Monday, September 21, 2009

Our Experience With "Socialized Medicine"!

It is September, 2009 and President Obama is active in pursuing health care reform legislation. I present the following blog as that this personal story certainly has context that is pertinent to this current issue. I will tell the account by simply presenting the facts of our personal experience with "Socialized Medicine". Borrowing a tag line from a particular news channel, "I Report... You Decide"!

As with our first two children, our third child was delivered at home. Why we chose home birthing will be another story. We were by all accounts having a very easy birth process. As our baby boy emerged into the world, all looked very well, he was alert, and like the others did not even cry and was at peace. As I presented the baby, with umbilicus still attached, into mamas arms, we noticed that indeed there was something gravely wrong. I recognized the leathery patch about the size of a silver dollar on the babies lower spine as something we had seen years before with our niece. Our little baby was born with Spina Bifida.

This spinal defect occurs early during the pregnancy and is often hereditary. Although it appeared that the baby had good movement in both legs, we knew that a defect at this level of the spine could have impact to his lower extremities. It presented no immediate emergency threat, but we were on the phone right away to our local general practitioner, he immediately recommended we head for Children's Hospital in Little Rock, Arkansas.

Now it had been planned that my mother would be present for this birth, but she and her husband showed up an hour late after their three day trip from California. So Grandma and Grandpa would now be baby sitters our two other boys while we took our new baby for care. After speaking with Children's Hospital we bundled up our newborn, protecting the lesion as they recommended and headed for Little Rock. Within a couple hours after Sue delivered the baby we were on our way to Little Rock via our personal vehicle on a 3 hour trip to Little Rock.

Checking in to the Children's hospital required a very minimum amount of paper work, and our baby was admitted straight away to the Neo-natal Intensive Care Unit. He would be scheduled for two surgeries. The first surgery would be to close the lesion on the spine, and the second surgery would be to place a Ventral Peritoneal Shunt that would assist in draining fluid from the cranium into the abdomen. (Most Spina Bifida cases will require a shunt to assist in draining excess fluid from the cranium).

Now excuse me for not providing the name of the infant.... His name is Brian, but at that time, we had yet to choose a name, thus I am referring to him simply as our baby.

We spent several days at the Ronald McDonald house across the street from the hospital making our stay much more comfortable. This was quite a blessing, as we did want to be near the hospital, and really could not afford to be staying in a hotel room.

The surgeries went well, but we would not know for months and even years as to the full impact of our babies spinal defect. As the doctors read the list of possible impacts too this child's life, all we could do was hope for the best. As the day of discharge from the hospital approached, we began to be concerned as to how we were going to survive financially as we knew that this stay in the hospital would be tens of thousands of dollars.

Now our current situation was this... Despite being employed as the Director of the Respiratory Therapy in our small town hospital, we could not afford the health insurance. Some may find this a bit hard to believe, but without revealing the meager wage at which I was employed at the time, I believe that you may soon understand.

It is discharge day.... We figure we better head down to see a financial counselor to explain to them that we were going to have a very difficult time in paying for this hospital experience. The nice lady pulled up our records and after a few seconds she said, that we had nothing to worry about... Our income was in the "poverty level" and that the hospital stay and the surgeries would all be mostly covered by Medicaid. We were surprised and speechless. As we left, we felt like we better hurry before they find that they had made a mistake...

When I returned back to work, the Hospital Director called me in and expressed his concern for our baby and how he hoped all had turned out well. He also stated that he was aware that I did not have any health insurance, and was wondering how we would be able to take care of this incident. I explained to him that fortunately, you pay me at a pay level as Director of Respiratory Therapy, that places me in the poverty range. Medicaid was covering most of the expenses. He looked dumb-founded.... He said he could not believe that. All I could say is that is the way it is. Even after this, I did not get a raise...

It does seem a curious matter to me that an allied health care worker with three years of specialized training, and 15 years experience, working as the director of a hospital department is making such a low salary that he cannot afford health care insurance for his family. In fact it is poverty level of pay. An extraordinary situation indeed.

Brian is now 21 years old and is living in Fayetteville, Arkansas. He still receives some benefits from Social Security Disability and will continue to rely on Medicaid. He has part time employment. He is doing very well, but has required 2 surgeries to repair a failed shunt. He has some minor impact to his lower motor skills, but overall does very well.

I am no longer employed as a Respiratory Therapist, and found staying home and designing web sites provided a better income than the hospital could pay. My wife and I now have health insurance through her employer. The insurance is reasonably affordable with our two incomes and we have overall been pleased with the coverage. We know that this is not the case for many. Reflecting back, I am very pleased that the Medicaid program was in place as is our son Brian.

Take the time to leave a comment, or tell your own story.

Some useful links.
Spina Bifida Association
Arkansas Children's Association
Ronald McDonald House Charities
Medicaid Program
Social Security Disability Program

Monday, September 14, 2009

Homeless in Houston, Texas

You have heard about it. People being homeless. It happens, for a variety of reasons. Sue and I had been married for almost 9 years when we chose to be homeless.

We had moved from Southern California, where we had both been born and went all through school there, dated there, got married there, and overall we were very happy there. So somehow we decide to leave our idealic setting in California and move to Houston, Texas.

We had some big plans to make some big money and so on, but there was very little we enjoyed about Houston. We had purchased a nice little 2 bedroom home in Houston from the sale of our home in California and had put down a substantial down payment to keep our payments low.

Then the infamous oil embargo hit and Houston was hit hard economically. This was just another insult on top of our struggle in living in this curious city. I will not go into detail as to what we found to not suit us in this city as I do not wish to offend. It very well may have been that we were the problem. You know... the old square peg, round hole kind of thing. We were the peg, and Houston was the hole.

I was employed as a Respiratory Therapist at a hospital while Sue took on private duty sitting for a wealthy little lady. She worked nights, I worked evenings, and we rarely got to see each other. So at some point, along with my brother and his wife, we all decided to stop chasing this dream, and find something different. Find a place to live where we can own some land, and grow a garden and raise some animals. We do some research and we zero in on Arkansas, and then specifically on Mena. There was affordable land, plenty of water, and a reasonable four seasons.

So after a weekend visit to Mena, we secure some land which we will divide between Sue and I and my brother and his wife. But before we can move we need to sell our home in Houston. After visiting a realtor, we are being told that property values are in the dumps as the oil embargo has hit Houston hard. There are a lot of properties on the market and they are not moving. The value of our home has us under water. So we put it on the market and hope to sell it and maybe break even.

We are now also making payments on our property in Arkansas, and we decide that to accelerate our being able to get out of Houston, we would rent out our home and move into a cheap apartment. So we rent out the home, and are so busy coming and going with our jobs we simply do not take the time to find an apartment.

Here is how it was working. Sue spends 5 nights a week doing her private duty sitting in a very nice home, where she usually gets a full nights rest. I am roughing it in my Volkswagon Van, until we find an apartment. On the weekends we would get to be together in the van. We had moved all of our belongings into a storage unit and would access as needed. After a couple of weeks it was evident that we were not going to rent that apartment. Sue took on another job as a delivery person for eyewear to the various Optometrists in the area. Now we were making some extra money. We were now able to double up on our payment to the property in Arkansas. So we decided that this homeless life-style would work.

My day would go as such. I would go to work in the afternoon. I would tie up my dog (a boxer) to the front bumper, and provide her with plenty of food and water and a carpet to lay on. I would check on her during breaks and lunch. After my shift, I would either simply sleep in the parking lot of the Hospital in the van, or would go out and find a place in some residential area to park on the side of the road. In the morning, I would usually go to our local fitness center for a shower, and sometimes would meet with Sue to play some racquetball. Meals were right out of the little ice chest. Cereal and Sandwiches.

Sue would spend most of her day doing her delivery route and she took care of the cat in her little Dodge. A kitty litter box was behind the drivers seat, and food and water behind the passenger seat. Then at night she would be with the little lady with whom she did the private duty sitting. In the morning, she would usually join me at the fitness center.

This was actually working very well! Yes, we were homeless, but by choice. It was not for lack of money, as we easily could have stayed in our home, or moved into that cheap apartment, but we soon realized that this was working pretty well and indeed was quite convenient. We were very determined to get to Arkansas, and our sacrifice was really not a big hardship.

Now things did not always go well. I got a complaint about my dog being in the parking lot of the hospital, as well as me sleeping there, thus I moved on to greener pastures. I thought that our dog was happy and I would let her run in a big field everyday. But one day I took her out to run and she simply kept on running. I waited and waited, and searched for her, but she was gone. I think she had grown weary of the "Hippie Bus". Then there was the late night visit to my van by the police.

I had parked just a block away from where Sue worked at night. A very nice neighborhood, so I felt safe. I am almost asleep when I see the flashing lights behind the van, and a flashlight was being rapped against my window. Oh, boy.... the police.... I am in my boxer shorts and figure the police would not mind, so I throw open the sliding door and there stands a young lady officer shining her flashlight on me. Her first words... "What are you doing"? I reply, I am trying to sleep. She shines her light into the back and sees my very comfortable bed, my little ice chest and my little chest of drawers. "Why are you sleeping in your van"? This is were I sleep. I am not trying to be cute with the officer as I did not know what kind of trouble I might be in. Do you not have a home? I explained that I do, but it is rented out. I am now sure she is viewing me as totally down on my luck, and homeless. She tells me to stay put while she calls the station.

While she is in her patrol car, I am imagining I am in all kinds of trouble, and fear I could be in jail tonight and have my car towed. She returns and states, "Okay, I have checked and apparently you are not breaking any laws, but the people that live in the home you parked in front of called as they saw you park, but you never got our of your vehicle and they got concerned and called the police". I explained to her where I worked, where my wife worked and that all was good. She gave me a funny look, and suggested that I should find a better place to park. After that incident, I got permission from the fitness center to park in their lot each night.

Weekends were great. Sue and I got to sleep in the bus, and it was like a continuous camping trip. In fact it was during these interesting times that we chose to start a family. Yeah baby.... were living in our cars, let's start that family.

Sue was 8 months pregnant when we moved to Arkansas. We had lost our home in Texas. Now all I had to do was find a job, and build a home in 1 month. But that will be another story.

Wednesday, September 9, 2009

The Most Dangerous Sport!

All sports have some element of danger. Some more than others. Some sports suffer from being assessed as being more dangerous than they actually are, while others seem fairly safe, but secretly hide a dark side that is not apparent to the casual observer.

Allow me to do a rundown on activities or sports of which I have participated, and give a brief statement as to it's danger level, on my own personal anecdotal level. This is in no way based on any scientific method. Only my own personal experience.

Motorcycles- Only one serious accident on the dirt bike and was able to limp away.

Motorcycles- Only one accident on the road bike. Minor abrasions.

Skateboarding- Sue and I quit before we suffered any broken bones.

Racquetball- Only minor bruising, and occasional blood letting.

Volleyball- Sprained ankles.

Running- Plantar Faciitis.

Hang Gliding- No injuries.

Ultralight Aircraft Flight- No injuries.

Sailing- No injuries.

Bicycling- No accidents while riding on the road.

Mountain Biking- Many cuts and abrasions, and injury to neck and back.

Rock Climbing- No injuries.

Snow Skiing- No injuries.

Soccer- Sprained ankles.

Volleyball- Sprained ankles.

To be fair, some of the above activities of which I partook were only for a limited amount of time. Skateboarding was a short lived activity, thus I was lucky to not suffer any major injuries. It is my opinion, that skateboarding is probably more dangerous than many of the other activities. Other activities, I participated over a very prolonged period, so the fact that I had injuries, such as with mountain biking does not necessarily mean it is inordinately dangerous. I have flown hang gliders for over 13 years without injury, thus this activity has been a relatively safe activity for me.

Now the purpose of this little discourse is to give my opinion as to what has been the most dangerous activity or sport for me. This determination is based on a rough evaluation of the amount of time I participated in each activity, and how many injuries or how close I came to disaster in the respective activities.

And the winner is!

Well actually, none of the above... I have withheld mentioning the activity that has been the most dangerous to me. I wanted you to first form your own opinion as to which of the above are the most dangerous, and then surprise you with the activity that has been the most dangerous for me.

Drumroll please!

And the winner in the category of the most dangerous activity for Mike...


For some of you this may be a surprise, while others (some fishermen) may agree with my assessment.

I never suffered an injury while fishing, but I had 3 incidents that would qualify as a "scared the hell out of me" type experience. And these three incidents occurred with only a very limited amount of time participating in the pastime. So in retrospect, the risk to reward ratio seemed to be fairly high.

Now before I detail the "scared the hell out of me" events, I will first want to express to the fishing fanatics, that I will be the first to admit that in each of these incidents, that they were primarily my fault. No matter what we do, we must take responsibility for our own actions, and be properly versed in how to conduct the activity in a safe manner.

Event #1
I am invited to join a friend in a Bass Fishing Tournament. The weather was predicted to have a possibility for strong storms. Storms in Arkansas can build rapidly. So of course we go fishing.

Now in tournament situations, one will often tolerate higher levels of risk than normal.... So we are seeing the sky getting very dark, but my buddy is reassuring that if we hear thunder we will head for the shore. Well the first thunder was accompanied by a lightening bolt that was very close. You know the simultaneous flash and the and loud report of thunder. Could not have even counted to "One Alligator" between the loud report and the very nearby lightening bolt. My buddy was leaping for the drivers seat and firing up the engine in haste and we headed for the shore. We rode out the storm in the thick woods.

Event #2
I cannot remember why I thought it would be a good idea to take my little 12 foot John Boat to the local lake in the middle of an Arkansas December. So I am alone on the lake but have dressed appropriately to tolerate the 40 degree weather. My life preserver is nearby, and I am motoring out with my little electric trolling motor. It happened very suddenly.... The little boat suddenly riding up on a submerged tree stump. The little flat bottom boat started to pitch hard to the left, and I had only a split second to make a decision. What went through my mind was that the boat was going to capsize. My split decision was to hopefully save the boat from capsizing by leaping out of the boat.

My first response when I came up out of the water was to be pleased to see that the boat had not capsized. My second response was, to be amazed at how cold the water was... The boat was perched up in a precarious position on the stump, and I felt great urgency in getting the boat off of the stump and trying to get back in the boat without dumping it over. I am not a strong swimmer and the bulk of the heavy water-soaked coat was becoming a concern.

I was able to pull the boat off the stump pretty easily. I knew that if I was to climb in the boat it would have to be from the stern. The little electric motor was preventing me from being able to access the stern on the narrow little boat. I worked on removing the motor from the back of the boat and pitching it into the boat. Now I had room to hopefully pull myself up into the boat over the stern. With much relief, I am able to pull myself into the boat without tipping the tiny craft. I hook the little motor back up and it is a long, slow and very cold trip back to shore.

Event #3
I save the best for last! My favorite mode of fishing was to join up with a buddy and fish our local creeks in flotation tubes. A short explanation to those who are not aware of this method. Take an automobile inner tube, insert it into a canvas pouch. After inflating the tube you have a seat within the center of the tube. When deployed in the water you float about belly deep in the water, and propel yourself through the water very slowly through the water by kicking your legs. Great device for fishing the slow and shallow creeks during the summer. Now set all this aside, as my good buddy felt that on this dry summer day, we would not need the tubes and simply could wade the creek. So, off we go to wade about a 2 mile stretch of creek.

The fishing was going very well. We were about half way to our destination, and were filling up our stringers with large mouth bass. We would wade a pool of water, then walk through shallow shoals to the next pool. I wade into the next pool, and I am casting a top water spinner lure to one side of the pool and my buddy is casting to the other. This particular pool is larger than the others and it is getting pretty deep as we proceed. So I have water up to my armpits, while I continue to cast, hoping for that next hit from another largemouth and then suddenly I am under water. I had stepped off a ledge, took a dunk and quickly paddled and kicked to get my head back above water. Now to find a foothold.

As I mentioned before, I am not a great swimmer and now I am swimming (dog paddling) with one hand as my right hand was holding on to the fishing pole. Not willing to let loose of the rod, I started to swim towards the bank, hoping to find a foothold. But each time I kicked, the stringer of fish hanging from my belt would wrap around my leg. Very rapidly the weight of the fish around my leg now limited me to swimming with one hand and one leg.

Okay... one would think at this moment, that common sense would kick in and that I would toss the rod. I did not. Or maybe call out to my buddy for some assistance. I did not. Now I am having short periods where I am not able to keep my head above water. I would go under, find the bottom and kick myself up to the surface again. Again, one would think that I would call for assistance, or at least lose the pol so that I would have two hands with which to swim. I did not.

So what the heck is going on here? Well I am sad to say that it is simply the male ego that had full control of my decision making process. Now you must know this.... that my good fishing buddy and I are very competitive. We compete at fishing, (who caught the biggest or most fish), we compete at racquetball, and we compete on our mountain bikes. If my buddy beats me in racquetball, I have to hear about it for weeks. If I loose my fishing pole, he will have that as fodder to make fun of me for months. If I actually have to have him help me, I will never live that one down. At every family gathering he would make sure to tell about the time he had to save me from drowning. So the pitiful reality was this.... I was willing to risk my life rather than risk being the butt of a joke.

It was about my third time to go under. I came up and I was really starting to struggle. My stroke with my one good arm and leg was panicked and barely getting me any forward motion, when my foot struck a rock. And as quickly as I had gone under, I had found a footing.

I stood on solid ground with my head above water, catching my breath. I turned around to see where my buddy was, and his back was to me as he casually casted his lure towards the opposite bank. Apparently he was unaware of my desperate situation I was in just seconds earlier.

I untangle the stringer of fish from my leg, checked my lure, and begin casting.... Just as if nothing had happened. I knew though that I had come very close to putting myself in a very desperate position. All because of my ego.

Many years passed without me telling anyone about this incident. It was probably over a decade before I confessed to my wife and my buddy of what had transpired that day. To this day I carry that day as a reminder of how wicked our egos can be. For my wife to have lost her husband, my children their father, and my mother her son would have been a terrible senseless waste.

We get together now and reflect back and can laugh at some of the crazy things we have done. Yes, I hang glide, race mountain bikes, and more. But I no longer fish.... Some just are not cut out for extreme sports.

Thursday, September 3, 2009

My First Day as a Respiratory Therapist

After graduating from High School in 1971, I took a job at the local car wash. I was making $1.25 an hour and was pleased to be employed. It was hard work, and fun but I certainly did not see myself wiping down cars for very long. My older brother had just finished a course so that he could become an "Inhalation Therapist". He got a job right away and was making $1.65 and hour. He encouraged me to take the one semester course to become an Inhalation Therapist. I asked him if I too would be making $1.65 an hour. Sure he said, and maybe even more! I was sold.... I did not know what an Inhalation Therapist was, but I was pretty sure it would beat wiping down cars.

So I enroll in the course. Part of the program was learning the practical application of our skills. We would be assigned to a local hospital and would be assigned to follow an actual Inhalation Therapist as he or she went through the daily routine. So a few days a week with our noses in books and a couple days a week seeing the practical application of the skills we were learning.

A large part of the practice is the dispensing of various inhaled medications through various devices. We would also be involved with monitoring of ventilators for post-op care or other situations that would require a patient to be on a ventilator. We would also be drawing blood from arteries to monitor the effectiveness of a patients respiration. And occasionally we would be part of a team that would assemble during emergency situations where a patients breathing or heart had stopped with our duty being to establish an airway and support breathing. Pretty interesting stuff, and you have no way to know how you are going to react to the real settings. It was all just book learning so far.

So I show up late on my first day of "Practical". Instead of being assigned to an Inhalation Therapist, I am left with the supervisor who seems a bit miffed about me showing up late. "Speedy" is what everyone called the supervisor.

So I am hanging out with Speedy as he takes calls, and takes care of paperwork. This is looking to be a pretty boring day. All the other students are out with therapists seeing some action. I did not realize that the fact that I had shown up late and was now languishing in an office watching some guy named Speedy take phone calls would actually lead me to one of the most intense days I had ever experienced.

It was late in the afternoon when Speedy got a call, and after hanging up the phone, he said, "Hey Mike, your in luck! Your going to surgery with me." Surgery? Why are we going to surgery. Speedy explained that he will be doing oximetry readings during an angiogram. He explained it all to me on the way, and requested that I just keep behind him and stay quite. So we scrub up, gown up, and I even get to wear one of the doctor masks.

The patient is awake and obviously a little anxious on the operating table. There is equipment everywhere. Most of it I did not know what it was at the time, and I was pretty overwhelmed.

This particular patient was an elderly gentleman, and had been involved in an auto accident a few days earlier. He had been recovering well but was having some irregular heart rhythms. They hoped to determine with the Angiogram if there is any damage to the heart from the accident. A catheter is inserted through the femoral artery and is advanced up the aorta to the heart, and a blood sample is drawn. Speedy processes the blood in a Radiometer Oximeter that detects the oxygen level in the arterial blood. All is going well, and Speedy processes another blood sample about every 10 minutes. Dyes are being injected through the catheter into the heart and we see live motion pictures of the heart beating and watch the blood that has the dye flow though the heart. I looked on with amazement!

It came on suddenly. Alarms were going off! The patients blood pressure was dropping. He was in tachycardia, Speedy went to the bedside with an Ambu bag to be ready to apply artificial ventilation if necessary. The patient was conscious and was very frightened and was saying "don't let me die, don't let me die!" Speedy was reassuring him that they were not going to let him die. The patients condition deteriorated rapidly.

The patient stopped breathing and his heart stopped beating. The surgeon made the decision to rapidly open the patients chest to do manual compression of the heart. Speedy was forcing 100 percent oxygen into the patients lungs with the Ambu bag while the surgeon rapidly opened up the chest with a large incision on the left chest between two ribs. The ribs were spread open to reveal the left lung. I could actually see the lung being inflated by Speedy's efforts. The surgeon reached in to do manual compressions of the heart with his gloved hand and what happened next was a surprise to everyone. A huge blast of blood exited out of the chest hitting the surgeon and the wall.

"That's it.... were done here" the surgeon stated. Speedy was told to stop the ventilation. I was in a state of shock! I was thinking to myself that I may have just seen for the very first time... a person die.

The autopsy later revealed that the patient had a cardiac tamponade. This is a condition where blood collects between the heart muscle and the thin membrane sack that surrounds the heart. Probably a result of the auto accident, and indeed would be the cause of the irregular heart rhythms. His condition became worse during the angiogram. The burst of blood was the heart wall blowing out when the surgeon attempted manual compression of the heart.

As we left surgery, Speedy asked me if I was okay? Yeah... I think so. He said most days are not like that. My first day introduction to being a Inhalation Therapist was quite an eye opener. It was no longer about me making 40 cents more an hour than if I worked at the car wash. This was dealing with real people and real life and death situations.

I spent close to three decades working as a Respiratory Therapist. There are good memories, and a lot of hard memories. That is another story.... Or maybe a whole book.

As I am no longer working as a Respiratory Therapist, I extend my appreciation to those who continue to do the noble work as health care workers as Nurses, Radiology Technicians, Laboratory Technicians, Respiratory Therapists, Physical Therapists, and all the other ancillary health care workers. Overall these good folks are underpaid, overworked and under appreciated.