Tuesday, April 22, 2014

A Healthcare Rant

I've had occasion to think a lot about our system of health care lately. Bubba is doing a big project at work for a new client that revolves around prevention and healthcare education and I love kicking around ideas with him on our evening walks, especially because I love that this giant organization is thinking in this way. The questions are huge and the obstacles seem enormous, but so do the implications if they can find a way to pull it off.

With 8 million people and counting signed up for the Affordable Healthcare Act, as a country we need to get it together with respect to the way we deliver (and even think about) healthcare.  In Washington state, the number of folks eligible for the Medicaid expansion has outpaced their wildest imaginations and it is increasingly becoming obvious that we need a new game plan in order to serve these people. Many providers refuse to take Medicaid and even Medicare because the reimbursements are so paltry compared to private insurers and there is a big question looming about whether or not we'll be able to find enough qualified practitioners to treat these new patients.

While we may utter the word "prevention" a lot with regards to health, the simple fact is that the vast majority of people don't truly understand what that means or how to put it in play in their own lives.  Yes, we all pretty much know that our lives will be better if we get enough sleep, manage our stress, eat healthy, exercise and don't smoke or do drugs, but actually knowing how to implement those things regularly and effectively is tremendously difficult.  When so many people, especially those newly eligible for health insurance, are struggling to pay the rent every month, finding the time to locate honest resources where they can educate themselves about what healthy food is or learning effective stress-management techniques is pretty far down on the list of priorities.

So where do most people get their information about health care? Not from their physician, it turns out, because as a system, our health care priorities lie in treatment of symptoms and deployment of technology, not conversation.  Doctors get paid to write prescriptions and schedule surgeries or diagnostic tests, not to sit with their patients for an hour at a time and help them understand how to read a food label or coach them in relaxation techniques or set up a viable exercise plan.  And while there are some physicians who take the time to really listen to their patients and explain things in depth, it isn't always easy to remember exactly what they said once you leave the office.  Yes, it is possible to find people who will teach us about nutrition and stress management and exercise, but they are rarely paid by insurance companies and most people can't afford their services.  Why don't we make it part of our health education to offer those services in the doctor's office as part of the care? The first real nutrition education my mother got from her healthcare provider was a class on how to eat after being diagnosed with diabetes. Helpful, but maybe classes on how to avoid diabetes in the first place would have been better, given that now Medicare pays hundreds of dollars for prescriptions every month that might have been unnecessary.

I predict that, thanks to the ACA, many healthcare providers will find themselves overwhelmed by a glut of new patients with complicated health histories. There are some who are relatively young and healthy who have signed up for coverage and may choose to establish a relationship with a physician, but there will be many more who have suffered with chronic conditions for years because they couldn't afford to have someone treat them.  It is here where the rubber meets the road and, I think, the issue that will prove to be the stickiest for this much-needed leap forward in our healthcare system.  A doctor who sees a middle-aged person with multiple complaints that have been ongoing for years will be hard-pressed to find enough time for a comprehensive introductory examination that can unravel years of health issues. Most of these patients will end up leaving their first doctor's appointment in years with a fist-full of prescriptions that may or may not make a significant difference in their long-term health, and will more likely treat symptoms instead of causes. Additionally, if the fee schedules don't change, the folks who have to pay for some portion of their prescriptions may find themselves unable to afford the treatments they've been offered.  Without some effort to integrate these individuals into a system that educates them and offers them someone to collaborate with when it comes to preserving their health or reversing chronic conditions, we are destined to continue to have the most inefficient, expensive healthcare system in the nation, albeit one that is covering more folks than ever before.  Until we revamp our priorities by paying more for consultations and less for quick-fix deployment of technologies like surgery or prescriptions, we can never hope to turn the tide from treatment to prevention. We will always be playing catch-up and we will never catch up to our national obsession with fast food and sugar and vapor cigarettes as a viable alternative to regular cigarettes, because we haven't been educated by people who have credibility, with whom we have an ongoing relationship. We have to enlist our healthcare providers as educators and partners and pay them to work with patients to keep them healthy and help them make good choices instead of giving them incentives to do expensive surgeries and prescribe drugs that treat symptoms. Until we are willing to turn our attentions from quick-fix ideas to long-term prevention strategies, we are doomed to continue down this path of being one of the unhealthiest countries in the world. With some of the most educated healthcare workers in the world, it is an absolute tragedy that this is the situation we find ourselves in, but if we choose to use doctors and nurses as collaborators instead of auto mechanics, we can make a difference.



Thursday, April 17, 2014

Spring Break's Gifts and Challenges

Spring Break. That's why it's been a while since I wrote anything.  It is this particular week that both strikes fear in to my heart for the coming summer (and having the girls around all day every day) and thrills me because I get to hang out with my girls and do things like walk the dog and read books in the sunshine and bake cookies.  This week has been a perfect window in to just that. And now that it's Thursday, I'm ready for them to go back to school. And I have no idea how I'm going to survive summer.  None.  I will certainly have to be more diligent about carving out time to write (and read) if I am to preserve what little portion of sanity I have left.

One incredibly bright beacon this week came thanks to Kris Prochaska and her talents.  Kris is a counselor by training who has built a practice around helping people decipher what she calls their "human design," in an effort to optimize the way they work and live in the world.  I wrote about one session with her last November where I had a multitude of "a-ha" moments and, following that, I became interested in seeing if she could help my girls navigate the treacherous waters of adolescence.  I pulled up our Human Design Charts (a mixture of information based on chakras and the zodiac and the I-Ching, among other things) and asked Kris to work with Lola first.  On Tuesday, she spent a little more than two hours with us helping Lola understand what Kris calls the blueprint of her personality in order to better understand how she can most effectively make good decisions that are in alignment with her design.  Kris explains it better on her site:
"In every case, when I am talking with my clients about miscommunication with their family, stress around money and marketing, and feeling overwhelmed around their calendar it boils down to the initial decision and commitment they made.  Invariably they say something like “how did I get in this AGAIN?” And we look at the energy and emotion behind the decision and realize they were making the decision and commitment from their little voices of fear, doubt, shame and lots of guilt.  Ugh.  No wonder stress and overwhelm is there.
Sometimes it’s not so much the little voices that are pulling us this way or that, but rather living out of alignment with how we are uniquely designed as individuals to manage our energy, communicate our message, or commit to the next business venture.All of your results stem from the moment you choose a course of action and how you approach that choice emotionally and energetically.  Wouldn’t it be prudent (and totally freakin’ powerful!) to know exactly what voices are making those choices, and how you best listen to the only voice that you need ever heed: your Inner Voice?"
We all have different ways of listening to (and finding) our inner authority and after talking with Kris, Lola has a much better shot at honoring hers. I am convinced that, armed with this information, she will be able to make her way through the challenges of teenagerhood with more clarity.  Eve is already bugging me to schedule her session with Kris, but my brain is so full from Lola's I feel like I need to go sit in a dark cave for a week to process it all.

I was looking forward to a few hours free today while the girls head to school for an exciting opportunity, but I'm afraid I won't be able to stay away.  Their school was one of four in the nation chosen by The Clinton Foundation to engage in a Skype discussion about empowering girls to change the world.  I am fairly certain that neither Eve nor Lola truly understands the significance (I know I wouldn't have when I was their age - hang out with a former Secretary of State on video? Who cares?), but I'm happy that the sun has gone away for today so they won't be resenting me for intruding upon their Spring Break by making them participate. Of course, because I understand the significance of it, I will likely be sitting on my hands in the back of the room, clamping my lips together to force myself to stay quiet and let the girls speak, so my "few hours free" won't be.

It will all definitely give me more to write about, although that isn't a challenge right now. I have so many half-begun essays and poems, so many pieces sent out for submission to different publications (some hanging out there for weeks, waiting, and others simply rejected), that I hardly know how to tell them apart anymore. It would take the entire summer of writing in a vacuum to complete them all, and that's only if nothing else occurred to me while I was writing.  There is a constant buzzing in my head from all the ideas and thoughts, both disparate and connected, and it's all I can do to remember what Kris told me about my particular cycles of activity and how this happens every Spring.  I will wait for the bees to settle in and be still so that I can take the time I need with each one and it will all get done - or at least the stuff that needs to get done will get done. The rest can just buzz on away like so much background noise.

How do you survive Spring Break?

Monday, April 07, 2014

Shut Up and Cook

While I was working on a new essay for Demeter Press, I took a quick break and found this. It's long, but worth the time it takes to read it. I found myself nodding my head over and over again as the author lamented the new "culture of shut up" that has permeated social media.  A bit of a twist on my "sea of unknowing," but more pop-culture friendly for certain.

The essay I'm working on is for an upcoming anthology on Mothers and Food and as I sat down to take my first stab at it in the unseasonable sunshine in the backyard, I was on fire.  Chronicling my years as a child of the PopTart Generation (my name for the 1970s era of "better living through chemistry") to my early years as a mother trying to do right by my babies when it came to food, and through our gluten allergy diagnoses, I am writing about the challenges of raising healthy children when you don't know what information is real.  So many of the things I thought I knew about food have been proven wrong - processed foods aren't healthy, fertilizers do more harm than good, GMOs are horrifically frightening, rice isn't a healthy alternative to wheat if you're gluten intolerant thanks to the arsenic levels, alternative grains aren't always the best, and on and on....  The whole essay now weighs in at 2500 words and it is decidedly defeatist, so I'll have to work on finding a way to lighten it up and find the silver lining somewhere.  That said, I do often feel a little undone by the latest food news as it comes my way because it seems to create more work for me as I plan meals and shop and cook for my family.  I come from a Ukrainian great-grandmother who loved nothing more than cooking for friends and family and I inherited her inability to cook for anything less than an army.  I absolutely feel like cooking for others is a way to show them I love them and at our dinner table, the more, the merrier. But I struggle with the fact that eating is hard work these days. And don't tell me to plant a garden in my backyard because I most certainly did NOT inherit that ability from my Gram.  I'll go out and support the farmer's markets, thankyouverymuch, but only if they grow organic produce.

Friday, April 04, 2014

Happy Birthday, Maya Angelou!

I have been lucky to see Maya Angelou speak a few times in my life. Three times, I have written about her on this blog. I truly believe her life is a precious gift for so many people and I wish her a very, very happy birthday.

Here are links to my previous posts about this amazing woman.

Of Storms and Rainbows

Thank You, Maya Angelou

Maya Angelou is My Mother


Monday, March 31, 2014

This Watercolor Life

I don't compartmentalize. Anything. Ever. I've heard it said that women don't, or at least that men do it better and more often. I don't know if that's true or not.  In my personal experience, I have observed that Bubba seems to be very adept at putting aside certain things that may be difficult emotionally so that he can go on with his work day and revisit them later.  I don't know if that means he simply doesn't think about those things at work, or if it's easier to think about them later when his emotions have died down or if he's even self-aware enough to ask those questions and answer them. He has told me that when he's at work, he isn't worried about the house or the dog's cancer or the kids or me. He trusts that we are all just fine - he has to, or he wouldn't be able to function.

A friend told me once that she believes that the reason fathers have an easier time shutting off their "father" persona at work than mothers is because they were never physically attached to their children via an umbilical cord.  I remember thinking at the time that I hoped one day someone would do a study of adoptive mothers to see if there was any truth in that supposition.  It is certainly true for me that I am never not a mother, that at any given time no matter what I am doing I am aware of my children somewhere making their way in the world, that I am always ready to answer a phone call from the school or a friend's mother in case one of my girls needs me.

But that could be because I don't compartmentalize.  My life is like a watercolor painting on some coarse, linen-like canvas, where any stroke of color you put down is likely to bleed in several directions to blend with what is already there.  Every conversation I have with a close friend is held up to the light and examined within the context of what I already know. Every time I have a fight with one of the kids or discover someone's massive screw-up, I question my entire parenting philosophy and make Bubba crazy with my self-investigation.

It wasn't always like this.  As a kid, I was an expert at keeping things separate.  What happened at home stayed at home. I didn't talk to anyone at school about the things that went on behind the front door of our house and, frankly, I didn't think about it at school, either.  Upon walking out the door into the world, I simply became someone else, someone confident and competent, someone who didn't have a personal life beyond school and sports and my job waiting tables.  I didn't allow myself to think about anything but what I was doing in that skin and even when I got home, I tried desperately to inhabit that other person's body.  Needless to say, my worlds eventually collided. I cracked the compartment wide open and began letting light in and the things stuffed inside all tumbled out and left footprints all over everything else in their haste.  Somehow, after years of talking and writing and thinking and figuring out who I am, I have managed to integrate all of my selves: daughter, mother, wife, sister, friend, writer. I don't know how to go back and, frankly, I don't want to, but it does mean that when something painful happens, I am likely to ruminate on it for a while as it slowly spreads out into places I can't predict, changing the landscape of me. That also means that when I'm feeling particularly happy and optimistic, I have a different perspective on everything. Occasionally, I am able to step back and take a look at this multilayered, crazy textured work of art and see how rich and amazing it is with the overlapping bits of dark and light and feel a deep gratitude for this life.  Occasionally, I am prompted to reach out and stroke a particularly awful piece of memory to see if it has maintained its power to sting after many many years even as I marvel at the way it mingles with its beautiful surroundings.  Honestly, I think it is this knowledge that keeps me moving forward when I am skewered through with pain, the belief that it will thin out and become part of something wonderful in the end.

Friday, March 28, 2014

Spring in the Northwest

Maybe it's that I have a lifetime of memories that involve rain, having spent most of my life in the Pacific Northwest, but I truly don't mind the grey, wet days.

"I hate the rain," Bubba grumbled as he pulled on his sneakers this morning and grabbed the umbrella on his way out the door for his morning walk.

"I know."  There was nothing else to say. He knows the rain doesn't bother me, even when I have to walk in it. Especially on a day like today, when yesterday afternoon brought brilliant sunshine and I was lucky to walk under a canopy of cherry blossoms with the dog, a pink carpet of tissue-thin petals lining the sidewalk.  Everywhere I went, I could smell the sweet perfume of daphne and I watched with a keen eye for the season's first tulips in someone's yard.

To wake up this morning to the sound of the water gurgling in the gutters conjured images of fat, shiny worms making their way across the pavement. I could hear the birds in the magnolia tree right outside my bedroom window and I always imagine they are celebrating the rain, anticipating puddles to splash in and the droves of worms coming out for an easy breakfast.

I sit at the kitchen table, the house silent except for the gentle swoosh of the dishwasher and there is something about hearing the movement of water as I watch the rain fall outside that feels cozy and comforting.  The dog, still damp from our morning walk, lies breathing heavily at my feet and out of the corner of my eye I catch sight of a huge crow descending into the yard.  My first instinct is revulsion.

Ugh, crow. I think. Why couldn't it be a robin or that sapsucker I see every once in a while? But I catch myself. Why not a crow? Because they eat garbage instead of worms and bugs or seed?  Because they are big? Because their cries do not sound like songs to me? In that instant, I feel a softening and turn to watch the crow more closely.  A smile spreads across my face as I watch it hop with a little jaunt across the stones toward the planter. He has every right to be here, too.

My pants are speckled with raindrops, the bottom cuffs soaked from puddles we walked through this morning.  The cherry blossoms were raining down on us and are stuck to the sleeves of my jacket like translucent pink polka dots.  The flagstones are shiny wet and I can't resist stepping hard into the puddle that forms right inside the gate, although I do look around to make sure none of the neighbors was watching.

When Bubba comes back from his walk and leans in for a kiss, I love the way his cheeks feel cold and damp against mine.  He smells fresh from the outdoors and I close my eyes and inhale deeply. This is the scent of Spring.

Wednesday, March 19, 2014

Of Oil and Water and the Deep Unknowing

As I walked the dog yesterday following a particularly ill-advised exchange on Facebook regarding a vitriolic "anti-vaxxers" blog post, I struggled to tease out the strings of what bothers me so much about these kinds of interactions.  The same gut-burning, chest-tightening, jaw-clenching feelings came over me yesterday that I get when I encounter anti-choice protestors or read stories about the Westboro Baptist Church and their hateful acts against homosexuals. It seemed to me that there was some wisdom in my body that wasn't making it through to my brain.

I am certainly bothered by the Us vs. Them mentality - the assumption that there are only two sides to these issues and the disregard that there might be a shared goal.  No, neither pro-life nor pro-choice activists think killing babies is okay. Yes, both think that it would be a good thing to reduce the number of abortions. Neither folks who vaccinate their children nor those who choose not to (or slow down the regimen or ask question after question before deciding) want horrible diseases to take over mankind. Yes, we all want healthy, thriving children.  And regardless of your sexual preference, each of us wants to live a meaningful, happy life shared with people we love.

But beyond that, I honestly think that there is a bigger issue. At least in these three instances, one group recognizes the need for individual allowances within the whole and supports a diverse population of choices and the other believes they are Right and everyone should just do what they say.  It is truly pro-choice versus anti-choice and the pro-choice contingent has a much more accepting, understanding, dare I say compassionate view of humanity. It is inclusive.

Being pro-choice (whether in relation to vaccinations, reproductive rights, homosexuality, etc.) means that I am floating in a vast sea of unknowing. It is scary sometimes and floating does not equal passivity. I must still often tread water to keep from drowning and often things come up from the deep to bite me in the ass.  It is difficult to find information and validate it and from time to time I have to seek out other people who are floating for support.  Residing in the vast sea of unknowing means that I have given up absolutes, I forego imposing my will on others, I admit that I don't know what it's like to be you.

The folks who have already decided - those who are certain they are Right - stand on the beach, firm in their own footsteps and throw rocks at those of us floating in the sea. Some of them might dip a toe in the water from time to time ("I get how you might think it's okay to ____________, but if you listen to me you'll see why I'm Right") but without fully giving over to the idea that maybe there is more they can't comprehend, their feet stay firmly on the ground. Others never even venture close to the water's edge, sunk deep into the sand and their convictions that Homosexuality is Wrong or People Who Don't Vaccinate are All Idiots or Being Pro-Choice Means You're a Baby Killer and just keep throwing shit and yelling.

But compassion means that my views have to include these folks, too.  As I walked, I puzzled on the idea of some sort of Venn diagram that might illustrate it, but there isn't one, because that would imply mutual acceptance or overlap of some kind.  In my ocean of "I don't know all that I can and I accept that others know differently than me and that's okay," I am okay with someone who chooses not to abort an unintended pregnancy or vaccinates their kids on the doctor's schedule or exhibits their heterosexual tendencies, because I accept the notion of choice and I know that what is right (without a capital R) for me is not necessarily right for another. So instead of a Venn diagram, my vast sea of unknowing encompasses everyone's choice including those folks on the beach. The beach-dwellers' circle is a little like a puddle of oil sitting atop my circle without accepting it or incorporating it.

In the sea of unknowing there are people who slowly stepped in foot by foot, cautiously examining what it might be like to float out there and truly not know; folks who were willing to entertain the idea that there are circumstances about which they know nothing that are part of the lives of other human beings every day. There are also those who were thrust into the water by a traumatic event - instantly faced with a horrible choice or a life event so jarring that it made them examine everything they thought they knew before. Others may have been born into it.  Don't be fooled, we are all afraid. There is something about not knowing that runs counter to the way we think and many of us continue to search for knowledge and investigate so that we are not consumed. The thing about lying back in the water and relaxing into the idea that there are things I cannot know is that I have no need to prove anything to anyone else. There are some questions for which there isn't a Universal Answer that applies to everyone and if we can't all share in the Right Answer, then at least we can share in the pursuit of a common goal, a shared humanity.

The beautiful thing about seeing these issues as diverse and complex is that it means we can progress. If there were only pro- and anti- camps (pro-vax/anti-vax, pro-abortion/anti-abortion, pro-homosexuality/anti-homosexuality), it would be like flipping a coin over and over again. There is no forward movement, no growth, only switching back and forth between views. If the definition of one group requires the certain annihilation of the other, there is no ground from which to work. The recognition that there are really not two distinct "sides" to any of these arguments gives us the opportunity to define a shared goal and work toward it.  Not that I think that will happen anytime soon, because it is far too tempting to stand on the beach with the sand beneath your feet and believe that you Know. When you can define the threat as something "out there," all you have to do to eliminate it is walk away and ignore it or stand on the shore and throw rocks at it. When you don't have to take the uncomfortable step forward and question your own knowing, why would you? I understand. But standing in the water doesn't mean you've given up what you believe, it just means you're willing to accept that not everyone sees the same horizon you do.

But here's the thing. Our knowledge of anything is never complete. If it were, Pluto would still be considered a planet and doctors would still be writing prescriptions for Thalidomide for pregnant women with morning sickness.  But we learned. We evolved. We questioned.

Once I fully succumbed to the pull of the deep unknowing, I couldn't imagine going back to shore. The richness and diversity of this place is amazing and I learn something new every moment. Being willing to suspend Knowing has allowed me to forge connections with brilliant, passionate, articulate people who agree that there is more to our lives than Black and White, Right and Wrong. And floating in this sea surrounded by others who will not judge my ideas and experiences because they, too, have accepted the unknowing feels safer than standing on that slowly shifting sand throwing rocks out at the sea.


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