Archive for the 'health' Category

Whose brother or sister?

February 23, 2014

“’This isn’t the drug user of the 1970s. It’s your brother, your sister. It crosses all socioeconomic strata.’”

This is a quotation from “Max Sandusky, prevention and screening director for the AIDS Support Group of Cape Cod” and it comes from an article in The Boston Globe called “Opiates taking heavy toll on Cape,” by Brian MacQuarrie, dated February 22, 2014.

Years ago when a child in one of our sons’ nursery school class died from strep, and a few months later our son came down with scarlet fever, just two days after having been examined by his pediatrician, someone important in the public health sector in the state government told my husband that nothing would likely be done about what was going on in the nursery school until the child of somebody important died.

It was pretty clear that someone in the school was a carrier — there were many strep cases at the school in addition to Jillian’s and our son’s — but no testing could be undertaken, nor could the staff member who seemed to be the carrier be asked to take steps to protect the children.  As I recall it, she had a connection to the health sector, perhaps through a second job, and the hypothesis was that she picked up bacteria at the facility but didn’t become ill from them.  And if it wasn’t she, then some sort of testing of everybody might have revealed a different pathway through which there was such an on-going and severe presence of strep in the school, even after vacation breaks.

In other words, it wasn’t just a single event during which children passed strep germs to each other;  and the public health official knew that.

We withdrew our child and found a new school for the fall.

There’s that set of lines from Richard Shindell’s song “Transit” about how “car thieves and crack dealers, mobsters and murderers [are someone’s] husbands and sons, fathers and brothers.”

When we are still picking and choosing whose lives are more and less important, we cannot yet congratulate ourselves on being “superior.”  It’s a paradox, resolved, it seems to me, by withdrawing the ego and no longer seeing the world in terms of competing groups.  We become “superior” (in the sense of “more elevated,” not in the sense of comparative elevation to others) by realizing that we are not.

We may pay more attention to an important public health problem now that more “important” people’s lives are involved, but we will not be resolving a more fundamental problem, and its manifestations in our society, until we stop with this “four legs good, two legs better” (Animal Farm, by George Orwell) attitude.

Filling an empty space

November 21, 2013

There’s a phenomenon that occurs with some people who develop substantial hearing loss in which their brains create the experience of sounds internally, apparently because there’s a dearth of externally produced sound to process.  I think the sounds are often repetitive and sing-song, if not song-like.

I think a parallel phenomenon can occur with people who have lost a substantial amount of vision.

I’m wondering whether people who lose their short term memory do a version of this, too, and we categorize it under “dementia.”  An elderly person may forget the initial reason for a task or the next steps that were to be taken in the course of completing that task, not realize they’ve forgotten those past facts, and instead come up with a new task involving the papers in front of them on their desk (for example), to fill the “gap” of what they are supposed to be doing.  The lack of awareness may be “dementia,” but if looked at in a more detailed way, it may look less like a kind of “craziness” and more like a combination of memory loss, lack of awareness of that loss, and a tendency to try to fill gaps creatively.

Cleaning up after others

November 16, 2013

I took in my garbage cans and recycling bins this morning.  The yard waste hadn’t been collected yet.  Instead, it had been added to.

Someone put very old Christmas decorations on top of one of the garbage cans I use for some of my yard waste.  It turned out to be a wreath and some sort of garland.  I clipped off the plastic cords and labels.  Jordan put them on the ground next to the can so that at least the collection folks will take our leaves.

The issue is that there’s a collection date (one) for Christmas trees and, I think, these other kinds of evergreen decorations.  It comes in early January.  I don’t know that they will be accepted as part of the regular collection program.  If not, then I’ve got somebody else’s detritus to dispose of, kind of like a game of hot potato.

It is more interesting to me than just that sort of potential hassle, because of the discussion about whether people with good health and particular lifestyles should need to contribute to the same insurance pool as people with bad health and lifestyles that contribute to their ill health — do we help clean up after others?

I’d say part of the answer has to do with, simply, whether we can and whether we are better positioned to provide the help than the other person.  If we can provide it, in some way that is effective and does not harm ourselves, I think we should at least try.  I think it’s a continuum, between no cost to ourselves and some cost to ourselves, and that different people draw a line in different places.

Public promises

November 13, 2013

I’ve written a number of comments expressing my reaction to the discrepancy between “If you like the health plan you have now, you can keep it” rhetoric and the reality of cancellation notices.  The discrepancy seems to be due to the fact that the power to control the situation and keep a policy was not left to the subscriber, in fact, not left to the person promised, but to the insurance company issuing the policy (that, and also because of a narrowly structured grandfather clause).

I think the grandfather clause should be expanded and the control left to the subscribers who currently exist.  I think the requirement to have comprehensive coverage needs to be phased in, in order to mitigate real harm to real people.  If this is not actuarially feasible, then the ACA was not sufficiently well-crafted, in my opinion.  I suspect it needed to have reined in the insurance companies on this issue;  if they hadn’t kept changing the policies of individual policy holders, more people would have qualified for grandfathering and there would be fewer people left with empty rhetoric and higher premiums.

But my point here was not to get into health care policy issues, but to sound off, again, on my life-long study of “empty promises.”  Here the promise was made publicly and there is no lack of evidence that it was made.  It did not have strings attached when it was uttered, it did not explain the structure and mechanics of the grandfather clause and how it would function in practice.  It induced reliance and could have been reasonably expected to do so.

A lot of people think this instance of an empty promise requires mitigation.  They see the actual financial hardship, they see the psychological cost to those who relied on the promise, they see the loss of good will.

I don’t have an individual policy, but I do benefit from the public criticism and call for mitigation, because it validates my sense that we don’t just put the burden on the person who was reasonable in relying on a promise that proves to be empty.  That is not our cultural consensus, is what I hear, or at least, it is an argument that people accept as reasonable, even if they decide for other reasons, reasonable or not, not to follow that argument.

Willy and I were once promised help with health insurance which never came through.  It was after botched medical care.  The ensuing damage to my health meant that the insurance I was currently eligible for was not adequate.  Willy was upset when this became a promise that was not honored, but his larger negative emotional reaction in this instance was to the damage to my health and to the lack of acknowledgment of what had happened.  I guess in an indirect way, maybe this current public problem may help me resolve all those issues, too.  I wonder if they would have helped Willy resolve them.  For him, it was an open wound he tried not to focus on.  He actually tried at one point to resolve the issues through direct communication, but was roundly rebuffed.  (I’ve sometimes thought that the people involved thought he was motivated by me, but no, this came from him, from his heart, and it meant a lot to him.)  He was hurt by that, too.  People, I guess, have their limitations.  Willy was pretty good at seeing people for who they are, not as they present themselves to themselves, to us, and to the world, but he still got hurt.  We all do the best we can.

Keeping up with the seasons

October 28, 2013

I was so proud of myself for figuring out the autumn hat thing — as I wrote some time around the turn of summer into fall, I had to figure out what to replace my straw hat with, when the seasons changed, since my skin continues to remain sensitive to the sun.

Eventually I found a floppy-brimmed felt hat with a rounded crown and a band and flower in the same grey felt.  I’ve been happy with it, although I need to hold onto my hat in a high wind (especially near the reservoir).

Today my ears were cold.

A friend had already asked me what I am going to do in the winter to keep my ears warm.  I talked about maybe using a scarf to help, but really I just haven’t thought it through yet.

I’ve got warm hats, ones that cover my ears, but they won’t protect my face from the sun.

I’m still not sure what the answer is.  Two hats?  A parasol?  Ear flaps?  Earmuffs, or a headband, plus my floppy broad-brimmed hat?  I will probably engage in a little trial and error to come up with something.

Intentional or unintentional

October 20, 2013

I don’t like dualism, but here I am going to contrast intentional mirroring with unintentional mirroring, an issue that’s been on my mind for a long time.

The mirroring that has power occurs not through behavior we engage in with the intention of mirroring.  Effective mirroring takes place at a deeper level, the level revealed when we manage to pull away our personal concerns, desires, and fears — that other strand is what produces the mirroring effect, it is not something we consciously craft.

When someone mirrors another in this way, they may not be aware of it.

Just as it is difficult to distinguish the difference between badly-intended behavior and stupid behavior, it is difficult to tell when a person is conscious of what is going on in their actions, including writing, and when they are unaware of what they are doing (“It’s just a song,” for example).  People may consciously write versions of their friends and relatives into their novels, but people may also write pieces of other, real people into their books, too, whether they are aware of it or not.  Maybe it happens when they think they are communing with a muse, I don’t know.

Contrived mirroring (self-conscious acts of trying to mirror someone’s behavior or attitude back to them) doesn’t have the same impact, I don’t think, as mirroring done through a deeper level of the person.  Contrived mirroring may be a technique to modify behavior, it may be a way of calling attention to itself, kind of like a friendly wave or a not- so- friendly gesture — some sort of indication of response — but I don’t see it having a very significant function in the great scheme of things.

Here’s, for me, at least, the rub:  how do you talk about the part of this that occurs unwittingly, with people who don’t “believe in it?”

One participant in the interaction cannot even tell you “where it hurts,” what is going wrong, the other claims they are not doing anything to impact the other person negatively.

People disconnected from their inner selves may actually not be aware of what they are doing, other people may have some degree of knowledge of what they are doing, but employ a defense of “deniability” — they hide behind how socially unacceptable in our culture it is to talk about any of this and claim they ain’t doin’ nothin’.

An abusive pattern can continue over and over again if neither party has a clue what is going on, just as post partum infections spread so easily in hospitals before people realized they needed wash unseen germs off their hands between examining patients.

What I think is true, however, is that we only need one member of the interactive pair to understand what is, wittingly or unwittingly, going on, to end the dysfunctional dynamic.  That person just has to tolerate being regarded as a little daft.

Hats and memories

September 21, 2013

I developed a substantial sensitivity to sunlight on the skin on my face, starting about the time my father died this past winter.  My dermatologist prescribed a topical creme to reduce inflammation (in the blood vessels, I think) and told me to stay out the sun, wear a broad-brimmed hat when I am out in the sun, etc.  We also discovered that my skin won’t tolerate even the mildest sunscreen.

I was not unhappy wearing a  broad-brimmed hat this spring and summer.  Now it’s fall, more or less, and straw or raffia don’t seem right.

So I thought (now this, I admit, is a little illogical), “Okay, the sun is more intense in summer, maybe I don’t need to wear a hat all the time when I’m out anymore, now that the season’s changing.”  No one had ever said this would be a seasonal issue, and it had started in the dead of winter, but I thought, “Maybe,” nonetheless.

So I didn’t wear a hat for a few days, and now my face hurts.

Those who see confirmation bias are free to do so.

Anyway, it’s pretty clear this skin condition has not cleared up (I suspect that had also been my hope), that the season makes no (or not enough of a?  I got away with no hat for a couple of days) difference, and that I will need to continue the hat thing.

Here’s where I’m running into an emotional issue.  Willy wore a hat, I think it’s called an outback style.

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Once I start wearing a non-straw hat, it will remind me of him, as if I am adopting one of his habits.  That feels uncomfortable.  That is part of what I am trying to avoid.

I think my project is to find a hat that I like, that suits (season and hair), and hope that it (and its style, whatever it turns out to be) resolves the echo issue in an unexpected and helpful way.

What to post

March 22, 2013

I was writing a post yesterday about what happens when life’s excessive difficulties result in a person’s implosion or explosion instead of a “faith experience.”  I called it “Foxholes,” in reference to the old saw, “There are no atheists in foxholes.”  (I think there are.)  After reading David Brooks’s column about foxes and hedgehogs, I didn’t want to post something called “Foxholes,” even if I had written most of it before I read his column.

So I’m going to add a little here about my adventures Wednesday night with our medical system, which I mentioned in a reply to a comment to Timothy Egan’s column on The Five Guys restaurant and its relationship to health insurance.

I had been taking an antibiotic, and after taking a dose, a short time later I felt awful.  Waves of chest pain, nausea, retching, a red itchy rash on the back of my neck and shoulders, including a couple of hives.  The antibiotic was minocycline.  I think what I had was probably a side effect reaction, not what we call an allergic reaction.

I’ve had allergic reactions to other medications, as well as side effect reactions to both meds and vaccines (or their bases, or both).  I was once told by a Dr. Melchinger, who was an internist in New Haven Willy and I both used, that I apparently have a body that will eventually if not sooner react negatively to medicine, and that I should not take any unless absolutely necessary — to save my window of tolerating them for when it’s especially critical.  So I’m a veteran of medication reactions.

I would have called the pharmacy, but they were closed.  I called the prescribing doctor, tried to page her, didn’t hear back, made some other calls, one of which told me try a local hospital and that they should have a nurses line to advise me.  They didn’t.  I tried the nurses line on my health insurance card.  They told me to go to the ER as I might be having a heart attack.  I didn’t think I was, and I thought an ER visit was “overkill” and a waste of resources (including my time and energy).  I tried paging my doctor again, then eventually I went to bed.

At 6:34 a.m. the next morning my doctor called me in response to the pages.  (The second page had been at about 11 p.m.)  To make a longer story shorter, she told me to come in at 11:30 that same morning, at which time we agreed (for slightly different reasons) that I shouldn’t continue taking the minocycline.  She made a new diagnosis and gave me a topical medication.  When I went to fill it, the pharmacist chatted me up, and when he heard its relationship to the minocycline Rx he had filled for me before, he seemed to recognize the reaction as one associated with minocycline and said immediately that I should avoid the med in the future.  It helped to hear that from him.   (Of course, he and I are old chums after discovering our mutual affinity for the Stop & Shop Friday special on rotisserie chicken.)

I am underwhelmed by a health care system in which even when I have good insurance, I can’t get helpful advice in the situation I was in.

When I told my mother about my adventure the next evening, she said she thought the hospital ER would have gotten excited over the heart attack idea and run lots of tests and even insisted on keeping me overnight.  I hope they could have done a differential diagnosis better than that, but who knows.

I’ve had the opposite experience, though, which was even worse: knowing I was seriously ill and being refused an examination, despite multiple requests.  It turned out to be a post-partum infection and the consequences were terrible, both short term and long term.

So the other night’s adventure was, to be sure, unpleasant, but not horrible.  I write about it mainly to point out that we use the ER in inappropriate ways not just when someone is uninsured — it’s as if it has given us an “out” in all sorts of situations, kind of like that Life cereal commercial in which the older kids have Mikey taste it:  “I know, we’ll just send the person to the ER,” as if there were no downsides to that approach.  And I also wanted to point out that having good insurance may be necessary but insufficient to gain access to appropriate care when necessary.  The system does not work as advertized.  Some of it is less-than-stellar implementation, some of it is structural.  Paging systems break down, 24-hour “urgent care” is not available, a patient’s history does not produce adequate planning for pretty predictable negative outcomes, etc.

Instead of patient satisfaction surveys, the system needs a feedback mechanism to transmit more complex information from people with actual experience of the system.  Actual care providers may have this complex information, too, but I suspect both experts within the private system and policy experts in the public sector don’t.  I sometimes think they want to solve the problems they want to solve, not the real problems that actually exist.

Colds

March 9, 2013

I apparently caught one, but what was odd was how it came on, suddenly, completely, and totally, right after I submitted a comment to Gwen Ifill’s Friday post late this afternoon.  (I’m talking, press the button, wham, I have a full-blown cold.)

Usually I might go to bed feeling “Maybe I’m coming down with something,” and then wake up completely congested, but this was all at once, from zero to sixty, as they say.

Rainbow, courtesy of Washington, D.C.

September 27, 2012

I am in the midst of multiple family medical difficulties, trying to locate my gratitude to the universe for the challenges to develop my (coping) skills.  I was thinking about how there’s always spiritual help, I just need to reach down deep enough with my heart.

As I was thinking that, I turned from the kitchen sink and there is this beautiful rainbow cast against an old cast iron stove on the other side of the room.  I spent a few minutes trying to figure out through what the light is being refracted, and it’s the Lucite block encapsulating the U.S. Capitol and Washington Monument in a little souvenir on the windowsill that my kids brought me back from a trip down there.

I could use the hopefulness of a rainbow today.  That it comes courtesy of Washington in a way is kind of interesting.