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Archive for the tag “health care”

Contents vs Package

I suspect when the birth control pill was first introduced to the public, the male doctors behind the scenes were having intense discussions about how it would be packaged.

“You know, Joe, the girls will need a way to remind them to take the pill once a day. They can’t possibly keep track of it themselves.”

“You’re right, Jim. We’ll find a way to package the pills individually. Maybe in a cute, discrete, pink dispenser that she can carry in her purse.”

“And what about that week off the pill? You know she won’t remember to stop after three weeks and restart on the fifth week.”

“Good point.”

“Oh, this should work. We’ll add a week of sugar pills. Tell them the church made us do it.”

Joe pulls open the bottom drawer by the lab table and opens the bottle of scotch. They toast to their new world of sex without consequences.

Now, 40+ years later, women still suffer the condescension that is the packaging for birth control pills. Every three months I buy a box that holds three smaller boxes each of which hold thick pamphlets printed on thin paper, a faux suede case for the bubble pack of pills, and said bubble pack of pills. Each pill is surrounded by impenetrable plastic on the top side and foil that will not be separated from the plastic on the bottom side.

Three rows of little yellow pills and one row of fake little white pills. I puncture each bubble with some amount of aggravation and put the yellow pills into a nice, easy to open bottle. It’s not labeled either!

As the cost of the birth control pill has risen at an outrageous rate over the last ten years, I have become more irritated by this packaging. I asked the pharmacist if my prescription could be ordered in a bottle with only active pills. Not an option. I know that some of the price increase is due to the deficit reduction act (seriously). That increase could have been off-set by reducing the amount of packaging.

It would bring me so much joy to not have to face a 1960’s attitude toward birth control every time I filled my prescription. Beyond my selfish attitude about being inconvenienced, lower costs for the pill equates to wider use which in turn means fewer unwanted pregnancies which reduces the number of women and children living in poverty.

Please, dear pharmaceutical companies, consider the impact you could have by changing the packaging of your birth control pills. Reduce waste. Reduce poverty. Change the world.


Never Give Up; Never Surrender

The complexity of health care in the United States makes even the most mundane procedure seem daunting. Wandering hospital halls without a GPS makes one realize they are in “the system.” Break free.

Easy to say, not easy to do. If you or a loved one is in crisis, it’s the only way to get the care you need. And it’s the only way we as a culture can change the system. All our whining, bitching and complaining is meaningless. We must advocate. One patient, one doctor, one administrator at a time.

What I realized in trying to get the appropriate care for Mom was that the first response the doctors had was what was safe within the system.

Don’t kick and scream. Put your emotions on hold. This challenge is one that requires you to be perfectly clear. There is no instruction manual. But here are some suggestions:

1. Always remain respectful and always believe that the person is there because they care and want to make a difference. Whether you are dealing with someone who has been kind or someone who’s been an ass, treat them with respect. Otherwise your self-respect will erode.

2. Be prepared to repeat medical history and current concerns over and over and over. Be clear and try to be as succinct as possible but also be thorough.

3. Educate yourself. Don’t think you can get your medical degree through Google but do use online source to inform yourself. If you are diagnosed with an illness, check symptoms and options for treatment. But do not dismiss the advice of your doctor. If you have questions or concerns, talk to them. Call them. Insist on being seen. Be persistent.

4. Be persistent. Make sure your doctor knows who you are. I discovered my mother’s primary care physician had other patients with the same name!

5. Remember your doctor sees probably 16 or more patients every day. While you are focused on one case – yours – your doctor is juggling multitudes of illness, referrals, sniffles, chronic diseases, suspected child abuse, unexpected pregnancies, hypochondriacs, undiagnosable mysteries… That doesn’t mean you should take pity; just remember that you have to remind him of your concerns.

The one thing that continues to baffle me is how slowly “the system” moves. Emergency and triage people are the stars. They jump in. But patients spend very little time with them. After emergency care, the patient is sucked into a system that seems to thrive on waiting.

We are all part of “the system” and there is enough blame to go around. Generally I blame insurance companies. They are responsible to their shareholders, not to the patients.

Hand-in-hand with insurance companies are health care administrators. These are the people who have forgotten their purpose beyond budget and marketing and billable services.

Doctors are the most powerful people within the system. I’m certain that most doctors truly care about the well-being of their patients. However, how many of them have stood up and said, “No.” No to time limits on office visits. No to limitations placed on nursing the requires nurses to get a doctor’s order to provide care for a patient. No to system rules that prevent a family from having access to needed care to help a loved one.

The second most powerful group inside the system is nurses. Across the country there is a shortage of nurses (except, from what I understand, Portland, OR). Many of them are unionized. Unions tend to deal with more concrete issues but they could be used for basic organization. Nurses have the foundation to stand up and say, “Stop. It’s time the system get out of the way and allow us to care for our patients.”

I confess. I am part of the system. It’s easy to forget that, working at Alaska Children’s Services. We’re a small organization and I don’t have to deal with billing or coding or regulations. I hope that my being there alters the system in some positive way. I hope that my advocacy for Mom’s well-being has supported someone’s care-giving.


After six itinerary changes, five airports and zero sleep, I landed in Anchorage. Somewhat disoriented and mildly displaced I wandered through the house. John asked me questions about what I’d like to eat and I couldn’t answer. Everything felt vague.

I expected this feeling after being away and in a high-stress situation for three weeks. But I also expected the joy of arrival to overwhelm everything. When I saw John, I wanted to cling to him like a silly teenager. I wanted to cry.

For the last 30 hours I’ve wanted to cry. Occasionally my crying muscles contract, my throat clenches, my sinuses fill and I think the dam is going to break. So far it just keeps filling.

The pain of the last few weeks must be greater than I imagine. Numbness set in and memory failed. caregiving isn’t for sissies and I am a sissy.

I expected Mom to need more physical care and that small part of it I could handle, even enjoy as I felt a sense of purpose. I cleansed and re-dressed the open wound on her tailbone. I put lotion on her feet. I even shaved her legs. I felt like I was adding value to her day.

Emotional care was what she really needed and I didn’t then, don’t now, and never will have anything to offer her in that area. Before I went on this journey I prepared my emotional defenses and they held up well. However, now I’m quite certain there was a leak in my armor and there is now a small but lethal toxic waste holding tank deep in my brain and the only way I can be rid of this sense of numbness is to re-process these toxins.

I’ve departed from and re-entered my life on many occasions. When I lived in New York City I went on annual backpacking trips in the Rocky Mountains. Coming back was always a shock. But both the world I lived in and the world I visited were beautiful and joyful.

Now I am trying to re-enter my beautiful and joyful life in Anchorage after visiting a world that is filled with the misery of my childhood, an intense isolation and relationships lost in complete dysfunction. It’s as if there is an oily film over my eyes and nerves and heart. The harder I try to wash it away, the more persistent it becomes.

I wish there was a magic soap, a simple answer, a stronger antidepressent. The only cure is probably time mixed with patient understanding. I thought re-entry would be simple. I thought I was leaving one place and returning to my home and family. But we never truly leave anyplace, anyone or any experience behind.

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