Yes, Deer...

No, I didn't spell that incorrectly.  More later.

How was your week?  I ask because mine was a real doozy.

So it's Thursday night and I'm waiting for the wife to pick me up from work.  I leave at four.  Round about four thirty, I called her, wondering where she was.  Round about five, she returned the call, apologizing profusely for falling asleep and telling me she was on her way.

Closing in on six, I got another call: she had hit a rock and gotten a flat.  Triple-A was forty five minutes away, so she'd be really late.

An hour later, guess what?  Yet another call.  Triple-A hadn't exactly appeared yet, although she had been on the phone with them for a while, attempting to give directions to the apparently direction-impaired soul driving the truck.

I don't know about you but I'd think that a national auto rescue corporation would have something of a sense of direction or at least a GPS.  Old school maps, maybe?

But no.

Another hour later, another call.  This time she called Triple-A and was told the direction-impaired driver terminated the request, which was her prerogative.  Unfortunately, nobody bothered to tell my wife; neither Sparky the driver nor the dispatcher.  This caused the entire process to start again.

You'd think a national auto rescue agency would have more than one driver in a large metropolitan area.  Still, it would be up to another hour.

Meanwhile at work, it's getting pretty bleak.  The entire crew has left for the day and I'm holding down the fort.  If I were the easily shakeable sort, I'd be terrified.  Instead I was bored.  Horribly bored.  So bored that I had to resort to doing my own work.  And maybe watching a little South Park.

The next wifely call revealed that the battery was dead.  Why?  Because Sparky the Direction-Impaired driver told my wife to leave the headlights on so she could be located easier.  Meanwhile the occupant of the house in front of which my wife was broken down, wandered over to inquire what she was doing parked across her driveway.  Once explained, she was terribly accommodating, offering food and a rest room, just in case.

Eventually a second driver showed up and had the car running in no time.  He was polite, had no trouble finding her at all and really wanted to assist her.

Closing in on ten pm, I was rescued from work.


FRIDAY

My wife said she'd be at Pep Boys first thing in the morning, bless her, to get the bad tire replaced (we had a warranty).  I took the opportunity to sleep late.

Unfortunately so did my wife. Or rather, her alarm slept late.

Off I went to Pep Boys, in a flurry of loving epithets and general four-letter verbal exercises.  Pep Boys, to their credit, jumped right on matters.

I somehow managed to VPN into work, thus becoming the first member of my department ever to work from Pep Boys.

Hours later, I had my replaced tire.  Too many hours, in fact, to efficiently return to work, so I went home.

While home, my wife informed me she couldn't find her credit cards.

Yes, the Tire Incident had morphed into a Missing Credit Card incident. [I am not blaming any organization or person, other than perhaps my wife for not having had them stapled to her forehead].

I had a doctor's appointment at seven.  Something looked odd about the car.  Of course something looked odd - I had a flat.  Yes, another flat - this time on a different tire.

Cursing Pep Boys and the Universe in general, I tore through the trunk, looking for our poor excuse for a spare and the tools necessary to change it.   Naturally the tire was in plain sight but the tools had entered the fifth dimension, which is located either at the very bottom of a car's trunk or the very bottom of a woman's pocketboot.

Continuing to curse, I somehow managed to change the tire with enough time to get to the doctor's.
While there, I inquired whether he had gotten a referral from my primary.

Oops.

Didn't he talk to me about this?  He just went cash-only.  No insurance.

Oh.

Well, that was awkward.
And wasn't his fee exactly the amount of money I had for the week?

Meanwhile, my wife had taken the entire day off and was spending it snoring on the couch.  As she had given up sleep for lent forty years ago, I left her alone.

SATURDAY

Back among the living, the wife took care of her missing credit cards and license, then went back, again, to Pep Boys.  Pep Boys fixed the issue with haste.

I don't know what they did to my car but it tends to veer toward Pep Boys whenever it sees one.

SUNDAY

After a day of rest, we were off to visit friends.

SMASH - out of the supermarket, we were almost hit.
BLORP - fifteen minutes later we narrowly avoided hitting yet another kamikaze deer.


Go ahead - tell me it's not personal.

Hospitals are Bad for Your Health

My nephew had a spot of bad luck lately.  While riding his cycle, he attempted to take out some lady's windshield with his body.  He succeeded and the results were most unattractive.  Fortunately he's alive and not at all hideously disfigured.  He was taken to the local trauma center for the county, where they have taken great care of him.  If he ever wonders how people feel about him, he needs only to discover the flood of people in the waiting room the night of the accident.  Even the hospital employees were impressed.

Mrs. leftystrat went to visit her nephew the other day and liked the place so much, she decided to stay a while.  Somebody noticed her getting wobbly and they gave her a free ride to the emergency room.  Two event-filled days later, she was discharged with no idea what happened.  The doctors were clueless and the discharge summary was riddled with errors and inconsistencies.

This was the same hospital.

We have a genuine healthcare crisis- this is no secret.  It's badly broken and waiting for collapse.  Meanwhile we pay and pay (recurring theme, regardless of industry).  I have some suggestions for hospitals, doctors, and patients to make things more efficient, hopefully resulting in less cost.


HOSPITALS / DOCTORS

• Talk to the patient.  Explain things concisely.  Be sure they understand.  Don't talk down.
• When you transfer a patient, WRITE THINGS DOWN.  COMMUNICATE.  The new unit will then know what happened and can treat the patient accordingly.
• Don't be an ass - the situation is tough enough already.
• Don't give canned/useless answers.  The patient is (hopefully) not an idiot.
• "What's the matter?" is not a confidence-inspiring question to ask family.
• When you are told the information is in the chart, don't tell the patient it isn't or you don't have it.
• Outside doctors prescribed meds for the patient: you should dispense them.  If you have a problem, contact the prescribing doctor - don't ignore the situation.
• Every action should not involve six hours of waiting for a doctor or paperwork.

PATIENTS

• Question everything.
• If you are not satisfied with an answer, ask again until you are.
• If the person you ask can't provide an answer, ask for someone who can.
• Hold staff to promises or deadlines.
• Question everything.
• Follow up.  If you didn't get the test results, make a call.
• If you aren't able, have a spouse, friend or family member act as your advocate.
• Keep all of your vital information up to date for you and your advocate.
• Question everything.

Things have changed drastically over the years.  People used to consider doctors infallible and unquestionable.  That might have worked before HMOs but now it's a recipe for bad health.  Many doctors and staff are horribly overworked and might miss something important.  Your health is YOUR responsibility - ignore it at your own peril.

If you are a passive patient, things will just happen to you.  You could stay in the hospital days longer than necessary.  Your care may be substandard.  You may receive unwanted, painful procedures that aren't necessary.  You may get the wrong meds or insufficient meds.  Know your meds and all important information.  Write it down. 

Example: My wife spent a day at the mercy of the hospital, largely getting nowhere.  The following day she started asking questions and taking down names.  The care improved exponentially and she was discharged by noon.  Even the head nurse complimented her on her ability to advocate for herself and make things happen.  Things happened for her on her schedule, not the doctors'.  This was all because she acted, even though great care should be standard.

Do you want to be a passive patient or do you want good healthcare?

Pain Meds - Let's Pass the Blame

I have watched the healthcare system go downhill for quite a number of years.  While there is no shortage of reasons for this, one of the larger ones is insurance.  I say this because we have still managed to get a certain level of care - it's just that insurance makes it so much more difficult.

When the HMOs started, all we heard was how efficient and inexpensive they were.  They promised us the moon: they delivered some sort of irradiated space rock.  They promised to lower overall healthcare costs: instead they climb like a Saturn 5 rocket.  First I suggest we hold the people who made the promises responsible.  Let them pay anything above reasonable from the date of the start of their HMO.

Next up is the prescription pain medication debacle.  My mother-in-law has been denied medication simply because the insurer refuses to pay for it.  Apparently this is perfectly ok.  My wife suffers chronic pain and used to take Oxycontin.  She had a lot of trouble getting it because people would abuse it and the pharmacies would look at her like a criminal and say they refuse to carry Oxycontin.  I say there's no problem: let the junkies kill themselves on it but allow the people who need it for pain management to have it.  This is not so much an insurance problem as a federal issue.

Fortunately for her, my wife no longer takes opioid-based medicine.  However, the insurance companies manage to screw this up anyway in terms of approvals.  Certain medicines require approval, as if the word of your prescribing doctor isn't enough.  Doctors have to jump through hoops to get the correct meds for some of their patients (pain and otherwise).  This requires additional staff in some practices.  Guess what this does to the cost of medicine in general?

As if this weren't enough fun by itself, the insurer reserves the right to review whether they will cover the prescription every year or so.  And of course, that time came upon us last week.  The time when the insurer has to decide if they'll cover the pain prescription that has been in-place for two years.  It would seem fairly obvious, but there we are.

The determination tends to come as a surprise.  The prescription is called into the pharmacy and my wife has to call the pharmacy to see if it's in yet.  This time it wasn't, because a review was required.  Now she has to contact the doctor to make sure he is on the ball, answering the review questions.  Once this is done, it can be up to forty eight hours before the determination is made.  That's forty eight hours without pain medication.  Since this debacle began close to Friday, we have to allow another forty eight hours because the prescription company doesn't work on weekends (although people have pain on weekends).

But wait - it gets better.  The prescription was dropped at the pharmacy early in the week.  When the prescription company was called, at first they said it was in process.  Then they said it wasn't.  Then they said it only got called in on Friday from the pharmacy.  That's certainly a lot of different answers.

The pharmacy was sorry.  Yes, sorry.  No pain meds for the weekend, but they're sorry.

Monday morning the prescription company says the doctor never called them back.  But the doctor wasn't supposed to call them back.  The prescription company screwed up and thought the meds were given for a different reason.  They're sorry too.

A few hours later, the pharmacy company said the doctor sent the wrong form and was going to have to send another one.  It would be another forty eight hours.  When my wife explained that this was not acceptable, they said they'd mark it urgent so it would only take twenty four hours.

Day Five with no pain meds.

I should mention at this point that if the doctor had put in a new prescription, the insurer would approve a small amount of pills until the review was completed.  Because this is an existing prescription, nothing doing.

I went to my company's benefit folks and told them to DO SOMETHING, please.

If I were less civilized, mayhem would ensue.  It may still.


Now tell me insurance isn't a problem.
When the bean counters are allowed to dictate coverage (HMO anyone), this is what happens.  The ObamaChrist is not our friend.

It's a Gallbladder!

Yes, at approximately 12:35pm today, my wife gave birth to a gallbladder.  Mother is sore but well, father is much better because he didn't have to watch.

Everybody was really surprised, as the entire routine took about four hours, house to house.  Apparently this type of thing used to require an overnight stay and a lot of grief.

Having worked in the field, I don't like doctors and I like hospitals less.  But I have to say that the experience was not bad, all things considered.  The hospital ran like a well-oiled machine, the surgeon was on time and visited me immediately after, and the staff was competent and really personable.

For those of you familiar with gallbladders, this was apparently an interesting case.  Initial symptoms looked a lot more like gastritis than gallbladder.  The diagnosis was a bit of a surprise but we trust the diagnostician.  The tests barely showed anything wrong.  The surgeon said he only operated because of the family history.  He was shocked to find the bladder was bogged, whatever that means.  Apparently it was much worse than any of the indicators.  He said the timing was right because it might have burst in the next two weeks.

We'll take those odds.

Once again we had a reminder that you have to be up on your condition and your meds before and after the procedure.  In spite of getting about five doctors together on pain meds, the staff still questioned my wife about the meds.  She actually brings a list of her meds with reason, dose, and prescribing doctor noted in case there are any questions.  In spite of this, they still tried to give her narcotics for pain (her pain meds are non-narcotic).

In short, don't go along for the medical ride.  Question everything and go no further until you're satisfied with the answers.  The life you save may be your own.

==========================

You know for a fact that absolutely no outing could possibly proceed without grief (hence this blog), so allow me to let loose.....

Since when do you need to show up at the hospital with two hundred dollars before you have a procedure?  Answer: since we got HMOs and since my coworkers are apparently crack addicts.

Follow this logic (if you can):  too many people were using emergency rooms as their primary care, so the insurance slapped on a fifty dollar fee for using the emergency room; waived if you got admitted.  Then it went to one hundred dollars.  I get the point- you were being penalized for using the emergency room.

I recently discovered that if admitted, there is now a five hundred dollar fee!  So now we're being penalized for being admitted, as opposed to being penalized for just appearing in the emergency room.  

When I complained to my benefits people about the fees, they told me those fees got raised so they didn't have to raise other fees.

And that helps me how?

============================

So I'm minding my own business in the waiting room, which is an impressive feat.  Today was especially cold, perhaps out of spite.  The hospital doors opened right into the waiting room, dumping large amounts of arctic air into the area.  

There was a very large flat-screen television mounted in the corner of the room.  You could see it from outside.  But even if you couldn't see it, you could hear it.  There was no apparent way to turn down the thunderous aural assault.  To make matters worse, there was no apparent way to change the damn channel either.

I cannot afford a flat-screen television that large.  Strangely enough, I cannot afford two hundred dollars copay for the procedure either, yet there I sat, traumatized by both.

There were several signs on the wall that I truly appreciated.  They told everyone to be courteous to your neighbors by not talking loudly, especially on cell phones.

Personally I thought it was a violation of the Geneva Convention to force anyone in a confined area to watch The View.   Perhaps this hospital never got the memo.  Next up, possibly to rhyme, possibly just to annoy, came The Chew.

I know this in spite of never having looked at the screen.  I was trying to check email and amuse myself in other ways.

It was at about this point that I got company in the waiting room.  There was one fellow closer to the television but by the look on his face, I think he was incoherent long before he sat down.  To my right was the television, to my left were two yentas.  Yenta is a Yiddish word meaning chatterbox or ratchetjaw.  So here were the perfect pair of negative Jewish stereotypes for my amusement.

But amusement is not really accurate.  Nor bemusement.  Perhaps something a bit closer to Two Hour Trip to Hell.  When I die, I figure I'm going south anyway.  If it's every bit as bad as its press indicates, hell will be eternity at Chuck E. Cheese's.

You have to understand my plight... thunderous bad tv on my right and two loud yentas to my left.  There was simply nowhere to go.  The phrase stereo assholes most accurately depicts my dilemma.

The Chew is apparently some sort of cooking show.  I would place it squarely in the Annoying Cooking Show category in spite of not watching many cooking shows.  Suffice it to say Jacques Pepin it wasn't.   What made the show more intolerable was the color commentary from the yentas....

tv:  ...we start with olive oil

yenta #1:  ooh, I don't use olive oil.

yenta #2: yeah, it's too expensive.

yenta #1: right.

I'm still trying to read something on my phone.  

tv:  we'll be right back.

yenta #1:  there are too many commercials

yenta #2:  yes there are

yenta #1:  I wish they wouldn't have so many commercials

Now I'm trying to read a book.  And failing.

yenta #1:  where do we check the status?

yenta #2:  I don't know - go to the desk.

yenta #1:  there's nobody there

yenta #2:  isn't that just perfect.  Nobody's home.

yenta #1:  there should be somebody there

yenta #2:  yes there should.  They're absolutely horrible.

yenta #1:  horrible.

I'm reading the signs up on the wall, which state to be courteous to your neighbors by not talking loudly, especially on cell phones.  I was thinking of repeatedly pointing to the signs but I had no way of knowing if either of them could read.  And by this point the other guy was looking even more glazed over than before.  I'm not positive but I think he killed himself rather than having to listen to the yentas for another minute.

And I felt a sudden pang of jealousy.

yenta #1:  oh my God, it was eight minutes.

yenta #2:  eight minutes?

yenta #1:  eight minutes before they went to commercial!  I timed it.

yenta #2:  so you need to pick up his prescription?

yenta #1:  yes, on the way home.

yenta #2:  [groan] how long will it take?  

yenta #1:  i don't know.

yenta #2:  you know you can't just take a prescription in and expect it to be filled on the spot.  It doesn't work like that.

I noticed I was reading the same paragraph over and over again.

yenta #2:  is he done yet?

yenta #1:  wait, let me look at the board... it says he's in ABC1.

yenta #2:  what does that mean?

yenta #1:  wait, let me look again.  Maybe he goes to ABC2 after.

yenta #2:  go find someone and ask.  Sheesh.

yenta #1:  there's nobody there.

yenta #2:  still?  This is terrible.  You'd think it was their job!

And if I shoot them, I will be the bad guy.

yenta #1:  it's very cold out.

yenta #2:  yeah, well, they shouldn't put the door so close.  Am I taking you to the pharmacy?  Maybe you can tell them it's an emergency for the sick patient in the car.  Because if I have to wait, you're walking home.  They should have told you this up front.

yenta #1:  they did tell me.  They gave me prescriptions.  Oh no - another commercial.  I forgot to time it this time.  So many commercials.

Some argue religion.  Some argue supreme beings or deities.  I am here to tell you that angels exist, ladies and gentlemen.  I saw my first one today.  Yes, she was dressed in scrubs so you couldn't see her wings but she was an angel all the same.  She stepped into the waiting room and asked if the yentas were there to pick up Steve.  The yentas said yes and stood.  It was at this precise moment that I could see her halo and golden light filled the room as the yentas prepared to get the )$*# out of my waiting room.

It saddens me that I shall never again see a sight as beautiful.

At that point, all I had to do was wait.  And listen to soap operas in my right ear.

Obligatory Yet Timely Mental Healthcare Rant [with update]

Mental healthcare has never been good in this country.  The HMOs effectively drove the final nail into its coffin.  There was a time when someone with mental issues would go to the Happy Place<tm> and stay there for a month or so, until some progress was made.  This was so long ago I only hear stories about it.

The reality of the situation is that mental healthcare has deteriorated into mere warehousing for people with ideas about hurting themselves or others.  And believe me when I tell you this: I have inadvertently become an expert in matters of mental healthcare.  Oddly enough this isn't even my field.  Although I find psychology fascinating, I come by this knowledge via my wife, whose main diagnosis is Dissociative Identity Disorder (formerly Multiple Personality Disorder).

One cannot get admitted to a mental facility unless there is suicidal ideation with a definite plan.  Otherwise the insurance will not pre-certify the inpatient stay (assuming, of course, there is insurance).  In the absence of insurance, the locality can provide coverage for the stay via Medicaid for the most part.

It's been about ten years since my wife saw the inside of a facility.   We both hoped that phase was long over.  Unfortunately it became necessary again recently.  The experience is even more alarming this time out.

Yes, there is bound to be change in ten years - one would hope for the better.  But not this time.  The intake was flawless, I have to give them that.    After that, things seemed to head downhill fairly rapidly, with small upward bumps.

There are a few places in the U.S. with Dissociative Disorders Units (DDUs) but none of them are closer than a few hours and insurance is a little picky about this.  As a result, it was back to the place from ten years ago.

As the HMOs were pounding the final nails into mental healthcare, the facilities became warehouses for the patients.  They were kept until they no longer felt like doing harm to themselves or others.  I am not making this up.  And heaven help the person who gets admitted on a Friday, as nothing happens on the weekends.  Nothing.

The intake people were nice enough to give me the name of the unit and information about visiting.  I felt good about this right up until I showed up for visiting hours.  Each of the signs for the unit said something different, some directly contradicting each other.  Every door I went through led me to a unit that did not have my wife.  One person told me she wasn't on the unit and turned away.  Fortunately a nice person made a call to find out where I had to go.

As it turned out, she wasn't on the unit I was told about.  At one point I swore that the next time I heard the word no, I would wind up being involuntarily committed.  Because of the incorrect unit and touring the entire campus, total visiting time was about thirty minutes.

While I do not expect every hospital to have a Dissociative Disorders Unit, my wife didn't expect to be the only clean person on a drug addiction unit.   Here's a fascinating little tidbit: drug and alcohol addiction seems to qualify for longer stays than most other disorders, mostly without insurance.  There does not appear to be a requirement for suicidal ideation either.

Here are a few small notes and issues:

• patient hears staff mocking the contents of wallet and pocketbook
• Most staff with MD after their name are arrogant, rude, and dismissive
• Psychiatrist says the meds that have been working for years are wrong and some can't possibly work.  Tries to change to one med that causes zombification.
• Psychiatrist, upon hearing diagnosis, asks if any of the alters are going to be a problem
• personal effects dropped off at 8am didn't appear till dinner
• some patients will wait days to see a social worker
• family and friends are having difficulty locating the patients

Don't get me wrong - many of the people who are not doctors were quite polite, helpful, and informative.  I even observed a staff member talking to patients like actual humans.  But all of the above does not engender a warm feeling about this institution and the competence of its arrogant professionals.  Will they keep the majority of patients from committing harm?  Probably.  Will much more happen?  Probably not.

I will suggest one small improvement to the system: mandate weekend work, so the facility can do some good, as opposed to warehousing.

I truly hope to not type another word about this.



-----------------------------------------------------

But alas, here I am.




I went to visit my wife today.  We discovered the reason why she was on the detox ward: because the shrink refused to prescribe her pain meds for her and knew she was going to go into detox.

Apparently this crowd took the hypocritical oath instead.

For anyone keeping score, here we are:  a patient comes to the hospital, the shrink refuses to prescribe meds that the patient has taken for years and throws her into detox from her legitimately prescribed medication. At no point does anybody check with the prescribing physicians.

On top of this, the patient has gotten absolutely no help for her actual admitting issue.  Literally nothing.  She was more than welcome to go to the AA meetings, though.  The place was a warehouse.  There was no therapy or much of anything else happening.  The most exciting moments of the day for the patients were the smoke breaks.  Even the non-smokers went because it was something to do.  This was not a healthy or healing environment.

I checked in with my wife to make sure she was ok (she was).  We asked again for pain meds and got the same runaround.  We signed her out and I'm typing this from my favorite chair.  My wife, meanwhile, is resting and dealing with all the symptoms of detox caused by the hospital.

I am not a lawyer but this smells like the definition of malpractice to me.   Someone needs to put this hospital and its insecure shrinks in line for the good of the patients.  The constant refrain was that the unit staff was great but the doctors were from hell.

We have long semi-joked that hospitals are the greatest deterrents against going into the hospital.   This really drove the point home.