Case Studies On The Importance Of Oral Care

Case Studies On The Importance Of Oral Care This submission is going to focus on the nursing care that I gave in one placement simulation and two consecutive shifts on placement, placing emphasis on oral care, medication management and communication. It will outline the fundamental aspects of clinical nursing skills that have taken place in my setting. This will also highlight the learning process taken place and how it helped me to enhance my knowledge, and ethical values in order to deliver quality and safety of care. Using other sources of current literature, I will use a reflective model to discuss how I have achieved the necessary level of learning outcome. By utilising this model I hope to demonstrate my knowledge and understanding in relation to these skills as well as identifying areas with scope for learning. Reflection is the process of reviewing an experience in order to describe analyse, evaluate and so inform learning about practice (Reid 1993). Gibbs (1988) model of reflection will be used as a framework, because it focuses on different aspects of an experience and allows revisiting the event fully. By contemplating it thus, I am able to appreciate it and guided to where future development work is required. For confidentiality purposes the patients real names will not be used and will be referred to patients as B and R. This is in line with the (NMC, 2008) requirements to maintain confidentiality at all times. A diary is supported in this assignment as an appendix within the time of the process. The reflective model I have chosen to use as guidance is Gibbs (1988). The care of a patients mouth forms an important component of assisting hygiene needs and yet is a nursing skill which is not always afforded the attention it fully deserves (Evans, 2001) Description I was part of a placement simulation group which went to the multi-skills laboratory to practice delivering and receiving oral hygiene. I was assigned a colleague to brush his teeth using a toothbrush and paste. I put on gloves to pre vent contamination (NICE 2003). Seeking his consent, I undertook a brief visual assessment of his mouths health. I then put him in a comfortable position so that he could tolerate the wash. Thereafter, I cleaned all-round the mouth, gums and tongue. I finished off by helping him to rinse his mouth with mouthwash. I treated my partner as though he was physically unable to hold the brush himself to scrub his own teeth, but he was able to communicate with me and was able to assist me in terms of spitting and gargling with water at the end of the procedure. Feelings When first informed that I was expected to undertake this task I felt anxious and concerned. I was aware that I had not brushed anyones teeth outside of my family before and that the mouth is an intimate and personal part of the body which is not usually exposed to anyone other than myself or the dentist. I was concerned about how my partner (whom I did not know well at that stage) would react to me examining his mouth. Writ ers have described such intimate physical assessments as creating a potentially intrusive situation (Lewis 2006, Sturdy 2007) which might cause the patient to feel uncertain and inadequate. I was also concerned that my own anxiety was shared by my partner who also appeared embarrassed and awkward at the time. This anxiety was increased when during the procedure my partner began to cough as though distressed. This caused me to feel hesitant about continuing- a situation recognised by Millon (1994) as a common response for carers to such an experience, although I persevered with his cooperation. When the task was completed I felt comfortable with my performance overall. Evaluation What was good about the experience was that, despite being aware that this role is often delegated to health care assistants (Kelly et al 2010), I was able to deliver a fundamental component of essential nursing care (Essence of Care 2003) quite effectively. The experience helped me to appreciate that oral c are provides any nurse with an ideal opportunity to undertake a thorough physical, emotional and cognitive assessment of a patient (DOH, 2001). I was satisfied delivering this aspect of care without harming the patient as no injuries were sustained (having I checked his mouth prior to and after cleansing). Also, I was pleased to have an opportunity to improve my communication skills through the delivery of this skill and to understand the impact that this might have on the development of a therapeutic relationship with future patients. From my colleagues reaction and feedback, I understood how feedback is an important learning tool. Despite my discomfort during the undertaking of this task, the experience highlighted the potentially complex problems I might have to solve in the provision of care needs to patients for whom I may not have had contact with before. Analysis Administration of this clinical skill involved undertaking an assessment of my colleagues mouth before delivering any care in order to help determine the most appropriate means of delivering oral care. Malkin (2009) asserts that this is a critical component of the procedure and was one I was keen not to overlook. The World Health Organisation (WHO 2010) describes a healthy mouth as being free of chronic mouth and facial pain and in the situation described; this is the condition I found my partners mouth to be in. I was therefore happy to proceed with cleaning his teeth as instructed. I selected to use a soft bristled toothbrush and toothpaste. The use of these adjuncts are described by many writers as being the most appropriate in terms of removing plaque and preventing trauma to the gums (Holman et al 2005,McCauliffe 2007).Despite this it has been identified that they are also most often not selected by nurses who appear uncertain about most effective evidence based practice ( McAuliffe 2007). Conclusion Clearly, mouth care is important and that, nurses have a role in assessing and maintaining it (Malkin, 2009).The task identified the role of the nurse in providing encouragement to the patient whilst delivering oral care. His weakness created a sense of dependency upon me and necessitated the utilisation of good communications skills on my part to complete the task properly. It has raised my awareness the effects of nursing interventions on others within my practice. Action Plan At the moment, I read more books a day than practice. My aim is to be proactive in the future by promptly opening up through total participation and doing more practices by brushing my teeth on regular basis. I would consider brushing others also and allowing them to brush mine in order to become familiar with areas that are often not well attended to. Keeping up to date with evidence based principles of practice will be maintained through the scrutiny of journals that refer to this aspect of care. I will take care to remember my feelings when providing and receiving oral hygiene before deliverin g it to patients in the future. Recognising the potential for embarrassment and awkwardness I will ensure that I treat the patient with sensitivity and discretion at all times. Administration of medicines is a key element of nursing care (Audit commission, 2002,). Therefore, one is accountable for the administration of medicines. Description I shadowed my mentor during the process of dispensing medication and knew that my role as a student nurse, each registered nurse is accountable for his/her practice. As a student it is important to seek consent from the patient before any care is given which I did. I went to the treatment room with my mentor and prepared for medication for morning. During the process of medication there are important nursing protocol steps to follow. Firstly, I checked order, assessing client, label medication, provide information to the client, check the medication when dispensing and record in the patients prescription chart. Patient R was present and I offere d him a cup of water along with the Clozapine 300mg in another cup. Before I came in contact with the patient, I read their notes and the medication they are on. This gave me the baseline whether the patients comply with medication and the reason why they do not comply. Feelings The routine for prescribing medication may be different in various clinical settings. Although I have participated dispensing medication, I felt nervous and did not want my patient to see this as a weakness. (Butler, 1991,) warns us that when our self-talk is negative, we are carrying around toxic environment for ourselves everywhere we go. My mentor took the role to encourage me by assuring that I was doing fine, talking me throughout the procedures of medication management. I had brief knowledge about medication and this gave the opportunity for my mentor to question my knowledge about the right dose, time, route, right patient and right drug. My role as a Nurse is to record and report deterioration improv ement and takes appropriate action for his treatment to care. Patient R felt that he did not need medication because he is not mentally ill. This was a barrier because he had no insight and it leads him to deteriorate with compliance. Evaluation This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC, 2008). The (NICE, 2008,) guidelines state principles for the administration of medicines that treatment and care should take into account patients needs and preferences and patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. The staff discussed his presentation to healthcare professionals in the Muti-disciplinary team (MTD) if they could change his medication time and dose as he presents lack of motivatio n and sedation. People with schizophrenia should have the opportunity to make informed decisions, including advance decisions and advance statements, about their care and treatment, in partnership with their healthcare professionals.(NICE, 2008,) This is the importance of communication working as a team within the MDT. Analysis Administrating drug medication is one of the most critical nursing responsibilities for both legal reason and safety patients. Hand washing was important protocol the infection control policy as hands are source of infection and hand washing would break the chain of infection. Patient R is on Clozapine. The use of this atypical antipsychotic licensed to people who are resistant to or intolerant of other antipsychotic drugs due to the potentially the use of adequate dose of two different antipsychotic agent. Clozapine can lower the number of white blood cells that help to fight infection (BNF, 2008,). Before initiating Clozapine, patients should have a history and physical examination. For example, if the patient has a history of cardiac illness, it is important that you have regular blood tests. The reason behind this is because, if white blood cells count falls below accepted lower limit are classified as Red alerts medication must be withdrawn, and any other prescriber in the future wishing to restart medication are aware of the patients haematological history. Once a week I would go with the Patient to the Clozapine clinic to have blood test done and to monitor his potential side effects of psychiatric drug treatment. Patient R was presenting various side effects sedation, drowsiness which makes him less motivated to get out of bed for his medication leaving him to forgetting the mornings. Conclusion Not all non-compliant choose to reject medication; it may be because they forget to take them and this may be cognitive confusion. Intolerance of various side effects is the most common cause of clients discontinuing medication use (Tayl or et al 1997). It is important to remember that the symptoms can fall into a number of different categories, so patient like to be told their diagnosis and what is wrong with them (Blenkiron, 1998,). This area was one of my weaknesses, and I asked my mentor the importance of the Clozapine clinic and how it is associated with regular blood monitoring. I learnt that in order to attend regular visits, all patients must have normal leucocytes and different counts. Action Planà ¢Ã¢â€š ¬Ã‚ ¦ Communication Description On this occasion I was being observed and supervised by my mentor to work with a 45year old Caucasian man, with a diagnosis of paranoid schizophrenia and on section 37/41 of the Mental Health Act 1983. He has previously presented with chaotic behaviour, auditory hallucinations, delusions as well as violent and threatening behaviour. In the morning I would do my observation of the patient and make an assessment of how he presented himself to see if he had attended to his per sonal hygiene and activities of daily living. According to (Greenwood, et al 1999), patients who are in hospital satisfaction with information are found to be lacking. Feelings As a student nurse my role and responsibility by the (NMC, 2008,) is that you must respect and support peoples rights to accept or decline treatment and care. I observed that Patent R found it difficult to wake up and take his medication, which was a problem that staff nurses struggled with time to time. (Watson, 1995,) emphasise that caring communication is holistic, taking into account the entire person and demonstrating respect for the clients ad people. Evaluation Listening is the most important communication skill in nursing. (NICE, 2004), emphasis that communication between healthcare professionals and patients is essential. I learnt that if patients are encouraged to have treatment choice, they need to have information about the recommendation given before committing themselves. This is why it is impor tant that patients must be central to and include in their care. For the patients to be able to do this, it requires the nurse to use communication skills effectively, to develop therapeutic nurse-patient relationship in which the patient feels safe enough to disclose and discuss issues they find central to them and from jargon. Analysis During the shift I communicated with other members of the team on any significant events or any concerns with the patient. At the end of the shift I recorded what the patient had done for that day and I gave handover to the staff who were taking over the next shift. This was very important because it would ensure continuity of care and reduces any errors or omissions. A good example of effective communication links to medication is to give instructions and provide training involving analysis and synthesis of the learners experience. In reference to my patient (Gamble, 2004), illustrates when a person has mental health problem it can affect the indiv idual cognitive process, their beliefs, perception and outward behavior. If Patient R discontinues Clozapine he will become psychotic again and create a turmoil leaving the community and his family members in distress. Conclusionà ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. I developed my knowledge by providing leaflets about Clozapine, encourage to attend to the clinic centre which they will explain the pros and cons of Clozapine. Action Planà ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦.. General Conclusion I identified that some patients felt uncomfortable with direct question so it was important to use (Bein and Miller 1992), Open ended question. The outcome if the client-nurse interaction depends on the nurses ability to engage the client in decision making and share the control and power in the relationship (Roberts, et al 1995,). I felt that their were barrier to communication as I felt that some of the staffs attitudes made me feel as if I was not part of the team and sometimes lead to me no being able t o give my views on issues regarding patients. Although I am aware that all nurses do not use evidence in the same way and may use different methods in clinical settings. I felt that working in partnership with the patient and other health professionals can enable time to build supportive and empathetic relationship as an essential part of care. (NICE, 2008,). The process of learning I went through is more complex than Gibbs suggests. It is not as cyclical as this model implies and I found myself jumping or combining some stages, before coming back. However, it has taken me out of my comfort zone, challenging my thinking.

Exemplary Leadership

Abstract In order to be a successful leader, one must have specific virtues to qualify them as effective. This analysis examines how a leader utilizes organizational power, the magnitude to which the leader is constrained by contingency factors, how the leader deals with ethical issues, and the leader’s decision-making style and influence tactics in addition to other characteristics.The leader detailed in this analysis is proven to be effective based on certain qualities and the methods he employ to successfully reach the organization’s goal, and motivate the employees to efficiently meet their subdivision and complete organizational goals. Upon completion of this analysis, it is recommended that a study is done to assess if factors such as age, sex, heritage, etc. contribute to the type of leader one becomes. Introduction Leaders are an essential part of every organization. The quality of leaders determines the success of the organization.There are exemplary leaders, a nd there are leaders that can learn a thing or two. What is a leader? Colquitt, Lepine, and Wesson (2011) define leadership as the use of power and influence to direct the activities of followers toward goal achievement (p. 451). This analysis will chronicle an exemplary leader that many other leaders can learn from. The analysis will assess the leaders use of sources of organizational power, how the leader is constrained by contingency factors, how the leader makes decisions, his influence tactics, and how ethical issues are dealt with.Context My boss at the job that I currently hold is a prototypical leader and the example chosen for this analysis. While studying Management at Howard University, one subject that was constantly visited is what makes a proficient leader. I always wondered where all of my bosses learned their horrible leadership skills from until I crossed paths with my present boss. His kindheartedness, importable nature, and accommodating temperament raises the bar for leaders everywhere.The way he interacts with his staff makes them happy to work dexterously to meet organizations goals above what is expected. These are the behaviors that Colquitt et al states an effective leader achieves. Discussion and Analysis The Use of Organizational Power Power is the aptitude to guide the performance of other individuals and limit unwanted influence in return (Colquitt et al. , 2011). The authors stated that even if one posses the power to influence, it does not guarantee they can effectively influence.Power is made up of five facets – legitimate, reward, coercive, expert, and referent. My supervisor has the power to request that I perform tasks within the scope of his authority – legitimate, the power to extend specific resources I need and rewards I want – reward, the power to control consequences for adverse behaviors – coercive, the expertise that I depend on to get my job done and to grow within the organization  œ expert, and finally he is an individual that I’d like to be associated with in the organization – referent.He has all five facets of power as described by Colquitt et al. My supervisor exercises his rights to power in order to help the organization reach its overall goals and not to be seen as a coercive leader. He exercises legitimate power for reasonable requests such as asking me to come in earlier than my scheduled time to attend an important meeting that could only be scheduled at that time. Notice that he makes reasonable requests, meaning that he gives the option to decline if I cannot make reasonable accommodations.He exercises reward power by periodically making mention of how he intends to go about upcoming performance appraisals. This is actually a strategic method as he utilizes his reward power to remind me of what he can do, which in turn heightens the effectiveness of legitimate power as I am more prone to be submissive to his requests in order to rece ive greater rewards. My supervisor has been in the marketing field – the basis of our department – for over fifteen years, which makes him somewhat of an expert, giving him expert power.My supervisor is not a fan of coercive power, as he does not feel the need to intimidate because he effectively gets his employees to do what they need to do. He encourages his employees to obtain the results he desires. Overall, my supervisor has a great deal of power. He strategically applies his powers in order to achieve what is most important – the organizational goal. As mentioned earlier, he uses his reward and legitimate power concurrently, which is beneficial for him and his staff.His expert power has strength in that I try to use it to my advantage to acquire new talents to help me grow in this organization and any future organizations. He is well respected because of his choice to not use coercive power. Contingency Factors There are four contingencies of power, which Colquitt et al tells us are substitutability, centrality, discretion, and visibility. My supervisor is insignificantly constrained by substitutability, which is the extent to which people have alternatives in accessing resources. My organization strongly attempts to adhere to budgets previously set for the year. o stick to budgets and discretion is the degree to which managers have the right to make decisions on their own (p. 455). Centrality represents how important a person’s job is and how many people depend on that person to complete their task, and visibility is how aware people are of a leader’s powers and position. . He does not have sole control of rewards and resources. As a non-profit, my organization relies heavily on budgets and each higher manager must adhere to their budgets that must be agreed upon by the chief financial officer and president.So even with his reward power, there are limitations. His centrality contingency is not a restraint. He has a ver y important role in the organization as we rely on him significantly to bring money into the organization. I personally depend on him for the completion of many of my assignments, as he must approve many of my tasks before it is executed fully. The discretion contingency may serve as a restraint for my supervisor; while he is Vice President of Marketing, the CFO or president must approve many of his big decisions.They can then revise or rebut his decision if they feel it is necessary. The visibility contingency is not necessarily a constraint or helper to my boss. The resources he can provide are not necessarily organizational record but his title makes it known that he is above most employees and under just the CFO and president; this makes it so he still has relatively high influence. Influence Tactics Colquitt et al (2011) defines influence as the use of an actual behavior that causes behavioral or attitudinal changes in others (p. 56) or as Ceasar and Grant (2004) define as Infl uence tactics are specific types of proactive behavior used to exercise influence. The influence tactics that my boss uses are exchange, consultation, collaboration, and ingratiation. One of my supervisor’s favorite influence tactics is the exchange tactic, which is when an individual extends a reward or resource to the target with the intent for them to perform a request (p). This tactic is most common when my supervisor has projects with outsourced associates.If we are compensating someone for their expertise and we need them to start working prior to receiving payment, he will construct and send an email stating â€Å"your payment is on its way, in the meantime please†¦Ã¢â‚¬  Usually, when I am asked to complete an assignment, I am also asked how we should implement it and at that point he approves or change it somewhat. This is the consultation tactic, which is when the target – me – is allowed to participate in deciding how to carry out or implement a request (p. 457). He uses the collaboration tactic, which involves making the request easier to complete.He generally provides me with the necessary resources I need to complete the task as well making it simpler so that it is done efficiently and effectively on the first try. Ingratiation is his favorite tactic to use. Ingratiation is the use of favors, compliments, or friendly behavior to make the target feel better about the influencer (p. 457). He never fails to tell me how awesome I am, or on occasions he would tell me that he does not need to review my work because he trusts me, or explain that he gave me a task because he knew I was smart enough to handle it.Influence tactics are the medium through which managers convert power into behaviors; when managers need others to perform tasks or participate in activities, influence tactics serve as a means of facilitating individual cooperation (Ceasar & Grant, 2004). The tactics that he uses are effective and he uses them appropri ately as well. He also uses personal appeals because in his line of work, he deals with a lot of outside clients.It is beneficial for him to build relationships with people in other industries so that they are readily available to help us when we need them. All in all, the tactics my boss uses results in internalization, which involves getting the target to agree with and become committed to a request (p. 459). Ethical Issues My boss works extremely well under intense conditions and with conflicts. Just recently, we joined with a major corporation for a campaign and sought help from a board certified doctor so that the information we offered would be further validated.Prior to execution of the assignment by the doctor, he let us know that he was not satisfied with the pay and proceeded to tell the major corporation false accounts of what we told him were part of the agreement. My boss could have outright denied his claims in the same rude manner that the doctor was exemplifying. Ins tead, he apologized to the doctor for the misunderstanding and attributed his false account to miscommunication. He then asked the doctor what his normal fee was for the task he performed, and he accommodated him accordingly.He then concluded he would never use the doctor again. In this example of an ethical issue, the fault is not of my organization or my boss but that of the doctor. However, my boss handled the situation in an ethical manner when he could have very well become as unethical as the doctor. I personally respected him for his handling of the situation, as I know my initial instinct would have been to react a lot differently. Decision-Making Styles Colquitt et al talks about four decision-making styles: delegative, facilitative, consultative, and autocratic.With delegative style, a leader gives an individual employee or a group of employees the responsibility for making the decision within some set of specified boundary conditions and with facilitative style, the leade r presents the problem to a group of employees and seeks consensus on a solution, making sure his or her own opinion receives no more weight than others (p. 488). With a consultative style, the leader present the problem to an individual employees or a group, asking for their opinions and suggestions before making a decision him- or her- self and with autocratic style, the leader makes the decision alone (p. 57). My boss uses three of the four decision-making styles as he sees appropriate. For example, he would use the delegative style in a situation where he gives the staff a project. He will provide the specified conditions and then allow us to determine the way we carry out the assignment. He would use the consultative style in a situation where he may want different viewpoints about a decision he has to make to see if he explored all relevant avenues before ultimately making the decision based on his own views.He uses the autocratic style when the decision does not directly affe ct the team and he needs no further input. Transformational Vs. Transactional Leadership According to Colquitt et al (2011), transformational leadership involves inspiring followers to commit to a shared vision that provides meaning to their work while also serving as a role model who helps followers develop their own potential and view problems from new perspectives (p. 496). Transactional leadership occurs when the leader rewards or disciplines the follower depending on the adequacy of the follower’s performance (p. 98). Grant (2012) defines transformational leadership as a central purpose to articulate a vision that focuses employees’ attention on their contributions to others. He states that this form of leadership motivate employees to perform more effectively. My boss is a transformational leader. Not only is he great at inspiring his staff to commit to a shared vision, he makes sure that their work is worth their while. He continually asks if our work is suffici ent and challenging enough because he does not want us to become bored.In addition, he gives us tasks that may go beyond our duties just to develop us into more valuable professionals. He gives us leeway to execute our tasks in a manner that is most comfortable to us while giving his input when we ask or when he sees it is necessary. He does not micro-manage and puts more focus on making us better employees so we can help him with our current skills while learning new skills to be more of a help in the future. Neutralizers Vs. Substitutes Neutralizers, as Colquitt et al (2011) explains, reduce the importance of the leader but have no beneficial impact on performance (p. 05). Substitutes reduce the importance of the leader while providing a direct benefit to employee performance. My supervisor’s effectiveness is rarely affected by substitutes. Because our organization is small, outside staff is less likely able to help us because each department has its specialty. Staff could gain experience that will lessen the extent to which they need the manager’s help but could never alleviate it completely because he is the provider of the tasks. Neutralizers are also minimal. There is task stability, formalization, and spatial distance, but inflexibility is not a factor.For the most part there are tasks that are unchanging and daily and there are written instructions for many of the tasks. Also, all leaders have offices and therefore there is spatial distance. Impact My supervisor has a major impact on performance and commitment in a positive way. His personality and leadership techniques make it so he is a pleasant person to work for. He governs over his employees just enough to make sure the work is done while giving enough space for them to be creative and comfortable. His behaviors definitely influence commitment because it is rare to find a boss of this caliber.Conclusions and Reflections I have always viewed my boss as a great boss. I never had the op portunity to think of why he was such a great boss. This assignment allowed me to do just that. And from my research, I found that my boss has virtually everything that makes a boss a great one from his personality to leadership skills. I have always had the attitude that I want to work for myself because most bosses were not very nice people. While I still desire to work for myself, I would not mind working with a boss like mine and now know that all bosses are not horrible people.I desire to be the exact type of boss that my boss is because his methods are effective. After taking the initiation and consideration assessment, I found that my score for initiating was considered low and the score for consideration was considered high. That coincides with the way I think I would lead. I would care about more about input from group members and their comfort than being more autocratic as a high initiative score would indicate. I would be interested in further researching if certain chara cteristics attribute to the sort of boss a person becomes such as gender, race, age, etc.References Colquitt, J. , Lepine, J. , Wesson. M. (2011). Organizational Behavior: Improving Performance and commitment in the workplace. New York, NY: McGraw-Hill Gardner, W. L. , & Ceasar, D. (2004). Transition to Self-Directed Work Teams: Implications of transition time and self-monitoring for managers' use of influence tactics. Journal Of Organizational Behavior, 25(1), 47-65. Grant, A. M. (2012). Leading with Meaning: Beneficiary contact, prosocial impact, and the performance effects of transformational leadership. Academy Of Management Journal, 55(2), 458-476.

Island of the Sequined Love Nun Chapter 54~55

54 Selling Tucker The Sky Priestess threw the straw hat across the room, then tore at the high-buttoned collar of the white dress. She was losing him. She hated that more than anything: losing control. She ripped the dress down the front and wrestled out of it. She stormed across the room, the dress still trailing from one foot, and pulled a bottle of vodka from the freezer. She poured herself a tumbler and drank half of it off while still holding the bottle, then refilled the glass while her temples throbbed with the cold. She carried the bottle and glass to a chair in front of the television, sat down, and turned it on. Nothing but static and snow. Sebastian was using the satellite dish. She threw the vodka bottle at the screen, but missed and it bounced off the case, taking a small chip out of the plastic. â€Å"Fuck!† She keyed the intercom next to her chair. â€Å"‘Bastian! Dammit!† â€Å"Yes, my sweet.† His voice was calm and oily. â€Å"What the fuck are you doing? I want to watch TV.† â€Å"I'm just finishing up, sweetheart.† â€Å"We need to talk.† She tossed back another slug of vodka. â€Å"Yes, we do. I'll be up in a moment.† â€Å"Bring some vodka from your house.† â€Å"As you wish.† Ten minutes later the Sorcerer walked into her bungalow, the picture of the patrician physician. He handed her the vodka and sat down across from her. â€Å"Pour me one, would you, darling?† Before she could catch herself, she'd gotten up and fetched him a glass from the kitchen. She handed it to him along with the bottle. â€Å"Your dress is torn, dear.† â€Å"No shit.† â€Å"I like the look,† the Sorcerer said, â€Å"although I'd have preferred to tear it off you myself.† â€Å"Not now. I think we have trouble.† The Sorcerer smiled. â€Å"We did, but as of tonight at midnight, our troubles are over. How was your walk this morning, by the way?† â€Å"I took Case to see the shark hunt. I thought it would keep him from getting island fever, something different to break the boredom.† â€Å"As opposed to fucking him.† She wasn't going to show any surprise, not after he'd laid a trap like that. â€Å"No, in addition to fucking him. It was a mistake.† â€Å"The shark hunt or the fucking?† She bristled, â€Å"The shark hunt. The fucking was fine. He saw the boy whose corneas we harvested.† â€Å"So.† â€Å"He freaked. I shouldn't have let him connect the people with the procedure.† â€Å"But I thought you could handle him.† He was enjoying this entirely too much for her taste. â€Å"Don't be smug, ‘Bastian. What are you going to do, lock him in the back room of the clinic? We need him.† â€Å"No, we don't. I've hired a new pilot. A Japanese.† â€Å"I thought we'd agreed that†¦Ã¢â‚¬  â€Å"It hasn't worked using Americans, has it? He starts tonight.† â€Å"How?† â€Å"You're going to go pick him up. The corporation assures me that he's the best, and he won't ask questions.† â€Å"I'm going to pick him up?† â€Å"We have a heart-lung order. You and Mr. Case need to deliver it.† â€Å"I can't do it, ‘Bastian. I can't do a performance and a heart-lung tonight. I'm too jangled.† â€Å"You don't have to do either, dear. We don't have to do the surgery. We'll make less money on it, but we only have to deliver the donor.† â€Å"But what about doing the choosing?† â€Å"You've done that already. You chose when you went to bed with our intrepid Mr. Case. The heart-lung donor is Tucker Case.† Tuck needed a drink. He looked around the bungalow, hoping that someone had left a stray bottle of vanilla extract or aftershave that might go well with a slice of mango. Mangoes he had, but anything containing ethyl alco-hol was not to be found. It would be hours before darkness could cover his escape to the drinking circle, where he intended to get gloriously hammered if he could look any of the Shark People in the eye and keep his stomach. Sorry, you guys. Just had to take the edge off of the guilt of blinding a child to get my own airplane. He tried to distract himself by reading, but the moral certainties of the literary spy guys only served to make him feel worse. Television was no help either. Some sort of Balinese shadow puppet show and Filipino news special on how swell it was to make American semiconductors for three bucks a day. He punched the remote to off and tossed it across the room. Frustration leaped out in a string of curses, followed by â€Å"All right, Mr. Ghost Pilot, where in the hell are you now?† And there was a knock on the door. â€Å"Kidding,† Tuck said. â€Å"I was kidding.† â€Å"Tucker, can I come in?† Beth Curtis said. â€Å"It's open.† It was always open. There was no lock on it. He looked away as she entered, afraid that, like the face of the Medusa, she might turn him to stone – or at least that part of him unaffected by conscience. She came up behind him and began kneading the muscles in his shoulders. He did not look back at her and still had no idea if she might be naked or wearing a clown suit. â€Å"You're upset. I understand. But it's not what you think.† â€Å"There's not a lot of room for misinterpretation.† â€Å"Isn't there? What if I told you that that boy was blind from birth. His corneas were healthy, but he was born with atrophied optic nerves.† â€Å"I feel much better, thanks. Kid wasn't using his eyes, so we ripped them out.† He felt her nails dig into his trapezius muscles. â€Å"Ripped out is hardly appropriate. It's a very delicate operation. And because we did it, another child is able to see. You seem to be missing that aspect of what we're doing here. Every time we deliver a kidney, we're saving a life.† She was right. He hadn't thought about that. â€Å"I just fly the plane,† he said. â€Å"And take the money. You could have this same job back in the States. You could be flying the organs of accident victims on Life Flight jets and accomplishing the same thing, except you wouldn't be making enough to pay the taxes on what you make here, right?† No, not exactly, he thought. Back in the States, he couldn't fly anything but a hang glider without his license. â€Å"I guess so,† he said. â€Å"But you could have told me what you were doing.† â€Å"And have you thinking about the little blind kid at five hundred miles per hour. I don't think so.† She bent over and kissed his earlobe lightly. â€Å"I'm not a monster, Tuck. I was a little girl once, with a mother and a father and a cat named Cupcake. I don't blind little kids.† Finally he turned in the chair to face her and was grateful to see that she was wearing one of her conservative Donna Reed dresses. â€Å"What happened to you, Beth? How in the hell do you get from ‘Here, Cupcake' to the Murdering Bitch Goddess of the Shark People?† He immediately regretted saying it. Not because it wasn't true, but because he'd given away the fact that he knew it was. He braced himself for the rage. She moved to the couch and sat down across from him. Then she curled into a ball, her face against the cushions, and covered her eyes. He said nothing. He just watched as her body quaked with silent sobs. He hoped this wasn't an act. He hoped that she was so offended that she would take his murder accusation for hyperbole. Five full minutes passed before she looked up. Her eyes were red and she'd managed to smear mascara across one cheek. â€Å"It's your fault,† she said. Tuck nodded and tried not to let a smile cross his lips. She was playing another part, and she didn't do the victim nearly as well as she did the seduction queen. He said, â€Å"I'm sorry, Beth. I was out of line.† She seemed surprised and broke character. Evidently, he'd stepped on her line, the one she'd been thinking of while pretending to cry. A second for composure and she was back at it. â€Å"It's your fault. I only wanted to have a friend, not a lover. All men are that way.† â€Å"Then you must not have gotten the newsletter: ‘Men Are Pigs.' Next issue is ‘Water Is Wet.' Don't miss it.† She fell out of character again. â€Å"What are you saying?† â€Å"You might have been a victim once, but now that's just a distant memory you use to rationalize what you do now. You use men because you can. I can't figure out what happened in San Francisco, though. A woman who looks like you should have been able to find an easier way to fuck her way to a fortune. The doc must have been a cakewalk for you.† â€Å"And you weren't?† Tuck felt as if someone had injected him with a truth serum that was lighting up his mind, and not with revelations about Beth Curtis. The light was shining on him. â€Å"Yeah, I guess I was a cakewalk. So what? Did you think for a minute that you might try not to go to bed with me? â€Å"Other than when I found out that you'd almost torn your balls off, not for a minute.† She was gritting her teeth. â€Å"And how big a task do you think you took on? It's not like you were corrupting me or anything. I've been on the other end of the game for years. I know you, Beth. I am you.† â€Å"You don't know anything.† She was visibly trying not to scream, but Tuck could see the blood rising in her face. He pushed on. â€Å"Freud says I'm this way because I was never hugged as a child. What's your excuse?† â€Å"Don't be smug. I could have you right now if I wanted.† As if to prove her point, she placed her feet at either end of the coffee table and began to pull up her dress. She wore white stockings and nothing else underneath. â€Å"Not interested,† Tuck said. â€Å"Been there, done that.† â€Å"You're so transparent,† she said. She crawled over the table and did a languid cat stretch as she ran her hands up the inside of his thighs. By the time her hands got to his belt buckle, she was face-to-face with him, almost touching noses. Tuck could smell the alcohol on her breath. She flicked her tongue on his lips. He just looked in her eyes, as cold and blue as crystal, like his own. She wasn't fooling anyone, and in realizing that, Tuck realized that he also had never fooled anybody. Every Mary Jean lady, every bar bimbo, every secretary, flight attendant, or girl at the grocery store had seen him coming and let him come. Beth unzipped his pants and took him in her hand, her face still only a millimeter from his, their eyes locked. â€Å"Your armor seems to have a weak spot, tough guy.† â€Å"Nope,† Tuck said. She slid down to the floor and took him into her mouth. Tuck suppressed a gasp. He watched her head moving on him. To keep himself from touching her he grabbed the arms of the chair and the wicker creaked as if it was being punished. â€Å"That's a pretty convincing argument,† said the male voice. Tuck looked up to see Vincent sitting on the couch where Beth had been a minute ago. â€Å"Jesus!† Tuck said. Beth let out a muffled moan and dug her nails into his ass. â€Å"Wrong!† Vincent said. â€Å"But never play cards with that guy.† The flyer was smoking a cigarette, but Tuck couldn't smell it. â€Å"Oh, don't worry. She can't hear me. Can't see me either, not that she's looking or anything.† Tuck just shook his head and pushed up on the arms of the chair. Beth took his movement for enthusiasm and paused to look up at him. Tuck met her gaze with eyes the size of golf balls. She smiled, her lipstick a bit worse for the wear, a string of saliva trailed from her lips. â€Å"Just enjoy. You lost. Losers flourish here.† She licked her lips and returned to her task. â€Å"Dame makes a point,† Vincent said. â€Å"I give you three to one she brings you around to her way of thinking. Whatta ya say?† â€Å"No.† Tuck waved the flyer off and shut his eyes. â€Å"Oh, yes,† Beth said, as if speaking into the microphone. Vincent flicked his cigarette butt out the window. â€Å"I'm not distracting you, am I? I just dropped in to take up on the dame's side, as she is unable to speak for herself at present.† Tuck was experiencing the worst case of bed spins he'd ever had – in a chair. Sexual vertigo. â€Å"Of course,† Vincent continued, â€Å"this is kinda turning into a religious experience for you, ain't it? Go with what you know, right? You let her run the show, you got no decisions to make and no worries ever after. Not a worry in the world. You got my word on that. Although, if it was me, I'd check out her story just to be safe. Look in the doc's computer maybe.† Beth was working her mouth and hands like she was pumping water on an inner fire that was consuming her with each second that passed. Tuck heard his own breath rise to a pant and the wicker chair crackle and creak and skid on the wooden floor. He was helping her now, wanting her to quench that flame and that was all there was. â€Å"You think about it,† Vincent said. â€Å"You'll do the right thing. You owe me, remember.† He faded and disappeared. â€Å"What does that mean?† Tuck said, then he moaned, arched his back, and came so hard he thought he would pass out, but she kept on and on until he couldn't stand the intensity and had to push her away. She landed on the floor at his feet and looked up like an angry she-cat. â€Å"You're mine,† she said. She was still breathing hard and her dress was still up around her waist. â€Å"We're friends.† It came out like a command, but Tuck heard a note of desperation below the panting and the ire, and he felt a wrenching pain in his chest like nothing he'd ever felt before. â€Å"I know you, Beth. I am you,† he said. But not anymore, he thought. He said, â€Å"Yes, we're friends.† She smiled like a little girl who'd been given a pony for her birthday. â€Å"I knew it,† she said. She climbed to her feet and smoothed down her skirt, then bent and kissed him on the eyebrow. He tried to smile. She said, â€Å"I'll see you in a few hours. We're flying out at nine. I have to go see to Sebastian.† Tuck zipped up his pants. â€Å"And get ready for your performance?† he said. â€Å"No, this isn't a medical flight. Just supplies.† Tuck nodded. â€Å"Beth, was that little boy blind from birth?† â€Å"Of course,† she said, looking offended. She was more convincing as the Sky Priestess. â€Å"You go see to Sebastian,† Tuck said. After she had left, Tuck looked at the ceiling and said, â€Å"Vincent, just in case you're listening, I'm not buying your bullshit. If you want to help me, fine. But if not, stay out of my way.† 55 Pay No Attention to That Man Behind the Computer Tuck went into the bathroom and washed his face, then combed his hair. He studied his face in the mirror, looking for that scary glint that he'd seen in Beth Curtis's eyes. He wasn't her. He wasn't as smart as she was, but he wasn't as crazy either. He cringed with the realization that he had spent most of his adult life being a jerk or a patsy and sometimes both simultan-eously. And it was no small irony to have had an epiphany during a blow job. Vincent, whatever he was, had been playing some kind of game from the beginning, mixing lies and truth, helping him only to get him into trouble. There was no grand bailout coming, and if he was going to find out what was really being planned for him, he had to get into the computer. The best time to sneak into the clinic was right now, in broad daylight. He hadn't seen any of the guards all day and Beth was â€Å"seeing to Sebastian.† If he got caught, he'd simply say he was trying to get the weather for to-night's flight. If the doc could e-mail and fax all over the world, then surely he would have access to weather services. It didn't matter; he didn't think he'd have a hard time convincing the doc that he was just being stupid. His entire life had set up the cover. He grabbed some paper and a pencil from the nightstand and stuffed them into his back pocket. While he was in there, he might as well see if he could pick up the coordinates for Okinawa. If he could sneak them into the nav computer on the Lear, he might just be able to get the military to force the jet down there. He didn't have a chance in hell of getting there on his own navigational skills. He stepped out on the lanai and gave a sidelong glance to the guards' quarters to make sure no one was just inside the door watching his bungalow. Satisfied, he walked to the clinic and tried the door. It was unlocked. He checked the compound again, saw nothing, and slipped into the clinic. He was immediately met by the sound of voices coming from the back room. Male voices, speaking Japanese. He tiptoed through the door that led into the operating room and opened it a crack. The door to the far side was open. He could see all the ninjas gathered around one of the hos-pital beds playing cards. It was visiting day for Stripe. He palmed the door shut and went to the computer. There had been a time when Tuck was so ignorant of computers that he thought a mouse pad was Disney's brand of sanitary napkin, but that was before he met Jake Skye. Jake had taught him how to access the weather maps, charts, and how to file his flight plans through the computer. In the process Tuck had also learned what Jake considered the most important computer skill, how to hack into someone else's stuff. The three CRTs were all on, two green over black and one color. Tuck focused on the color screen. It was friendlier and it was displaying a screen saver he recognized, a slide show of dolphins. He moved the mouse and the familiar Windows screen appeared. There was a cheer from the back room and Tuck nearly drove the mouse off the top of the desk. Must have been a good hand. He expected to see obscure medical programs, something he'd never figure out, but it looked like the doc used the same stuff everyone in the States did. Tuck clicked on the database icon and the program jumped to fill the screen. He opened a file menu; there were only two. One was named SUPPLIES, the other TT. Tissue types? He clicked it. The ENTER PASSWORD field opened. â€Å"Shit.† Jake had always told him that people used obvious passwords if you knew the people. Something they wouldn't forget. Put yourself in their place, you'll figure out their passwords, and don't eliminate the possibility that it may be written on a Post-it note stuck to the computer. Tuck looked for Post-it notes, then open the desk drawers and riffled through the papers for anything that looked like a password. He pushed out the chair and looked under the desk. Bingo! There were two long numbers written on tape on the bottom of the desk drawer. He pulled the paper and pencil from his pocket and copied them down, then entered the first one in the password field. was the response Tuck typed in the second number. Look for the obvious. Tuck typed SKY PRIESTESS. The guards were laughing in the other room. Tuck typed in VINCENT. DOCTOR. It would be something that the doc would be sitting here thinking about. It would be on his mind. Tuck typed BETH. BETHS TITS. Wait a minute. This was the doc thinking. He typed BETHS BREASTS. The file scrolled open, filling the screen with a list of names down the left side followed by rows and columns of letters and numbers. All of the names Tuck could see were native. Across the top were five columns that must be the tissue types and blood types, next to those, kidney, liver, heart, lung, cornea, and pancreas. Christ, it was an inventory sheet. And the heart, lung, liver, and pancreas categories convinced him once and for all that there was no benevolent intention behind the Curtises' plan. They were going to the meat market with the Shark People until the village was empty. Tuck typed in SEPIE in the FIND field. An X had been placed in all the organ categories except kidney. There he found an H and a date. H? Har-vested. The date was the day they harvested it. He typed in PARDEE, JEFFERSON. No â€Å"x's† in any of the columns, but two H's under heart and lungs. Of course the other organs weren't marked. They'd been donated to the sharks and were no longer available. There was nothing under SOMMERS, JAMES. That too made sense. How would they get the organs to Japan without a pilot. Tuck wished he'd gotten the little blind boy's name. He couldn't take the time to scroll though all three hundred or so names looking for missing corneas. He typed in CASE, TUCKER. There were H's marked under the heart and lung category. The harvest date was today. â€Å"You fuckers,† he said. There was a shuffling in the back room and he stood so quickly the chair rolled back and banged into a cabinet on the other side of the office. The database was still up on the screen. Tuck reached out and punched the button on the monitor. It clicked off as Mato came through the door. â€Å"What are you guys doing here?† Tuck said. Mato pulled up. He seemed confused. He was supposed to be doing the yelling. â€Å"We're flying tonight,† Tuck said. â€Å"Do you guys have the plane fueled up?† Mato shook his head. â€Å"Then get on it. I wondered where you were.† Mato just looked at him. â€Å"Go!† Tuck said. â€Å"Now!† Mato started to slink toward the door, obviously not comfortable with leaving Tuck in the clinic. Another guard came into the office and when Mato looked up, Tuck snatched his paper and pencil from the desk. He dropped the pencil and when he bent to pick it up, he hit the main power switch on the computer. The computer would reboot when turned on and the doctor would only know that it had been turned off. He'd never suspect that someone had been into the donor files. â€Å"Let's go, you guys.† Tuck pushed past Mato out the office door, shoving the paper in his pocket as he went. Tuck made quite a show of the preflight on the Lear, demanding three times that the guard with access to the key to the main power cutoff turn it on so he could check out the plane. The guard wasn't buying it. He walked away from Tuck snickering. Tuck checked under the instrument panel. Maybe there would be some obvious way to hot-wire the switch. He'd been lucky with the computer. The switch and all the wires leading into it were covered by a steel case. He couldn't get into it with a blowtorch, and frankly, he had no idea which wires did what. It probably wasn't even a simple switch, but a relay that lead to another switch. There'd be no way to wire around it. He left the hangar and went back to his bungalow. Unless he found some way to get off the island, he was going to be short a couple of lungs and a heart come midnight. Beth would have at least one guard on the plane with her, probably two, given the circumstances. And he had no doubt that she'd shoot him in the crotch and make him fly to Japan anyway. There had to be another way. Like a boat. Kimi's boat. Didn't these guys travel thousands of miles over the Pacific in canoes like that? What could the doc do? He'd been so careful about safeguarding the island that the guards didn't even have a boat to chase him with. Tuck put on his shorts and took his fins and mask to the bathroom. He knotted the ends of his trouser legs and started filling them with supplies. A shirt, a light jacket, some disinfectant, sunscreen, a short kitchen knife. He found a small jar of sugar in the kitchen, dumped the sugar into the sink, and filled the jar with matches and Band-Aids. When he was ready to seal it, he saw the slip of paper he'd written on in the office sticking from the pocket of the trousers and shoved it into the jar as an afterthought. He topped off the pants bag with a pair of sneakers, then pulled the webbed belt tight to cinch it all up. He could swim with the pants legs like water wings. The wet clothing would get heavy, but not until he hit the beach on the far side of the minefield. To Tuck's way of thinking, once he was past the minefield he was halfway there. Then all he had to do was convince the old cannibal to give him the canoe, enough food and water to get somewhere, and Kimi to navigate. Where in the hell would they go? Yap? Guam? One step at a time. First he had to get out of the compound. He checked the guards' positions. Leaning out the window, he could see three – no, four – at the hangar. He waited. He'd never tried to make the swim while it was still light. They'd be able to see him in the water from as far away as the runway. He just had to hope that they didn't look in that direction. The guards were rolling barrels into the hangar to hand-pump the jet fuel into the Lear. Two on each barrel, four out in the compound, bingo. One guy had to be in the hangar cranking the pump. And Stripe was in the clinic. Showtime! Tuck went into the bathroom, lifted the hatch, threw down the pants bag and his swimming stuff, and followed it through. He weighed sneaking against running, stealth against speed, and decided to go like a newborn turtle for the water. The only people who might see him were the Doc and Beth, and they were probably in the process of pushing the twin beds together and doing the Ozzie and Harriet double-skin sweat slap – or whatever sort of weird shit they did. He hoped it was painful. He broke into a dead run across the gravel, feeling the coral dig at his feet and the ferns whip at his ankles but keeping his focus on the beach. As he passed the clinic, he thought he saw some movement out of the corner of his eye, but he didn't turn. He was Carl Lewis, Michael Johnson, and Edwin Moses (except he was white and slow), a single head turn could cause him to lose his stride and the race – and boy, does that beach seem farther when you're running than when you're sneaking. He almost tumbled when he hit the sand, but managed a controlled forward stumble that put him face-first in four inches of water. The baby turtle had made it to the water, but now he faced a whole new set of dangers at sea, not the least of which was trying to swim with a pair of stuffed khakis around his neck. He kicked a few feet out into the water, put on his fins and mask, and began the swim. He'd been furious from the moment he heard the pilot's voice in the clinic and he had fought the cloud of painkillers and the pressure in his head to get to him. Yamata watched the pilot stumble into the water before he tried shouting for the others. The shout came out little more than a grunt through his wired jaw, and his crushed sinuses allowed little sound to pass through his nose. His gun was in the guards' quarters, the others were at the hangar, and his hated enemy was escaping. He decided to go for his gun. The others might want to take the pilot alive.

Difference in Salaries between Male and Female Chefs

â€Å"If you want to become a great chef, you have to work with great chefs. And that’s exactly what I did†(Gordon Ramsay Quote†). Gordon Ramsay said to become a great chef you have to work with great chefs he never said you had to be a male or female. Its shouldn’t matter about their genders. So why do female chefs get paid so little and male get paid way more ? â€Å"Nation’s Restaurant News found out male executive chefs was $17,950 higher than female executive chefs $68,000 V.S. $50,050†(Coomes). Theres so many reasons female chefs should get paid as much as male chefs. Male shouldn’t be the only ones shining , female should be able to shine too. Female chefs should be paid as much as male chefs because it shouldn’t matter the gender and they are doing exactly the same thing. In general female get paid so little and male get paid so much more . This will be including female chefs in the food industry. According to Bloomberg.c om â€Å"Women hold just 6.3 percent of head chef positions in the u.s , according to a survey of 15 prominent restaurant group. And while female workers make up a majority of food service employee - and up to 40 percent of graduates from some of the country’s top cooking school - government data shows there’s currently a larger percentage of female CEOs in the u.s. than head chefs†(). Females and males should be treated and paid equal. Womans are not always going to depend on a male. So how will people like female survive If they get paid so little?Show MoreRelatedGender Inequality : Sports And Women s Professional Level Of Sport1469 Words   |  6 Pagescleaners, and the chef. Whereas men are perceived as strong, independent, and athletic. When these social norms are broken, it is not uncommon for specific labels to be given, such as being called a lesbian. 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