Wednesday, September 29, 2010

Dr. Goldman, You're Fired!

Dr Goldman, my all-in-one primary care doctor of the last nine years, is fired. Here is the list of infractions over the last three months:
1. Flagging low blood sugar during my recent well check
2. Flagging high cholesterol during my recent well check
3. Telling me I am healthy as is and don't need to lose weight (I LOVE her for that, but it is bad advice)
4. Insisting I come in for an office visit for what I was pretty sure was a cold by telling me I might have pneumonia
Having an auto referral system that prevented a local urgent care clinic from getting a live time referral and therefore prevented me from getting what ended up being a strep-free throat culture closer to home.

This is not a story of customer service outrage, but rather a reflection on the messed up state of health care services in America. It took me 5.25 hours, a 1/4 tank of gas, and either visits to or communication with five separate medical practices to get a throat culture today. Let's review:
Step One: At 10:30 this morning, concerned about my fever seeming unabated I called my primary care doctor, who insisted I come in to the office for a throat culture.
Step Two: At 12:22 PM BMG checks in while on his lunch hour to see how I am doing. Hearing that I didn't feel well enough to make the 2-hour round trip drive, he suggests I might be able to get a throat culture closer to home.
Step Three: At 12:37 PM I call my primary care provider only to learn the entire office is shut down for an hour while they take lunch.
Step Four: At 1:06 PM, I call my primary care provider to ask if I can get a throat culture closer to home, like, for example, at the urgent care center at South Shore Hospital. They say, "Sure, you can do that."
Step Five: I hop into the car and drive to South Shore Hospital. Arriving at approximately 1:45 PM, I park, head to the concierge and ask for directions to the urgent care clinic. That's when I'm told they South Shore Hospital doesn't have an urgent care center. "I'm told they are concerned about competition with CVS," says the nice man at the hospital concierge desk.
Step Six: At 1:56 PM I call BMG who helps me find another medical practice in the area with "Urgent Care" in the practice name.
Step Seven: At 1:59 PM I call the new practice only to learn they don't provide urgent care services to anyone other than their patients. They give me the name of ANOTHER nearby medical practice.
Step Eight: At 2:02 PM I call what is now the fourth doctor's office I've talked with today, explain my need. They say "Sure you can come in."
Step Nine: At 2:22 I arrive at the fourth practice. It is sketchy inside, but I'm desperate. I explain my situation and they ask me if I'm in the market for a new doctor. I look at them and say, "I'd like to take care of my immediate need for a throat culture before I answer that question." The receptionist insists they can't see me without a referral from my doctor. I give them my doctor's phone number. They call and claim the phone just "rings and rings."
Step Ten: At 2:26 I call my primary care provider from my cell phone, and go through the voice activated referral line and submit a referral request. I hang up and tell the sketchy practice the referral has been requested. They say they won't see me if they can't talk to my doctor's office directly. My doctor's office won't talk with them directly and apparently the sketchy practice can't make a phone call.
Step Eleven: At 2:29 PM I leave in a sweaty huff and call BMG and tell him I'm giving up.
Step Twelve: Concerned about my apparent lack of concern for my health he (a) tells me again my doctor sucks and I need a new one, and (b) realizing that isn't helpful in the moment (after I scream, "That doesn't help me right now"), he finds a CVS 1-Minute Clinic a short 8 miles from home.
Step Thirteen: I drive back towards home to the CVS clinic. The medical provider administers a rapid strep test, affirms I don't have strep, and sends me home at 3:15 PM with an order to drink fluids and get plenty of rest.


What if I didn't have a car? Or a cell phone? Or someone who could help me with web research during my muddled state? What if I were toting kids around with me on this stupid odyssey?

It is no wonder to me that America's health status relative to the cost per capita spent on health services is lowest among industrialized, shoot, even developing, nations. If I was more than a little sick, had kids, or was using public transportation I would have stopped at Step Five and gone directly to the emergency room. As it was I had resources, including a degree in public health, that led me to make the choices I made today (for better or for worse).

And it is with these resources that I'm going to find a new all-in-one primary care provider who can see me with minimal travel hassles the next time I'm too sick to drive to work.

Sunday, September 19, 2010

Homeless cats

As I was waking up this morning I had a dream about taking Brisket, one of my kittens, for a walk to visit one of his cat friends. Brisket was curled up all cozy and warm in a cardboard box I was carrying.

I had seen Brisket and his friend cat hanging out on this busy street corner before and, like a good cat mama, wanted to meet the cat and make sure the two were safe as they played. This is why I was escorting Brisket there.

As we rounded the corner I realized that Brisket's friend cat had a sibling and two owners. They were all on the corner together, and they were all obviously homeless. The cat parents were an elderly couple, wearing coat upon coat upon coat, each with a different pattern of tears in them. They were pale white with stringy white hair, his hanging out from underneath a black beret, hers from underneath a kerchief. The homeless wife stood in front of the homeless husband, his arms at her side, with tens of ragged bags at their feet. She held a cat while Brisket's cat friend sat nestled atop a suitcase. Both the homeless wife and the homeless husband stared straight ahead, neither person talking.

In my dream I stopped short and wondered, "What next?" If I continued with the kitty play date I would naturally have to introduce myself to them. And, while our pets played I'd need to talk with them, and I knew there was no way I could avoid learning more about their circumstances, and then I'd naturally need to dedicate myself to helping them.


It was at this moment of wild panic and conjecture that I woke up. Brisket was resting on my pillow. I was safe, in my home, in my warm bed. I moved Brisket to my chest, absentmindedly stroked his back, and reflected on the dream.


Homelessness is one of the issues that cuts to the core of my heart. Everyone should have a home where they feel safe and comfortable - where they can escape from the perils of their world. This, I believe, is a basic human need. When I hear of children who are homeless my heart breaks.

Given the depth of my empathy for individuals struggling with homelessness, I know I cannot have a career doing this work. This is why I give money and time to homeless causes. I give money to organizations that are relieving immediate suffering by providing food, clothing, and shelter. I give money to organizations that are creating points of normalcy for homeless children and families. And I give money to organizations that strive to prevent homelessness or to create long term solutions to the problem in US society.

One of these organizations is the Somerville Homeless Coalition. They recently had an anonymous donor give them a $20,000 challenge grant. For every dollar I give the donor gives $1, up to $20K. This can go a long way to helping building permanent housing for homeless families in Somerville and surrounding communities.

If ending homelessness, or being part of a challenge, strikes a chord with you, then I invite you to give to the Somerville Homeless Coalition during this $20K challenge grant period.

If homelessness isn't your issue, no harm, no foul. Take a moment to think about the last time you gave time or money to a cause that made your heart go pitter pat. Share your cause in the comments section below, and consider making a gift this week.

Friday, September 17, 2010

If I were just a stump would you feed me Doritos?

I haven't yet documented my DNR, but I'm clear that I don't value life (or fear death?) enough to crave extraordinary heroic life saving heroic measures in the event (knock on wood) that something terrible happens to me. I haven't documented my DNR yet because I'm not sure where the line gets drawn.

My older sister and I were talking about this issue today vis-a-vis her decision making about heroic measures for both of her dogs who are suffering from slightly out-of-the-ordinary maladies.

Big Sister H articulated her (also undocumented) DNR beautifully when she said, "I don't want heroic measures if they will result in me breathing but with a poor quality of life."

"But how do you define 'poor quality of life'" I asked. "This is why my DNR or living will isn't yet written down. I'm now sure where to draw the line."

My sister explained that if she is in a position where she is in constant pain or severe discomfort, or she can't enjoy her life x% of the time - regardless of her mobility, she'd experience that as low quality of life.

I persisted. "What if you had no arms and no legs, but still had full capacity to 'enjoy' things. Is that quality of life?"

"Well, I don't think I'd have good quality of life if I were just a stump," she conceded. "Unless....there was always someone around to feed me Doritos, because I think that would bring me enjoyment if I were just a stump." She paused. "In fact, if they just put a big bowl of Doritos near my stumpy self that I could then stick my face in to eat whenever I wanted, that would probably be a good enough quality of life."


I'm still not sure what my 'quality of life' threshold is. Join the conversation. Share your thoughts in the comment section below.

Tuesday, September 14, 2010

Interspecies Communication

I want to detail two very different interactions I had just minutes apart while on an early evening walk through my neighborhood.

The first interaction took place as I passed another walker, a man in early middle age also walking at a brisk pace:
Me: With a nod in his direction, "Hey."
Man: "I'm fine, how are you?"
Me: Puzzled, "I'm fine."
Man: "Thank you."
We both continued to walk throughout the brief interaction. Once he was clearly behind me I started shaking my head, thinking, "That might have been one of the most inauthentic conversations I've had in a long time. That man didn't hear a word I said." He was merely going through the motion of social niceties.

The second interaction was maybe three minutes later. I rounded a corner I heard a rustling in the decorative brush in a neighbor's side yard. I slowed my pace, wondering what might be making the noise.
"Is it a cat?" I wondered. "Maybe the neighborhood fox. What would I do if I ran into a fox?"

As my internal musing continued an animal burst out of the ornamental grasses. It was a skunk.

I froze.

The skunk froze, with its gorgeous tail waving slightly in the ocean breeze.

I slowly started to back away.

The skunk did the same.

When it assessed there was enough distance between us it finished scurrying across the road into the bushes of another neighbor. With the skunk out of sight I hurried past our rendezvous point and continued my walk.

As I did so I thought to myself, "I think the skunk and I understood each other better than me and that other man did. We both communicated we were scared. We both knew to back away, and we both knew the skunk needed to safely cross the street before I could continue my walk. And all without uttering a sound."

Monday, September 6, 2010

And now for an immature moment

My jaw dropped a few moments ago, when I learned that BMG had never heard this popular nursery rhyme:

"Artie Farty had a party
All his friends were there.
Tutti Fruitti blew a beauty,
And they all went out for air."

Please leave a note in the comment section if you have heard this before. I want to figure out if I had the warped childhood, or if BMG is the deprived one.

Sunday, September 5, 2010

The Miracle of Potlucks

I grew up in a handful of church communities where potluck suppers, particularly during Lent, where de rigueur. My family would show up with casserole, a bag filled with our plates and silverware, and we'd sit down to eat. I was always intrigued by the smorgasbord on the table. How many other people brought homemade mac and cheese, I'd wonder as I scanned the table deciding what I'd want to eat. Potlucks provided an opportunity to share one of your family staples with friends, while also trying something new.

As I went through graduate school, potlucks were a strategy for hosting a dinner party without breaking the bank. Later, when I moved through my hippie phase, they were democratic social gatherings. Everyone gets to contribute, the meal was never extravagant, and there were no class barriers for we didn't know who brought the Tofurkey with all the fixings, or who brought the bag of mealey apples.

Wikipedia, for better or for worse, tells us that a potluck is a meal with no particular menu. For me, a potluck is a meal where the whims of the guest create the menu. What you eat is the amalgam of luck, desire, and individual taste. Everyone brings brownies? Awesome! Brownies for dinner. How lucky is that?

Potlucks are never planned, always a surprise.

So, for all of you people who call to ask "what can I bring?" when invited to a potluck, I offer you the Eight Commandments of Potluck Dinners:
1. Stop asking "what can I bring?" If your host or hostess wanted to tell you what to bring s/he would not have planned a potluck.
2. Take a deep breath and think about what you want to eat at the party, what meal you'd like to share or show off, and what your time, budget & energy level can handle. And then bring that.
3. Don't worry if everyone else brings the same thing you did. That's the fun of a potluck. Seriously.
4. Don't bring anything to the party that requires (a) baking, or (b) extensive preparations before it can be served. I once went to a New Year's Eve potluck where someone brought a bag of dried black eyed peas to cook. She ended spending the whole time at the stove while everyone else danced and drank. She missed most of the party and, by the time the peas were ready to eat, people were too full or had actually left the party.
5. Don't have a lot of time or a lot of cash? Who cares. Go to the grocery store, buy two Granny Smith Apples, a box of Triscuit, and an 8 oz. block of cheddar and you're done. Is that too much work? No problem. Swing by the corner store en route to the party and grab a bag of chips. You won't be the first person to do this and you won't be the last.
6. Don't bring anything that requires other ingredients. For example, if you bring margarita mix (fun!) and expect your host to have tequila, a blender and ice, you may end up bringing the loser dish of the day. The lesson here is if you bring margarita mix, also bring the tequila, the blender, and the ice.
7. Don't bring anything that requires unusual serve ware. No soup, no gallon tubs of ice cream (popsicles or Hoodsies are fine), no lobsters. Period. Expect your host/ess has plates, cups and plastic silverware and plan around that.
8. Expect that the food you bring will be served in the vessel that carried it to the party. If you want your great-aunt's silver tray back, put your name on it in a discrete place so the host/ess knows who it belongs to as s/he cleans up after the party. If you want to bring your serving vessel home with you plan accordingly.

What potluck advice would you add? Leave a note in the comment section so we can help each other develop the faith needed to believe in the miracle of potlucks.

Saturday, September 4, 2010

Feeling Groovy

I think I've been a little depressed lately. Not Abilify depressed, but definitely not myself.

Today things feel like they've turned around, even for for only a day. How is it different? I noticed I had energy for yard work I've neglected literally for three months. When I was 95% done with yard work I pushed myself to take another 30 minutes to get to 100% done. Then I cooked, not a gourmet meal, but a satisfying meal for myself, without worrying if it would work for BMG. I have a new book from the library that I'm excited to read and don't feel an ounce of guilt about wanting to read when then house is coated in dust and I have a satchel full of work to do.

I've been on the go for 11 hours I don't feel exhausted, sad, or listless. I haven't felt this energized at 7:00 PM in a very long time.

I'm not sure what shifted.
  • Maybe, because BMG is doing more chores around the house I feel less burdened at home?

  • Is it the cumulative effect of nearly 15 years of personal introspection settling into my soul?

  • Maybe it is the long weekend with nothing I HAVE to do? (That's not it, I rarely have anything I HAVE to do. So much of the "HAVE to" is created in my own mind.)

  • I listened to a snippet of a moving story featuring Holocaust survivors' memories on NPR while running errands today. Could that be it? Or maybe the stirring cry I had while finishing "The Hour I First Believed" by Wally Lamb?

  • I am in the midst of a brief reconnection with a dear friend and spiritual touchstone and saw my best friend from childhood last weekend too, which is causing me to look inside of myself and the person I have been, or people have believed me to be causing the shift?
No idea why, but I know it feels good.