Thursday, December 08, 2016

Repost: The Power of a Gratitude Practice

As a person who has struggled with anxiety and depression throughout her life, perhaps choosing a career as a writer wasn’t the best way to go. Writers, especially freelance writers, experience far more rejection than the average person.

Fortunately, during some intense research I was doing on adolescence and brain development, I discovered several studies on the power of gratitude. When I was really wrestling with darkness, mornings were the most challenging time for me. I woke up, opening one eye at a time to gauge whether that semi-truck of pain and longing was heading for me before I swung my feet out of bed onto the floor. Often, before I could get both eyes open, my mind would begin to race and my heart would pound as I anticipated what the day had in store for me. After reading about the way gratitude shifts our thinking patterns and affects our brain chemistry, I decided to start each day with a short list of things for which I was truly grateful. I envisioned it as a sort of shield against that truck hurtling toward me.

In the beginning, it was often hard to come up with a list; not because I don’t have many, many blessings in my life, but because I have an innate tendency to qualify them. As soon as I think of one, I either compare it to someone else and feel guilty that, say, my kids are healthy and I have a friend whose kids aren’t – which effectively soils the gratitude – or it feels trite and petty, like being grateful that I have enough money to pay my bills. Even in my gratitude practice, I found myself wanting – either for more ‘pure’ things like love (which feels a little too nebulous sometimes, to be honest) or for deep, profound items on my list that really resonated in my bones. I am nothing if not stubborn, though, and motivated by the fervent desire to keep my depression and anxiety at bay, I kept going despite the sometimes pathetic nature of my lists. Every day, I thought that maybe tomorrow I could come up with something beyond gratitude for my soft, warm bed, my kids, and my husband to be grateful for.

When my teenage daughter was struggling with anxiety upon starting high school, I encouraged her to start a gratitude practice to see if it could help her. Every night before bed, I would text her three things for which I was grateful and she would text me back right before falling asleep. My hope was that if the last thoughts she had every day were ones that filled her up rather than dragging her down, perhaps she would wake up with optimism for the coming day instead of dread. Her lists began much as mine had. She was grateful for a full belly and a soft pillow and a roof over her head. But over time, she was able to open up and recall specific things that had happened during the day that were positive – a friendly smile in the cafeteria, being picked by a classmate to partner on a project because she is so organized, to appreciating a trusting relationship with a special teacher. Her perspective shifted over a period of weeks and she went from finding excuses to stay in bed to getting up and tackling each new day and its challenges with a feeling of competence and groundedness.

Over time, my definition of gratitude has developed and I’ve come to understand what it is about this practice that has been so effective for me. In the beginning, I often attempted to come up with things by starting with, “at least I’m not….” What I discovered is that if I am comparing my life to someone else’s (as in, “at least I’m not part of this oppressed group or that oppressed group,” or thinking about all the ways my situation could be worse such as, “neither of my kids is terminally ill and I’m not homeless,”), I’m not really being grateful. That’s just another way my anxiety is telling me my life could run off the rails at some point, so I should really be cautious. Instead of helping me feel calm and centered, it is really reminding me that one or more of those things could potentially happen and, for now, I’m just dodging a bullet.

If I am making a mental note of the number of “good” things in my life as compared to the number of “bad” things, that is also not helpful gratitude. Weighing them against each other in a sort of balance sheet is not a positive step. The fact is, both things exist simultaneously (and are often intertwined with each other) in my life and in my mind, but gratitude is about the ones I consciously choose to pay attention to. It doesn’t make the challenges and difficulties in my life disappear, it simply allows me to notice that there are many positive things in my life, too.

The human brain is wired to look for deficiencies, expect sabotage, and find the things that need ‘fixing.’ This isn’t always a bad thing – often I am happy to know that there is something I can do to make things better. But unless I take the time to really engage in a gratitude practice, I won’t notice the things that are absolutely right and lovely in the world all around me. I might notice the pile of unfolded laundry lying on the couch, but I can also choose to see that the dishes are all clean and the dog is fed and happily snoozing in his bed and an essay I was working on this morning is coming along nicely.

I am loathe to imply that gratitude is a complicated thing, though, because when I am in the zone, it truly isn’t. When I am really tuned in to the goodness and abundance in my life, the list of things for which I am grateful grows quickly and easily. For me, the key to gratitude is to simplify things. When I am frustrated and irritable, the best thing for me to do is stop and look around. I see my computer and I am grateful for the ability to write and connect with people who are important to me online. I catch sight of a glass of water on the counter and appreciate clean water and a cupboard full of dishes. I note my sunglasses on the table next to me and close my eyes and thank goodness that I can so often feel the warm sun on my back. When I can keep myself from trying to create stories or context, I can find simple, pure gratitude and suddenly, there is more air in the room.


Knowing that every time I actively look for things that are right in my life means I am activating the parts of my brain that produce serotonin and dopamine gives me hope. When I started that gratitude practice all those years ago out of desperation, I was beginning a process of rewiring my brain to more easily find happiness. Sticking with it, I realized that it does become easier over time to recognize and appreciate simple things that give me joy. While I still struggle with anxiety (and rejection), I am more able to see it as a part of this messy, glorious life I am living instead of letting it keep me from getting out of bed in the morning.

Friday, December 02, 2016

Treading New Ground

I had thought that, since I lost one parent already, there would be a sense of familiarity, of deja vu, of "been there, done that" when I lost the next one. Not in a dismissive way, just an "ok, I've got this, I know what to expect" kind of way.

Nope.

Dad was diagnosed with lung cancer. He told me early on, I was there to listen, I went down when he had surgery to remove part of his left lung and some lymph nodes, I let him bounce ideas off of me for future treatments. We weren't certain of the timeline, but we knew he was sick and he was absolutely honest with me about how sick he was. It was excoriatingly, skin-flayingly, teeth-grindingly painful in the last week to watch him suffer. He knew me until the minute he died in my arms.

But Alzheimer's or dementia or whatever the hell this is that Mom has is a completely different animal. She isn't having some diseased cells cut away. She isn't calling me to tell me about the latest drugs or therapies her doctor has offered. She might live for six months or six years. She has no idea who I am.

This one-sided relationship is teeth-grindingly painful in a completely different way. When Dad took a turn for the worse, it was obvious. Over a period of several days, he began having pain in his legs and hips and when they took x-rays it was clear that the cancer had spread to his bones. An MRI showed it was in his brain, too - the cancer cells lit up like the night sky I once saw in the middle of nowhere, New Mexico. From that point forward, we knew there was no rallying, no bouncing back.

Mom's slide has been gradual except when it seems to leap forward, and there have been many times over the last year when she was almost able to snap out of it and recognize me and have a conversation. The cruelest part of that is that it gave me hope. It made me wonder how we could capture those lucid moments and prolong them, whether there was some magical drug that she could take that would clear the way for a return to herself. Those moments, when they are gone, are all I can hope for and envision, but they are much fewer and farther between and I know I won't get a signal that tells me I've seen the last one. I didn't get a sign the last time I spoke to Mom on the phone that said it wouldn't happen again. I didn't get a warning the last time she called me by name and knew I was her daughter so that I could savor it.

There is a part of me that wonders if I am a little bit narcissistic in my grief. A part that thinks maybe it shouldn't matter so much whether she knows who I am, that tells me to just get on with caring for her the best way I know how without worrying whether she remembers I'm hers. Because somehow, I want to be special. I don't want to be just one of another cast of characters who comes through to visit and smile at her. I want to be her daughter, not for any sort of recognition of my efforts, but because I mean something more. There is something about the reciprocity of a loving relationship that makes it feel whole. When I sat with Dad during his last days, holding his hand and telling him stories, even though he couldn't speak, there was a familiarity. He squeezed my hand and his eyes danced during the funny parts, and his rough, calloused thumb rubbed back and forth against mine when I was being serious. We had a history that was fully intact until the moment he took his last breath and when I grieved for him, I grieved for all of it simultaneously, the loss of his body, his Self, and our relationship.  

This time, I am grieving in stages. While there are parts of Mom's Self that are still fully intact - her sarcasm and playfulness comes out sometimes with her husband - I have lost the history of our relationship as mother and daughter. She knows I am familiar, but she doesn't know why. Our inside jokes now belong to me, even though she is physically still here. When we sit together, I can't tell her stories about my kids or my husband because it confuses her - she doesn't know these people, why am I talking about them? We can't reminisce or look forward to sharing family holidays together or significant moments in the future because she isn't coming to my girls' high school graduations or weddings. There is a quality of suspended animation to it all, a sense that I am walking without a foundation beneath me.

I wish I had a succinct ending to this post. I usually am able to close the loop with some sort of insight, but maybe the fact that I can't this time is an apt metaphor for how all of this feels right now - loose and unfinished.

Monday, November 28, 2016

Memoir Excerpt on The Manifest-Station

Yesterday, Jennifer Pastiloff's site, The Manifest-Station, featured an excerpt of my memoir-in-progress on their site. I am thrilled to have this process begin. You can find it here. 

Saturday, November 12, 2016

Please Don't Unfriend Me

In the past several days, I have seen more requests for people to "unfriend" and "unlike" pages on social media than ever before.

I have spoken with people who acknowledge that their loved ones voted for a different Presidential candidate than they did and roll their eyes, saying that they don't get it.

I have seen calls for parts of the country to split off from the rest because of the deep philosophical divisions that showed up on Tuesday night, and I have listened and watched as groups form with the intent to "fight." I heard one person say last night that she doesn't talk to people who voted differently than her because "we can't."

We can't afford to not talk about this.

It's hard.
It is often painful.
It sometimes feels as though we are speaking different languages.

And we have to try.

The future of our country depends on it.

The first thing we can do is stop pretending that debate is conversation. In a debate, there are sides. There are factions with deep-seated beliefs and the goal is to show up and talk the other person under the table. The entire setup is predicated on the idea that this is a zero-sum game. That one side is "right" and the other is "wrong." Debates are about power, they aren't about common ground, and what the American people need right now is to find our common ground.

Instead of one-upping each other, we need to listen.
Instead of either/or, we need to start thinking in terms of yes/and.

When Lola headed out to take the bus with a couple of friends to the movies yesterday, I nearly had a panic attack. At some point, it occurred to me that I was sending my 14-year old daughter out with another young woman (who happens to be black) on to public transit and out into the world without an adult. Before Tuesday, I wouldn't have given it a second thought. But in the days following the election, my Facebook feed was filled with stories of women and girls being harassed in public, people of color and Muslims attacked for simply being who they are, and I was gripped by fear. I hated the fact that I had to give her instructions as to how to behave on the bus - eyes up at all times, assess the situation constantly, if your gut tells you something isn't right, scan the area for the nearest trustworthy adult and have an exit strategy that puts you in a safe place. I tried to do it as calmly as I could without scaring her, but still letting her know that she needed to heed my warning.

I am keenly aware of the daily fear that accompanies being a woman in this country. I am also aware of what many of my friends who are people of color go through on a daily basis and I think I understand their fears. I have heard and acknowledge the fears of those who are immigrants, refugees, and people who do not identify as Christian. I also feel as though I understand the concerns of folks who are part of the LGBTQ community.

And...

Yesterday, I had a very interesting exchange on Facebook with someone who supported Donald Trump's presidential bid. He wrote that he wanted us to all stop fighting and start working to make this country great for "our kids," and I inquired whether he meant all kids - black and brown kids, immigrant kids, gay and transgendered kids, and Muslim kids. What ensued was more than 30 minutes of back and forth clarification, peeling layers to really understand what he meant by making our country great and if it was inclusive of all of us. What I learned was that he doesn't care a whit about reversing Roe v. Wade or marriage equality. He isn't interested in deporting anyone and he believes that the Bill of Rights was written to include every single one of us, regardless of what we look like or where we worship or who we love. His reasons for voting the way he did had nothing to do with racism, xenophobia, homophobia or sexism.

In my quest to understand, I had to refrain from lumping him into the box that is so handy and makes it easy to jump right back in to that zero-sum game of Wrong and Right. Goodness knows, I didn't agree with Hillary Clinton on everything she said. In fact, I vehemently disagree with her on several issues, and I know that I wouldn't want to be characterized as someone who is in full support of her positions on military spending or energy policy. Because of that, it is my responsibility to treat others the same way. I can't make a blanket statement that every single person who voted for Trump is racist, misogynistic or sexist. They may well have voted for him despite that.

And...

The fears of folks Trump has alienated and denigrated are real.
They have every right to have their feelings validated and fight to keep their personal freedoms.

And...

The fears of folks who don't live in urban areas where the economy is rebounding, where opportunities exist for job training and social programs are just as real. Those folks who have struggled to put food on the table for their kids, whose schools have been taken over by the state because they have failed to meet standards for years, who have been farmers and miners for generations and still want to be, but those jobs are going away or getting harder to do without the support of the government? Their feelings are just as real. Their fears are just as existential.
They have every right to fight for someone they hope can pay attention to their plight, too.

Just because I haven't lived those fears doesn't mean they aren't real. They just don't show up on my radar. Like the fears of women and immigrants and minorities don't show up on the radar of folks who haven't lived that reality.

We can continue to try and convince each other that the things that show up on our personal radars are more important than the things that show up on someone else's if we want to. We may gather bigger numbers next time and "win" elections. But we won't have addressed the underlying issues that are driving the divide and we will continue the wild swing of this pendulum that throws our country into chaos every few years. The only way to slow it down is to learn about each other, to set aside what we think we know and listen to what others live with. Unfriending each other or voting to split states off from the Union might make us feel safer, but it only deepens the divide. And it won't make the other side go away. It certainly won't make them change their minds. It is the equivalent of a parent kicking their teenage daughter out of the house because she is pregnant. It doesn't make her any less pregnant, it just leaves her with fewer supports and it means you don't have to look at her anymore when you come downstairs for breakfast. We have to face this with compassion and a genuine desire to find commonality or we will continue to break apart even more.  I truly believe that the people of this country have more in common with each other than we know. It is in our own best interest to find those goals we all share and begin talking to one another because it appears that there are some folks in power who are more interested in being Right than they are in being part of something real and honest and human.

Wednesday, November 09, 2016

Immediate Takeaways from Last Night's Election


I sit here full to the brim. My heart is heavy, my stomach quivering, mouth dry and thoughts racing. I remind myself to breathe deeply a few times a minute and struggle to define what is happening. I am both drawn to social media and reminded to pay attention to how it makes me feel. I am grateful for the conversations I have had with Eve and Lola last night and this morning; appreciative of the opportunity to temper anger and fear with reflection and self-awareness. So far, here is what I believe to be true:


  • Americans who voted for vastly different outcomes than I did have just as much right to cast their votes as anyone else. Regardless of whether someone's vote was cast in anger or fear or hatred, the fact remains that we live in a democracy. Everyone's vote counts. 
  • I can't know what motivated anyone else's vote unless they tell me, and trusting the media to tell me isn't a valid option. They're the ones who were so wrong about how this election would go, remember? That means they have little insight into the way many people's minds work. The media is just as divided as this country's electorate is and is mostly populated by a group of college-educated, white folks. That is hardly an accurate representation of the country.
  • There are no more racist, misogynist, elitist, ableist people in America today than there were yesterday. And, more importantly, we can't know what motivated people's votes (see bullet point above), so saying that this election was a mandate for racism, sexism, or elitism is altogether incendiary and not useful. We don't know that, frankly.
  • The people of this country have allowed themselves to be divided by fear, income inequality, geography, and hatred. Fear is a powerful motivator, but unless we really strive to listen to each other with the intent to understand, we will get nowhere. I have watched (and I am guilty of this, too) people purport to have 'discussions' about the election that were simply about convincing the other person that they are wrong. When discussions become about right/wrong, winning/losing, they cease to be about understanding. It is human nature to dig in and defend our position. It feels too scary to stop and wonder whether anything is truly black and white and whether we could have something to learn from someone who thinks differently than we do. Until we learn to acknowledge and set aside our fears, we cannot hope to build bridges and come together around common goals. We won't even be able to identify common goals.
  • We often fail to recognize the ripple effects of our actions. Folks who voted as a reaction to something may soon come to regret that choice if the stock market crashes, they lose their health insurance, or Roe v. Wade is repealed. We are all connected and every single action we take has consequences that we can't predict. Reacting out of fear or anger or hatred often doesn't give us the time to think about what those actions might set in motion. Folks who are waking up today and reacting to the news out of anger or hatred - vowing to fight against those who elected our new president or threatening to leave the country - have every right to feel those emotions, but acting on them will only drive us farther apart as a people. We are all connected. 
  • The dichotomy that exists in America is amazing. The popular vote was split nearly 50/50. In the face of elections where conservative Republicans will control the White House, Congress, and the Senate, the number of women of color in the Senate quadrupled last night. Gun control measures are expected to pass in four states, and there were at least ten anti-corruption measures that passed across the country last night. My state just elected the first Iranian-American, disabled Lieutenant Governor. We are a complex nation of people who have more in common than we know, and if we can come together and begin to remember that the value of human beings is immense, and more important than money, we can begin to heal. 
I don't mean to sound naive. I live in a position of privilege that means I am not imminently worried about my citizenship, my health insurance, my civil rights, or my ability to remain in my home. That position affords me both power and responsibility. I will continue to remember that it is my duty to be engaged, to listen and try to understand, and to support the things I believe in most vehemently, all the while acknowledging the right of others to believe differently. That is what this country has always purported to be about. 

Tuesday, November 08, 2016

The Waiting

I can't believe that it's been over a month since I wrote here. Life is so full and so still, all at the same time. My daughters are continuing their inexorable shift to adulthood, the summer sun is giving way to brilliant oranges and reds in the trees while the light dims ever faster, and the house is quiet without my mostly-companion, CB. It is as though the days are pregnant with possibility and I can't yet predict the due date. I have a completed first draft of my memoir sitting on my desktop, notes from a fellow writer scribbled in the margins. There are emails from folks interested in my other work waiting for responses I can't bring myself to write quite yet. I voted by absentee ballot nearly two weeks ago and have sat in limbo since then, waiting for the moment someone will tally up my choices with the rest. There have been meetings about college applications for Eve and practice sessions for Lola's upcoming band gig and it feels like the things on the calendar are both racing toward me and sitting out in the future like some hologram I can't quite feel the edges of.

Some days, as I walk the streets of my neighborhood, I think that this must be what it feels like to float in a sensory deprivation tank. I know that there are things outside, but in this moment, I can only prepare and ruminate because it's not quite time. I don't feel a sense of angst or frustration about it, just an uneasy stillness. I have to remind myself that it will all unfold eventually and remaining open to the possibility and grounded at my core are the two healthiest things I can do.

When I was in junior high, we used to pass notes to each other in class - elaborately folded, origami-like things that would bloom open when you pulled a tab. The cleverness of the design was as satisfying as the note's contents, and we had half a dozen different ways to put them together. I had a friend who was incredibly talented at folding a simple sheet of notebook paper adorned with a drawing that would show one thing when it was folded and another when it lay flat on the desk. I marveled at her skill but could not reproduce it. Trying to imagine the sequence of creases and the 3-dimensional shape of the paper was beyond my ability. I copied my friends and was able to master perhaps two of the special patterns and contented myself with crafting a funny or sweet message inside.

I feel a little like that now - unable to decipher exactly how things are wrapped up and packaged, and I am reminded that it has never been one of my strengths. Instead of picking at it or pushing myself to learn how to do it, I choose to wait until it unfolds and see what is contained within. Then, knowing that one of the things I do best is to add content, I will set about doing my part.

Friday, September 30, 2016

On What it Means to Be Human

There are days when I find it really hard to just be a person making my way through the world, this world of instant opinions and shouting and clickbait and judgment. But, not coincidentally, I've learned that those days are the ones where I've narrowed my "world" to digital interaction - be it social media or watching the news.  It is on those days when I forget that what makes me breathe more deeply, lets my shoulders crawl back down my spine from the place they often perch up near my earlobes, helps me relax into my own skin is actual human contact. Face to face encounters. Speaking with other human beings while I look them in the eye.

As a writer and an introvert, I spend a great deal of my time alone, but with the internet at my fingertips, it doesn't always feel that way, and I sometimes forget that those experiences are not true human relations. I absolutely appreciate the web for purposes of research and connection - especially to those who live far away but about whom I care deeply. But they are no substitute for being in the physical presence of another person.

As I watch how quickly arguments get out of control and how easily it is to throw insults around, I am reminded of what it means to be human.

Last week when a person I love dearly was struggling with something, I felt sad for her. Half of my brain was scrambling to find a solution so that she wouldn't have to endure this discomfort any longer than absolutely necessary, and the other half was listing the reasons this particular situation wasn't really all that horrible (no doubt in some effort to both distance my self and to pretend that she wasn't in as much pain as she was demonstrating).

Fortunately, I was able to let my brain fire off thoughts like buckshot without ever opening my mouth. Instead, I sat with her until my feelings of discomfort with her pain subsided. And when I had sufficiently recognized my visceral response for what it was, I said this:

I don't get to decide what is hard for you and what isn't. And, I think mostly, you don't either. If I love you, my job is to trust you when you say something hurts. My experience or judgment of the situation has no place in the equation. It may be that you're walking barefoot over a bed of hot coals and, while my first thought might be to tell you to put some shoes on or find another path, that's not helpful. For whatever reason, you've found yourself here right now and if I want to show my love and support for you, I will acknowledge your pain and struggle and hold your hand while you feel it. I don't get to co-opt your feelings or your story. It is not my place to show you my own personal bed of hot coals in order to distract you from yours or prove that mine is longer or hotter. I will simply believe you when you say you are hurting and offer my strength as you make your way through this difficult time. 

So much of the content I see online and on TV on a daily basis consists of people fighting over whose trauma is the worst. We are competing for clicks and likes and bragging rights and forgetting to recognize that without connection to each other, none of us can survive our individual traumas. And while there are some incredibly positive things that happen online, too (I love seeing news of babies being born and people falling in love and hard problems being solved), there is no substitute for a hug or a high five from a warm-blooded person standing next to you sharing that news.  And so the next time I find myself neck-deep in frustration or sadness after checking my Facebook feed and the local news, hopefully I will remember to go find someone to look in the eye. Because being human is so much more satisfying than being "right" or being righteous.

Friday, September 16, 2016

PTSD and Wildfires: A Metaphor


I was listening to a story on NPR the other day about wildfires in the Pacific Northwest and one person who was being interviewed was part of what they call a “mop-up” crew. These are the people who come in after the fire is out and look for dead wood that might fall, trench areas that need it, and look for parts that still might be smoldering.  In large forests, it’s fairly common for roots to be on fire quietly beneath the forest floor and spontaneously erupt into new fires if the area isn’t checked thoroughly. It is these folks' job to be hyper vigilant, to scan the terrain for danger. 

I feel like that’s my nervous system in a nutshell. The original traumas were the raging wildfires that I worked to control and extinguish, but there are still hotspots in places I haven’t looked and when someone says or does something that triggers my original abandonment issues, I am suddenly right back in the middle of that forest with a raging flare-up. Hello, PTSD. 

Despite all the work I’ve done in therapy and on my own, learning to uncover my deepest insecurities and face them, sitting patiently with my demons and learning to embrace them, combating the mean voice in my head that says I’m worthless, there are still pockets of mess that I am occasionally surprised to find. Somehow, I thought I took care of this, but there was one more tree with smoldering roots just waiting for some oxygen to feed it. And oxygen feels like such a benign thing, right? Who is afraid of oxygen? Often, it is as much a surprise to me as it is to the person who said or did whatever they did, and as much as I’d like to be able to apologize for my massive response, the fact remains that now I have a new fucking fire to put out. I wish I had the time to explain or assure you that it's all going to be fine, but I don't. I have to put on my helmet and boots and fireproof jacket and wade in because ignoring these small flares isn't an option. 

There’s no way I have the time or resources to send out a mop up crew to look for every possible spot that might flare up some day. The most I can do is clear out the old dead undergrowth, set boundaries to help me feel safe, and look those damn flames in the eye when they rise up. The good news is that because I did the hard work to put out the original fires, it doesn’t take as much time or effort to quiet these smaller ones, and as long as I am completely honest and upfront with people about feeling triggered, I have done my part. 

Honestly, most of the time I go through life just admiring this forest of mine - wandering through its lush greenery and feeling blessed at the variety of things that grow there. I am so grateful to have come through those fires of my youth and be where I am today, and frankly, happy that I am in such a good place that I do get surprised when a flare-up happens. [That doesn't mean that I'm not annoyed as hell when it does. My inner monologue goes a little like this: Really? What the hell? Didn't we deal with this already? Who is the one in there that keeps flipping the switch? I told you, we're not in danger anymore. This is different.]

But these days, I can quickly move from frustration to compassion. Obviously, there's someone in there who is still afraid, who remembers all too well what it meant to be engulfed in flames, and she is hollering for help. And that's when I go into mop up mode. 



Monday, August 22, 2016

Choosing Grief

It has been a challenging few weeks around here and I feel like I'm learning a lot about grief and emotional overwhelm. The first thing I've noticed is that they both feel very different to me as an adult than they did when I was a kid, but maybe that's because I have a much stronger bedrock beneath my feet these days. Maybe knowing that the bills will get paid and there is someone to share the load of parenting and managing everyday things leaves me more space to just feel what I'm feeling. Or maybe being an adult means that I don't have anyone telling me that my strong emotions make them uncomfortable or that I'm over-reacting, or if they do say that, I don't give a shit.

My brother-in-law died quite suddenly at the beginning of July and even though I hadn't seen him in several months, I was acutely aware of the loss. Like me, he married into Bubba's family - a close-knit, fairly traditional clan - as someone who came from a very different background and family dynamic. We bonded over our "black-sheep-ness" and became allies early on. He was someone who always, always had my back, someone who was as sensitive and stubborn as I am, someone who always went to bat for the underdog. He was fiercely protective of me and my kids and Bubba's sister and we had great fun together - often in the kitchen during family gatherings. Even in my grief, I marvel at the fact that our paths ever crossed, given the difference in our ages and the fact that he was Croatian, and I am grateful for the two decades I got to share with him on the planet.

A week or so later, I lost my beloved CB, my "mostly companion," my shadow, my furry boyfriend. For more than a decade, he followed me through the house, prompted me to go for walks to clear my head, slept next to my side of the bed, scared strangers at the door, and cracked me up with his ridiculous dog antics. He was loyal and loving and when it came time to let him go, he sat with his head in my lap and trusted me implicitly. I still hear phantom toenail clicking along the hardwood floors and expect to see his smiling face at the door when I come home from the grocery store. Taking walks in the neighborhood without him is strange and disconcerting and I can't bring myself to move his bed from its spot in the family room quite yet. I feel his presence in every room of my house and my grief is tempered by the absolute joy he brought to my life each and every day, by the years he was there to wake me up with positive energy.

Two days ago, my grandfather had a stroke and reminded everyone when he got to the hospital that he doesn't want any lifesaving measures. He has lived a good, long life, outlived one of his children (my dad), two wives, and has struggled for a while to really feel as though he was thriving. He is my last remaining grandparent and my childhood memories of him are strong and clear. He is a gentle, funny man who was always ready to teach us something, whether it was a magic trick or how to use a belt sander. In my father's last months, he was such a comfort and source of love for my dad and watching the two of them interact was incredibly healing for me.

Yesterday, a dear friend of mine lost her husband in a freak car accident. He leaves behind two teenage children and my lovely friend who has been a rock for me more than once. I am overwhelmed. And I am thankful that I have learned a thing or two about grieving - at least my process for grieving.

I have learned that while it is often incredibly helpful to have friends and family around, ultimately I have to grieve in my own time in my own way. I have learned that grief - like life - is not a linear process, but one that requires me to circle back around to what feels like the same spot over and over again, but that each time I come back around, I have a slightly different perspective, an ever-so-advanced understanding of what I'm feeling and how it fits into the larger picture.

When CB died, I was home alone for a few days. Someone advised me to "go do something - don't stay in the quiet house - distraction is good," and while I know they meant well, I know from experience that distraction only leads to protracted grief. I came up with a sort of formula that consisted of deep, unapologetic dives into sadness followed by a period of mindless activity like laundry or cleaning out the fridge followed by social interaction. By allowing myself to really feel what I was feeling without descending into it so far that I couldn't get out, I was able to feel the edges of my sadness and honor them without letting them define me. I follow this pattern over and over again without placing any sort of expectation on how long it will take me to "finish," and the simple act of accepting my own feelings, whatever they might be, is an exercise in trusting myself.

I have also learned that it is important to surround myself with people who understand that grief is not a quick and dirty, check off the boxes kind of process. I need to surround myself with people who don't find my strong emotions uncomfortable or unpleasant because that means I either have to stifle my true feelings or I end up emotionally taking care of them. I actively seek those who are willing to sit with me during those deep dives without trying to fix or abbreviate or deny my feelings. These are often people who have really grieved themselves, and they 'get it.'

While there is a tendency to throw my hands up in the air and ask Why? as the tragedies pile on, I have learned that that is simply a distraction tactic that doesn't serve me in the end. It doesn't matter why. I am in the midst of sadness and overwhelm and the only way out is through. There was a time in my life when I would have wished for a magic wand or a time machine to transport me through these days quickly and efficiently, but these days I am content to take the feelings as they come and do my best to find the revelations that often accompany them. It can be painful and often overwhelming, but it is all part of this glorious, messy, beautiful, painful, honest life I choose to live.

Saturday, August 13, 2016

The Elephant in the Room

When the girls were little, I signed them up for a program at the local park where they could learn to ride ponies. They sat in a barn and learned about safety, donned bike helmets and boots, and climbed atop plastic step-stools to hoist themselves up into the saddle. Over a period of weeks, they learned to groom, feed, saddle, and ride these gentle creatures while I stood and snapped pictures on the other side of the fence. After each lesson, they were excited to tell me about the ponies' names and temperaments and the things they had learned about how to interact with them. When brushing the ponies, they knew to pat their way around the hind end so that the animals always knew where they were, and if they were walking near the ponies but in a blindspot, they were taught to do an "elephant circle" so as to be out of reach of a well-placed kick should the pony get spooked.

One thing you should know about me is that I prefer patting my way around to making elephant circles. If there is an elephant in the vicinity, I am the person who will point it out. I will tell you about it, indicate exactly where it is, tug on your sleeve to alert you, and describe it in great detail. Even if you indicate that you are not interested in anything having to do with this great beast in your midst, it is unlikely that I will stop trying to talk about it. In fact, if I am particularly affected by the sight of this elephant and you actively try to turn my attention elsewhere, I am likely to take you by the hand and lead you to it, make you stroke its leathery flesh, lean in for a sniff and ask you to look it in the eye.

It is not a characteristic of mine that all people appreciate.
I understand.

The other thing you should know about me is that this characteristic is necessary for my survival.

Most of my childhood was spent hearing that crying was an unnecessary activity. That sadness and fear were altogether useless. That the preferred emotions were happiness or anger and anything else was "wallowing" or "self-pity." From time to time there were entire herds of elephants living in my house that went unacknowledged. The adults perfected elephant circles as they went through their days, picking their way carefully through and around and underneath so as not to discuss any subject that might be uncomfortable. Living like this makes a person feel a little crazy. As a kid, I tried in vain to point out the elephants and was either ignored or reprimanded. I began to believe that I was the only one who saw them, that there was something wrong with me. Or that my ability to see them - my "sensitivity" (spoken with a sneer of derision) - was a fatal character flaw. I alternated between jumping up and down and pointing and cowering in my room wondering whether there was something seriously wrong with me. Eventually, I learned to avoid the rooms where they lived altogether and take cues from other people regarding which things were ok to speak of and which ones were not.

My tactics as an adult are quite the opposite. I have come to realize that, for me, ignoring the elephants is an exercise in self-destruction. To deny my feelings about any particular situation is to pretend that they don't matter. So while I won't ask you to see the elephant in the room the same way I do, or to experience the same emotions in response to it, don't be surprised if I lead you to it and describe it in great detail so that you are forced to acknowledge that it exists. So that you might begin to understand why it is something that is important to me. So that at least we can agree on one thing - that I am not crazy. I apologize if this makes you uncomfortable, but I've learned that leaning into discomfort is the best way to define its edges and begin to loosen its hold on me.

Friday, August 05, 2016

Bittersweet Moments

I will admit to being altogether unsure of how to begin. My faithful companion of over a decade is failing and, while he may live for another several weeks, things are getting rough.

We were away for three weeks at the beginning of the summer and I knew at that point that he had a small tumor on his liver and a few more "bumps" on his skin in various places, but none of them were causing him any distress. Indeed, he was eating and drinking normally and he still raced for the front door with a shoe in his mouth when the doorbell rang. The house-sitter said that had I not told her about the tumors, she never would have known.

By the time we returned, two of the bumps on his neck and shoulder had grown significantly and within another day one of them burst open. The vet said that it was cancerous, but given his age and medical status, surgery was not likely to be helpful. Still, he does not show any signs of being in pain, so I dutifully change the bandage a couple of times a day and make sure it doesn't get infected.

Over the past three weeks, he has both surprised me with his continued health and given me a scare or two. The tumor on his liver is now the size of a lemon, the one on his shoulder about the size of a lime. He has at least six more that I can feel along his back and head that grow larger every day. He is down to eating once a day and has less energy than before, but his eyes still sparkle when I come in the room and his tail wags. He makes it up the stairs to lie next to my side of the bed every night and perks up when I offer a walk. Last Thursday we had 15 people over for a backyard bbq and he made the rounds, poking everyone in the thigh with his nose and demanding to be petted with his tail thumping wildly. He slept for the rest of the night after making sure each and every guest acknowledged him.

Our walks are very different than they ever were. He also has some dementia, so it isn't strange to have him stop suddenly in the middle of the sidewalk or street and look at me in utter confusion. Other times, he refuses to walk unless we go on his chosen route, but that route has increasingly become a simple straight line away from home and when I determine that we must turn back or I'll be stuck carrying him, he plants his feet stubbornly and won't move. The tumor on his neck means that I can't tug on the leash to make him move, and today I was considering picking his 70# frame up and shoving him forward to get him moving. When I wrapped my arms around him, he sat down and licked my face. I waited a few minutes, coaxed sweetly, cursed the fact that I hadn't thought to bring treats to entice him, and finally did the parent-of-a-toddler-at-Target move. I left. I dropped the leash, turned my back on him, and walked away (don't worry - it was a quiet residential street and there were no cars around). After about 20 paces, I snuck a look over my shoulder and saw him slowly following me.

I don't know how much longer we will go on like this. I have spoken with the vet who assures me that  I'll "know" when it's time, and I hope he's right. At this point, he seems happy, he isn't indicating that he is in any pain, and he is still interested in eating and drinking. I am learning to pay really close attention to his cues and slow down. If he wants to take 40 minutes to go around the block, sniffing and lying down in the cool grass for a bit, I'm game. If he would rather snack on peanut butter and bison treats than his kibble, I'm fine with that. And if I need to lie down on the floor with him and scratch his ears several times a day, it's the least I can do for this magical creature who has loved me unquestioningly and wholeheartedly for eleven years or so. The fact that he continues to just be who he is and look to me for comfort when he needs it is all the encouragement I need to drop what I'm doing and just hang out.

Thursday, July 14, 2016

Working on Getting More Compassionate With Each Passing Day

Sometimes I have revelations that are laughable. Things that I feel like I ought to have known or accepted years ago, but have only just recently sunk into my bones and opened my heart and mind up just a little bit more.

I had a boyfriend in high school that marked a huge turning point for me - a shift in the way I saw myself and the world. I think that's not unusual. I know many women who made choices that were seemingly unlike their previous personality; a "rebel phase," you could call it for some of us. It wasn't a bad relationship, but it ended badly and it went on longer than I was comfortable with and for many years afterward, my impression of the entire time we were together was colored by sadness and resentment that I had wasted so much time.  Over the decade afterward, I moved on, boldly and purposefully, and determined to never repeat the kinds of mistakes I made during that time. As I moved forward, my characterization of my ex became softer and more understanding. I began to take responsibility for my mis-steps and the ways in which I contributed to the unhealthy dynamic of our relationship - at least in my own head. We had no contact until one day several years ago when I got a Facebook friend request from him.

I declined it without hesitation.

A week later, there it was again. This time, I looked at his profile, curious to see what his life was like, and what I discovered was that many of our mutual high school friends were connected to him online. My sister was his Facebook friend.

I declined the request again.

A few days later I got a message from him asking why I was declining the requests. He was incredulous that I hadn't moved on, forgiven, gotten perspective on how young and stupid we had been. And the thing is, I had done all of those things. And I still didn't want to be his Facebook friend. I think I dashed off some message to the effect that I had no hard feelings toward him, but that my life has changed significantly and I am only interested in relationships that offer positive energy. I imagined the eye-roll when he read it. Hell, I probably even rolled my eyes at myself when I wrote it, but it was enough to stop the requests.

In the last several years, I have occasionally seen his comments on my friends' pages and thought not much of it.

Today, I saw something that my sister posted that reminded me of their friendship all those years ago - a shared love of skateboarding and punk rock music and aspirations for a particular lifestyle, none of which I had in common with them. And that's where the revelation came in. While I never begrudged any of my friends or family for not banishing him from their lives when I did (and I did, albeit in a very sloppy way), I never really considered what he may have meant to them. I didn't think about it. I never entertained thoughts of what he might have represented for my sister or another friend, what role he played in their lives, and how important it might have been. And as I sat and thought about it, I was struck by the notion that each of us means something unique to the people in our lives. The person he was with me is not the person he was with his skater-friends or his co-workers or his mother. All these years, I've been seeing him only through the context of my relationship with him and, while that was an important step in my own personal development because it taught me to define personal boundaries and honor them to keep myself safe, it is not the extent of the person he is. In terms of my personal relationship with him, it's fine for me to see him through that lens, but in terms of a definition of who he is as a person, it's unfair.

I know he meant a great deal to a lot of people I care for and it occurred to me that the more I can see each and every person I encounter through that lens, the better. Simply knowing, in my bones, that we all are so much more complex than we seem offers me an opportunity to open to compassion and understanding. If I can remember that everyone has the capacity for love and caring and likely offers that to someone in their own life, that each individual is important to someone else, I can begin to put less stock in my impression and allow them more space to show me those things.

I was in no position to do any of that in high school, to be certain. I was also incapable of seeing myself as a whole, complicated person, if I'm being honest. But the realization that different people can mean very different things to the people in their lives finally sunk in today and I think it has given me a higher perspective from which to see the world.

"Our goal is to have kind consideration for all sentient beings every moment forever." Katagiri Roshi

Saturday, July 09, 2016

Welcome to the Most Fearful Nation

Slowly but surely, inexorably, every step this country takes pushes us farther into a corner. It didn't start with 9/11, but it certainly accelerated our descent into fear, and we are now reaping what we have sown. A populace who succumbs to the shouted words of its leaders to "protect yourselves," "be alert," "report suspicious activity," and complies, putting police officers in schools, adding security protocols layer by layer, selling military-grade weapons to local police departments - this populace has come to this: snipers on rooftops shooting at peaceful demonstrations, punching each other at political rallies, spending millions of dollars attempting to block individuals from using public restrooms.

How can we be surprised? When we have all listened to the rhetoric that warns us about the Other?
How can we feign shock when we have been conditioned to look for what separates us and be on guard?
When our politicians increasingly skip over the step of diplomacy and build coalitions to "bomb the shit out of [insert country/terrorist group here]," can we not see how much of our collective American psyche is built on fear?

The thing about fear is that it is necessarily reactive. We like to think it is proactive, that we are simply PROTECTING OURSELVES, but the act of protection means that there is something we are afraid of. And in protecting ourselves, we build walls, we isolate ourselves and retreat into tight spaces where often the only recourse is to fight our way out. We have bought into the idea that in order to be safe, we must be feared ourselves, and so we arm ourselves with weapons and hateful words to be used against others.

And this fear takes on a life of its own - it prompts someone to report a suspicious character simply because of the way he or she is dressed or to be kicked off of an airplane for being middle eastern and doing math.

It takes us to the point where we are so fearful of sharing a public restroom with someone who doesn't look like us, act like us, think like us, that we try to enact laws to keep transgendered people from peeing in the stall next to us.

Every time an unarmed person of color is shot by a police officer, we live the result of that fear.
Every time a non-binary-gender-conforming person is killed or beaten, we live the result of that fear.
Every time we choose violence over dialogue and assume that the only way to protect ourselves is by shooting first, we reinforce that fear and paint ourselves farther into that corner.

The United States has become a country whose primary focus is on protecting itself, whose primary motivation - by default - is fear. It will only get worse from here unless we make a conscious effort to elect officials who come from a place of community, openness, shared humanity. The only thing we will get from fear is more fear.

Monday, July 04, 2016

Requiem for the Living

I read somewhere a reminder that everything is simultaneously living and dying. And, of course I knew that, but we do our best to think otherwise, don't we? We either work to ignore it or reverse it in almost every act we take. But the end is part of the beginning as much as green is born with shades of blue embedded in it.

And it made me wonder whether the best thing to do is simply to float along in full acknowledgment of this minute
 this moment  
 this adventure
Or should I work to give the living a little more advantage? Stretch out the living part a bit more? Use my energy to tip the scales?

It's easy to go back and forth from camp to camp. So that's what I do.

Sometimes I live in memory, stacking up joyful moments like gold bars, hoping that once the dying is done I will have this wall to lean back upon. And sometimes I realize that so much stacking means I'm not appreciating the living that is happening behind my back, and I set aside my blocks and turn around.

Spending time surrounded by the awareness that what is here now won't be forever makes for a certain quality of awake-ness that is uncomfortable. It requires me to be mindful of emotional connection instead of physical action.

"I love you" versus "let me do this for you" or "let's make new memories."

It is also difficult to define the world in terms of Not-me. That is, to not process every potentiality and new situation with regard to what it requests and requires of me and how it makes me feel. I have to float back and see myself as one part of the whole and that both humbles me and reminds me that I am an important piece of the puzzle. That in any moment I can choose to turn my back, shore up the living, or accept my place and experience what is. Perhaps the beauty in that is that I do. I choose. Among the breath and the pulse and the movement and the slowing and the dying, I choose. And the more I can remember that it is all beautiful and glorious and a gift that I am here, part of it, for a while, the stronger I feel.

Monday, May 30, 2016

When "Owning It" Is Harder Than it Sounds

Because how do you write about the things that aren't yours to tell? How do you begin to separate what is yours and what isn't?

It is a tricky proposition, this. And not only because of the risk of hurting someone I love, but because of what it means to me. Sorting through the seminal memories and moments in my life means really looking hard at where my head was, where my heart was, and what I knew and wanted at the time. It would be easy to look back with the accumulation of experience and wisdom riding shotgun and nod knowingly in the direction of what should have been, but that doesn't make for a true story. It smacks of justification or pity-partying and paints a picture of Right and Wrong that doesn't exist in life, to be sure.

The hardest bit is in the owning of my entire, smelly backpack of crap and roses.

Own it, someone says, urging us to stand up for ourselves and not be ashamed of who we are. It sounds empowering - a battle cry for my generation. Owning it is frightening.

Owning it means I acknowledge an attachment to the story and once I'm attached to something, the idea that it could be taken away is frightening. Something owned can also be un-owned. Writing about other people's shit is the epitome of non-attachment. It says, "That isn't mine, but I'll tell you all about it and together we can exchange looks expressing how happy we are that it isn't ours." There is a complicity inherent in telling someone else's story. Telling my story - owning it - feels very lonely and vulnerable.

Owning it also opens me up to the risk of becoming defined by the story I tell; having it morph into a shorthand by which other people describe me or think they 'know' me. The complicity has shifted to include everyone else but me as soon as I own my story and tell it honestly.

I've discovered that it is so much easier to solve someone else's problems than it is to deal with my own. I once told a friend. She agreed. And now, when I sense the urge to find the cracks in someone else's armor, I am prompted to wonder whether it is because I am ignoring my own.

Ultimately, the only lens through which I can see life is my own, and that means that the only story I have the right to tell is mine. Anything else is just make-believe. And, it turns out, I'm not much of a fiction writer, so I guess I'll just keep sifting through to find the stories that are mine.

Thursday, May 26, 2016

Stream of Consciousness Morning

Saturday, Sunday, Monday I had hours for writing. The luxury of time meant that I woke early, poured coffee, sat at a rented desk and pounded the keyboard until I had 60 pages. Walks along the beach, more coffee, shuffling pages of memories and piecing things together.

Tuesday and Wednesday I was back in my normal life - driving, cooking, shopping, working at my 'other' job which doesn't entail writing so much as networking and trying to hawk what I've already written. But this morning, I could see a way clear to more writing.

First, the tasks that launch the day - packing lunch, toasting bagels, walking the dog.

My mind drifts and swells. I marvel at how much of my writing happens while I smear cream cheese on the bagel, tug the dog along our familiar route, stand in the shower.

I pass dogwood tree after dogwood tree, loaded down with so many blossoms that I can't see the leaves beneath them. I am struck by the sheer weight of beauty, how it weighs down the branches, the stems of peonies curving to rest the flowers on the sidewalk, their scent rising up to me. These plants with their short-lived bursts of shocking glory are my favorite. The ones with the less showy, compact blossoms that live on sturdy stems and branches barely merit a glance. What does that say about me?

There is a Frito-Lay truck parked along our route to school and I think about how, sometimes, I have an uncontrollable craving for potato chips. Not often, but when it comes it is intense. I imagine being the driver of that truck, pulling over to a quiet alley, climbing over the seat to get to the boxes and boxes, ripping open a bag and plucking one paper-thin chip out and then another and another. Wiping the grease on my pants.

We pass an apartment whose living room window frames a birdcage and I think, "Do people still keep birds as pets?" I remember my sister's parakeets - one blue and one green. The biting, ammonia smell of their cage, the wooden swing, the way she had to put a blanket over it at night to keep them quiet. What would have happened if we had simply turned out all of the lamps and let the actual night take over? Would they have slept?

Everyone else is gone for the day but there are imprints everywhere. Stray shoes, crumbs on the counter, a favorite pencil on the kitchen table. I am alone to write but the end of the day calls. What's for dinner? Are there towels clean? What time is my guitar lesson?

Monday, May 16, 2016

Does Anyone Else Drive Like This?


 
It seems that every new milestone my kids hit offers me an opportunity to examine why I do the things I do. I often fall into the trap of thinking that everyone does things the way I do, simply because I've always done it that way. Fortunately (?), my kids challenge me on that every once in a while.

In the past year, Lola has begun commenting on the way I drive. I don't know if it's because she is watching her sister learn to drive or because she is old enough to sit shotgun or if it has something to do with her drinking coffee and wearing makeup these days. All I know is that she gets annoyed with me for not stopping on a dime.  In the morning, the route to her school is pretty bumpy with potholes and lots of construction between here and there. She often brings a cup of coffee with her to drink on the way, but because of the condition of the road, it's a dangerous proposition to try and drink it unless the car is fully stopped.  Putting lipstick on is pretty treacherous, too, if you only want to apply it to your lips. And therein lies the rub.

I never really paid attention to it, but there is this game I play with myself when I drive that started back when I was a teenager driving a stick-shift. This game got more compelling when I started driving a hybrid car. The goal is to never come to a complete, full stop and avoid using the brakes if at all possible.  When I was driving a manual, I would try to slow the car by anticipating the traffic in front of me and simply downshifting, and I considered it a win if I could successfully slow down enough for a red light to stay in second gear and come up on the car in front of me (or the light itself) just as the light turned green, so I could begin to accelerate without ever hitting the brakes. I got really good at it.

Don't judge me.

When I got my hybrid, I was fascinated by the display screen that indicates whether the car is using gasoline or the electric battery. When you're coasting or apply the brakes, it shows you that you're recharging the battery, and when you accelerate, you can see that you're using gas or gas plus the electric battery.  In the first few weeks I had the car, I watched (probably WAY too) closely and loved the idea that I could coast to a stop - or nearly a stop - without using any gas at all. The game intensified.  I have nearly perfected my technique on the routes I normally drive, unless there is a huge traffic jam. I watch for pedestrians, cyclists, and cars ahead of me and gauge when to take my foot off the gas and begin coasting so that I can merely slow down and then speed up at the next opportunity, depending on whether it's a red light or a person crossing the street.

While it isn't necessarily forefront in my mind (I've been driving for nearly 30 years, so it's pretty second-nature at this point), there are times when I'm aware of it and I mentally congratulate myself for a particularly tricky maneuver. But it's all in my head and, until recently, I was the only one who knew what I was doing. Unfortunately, while I'm busy patting myself on the back, Lola is in the passenger seat, thermos or lipstick at the ready, anticipating her next opportunity to pounce and get a little satisfaction. She doesn't dare put anything to her lips unless I'm totally stopped for fear of wearing hot coffee or smearing makeup across her cheek as I accelerate.

Eve asked me to take her out for a practice drive yesterday and I was laughing as I told her how Lola yells at me every morning, saying, "Mom! Seriously! Just stop already, would you? Quit slowing down!"

I explained the game I play and Eve's hands squeezed the steering wheel hard, her knuckles turning white. She slowly turned her head toward me.

"That's why you always freak out when I stop at the last minute behind another car, isn't it?"

"Hmmm. Oops....  Sorry."

"Geez, Mom. Not everyone drives like you. Maybe nobody."

She might have a point there. When I think about it (which, frankly, I never really did before now), it's pretty obsessive and more than a little weird.

I wonder what other things I do without realizing that they are odd.
I suspect I'll figure them out as the girls get older.
Crap.

Wednesday, May 11, 2016

Two Reasons I Think Single-Payer HealthCare Needs to Happen

Warning: Rant coming in 3, 2, 1

There have been times in my life when I have been so f%*king DONE with our country's convoluted system of healthcare that I wasn't sure whether to cry, throw myself on the floor and pound my fists until they're black and blue or scream bloody murder from the highest peak I can find.

I know lots of folks who can relate.

Seriously. Socialized medicine, folks. I mean it.

I know it won't make everything easy-peasy, simple and clean, but it can't make things worse.

When I went to college, I was determined to become a pediatrician. That's all I had wanted to be since I was in elementary school and I could see it happening. I took organic chemistry, cell physiology, medical ethics classes. I struggled with some more than others, but I loved them all. My senior year, I studied for and took the ridiculously long MCAT and spent hundreds of dollars applying to medical schools and then decided to take a year off to work in the field before deciding whether to go ahead and go.

I ended up working for several years as a surgical assistant for a small group of doctors and I learned about the other side: the business of medicine. I hung out with the business manager and discovered how to tweak our diagnosis codes and pore through the (then) printed catalogs of allowed procedures to bill things so they would get paid for. When patients came in for emergency surgery, after the OR was scrubbed of blood and every last instrument was cleaned and put in the sterilizer, we convened for a quick meeting to determine just how to position the procedure to whichever insurance company might be involved so that we could have a higher chance of being paid. This not only determined which codes we used to bill, but it often meant that the doctor had to dictate his notes in a particular way so that, in case the insurance adjuster (not a physician or a nurse in most cases) asked for them, they would fully support the billing we submitted.

During those years, I discovered that if what I truly wanted to do was build relationships with patients that impacted their lives and their health, going to medical school was not the way to do it. As the surgical assistant, I spent more time with the patients than anyone - pre and post-op - and heard about the other things going on in their lives as I changed bandages and removed stitches. The doctors, while they may have liked to have more time to spend with patients, spent the majority of their time maximizing insurance payments by dictating notes, seeing a ridiculous number of patients per day, scheduling back-to-back surgeries to maximize OR usage, and occasionally getting on the phone with an insurance company who was refusing to pay for more than two scalpels or two hours of anesthesia to defend their choices.

Needless to say, I chose not to go to medical school.  And in the next several years, I spent time fighting with insurance companies for a physical therapy business, a dermatologist, and the state mental health division, not to mention myself and my family. I learned just how insurance companies make rules that increase their profits and narrow choices for their customers. I discovered that the high-level relationships that are made between drug companies and major hospital groups and insurers almost never benefit the health or wellness of a customer unless it happens to be in alignment with the bottom line of the companies involved.

A few weeks ago I called a doctor's office for a family member to get diagnosis and procedure codes for an anticipated surgery. I then called the insurance company armed with information to ask whether these codes were considered covered procedures. After nearly an hour on the phone I came away with a vague answer that included information about the deductible and the potential coverage depending on a number of variables over which we have no control.  If the doctor is "in network" (he is), his services are covered at X%. If the hospital is "in network" (they are), their nursing and OR services are covered at X%, as long as it is a day-surgery. Overnight stays are covered at X-Y%. If the anesthesiologist is "in network" (we have no control over that and no way of knowing until the day of the surgery who that person might be), their services are covered at X%, but if that doctor is "out of network," services are not covered at all. Not only that, but on "out of network" providers, the amount the patient pays is not applied to the deductible or the out-of-pocket maximums for the year (presumably because we had the audacity to go rogue - even though we have no choice in the matter). There are further decisions about OR supplies (one would think that those would be considered part of the surgery facility charge, but, no, it seems they are billed separately), so if the surgeon chooses a more expensive bandage or stitches, it is likely those won't be covered at all.  I could go on, but you get the gist.

This morning, I phoned our dentist's office to discuss a particularly high bill we received and after another hour of talking with them and the insurance company, I was told that Lola's emergency dental procedure last summer while we were on vacation was not only not covered (out of network), but none of the $500 we paid for it were applied to our deductible (out of network). I calmly asked the representative,

"So, this was literally an emergency. As in, the plane touched down, we stopped at the pharmacy to get pain killers for our daughter, and as soon as we hit the hotel we asked the concierge to recommend a dentist who could see her ASAP (Saturday morning in Hawaii). First of all, does your insurance company have in-network providers in Hawaii? And if so, am I expected to call all of the islands to find one who happens to practice on the weekend and is willing to see my daughter? Is that a thing I should have done?"

"No. It's not a thing," he says.

"Explain that to me, please."

"Was it a medical emergency? Because if it was, you should have run it through your medical claim instead of dental, and then it might have been covered even if it were out of network. But it wasn't, and it's too late now. It was processed as out of network and that's how it's going to stay. And, no, we don't have any in-network providers in Hawaii."

So, ultimately, it's my fault that I didn't sell it as a medical emergency? Or is it the dentists' office fault? The dentist who got up on a Saturday morning and spent three and a half hours with Lola patiently tending to her and then calling us that night to make sure she was ok.

And why wasn't my out of pocket amount applied to the deductible? Because we went rogue. Because we didn't follow the rules. Because, if it had been, the insurance company (Premera Blue Cross, btw) would have been on the hook for all the rest of the follow up procedures that have taken place as a result of this situation in the last nine months. But they aren't, because it all started with us needing dental care somewhere else in a hurry.  When I pointed this out to the representative this was his response:

"Well, you just really want to have your dental emergencies when you're at home. That's the best way to do it."

Duly noted.

Socialized medicine, folks. Single payer. The same rules for everyone.

Health care (even dental care). It's a basic need.

Monday, May 02, 2016

Diving In, Part 3: New Vaccines and Random Questions

Part 1 is here
Part 2 is here

I would like to go on record as saying that I don't think vaccines are a bad thing, in and of themselves. I do think that they have served an important function in our understanding and the prevention of many diseases. However, I don't think there is such a thing as a panacea, as much as we would like there to be, and over the past few decades, the medical-industrial complex has become so interwoven with the public health system that I'm not certain it is serving the people it claims to serve any longer.

One example of this phenomenon lies with the development of HPV vaccines. I wrote about this in 2013 here, detailing my issues with the vaccine Gardasil. Since that time, more countries have either banned or started investigating this particular vaccine because of the high number of adverse side effects, and yet in the US, our public health officials continue to advocate for its use within an even wider population. It is now recommended that boys have this vaccine and that all children have it starting at a younger age (an age at which NO trials have been done to determine safety or efficacy). If we were truly interested in long-term public health and not making money for pharmaceutical companies, we would proceed cautiously with this vaccine which has been shown to have some correlation with teenage-onset menopause and severe neurological issues.

Another example of the rush to develop vaccines that (I believe) are unnecessary is the chickenpox, or Varicella zoster, vaccine. Ours is one of the few countries that routinely and widely vaccinates our children for this disease that has not been shown to be deadly in the vast majority of cases. This article found at the National Center for Biotechnology Information illustrates the reason why, after much scrutiny of the matter, the United Kingdom does not push chickenpox vaccines on its children as a matter of routine. The conclusion of the physicians there was that there are two main areas of concern regarding this vaccine:

1. "...introduction of a routine childhood vaccination drives up the age at which those who are and remain non‐immune get the illness and chickenpox tends to be more severe the older you are,"

and


2. "...what will happen to the epidemiology of shingles if chickenpox vaccination is introduced in the United Kingdom?"


The answer to these questions from pediatricians I have taken my children to are as follows:

1. If your kids don't get the disease naturally now, because all the rest of the kids are vaccinated for it, they will more likely get it when they're older, when it is much worse, so they might as well follow the crowd and get the vaccine. What they neglect to mention is that the efficacy of the vaccine has been shown to be between 3 and 5 years, which means indefinite booster shots for the rest of their lives. And if they don't - say they forget for a year or two when they first move out (like in college, when they're exposed to tons of different infectious diseases), they'll likely get a horrible case of it. They also neglect to mention that, had we not developed this vaccine and given it so widely (as opposed to just kids who are immunocompromised or otherwise indicated to have it), we wouldn't have the issue of kids not getting it naturally. 


2. There's a shingles vaccine. Don't worry. Great, so now, on top of the multiple chickenpox vaccines my kids will be getting for the rest of their lives, they have to get shingles vaccines? 

If you're a pharmaceutical company, you've created a solution to a problem that didn't really exist. But with the CDC on your side, you are guaranteed to have a captive audience for your vaccines for years to come. And in my state, physicians are given financial incentives (higher ranking with Medicaid and state insurance programs as well as payment) if they have a significant percentage of their patients who vaccinate fully. Thus the pressure I get every time I take my kids to the doctor for a check up.



It seems that, in the UK, they have decided to be more conservative with their recommendation and follow the research instead of the money. Interestingly, it turns out that in households with children who acquire chickenpox naturally, there is a smaller incidence of shingles. What that means is that there is likely a protective factor against shingles for adults living with children who have naturally acquired immunity to chickenpox. 
So, why the development of the chickenpox vaccine? Previous to the development of this vaccine, fewer than 100 people per year (out of 4,000,000 who contracted the disease) had complications that led to death. One hundred people sounds like a lot, but that is 0.0025% (or 0.000025) of the people with the disease. And the rest of those people had not only naturally acquired immunity, but some protection against shingles as adults. The normal lifetime risk of getting shingles is 10-30%, but the UK researchers noted that, with a chickenpox vaccine program, the incidence of shingles rises 30-50% until everyone is vaccinated, which could take decades. 


In my opinion, this particular vaccine has become a boon for pharmaceutical companies despite the fact that it protects very few people from the serious side effects of childhood chickenpox and instead, opens up an entire generation of young adults to risk for adult chickenpox infection and future shingles. If you add in the risk associated with multiple vaccines (some reported side effects of the Varicella vaccine include shock, seizures, encephalitis, thrombocytopenia and Guillian Barre syndrome), you're looking at a lifetime of risking your health again and again versus the risks associated with acquiring chickenpox naturally and suffering it's side effects.


Back when vaccines were first developed, they were designed to combat highly infectious, deadly diseases, and they were mostly developed by pure scientists who had little financial stake in the outcome. These days, pharmaceutical companies who are concerned with their stakeholders' satisfaction commission their own scientists to create vaccines that may or may not be immediately necessary (the "fast tracking" of Gardasil is one egregious example of a corporate push to market that was altogether unnecessary) and gradually increase the population and number of boosters that are given, continually growing their market share. Until we can be assured that the entities who are recommending the vaccine schedule have no conflict of interest and have done truly independent studies on safety, efficacy, and necessity of each and every one of the vaccines on our current US schedule, it is unfortunately up to the consumer to advocate for themselves, their families, and follow the money. 





Thursday, April 21, 2016

Diving In, Part Two (Or, Why the Vaccine Debate Isn't Cut and Dried)



In case you missed, it, Part 1 of my writing on vaccines in the US can be found here.


I suppose that, like most other very controversial subjects, it shouldn't surprise me that the vaccine debate tends to get framed as an all or nothing, black and white, choosing sides issue. Whenever we are driven by fear, human beings tend to lose the ability to think rationally and begin to believe that there is a Right and a Wrong answer, and the question of whether or not to vaccinate can certainly be a fearful one.
I do continue to be mystified, however, by people who should know better - public health officials and medical practitioners, for starters - that position vaccines as an all-or-nothing proposition, and here is why:
Vaccines are not all created equal. Accusing me of being "anti-vaccine" because I am concerned about the safety and/or efficacy of some vaccines or the current US vaccination schedule is akin to saying I am "anti-car" because I wouldn't consider driving a Volkswagen but I might choose a Toyota.
  • There are a vast array of vaccines available, some of which were created decades ago and some that are fairly recent. 
  • Some vaccines on the market are multivalent (that is, they are designed to inoculate against more than one disease-causing organism) and others are monovalent (for one organism only).
  • Some vaccines were created to work against bacterial disease and others were designed for viruses.
  • Some vaccines contain adjuvants (chemicals that are supposed to increase the body's immune response to create stronger immunity) such as aluminum and others do not.
  • Some vaccines are designed to be injected once in a person's lifetime and others require multiple boosters in order to maintain a high level of immunity.
  • Some vaccines contain inert ingredients derived from animal parts, others from human fetal tissue, and things like MSG (monosodium glutamate).
  • Some vaccines have been tested many times over a long period of years on individuals of all ages, genders and races, and others have been "fast-tracked" which means that there was a determination that there was some public health risk that necessitated them getting to market faster, so there hasn't been the same rigorous level of testing. 
I could go on, but hopefully it is imminently clear that the vaccines Americans are encouraged to give their children (and have themselves) are very different from one another. Much like buying a car, it is important to do research on each individual vaccine in order to determine a risk/benefit ratio and decide what is comfortable for you. For example, when my daughters' doctor recommended the chickenpox vaccine for them, I researched it as thoroughly as I could and ultimately chose not to have them get those shots because I felt as though the risks outweighed the benefits. Similarly, they have not had the HPV vaccine and I don't foresee either of them getting it anytime soon. (If you're curious about why, you can read this post particular to the Gardasil vaccine. Since I wrote it, there has been a great deal more information published by other people who are critical of both Gardasil and Cervarix that shouldn't be difficult to locate online.)

Please don't think that I am under the impression that doing research on the safety  and efficacy of individual vaccines is a simple endeavor. I am fully aware that it is not, and I know how lucky I am to have both the time and the educational background to locate, digest, and mostly understand the data. Many, many people are unable to do what I have done, and the system is unfortunately not set up to support any kind of patient education regarding vaccines or any other pharmaceutical, for that matter. Many vaccines are available through drugstores and grocery stores in America, which makes it a challenge to have an in-depth conversation with the provider regarding risks and possible complications. Even if you go to a physician for vaccines, many of them aren't as well-informed about the individual attributes of each vaccine as they could be, and a great deal of them are unwilling to have a candid conversation about the ingredients of individual vaccines. In a perfect world, the person who is recommending that you inject your child with something would have looked at the studies done on that drug to determine whether or not it is a good idea, but the amount of information is incredibly huge. The doctors I've met are content relying on the word of the CDC that vaccines are safe, but because these drugs are created and sold by massive corporations who may or may not be interested in the greater good of public health, but who are nevertheless incentivized to create a product that they can bring to market quickly that will produce enormous profits for their shareholders. In turn, these corporations use that money to lobby lawmakers who wield a great deal of power over government agencies responsible for determining whether these vaccines are safe and effective and when they get to go to market, as well as recommending where in the vaccine schedule they ought to be placed. There is a very clear conflict of interest for many physicians and scientists working on vaccines who are being paid by large pharmaceutical companies to create new vaccines. And, in many states, regular family physicians are paid by the state to give patients vaccines, so the more children they inoculate, the more they are rewarded. 

Ultimately, this issue is much more nuanced than many of us would like to believe, and because it is so complicated, we often fail to have productive conversations about it. In my heart of hearts, I believe that we are all striving for a country with healthy children, but if we are going to get there, it will, at some point, mean that we sit down together without fear or anger or labels and get everything out on the table with that singular goal in mind. 









 
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