Category Archives: Healthcare

The Variety of Grief

I once heard a very kind priest friend say of a well-known priest author, “That man has never had a thought he didn’t feel he had to express.” I was a momentarily taken aback, because my friend was a very kind man who never said anything negative about anyone. I realized then that he was expressing the same mystification most introverts must feel about extroverts. Of course, extroverts frequently misinterpret introverts’ silence and need for privacy as dislike or disinterest or even distrust.
After years of studying and working with the Myers/Briggs Type Indicator, I have admitted that I don’t really know what I think about something until I manage to express it in words. And verbal dialogue is also intrinsic to my sense of relationship. I’ve learned that this is not only problematic for introverts that live or work with me, but often downright irritating.
Luckily, I have lived long enough to experience the wonderful outlet of the internet. I can express and hear myself in print at any hour of the day or night. And no one has to listen unless they want to and only when it’s convenient for them and only as long as they wish. And the introverts don ‘t have to say anything unless they feel like it and even then, all they have to do is hit one key to make a response.
Recently, I’ve been experiencing life changing challenges and I really do need to explore my feelings and insights by expressing them. Also, I think it’s possible that my describing what I’m feeling and learning may be some help to someone else out there. And happily, if not, they don’t need to waste their time reading what I write.
One of the challenges I am still facing is that we really do differ in our ways of dealing with grief. No matter how many stages are described as general, we don’t experience or work through them all the same. Partly because of differences in personality, but also because of many different factors about the way a loved one died, the timing for them and us, and past experiences with our own grief and others’ ways of grieving.
My husband was like a cat with nine lives. When I read back over his medical history, he came through so many close calls with death, I lose count. And in the last few years he fought valiantly with cardiac issues with stents and a pacemaker, AFIB, Idiopathic Pulmonary Fibrosis, successful surgery for a malignant tumor in his lung, a return of lung cancer that was inoperable and that spread beyond the lungs as stage 4 cancer, stage 3 Kidney disease…..all of which weakened him too much to risk chemo therapy. He was in and out of ER’s, hospitalizations of various lengths up to two weeks several times, and finally five months in a nursing home, first attempting through therapy to get strong enough for chemo, then failing that, for nursing care and hospice.
We have five grown children who have been simply awesome in their active care giving and support through all of this. And each of them is grieving in their own way now. And I have realized that not all of them are finding my way easy to understand.
To begin with, I generally live in the future of possibilities, both negative and positive ones. In other words, I worry way ahead of things, but I also like to explore new ways of being happy or productive or creative or loving.
When my husband was diagnosed with IPF over two years ago and I learned it was incurable, fatal, and a horrible way to die, I began to worry and pray that he would be spared that death. Of course, heart failure seemed a much better way to die, but with a pacemaker, less likely. My husband’s strongest trait was perseverance. When he grew weaker and no longer able to work effectively at what he loved, he became stressed and began to have some memory issues.
Finally he had to admit that he could no longer continue working. Now he was suffering anxiety attacks, frequent pneumonia and bronchial infections, then surgery to remove a tumor in his right lung, and then cellulitis contracted during a hospitalization, and finally kidney issues and depression. The physical and emotional stress affected him in many ways and by the time he entered the nursing home with stage 4 cancer, he simply wasn’t the strong silent gentle man that I had lived with for almost sixty years.
I did not love him less. I loved him more. And I gladly learned how to take care of many of his medical needs. But long before he could accept that he was dying, I began to work through my fears, experience loneliness, take over unfamiliar tasks, and try in many ways to prepare for having to survive on my own.
The wonderful physical, financial, and emotional support our five children gave us helped me to do this. And my faith and the amazing love and faith of caregivers at the nursing home lifted me out of my darkest moments. And the nurses and support staff of Hospice were able to help me anticipate and understand the rapid changes that were happening toward the end. The dying need very different things than those who are able to try to get well.
Some of the influences on my way of dealing with the loss of my husband were my tendency to anticipate and plan ahead, my deepest fear of his having to suffer terribly fighting to breathe, my having seen my very strong mother simply close down when my father died totally unexpectedly at fifty-two, watching her die by inches with Alzheimer’s for fourteen years, but particularly my many experiences of grace and glimpses of meaning in my own and sometimes others’ suffering over my eighty-one years.
I have usually dealt with short crises fairly well. It’s been the long haul attrition kind of things that could defeat me. So, over the two and a half years of constant crises, I have learned to watch for beauty, kindness, love, tiny joys like sunshine and flowers and birds and small kindnesses and laughter. I see these as grace, as the gentle touches of God. They are all around us every day if we watch for them. They seem small in the face of death of one we love, but they are myriad.
I am a weak person, easily overwhelmed by too many practical details and emotionally vulnerable to the unexpected blow. Having a large caring family help me deal with details has been an incredible blessing. Having time and medical personnel who have been down this road before me to help me understand each phase softened each blow. The blessing of the final gentle pain free death from his heart stopping before his having to fight to breathe has kept me from despair.
At times the reality that he will never be with me again in this life feels heart breaking and overwhelms me. But so far, at least, it has not robbed me of gratitude for my caring family, of healing laughter, hope for creativity in my life, the energy to try to keep reasonably functional, or my many memories of the love and joy my husband gave me.

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Zip Codes in Heaven?

I had a fun blessing this morning.

The other day when exhausted, I attempted to close my husband Julian’s RX account with the Medicare medicine insurance. I didn’t have the correct number in reach and the recorded voice kept saying “I can’t understand your answer and kept asking for the same thing over and over, even after I kept answering, “He died.” Finally, I shouted, “Go to hell!” and hung up. Needless to say, the recording was unimpressed. Today, I started over, with the attitude that I was too tired to do anything else, so sitting down arguing with recordings was as good a way as any to spend this day.  I at least had one of the magical thirteen digit numbers, so I finally got to speak to a person. After explaining that I wanted to close my husband’s account because he had died and thanking the woman for her condolences, she asked, “What is his zip code?” Of course, I couldn’t resist that. When I replied, “I don’t think they have zip codes in heaven,” there was a profound silence, followed by a smothered giggle.  I rescued her by apologizing and admitting that I just could not resist that.
After that we quickly developed a rapport, so she apologized profusely each of the six times she put me on hold and I cheerfully told her it was fine, their music was lovely and I didn’t want to do anything today anyway. \And actually the music was lovely and soothing and during one protracted wait, I found myself kind of floating around in my head thinking about the oneness of all things and that the Spirit is in each of us and we are all in the spirit, and everything is one whether in this life or elsewhere and I actually felt close to Julian and comforted. Who knew? Attitude is everything.
Anyway, when she came back to tell me she needed to transfer me to someone with Medicare, I was very mellow and thought that was great, because I needed to call them anyway.
The transfer presented challenges however and at one point she and I both thought we had been disconnected. But what once was lost, now was found and we parted friends forever and I got a new person and new music. We played the “on hold” game for a while and then she announced cheerfully that she was going to transfer me to a live person. That made me wonder about her for a moment, but in the spirit of cooperation, I assured her that I definitely had a preference for alive people.

A Jesus Kind of Love

The most incredibly kind and gentle people I have met are the personnel at nursing homes. They are often overworked, because this is a ministry, not a job. Unless someone feels called to this, they don’t last. And if the administration of a nursing home is only about profit, not their patients’ whole physical, mental, emotional and spiritual selves, even the called may have to find another place to minister. Which means that nursing homes are often short staffed.  At the Meadows in Nashville, where I was for therapy after my shoulder was broken in three places and now my husband is in Hospice care for terminal cancer, we have encountered amazingly loving care and a shared sense of everyone’s call to be a channel of God’s love.From the administrative and nursing personnel to the techs and maintenance staff and all in between, we have been surrounded by tender concern and care.  Old age’s infirmities wipe out the masks of image and appearances that separate us from one another’s core human vulnerability. When someone can wipe our bottoms with the same tenderness and love we gave our newborns, we know we are loved. When they take time afterward to hug us with a smile, asking if there is anything else they can do, we feel blessed, not humiliated. I think in Jesus’ time and culture, a man washing others’ dirty feet was this kind of love.

Liberal I Am, Sam I Am, and Christian Too, Why Aren’t You?

Lori Gallagher Witt                                                                                  Lynn Coffinberry                                                                                                Eileen Norman

This was started by a woman named Lori Gallagher Witt, the brilliance is hers, the rest has been edited to best express similar, though not identical, opinions of those passing the main ideas on.

An open letter to friends and family who are shocked to discover I’m a liberal… I’ve always been a liberal, but that doesn’t mean what a lot of you seem to think it does.
Let’s break it down, shall we? Spoiler alert: Not every liberal is the same, though the majority of liberals I know think along roughly these same lines:
1. I believe a country should take care of its weakest members. A country cannot call itself civilized when its children, disabled, sick, and elderly are neglected. Period.
2. I believe healthcare is a right, not a privilege. Somehow that’s interpreted as “I believe Obamacare is the end-all, be-all.” This is not the case. I’m fully aware that the ACA has problems, that a national healthcare system would require everyone to chip in, and that it’s impossible to create one that is devoid of flaws, but I have yet to hear an argument against it that makes “let people die because they can’t afford healthcare” a better alternative. I believe healthcare should be far cheaper than it is, and that everyone should have access to it. And no, I’m not opposed to paying higher taxes in the name of making that happen.
3. I believe education should be affordable and accessible to everyone. It doesn’t necessarily have to be free (though it works in other countries so I’m mystified as to why it can’t work in the US), but at the end of the day, there is no excuse for students graduating college saddled with five- or six-figure debt.
4. I don’t believe your money should be taken from you and given to people who don’t want to work. I have literally never encountered anyone who believes this. Ever. I just have a massive moral problem with a society where a handful of people can possess the majority of the wealth while there are people literally starving to death, freezing to death, or dying because they can’t afford to go to the doctor. Fair wages, lower housing costs, universal healthcare, affordable education, and the wealthy actually paying their share  would go a long way toward alleviating this.  Believing that  does not make me a communist.
5. I don’t throw around “I’m willing to pay higher taxes” lightly. I’m retired and on a fixed income, but I still pay taxes. If I’m suggesting something that involves paying more, well, it’s because I’m fine with paying my share as long as it’s actually going to something besides lining corporate pockets or bombing other countries while Americans die without healthcare.
6. I believe companies should be required to pay their employees a decent, livable wage. Somehow this is always interpreted as paying fast food workers enough to buy a Mercedes.  What it means is enough for them to have at least transportation to a job and that no one should have to work three full-time jobs just to keep their head above water. Restaurant servers should not have to rely on tips, multi-billion dollar companies should not have employees on food stamps, workers shouldn’t have to work themselves into the ground just to barely make ends meet, and minimum wage should be enough for someone to work 40 hours and live.
7. I am not anti-Christian. In fact I am a born again Christian who believes Jesus died to save us from our inborn human selfishness.  I have no desire to stop Christians from being Christians in whatever way they see that playing out in their own lives.    (BTW, prayer in school is NOT illegal; *compulsory* prayer in school is. Besides, no one can keep anyone from praying, which is just conversation with God.) All I ask is that my Christian brothers and sisters recognize *everyone’s* right to live according to *their* beliefs.  I believe in “do unto others as you would have them do unto you.” I don’t want anyone trying to force me or anyone else to live by their particular religion’s rules. Besides, you cannot force Christianity on anyone. It doesn’t work that way. To be real it has to be a free choice.

8. I don’t believe LGBT people should have more rights than anyone else. I just believe they should have the *same* rights as everyone else.

9. I don’t believe illegal immigrants should come to America and have the world at their feet, especially since THIS ISN’T WHAT THEY DO (spoiler: undocumented immigrants are ineligible for all those programs they’re supposed to be abusing, and if they’re “stealing” your job it’s because your employer is hiring illegally). I’m not opposed to deporting people who are here illegally, but I believe there are far more humane ways to handle undocumented immigration than our current practices (i.e., detaining children, splitting up families, ending DACA, etc).  And since it became illegal to hire non-citizens, many industries are having to shut down some of their production lines because of labor shortages.  It seems Americans don’t want the jobs the illegal immigrants were taking from them.
10. I don’t believe the government should regulate everything, but since greed is such a driving force in our country, we NEED regulations to prevent cut corners, environmental destruction, tainted food/water, unsafe materials in consumable goods or medical equipment, etc. It’s not that I want the government’s hands in everything — I just don’t trust people trying to make money to ensure that their products/practices/etc. are actually SAFE. Is the government devoid of shadiness? Of course not. But with those regulations in place, consumers have recourse if they’re harmed and companies are liable for medical bills, environmental cleanup, etc. Just kind of seems like common sense when the alternative to government regulation is letting companies make their bottom line the deciding factor on what is in the public interest and what is harmful.
11. I believe our current administration is fascist. Not because I dislike them or because I can’t get over an election, but because I’ve spent too many years reading and learning about the Third Reich to miss the similarities. Not because any administration I dislike must be Nazis, but because things are actually mirroring authoritarian and fascist regimes of the past.
12. I believe the systemic racism and misogyny in our society is much worse than many people think, and desperately needs to be addressed. Which means those with privilege — white, straight, male, affluent, etc. — need to start listening, even if you don’t like what you’re hearing, so we can start dismantling everything that’s causing people to be marginalized.
13. I am not interested in coming after your guns, nor is anyone serving in government. What I am interested in is sensible policies, including background checks, that just MIGHT save one person’s, perhaps a toddler’s, life by the hand of someone who should not have a gun.
14. I believe in so-called political correctness. I prefer to think it’s social politeness. If I call you Chuck and you say you prefer to be called Charles, I’ll call you Charles. It’s the polite thing to do. Not because everyone is a delicate snowflake, but because as Maya Angelou put it, when we know better, we do better. When someone tells you that a term or phrase is more accurate/less hurtful than the one you’re using, you now know better. So why not do better? How does it hurt you to NOT hurt another person?
15. I believe in funding sustainable energy, including offering education to people currently working in coal or oil so they can change jobs. There are too many sustainable options available for us to continue with coal and oil. Sorry, billionaires. Maybe try investing in something else.
16. I believe that women should not be treated as a separate class of human. They should be paid the same as men who do the same work, should have the same rights as men and should be free from abuse. Why on earth shouldn’t they be?
I think that about covers it. Bottom line is that I’m a liberal because I think we should take care of each other. That doesn’t mean you should work 80 hours a week so your lazy neighbor can get all your money. It just means I don’t believe there is any scenario in which preventable suffering is an acceptable outcome for the sake of profit or corporate savings.
So, I’m a liberal.
(I didn’t write the above from scratch but edited and added to a similar post to reflect my personal beliefs. Please feel free to do the same with this post).

Two Books with a Non-Political Approach to Saving our Failing American Healthcare

An American Sickness by Elisabeth Rosenthal At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system – and offers practical solutions to its myriad problems.
“Patients can save thousands of dollars by purchasing An American Sickness by Elisabeth Rosenthal.”— New York Journal of Books
In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast?
Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw.
The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn’t just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a health care system that no longer has our well-being at heart.

Catastrophic Care by David Goldhill
Catastrophic Care explodes the myth that Medicare and insurance coverage can make care cheaper and improve our health. It shows how efforts to reform the system, including the Affordable Care Act, will do nothing to address the waste of the health care industry, which currently costs the country nearly $2.7 trillion annually and in which as many as 200, 000 Americans die each year from preventable erros. Catastrophic Care proposes a completely new approach, one that will change the way you think about one of our most pressing national problems.
The London Guardian’s Michael Wolff says: Powerful—edge0of-the-seat riveting—because it is not, in any sense a policy book. Rather, this is a story about saving ourselves…It steps outside the established political debate and lexicon. It is one of the rare books addressing a major national policy issue that is able to do so in language not already debased by the problem itself. Alas, healthcare civilians can’t actually read most books about healthcare……But you can read this one.
Harvard Medical School Dean of Faculty, Jeffrey S. Flier says: For those who are troubled by both the failures of our health care system and the misdirected diagnosis and prescriptions offered by pundits, policy experts, and politicians from across the political spectrum, Goldhill offers a much needed antidote. By pointing out the almost invisible incentives and regulations that drive the dysfunction of our current system, he offers an illuminating framework for understanding the crisis, and then a path to the kind of reforms that will surely be necessary.

Health Care in Tennessee

My somewhat sketchy notes on Tennessee Congressman Jim Cooper’s question and answer session on Health Care. Cooper has impressive educational credentials that include Oxford and Harvard and he currently teaches part time at Vanderbilt. His Cell number: 615 714 1719.

Fifteen years ago, thanks to getting a yearly colonoscopy, he was successfully treated for colon cancer.  Not everyone can afford to have yearly wellness checkups.  Yet, the first of our constitutional rights is the right to life for all, not just the wealthy.
He says that in the U.S., Medical care is a business primarily for profit. We have more care, but not better care. Our healthcare ranks 37th in the world. As many as 30% of treatments prescribed are unnecessary. There’s a 15% chance of coming out of the hospital worse than you went in. We’ve lost 8 hospitals in TN, more than any state except Texas.
Blue Cross/Blue Shield controls 60 -70% of the health insurance market. This gives them the power to make a 69% rate increase unchallenged. They get a one billion dollar bail out automatically every year. Medical insurance has to be attached to local provider networks of hospitals and doctors, so we are limited to insurers within our states of residence.
In the past Republicans and Democrats would work together for the good of the people. No longer. Cooper is a Blue Dog Democrat…willing to work across party lines.
In Tennessee, the legislature only needs a simple majority to override the Governor. The infamous Jeremy Durham got a law passed that says the Governor can’t start legislation on medical care. Governor Haslam’s attempts to expand Medicaid have not been forceful or focused enough to overcome the legislature’s resistance. In the South there’s a strong prejudice that if you are poor, it’s your fault.
An excellent book on Health Care in the U.S. ,that he uses in his classes at Vanderbilt, is “Catastrophic Care: Why Everything We Think We know about Healthcare is Wrong” by David Goldbill. (I ordered a used paperback on Amazon for $8.07 including mailing.)
Jim Cooper has a website where you can sign up for email newsletters: http://www.cooper.house.gov with updated information about issues that impact Middle Tennesseans.
Most effective means of contacting legislators is old fashioned snail mail letters with a logical presentation of your opinion (not based on misinformation from face book). He says that Tennessee’s Republicans in the U.S. Congress, Alexander and Corker, are reasonable moderates, which makes it definitely worth writing them sensible non-acrimonious letters.
But he says to make your opinions known to all of your elected officials whether by email, phone calls, faxes, post cards, or a snail mail letter. Check the website http://www.tn.gov for information on how to contact our state legislators and for information on bills currently in committee or coming up for votes.  For U.S. Congressional information check usa.gov/elected-officials .