Friday, December 30, 2016
Thursday, December 29, 2016
December 29 Birthday
Dorothy Evelyn Rita Madigan
December 29, 1939 June 1, 2011
I remember both days, each day incomprehensible, the first unable to understand, the second, not wanting to.
"The winter of our discontent
Will smother the trees and flowers,
But amidst the ice and biting frost,
May reveal our finest of hours.
Only in darkness does light exist;
Only in love will our lives be missed."
---Anon, DSS c.1991
December 29, 1939 June 1, 2011
I remember both days, each day incomprehensible, the first unable to understand, the second, not wanting to.
"The winter of our discontent
Will smother the trees and flowers,
But amidst the ice and biting frost,
May reveal our finest of hours.
Only in darkness does light exist;
Only in love will our lives be missed."
---Anon, DSS c.1991
Friday, November 11, 2016
Thursday, November 10, 2016
Wednesday, November 9, 2016
Wednesday, November 2, 2016
The O.T. or How would you answer the question. Update 7-10-2020
Granted, I don't think I've ever encountered an Occupational Therapist before, and definitely not in a professional capacity. Plenty of Physical Therapists though, and I'm aware there is a distinction between the services they provide. Even so, I was not expecting the question the therapist posed, nor was I prepared for the answer it evoked.
Addressing the patient, he asked, "What would you consider a good day?" Almost without hesitation, the response was, "Yesterday my daughter and her 2 boys picked me up and we drove over to a fish fry place for lunch, and then we stopped at my brother's house. She and the kids helped me up the steps and I sat and enjoyed a talk with him for a while."
I don't know why this seemed so significant at the time, or why it still does, or for that matter why I'm writing this through tears, maybe effects of the CMA. I asked an old friend this question tonight and she replied, "To be in Paris without fear of terrorists."
I contemplate how I would answer this question. The odds of my ever being asked are infinitesimal, not being likely to ever receive this type of therapy and even less likely that any other therapist would ask that question. Still my mind attempts an answer: Is the good day one that's already passed, or one that's yet to come, is the day to be one that may be possible, or is it a day of fantasy and dreams. My mind is essentially empty now, blocked by the unwanted answer to an impossible question, and struggles to leap over that chasm to an answer, any answer. For now, the two choices are the same: the reality scenario is just as much a fantasy as the other. I decide my idea of a good day would to be able to decide how to answer, and to pretend there was the possibility that one could happen.
Addressing the patient, he asked, "What would you consider a good day?" Almost without hesitation, the response was, "Yesterday my daughter and her 2 boys picked me up and we drove over to a fish fry place for lunch, and then we stopped at my brother's house. She and the kids helped me up the steps and I sat and enjoyed a talk with him for a while."
I don't know why this seemed so significant at the time, or why it still does, or for that matter why I'm writing this through tears, maybe effects of the CMA. I asked an old friend this question tonight and she replied, "To be in Paris without fear of terrorists."
I contemplate how I would answer this question. The odds of my ever being asked are infinitesimal, not being likely to ever receive this type of therapy and even less likely that any other therapist would ask that question. Still my mind attempts an answer: Is the good day one that's already passed, or one that's yet to come, is the day to be one that may be possible, or is it a day of fantasy and dreams. My mind is essentially empty now, blocked by the unwanted answer to an impossible question, and struggles to leap over that chasm to an answer, any answer. For now, the two choices are the same: the reality scenario is just as much a fantasy as the other. I decide my idea of a good day would to be able to decide how to answer, and to pretend there was the possibility that one could happen.
When to Call It Quits
I don't have enough Kleenex in the house to watch much more of the Country Music Awards, So I thought I'd turn to my faithful old blog, but I'm afraid the mood has been set.
During the course of my lifetime, I've heard many people speculate about at what point they would no longer wish to live. A child I once worked with said he could not imagine a life without Reese's Peanut Butter Cups, and I recall Barbara Walters responding to that very question by answering that it would be when her friends were all gone.
Offerings of a variety of other reasons why life would not be worth living could fill a lot of pages: I've heard many, and if I were to comment on their validity, could say that over the years, people do change their minds. The majority of people in their twenties probably look upon a life without sexual fulfillment as a life unlived, but as time exacts its inevitable toll, that deprivation becomes---meh. Suicides excepted, of the too many deathbeds I've been next to, the person struggles for every last breath of life, regardless of what they might have once thought they couldn't have lived without.
The thought occurred to me today as I sat in an office, waiting. I can do a crossword puzzle while I wait, or a Word Jumble, but I think if I ever reach the point where I carry a little book of Word Search puzzles, the time has come.
During the course of my lifetime, I've heard many people speculate about at what point they would no longer wish to live. A child I once worked with said he could not imagine a life without Reese's Peanut Butter Cups, and I recall Barbara Walters responding to that very question by answering that it would be when her friends were all gone.
Offerings of a variety of other reasons why life would not be worth living could fill a lot of pages: I've heard many, and if I were to comment on their validity, could say that over the years, people do change their minds. The majority of people in their twenties probably look upon a life without sexual fulfillment as a life unlived, but as time exacts its inevitable toll, that deprivation becomes---meh. Suicides excepted, of the too many deathbeds I've been next to, the person struggles for every last breath of life, regardless of what they might have once thought they couldn't have lived without.
The thought occurred to me today as I sat in an office, waiting. I can do a crossword puzzle while I wait, or a Word Jumble, but I think if I ever reach the point where I carry a little book of Word Search puzzles, the time has come.
Wednesday, October 19, 2016
Fear and Loathing
Sometimes, what you think is the right thing to do, or else the only thing you are capable of doing, makes you hate yourself.
Tuesday, October 18, 2016
The Dying Room
She was in her 95th year and, against her wishes, found herself in the hospital, its saving grace, in her eyes, was that it was a Catholic hospital. The cardiologist on call said, based on their testing, that she would be a candidate for a pacemaker, for her irregular heartbeat. But what about her kidney function was the other concern. He quickly responded that would indeed be a consideration, but not in his area. So the pacemaker was not installed.
I think it was a Tuesday she was convinced to go to the hospital, which she reluctantly agreed to, with the condition she'd be checked out and could be home by Friday.
Her condition did not improve after her diagnoses, such as they were. She'd been on an IV, one which included a morphine drip, though she had not complained of pain, only extreme weakness. I remember a nurse asking her what level of pain, and though she answered in the negative, the nurse administered more morphine. This was over 20 years ago, and we were relatively naive about the workings of hospitals, had no reason to question their treatment.
That became all too clear when, on the third day, they told us they would be moving her from the room in the ward she'd been in to another, this one in a rather secluded area, by the door. So she wouldn't be disturbed, they said.
There were 3 of us family members with her at the time of the move, and the room was small, so we had to make way for their bringing her into the new room. Two people stepped out into the hallway, but I was near the bathroom so I went in there to make way, apparently unnoticed. There were 2 staff members arranging her transfer from the transport bed to her new bed, which was near the wall and in front of the bathroom where I was waiting. The others were in the hall. The nurses, or I suppose aides, wheeled her over to the bed and just dumped her into the new bed, like a sack of vegetables, or trash. She, who was never one to complain, moaned at the shock and pain. I stepped out of the bathroom, horrified, and told them so. Their response was that the room was so small they had no choice.
So now she's in this small room, near the doorway, and the morphine drip has been increased. She is lucid, but weak. She still has some appetite, says she wants to eat but can't think of any food that would be agreeable, and requests a peanut butter sandwich from home. Her niece brushes out her long thick hair and pins it up for her. She hopes her nephew will give her dog a promised bath. I stay with her that night, on a sleeping bag brought from home. She has a tube in her nose, to help her breathe, she's told. The nurse tells me to call them if anything happens, and not to touch anything. I suddenly recall that when we first arrived, I had seen a stretcher with a covered figure being carried out of this very room. Clarification sets in: there is a reason for the location of this room, away from the others and near the doorway. The dying room.
Her breathing comes to an end that very night. I dutifully notify the nurses' station, after I removed the tube from her nose. It was Friday, and she was leaving the hospital.
I think it was a Tuesday she was convinced to go to the hospital, which she reluctantly agreed to, with the condition she'd be checked out and could be home by Friday.
Her condition did not improve after her diagnoses, such as they were. She'd been on an IV, one which included a morphine drip, though she had not complained of pain, only extreme weakness. I remember a nurse asking her what level of pain, and though she answered in the negative, the nurse administered more morphine. This was over 20 years ago, and we were relatively naive about the workings of hospitals, had no reason to question their treatment.
That became all too clear when, on the third day, they told us they would be moving her from the room in the ward she'd been in to another, this one in a rather secluded area, by the door. So she wouldn't be disturbed, they said.
There were 3 of us family members with her at the time of the move, and the room was small, so we had to make way for their bringing her into the new room. Two people stepped out into the hallway, but I was near the bathroom so I went in there to make way, apparently unnoticed. There were 2 staff members arranging her transfer from the transport bed to her new bed, which was near the wall and in front of the bathroom where I was waiting. The others were in the hall. The nurses, or I suppose aides, wheeled her over to the bed and just dumped her into the new bed, like a sack of vegetables, or trash. She, who was never one to complain, moaned at the shock and pain. I stepped out of the bathroom, horrified, and told them so. Their response was that the room was so small they had no choice.
So now she's in this small room, near the doorway, and the morphine drip has been increased. She is lucid, but weak. She still has some appetite, says she wants to eat but can't think of any food that would be agreeable, and requests a peanut butter sandwich from home. Her niece brushes out her long thick hair and pins it up for her. She hopes her nephew will give her dog a promised bath. I stay with her that night, on a sleeping bag brought from home. She has a tube in her nose, to help her breathe, she's told. The nurse tells me to call them if anything happens, and not to touch anything. I suddenly recall that when we first arrived, I had seen a stretcher with a covered figure being carried out of this very room. Clarification sets in: there is a reason for the location of this room, away from the others and near the doorway. The dying room.
Her breathing comes to an end that very night. I dutifully notify the nurses' station, after I removed the tube from her nose. It was Friday, and she was leaving the hospital.
Friday, September 2, 2016
Sunday, August 28, 2016
"You Brought It Up"
The doctor, a specialist, is so esteemed, erudite, and learned, therefore busy, that a prospective patient needs a physician's referral as a first step. Then the request for appointment is reviewed by a panel of nurses for consideration, and possible acceptance. Yes, exactly, a "panel of nurses."
The consult, finally granted, leads to his saying that, contrary to what you may think, the condition is not rare. The "condition" being diagnosed as a part of a vast spectrum. His mother has it, he states, has had it for a time. I ask how she is doing. "I don't like to talk about it," he says, "but I will if you want me to."
"Sorry," is all I say, but he goes on to talk about it anyway, some details about both his parents. He volunteers that if he himself were to seek assisted living, he would consider going to the Midwest, where the costs are much lower. He mentions Milwaukee, a beautiful city.
The next day we are in an attorney's office. She is preparing for her son's wedding in Syracuse. She will wear navy blue with silver accessories, though her favorite color is lavender, which would clash with the bridesmaid's dresses.
The last day of the week finds me in an accountant's office. I need a return appointment, but it will be delayed because his wife is to undergo eye surgery at Ellis Hospital.
This comprises my entire social interaction for the week, nay, the month, oh, OK, the entire year, to date.
The consult, finally granted, leads to his saying that, contrary to what you may think, the condition is not rare. The "condition" being diagnosed as a part of a vast spectrum. His mother has it, he states, has had it for a time. I ask how she is doing. "I don't like to talk about it," he says, "but I will if you want me to."
"Sorry," is all I say, but he goes on to talk about it anyway, some details about both his parents. He volunteers that if he himself were to seek assisted living, he would consider going to the Midwest, where the costs are much lower. He mentions Milwaukee, a beautiful city.
The next day we are in an attorney's office. She is preparing for her son's wedding in Syracuse. She will wear navy blue with silver accessories, though her favorite color is lavender, which would clash with the bridesmaid's dresses.
The last day of the week finds me in an accountant's office. I need a return appointment, but it will be delayed because his wife is to undergo eye surgery at Ellis Hospital.
This comprises my entire social interaction for the week, nay, the month, oh, OK, the entire year, to date.
Friday, August 26, 2016
"Ethical and Religious Directives for Catholic Health Care Services"
"A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community."
Who writes this stuff? So a billionaire in mortal physical distress would not have to worry about imposing an EXCESSIVE EXPENSE on family or community, but the rest of us should take that into consideration, before, say, consuming an inordinate amount of antibiotics. And who would "the community" be? Since this was written before the GoFundMe sites, the community would most likely refer to the insurance companies or Medicare.
I suspect the highly touted Advance Directives and Living Wills, etc. make little or no difference in the long run, except maybe for your choice of donating your body parts. The issuing of such may serve as further justification for the decision-makers. Legal justification, that is; moral justification has no place in pragmatic statements.
It's simplistic to define terminology: if you need to explain what the subjective word "proportionate" means, just use other equally subjective words to define it. Who can separate the concept of "hope of benefit" from "reasonable hope of benefit" or determine what amount of expense is "excessive expense"?
I see that the "judgment of the patient" is the deciding factor. But then, at this time, isn't someone else in charge of determining the patient's ability to make a rational judgment?
Who writes this stuff? So a billionaire in mortal physical distress would not have to worry about imposing an EXCESSIVE EXPENSE on family or community, but the rest of us should take that into consideration, before, say, consuming an inordinate amount of antibiotics. And who would "the community" be? Since this was written before the GoFundMe sites, the community would most likely refer to the insurance companies or Medicare.
I suspect the highly touted Advance Directives and Living Wills, etc. make little or no difference in the long run, except maybe for your choice of donating your body parts. The issuing of such may serve as further justification for the decision-makers. Legal justification, that is; moral justification has no place in pragmatic statements.
It's simplistic to define terminology: if you need to explain what the subjective word "proportionate" means, just use other equally subjective words to define it. Who can separate the concept of "hope of benefit" from "reasonable hope of benefit" or determine what amount of expense is "excessive expense"?
I see that the "judgment of the patient" is the deciding factor. But then, at this time, isn't someone else in charge of determining the patient's ability to make a rational judgment?
Wednesday, July 27, 2016
Survey Monkey...
...just emailed request for review of Capital Cardiology Associates. Maybe the group is utilizing a survey company to try to improve conditions for their patients. I complied.
Friday, July 15, 2016
Report report: 2 yr. TKR FU
I went to Ortho NY for two-year follow-up visit with Dr. C. for the TKR of my left knee. Also a three-year check of my right TKR. After negotiating the wrap-around line of patients at the receptionist window, I went to the X-ray room for fast and efficient pics of both knees, one recumbent of both, and then three views of each knee while standing.
Dr. C. introduced me to an observer who was shadowing him, a student, at Buffalo. I suppose somebody has to be learning the profession. Replacement orthopedists will be in great demand; the present generation of the aggressive physically fit will see to that. While Dr. C. is fairly young, a year or so older than my youngest child, he has performed thousands and thousands of surgical procedures. He is acclaimed for his expertise which derives from experience, so anyone aspiring to be a skilled surgeon has a long and grueling road ahead. That student looked so young.
The examination comprises measuring the degree of flexion of the knee, from 0 to 116 or so, with the right knee slightly better. He checks the lateral movements as well, looks for any indications of loosening. Checks how I walk, asks if I have any problem climbing stairs. I say no problem, don't tell him about my 100 steps a day, wanting to preserve my status as sane. All looks good. He is very pleased with how the scars look---almost invisible, he says.
More innovations in technology: previously the doctor would ask you if you wanted to see your X-rays and if you did, would have you go to the viewer outside the room to look at the pics. This time, there was a viewer in the examining room. Behold your films. They look like the pictures you can see on the computer sites, your anatomy now a graphic illustration. Fortunately, my X-ray pictures now look like the "after" pictures, with the leg structures completely straight. Before my first surgery, my legs were so bowed that I couldn't even stand with my knees together.
Dr. C. pointed out the different components of the knee replacement. Titanium here, at the tibia, and the femur. The patella, in the center of course, is the area of the problematic. It's plastic he says, a much better plastic than before, but it will eventually be absorbed into the surrounding bone. Inevitably, but the plastic lasts much longer now, up to 20 years. "How does it get absorbed into the bone?" I asked, "Does it liquefy?" He said no, it breaks into tiny little particles. It used to be, he said, that they didn't know why the knee replacements were failing. The immune system tries to ward off the particle invasion, and inflammation results. Once they figured that out, they worked on developing a better plastic, still not perfect though.
He asked if I was happy with my knees, how they felt, if they were better than before. I told him they were pain free, had had no pain at all in left TKR, that I had postponed the surgery for a long time because I dreaded the long and painful results that I had heard and read about. He said the people who have the worst results are the ones who post their stories; those who have good outcomes don't comment. I said in my experience I'd found that no one wants to hear about a good outcome. He said, "Tell them anyway."
Dr. C. introduced me to an observer who was shadowing him, a student, at Buffalo. I suppose somebody has to be learning the profession. Replacement orthopedists will be in great demand; the present generation of the aggressive physically fit will see to that. While Dr. C. is fairly young, a year or so older than my youngest child, he has performed thousands and thousands of surgical procedures. He is acclaimed for his expertise which derives from experience, so anyone aspiring to be a skilled surgeon has a long and grueling road ahead. That student looked so young.
The examination comprises measuring the degree of flexion of the knee, from 0 to 116 or so, with the right knee slightly better. He checks the lateral movements as well, looks for any indications of loosening. Checks how I walk, asks if I have any problem climbing stairs. I say no problem, don't tell him about my 100 steps a day, wanting to preserve my status as sane. All looks good. He is very pleased with how the scars look---almost invisible, he says.
More innovations in technology: previously the doctor would ask you if you wanted to see your X-rays and if you did, would have you go to the viewer outside the room to look at the pics. This time, there was a viewer in the examining room. Behold your films. They look like the pictures you can see on the computer sites, your anatomy now a graphic illustration. Fortunately, my X-ray pictures now look like the "after" pictures, with the leg structures completely straight. Before my first surgery, my legs were so bowed that I couldn't even stand with my knees together.
Dr. C. pointed out the different components of the knee replacement. Titanium here, at the tibia, and the femur. The patella, in the center of course, is the area of the problematic. It's plastic he says, a much better plastic than before, but it will eventually be absorbed into the surrounding bone. Inevitably, but the plastic lasts much longer now, up to 20 years. "How does it get absorbed into the bone?" I asked, "Does it liquefy?" He said no, it breaks into tiny little particles. It used to be, he said, that they didn't know why the knee replacements were failing. The immune system tries to ward off the particle invasion, and inflammation results. Once they figured that out, they worked on developing a better plastic, still not perfect though.
He asked if I was happy with my knees, how they felt, if they were better than before. I told him they were pain free, had had no pain at all in left TKR, that I had postponed the surgery for a long time because I dreaded the long and painful results that I had heard and read about. He said the people who have the worst results are the ones who post their stories; those who have good outcomes don't comment. I said in my experience I'd found that no one wants to hear about a good outcome. He said, "Tell them anyway."
Saturday, April 9, 2016
Dr. K., You're one of them.
By that, I mean a doctor. Not that there's anything wrong with that. Being a doctor is a very good thing. But when you're advising a patient about medical choices with a doctor, and especially a surgeon, you must be venturing into the area of professional courtesy, one physician to another.
Most patients would not have the temerity to interview a doctor about available options. Or maybe it's just me. Once I committed to having knee replacement surgery, and selected a surgeon, I pretty much opted out of any decision making. It is true the surgeon I selected was not the first one I sought help from. Several years earlier, at my first visit to an orthopedist, I was totally surprised when he told me that the worst thing he could tell me was that I needed both knees replaced. That was what he was telling me, he said, and he could do that, in relatively short order. He said I needed him more than he needed me and to call his office to set up an appointment when I wished to. He never mentioned any options, and it never occurred to me to ask.
So, about 7 years later, when my knees were so painful to stand on, I could hardly cook Thanksgiving dinner, not to mention barely being able to walk across the lawn to the end of our yard, and having my own child tell me that it appalled him to watch me hobbling around on my crooked and bowed-out legs, I seriously contemplated the surgery. I called another surgeon, though, one who came highly recommended not only for his expertise in orthopedics, but also for his appearance. A woman poll inspector in Raymertown claimed he had enabled her to go from wheelchair-bound to being able to not only walk without a limp, but to skip. And to prove her point, she actually skipped around the room. She went on to say that her orthopedist was not only the best doctor she had ever seen, but also the best-looking man she had ever seen. Similar testimonials were given by our own librarian. I was ready to discount their glowing reviews, but when I mentioned the surgeon's name to my brother-in-law, his first comment was what a handsome man he was, in addition to his surgical skills.
At my appointment with him, he took a detailed history, stated that there was nothing that contra-indicated TKR, and told me he could fix the knee and straighten the leg. He suggested I go home and talk it over, but I said I'd schedule it right then. But, Dr. Komaroff, at no point did the discussion of surgical options arise. And it is true you write that your surgeon MAY discuss several choices. The surgeon I saw was careful to explain everything that could possibly go wrong, including the eventual deterioration of the "artificial materials." But he did not offer me a choice of materials, he did not ask if I wanted cemented or cementless implants. He did not let me choose between a fixed-bearing or rotating knee platform.
I think for most of us, who are not member of the medical profession, and who do not want to spend an eternity searching out every possible angle, the best we can do is pick a surgeon who we have heard good things about. I think it is true that most such surgeons have developed their skills using a certain protocol. If they use cement to glue the parts in place, they are not going to go cementless. They are not going to waver between fixed and rotating knee platforms. They will have made their choice of implant, from the lab they have chosen.
To summarize, in my case, and I suspect most, the surgeon informs you of what appliance he uses, such as "Signature." He does not ask the patient what procedure or materials or technique they want. I guess it may be different among the society of physicians, but, Dr. K., that's how it works out for mere mortals.
Most patients would not have the temerity to interview a doctor about available options. Or maybe it's just me. Once I committed to having knee replacement surgery, and selected a surgeon, I pretty much opted out of any decision making. It is true the surgeon I selected was not the first one I sought help from. Several years earlier, at my first visit to an orthopedist, I was totally surprised when he told me that the worst thing he could tell me was that I needed both knees replaced. That was what he was telling me, he said, and he could do that, in relatively short order. He said I needed him more than he needed me and to call his office to set up an appointment when I wished to. He never mentioned any options, and it never occurred to me to ask.
So, about 7 years later, when my knees were so painful to stand on, I could hardly cook Thanksgiving dinner, not to mention barely being able to walk across the lawn to the end of our yard, and having my own child tell me that it appalled him to watch me hobbling around on my crooked and bowed-out legs, I seriously contemplated the surgery. I called another surgeon, though, one who came highly recommended not only for his expertise in orthopedics, but also for his appearance. A woman poll inspector in Raymertown claimed he had enabled her to go from wheelchair-bound to being able to not only walk without a limp, but to skip. And to prove her point, she actually skipped around the room. She went on to say that her orthopedist was not only the best doctor she had ever seen, but also the best-looking man she had ever seen. Similar testimonials were given by our own librarian. I was ready to discount their glowing reviews, but when I mentioned the surgeon's name to my brother-in-law, his first comment was what a handsome man he was, in addition to his surgical skills.
At my appointment with him, he took a detailed history, stated that there was nothing that contra-indicated TKR, and told me he could fix the knee and straighten the leg. He suggested I go home and talk it over, but I said I'd schedule it right then. But, Dr. Komaroff, at no point did the discussion of surgical options arise. And it is true you write that your surgeon MAY discuss several choices. The surgeon I saw was careful to explain everything that could possibly go wrong, including the eventual deterioration of the "artificial materials." But he did not offer me a choice of materials, he did not ask if I wanted cemented or cementless implants. He did not let me choose between a fixed-bearing or rotating knee platform.
I think for most of us, who are not member of the medical profession, and who do not want to spend an eternity searching out every possible angle, the best we can do is pick a surgeon who we have heard good things about. I think it is true that most such surgeons have developed their skills using a certain protocol. If they use cement to glue the parts in place, they are not going to go cementless. They are not going to waver between fixed and rotating knee platforms. They will have made their choice of implant, from the lab they have chosen.
To summarize, in my case, and I suspect most, the surgeon informs you of what appliance he uses, such as "Signature." He does not ask the patient what procedure or materials or technique they want. I guess it may be different among the society of physicians, but, Dr. K., that's how it works out for mere mortals.
Friday, April 8, 2016
A.I. Moment to Remember
It was May 25, 2005, the end of Season 4. We'd picked up Dorothy and were traveling to Cape Cod, where all the boys already were. The rain came down in buckets on the drive that night, forcing traffic to a standstill. American Idol was hot back then, and we were eager to find out who would win. Carrie Underwood edged out Bo Bice. ("Scary Underwear or Mo' Ice? " read the sign on the cabin door.)
The final season came to an end April 7, 2016, a day when the rain also came down in torrents. The length of the show's run had been curtailed by increasing apathy and ennui, the two finalists pale reflections of contestants who had gone before. We learned that Trent beat out LaPorsha, and that Bo Bice now sports a crewcut. Alas.
The final season came to an end April 7, 2016, a day when the rain also came down in torrents. The length of the show's run had been curtailed by increasing apathy and ennui, the two finalists pale reflections of contestants who had gone before. We learned that Trent beat out LaPorsha, and that Bo Bice now sports a crewcut. Alas.
Saturday, April 2, 2016
Tick Tock
February 1st was a nice day. I walked along the roadside in front of my house and picked up some litter that slobs still throw out of their cars. Later that afternoon, as I was on the computer, I detected a tick crawling on my leg. It hadn't bitten me yet,as far as I could tell.
Yesterday, April 1st, was also a nice day. It had been windy, and I picked up some branches on our lawn that had fallen off the maple tree in front of the house, dead branches, some quite large. I threw them down the bank behind the house. Later, that night, my arm felt itchy and I scratched it, loosening what I at first thought was a small scab, a very small scab. I was next to the bathroom sink counter, where I saw it move. It was a tiny tick, evidently lodged just under my skin. That area of my arm has, not a bull's eye rash, but a circle of small dots, as if the tick was trying to find the ideal blood-sucking spot. I just hope it was a healthy tick.
Yesterday, April 1st, was also a nice day. It had been windy, and I picked up some branches on our lawn that had fallen off the maple tree in front of the house, dead branches, some quite large. I threw them down the bank behind the house. Later, that night, my arm felt itchy and I scratched it, loosening what I at first thought was a small scab, a very small scab. I was next to the bathroom sink counter, where I saw it move. It was a tiny tick, evidently lodged just under my skin. That area of my arm has, not a bull's eye rash, but a circle of small dots, as if the tick was trying to find the ideal blood-sucking spot. I just hope it was a healthy tick.
Friday, April 1, 2016
Dr. Who?
Received a call this morning about my annual doctor's appointment, a visit not scheduled until late June. A man identified himself as Adam and said he was calling to tell me that Dr. C., whom I had been seeing there for about 20 years, would not be at my June appointment because he was leaving the practice. He didn't give any reason for his departure, nor did I ask. "Would you like to schedule with another doctor there?" he asked. I said sure. What do I care? I'm pretty sure that Dr. C. is not retiring as yet, and it seems they would have commented about an illness. I thought it was usual for a person's physician to notify his patients that he was leaving, but that may be a courtesy from the past, and probably a doctor's departure has legal ramifications. "Doctor, Lawyer," they're of the same ilk.
Anyway, that particular office causes me such distress just by entering the door or, even before, the parking lot, that I wouldn't mind avoiding it altogether.
Anyway, that particular office causes me such distress just by entering the door or, even before, the parking lot, that I wouldn't mind avoiding it altogether.
Patient Parsing or Words and Numbers
In the vast and mysterious medical world of patient encounters,(Yes, that's what they call them--you can look it up) I have come to the conclusion that numbers trump words, almost every time.
Test the theory. Walk into a medical office, prepared to state your case. That means you want to explain your condition or your concerns, if you have any, or to relate any perceived changes, or just to understand what has, or is, occurring in the mortal coil you know as your body. Nine times out of ten, your doctors, or your medical providers, are sitting in front of a printout of your latest medical tests or notes presented by an assistant of some order. It would be the first time the doctors have seen them, or thought of the patient to whom they applied. That would be you. When they turn from the computer and ask how you are doing, it's up to you whether to respond with your health issues, or to just take the query as a greeting, and respond accordingly. "Fine, thank you. And yourself?"
It doesn't matter, either way. Your words are not supreme. The doctors rely on the numbers. What you utter is soon forgotten. You will be directed into the cattle chute of possibilities indicated by your numbers, not your words. And therefore more technical data, fit to be deciphered into statistics which too often defy any meaningful verbal transition.
Test the theory. Walk into a medical office, prepared to state your case. That means you want to explain your condition or your concerns, if you have any, or to relate any perceived changes, or just to understand what has, or is, occurring in the mortal coil you know as your body. Nine times out of ten, your doctors, or your medical providers, are sitting in front of a printout of your latest medical tests or notes presented by an assistant of some order. It would be the first time the doctors have seen them, or thought of the patient to whom they applied. That would be you. When they turn from the computer and ask how you are doing, it's up to you whether to respond with your health issues, or to just take the query as a greeting, and respond accordingly. "Fine, thank you. And yourself?"
It doesn't matter, either way. Your words are not supreme. The doctors rely on the numbers. What you utter is soon forgotten. You will be directed into the cattle chute of possibilities indicated by your numbers, not your words. And therefore more technical data, fit to be deciphered into statistics which too often defy any meaningful verbal transition.
Friday, March 25, 2016
It's About the Value, Stupid
From a magazine in the opthalmology office, a publication intended for professionals, but found strewn on the waiting room table amid copies of "People" and other such light reading: the article is entitled "It's About Value" and addresses the issue of how much to charge,
A doctor has emailed his concern that what he charges for a pair of eyeglasses shocks even him. The doctor is advised that as long as he keeps his pricing complaints to less than 20% of his patients, he is okay. Pricing complaints can not be regarded as being in a vacuum.
The author, a doctor, relates a time-honored equation:
"Value=Quality / Price, or Value =Perceived benefits / Price."
When the price is constant, you need to increase quality and perceived benefits. Remember there are 2 prices in every transaction---the anticipated perceived price and the actual price. THAT IS WHY A MERCEDES DOESN'T COST $14, the advising doctor states. The brand radiates a perception of high quality with the associated expectation of high price.
So, if you, the questioning and somewhat appalled doctor, are profit driven, and what doctor isn't, you want to attract patients who perceive your pricing as on the higher end of the scale, and equate high value with high price. When they actually see the higher prices, their expectations are met.
Two scenarios are set:
#1---Eyeglasses sold by a disinterested salesperson, which are sloppily presented on a tray with no case.
#2--Eyeglasses presented by a highly educated (trained) salesperson who offers a soft drink and a story about how the frames are made, supplies a nice eyeglass case, and then follows up with thank-you emails.
The author triumphantly posits that the eyeglasses are exactly the same in both examples. But which frame has the higher value--- Aha! The obvious answer is that exemplary service helps to support higher product fees. The "value" is increased, and thereby soothes the doctor shocked by the price of his own product.
So even if a Mercedes were a bucket of bolts, its reputation would justify its high price, and that, dear eyeglass buyer, is why you pay an exorbitant price for the eyeglass frames sold at your friendly eye-doctor's establishment.
*The author of the above-cited article is the president of an organization which "specializes in making optometrists more profitable."
A doctor has emailed his concern that what he charges for a pair of eyeglasses shocks even him. The doctor is advised that as long as he keeps his pricing complaints to less than 20% of his patients, he is okay. Pricing complaints can not be regarded as being in a vacuum.
The author, a doctor, relates a time-honored equation:
"Value=Quality / Price, or Value =Perceived benefits / Price."
When the price is constant, you need to increase quality and perceived benefits. Remember there are 2 prices in every transaction---the anticipated perceived price and the actual price. THAT IS WHY A MERCEDES DOESN'T COST $14, the advising doctor states. The brand radiates a perception of high quality with the associated expectation of high price.
So, if you, the questioning and somewhat appalled doctor, are profit driven, and what doctor isn't, you want to attract patients who perceive your pricing as on the higher end of the scale, and equate high value with high price. When they actually see the higher prices, their expectations are met.
Two scenarios are set:
#1---Eyeglasses sold by a disinterested salesperson, which are sloppily presented on a tray with no case.
#2--Eyeglasses presented by a highly educated (trained) salesperson who offers a soft drink and a story about how the frames are made, supplies a nice eyeglass case, and then follows up with thank-you emails.
The author triumphantly posits that the eyeglasses are exactly the same in both examples. But which frame has the higher value--- Aha! The obvious answer is that exemplary service helps to support higher product fees. The "value" is increased, and thereby soothes the doctor shocked by the price of his own product.
So even if a Mercedes were a bucket of bolts, its reputation would justify its high price, and that, dear eyeglass buyer, is why you pay an exorbitant price for the eyeglass frames sold at your friendly eye-doctor's establishment.
*The author of the above-cited article is the president of an organization which "specializes in making optometrists more profitable."
Wednesday, March 2, 2016
Search
"And learn our souls are all we own...
And maybe we won't feel so all alone
Before we turn to stone."
And maybe we won't feel so all alone
Before we turn to stone."
Friday, February 19, 2016
Saturday, February 13, 2016
Hole-in-the-Wall
The surface looks smooth, pristine even,
As if nothing had ever happened.
But damage had been done:
A jagged hole laid open,
A visible throbbing reminder
That nothing can stay the same
Forever.
As if nothing had ever happened.
But damage had been done:
A jagged hole laid open,
A visible throbbing reminder
That nothing can stay the same
Forever.
Tuesday, February 9, 2016
The Un-Numb
The dentist asked if I wanted the numb needle for a small filling, in the area at the junction of crown and tooth. I thought he should know so I said probably not. The procedure was uncomfortable, not to mention painful. "Next time, " he said, "we'll go for numbness, because I don't like to see people in pain. I'm not a masochist." "No," I told him. "You mean sadist. The masochist is the one in the chair."
Monday, February 1, 2016
Life / File Anagram
I was at the medical office today, for routine visit, though a few years overdue. The intake nurse, updating my records, asked the usual questions, including, "You have an allergy to penicillin, and Zoloft?" Yes, to penicillin. But, no, I have never taken or even been prescribed Zoloft. Whose file is this anyway?
Wednesday, January 20, 2016
Sunday, January 10, 2016
--ists
I learn something new, if not every day, at least frequently. Not long ago, I was introduced to the term "Hospitalist" when one came to visit me after my knee surgery, then I learned about "Intensivist," from billing, I seem to recall. The latest is "Electrophysiologist." Their expertise lies in the aspects of cathether ablations of heart rhythm disorders, and implant pacemakers, defibrillators, and implantable loop recorders.
Monday, January 4, 2016
Rigid? Or rigged?
It was the first time I accompanied the patient to the neurology appointment. The doctor conducted several exercises for strength and flexibility, I'm supposing. "Squeeze my hand as hard as you can. Extend your arms and don't let me push them down." Then the doctor tried to flex his leg when bent, and said his muscles were so rigid it was like lifting concrete. He tried it twice, with the same result. The doctor concluded the visit by deferring any diagnosis to the ultimate specialist at the Movement Disorder facility.
At today's visit to the primary doctor, when asked, I mentioned the neurologist's comment on the muscle rigidity in the legs. The primary doctor performed the same movements, but with complete ease. He seemed a little baffled. At home, I attempted the same movements with similar ease of results. I asked the patient what he thought about the extreme differences in flexibility.
My Occam's razor has sliced through to conclude that when one's hearing aid batteries are weak, the word "Relax" can be heard as "Resist."
At today's visit to the primary doctor, when asked, I mentioned the neurologist's comment on the muscle rigidity in the legs. The primary doctor performed the same movements, but with complete ease. He seemed a little baffled. At home, I attempted the same movements with similar ease of results. I asked the patient what he thought about the extreme differences in flexibility.
My Occam's razor has sliced through to conclude that when one's hearing aid batteries are weak, the word "Relax" can be heard as "Resist."
Forget About It
Dave's primary doctor--I taught his sister back in the day, when she was a high school junior and he was a mere seventh grader. I vaguely remember seeing him as a little kid. I have not seem him since then. He and Dave used to play golf together at the Battenkill. A number of years ago, during those halcyon days, a noted artist painted pictures of the Golf Course and some of the club members, which included the doctor's then wife, offered them for sale. Marilyn spent several hundred dollars for a painting of the 6th Hole, a serenely beautiful scene, even if you're not into golf.
Somehow it fell to the doctor to deliver the painting, when it became available. Through ill fortune, I happened to be the one to answer the phone when he called for directions to our house. He was calling from his car, and I made the assumption he was driving from Greenwich, the home of the golf course. So I directed him from there. But it turned out he was calling from Cambridge, so he got lost. I can't remember how the painting finally got here: probably Dave picked it up at the Battenkill. Naturally, I felt embarrassed to have sent a doctor, of all people, on a wild goose chase. But all worked out, and hopefully was forgotten.
Today I drove Dave to his doctor's appointment, which I have been doing since the fall, on June 17. Before that, I never even went with him to his appointments, much less into the room. But a few weeks ago, I changed that and went with him into his neurologist's office, and today for the first time into his primary doctor's office.
The doctor greeted Dave and then turned to me and said he thought he remembered meeting me. Dave offered that I used to teach in Cambridge, but the doctor said that would have been when his sister was there. Then, said the doctor, he thought it might have been when he delivered a painting of the golf course.
I said, "Gulp!"
Somehow it fell to the doctor to deliver the painting, when it became available. Through ill fortune, I happened to be the one to answer the phone when he called for directions to our house. He was calling from his car, and I made the assumption he was driving from Greenwich, the home of the golf course. So I directed him from there. But it turned out he was calling from Cambridge, so he got lost. I can't remember how the painting finally got here: probably Dave picked it up at the Battenkill. Naturally, I felt embarrassed to have sent a doctor, of all people, on a wild goose chase. But all worked out, and hopefully was forgotten.
Today I drove Dave to his doctor's appointment, which I have been doing since the fall, on June 17. Before that, I never even went with him to his appointments, much less into the room. But a few weeks ago, I changed that and went with him into his neurologist's office, and today for the first time into his primary doctor's office.
The doctor greeted Dave and then turned to me and said he thought he remembered meeting me. Dave offered that I used to teach in Cambridge, but the doctor said that would have been when his sister was there. Then, said the doctor, he thought it might have been when he delivered a painting of the golf course.
I said, "Gulp!"
Real Simple
I don't have much opportunity to engage in conversation these days. But in the past month, two different medical professionals, and also a family member, have mentioned the same term. Occam's Razor is evidently a touchstone in the world of medical diagnostics. Simply put, it espouses the principle of parsimony. The assumptions introduced to explain a thing must not be multiplied beyond necessity. What can be done with few assumptions is done in vain with more.The simplest answer is often THE answer. Now if we know what we're talking about, why not just say it?
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