Captain Obvious Reports: Don’t Cough Into Your HAND, Silly!

Okay, this one I’m embarrassed  about.

“If  you cough, cough into your hand or fist.”  That’s what I was told as a child, what I’ve always done, and what I’ve taught Son.

Never in all those years did it ever occur  to me that coughing into my hand actually endangers more people than coughing into a crowded elevator.

Why does it endanger more?  Because I then use that hand to shake yours, or to turn the doorknob, or to move hangers on a clothes rack.  So the viral or bacterial germs go from my wretchedly sick insides to my hand, where I pass them onto whomever or whatever I come in contact with, leaving whomever or whatever they come in contact with free to share  some more.


It makes much more sense to cough into a tissue (and immediate dispose of it).  If a tissue is unavailable then the best thing to do is cough into your elbow.  At least then the germs aren’t  as easily spread, though I recommend steering clear of any mosh pits or orgies.

But then, I’d recommend that anyway.  At least until you’re well.

So my new mantra to Son will be, “Cough into your elbow”.

I’m sure many of you figured this out ages ago and didn’t need a Captain Obvious Report.

But for those of you out there who regularly or temporarily reside in Oblivia, Captain Obvious bulletins are helpful, aren’t they?


When Your Wife Has It Coming Out of Both Ends, It’s Time to Man Up and Not be an Ass

I had a colonoscopy today.

For those of you lucky enough not to know, in order to do a colonoscopy the doctors need a clear, clean colon. And there’s only one way to do that.

In my case that meant 4 Dulcolax and a 238ml bottle of Miralax poured into some Crystal Light iced tea. This after eating nothing but a lemon italian ice and 1 bottle of Ensure for the 21 hours prior.

After awhile the stuff started working, but then the same thing happened this time that happened last time I went through this: I started getting nauseous. Very nauseous. Despite drinking a ton of water I started vomiting. I’m not sure if my system didn’t like the Mirolax, or if it didn’t like it combined with Crystal Light iced tea, or if I was just getting dehydrated.

So, suffice to say I did not feel well.

It was a rough night, but Husband was kind enough to finish giving Son the pizza I microwaved for him, and to make supper for himself. He was also nice enough to leave me the dishes and the job of making Son’s lunch for school the next day. He did agree to drop Son off at school the next morning – only the second time ever (the first was last year’s Colonoscopy). I’m not complaining – that’s what I do while he’s at work.

But why is it that some men need explicit instructions on how to do simple daily tasks? Why does a man with a four year old have to be told night after night where the pajamas are kept (okay, he stopped asking awhile ago, but he asked for waaaaay too long!)? And why does the observation that Son needs a bath have to predicate a hissy fit of epic proportions about being late for work instead of a simple question of whether it needed to be done before school or if it could wait until after? And why would he not know that his sick wife would appreciate help getting Son ready for school, that “getting ready for school” means getting him dressed and fed, and to do that himself?

So I, still issuing orders from both ends, made Son breakfast and got him dressed. Husband did put on his socks and shoes and put the lunch I’d made the night before into his lunchbox with the cold pack, so there’s that.

And I think he wished me good luck as he left with Son, but I wouldn’t know.

I was still issuing orders.

Warm, Fuzzy Socks

My cousin is dying. She has a recurrence of leukemia and chose not to treat it this time.

She’s in hospice today, almost four months after she got the news. She lives 1000 miles away, and I have plans to go see her in three weeks for the event she really wants to attend – her nephew’s Bar Mitzvah. I spoke to her last week and her numbers were still good. We laughed and joked and talked about the serious stuff. We talked about the warm, fuzzy socks I sent her, and how they’re like a hug for your feet. We talked about me staying with her for the Bar Mitzvah (she offered, I declined), and we looked forward to seeing each other again. I was sure there was plenty of time.

I was wrong.

I spoke to her yesterday, and the day before. The warm, vital woman I’ve looked up to since childhood is there one hundred percent. She doesn’t sound sick. She’s lived for many years with Multiple Sclerosis, she’s beaten the cancer once. My heart wants to believe it’s a mistake, but my head knows it isn’t.

We’ve had her for longer than we thought we would. She’s had a rough road physically, but she’s also had many blessings. A wonderful husband, a gorgeous son who is already a man at fourteen, family and friends that adore and admire her.

I’m not going to be there when she dies. I’m not going to be there for her funeral.   I’ve decided to go for the celebration of her nephew’s Bar Mitzvah that we’ve all looked so forward to.  We’ll celebrate my little cousin becoming a man, and we’ll celebrate the life of my cousin, his aunt, who loved us all.

In the meantime, I hope she’s wearing the warm, fuzzy socks.

Concierge Doctor Plans – Not Frugal But Perhaps Money Well Spent

A few years ago I started hearing about so-called Concierge doctors. These doctors limit the number of patients in their practice and charge membership fees (for goodness sake!) for the privilege of being their patient. The knowledge was floating around the periphery of my brain, but aside from the initial internal outrage at the gall of those doctors I really didn’t give it much thought.

Then, about four years ago, Husband started feeling poorly, and he wasn’t feeling better several months later. He didn’t have his own doctor, having not darkened one’s doorstep in over ten years. Since my own doctor wasn’t nearby I started calling around trying to find a doctor for him; at least once his 40 lb weight loss and debilitating fatigue finally got to him.

It was an exercise in frustration. After at least fifteen calls the only doctor I could find that could see him within two months was in a Concierge practice. When the receptionist explained to me that the doctor would be happy to see Husband the next day, but first there would be a $3000 membership fee to join the practice my eyeballs very nearly popped straight out of my head. Three thousand dollars? Before the doctor even saw him? Outrageous! I wound up calling my doctor and making the trek with Husband the next day (we found out he was diabetic, with a blood sugar level of over 400 that day!).

The next few months were spent getting Husband every test imaginable and getting his diabetes under control. We’ve had lots of interesting (read: awful) experiences with doctors along the way, and I’m sure I’ll blog about them at some point.

I honestly had not given the subject of concierge medicine much thought since then. Until last week.

Husband’s grandmother, G-d bless her, turns 95 next week. Mama’s got all her marbles and then some, but has some issues with her sight, blood pressure, hearing… all a pretty normal part of living ninety-five years. She tells me that her parts are wearing out; I tell her they’ve still got a lot of wear. After all, she still regularly beats me at rummy, makes a mean Pasta Fagioli, and can gossip up a storm.

When I heard her doctor was switching over to a concierge set-up my initial reaction was negative. It seems to me to be flirting pretty boldly with double-billing, and on a fixed income the new $1500 a year membership fee seemed ridiculous for her to pay if she didn’t have to. After all, there are plenty of doctors around.

She went to hear about it with her son and daughter-in-law, who practically forced her to sign up. I saw her immediately afterwards, when she was contemplating calling and canceling the transaction. Based on my own preconceptions I was privately hoping she would.

Then I started reading the brochure, and I started thinking about it.

Mama has had a lot of problems with doctors. Well, not really the doctors. The doctors are usually pretty good, or at least have good intentions. But they are hampered by the current state of health insurance in this country, which makes it nearly impossible for doctors to see enough patients to pay their student loans, malpractice insurance and earn a living without having to resort to fast-food-like service. And some of it is because of office personnel who inexplicably think we owe them something because…I don’t know why. Because we pay their salaries? Either way her care has suffered, and she’s been hospitalized unnecessarily more than once and avoided a stroke due to an overdose of medication by the hair on her chinny chin chin.

My mother-in-law found her this new doctor a few years ago and everything has been pretty smooth since. Sure, there are screw-ups with labwork and appointment times occasionally, but much, much better than before.

This doctor has decided to join an already-existing concierge-type network plan. For her $1500 annual fee she’ll get a much more comprehensive than normal yearly physical, a personalized wellness plan, a CD of all her medical records, VIP access at Cleveland Clinic and concierge service at any of their member facilities, travel services and more.

All of which is good, though some of it is simple marketingspeak. The real benefit, the real reason to do it, is the access to the physician.

Appointments will be available either same-day or next-day with no waiting. And they will last, theoretically, as long as Mama needs. The doctor is available 24/7, and if she tells her that she needs to go to the hospital she’ll meet her there (if you’ve ever spent hours waiting in an Emergency Room you may think the $1500 cost is worth it for that alone).

How can she do it? She’ll be limiting herself to 400 patients (200 less than the plan normally requires), down from about (I’m guessing) 2000 now. That means she’ll be able to actually manage all of Mama’s care, be familiar with what’s going on with her, help her make decisions that are right for her. Mama is 95; she just wants help making the little things that keep coming up (like a recent onset of vertigo) and making her chronic ailments more comfortable until The Big Thing comes along.

Why not make it less stressful? Why not spend $125 a month to give her easier access, so that she can get care and answers right away? Why not? As I said to her, “Mama, why not spend your money to make yourself more comfortable? What better thing are you going to spend your money on?” She lives with my mother-in-law and doesn’t have many expenses. And even if she could not afford it we would all chip in to get her this kind of service with a doctor she already trusts. She’ll always have all of the creature comforts she needs. And if she’s not wasting money on prescriptions she shouldn’t be taking and wasting time and money waiting and schlepping and… well, I’m obviously a convert.

Surprised the heck out of me.

I’m not sure I’d feel the same way about some of the other fee-for service or retainer-type concierge set-ups ($15000 a year? Come on!). This plan is much more.

And this isn’t insurance. It doesn’t cover procedures or prescriptions or any other gaps in coverage on her policy.

The annual fee may be paid through employer Section 125 plans, and is compatible with flexible spending accounts (FSAs), medical savings accounts (MSAs), and health reimbursement accounts (HRAs). The fee may also be paid through the newly established health savings accounts (HSAs).

I don’t think these plans are right for everyone, by far. For Husband and I it would be $250 a month, which is about $249 a month over what we could afford to spend on it. But if you’ve got the money, or if you’ve got a chronic or acute illness, what great peace of mind you can have for a measly $125 a month. And, in Mama’s case, her kids will rest easier, and all of us will worry a little bit less.

We want her around as long as possible, but we want her comfortable, and happy.

The Choice

I have a cousin who is the bravest person I know.

She hasn’t had it easy. She was diagnosed with MS in her thirties, but wouldn’t let her doctor write it in her chart until after she was approved for the adoption she wanted so badly.

She got her wonderful son, and he has brought so much joy to her, and to our family. Her disease progressed to the point where she can’t see all that great, and she’s needed help walking. But still she lives life to it’s fullest. Always has.

Then a couple of years ago she was diagnosed with leukemia. She fought it, hard. It took a toll, but she was well enough to kvell at her son’s Bar Mitzvah last year, and she clawed and scratched her way into remission.

Then, today, I got a call from my Dad I hoped to never get. The leukemia is back.

Of course we are all devastated. My Dad asked me to call my brothers and sisters, as he just was having a hard time with it. She is his first niece, and has always held a very special place in his heart. With my stepmother’s death just seven short months ago, the knowledge that he will soon lose another woman he deeply loves has left him bereft.

And lose her we will. She doesn’t want the chemo this time.

That’s a hell of a decision to make, isn’t it? Either path promises pain and sadness and tears and sickness and heartbreak and death. How do you choose between spending as much time with your child as possible or spending less time, but hopefully feeling better? Just making that choice shows more courage than I have.

I’m just filled with sadness that we’ll lose her, sadness that her son won’t have her holding his hand into adulthood, sad that I won’t be getting her silly/beautiful/poignant e-mails.

Sad that my aunt and uncle will suffer the loss of their daughter, every parent’s biggest fear.

But there’s really no time for that. We could have her another six months, at least I hope so. I won’t waste another moment.

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