Thursday, April 23, 2009

Solving the Medical Crisis, One hypochondriac at a time

I woke up at 4 am this morning with the worst abdominal pain I can remember. I'd been in Ruby's bed since 3 am when I'd walked her back to her room, a nightly event. I have a weak spot for the kid who wants to bed down with someone rather than alone; I was her long ago. Anyways, I wiggled out and wandered back to my plusher bed and hoped the pain would subside.

No luck. I never slept again and eventually got up again at 5:30, pain worse than ever. I gave the ole porcelain god a shot, and then dropped down a few laxatives left over from my postpartum days and called my mom. The truth is, though I idly hoped that the laxatives would force out some internal evil spirit, I was sure I had my first kidney stone. My mom and sister have both passed about three of stones each, and since it is often a genetically linked malady, I've been waiting for years for the day to arrive. I phoned my mom at 8:30 her time, and asked her to recall her symptoms. She was vague and insisted they would be different for everyone, not very comforting.

Less comforting than that was the fact that outside of my mother, sister, and one close friend, I have known one other person who frequently had stones (of course, most people probably don't advertise). Jim, a former neighbor, friend, and church member when I was kid, had so many kidney stones in his life that he became complacent about medical care, figured he had passed them before, he'd pass them again. His final stone took his life. After waiting two days, through excruciating pain, for the stone to pass, he finally went to the doctor, but it was too late. Uric poisoning had entered his bloodstream and he passed away about 36 hours after making the trip.

The way I was feeling, I just wasn't going to let it go; visions of motherless children were haunting me. After I hung up, I turned to Web MD. After a symptom check, I had a new forerunner: appendicitis. And wouldn't you know it, if it was my appendix, taking laxatives is strictly forbidden, it will cause a rupture. Perfect.

I went back to bed and slept on my side in doubled over position, holding my abdomen and beginning Lamaze breathing when Jason woke up to ask if I was OK. No, I told him, I don't think so. I proceeded to outline my symptoms and corresponding suspicions and suggested I might need to see a doctor. He agreed, but waited for me to make the final call. I delayed another 30 minutes, but after nearly 3 hours with no let up on the pain, which radiated from my belly up to my breastbone, down to my hips, and through to my back, I was ready.

Jason sprung into action. He dressed the kids, loaded us all in the car, picked up an egg mcmuff for Ruby and Trey to share and dropped them off at daycare. Then, we headed for urgent care at Gateway, and before I knew it, I was in the doctor's office.

Why is it that as soon as you reach the doctor's office things start to taper off? While I was still in pain, each time I was left in the room: to check on the urine, to wait for the doctor, to order the blood count, to analyze the blood draw... I wondered, am I getting used to it or am I subtly feeling better? The doctor's final decision was to order a CAT scan to rule out the appendix. It seemed a reasonable plan as I still had severe cramping, albeit oh-so-subtly less intense. If it was appendicitis I wanted to know now.

The order had me at the hospital in one hour, so we came back to the house and I slept for 45 minutes. I awoke feeling better, a lot better, who knows what really happened, maybe I had let the evil demon out as I passed gas in blissful oblivion. But, given the drama act I'd put in all morning, and the fact that Jason had taken his whole morning off, we decided to stay the course. If I simply let him head off to work, blew off the scan, then who knows, I could feel worse in 15 minutes and change my mind again. Since neither of us have ever had scans, and we have good health insurance, it seemed a worthwhile venture to rule out something as serious as an inflamed appendix.

So, off we went to the hospital, where I was surrounded by many, many patients much sicker than I. I waited in a lobby with other walk-ins and watched countless hospital beds pushed in and out of the X-ray Imaging department. What we all had in common were our 32 oz. Big Gulps: iodine and water mixtures for tinting your insides for the photo shoot.

I was supposed to wait an hour, but that grew to 1.5, during which I made steady improvement and my pain had all but disappeared. I spent some time checking with my insurance and pricing the scan, and after learning I would be making a significant investment, started to have real doubts about this whole thing. I told the receptionist I was feeling better and had decided to cancel, but Jason encouraged me to follow through. When a lab tech came out to tell me it would be another 30-40 minutes, I drove Jason to pick up our other car and run off to work, and I returned by myself to the hospital.

Things sped up at that point. I was given a saline IV, through which some new dyes were injected, and my abdomen was photographed and read. It was invasive enough that I'll spare you most of the details on that. Another 20 minutes brought me word from the radiologist that the appendix looked fine. All for naught.

So, as I sit here tonight with a flu-induced headache and general malaise, I'm pondering the thoughts I had throughout the day. How did I end up getting a CAT scan that I really shouldn't have? Do we blame the doc for overprescribing tests? Do we blame the insurance companies for offering to pay for them? Obviously, we can't go that direction, what if my outcome had been different? The rupturing of the appendix can kill you pretty quickly and I would not have footed the whole bill - NO WAY.

HMO's tried to cut costs by rationing doctors on the number of referrals, diagnostic tests, and hospital stays they could recommend. And bonuses were added for those who came under their allowances. Clearly, that will never work either, as it totally clouds the clinical and ethical principles the doctor follows in his/her decision-making.

What about WebMD, and the internet in general? If you are prone to worry about your body enough to research, aren't there a lot of scary illnesses to be found out there?

So, why did I get the scan? The easy answer is that I'm a hypochondriac in the care of responsive, and cautious doctors. And maybe that's it, the whole thing ended up pretty embarrassing (though admittedly the outcome would be what you would HOPE for) but it was ultimately my decision all along the way and there were multiple opportunities to back out. On some level, finding something would have been vindicating (though the nurse did admit there might still be a kidney stone, they used the wrong contrast color to see that), but of course in the long run, not in my best interest. And in some measure, I am relieved, and too exhausted (and still a little sick) to really care.

Will I make a different decision in the future? Well, I doubt it. Whatever is the real matter, I was a sick woman this morning, and I just can't promise that when I encounter totally foreign symptoms I will be able to just ride it out. So, I guess that the only solution is to isolate the worriers, the hypochondriacs like me, and rediscover a protocol for their aches and pains that can rescue the medical community and the insured from this overpriced economic disaster.

For now, I'm just grateful I have good insurance.

Friday, April 17, 2009

The Difference Between Us and Them: An appeal to corporate district management

Layoffs are happening everywhere, unemployment is skyrocketing; these are bitter pills for individuals and families. Yet, there is a difference between the business that slows down production due to decreased demand that must lay off workers, and the school building where demand does not subside but teachers are laid off all the same.

Certainly, you must respect the fact that as every household grocery bill goes up, costs for companies do too. Fine, that also provides the impetus for cuts. And yes, decreased tax revenue that is the result of the general recession means WE have to make lots of cuts. However, I really would suggest that PPS take a good, hard, unbiased look at central office positions before deepening any cuts in the teaching force.

There is certainly progress being made as never before: online trainings, better communication, lots of reformist thinking in the central office, and plenty of district-wide administrative meetings as we work through the problems, but if we need to sacrifice some of that in order to not burn out what really makes PPS work: PPS teachers, then I believe we have an OBLIGATION to do that. If we admit that now is not the time for frills, then why is it up to schools to make cuts while we read about new central office positions emerging?

What is 30 kids in class v. 35? Sure, that makes it harder, but everyone's going to have to pitch in, right? Well, when's the last time YOU were that teacher? Why not take at least a month or two to go into a classroom and teach again? I think there might be a lot of clarity gained if central office staff regularly worked in our schools. If nothing else, I think THAT is an initiative worth undertaking in the future.

If it was up to me (or anyone else, I am sure), everyone would keep their job. We'd go full steam ahead and continue to realize our potential as one of the finest urban school districts in the country; but I have to speak out, because it really worries me that people who aren't living the reality of the classrooms are charged with making budget allocations.

When I look at the controversy over the proposed high school schedule for instance, I am staggered and demoralized by the erroneous assumptions that seem to underlie the proposal. It is not that teachers do not want to work a longer day, they already do. Most teachers are available to kids before school, during lunch, and after school (and you might find that the staggered availability is a plus for kids rather than a minus); all teachers plan and grade every night and lots of weekends; they oversee extracurricular activities and events and they are attendees and spectators of community events that involve their students and parents. If a 60-hour week doesn't sound about average, then again, with all due respect, I'd have to ask when is the last time you taught?

When I started teaching 9 years ago, the average class size was about 28, now it is 34. What will it be in another nine years? Don't there have to be better solutions than eliminating staff, increasing class sizes, freezing salaries, increasing health care premiums? If not, then the schools of tomorrow don't look very good. What makes the most impact on students? Their teachers! Not some magic pill anchor paper, TAG meeting, or snazzy newsletter. Though there are some positive outcomes here, they don't make the same impact.

Quality teachers are able to lead balanced lives, and see their profession as at least financially sustainable. There's a tipping point where that quality will disappear altogether, and we are teetering on that brink now. You can blame the economy, rising health care, state legislators, who or whatever; it does not change the fact that we can not go on like this. When will we face it?

Please, put money back in schools, put control of the money and time back in the buildings. Simplify, but simplify with students in mind.

Friday, February 27, 2009

All for One, and Two for All!

I knew wouldn't be long before teachers would be asked to work for free again, but it was longer than I thought. Back in 2002, Portland Public School Teachers "offered" to work two weeks for free. The offer was part of a deal brokered by the teachers' union in order to settle contract negotiations. The other choice: teachers pay a portion of their health care premium. Teachers, who hated to see the Portland students suffer the legacy of missed days and a media frenzy that might feed a poor perception of the district in the eyes of college admissions officers and employers, conceded. For most teachers, volunteering extra time for the direct benefit of students is a consistent and welcome sacrifice; and the option was a lose-lose anyway, in compensation terms.

Th next contract negotiation brought employee contributions to health care anyway. It was delayed by a year, but it came nonetheless. In my nine-year teaching career with the Portland district, I can't think of any concessions teachers have won on the contract. We just receive a survey asking us to rank a number of things we could give up. At the time of the two weeks of free work, I tried to swallow my fear that this set precedent and just embrace the opportunity to pitch in and give back to my students, who at that time stood right beside us, demanding their right to a quality education.

But once you've worked for free, it inevitably becomes a cost-saving measure, and no one stands by worrying about a shortened school year, including students and parents. It is assumed that you'll do it, and if you don't want to, well there are plenty of other losses to threaten you with. So, here we are again, Governor Kulongoski has publicly requested that we work for free. And not just us, but now teachers in every district across the state of Oregon. He didn't stipulate the number of days, but I suppose this will depend on how serious the economic woes of your district really are.

Now, I have nothing against Kulongoski; I voted for him, twice. Heck, he's even going to work 4 days for free himself, effectively cutting his salary by 5%, according to The Oregonian (Does this mean that he works 80 days?) . Great! We'll only cut ours by 5.26% (we're paid for 190 days a year) if we go back to our old 10-day donation. No biggie, right?

But I don't need to get a calculator out to see if I can hack it, these days I live life on a strict budget. Why? Well since 2002, I was foolish enough to add 2 children to the house and reduce to a half-time schedule to spend a little time with them. With two teachers in our household, we have cut way back, maybe not to the absolute quick (I don't feed rely on ramen noodles as a primary staple), but we have established a budget, made new investments and expenditures, and even run up some credit debt in anticipation of a return to two full incomes and public schooling for our children, someday. Now, mid-year, will we need to figure out in short order how to squeeze an already tight wallet enough to produce a surplus of two weeks pay?

Since we aren't planning to default on our home or college loans, nor ditch our life insurance, or stop feeding our children, it won't be an easy choice. Maybe we can sell our remaining Blazer tickets, though it is the only time that we get out (usually one at a time) without kids, or we can stop contributing to our children's college funds (we're just losing money anyway), but still I can't figure out how we'll do it - it's not enough. And it isn't just two weeks of income, teachers with young children in daycare like ours need to consider the costs we will incur as we stride off to our new volunteer positions.

Since I'm in a position to really sweat this one (last time I was single and still got haircuts and drank an occasional latte), I can't help but wonder if we will get anything in return. Maybe a better discount for the books we buy at Borders, or a 2nd annual Teacher's Savings Day at Office Max? But as Gail Rasmussen of the OEA noted, even these generous returns on our investment won't really be used when our own shortfalls cause us to stop spending, thus ensuring we aren't the only ones hurt by this furlough. And as I ponder plausible solutions, I'm suddenly struck with a brilliant idea: What if everyone works 2 weeks for free?

Now before you start to feel violated (believe me teachers also have this nerve attack, the one you're having, at the suggestion of working for free), and start muttering about teachers' summers and other vacations, I must gently remind you that we are only paid for the days we actually work (though it is true that we can arrange to have pay taken out and paid to us during non-work periods); and also that teaching is a high turnover profession and we need more good teachers (and you too can take out student loans and become one). Now, if I haven't lost you, bear with me for just a while longer.

Let's start with the everyday expenses typically incurred during those weeks. Just think of how we might ALL benefit if the gas station staff works without pay, surely we can lower fuel prices while we all go off to our pro bono jobs. With fuel less, and Trimet drivers working for free, mass transit can drop fares in half, a good option for those of us who already sold our cars. Food prices would drop significantly with everyone in that industry working for nothing, health care would be at its most affordable, and we could waive a major percentage of all utility bills. Half-off sales at retailers would abound, and for those who had some savings, purchasing would inevitably rise. Now, isn't this sounding better already?

How about the loans and mortgages? Well, banks could drop interest rates for two weeks, especially after living so fat on my new reduced savings rates. Housing sales would go up, and overall optimism could reign again. In fact, maybe we could all learn to truly love our jobs in the absence of the infecting influence that money must have on our motivation, draining all the intrinsic and filling it with the empty satisfaction of the extrinsic.

Indeed, I think I have not only stumbled on a solution for myself, but the ultimate national stimulus! Just vote me, Owens, 2012.