Monday, May 22, 2017

Sixes and Threes

I had no intention of marking the 6 month anniversary, yet here I am at San Jose International Airport, unavoidably wallowing in the memories of the day that changed the course of my life. 

This morning I had a follow-up appointment with my orthopedic surgeon.  Dr Matityahu wear Dockers with sneakers, and looks like Ben Stiller.  The walls of his exam room are covered with pictures of him watching BMX riders crash their motorcycles.  When he enters a room, his cold blue eyes connect with mine in a way that seems far more practiced than authentic.  

“Wanna see your x-rays?” he asks brightly, momentarily filling me with hopefulness.  Then continuing in the same bouncy tone of voice, “Look, here, all the major cracks across the bone are still wide open, like they haven’t healed at all.  And see this wispy bit here?  That should all be thick and solid, but your bone just isn’t growing back.  How much calcium are you taking? You should probably talk to your ObGyn about osteoporosis.  And get your thyroid checked.  Make no mistake, this was a really major injury, and you’re an old lady, so you better start managing your health like one…”

“Look, I realize you went to medical school, head the orthopedic department of two hospitals, and are a published leader in your field, but my friend’s Pilates instructor says that I should be going to physical therapy 3 times a week.”

“Oh My God!  You’re right!” he said, “How could I possibly have overlooked that.  It’s a good thing your friend mentioned your case to her Pilates instructor, or you might never have walked again.” Then he wrote me a prescription for physical therapy and said to come back in 3 months.

A few hours later, I rounded the curve of Terminal A and passed through the ill-fated crosswalk where 6 months to the day – and nearly to the hour - an 82-year old woman driving a 2000 Honda Civic failed to see the flashing lights warning to watch for pedestrians and struck me just as I planted my full weight sending me cartwheeling into the air wailing in pain and breaking my left leg just below the knee.  I wish the next few hours were a blur, but I retained full consciousness for several hours, until I was finally pumped with enough morphine, dilaudid, and codeine to put me to something resembling sleep. 

And so I remember every bump and bruise of being strapped onto a board and lifted into an ambulance, every question and comment from the med tech with horrible halitosis, every stop and start of the rush-hour ride to Regional Medical Center, every humorless joke and half-hearted apology from the ER nurses who finally brought me ice chips, and every scream and curse as I was wrestled in and out of CT scanners. 

Yet all of that pales in comparison to the cumulative pain that lead to the even bigger break that occurred 3 months later, but that is a story for another time. 

Here in the present, things really aren’t quite as dire as cheery Dr Matityahu would make it seem.  I make progress every few days – then I slide backwards for a day or two.  I can walk several hundred yards without my crutches, but I look like a drunk toddler.  I have been out and about on my new bicycle – and oh but that feels like freedom! – but then I have to lay on the couch for a day to recover.  I am excited about the future, even though I am forced to take life one day at a time for now…at least for the next 3 months.

Thursday, February 16, 2017

I Don't Practice Santeria...

...oh, wait...yes, I do...

This little leg trinket came from a curio shop in Cabo San Lucas.  I found it in a cabinet filled with similar trinkets - arms, hands, hearts, livers...charms for whatever body part is ailing.  I bought it for Kevin when he broke his leg, but he wasn't amused by my whimsical medical superstitions.

My shabby Spanish was not entirely adequate to receive the instructions that came with the talisman when I purchased it, but I was clear that the wearing of it is meant to corral energies (or maybe spirits, but whatever) to help me heal. I found it when I came home from the hospital.

Yesterday, the leg was gone.

I felt sure that this was a good sign, that it signifies the end of this chapter.  A punctuation mark of sorts.  Evidently, the Universe knows more than I do, because I most certainly do not feel fully healed. At least not physically.  

But my emotional health is ready to run marathons...

Sunday, January 15, 2017

50 Shades of Pain

My mother once told me that the Inuit have 50 words for snow, each describing subtle defining characteristics of various states of snow.  I need at least twice that many words for the amazing variety of pain I experience on a daily (and nightly) basis.

To be sure twinge, ache, throb, sting, burn, and tingle are all lovely words.  I am intimately acquainted with each of them.  I invoke them daily.  However, I need terms that convey far more complex sensations than any of those found in your typical thesaurus.  I've never been very clever when it comes to inventions, so perhaps my kind readers can help me come up with new words that capture the following experiences:

1) Elephants wearing crampons are river dancing on the superior surface of my tibia.

2) Fire-breathing termites are eating the flesh from behind my knee-cap.  They pee sulfuric acid.

3) Someone smacked my knee with a cactus paddle dipped in Ghost chili extract.

4)  Try-outs for the worlds tiniest Bruce Lee look-alike are being held deep within my bone marrow.

5) The feeling you get when your calf muscle suddenly turns inside-out.

6) X-wing pilots and tie fighters are suddenly cooperating and firing lasers at my meniscus.

7) That thing from alien has latched onto my knee and is injecting an embryo behind my patella.

Fortunately, these sensations are as short-lived as they are intense and sudden - which is to say that I might be gurgling away happily one moment then spewing a non-ending eruption of nonsensical expletives, even though outwardly, nothing has changed.  It's actually rather extraordinary, to experience such spontaneous generation of sensation

 Perhaps Spanish is a more efficient than English*, but as far as I can recall, there is only one word for pain in Spanish.   And I clearly remember how I learned it.  When Kevin was being processed through the nightmarish wards of the public hospital in Mexico, every single staff member asked him "?Tiene Dolor?"  I don't know why they bothered to ask if he had pain, when they absolutely no intention nor ability to do anything about it.  I guess they are just a curious people and a crying man with limbs jutting in inappropriate directions presented a mystery that required further investigation.

*Of course, it is also possible that I am mostly ignorant of advanced Spanish vocabulary and I couldn't be arsed to look up dolor in a Spanish Thesaurus - which I only assume exists...

Thursday, January 12, 2017

Week 7 Update

Not much to report, really.  Today's x-rays show strong evidence that the bone is filling in as it should, the hardware has remained perfectly in-place, and that all is well with the dimensions of the joint - meaning I should be spared the garish limp that once got Kevin cut off at a pub before he'd even had one sip.  I am still not allowed to put ANY weight on the leg for another 6 weeks (so I am still off work) I was cautioned against excessive use in order to give the meniscus plenty of time to re-seat, so no working out on the stationary bike or vacuuming.  I am allowed to swim (without kicking), and I was given the all-clear to fly.

Speaking of flying and swimming, my most wonderful and darling friend is giving me the run of his luxury high-rise condo in Miami for 10 days of blissfully healing warm air and soothing sub-tropical humidity!  Although Kevin keeps the wood stove a-blazin', the chill and gloom of winter in Shingletown is beginning to dampen my spirits.  When my friend offered his flat (and by offered, I mean said yes when I begged), I felt like I was given a new lease on hope, something to liven up daydreams, which have lately been confined to wondering what I might eat for dinner.  Of course, I will still wonder what's for dinner in Miami, but I will be wearing far less clothing while I do it sitting by the pool and my options will be much expanded to include Cuban sandwiches and Stone Crab.

Speaking of Shingletown dining options - my fantabulous work-mates chipped in and organized a huge delivery of fun food-stuffs from Trader Joes, which has turned out to be a wonderful life saver on stormy nights when inspiration and raw ingredients are in short supply.  They also sent me some meals from Blue Apron - which should arrive today - I'll report back later on that experience.

Oh wait - hang on, I think FedEx just knocked on the door...I'll be right back.

Hey, here's a bit of fun:

Just in time - my tummy is grumbling.

Monday, January 9, 2017

An All-Inclusive Resort Only Costs $400 a Night...

If I were the sort of person who wallowed in statistics, or even bartered in facts for that matter, this article would be filled with tedious decimal points and percentage values; it would contain citations and references to tables, graphs, and historical data; and it would be as painful to read as it would be to write.  Luckily, veracity and exactitude do not concern me (nor most of America, apparently) when it comes to crafting a good story.  Personal experience is the most reliable source of useful information.  And writing about myself is far more interesting to me than is compiling and summarizing the opinions of a bunch of educated, well-informed strangers.  However, just because my supporting arguments will be entirely anecdotal (and, there will be some numbers and probably a chart) is no reason to throw out proper form and structure.  Therefore, allow me to begin with a hypothesis:

Healthcare in America is stupid.

OK, perhaps that statement is too broad.  The actual 'care' portion of healthcare in America is awesome.  The doctors and surgeons, the facilities and resources, and approximately 10% of the nurses are exceptional.  Methods are modern, clean, and effective.  I received excellent world-class care for my health.  Seriously, I cannot praise my team at RMC Medical Center enough, although I may have some serious displacement issues with the very attractive surgeons who so tenderly reassembled my broken leg and gave me lots of delicious pain killers.

However, in America "healthcare" is a double-barreled word which also describes the idiotic and confounding accounting and payment practices that support an otherwise wonderful team of talented and dedicated caregivers (minus 90% of nurses, of course).  The word - which should belong exclusively to the realm of solace and comfort -  is inextricably linked to anxiety-inducing terms such as monthly premiums, co-payments, and out-of-pocket maximums.  I think it is a bit of a shame (why am I pulling punches? I think it is a bloody disgrace) that any consideration of well-being jumps immediately to an evaluation of the affordability of treatment or prophylaxis.

But, IS healthcare in America REALLY  that expensive? This lovely little summary from my insurance company illustrates the amount of slop and overhead that is built into the current healthcare accounting strategy:

At first glance, the answer to my semi-rhetorical question is Absofuckinglutely, healthcare in America is preposterously expensive and add to that an additional $18,000 worth of emergency services bringing the total billable expenses to $378,000 or ~$3,000 per HOUR for my 5-night stay.   That's about the size of an average 30-year mortgage.

However, on closer inspection of the bill, you'll notice an accounting miracle called "discounts" whereby 80% of the bill magically disappears, leaving behind $65,000 in actual charges which represents a slightly more reasonable hourly charge of $520.  My actual out-of-pocket expenses for the whole party total $4,000, or a mere $32/per hour - which is about what I make, come to think of it.

Luckily, I am among the fortunate well-employed who have bonafide health insurance.  I pay $3600 per year in premium co-payments.  My company pays an additional $6,000.  With my current coverage, I must budget $7600 - $11, 600 per year for healthcare to cover out-of-pocket expenses, including the premium.  Is it a lot of money?  Yes, but it won't send me to the poorhouse.

But, what if you don't have health insurance?  How can anyone but the wealthiest citizens afford a hospital bill the size of a 30 year mortgage, especially when they can't even afford a 30-year mortgage? 

There is a dirty little secret about healthcare that most Americans don't know.  If you do NOT have insurance, there is another magical accounting strategy that employs 'write offs' in place of  'discounts'.  This method avoids heart-stopping over-inflated bills such as above, and in the end the patient still ends up paying the same amount of cash out of pocket - only on a per-incident basis instead of some arbitrary calendar dates.  In many ways, not having insurance is more streamlined, less confusing, but just as stupid.  For specific personal details of what happens when you have a broken leg without insurance, I refer you to the sad and desperate events13 years ago, which inadvertently lead to my 30 year mortgage.

By this point, I am sure that some of my foreign-national readers, and perhaps many of my domestic, are asking, but what about Obamacare?  Didn't that fix things?

Absofuckinglutely not.

I want to be clear to divorce my admiration for the Man from my disappointment at his attempt to reform our stupid healthcare system.  Americans on both sides of the Obamacare debate were completely misinformed as to its function.  Central to the arguments both for and against Obamacare was the assumption that it was in fact, free and universal healthcare.  It is neither.  It is merely a mandate to purchase health insurance coverage at levels similar to what I have described above - and at similar costs, with one important distinction.  If your employer does not provide benefits or you do not qualify for assistance, then you are forced to cover the entire annual premium of $9600+ per year (plus budget $4,000 per person to actually use the insurance).  The average American household income is $50,000 per year.  

Obamacare is not healthcare.  It is mandatory catastrophe insurance that is causing many Americans real financial harm in the form of a brand new $9600 per year bill that arose from the simple sweep of a pen. More insidiously, Obamacare strives to dissipate the advantages of not having health insurance by imposing a penalty tax that is equivalent to the premiums on those that 'choose' not to purchase it.  So, you can pay $9600 per year for insurance you can't afford to use or pay $9600 in penalties, and still not have insurance.  I fail to see how this is an improvement for anyone other than the government and the insurance companies.

Just plain stupid.   

Oh, but how to fix it?  I mean really fix it...

The insurance companies must be removed from primary healthcare decisions.  There is still a place for insurance - it can be the vehicle through which the wealthy may purchase superior services, but never at the expense of basic services for the poor.  Premiums are replaced with taxes - but not 20% of one's income!!  Patients should contract with primary care providers directly - "Negotiated rates" get replaced with true-and-fair costs.  Doctors need to be more humble and less revered.  They are humans who try to help, not infallible healers nor demigods.  Providers must have protection from litigation and must never be influenced by profit margins or costs when prescribing the best course of treatment. Ideally, healthcare is not tied to employment, so that one never feels trapped or unable to take a risk.  With a system such as I propose, there is room for lots of care, and lots of health - for a cost that is fair and affordable.

I know this system works well, because I have experienced it first hand in Australia during those sad and desperate events 5 years ago - where $65,000 worth of healthcare cost us absofuckinglutely nothing.

Saturday, December 31, 2016

Scribble Me This

I wrote a letter this morning.  No, not an email - an actual letter, on paper, with a pen.  My right hand is hurling insults at me for taxing long forgotten muscle fibers to scribe squiggly curly-queues across a blank sheet, but my mind loves how the sentences flow into the ink and onto the paper, effortlessly, elegantly, with a sweet scribbling sound - not the disjointed tappity-tap of uncertain keystrokes that are so easily mislaid and corrected.  Keyboard typing allows the brain to be much more impetuous and less disciplined.  Writing in cursive requires forethought and commitment to both structure and vocabulary.

Do they even teach cursive writing anymore?  Or are kids given instruction in proper thumb typing technique?  I don't recall the mechanics of learning most of the things that I have been taught, but I distinctly recall any subject with which I struggled (and by struggled, I mean I did not receive effusive praise).  My cursive writing was a struggle, and the feedback was most discouraging.  To this day, I cringe with shame each time I attempt to form the little hump between an o and an n or an m, and my lower case r's are always missing their horn.  Upper case K causes me great stress and I still have to pause to decide which direction to make the loop before each g, p, and q.

I recall just how modern I felt when I signed up for a typing class in Junior High School that used electric typewriters with built-in correction tape (which we weren't allowed to use.)  My typing was only marginally better than my cursive, but more than training my fingers, typing without the ability to edit on the fly trained my mind to form complete thoughts in advance of expressing them.  Unfortunately, this lesson remained ensconced in the neural clusters that control my fingers and did not bleed over into the portions of the brain responsible for speech - which still comes out raw and unedited.

My instinct is to feel nostalgic melancholy over the demise of cursive writing and typewriters, as if some elegant social more were being discarded willy-nilly.  As my mind tumble-dries the pros and cons of various methods of communication, some notion inevitably falls into a sentence that begins with "Kids these days..." and normally, I am happy press that idea into the creases.  I like to imagine a little scene, in which my grandchildren see me writing a letter.  They ooh and ahh over my cryptic alphabet and ask me to teach them the secret code, so they can have something to lord over their classmates who use voice recognition to write their essays in a stream of consciousness, only no one writes essays anymore, because expressing a supported opinion might offend someone. The modern essay is only 160 characters long.

Only, I don't have any children, so it is pretty unlikely that I will have any grandchildren, and even less likely that they would catch me writing a letter, because I would probably be teaching them to play Space Invaders...on my Xbox360.

Monday, December 12, 2016

The Presumption of Malfeasance

Earlier this year, I had occasion to spend a few hours in the waiting room of a hospital ER (everything is/was fine; the particulars are not relevant to this narrative).  My phone battery was dead, and not wanting to touch any infected magazines, I amused myself by people watching and eavesdropping.

A rough-cut bearded man with long gray hair wearing loose, greasy overalls approached the triage desk.  He explained that his wife was hurt, and that she had run out of her pain meds and called her doctors and they had said she could have more, so he was here to pick them up.  The ER nurse didn't even bother to roll her eyes - and I imagined this scene was well rehearsed on a daily, if not hourly basis.  She explained that he had to to go to the pharmacy, that prescriptions are not filled from the ER.  He was insistent and became quite agitated.  A doctor and a security guard eventually helped the man understand the difference between the ER and the Pharmacy, and he lumbered off to another building, but returned empty-handed and even more insistent.  I have since learned the term, Code Grey.

At no point did I hesitate to think that this man might be genuine, that he might simply be confused and overwhelmed by a complicated system in which he clearly does not walk often, nor gracefully.  I had no doubt that his wife had some sort of condition, and would eagerly concede that it involves some sort of pain, but I had absolute perfect faith in my assumption that this man was just trying to manipulate the legal drug trade to get another fix.

Yesterday, Kevin was on the receiving end of such emotional generosity, as he was turned away from 3 pharmacies who would not honor my prescription for narcotic pain-killers.  My imagination dressed him in greasy overalls as he explained that his wife was struck by a car in San Jose, but we live up here, and I have a broken leg, so can't make the drive down from Shingletown, all the while becoming increasingly agitated by the silent judgments being caste upon him by the pharmacists and physicians, whose greed and negligence created the problem in the first place.

Unfortunately, this lesson in karma is going to be lost, because the convenience of thinking the worst of people is irresistible.  It takes so much less imagination and emotional investment to drop to the lowest rung on the ladder of explanations. Dismissing a person as a junkie is quick, efficient, tidy, effortless. It takes more energy to imagine the complexity of a real-life situation, to consider the interplay of cause-and-effect over time that leads to addiction and disassociation.  To think like this requires empathy, and engaging with empathy puts one at risk for feeling unpleasant emotions.  And no one wants to do that...

Which is exactly why pain-killers are essential.