an employee does his/her job!
Objective questions could do that, and would be easier to defend as a true performance assessment, while keeping the subjectivity of like and dislike out of it. Why wouldn't a health care organization that wants to provide quality nursing services be more interested in how well nurses perform rather than how well they mouth the words of the corporate line (for they really don't want nurses to say anything)?
One reason is that an assessment tool of objective criteria of nursing performance is harder to devise than one based on subjectivity. You can't really get it out of a guru's book, and I'm not sure that they are smart enough to do it themselves.
A second reason has more to do with the manner in which the subjective assessment tool can strike fear into the workplace of those who have it used capriciously against them (see the most recent two entries). No objective criteria to tell me I'm a bad nurse? Just tell me I have a negative attitude! That's a great reason to fire a good nurse, despite this era of nursing shortages.
Of course, as I mentioned in the last entry, the low-middle-high assessment tool is a one way street: those at the top evaluate those underneath them, and never have to be evaluated by them. That means, the top dog is the one whose attitude and belief system is what everyone else in the organization has to agree with or at least espouse, at least at work. But the top dog isn't the pope, doesn't wear a funny hate, and isn't infallible. Excellence hardwired doesn't seem to account much for that fact.
And, if you're not the top dog, don't go mentioning it; you'll be labeled a low-performer.
Friday, June 6, 2008
Labor Remembers (For P.R.)
On a more somber note, the same administrative players who attempted to terminate me turned around and did the same number on my boss, the ER director. Oddly enough, one of their complaints about her, what they say made her such a "low performing" manager, was that she failed to leave a paper trail long and deep enough for them to fire me without fear of a wrongful termination lawsuit.
Of course, they didn't say it in so many words.
The fact that both events occurred within the same week and the fact that it was the CNO's last week of employment in the organization suggests to me that both were attempted hatchet jobs. The fact that the CNO chose her last day and her last two hours of work to attempt to discipline my ER boss suggests that she (the CNO), and not my boss, had done her job poorly.
Think about it.
You are the Chief Nursing Officer in an organization, the tallest hog at the RN trough, and yet you tolerate and fail to reprimand two "negative" and "malcontent" nursing employees for almost two years, waiting only until your last week on the job to do anything about their "divisive" behavior? Talk about a bad manager! Low performer, indeed!
But Idaho is a "right-to-work" state (read: right to be fired at will for any reason at all) and so I guess you don't have to be good at managing or administrating in order to fire an employee any time you want to, regardless of whether or not you've followed your own organizational policies (which, in fact, in my case, they didn't). Power seems to be the administrative remedy for lack of competence, finesse, or adherence to organizational rules.
My boss and I took different paths, however. I chose to fight back and keep my job. My boss chose to tell the CEO (for the CNO had already cut and run) to take the job and their evaluation of her and shove 'em.
I respect her for that, and for sticking up for me when she did. Just goes to show, the ethical aren't always the winners, and those at the top who think they've won aren't always ethical, or winners.
In fact, if I had to rate their administrative performance, I'd say they're pretty low performers because they really made a mess out of this. Not only am I still an employee, but now the ER is in shambles for lack of a director. Makes me wonder who is the greater threat to the organization's ability to meet its stated goal of quality and compassionate health care.
Of course, they didn't say it in so many words.
The fact that both events occurred within the same week and the fact that it was the CNO's last week of employment in the organization suggests to me that both were attempted hatchet jobs. The fact that the CNO chose her last day and her last two hours of work to attempt to discipline my ER boss suggests that she (the CNO), and not my boss, had done her job poorly.
Think about it.
You are the Chief Nursing Officer in an organization, the tallest hog at the RN trough, and yet you tolerate and fail to reprimand two "negative" and "malcontent" nursing employees for almost two years, waiting only until your last week on the job to do anything about their "divisive" behavior? Talk about a bad manager! Low performer, indeed!
But Idaho is a "right-to-work" state (read: right to be fired at will for any reason at all) and so I guess you don't have to be good at managing or administrating in order to fire an employee any time you want to, regardless of whether or not you've followed your own organizational policies (which, in fact, in my case, they didn't). Power seems to be the administrative remedy for lack of competence, finesse, or adherence to organizational rules.
My boss and I took different paths, however. I chose to fight back and keep my job. My boss chose to tell the CEO (for the CNO had already cut and run) to take the job and their evaluation of her and shove 'em.
I respect her for that, and for sticking up for me when she did. Just goes to show, the ethical aren't always the winners, and those at the top who think they've won aren't always ethical, or winners.
In fact, if I had to rate their administrative performance, I'd say they're pretty low performers because they really made a mess out of this. Not only am I still an employee, but now the ER is in shambles for lack of a director. Makes me wonder who is the greater threat to the organization's ability to meet its stated goal of quality and compassionate health care.
Sunday, June 1, 2008
Nursing Interventions for Corporate Amnesia
"I am not a critical person by nature."
I said this a lot when I was in graduate school studying sociology. My friends noticed about me a propensity to be hyper-critical when it came to examining the hypocrisy and unfairness of power structures. In saying this about myself, my point was that it is not natural to be so critical...one has to learn the skill. I learned it well.
No longer a social scientist by trade, I have not been able to shake off the critical legacy of those years. Even as a nurse, when faced with bureaucracy, hierarchy, and corporatism, I tend to revert to my sociological underpinnings to reveal the negative aspects of these realities in my workplace.
Others around me--nurses and administration--don't seem to understand this, and I am not sure why. Wouldn't my nursing and my understanding of the organizational context within which I do it be different if I brought to it a different background: literature, law, mortuary science? Of course.
In short, some don't understand why I think about such things. More specifically, administration does not understand why I, as a nurse, think at all.
Recently, I was fired. Ostensibly, the reason for the termination was said to be "insubordination," a euphemism (in my opinion) for having a different opinion.
In fact, the reasons stipulated on the disciplinary action plan that they eventually agreed to after tempting me to voluntarily resign rather than face termination, had more to do with subjective interpretations of my words and attitudes than they do any objective assessment of my nursing skills, performance, or any realistic "threat" I present to the administration or the organization, in general.
Ironically, the overall attitudinal problem they seem to think I have is that of believing the organization is divided into two main groups, nursing staff and administration, and that when problems arise, this division often plays out as a "them versus us" scenario. Ironic because the very concept they accuse me of believing and espousing (at times) is the reality they were using to try to eliminate me as an employee!
As Yosarian said, "That's some catch, that Catch-22!"
Okay. Am I a member of the same bureaucratic organization as they are? Does the same hierarchy of power exist in their world as mine? Does one's position--them on the top, me/us near the bottom--really blind one to an understanding of the nature of authority and the perceived inviolability of command?
What dream world do they live in?
I once heard--and I think E. P. Thompson, the famous English labor historian originally said it--that the real difference between owners and workers, between corporations and labor unions, is that the latter have memory while the former exhibit selective amnesia. In corporate hospital culture, even though in this case it is a non-for-profit corporation, the same is true.
How else to explain how the CEO and CNO can tell me I'm fired one day and then several days later confront me with smiles on their faces, wanting to chat about how things are in my life? If they are just trying to save face, I wonder what sort of face they see in the mirror.
Call it my negative attitude, call it my dark humor, call it my knee-jerk reaction to authority. But don't sweep it under the rug! Challenge me, make me explain myself, TELL ME I'M WRONG!!!
No. It's easier for them to say I'm rude or sarcastic...so much easier than saying I'm mistaken, or wrong, or a bad nurse.
What is the cure for this corporate amnesia? Learn to be critical, learn to be honest, learn to speak truth to power. That's what I've tried to do with my life. I did it when I was a social scientist; I'll do it now as a nurse. For I didn't leave everything behind when I became a nurse.
Wonder why they don't understand this?
I said this a lot when I was in graduate school studying sociology. My friends noticed about me a propensity to be hyper-critical when it came to examining the hypocrisy and unfairness of power structures. In saying this about myself, my point was that it is not natural to be so critical...one has to learn the skill. I learned it well.
No longer a social scientist by trade, I have not been able to shake off the critical legacy of those years. Even as a nurse, when faced with bureaucracy, hierarchy, and corporatism, I tend to revert to my sociological underpinnings to reveal the negative aspects of these realities in my workplace.
Others around me--nurses and administration--don't seem to understand this, and I am not sure why. Wouldn't my nursing and my understanding of the organizational context within which I do it be different if I brought to it a different background: literature, law, mortuary science? Of course.
In short, some don't understand why I think about such things. More specifically, administration does not understand why I, as a nurse, think at all.
Recently, I was fired. Ostensibly, the reason for the termination was said to be "insubordination," a euphemism (in my opinion) for having a different opinion.
In fact, the reasons stipulated on the disciplinary action plan that they eventually agreed to after tempting me to voluntarily resign rather than face termination, had more to do with subjective interpretations of my words and attitudes than they do any objective assessment of my nursing skills, performance, or any realistic "threat" I present to the administration or the organization, in general.
Ironically, the overall attitudinal problem they seem to think I have is that of believing the organization is divided into two main groups, nursing staff and administration, and that when problems arise, this division often plays out as a "them versus us" scenario. Ironic because the very concept they accuse me of believing and espousing (at times) is the reality they were using to try to eliminate me as an employee!
As Yosarian said, "That's some catch, that Catch-22!"
Okay. Am I a member of the same bureaucratic organization as they are? Does the same hierarchy of power exist in their world as mine? Does one's position--them on the top, me/us near the bottom--really blind one to an understanding of the nature of authority and the perceived inviolability of command?
What dream world do they live in?
I once heard--and I think E. P. Thompson, the famous English labor historian originally said it--that the real difference between owners and workers, between corporations and labor unions, is that the latter have memory while the former exhibit selective amnesia. In corporate hospital culture, even though in this case it is a non-for-profit corporation, the same is true.
How else to explain how the CEO and CNO can tell me I'm fired one day and then several days later confront me with smiles on their faces, wanting to chat about how things are in my life? If they are just trying to save face, I wonder what sort of face they see in the mirror.
Call it my negative attitude, call it my dark humor, call it my knee-jerk reaction to authority. But don't sweep it under the rug! Challenge me, make me explain myself, TELL ME I'M WRONG!!!
No. It's easier for them to say I'm rude or sarcastic...so much easier than saying I'm mistaken, or wrong, or a bad nurse.
What is the cure for this corporate amnesia? Learn to be critical, learn to be honest, learn to speak truth to power. That's what I've tried to do with my life. I did it when I was a social scientist; I'll do it now as a nurse. For I didn't leave everything behind when I became a nurse.
Wonder why they don't understand this?
Thursday, May 8, 2008
Follow-up Care
The other day a former-ER patient called and asked for Ed. I told him that there is no one named Ed who works in the ER.
He seemed confused and flustered. He also sounded intoxicated.
Often, patients call to follow up on discharge instructions, or to ask questions about what they are supposed to do next to take care of themselves.
So, I asked the patient the nature of his call and the nature of his original complaint, and I attempted to verify whether or not he was taking his prescribed medications properly, one of which was a narcotic pain reliever.
After speaking with him for about five minutes, I realized that he was taking about twice as much pain medication as he should have been. He admitted to drinking alcohol as well, something I immediately advised him not to do while taking narcotics. Then I reiterated that he should not drive or operate machinery, given the potentially dangerous combination of intoxicants he was taking.
Eventually, I had addressed as many of his issues as I could over the phone and I told him if he felt he needed to be re-seen by an ER physician we would be glad to see him again.
He replied, "Thanks. Are you sure Ed isn't there?"
"Sir, I've already told you there is no Ed in our department. Who told you to ask for Ed?"
"It's on my discharge instructions...If problems persist, call Ed."
Silence.
"E-D, sir. As in, Emergency Department."
He seemed confused and flustered. He also sounded intoxicated.
Often, patients call to follow up on discharge instructions, or to ask questions about what they are supposed to do next to take care of themselves.
So, I asked the patient the nature of his call and the nature of his original complaint, and I attempted to verify whether or not he was taking his prescribed medications properly, one of which was a narcotic pain reliever.
After speaking with him for about five minutes, I realized that he was taking about twice as much pain medication as he should have been. He admitted to drinking alcohol as well, something I immediately advised him not to do while taking narcotics. Then I reiterated that he should not drive or operate machinery, given the potentially dangerous combination of intoxicants he was taking.
Eventually, I had addressed as many of his issues as I could over the phone and I told him if he felt he needed to be re-seen by an ER physician we would be glad to see him again.
He replied, "Thanks. Are you sure Ed isn't there?"
"Sir, I've already told you there is no Ed in our department. Who told you to ask for Ed?"
"It's on my discharge instructions...If problems persist, call Ed."
Silence.
"E-D, sir. As in, Emergency Department."
Monday, April 21, 2008
Types of Patients XI: Animal Bites
I've already mentioned the mandate that ER nurses notify law enforcement when we have reasonable suspicion that a crime may have been committed. As well, a reader's comment mentioned the interest of public safety in such reporting. This is never more true than in the case of wounds caused by animal bites.
Regardless of whether or not an animal bite constitutes a crime, reporting such events to law enforcement or to public health is essential to avoid the possibility that a menace to public safety is left unchecked. The menace might be a mean dog (provoked or not), a feral cat, or (and, yes, I have seen this) a vicious squirrel, etc.
The purpose of mandatory reporting of animal bites is not punitive; it is to improve public safety. Whereas cases involving pet owners (e.g., pet dog bites passing neighbor) may seem to be predicated upon sanctions--for the owner and the pet--in fact, very few responsible pet owners are prosecuted if they do the right thing by their pet and by the public (i.e., up-to-date vaccinations, payment of damages, hospital expenses, etc.) and few end up losing their pet.
Irresponsible pet owners suffer more. These are the owners who don't vaccinate their animals, don't attempt to train them, and usually don't put much stock in animal restraints. In fact, some owners of this ilk actually intend to produce vicious animals mostly for the purpose of protecting property.
Mandatory reporting does not require that I as an ER nurse investigate or understand the reasons for the incident. I leave that to law enforcement. As I told one dog bite patient who didn't want me to notify the police about the neighbor's dog that attacked him because he thought it was his (the patient's) fault: "What if you were a four year old child?"
And I've seen four year old children scarred for life in just this way. I do not pretend to know that it is somebody's fault. Many of these incidents are, in fact, accidents. Mandatory reporting intends to minimize the repetition of such "accidents" in the same way that mandatory seat belt laws intend to save lives.
The ABCs:
A -- Most animal bite victims have injuries to extremities; therefore, airway is usually not a problem.
B -- For similar reasons, breathing is usually not an issue either unless there exists some sort of co-morbidity, such as asthma, attacks of which can be exacerbated by the intensity or ferocity of the animal attack.
C -- But bleeding can be an issue. Like other bleeding injuries, animal bites require direct pressure to stop bleeding. Tourniquets are ill-advised unless used as a last resort.
Animal bites also require copious wound care. Wound irrigation. Closing the wounds either by sutures, staples, steri-strips, or occlusive dressings. And antibiotic administration (either oral or IV) to prevent further adventitious infections.
And lastly, because animal bites represent a disruption in skin integrity, tetanus vaccination status must assessed, discerned, and updated if necessary.
No one likes being bit by an animal, domestic or wild. And very few pet owners like to hear that their pet bit someone. I don't really like reporting such incidents to law enforcement, but I do because I realize it might be my child next time, and the bite might not be so very innocent.
Regardless of whether or not an animal bite constitutes a crime, reporting such events to law enforcement or to public health is essential to avoid the possibility that a menace to public safety is left unchecked. The menace might be a mean dog (provoked or not), a feral cat, or (and, yes, I have seen this) a vicious squirrel, etc.
The purpose of mandatory reporting of animal bites is not punitive; it is to improve public safety. Whereas cases involving pet owners (e.g., pet dog bites passing neighbor) may seem to be predicated upon sanctions--for the owner and the pet--in fact, very few responsible pet owners are prosecuted if they do the right thing by their pet and by the public (i.e., up-to-date vaccinations, payment of damages, hospital expenses, etc.) and few end up losing their pet.
Irresponsible pet owners suffer more. These are the owners who don't vaccinate their animals, don't attempt to train them, and usually don't put much stock in animal restraints. In fact, some owners of this ilk actually intend to produce vicious animals mostly for the purpose of protecting property.
Mandatory reporting does not require that I as an ER nurse investigate or understand the reasons for the incident. I leave that to law enforcement. As I told one dog bite patient who didn't want me to notify the police about the neighbor's dog that attacked him because he thought it was his (the patient's) fault: "What if you were a four year old child?"
And I've seen four year old children scarred for life in just this way. I do not pretend to know that it is somebody's fault. Many of these incidents are, in fact, accidents. Mandatory reporting intends to minimize the repetition of such "accidents" in the same way that mandatory seat belt laws intend to save lives.
The ABCs:
A -- Most animal bite victims have injuries to extremities; therefore, airway is usually not a problem.
B -- For similar reasons, breathing is usually not an issue either unless there exists some sort of co-morbidity, such as asthma, attacks of which can be exacerbated by the intensity or ferocity of the animal attack.
C -- But bleeding can be an issue. Like other bleeding injuries, animal bites require direct pressure to stop bleeding. Tourniquets are ill-advised unless used as a last resort.
Animal bites also require copious wound care. Wound irrigation. Closing the wounds either by sutures, staples, steri-strips, or occlusive dressings. And antibiotic administration (either oral or IV) to prevent further adventitious infections.
And lastly, because animal bites represent a disruption in skin integrity, tetanus vaccination status must assessed, discerned, and updated if necessary.
No one likes being bit by an animal, domestic or wild. And very few pet owners like to hear that their pet bit someone. I don't really like reporting such incidents to law enforcement, but I do because I realize it might be my child next time, and the bite might not be so very innocent.
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