Archive for the ‘Medical Crisis’ Category

Catholic Healthcare Comes To My Hospital: a “win-win-win-win” for Holy Redeemer Health System

July 14, 2012

Residents of southeastern Pennsylvania are dreading an arranged marriage.

Funny thing about that merger between Abington Memorial Hospital (where I have been a patient) and Holy Redeemer Health System.

The only people who are calling it a “merger” are the ones who had nothing to do with the decision. So far, these two hospitals outside of Philadelphia, PA (one a local Catholic health system, one a secular community hospital) are more tight-lipped about their new relationship than any recently divorced Hollywood starlet who takes up with a rock singer.

In an official statement dated June 6th, 2012, Abington Health announced plans to form “a new regional health system” with Holy Redeemer, saying, “Abington and Holy Redeemer are committed to providing information to the community as it becomes available.”

So they say.

“There are so many rumors because the hospitals have not been forthcoming. They’re not talking to the public,” says Rita Poley, an artist and curator living in Elkins Park who created a fast-growing Facebook page, “Stop the Abington Hospital Merger”, to oppose what the hospitals call the “new regional system”. The extent of the silence on the proposed “new organization”, which would bring Catholic health directives to a major secular facility, has shocked Abington staff, who did not find out about their board’s decision to pursue the partnership with Holy Redeemer until the news broke in the press.

The local public – especially the large Jewish community in the area – has a livid reaction to what everyone has termed “the merger”, despite the fact that the word “merger” doesn’t appear in any of the hospital releases I’ve received. Rather, in written statements, the hospitals refer to the move as a partnership, a “plan”, a “vision” and a “continuum of services”.

Why are we all so gol-darned upset?

This is big news here, but I realize that more far-flung readers may not know what I’m talking about. This short article from The New York Times, published last February, is a good introduction to the issue of Catholic-secular hospital mergers in the US.

Catholic hospitals, which serve a significant portion of the American public, operate by special guidelines that put religious principles ahead of medical ones.

The most controversial of these rules involve pregnancy (and pregnancy’s prelude) and the end of life. Directives from the US Conference of Catholic Bishops (USCCB) website govern the use of contraceptives, fertility treatments, abortion, and end-of-life choices.

Catholic hospitals prohibit the use of contraceptives or even counseling about contraceptives, aside from “natural family planning” between husbands and wives.

They prohibit abortion in almost every imaginable case, including the earliest stages of conception in the case of rape, life-threatening pregnancies that take hold outside the womb, and cases where the fetus will not survive on its own or be born with fatal defects.

They prohibit sterilization procedures for people who do not want to have children.

They prohibit many forms of fertility treatments, including those that would use a donor egg or sperm because this is undignified and “contrary to the covenant of marriage and the unity of the spouses.”

The Catholic edict of life’s sacredness, from conception to last breath, also means that Catholic institutions “will not honor” an advance healthcare directive (for example, what measures a person wants or does not want performed to prolong life) that they judge contrary to Catholic teaching.

“Any partnership that will affect the mission or religious and ethical identity of the Catholic health care institutional services must respect church teaching and discipline,” the directives say.

That last one is the problem here.

In considering the partnership, Abington, a nationally-renowned high-tech trauma center, agrees that they will stop providing abortions once the partnership is finalized next spring.

Statements from both hospitals attempt to minimize the abortion issue. They point out that according to Pennsylvania records, in the twelve months leading up to last March, in the five-county area of southeastern PA served by the hospital, Abington performed only 48 abortions out of 17,575.

Come on, admit it. Aren’t we all just making a mountain out of a molehill here? Women will obviously be able to find a clinic once Abington complies with Catholic directives.

That’s misleading, Abington physician Dr. Philip Rosenfeld told me in an interview this week. Dr. Rosenfeld is an ear, nose and throat specialist who has been practicing at Abington for 40 years, not counting his Abington internship and surgical residency.

He is disappointed that hospital statements would downplay the abortion issue in this way. He says that describing the statistically tiny number of abortions performed at Abington misses the point.

But why would an ear, nose, and throat doctor care? Unless a pregnant lady needs her tonsils out or something, what does Dr. Rosenfeld have to do with rules in the obstetrics department?

“It’s not just abortions,” he says. “It’s what should rule the hospital. Should it be ruled by someone’s religious convictions? The only thing that should guide your medical decision is what is best for this patient.”

Dr. Rosenfeld tells me that among Abington doctors and staff, opposition to the Catholic partnership is strident and unanimous.  From OB-GYNs to ophthalmologists, Abington doctors are as aghast at the prohibition of abortions as they would be if the Holy Redeemer directives stipulated that appendectomies were to be discontinued as immoral. That’s because, according to Dr. Rosenfeld, this edict touches more than the OB-GYN department: it affects the core philosophy of healthcare itself.

Abington is a secular hospital with a full range of healthcare services, Dr. Rosenfeld explains. “That’s the way we’ve always been, that’s the way we should be. Our orientation should be the patient, not anybody’s religion.”

Many outlets have already covered the fact that Abington is not your average abortion clinic. The number of abortions it performs may be statistically small, but they’re performed at the hospital for a reason. Many of them are emergency life-saving procedures, where women face death unless the pregnancy is terminated.

“Most of these abortions are not about family planning,” Poley adds. “Many of them are medical emergencies. If you’re going to take women out of the hospital, out of the care of their doctors, and say, ‘go to a clinic’, what kind of medical care is that? It’s outrageous.”

(This worthwhile blog post by a local doctor explains many possible implications for women’s care, should Abington comply with Holy Redeemer’s directive).

To drive the point home, Dr. Rosenfeld illustrates with a case two years ago involving a pregnant Holy Redeemer patient.

“She needed an emergency abortion. It was life-threatening. What do you think they did? They sent her to Abington. They wouldn’t do it there, even though they risked her life to transport her.”

Rita Poley was shocked by the Abington/Holy Redeemer news, and the way it was allowed to blindside the public and hospital staffers alike.

Rita Poley

“My daughter said, you know what you need, Mom? You need a Facebook page.”

With the help of a friend, Poley launched her Stop The Abington Hospital Merger page on July 3rd, and begin circulating a petition to halt the partnership.

About a week later, it had 25,000 views and 800 “likes”. The next day, unique visitors to the page was up to 36,000, and it topped 55,000 by the end of the week.  The petition garnered over 4,000 signatures in one week. As of July 14th, it had well over 5,000. Poley notes that support is coming in across religious lines.

While she was glad to speak up, Poley was unprepared for the deluge of community and local and national media attention that followed her decision to spearhead the opposition. “I’m like this little artist person,” she laughs of trying to balance all the publicity with her busy job as curator and director of the Temple Judea Museum.

The child of parents who owned a Jewish bakery in Philadelphia, Poley insists that she’s “not a regular activist,” but she’s no stranger to motivating for a good cause.

“My first activism was when I was nine years old. I wrote to City Hall to ask them to put a traffic light on a busy corner,” she remembers.

Poley is moved to protect the principle of community healthcare unbiased by religious dogma. But the deafening silence from the decision-makers disturbs her just as much.

The lack of public hearings, and a refusal by board officials to give interviews, worries her and countless other community members who want to know what’s happening.

In current statements, the hospitals say that despite traditional Catholic directives, Abington will continue to provide contraceptive services, tubal ligations and vasectomies, operate its well-known fertility clinic, and honor patients’ end-of-life directives and Do Not Resuscitate orders.

“Patients receiving care at Abington will have access to all reproductive health services except abortion,” reads a July 12th statement. “Abington Health’s philosophy and practices regarding end-of-life care will remain unchanged.”

“What does this mean?” Poley asks. Given the refusal of hospital officials so far to discuss anything further with the public, “what’s going to happen next month, in six months, or a year?” The demonstrated reality of secular/religious hospital mergers and Catholic directives across the US healthcare system, combined with the suspicious silence from the entities involved in this local tempest, make community members extremely nervous about what might be coming, and whether it might happen behind doors firmly shut to staff, the press and the community the hospital serves.

“There was not a word said,” Dr. Rosenfeld explains of the new partnership. “Everyone on the board had to sign a confidentiality agreement until the decision was released. And among the other people who had no idea was the chairman of the [Abington] OB-GYN department. He had no idea that this was coming until it came. He was blindsided by a cannon, basically. Nobody knew.”

To him, this is almost as sinister as the prospect of religious teachings, instead of medical expertise and respect for individual patients, guiding Abington doctors’ care.

“You can’t get through to the administration now with your opinion,” he says. “They’re not interested, they’re not responding. And that’s why [the press] can’t get through either. They don’t want to hear from you; they don’t want to hear from anybody.”

He urges community members to continue an onslaught of letters, phone-calls and e-mails to the Abington board. “Unless enough of the board members’ minds can be changed in the near future, this will go through to the great harm of the hospital and the community,” he says emphatically.

As a journalist, I wanted to balance my perspective. I don’t want press releases whose real purpose is to keep me at arm’s length, rather than inform me.

Someone close to the negotiations at Holy Redeemer spoke with me on the promise of strict confidentiality. This source described the partnership as a beneficial meeting between Abington’s “high-tech” and Holy Redeemer’s “high-touch” philosophies. While Abington is known for cutting-edge trauma treatment, Holy Redeemer is one of the largest and best-regarded hospice and long-term care providers in the region.

So I tried to get an interview.

I e-mailed Barbara L’Amoreaux, a spokesperson for Holy Redeemer. When she didn’t respond to my query, I called the next day.

I asked if she could connect me with anyone there for an official statement. She said she was just about to send me an updated release. I asked if anyone would give an interview, to balance comments from the opposition.

She said they were not giving any interviews, but that she would keep me in mind if that changed.

She also chuckled audibly.

The statement she sent confirmed that in partnering with Holy Redeemer, Abington would not perform abortions come spring of 2013. But the statement also reads that Abington will continue to provide “all necessary measures to preserve the health of the mother, including those that may result in terminating a pregnancy”.

I e-mailed again to ask for clarification on this point, but she didn’t reply.

Instead of denying interviews, Holy Redeemer might do well to revisit the USCCB directives.

“The possibility of scandal must be considered when applying the principles governing cooperation,” USCCB writes of secular/Catholic mergers. “Scandal can sometimes be avoided by an appropriate explanation of what is in fact being done at the health care facility under Catholic auspices.”

Before we ask that Abington and Holy Redeemer shut their partnership negotiations, we should ask that they open their mouths outside the boardroom.

“I can only conjecture on why they’re keeping quiet,” Dr. Rosenfeld says. “But for them, it’s a huge plus.” According to him, Abington is a profitable hospital, while Holy Redeemer is not: “this is Abington becoming their savior. Not only do they get saved economically, but they get their religious dogma as part of the entire institution. For them, it’s a win-win-win-win and why would they comment?”

“They know what they’re doing,” one of my neighbors said bitterly at the local train station this week.

As I interviewed Poley at a coffee shop a few blocks from each of our homes, the woman sitting at the next table, unnoticed at the time by Poley, slid a piece of paper onto our table before leaving the shop.

“As long as they don’t satisfy this community outrage, this will continue to fester,” Poley promises. “This will become more and more of a community effort.”

What’s your opinion? Do you go to a Catholic hospital? Why or why not? What has your experience been?

Update: on July 18th, among increasing community outcry, a statement was released calling off the partnership between the two hospitals. 

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Posted in Medical Crisis, Religion | 5 Comments »

It Would Be Better If I’d Never Been Born: Depression and Parenthood

June 5, 2012

Perennially controversial comic Sarah Silverman touched a nerve this week in a TV interview that set off a new round of commentary on modern parenting. The Week magazine rounded up the perspectives under the online headline “Is it irresponsible for the depressed to have children?”

Silverman, who has flouted the American habit of keeping quiet about personal struggles with depression, announced that the trouble has led her to decide that she doesn’t want biological children.

While she says she’d love to adopt, she says she won’t have biological children because she fears passing the trouble on to them. “I know that I have this depression and that it’s in my family. Every family has their stuff but, for me, I just don’t feel strong enough to see that in a child.”

Commentators, including contributors to the websites Mommyish and Jezebel, conceded that the choice to have children (or not) is a very personal one that, in general, should not be impugned by outside parties. Writer Anna Breslaw sympathizes with Silverman because of her own experience with depression. Since the latest science does indeed point to the fact that depression has a genetic component – people with immediate family members who suffer from depression (especially repeated bouts) apparently have an off-the-charts risk of developing it themselves – it’s not unreasonable that people who have experienced depression should think twice about conceiving somebody new.

Kudos to Sarah Silverman for talking openly about depression, and promoting adoption. But immediately after reading the commentary on her interview, I strongly felt that I had to speak up as a person who has suffered from depression on and off for about twenty years and still wants to start a family.

Fears of burdening our children with depression are a valid topic, but I’m afraid that this debate about whether or not depressed people should have children oversimplifies a lot of the issues.

I can’t speak for other people, but I can comment on my own long history with this terrible problem. Nowadays kids are stuffed with all kinds of drugs at the first sign of melancholy or distraction, but when I was a kid in the eighties and nineties, depression was not necessarily a diagnosis that parents and pediatricians were on the lookout for in very young people. But having carried cycles of the same devastating feelings from grade-school to my senior year of high school (when I saw my first psychologist), I know without a doubt that I was depressed as a young child.

The first major bout of depression that I distinctly remember (defined in retrospect, of course) was at about ten or twelve years old. Since then, I’ve cycled in and out of pretty severe depressive phases every two or three years, alternating with a fairly relentless case of generalized anxiety disorder. So I suppose that by the dictates of modern science, that makes me a pretty high-risk future parent.

By now, the symptoms of my recurrent depression are as familiar as a head-cold. My habitual anxiety loses its grip to a listlessness that infuses everything from my marriage to my work. Everything seems strangely drab and the things I usually enjoy, like writing, seem pointless. Whether it was school-day classes back then or days on the job as a journalist now, I feel a distinctive mental fuzziness and drift, as if I’m a hologram of myself and not really part of whatever’s happening around me. I find it difficult to maintain my customary focus during interviews, and articles that I can usually wrap up in an hour become a day-long effort. Putting my fingers to the keyboard feels like trying to touch the wrong ends of magnets together.

The thoughts that accompany these changes are as stupid and pervasive as reality TV.

I’m a failure.

The world would be a better place without me.

I’m always going to feel this way.

My joints ache as if I’ve got arthritis, I skip meals because I can’t muster the energy to cook or eat, and I don’t call or message anybody unless I have to. It all lasts several weeks at least.

I’ve been on lots of medications over the years, but I never saw noticeable improvement from any of them. Their most notable effects on me seem to be the flat-lining of my remaining mental and physical faculties and a burgeoning obsession with suicide.

Other people may find the antidepressants helpful and that’s fine. But now I stick to therapy.

One reason the don’t-have-kids-because-you’re-depressed viewpoint worries me is that it reduces depression to a factor of our genes.

The first problem with that is even if you’re genetically predisposed to depression, it’s not a guarantee you’ll suffer it. Secondly, “genetics” is increasingly becoming the answer of choice for so many disorders, when we really should be considering a range of environmental or situational factors in addition to our bodies’ hard-wiring.

When I was first diagnosed with depression, practitioners emphasized to me that I should view it like a medical illness that I have no control over. A big part of depression is undoubtedly rooted in our brain chemistry, so there is merit to this view, especially given the unfair stigma that depression sufferers continue to face from luckier citizens who believe that, given the willpower, one can just “snap out of” those desperately blue weeks, months or years.

But now that I’ve lived with bouts of depression for many years, I would say a key to managing it is realizing that, like many illnesses, there are measures you can take that make you more or less susceptible to its ravages.

Just as diabetics or heart patients or those with certain auto-immune disorders can avoid foods, lifestyles or activities that exacerbate their symptoms, folks vulnerable to depression should realize that their environment and actions can hurt or help.

My secret to managing those dark bouts is to keep working no matter what. That might not be right for everybody, but forcing myself to focus and be productive, even when it seems impossibly hard, keeps my demons at bay until some light seeps back into my existence, as it usually does after awhile, often as the winter turns to spring.

I am not at the mercy of my depression as a dictate of my genetics. It can be managed like a chronic illness. An awareness of having climbed up out of the depths before eventually helps me remember that the worst phases aren’t permanent. I try to dwell on this instead of dwelling on the hopelessness.

This is not to say one can simply wish oneself out of a depressive episode. And my experience may be milder than others’. But whether it’s you or your kid, I don’t think anyone should sit back and say, well, it’s just a matter of genes. The truth is somewhere between your genetic destiny and the environment and lifestyle you cultivate.

But I’m worried that that middle-ground truth is getting trampled if we declare that depressed people shouldn’t be passing on their genes.

Besides, what makes depression so special? We’re hardly calling for people with a family history of cancer or diabetes to eschew child-bearing.  Speculating on depression as a worthy reason for not having a family, when you’d want one otherwise, just seems to increase the disorder’s stigma.

“Sarah Silverman Considering Adoption Makes Me Respect the Crap Out of Her” is the headline of Alexis Rhiannon’s piece on Crushable.com.  Silverman’s comments on depression are part of a larger discussion on her support for adoption.

What I hope folks realize, as they debate her comments on adoption in light of her depression, is that adopted kids don’t have a blank genetic slate because you didn’t birth them.

Adoption is a fabulous thing. My own mom was adopted in infancy.  But I don’t think parents who adopt should do so assuming that their kids will then be free of problems. That’s a glib, de-humanizing view of adoptees, in my opinion. Everyone is predisposed to something. If you choose to try to avoid whatever medical boogeyman runs in your family, who’s to say something else doesn’t run in your adopted kid’s genes?

I accept that any kid of mine will have a heightened risk of depression. I hope that with sensitive and empathetic parenting efforts, I can recognize the signs and, with the help of my own experience and caring professionals, get my kids the help they need, just as I would if it turns out they have asthma or celiac disease.

I dislike the implication that life can’t be lived with depression. I and millions of other people prove every day that it can.  Like other illnesses, it has many dark days. But even if it’s recurrent, as my condition seems to be, it’s not insurmountable – whatever society says about people who are depressed. While I still fall into some pretty bad places sometimes, the bouts of depression I have now do not last as long, and are not as intense, as the ones I had a decade ago. I think awareness of my weaknesses, as well as my strengths, in addition to productive coping strategies, help over time.

If we took everyone who was ever depressed out of the world’s history, we’d lack for some brilliant writers, artists, thinkers and leaders.

The stigma of depression is surely alive and well if, by the time we’re discussing its possible genetic roots, we’re suggesting that it is better not to be born than it is to be at risk for depression.

I don’t buy that. So my future kids can take their chances.

P.S. check out “Adventures in Depression” at one of my favorite blogs, Hyperbole and a Half. 

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Posted in Feelin' Grumpy, Follies and Excrescences Involving Children, Medical Crisis | 10 Comments »

Enjoying Your Health Care, Supreme Court Judges? You’re Welcome.

April 23, 2012

A well-cared-for bunch.

I’ve been lucky for several years – and by lucky, I mean that by eking $350 a month out of my tiny salary, I have had access to most of the medical care that I need.

I worked a decent job my first year out of college (this was 2007, mind you, right before everything went to hell) which offered an insurance plan. When I left that job, I continued that insurance through a provision of US law known as COBRA, which allows people to retain their health care for a certain number of months from a former employer, if they pay the full cost of the insurance. It’s expensive as hell, but when you have a tricky chronic illness like I do, better than nothing.

So I paid COBRA til I landed my next job, which, happily for me, came with health insurance. Eighteen months ago, I lost that job without warning, but continued the insurance policy out of pocket. Now my time has run out.

I know some of you, my valued readers, are joining us from outside the US, from places where, perhaps, there is a modicum of humanity and reason in the health care system. Here’s how it works over here.

Got health insurance through a traditional job? Great.

Are you self-employed? I’m sorry. I hope you have several hundred dollars – or even thousands, if you want to insure your family – per month to spare for insurance premiums with deductibles of at least a few thousand dollars. Oh, you’re not rich? Hm. Well, that’s too bad. I hope you don’t break a leg or get cancer or anything.

Because here in the great United States, you’ll probably die before you can come up with the money for that care on your own.

What a lot of people in my position do is cross their fingers and wait. But most of my impecunious twenty-something friends have fallen under the health-care axe sooner or later – often through bike accidents or broken limbs. When folks like them can’t pay the bills, these costs get spread through the system, causing higher costs for care and insurance for everyone else.

My husband is uninsured, but he’s only been sick twice in about five years.

I brought him to my own doctor once, even though he was sans insurance, because he was having chest pains (fortunately it turned out to be a muscular injury). The appointment involved the doctor listening to him with a stethoscope and asking him questions for ten or fifteen minutes. The bill was $170.

A few years later, he got a severe case of tonsillitis. He had a high fever and couldn’t eat. We were in South Africa, so we found a neighborhood clinic and he got a doctor’s consultation, an immediate penicillin injection, a course of oral antibiotics, painkillers and restorative vitamins all for about the equivalent of $40.

That’s less than the copay for one prescription fill of my daily medicine on my current insurance policy.

My husband doesn’t like being uninsured, but he takes it in stride. The prospect of losing my insurance next week is terrifying, because medically, I ain’t doing so well.

I don’t engage in dangerous activities, smoke or drink. But I have a very painful chronic illness whose symptoms are manageable with daily medication. I’m currently trying to stop taking it every day, in preparation for when I may not be able to get it at all. Because that’s another common gem of the American health-care system. You had that condition before you bought this policy? Sorry, we don’t cover any of THAT care.

Next week, if all goes well, I’ll be purchasing a new policy with a premium of a few hundred dollars a month for my husband and me. This’ll cover five doctor visits per year (with a $30 copay for each). If one of us ends up in the hospital, we’ll be responsible for 40% of the total cost, after a deductible of a few thousand dollars, of course. Non-generic medications?  As if! Maternity care? Don’t be ridiculous. But this is the reality of what we can afford (and there is no guarantee another plan will agree to cover me at all or that I could pay what they decide to charge, based on my history).

We’re willing to scrape about $3,000 a year out of our budget so that, God forbid, if one of us ends up in the emergency room, it’ll be a crisis to the tune of $350, not bankruptcy.

Of course, a lot of Americans are foaming at the mouth right now because the infamous President Obama thinks he can patch things up. The US Supreme Court is now debating whether Obama’s new healthcare law is allowable under the Constitution.

Obama and many liberal allies want to improve Americans’ quality of life (or, depending who you ask, take over the world in his dastardly big-government socialist grip) by making sure that the rich or those with job-related insurance are not the only ones with health care. Obama also wants people to be able to access care for conditions that existed before they obtained their current insurance policy, and he’d like to prevent insurance companies from taking people’s money while they’re healthy, and then revoking their coverage when they get sick (another shining gem of health care in America).

Sounds great, right?

NO! Say conservatives.

Why?

To help insurance companies realistically bear the costs of better access to care for everyone, no more would people like my healthy husband be able to opt out of buying insurance. Everyone would be required to buy it, with government subsidies available for those who can’t afford it on their own.

Excellent, say most liberals. A huge influx of healthy new insurance customers will balance the increased costs of sick people’s care. And besides, nobody ever makes it through life without getting sick or hurt. When it happens to uninsured people, those costs are still borne by the larger system and ultimately passed on to all of us. Let’s make every individual responsible for this human inevitability.

This is an American tragedy! Say most conservatives. How can there possibly be a Constitutional basis for forcing every American to buy a certain product? It’s an unprecedented government intrusion.

Federal legislators narrowly passed Obama’s law. Individual states with conservative majorities challenged it in court. And now the nine justices of the US Supreme Court, five of whom lean conservative, and four of whom lean liberal, are going to decide the issue once and for all.

Political writer Paul Begala, in a recent Newsweek Magazine/Daily Beast column, applauds Obamacare – or at least denigrates the conservative Justices (no surprise there – his pieces are usually a mix of liberal cheerleading and big-time political name-dropping).

He echoes what a lot of commentators have noticed about the Justices’ arguments. Conservative Justices see a slippery slope: if the government can force us to buy health insurance, who’s to say it can’t then force us to buy cell phones, burial insurance or broccoli?

It’s bad enough when your parents tell you to eat your vegetables. But the President? Ouch.

Begala points out an obscure 1792 law signed by George Washington requiring every white, able-bodied man between 18 and 45 to purchase a musket and ammunition. Clearly, the Founding Fathers imagined a Constitutional precedent for forcing us to buy something for the good of the nation.

Begala says it’s ludicrous to compare burial insurance to health insurance in this context: “we don’t have a burial-insurance crisis in America.” A lack of burial insurance is not bankrupting American families, eating up 17% of our national budget each year, and leaving Americans to die – as in one recent California case Begala cites, of an uninsured man whose appendix burst when he put off going to the doctor, afraid of the cost –  because they can’t afford medical care.

I’m glad the Justices are there to decide this question in the best interest of the American people, according to our laws.

Were I on the Supreme Court, I would have to recuse myself immediately. In fact, I’m so personally biased I probably shouldn’t even be writing this blog post, in case my simple, self-pitying, ham-handed analysis influences anyone’s opinion.

Unlike the impartial Justices, I lose a lot of sleep to dark worries about what’s going to happen to me when my current insurance runs out. On bad days, I wake up to a forest fire under my skin and lie there wondering if I should take my medicine today, or save the limited supply for a day that might be worse.

The Justices, as well as their legislative colleagues, probably don’t have these worries. As Begala points out, the health care of uninsured people in America adds over $1,000 per year to the policies of those who buy insurance, but Justice Samuel Alito dismissed this as a “small” concern.

Perhaps he only thinks it’s small, Begala says, “because as a government employee his health-care bills are paid by We the People.” Indeed, the ones in charge of the nation’s health-care policy enjoy remarkable health-care themselves.

As Congress furiously debates the so-called Buffett Rule, a liberal election-year stunt which would up millionaires’ tax rates to thirty percent, I watch and shrug. Between my federal, state and local taxes as a self-employed person, thirty percent is about what I pay. As a freelance journalist, I suspect that that 30% hits me a little harder than it would hit Presidential candidate Mitt Romney, who paid about 15% last year on his $250 million fortune. I’m putting off grocery shopping till my next check arrives, and he’s installing an elevator for his cars in his $12 million villa.

But when I pay my taxes every quarter, I imagine myself paying for police and traffic lights and sidewalks and Grampa’s social security, and I don’t mind too much.

Congress and the Supreme Court Justices apparently have no problem with requiring us to pay taxes. Since our taxes support their top-notch health-care plans, I guess the principle is this: it’s ok to require me to pay for YOUR health-care, but heaven forbid I be required to pay for my own.

When I whined intemperately about my woes on Facebook this week, a friend replied sharply with her own suggestions, including getting family to lend money for my care, or pawning my belongings. Or I could “register as poor and go to a free clinic.” She also suggested going to Canada or England so I could get my care for free.

My generous parents have helped me to get care when things were really desperate, but that’s not a sustainable solution, and I’m an adult who doesn’t want to ask. I do have some nice wedding gifts stashed away – maybe a lovingly given crystal pitcher could pay for a round or two of meds, but the thought makes me sad. I bet a free clinic could patch me up if I sprained an ankle, but even experienced practitioners frequently know nothing about my medical condition – it’s not very common and is poorly understood. I respectfully doubt that a free clinic is equipped to deal with me. Maybe another country would take me in, but airfare’s pretty expensive. Plus, on a system-wide level, I bet taxpayers in those countries wouldn’t view my care as “free”.

I do deserve a lecture, for making such a public show of my problems while also shooting down well-meant suggestions. But I’m writing this because I bet many people can relate to my situation, and no-one – from my Facebook friends to my doctor, who recommends physical therapy at $100-$400 a month (from a practitioner who does not take insurance at all) – has provided a viable answer.

Good luck, Supreme Court. You could never trust me to figure this out, and besides, I have enough to worry about.

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Posted in Medical Crisis, My Worst Fears | 11 Comments »

The Violation of the Bishops

February 12, 2012

Timothy Dolan, President of the US Conference of Catholic Bishops (photo from the LA Times)

Just in time for Valentine’s Day, America’s President and one of its most prominent religious groups have launched a brawl that reminds us yet again what a royal pain women are. They can get pregnant – but even worse than that, nowadays, they can decide whether or not to get pregnant.

This week, Obama drew the ire of the United States Conference of Catholic Bishops when he announced that Catholic-run institutions – such as schools and hospitals which serve and employ people of all backgrounds – could no longer deny their female employees insurance coverage for contraceptives.

Perhaps I shouldn’t read too much into it, but I can’t help it. I infer that Catholic employers welcome only those females who are abstinent, pregnant/trying to become pregnant, or infertile/menopausal.

The official line from the Catholic Church is that birth control is immoral – God wants you to have as many babies as possible, so United States public policy should not promote or enable contraception. Never mind that repeated polls on the topic of contraception in America reveal that a majority of voters support the availability of birth control, and that a huge percentage of American women (up to 99%, according to some sources), including Catholics, have used it. In current polls on this particular Catholic health-care fracas, even a majority of Catholics themselves believe that these institutions’ employees should have access to birth control. Even a Fox News poll shows that a majority of those asked support Obama’s mandate.

This is probably because, if you ignore the outrage over religion for a minute, a giant US employer is denying its staffers important health care, which other employers routinely offer, for reasons that are not practically, financially or legally based.

This hasn’t stopped Republican Speaker of the House John Boehner, as well as the Republican Presidential candidates, from trumpeting that they will not abide this terrible intrusion upon America’s freedom of religion.  Some Democrats in Congress have agreed that the Catholic institutions should not have to pay for insurance that covers birth control.

Our Founding Fathers obviously thought freedom of religion was important – it’s the first item up for business on the US Constitution’s Bill of Rights, first line of the First Amendment:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.

I’m no Constitutional scholar. But here is my understanding of this sentence:

The Bill of Rights in stick figures.

Ok, I get it, the waters here are tricky. By telling Catholic employers that their health-care policies must cover contraceptives against their sacred moral convictions, isn’t the US Government making a law that forces a particular religious group to curtail the practice of their religion?

Perhaps government has no right to make any kind of mandate about what employers or insurers should or shouldn’t cover (anyone opposed to Obamacare can explain it to you). Why should Catholic-run institutions have to offer insurance that covers birth control, when they’re morally opposed to it?

For my part, for all the screaming about Constitutional protections for religious practice, I’m still not convinced that the bishops’ stance falls under the protection of the Bill of Rights. As far as I can tell, Obama is not mandating that anyone become Catholic or not become Catholic (“no law respecting the establishment of religion”), and he’s not curtailing the ability of anyone to practice their Catholic faith (“prohibiting the free exercise thereof”).  What he is curtailing is the ability of a Catholic employer to press its beliefs on non-Catholic employees (or, as polls suggest, Catholics who use birth control despite the word of His Holiness).

But because politicians and the US Conference of Catholic Bishops can howl much louder than average Americans who support fair insurance practices, Obama has suggested a compromise on his mandate. Instead of the Catholic institutions paying the cost of the health insurance that provides birth control, the insurers used by these institutions will instead be required to pick up the tab for the Catholic employees’ contraceptives. That way, Catholic institutions are not being forced to pay for something they find immoral.

Of course, this hasn’t dampened the rage one bit. The bishops still find the whole thing wretched, because in the end, the women their church employs will still have easy access to birth control, and that is what the bishops can’t abide.

It’s clear to me that in this case, “freedom of religion” in fact means the freedom of powerful Catholics to press their beliefs on others. And here we have the extraordinary proposition that religious devotees are not truly free to practice their religion unless they’re also able to force others to comply with their beliefs.

Because no-one is more qualified to decide what happens to ordinary working women’s ovaries than a group of powerful, celibate men.

Some Republicans insist that Obama’s compromise is not feasible because it’s unfair to burden the Catholic institutions’ insurers with the cost of birth control coverage. It only adds to an already over-burdened system and will drive costs up for everyone. But this isn’t realistic. Most insurers already cover contraceptives. If you were to ask the insurers of the female employees of Catholic-run institutions if they could bear to cover the cost of those women’s birth control, I bet the only problem would be that the insurers could not say “yes” fast enough to quell their fears that the women would become pregnant on the insurer’s dime.

Many news stories on this topic report that the bishops’ rights or freedoms have been “violated”.  Just as American and European politicians should stop likening ideologically opposed colleagues to Hitler, let’s not pretend that Catholic bishops are in any way “violated” by a woman’s having access to birth control. Insurance policies are being required to offer contraception coverage to American workers regardless of their employers’ religious beliefs; it’s not as if the bishops are being forced to organize anti-child rallies in the candlelit bedrooms of women who use Nuva-Ring. Last time I checked, my choice to avoid pregnancy does not stop any bishop anywhere from living his life as he chooses (unless, of course, the life he chooses is a mission to control my reproductive health – but especially since I don’t work for him, I doubt he has legal grounds for that).

Here are some diagrams for you:

Reality.

Reality.

Reality.

Now that I said all that, I don’t actually believe that this whole mess has anything to with an investment in protecting Americans’ sovereign rights. Just imagine the uproar if the large-scale American employer in question was Muslim instead of Christian, and denied its employees coverage of some sort of preventive medical care to which devotees of Islam are opposed, and Obama pronounced that this Muslim-run employer had the right to arbitrate its employees’ access to medical treatment according to the employer’s religious beliefs.

All the happy inter-faith community centers in the world could not drown out the screams of “Sharia!”

In truth, it’s all about who’s powerful and popular in America (Christians), and who’s got a lot of money and government lobbying power (Christians).

Like I said before, let’s face it, women are just going to be a problem either way. Between paying for the care associated with childbearing and paying for birth control, insurers will always choose the latter, and those darn women will go on continuing the human race (or not), no matter what the bishops or the health care system has to say. Meanwhile, the majority of citizens in a democracy support public policy that makes birth control easily available – not to mention the importance of some forms of birth control in preventing deadly infections. If you also believe that the US Conference of Catholic Bishops has more of a voice than it should in American health-care policy, feel free to share this essay.

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Woman Are Bad Drivers, and Other Things My Doctor Told Me

March 12, 2011

Next week, I am doing the closest thing on earth to actual spaceflight. In the near future, people who are rich enough are going to blast into space for the fun of it. But we can’t just bundle them into a shuttle and begin the countdown. For a magazine story, I am taking a civilian training course on the physiological effects of being shot into space, including a ride in a giant centrifuge that simulates the g-forces of a sub-orbital rocket. I plan to pretend I’m Jim Lovell in Apollo 13 (minus the whole Houston-we-have-a-problem thing).

But before I take my ride, the Federal Aviation Administration insists on making sure the G-forces won’t kill me. I have to get a special medical certificate from an FAA-approved doctor. I called the first Philadelphia doctor on the FAA website.

I apologized for the short notice, but asked if I could get an appointment before the 17th of March.

“Oh, St. Patrick’s Day!” said the doctor.

“Yes, I guess it is.”

“That’s a good day!”

“Yeah, I suppose it is.”

“How about ten o’clock tomorrow?”

My husband agreed to come along, and we set out in his car the next morning in the pouring rain.

The doctor, retired except for FAA medical exams on aspiring pilots and G-force journalists, met us at the front door and ushered us into his spacious living room, where a cooking show blared on a small TV. Lala sat down, and the doctor and I went into a home office complete with a Mac and four or five pairs of the glasses on the desk, a scale, a vision chart, a bowing shelf of cookbooks, and a framed photo of the Pope watching over it all.

He settled me in a chair by the desk and handed me a medical form.

Seemed like pretty standard medical stuff, except for the boxes asking how many hours I’d piloted planes. He indicated the areas I needed to complete, and watched my answers with interest.

“So you’re a writer,” he said. “Pretty good with the English? I mean, what the Americans call English. Such a shame how they’ve bastardized the language.”

If I was Bruce Banner, this is where I’d turn green. My pen froze and I found my finger in the air like a sailor testing a dangerous wind. “American English is a perfectly legitimate evolution of the language,” I declared before I remembered my inside voice.

“Ooh, I kid, sweetheart, I do. I love America – I’m an American, meself, now.”

I subsided to writing down my medication.

“A lovely language, wherever it is,” he said. “But the Irish do speak the best English in the world.”

“They do? I’ve never been to Ireland.”

“Oh, haven’t you! Well you must go. It was the Irish taught the English how to speak.”

“Did they?”

“Oh yes. You know, the best writers in the world are Irish,” he added slyly.

“I was just reading some Frank McCourt this week.”

“Oh, McCourt.” He shook his head. “He died last year, God bless him, he were a professor in New York and all, but do you know, he didn’t do well back in Limerick.”

“He didn’t?”

“No, not popular a-tall. I grew up in Dublin, see, at the same time. Folks in Limerick think badly because none of it were true.”

“Really? The whole miserable, Irish, Catholic childhood thing?” I wanted to believe him – from Angela’s Ashes to Teacher Man, I had always found McCourt to be a bit of a whiner.

“Oh, he did. I tell you, I’ve been in Limerick and it’s nowhere like he said it were – dirt everywhere and people pissin’ in the gutters and all of that. No, he made it all up. Now tell me about yourself.”

I gave the short version of my hometown, college, and writing career.

We debated the merits of Marylanders versus Philadelphians (“people in Maryland are the loveliest people in the world”), and then he unfolded the tales of his daughters, one a fat, short sweetheart living in Dublin and the other a sweetheart doing PR for Vegas casinos, who once brought the doctor to a three-day press event for gourmet chefs in New York City (“and I tell you, all the food was free!”), where he met that siren of the Food Network, Giada De Laurentiis (“such a sweetheart, that girl, let me tell you, a real real sweetheart”).

He took my weight and then perused my forms. “What’s this medicine here, then?” he asked.

I explained that it treats an unusual condition called Interstitial Cystitis, which causes ulcers in the bladder. There is a website that says I am Strong, Caring, Courageous, Smart, Determined, Thoughtful, Generous, Hopeful and Loving despite my Interstitial Cystitis. I rarely visit it.

He waved the Interstitial Cystitis away with his hand. “Oh but that’s nothing,” he said. “Of course most women have some kind of problem, you know, like that.” I waited for the inevitable next line, uttered by every non-urologist who ever learns my secret. “You know what you need. You need some of that red stuff, you know, what is it…the juice that’s red.”

“Cranberry juice?”

“Yes, yes, that’s the ticket.”

“Thanks, but cranberry is actually very bad for Interstitial Cystitis.”

“Well. That is quite a fancy diagnosis you’ve got there.” He considered me afresh over the rims of his glasses.

“Now what is the problem with your eyes?” he asked.

“I’m near-sighted and I’ve got pretty bad astigmatism.”

“But what is astigmatism?” he pressed.

“An irregularity in the shape of the cornea?”

“But what does it cause?”

“It causes a fault in the angle of the light through the lens?”

“I know what astigmatism is! I’m a doctor!” he barked. “It causes poor depth perception!”

It is certainly true that I can’t catch anything thrown to me when I’m not wearing my glasses.

“Well, take them off then and tell me what you read on that eye chart.”

“What’s the first letter?”

“E.”

“Very good. And the next two letters?”

“I don’t know.”

“Oh, try to read it – you must be able to read it.”

I squinted and strained. “I really can’t read it.”

“Well now, that’s a problem, isn’t it, because I can’t give you your certificate if you can’t read that line.”

I imagined my editor slumping in his chair, sighing in disappointment because he could not publish a story about what it’s really like to ride the simulator.

“Don’t be afraid of the chart,” soothed the doctor. “You can do it. Go ahead and lean in. Close one eye and squint. You have to be able to read that line.”

When your body fails you at moments like this, you have to be resourceful. I had seen the chart with my glasses a few minutes ago. What had those letters been? An “F” and a “P”, I was almost sure. If I was right I had a 50/50 shot. That first blur could be an “F”.

“F?”

“That’s right, you’ve got it! And the next?”

“Uhhhh…..P?”

“Oh good girl, you’ve got it! I knew you could read it.”

I assuaged my conscience with the thought that I am never going to actually fly a plane- just ride a simulator – and therefore am not endangering anyone.

I put my glasses back on and reeled off a much smaller line with ease.

“You know you’ve gone from 20/100 to 20/20 with your lenses?” he said. “It’s been a long time since I’ve had eyes as bad as that in my office.”

Perhaps that is because people who aspire to become pilots generally aren’t the people who go around patting down the bedroom after they get out of the shower, because they cannot see that their spouse, as a joke, has had the glasses stuck in his waistband all along while he pretends to help look.

The doctor resumed my chart.

“Your periods, now, no problems there?” He leaned in conspiratorially. “You know some people, especially the old ones back home, what do you call them, chauvinists they are, would say that the, you know, the PMS and those kinds of women’s gripes are just the ladies whining because they want to lay about and not get to work.”

“How unfortunate that anyone would say that.” My voice crept near the bastardized-English levels.

“Yes, yes, well that’s the chauvinists, it is.” He buried himself in the form and then his gaze popped back up.

“And where,” he burst out, “do we get the meanin’ of the word ‘chauvinist’?”

I gave it serious thought and came up empty. “I don’t know the etymology of that word.”

Whether or not he knew it will remain forever a mystery. “I like the way you speak,” he announced instead.

“You know,” he continued, “You remind me of my granddaughter. 21 she is, out in California. Such a sweetheart. We have secrets, you know. She tells me things because she knows I won’t tell anythin’ to anyone else.”

He moved in with a stethoscope and blood pressure cuff, rhapsodized over my perfect blood pressure and heart rate, and checked my ankles for swelling.

“Well, my girl, do you ever want to fly?”

“You mean like be a pilot? No, never.”

“Why not?” he demanded.

“I guess I wouldn’t want that responsibility,” I replied lamely. “I’m happy to let other people fly, and I’ll write about it.” He seemed inordinately disappointed for someone who just watched me straining to read an inch-high “P” at twenty feet.

He bent over my forms and poised his pen to sign the last box, but his eyes popped back up.

“What d’ye drink?”

“I don’t really drink,” I said.

“You say you don’t drink a-tall?” He said, eyes round. “Whyever not?”

“It’s very bad for the Interstitial Cystitis.” No Sea Breezes for this little trooper. (Is there anyone else out there who has this condition who does not use a kitten or a fairy for her profile picture and who sometimes leaves the house instead of covering online message boards with litanies of her pills? If so please, please contact me.)

“Ah. Well, well. The Italian food is what gets me down, you know the sauces and the salsas and all of that. But I tell you what you do. Put some sugar on your pizza, and it’ll go down very nice.”

He rolled a small yellow certificate into a typewriter and began to peck. “Spell your name again for me, sweetheart.”

I spelled it.

“Now tell me,” he said, pointing to the next room, “if your husband there was a woman, would his name be ‘Mabasa’, you know with an ‘a’ instead of an ‘o’?”

“No, in South Africa last names…surnames…it works the same as it does here. The name is the same whether you’re a man or a woman.”

“I see.” His gaze sharpened. “And what do they call the last names down there?”

“Surnames. They speak more British-style English there.”

He nodded with evident satisfaction, and turned back to the typewriter.

He typed a few letters before the chair swiveled again. “D’you watch Bill O’Reilly?”

“No.” I said. “I mean, uh, I don’t watch much TV.”

“Ay well that’s best. Best not to go into all that, it is. Me daughters and me, we get all into it, we do, going every which way, those politics. Yes, yes, best not to go into that.” He typed a few more. “And d’ye know that other fellow on the TV, Brett or Ben his name is, the one with the glasses, I don’t suppose you…?”

“Glenn Beck?”

“Yes, yes, that’s him. Now that man, that man I think could stand to calm down a little bit.”

“I do think that would be best for everyone.”

“And how do you like grammar? I bet you’re a stickler for the grammar.”

I replied in the vein of a relative grammatical moderate. While incorrect spelling practically gives me hives, I am less interested in a rigid enforcement of grammar.

“They just don’t teach it in the schools anymore,” he sorrowed and returned to the typewriter, but not for long.

“That Bill O’Reilly…the year of the Chosen One, do you…well perhaps I ought not….yes, well, anyway.” He subsided to his typing.

He finished, extracted the certificate, and poised his pen over the signature box.

“Ooh, look at that now,” he exclaimed, pointing to a photo of himself with a magnificent German shepherd on his computer desktop.

“That’s my daughter’s dog. My daughter married John, and John is jealous, you see, because the dog loves me more than he loves him. All I have to do is look at him, like this, and he come right over to me. But here’s the secret! John doesn’t know I keep the treats right here in my pocket!”

“So he’s your grand-dog,” I said.

“Ay, he is that, my grand-dog!” He went into a convulsion of mirth, slapped his thigh, and then remembered his pen.

“Now I’ll sign with a bit of a flourish, how’s that?”

“Please, the more flourish, the better.”

“Now, which should it be, corrective lenses or correcting lenses?” he asked shrewdly, holding the certificate aloft.

“Well, ‘corrective’ is how I’ve always heard it,” I say. “but I guess ‘correcting’  is also correct? One’s an adjective and one’s a participle?”

He handed me the certificate and I signed in the box marked AIRMAN’S SIGNATURE.

“I like the way you use the language,” he declared, and I knew it was high praise. “Now do you do your writing, your articles and such, on the computer, like?”

“I do.”

“So you know how to use the, what is it, the office thing, the documents?”

“Microsoft Word?”

“Yes, that’s it!”

“Yes, I know how to use it.”

“I just got mine yesterday. The nicest young man was here and he showed me how to do it. But now I just don’t know how to open it and all. D’you know how to find where it is?”

“Well, let’s see.” I took the mouse.

He was lucky. My technological expertise is pretty much limited to Microsoft Word and showing people over fifty how to adjust the volume on their cell phones.

I showed him how to find Word in the Start menu, how to create a document, save it and find it again and delete it.

Delighted, he thanked me, and we joined my husband and Giada in the living room. “Now who’s driving home?” the doctor asked.

“I am,” my husband replied.

“Oh good,” the doctor said to him. “You know the ladies, they’re terrible drivers.” He clapped my husband on the back as he ushered us out with utter bonhomie. “Ooh, but we kid. That’s only what the chauvinists would say. Enjoy your ride and please do let me know how it all turns out!”

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THE LUMBAR EMERGENCY

September 3, 2009

When you’re alone and gripped by sudden, incapacitating agony, what else is there but your purse?I have been mocked by more than one man for the variety of things I find necessary to stash in there. The wisdom of always having something to read, a notebook, an umbrella, a wad of napkins, an extra bus token, gym pants and a piece of fruit, in addition to keys, wallet and cell phone, seems to escape most men.

With husband out of town, I gathered the aforementioned items (and really, that list only scratches the surface – or unzips the pocket, so to speak) in preparation for a double-shift Saturday downtown. As I bent over the couch to stuff a clean work polo into the purse, there was a pop in my lower back like the crisp, tender snap of a raw string bean.

My next conscious thought was worry that the upstairs neighbors would hear the incoherent howls of pain and call the authorities. I suddenly knew, without a doubt, that life as I knew it was over. I would forever remember this bend over the couch as the moment when I went from an active life of work and gym, theatre and feeding the fish and scribbling borderline inappropriate blogs to a life of total, excruciating immobility right here on the arm of the couch.

Could I bend forward a bit? NO. Could I arch my back a bit to relieve the blowtorch fixed on the muscles of my lumbar region? NOOOOO. Could I just…get…onto…my…knees…in preparation for someday, somehow, lowering myself onto the carpet? YAAAHHH! I think I’m crying, yes, I’m crying.

What do I have at hand? Well! Everything, it turns out. There, in arm’s reach, is my purse. Phone. Dial my boss. Gasp something about not being able to work today. Still on my knees, I cling to the arm of the couch like a shipwrecked sailor. What else is in my purse? A bottle of Advil! Can’t take that on an empty stomach…Aha! An apple! I crunched the apple between spasms of anguish and swallowed a few pills with the last bite. What else? Ah, William Makepeace Thackeray’s “Vanity Fair”. That is thick enough to support my head, if I could make it down to the carpet…

I could tell you how I finally made it into bed, and how, later, I picked up the laptop and brought it to the bedroom, but why recount such a blubbering odyssey of pain? Everything more than one foot away might as well have been at the bottom of the Grand Canyon. I brought a few apples into the bed, along with Thackeray and the cell phone. Fortunately I stash novels all over the house, and I also had my pick of Stephen King, Charlotte Bronte or Arthur Golden. By 3pm the apples were eaten. I updated my Facebook status, pecking at the keyboard as best as I could flat on my back, so friends could infer how my life was hanging by a thread. I accessed my Netflix account and found BBC’s “Pride and Prejudice.” It’s a testament to the depth of my pain that I was unable to enjoy it. A lonely girl in possession of a large back pain must be in want of narcotics…hang Lizzie and Jane and Bingley and all the rest.

My mother called. My puling refusal to request any help from local family only resulted in a call put in to my aunt in Willow Grove. Who knew such wracking, searing pain could follow an attempt to sit up? The torture of standing up can’t be decently described herein. My ears rang, a cold sweat dampened my shirt, and I grasped the sink in acceptance of my fate: throwing up, and then a swift, undignified death on the bathroom rug.

I did not throw up, nor did I die. I staggered back to bed. My aunt Judy arrived, bearing a sandwich, a smoothie, and an ice pack. Since these things never happen on a day that the doctor’s office is open, we were soon off to the hospital.

Intake. I thought my feet looked stupid on the angled footrests of the wheelchair, but it was too painful to shift them. The intake technician typed that I “claimed” not to abuse alcohol or drugs, handed me the paperwork, and wheeled me to the blood pressure station. I saw the young woman who had had her blood pressure taken before me – nothing obviously wrong with her but a cough. Great. On top of everything else, I’ll catch Swine Flu. Then to a bed whose curtains seemed designed to puff out with each passing doctor, offering everyone at the nurses’ station an excellent view.  And of course, the final humiliation of donning a faded, gap-reared hospital gown with haphazard, unreachable snaps and a front pocket advising everyone to “wash your hands.” Forget high emergency-room co-pays. That gown should be enough to deter anyone from seeking medical help.

“Well well, I see by your paperwork here that you injured your back when you bent over your coach,” the bald doctor giggled as he threw back the wafting curtain. Addled by pain and having escaped part of the awful day in the early 19th century with the company of Becky Sharp and Miss Crawley, and Austen’s husband- grubbing ladies, all of whom undoubtedly schemed in coaches, this seemed sensible. “There’s a typo on your paperwork,” the doctor crowed. He made me stand and poked energetically at my lumbar vertebra. “Ow. OW.” “Well, you expected that to hurt,” he said.

“I see you hurt your back leaning over your coach,” quipped the next arrival, who made me roll on my side so he could poke my back. The nurse was more sympathetic. “Is the pain shooting down your legs at all?” she asked. She returned with an orange pill and a cup of water. “Can I go home now?” I whined. “You’ve got to wait twenty to thirty minutes, to see if the diazepam works,” she said, shoving the scanty curtain briskly aside as she left. I made an agonizing progress to the ladies’ room, during which the humorous bald doctor handed me a cane. I wish I had told him that it wouldn’t fit in my coach.

I sat on the edge of the bed, unwilling to bear the spasms of any further motion. Were my eyes just closed? Gosh, that felt good. I wanted to lay my head down. I yawned and yawned again. Where could I put my head? Why, there’s a pillow. No horrific spasm as I scooted down until I was prone on the bed. Yawn. YAWN. Bring me my coach. Or was that couch?  Now Judy had sheets of paper authorizing bottles of Vicodin, diazepam, and 600 mg pills of Advil. Two sensations on the ride home: gratitude to Judy, and a powerful wish for a beer. It was hard to get the key in the door handle of my apartment. Right side up or upside down? How does it fit? Into bed again, broad ice pack cool under me. The cell phone rings. What is it you say when you pick up the phone? I’m floating. Or am I asleep? Does it matter? Not a bit. I might, just might, be able to stand up tomorrow. There is room for a few extra bottles in my purse.

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