The Apollo Mission

I reconnected with Dr. Apollo (a pseudonym) after  my recent Oberlin College reunion.  I’m a doc, you’re a doc, let’s chat sometime.  He agrees to be interviewed after reading my blog post on physician burnout.  “Oh my gosh,” he says.  “This is exactly what we talk about!”  Scheduling the interview turns out to be a minor challenge.  Apollo and his wife have been trying to update their will for four years.  The night before we chat, Apollo spends the evening on the computer, finishing the electronic chart notes for his clinic patients.  Then he completes the twenty-five charts pending from earlier in the week.  He goes to bed at 6 am.

I send him a Facebook message that he reads at 1:27 am.  The next afternoon, I catch him in the car.  His wife’s driving.  For a guy who commonly gets three hours of sleep a night, he sounds pretty good.

Apollo loves medicine.  He was chief resident in Internal Medicine before pursuing a fellowship in Infectious Disease.  He wound up in a large health system in Ohio.  Germs rock his world.

Like Family Medicine and general Internal Medicine, Infectious Disease isn’t a procedure-driven specialty.  Dr. Apollo is paid for “production,” for the number of wRVUs (work Relative Value Units) generated in a day – or night.  The thinking specialties, Pediatrics and Internal and Family Medicine, pay far less than interventional or surgical specialties like Cardiology and Orthopedics.

The compensation system can’t even comprehend the complexity of the patients Apollo sees on a typical day.  Imagine the time it would take to communicate with an elderly Latino immigrant through an interpreter.  And by the way, the patient is deaf.  Add a sign-language interpreter.  What if I told you that the patient has multi-drug-resistant tuberculosis (add a boatload of protective gear) and is actively suicidal?

You have twenty minutes.  Good luck.

Life in the hospital is equally challenging.  About ten years ago, Apollo would make rounds on 6-8 patients per day, two of whom were new consults.  Now he rounds on 16-20 patients per day on top of 6-8 new Infectious Disease consults.  Weekends are grim with only one doc on service and an average census of 30 ID patients.  Apollo spoke up in defense of quality patient care.  This isn’t safe!  We need more docs!  Administration informed him that he could hire a moonlighter with his own money.

There was one day back in about 2002 when I was on my hospital week.  My census was 18, including folks in the ICU, pre- and post-operative consultations, newborns (some of whose parents requested neonatal circumcision – another topic, another time…), small-bowel obstructions, pretty much the routine spectrum of Family Medicine.  I cried that day.  I think I was standing at the nurses’ station.  Derica, one of my favorite nurses, did her best to reassure me.  It’s okay.  You’ll get through it.

Dr. Apollo is getting through it.  Sort of.  On top of caring for real-live patients, Apollo is also available via pager to whomever wants to chat.  This is a “service” that the specialists in the system provide, an unpaid service.  In procedure-driven specialties, the docs might see some procedural revenue.  In the thinking specialties, these “curbside consults” are a charitable contribution to the organization.

Let’s pretend I’m in clinic again, and I’m seeing a young man with newly-diagnosed HIV disease for his hospital follow-up.  I have questions about his medication regimen that require ID input.  In the olden days, I would ask my RN to please contact my favorite Infectious Disease doc’s office and try to get her on the line.  What would she get in return for being available to help me?  A new clinic patient.  And my undying loyalty and gratitude.  Maybe I could work her son into my schedule for his forgotten sports physical.  What goes around comes around.

Now, if I practiced in Apollo’s system, I would call a general number if I couldn’t find my MA, and request that an ID specialist call me back.  I’d ask Apollo to look at my patient’s x-rays and med list, and weigh in on a follow-up course.  I have no personal connection to Apollo.  He’ll never see my patient.  But his name is on the chart.  Welcome to liability risk with no benefit whatsoever.

On a recent Wednesday, Apollo tracked these “curbside consult” phone calls.  He spent four hours on the phone.  Unpaid.  What goes around comes back to the pocketbook of the CEO.

Ebola almost killed Dr. Apollo.  Three of his colleagues had recently left the department.  The new hire came from California and lacked familiarity with the facility, the staff, and the computers.  Ebola hit.  Who do you turn to when Ebola hits?  Your Infectious Disease specialists, duh.  In one week, Apollo pulled three all-nighters.  One day, he had eight hours of (unpaid) meetings and saw 18 patients in the hospital.

Apollo is burning out.  It’s a smoldering burn, gathering energy over the last several years.  His department continues to hemorrhage docs and the system continues to just not get it.  (Medical students and residents get it.  The applicant pool for Infectious Disease is in a three-year decline.)  Dr. Apollo took a stand last year, demanding compensation for the curbside consults, input into clinic support staff hiring, and more time with complex patients in his clinic schedule.

The organization basically said – Prove how much time you’re spending on the curbsides!  All the calls are recorded, and somewhere in the system that data is available.  Is it available to the docs appropriately asking for compensation?  No.  Clinic support staff decisions continue to be made without physician input.  In response to the need for more time with complex patients, an administrator said, “Fine.  You just can’t lose productivity.”  And suggested that Apollo add time slots earlier in the day and work through lunch.

“It feels like we have so little autonomy,” Dr. Apollo says.  On a recent day in clinic, a nurse asked Apollo to add a patient in to his schedule.  He said no, please put them in tomorrow’s schedule.  The patient was stuffed into his day anyhow.  “What did you do?” I ask.  “I just saw the patient,” he replies.  What else can he do?

Dr. Apollo recently attended a medical conference on physician burnout.  His pager went off so many times that he had to leave.  #irony

I ask Dr. Apollo about his greatest joy, if there is any joy left at all.  “I think probably it’s that there are certain patients that I do love taking care of.”  He enjoys the social justice aspect of infectious disease, particularly in regard to refugee populations.  “In the past month, every time I see a refugee, I thank them for coming to Ohio.  I say, ‘The state is so much better because you came here.’”

What recharges his batteries?  An appreciative patient.  A successful strategy to improve the efficiency of patient care.  Academic projects such as putting together a talk or a reading.

There’s no time.

The hamster wheel of productivity strips the organization of opportunities for creativity and innovation.

There’s not even room for creativity in a chart note.  The doc’s assessment winds up being a list of diagnoses instead of the thought process behind the list.  “Medicine is about storytelling.  We even comment on it it our notes!  ‘The patient is a poor historian.’  We value that!”

The story is lost.  And the therapeutic relationship suffers.  It’s “like a factory model of healthcare,” Apollo notes.  (His son concurs from the backseat.)  “I try to keep eye contact [with the patient while typing on the computer].  I can type fairly well without looking at the keyboard.”  Sometimes he glances down and finds a paragraph of gibberish.

Dr. Apollo is plotting his escape.  He’s researching other Internal Medicine fellowship options.  What time do docs leave clinic?  What’s the average number of patient visits in a day?  Would he be able to incorporate his love of infectious nasties?  Do the docs recognize their own children?  This is a bold and radical step for a middle-aged man, to take a drastic (but temporary) paycut for the promise of eventual sanity.

I ask what change he would make on a macro level, a BIG THING.  “Single-payer,” Apollo says immediately.  He cites a graph of the steadily increasing number of physicians over the past several decades, overlaid with the exponential increase in administrators.

If Dr. Apollo switches subspecialties, maybe he’ll have the time to help with the Revolution.

I ask where he hopes to wind up after completing yet another fellowship.  He’d consider staying in his current organization.  I’m shocked.  In spite of everything?  “The [redacted to prevent more physicians from flocking to this subspecialty] docs love it!  I don’t want to burn bridges.”  And he wouldn’t want to leave his home state.

Better the devil you know?

Dr. Apollo is convinced that necessary changes to the US healthcare system will be driven by patients.  I agree.  If patients understood the abusive system that gobbles down young idealistic medical students and spits out jaded, ulcer-riddled automatons, surely they would protest.  “If doctors advocate for themselves,” Apollo continues, “it’ll look self-serving.”

What then must we do?  I’m a patient.  You’re a patient.  Please.  Speak up!  Get on the phone.  Grab your computer.  Tell that CEO to stop killing your doctor or there will be no doctors left to kill.

 

Musical Moment

Apollo is the Greek god of healing.  And herding.  Convenient.

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Lend Me Your Eir

Over 13,000 people read my recent post on physician burnout.  Thank you.  Clearly, folks are interested in this topic.  Smart researchers are examining provider stress and burnout.  Readers mentioned several resources including Let My Doctor Practice and Physicians Working Together.  I’m not a researcher.  I’m not a practicing physician.  What can I contribute to the discussion?

When I was still a clinic doc, my greatest frustration was the electronic medical record.  We transitioned from transcription to the EMR during my clinic tenure.  I refused to develop my own “dot phrases” and “smart phrases,” generic chunks of documentation that could simply be dumped into anyone’s chart.  I was my own transcriptionist.  I listened to the patient’s story and translated it into a coherent SOAP (subjective, objective, assessment, plan) note.

A good SOAP note contains just the right number of words; It’s descriptive but not over-wrought.  You see into the patient’s mind, into her version of events.  You add details of the physical exam and then you make an assessment – This is what I’m thinking based on the data I’ve collected.  And here is the plan that I’ve made with input from my patient.

Medicine is storytelling.

For the next few weeks, I’ll tell the reverse stories, the backstories, the stories beneath the white coat.

I’ve already interviewed a family doc, an internist, and a medical spouse.  Anonymity is critical.  Squeaky wheels tend to be removed.  Anticipate that I might alter identifying data to protect those who speak the truth.

If you’d like to stay in the conversation, please sign up for my blog (below or up on the right-hand side).  You’ll get a confirming email RIGHT AWAY saying Thanks For Subscribing!  If you don’t see the confirmation, check your spam folder.

Eir is the Norse goddess of healing.  May she watch over this space.

 

Musical Moment

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Laying Down My Stethoscope

One of the Star Tribune’s leading articles 8/7/16 is “Doctors Battling Crisis of Burnout.”  The article talks about how many health care organizations are recognizing physician stress and burnout as an important issue and taking steps to help providers develop “resilience” in the face of stress.  Such steps include offering an exercise room at work, hosting dinners to discuss stress, and sending cleaners to doctors’ homes when the workload is particularly dense.

Pardon me while I try to prevent my brain from exploding.

People ask me at least weekly if I’m going back to work anytime soon.  After I completed residency, I signed a contract for ¾ time with one of the major healthcare organizations in the Twin Cities.  I had my own dedicated RN – this sounds possessive, but I assure you, I was hers, too.  Full-time status was considered to be 28 face-to-face hours with patients per week.  This doesn’t include the hours spent on phone calls, charting, paperwork, prescription refills, etc.

I worked one week out of every eight in the hospital, loving the interaction with our clinic’s patients and hospital specialists with whom I’d trained.  I took overnight call about three times a month, sometimes more.  Those nights were rough, often with little sleep and hours spent at the hospital.

I dictated my patient visits and handed the tape to our site transcriptionist.  The notes were filed in the chart in reverse chronological order.  The paper-bound story of a patient’s medical life.

When my son was born, we were up to 34 face-to-face hours as the expectation for full-time status.  Not including phone calls, charting, paperwork,, prescription refills, etc.  Benefits were dependent on your FTE (full time equivalent).  I was my own transcriptionist at that point.  We had transitioned, painfully, to an electronic medical record.  Physicians were encouraged to develop “dot phrases,” generic pre-fab chart note chunks, that could be plunked into anyone’s note and tweaked as necessary.  It’s like calling paint-by-number “art.”

We were paid on “production,” how much revenue we generated for the organization.  wRVUs is the technical term – “work Relative Value Units.”

RNs were a hot commodity by that time, sequestered into specialized roles like Coumadin management and phone triage.  Providers (we were mostly physicians with a couple nurse practitioners) worked with medical assistants, some of whom floated to different clinic sites.

So when the Big E was born, Ace and I each had non-coordinated, independent, overnight call schedules.  I asked for some time away from call with a concomitant decrease in pay.  The organization turfed the question back to my colleagues.  They declined.  I can understand it – if I didn’t take call and the organization offered no support, the burden fell upon my partners.

I gave my notice.  But the organization contractually required ninety days.  Eventually, the ninety years/days were up.  I wanted to continue working for the organization in urgent care sporadically but that meant I couldn’t cash in on the physician retention benefit plan.  I worked in urgent care twice and haven’t worked for money since.  We are fortunate.  We can make it on one income.

Last time I checked, “full-time” was considered to be 38 face-to-face hours per week.  That still doesn’t include phone calls, charting, paperwork, prescription refills, etc.  Part-time employment is not allowed unless you were “grandfathered” in.  Patient visits are scheduled at twenty minute intervals.  Yes, you’re expected to do a complete physical exam in twenty minutes on that 64-year-old three-pack-per-day hypertensive, dyslipidemic, diabetic who is transferring care from Florida and arrives with an oxygen tank and a wheelchair.  Providers work with whatever medical assistant is assigned to the patient care team for that day.

“When are you going back to clinic?” you ask.

After the revolution.

Physicians and mid-level providers are the way healthcare organizations make money.  VPs do not generate revenue.  Nurse managers do not generate revenue.  Presidents do not generate revenue.  When organizations find themselves in tough times financially, they whip the doctors. Work more!  See more patients!  Get us more money!

Pay-for-performance is a particularly devious form of torture.  Your pay is docked if your patients’ blood sugar control isn’t perfect or if their blood pressure isn’t within certain parameters.  Physicians are held personally responsible for patient outcomes.  On one level, of course this is appropriate.  Physicians must practice ethical, up-to-date medicine.  On another level, I can’t control whether my patients actually take their medication, follow my exercise advice, or smoke right before their appointment.

What would a revolution look like?

1) Medical scribes for all providers.  Physicians shouldn’t be typing their notes.  This is an unbelievable waste of the specialized knowledge of the sole income generators in a healthcare system.

2) Single-payer, universal healthcare system.  You can’t imagine the convoluted mess of human resources necessary to support our idiotic patchwork-payer system.

3) Allow part-time employment and build in support for life circumstances (illness, leave, surgery, birth, family emergency).

4) Reward thinking specialties (family medicine, internal medicine, pediatrics), not just procedure-driven specialties (gastroenterology, surgery, etc).

5) Make medical school free.  I graduated from med school in 1997 with $60,600 debt.  I paid most of it off during residency.  The average medical student today graduates with $170,000 in debt.  And we wonder why there is a shortage of primary care docs.

6) Study upper-level administrative pay and figure out a rational approach.

(7)As long as we’re having a revolution, let’s make it possible for a family to live on one average  income.)

8) Give some control back to docs.  If I want 45 minutes for a complete physical, let me have it.  I know I won’t be paid as much.  So be it.

9) Pay should depend upon quality and complexity of care as well as production.  But figure out the right ways to measure quality.

10) Off-load providers.  Providers should only be doing provider-level work.  This sounds arrogant to some, I realize.  Gee, the poor doctor didn’t want to room her own patient.  In terms of office efficiency, though, this is the only system that makes sense.  Develop protocols for refills, triage, rooming, updating chart info, etc, AND FOLLOW THEM.  PharmDs can do a lot of medication management for chronic disease.

There’s a lot more to the revolution.  And I have a headache.

In short, it’s great that more attention is being paid to physician burnout and stress.  However, the answers lie not in fixing the physicians, making them more “resilient,” but in fixing the healthcare system that’s burning them out.

PS (8/11/2016): Over 4500 people have read this post since Monday.

1) Thank you for caring about the health of healthcare.

2) I plan to continue with this topic for at least a couple weeks.  I generally post on Mondays.  If you want to stay in the conversation, please consider signing up for my blog (below or up on the right-hand side).  You’ll get a confirming email RIGHT AWAY saying Thanks For Subscribing!  If you don’t see the confirmation, check your spam folder.  Please.  (And here’s the next post.)

Musical Moment

 

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Heart, Broken

Rafa the Pomeranian turns eight in August.  When I accidentally acquired Rafa in the summer of 2011 (Happy Birthday to me!), Second Chance Animal Rescue thought he was about three.  I decided his birthday would be August 8, a date he shares with my friends, Jen and Rollin.

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Cute, amirite? Doesn’t look like the type of dude who would gnaw off your arm.

Rafa is a pretty good dog.  He likes people.  He doesn’t bite children.  He barks like crazy at other dogs but he’s super cute and fuzzy so no one cares.  Much.  Rafa loves to sit on a pitcher’s mound of dirt, gazing at the neighbors’ back door, patiently waiting for their dogs to be released so he can BARK LIKE CRAZY and zip up and down along the fence line, talking about how he wants to rip them apart and munch on their lovely furry legs.

Rafa has always had a “slight” heart murmur.  Ace stole my stethoscope when I quit working in a clinic and we never bothered to listen to Rafa’s heart – don’t play doctor to your own kids and all that.  He (the dog) has always had a “slight” cough as well.  (Incidentally, Ace has a “slight” cough at the moment, too.)  Basically if you squeeze his chest he coughs.  We don’t squeeze his chest.

His cough worsened to the point that he was waking up at 5 am hacking.  5 am is not a good time for me.  The vet said Rafa’s murmur was louder and he wanted an xray.  The xray showed an enlarged heart that was probably compressing the trachea.  Our vet suggested a cardiac echo ($400).  I suggested a trial of medications (??$$).

I think Rafa is older than his stated age.  My guess is closer to 10 or 11.  The vet con-curs.

Ace and I bothered to listen to Rafa’s heart.  Generally, one hopes to hear a Lub and a Dub.  Rafa’s Lub and Dub are obscured by a WHOOSH.  Holy cow.

So here’s the theory: Rafa had a mildly leaky mitral valve.  The valve wore out over time and now he has significant mitral regurgitation, where the blood isn’t effectively pumped from one chamber to the next.  Inefficient pumping means more blood is pooling, stretching out the chambers of the heart.  And the enlarged heart mashes on his trachea and makes him cough.

I’m getting some good practice for old age, anyone’s old age, could be my parents, could be my husband.  Here is Rafa’s med list:

1)    Enalapril 2.5 mg per day

2)    Salix (human Lasix) 12.5 mg one or two tabs up to every six hours for symptoms of volume overload

3)    Dextromethorphan (plain, not with Guiafenesin) 13 mg as needed for cough

4)    Hydrocodone (?mg) ¼ tab (I accidentally gave him one tab for each of the first three nights – fortunately he kept breathing) up to every six hours

That was the initial list.  Then I decided to do a little research on the internet.  (Oooh, did you feel the vet roll his eyes?)  I found a lovely review of the research on the utility of Taurine and L-Carnitine supplementation in canines with cardiomyopathy.  And fish oil helps, too!IMG_2046

Off to Mastel’s Health Food Store.  The ladies at Mastel’s were extraordinarily helpful, showed me their pet supplement section, and assisted with finding appropriate preparations of Taurine, L-Carnitine, and fish oil.  If you have any supplement needs, I highly recommend this joint.

5) Add Taurine 500 mg once a day up to three times a day and

6) L-Carnitine 250 mg up to three times a day and

7) Carlson’s Fish Oil 2 mg daily

I called the vet and left a message about the supplements.  And I asked for antibiotics.  Basically, I want to leave no medicinal stone unturned.  I really don’t think my poor furbaby has kennel cough, but if he does, I wish to blast it to kingdom come with massive nuclear devices.

8) Add Clavamox (amoxicillin) 100 mg twice a day for seven days

Janna, my holistic vet friend in Wisconsin, suggested adding 9) Vitamin E and 10) Selenium as well.  I will eventually.

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Step One – grind pills to powder

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Step Two – add liquids

The morning routine consists of grinding everything but the fish oil and dextromethorphan with a mortar and pestle, dumping in the fish oil and DM, stirring the mess into a slurry, and adding half a teaspoon of unsalted peanut butter.

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Step Three – mix in 1/2 tsp unsalted peanut butter

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Step Four – Pomeranian narfs it up

 

 

 

 

 

 

Rafa loves it.

I’m not sure if he’s getting better.  He’s not as vigorous on our walks.  He still wakes up coughing each morning and coughs in fits throughout the day.  When I pick him up to snuggle him, I have to be extra special careful.

My dog is getting better medical care than many humans, even in the US.  I feel a bit sheepish/doggish about this fact, like I’m privileged.  I am privileged, privileged to enjoy the company of the World’s Largest Pomeranian, privileged to be in a position to try to help him enjoy good health.

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Getting some love from Grampa.

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The Big Pile. So far.

Please send a little love in Rafa’s direction.  He’s heart broken.                  And so am I.

Musical Moment

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Things Fall Apart

Entropy beckons.

All systems crave chaos.

Wrinkles.  Dementia.  Peeling paint.

Cleveland devolves, a frenzied orgy of hate.

Stone her!

Maggots in the flour.

Will the bread rise?  Will the bread rise?

Entropy makes his grand entrance, adorned with careless exclamation points.  We are the champions!  What face will he wear today?  Misogyny or Racism?  White Supremacy or Terrorism?

(Things fall apart.)

Feast on the flesh of a thousand immigrants!

Cockroaches scuttle across the parquet floor, seeking the comfort of corruption and decay.

Make America great again!

We speak.  We question.  We love.

And his tuxedo, sewn from the threads of ignorance and fear -

his tuxedo begins to fray.

Will the maggoty bread rise?

Light your candle!  Unravel the toxic cloak!  Lean your energy against the chaos.

Light your candle in this dark day.

Musical Moment

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Fresher Than

I met Mademoiselle in the fall of 1993.  We were sudden housemates at the rundown Phi Rho Sigma medical fraternity.  Please understand that Phi Rho wasn’t a frat in the Animal House sense of the word.  No goldfish, no hazing, no group activities.  There might’ve been a party, one, that I remember.

The frat had a cat for about two weeks, a mostly feral lad with a lackadaisical “owner” who fed him only occasionally.  In one of my Worst Decisions Ever, I captured Louie, stuffed him into a box (from which he escaped and rampaged about my Volvo 240 DL while I was attempting to drive), dragged him to my family’s vet, and got him a set of shots.  We ensconced him in the common room of one of the Phi Rho houses with a litter box, food, water, and occasional human interaction.  Louie the Free Range Cat was having none of it.  He pooped ALL OVER and at the end of a couple weeks we returned him to the wild to which he was accustomed.  But I digress.

I enrolled in the cult-like Summer Anatomy.  All of human anatomy, literally every single artery, vein, nerve, muscle, origin, insertion, organ jammed into two months.  Dr. Robertson, our esteemed professor, lectured entirely from memory.  My hair reeked of formalin and I couldn’t eat chicken for several months.

Prior to joining the fraternity, I lived above the Food Basket, a grocery store located about two blocks from the medical school.  I never actually lived there.  My friends helped me move my belongings up the rickety wooden fire escape.  Goldenrod, my 1970s hide-a-bed, nearly killed my friend Molly’s betrothed.

The entire apartment vibrated, dancing to the rhythm of the freezer units hung from my floor – the Food Basket ceiling.  I moved out.  Goldenrod played nice on the way to Phi Rho.  Summer Anatomy meant I lived alone for a couple months in the three-bedroom, second-floor apartment.  I got the best room.

Meela moved in at the start of the regular class schedule.  A woman of few words, she had a quietly wicked sense of humor.  I can still see the position of her hand as she’d adjust the frame of her glasses.  Meela practices emergency medicine in New Mexico.  I’m sure she’s perfect.  Absolutely unflappable.

Mademoiselle’s real name is Patience.  Her other real name is Ekuatinne.  Born in Minneapolis, raised in  Cameroon, and fluent in at least three languages, Patience returned to Minnesota at 17 and eventually landed at the U of MN Medical School.  She rounded out the inhabitants of our apartment, taking the glorified closet known as the third bedroom.  The three of us tied dishtowels around our waists and Mademoiselle attempted to teach me and Meela the basics of Cameroonian dance, with limited success.

Patience made a lasting impression, changed my life really, in the form of Moist Flushable Wipes.  I questioned her about the rectangular pack of something sitting on the back of the toilet and she schooled me on the many merits of the MFW.  I became an instant convert.  “Fresher than toilet tissue alone,” was the motto of Cottonelle brand Moist Flushable Wipes.

Indeed.

When Ace and I decided to join together in unruly matrimony, Moist Flushable Wipes came along as part of my dowry.  Apparently, MFWs are hard on the sewer system, hard on it to the point that cities are considering banning them.  Ace went into a tailspin when we got wind of the rumors.  I rushed to Costco and purchased a petite back inventory.  We plan to install our own wipe-munching system in our sewer line if necessary; we’d do just about anything to preserve our right to bear MFWs.  I sometimes wonder if Ace will be standing at my funeral, rhapsodizing in his introverted nonverbal way, about the Three Best Things that ever happened to him: The Big E, me, and Moist Flushable Wipes.

 

Musical Moment

 

 

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Disease Model of Systemic Racism

Chief Complaint: Stage IV Systemic Racism

History of Present Illness:

The USA is a North American Country with a 250+ year history of Institutionalized Racism.  Multiple prior exacerbations include: slavery, annihilation/dispossession/forced assimilation/reservation marginalization of native peoples, the Chinese Exclusion Act, internment camps during WWII, lynch mobs, assassinations, anti-miscegenation statutes, the Tuskegee Syphilis Experiment, segregation, destruction of the thriving African-American Rondo Community in Saint Paul by Interstate 94, for-profit prisons, and the corrupt political system.  (Please note, this is not an exhaustive list.)

The country presents today with a recent escalation in symptoms, manifesting in the shooting deaths of two black men by police officers.  Mr. Alton Sterling died in Baton Rouge, LA, on 7/5/16.  Mr. Philando Castile died in Falcon Heights, MN, during a routine traffic stop on 7/7/16.  The shootings triggered an autoimmune response, with a sniper attack on Dallas police officers, resulting in five deaths and numerous serious injuries.

These recent symptoms have caused significant widespread distress, with frank emotional trauma, copious anger, and serious economic and logistical interruption.  The US wonders if any new treatment modalities are available and also seeks immediate amelioration of pain.

Prior treatment attempts utilized forced de-segregation, affirmative action, the Black Panther movement, anti-discrimination laws, the Black Lives Matter movement, “need-blind” admissions, and internet campaigns.

Objective: Vital signs unstable with notable pressure buildup in various organ systems.  Areas of deeper skin pigmentation across the country continue to be associated with poverty, incarceration, and lack of educational and employment opportunity.  Brief focused physical exam demonstrates ongoing increased concentration of people in the region of the Governor’s Mansion on Summit Avenue in Minnesota, as well as smaller vigil-type clusters at the sites of recent shootings.  The overnight blockage of both directions of I-94 in Saint Paul on 7/9/16 has resolved.

Comprehensive imaging again reveals stage IV disease, with widespread metastasis via hematogenous and lymphatic spread to all major organ systems, including but not limited to: education, employment, housing, politics, nutrition, military, law enforcement, social services, prison system, and healthcare.

Assessment:

The United States presents with ongoing Malignant Stage IV Systemic Racism intercalated within all major organ systems in the country.  Today’s visit was prompted by a recent escalation in symptoms resulting in death, distress, and trauma.  The country seeks information about curative procedures, therapeutic trials, and pain relief options.

Plan:

With Stage IV involvement, the patient will require an intensive multidisciplinary approach utilizing numerous specialists.  Curation is a lofty goal and perhaps unattainable.  However, hope is not lost as we know that even the placebo effect (If-You-Can’t-Say-Anything-Nice-Shut-Your-Trap) results in statistically significant improvement in symptoms.

Specific therapeutic suggestions include:

1)    Surgery:  We know from past treatment attempts that violent radical surgical approaches result in a high level of collateral damage.  We will instead proceed with tumor debulking, where pockets of Racism are identified publically and provided high-dose education and legal poultices when necessary.  Systematic dissection of all involved systems is necessary.  Anticipate the need for significant reforms in education, housing, law enforcement, the prison system, healthcare, and etc.

2)    Adjuvant Chemotherapy:  We will begin a therapeutic trial of the new chemo cocktail fICE (facilitated Interaction, Compassion, Empathy).  This combination works most potently at the cellular level, person-to-person.  Common side effects of this novel chemotherapy include new friendships, relief, joy, and heightened understanding.  During chemotherapy, people with less melanocytic activity are advised to close their mouths, open their ears, and bear witness.

3)    Radiation: Plan to utilize two different modalities including HDR brachytherapy and EBR therapy.  The specific radioactive energy type is LOVE, the most potent energy available at the time of this publication.  As we know from lab studies, Racist cells die in the presence of LOVE.

A)   High Dose Rate Brachytherapy: Love will be implanted directly into tumor-filled, Racist areas.  Dr. Martin Luther King Jr. experimented with the direct implantation of love, with good result.

B)   External Beam Radiation: We recommend full-body, daily, high-dose radiation with LOVE.  Contrary to other radiation agents, there is no limit to the total Gy dose of LOVE that can be delivered.  In fact, we continue to see an encouraging dose-response relationship even at extremely high doses.  No negative side effects have been reported in the literature.

4)    Close follow-up at regular intervals and prn to evaluate progress.

 

Musical Moment

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You Tarzan, Me Offended

“I’m sorry.”

These were the first words I uttered to my friend Molly, after dragging her out to see Tarzan on one of the finest afternoons of the summer.

“Looking on the bright side,” she replied, “at least we know that Rotten Tomatoes reviews are accurate.”  I last dragged her out for a Prince tribute concert.  At least I’m batting .500.

I lured 100% Swedish Molly from her home with promises of a scantily-clad Alexander Skarsgård.  How bad can it be watching ASkar swing from trees in a loinskin for a couple hours?  We are staunch believers in Equal Opportunity Objectification.

We decided to see the flick at Southdale, for the potent combination of nostalgia and proximity to Molly’s domicile.  She and I basically lived at Southdale for a couple years, way back in the early ’80s, subsisting entirely on curly fries.  Let me tell you, a few things have changed.  I just about missed the theater entirely, couldn’t see it through the jungle of condominiums.  I pulled into the tiny parking spot, grateful to be driving a smallish Subaru, already wondering how I’d ever back the car out if the lot filled up.

Once inside, the nice high school boy with a mouthful of orthodontia informed me that I owed him $10.

“For a matinee?” I squawked.

“We have three price points,” he began, and I totally tuned him out.

I nearly told him a person could see live theater in this very town for less than $10, but there I was, receipt in hand, feeding the Hollywood machine.

The previews were wretched with the exception of Fantastic Beasts and Where To Find Them, a movie that, unfortunately and predictably, will feature mostly white people running around in period dress.

I didn’t know the meaning of “trope” until I started writing.  A trope is literary shorthand, laziness with words, a stereotype that makes the reader say, “Ah, I recognize this person/situation/concept.”  I pulled one on you up above with the high schooler at the register.  Can’t you picture the scrawny nerd with his braces, all earnest and helpful, making the most of his first job in cinema?

Tarzan is a cornutropia.

1) The brawny brooding white hero, trapped in the mundane day-to-day of Lord-ing.  Peel back the veneer of gentility to unleash his inner beast!

2) The wisecracking black sidekick, tagging along so we can laugh at his physical clumsiness and verbal quips.

3) The beautiful and feisty white love interest, in this case wife, who is in constant need of rescuing, while wearing a wet clingy white dress and perfect makeup.

4) The love interest’s black friend, a man who is like a brother, never like a lover.

5) The mustachioed Aryan European villain with a penchant for fine wine, table manners, and brutality.

6) Anthropomorphized animals.  Tons of them.

7) (backstory) The castaways living in a quaint treehouse.

8) (backstory) The orphan boy raised by wolves/gorillas/gila monsters.

9) Colonialism.  White men parading around exotic locations in uniform.

10) Happy African tribespeople singing and dancing.

11) Revenge and greed as anyone’s undoing.

12) Slavery.  Black people in chains on ships and trains.

13) Tribal legends of a white-man spirit.

14) The white savior who unites the tribes.

15) The menfolk waiting around during a birth, smoking cigars, or squatting on the savannah.

16) The birth of a baby as the dawn of a new era of fluffy unicorn sprinkles.

I don’t know if it’s possible to do Tarzan in a culturally-sensitive manner.  How about starting with a black director? A mixed-race Tarzan/Jane coupling would add an intriguing twist.  And a Jane who saves herself, or even her mate?  That’d be awesome.

The bottom line is it’s two hours and $10 that I’ll never get back.

And, for the record, like a good Oberlin grad, I’m offended.  (Trope alert: PC Oberlin alumna.)

Musical Moment – Hozier’s “Better Love” appears on the soundtrack.  Today’s musical moment features a more appropriate Hozier tune.

PS – To Alexander Skarsgård’s trainer: Well-played, old chap.  Well-played.  You almost offset the insufferability of literally everything else.  I had already started writing this post before I saw the movie: “On Sunday, I worshipped at the House Of Alexander Skarsgård.”  And I came up with all kinds of cute hashtags.  #TakeMeToChurch #BodyIsATemple #ASkar4Ever.  Alas, the movie was SO BAD that I couldn’t even do a decent itemization of Lord Greystoke’s precisely chiseled anatomy.  So all that work you did defining the two heads of the biceps, the three attachments of the deltoids, pectoralis major, platysmus, rectus abdominis, etc, all that work was overshadowed by epic badness.

Bummer.

 

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When N is Greater Than 1

We borrowed a couple children this past weekend, imported them direct from Wisconsin.  The sister and brother duo arrived on Friday and returned home Sunday.  These children are perfect; they’re polite, helpful, not especially sticky, musical, they follow directions, they attend to their own bowel and bladder functions, and are, in fact, strictly charming.  Regardless, Ace and I have one child.  On purpose.  We are used to one child.

I came to a few conclusions over the course of the weekend:

1)    Never underestimate the ability of groups of children to organize, lobby, negotiate, and unionize.  Groups of kids who aren’t all related are particularly canny.

2)    A tween’s willingness to snuggle his mother is inversely related to the number of compatriots present.  My normally snuggly boy barely even grunted at me all weekend.

3)    By the time you sunscreen three children, either they’ve lost interest in outdoor activities or it’s bedtime.  When the kids’ mom arrived to pick them up, she quipped to her daughter, “Ah, I see you’ve been sunscreened by a Lippin.  You look like a geisha.”

4)    The culinary steaks were high for Ace and me because the mother of the borrowed children loves to cook.  At one point, the borrowed girl innocently asked, “What’s for dinner?”  In our home, this question is generally met with uproarious laughter and fits of hysteria.  I toned down my response to, “I have absolutely no idea.”  Feeding Child is taxing.  Feeding Children is a full-time job.

5)    Sleep might be at the bottom of your pyramid.  It is not at the bottom of tweens’ pyramid.  I wandered into the boys’ bedroom at 0013 (- yes, you read that correctly – thirteen minutes AFTER MIDNIGHT -) and ordered them to stop chatting and GO TO SLEEP.

6)    The relationship between number of children present and type/quantity of laundry generated is both nonlinear and unpredictable.  The two boys emptied a drawer full of sheets and blankets because “we were cold.”  Points for self-sufficiency.

7)    Children, even Waldorf and Quaker children, are remarkably fluent in a palette of languages generally inaccessible to adults: Minecraftian, Nerftongue, Dragon Vale Speak.  Je ne comprends pas.

I’m curious to know what you would add to this list.  Have you ever borrowed children?  What are your observations?

And hey, I like you.  If you like this blog, please sign up for it at the end of this post or up there on the right-hand side of your screen.  I promise not to exploit our relationship in annoying ways.

xoxo Anne

Musical Moment

 

 

 

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Speak In. Speak Out

This is the time to mobilize your righteous indignation.  Put all that practice from your formative years to good use:

Marching around the square chanting “Hey hey, ho ho, racism has got to go.”  Attending workshops on “safe sex” (Remember the “safe sex” of the ’80s that pre-dated the more ominous “safer sex”?).  All the verbal support you pledged your queer friends before they could legally marry.  The outrage you felt as the years rolled by and the bullet-riddled bodies continued to pile up.  The growing conversations on poverty, addiction, privilege, violence, race, pain.

I’m asking you to take the ball of fire that you’ve been building, that internal combustion in response to Orlando and Stanford and Columbine and Steubenville and Sandy Hook and Penn State and Fort Hood and Vanderbilt and Binghamton and Oakland and Aurora and Tucson and Seal Beach and the University of Alabama and Santa Monica and HOW LONG ARE WE GOING TO ALLOW THIS LIST TO GET?

Take that ball of fire and do two things:

1) Speak In: Talk with your closest people – your partners, your children.  Talk about sex.  Talk about consent.  Talk about intimate violence.  Teach and model conflict resolution.  Demonstrate how to manage anger.  Practice peace.

2) Speak Out: Contact your elected officials.  The time for helplessness is over.  No more sitting idly by, offering condolences.  March.  Sit in.  Dance in.  Chant.  Sing in.  Challenge misogynists and racists and homophobes.

Do something.

Musical Moment

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