The Cost of Healthcare

blood pressure

“Why don’t you just go to the doctor?” my husband asks after hearing my chest crack and pop.

“It’s complicated,” I moan in pain.

Maybe he doesn’t know about the extent of my white coat syndrome and that merely making an appointment makes my heart race and my palms get sweaty. Or that as a kid, I never went to the doctor outside of ingesting a battery or being covered with purple lesions.  And if we did go, it always resulted in the occurrence of something uncomfortable or more painful than the original issue.

As an adult, there is little difference except that now the pain comes from the initial cost of the copay and then later the portion of the bill not covered through insurance.

“It’s all explained in your insurance policy,” the customer service rep explains. “You know, in the really fine print. You agreed to pay for anything not covered when you signed in to see Dr. Gulash.”

Trickery and crooks! I scream in my mind, and then passively settle on a monthly payment of six months to pay off the balance.  It’s easier than taking a stand and getting sent to collections.   The bitter sting of that bill is still on my mind as I refuse to get the cracking and popping evaluated, not just yet anyway.

Let’s follow the journey of Papa Puney who decided not to wait until there were no other options and his proactive approach to his healthcare.

Papa Puney is fit man in his fifties; he sits in a hard plastic chair at the doctor’s office, off to the side and away from the sick people. There are stacks of germ covered magazines next to a pump bottle of hand sanitizer.  It’s a nice gesture but too little too late for most.

He calmly waits and peruses through emails and Facebook on his phone.   He has been working to lower his blood pressure through diet, exercise and limiting his views on the Donald’s latest tweets.   He moves his upper lip unconsciously and the mustache above it bristles out, not unlike a well groomed porcupine, as he flips through the online posts.

A young woman with dry, dyed black hair pops her head out of the door next to the receptionist’s desk.

“Mr. Papa Puney?”

She holds the door open with shiny, red nails. The man looks up in acknowledgement of his name.

“We’re ready for you now.”

Opening the door wider, she waits for the proactive patient to follow her down a tile hallway that smells of antiseptic cleaner.

The woman chews gum as she leads the man into his own room.   PP feels a seed of irritation begin to grow with each snap and pop of the gum.

“Sit right here and the nurse practitioner will be right in,” she gestured with her hand to another hard backed chair.

“Wait a minute, what about the doctor?”

“Oh, he is too busy to see you today. The NP will be right in,” the woman explains cheerfully and leaves before PP can say anything else.

PP waits and feels his heart rate increasing and the blood pulsing through his veins. PP waits and waits, keeping busy by cruising the internet until he reaches the end of the interwebs and still he waits.

Finally, the door opens and a chubby blonde woman in her early thirties with purple Crocs enters the room.

“Hey there, Bub, what’s going on with this blood pressure of yours?”

“Bub?” PP asks.

He feels a pounding in his head as his blood pressure rises like a tribal drum urging him on to stand and leave. No, this is not going to work.  There are other ways to lower blood pressure.   PP excuses himself from the clinic and takes a trip to Burger King to reassess his health goals and the price of proactivity.

Bub out.

Timely

What Spring Brings

Pleased

There are no leaves on the trees, but the grass already needs to be cut. Daffodils that survived a surprise freeze of early Spring are popping up and joined by red and pink tulips and green hostas.

A barefoot woman stands on the front porch shaking a plastic bag of trail mix. She takes a few steps forward and begins to yell towards a tree in a high pitched voice, usually reserved for things that are small and furry.

“Sneaky, come down here, Sneaky.”

On the street, a man slowly rides by on a bike with a wicker basket. He cranes his neck but only sees tiny green buds beginning to develop on the branches.  There is nothing to match the description of what he imagines to be a Sneaky.

You just never know, he thinks, and holds down the contents of the basket on the front of his bike. It is overflowing with a shrubbery that he acquired from the yard of his out of town neighbors.

“Sneaky, its snack time.”

The woman shakes the bag again and this time a man watches from inside of the house. With one finger, he lifts the blind up a little higher and peers out with a pair of blue eyes.   As much as he wants to look away, he cannot bring himself to do it.  He is running through his options on which family member would sign the involuntary commitment paperwork.

“Trust us, it’s for your own good.”

He envisions the woman being lifted up and carried out by men in matching white scrubs.  He sees her little legs kicking as she squirms to escape and feels a sense of guilt in the pit of his stomach for letting his imagination take his wife away in a straight jacket.

Laughter from the sidewalk brings the man’s focus back.

The woman’s hand is extended with a pile of almonds on her palm from which a little brown squirrel is selecting the best nut.

“Only the best for you, Sneaky.”

She looks back, intuiting that she had an audience of one, and raises one eyebrow.

“Told you so,” she says with a shrug and a smile.

She is most pleased; Sneaky returned as did her creditability, all in few, short minutes.

sg

A Seed of Promise

Luck

A  massive apple seed fell onto the floor from under the pillow.  It was brown and flat, still and unassuming.  Perfect for planting. What luck!

However, when the  seed stretched out its legs and started walking, several things became known at once.

The seed would never produce a healthy tree and give shade to weary passerby or a juicy, ripe fruit to satisfy an empty stomach.  It would never send roots down into the earth to bully the worms or stretch its branches up towards the sky for birds to take shelter from a storm.

The seed that held such promise turned out to be a bedbug. Perhaps it was one of many, all living off of the life blood of its gracious host, destined to feed and breed and wait for death.

Isn’t that life?

 

apple s

.

 

Bells and Whistles

Instinct

b

The man is tall, towering and mostly toothless. He wears blue sweats and a plain black t-shirt.  Like the man, the clothes are clean but worn out.  Grey stubble grows on his chin and head.  It is a low maintenance style that he picked up in the Big House and decided never to change.

He steps inside the office and looks quickly to his left and right. Under a broad forehead, his eyes are deep set with a slight bulge from an untreated health condition; they pick up who, what, and where of those present.

He is a mangy wolf sniffing out an easy dinner. There is an unnatural shine to his eyes as a small woman greets the visitor with a barely hidden disdain usually reserved for car and life insurance salesmen.  He is not scheduled to meet until later in the week.

Just Puney, the man accurately surmises. Excellent, he thinks as he shuts the door behind him; it closes with a definite click of the latch.

“Keep it open.”

He experiences a physical shock and takes a half-step back. Puney’s voice sounds different, clear and strong.  She stands back from the doorway, out of arm’s reach from the man.

“Oh, I thought you wanted it closed.” He laughs in a forced and creepy series of “Heh, hehs.”

“The door was open when you walked in. Why would you think that?”

Puney stares at the man, very hard. She looks him in the face, gathering information as quickly as he did seconds earlier.  Fine hairs on her neck prickle and stand at attention.  There is a physical connection to her animal ancestors, a leftover gift of evolution that is needed now as much as in the past.

“Open. The. Door.”

She speaks slowly to ensure that he understands. Her feet are firmly planted and her knees are slightly bent, ready to spring out of harm’s way.  In her hand, she holds a pen, no longer twirling it between her fingers.  Rather, it is repositioned in her palm, grasped by all fingers as a weapon, ready to stab and poke as needed.

Taking another step back, the man opens the door and a gust of fresh air gusts into the room. Puney exhales a sigh of relief, not realizing until that moment she was holding her breath.  In a cross between a smile and a snarl, she shows her teeth.

“Now, what can I do for you?” she asks and wonders with an internal sense of exhaustion, what can I do for me?

When everyone and everything is a potential threat, Puney startles at the drop of pin. Her instincts are shadowed by anxiety and exaggerated by the constant clanging of bells and whistles sounding their warning. It’s a hyper-vigilance that cannot be maintained. She knows something has got to give and sincerely hopes that it’s not her.

The Guilty Witness

“Before we get started, I want to say that wasn’t a crack pipe in my suitcase.”

This was not a good way to start an interview, especially with a detective, I thought as I casually eavesdropped on the men. I peeked around the corner and then returned to my position, busily typing away at pointless notes, listening all the while.

A good natured detective sat next to the man. He held his thumb on the record button of a slender, silver device while the corner of his mouth tugged upwards. He had yet to ask any questions and already the information was pouring forth, and like a tipped over bottle of malt liquor, it stunk.

“Ok,” the detective agreed. “We are in agreement that the pipe found in the suitcase was not used for smoking crack. Can you explain what it was used for?”

They reached a consensus so quickly, I marveled. It is easier to swim with the flow of the stream rather than to resist it.  There is a Buddhist quote in there somewhere.  I made a search of the internet of swimming upstream and found reference to a crappy Australian movie.

“Weed,” the man said with a nervous laugh. “I smoke weed.”

Oh great, that’s much better than crack. I rolled my eyes and continued my search.

Found a better quote, “Three things cannot be hidden long: the sun, the moon and the truth.”

“I see, you smoke a little reefer,” the detective said with a nod.

The tugging at the corner of the detective’s mouth gave way to a smile. He had nice clean teeth, all accounted for in a straight line of healthy white.  He was really jiving now, pulling out his street lingo for drugs.

Suddenly, the man received a message on his phone. He got up and announced, “I’ve got to smoke a cigarette.  I’ll be right back.”

He went across the street, forgetful or unaware of the window through which the detective was able to watch him walk up to a car and make mysterious transaction and return without once lighting a cigarette.

Namaste, little brother, the truth will almost certainly not set you free and it will all be known soon enough.

 

 

There he goes again.

spring-bird

There he goes again.

I watch from my office window as a man in faded blue jeans limps across the street using a crooked stick for a cane. He wears a straw hat over a mess of grey hair.  From this distance, it is hard to tell if he is wearing his teeth, but it seems unlikely.  In his free hand, he carries a plastic bag from the gas station.  The bag contains his sickness and the cure.

I am surprised to see the man return so soon after the bitter cold of winter, certain that he resettled in the south, retired and resigned from a life of struggle on the street. Then like a bird of spring, he suddenly returned and resumed his daily activities as though there was never any interruption.

Most mornings, the man leaves his nest of dirty blankets and plastic bags and travels across the street to fuel up on cigarettes, cheap booze, and a pack of peanuts or crackers.   He returns to doze in the comfort of his makeshift home until he runs out of supplies and is forced to make the trek once again.  Sometimes he is gone for long stretches of time.  I like to think he made it to the mission for a hot meal and a few days off the street or is visiting with an old friend rather than the more likely truth that he was arrested for public intoxication or hospitalized for seizures.

Time and time again, he returns. Unchanged and uncompromised.  Always limping and always with the hat.

He is surviving off of the elements, earth, wind, air and fire, and asks for nothing more. Yet, the people around him refuse to accept his decision to live and die in the alley behind an abandoned building. He remains at odds with these concerned neighbors.  They want him housed and sober, in treatment, at the least.  They want him to sleep in a bed and eat nutritious meals, to be warm and safe.

Meanwhile, he is determined to drink himself to death, programmed to self-destruct by a wicked and powerful hand. He is centered and focused on a course that is difficult to change; it is one that he is not interested in diverting from and next to impossible for his concerned neighbors to understand.   While they scheme to bring him in, coordinating agencies and professionals in the effort, they forget to look up at my spring bird.

He needs freedom, dignity and is one of the rare few who has not forgotten how to fly.

There he goes again.

 
Center

Dancers and Fighters

fire

“The guy was here and you blew him off.”

“No, I didn’t. The guy never showed.”

“Yes, he was here; his name was on the sign-in sheet.”

The two spar back and forth, dodging shots to the head and heart.

As luck would have it, they are seated next to each other. It’s easier to engage this way. Red spreads across the man’s eyes and brain; he flares his nostrils as he passes the blame to the blameless.

“He was here, he told me you forgot about the appointment,” the woman continues.

Others sat on either side of the pair, secretly hopeful for a Jerry Springer type of escalation in which no less than one chair was thrown by the end.

They are close to yelling now but neither are listening, both firm in their righteous indignation. Still the others watch as curious spectators and cautious observers, complacent with the new status quo of alternative facts and disenfranchised minorities.

The rhythm is off as they dance around the growing fire, unaware of the flames, or of the short and temporary separation from savagery that they have traversed only so very recently.

Rhythmic

The Airing Of Grievances

The large conference room was filled with angry faces. Several tables were configured in a semi-circle around the accused and her comrades, who happened to be the management.  The workers were on the edge of turning savage; they snarled and breathed heavily as they prepared for the meeting.

It was an airing of grievances, of which there were many.

Icily the accused stared out at the workers, refusing to look away. She sat with her straight back in perfect composure.  There was no reason for her to answer to these swine.  In front of her, she had neatly folded her hands one over the other, which would have been non-confrontational, if she hadn’t been wearing a pair of tight, black leather gloves.

Everything else about her was normal; light pink blouse, pleated slacks, modest, black heels and a dainty gold chain that lay softly over her collarbone and around her neck. She wore just a hint of makeup and kept her intricately braided hair pulled back with a clip.

Everything but those damned black leather gloves said she was willing to make peace.

Almost certainly, it was the gloves that tipped the workers over the fine line of decency. The gloves proved that she had something to hide, a reason to veil her dishonest hands and a lack of shame that anyone else was implicated.

The first stone was thrown, followed by another and then another. Her comrades stepped away, unwilling to risk being struck as well.  Out of respect, they lowered their eyes, unwilling to participate in the violence but unable to stop it.  Small pebbles grew into rocks with the workers’ confidence until finally a boulder was pushed over onto the accused.  She held her hands up to shield the blow; the gloves did nothing to save her but they did send her out in criminal style.

gloves-2

 

Hospice, the conversation killer

Expectation

wilted-flowers
Hospice, it’s a real conversation killer.

So death, what a bummer, amiright?

The couple, Jack and Jill, rode in silence with the occasional interjection about the weather and the Grammy’s.  When they arrived, it was a relief to leave the car.  They stepped out of their temporary vacuum world onto a freshly sealed, asphalt parking lot.

“This is nice,” Jill said with a grimace against the cold.

She pulled her coat together with one hand and held a bouquet of wilted flowers in the other. At the top of the inclined parking lot was a light grey stone, two-story building with clean, white trim around the windows. Along the edges of the building dry, brown, stick bushes waited for Spring to come alive with bright and vibrant colors, unlike the occupants of the building, grey and prostate, watching the world turn from their beds.

Next to the door, a sign read, “This is a secure facility, please ring bell for assistance.”

Jack studied it for a second, pushed the red button and waited; he was very good at following directions. The door clicked after a few seconds and was opened by an unseen hand.

“After you,” Jack said gesturing for Jill to walk in front of him.

Jack was also known for his good manners and gentle nature. Once inside, they met with another obstacle, Doris.  Doris sat at a table in the foyer, posing as a receptionist, bouncer, and tour guide, depending on the day.

“We’re here to see Beverly De…”

“Bev DeMonn?” Doris cut him off eagerly as though to say yes, we know the same people, isn’t that a coincidence.

Doris was a small woman with short hair done up in that old-lady-way requiring weekly visits to the beauty shop for a wash and style.  She nervously adjusted her glasses on her face and shuffled a stack of papers on her desk.

Jack stood tall and looked Doris in the eyes. He shook his head in confirmation and gave a warm smile.

“Yes, exactly, she’s my grandmother.”

“That’s nice,” Doris said with as much sincerity as she could muster. “Right this way.”

Jack and Jill followed Doris’s shuffling steps as she led them down a hallway and through an open sitting area. There was a fireplace pumping out dry heat, warming two empty arm chairs and an empty couch. The place was strangely quiet and still for such a large facility.

“It’s nap time,” Doris explained, reading their minds. Then in a whisper over her shoulder, she added, “And we just lost a few residents.”

“That must explain all of the locks, everyone wandered out,” Jill snickered.

“Not funny,” Jack hissed without looking at his companion.

“Ok, ok,” Jill said unrepentantly with a shrug, “anything to lighten the mood.”

Suddenly, the lights grew brighter as they stepped into a cafeteria. The kitchen area was against the far wall.  The rest of the area was taken up by empty tables and chairs.

A shriveled up human, presumably a female from the fuzzy pink sweater with shoulder pads that she wore, sat alone at a table. In front of her, there was a small dish with a half-melted, purple Popsicle.  A wooden stick leaned out over the edge, like a riderless teeter-totter.  With a weak shove, the woman pushed the dish to the side and folded her bluish hands on the table.

“Bev, you have company,” Doris announced and readjusted her glasses.

Bev looked straight ahead, her eyes a bleary blue with pupils drawn into pinpoints.

“Grandma, it’s me, Jack.”

Perhaps he was as unrecognizable to her as she was to him; her once black hair was now gray, her face shrunken in without dentures to support a shape, and her body was half of its previous size.

A dehydrated apricot, apple, plum? Jack tried to match up the fruit with the woman without any luck.

“Oh, and this came for you.”

Doris reached into the pocket of her sweater and pulled out a letter, postmarked and stamped from Florida. Bev turned to Doris, reached out with a claw like hand and grabbed the letter without a word.  She sliced it open with the long nail on her index finger and extracted the contents.

Slowly, she read each word of the epistle, feasting her eyes as she refused to allow her body. Jack pulled out a chair and sat next to his grandmother while Jill selected a seat across the table from the two.

On Bev read and still she refused to acknowledge her company.

“How are you, Grandma Beverly? We heard you were sick and brought you these flowers,” Jill spoke loudly.

For the first time, Bev looked up at Jill.

“I can hear just fine. What time is it?”

Jack stepped into the conversation, seizing his opportunity. Gingerly, he put his hand on her arm and said, “Its two o’clock, Grandma.”

“Hmmm…too bad,” Bev exclaimed and returned to her letter.

Dying was not about to change her mind about these unsaved heathens. It was simply too late to do anything about it. So Jack and Jill went back down the hill, got into their car and drove away with a sad promise not to return until another much, much later day.

Make Believe World

bottle

The man walked into the office, dragging his feet and with his head hung low. His clothes were the same ones that he wore the day before but now wrinkled and stinking of smoke.  A woman sat at a desk with pictures of cats around the computer screen.  There were so many different felines, it was hard to imagine that they all belonged to her but not impossible.  Remember the show, Hoarders.

Nodding her head in acknowledgement, the woman sighed.   She looked up at the clock on the wall, as a not to subtle sign of her annoyance.

“I know I’m late,” he said and sat across from the woman.

Like a tidal wave crashing down on the shore, the smell of alcohol hit the woman’s nostrils as the man spoke.  He belched and filled the room with more of his unprocessed booze and bodily fluid smells.

“Huh, huh,” he laughed as the woman inwardly gagged.

The man continued without blinking.

“I went to a hotel party last night and time got away from me. I woke up, looked at my watch….”

He pulled his sleeve back to show his bare wrist where a watch might have been if he wore a watch, demonstrating how it might have happened and went on, “Oh shit, I’ve got to go.  And I came straight here.”

There was no mistaking the pride in his face. Was it because of the good decision that he made on how to spend his day or that he had just awoken in a strange hotel room after a hotel party with a roomful of strangers?

Unable to stand the woman’s silence, he shifted uncomfortably in his chair and stared at a stain on the wall, at his shoes, at the cats; everywhere other than the woman’s face.

“Hey, at least I’m here.”

Would he use that line on an employer if he was an hour and a half late, still reeking of his night of debauchery? Did that work with his parents and the mother of his son?

The woman laughed to hide her sadness, to give her a moment to collect her thoughts, but her eyes still spoke. Disappointment is a powerful emotion that is hard to hide, destructive and unnecessary when it comes about because of unrealistic expectations.

She thought what do you want me to say? That everything is going to be ok? That your addiction isn’t going to destroy what is left of your life?  That you still have to hit rock bottom before committing to change?  There is no rock bottom.  There is just a bottomless pit into which you are falling deeper and deeper unless maybe this will be the day you reach out for a rope to begin the long, hard challenge of climbing back towards the light.

“Yes,” she affirmed the man. “At least you are here.”

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