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.

Saturday, December 10, 2016

Chapter 49 - prologue

Thus far, my life can be divided into several well-defined chapters.  Most chapters are a consequence of choice.  They begin with deliberation, emotion, contemplation then a decision to take action - foolish or otherwise.  Such chapters unfold like adventures, the obstacles faced with willing anticipation.  Personal growth is the stated goal of these chapters.

Some chapters are a consequence of fate.  They begin with a crash-bang-boom out-of- nowhere gust of wind that sets life on a new trajectory in an unexpected instant.  Such chapters unfold like misfortunes, the tribulations begrudgingly overcome.  Personal growth is an inevitable outcome of these chapters.

Chapter 49 begins with a crash-bang-boom.  Literally.  On November 22nd, 2016, one day after my birthday, I was struck by a car while crossing the street at San Jose Airport.  My husband and I were returning from a highly emotional trip to Mexico, where we visited the crash-bang-boom staircase that launched a similar chapter 13 years ago.  Now, we can sit around and compare x-rays of the miraculous hardware that holds our respective leg-bones together.

It is usually quite obvious when the intentional chapters have concluded.  There is typically some sort of filing: you graduate and file for a diploma; or you file a change of address card as the moving van pulls away; or you file for unemployment because you got 'made redundant'. Again.  At any rate something happens that serves as a clear demarcation that the next chapter has begun.

With crash-bang-boom chapters, the endings are not always discernible.  Damage occurs in an instant, but healing is progressive, epic, often eternal.  You cannot file for a certificate of Completion of Grieving.  There is no ceremony to mark the moment you are 'over it', because that moment is fragile and fleeting and impermanent.  Even faded scars invoke the memory of pain and mended bones ache on cold rainy nights.  These chapters continue to write themselves indefinitely, a subtext that underlies the rest of the manuscript.

But Chapter 49 will have a distinct, unavoidable, expiration date of an ending.  Chapter 49 will be exactly 365 days.  Not that I expect to be 'over it', or back to 'normal', or fully 'healed', but because a far more daunting chapter begins at midnight on November 21st 2017.  I am not afraid to admit that I am afraid of what's to come.  And so I am going to take the time to savor this chapter, to indulge in myself, to invest in my body, to nourish my spirit, to gather courage, to build strength, to read, to write, and most of all, to dream.*



*and by that, I mean the kind of dreams where you imagine an amazing version of your self - like maybe you are successful novelist, living in a tower on a beach-front passion-fruit plantation -  not the kind of dreams where you are limping down the street wearing nothing but a wet towel and a homeless guy throws a giant meat fork at you...



Sunday, March 20, 2016

Remember Your Failure at the Cave


The Salinas Valley was blanketed under a thick layer of morning fog, but far above it, the trail head was drenched in slanted yellow sunlight.  Dew-soaked spider webs formed small crystal bowls nestled atop fresh green grass.  Run off from the recent rains trickled into a transient stream across the trail and burbled over rocks and small stones.  The trail was walled by sheer brown stone cliffs, but in the places where stone had yielded to the forces of erosion creating small islands of soil were lush blooms of color - miniature yellow sun flowers, teeny purple lupines, orange poppies, bright white something or others - all tiny, fragile, tenacious.  I took a deep sweet breath and tasted the flavors that were all around me and reflected on the contrast to the tableau in which I was immersed just 7 days earlier.

One week ago - at just about the same time on a Saturday morning (i.e. bloody early), I disembarked from an airplane at JFK in New York City bleary-eyed but reasonably rested and excited to catch up with friends from across both oceans, a multi-continental reunion.  I stopped at a coffee counter at Baggage claim and found a sample packet of vitamins attached to my coffee cup, a thoughtful welcome gesture, to revive me from the flight and fortify me for the convoluted Subway ride into Manhattan.

The New York Subway System is a curious beast.  It is an entity, a vehicle, a destination, and a culture unto itself.  It has personality, moods, history.  It  assaults the senses, evokes emotion, and sends the mind wandering down tunnels of thought.  It is both adored and abhorred, both fearful and fascinating.  At street level, you can buy scads of subway related regalia to demonstrate your respect and admiration - umbrellas, sweatshirts, table cloths imprinted with prideful maps of the system, but below ground, that same respect is shown by moving efficiently through the gates and deftly navigating the crushing maze of tile passageways and  narrow staircases.

The trail dipped down to a small  bridge across the seasonal stream.  A ranger came down from the other side, and we paused on the wooden planks for a chat. He had a reassuring authority, caretaker of this wild place.  We exchanged pleasantries and expressed our mutual enchantment with the bounty of wild flowers and shades of green before he continued on his way.  I lingered by the edge of the water and listened to the soft ribbets and chirps of frogs celebrating the glory of a wet spring.  I climbed up from the creek bed to a rocky promonotory that jutted into a natural cathedral of rock. Sheer red walls flanked me left and right, while a lush green box canyon formed the transept, rock spires the pulpit. High above, a pair of red-tailed hawks circled while their chicks cried out from their rocky nest.  A blue jay echoed their call from a bush beside me.

The serpentine staircase spiralled down to the lower platform.  As I round the corner, a nervous young man quickly wheeled around and followed me down the stairs.  At the bottom, I turned to face him and we had a conversation with our eyes, mine expressing vigilance and caution, his revealing that something deep inside him was broken, lost.  At the edge of the platform, the passengers leaned onto the tracks to watch the resident subway rats forage among the discarded cigarette packs, batteries, and paper coffee cups.  The rats carried on, unconcerned by the approaching train.  I ascended up through the comparatively fresh air into a canyon of concrete buildings that emptied into the buzzing amphitheater of Times Square.  Flocks of dingy grey pigeons weaved among double decker buses.  A seagull plundered a rubbish bin behind the hot dog cart beside me.

The sunny morning had brought a host of visitors to the park, and I exchanged pleasant greetings with those I met along the trail.  Some stopped for a chat, others, preserved their solitude with a courteous nod.  Everyone was enamored with the carpet of wildflowers, stopping for a close-up photo or a long sniff.

The streets of New York are filled with people, day or night, regardless of the weather.  Eye contact is avoided, loneliness is pervasive but preferable to invasive conversation.  The streets are lined with make-shift gardens and vendors selling cut flowers, tiny pockets of green and color.  Everything else is grey.


Cave is a rather grandiose term for a small dark tunnel beneath a giant rock fall, but semantics are irrelevant when you are engulfed in perfect darkness.  Kevin and I had visited the Balconies Caves at Pinnacles many, many years ago.  Not having heeded the signs about the requirement for flashlights, we attempted to piggy back through the caves on the light of the group ahead of us, but we discovered that Kevin suffers from paralyzing claustrophobia and they soon pulled away from us, leaving us blind and deafened by the sound of my husband's labored breathing.  As our eyes adjusted, he saw a sliver of light in the rocks above him and scurried lizard-like for safety.  Abandoned but giggling, I carefully picked my way back to the opening from which we had come, and we took the by-pass trail that lead up and around the caves instead.

On this beautiful morning, we found our selves at that same junction.  I lobbied to address our unfinished business in the cave, now being permanently equipped with a flashlight on my swiss-army phone.  A wave of panic flashed across his face as I watched him relive the trauma and I knew that something deep inside him had been broken that day.  We started towards the bypass trail when he turned and said "We could split up and meet back at the car?"  I barely had time to smile goodbye before racing towards the gated entrance of the ominous caves.



The trail zig-zagged around two large boulders into a room illuminated by shafts of light streaming through gaps in the rocks.  I wondered which had been Kevin's escape hatch, but memories are painted on distorted canvas, and I couldn't overlay the location.  Beyond the next turn, the gaps were sealed and the darkness became absolute.  I stood still for a moment, calming my mind and surrendering to my base senses.  I felt the cool draft of air rising from the stream that ran through the tunnel. I listened to the water cascading and smelled the wetness of the rock. I welcomed stillness - and in that moment of stillness came the thought "You are under a huge pile of loose rocks directly on the San Andreas Fault."

And the stillness was shattered.

I switched on my camera light and surveyed my surroundings as my breathing accelerated.  In the center of my path sat an enormous round stone ball and I could not help but conjure scenes of it rolling towards me a la Indian Jones.  I rounded to the right side, but loose rocks had filled the gap between the boulder and the cliff face.  The left side had a tiny crawl space where the creek trickled through, but surely that was not the trail.  I felt fear and panic rising in my chest and stepped back towards the entrance of the cave, wondering if I could catch up to Kevin on the bypass.  But then I thought of Luke Skywalker facing his fears, and I remembered that Indian Jones managed to escape the boulder and then I started thinking about the profound influence George Lucas and Steven Spielberg have had on shaping who I am and how I fit into the world and I turned around with new resolve and only a little bit of embarrassment.

Re-examining the boulder from a distance, I was able to pick out the soggy footprints left behind from the group ahead of me.  They revealed a secret staircase chipped into the rock that lead up and around the gravel pack and into the next cavern, which emptied into a shaft of light.  The darkness was behind me and my trials were complete.  Or so I thought.  There are more perils than darkness.

Here, the cliff walls nearly touched at their base, such that the trail was a mere gap of 12 inches across - and that gap was filled with flowing water.  I steadied myself with an arm against each wall and my boots were high enough to keep the water away from my feet.  But the crevasse was filled with fallen boulders and I soon came to an impasse.  Here, I would be forced to wade through 18 inches of  water - possibly on hands and knees to pass beneath yet another round boulder.  I opted instead to go up and around the boulder - scrambling up the slippery wall was not easy, but gravity became an entirely different enemy whilst sliding down the rock face on the other side.  And so shall I bear my own scars from this adventure, only on my knees, not in my eyes.  I do not know if I faced my destiny in the cave, but I did learn an important lesson.

I emerged through the gate that marks the entrance to the cave, and I turned briefly to wonder what the journey would be like taken from the other direction.  Walking back to the car, I experienced a modest feeling of adventure and accomplishment that naturally elevated my heart and the corners of my mouth.  The warmth of the morning lifted the thick perfume of the wildflowers into the air, cloying and it reminded me of the smell of urine in the subway.  New York seems so close temporally, even geographically, but the metaphysical distances between these two worlds is unfathomable.  And yet they are linked...amidst formations of either stone or concrete, human beings seek and receive solace in nature, whether on a grand scale of complete immersion, or wherever and however you can get it.

Even if that is only rats on the subway track.