Going Green

I'm not much of an environmentalist, I'm afraid. Oh, I insist on fluorescent bulbs, but I sometimes forget and throw paper or bottles into the trash instead of the recycling bin, and I can never remember what I'm supposed to do with the little dead batteries from the remote. But my stay in a couple of medical institutions shocked me. Every day, I watch several yards of plastic tubing and three or four little syringes tossed into the waste bin after my infusion. Not to mention the disposable gloves that the nurses pull on and toss after each procedure, even the ones that take only a few seconds.

I know there are perfectly good reasons for all this waste, but in a big hospital like Stanford it must be prodigious. What happens to all that stuff? Is it dumped? Incinerated? Or somehow purged of its previous uses and recycled? None of those alternatives is particularly attractive. And the energy costs of running all that equipment must be astronomical. (Is there a fresher word than "astronomical"? Cosmic? Galactic?)

In an age when we're all being urged to turn down our thermostats and recycle and drive less, it seems like the hospitals are exempt. Maybe that's how it should be -- I certainly don't want to get my meds through an IV line somebody else has used before me -- but I wonder how conscientious hospital management is being encouraged to be.

Happier New Year! Please?

It's that time when we still write the previous year on checks. (If we write checks. I do most of my bill-paying online.) When the newspapers are full of lists of who did what and whatever it meant for good or ill. And when there are jokes about New Year's resolutions.

I make no resolutions other than to keep up my meds and stay out of the emergency room. I will not, I think, intentionally break those.

My hope for 2009 is that it will be a landmark year politically and socially. Someone observed recently that just as the Sixties ended with the landslide re-election of Richard Nixon in 1972 (and you can argue that the Eighties began with Reagan's election and the Nineties with Clinton's), so the 21st century won't really begin until Obama's inauguration on January 20. A specious observation but a pleasant one nevertheless. It embodies the hope we feel, not just at the beginning of the Obama administration, but at the prospect of the end of the Bush-Cheney reign of error.

I also hope that that tarnished old word "liberal" will get polished up again, so we don't have to keep using euphemisms like "progressive." (Progress being something of an illusion -- at least in the short-term scheme of things.) The problem with liberals -- oh, where to go with a sentence that starts like that? The problem with liberals is that they keep seeing their own faults. Conservatives, on the other hand, adhere to the "never apologize, never explain" rule, best exemplified by Bush's stubborn refusal to admit that he might have screwed up a teeny bit during his presidency.

Liberal ambivalence, and liberals' tendency to pride themselves on being open-minded, is often their undoing. Even Obama has fallen into this trap by being "open-minded" enough to invite the execrable Rick Warren to invoke his deity at the inauguration. Liberals can also be mighty self-righteous, which enables a wartnoggin like Jonah Goldberg to coin the oxymoron "liberal fascism" -- and for some ambivalent liberals to say, "Well, he might have something there." (Aside: Does Rush Limbaugh's pill-popping make him an Oxy moron? Sorry.)

There's no doubt that this New Year's begins on a somber note, with everyone's 401(k) in tatters, stores shuttering, unemployment ballooning, mortgages collapsing, Israel bigfooting it around in Gaza, the climate going wacko, and so on. If ever there was a time of "malaise" -- Jimmy Carter's infamous epithet -- this is it.

But Obama continues to radiate a calm determination that things can be fixed. Of all the character traits he's shown, his unflappability is for me the most attractive. "No drama Obama," his staff called him. We live in what might be described as "interesting times." (Remember the old Chinese curse: "May you live in interesting times.") Maybe we should hope that they get a little less interesting -- no drama, please -- this year.

That's a Load off My Mind

I saw Dr. B this morning, and the lesion has shrunk by half! Even he was surprised at the improvement. He wants me to continue the IV therapy and the pills, but for the first time he seemed almost ... happy. (He's not a very demonstrative type.)

My sight, I know, has improved slightly. Now it's almost like there's less of a blind spot than a sort of wrinkle in what my left eye sees. I told my daughter, as she was driving me back from the appointment, that I'm almost ready to try driving -- around the block. Neighbors beware!

Oh, and I got a haircut, my first in maybe five or six months. I had it shorn back to the No. 2 buzz cut that I had before. The only fault is that it makes the hole in my head -- a depression in the scalp about the size of a dime -- more visible. But he jests at scars who never felt a wound, right?

Climbing the Phone Tree

I got my first bill from my medical adventure the other day: $1,083.74 for office visits and lab tests at the clinic I went to on the day I discovered I was sick. Medicare had declined to pay any of it.

It was a mistake fairly easily corrected. Medicare had me listed as having "other insurance" as the primary payer. It seems that Medicare updates its records once a year, in October. So unless you make a point of telling them what's going on, if you change insurers after their update day, they won't know about it until next October. In my case, I had paid-up insurance from my former employer through the end of October 2007 -- after the Medicare update. At the end of October, that policy ceased, and Medicare became my primary carrier. (I also have a Medicare supplemental policy.) But Medicare didn't know about it, so all of my medical bills from October 2007 to October 2008 were denied.

This good news out of all this medical mishegoss is that it was relatively easily cleared up. Conservatives are always arguing against government programs because of the "bureaucracy." But my experience with Medicare is that their bureaucracy is more efficient and responsive and more pleasant to deal with than that of the big private insurance companies. Maybe it's because the big private insurance companies can pick and choose whom they insure, while Medicare has to deal with anyone over 65, some of whom must require careful and clear explanations. As I know from my experience in the nursing home, anyone who works with the elderly needs the patience of a saint.

This is, of course, another argument for a single-payer national insurance system -- the only kind of health reform that I think will work. It took me three phone calls to clear it all up -- one to the clinic to find out why the charges weren't paid, one to Medicare to ask why they weren't listed as the primary insurer and to be assured that the mistake was corrected, and another to the clinic to ask them to resubmit. One phone call should have been sufficient.

And don't get me started on voice-recognition phone trees:

ROBOVOICE: You said "enrollment."
ME: No, I didn't! I said "claims."
ROBOVOICE: Please choose from one of the following options....

We Wish You a Murray Crispness

Deck us all with Boston Charlie,
Walla Walla, Wash., and Kalamazoo.
Nora's freezing on the trolley.
Swaller dollar cauliflower alley-ga-roo.

Don't we know archaic barrel?
Lullaby lilla-boy, Louisville Lou.
Trolley Molly don't love Harold.
Boola boola Pensacoola hullabaloo!

A Heartbreaker

The ineffable Kenneth Starr is back in the news, this time leading a movement to invalidate the same-sex marriages that were solemnized in the period between the California Supreme Court's ruling and the passage of Proposition 8. In response, a group called the Courage Campaign is putting together a powerful response, and a simple one: a slide show of couples, some with their children, pleading that they not be forcibly divorced by the state.

Product Placement

Household hint for today: If you've got a cast or some sort of surgical dressing that needs to be waterproofed whenever you bathe, wrap it in Glad Press'n Seal. It sticks to itself and to the skin, and doesn't need as much tape to hold it in place.

I learned this tip from a nurse at the Ambulatory Treatment Infusion Center (acronymically called, of course, "the attic") when I was describing how hard it was to wrap a plastic bag around my left arm with my right hand in order to cover my PICC line. They had given me one of those plastic sleeve thingies that are usually used to cover casts, but it also covered my left hand, meaning I couldn't use it to wash with.

So I got a roll of Press'n Seal (why they can't call it, more correctly, "Press 'n' Seal" I don't know) and sure enough, it does the trick.

What a strange little world of expediencies I have found myself in.

...Or Maybe Rachel Maddow Is the Smartest Person on TV

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An Eye for an Eye

I went to see an ophthalmologist, Dr. L., today. I aced the eye chart, even with my wonky left eye, but there's still a problem with my vision. Dr. L. says it may never go away. When I said, oh, maybe the brain will find a work-around -- something others have said to me -- she said, Probably not. "The brain isn't really all that flexible. And the lesion has deprived part of it of oxygen." In other words, I've got a dead spot in my brain.

Oddly enough, her candor appeals to me. I'm a little tired of the choruses of "Climb Every Mountain," "You'll Never Walk Alone" and "Cockeyed Optimist" that people keep singing at me. A little honest resignation to reality never hurt anyone.

Nothing But the Tooth

Why don't hospitals and clinics have dentists on staff? Why is dentistry different from other specialties that deal with the human body? Why don't dentists get the training that M.D.s get? Why do medical plans not cover dentistry? (Especially Medicare. You'd think nobody needed help paying for dentistry more than its recipients.)

All these questions occurred to me as I was lying on a bed in the hallway at the Stanford E.R., waiting for the diagnosis of what had made me go partially blind. (Literally in the hallway. Stanford's E.R. is so crowded that it has put beds in the hall, especially for patients who don't need modesty curtains. They're even labeled: Hall 1, Hall 2, etc.) My neighboring patients included a woman with no family, no job (hence, no insurance), and a variety of serious and unpleasant illnesses; a diabetic man who had neglected the injury to his foot he received on the job and was now threatened with amputation because it had turned gangrenous; and a grizzled biker type who was there because he wanted a pain-killer for -- he said -- a really bad toothache. The young resident who saw him winced at the state of the man's teeth.

"How long has it been since you saw a dentist?"
"I dunno. A while I guess."
"You need to see one."
(with utter lack of conviction) "OK."

He got the meds and left.

We're constantly told how important dental health is. How infected teeth can spread infection to the rest of the body. In my case, in which the source of an infection was crucial, I was repeatedly quizzed about my teeth. (I am pleased to report that there was a chorus of admiration when a team of doctors and med students examined my "dentition" one day. I must tell my fine young dentist, Dr. W., to whom I once commented, "I have fillings older than you." He has since replaced them. Expensively.)

So why isn't dentistry an integral part of the medical picture? I guess if I Googled enough I'd get an answer, something to do with the histories of the separate professions, rivalries and jealousies and economic advantages. But in a time of reform, when everything is being examined with a view to making it new, when "holistic" is a byword, shouldn't this odd, arbitrary division between dentistry and medicine be re-examined?