Be kinder than is necessary. . .

"Be kinder than is necessary. . .for everyone you meet is fighting some kind of battle."

~ T.H. Thompson and John Watson

His biggest fan.

Cam Newton

Zachary:  "Daddy is always trying to get me to be excited about Cam Newton from the Panthers."

Me:  "I kind of like Cam Newton. He gives you plenty to get excited about."

Zachary:  "He's okay."

Me:  "Just okay?"

Ray Lewis

Zachary:  "I mean, I like him okay. But he's not, like. . . .like Ray Lewis from the Baltimore Ravens."

Me:  "Ray Lewis? He's your favorite?"

Zachary:  "My number one favorite of all the football players."

Me: "That's cool."

Zachary:  "Yeah, Mom. He retired last year. But he won the SuperBowl. Every time I play Madden '13 on my Wii, I'm the Ravens because I like Ray Lewis."

Me:  "Not the Falcons?"

Zachary:  "I like the Falcons a lot because that's Dad's team. But the Ravens is my team, Mom."

Me:  "Gotcha. And I guess Ray Lewis is your dude, huh?"

Zachary:  "No, Mom." Pats his chest. "I'M my dude.  I am."

And he was dead serious.

***
Happy Hump Day.

How do you see you? Are you your own biggest fan?Are you your own metaphorical "dude?" If you aren't, ask yourself why not? And what are you doing to change that?

"I'M my dude."  ~ Zachary Manning

(I didn't tell Zack but. . . Mommy kind of likes Cam Newton because of his easiness on the ol' eyeballs. Is that bad?)

Life is good.

Saturday was amazing. It was the first weekend that mother nature had gotten the September memo and put that tiny bite of fall into the morning air. And it was perfect because nothing says "football season" like that kind of weather. The kind you tailgate in or the kind that makes you wince when you see exuberant frat boys gyrating on fifty yard lines with painted chests.

And so. The BHE (aka Coach Harry) headed out with Zachary a bit early and Isaiah and I joined them in time for the game. And I know I already said it but I need to say it again. The weather was just right. Sunny but cool. Blue-blue skies and this gentle breeze that felt like a song brushing across your face. Something about it all felt magical. I'm not sure why but it did.

Isaiah and I set up our lawn chairs and made ourselves comfortable. We were good fans appropriately dressed in the team colors and fully prepared to hoop, holler and okay, just maybe, trash talk a little bit.

Because in football a little bit of trash talking is allowed.  Just nice trash talking.

So yeah. The team bursts through the hand-painted poster and that made me really happy mostly because it's the kind of thing Deanna would have made for Zachary if he asked her. And I remember him once asking why she didn't make him more posters and her saying, "You didn't ask me. Just ask." So after that a monster was created.

Yep.

Zachary didn't necessarily ask anyone to make a poster but he did ask us to wear orange. He also asked if I'd get shirt made with his number on it so that the world would know he was my son. He liked that gesture last year so decided to "just ask" again. He also "just asked" a lot of people to come to one of his games. Uncles. Friends. Even his school principal. He asked just like his auntie instructed. He sure did.

 

So at this game on this magical day, some of those people got up early and stood out there in that same soft breeze. They, too, had lawn chairs and even orange on. No, no none had their chest painted but still. It was good to see the support. He was especially excited when his two coaches from last year were standing on the sidelines with those coach-y looking folded arms. His chest poked out further. His face got more determined.

Zachary is mostly a cornerback. Yes. Little Zachary. He gets down low and is unafraid to hit or tackle anyone. And it's super exciting to see once you get over the whole seeing your kid jump on top of someone thing. So yeah, my little blocker was more ready than ever. He was beating his pads with his hands and giving chest bumps. It was on.

So all of us were standing on the sidelines or sitting in our lawn chairs smiling and laughing. The coaches with their coach-y armfolds and Isaiah with his iPad. And that play got called and people started running you could hear the pads clapping together like always. But then, something else happened.

Wait. Huh?

The ball was passed to #3 and he slipped and spun out of that pack. Someone dove at him and he shifted his body sideways and outstretched one hand. And got away. Out. Fast. With people chasing behind him as fast as they could. Faster and faster until finally it was clear. No one was going to catch him. At least not this time.

Touchdown.

Now. Picture this. Your first real time running the ball and you make this really dramatic touchdown. But not just with your mom and brother on the sidelines but with your prior coaches who knew you when you were first learning the game and your godfather who held you as a tiny baby when you were dedicated and even some people from your school because you invited them. Imagine all of that and all of them jumping up and down and cheering like crazy in their orange. Then. Envision the best part--your father who happens to be your head coach--losing his mind and being unable to contain his elation.

Can you even get your mind around it?

It was awesome. No. It was more than awesome. It was magical. Really and truly magical.

And you know what? #3 made another touchdown, too. What's even cooler is that his other teammate from last year who was also one of "the little guys" back then scored twice, too. And those coaches from last year who knew them way-back-when were hooping and hollering and jumping up and down. It's so hard to tell through the grills of their helmets but man, oh man were those kids over the moon.

And even though it isn't always about winning and yadda-yadda-yadda, we can all admit that it feels pretty damn good when you do. We talked about how hard those kids and yes, Coach Harry, had worked to get where they were. We shared about how the things he'd learned last year from his other team applied to now and even how running track had strengthened his legs and helped him to run faster. And as we talked about all of those things, I somehow felt less resentful of the time commitment that had gone into all of those things. It was a powerful life lesson of what happens when you just keep working at something until you get better.

Then Isaiah reminded me of one of our "precepts" that we talk about on the way to school each day. These are our "words to live by" that we've been creating and discussing which mostly feels like me talking and him eye-rolling. But, yeah, it turns out that he was listening and reflecting because he said it right then and there.

"The only way to get better at anything is through hard work and not giving up." He recited that  precept and then smiled big and wide. And Zachary looked at him and smiled right back because those words were resonating with him.

After the game, we went to our favorite neighborhood Cuban-Spanish spot for lunch. And the boys were recapping the game and talking about Pokemon cards and, for once, something other than Minecraft. Harry and I were chatting and laughing and intermittently holding hands under the table.

"Good Lord. That was SO exciting, wasn't it?" I said.

"Yeah, man. All the boys did so great. But yeah, I had to keep it together when my son ran into that end zone." Harry shook his head and chuckled to himself. "Man."

That last "man" was quiet. He looked a little wistful in that moment and that's when I knew. I knew that even in the midst of all the magic, we were feeling the exact same way at that moment.

"Yeah." I twisted my mouth sideways and felt my eyes starting to prickle a bit. I squeezed my eyes tight and took a deep breath.

Nobody had to say it. We knew.

There was nobody who would have loved this day more than Deanna. No one. She would have likely been yelling so loud that someone on the other team would have asked to have her removed. And when the second touchdown came? Man, please. They would've had to take her away in handcuffs for going so crazy.

Even the coaches from last year remembered. One of them said, "Damn, you know your sister would have been out here crunk!" And I was super glad that he said "crunk" because that word is slang and funny enough to break up any emotion that came from him not only mentioning but remembering Deanna.

Which reminds me. That same coach who only knew my sister from her fancy posters and big booming voice stood solemnly with all of us in that memorial service for Deanna last year. It remains a gesture that I will never, ever forget for as long as I live.

Anyways.

So the day was magical and beautiful but at the same time bittersweet. And, yes, we all agreed that Deanna was there--she was--and that she gave those boys wings. But still. It did kind of hurt that we didn't get to witness her witnessing it. I think that was the part I was the most bummed about.

But you know? The kids talked about Deanna right out in the open. And they weren't sad or wistful or bummed or any such thing. They were eating their quesadillas and saying things like, "Oh man! Auntie would have been SUPER DUPER loud!" and "Auntie probably would have run all the way into the end zone with you!" And they just laughed and laughed.

Which made us laugh, too.

"It's cool that Zachary is still wearing Auntie's lucky number this year, too," Isaiah said with food in his mouth. "That's giving him some good luck, right mom?"

And I nodded and said, "You might be right, bud."

Then they changed the subject but I just sat there thinking about one of Isaiah's precepts from last week.

"Life is good."

"That's it?" I asked.

"Yes, mom. That's my precept. Life is good."

And once I thought more about this beautiful, magical day and my life with these beautiful, magical people who share and create these beautiful, magical memories together, I understood. Isaiah was right. Those were words to live by.

Life is good.

Joy, pain, sunshine, and rain. . . Life is good. It so very is.

Yeah.

***
Happy Monday.

Neighborhood watch.

August, 2013

On my way to Grady, I pass under this bridge everyday where a significant number of unstably housed people--likely patients--sleep and pretty much live. Men. Women. Old. Young. Black. White. Latino. They form little pallets that follow rules of personal space and their belongings are usually neatly stacked next to them. 

That is, until someone comes and moves them all which seems to happen every week or so. But it only takes a couple of days for them--or a new crop of people--to return.

For whatever reason, I always feel a bit relieved when they do. Return, that is. 

Yeah.

One time I saw a man sitting on the curb with a bottle of water brushing his teeth. He waved his hand at me and smiled with a mouthful of bubbly foam. And me, I laughed and waved right back. Last week, I saw two men and a woman doing jumping jacks and lunges. I honked my horn and gave them a thumbs up. But most of the time, I just see heaps of blankets strewn across cardboard--with or without the tell-tale lump of a human being underneath. 

I guess it makes sense that the authorities get called to come brush this little mini-borough of people away. I mean, I guess. The area has gone through a bit of a revitalization and lots of new condos and lofts are just steps away. I would imagine that some person walking their dog has looked and noticed and felt some  kind of way. And honestly, I can't judge that dog-walking homeowner for feeling how they feel when they feel it. But what I will say is that something about seeing everyone peacefully co-habitating along that strip of concrete always warms my heart. 

December, 2011

I suppose the dog-walkers can somewhat blame me and some of the other Grady people I know for a part of this. Confession: We've all been known to drop off a blanket or two on the colder days and okay, even a pillow once. We may or may not hand food out of the window during morning traffic or lunch leftovers as the work day has come to a close. And sure, I guess it could be considered dangerous to do that but I admit that for whatever reason, I never feel afraid.

I don't.

September, 2013

But this? This is what I saw the other day. And you know? I'm not sure who did this. I keep trying to to wrap my brain around someone pulling it out of the back of their truck or SUV and plopping it down under the bridge. And then everyone sort of communally sharing it in the same way living room furniture generally is shared.

And no. I have no idea what the story is behind that chair. Perhaps it could be just some lazy person who didn't feel like taking it wherever it needed to be taken. Maybe.

But maybe--just maybe--that dog-walking homeowner wanted his or her new neighbors to feel at home, too. Maybe.  

And you know? Something about imagining it through that lens made me smile. 

Yeah.

***

Bust a move(ment).

Dude.

If I had a dollar for every time I counseled a patient about their sluggish bowel habits, I'd be a gabillionaire. For reals.

Bowels. There is not a day that goes by where I don't talk about them, ask about them, and make plans for them. Seriously. Because if I don't know ANYTHING else, I know this:

People do NOT like it when their bowels aren't moving.

When I'm rounding in the hospital, that's always a question I ask. And if they aren't moving, I make sure to do something to fix that. I do, because bowels that don't move make people unhappy. And that isn't just an issue with hospitalized patients.

No, 'tis not.

So, yeah. In the hospital, I know there can be tons of reasons for bowels going on strike, but outside of the hospital? That's a different story. Usually it's the person with the typical Western diet. Low on fiber, high on refined sugars. They ramble off a recall of foods they've eaten for the last few days, and you understand why things aren't moving and grooving.

So what happens next? Well. I do everything I can to avoid having them take a bunch of pills to soften their movements. I talk all about adding fiber and all that stuff which is usually met with a slightly hairy eyeball. OR it's met with a whole soliloquy about how they ARE eating a ton of fiber.

Then, I started realizing how many conversations I've had with people who aren't my patients but who have locked up innards. And to them I say the same thing. Eat the right things and your bowels will be a no-strain zone.

Yup.

So they ask me for specifics and I tell them. And you know? If they follow what I told them, those suckers get to pumpin' in know time. And let me tell you, there's no gratitude like poop gratitude. Seriously. Okay, so. .  .over time, I've gotten to be a bit cocky about my ability to get things going. And since I am 100% sure that at least one person reading this either lives with someone who STAYS constipated all the time or personally is a once-per-week pooper who get's super miserable by day 6, I will bring my fool proof, stealthy non-pharmacologic bowel program straight to you for no charge.

Okay. You ready?

Step one:  Drink plenty of water. Soft bowels have lots of water in them. Duh.

Step two:  Eat more fiber.

But how is that supposed to happen? Or better yet, how can I get this stubborn person I live with to eat more fiber?

Bwwwwah ha ha haaaaaa! Guess no more, people. That's what you have ME for!

For you non-lactose intolerant people, one of the easiest ways to get your fiber on is through cereal. And no. Not just any cereal. The real, true high fiber ones.

I bring you exhibit A.

Let me be clear on something: All raisin bran cereals are NOT created equal. I personally think the Post brand not only tastes better, it has a crap-ton (no pun intended) of fiber in it. And what constitutes a "crap-ton?" Well, I'd say anything that gives you more than 30% of your daily allowance of fiber in one fell swoop totally meets that criteria.

This alone might do the trick.

I'm also a big fan of Frosted Mini-wheats. I actually suggest them to people as a midmorning or midafternoon snack. They're tasty and super high in fiber. I regularly pack these in my kids' lunchboxes. It keeps them moving and grooving--and does so inconspicuously.

I pack them for myself, too. Although as "the regulator" it is for less urgent reasons than some others in my household.

Ah hem.

Mini-wheats do a solid job with 23% of your daily allowance of fiber. That combined with a piece of fruit in a lunch box on whole wheat bread? Chile please.

And for those who are concerned about the crap-ton of sugar that can be found in these? Another great consideration is this:

 

 

I added this part in for Sweet Jo who made that very good point in the comments. Everyone isn't ready for Grape Nuts. I personally love them and am happy to sprinkle them on salads, in yogurt or in just about anything. But my feeling is that for this to work, it has to be something that the person will actually eat. I am the only one in my house willing to eat this. So as for the sugars, I recommend remembering that moderation is the key and that the likelihood of your BMI skyrocketing because of Raisin Bran alone is virtually zero.

Hmmm. What else?

Oh. This.

 

You've got to move to move. For reals. One of the biggest reasons (I think) that people have sluggish bowels is because they have sluggish bodies. The gut is lined with MUSCLE. Muscles need oxygen and blood flow and all that good stuff to work their best. People who exercise are less likely to have issues with regularity.

Yup.

Dark green leafies go without saying. We know that those are great sources of iron but also fiber. So mix some spinach and kale into that salad. Do it people.

And now for my ace in the hole. . . . . which I say is non-pharmacologic but I guess you could consider this like a med of sorts. . . .

The clear, soluble fiber supplement. 

OH. EM. GEE.

This stuff is genius. It's tasteless. It's odorless. It's not grainy or gritty. And it works.

The brand names ones are things like "Benefiber" or "Fibersure." I'm too cheap for that so I just get the Target brand. It's all the same.

You know how that Frank's Red Hot lady says, "I put that SH*T on everything!"

Well, I need to be on a commercial saying, "I put that SH*T in everything!"



It dissolves best in hot things. So I throw a few tablespoons in spaghetti sauce, chili, chicken and dumplings. . .you name it. If it can be stirred, I've made it into something higher in fiber. Oh and boo-ed up people? If you are kind like me and prepare your husband, wife, girlfriend, boyfriend or partner's coffee for them in the morning?

BBBAAAAAA-DDOOOOWWWW!

And all I will say is that any loving significant other who prepares meals and such in their homes should make no apologies for putting their loved ones on "a little plan" as I like to call it. And "little plans" are more than just about moving bowels. It's nothing for Harry to be like, "Damn, did you put the food up already?" And I say, "Yep." Then he says, "Dang. Am I on a little plan or something?" To which I reply, "Yup."

Ha.

Surely do.

And so. I say to you all. Who needs laxative pills? I'd say it's the person who isn't doing the things mentioned above. This plan gets even the most stubborn innards going.

And YES the caveats are things like taking iron or chronic opioid medications. But MOST people who are constipated DO NOT fall into this category. So there.

Eat fiber. Drink water. Get up offa that thang. Move your bowels. And then repeat.

Come on, people! Let's start a movement!!! Let's start several of them!

Bwwah ha ha ha.

That's all I got this morning. How you doing?

***
Happy Friday.

Team S.J.G.R. Thursday Huddle #11: Your Primary Care.

What's up, team? Sorry to be getting this up so late. Back-to-school night and a full work day trumped blogging earlier. But better late than never, right?

Riggggght.

So check it. Today I did one of my least favorite things on the planet. I went to see my primary care doctor.

Terrible, right?

First, let me be clear: My PCP is amazing. She's smart and thoughtful and empathic and decisive. She remembers things that I tell her and floats effortlessly between my care and things like how my kids are doing in school and how things are going at work. Her eyes were so caring when asking questions about how I've been coping with Deanna's transition that, despite my best efforts, I did that thing that I'm usually on the other side of. Yeah, man. I broke down and cried for a few moments. And she was awesome, man. She listened -- like FOR REAL listened -- and never once made me feel like all of it was some part of a giant psychoanalysis but instead just one human being caring about another one. She even makes things as unpalatable as lady-part examinations not so daunting since her bedside manner is so tremendous.

Yeah. My PCP is rad.

So. I'm sure you're all like, "Then why is seeing your primary care provider one of your least favorite things on the planet?"

Is it the blood letting? Is it the paperwork? Nope. It's not any of those things. It's actually something quite simple, really. Here's the confession: I simply hate being a patient.

Dude.

I hate it. Everything about it. And yes I said "hate"-- a word that is a bad word in my house. And since my kids won't be (at least not right now) reading this, I need to use that word for emphasis. Hate.

Sidebar: I told the kids a few years back, "There's just no reason to say 'hate.'" And Isaiah replied, "But what are you supposed to say when you just really, really don't like something?" I quickly shot back, "Easy. You just say you really, really don't like it." And Zachary said, "But wouldn't it just be faster to just say you hate it?"

Uuuhhh, yeah.

Anty who. I hate being in the patient role. The exploration. The investigation. The suggestions and thoughts. Even when they make perfect sense like my doctor did today. Like her asking me about this stress fracture I had back in the winter and then wondering if that had anything to do with the low Vitamin D level that I may or may not have had in 2009. Sure, it's a good--no, a great thought--but still. I hate it all.

Here's the thing: I am so used to being the doctor that I would mostly prefer to have my lip glued to a car bumper and then be dragged over broken glass to slipping into a paper gown and dropping a sheet over my lap. And I use that metaphor to emphasize how much I don't like being on the other side of a primary care appointment.

For reals.

But that? That doesn't really matter. Because on November 15, 2012, shit just got real. The reality kicked me straight in my two front teeth and screamed in the loudest voice possible that "JUST BECAUSE YOU FEEL FINE DOESN'T MEAN YOU ARE FINE." Because you can be hanging out with family and friends at your kitchen table on one night and gone the next. This I know for sure. Something discoverable and potentially reversible could be brewing and needing to be assessed. Or even if it isn't reversible altogether, it could be something that's at least treatable. But none of that can happen if you don't GET UP OFFA THAT THANG and see your PRIMARY CARE PROVIDER.

Yes. Your PRIMARY. CARE. PROVIDER. Not the person who delivered your babies and who has agreed to write your birth control or replace your IUD and listen to your heart and do your Pap Smear while you're there. No.

Wait. I take that back. If you're super young and without any health problems then that's mostly okay. But if you're over 40 and you have anything running in your family or personally, you cannot BS when it comes to getting yourself under a doctor's care.

Even if you hate it.

Your overall health needs to be your primary care. See, me? I have always gone to doctors with a CLEAR agenda. That agenda being: "Hello, I'm pregnant and you need to do the things pregnant ladies need." Or "Hello. My ankle is 'flicted and you need to do the things 'flicted ankle people need." But PRIMARY CARE? Geeze. That's altogether different. It's like putting your car on that diagnostic machine, man. And saying, "Hello. I'm mostly okay outside of my crappy eating habits and muffin top. Now you get to look at me and find shit even if it scares me to death."

Pretty much.

But let me be CONCRETE. Primary Care Providers--are ALL about preventing heart disease. ALL about it. Like, for real? That's like 87% of everything we do. For real. Like, we bug you about salt intake and blood pressure readings. Why? Because it hurts your heart. We sweat you about exercise and body mass index. The big deal? Cardiovascular health, dude. Our diabetics get stalked about their high blood sugars and the smokers get nagged to death about lighting up. That's not rocket science either. Those things take you quickly from one ticket to five in the heart attack lottery.

So serious business? That should be your primary care. Why? Because heart disease is the thing most likely to take your life or disable you. More than ANYTHING else. And no, I am not trivializing very important things like cancer diagnoses--I'm not. Of course those with family histories and personal histories should be thinking about those things. But they should also be concerned about heart health. We ALL should.

So that's the deal. I tazed myself in the back until I got to my PCP to be seen. And I stuck out my arm and let that lady plunge that needle with the Vacutainer on the end of it deep into the crook of my arm. I let that same lady schedule my mammogram which perhaps is another thing I'd exchange for that same broken glass trudge--even if doused afterwards with rubbing alcohol.

Umm, yeah. Hate those cold metal plates smashing me, too. Yes, hate.

So yeah. I took my lumps today. And since things were cool, I don't need to take more for another year. You know what else? I got to tell my doctor all about you guys. About us all moving for 150 minutes or more per week and about me running two 10Ks since she saw me last. I also got to beam when she was examining me and told me that my resting heart rate was slower and that she could tell I was exercising. It felt good not to fudge the facts about how much how often.

"I run. About four times per week for 45 minutes or more."

Which is TRUE, man. TRUE. So yeah, that was good.

Okay. So here is your clarion call. Have you seen a doctor this year? Did you see one last year? Was that doctor a PRIMARY CARE PROVIDER? If not, you need to rectify that.

Real quick: Caveats include people who are under the care of, say, a Cardiologist or Endocrinologist who is serving as a primary (or rather principal) care provider. Or people with HIV seen by an Infectious Disease trained HIV PCP provider. Otherwise? You need to GET UP OFFA THAT THANG and see a PRIMARY DOCTOR.

YES.

Make it your primary care to see about your heart health. Let go of only seeing doctors for your minor agendas because you're afraid. Stop being defensive and listen. Set some goals and let your PCP hold your feet to the fire. But especially look into the eyes of the people who love and count on you and try to justify not taking care of yourself. You won't be able to.

I know. The cost can be oppressive without insurance. But as a person who works in a setting where over 90% of the patients lack insurance, I know for certain that there is a way to see about yourself and your heart health even if you aren't covered by private insurance.

YUP.

Marching orders:

1. If you don't have a PCP, pick one. Even if you hate it, make up your mind to go.
2. Call by TUESDAY and make you an appointment for a PHYSICAL if you haven't had one.
3. Pick somebody you feel comfortable with.
4. Get the most out of the visit by being honest.
5. Set a goal to improve you're weight or some other parameter before your next visit.
6. Take all meds exactly as prescribed. Not "as needed."
7. Fight the urge to retreat to hypothetical la-la land.


That's all I got.

***
Happy Thursday, Team!

 Now playing. . . .the Team S.J.G.R. theme song. . . and JAMES BROWN singing it live. . . all while GETTING UP OFFA THAT THANG. OMG love this! Could watch it all day. Hell, I burned 200 calories just watching. . .LOL! (BTW....the funniest part about this is how LAME the audience is. They are TOTALLY just sitting there while JB is getting after it! Hilarious!)

It's all about the Benjamins, baby.

This is Kristi. She's one of the amazing hospital pharmacists at Grady Hospital. She is smart and diligent and empathic and generous with her knowledge. I stopped in her office today along with one of the residents because I needed her help.

The question wasn't about the pharmacokinetics of some drug or even about some kind of drug-drug interaction. Nope. This was question about what is, unfortunately, one of the most common things that gets discussed at public hospitals: Cost.

Okay, so check it. Grady Hospital and the handful of other safety net hospitals in the U.S. that turn no one away due to limited ability to pay has programs in place specifically for our poorest patients. That is, if you are at 200% of the U.S. poverty line or below, you qualify for a significant amount of assistance with whatever it is you need. And that? Now that is wonderful thing.

Now. If you are like me, you probably have no idea what 200% of the federal poverty level is. And maybe you are one of those people who just walks around with that kind of information in your head, but I'm not. So me? I had to look it up today. And I'll tell you why.

I saw a patient today who was sitting in front of me in a work uniform. Had worked some crazy oddball shift in order to get out in time to make this appointment with us for management of high blood pressure and diabetes. And really, this patient was super motivated, kept appointments, and went through great effort to make it over to see us.

Okay, so we check the lab results from the most recent blood draw and things look horrible. Like for real, horrible. The blood sugars are out of whack and the patient is clearly not doing what we asked at the last visit. And so we asked the patient straight up:

"What's up with your blood sugars? Is everything okay?"

"No," our patient replied, "I only take my insulin here and there because I can't afford it. I can't afford the blood pressure pills, neither."

And that was weird because this patient wasn't new to us. I mean, this patient had been coming to Grady in that same work uniform for many years. Why was this suddenly an issue?

My resident blurted out a question before I could. "Don't you have a Grady card?"

What she was speaking about was the sliding scale card given to patients with limited ability to pay. The patient gave a hard head shake.

"I used to. But my job gave me just a little bit more money so now I don't qualify no more."

And let me tell you. This patient was a hard worker. I also know that uniform was not one worn by a person who makes stacks and stacks of money. And so we talked about it and the patient said, "Essentially, I am now just over the line." Which was later clarified to be 201% of the federal poverty level. I agreed to look into what we could do to assist by talking to Kristi and also our social worker.

And so. I also looked to see what that all meant in concrete language.

Household Size	100%	133%	150%	200%	300%	400%
1	$11,490	$15,282	$17,235	$22,980	$34,470	$45,960
2	15,510	20,628	23,265	31,020	46,530	62,040
3	19,530	25,975	29,295	39,060	58,590	78,120
4	23,550	31,322	35,325	47,100	70,650	94,200
5	27,570	36,668	41,355	55,140	82,710	110,280
6	31,590	42,015	47,385	63,180	94,770	126,360
7	35,610	47,361	53,415	71,220	106,830	142,440
8	39,630	52,708	59,445	79,260	118,890	158,520
For each additional person, add	$4,020	$5,347	$6,030	$8,040	$12,060	$16,080

It gets cut off on this chart, but just know that $22,980 was the 200% marker for a single person and $31,020 for a two person household. Yeah. So my (single) patient was making like $24K per year up from like $22,500. And you know what? That patient was working hard for that little bit of money. Hard.

And so. I talked to all of the people that you talk to about these kinds of things and heard the same answers. Which essentially is that in order for us to help the very least of these, we have to draw the line in the sand somewhere. Unfortunately, our patient landed right on the wrong side of this and pretty much, there wasn't much we could do to help in the way the patient wanted.

And so. I stood in front of Kristi's desk talking about all of this and picking her brain about what to do. And she was at least able to locate some patient assistance programs on the blood pressure meds and lists of a few medications at pharmacies with fixed prices. But then we talked about the diabetic supplies that the patient would need for things like testing blood sugars and injecting insulin.

Okay.

So I took this picture of Kristi right in the moment where we all realized just how little slack people with low incomes get when it comes to something like diabetes. I mean. . .it already sucks to have diabetes, but this? This just makes it suck monumentally more. See, Kristi was looking at a screen that compared costs between certain diabetes test supplies and others. And it was dismal.

Even with "the hookup" from a special coupon, all of the supplies would run close to $100 dollars per month. $100. A straight up Benjamin Franklin one hundred dollar bill. Seriously? How in the HELL is this patient supposed to come up off of that much money for that AND eat? How.

Now. Can I just say that I don't have any prescriptions that cost me that much -- but when I did briefly take Nexium and it cost me like fifty-something bucks, I was LOSING MY MIND about it for an entire month? You'd better believe I was. And every single time I go to get some allergy medicine, I spit a little fire at the counter, too.

Man. A HUNDRED BUCKS? Dude. $100 is a lot of money. Especially for some strips and some syringes, man. So how you blame somebody for doing rock, paper, scissors when it comes to something like this? Like seriously, how can you? And, real talk, how can you even blame somebody for saying "bump it" when it comes to testing blood sugars since the strips cost a grip?

Answer: You can't.

Yeah. So here was the moment where we were all frozen in this sobering reality. Staring at that screen and wishing for a pop up with Oprah saying, "YOU GET INSURANCE! YOU GET INSURANCE! YOU GET INSURANCE!" Uuuuh, but yeah, it never happened. And the look on Kristi's face tells it all. I swear to you that right inside this moment every person there felt so helpless and discouraged. I am certain that I am not the only one who wanted to cry. I know that for certain.

Man. Here is a person who is putting on a uniform and working with greasy food all day. Someone who is dealing with demanding people and attitudes and anything else you can think of. All in an earnest effort to make a dollar out of fifteen cents.

So the very, very best we could do was this:

• Patient assistance meds through a pharmaceutical company 
• Medications off of the "four dollar list" at WalMart and similar places.
• A suggestion for the least expensive testing supplies based upon our research. 

And you know? It was still dear (in price,) as my mom says. Otherwise, it wasn't dear at all.

Yeah. I'm not even sure what my point was in telling you about this. I guess I just want to shine a light on the every day struggles of people who are out here slugging it out and trying to make it happen, man. And how many things stand in the way of them going to their full potential.

"I asked for them to keep my salary where it was, " the patient said, "but they won't do it. When you been there a certain amount of time, they got to raise you up some." And honestly, all I could say to that was one word that I kept to myself.

Damn.

"Seem like you better off quitting and getting disability," the patient added.

Which broke my heart even more because, in this instance, it almost was completely true.

Look, man. All I'm saying is this. It's people out here struggling. And they are not lazy or shiftless or any such thing. A lot are just resource poor or folks who made it as far as tenth grade without being able to read--meaning someone looked to the side and just nudged them on ahead. Like my patient today. Which is a whole separate issue, but still an issue. I'm just saying. It's rough out there, man.

Damn.

***
Happy Monday.

Now playing on my mental iPod. . . . .



And check this out. . . I haven't seen it but TOTALLY want to. This is the reality that we see every single day.

Feeling 42 (even though today I'm 43)

 It feels like a perfect night to dress up like team moms
And sign up for sports teams, uh uh uh uh

It feels like a perfect night for red wine at midnight
To covet shoes on Zappos, uh uh uh uh

Yeaaaah
We're happy tired and in debt at the same time
It's miserable and magical oh yeah
Tonight's the night when we forget about the dishes, it's time uh uh

I don't know about you but I'm feeling 42
Everything will be alright if you keep pick up these damn shoes

 

You don't know about me 'cause I'm not on YouTube
Everything will be alright if we just keep dancing like we're 42, 42

42. . . 42

It seems like one of those nights
This table's too junky 
for dinner and homework uh uh, uh uh 

It seems like one of those nights
We ditch the whole thing and end up singing instead of reading

Yeaaaah
We're dieting and sexy in the best way

We're training for a 10K, oh yeah
Tonight's the night when we forget about the Spanx lines, it's time uh uh

I don't know about you but I'm feeling 42
Everything will be alright if you just do what I told you

You don't know about me ('cause I'm not in your carpool)
Everything will be alright if we just keep dancing like we're 42, 42

I don't know about you, 42, 42

It feels like one of those nights
Don't know if I'm snack mom!

It feels like one of those nights
When Mom won't be sleeping

It feels like one of those nights
I don't need no bad news 
I want some new shoes, I want some new shoes

I don't know about you but I'm feeling 42
Everything will be alright if there's no calls from school

Yeah, I know about Wii, and I'm nice on X-box, too
Everything will be alright if we just keep dancing like we're 42, 42

42, yeah, 42, yeah yeah

It feels like one of those nights
We need a girls' night!

It feels like one of those nights
The dads won't be sleeping!

It feels like one of those nights
The kids aren't up, dude . . . .

I gotta have you, I gotta have you. . . . .

***
Happy Saturday. And Happy Birthday to me. And to you, it yours is today or coming up.

Even though I'm technically 43 today, all of it blends together at a certain point. Plus, "43" didn't work for the song. Ha ha ha. Oh yeah! All of the pictures are from my year as a 42 year-old so that counts. It totally counts, man.

Lots of good 43 year old shenanigans planned for tonight. . . . . . .

Now playing on my mental iPod -- but with my revised lyrics!