Exam and Questions

On my return from Italy last week, the flight from Rome was full, with physician, scientists, and vendors headed to Chicago for a very large annual radiology conference. This lead to plenty of polite chatter before and after the mid-flight naps. Coming back into the US requires going through both immigration and customs.  A two step process with less than welcoming lines, and a fair bit of confusion for the uninitiated traveler. It really makes the US look a bit unfriendly, compared to entering the EU.

I got put in a line that was not moving. Literally. I could see ahead a couple of people that the white haired immigration official was talking intently at a somewhat cowering middle aged man. From a distance he seemed to be scolding the man, took his photo, took his palm prints, and kept talking at the man. Naturally those of in this line going nowhere watched with irritation as everyone around us whizzed pass their immigration official.

Finally I got close. I could hear the lady ahead of me say that that she had been Italy as a cupcake consultant. Really, that's what I heard. My turn.

The white haired man asked where have you been?
Italy
For how long?
Two weeks.
Business of pleasure?
A little business and a lot of pleasure.
(he smiled, vaguely)
What to do you do?
I'm a professor.
What do you profess?

I burst out laughing. He grinned widely, with that "got ya" look. Then he said that teachers always explain what they teach, but professors always laugh.  I asked what was the best answer he had heard. He replied "as little as possible."  I nodded. He handed me my passport and I moved on.

But, the question dangles. What do I profess? It's one of those questions against which to measure a life and a life's work.  Like the "in this I believe" essays. So rarely do we pause and take stock of where we are and where we are headed.

Some time ago, I decided, after a considerable amount of trying on ideas, that I believe in curiosity. I like that I now have a new question to ponder, to nudge my self-awareness. 

Nerds at the Round Table

Some days seem to mark themselves as important.  A memory has substance. A task list rolls forward. The sound of laughter lingers.  Not too long ago, I had one of those days. 

Last month I had served as a grant reviewer for a new federal granting agency, and kept thinking that I can do this.  So, I forwarded to one colleague the announcement for this rather new grant funding stream. She immediately responded with "let's pull out that grant on post partum women that we almost did."  Being office neighbors and friends for several years, I knew exactly what she was referring to. And, as simply as that is how grant application activities get started.

By the following week we had a meeting scheduled with two other colleagues from medicine. We met in my new, slightly larger office which has curtains and a round table for meeting.  Among the four of us (women), the ideas immediately started flowing.  We noted which grant guidance nuances that would need to be addressed. We mapped out an overall research plan and a subject recruitment plan. We all groaned at the short amount of time to do so much, and at a time when we all already have pretty full plates. But, the grant idea is good and like hounds we were following the scent of potential funding. The mix of brain power and enthusiasm around the table far outweighed our reservations.  So, I have a section of the grant proposal to develop, as do the others.

My office neighbor and I handed the title of principal investigator to our younger, not yet tenured colleague. We both have reached a place where we can be more generous in that way, and love the mentoring aspect of this emerging project.

Yes, us four nerds at my office round table were having fun. The way academic work ought to be fun. Now, we are focused on getting the proposal written and pulled together, and then we will cross our fingers. Hopefully, early next year, I'll have good news. Meanwhile, I have the good news of enjoying, a little bit like the "whistle while you work" enjoyment of life.

Clumpiness of Life

Astronomers have found that matter is not evenly distributed across the universe; it's a clumpy distribution. Hence we have galaxies.  I find this a very useful analogy of how human life unfolds: in clumps of business and events. I've been in one of those clumps for the past few weeks. Not oppressively dense, but dense enough to need to stay focused on timelines and deadlines and tasks.

One contributor to the clump was an invitation to return to RWJF in Princeton, NJ, to continue the discussion of the future of public health nursing. We were a small group and spent a full day of identifying barriers and possible solutions to improving and supporting the existing workforce. So, I prepared a little handout for the meeting and made the round trip in two days. I felt as though it was a good discussion and now we will wait and see what RWJF decides to do.

Another contributor the recent clump has been students wanting to meet about their MPH capstone paper. It's usually this time of year that those who want to graduate in May come asking for help. I think of this as a good thing. But, these meetings do fill up the calendar. Thankfully, those I have spoken with seem to be on task, on target and on time. To be honest, the capstone paper is the one activity in which I really work with the students, helping them pull all the content together into a package that will help them get a job.

A third contributor to the clumpiness is the revisions to my textbook. In July I forwarded all the chapters for the 3rd edition. Now, I am getting those files back with questions from the editor. Things like "this url is outdated" and "where does this table go".  Things that need attention to make the book as good as possible. But, these little things take time. There's no glossing over them.

The last clump contributor was the decision to write a grant proposal for a Dec 5 deadline. Although I am not the PI, the research team (more the proposal team) have swung into high gear.  These deadlines have a way of motivating, being a distraction, and generating some anxiety. I'll update the blog with how the project progresses.

Now, that the clump is thinning, a little, I can make my way back to the routine work of HCMR editorship, course instructor, research collaborator, and manuscript writer.  I guess the clumpiness analogy only goes so far; there's no vacuum in my life.

Changing Agendas

What's on the calendar determines so much. The reserved time slots, with corresponding locations and who, determine my outlook for that day, and sometimes for that week. Those notes about the future determine whether I am more likely to say "yes" or "no" to a request of any type. They determine how I pace myself in the work to be done around those reserved, committed times.  All of this might sound, well, deterministic, and it is.

It has become a reality that my time is less for me or about me and more and more for and about others. This is not a complaint, just a statement of my experiences. This past week I had blocked out three full days, plus the preceding afternoon, for a conference in Atlanta. I had prepared for the conference by reading the materials posted to the meeting e-room. I had alerted everyone that I would not be accessible during those days, and probably not reading email expect very sporadically.

Then winter happened. It happened with cold and snow in Atlanta, a place where cold and snow generates panic not snow plow trucks. So, two days before departure, I got an email and a followup phone call to say the conference was postponed. What?! Suddenly, I had all that time available for me, for catching up, for playing hooky, for getting more work done, for having blank days. The vast amount of time now unscheduled was a true shock. Reverberating not only across my calendar and mindset, but also into my gut and bones. Like getting sudden good news that goes visceral.

Those three days passed quickly. (Nature abhors a vacuum and I abhor not being busy.)  By Friday afternoon, I realized what a blessing I had received. I could not possibly have gotten done all that I needed for the upcoming week, based on the calendar's portrayal of the future.

What routine looks like

This week has been more cruise control, with a steady and easy flow of routine activities resulting in a few "products" ~

• Editorship work resulted in getting manuscripts processed (accept/reject/revise) in a timely manner so that my stats look good on the amount of time for turning around manuscripts.

• Presentation preparations resulted in having the powerpoint presentations for the two presentations at APHA ready to be unloaded to its website by the deadline.

• Committee membership attendance resulted in furthering discussions but no decisions with immediate results-some activities fall into the category of fermentation, an important process to arrive at a smooth final product....

• Teacher work included reading the assigned articles to be prepared for class discussion and grading their second assignment papers. Hopefully, the teaching work results in students with enhanced skills and a feeling of being mentored. Some results are more like secondary consequences which are not results for the primary party.

• As an author I worked on one of the many manuscripts in the queue (front and back burners) with the result of inching toward a manuscript for submission - note that I say submission because that is the really the only aspect of authorship that I have direct and sole responsibility for.

So, overall, it it felt like a groove, uncomplicated, focused, doable with no threats or looming deadlines. A groove with results as well as opportunities to have intellectual stimulation.

Three's

Things come in three's. If they come in two's or four's, we dismiss that as not counting. Three births, three deaths, three accidents, three deadlines. Yes, life happens in three's and I'm heading into the finale for three big projects, all due within a week.

1. Report to the IL Dept of Health and Family Services summarizing the results of our evaluation of the Healthy Births for Healthy Communities (HBHC). All the project staff are gone; the money has ended. Still we have to produce three substantial reports in order to get paid. This project was ongoing for four years, so you know we have too much data and too little time to do complex analyses. Still, it was a good run.

2. Grant proposal due to be submitted to the office at the University which submits all grant applications via the online, federal system. Even with the relatively new NIH forms, we were able to crank out the proposal in a couple of weeks. Of course, the idea had been peculating for months and the groundwork for pulling the proposal together had been done. Still, at 80 pages max, we did it.

3. The coming Monday, Tuesday and Wednesday is the research agenda setting conference that I am 'hosting'. Naturally, during the last week I received requests to attend, but I politely said we had reached the limit of 50 invited participants. The presenters have turned in thier handouts and sent us their Powerpoint presentations. The photocopying has begun of all the handouts, and I have new clothes for the event. Still, there's some party/hostess nervousness about not forgetting any last minute details.

So, when someone says "things don't really come in three's", don't believe them.

June revealed

Yes, it has been way too long since my last post. The absence reflects the amount on my perveribal plate. But, I've not forgotten my blog followers and promise to post at least weekly for the forseeable future.  So, what HAVE I been doing for the past month ~ besides packing, unpacking, mega-packing and moving too fast to even make a To Do list?

Early June: I spent three days in Washington DC. I gave two presentations at the ACHNE/ASTDN meeting in Crystal City. For those who don't know the DC area, this is a rather boring place, with mostly office buildings and half deserted underground quasi-shopping malls. And, aside from the academic-scholarly activities, I was mostly concerned with where to watch the US Soccer team play. World Cup trumped old women nurses trying to seem important. Sorry, ladies.  I actually had stronger bonding with the doormen who were looking over my shoulder at the games. The amount of gray hair in attendance was spooky and foreboding for the future of public health nursing.  I felt "embedded", like a reported with the armed forces. Watching, not wanting to get hurt, but still in the line of fire. Naturally, I was typically a-PC, and took a few shots. Not smart, I know, but it's frustrating to be around such myopia with such a big heart. It's a truly sad combination. Also frustrating was the lack of walking the talk, with regards to multi-disciplinary collaboration. On the up side, I had great times having dinner with my KRISP project co-investigators. I wish I could have more of those times.

Mid-June: The panic that had started at the beginning of June grew. Panic over the long list of tiny things that needed doing before the end of June when I would leave for Chile ~ At home I needed to pack, ready the house for guests, find a place for Lisette to live, put a hold on the newspaper delivery, assure that my neighbor would collect the mail, get my credit card cleared for international travel, keep up with my emails and secretary work for the Chicago MSIA Ministers, and empty the refrig through careful menu planning.  At work ~ coordinate payment of summer salary from two grants and across two finance mangers, sign all needed forms for students planning to graduate in summer, keep up with grant activities like filing IRB amendments, respond to an astounding amount of email on what ought to be simple topics, and keep working on manuscripts and promotion papers.  YIKES. Looking back on the list is enough to re-freak me out.

End of June: Get on the plane and arrive in Santiago, Chile. The Chilean saga will be in subsequent posts.

Federal Funding

Let me quasi-quote myself (from a forthcoming editorial) ~

Within the U.S. Department of Health and Human Services (DHHS), five agencies are likely to address health care management: the Agency for Health Care Research and Quality (AHRQ), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration’s (HRSA), and the Centers for Medicare and Medicaid Services (CMS). These five, I’ll call them the Big 5, receive considerable federal funding for research, health care reimbursement, and training. The NIH budget of $30.6 billion (FY 2009 Budget) is nearly four times CDC’s $8.8 billion and HRSA’s $7.5 billion budgets for Fiscal Year 2010, and dwarfs AHRQ’s $372 million budget request for fiscal year 2010. The CMS 2010 Fiscal Year budget was $818 billion, of which $811 billion was earmarked for health insurance and long term care.

These numbers are profoundly staggering. Except for CMS, which is essentially federal health insurance for the elderly and the poor, the agencies focus on improving health care services. I don't quibble with the amounts, but only wish that more of the funds would be for prevention of disease rather than for treatment. I also wish that more of the money would go toward services and programs that are population-focused. One could argue that is the case with Medicaid, but it boils down to reimbursement for individual care.

These issues are on my mind as I struggle with the local health departments to figure out how to aligng funding with prevention and population-focused practice. When I look at the budget numbers, I see possibilities but not motivation. I can only wonder what the future will hold and how much of the future I might be able to shape.

Meandering Monday

This is one of those with low anxiety, low pressure, and without a clear theme, which makes it a day requiring self-discipline and self-direction. I worked at home for a bit before heading into the office. Specifically, working to identify one last speaker for the AHRQ conference. Once at the office, the morning meetings were short, efficient and laced with easy conversation. This afternoon will have more intensity, based on personalities. I MUST work on my editorship; I'm woefully behind on processing manuscripts. And, I need to be sure all is in order for the meetings tomorrow.

Late in the afternoon, I have a skype conversation about my trip to Chile. More on that after the call.

Now, back to task.

4 hours and counting

This morning I set out to work 4 hours from 7am to 11, but it end up being closer to noon.  I stream radio when I start work, pause when I get up (bathroom, tea, stretch, check Blog or Facebook), and resume the clock and stream when I resume work.  All those little "breaks" take a huge chuck out of a work day.  Still, the 4 hours were productive, resulting in small progress on the AHRQ conference grant.

Now, I need to shower, pack and hit the road barely ahead of rush hour traffic headed out of Chicago. I'm off to see, not the Wizard, but two of the local health departments that participating in my KRISP grant.  Tomorrow will be heavy "This is public health."  I still need to work on the ppt presentation for the 8:30am meeting. I also need to choose a  few handouts for the meetings.  I'll do that in the shower.

It's a long drive for two short meetings, which are a 30 minute drive from each other. Sometimes, physical presence is required to nudge things along and lend credibility to the project. I'm not complaining. On the drive down to Peoria, I'll be rehearing what I'll say, strategizing how best to get buy-in from all the nursing staff, and thinking about manuscripts that can come from this. Car time is not for books-on-tape, not when it's work travel. The clock will be ticking; thinking and driving does count as multitasking.