Christmas Music in Early November

On November 8, 2020, I tuned into our favorite radio station in south Florida and Christmas music popped on. I began to reach for the dial, in disgust at the early commercialism, but instead began singing. That's right - I was singing to Christmas music in early November. 

I needed to feel good again, to exhale, to take the stress off my sleep-deprived brain, to erase the relentless, rabid, targeted tweets of 2020 and SING about the time of year that cocoons me like a warm, fuzzy comforter. 

The U.S. had reached a total of 10,000,000 Covid infections. Nearly 240,000 had died. One hundred thousand small businesses had closed since the start of the pandemic. President Trump wasn't conceding the election so that President-elect Biden could begin the transition process, despite Biden's winning enough popular votes (discounting those still being counted) to give him more than the necessary 270 in the electoral college and no evidence of fraud in any state.

I'd barely written anything new in the spring and summer of 2020...I just wasn't motivated. We weren't socializing, we certainly weren't traveling, and we hardly left the house except to exercise. I managed a few humorous blogs and posted some friends' travel stories, while diving into books, cooking, and gardening.

In late October we drove 1500 miles from Massachusetts to Florida to vote in the Presidential election, aware that Florida traditionally went to the Republicans. It did again. We paid $109 each for Covid tests (both negative) so that we could unpack. Our air-conditioning went out in 85-degree temperatures the first night we arrived. Two plumbing items had to be replaced and an outdoor electric storm shutter was stuck. A week later, Tropical Storm Eta hit with 55 mph winds and slashing rains. 

Of all the tragedies emerging, a generation of children teaching themselves on sofas and mattresses had the potential to become the most devastating. Researchers at Brown University projected in May, 2020, that students would return in the fall, 2020, with approximately two-thirds of the reading gains relative to a regular school year and about one-third to one-half of the learning gains in math.  (NY Times, Nov. 8, 2020, Ginia Bellafante, "The Pandemic Widens the Learning Gap," p. 29.)

Still, I sang! I sang off-tune and hummed the words I'd forgotten because I was blessed to have a husband of 55 years who still loved me; because our family enjoyed good health and wasn't devastated by the Covid virus, as so many hundreds of thousands had been; because we had retirement funds and weren't stressed about our living quarters or our food supply; because we had a support system of relatives and friends who enriched us in innumerable ways; because our family had never been forcefully separated or racially attacked.

And I wasn't the only one singing. On November 8th, multitudes in protective masks poured from their doors to chant, to sing, to pop champagne. Our nation would need time to accept, to lessen the rancor, to coalesce, to change the systemic ills, to heal. Meanwhile, I listened to Christmas music and sang. I wondered how many others were singing, too.

 

Over the Hill

So now I’ve reached the age where people expect I won’t be able to do certain things myself. I went over the hill maybe seventeen birthdays ago but I don’t acknowledge I’ve even hit the upgrade yet. I can certainly take care of myself and I don’t plan to give up activities like tennis or travel. However, there are things I used to be able to do that don’t come so easily anymore.

For example, I used to be able to open any kind of lid or wrapper. My unladylike biceps are a result of years of work-outs at fitness centers, and I still play a sport at least four times a week. However, three out of four times I cannot open the top of an iced tea bottle. I usually hand it to Charley, who struggles a bit and may tap it with a utensil, but succeeds. Is it because the arthritis in my wrist is getting worse or is it because the brand I buy uses tightening machines designed to frustrate me? I have now switched to iced tea cans.

Then there are the liners inside cereal boxes. I can never pull the glued tops apart to open a new one. “Do they use Gorilla Glue on these things?” I lament. Finally, I give up and use scissors.

The other day it took two of us to open a clear plastic Q-Tip container. Adhesive labeling covered both ends. Once I had ripped all that off, I tried to pry open two small protrusions on one side which I thought were tabs. Negative. I checked the other side. It was perfectly smooth with an indentation half-way around. I pushed on the indentation. No luck. “Can you open this thing?” I said, handing it to Charley. Negative. That’s when I pressed as hard as I could on the top. Magically it flipped backward!

I sometimes walk into a room and forget why I’m there. No-one can help me with that. I walk out and remember and walk back in again.

Dare I mention the hearing problem…both mine and Charley’s? I have to repeat almost everything  and ask him to turn the television down when he says it’s already down. If he’s got it on and shouts to me in the kitchen, I usually can’t hear him. “See? You can’t hear, either,” he says.

When someone comes to clean our house, the beds are made, the dishwasher emptied, and Charley has put dirty laundry in the washing machine. There might be a chore I need to do like change a light bulb on a one-step stool or gather up the scatter rugs to shake on the deck. “You shouldn’t be on that stool!” the housekeeper admonishes. “You might lose your balance. And scatter rugs are dangerous. You might trip.” I replay the refrain in my head and realize I have now become my parents.

Pam's parents, Ev and Walt

At least I know I’m not alone. I see other signs of aging among those around me – on the tennis court, for example. After a few games, one of the ladies might suddenly drop her racket and run in the direction of the bathroom. Or one of the men might suddenly head toward the tennis shop. “I forgot my drink,” he’ll say, holding up a bottle and stopping to talk to someone through the fence upon his return, while the rest of the men wait on the court. Despite an on-line schedule, we might have seven ladies show up instead of eight. Or nine. Or one might begin to play in reading glasses that have to be switched to the distance glasses left in the car.

And then there’s the matter of keeping score. In tennis, the server is supposed to yell the score before each point. Some women are perfectly silent. I’m never sure whether it’s because they don’t want to be bothered or because they haven’t been able to keep track. Three out of four on the court aren’t paying attention, anyway.

I’ve purchased little beads on a string to keep track of my strokes in golf. That way my partner will still be talking to me when we finish. But first I have to remember if I moved a bead.

The Physician's "Squeeze"

As a person outside the medical community, I want to mention a couple of scenarios I've read about that are emerging in this country affecting physicians.  Much of this information is based on a report by Dr. Sandeep Jauhar (author of Intern: A Doctor's Initiation, 2009) in SaturdayEveningPost.com (Jan.-Feb.'15, pgs. 34-38, 78).

Let's start with where the U.S. ranks in life expectancy among developed nations - #45 - according to a report by The Commonwealth Fund, a healthcare research group.

If you live in Miami, Medicare will spend $8414/person/year versus $3341/person/year in Minneapolis. Why?  A large supply of doctors in Miami means more per capita utilization of services and testing, hospitalizations, and intensive care stays.

Doctors in this country are reimbursed for whatever they bill.  They're paid separately by insurers for patient visits.  As long as their patients are in the hospital, doctors can bill and be paid for each visit. In our healthcare system, "if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur."
(SaturdayEveningPost.com, Jan.-Feb., '15, p. 36).

Volume counts.  Fear of lawsuits creates volume in terms of services (some unnecessary) and referrals.  Better-informed patients might be the most potent restraint for over-utilization.

Here's the other side of the coin.  According to Dr. Jauhar, he was under pressure
at Long Island Jewish Medical Center to reduce the length of stay of patients
hospitalized with heart failure.  The shorter the patient's stay, the more the hospital's costs were reduced (associated with less use of hospital resources during a shorter stay).

It's a physician's squeeze.

The result?

Doctors are trying to sell their practices; uncompensated care is growing; admissions and elective procedures (money makers) are declining; and hospitals are cutting costs, staff, and services.

Dr. Jauhar suggests several options:
          - Hire doctors as employees and put them on salary, removing incentives to
            overtest
          - Use bundled payments for packages (an entire hospitalization, for example),
            rather than discrete services
          - Move to an "accountable care organization" in which teams of doctors would
             be responsible (and paid) for patients' clinical outcomes.  Most doctors have
             performed poorly in such situations. (pg. 38)

A recent Time magazine article by Steven Brill  (Jan. 19, 2015) suggests another option:
          - The University of Pittsburgh Medical Center's model (Brill also cites the
            Cleveland Clinic's model, a 75-facility enterprise)
             in which hospitals, doctors, clinics, AND INSURANCE COMPANY would be
             under one roof.  Tight regulations for these conglomerates, mostly through
             use of
             federal anti-trust laws and state regulatory authority, would ensure their
             accountability.  The in-house insurance company
             would have the incentive to control the doctors' and hospitals' costs
             AS WELL AS the means to do so. There would be less incentive to
             inflate costs or overtreat, because the in-house "boss" would get the bill
             through the insurance company.





 
       

How Not to Get Sick(er) in the Hospital

This is a recap of a Consumer Reports article of the same title, February, 2015, pages 32-37.  The information reinforces the experiences I relate in my book, ELDERLY PARENTS WITH ALL THEIR MARBLES: A SURVIVAL GUIDE FOR THE KIDS. In a future blog I'll discuss the physician's "squeeze."

TO INCREASE THE ODDS OF A GOOD HOSPITAL EXPERIENCE:

- Check infection rates at local hospitals before surgery.
   Go to www.LeapFrogGroup.org to check
   hospital performances on
   patient safety, high risk procedures, and intensive care.

- Pick a medical team that will involve you in decisions
   about your care and respect your capacity to make
   those decisions.

-  Make clear to the staff you want to be treated with patient respect and dignity.
   Among 1,200 recently hospitalized people surveyed by Consumer Reports,
   29% said they rarely received respect from the medical staff.  Those patients were
   2 1/2 times more likely to experience a hospital-acquired infection, a wrong
   diagnosis, an adverse drug reaction, or a prescribing mistake.

   Respectful treatment includes:
   Doctors minimizing use of medical jargon or explaining it
   Staffers introducing themselves before doing anything else
   Doctors and staff listening to your concerns, answering questions, honoring your
       wishes
   Medical teams acknowledging mistakes and treating you like a person

   If a patient doesn't think the staff is listening or his wishes aren't
   being met, he'll hesitate to ask questions, point out mistakes, or communicate
   in ways that could improve his situation.

   "The safest hospitals," according to a group of Harvard Medical School doctors and
   researchers as reported in Academic Medicine (journal), "share core values of
   transparency, accountability, and mutual respect."

   "Every day almost 2,000 people on average pick up an infection in the hospital and
   about 1,100 preventable drug errors occur.  Hospital medical errors are linked to
   440,000 deaths annually."

   The greatest danger for a patient in the hospital is NOT 
   infection or drug error.  
   It's REMAINING SILENT!
   Patient (or advocate) engagement
   has been nicknamed
   "the blockbuster drug of the century."

IF YOU'RE A PATIENT IN A HOSPITAL:

- Let a nurse know the extent of your pain.

- Find out what tests and procedures are for.

- Ask about drug side effects and interactions.

- Be a person to the staff, not a diagnosis.  Talk about your family or personal details

  about your life.

- Invite doctors to have a seat and look at them in the eye to initiate direct
  eye contact away from an electronic device or clipboard.

- Bring an advocate with you (family member, friend, health care proxy, 

   health care manager) to make sure you're comfortable, to get information 

   from the doctor written down, to help you make decisions, to speak for you 

   if you aren't able.  The advocate should meet the head nurse, attending physician, 

   therapist, and aide.

- Have an advocate with you when the most hospital errors occur (shift changes 

  and care transitions).

- Keep a journal and pen or e-device for questions and notes.

- Make a list of questions for the doctor when he makes his rounds.

- Ask your questions but try not to alienate the doctor or staff.

- Ask a doctor to repeat himself if you don't understand. 

- If you don't see your doctor or nurse wash his/her hands, make a respectful request

   that he does so.  Gloves don't necessarily stop the spread of infection.

Many thanks to my friend Al West for passing this article along to me!

   

                                         
 

My Father's Voice

This guest post is by pharmacist, author of murder mysteries, and friend, Don Weiss. 

My father died on August 8^th, 1982.  I was 30 years old.  The day of his funeral dawned hot and sunny. I was amazed at the number of people who showed up at the cemetery. People whom I knew and people who were perfect strangers. The common denominator, my father had touched these people’s lives in some way. Enough so that they wanted to honor the man they knew in life.

My dad was a member of Tom Brokaw’s “greatest generation.” He served honorably in World War II as a combat field medic, earning a purple heart and a bronze star at the age of 24. 

What I remember about my dad was his sense of humor, his humility, and how he had the ability to make you feel safe when he was around. He was completely dedicated to his sons and his wife, and worked twelve hours a day for as long as I can remember. I can still remember the sound of his car pulling into the driveway and how good that felt.

Going with dad to see the Phillies play at old Connie Mack Stadium and going with him to watch the Eagles play, and the day he took my brother and me to the zoo (to give my mother a break). Trips to the Franklin Institute and the Academy of Natural Sciences and never protesting when my mother would plan a family outing on my dad’s only day off.

When I was a rebellious fifteen year-old, I mouthed off to my father. He smacked me across the face at something faster than the speed of light. It wasn’t a hard slap; it was more for the shock value, but boy did it get my attention. It was the first and last time it happened and with the exception of a brief spanking when I was little, it was the only other time that my father laid a hand on me.

My dad would never come to the table unless he was showered, shaved and dressed and I never saw him get something from the kitchen without asking my mother if he could get her anything.

When I was seventeen and still rebellious, my dad suffered his first of three heart attacks. Two years earlier he was diagnosed with Parkinson’s disease. Both began to rob dad of his vitality and I had to grow up fast to help my mother care for him.

He recovered well enough to go back to work, but he wasn’t the same guy. On the eve of his second heart attack, I was home when it happened. With dad in the backseat, I drove the car to the hospital. Again dad recovered enough to go back to work but three years later at the age of 60, he retired on disability. He cooked meals and did other work around the house as much as his physical condition would allow. On rainy days, he would wait at the bus stop for my mom holding an umbrella. Three years later he succumbed to his third heart attack. Parkinson’s had taken a huge toll on him as well, and he was only a shell of the man that I knew.

My huge regret in life is not spending more time with my dad during those last years. I had moved away seven years earlier and only got to see my folks two or three times a year. I wish that I could have talked with him more. The last words I spoke to him were “Hi dad, how are you?” All he said was “I’m fine; I’ll put your mother on.”

Now that I’m going through my own period of self doubt, I can only guess at what advice father would give me.  All I can hope for is that I’m as good a man.

The Five-Day Challenge

I took the challenge.  No, it wasn't a bucket of ice water over my head for MLS or a cleansing of my organs or any kind of iron-woman challenge.  It was the Skoop 5-day challenge.

My daughter-in-law asked me, "Would you like to try a powdered product I believe in?"

I knew she was a former spinning instructor and into all things healthy, including juicing.  "What is it?" I said.

"It's a plant-based super-food, really healthy.  I don't juice any more, because this one product contains so many of the natural foods I put into the juicer, and more."

I remembered her kitchen, littered with rinds and seeds after one juicing session.  I wasn't about to make that kind of a mess in my kitchen and besides, I was retired with no time to waste - there were more important things to explore!

"Like what?"

"Like antioxidants, veggies, probiotics, omegas, fruits, and greens in the form of grasses.  They're all super-foods from plants."

"Sounds like fodder for cows to me!"  I could still taste the juicing concoctions she'd put together that tasted like cucumber and not much else.

"Skoop 'B Strong' is a protein boost, without cholesterol or sugar.  You could try the Skoop 'A Game' for energy. There are different flavors, if you want to do the five-day challenge. The first day there's a packet with chocolate flavor, the next one has the flavor of greens, then the chocolate, and so forth for five days."

"How do I make it so I can actually swallow it?"

"You add frozen fruit or a non-fat soy or almond milk."

"Can I still eat my meals?"

"Well, I take mine first thing in the morning for a real energy boost.  On those days I usually skip breakfast because I mix the Skoop A and B together for a complete meal. But you can put it in food, not just drink it.  You can mix it with yogurt or oatmeal or bake with it."

"So I won't need my Kashi twigs and blueberries on the day I use my potion?"

"Nope.  The super-foods grow tissue, fight sickness and infection, heal wounds and inflammation, and give you energy.  Oh, and the Skoop owners started something called MISSION NUTRITION. They pledged a child's serving of fruits and vegetables placed in school lunch salad bars across the country for each serving of Skoop sold."

"You're a good rep for the product!  I'd try the five-day challenge with some 'A Game' samples."  Which she promptly produced.

I have to admit, I cheated.  Chocolate tops the list of my primary food groups, but the first day's chocolate powder, frothing in the blender with a cup of water, tasted nothing like the Hershey bar I was imagining.  And the only fruits I had in the house were blueberries and apples.  So I added some cherries from a can of pie filling, including a couple of tablespoons of the thick, sweet syrup.  I sipped mouthfuls of the concoction, no problem.

The next day I dumped the green-grass powder into my blender for breakfast.  I figured mixing it with water wouldn't hide the flavor of still-ripe hay.  So I poured a cup of vanilla-flavored soy milk in. Downright tasty!  Much better than the chocolate, actually.

The next day's packet was chocolate again.  By then I'd bought a package of frozen pineapple/strawberries and fresh bananas.  I dumped some of each into the whirl.  Tasted just like a milkshake - really.

We had to go away for two days to attend a memorial service. I welcomed my Kashi twigs with blueberries, but didn't tell my daughter-in-law that. I'd promised to finish the challenge, and I would.

After my liquid energy boosts, I ran around the tennis court like a gazelle.  Maybe my daughter-in-law was onto something for us over-60's?  If only Skoop would help my golf game!
Visit trish.healthyskoop.com for information about the company's three products.