More New Years Gifts

This is the second installment of my New Years gifts to you. Thank you for giving me the opportunity to share with you. I hope this New Year brings us all joy and health in a world that knows more peace.

1. Dancing cockatoo
   
2. Flow
3. Paintjam
4. The Jean-Paul Sartre Cookbook
5. Chris Bliss - Amazing Juggler

Medical Blog Awards 2007

Much to my surprise and delight, this blog has been nominated for a Medical Blog Awards 2007 -- Best Patient Blog award - a competition sponsored by Medgaget.

While I have no delusions of winning this award, especially given the wonderful blogs nominated in this category, I am flabbergasted by the inclusion.

Here is the timetable of events. If your are so inclined, please feel free to vote for this blog when that phase of activity is open.:

-- Nominations will be accepted until Monday, December 31, 2007.

-- We will announce the finalists on Monday, January 7th, 2008

-- Polls will be open from Tuesday, January 8th, 2008 and will close at midnight on Sunday, January 20, 2008 (PST).

-- Winners will be announced on Wednesday, January 23, 2008.

Keep your eye on Medgaget for status updates. And thank you for your support and for reading In Sickness & In Health

New Years Gifts for You

This is the first installment of my New Years gifts to you. Thank you for giving me the opportunity to share with you. I hope this New Year brings us all joy and health in a world that knows more peace.

1. Herding Cats
   
2. Free Rice
3. Richard III & Peter Sellers
   
4. Ashes and Snow
5. Opera Guy

American Cancer Society Report: People with Inadequate Health Insurance are More Likely to Die

An article on WebMD tells a not unexpected, but still deplorable, story:

Cancer patients without adequate health insurance tend to face grimmer odds than those with good health insurance, says an American Cancer Society report. The American Cancer Society based its report on information from the CDC and from the National Cancer Data Base.

The report shows that people with no health insurance or inadequate health insurance face four main challenges when it comes to cancer:

• They're less likely to get screened for cancer.
• They're less likely to get counseled about cancer prevention.
• They're more likely to get diagnosed late, when their cancer is harder to treat.
• They're more likely to die from cancer than people with adequate health insurance.

Health insurance isn't the only gap in cancer care. Racial and ethnic disparities also affect cancer outcomes.

Ever since I developed a chronic pain condition, and like too many other pain patients, wandered from specialist to specialist, from one health care system to another, from western to alternative treatments, I have been aware that my white, English speaking, educated, middle class, married, insured status served me well.

I was always taken seriously. No one ever intimated that my pain was not real, even though no cause was ever ascertained. With medium effort, I got referrals to specialists outside my provider network. My phone calls to my care team were returned.

My status ticket got me a seat on most every train I wanted to ride. Even though I knew the system was slanted in my favor and that others were disadvantaged, I took my advantage. I was sick, I was in wretched pain every day, and I was willing to do anything to make it stop. Even during my worst periods, I was aware of this unfairness -- and felt guilty and lucky.

Richard, my husband, also played the privilege card, many times - always for my benefit. And I counted on him to play it well, especially when I wanted insurance approval for seeing a pain specialist at Johns Hopkins or when our mail-order drug vendor was taking too long in delivering my medications.

We talked about everything else, but we never talked about this. I think we were both focused on survival and couldn't afford to let ethics dampen our efforts and our access to resources we both knew others weren't getting. Shame would come later - when I began to climb out of the pain pit.

Now I work with hospital systems that are trying to make a difference, trying to bring health care to all members of their community. Are my efforts helping to make things more equitable? Barely - one mini-micro drop of water on a parched landscape. I still feel guilty and lucky - but I have to do something.

Grand Rounds are up at Trick-cycling for Beginners

Grand Rounds are up at Trick-Cycling for Beginners, a truly wonderful blog written with humor and truth by a psychiatrist in the U.K. She introduces her Ground Round choices with a haiku -- how inventive is that! I am honored to be among her picks.

Popped but not Forgotten

The ultimate stress reliever - you must check this out.

I learned about this through the How to Cope with Pain blog.

I've been tagged

Rosalind at Keep Working, Girlfriend tagged me for the meme challenge. This is the second time within a two week period that I've been tagged. While I am very appreciative, I have to confess, it was really hard to come up with seven more interesting facts about myself without stepping onto some psychological land mines or outright lying.

For readers new to the meme challenge, here are the rules:

1-Link to your tagger and post these rules on your blog
2-Share 7 facts about yourself on your blog, some random, some weird
3-Tag 6 people at the end of your post by leaving their names as well as links to their blogs
4- Let them know they are TAGGED by leaving a comment on their blog

7 Facts About Me:

1. I have never gotten a parking ticket.
2. I am genetically incapable of being late for anything. I usually arrive at least 15 minutes early. For me arriving on time feels like I’m five minutes late.
3. I speak five languages (Spanish, French, Portuguese, Hebrew, English) – two of them badly.
4. I used to ace my college classes by writing class notes in tiny script on index cards and then memorizing each card so that I could recall the visual image of the sentences on the cards during an exam.
5. I play one musical instrument, the guitar, badly.
6. I have been in a women’s group that has met monthly for over fifteen years. I don’t know where or who I would be without these amazing women.
7. One of my best teenage memories is being alone in the house during a power outage in the winter. I made a fire in the fireplace and lay down on the floor next to my dog and read Alice in Wonderland out loud to her until we both fell asleep.

I'm tagging:

I'd Like to Buy a Bowel
Living With Fibromyalgia
Wachter's World
The Daily Headache
Well Soul
Own Your Health

Good Reads: Operating Room Etiquette; Rudeness at the Local Pharmacy; the New Yorker & Checklists in the ICU

Terry at Counting Sheep posted a very intriguing list of the rules of operating room etiquette for staff and patients. Did you know that sleeping patients have the right of way. Stretcher traffic in hallways dictates that the anesthetized patient should always go first? Did you know that as the anesthesia lightens and the patient awakens at the end of the case, all music and extraneous conversations and noise come to an end, to enhance a smooth and quiet wakeup and transition for the patient? And that nothing to eat or drink after midnight on the night before your surgery includes lozenges, juice, candy, gum, and coffee with or without cream.

Sandy at Fighting Fatigue posted a disturbing, but too common, story about how a pharmacist demeaned her when she went to fill her prescription for her pain pills.

And check out the article by Atul Gawande in the New Yorker about a crusade to improve the safety of intensive care through the use of something low tech and ordinary -- checklists.

Sudden Trauma: What's a Couples to Do?

I just got an email from an old colleague. He wrote that his wife, on her way back from posting a letter across the street, tripped and fell, hitting her head on a rock. She was unconscious and had to be rushed to a trauma ICU where they removed a piece of her skull so the blood could drain out. The odds of people surviving the procedure are 50-50. She is part of the lucky 50% and is doing very well.

When I heard this news I was whiplashed by the fact that it happened to her – a vibrant, smart consultant, a vegetarian, a yoga practitioner with a high social and spiritual consciousness. None of these qualities protected her from the chaos that buzzes around us all the time. And, of course, the extrapolation is that we are all susceptible.

As couples, we drift from moment to moment, counting on the illusion of control while ignoring the ubiquity of chaos, so that we can chart our lives with a sense of continuity and security. We plan to buy our first home, to have babies, to find satisfying careers, to travel, to grow old with dignity, and to retire with secure income streams. Some of us may separate or divorce, have boring jobs, and wind up with cats instead of kids. But that is never the script we write for ourselves. And nowhere in our story is there a placeholder for the intrusion of illness or trauma.

I think the best we can do, which is what these friends have done, is to build a loving foundation and to have had enough practice at communicating about the smaller hard stuff, so that when the skies rip apart and the lightening bolts strike, we can still find each other in the storm.

This Week's Grand Rounds at Dr. Geek's Place

Enoch Choi, M. D., otherwise known as Dr. Geek is hosting this week's Grand Rounds. Have a read. Thanks for including me Dr. G.

A Story About Chronic Back Pain and a Relationship Gone Sour: Kate and Frank

This is a true story. All identifying information has been changed to protect confidentiality.

Chronic, long term illness can make couples turn nasty. Almost everyone can rally for the occasional acute situation – a hernia, a broken leg, appendicitis, a cancer diagnosis. But when the acute doesn’t resolve, when it takes hold with its vampire teeth and begins to draw away the life energy, the couple relationship can slowly begin to toxify, and even die.

Frank and Kate settled for each other. Each of them had gone for several hot-blooded rides on the relationship roller coaster where they started with the thrill of infatuation and landed at the finish line broken-hearted. With each ride they took, they became a little bit more panicky and a little bit more cynical. Separately they each decided that any relationship that began with chemistry was destined to crash. The pledged secretly to forswear infatuation and seek stability.

When they began dating there were no sparks, no buzz, but there was compatibility. They preferred to read biographies rather than novels. They didn’t like spicy food. They cross-country skied in the winter and rode bicycles in the spring. They rarely argued about personal matters. The only tension that disrupted their calm surface was that they managed a retail business together and Frank started becoming more dependent on Kate for maintaining the office (which she did not enjoy) while he handled sales (which he did enjoy, and was good at).

Five years and two children into their marriage, Frank started developing back pain. He threw himself into the hands of the medical system. Two surgeries and hundreds of pain pills later, Frank was still in chronic pain and hooked on an array of medications that made him drowsy and impaired his memory. For a while Kate commiserated and compensated. She took over all the household responsibilities in addition to managing more of the business. And she did this while trying to bolster Frank’s increasingly depressed ego.

Frank was indeed in pain, and impaired. He asked Kate to prepare special meals for him and to be the one to chauffeur the kids to gymnastics and soccer. Kate began to think that he was exploiting the “privilege” his role as patient offered him. She continued to maintain him, but her early compassion slowly turned to ice cold resentment. Frank reflexively responded to her growing distance by increasing his neediness. He developed headaches, lost track of customer calls, slept until noon, and took frequent naps. Kate felt trapped because they were locked into their business as their only source of income. She became harsher, and he became more helpless. The relationship had turned nasty.

There is no happy ending to report. Kate and Frank continue in this toxic loop that is their relationship. Kate finds distraction and sympathy with her women friends, and Frank finds the same with his army of doctors. While they each might have some subterranean motives for remaining in this tangle that has become their relationship, neither one has any interest in disentangling and repairing. They carry on.

Do you know a couple who found illness too heavy a load for their relationship to bear? Or who found that illness put too much pressure on already frayed relationship seams?