The Post Where I explain where I’ve been.

Mentally, I’ve been away.  On a vacation where I’ve prioritized my health above all; rather, my health has forced me to pay attention to my body, and nothing else.  This explains why, since Wednesday night, with brief forays into trying to go to work (with varying degrees of success) I’ve not been up to my usual bloggity self. 

My health care, and my treatment options, have led me to think at some length about the health care legislation Obama is trying to pass, and the mess our insurance companies have us in.  I have reasonably fair insurance.  That is to say, I have to pay $50 to go to a specialist, but I can get any care I need, my prescriptions are affordable, and I can fight to get coverage for things that are medically necessary.  I am lucky.  In facing my choices this week, I began to realize what would happen if I did not have choices, or if my insurance company tried to make them for me.

Option a) Take medication, which would probably cost me $8-10.

Option b) Have a “minor” procedure, which falls under the subheading of “minor surgery” which involves “general anaesthesia” and other things in “quotation marks”. 

I chose the medication.  And I’ve been in acute pain or discomfort all weekend long, unable to sleep, distracted when I tried to go out and do normal people things, and bound to the couch or bed for much of my waking hours.  Then I went to the doctor yesterday, who informed me my condition had not completely resolved and I have to go through a modified version of the medication again.  I asked myself if I’d made a bad choice.  Didn’t I choose the “responsible” thing, the thing with less burden to myself, my loved ones, my insurance company, the hospitals of this country, and the doctors who are now free to attend to emergencies?  Didn’t I choose the thing that should be effective enough in most cases that people with my condition shouldn’t have to go under the knife?  My choice didn’t take up a hospital bed, require the attention of several doctors, nurses, and support staff, make tall piles of paperwork, or cost me more, yet I still question it, as I sit here in still more, unrelenting pain. 

Had I opted for the surgery originally, I don’t know what the outcome would be.  Would I even have a surgery date yet?  I hadn’t even bothered to find out what my copays would be for an inpatient “procedure”, nor what the recovery would be like.  I don’t know if the pain level would be any better, or how long I’d miss work recovering.  I didn’t ask about any of these things because surgery — minor or not — is not something I go into with a light hand.  Less work for me?  Less time in my home in pain?  Nurses with real pain meds at the press of a button?  I just didn’t consider it. 

But I’m glad I had an option.  There are those who would rather take the medication, and deal with the side effects at home, with loved ones there to bring them tea or ice cream, and a sympathetic dog to bring comfort and warmth.  There are those (perhaps without such soothing animals or attentive humans) who would rather have their issues taken care of medically, surgically, hospitally, with as little patient involvement as possible.  But we need that choice.  Medicine is not just about money ($8 pill vs. thousands for a hospital procedure), nor about efficacy (and here I have no idea how effective the two treatments are). 

They talk on the TV, on the radio, in the newspapers about the blue pill and the red pill.  If for 95% of the public, the blue pill works great and costs less, then fantastic!  But for the 5% who cannot tolerate the blue pill, or for whom the blue pill does not work, we need the red pill.  Even if it costs more.  Beccause it’s also about treating the patient, not just the disease.  We didn’t just learn that from Patch Adams either.

Mr. Apron used to work as a standardized patient, posing as a “patient” for medical students learning how to interact with and diagnose patients.  The most important aspect of this job was not to play 20 questions with 3rd year medical students trying to guess that he had had a closed head injury 2 weeks ago; it was the doctor-patient interaction.  The way the doctor makes you feel, treats you, listens to you, will inform your care, guide your decisions, perhaps more even than cost, or efficacy, or the reputation of your health system’s “top docs”. 

In all these efforts trying to quantify medicine, trying to rate doctors on the number of expensive tests they order, tabulate the experences they have with procedures, and count the number of sick patients they see, they are forgetting that, even in the midst of a healthcare system weighed down by debts, inefficiency, and abuses, there will always be good doctors and bad doctors.  There should always be tough decisions to be made, informed decisions to be made by a patient and her family, because that means there are choices, and that we as consumers/patients/human beings have the ability and the right to take care of our bodies and our minds.  No insurance company, no HMO, no hospital, no doctor, no flashy billboard can tell us otherwise. 

With any luck, I should be back to myself within 24 hours.  The advil seems to have finally kicked in (or maybe it was the Fresca, with its magical “citrus” powers), and I thank you all for listening to my rant.  It’s been difficult not to share my experiences this past weekend, but I do need to keep some parts of my life private.  When there’s something more exciting — and less gross — you know I’ll fill you in on all the details.

Until then, feel better soon.

Dissed-ability

Of course, I had all the greatest intentions on the blogging front this week.  The kids were on vacation, so I had what I thought were absurd amounts of free time on my hands to catch up on paperwork and get a good blogging momentum started.  Blog fail.  Monday I was at a conference all day long.  Tuesday, I did write about my surgical “options”.  Wednesday was endless staff meetings and a video called “Including Samuel” about a boy with cerebral palsy who is fully mainstreamed into his elementary school.  Thursday started off promising, but then I had an IEP from 10 till almost noon, then lunch, and finally I had to meet with a coworker to plan our summer language groups and make materials.  So I spent the afternoon photocopying, stapling, and filing knock-off versions of “Brown Bear, Brown Bear, What Do You See?” as coloring books.  Today I had off from work, but Mr. Apron and I compiled a hefty to-do list which left me running around all day.  Sigh.  Here is my Friday blog.

Yesterday at work, a coworker admonished me for not enrolling in the optional short-term disability insurance offered by my company.  It’s fantastic, she said, and pays something like 60% of your salary if you can’t work or if you’re on maternity leave.  Of course, she was assuming two things:  one, that I hadn’t enrolled in it when I was hired or during our open-enrollment period which just ended June 30th; and two, that I was a young married thing and would be caring about such things soon.

Don’t you hate it when the know-it-alls are right?  When I have been interviewing for and hired at my two “real” jobs that offered benefits, I have been more concerned with getting a job and was not brilliant enough to go benefit-shopping like some of my classmates.  I guess that attitude came from the difficulty I had getting my first job, and how grateful I was just to be employed.  With my current job, too, having been hired at a time when it seemed all other sectors were cutting back, I was just happy to get an offer.  The other factor is that I can’t navigate my way into any of the benefits any more than Finley can free himself from a blanket we throw over his head.  I am now familiar with the workings of an HMO, thanks to my brain surgery experience.  I understand about diagnosis codes, copays, referrals, deductibles, and how insurance, not a doctor, decides when you are cured.  What I know nothing about are everything else in that healthcare packet I was given when hired.  Long-term medical, short-term disability, health savings accounts, dependant care accounts, etc.  During my hiring and during open enrollment, my eyes glazed over and I checked N/A on the payroll deduction form without giving it a second thought, because second thoughts about things I don’t understand make me cry. 

Nevertheless, I googled short-term disability insurance, short-term medical insurance, etc.  I went to the company’s website and clicked on the link to their STM provider.  I downloaded the form, printed it out, and e-mailed the HR lady who would know definitively about such things.  Of course, the form I printed out stated quite assertively one could only enroll during open enrollment.  And pregnancy is a pre-existing condition; you have to be enrolled before you’re impregnated. 

She called me back right before the IEP. 

“Now, you know the open enrollment period is closed, right?”

“Yeah, I was afraid of that.”

“But I called my supervisor, and I haven’t heard back yet, but I think I can sneak you for this year in because it’s only July 2nd.  But I need to know, and I’m not supposed to ask you this, but…are you pregnant already?”

“No, not yet.”

She faxed over the forms later in the day.  The cover letter read: “Urgent…I was able to get you into this year’s open enrollment.  Fill these out and return them  today.”   I was able to fill them out without crying, and I was able to use the fax machine to send them back.  Double success!

Now, my coworkers were as puzzled as you are why I was so excited to get that fax.  Last month-ish, I e-mailed HR to find out what the maternity leave policy was.  The HR lady elucidated something about the Family Medical Leave Act, and told me to check the hopelessly confusing and under-useful employee handbook.  They both said the same thing.  FMLA entitles one to take up to 12 weeks unpaid leave during the year a child is born/adopted.  You can take it all at once, or use it to cut back on your weekly hours, or some combination thereof.  But it’s unpaid.  For three months.  That’s a pretty serious burden to a family with a new infant.  Basically, this ground-breaking new allowance of leave, this new federal law, all it does is guarantee your job will be there for you when you come crawling back after being basically unemployed for 3 months. 

But short-term disability, which includes pregnancy and post-partum-ness as a short-term disability, entitles me to up to 13 weeks of 66 2/3% of my pay.  It can also be taken piecemeal.  So one could, if one was inclined, stay home for 8 weeks, then come back 3 days/week and use the other 2 days’ worth to keep one as a full-time employee, and therefore keep one’s health insurance. 

Ah, so this is how it’s done.  When I first found out about FMLA, I called my mother and asked her how women did this.  I couldn’t understand how the entire country’s worth of mothers takes unpaid leave.  But now it makes more sense. 

On face value it would seem odd that I enthusiastically texted Mr. Apron on Thursday teasing him, “Good news : baby-making”.  And even stranger that I’m so excited about STM.  But now we can start realistically thinking about baby-making.  Mr. Apron has been very gung-ho (read: horny), and I’ve been bogged down in the pragmatics and logistics of such petty issues as health insurance, child-care, maternity leave, medication restrictions during pregnancy and unpasteurized cheeses.  I think we’re cutting down these barriers one by one.  What’s funny is that we have all these pre-pregnancy books (see Mr. Apron’s blog for reviews) from the library, and not one says that checking out STM before you conceive is an important thing to do.  They’re too concerned with charting basal body temperature and supporting old wives’ tales about how to make a boy vs. a girl. 

It’s sad that these are the things we have to be concerned about when so much of becoming a parent is (I’m guessing here) about bonding with your ever-expanding belly, and, later, the thing that came out of it.  But it is important.  It lays the groundwork to let us have time to be with our children when they’re young.  And fill their eager minds with all sorts of poppycock designed to keep them safe and naive for as long as possible, or at least until middle school. 

Good luck with puberty.