Monday, September 29, 2008

More Facts

So reportedly the US is the richest country in the world. Supposedly. Let's see what that means. The US is ranked behind Cuba, Denmark, Israel, Germany, Norway, France and Sweden in infant mortality. So out of 1000 babies, 6.30 will die before age 1. We are ranked behind the same countries except for Cuba in life expectancy. We can expect to die at age 78.14 while France enjoys wine and cheese until age 80.87. That's totally unfair. 16 percent of out gross domestic product is spent on health care. The UK spends about 8.3 percent, and despite copious cigar smoking in Cuba, they only spend 7.6 percent. To break that down even further, approximately $6700 is spent annually on each American for health care. Now wait, I thought I was the one that spent that on co-pays and premiums. I had no idea the government contributed! Apparently that includes the 47 million folks that are uninsured as well. The projected expenditure for Medicaid and Medicare for the year 2017 is 1.26 trillion dollars. That's up from 559 billion dollars spent on those two programs in 2007.

Now what's kind sad is the fact that in 1945 President Truman had a plan for a national health program. Unfortunately for us the American Medical Association and the House of Representatives shot it down as a "communist plot." However, as early as the 1910's reformers had a national conference on social insurance and earlier than that, lumber, mining and railroad companies recognized the need for good health among their workers and offered it to their workers to keep up with production.

Let's look at some other statistics now. In my state, which is one of the wealthiest in the nation boasts a population of 283,000 that are food insecure throughout the year. 25% of those that visit food banks are working families. Our state food banks service 350,000 people per year. That's a lot. In 2007, 7.9% of people in my state were living below the poverty level. Guess what the definition of poverty level is? For a family of four you can't make more than $18,100 per year to get some state benefits. Um, that's pretty low. The median value of a home in my state is around $157k which equates to about a $1,265 mortgage payment per month which according to stats is unaffordable for about 60% of the state's population. So, even if you have a shitty apartment in a shitty neighborhood and are food insecure, but you make say, $18,300, you may not qualify for any state benefits because you are too rich. Makes sense doesn't it?

There is a great site called A pretty eye opening website I think. For example, my town contributed something like $168.2 million to the Iraq war effort. This amount of money could have provided health care for 55,577 people. You can put in your town and see what the trade off is for what has been spent on the war so far. Very interesting.

So we are heading into the cold season and oil is at an all time high. I worry about these families, hell, I worry about my own family. Food or heat, medicine or food, clothing or gas to get to work, its pretty scary and I have a good job. I've already hit up people in my department for old coats and shoes for the homeless closet, because God knows, we are going to need it.

Help Wanted

I just saw a sign advertising a job for a garbage truck driver. It can't be that hard can it? I mean, you just drive a truck around and pick up folks garbage with a mechanical device. I also hear they pay well. I could sit there, listen to music, enjoy the fall foliage on my run, wear a t-shirt and jeans (well, maternity jeans but still), not have to speak to another human being for hours at a time. It sounds really wonderful. I'm having them fax me an application. If I get the job perhaps my rants will be about other types of "garbage." (har de har har har)

Wednesday, September 24, 2008


At any given time there are over 4000 homeless in my state (in New England).
Last year shelter workers had to turn away 30,000 in need of shelter for lack of room.
2000 people, including 400 children are in shelters everyday.
One January night in 2007 when the temperature was 20 degrees, a count all around our state was taken. There were found to be 3,325 households homeless. Of these, there were 392 families and 797 children. 10 percent of these families were found sleeping on the street or in places unsuitable for habitation.
With heating oil, food prices and other commodities at an all time high this year, I can only imagine what January will look like this year. I have stocked up my homeless closet with hats, scarves, mittens, socks and sweatshirts and coats. It won't be enough. I have many packets of information at the ready for those who need shelter. I don't know if it will help.
Why is this so prevalent in this country when so many have so much?
I hate this time of year..............I feel so helpless.

Until Death

He wants to give up but is worried. He feels he hasn't told his family everything. He worries about his wife, will she be okay? Will his sons take care of her? Will his daughter stay with her awhile? It's been 60 years together. He has so much to say but breathing is so hard. His wifes eyes fill with tears. "It's okay hon. It's okay. Rest now" He does rest, and he holds her hand and caresses it, the hand that he pledged his love to so many years ago. She kisses him and smoothes his hair. She pulls up his blanket that covers his emaciated frame, the frame that swung their children in the air, the frame that provided her the comfort of his embrace. And they sit there together, no words are needed after years of learning each others looks, body language and sighs. She is there when he passes to the other side, she closes his eyes, she folds his hands, she kisses him, sighs and goes to meet their children.

Monday, September 22, 2008

Feelings, nothing more than feelings..........

OH, MY, GOD! She's crying. Quick get kleenex, stat! Send in the militia of social work and pastoral care, bring in a carton of kleenex, particularly the scratchy, millimeter thin kind that shreds with one blow. She's crying, for God's sake because she is overwhelmed. Her father is in the room dying, they have just made the decision for a DNR/DNI order, he is getting meds to make him comfortable. She has a right to be upset. She has the right to cry and sending in a militia of "caring people" isn't going to make the situation any less upsetting. Truth is, she has been up all night, has been thinking about this decision for weeks, she hasn't had breakfast and barely ate dinner last night. She is thirsty, she feels grungy after being up all night and really would appreciate a hot washcloth and some coffee, maybe a muffin and some orange juice. These are readily had around here and so I bring them. She really has made peace with her decision, she is just glad that he won't suffer anymore, she understands the ramifications, she wants Dad to pass with the dignity that he held throughout his life.

Some folks really don't want to talk. Some folks prefer being alone in their pain. Some just want some nice ice cold water. Some want to talk to their loved one alone. Some wail, some sniffle, some yell. Some love to talk and talk. It's cathartic to talk about their loved one's life. He was a teacher, an artist, an architect, a bus driver. She was a nasty old biddie but I loved her. He was a dirty old man but a fabulous painter. They just need time. They need their feelings, they need to cry, and sometimes, they need to cry alone.

Tuesday, September 16, 2008


So it's 8:46am. I got here approximately 46 minutes ago and today has declared itself as "Beat Your Significant Other Day." I have three patients. All beaten up by significant others. I haven't even had my coffee yet.

Coffee, then domestic violence. 'sigh'

Wednesday, September 10, 2008


She's pissed that he wrecked his car. What she should be pissed about is that he drank so much and then wrecked his car. She's known he's an alcoholic for years but that's not what she is upset about. I guess the hard reality of living with an alcoholic is too much to bear so it's easier to get angry about the wrecked car than his disease.

He is so annoyed that she is in the hospital again. She's here every week. She takes her meds, she goes to dialysis, she seemingly does everything she is supposed to do and yet she is still here. He is tired, he needs a break, he thought about not coming to the hospital with her today but decided that he should. So he yells at the doctor. It is the doctor that is responsible for this continual failure. It would suck to actually grieve about the fact that she won't get better because of her disease process and that eventually he will lose her.

They are so angry that they have been waiting for over an hour to be seen. Other patients have come in and seen the doctor already. Why is it that we have had to wait so long? Why isn't my sore throat a priority? The truth is, if they had done what they were supposed to when they were seen for the same thing two days ago it wouldn't have gotten worse and they wouldn't be back here waiting.

He is beyond furious that I won't give him a taxi voucher for him to get home. He got one last week that was for over $100. He hates the doctors where he lives, he took a bus to get here, he signed out AMA the last hospitalization, he refused the prescriptions he was given. His friends won't give him a ride home. In fact, they won't even answer the phone anymore. It is far easier to blame the establishment than take responsibility. It is far easier to be furious that acknowledge his loneliness and despair that he can't seem to stop drinking, that he is now alone, that he lost his leg last year, that he just doesn't care anymore.

She tries to hit anyone that goes by. Her eyes are wild. She is now in restraints. She howls like a wild animal caught in a trap. She lets loose a stream of expletives towards her nurse, the doctor, towards myself. "How dare you!" " I want out!" "Why didn't you just let me die?" She mumbles off into tears. "I just wanted some peace.............." and then, another stream of foul language and yelling. So angry, so disgusted that she is still here and we saved her from dying.

Anger directed inward or projected at those who tried to help. It is blatant, it is subtle yet frightening in it's intensity. It is misdirected, it is too hard to be okay with the sadness that came before the storm. To be sad is to acknowledge the loss of something, to be angry is to blame for the loss that has occurred.

Tuesday, September 9, 2008

Tom and Huck

Maybe you had a neighborhood like mine with tons of kids zooming by on their bikes, climbing trees, playing hide and go seek running in bands throughout the neighborhood. Or maybe you didn't. It was somewhat reminiscent of Tom Sawyer and Huck Finn in the summertime, kids everywhere, running down to the beach, showing up at home with dirt smeared faces and torn clothes. And this is what I hoped for my children. When I first moved into my house almost five years ago I wasn't sure that there would be many children to play with although the street was perfect, tree lined, a brook at the bottom, a dead end street, quiet. This weekend turned into a Mark Twain book and I was ecstactic. All the children were out, the weather was warm and sunny, Reese and Mosey were thrown out of the house, as were all the other kids, bikes came out, sidewalk chalk, wagons, balls, kids zooming down the street on their bikes yelling to each other as they went, the younger ones pedaling as fast as they could to keep up. Everyone ended up at my house climbing on the swingset, making tons of noise, the screen door banged a thousand times as kids came in and out for drinks of water and bathroom breaks. Mosey scraped her knee so out came the lawn blanket and some quiet games for awhile, marbles and a building set, a couple of books and popsicles. And I smiled from the front porch with my coffee. This is what I wanted for my children, dirt on their faces, bandaides on their knees, strawberry popsicle juice dripping down their chins staining their shirts playing marbles on the blanket in the spring sun. All I needed now was some whitewash to start painting the fence, aaah, now that would be perfect.

Saturday, September 6, 2008

A Grassroots Organization Worthy of Joining

So somehow I have to figure out how to take maternity leave without losing my house. Did you know that the US and Australia are two of the only countries without some sort of paid maternity leave? I know women who have gone back to work two weeks after delivery. This is terrible for both mother and baby. We are one of the wealthiest countries in the world and we don't give a hoot about families or healthcare. Check this out; a graph of countries and what they offer for paid maternity leave. Even the poorest countries in Africa have it. What is up with this? I"m not usually a huge political activist but whining isn't going to solve anything......


Federal employees may be the first ones to reap the benefits of paid maternity leave if the bill passes. Why not everyone else?

Tuesday, September 2, 2008

Bureaucratic nonsense

Today I see this guy who has cancer, diabetes, and a host of other chronic conditions. He is weak and pale, he has no ride home. He is estranged from his family, has few friends, was living at a nursing home for a couple years but managed to get out and live on his own, to his credit. He makes about $925 a month about $250 of which goes to back child support for his children who are now adults. His rent is $500 a month which around here is cheaper than cheap. He then has co-pays from Medicare for about 10 different meds. He has no car and lives in a rural area which has no public transportation. He will need followup doctor visits. One day he was desperate to get his meds from the drugstore so a friend lent him his car so he could get them. The guy, though previously a truck driver now lacks a drivers license. He gets into a fender bender and gets charged and now has to appear in court. He has no idea how he will get there.

This man is not eligible for Medicaid for some bizarre reason. He is so sick most of the time that he is virtually unable to follow through with getting the child support changed, and work with his state worker so that he can qualify for Medicaid. At this point he literally has to choose whether to take his meds or eat. He can't get to most of his doctors appointments due to his lack of transportation but is getting weaker and weaker. He is not yet sixty so he doesn't qualify for protective services, so we get him a visiting nurse. He wonders why he even bothered to work and try to get out of the nursing home since he is so much worse off financially and medically than before.

Granted, this man has probably made some poor decisions, he has likely burned a ton of bridges but at least he has tried to become independent. Why do we reward those who stay in costly nursing homes and never try to fend for themselves and cause those who attempt to be independent become more dependent in the long run because they lack the resources to maintain their independence? How is one to survive on less than $700 a month when one has a chronic disease, is in already cheap housing and has to pay out of pocket for transportation. How is a sick man supposed to schlepp into state workers offices to fight over bureaucratic nonsense? We need universal healthcare.