THE COVID DIARIES - Pandemic of Divisiveness

During the pandemic Stay-at-Home Order, families with little kids are discovering creative ideas for homeschooling. The networks happily share these, via video-call, from one family kitchen into the homes of millions of other family kitchens.  Flipping TV news channels, this story is broadcast gleefully on FOX, while on CNN, the president and governors are verbally duking it out about the vast shortage of ventilators and protective masks. Simultaneously in a parallel universe of hell being broadcast on MSNBC, health care workers and patients are fighting for their lives in a relentless efflux of COVID-19 virus inside the front lines of New York City hospitals.

My mind turns back to the image of the cute family, holding their hands over their hearts and reciting the Pledge of Allegiance.  The year is 1960 and I am a little girl again at McMeen Elementary School standing in front of the flag on the front lawn reciting the words:

"I pledge allegiance to the flag of the United States of America, and to the republic for which is stands, one nation under God, indivisible, with liberty and justice for all."

I am reminded that when we recite The Pledge of Allegiance, we are promising to be indivisible!!  Not divisive. Not divided. Thinking back in time, with each generation, this pledge of indivisibility has taken on a different meaning.  

Post WWII, it surely referred to patriotism. We were united as one and our country was indivisible in our quest to preserve the freedoms we had fought and sacrificed so hard for. I remember during the 1950's it was the patriotic duty of every American family to report to the neighborhood polio vaccination center for the virus laden sugar cube.

With great seriousness and resoluteness my father, a flight engineer in the Pacific theater who had previously been stationed at Lowry Air Force Base, drove all six of us, the three blocks to McMeen Elementary to do our part for our country and take the vaccine. We all took this very seriously.

Fast forward 60 years and the word divisiveness has taken on a new meaning as we watch history in the making.  Political divisiveness has been normalized to include ridicule, deception and vindictiveness. One result of this is the pandemic of divisiveness in human relationships; the one-on-one interactions we have with each other that make up the fabric of our society, our composition, the constitution of who we are. Are we, as individuals, weavers and connectors? Or are we toxic rippers? What does each one of us contribute to the fabric of our family?

During this period of forced physical divisiveness to flatten the curve of COVID-19 infection, each of us makes a personal decision as to whether we want to face this pandemic as a weaver or ripper. Do we choose to weave our relationships to strengthen, appreciate and express gratitude to those that know us and love us? Or do we choose to be rippers, flame throwers, or destroyers? Do we reach out to others by phone or video call and stay in touch? Do we send a card or leave a little surprise on a doorstep? Do we have the individual fortitude to make an effort to mend relationships that may have been frayed?

The Jewish concept of Tikkun Olam is defined by acts of kindness performed to perfect or repair the world.  Our world needs repairing. We have each been presented with this challenge.  In doing so, we demonstrate who we are and reveal the best (or worst) parts of ourselves.

A Walk in the Hood

Blossom Graduates College

Back in 2008, I blogged about this beautiful young lady who was entering middle school and couldn't read. Seriously! Kind of tossed aside into the special needs program of the public school system and forgotten. Well, we needed each other...a lot... and somehow, this unlikely couple, a Jewish mother and young Muslim girl hooked up. It's a mother-daughter relationship. Tight!

Fast forward another 7 years, and look who graduated from the University of Colorado at Denver.  The first person in her family to ever attend college. Unbelievable. The party was amazing. Lots of worrisome talk about family members still in Syria, but nevertheless, it was pretty phenomenal for the hubbie and I to kind of be the guests of honor among all of Blossom's friends and family. Lots of Arabic going on in the background. Delicious food.  Her mom knows I'm vegetarian and she always prepares for me. I love her for that. Her dad is a sweetheart. The uncle speaks Hebrew. Hubbie and him go at it relishing their conversation.

Blossom called me recently to tell me some wonderful news.  "I'm calling YOU, even before I tell my parents!" see excitedly said. "I've been admitted to graduate school!"

Do You Know This Man?

Meet my New Cousin!

Well, wouldn't you know it?  Of all the so-called celebrities on 23andMe, I end up sharing my genetic haplogroup with Mario Batali.  I mean, really, couldn't it have been Meryl Streep?

She does look like my sister, after all.   

But, okay, I'll take Mario if I have to. I read on-line that he makes a mean latke, and, well, it is almost Thanksgiving, I mean Chanukah, ya know.

What's a haplogroup, you ask?  A haplogroup is a genetic population group of people who share a common ancestor on the patrilineal or matrilineal line. Haplogroups are assigned letters of the alphabet, and refinements consist of additional number and letter combinations.

My common haplogroup with Mario is....drum roll please...."J"! Now, actually, there really is more specificity, because that letter J is followed by a least one digit and number depending on various mutations that occurred throughout history that are found in my DNA.   But, I'll get into that later.  

As for now, I'm still processing that I'm related to this guy. 

Have you ever seen his shoes?!

No, you say? Then click here!

On the other hand, seriously, EVERYONE IS RELATED anyway, regardless of nationality, color or religion, so really, what's the big deal? 

Therefore, in the mean time, until next time, start planning for Thanksgiving 2013, and enjoy this delicious recipe from my new cousin, Mario:

Latke Love from Mario Batali

MARIO’S HANUKKAH LATKES
2 large russet potatoes
2 medium Yukon gold potatoes
3 tablespoons milk
1 egg
1/2 teaspoon baking powder
4 tablespoons matzoh meal
Salt and pepper, to taste
1/2 cup extra virgin olive oil
Wash the potatoes but do not peel them. Grate the 2 russet potatoes on the large holes of a grater and grate the Yukon gold on the medium holes. Add the milk, egg, baking powder, and matzoh meal. Season with salt and pepper and stir to blend well and toss into a colander for about one minute to drain just a bit of the juices. Replace in the mixing bowl.
Heat a scant 1/2 inch of oil in a large skillet until it is very hot but not smoking. Drop the potato mixture by large spoonfuls, then flatten slightly with a spatula to create a lacy edge. Turn them once.
When they are golden brown on the bottom side, cook them several minutes longer and drain them on paper towels (the lakes will have crisp edges).
Serve hot with marscarpone and /or applesauce

What is my Ancestry Composition?

Say what?!

(sample)

From the time I was born  61 years ago, until I was a teenager, my entire identity was that of an American, albeit a Jewish one. Reality, as I knew it, started in 1952 in Denver, Colorado, United States of America. That's what I knew, period.  During my childhood, no one ever mentioned the old country, so for a long time, I didn't know there was one.  My great-grandparents and grandparents were so relieved to have escaped the pogroms and atrocities of those butchering Cossacks, that when they emigrated to America, they just wanted to start anew, safe and free from the centuries of terrifying antisemitism and oppression. One time, I remember as a young girl, I asked my Grandma Golden a question about her family's life before immigrating to America. When she didn't respond, my Grandpa began to answer for her, but she instantly chastised him, "Shah!! Don't talk about it!!"  That misery was over and they didn't want to burden their children or grandchildren. 

Fast forward, 45 years and thanks to my sister Rhonda, a lot of extensive research has been done on the Cooper/Golden/Becker/Shafner family trees which essentially go back to the pogroms of the Ukraine around the late 1800's and early 1900's. Then the genealogical records hit a brick wall. I've often wondered throughout the years, who was my family before then? Where did they live? Where did THEY come from?  

Now, knowing that I'm purportedly Ashkenazi Jewish according to my family lore, I could surmise quite a bit. After all, when our Second Temple was destroyed and Jerusalem fell to the Romans in 70 C.E., the Jewish diaspora began. We left town and migrated throughout Europe and beyond, for the next 2000 years! Then finally, with the recent establishment of Israel in 1948, a lot of us moved back. Those of us that didn't, still go to visit our michpocha that did.  But, hey, 2000 years is a long time.  A lot can happen! So, what happened to MY family?  Now that I've gotten older and become a Grandma myself, I just want to know more about my lineage.

Now, recently in this year 2013, I learned about a simple saliva test called 23andMe that might provide some answers.  And indeed, the answers are starting to trickle in. Initially, the first wave of information is all about health issues, what I've inherited, what I'm at risk of.  Interesting stuff, which I'll tell you about later. Right now, the ancestry information is starting to appear in my report AND it continues to get updated.  Of particular note is that the information I am receiving is only from my mother's side.  Even though half of my genetic composition comes from my father, women do not have the Y chromosome that’s passed down from father to son. So to get my paternal lineage too, my dad will soon have to spit into a test tube like I did.

Then, another piece of the puzzle will come together and maybe, just maybe, I'll find out where those light blond-hair, blue eye genes come from that my sisters inherited from my dad.

And those almond shaped eyes on the Cooper side from my mom.  

And whether or not, as I've always joked, "Did Genghis Khan from the east or some tall Scandinavian warriors from the north play a part in any of this?  

You never know.

Until maybe... now.

Facebook Circa 1960

When I was a little girl, this black and white rotary wall phone 
(# Main 3-0060), hung on my Grandma Golden's kitchen wall. Edith (née Cooper) lived in Denver's "West Side" in the red brick house, on the corner, at 1400 Raleigh street, one block west of the old Yeshiva and one block south of  Tobin's Drug Store. Grandma had a metal folding chair that she parked beneath her phone...her lifeline to the news and gossip.  Every morning, she'd sit down on that chair and call everyone in the family, one by one, to make sure they were okay and to find out what was new. She didn't usually talk long, a few minutes per person maybe, but she ran down the list of siblings, children, friends...and checked in. I've got that image etched in my memory.

Fast forward more than half a century.  As soon as I wake up in the morning, I make my cup of coffee, sit down on the couch and I also check in on all my friends and family with my phone.  However, it's not with a rotary wall phone anymore, it's with a cell phone! I don't call people either.  I open my Facebook page...not in black & white, but in color!  Yes, indeed, I now have the extremely pleasurable opportunity to see what's going on, not with just my short list of family and friends, but my REAL list of 329 "Friends", and find out what they're all up to.

For years, I use to cut out and collect articles from the newspaper that I thought were of interest and pass them out to my friends when we eventually got together.  Now I just post them on my Facebook page. 
THERE! Check THAT out! 

Or, even better, I get to see all the wedding pictures and kids pictures that I NEVER would have gotten to see years ago. Who had the time or wherewithal to share pictures? One day you would know someone had a baby and then time would pass and you would get introduced to them as adults at some event. No more of that! Oh, no. Now I get to see all the babies & brides. Facebook is a a picture-fest and I LOVE it!!  I get to read about everyone's adventures traveling all over Denver and the planet. I get to keep in touch with family members around the world. I get to share great jokes and laugh out loud in the wee hours of the morning, so my husband, half asleep, can ask, "What's so funny?". 

Some people believe the internet is isolating. 

Not true with Facebook. I love being in touch with all 329 of you and checking in every morning!

What would Grandma say to that?!

Learning Life's Lenses

When I was 12 years-old, back in the day, taking the bus with your best friend downtown to the Woolworths on 16th Street was a major event for a girl growing up in Denver. When that enormous Woolworths was built in the 60's, one block long and one block wide, you could spend a whole afternoon in there wandering around, exploring, eating, and having fun before it was time to turn around and catch the bus back home.  If you were lucky enough to have a quarter left over after bus-fare & a hoagie, then you might indulge in one of the most amazing experiences of all mankind, the Photomaton. 

Somewhere in various closets, boxes & scrapbooks, there are strips of black & white photos where my smiles, silly expressions & youth are frozen in time...not many but some.  After all, a quarter was a lot of money, back in the day, and you really had to think twice before indulging in such an extravagance.

Last night, barely 9 hours ago, I found myself sitting, I mean, standing (no seat),  in a Photomaton; not at Woolsworths, or an airport, or even the old  Elitch Gardens, but at a wedding, in the foyer of a synagogue, no less.  My future daughter-in-law, KatieE (to differentiate from KatieA, my current daughter-in-law) had enticed me in, dressed us both up in ridiculous props, and together we posed making the silliest expressions we could muster together without cracking up. This modern photomaton had a choice of either color OR black & white pictures, but KatieE picked black & white and in a few minutes the nice lady running the laptop (no developing chemical smells anymore) handed us our strip of poses.

There they were, the four little vertically arranged squares of frozen time. Me, a grandma in a sombrero, giving the camera my best Jodi expression (my baby sister's notoriously outlandish face scrunch guaranteed to make our mother laugh out loud) cheek-to-cheek with my beautiful future daughter-in-law, rolling our eyes together in a mutual conspiracy of hilarity. 

Did I look utterly ridiculous, outrageous & totally embarrass myself?

I sure did!

Did I behave in a manner not befitting a woman of my maturity?

Yes.

Did I care?

Not in the least.

And do you know why? Because in my heart and mind, I really wasn't focused on the camera lens which was focused on me. I was focused on memorizing those precious, cherished minutes with KatieE, in the booth, acting silly together and having fun.

I wanted to visualize the promise of a beautiful future together for her and my youngest son, not just in those wonderful, four fleeting snapshots of black & white time frozen on a strip of paper, but through the lens of my mind's eye where unpretentious, yet brilliantly vivid hues of joy, love & hope reside securely in my soul.

A Snuggly Moment

 

When my kids were babies, I carried them around in a Snuggly. I loved it because when the baby was sleeping, the side of his face would be against my heart and his legs would wrap around my sides. It was delicious. Talk about living in the moment. It was the ultimate moment.  As the kids grew up, I yearned for that feeling again, of peace, bliss, contentment, my child's heart beating against my own.

Alas, this past Shabbas, a special treat.

My 23-month-old grandson came to shul with me. While his daddy and great-grandparents were in the sanctuary (mommy was resting at home), JG and I sat with the other toddlers in the preschool. After awhile, however, he wanted to leave and as I carried him through the hallways towards the large entryway of the building, he started falling asleep on my shoulder.

I slowly sat down and reclined into a big plush chair and allowed JG's body to wrap around mine. His rosy cheeks melted into a deep sleep on my chest. His little brown extra-wide Shabbos shoes wrapped around each side of my waist. I leaned my head back, sank into the cushions and closed my eyes. And above me, suddenly the malfunctioning Shabbos speaker started working. Cantor Kutner's magnificent Hebrew chanting began mesmerizing me with his exquisite,  melodic voice.

I listened. I felt the weight of JG's body against mine; his heart beating. His beautiful long eyelashes accentuating his gorgeous face.  Oh, my love for this child!

Pure bliss.

The Joys of Research

Sometime during last month, around Christmas & Chanukah, I began asking myself some crazy questions:

1. Why is there so much arrogance and intolerance when it comes to religion?
2. Do people even know the history or reasons for the holidays they celebrate?
3. What does buying a bunch of crap at the mall and going into debt have to do with Christ’s birthday?
4. What does Jesus of Nazareth have to do with Santa Clause & light laden trees?

And if that isn’t enough, how about these:
1. How many generations did my family live in Russia before they immigrated to the United States?
2. How come blond hair and blue eyes run in my family if we are Jewish and Semitic?
3. Why do Jewish people tend to look like the other people in the countries they live in?
and..ta da, here's a big one!
4. Why don’t the Republican presidential candidates behave with dignity and stop disparaging Obama AND each other? (Disgusting!)

Well, guess what? I’ve doing a whole lot a reading lately. Thanks to the wonders of my handy dandy new Kindle that I got for my birthday (thanks guys!), the Denver Public Library, & the wonders of internet research, I've been learning a lot that either I never knew or I've just forgotten. Maybe it's my age, maybe it's being a grandma, maybe it's because I indulged in buying myself a new comfy, recliner that's back-friendly, but for the last couple of months, I've been carving 3 hours of reading time out of each morning before I go to work, or shul, or excercise.  What's going on with me?

I'd like to share with you some of what I've learned. My goal is not to induce controversy, only knowledge & understanding.

And, of course, good manners.
I invite your comments.

Just a Walk in the Park on 9-11

The afternoon has arrived when I have my grandson all to myself.  I am in a state of grandma euphoric bliss.  Mommy is at work. Daddy is napping after working all night. One of my very best friends, the baby's other grandma, is out of town. The great-grandparents have gone home to rest. Uncle is in the coffee shop studying.  The baby is all mine!  After feeding him, I buckle Joey into his stroller and off we go to explore my neighborhood for the very first time...together.

It's just him and me on a glorious day.

We head off to the nearest park which is in the center of a Jewish neighborhood.  We see a big gathering of families together. Women in ornate burkas, men in conversation.  Ramadan is over. Maybe they are celebrating.  Where are the young children?  We head over to the playground.

Aha! There they are.  The Jewish kids and the Muslim kids playing, exuberantly laughing, able to jump on the swings and the merry-go-round, cooperating together in play as if they've always been friends.

I spot the only other adults at the playground sitting on a bench, an Orthodox Jewish couple watching their daughter play on the swing with two other little girls. I know the couple is Jewish because the woman is wearing a typical headcovering often seen among religious Jewish women.  I strike up a conversation and they point out their daughter to me. She is the one in the blue sweater. We laugh about how much fun these Jewish and Muslim kids are having together and listen to their innocent conversation as they inquire about each other.  They are clearly have a great time. We enjoy watching them enjoying themselves. Joey is fascinated from his vantage point in the stroller listening to their high-pitches voices and observing the swinging motion.

After awhile, a tall male adult walks up in traditional Muslim attire and calls all his kids back to the picnic.  A beautiful park on a beautiful day with our children. Somehow we all feel connected just wanting our kids to be happy in this world. 

What else is there?

"G=d Brought Joy in the Midst of Pain"

It's been 13 years since my best friend, Robin, found her birth family when she was 48. She tells me repeatedly - even this morning- that I was the midwife who was instrumental in birthing a new life with her two younger sisters, two younger brothers, her aunties, cousins, nieces, nephews, and enumerable extended family members. When I embarked on the tedious search for spools of damaged microfilm from Salt Lake City's Mormon Church archives to locate Robin's original birth record and then secret friends in the underground railroad of sealed adoptions, who could have imagined then the phone conversation I would have with Robin this morning.

I should tell you first that when I located Robin's Aunt Minnie, I was very disappointed to find out that Estelle, Robin's birth mother, had already passed away.  Estelle Arshansky's pregnancy had been kept a secret from most of her family including her own parents.   Sisters, Minnie and Beattie, quietly arranged for their big sister to travel alone to a Jewish home for unwed mothers in Staten Island whilst most of the family believed she was leaving to help out an aunt who had just given birth. Soon, however, Estelle gave birth to her own child; a healthy baby girl but in anguish had no other choice but to relinquish her for adoption and return home to finish high school. Eventually as time passed, she went on to marry and have four more children and a new life without her precious first born. The secret was hidden away for half a century, that is until I called Aunt Minnie in Brooklyn thinking she might be Robin's biological mother. My ensuing questions elicited a deluge of primordial emotions and tears from the recesses of long repressed secrets. Aunt Minnie acquiesced that she had been praying for this moment when her sister's daughter would look for her. The four younger siblings were still reeling from the loss of their mother and suddenly an elder sister whom they had no knowledge of was about to enter their lives. Minnie and Beattie, had never told their youngest sister, Essie, either. Minnie called a family meeting with her four nieces and nephews and  told them, as they sat in stunned silence, the story of their mother's high school romance. They had an older sister who was given up for adoption who was now living in Denver, widowed, with three young children.

Let me just tell you that I travelled to Brooklyn for the eventual reuniting some three months later after letters and photos were exchanged. That evening in Brooklyn was profound and wonderful. Having grown up as an only child, albeit to wonderful and loving parents, the trepidation for Robin of meeting these new souls was overwhelming. Yet, upon seeing seeing their faces and feeling their hugs, it was love at first sight. The immediate bond they formed has only grown tighter over the last thirteen years.

Less than one month ago, Dennis, Robin's eldest sibling, was diagnosed with pancreatic cancer. Last week, Robin flew to New York to be by his side in the ICU with his wife, Maxine, son Ian, his pregnant wife Dana, daughter Erin and other family members. The illness had progressed so rapidly that most of the family weren't even aware that Dennis was so seriously ill. He passed shortly thereafter. The shock and grief were indescribable.

At the funeral, Robin was told by her sister Abbe, "G=d brought you here, as our big sister. Take the seat our mother would have taken. You comfort us in our pain. You are her." Extended family members who attended and had not met Robin before were taken aback. She looked so much like her mother, Estelle.

At the Shiva house Saturday night, the Rabbi was conducting a Havdalah service, passing around the spices and speaking to the family which Robin was listening to with intensity. She became aware of whispering in the background. Suddenly Maxine spoke into Robin's ear, "Dana's in the dining room. Her water just broke!"

That night Dennis & Maxine's first grandchild, a baby girl was born. She was given the name Dylan after her grandfather, of blessed memory. And as Robin relayed this story to me this morning, she passionately exclaimed, "G=d brought joy in the midst of pain!"

"Did you hear what you just said to me, Robin?" I asked her. "Repeat what you just said."

She repeated, "G=d brought joy in the mist of pain!"

"Oh my G=d!" she whispered in understanding.

You see, dear reader, it was in the basement of a local Denver Church of the Latter Day Saints, scanning thousands of microfilmed birth records, that I had found out, and excitedly called Robin to tell her, that Estelle had indeed named her precious newborn baby daughter!  She had given her a name! In fact, the name was so beautiful and descriptive that there could never again be any  doubt whatsoever that Estelle had longed for the day, when just maybe, this treasured child might know how much her mother truly loved her.


That name was...Joy.

Kissing a Butterfly

A few weeks ago as I was hurrying to leave for work, I opened the front door, took one step outside and saw a beautiful butterfly in my path. A range of emotions flooded over me. Many years ago when my grandmother passed away, someone told me that birds and butterflys are symbols of loved ones who are communicating with us from the other side. That December, on a cold winter day, I was amazed to find a beautiful butterfly flying around my living room. I watched it in awe and then, after a short time, it just disappeared. In the spring, when I stood on a ladder to retrieve a child's ball from the roof, I looked over the ledge and came eye-to-eye with a little blue parakeet. Amazed, I picked him up and brought him into the house. One day, I took his cage outside and it inadvertantly opened. In an instant, the little bird flew away into the sun.

Last summer, a huge, beautiful, white butterfly was sitting on my porch when I opened the front door. I froze when I saw it, but when I walked towards it, it flew away. This day, the butterfly allowed me to approach and I knelt down to the sidewalk. I touched my finger to it's foreleg and it crawed up my hand. We talked for a while. I took pictures with my cell phone. I had to go to work (did I really?) but the butterfly didn't want to leave me.

And I didn't want to leave it either.

After a while, I nudged it onto the flowers. My husband, who I thought was sleeping, told me that evening that he had been standing at the front door and watched the whole encounter.

Kissing a butterfly.

Whatcha talkin' about Willis?

Babies like pacifiers, toddlers love their blankies, and Willis, well, he loves his orange. It's a family joke. As soon as we all sit down to dinner, five minutes into our conversation, Willis starts whining. If we ignore him, he starts kicking his full water and food bowls upside down. Clunk! Crash! Spill! If that doesn't get our attention, he starts barking in our faces. What does he want? An orange. A small clemantine, cutie-pie one that will fit into his little Bichon Frise/mini-Doberman Pinscher mouth which he holds there for a few hours...until just the right time to eat it. And don't come near him once he has his fruit either. He will bare his teeth at you and growl to protect his treasure. (This is where his wolf ancestry instinct kicks in. He behaves as if he's protecting his hunt. But hey, someone try to tell him it's not a rabbit. It's an orange.)

In lieu of oranges, sometimes tomatoes work. Willis developed a taste for cherry tomatoes from the garden where he learned to pluck them off the vine and eat them. He also likes apples which use to fall into our yard from a neighboring tree. But truly, he prefers oranges. In a later blog, I will explain how Willis sleeps on top of his cheeseburger toy, but that's for another time. And for those of you who have been enjoying Willis' antics for the past 12 years, yes, this is the same dog that used to entertain the whole neighborhood by climbing up trees in his younger days to retrieve...what else?...fruit.

Diff'rent Strokes!

Listen up, Fatsos. YOU ARE WHAT YOU EAT!

My grandpa told me. My mother drummed it into me. And now holistic nutritionist Gillian McKeith from BBC America is stalking British fatsos in the malls and grocery stores of England and shaming them into reclaiming their health. Some of these obese people actually contact her directly out of sugar induced despair and she makes home visits. Bellies unbarred, we see the parents modeling their rotund profiles in underwear, bulging guts hanging over their waistbands. The man-breasts are usually as big as the woman-breasts. And then there's the children, all beautiful, overweight, lethargic, and on their way to becoming fatsos too. Everyone has headaches, joint pain, constipation, and a multitude of health problems related to "fat-filled, overly salted, processed convenience foods, and take-out". The kids can't concentrate, don't exercise, and are in a doughnut glazed stupor playing video games. The whole family is genuinely clueless that their diet is toxic. So what does Gillian McKeith do? She drags their sorry asses into a room spreadout with all the food they eat in seven days. One look and the family is almost as aghast as she is. The table is literally overflowing with pounds of sugar, mountains of deep fried chips (french fries), sweetrolls, cakes, white bread, gobs of butter, fatty, processed lunchmeat, chicken nuggets, frozen pizzas, massive quantities of red meat and bags & bags of high fat "take-away" fast food. There isn't a fruit or vegetable in sight except for the catsup. And if that isn't enough to shock them into nutrition submission, the coup d’état of disgrace is when Gillian makes each family member save a "poo" sample in a tupperware container in which they must smell and view the bacterial laden, undigested, sorry states of their gluttony. They get a lesson in what a healthy poo is and it ain't that! "You must be farting and belching all the time! And your breath must stink!" Gillian snaps. Both parents are stunned with embarrassment, but nod affirmatively.

Back at the lab, a doctor is busy analyzing the family's blood samples. Inevitably everyone is malnourished and vitamin deficient. It's mind boggling that Gillian has to take these ostensibly normal intelligence, middle class people to the grocery store and introduce them to the produce department. For the next 8 weeks, the family must follow a vegetarian menu and prepare every meal from scratch. No takeout. It's all fruits, vegetables, whole grains, legumes, and nuts. No sugar, white stuff, or caffeine. And guess what happens? Everyone drops 2 clothing sizes, gets healthy, feels great, and has a ton of energy. The families emerge from their junk food comas committed to sticking with the plan, exercising, and loosing more weight. They look like different people.

Why do I watch this show you might (or night not) wonder? For one reason, I'm intrigued that any first world country could actually be in worse health than the United States. It's hard to watch sometimes, but the subtle British humor on the show punctuates the absurdity of the Brits' eating habits while the commentator's syrupy sweet sarcasm describes the deplorable burden obesity is placing on England's health care system.

Truth be told, however, the real reason I watch this show to motivate myself. When I'm having the late evening munchies, I watch one or two of the several episodes my cablebox has recorded that day. Within 5 minutes, I've lost my appetite and feel inspired by Gillian McKeith to skip the snack. It works every time.

Barak Obama will be appointing a new surgeon general any day now. I propose that his first priority be to insist that Americans start taking responsibility for their own health. (Sanjay Gupta, are you listening?) We have to force a nutrition revolution here in America. Half of the people waiting in line in the emergencies rooms right now should instead be waiting in line at the salad bars. They're reliant on expensive, unnecessary health care instead of diet and exercise to maintain their health. I propose we collect all the sugar, processed foods, and white stuff in America and ship it to the Taliban in Pakistan and Afghanistan. In six months, they'll all be fat and sick from hypertension. In a year they'll be obese and dying from heart disease. Then we can bring all the troops home.

America is in a health crisis. Insurance premiums are astronomical, and it's not just because the CEO's of the health insurance companies are making million dollar salaries. The insurance is paying for hospitalizations, medications, and the care of millions of sick people who have preventative illnesses that are directly related to poor life style choices.

Nearly everyday I see patients in my clinic who are 70 to 100 years of age. Some are vigorous and healthy. Many are sickly and decrepid. I'm often reminded that "An ounce of prevention is worth a pound of cure."

Think about it.

The Brady Bunch

Move over Oprah & Dr. Phil. I've had it with your anx. You no longer have priority status on my Tivo. I need peace, love, and happiness and I've found them. There's some new kids on the block..25 of them with one on the way...and I'm hooked.

TLC, the cable channel makes the fictitious Brady Bunch of the 1960's look like no big deal. Remember when six kids was a lot? Forget about it! Now we have real life families, like the Duggar's "17 Kids & Counting" and the Gosslin's "John & Kate Plus Eight" . Not since our adoration of the nine Osmond kids in the 1970's have us Baby Boomers had a feel good show to watch where we can relax, smile, and believe for an hour that there is hope in the world.

The fascination is not that the families have a lot of children per se. After having beautiful twin girls, Kate Gosslin beat astronomical odds by giving birth to 6 healthy sextuplets who are now 3 years old. During the show introduction, she shows a clip from her pregnancy...including a belly that is so fascinatingly huge, it defies belief. Except that it's real. Fast forward a few years, and now Kate and Jon are livin' the dream in suburban Pennsylvania. I don't know what's more fun to watch, the kids or Jon and Kate's end of day ("we made it through another day!") banter. On the latest episode, they're packing up the whole family for a trip to Hawaii to have their fantacy wedding which they didn't get the first time around.

On the other hand, Jim Bob and Michelle Duggar live in rural Arkansas in an enormous, gorgeous home that the whole family built themselves. They pay cash for everything and have no debt. Mom home-schools and buys in the thrift store. They have seventeen gorgeous, healthy, happy kids whose names all start with the letter "J" - Joshua, John-David, Jana, Jill, Jessa, Jinger, Joseph, Josiah, Joy-Anna, Jedidiah, Jeremiah, Jason, James, Justin, Jackson, Johannah and Jennifer with a girl due in January (Baby Jan for January?). I don't know how the parents keep their sanity.... let alone keep the kids' names straight...but they are deeply religious and obviously their faith plays a great part. Dad is a gentle leader. Mom has a voice that is so sweet and tender that that just the sound of it can make a misbehaving toddler turn her head in shame. The eldest boy, Josh, 20, was recently married to 20 year old Anna, whom he met at a home schooling conference. Viewers (that's me!) have been watching the courtship on the 10 week series. The newlyweds are going to live in a small house near the big house. In a few years, they may have a big house of their own.

If you've every watched ABC's Supernanny and seen the sad, suffering parents with the 2, 3 or 4 angry, fighting, and disrespectful children that Nanny Jo Frost is confronted with, you have to wonder. What the heck happened that allowed these much smaller families to become so frightenly dysfunctional and out-of-control? The juxtaposition between them and the Duggar's and Gosslin's is worth thinking about...and learning from. (Did someone say "old-fashioned family values?")

In the mean time, I can't wait for the upcoming episodes of Josh Duggar's wedding and the Gosslin's renewing their vows.

I wish they were on right now.

America the Fat

Time Magazine recently reported in their 6/23/08 issue, p.67, "In the 1950's kids had three cups of milk for every cup of soda. Today that ratio is reversed, (three cups of soda for every cup of milk) meaning they get all the calories and none of the nutrients."

When I was growing up back in the 50's, kids were expected to drink a glass of milk with their breakfast and again at dinner. In the school cafeteria we were handed a carton of whole milk with our nutritionally balanced lunch and we drank it dutifully. Every kid did it because we were instilled from a very young age with a personal responsibility to eat right and exercise in order to be healthy. Just as we implicitly accepted our polio vaccine on sugar cubes, as kids we were obligated to ourselves, our family, our community, and our country to drink our milk. It was a national duty. And during the Kennedy administration, we believed milk was some sort of perfect super food and our best defense in keeping us out of the doctor's office; a prophylaxis against illness. And healthy kids meant a healthy future for America.

But soda? I was 12 years old when I tasted my first Coke. In those days, Coke was a treat, and treats were taken seriously, forboden save for special occasions which were few and far between, like cake on a birthday or turkey on Thanksgiving. They were anticipated with excitement, savored, and appreciated; not indulged in at whim as they are today. A fat kid was an oxymoron.

Today one third of American children are obese. Not only is this group endemic with Type II Diabetes, but the American Academy of Pediatrics now endorses the use of statins such as Lipitor for these kids to control their dangerously high cholesterol levels and avert the heart disease which can lead to heart attacks.

Many of the senior patients we see at the clinic also struggle with these same diseases. Some have spent their adult lives indulging in poor life style choices and now they're suffering the consequences. How ironic that these patients will find their own pre-adolescent grandchildren struggling along side them with the same life-threatening, preventable maladies.

Remember the 900-pound man seen on the Discovery Channel or Dr. Phil who is bedridden from obesity? Every day his mother still serves him the liters of soda and high-calorie foods that she fed him as a child. Now as an adult, he is so profoundly addicted that despite his agony, he still demands more of the same. And the mother, despite her son's morbidity, accommodates him.

Obese kids who regularly drink soda, eat high-fat fast-foods, and are sedentary lack basic health education and a supportive environment to reinforce it. Blame is rampant, but irregardless, our youth are our future and they must once again become a national priority in this country. We should vote for a President who will genuinely advance the mental and physical health of our children...from birth through early adulthood. Surely this will require extraordinary changes in our society and an extraordinary leader to bring them about.

Obama or McCain?

Blossom

A professional songwriter friend of mine and I launch a volunteer after school mentoring program and Blossom is referred to us by social services. She is 12-years old. One evening as the kids are singing, I notice she is staring at the lyrics handout. She hides it well, but something is wrong. This American-born girl can't read.

When it is time for the kids to be picked up, I tell Blossom to ask her mother to come to the music room. I need to talk to this woman whom I have never seen before and know nothing about. And she comes in, eyeing me nervously with four little children in tow. We sit facing each other, mother to mother. I speak softly and gently, "Why can't Blossom read?", I ask. And as if a dam breaks open, she responds in a sudden, frantic torrent of broken English with a thick accent. "I ask for help! I talk to the teachers! I try and try! No one will listen to me! No one will help her," she wails.

"A 12-year old girl who can't read?", I think to myself. "How is this possible? How humiliating for this beautiful young lady about to start middle school."

I look over at Blossom crying in shame. I look into her mother's eyes. "I will help her," I hear myself say. "Bring her to my home every Sunday for 2 hours. I will teach her to read."

As I sit on their living room couch, I learn the family is Muslim, the mother from Nazareth, Israel, the father from Syria. I tell them I am Jewish lest this will somehow alter their desire for me to tutor their daughter. To my surprise, they are happy with this disclosure and express their gratitude with cups of tea and a plate of homemade baklava.

I take Blossom to the library for books. I assess her reading. I am appalled. I call the school and arrange a formal meeting with Blossom's teachers. "How can this happen?", I challenge them. They tell me that in the third grade, Blossom was determined to have an auditory learning disability. I am told that reading isn't taught after 3rd grade, so since she couldn't keep up with the other children, she was placed in a special education tract. And, as I see it, essentially forgotten. Here she is, entering 6th grade, and she is unsure of how to sound out vowels. I can hardly believe it. It's pitiful. But Blossom is hungry...ravenous...to learn.

That was three years ago. My involvement in the after school program has long since ended, but my mentoring Blossom continues today. She is 15 now and wears a hijab unlike the other women of her family. In a high school rampant with teenage pregnancies, her head covering is her unspoken declaration of modesty and self-assuredness. In my home, her learning extends beyond books. She delights in frying perfect latkes and shares in the lighting of Chanukah candles with three generations of my family. Her mother pays me in tabbouleh with fresh mint and stuffed grape leaves with rice.

And Blossom reads abundantly..at about a sixth grade level right now. In spite of her challenges, she has a fierce determination to keep practicing and improving. She calls me on the phone five or six evenings each week and we go over lists of vocabulary words together.

And as long as Blossom works hard, I will continue to push her and encourage her...and be there for her.

Some day I hope to dance at her wedding.

08-08-08 0lympics 洪水 0h My!

I'm tantalized by Planet China.

Ever since my university independent study on the Sino-Soviet conflict, Mao Tse-tung, and the Cultural Revolution, ever since the table-tennis match and Nixon's visit, I've been fascinated with that Quiet Giant composing one-fifth of the world's population. I disdain the communistic thought control yet I am in awe of the culture and the physical beauty of the country. I worry about China's emergence as a powerful leader into the world market buying up U.S. Treasury Bonds as we sink deeper into debt.

But, hey, TGIF! The Olympic opening ceremonies are on TV tonight. I've been looking forward to these for months...years. The Olympics are incredible enough, but from China? It's probably one of the most significant events in the history of human civilization. I am exhausted and stressed from work and I want to get home and watch the extravaganza!

I can't wait!

And there it is on the big screen! Beijing and the massive architectural wonder of a Bird's Nest where ninety thousand athletes, dignitaries and spectators from every country in the world are converging in 65% humidity as a statement of global unity! The promise of the future of mankind! I am transfixed. Only fire, flood, or pestilence will steal me from this pleasure! Bring it on!

An hour later, I haven't blinked. I am mesmerized by the performers, the children, the costumes, the colors, the faces. I am watching George W and Vladimir Putin on camera 'yuckin it up in their stadium seats. Suddenly I hear blaring alarms. The TV screen goes black and a bold message appears across it. "What's this?!" I think to myself. "Am I witnessing the Chinese censoring of American television?"

Not so lucky! It's a Civil Defense weather warning. "A dangerous storm is passing over certain parts of the city." "FLOODING IS IMMINENT!", it yells at me.

"Is it raining?" I'm downstairs totally unaware. And within seconds, Niagara Falls breaks through the windows and water is pouring into the basement! "HELP ME!", I scream. The family bursts into action. Buckets, mops, towels, fans. My husband is outside in the torrential rain looking like a sailor bailing out his ship to keep it from sinking.

Another hour later the storm passes and the flooding is over. And so are my Olympic opening ceremonies. I'm exhausted from sopping up gallons of water and running up and down the stairs.

But, hey! Ninety thousand people may be sweatin' the big stuff in the Beijing humidity, but I ain't sweatin' the small stuff here in the States. What's so bad about a couple of rooms with soaking wet carpeting that already smell of mildew? Through the wonders of cable video, the hoopla has been magically recorded and I can still watch it, tomorrow, commercial free, with the push of a button.

And...I can't wait!

Oxycodone Known

Since our State Board of Pharmacy recently published an on-line prescription history database for doctors, we've verified that some of our patients who we suspected were abusers, are abusers. They're addicted to oxycodone and other narcotics, and they've been going from doctor to doctor, making up stories, and getting multiple prescriptions filled. Now we have the ability to screen new patients carefully for prescription drug abuse and while we're on the phone setting up the appointment, I can download the entire prescription history in 3 minutes.

Some of the patients genuinely need oxycodone like the patient with the shredded rotator cuff which was verified by an MRI. But sometimes we have to remind ourselves not be suspicious all the time, that is, ever since we met Mr. Kidder (sic). He walked into the office unexpectedly one morning, stating he had fallen in the shower and hurt his tailbone. "Could he see a doctor?", he pleaded sincerely.

One look at the patient and Dr. Richard informed me that he believed Mr. Kidder to be a drug-seeker. To prove his point, and squelch any doubts among the staff, the kind doctor gently conducted his physical examination which, due to the nature of the so-called injury, included a rectal digitation. In that, according to Dr. Richard, the patient didn't flinch, the coccyx was determined to be not fractured, and Extra-Strength Tylenol was prescribed for the professed discomfort. The patient, upon realizing that he would not conclude his visit with the desired oxycodone prescription in hand, discreetly departed the premises in a state of profound consternation.

He left behind a balance due, his bogus address and phone number, and a lengthy narcotic abuse report, freshly downloaded and printed.

Mr. Kidder, indeed.

InSecure Horizons

My mother calls me. Her dearest friend, 93-year old Miss Bessie, wants to know if I will look at her bills from the rehab facility she stayed in two years ago. The balance due is over $5,000 and Bessie can't understand the paperwork.

Miss Bessie is no frail, old lady suffering from dementia. Far from it. When I visited her in the rehab facility where she was recovering from a broken shoulder, she was sitting in a chair with a new Apple laptop shooting off emails to her family. She's a retired librarian and sharp as a tack. She may be 93, but she looks and acts 20 years younger.

So, at my mother's request, I, being the good daughter that I am, dutifully drive to the assisted living center where Bessie now lives and pick up her plastic grocery bag full of bills and health insurance policy documentation. I adore Bessie, but I dread this. It's like doing a jigsaw puzzle with 500 pieces and no distinct picture. It's so anxiety provoking that I make up my mind that I will not even attempt it until which time I am fully rested, calm, and in a good mood. And most importantly, when I have a window of opportunity to tackle this at work. I'm thinking in about 5 years.

It takes me about a week to psych myself up. The bag is sitting on my desk next to the laser printer. I pick it up, look inside, see all the puzzle pieces, and spread them out on my desk. I open up a new excel spreadsheet on my computer screen to enter and track the charges and I start with the rehab facility bills. ("No wonder Bessie couldn't understand these," I think to myself. "This is ridiculous!") Then I comb through the Secure Horizons contract. Then I call Secure Horizons who refuses to talk to me until I tell them I'm with a doctor's office and give them all the secret information that allows me to get past their HIPPA gatekeepers and convince them that we can discuss Bessie's billing problems behind her back. I challenge their reimbursements to the rehab facility and point out their mistakes. It turns out that Secure Horizons reimbursed the rehab facility at a different daily rate than was on Bessie's contract. There was a $800 error in Bessie's favor.

I call the rehab facility, email them the excel spreadsheet with all the reconciliation detail and wait. Three weeks later Secure Horizons sends a check to the rehab facility, but not for the full $800. I have to call them again, B.S. my way through their umpteen layers of HIPPA security and once again point out the error of their ways. And finally they pay up. Bessie gets her bill reduced by $800. She's elated. Probably more from the peace of mind knowing that she wasn't taken advantage by the rehab facility and Secure Horizons than the money itself. She pays off the rehab facility. She's smiling her beautiful smile again.

Now, you tell me, how in the heck was Bessie suppose to do this herself? What about all the other hundreds of thousands of other seniors receiving bloated bills from rehab facilities, hospitals, and doctors? There is no possible way these innocent, naive, trusting people will ever know they're overpaying. The bills are nearly impossible to understand and so difficult to dissect that I'm sure most never are.

Bessie's health insurance, Secure Horizons, is one of dozens of the Medicare Advantage Plans, marketed to seniors with the promise of giving them an advantage over straight Medicare and a supplemental plan. An advantage?

In our office, we call most of them Medicare disadvantage plans.

"Hi, Ray Charles!"

Charles wasn't really his last name, but Ray was really his first name and he had been a patient in this practice for 25 years. I only knew him for the last two. Ray suffered from schizoid disorder. He lived in a group home. A social worker brought him to our office every six weeks to monitor his delicate health issues. One thing I noticed was that when Ray came in, the staff got excited. They treated him like he was a member of their own family. They took care of him with so much tender loving care that I couldn't help loving him too, even though he was quiet and not particularly communicative, and he didn't really know me. Ray was tall, refined, and always wore his gold chains. He walked with a cane.

One day, Ray called and I answered the phone. The deep, monotone voice said, "This is Ray." And, I, in an impetuous moment responded enthusiastically, "Hi, Ray Charles!" And Ray cracked up laughing.

And then I did it every time he called and every time he came in and it always broke through his depression, even for a few seconds.

On Monday, Louise the social worker brought Ray to the office. He was AMA from the hospital (Against Medical Advise) for a GI bleed and only wanted to come to our clinic. I walked into the exam room and saw him sitting there waiting solummly, and exclaimed, "Hi Ray Charles!" He and Louise both cracked up laughing.

Yesterday, Louise called and said that Ray had been readmitted to the hospital. He'd had a very successful GI surgery. But something had gone wrong. She was still trying to find out.

And Ray had passed away.

I hung up the phone, sank into my chair, and wept. I informed the staff.

"Goodbye, Ray Charles." I thought.

"Thank you for all those times you made me smile. You never knew how much they meant to me."

Paper Travail

I'm experiencing the reality of something I read in a Time magazine article a long time ago. Something in the article was so profound that it resonated with me then on a personal level and it's resonating with me now on a professional level... years later. Usually when I read something that truly impresses me, I want to save it. I tear it out of the magazine or save the magazine or copy the article. But in this case I didn't and I regret it because the gnawing feeling is bugging me.

Today, with the patient chatter in the front office particularly subdued, I search for the Time magazine archive website and search...and search. What key words should I use? I try this and that and this again. I concentrate on staying calm as I maneuver through thousands of articles. I focus. And low and behold, Eureka! I find it!

It's the cover story, "10 Ways to Cure the Health Care Mess", from the November 25, 1991 issue by Janice Castro.

Here's the quote I'm looking for: "The U.S. has more than 1,500 different health-insurance programs, each one with its own marketing department, complex forms and regulations. Doctors, nurses and clerks are buried in the paperwork needed to keep track of whom to bill for every aspirin tablet. It's a massive waste of time. U.S. health-care providers will spend as much as $90 billion this year on record keeping, according to a Harvard study."

And that was written nearly 17 years ago!

Today, amidst the ever increasing absurdity of having to keep track of every single patient's individual insurance company (of which I count 60 companies among our records) and specific plan (of which there are too many to count), which by the way the patient frequently changes from year to year, (and we have to keep track of that too or we don't get paid) or if they're on Medicare, to bill to Medicare first and then bill again to their supplemental insurance plan (if they have one) and bill to each private insurance company separately, and recognizing that when we do eventually get paid, a sizable chunk of it will go to the billing company who slogs through this mess for us, and don't forget we must also keep track of each patient's network of specialists when trying to refer because they don't have a clue how to navigate the system themselves (how could they?) and, oh, keeping track of that plan's medication formulary because Plan A doesn't cover this drug or that drug and requires a physician's letter to document the justification, and while your fighting that battle with the insurance company and they're stone-walling you as long as possible, the patient dies and then the issue goes away on it's own...

Stop the insanity! Yes, Janice Castro articulated the situation perfectly, "It all is a massive waste of time." And the waste has grown exponentially since 1991.

What have we created? A health care system that forces our doctors to spend a substantial portion of their 24-hour day coping with a bungling administrative quagmire constructed by a billion dollar profit-focused insurance industry instead of allowing them to spend most of their time, attention, energies, and advanced education on what is important - practicing medicine.

Oh, and by the way, many of our best and brightest minds are opting out of medicine altogether because they can no longer stand dealing with this "Health Care Mess".

It's shameful.

Livin' in the 90's

Last summer, my then 94-year old father-in-law was gallivanting around Europe with one of his sons. He had always wanted to visit the towns that bore his last name. One was in Germany, one in Czechoslovakia. And he did so. And he was having the time of his life, that is, until one morning while staying in a little inn in Poland, he couldn't lift his head off the pillow. His body wasn't working. An ambulance was summoned and Zaidy was rushed to the small, nearby hospital. He had suffered a stroke.

I'll spare you the terror that went through our minds when we received the phone call. It was bad enough that Zaidy was deathly ill in a foreign country, but this was in the very same country that turned over his whole family to the Germans back in 1943 so they could be transferred to the concentration camps in cattle cars never to be seen again...his parents, grandparents, sister, 9 brothers, their spouses, and children. As a young adult, Zaidy was out of town when it happened.

But now this Holocaust survivor was at the mercy of the Polish doctors to save his life. What a paradoxical situation to be in. What an enigma he must have seemed to them. Trust me. They probably had never seen a Jewish patient in that hospital before, let alone a near-centenarian who survived World War II! He sure got their attention! Zaidy was the talk of the entire hospital, the entire town. And call it collective guilt or old-fashioned medical professionalism, they saved his life.

After a week or so, Zaidy was transferred to a major hospital in Germany to further his recovery and receive physical therapy. He speaks German as well as Polish and though his speech may have been slurred, he could still communicate very well with the staff. Much to our tremendous relief, Zaidy got superb care there too.

Amazingly, although incontinent and unable to walk, our barely 110 pound Zaidy boarded a jet a few weeks later and made the transatlantic flight... ...back to the States and the American health care system. Taken to the ER immediately upon arrival, Kaiser Permanente relinquished him directly to a rehab facility in which he was allowed a maximum stay of 21 days or so. That is, as long as he was showing improvement. Otherwise, we were informed, he'd be discharged sooner.

The day after Zaidy's admission, I arrived to work bright and early for our monthly staff meeting. In addition to our clinic practice, we also visit 60 facilities throughout the city. I looked around the table. I think there were 9 or 10 doctors and nurse practitioners that day. What did they think of this particular care center that Zaidy was in? "Was it good?, I asked, hopefully.

Dead silence. Nobody said a word. They all just starred at me.

Finally, Candy, one of the Nurse Practioners answered. "The truth is," she said, "you never want one of your family members to go to one of those places, if you can possibly avoid it, especially THAT one. But if you have to do it, remember, it's up to the family to make sure that the family member gets the care he needs. They need to be all over it!

Long story, short...in that rehab facility, my family became omnipresent!

And Zaidy got the care he needed. Excellent care, in fact.

And after 21 days or so, he went home back to his condo, albeit fragile and weak.

It was difficult. Lots of physical therapy. Lots of effort and determination on his part. It wasn't long however before Zaidy celebrated his 95th birthday. Soon he was walking again without a discernible limp and cooking in the kitchen. He renewed his driver's license. He was playing golf again.

And just recently, with some amazing tutelage from his eldest grandson, Zaidy started using a computer again. He signed up for high-speed Internet and registered an email address. Now we can hardly break him away from UTube where he watches his favorite Yiddish videos.

What a guy. Yasher Koach, Zaidy!

Health Care as a Commodity

National Public Radio (NPR) is featuring a series on health care systems around the world. Today's segment, which I listen to as I drive home from work, is about how health care is rationed in Britain in order to afford universal coverage. The interviewee, Sir Michael Rawlins, Chairman of the National Institute for Health and Clinical Excellence comments,

"And we, in Britain, as in most of Europe, actually, have a health care system, based on a principle of social solidarity, that we look after each other in times when we’re sick. And that’s very precious to us. And I think that’s what we find so difficult to understand about your health care system (in
America). You don’t have that."

I agree.

Why don't we have a system of social solidarity? Why don't we look after each other more when we're sick? And why isn't this precious to American society?

Is it greed?

Is it because we treat health care as a commodity?

If you've got deep pockets, you can buy some. If not...well...too bad for you and your children. Do without. Sorry.

Well, the difference is we're not talking about buying a new car here. We are talking about access to a quality service that has the potential of preserving life!

Does my life have a price point? What is it?

I personally struggle with the reality that throughout much of human history, human life has been regarded as cheap. Even expendable. In fact, even today, in many parts of the world, it still is. Somehow though, post-World War II, I thought our country was different. This is the United States of America, by God! I grew up with the Declaration of Independence etched in my brain:

"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness."

Life? Could that be construed to suggest that we are entitled to the security of knowing we have access to life-preserving health care if we need it? Is health care an unalienable right endowed by our Creator that our government assures us?

Hubert H. Humphrey once defined the moral test of a government as:

"how that government treats those who are in the dawn of life- the children, those who are in the twilight of life-the elderly, those who are in the shadows of life-the sick, handicapped, and the needy. "

Who are the needy?

With the way our health care system is sucking the life blood out of the working family with its crushingly high premiums, 5-figure deductibles and $100+ medications, the needy is now the middle class...the heart of American society.

Today that heart is broken.

Today would our government pass Hubert Humphrey's moral test?

How our Health Care System Fosters Stress, Anxiety & Depression

Two word: Medical Bills.

There's nothing like coming home from the hospital and finding a fistful of medical bills waiting for you. From the doctors, the hospital, the health insurance companies, and all kinds of people and places you don't even recognize. There's nothing like the sight of those anxiety provoking medical bills to trigger your adrenal glands to shoot out cortisol, for your palms to get sweaty, for your heart rate and blood pressure to skyrocket, for your struggling immune system to plunge, and for your recovery to come to a screeching halt. Just in case you weren't really sick when you went into the hospital, you can be sure that you're really sick now, confused by the cold, callous bills that keep appearing in the mailbox that require intense concentration to make any sense, if that's even possible, and imply that you're going to have to take a third mortgage on your home to pay for. The experience is so overwhelming that by the time you see your doctor for a follow-up visit, she wants to prescribe Zoloft for depression to help you cope with the punishing experience of recovering, not from your illness, but from wading through the incessant stream of paperwork that requires so much of your time and energy when you should be resting and regaining your health. If there's one positive thing to say about Kaiser Permanente, they don't put their patients through this torture.

Remember Michael Moore's movie, SICKO? Whether or not you believe the health care systems in England and France are inferior or superior to ours, or that Michael Moore is a jerk, let's be honest. There he is in an English hospital at the cashier window and he's told the only financial concerns discharged patients have when they leave the hospital is to make sure they stop by and receive their parking money. No bills then and no bills when they get home. Huh? But the scene that REALLY gets my attention is the young man in France who has been discharged from the hospital with doctor's orders to take 6 weeks and rest to fully recover (on the beach, no less) before returning to work. (Is this for real?!) None of this American stupidity of returning to work while you're still recovering for fear of losing your health insurance! That is really sicko. Just last week, we saw a nurse practitioner in our office for free because she had been laid off when a hospital closed and couldn't afford the COBRA. She fell in her backyard, broke her arm and needed a letter that she was fit to return to work. She wasn't. The fracture was still fresh and not healing optimally. She should have had surgery. The woman couldn't pay her rent. We wrote the letter anyway.

There are a myriad of reasons why our health care costs are so high. But in an insidious, twisted way, one reason is because our own health care system fosters not health, but illness. Stress isn't just a state of mind. It effects the entire body, particularly our digestive and immune systems, cardiac function, brain chemistry, and hormone balance. Everything goes haywire when we're stressed. With rising gas prices and worries about global warming and national security, can't we just have some peace of mind when it comes to health care? Is it so much to ask for a system that we can count on when we're ill and need to be cared for? A system we can trust in and be proud of? A system that doesn't constantly threaten us with personal bankruptcy?

We spend billions of dollars on expensive drugs, invasive surgeries and hospital stays, but we fool ourselves into believing that many are anything more than temporary panaceas to treat physical illnesses brought on by chronic emotional stress. Imagine a health care system structured to minimize stress, anxiety, and promote mental health.

Health insurance providers need to focus their efforts on absolutely minimizing the crushing stress they create for the average consumer. This shift would go a long way in minimizing illness and improving the overall health of our citizens. The positive impact this could have on the well-being of our nation would be incredible.

No doubt about it.

Medicarelessness

Today our R.N., who cares for all our patients as if they're her own family members, reached into her purse and handed me her personal VISA card. Out of frustration, she decided to pay for a patient's Plavix because he's run out of pills and he's run out of money...and Medicare won't pay for his meds now. Remember that darn Medicare doughnut hole? The one you sink or swim in when you've spent x-amount of dollars on medications in a given year? When it's your time to swim in the doughnut hole, you have to pay 100% out-of-pocket for awhile. Otherwise, you sink.

Sammy, who has been a patient of ours for 30 years, is in his 60's. He lives with his mom, Gladdy, who is in her 90's. She keeps calling us crying because she can't find a way to pay for Sammy's pills. Safeway Pharmacy already called us that he owes them $400. Who knew Safeway took pity on poor people and allowed them some slack paying for their meds. Sammy is out of slack. The R.N. is desperate to find him some medication. She calls his cardiologist and begs for samples. (They’re rationing.) They reluctantly allow one week's worth. They, in turn, promise to apply for Plavix assistance through the generous folks at Bristol Myers. I agree to try to apply for emergency assistance from Medicare...on Monday.

I take the R.N.'s VISA card and click on the link to my favorite Canadian pharmacy and order 3 months worth of Clopidogrel, generic Plavix, which isn't even available in the United States. It's $77.00. In the U.S., the brand name stuff would have cost Sammy about $270. Eventually, the medical practice will end up reimbursing the R.N. and paying for Sammy's Clopidogrel because we don't want him to die.

Lately, we've been paying for some patient lab tests and not charging the health care workers who come in to see us because they work hard and take care of our patients in the nursing homes. Most of them are overworked, underpaid, and underinsured. So, we try to take care of them when they ask, so they are healthy enough to take care of our Medicare and Medicaid patients who reside in those pathetic warehouses that you never want to send your family member to if you can possibly avoid it.

Anyhow, Sammy needs more than Plavix. His mother needs her medications too.

There are a lot of Sammy's and Gladdy's now. Many are just not getting their medications...and ending up in the E.R., where they get meds for a while and recover, which Medicare will pay for. Then they're discharged.

Once back home, some still won't have found a way to pay for their medications and will just sink down into the doughnut hole...never to come up.

MediCARE? or Medicarelessness?

A Taste of My Own Medicine

We see primarily Medicare and Medicaid patients in our private medical clinic....mostly the patients the other doctors don't want to see anymore because the reimbursements keep dropping. I get calls all the time from sick people telling me their doctors are dumping them because they are on Medicare. As far as the Medicaid patients, most were already dumped a long time ago. "Are we accepting new patients?" they ask hopefully. And when I say "yes we are", I can hear the familiar sigh of relief through the phone. But, this is a topic for another blog entry.

Today I am the patient. I have been sick for 2 weeks with a progressively worsening sinusitis. Never mind the stressors in my life that have compromised my immune system and allowed me to become ill from all the infectious bacteria on the doorknobs and elevator buttons I have touched. Those stressors are also topics for another blog as well.

Today I desperately need an antibiotic to treat the infection in my body that my own white blood cells are struggling with. And...drum roll, please....that antibiotic of choice, after much conversation with the R.N., the N.P., the M.D., and the Pharm.D. is..Levaquin! Okay! The script is called into our pharmacy. I retreat to my office and place a few phone calls with my raspy voice that disguises who I am and then race downstairs to pick up my prescription. The cost? Why, it's a mere $148! And that's AFTER the newly implemented Anthem Blue Cross plan health savings account discount (The medical practice recently switched from Humana when we received notice that our monthly premiums were being increased; mine to $1,600). Sticker shock ensues. Suddenly I feel sicker than I already felt...and that was sick enough. Let me sit down please in one of your two chairs facing Suze Orman on Oprah.

One hundred and forty eight dollars for the 7 white pills which will eliminate the thick green snot, the coughing, the sneezing, and restore my sense of smell and taste. Okay, I get it now. The insurance company wants to discourage me from buying medication to treat my illness. Their plan is working. Next time I get sick like this, I may be disincentivized from getting treatment. After all, my premium only costs $1,000/mo for my husband, son, and me with a $10,000 annual deductible. Isn't that great? We only have to pay the first 10 grand (including medication costs), plus our annual premium of 12 grand and THEN any further expenses are covered 100%. I’m still paying off medical bills from 2007 that the insurance didn’t cover.

Who can afford this? I can't. If the doctors who I work for didn't pitch in a little to cover the costs, I know firsthand what the consequences could be. Tragedy.

And that is also a topic I will expound upon in another blog.