Fixing What I Can

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I fixed the salt cellar this morning. It wasn’t terribly
complicated, but it took a little bit of ingenuity and some focus and a real
desire to have it fixed. I made it last year at one of those paint-your-own-ceramic
workshops. Eve and I were having a mom-daughter day and I decided the last
thing our cupboards needed was another coffee mug, so I chose this ceramic salt
container with a rubber flange on the lid to keep it air tight and Eve pronounced it “cute,” which is an enormous compliment coming from a 16-year old
girl who is your daughter.
It lasted about a week
before the wooden lid came loose from the part with the rubber seal and Lola decided shove it farther down inside rather than trying to pry it loose. This
resulted in the container being full of salt beneath part of the lid that was
firmly stuck halfway down, and no way to remove it. We left it like that for
months, filling the upper part of the container with salt and calling it good.
But this morning as I
stood over a pan of hash browns, imagining what it is going to be like to pack
Mom’s stuff up and move her to memory care in the next week or so, I took on a
project I thought I could fix. As tears tracked slowly down my cheeks, I
contemplated what it would take to pry the lid out. I started by running a
sharp knife around the edge of the rubber, hoping to ease it loose, but abandoned
that after imagining the knife slipping out and slicing my finger. Next, I got
a corkscrew and tried to drive it into the center of the wood to get ahold of
it and lift up, but the wood was too dense. When I went to the junk drawer to
get a screwdriver and screw, I heard Dad’s voice in my head, telling me this
was the ticket.
I screwed it in until
it just took hold and then grabbed the vice grips, stopping for a second to
wonder how many other households have a pair of vice grips in the kitchen drawer
and mentally patting myself on the back for my cleverness. I clamped them over
the top of the screw and gently rocked the vice grips back and forth until the
lid slid up and out.
I flipped Eve’s hash
browns to crisp up on the other side, put the tools away and grabbed the
superglue. Within minutes, the potatoes were on a plate and the two halves of
the lid were tightly bonded back together. I washed out the salt cellar, refilled
it with fresh salt, and wiped down the counter.

When Eve came in to
eat, she opened it up, pinched out a bit of salt, and sprinkled it on her
potatoes. She didn’t even notice that it was fixed. Par for the course with a
teenager in the morning, I suppose, but it didn’t diminish either my sense of
pride or the immense feeling of relief I had that I had found something I could
accomplish today.

Breaking the Spell

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To say that things have been tension-filled in my life lately would be a gross understatement. I won’t go in to details – partially because I don’t really want to see it all sitting together in one, organized list of things that I’m challenged with, and partially because I don’t want to give the struggles too much power. I’m maintaining a balance by remembering to start every day with a list of things for which I’m grateful and by playing with my new puppies a lot (side note: I don’t truly understand why snuggling something fluffy and soft is so soothing, but I do fully appreciate it). When I remember to, I carve out time to exercise and check in with friends and run a hot bath.

But last Wednesday I had one of those days. Despite all my (herculean) efforts to craft a workable plan for the day, things went awry. I had known for months that this particular day was going to be logistically challenging on many different levels and I did my best to cross all of my t’s and dot all of my i’s, but I still couldn’t plan for every contingency. And I couldn’t have known what other emotional things would be lurking in the background, so despite the fact that the day was supposed to be filled with activities that were generative and collaborative and working toward something I am passionate about, I was a bit anxious and split-minded.

And then, during the first morning break, I saw I had a voice mail from an unknown number and when I listened to it, my anxiety ratcheted up four levels.

By lunch time, my chest was tight, my shoulders were hunched up near my earlobes, my heart was racing, palms sweaty, jaw clenched – all the hallmarks of a near panic attack. I left to grab some takeout and came close to bursting in to tears as I placed my order. I sucked air, swallowed hard, and sat on the cushioned bench to wait for my food. And then I remembered that while my mind can only be in the past or the future, my body can only be in the present moment. What my body was trying to tell me by freaking out was that I was hating this present reality. I didn’t want to be in this emotional place I was in. I was feeling overwhelmed.

That might sound like a “Duh” moment as opposed to a revelation, but let me tell you what happened next.

I articulated that very thing in my mind. I said to myself:
I do not want to be feeling this way right now.
I am really uncomfortable with all of this anxiety and the things going on in my life right now that are leading me to feel unhappy and stressed.
And there’s nowhere else I can be in this moment.


In that moment, the stress response left my body and the words floated in my head. It was as if, by giving myself permission to feel what I was feeling and acknowledging that it really sucked, the response moved from my body into my head and suddenly it wasn’t so unbearable. I had figured out how to soothe myself by recognizing that what I was going through was really hard, and that’s all it took to shift things. I finished the afternoon in a much clearer, calmer state. While none of the stressors had disappeared, it seems that they had agreed to move to the side once they were recognized and let me do what I had to do.

Since that moment, I’ve had a few other experiences where I was able to simply notice in my head that I was in a less than ideal situation without feeling it in my gut or my chest or my jaw. It is a pretty cool thing to be able to do and I’m under no illusion that I’ll be able to do this every time I feel anxious or stressed, but for now, it is a reminder that mindfulness works.

I know, another “Duh” moment. But even as someone who has practiced mindfulness for years, I am realizing that there are breakthrough moments where I can continue to learn more about my own responses to different scenarios just by going through the motions of things I’ve done a million times before. Even if I “know” something works, it is altogether different to feel it working in my own experience and I’m truly grateful for the progressive leaps like this because they help me remember that there is always more to learn.

Repost: The Power of a Gratitude Practice

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As a person who has struggled with anxiety and depression
throughout her life, perhaps choosing a career as a writer wasn’t the best way
to go. Writers, especially freelance writers, experience far more rejection
than the average person.
Fortunately, during some intense research I was doing on
adolescence and brain development, I discovered several studies on the power of
gratitude. When I was really wrestling with darkness, mornings were the most
challenging time for me. I woke up, opening one eye at a time to gauge whether
that semi-truck of pain and longing was heading for me before I swung my feet
out of bed onto the floor. Often, before I could get both eyes open, my mind
would begin to race and my heart would pound as I anticipated what the day had
in store for me. After reading about the way gratitude shifts our thinking
patterns and affects our brain chemistry, I decided to start each day with a
short list of things for which I was truly grateful. I envisioned it as a sort
of shield against that truck hurtling toward me.
In the beginning, it was often hard to come up with a list;
not because I don’t have many, many blessings in my life, but because I have an
innate tendency to qualify them. As soon as I think of one, I either compare it
to someone else and feel guilty that, say, my kids are healthy and I have a
friend whose kids aren’t – which effectively soils the gratitude – or it feels
trite and petty, like being grateful that I have enough money to pay my bills.
Even in my gratitude practice, I found myself wanting – either for more ‘pure’
things like love (which feels a little too nebulous sometimes, to be honest) or
for deep, profound items on my list that really resonated in my bones. I am
nothing if not stubborn, though, and motivated by the fervent desire to keep my
depression and anxiety at bay, I kept going despite the sometimes pathetic
nature of my lists. Every day, I thought that maybe tomorrow I could come up
with something beyond gratitude for my soft, warm bed, my kids, and my husband to
be grateful for.
When my teenage daughter was struggling with anxiety upon
starting high school, I encouraged her to start a gratitude practice to see if
it could help her. Every night before bed, I would text her three things for
which I was grateful and she would text me back right before falling asleep. My
hope was that if the last thoughts she had every day were ones that filled her
up rather than dragging her down, perhaps she would wake up with optimism for
the coming day instead of dread. Her lists began much as mine had. She was
grateful for a full belly and a soft pillow and a roof over her head. But over
time, she was able to open up and recall specific things that had happened
during the day that were positive – a friendly smile in the cafeteria, being
picked by a classmate to partner on a project because she is so organized, to
appreciating a trusting relationship with a special teacher. Her perspective
shifted over a period of weeks and she went from finding excuses to stay in bed
to getting up and tackling each new day and its challenges with a feeling of
competence and groundedness.
Over time, my definition of gratitude has developed and I’ve
come to understand what it is about this practice that has been so effective
for me. In the beginning, I often attempted to come up with things by starting
with, “at least I’m not….” What I discovered is that if I am comparing my life
to someone else’s (as in, “at least I’m not part of this oppressed group or
that oppressed group,” or thinking about all the ways my situation could be
worse such as, “neither of my kids is terminally ill and I’m not homeless,”),
I’m not really being grateful. That’s just another way my anxiety is telling me
my life could run off the rails at some point, so I should really be cautious.
Instead of helping me feel calm and centered, it is really reminding me that
one or more of those things could potentially happen and, for now, I’m just
dodging a bullet.
If I am making a mental note of the number of “good” things
in my life as compared to the number of “bad” things, that is also not helpful
gratitude. Weighing them against each other in a sort of balance sheet is not a
positive step. The fact is, both things exist simultaneously (and are often
intertwined with each other) in my life and in my mind, but gratitude is about
the ones I consciously choose to pay attention to. It doesn’t make the
challenges and difficulties in my life disappear, it simply allows me to notice
that there are many positive things in my life, too.
The human brain is wired to look for deficiencies, expect
sabotage, and find the things that need ‘fixing.’ This isn’t always a bad thing
– often I am happy to know that there is something I can do to make things
better. But unless I take the time to really engage in a gratitude practice, I
won’t notice the things that are absolutely right and lovely in the world all
around me. I might notice the pile of unfolded laundry lying on the couch, but
I can also choose to see that the dishes are all clean and the dog is fed and
happily snoozing in his bed and an essay I was working on this morning is coming
along nicely.
I am loathe to imply that gratitude is a complicated thing,
though, because when I am in the zone, it truly isn’t. When I am really tuned
in to the goodness and abundance in my life, the list of things for which I am
grateful grows quickly and easily. For me, the key to gratitude is to simplify
things. When I am frustrated and irritable, the best thing for me to do is stop
and look around. I see my computer and I am grateful for the ability to write
and connect with people who are important to me online. I catch sight of a
glass of water on the counter and appreciate clean water and a cupboard full of
dishes. I note my sunglasses on the table next to me and close my eyes and
thank goodness that I can so often feel the warm sun on my back. When I can
keep myself from trying to create stories or context, I can find simple, pure
gratitude and suddenly, there is more air in the room.

Knowing that every time I actively look for things that are
right in my life means I am activating the parts of my brain that produce
serotonin and dopamine gives me hope. When I started that gratitude practice
all those years ago out of desperation, I was beginning a process of rewiring
my brain to more easily find happiness. Sticking with it, I realized that it
does become easier over time to recognize and appreciate simple things that
give me joy. While I still struggle with anxiety (and rejection), I am more
able to see it as a part of this messy, glorious life I am living instead of
letting it keep me from getting out of bed in the morning.

PTSD and Wildfires: A Metaphor

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I was listening to a story on NPR the other day about
wildfires in the Pacific Northwest and one person who was being interviewed was
part of what they call a “mop-up” crew. These are the people who come in after
the fire is out and look for dead wood that might fall, trench areas that need
it, and look for parts that still might be smoldering.  In large forests, it’s fairly common for roots to be on fire quietly beneath the forest floor and spontaneously
erupt into new fires if the area isn’t checked thoroughly. It is these folks’ job to be hyper vigilant, to scan the terrain for danger. 
I feel like that’s my nervous system in a nutshell. The
original traumas were the raging wildfires that I worked to control and
extinguish, but there are still hotspots in places I haven’t looked and when
someone says or does something that triggers my original abandonment issues, I
am suddenly right back in the middle of that forest with a raging flare-up. Hello, PTSD. 
Despite all the work I’ve done in therapy and on my own,
learning to uncover my deepest insecurities and face them, sitting patiently
with my demons and learning to embrace them, combating the mean voice in my
head that says I’m worthless, there are still pockets of mess that I am occasionally
surprised to find. Somehow, I thought I took care of this, but there was one more tree with
smoldering roots just waiting for some oxygen to feed it. And oxygen feels like such a benign thing, right? Who is afraid of oxygen? Often, it is
as much a surprise to me as it is to the person who said or did whatever they
did, and as much as I’d like to be able to apologize for my massive response,
the fact remains that now I have a new
fucking fire to put out. I wish I had the time to explain or assure you that it’s all going to be fine, but I don’t. I have to put on my helmet and boots and fireproof jacket and wade in because ignoring these small flares isn’t an option. 

There’s no way I have the time or resources to
send out a mop up crew to look for every possible spot that might flare up some
day. The most I can do is clear out the old dead undergrowth, set boundaries to
help me feel safe, and look those damn flames in the eye when they rise up. The
good news is that because I did the hard work to put out the original fires, it doesn’t take as much time or effort to quiet these smaller ones, and as long as I am completely honest and upfront with people about feeling triggered, I have done my part. 
Honestly, most of the time I go through life just admiring this forest of mine – wandering through its lush greenery and feeling blessed at the variety of things that grow there. I am so grateful to have come through those fires of my youth and be where I am today, and frankly, happy that I am in such a good place that I do get surprised when a flare-up happens. [That doesn’t mean that I’m not annoyed as hell when it does. My inner monologue goes a little like this: Really? What the hell? Didn’t we deal with this already? Who is the one in there that keeps flipping the switch? I told you, we’re not in danger anymore. This is different.]
But these days, I can quickly move from frustration to compassion. Obviously, there’s someone in there who is still afraid, who remembers all too well what it meant to be engulfed in flames, and she is hollering for help. And that’s when I go into mop up mode. 

Choosing Grief

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It has been a challenging few weeks around here and I feel like I’m learning a lot about grief and emotional overwhelm. The first thing I’ve noticed is that they both feel very different to me as an adult than they did when I was a kid, but maybe that’s because I have a much stronger bedrock beneath my feet these days. Maybe knowing that the bills will get paid and there is someone to share the load of parenting and managing everyday things leaves me more space to just feel what I’m feeling. Or maybe being an adult means that I don’t have anyone telling me that my strong emotions make them uncomfortable or that I’m over-reacting, or if they do say that, I don’t give a shit.

My brother-in-law died quite suddenly at the beginning of July and even though I hadn’t seen him in several months, I was acutely aware of the loss. Like me, he married into Bubba’s family – a close-knit, fairly traditional clan – as someone who came from a very different background and family dynamic. We bonded over our “black-sheep-ness” and became allies early on. He was someone who always, always had my back, someone who was as sensitive and stubborn as I am, someone who always went to bat for the underdog. He was fiercely protective of me and my kids and Bubba’s sister and we had great fun together – often in the kitchen during family gatherings. Even in my grief, I marvel at the fact that our paths ever crossed, given the difference in our ages and the fact that he was Croatian, and I am grateful for the two decades I got to share with him on the planet.

A week or so later, I lost my beloved CB, my “mostly companion,” my shadow, my furry boyfriend. For more than a decade, he followed me through the house, prompted me to go for walks to clear my head, slept next to my side of the bed, scared strangers at the door, and cracked me up with his ridiculous dog antics. He was loyal and loving and when it came time to let him go, he sat with his head in my lap and trusted me implicitly. I still hear phantom toenail clicking along the hardwood floors and expect to see his smiling face at the door when I come home from the grocery store. Taking walks in the neighborhood without him is strange and disconcerting and I can’t bring myself to move his bed from its spot in the family room quite yet. I feel his presence in every room of my house and my grief is tempered by the absolute joy he brought to my life each and every day, by the years he was there to wake me up with positive energy.

Two days ago, my grandfather had a stroke and reminded everyone when he got to the hospital that he doesn’t want any lifesaving measures. He has lived a good, long life, outlived one of his children (my dad), two wives, and has struggled for a while to really feel as though he was thriving. He is my last remaining grandparent and my childhood memories of him are strong and clear. He is a gentle, funny man who was always ready to teach us something, whether it was a magic trick or how to use a belt sander. In my father’s last months, he was such a comfort and source of love for my dad and watching the two of them interact was incredibly healing for me.

Yesterday, a dear friend of mine lost her husband in a freak car accident. He leaves behind two teenage children and my lovely friend who has been a rock for me more than once. I am overwhelmed. And I am thankful that I have learned a thing or two about grieving – at least my process for grieving.

I have learned that while it is often incredibly helpful to have friends and family around, ultimately I have to grieve in my own time in my own way. I have learned that grief – like life – is not a linear process, but one that requires me to circle back around to what feels like the same spot over and over again, but that each time I come back around, I have a slightly different perspective, an ever-so-advanced understanding of what I’m feeling and how it fits into the larger picture.

When CB died, I was home alone for a few days. Someone advised me to “go do something – don’t stay in the quiet house – distraction is good,” and while I know they meant well, I know from experience that distraction only leads to protracted grief. I came up with a sort of formula that consisted of deep, unapologetic dives into sadness followed by a period of mindless activity like laundry or cleaning out the fridge followed by social interaction. By allowing myself to really feel what I was feeling without descending into it so far that I couldn’t get out, I was able to feel the edges of my sadness and honor them without letting them define me. I follow this pattern over and over again without placing any sort of expectation on how long it will take me to “finish,” and the simple act of accepting my own feelings, whatever they might be, is an exercise in trusting myself.

I have also learned that it is important to surround myself with people who understand that grief is not a quick and dirty, check off the boxes kind of process. I need to surround myself with people who don’t find my strong emotions uncomfortable or unpleasant because that means I either have to stifle my true feelings or I end up emotionally taking care of them. I actively seek those who are willing to sit with me during those deep dives without trying to fix or abbreviate or deny my feelings. These are often people who have really grieved themselves, and they ‘get it.’

While there is a tendency to throw my hands up in the air and ask Why? as the tragedies pile on, I have learned that that is simply a distraction tactic that doesn’t serve me in the end. It doesn’t matter why. I am in the midst of sadness and overwhelm and the only way out is through. There was a time in my life when I would have wished for a magic wand or a time machine to transport me through these days quickly and efficiently, but these days I am content to take the feelings as they come and do my best to find the revelations that often accompany them. It can be painful and often overwhelming, but it is all part of this glorious, messy, beautiful, painful, honest life I choose to live.

The Elephant in the Room

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When the girls were little, I signed them up for a program at the local park where they could learn to ride ponies. They sat in a barn and learned about safety, donned bike helmets and boots, and climbed atop plastic step-stools to hoist themselves up into the saddle. Over a period of weeks, they learned to groom, feed, saddle, and ride these gentle creatures while I stood and snapped pictures on the other side of the fence. After each lesson, they were excited to tell me about the ponies’ names and temperaments and the things they had learned about how to interact with them. When brushing the ponies, they knew to pat their way around the hind end so that the animals always knew where they were, and if they were walking near the ponies but in a blindspot, they were taught to do an “elephant circle” so as to be out of reach of a well-placed kick should the pony get spooked.

One thing you should know about me is that I prefer patting my way around to making elephant circles. If there is an elephant in the vicinity, I am the person who will point it out. I will tell you about it, indicate exactly where it is, tug on your sleeve to alert you, and describe it in great detail. Even if you indicate that you are not interested in anything having to do with this great beast in your midst, it is unlikely that I will stop trying to talk about it. In fact, if I am particularly affected by the sight of this elephant and you actively try to turn my attention elsewhere, I am likely to take you by the hand and lead you to it, make you stroke its leathery flesh, lean in for a sniff and ask you to look it in the eye.

It is not a characteristic of mine that all people appreciate.
I understand.

The other thing you should know about me is that this characteristic is necessary for my survival.

Most of my childhood was spent hearing that crying was an unnecessary activity. That sadness and fear were altogether useless. That the preferred emotions were happiness or anger and anything else was “wallowing” or “self-pity.” From time to time there were entire herds of elephants living in my house that went unacknowledged. The adults perfected elephant circles as they went through their days, picking their way carefully through and around and underneath so as not to discuss any subject that might be uncomfortable. Living like this makes a person feel a little crazy. As a kid, I tried in vain to point out the elephants and was either ignored or reprimanded. I began to believe that I was the only one who saw them, that there was something wrong with me. Or that my ability to see them – my “sensitivity” (spoken with a sneer of derision) – was a fatal character flaw. I alternated between jumping up and down and pointing and cowering in my room wondering whether there was something seriously wrong with me. Eventually, I learned to avoid the rooms where they lived altogether and take cues from other people regarding which things were ok to speak of and which ones were not.

My tactics as an adult are quite the opposite. I have come to realize that, for me, ignoring the elephants is an exercise in self-destruction. To deny my feelings about any particular situation is to pretend that they don’t matter. So while I won’t ask you to see the elephant in the room the same way I do, or to experience the same emotions in response to it, don’t be surprised if I lead you to it and describe it in great detail so that you are forced to acknowledge that it exists. So that you might begin to understand why it is something that is important to me. So that at least we can agree on one thing – that I am not crazy. I apologize if this makes you uncomfortable, but I’ve learned that leaning into discomfort is the best way to define its edges and begin to loosen its hold on me.

Requiem for the Living

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I read somewhere a reminder that everything is simultaneously living and dying. And, of course I knew that, but we do our best to think otherwise, don’t we? We either work to ignore it or reverse it in almost every act we take. But the end is part of the beginning as much as green is born with shades of blue embedded in it.

And it made me wonder whether the best thing to do is simply to float along in full acknowledgment of this minute
 this moment  
 this adventure
Or should I work to give the living a little more advantage? Stretch out the living part a bit more? Use my energy to tip the scales?

It’s easy to go back and forth from camp to camp. So that’s what I do.

Sometimes I live in memory, stacking up joyful moments like gold bars, hoping that once the dying is done I will have this wall to lean back upon. And sometimes I realize that so much stacking means I’m not appreciating the living that is happening behind my back, and I set aside my blocks and turn around.

Spending time surrounded by the awareness that what is here now won’t be forever makes for a certain quality of awake-ness that is uncomfortable. It requires me to be mindful of emotional connection instead of physical action.

“I love you” versus “let me do this for you” or “let’s make new memories.”

It is also difficult to define the world in terms of Not-me. That is, to not process every potentiality and new situation with regard to what it requests and requires of me and how it makes me feel. I have to float back and see myself as one part of the whole and that both humbles me and reminds me that I am an important piece of the puzzle. That in any moment I can choose to turn my back, shore up the living, or accept my place and experience what is. Perhaps the beauty in that is that I do. I choose. Among the breath and the pulse and the movement and the slowing and the dying, I choose. And the more I can remember that it is all beautiful and glorious and a gift that I am here, part of it, for a while, the stronger I feel.

Stream of Consciousness Morning

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Saturday, Sunday, Monday I had hours for writing. The luxury of time meant that I woke early, poured coffee, sat at a rented desk and pounded the keyboard until I had 60 pages. Walks along the beach, more coffee, shuffling pages of memories and piecing things together.

Tuesday and Wednesday I was back in my normal life – driving, cooking, shopping, working at my ‘other’ job which doesn’t entail writing so much as networking and trying to hawk what I’ve already written. But this morning, I could see a way clear to more writing.

First, the tasks that launch the day – packing lunch, toasting bagels, walking the dog.

My mind drifts and swells. I marvel at how much of my writing happens while I smear cream cheese on the bagel, tug the dog along our familiar route, stand in the shower.

I pass dogwood tree after dogwood tree, loaded down with so many blossoms that I can’t see the leaves beneath them. I am struck by the sheer weight of beauty, how it weighs down the branches, the stems of peonies curving to rest the flowers on the sidewalk, their scent rising up to me. These plants with their short-lived bursts of shocking glory are my favorite. The ones with the less showy, compact blossoms that live on sturdy stems and branches barely merit a glance. What does that say about me?

There is a Frito-Lay truck parked along our route to school and I think about how, sometimes, I have an uncontrollable craving for potato chips. Not often, but when it comes it is intense. I imagine being the driver of that truck, pulling over to a quiet alley, climbing over the seat to get to the boxes and boxes, ripping open a bag and plucking one paper-thin chip out and then another and another. Wiping the grease on my pants.

We pass an apartment whose living room window frames a birdcage and I think, “Do people still keep birds as pets?” I remember my sister’s parakeets – one blue and one green. The biting, ammonia smell of their cage, the wooden swing, the way she had to put a blanket over it at night to keep them quiet. What would have happened if we had simply turned out all of the lamps and let the actual night take over? Would they have slept?

Everyone else is gone for the day but there are imprints everywhere. Stray shoes, crumbs on the counter, a favorite pencil on the kitchen table. I am alone to write but the end of the day calls. What’s for dinner? Are there towels clean? What time is my guitar lesson?

Two Reasons I Think Single-Payer HealthCare Needs to Happen

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Warning: Rant coming in 3, 2, 1

There have been times in my life when I have been so f%*king DONE with our country’s convoluted system of healthcare that I wasn’t sure whether to cry, throw myself on the floor and pound my fists until they’re black and blue or scream bloody murder from the highest peak I can find.

I know lots of folks who can relate.

Seriously. Socialized medicine, folks. I mean it.

I know it won’t make everything easy-peasy, simple and clean, but it can’t make things worse.

When I went to college, I was determined to become a pediatrician. That’s all I had wanted to be since I was in elementary school and I could see it happening. I took organic chemistry, cell physiology, medical ethics classes. I struggled with some more than others, but I loved them all. My senior year, I studied for and took the ridiculously long MCAT and spent hundreds of dollars applying to medical schools and then decided to take a year off to work in the field before deciding whether to go ahead and go.

I ended up working for several years as a surgical assistant for a small group of doctors and I learned about the other side: the business of medicine. I hung out with the business manager and discovered how to tweak our diagnosis codes and pore through the (then) printed catalogs of allowed procedures to bill things so they would get paid for. When patients came in for emergency surgery, after the OR was scrubbed of blood and every last instrument was cleaned and put in the sterilizer, we convened for a quick meeting to determine just how to position the procedure to whichever insurance company might be involved so that we could have a higher chance of being paid. This not only determined which codes we used to bill, but it often meant that the doctor had to dictate his notes in a particular way so that, in case the insurance adjuster (not a physician or a nurse in most cases) asked for them, they would fully support the billing we submitted.

During those years, I discovered that if what I truly wanted to do was build relationships with patients that impacted their lives and their health, going to medical school was not the way to do it. As the surgical assistant, I spent more time with the patients than anyone – pre and post-op – and heard about the other things going on in their lives as I changed bandages and removed stitches. The doctors, while they may have liked to have more time to spend with patients, spent the majority of their time maximizing insurance payments by dictating notes, seeing a ridiculous number of patients per day, scheduling back-to-back surgeries to maximize OR usage, and occasionally getting on the phone with an insurance company who was refusing to pay for more than two scalpels or two hours of anesthesia to defend their choices.

Needless to say, I chose not to go to medical school.  And in the next several years, I spent time fighting with insurance companies for a physical therapy business, a dermatologist, and the state mental health division, not to mention myself and my family. I learned just how insurance companies make rules that increase their profits and narrow choices for their customers. I discovered that the high-level relationships that are made between drug companies and major hospital groups and insurers almost never benefit the health or wellness of a customer unless it happens to be in alignment with the bottom line of the companies involved.

A few weeks ago I called a doctor’s office for a family member to get diagnosis and procedure codes for an anticipated surgery. I then called the insurance company armed with information to ask whether these codes were considered covered procedures. After nearly an hour on the phone I came away with a vague answer that included information about the deductible and the potential coverage depending on a number of variables over which we have no control.  If the doctor is “in network” (he is), his services are covered at X%. If the hospital is “in network” (they are), their nursing and OR services are covered at X%, as long as it is a day-surgery. Overnight stays are covered at X-Y%. If the anesthesiologist is “in network” (we have no control over that and no way of knowing until the day of the surgery who that person might be), their services are covered at X%, but if that doctor is “out of network,” services are not covered at all. Not only that, but on “out of network” providers, the amount the patient pays is not applied to the deductible or the out-of-pocket maximums for the year (presumably because we had the audacity to go rogue – even though we have no choice in the matter). There are further decisions about OR supplies (one would think that those would be considered part of the surgery facility charge, but, no, it seems they are billed separately), so if the surgeon chooses a more expensive bandage or stitches, it is likely those won’t be covered at all.  I could go on, but you get the gist.

This morning, I phoned our dentist’s office to discuss a particularly high bill we received and after another hour of talking with them and the insurance company, I was told that Lola’s emergency dental procedure last summer while we were on vacation was not only not covered (out of network), but none of the $500 we paid for it were applied to our deductible (out of network). I calmly asked the representative,

“So, this was literally an emergency. As in, the plane touched down, we stopped at the pharmacy to get pain killers for our daughter, and as soon as we hit the hotel we asked the concierge to recommend a dentist who could see her ASAP (Saturday morning in Hawaii). First of all, does your insurance company have in-network providers in Hawaii? And if so, am I expected to call all of the islands to find one who happens to practice on the weekend and is willing to see my daughter? Is that a thing I should have done?”

“No. It’s not a thing,” he says.

“Explain that to me, please.”

“Was it a medical emergency? Because if it was, you should have run it through your medical claim instead of dental, and then it might have been covered even if it were out of network. But it wasn’t, and it’s too late now. It was processed as out of network and that’s how it’s going to stay. And, no, we don’t have any in-network providers in Hawaii.”

So, ultimately, it’s my fault that I didn’t sell it as a medical emergency? Or is it the dentists’ office fault? The dentist who got up on a Saturday morning and spent three and a half hours with Lola patiently tending to her and then calling us that night to make sure she was ok.

And why wasn’t my out of pocket amount applied to the deductible? Because we went rogue. Because we didn’t follow the rules. Because, if it had been, the insurance company (Premera Blue Cross, btw) would have been on the hook for all the rest of the follow up procedures that have taken place as a result of this situation in the last nine months. But they aren’t, because it all started with us needing dental care somewhere else in a hurry.  When I pointed this out to the representative this was his response:

“Well, you just really want to have your dental emergencies when you’re at home. That’s the best way to do it.”

Duly noted.

Socialized medicine, folks. Single payer. The same rules for everyone.

Health care (even dental care). It’s a basic need.

Talking To Kids About Sex (With Visual Aids)

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This is a response to Elizabeth’s comment on the previous post about sex as a commodity, and I will preface it by saying I wish I had a definitive answer. She asked how I would educate my sons about sex and rape culture if I had sons, and I think it is a particularly salient question. I thought about it in the context of my brothers and my dad, but my teenage years were a different time. Not that there wasn’t a hearty dose of misogyny and male entitlement, but it wasn’t talked about at all, and rarely was it ever challenged.

After puzzling on it for a bit, I went to a source I trust: Lola. As a 13-year old girl who is proficient in social media, steeped in girls’ empowerment, and has a strong, vocal opinion on social justice, I was interested in her ideas about how to talk to teenage boys about rape culture.  She started out by encouraging parents to watch this YouTube video about consent with their kids. All of them, boys and girls, starting at a pretty young age. It’s a pretty powerful analogy and points out just how absurd our ideas about sexual consent are.

I love this video because it doesn’t avoid the idea that a person’s consent status can change at any point. Yes, it is possible for someone to say “yes” and then change their mind, two or five or twenty-five minutes later. And no matter when it happens, it’s valid. I’ve talked to my kids about the concept of the Least Common Denominator (don’t let your eyes glaze over – this has nothing to do with math). That means that the person who is the least comfortable gets to make the rules. The lowest threshold for sexual intimacy is the trump card. So if I really want to have full sexual intercourse but my partner just really wants to make out on the couch, we stop there. Period.

The second point Lola said was important to share with teenage boys is that, even though they may not have personally done anything to make a girl feel uncomfortable, rape culture means that in many situations, we just are.  Even I, in my mid-40s and fairly fit, am always nervous when I get into an elevator with just one other person who is male. Always. That is rape culture. Rape culture is me not feeling comfortable getting into an Uber or a Lyft by myself with a male driver. Chances are, he is a nice guy who will pick me up and take me to the destination I requested without any detours, but rape culture means that I am acutely aware at all times that I lack power – and therefore physical autonomy – until I get out of the car.  And rape culture also means that I often suffer through comments on my physical appearance and speculation about what I might be going out to do (often with lewd body language) and don’t speak up because it might anger the driver and then I’m screwed. Lola said she would want boys to know that these kind of experiences happen daily to girls and women, even if they themselves aren’t perpetuating it. She wondered if they might be willing to imagine what it would be like to be constantly on guard, wondering if the next guy who spoke to you would try to do more than speak.

We ended up having a conversation about street harassment and she cracked me up when she said, “They should know that girls and women don’t get dressed in the morning so that they can go out and get comments on their appearance from total strangers. Ever. That’s not a thing.” Even if guys think it’s totally innocent or a compliment to tell someone how they look, it ultimately makes women and girls feel unsafe simply walking down the street.  This video is a powerful one because it is a small sampling of what many women experience on a daily basis as they go about their business. And the irony is, no matter how she was dressed, if she had been accompanied by a man her age or older, none of that would have happened.  Nobody would have commented on her appearance – some out of fear of the other man, and some out of respect for him. But none of them out of respect for her. And that is rape culture.

The fact is, as I wrote in my last post, in our culture sex is often about power, and those who are born with more power are the ones who often make the rules about sex. Frankly, the most impactful thing I’ve been able to do when I’m having a conversation about sex with my girls is to listen. I like to think that I’m fairly plugged in to pop culture, but I know that there is a lot that goes on that I don’t see. And I’ve discovered that if I listen without judgment, my kids actually first love to shock me with the tales of goings-on in their world, and then feel like they can dig a little deeper and think about how all of it makes them feel.  I have also discovered that talking about sex and sexuality in lots of different ways – commenting when we’re watching a TV show together or when I hear a story on NPR with them in the car, showing them a video like the ones in this post and watching for their reactions, or slipping this letter under someone’s bedroom door – gives us opportunities to continually explore and challenge the ideas we have about sex.

Elizabeth is right. Talking to our kids about sex is incredibly hard. Sometimes they get annoyed and don’t want to talk (or listen). Sometimes I’m not the best at explaining something or helping them understand where I’m coming from. Sometimes I’m not good at listening without judgment. But the most important thing I ever did for my girls was to let them know that I’m willing to keep trying. That they can come talk to me about hard things whenever they want to and that I will bring tough subjects up from time to time and ask them to indulge me. Because if we as parents don’t work to counter the basic themes about sex that our kids get from school and the mass media, nobody will.