Health Insurance and Other Deadly Things

 My hearing aid beeped this morning signaling it was time for a battery change. Ugh. For the past several months I have fought with the child-resistant packaging— risking slicing my not-so-nimble fingers trying to engage an ordinary size scissor into the plastic encasing a pinkie finger size button battery. I was alerted about this problem by my audiologist who mentioned the packaging would be more difficult to open and dispense due to the death of a child from ingesting one of these teeny batteries. How could something that has brought me the joy of interacting with the world— hearing the chirping birds, buzzing bees, chatter of friends—how could an object that changed my life for the better be the cause of unimaginable grief to a family? 

Today I looked up that child. I learned her name, I saw her photos. Reese Elizabeth Hamsmith was an adorable, active, fill-the-room child. She swallowed a button battery at the age of 17 months.  She endured multiple surgeries and procedures and died at the age of 18 months in December of 2020. Her mom, Trista, created an organization called Reese's Purpose to "identify, advocate and correct safety issues impacting children and their families." And what a job they have done! President Biden signed Reese's Law in August of 2022. The bill was introduced in the Senate by lead sponsors Richard Blumenthal and Marsha Blackburn — a most unlikely pairing. In announcing the bills bipartisan passage they used familiar phrases: "common-sense legislation"  and "families can have greater peace of mind."

I will happily struggle opening my hearing aid battery packaging  knowing that it is intended to protect the lives of children with much curiosity and busy hands. I applaud the efforts of Reese's Purpose and wish the organization great success as they expand the scope of their child safety mission. I extend deep sympathy to the Hamsmith's on the loss of their beautiful child. 

And yet, I cannot shake the feeling of outrage I have that politicians cannot come together in a bipartisan way to promote "common-sense legislation" and ensure "families can have greater peace of mind" when they drop off their children at school. When the slaughter at Sandy Hook took place I would've bet a lot of money that politicians could not look at those precious faces or into their parent's eyes without passing a common-sense gun safety law. But, it has happened again, and again, and again—to young and old, to churchgoers, synagogue attendees, shoppers, moviegoers...anywhere, everywhere, over and over— thoughts and prayers, thoughts and prayers, thoughts and prayers...No bipartisan action to really make a difference. No political will to tackle an industry that contributes millions to campaigns. 

Brian Thompson, CEO of United Healthcare, was gunned down on a NYC street on December 4th. Murdered. Some say "assassinated." Whatever the word; his life was taken. Tragic. Sincere condolences to the Thompson family and those who knew and loved him. 

In the media frenzy following his death it became clear that some people had little empathy regarding Mr. Thompson's fate. Many of those people were the victims or loved ones of victims who believed a death or great harm was done due to United Healthcare's denials of necessary care and treatment. Their stories are gut-wrenching. Heartbreaking.   A denial, a delay, a death. What do we call that? It's not a murder. I mean—it's not like someone gunned them down. But someone turned them down. Denied them care. Denied what they needed to treat pain or cancer or diabetes or epilepsy. Denied what they needed to live more comfortably, to live at all. What do we call this? Who do we hold accountable? How can Brian Thompson's death be called an act of terror (ostensibly because a class of people—CEOs)—are intimidated by this act and the deaths of innocents sitting in their classrooms are not in spite of the fact school shootings occur over and over and shooter drills are conducted routinely? Is this not an entire class of people that are intimidated? 

We have a problem Houston. The insurance industry is a huge donor to parties on both sides of the aisle. They are against Medicare for all (or anything similar). Their profits depend on saying no. They do not manage care. They manage money. When patients start to use up "resources" ($) that negatively impacts profit margins—and so delay and deny becomes the game plan. A deadly plan for some. But who reports death by insurance denial? What do we call it? 

What have I done here? Where am I going? I'm not quite sure. I know I have more questions than answers. I know that I devoted my professional life to caring for people—teaching wellness, administering treatments, mitigating pain, and promoting comfort when other measures were no longer effective. I have seen my share of death—held the hand of patients when they took their last breath, hugged family members and friends who lost someone. 

I do not understand how we as a nation can continue to value guns over lives and profits over health. I want us to find "common-sense" solutions. Given the division in the country, the incoming Administration and the vast amounts of money being funneled to Congress, I fear the victims of mass shootings and health insurance denials will not motivate politicians to act in the same way as a beautiful little girl who swallowed a button battery. I fear we are beyond caring when great sums of money are involved. I fear that we have truly lost our way. I hope to be proven otherwise.

Peace. 

The Ones I Know

 Since November 5th I've been trying to figure out how a convicted felon, sexual abuser, adulterer, mean-spirited racist, misogynist, mocker of the disabled, inciter of an insurrection, an old, white (orange) man was elected by my fellow citizenry to the highest office in the land. I will leave the political analysis to others. Throughout the multitude of posts on social media since the election there has been a common question asked in a variety of ways boiling down to some version of how will you deal with people you know who voted for him? I am beyond abhorred by the amoral, vile, vulgar person that is Trump.  I believe with all of my heart and soul that he is a liar, a thief, a man-child and taking a not-so-wild guess based on my nursing and life experiences—he has some form of dementia. All that said, the people I know who voted for him do not possess such horrific traits.

The ones I know (and they number somewhere between 70-80 people I am pretty certain voted Trump/Vance) are from family, extended family, family of family, former friends who had their friendship already not been part of our past it would never have survived through the  last four years, people I used to work for and work with, people who worked for me—many who were friends at one point or another— a lot who were frequent guests in our home, a mentor who I still care quite deeply about and a very small number in our current social circle.

So what do the ones I know have in common? Well, they are highly educated. I would guesstimate 95% have college degrees, many have post graduate degrees. Among them are doctors, lawyers, nurses, teachers, small business owners, investors and financial brokers. There are retired Capitol Hill police and other federal law enforcement officers and bureaucrats. The majority came from working class backgrounds such as my own and Barry's, more than a few have inherited or built considerable wealth. Not one of the ones I know live paycheck to paycheck, lost a job to an immigrant or had their miscarriages mismanaged because doctors were afraid to care for them. The ones I know, are in large part, what the far right talking heads and radio personalities refer to deridingly as the "elites." They are successful. Many have multi-million dollar homes— some, two. Some have boats and other luxury toys. Some travel lavishly. Most, if not all, have comfortable, even enviable lives. They are white. On the surface they appear MUCH. LIKE. ME.

I have no idea why most of the ones I know voted the way they did. I suspect many were economically motivated by the promise of tax cuts, surely not the price of eggs! A few are devoted to their churches teachings—perhaps they saw their vote as ensuring that women's rights to access reproductive health care/services would not be restored. I believe there may be a couple misogynists and racists among them so perhaps casting a vote for a black woman was out of the question. What I DO know about the ones I know who voted for Trump is that they voted for the person described in the first paragraph above. I believe the majority of the ones I know will not suffer any ills as a result of their vote, save the loss of health care/reproductive freedom for their wives, girlfriends, daughters, sisters, nieces— apparently, an acceptable price to pay.

So here we are. I've posted several times that people need to "buckle up." It's going to be a rough ride for the majority of Americans no matter who they cast their vote for. The ones I know ,will, in this case, be in the minority. Oh—and how will I deal with the ones I know? That is a difficult question indeed. I'll let you know some time. Later. 

The Heart of the Matter

Barry had open heart surgery in May. Prior to the surgery he had no cardiac symptoms— no fatigue, no shortness of breath, no pain. Nothing. The surgery is known as a Coronary Artery Bypass Graft (CABG)  and in Barry's case was a triple bypass. He's doing great. We have so much to be grateful for, so many people to thank and acknowledge at UC San Diego Health—I'll get started now.

Tony Lopez MD, Internal Medicine. For years we have experienced your extraordinary diagnostic skills and caring. Last fall you ordered a Cardio CT Calcium Score. Barry's score was 6,000. The score indicating hi-risk for a potential cardiac event within two years is 400. So—you ordered a stress test and referred to Cardiology.  And thus, this often nerve-wracking but ultimately successful medical journey began. Words are insufficient to express our gratitude you ordered that test. Thank you from the bottom of my heart. 

Edward Duran MD, Cardiology. Thank you for your thorough review of test results and medical history, for your explanation of various tests and for your data-driven assessment. We appreciate that you discussed the risks of an angiogram and entrusted the decision whether to have one to Barry. Thank you as well for listening to my why can't you just order a Cardio CT Calcium Score on everyone harangue. Though there is some disagreement about the when and why of ordering such a test— in our view, it was the only indicator something was amiss. 

Lawrence Ang MD, Cardiology. Thank you for your skill in threading a catheter through coronary arteries and for your professional and compassionate explanation of why, in Barry's case, you felt cardiac surgery was the best option. 

Mark J. Kearns MD, FRCSC, Cardiothoracic surgeon. Where do I start? I won't speak for Barry on this since his relaxed, chill demeanor is a far cry from the abject fear I was experiencing. Your calming presence and patient answers to our multiple questions immediately put me at ease. You talked to us not at us. You are professional, kind, confident and competent. When we left that pre-op visit with you I was certain Barry's heart would be safe in your hands. It was—thanks to you and the team in the OR and the ICU.  Shout out to David G., David C. and Ana.  And Kiko, thank you for your efficient and gracious scheduling, rescheduling and rescheduling! 

The staff of the Cardiovascular ICU. What a great team! I practiced nursing for nearly 50 years and have had my share of health care experiences with family and friends and I have never witnessed a more competent, professional and caring group of nurses. Thank you all—especially Sabrina, Mary, Cameron, Colin and Collin.

Barry Greenberg MD, FHFSA, Cardiology. Who knew over two decades ago when my home care agency was caring for your patients, that our paths would cross again thanks to my friendship with your beautiful wife Jennifer? I called her in a panic about that darn Cardio CT Calcium Score and next thing I knew you called Barry and I—and in a reasoned, thoughtful way assessed the situation and assured us there was no urgency. You gave us a gift—the enjoyment of the holidays and every day thereafter as we navigated the tests, procedures and waits. Thank you.

Finally, thanks to all the family and friends who supported us throughout—brothers, aunts, cousins, lifelong friends, Barry's college buddies, my dear tap sistas, a special loaned angel— your encouraging words, prayers, texts, calls, messages, cards, notes, lunches, coffees, wines and more. All of it—every single act and gesture meant more than you know. 

Our hearts are full💓