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. 





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