The Art of the Life and Death Deal

Hi Donald - I am once again delighted to introduce a guest contributor - nurse extraordinaire Laura Jansen. Take it away, Laura!

Dear Mr. Trump,

You have sold many copies of a book in which you offer insights into how to make advantageous business deals, and I can offer you no additional help with maximizing profits in a negotiation. In my own profession of emergency nursing, we make deals with much higher stakes - life and death deals. Every nurse, doctor, and medical technician can tell you about the experience of both succeeding and failing to save lives, and what it means to be a part of a team that makes the preservation of life their regular job. My personal perspective, and the one I would like to share with you, is that of overseeing the resources that those frontline responders need to be able to save lives around the clock.

You see Mr. Trump, as president you will not be asked to hold pressure on the amputated extremity of a soldier injured by an explosive device - but my colleagues in the military are going to be doing just that. You are not going to be asked to distribute clean water to a community damaged by disaster, but my counterparts in disaster response are constantly prepared to take on that role. We will all serve under you, and we will all depend on you to be compassionate and decisive when deploying personnel and supplies to places that need them desperately. We will depend on you to make the right deals in life and death situations.

My specific role in emergency medicine is to coordinate the actions of the staff working during my shifts. When 62 people are suffering in our waiting area, and two beds open up, it is my job to decide who will get to a bed and who will continue to wait 9, 11, 15 hours in a crowded waiting room. My workplace is better resourced than many, so no one who is critically hurt or ill will ever wait long to get help - and yet even with everything we have, there are many times when demand drastically exceeds the physical space and human resources available to meet our patients’ needs.

Mr. Trump, you are a wealthy individual. However, your personal wealth is not large enough to lift all of America out of poverty and suffering. You will be given a massive amount of resources as president. However, even if you re-distributed our entire federal budget to health and housing, you might still fall short of meeting your promises to voters that you will improve their communities and offer them a great future. The truth is Mr. Trump, during your presidency both military and civilian lives are going to be lost because of choices you make. This is unavoidable, but it is painful, and if you haven’t thought about what it will feel like, now is a good time for that. They’re not just “life” deals, Mr. Trump – there’s going to be some death too.

In the past, you have “won” in your professional life by accumulating wealth from your business ventures. During your presidency, accumulating wealth for one group will not be viewed as a “win” by citizens who lose home, family, or life. You are tasked with protecting every one of us. We will not understand when tax breaks for the wealthy fail to create jobs for the unemployed. We will not accept an increase in catastrophic weather events in exchange for continued fossil fuel utilization. We will not be grateful for stock market growth at the expense of a reduction in social security benefits or access to health care. For every solution you propose we will have 60 more problems, and we will consider every one of them to be life and death - because for someone in our country, they will be exactly that. So, as someone whose whole job is to stretch scarce resources to meet the needs of many, I offer you two pieces of advice when making life and death deals:

First, never turn away information brought to you by someone advocating for the relief of suffering. It is easy to become overwhelmed by people rushing up to you when you know that you cannot immediately give them what they want. However, you make the best decisions when you have all the best information available. You cannot be in all places at once. You will need reliable chains of people reporting to you so that you are never under-informed about the problems you face. The quality of the information you receive is directly linked to the quality of the work you will do, so value the people collecting your information for you as highly as possible. This is why we are all so interested in the cabinet members you select this month.

Second, if you aren’t constantly altering your plans in order to meet every need that arises - you’re not doing your job. Nobody knows what will happen tonight, next month or throughout the next 4 years. Excellent, brave, talented, smart and generous Americans will be at the ready every minute of every day to serve our country, your administration, and one another. We are capable of great things. We will need you to always be alert enough to adapt to the needs of each day, and never too proud to alter course if situations change and new priorities are required. I’m afraid you aren’t going to get much time off. The direction you point us and the instructions you give will determine your place in history. I can tell you that some days you will wish that your role could be more glorious. Some days you will want to trade places with the person holding pressure on a bleeding soldier’s leg, rather than being the person trying to convince Congress to fund that soldier’s rehab needs months later. Making life and death deals is going to age you terribly. But if you are ready for the biggest challenge you have ever taken on, myself and others will advise and assist you however we can.

Sincerely,

Laura Jansen, RN, BSN, CEN

PS - Donald, I wish you knew Laura better - if you did, you would appreciate how valuable her advice is to you. She is one of the best nurses I have ever worked with, and her ability to meld decisiveness with compassion is nothing short of inspiring. I wish that I were half the medical professional that she is!