All posts tagged work

Next Step in Robert Wood Johnson’s Emergency Room Expansion Begins Tomorrow – TAPinto.net

NEW BRUNSWICK, NJ The second phase of construction forRobert Wood Johnson University Hospitals upgraded emergency department is slated to launch tomorrow, June 14, and span six weeks, according to the medical center.

Anyone in need of treatment must enter the emergency room through the intersection of Easton Avenue and Little Albany Street, according to the hospital. Since work began in March, patients were able to arrive through a drop-off spot near Somerset Streets intersection with Little Albany.

The project is set to grow Robert Wood Johnsons emergency department from 40,000 to 60,000 square feet, according to the hospital.

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When construction is completed, the emergency room should contain more than 100 units, including three new trauma bays, for treating patients, according to the hospital. Work is also poised to result in a new ambulance bay that can park eight vehicles at once, in-department radiology imaging and a fast-track option for patients.

The hospital has undertaken the renovations due to a spike in demand, officials have said. That has resulted from steady growth in Middlesex Countyincluding New Brunswickand neighboring communities, according to U.S. Census figures.

While the emergency department will continue to deliver services uninterrupted throughout construction, the work has altered traffic patterns in New Brunswick.

Drivers who want to enter the East Tower Parking Garage should use the French Street access point during the upcoming second phase of construction, according to the hospital. Those who wish to access the Rutgers Cancer Institute of New Jersey should enter Little Albany Street through Easton Avenue.

But during this phase, the area will be used exclusively for patients and the emergency department, according to the hospital.

Other motorists wont be permitted there as the project moves forward, the hospital wrote online. They should make otherarrangements.

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Wisconsin proposal would help keep chronically ill out of emergency rooms – Milwaukee Journal Sentinel

The emergency room entrance at Columbia St. Mary’s Hospital’s emergency department at 2301 N. Lake Drive in Milwaukee.(Photo: Mike De Sisti / Milwaukee Journal Sentinel)Buy Photo

MADISON – Last year in Wisconsin, thousands of people visited an emergency room more than seven times eacha stream of bad outcomes for taxpayers, the health care industry and the patients themselves.

To respond, lawmakers voted last week to givehospitals a powerful financial incentive to reduce emergency room costs within the state’s Medicaid health programs for the needy.

The pilot proposal: Work with diabetics and patients with asthmaandheart disease to control the health conditions that are landing them in the emergency room. If successful, the proposal could mitigate millions of dollars in unnecessary costs for taxpayers and give patients better lives to boot.

“It’s really creative,” said Eric Borgerding, the CEO of the Wisconsin Hospital Association and a supporter of the proposal. “I’m confident it will result in a reduction of emergency department utilization.”

The approach: Payhealth care providers to prevent bad outcomes and emergency room visits for patients rather than paying them even more to provide emergency room care after a patient has had a bout with asthma, or worse yet, a heart attack.

The caveat: Gov. Scott Walker’s administration wasn’t closely involved in the proposal and is still reviewing it, with one top official asking whether the state needs a completely new initiative to accomplish what its existing programs couldbe doing already.

Pointing to numbers from the state hospital association, Borgerding and Rep. Joe Sanfelippo (R-New Berlin) said that last year 10,000 Medicaid recipients in Wisconsin used an emergency room more than seven times at a total cost of $52 million.

Sanfelippo worked on the Medicaidpilot after seeing the success that Aurora Health Care and St. Joseph Hospitals were having with a similar initiative.

“I thought, ‘Hey, maybe this is a trend and something we can build on,’ ” Sanfelippo said of the hospitals’ efforts.

By working with a core group of frequent ER visitors, the hospitals worked to ensure that patients regularly saw a primary care doctor, dealing with challenges ranging from child care and transportation to mental illness. Aurora cut per patient costs by an average of $55,000 within the target groupat its St. Luke’s hospital and nearly $34,000 a patient at its Sinai location. St. Luke’s saw a startling 68% decrease in ER visits and an 80% cut in ER costs among the targeted patients.

“We think there’s a lot of room for expanding this,” said Mark Huber, Aurora’s senior vice president for social responsibility.

Anne Johnson, an emergency room physician for Aurora, gives the example of a patient in her 60s with emphysema and anxiety issues who used to showup at the ER five times a month.

A team at Aurora that included a social worker looked into the woman’s case, working to ensure she got the medicine needed to manage her condition and contacting the woman’s niece about her aunt’s challenges.

“Her family member had no idea,” Johnson said.

Today, the woman is coping with her condition much better and only needs the emergency room every six months, Johnson said.

Sanfelippo’s proposal, which was approved by the Joint Finance Committee Thursday, would set aside $2.3 million over the next two years to encourage hospitals and health systems to take similar steps. The provision in the state budget still needs to be approved by both houses of the Legislature and Walker.

Under the program, hospitals and health systems would get up to $1,000 a year for each frequent emergency room patient enrolled and try to lower his or her ER use and costs. If the health systems prevented ER visits and saved money for taxpayers, the state Department of Health Services would pay half of the savings to the health care provider.

Sen. Jon Erpenbach (D-Middleton) didn’t rule out Sanfelippo’s proposal but noted there were other approaches to prevent emergency room use, including expanding the state’s Medicaid program to more people.

“There’s a lot of ways to work on over-utilization of the ER,” he said.

State Medicaid director Michael Heifetz was also cautious.

Heifetz acknowledged the need to actively manage Medicaid patients’ cases. But he also pointed out that the great majority of patients in Medicaid are already in HMOs, which should be doing at least some of this work already.

The proposal also lays out in some detail how to add more case management into the state’s system, reducing the flexibility for state officials, he said.

“It’s very prescriptive and needs further review,” Heifetz said of the provisions.

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Cotton Swab Injuries Send 34 Kids to the Emergency Room Every Day – Mental Floss

Jacques Mattheij made a small, but awesome, mistake. He went on eBay one evening and bid on a bunch of bulk LEGO brick auctions, then went to sleep. Upon waking, he discovered that he was the high bidder on many, and was now the proud owner of two tons of LEGO bricks. (This is about 4400 pounds.) He wrote, “[L]esson 1: if you win almost all bids you are bidding too high.”

Mattheij had noticed that bulk, unsorted bricks sell for something like 10/kilogram, whereas sets are roughly 40/kg and rare parts go for up to 100/kg. Much of the value of the bricks is in their sorting. If he could reduce the entropy of these bins of unsorted bricks, he could make a tidy profit. While many people do this work by hand, the problem is enormousjust the kind of challenge for a computer. Mattheij writes:

There are 38000+ shapes and there are 100+ possible shades of color (you can roughly tell how old someone is by asking them what lego colors they remember from their youth).

In the following months, Mattheij built a proof-of-concept sorting system using, of course, LEGO. He broke the problem down into a series of sub-problems (including “feeding LEGO reliably from a hopper is surprisingly hard,” one of those facts of nature that will stymie even the best system design). After tinkering with the prototype at length, he expanded the system to a surprisingly complex system of conveyer belts (powered by a home treadmill), various pieces of cabinetry, and “copious quantities of crazy glue.”

Here’s a video showing the current system running at low speed:

The key part of the system was running the bricks past a camera paired with a computer running a neural net-based image classifier. That allows the computer (when sufficiently trained on brick images) to recognize bricks and thus categorize them by color, shape, or other parameters. Remember that as bricks pass by, they can be in any orientation, can be dirty, can even be stuck to other pieces. So having a flexible software system is key to recognizingin a fraction of a secondwhat a given brick is, in order to sort it out. When a match is found, a jet of compressed air pops the piece off the conveyer belt and into a waiting bin.

After much experimentation, Mattheij rewrote the software (several times in fact) to accomplish a variety of basic tasks. At its core, the system takes images from a webcam and feeds them to a neural network to do the classification. Of course, the neural net needs to be “trained” by showing it lots of images, and telling it what those images represent. Mattheij’s breakthrough was allowing the machine to effectively train itself, with guidance: Running pieces through allows the system to take its own photos, make a guess, and build on that guess. As long as Mattheij corrects the incorrect guesses, he ends up with a decent (and self-reinforcing) corpus of training data. As the machine continues running, it can rack up more training, allowing it to recognize a broad variety of pieces on the fly.

Here’s another video, focusing on how the pieces move on conveyer belts (running at slow speed so puny humans can follow). You can also see the air jets in action:

In an email interview, Mattheij told Mental Floss that the system currently sorts LEGO bricks into more than 50 categories. It can also be run in a color-sorting mode to bin the parts across 12 color groups. (Thus at present you’d likely do a two-pass sort on the bricks: once for shape, then a separate pass for color.) He continues to refine the system, with a focus on making its recognition abilities faster. At some point down the line, he plans to make the software portion open source. You’re on your own as far as building conveyer belts, bins, and so forth.

Check out Mattheij’s writeup in two parts for more information. It starts with an overview of the story, followed up with a deep dive on the software. He’s also tweeting about the project (among other things). And if you look around a bit, you’ll find bulk LEGO brick auctions onlineit’s definitely a thing!

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Cotton Swab Injuries Send 34 Kids to the Emergency Room Every Day – Mental Floss

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Why visiting the ER costs so much money | KAGSTV.com – KAGS News

9Wants To Know looks at how something as simple as giving a patient a cheap splint or over-the-counter medication in an Emergency Room can lead to bills in the thousands of dollars. KUSA

Suspected strep throats, miserable bladder infections, and potentially torn ligaments dont necessarily scream EMERGENCY, but a 9Wants to Know investigation has discovered theyre leading to massive charges nonetheless.

And in a country where hospitals are recommended, but not required, to follow a series of industry guidelines, ER visitors remain subject to a complicated system that pays hospitals more for doing more.

Thats even when more involves something as simple as giving the patient a cheap splint or handing them an over-the-counter medication readily available at any nearby grocery store.

Paige Thoele felt awful.

So last July she did what around 1.8 million Coloradans do every year.

Paige Thoele was charged for a level 4 ER visit for treatment for a bladder infection (Photo: KUSA)

She went to an emergency room. In her case, she went to St. Anthony Hospitals ER.

I had a bladder infection. I was miserable, she told us.

In the grand scheme of things, Paige now knows the visit might have been a mistake. ERs tend to be expensive, but at the time, she felt sick enough to go.

According to hospital paperwork, the July 13 visit was fairly standard for patients with bladder infections.

Staff tested her urine, looking for an infection.

Yep, I peed in a cup, she explained.

A doctor gave her two tablets of phenazopyrdine, a relatively inexpensive, over-the counter medication. At Walgreens, she could buy a box of 36 tablets for around $8.

The doctor also wrote her a prescription for a painkiller.

It takes two to three points for an ER visit to be classified “level 3.” (Photo: KUSA)

About 52 minutes from start to finish, she said. The doctor saw me for about five minutes.

Weeks later, a letter from the hospitals owner informed her she had a balance in her account of $3,733.12.

I was shocked, she said.

By far, the largest charge on the invoice was for this: HD ED Level IV.

They billed me at a level 4 admittance, she said.

Do you know why? I asked.

No, no idea, she replied.

What she also didnt know at the time was the fact that she had been caught up in a numbers game where the difference between a 3 and a 4, for example, could be as much as a thousand or more dollars when it comes to the bill.

Dr. Dave Friedenson knows hes likely the exception as opposed to the rule when it comes to emergency medicine.

Not only is he the immediate-past president of the Colorado chapter of the American College of Emergency Physicians, hes also the chief medical officer of a medical coding company.

So he, unlike many ER doctors, knows just how much more can be tacked onto a bill with one simple, seemingly innocuous decision within an emergency room.

An over-the-counter medication?

Yes.

A urine screen.

Yes.

Dr. Dave Friedenson is the past president of the Colorado chapter of the American College of Emergency Physicians and the chief medical officer of a medical coding company. (Photo: KUSA)

So if the doctor decides to order a splint, even if its a cheap splint, for somebody, then that can up the code? I asked.

Absolutely, he replied.

That appears to be what happened to Laura Prinzi when she visited Swedish Hospitals SW ER late last year for a pain in her knee.

Every few steps I would have a shooting pain, she said.

Prinzi figures it took the doctor less than five minutes to diagnose the problem.

Her ACL appeared intact.

No X-Ray, no MRI, and no CT Scan.

The doctor did, however, offer her one thing.

They gave me a soft splint, and I was on my way, she said.

Weeks later, an itemized statement from Swedish showed up in the mail. There was only one charge.

SHOW US YOUR BILLS: Tell us about your high ER costs

RELATED: How peeing in a cup can cost you $6,250

Next to the line, EMER DEPT LEVEL 3 was this: $2,783.00.

Its a lot of money, Prinzi said.

On that same line, Swedish assigned the code 99283 to the visit.

Laura Prinzi visited an emergency room for pain in her knee (Photo: KUSA)

In order to understand the meaning of that code, you have to understand a little more about hospital codes in general.

In 1983, the Centers for Medicare and Medicaid (CMS) established whats known as the Healthcare Common Procedure Coding System (HCPCS). Using the American Medical Associations Current Procedural Terminology (CPT) codes, CMS established a uniform way to process claims.

Yes, we know, there are a lot of acronyms here. For that, were sorry, but this is important to understand.

Private insurance companies quickly adopted the CPT codes as a way to simplify their own processes.

Today, there are generally five CPT codes attached to ER visits.

99281, 99282, 99283, 99284, and 99285.

You only need to pay attention to the last number of each.

So, for example, a 99283 is a level 3 visit.

And a 99285 is a level 5.

INTERACTIVE: Emergency department severity level trends

Hospitals bill the bulk of their charges for ER visits this way. Each one represents whats commonly referred to as a facility charge.

ERs are expensive. No one denies that. They are open and staffed 24 hours a day. Staff has access to all sorts of high-tech equipment that can be used at a moments notice.

And, by law, they have to treat everyone who comes in the building, no matter any persons ability to pay.

Many times, people dont pay. Thats part of the reason why there are facility fees for the rest of us.

So, yes, ER bills can easily stretch into the thousands.

After getting rejected by multiple hospitals, UCHealth finally agreed to talk to Chris Vanderveen.

But what many people dont realize is the code attached to your visit has a ton to do with the amount youll be asked to pay.

Weve reviewed more than a 100 bills as part of our showusyourbills@9news.com campaign.

Level 3 visits routinely result in charges in excess of $2,000.

Level 5 visits can lead to charges that near $10,000.

Insurance will frequently negotiate lower rates for people. People with copays might only be responsible for a few hundred bucks per visit.

People with deductibles about half of those who receive health insurance through their work have a deductible of at least a $1,000, according to the Kaiser Family Foundation frequently are asked to pay at least a sizeable percentage of the charge.

So how a hospital codes you next visit, can make a massive difference in terms of what youre expected to pay.

And, as Dr. Friedenson told us, The more the hospital does, the higher the code.

Last November, Keith Westfall brought his daughter to the ER at Castle Rock Adventist when a large rash developed on her back.

It was very alarming, yes, Westfall said.

Keith Westfall took his daughter to an emergency room for a rash and was charged at a level 5 visit the first day, a level 3 visit the second day. (Photo: KUSA)

I didnt know what it was. Measles? I just didnt know, he said.

At the hospital, doctors ran a number of tests on her. She received an IV as well in order to medicate and hydrate her.

A few hours later, they sent her home with not much of a diagnosis, according to Westfall.

The next day, the rash looked even worse, and so he went back to the same ER.

Same deal, same deal, Westfall insisted.

Hospital paperwork shows staff did much of the same work they had done the day before. The coding wouldnt necessarily indicate that, however.

The first visit resulted in a level 5 (99285) code and a $9,817.07 facility charge.

The second visit resulted in a level 3 (99283) code. Westfalls records dont show how much the facility charge was for the visit, but the entire amount charged including all tests and other services came out to $4,346.52.

A February letter sent by a patient representative at Castle Rock Adventist to Westfall doesnt provide any explanation for the two different codes other than to say, Your bill reflects the level of care your daughter received each day she was here Since the bill is in alignment with the care your daughter received, your bill will not be adjusted and you re expected to pay the full amount.

Keith Westfall got a $,9817.07 facility charge for taking his daughter to the ER when a large rash developed on her back. (Photo: KUSA)

Centura, the owner of the hospital, told us in a statement that it follows American College of Emergency Physicians (ACEP) guidelines in determining how to code ER visits.

Dr. Friedenson, Colorados past president of ACEP, told 9NEWS the guidelines, for the most part, have no teeth.

He said ACEP has asked for its guidelines to become, in essence, national standards but the cause hasnt gone over too well with many hospitals.

So as of now theres no national standard for how hospitals code? I asked him.

Thats correct, he replied.

It all means, hospitals can say theyre following ACEP guidelines, but theres really not much a patient can do if he or she feels like their coding was done improperly.

Dr. Friedenson was quick to point out he believes most hospitals follow ACEP guidelines very closely, but he also acknowledged there are exceptions.

Which got us thinking about Paige Thoele and her level 4 ER code for her bladder infection.

Its hard to look at the list of charges for Paige Thoeles 2016 visit for a bladder infection and not stare at the figure next to the line ED LEVEL IV.

$3,460.15

That was the amount the hospital charged her for her 52 minute visit to Centura-owner St. Anthony Hospital.

Paige Thoele was charged for a level 4 ER visit for treatment for a bladder infection (Photo: KUSA)

It was also, by far, the largest charge on the list. As of now, half of it remains her responsibility.

Thoele wasnt exactly knowledgeable of ER coding when she complained to the hospitals billing department, but she was certain there had to be a mistake.

In January, the Centura Dispute and Resolution Department sent her a letter explaining to her why the hospital charged her the way it did.

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Samaritan’s emergency department will have limited access on Tuesday – WatertownDailyTimes.com

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WATERTOWN A large crane hoisting massive equipment to the Samaritan Medical Center roof will limit access to the hospitals emergency room on Tuesday.

As part of ongoing expansion and renovation projects, the crane will be set up in front of the hospitals ambulance bays, causing ambulances to bring patients to Samaritans main entrance on Washington Street. The work is expected to occur from about 7 a.m. to 9 p.m. on Tuesday, according to a press release.

Staff will then escort patients and EMS providers directly into the emergency room via a planned route, the press release said. Extra staff and security will be on hand during the construction to ensure patient safety.

The work is expected to be finished in one day, SMC officials said in the press release.

The crane will install massive air handlers to the roof. All hospital services will remain operational during the work.

The patient registration area also will affected by the work on the roof.

area will be blocked off on Tuesday. Patients will be directed to enter through Samaritans Medical Office Building, turn left and proceed to registration from there.

A similar project will occur in early to mid-July when some other equipment is hoisted through the roof on the ground floor near registration.

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I spent years in the ER with my mom. It isn’t a substitute for real health care. – Shareblue Media

In the last threeyears of my mothers life, she and I spent hour after hour in the emergency room of the hospital. Sitting there, watching great doctors and nurses deal with a stream of patients in various states of crisis, one would quickly realize that the conservative mantra that people without health insurance can simply go to emergency rooms is absolute nonsense.

The wrongheaded idea is not a recent conservative talking point. In 2012, while running against President Obama and in favor of repealing Obamacare, Mitt Romney said, we do provide care for people who dont have insurance, and went on to describe a scenario involving a heart attack and the emergency room.

That isnt a health care system. That is a stop someone from dying system, and as soon as youre stabilized, theyll rush in and ask for your proof of insurance, because the system demands medical professionals also work as collection agents.

My mother suffered from End Stage Renal Diseasein laymans terms, that meant her kidneys were failing. When we rushed her to the emergency room such a frequent occurrence that it has all blurred into one long session with fluorescent lights overhead in my memory, but it was over 20 times between 2012 and 2015 it was because she had tipped over into the danger zone, having trouble breathing or remaining conscious.

The emergency room was helpful. But it wasnt health care. Health care was the multiple visits per week, for hours on end, to the dialysis clinic where the work her kidneys could no longer do was outsourced to a large machine. She had to have the blood in her body removed, processed through the machine, and returned to her.

That is simply not something which can be easily handled by a busy emergency room. Thats an entire system of doctors, nurses, nurses aides, nutritionists, social workers, administrators, and more, working in concert to try to give people some semblance of normalcy as their bodies fail them.

And yes, there are also the families who must deal with this their lives disrupted and forever changed because somebody they love is going through hell. If youve heard the anguished screams of the person who brought you into this world as they suffer in pain, you understand something of what hell is.

And on top of the emotional cost ofthe mental anguish of a severe illness, there is the actual cost to deal with, as well.

My mom was covered. But if she hadnt been, she couldnt just go to the emergency room, and to dismiss serious illness in this way is ghoulish and uncaring and unfeeling to everyone involved.

Yet it has become the go-to for Republicans and conservatives, a sign that they havent really thought about this issue, or that they simply dont care.

Health care real coverage with capable doctors and nurses doing their jobs kept my mom alive so I could sit with her a few more precious hours before she left us. Thats what America needs, not dismissive and insulting slogans from privileged politicians, disconnected from reality.

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I spent years in the ER with my mom. It isn’t a substitute for real health care. – Shareblue Media

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Choosing between urgent care and the emergency room – The Wilton Bulletin

Janet Nazarian

Urgent care or the emergency room? When a medical problem needs to be attended to right away and a doctors appointment is not possible how does someone decide where to go?

Janet Nazarian, marketing director of AFC Urgent Care Norwalk, will discuss the urgent care trend at the Wilton Kiwanis Clubs weekly luncheon on Wednesday, April 26. She will advise Kiwanians about the different services offered at American Family Cares facility on Route 7. Her talk will include advice about when to go to the ER and when to choose urgent care.

AFC Urgent Care Norwalk claims to provide convenient treatment for non-life-threatening illness and injury at 20% of the cost of the ER. The center offers night and weekend hours and staff physicians can perform physical exams.

The luncheon begins at noon, with the talk at 1, at WEPCO, 48 New Canaan Road. Non-members are welcome but reservations are required. Call Bud Taylor at 203-354-0208.

Homefront

The Kiwanis Clubs annual Homefront rehabilitation of a Norwalk home will be Saturday, May 6. It is in need of yard clean-up, rebuilding a stairway, light masonry, painting, junk removal, and light carpentry work. , Team captains Bob Parisot and Kevin Craw surveyed the work to be done and spoke with the owner who would be very appreciative of any help that can be given.

Sign up on the Kiwanis website at wiltonkiwanis.org.

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Life In The Emergency Room – Huffington Post

My Dad used to tell me a story that I think of often in my work.

A young surgeon had just started his residency at a prestigious teaching hospital. He was paired with an older surgeon who had been there for a very long time who would, in the coming months, train him to perfect his craft.

A patient arrived at the ER during the young doctors first shift. She was bleeding profusely out of a deep laceration in her neck and was immediately wheeled into the OR.

The young surgeon and the older surgeon scrubbed up and hurried in to operate on the patient.

The older surgeon turned to the young surgeon and said, Shes lacerated a major artery. Remove the damaged portion, suture the artery back together, and close the wound.

The young surgeon nervously asked, How much time does she have?

The older surgeon responded, She only has about 40 seconds, so slow down, take your time, and do the job right. Shell die if you hurry.

I find that the most difficult thing in my work as a pastor, advisor, and one who deeply cares about the wellbeing of people is being able to separate what is primary from what is tertiary.

There are always so many in my work who need my time and attention, and the management of that often feels like triage.

This may also be the case for you if you are in any type of field that requires you to work with the physical, emotional, or spiritual needs of others. You may be a counselor, a teacher, or a therapist. You may be a nurse, a doctor, or someones primary care giver. Maybe you are a stay-at-home parent. The pressure of triage is always there for those of us who do people work.

It feels like triage because… well… it is.

You may, as I often do, leave your place of work at the end of a very long day feeling guilty. Your inner dialogue whispers to you in icy tones, You could have fit in one more appointment! That person is in serious pain! How can you just walk away from them? You are so selfish!

Empathy is a powerful thing. It has the ability to listen, respond, and heal. But empathy can also be our undoing if we forget to be empathic toward ourselves.

At some point we have to stop, acknowledge that we are giving too much, doing too much, and trying to fix the world overnight. And you know what? We never will. In fact, the world will still need fixing when we take our final breath. We will leave the world just as we arrived in it a place where there is always more work to be done.

Accepting this as a reality can be cathartic. We need to discipline ourselves to think this way, not as an excuse for laziness, but because we are such a driven people, and we dont know how to turn it off when we need to.

Its okay to let some things go until tomorrow, next week, or even next month. It may be a task. It may be a person. It may be a project. These things will always be shouting at us to act now, to work harder, and to give even more of ourselves than we have to give. But in truth, its going to be okay letting many of those things sit in the waiting room a little longer until we are available and able.

Harry Emerson Fosdick once said, Its a great time to be alive. The world is falling apart.

And it is. So slow down, take your time, and do the work well. The rest of it will still be there to greet you when you return.

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Life In The Emergency Room – Huffington Post

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