Tuesday, December 22, 2009


Well as everyone is trying to get to where they need to be and settle in for the Holiday, our Senators are working really exceedingly hard pulling in some long hours. I know they have some really great health benefits, administrated for most by a private sector company. I used to be a Federal employee and work for the VA, the largest "socialized" health care system in the country. I know the Federal Employee Health Benefits I had (FEHB) were awesome. I know they cost a fraction about 90% less of what I now pay for my health benefits as a private practice physician. Nothing like being penalized severely for not being in a "large pool". We must always shift the cost somewhere right?
As a "consumer" a patient, I like to think that overall at 48 I am in pretty good health. The Health Care legislation and the political history that will be made, frankly scare me half to death as a patient.
As a physician it demoralizes me. Things are bad now, I can't practice medicine to much without a bureaucratic entity telling me what I can and can;t do even in private practice. I can't prescribe the correct and appropriate medication to help a patient without begging some non-medical person for permission and fighting through stacks of paperwork and forms, meant to break down the doctor so you give up and prescribe something less than optimal. (Cost Containment)
My innate and 20 years of clinical wisdom and experience are not rationally challenged but instead are beaten down daily. My ethical sense is constantly urged to be compromised every day, yet I keep fighting for my patients. Maybe to no avail.
I am told who I can and can not refer a patient to regardless of if I know whom the best person is. The insurance company does that, regardless of whom is the best.
I am used to that. From what I can see (although like everyone else including many of the Senators I did not read the thousands of pages of the bill), that is NOT going to change. It may even get worse. It most likely will get worse. It really does not seem like REFORM. It is hard to follow S. 1796 America's Healthy Future Act.
Check it out at open congress introduced by Senator Baacus from Montana back in October.

Then there is Harry Reid. I heard him addressing the senate the other night and he cited some really sad stories of patients scenarios in Nevada, and not being able to access health care. He sounded really sad for these people like he cared.

According to wiki: http://en.wikipedia.org/wiki/Harry_Reid

"Reid is a first generation member of The Church of Jesus Christ of Latter-day Saints.[56] Reid and his wife, who was born to Jewish parents, converted to Mormonism while Reid was a college student.[3] He stated in an interview with Brigham Young University's Daily Universe that "I think it is much easier to be a good member of the Church and a Democrat than a good member of the Church and a Republican." He went on to say that the Democrats' emphasis on helping others, as opposed to what he considers Republican dogma to the contrary, is the reason he's a Democrat.[57] He delivered a speech at BYU to about 20,000 students on October 9, 2007, in which he expressed his opinion that Democratic values mirror Mormon values.[58]"

And to think I thought it was not progressive to interface religion and politics. So which is it?

How did this happen? Is this America's Christmas present? Read all about it. I actually was able to follow this story.

Oh well God Bless America.
I hope it gets better for patients. I wish I could practice medicine ethically unhindered. Do we really need doctors anymore? Can't we just get by with administrators, and nurses and nurse practitioners and physician assistants, and lots of techs and lots and lots of mid-level providers, and lots more technology and electronic means perhaps a lot more federal employees and bureaucracy? I mean there is a doctor shortage in many parts anyway? whats the difference? Doctors are too expensive right?
Isn't it doctors that have driven up the cost of health care? Or Wait maybe we collectively as Americans are done playing that mantra record.
As Americans we can just sit back and wait.
Oh well God Help America.
Merry Christmas.

Saturday, December 12, 2009

Fond Memories

One of the happiest times I remember about my mother long before she had Alzheimer's disease was a certain day of the year. It was St. Joseph's day. It occurred every year on March 19th. The Catholic Church recognizes almost every day of the year as some feast day, and this was always considered a most important day in the church.
Way back when in the sixties and early seventies, my catholic grade school even used to give that day off from school, to honor the day. Over my grade school years the day off became only a half day off. It seems that perhaps in keeping with the political words of progressiveness, perhaps honoring feast days and patron Saints became less significant. Yet it was not so long ago this was a most important day in the church.
On that day, my mother would take me downtown to St Peter's Cathedral in Erie, Pennsylvania and then to St Joseph's Church on Sassafras street. We would light a blessed candle at each of the St Joseph side alters, and actually get on our knees and pray. In those days the churches used to have kneelers in front of the alters, many still do. We said our intentions.
The years used to go by more slowly back then. It was a timeless tradition. It was about religion and praying but it was also about a mother and son bond.
After going to church we usually stopped by Carlisle's department store and had lunch. It was so special it was like a birthday or Christmas to a kid.
My mother would by me a present, a commemorative gift. One year it was microscope slides, another year it was a Grand Funk Railroad Album. It was a big day.
I think my mother looked forward to it as much as I did.
She was selfless when it came to raising her kids.
It was not so long ago, yet it was ages ago. It was still a bit before the "me-first" generation when it really was not pretentious or politically incorrect to put your kids before yourself.
Putting your kids before yourself as a parent nowadays sometimes is done out of a fierce competitiveness, in keeping with the "me-first" times. Kids now become objects of the parents, since we are often so narcissistically wounded and must move so fast and "get ahead" of everyone else.
I think those special St. Joseph's days were born out of love. I had obviously never heard of Alzheimer's disease back then and I had no idea that in just a few short years the disease would take my mother.
My parent's were fortunate enough to travel to Europe once in 1966. I was about four years old. They went to Italy and got to attend a mass celebrated by Pope Paul VI at the Vatican. My mother got me a brown Rosary blessed by the Pope. It was my first communion rosary which I made in 1970. On St Joseph's day I used to bring that with me to church and would say a decat or several for all my intentions. I still have that rosary. It is a keepsake.
St Joseph was the patron Saint of the Universal Church, the worker, and the family. It was something bigger than all of us. It was something to strive for and someone to pray to and emulate.
I realize in the world today, the world of relativism, with all the cool intellectual and "actualized" agnostics and atheists out there, most of this stuff is now considered hokey or ignorant.
All I can say is every single person out there had or has a mother, regardless of religious affiliation or lack of affiliation. It was a powerful and timeless context for my mother and I.
As a kid I thought we would have this tradition forever. My mother and I would sometimes talk about that. St Joseph's day would always be our special day, no matter how old I was. The tradition of going to church and lunch of stopped when I was about 13 or 14. My father died when I was sixteen and my mother was diagnosed with Alzheimer's shortly thereafter.
Perhaps somewhere in the collective unconscious my mother knew, or God knew what was to come. March 19th St Joseph's Day was a timeless gift for both of us.
When you have such an important decent gift of love and a tradition like this, it makes the awfulness of the disease seem that much more awful.
To have something like that and then have a disease like Alzheimer's take it away is maybe worse than never having had anything at all.
Yet, I know in the end, that special day and that special time can never be taken away from me as it will live in my heart forever.

Sunday, December 6, 2009

Holiday Times

The holidays mean family right? time to get together, to reminisce, build new memories. create new traditions, act on old ones. Christmas, Hanukkah, tress lights, wreaths, Best Buy, Airports, travel, winter, December.
In the Western World, we sometimes feel a pressure to make everything perfect, make sure everyone bonds and has a good time, that new happy memories are built. Sometimes it does not go that way despite the pretense. There is major letdown, hence people get depressed, because they think they are supposed to be happy and merry, (as opposed to other times of the year. So then we think of the true meaning of the Holidays or at least try to, to rationalize and divert from the letdown. We think of the less fortunate, and send gifts and volunteer for those less fortunate, (as opposed to other times of the year).
Sometimes when families get together, old dynamics come up. We psychologically regress to the role and place we fell into things in the old days. It is insidious, and most people are not aware of it or only slightly aware of it. It can lead to resentment, when we are thirty or forty years old and cast into the realm of the six year old.
If you are fortunate enough to have an intact family, relatively healthy then you are quite blessed.
If you have lost a family member, a close relative, then you know all to well things are never the same at holiday time, no matter how many years it has been. If this is the first year without a loved one at the holidays then things may seem more than a bit off.
If you are elderly or have early dementia, you may crave and be excited for the holidays, and those family members, "the kids" to come home. To see the grandchildren. If you are a son or a daughter, and a parent has dementia you may be ambivalent or even fear spending the holidays together, as things are never quite the same.
Don't forget about the blended families and divorces. Will you have the kids this year? will the holidays be "split"? Will you be putting a son(s) or daughter(s) on a plane across the country as an accompanied or unaccompanied minor?
Dementia and the Holidays are not exactly the best mix, but we do try to make the best of it.
If your parents or grandparents are deceased like mine, you may long for the very old days of the original intact family of origin. The holidays force us to revisit the past and often our grief.
You may try to make it nice for the kids, caught up and lost between the materialism and trying to teach the omnipresent "long lost meaning".
Do you live down the street from where you grew up? Do you see your relatives throughout the year? (A common phenomenon up where I reside,-many people leave home and make it all the way down to "the cities") are the holidays a hassle or a time to be thankful?
Whether you had a happy childhood or one filled with chaos and drama, or too much alcohol for example, now maybe things are "better" or some level, more seemingly cohesiveness, having lived through the "war", whatever way you look at it, the holidays are an emotional time, for better or worse, an emotional time.
If things are "perfect" do you await your son or daughter to come back from Yale, or Pitt, or Penn or "The U"- whichever "U" you want, there are lots, or law school, or medical school. Is there a pressure to make everything perfect?
For those Alzheimer's families, it is one more holiday. Remember the holidays are embedded in our long term memories, like music for example. They were such an exception to normal everyday life, we put them in our long term memory banks In a special way. Make the best of it, it can bring moments of joy in the preserved longer term memories of you loved one. Remember long term memories last the longest.
If you have lost your home, and a parent or parents are in a nursing home or assisted living, the time spent together, even if it is not home, is what the holiday and every day of the year should be about. No price tag for that one.

Talking about the book with the Lake Superior wind....... a calm day