Happy New Year!

Sydney 2009 Fireworks...

Mortuary of the Week Revisted: Sad Point Made

Image by Getty Images via DaylifeI worked throughout the Christmas holiday. Two people, in our inpatient units, died during my work "week". In both cases, I was unable to contact any family members for either patient and no preferred mortuary was on record. That was a pretty crazy coincidence since I'd just posted an article last week about this very subject!

After many contact attempts, I finally had to leave a message on voicemail for the daughter of one of the deceased and then call the Mortuary of the Week (MOW). As for the other patient... well, her husband had left his phone off the hook all night. So he'll get a call from the MOW ,in the morning, telling him that his wife has died and they have her body at their funeral home. How crappy is that?!

I managed to avoid getting ranty in my previous post about MOW's, but I'm afraid that now, I must succumb. Because frankly, I have yet to hear anyone tell me the truth about why a funeral home has not been chosen for their terminally or chronically ill family member:

• Please don't tell me that you were surprised by your loved one's death when I know that the patient has been chronically ill for years and a hospice patient for months.
  
• Please don't blame our social worker for not getting to you "tout suite" with our list of local funeral homes. The exact same information is in the Yellow Pages.
• Most of all, please don't blame your dead loved one for not choosing a funeral home. You've watched your 84 year old mother decline mentally and physically for years. As her 58 year old "child" you should have had the maturity and foresight to just think about a funeral home.

Oh my, I think I must have had all the holiday spirit sucked right out of me last week! Well, I'll neatly fold my "ranty panties" and put them back in the drawer for now. Hopefully, I won't be wearing them again for a very long time.

Turner Classic Movies 2008 Tribute

Merry Christmas to All!

We wish you all the very best for this holiday season...


NeverEnoughLights.com

Fun-filled Funereal Facts

Mortuary of the Week


The "mortuary of the week" (MOW) is a concept that has been adopted by many communities across the country. Each funeral home, within the community, will rotate on a weekly basis tending to Coroner's cases and to those who have died without family to consult or a funeral home decided upon.

It is also something well known to an "after hours" hospice nurse. All too frequently, a patient will die in a facility or inpatient unit with no preferred funeral home on their record. To make matters even more complicated, many family contacts do not answer their phones during the wee hours. It is then that I am forced to announce their loved one's death to an answering machine and call the mortuary of the week. It's something that never fails to leave me without a large knot in my stomach.

For now (and to keep this from becoming "ranty"), I'll chalk most of it up to ignorance of how the post-death system works. Some people think that all hospices and skilled nursing facilities have an in-house morgue to keep bodies stored until a funeral home is chosen... not so! Others are under the impression that all dead are taken to the Coroner's until family is notified. Sorry, the Coroner has no interest in a hospice patient. Lastly, my hospice will not look kindly upon my leaving a corpse, "in situ", for hours until family can be contacted and a funeral home decided upon. It is understood that I will facilitate the removal of the body as quickly as possible.

It would be a blessing if everyone, healthy or otherwise, would simply tell their friends or family which mortuary they would prefer to handle their arrangements. No "pre-arrangements" or even speaking to a funeral director need be done. Just know who to call... The mortuary will be most excellent at handling the rest of the business.

Articles of Interest

Jessica Knapp, author of The Good Death, continues her quest to promote dialogue about death. Please see her post, Assisted Suicide in Britain, that covers the recently televised documentary of the assisted suicide of American-born, Craig Ewert. It makes me wonder if any of America's "Big 4" networks would dare to televise this documentary.

Oh, good grief! Jessica has already addressed my question! I can't keep up with this woman!
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The Spanish city of Santa Coloma de Gramenet has put the "dead to work" by erecting solar panels in their cemetery. Bueno! Now they can recharge the batteries of all those buried with their cell phones!
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Gail Rae Hudson of The Mom & Me Journals dot Net moves forward in exploring her life without Mom and the nature of her grief:

"There is a part of me that also wishes I lived in a culture that not only allowed me to drop to the ground and wail but would expect and encourage me to crawl into the arms of all-encompassing grief and tug at my clothes, scratch at my skin, pull at my hair, ululate at a piercing pitch...I find myself calling up images of this kind of grief expression at frequent intervals. Worldwide Images of Grief. Does such a video exist? If it doesn't, it should."
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Dr. Amy Clarkson, at Pallimed: Arts & Humanities, has an excellent post about Prussian artist, Kathe Kollwitz. This truly brings back some memories for me. I devoted a lot of time studying this artist in my numerous, college art history classes. As a young college student, I found Kollwitz morbid, dreary and boring. As a mature woman and hospice nurse, she has become far more relevant and stirs many, all too familiar, feelings of grief.
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Finally, this is very bizarre and may not be to everyone's taste. So consider yourself forewarned. A Colorado surgeon found a "foot" within a newborn baby's brain. Click here for the full story and pictures.

"Bed Blogging" From Dethmama Manor

It's horribly cold and wet... rain and snow... snow and rain.

Due to the endless, damp, hallways and cavernous rooms of DM Manor, I've shut myself up within the confines of my humble boudoir. From here, I am comforted by a rollicking fire in the fireplace and the warm glow of the Apple symbol from the back of my MacBook. I've not been out of my peignoir since... Well, I don't really know. I've been quite involved with the Internet wasteland and playing my favorite RPG, Okami on the Wii.

I'm taking a little time off from work right now. A "staycation" if you will. You'll likely not notice any difference in the Chronicles, because I'm quite preoccupied with writing at this time. Especially with regard to adding to my "True Adventures". These are the most difficult to write and cause no end of pain, suffering and bleeding from my eyes.

Nevertheless, I am thinking of you all and dearly hope that you and your loved ones are keeping warm and cozy. For now, I shall snuggle with my dear Munchkin and pour another Pinot Noir.

Munchkin

Getting Perspective

Grand Rounds Vol.5 No. 13

This week's Grand Rounds are being held at Laurie Edwards', A Chronic Dose: A Chronic Illness Blog. Please stop by and peruse medblog submissions from around the world. Believe me, there's something there for everyone!

"That Girl": 12/08/2008

"That Girl", beloved mother and companion of my dear blogfriend, Gail Rae Hudson, died Monday, December 8th.

While it is indisputable that "Mom" was a woman of extraordinary character, one cannot ignore the attributes of her daughter. Gail's deep love, conviction and unfailing attention to her mother's care allowed "Mom" to pass on to her next great adventure within the walls of her beloved home. They were truly blessed to have each other.

Although Gail is surely going through an emotionally, tumultuous time, she continues to post on her amazing blog, The Mom & Me Journals dot Net. Gail's fiery spirit and legacy-in-the-making must go on... Thanks, Gail, I'd miss you terribly if you didn't.

Your Moment of Awwwww...

Gotta give some equal time to the rodents...

Dancing squirrels!


and "Kill Bill" Prairie Dog!

Bettie Page: 1923 - 2008

Bettie Page, the ultimate pin-up girl, died Thursday, December 11, 2008 at the age of 85. The most successful pin-up model of the 1950's, she was considered by many to be "the model of the century". Please click here for a very nice Memorial website.

A Talk With a Doc

1900 hrs. -- I'm at the hospital on a consult for a prospective hospice patient. At the nurse's station, I sit near Mrs. L's primary physician as I study her chart.

"So, what do you do over at hospice?" asks Dr. S.

"Well, my primary duty is to take care of after hours emergencies", I reply."

"HAH!", laughs the doc. "What emergencies could hospice patients possibly have?"

I keep silent. A little anger is rising up within me. There is no way to respond to his thoughtless remark without betraying my feelings. I get up and go into Mrs L.'s room.

Earlier in the day, Dr. S. had ordered a Dilaudid drip for the patient. Running at a rate of 1 mg. per hour, it clearly is inadequate for Mrs L's pain. She's in agony. Her poor husband, sitting by her side, is suffering nearly as much as she. I immediately return to the nurse's station.

"Dr. S., could you please write titration orders on the IV Dilaudid so we can get her comfortable? The hospice won't be able to get her into an inpatient unit until tomorrow and her pain isn't under control yet."

The doc's eyes widen considerably. I instinctively know that he's hesitant -- no, he's afraid to increase the rate of the drip. "Noooo... I can't do that", he finally answers and gets up from the desk and walks briskly away.

Watching him leave, I raise my voice, "Why did you order Dilaudid if you weren't going to use it for her pain?"

He disappears into the elevator. Shit.

It's the Holidays which means... Open Enrollment

by Insurance Guru

Open enrollment, the bane of my December existence... While trying to budget for Christmas presents, cope with the extra workload at the office and praying I get to keep my job, I must sort through the various insurance plans being offered for the next year.

I use the term insurance with a bit of sarcasm here. You would think being employed by one of the nation's largest Insurance Companies, I would have the Cadillac Escalade of plans to pick from at a cost that would make mere mortals weep. NOT. The last 5 years have seen a steady decline in plan options and increase in cost for we cube farmers.

The plans offered to me are so hideous that I don't even use my employer's insurance. I've got the Guru's family enrolled on the Future Ex-husband's retiree plan. How absurd is that?

If I worked at Wal-Mart, I would get an employee discount, if I worked at a gym, I would get free membership, if I worked at AIG, I would get spa days. I guess I should just suck it up and count the twin blessings of employment and medical insurance.

During this joyous season of Open Enrollment, I encourage you to look at all the plan offerings and how each would cover you and your family in the year ahead. Consider if that dodgy knee or new baby is a concern. New glasses? Braces?

Most of all, if you are lucky enough to have an employer sponsored insurance plan, take advantage of it! A little insurance is better than none. Take a look at this little video that Dethmama dug up.

Ghost Tour

It's been a long time since our last Ghost Tour...

Since then, there has been a scandal surrounding the Ghost Hunters, originating from their live, televised Halloween special this year. Click here for a "behind the scenes" look at the show and the infamous "jacket tugging" incident... Yeah, it doesn't look good. Pretty heartbreaking for fans like me (sigh).
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Cullan Hudson's blog, Strange State, has a sweet little video featuring a "Museum Ghost". Check out his blog, too. Cullan is an excellent writer and story teller, with an intelligent, skeptical approach to the paranormal.
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A while back, I first saw this video on Cullan's blog. It's pretty intriguing.


After many infuriating attempts, I was finally able to stop the video at a point where I'm willing to bet my lunch money that I caught the image of someone to the far right that's pushing the "Ghost Train". Yeah, we got "punk'd". Here's my screen shot of the suspicious frame from the video.





Of course, what I'm looking at may just be an example of pareidolia. Which is my lame attempt to segue into my next paranormal item of interest...

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Forgetomori, a blog by Kentaro Mori, is in my opinion one of the best sites around for all things strange and wonderful. His recent post, Best Pareidolia Ever, is an absolutely amazing example of the phenomenon. One look at this and you'll think twice before bidding on that "Jesus on a Doggie Door" on eBay. (Thanks, Buck!)
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Finally, we need to see what our "drunken brother" ghost is up to...




Click on the lable "Ghost Tour" to get caught up on all the good ghostie stuff!

Patience is a Virtue? ...Not.

by Insurance Guru

Dethmama mentioned one day that some of her patients had complained of having to wait up to several months to see an oncologist. It could just be an urban legend, but regardless, they felt that they had had to wait too long to see a specialist.

If you feel that you can't see a specialist within an acceptable time frame and your PCP isn't helping, call your Insurance Company. If all the paperwork required to see a specialist is approved, you are not restricted to the specialist that your PCP chose. Your Insurance Company can provide a list of specialists for you to pick from. You may not get the closest specialist to your home, but hey - if I need an oncologist - I want one NOW!

PCPs often refer their patients only to the specialists near their offices. I won't speculate on the reasons, but your PCP should be working for your health, not toward maintaining a relationship with the specialists in their area.

So, dig out the number for your Insurance Company, and get on the phone... Now!

Joie de Vivre et Madame M.

1940 hrs. -- It was an ordinary house in an ordinary neighborhood until I walked inside. The home is filled with lush, expensive furnishings. My eyes are dazzled by the glittering, crystal chandeliers, rich rugs and fabrics. Nearly every square inch of available wall space is taken up by gilt-framed oils and drawings. Books, trinkets, memorabilia and personal photos inhabit nearly every flat surface in the home. Mrs. M. once had a lot of dusting to do!

I follow the deceased's daughter, Iris, to the hospital bed in the dining room. Mrs. M's body is lying in dignified repose. A turban hides her thinning hair and her face is in full makeup.

"Oh my, she looks beautiful!", I exclaim.

"Well, I know Mom would never want to leave the house unless she was completely made up", says the daughter.

Although tearful, Iris is eager to tell me a bit about her mother's story. A singer, dancer and artist, Mrs. M. was well loved by all who knew her. Many of the treasures in her home had been collected from her frequent ventures abroad. In a photo, from her "prime", Iris' mother bears an uncanny resemblance to Brigitte Bardot and likewise, the '60's was certainly her decade.

Looking at the daughter, I can clearly tell that she loved and admired her mother. Nevertheless, a parent like this would be an almost impossible act to follow. I make a point of not inquiring about Iris' own work, interests or accomplishments.

The doorbell rings... Not wanting to see her mother's body taken away, Iris retreats to her own home, just next door. I greet the funeral home's removal team at the door. From the foyer, one of the men is able to see straight into the dining room where Mrs. M. lies.

Leaning close to me he whispers, "Is she a gypsy?"

It's true, even from nearly thirty feet away, the rouged cheeks, painted lips, false eyelashes and turban are striking.

"No", I reply. "What you see is je ne sais quoi."

Fin.

The Mom & Me Journals dot Net

I'd like to say that I discovered Gail Rae Hudson's blog, The Mom & Me Journals dot Net, during my tireless websurfing, but I'd be lying. It was Gail that discovered Dethmama Chronicles some time after her mother began receiving hospice services at home. I was introduced to Gail's amazing blog after reading a very touching email that she'd sent to me.

It's an expansive work in progress... Ranging from medication and blood glucose logs, to daily journal entries, to audio interviews with her mother and written family histories. This site is not designed for the casual peruser and rightfully so. This is an intimate labor of love. A kind of legacy-in-the-making, that makes one feel honored to be allowed to view.

Thanks, Gail... I'm so glad that you found me.

Happy Thanksgiving From Dethmama and Insurance Guru

We'll see you Monday!

Engage With Grace: The One Slide Project

A message from the Engage With Grace team:
We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones "know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences.

But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking. Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started.

The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help us get talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about the end of life experience for yourself, and for your loved ones. Then commit to helping others do the same.

Get this conversation started. Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was
written by Alexandra Drane and the Engage With Grace team)

Finding Bigfoot 1.5

by Insurance Guru

I've been trying to get an authorization/referral/Papal blessing to see an orthopedic doctor for over two months now... see Finding a Good PCP is Like Finding Bigfoot.

I finally spoke (4th time's the charm) with someone at my PCP's office that actually SENT a fax to the Insurance Company. Within 24 hours, my Insurance Company sent me an e-mail letting me know of the approval. I printed out the referral/auth/blessing and faxed it to the orthopedic office. After two days, I called to get the elusive ortho appointment...

Office: "Do you have a referral?"

Me: "Yes, I printed it from my Insurance Company's website and faxed it myself two days ago.

Office: "Well, I only see this fax and it's not from the Insurance Company so we can't accept this. We need something with the office codes on it and saying that it's approved."

Me: "Oh, you mean like right there on the paper where it says "approved" and the approved codes for the office visits?"

Office: " Well yeah, but we need the number of visits and it has to come from the Insurance Company."

Me: "So where it says I have 4 visits and the Insurance Company name and my name and the effective dates of the auth and your office name, address and phone numbers... this won't work?"

Office: "No - we need it to come from the Insurance Company. Have a nice day."

Me: lighting my hair on fire and cursing small animals.

Well, my Insurance Company happily faxed them the auth and exactly three months after this began, I have an appointment. Don't even ask how many people I had to talk to or how long I was on hold. I'll start cursing small animals again. My hair is now too short to light.

For all of this effort, they better wave a magic wand over my knee and send me on my way!

The Lemonade From Lemons Award

I certainly had a lovely "pick me up" on Friday. Kit Courteney, author of the blog Kit Courteney Writes, has bestowed the coveted "Lemonade Award" upon Dethmama Chronicles.

Kit, an aspiring novelist from the U.K., is married and has two dogs and a cat to further enliven her household. Her delightful blog often serves as a retreat for my death-obsessed mind. Please give her site a "look-see". She also has some really great blogger buddies!

Thanks, Kit. This award will be proudly displayed on the fireplace mantel of my blog, where I may always gaze upon it.

Coping and Catharsis

Not too long ago, I was having an email exchange with a woman that wanted information about hospice for a short story she was writing. Her last question was, "How do you deal with a constant level of exposure to something so difficult?" It was a good question and the timing wasn't too shabby, either... Shortly after our exchange, I read Dr. Drew Rosielle's post, Old Milwaukee and Art Therapy, in Pallimed's Arts & Humanities section.

In his beautifully written and sensitive post, Dr. Rosielle shares his experience of strolling through Old Montreal and encountering a photo exhibition called Cancer Connections/Cancer:vu et vecu. It was here that he had his liberating and surprising emotional purge... far away from home and safely anonymous within a crowd.

There is an immeasurable difference between coping and catharsis. The cathartic moment is truly a golden moment. By permitting ourselves to succumb to catharsis, our sorrows, losses and fears are released and our "coping slate" is wiped clean. After such an event, we are ready to begin "coping anew".

As for me... about two or three times a year, when I'm fresh out of coping, I sit alone at night and weep and howl like a crazy person. I envy Drew's catharsis... because I'm way overdue.

Your Moment of Awwwww...

The Talking Cats




The Talking Cats Translated

Grand Rounds 5.9

The weekly medblog carnival, Grand Rounds, is at Dr. Deb this week. Please take a moment and check out the wonderful submissions from around the world. Her iPod theme is just great!

The Biller "Du Jour"

by Insurance Guru

Biller "du jour" -- I've been using this term for nearly 20 years to describe a phenomena that faces all claims examiners. You know how you ask for the "soup du jour"? Well, medical billers tend to stay just as long on the menu. They've got a tough job with low pay... so chances are that the biller you're dealing with is new on the job and under-trained. Since Insurance Companies and Providers interact in a kind of "delicate dance", a lightly trained rear behind the biller's desk could be courting catastrophe.

Here's an example: Biller Du Jour sends us a bill for an established patient visit for a yearly physical. Fine -- the diagnosis and office codes all check out, but then they tell us that these services happened at a surgery center. We have to deny that and send it back. A claim is a legal document -- we can't just have a chuckle and fix it. Well, we do chuckle.

The claim that still cracks me up is a physician inpatient visit. No problemo -- everything checks out except for the hemocult that was billed. Inpatient? Really, a hemocult is a card with some circles on it. You take it home and put some of your poo on the circles and mail it to the lab. My brain had a really good time trying to figure out what the doctor could possibly do in a hospital to get paid for that. (Insert Mission Impossible theme here) -- Dr. No stealthily visits patient X in the hospital, gloves up, checks for spies and quickly gets a poo sample. Dr. No slides the hemocult card out of his pocket, expertly applies poo to the circles, zips up the sample and it's back into his pocket and off he goes for a shaken, not stirred martini. Not. Gonna. Happen.

We all run into a Mr. or Ms. Du Jour -- probably on a daily basis ... The customer service rep on the phone, the "expert" computer person at Best Buy or the "top-notch" office staff at your PCP's office. Unfortunately ,in the insurance industry, it just creates denied claims and very unhappy patients. Your Insurance Company can't do anything about it short of telling the biller how to bill. Which is... Not. Gonna. Happen.

My apologies to past, current and future medical billers.... it's a tough way to earn a living.

A Physician Phreaks Out!

A Cautionary Tale

I was perusing Sallysue's Soapbox a few days ago and came across this tidbit...

Dr. Karen Kim, a pediatrician, from Pooler, GA was neither happy with the election results nor the performance of her employees. Unfortunately, she impulsively sent the following memo to the staff at her clinic:




Dr Kim soon sent another letter, in a gentler tone, that addressed some of her feelings of frustration. The letter reproduces very poorly so click here to see it. For the full story, please visit the WSAV, Savannah, GA website. Dr. Kim has since resigned from Pooler Pediatrics and is devoting more time to her children.

A lesson to be learned here by all of us... Never send out a letter or memo written in the throes of frustration or disgust. That goes right up there with "never blog drunk"!

Addendum to "Getting Perspective"

At the end of the video on my previous post, there is a comparison made that if the earth were the size of a grain of sand, then the Milky Way galaxy would be the size of New Jersey. Naturally, I wanted to see how many atoms each human being would represent if living upon the grain of sand. This mental exercise was stopped dead cold...

There are about 70 million, million, million atoms in a grain of sand!! Or "only" about 23 million, million, million molecules. Immediately after that revelation, I saw flashes of light and noted an odd, burning odor. Yep, I hurt my brain.

Getting Perspective

I don't care how much you think you've wrapped your head around this... You're mistaken.

1,000 Cranes

0535 hrs. -- As I approach the door to the home of Mr. and Mrs. O., I see that the sun will be rising soon and it's going to be a beauty. It seems that now, I rarely get to see the sunrise... which I think is far superior to a sunset. Lately, only the death of one of my patients gives me this opportunity.

A little over twelve hours ago, Mrs. O. had just returned home from an overnight stay at a psych hospital. Her suffering, from her terminal illness, had compelled her to make a sincere, but clumsy, suicide attempt. Newly "signed" onto hospice care, we were all hopeful that some relief could be found for her...but now she is dead.

After making my pronouncement, I perform a brief examination of the body. No new marks, no remnants of pills in her mouth or in the bed. No orange-colored, oral secretions from liquid morphine. She is, in fact, for lack of a better word, "pristine" and her facial expression is well... beautiful and serene.

Mr. O. prepares a simple breakfast for himself while we wait for the funeral home to arrive. Sitting at the table I notice, hanging from the ceiling, an amazing origami display. Seemingly countless, shimmering, paper cranes, suspended from colorful strings, that reach from ceiling to floor.

"What is this?", I ask. "It's absolutely stunning!"

"Oh, that's one thousand cranes," says Mr. O., looking up from his bowl of cereal. "Well, actually, it's two thousand cranes," he adds. " I made them."

Mr. O. quietly explains the two occasions that inspired him to make the origami cranes and then falls silent. For several minutes we share a comfortable silence. He with his breakfast and me with my tea.

"You know, she went so peacefully," says Mr. O., and I look into his kind eyes and nod my head.

Suddenly, sunlight spills through the window and sets the origami cranes ablaze in flashes of light and color. I can't take my eyes away from it. It's indescribably beautiful. For now, I will only look at this. Maybe later, I will think.

Congratulations, Barack Obama!

Image by zyrcster via Flickr

Yma Sumac: 9/13/22 - 11/01/08

I had no idea who this woman was... other than her name frequently crops up in my crossword puzzles. She was actually a very popular singer in the 1950's and reportedly had a vocal range that exceeded four octaves! The footage below is a tribute to Ms. Sumac. Take a moment to hear her amazing, almost unearthly voice.

A Brief Reflection on Death and Consciousness

I've had a little more time to reflect on the article from Scientific American, "Never Say Die:Why We Can't Imagine Death",by Jesse Bering. Here, I will attempt to state my case, as briefly and clearly as possible, as to why I disagree with Mr. Bering...

Mr. Bering seems to make no distinction between mind and consciousness. The terms "mind" and "consciousness" are often interchanged, but countless generations of those dedicated to the practice of meditation will likely have no difficulty in knowing the difference. Consciousness is essentially "awareness" which is not the same as the busy, thinking and deducing mind. We may (or may not) need a brain to support our "mind", but I'm not at all convinced that it is required to support consciousness. At least one of the nearly 300 commenters noted this narrow view by stating:"in an 11 dimensional universe, its (sic) foolish and egotistical to think that life and consciousness only occur in 3".

It's true... the loss of one's sense of "self" contributes greatly to the fear of death. However, it is this very state that is sought after by so many meditators. Anyone who has experienced this state of pure, thought-free awareness has, indeed, lost any sense of self. I can assure you that not one of these people will tell you that the experience was anything but a kind of bliss that eludes description.

I will end by encouraging you to view the video below. It's a short talk by Jill Bolte Taylor, a brain researcher, who suffered a stroke in 1996. Due to the injury to the left side of her brain, she was essentially thrown, involuntarily, into what I would describe as a form of meditative practice. She is the author of My Stroke of Insight: A Brain Scientist's Personal Journey.

(Yes, I do have a very, personal viewpoint... I was a serious student of Zen Buddhism for many years, am also a former meditation instructor and have, so far, survived two strokes.)

Finding a Good PCP is Like Finding Bigfoot

by Insurance Guru

If you have health insurance, I bet you have a PCP (Primary Care Physician). A good doctor is hard to find. If you have one, bless you, but I am very jealous. The problem is - it isn't enough to have a doctor you that will listen to you, but the office staff has to have a brain, too.

Think about it... your wonderful doctor has given you a thorough physical, but for a complete picture, you need some labs and maybe a chest x-ray. Insurance Companies usually don't let PCPs provide those services in their offices even if they have the equipment. They get a much better discount with a big radiology office or lab company. So off you go with your lab and radiology slips... What? The staff sent you to the place that doesn't accept your insurance? What? The paper work isn't filled out correctly? You want to take a sample from where? What?

I'm currently in a battle to get an authorization to see an orthopedic doc. I've been waging this war for two months-- and I "speak insurance"! I've talked to my PCP's office (when I can get them to pick up the phone) and the ortho's office (when I can get them to pick up a phone) and my insurance company (weird, they do pick up the phone). I just need my PCP's office to tell my insurance company that I have a bad knee and could someone pretty please look at it before my leg falls off.

It worries me that I cannot get this simple problem resolved with all my insurance experience. What happens to the folks that just give up because they can't navigate the system? "Press 1 for a black hole; press 2 if it makes you feel better."

You should be able to have confidence knowing that your doctor's office can handle all of your health care needs. They should speak insurance... how else are they getting paid?

I like my doctor, but hate the office staff and as I get older and need more services that can't be done by my PCP, this issue will become critical. So -- put as much research into finding a good doctor as you do buying a car. Check the internet, ask your friends, kick the tires and take a test drive. You don't like what you see? Open up that provider directory and see if you can find your perfectmatchPCP.dot.com.... and beware the office staff.

Articles of Interest

The Good Death points us toward a great article from "Scientific American" that discusses consciousness after death.
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Voodoo Medicine Man gives us pointers on "How to Know You're in the Wrong ER".
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Sallysue, a new nurse-blogger at Sallysue's Soapbox, is singing the "Night Shift Blues"
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Leo Levy at DNR/DNI gives us all his trademark, reality check with his post, "Tie Me Up, Tie Me Down".
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Last and definitely NOT least... It's been waaaay too long since I last visited Pallimed's Arts & Humanities section. Very stupid on my part (I'm subscribing to the site as I write this). Here are just a couple tidbits to entice you to visit: "Postmortem Photography - A Lost Art?" and a great post featuring artist "Laurie Lipton".

The article about postmortem photography completely jogged my memory about an adventure that I need to write about. Yay!

"Cascadian Green Is People!"...

I was going to take us on another Ghost Tour for Halloween, but this was too irresistible...

The authors of the lovely food blog, "Bread and Honey", recently noticed something quite odd about the packaging for Cascadian Farms Broccoli. Here's a link that will take you to two posts about their discoveries. It's somehow, both disturbing and endearing.

Early Voting: Sweet, Sweet Release

I voted last week and I cannot begin to describe the feeling of having the burden of this election removed from my shoulders. I am no longer required to watch the ads, follow the polls or read the latest "dirt" on our candidates. My vote is cast... my mind can't be changed. It's over. I'm free!

This is me AFTER voting...



This is me BEFORE voting...

Fun-filled Funereal Facts

"Suzy From Dubuque" Syndrome*

"Suzy From Dubuque" Syndrome (SFDS) is an affliction that often attacks family members of the elderly and/or dying. It specifically attacks those family members that have NOT been in recent contact with the patient. SFDS does not make itself manifest until its victim sees the patient after an absence of least 6 months to many years. Here are some common signs/symptoms:

• Uncontrollable fits of criticism aimed toward the "hands on" caregiver's ability to properly meet the needs of the patient.
• Irresistible desire to undermine the wishes of the caregiver and patient by insisting on hospitalization, lab work, invasive testing, IV fluids, tube feeding, etc.
• Feeling of superiority in medical knowledge and caregiving techniques directly proportionate to the amount of time spent away from the patient.

Of course, SFDS has a profound impact on the caregiver who is most likely letting the visiting, long-absent "Suzy" stay in their spare bedroom. Some common effects of SFDS on the caregiver:

• Marked decrease in confidence about one's ability to care for their loved one.
• Marked increase in guilt related to their new-found "inadequacies".
  
• Loss of ability to advocate for their loved one as they increasingly cave in to the demands of the SFDS afflicted family member.

This syndrome is extremely difficult to treat. Medical professionals can play an important part in helping to shore up the caregiver's confidence and aiming reality checks toward the "Suzy". However, if SFDS is to abate at all, it is usually due to one of the following:

• The "Suzy" has no more time off from work and must return home.
  
• The caregiver has finally developed the "huevos" to tell the "Suzy" to "eff off" and sends them packing.
  
• The patient has died. (Probably the most common cure for SFDS)

(The old, two by four up the side of the head of the "Suzy" has potential, but has never been tried by myself or any caregiver that I know of.)

*My sincere apologies to any literal Suzy from Dubuque that may be reading this

Almost Better Than a Death Match

I am beyond sick of this nasty, political campaign... From now on, I'm only gonna pay attention to stuff like this!

Your Moment Of Awwwww...

Ninja Cat (As scary as Tripod, but with more legs)

Pallimed: Hosting Grand Rounds

Pallimed is hosting Grand Rounds this week. Absolutely fantastic reading to be had by all! Don't forget to check the comments section for a listing of more, excellent submissions.

I also want to thank Pallimed, from the bottom of my heart, for including Dethmama Chronicles in this issue of Grand Rounds. What an honor!

A Day in the Life of a Claims Examiner-- Part One

Insurance Guru

I've had this rant bouncing about my brain for many years. I processed health insurance claims for several years and trained examiners for a couple more.

There seems to be a perception out there that examiners are routinely told to deny, delay or otherwise hinder paying claims so that the Company can hang onto its bucks for some nefarious world domination scheme.

I've worked for four, very large insurance companies and this has NEVER been a policy. Who wants to work a claim more than once? A claims shop is all about inventory and days on hand. A claim that's been in the shop over 10 days will have someone stopping by your desk and tapping a toe until it's processed.

We are also people. The claims that create the most difficulties to process are, of course, the ones for the most catastrophic cases. The last thing we want to do is add stress to patients and families by not doing everything in our power to get that claim paid. We had an informal rule that if a claim came in for a patient now deceased, it got paid. Now. We would run it up the food chain until it got released by whomever had the security to get it past whatever edits we were facing.

The average claims shop is not run by Scrooge McDuck nor is it full of claims processing Gremlins with popcorn bags on their ears. They are just like me and want nothing more than to process your claim timely, accurately and only once.

Bad Kitty and the Hospice Nurse

2250 hrs. -- After being, seemingly, on his death bed for several days, Stanley L. has "rallied". Not only is he now up and about, but he's also being abusive, paranoid and is refusing to take his meds.

I sit at the cluttered, kitchen table with the patient and his wife. Marie looks disheveled and exhausted. Stanley is painfully gaunt, grizzled and exuding obstinance. Frankly, I'm a bit surprised that this frail, dying man has made the trip from his bedroom to the kitchen. Note to self: never underestimate the power of the near-death "rally".

"Please, take your pills, Stan", I beg. "I know that you'd feel so much better."

"Forget it. I just want you to call the police and get that crazy woman out of my house! She has no business bein' here!"

All of my pleas and logic are for naught. Our conversation is going in circles. Stan vehemently refuses to take his medications and then returns to his delusional train of thought. I look at Marie... she rolls her eyes and gives a little shake of her head.

Suddenly, a cat jumps onto the table and positions itself directly in front of me. Its face is within inches of mine.

"Don't touch him!", shouts Stanley. "He's mean!"

I can take a hint. The cat is matted and filthy. Its left, front leg is missing, his left ear is nearly bitten off and the left eye is also gone. Good grief... no wonder the cat is so ill-tempered, it's missing at least one of everything.

"Hello, Tripod," I say.

"How the hell did ya know that's his name?", laughs Stanley. I feign surprise about my "lucky" guess and manage to get him to chat a bit about his beloved cat. Maybe now, I can take advantage of Mr. L's improved mood...

Taking the small cluster of pills in my hand, I explain the purpose of each one to Mr. L., hoping that he'll realize that no harm is intended.

"Okay, I'll take them.", he says, reaching for the pills. I hand them over and Mr. L. promptly flings them to the floor. Tripod immediately makes a three-legged leap from the table and heads for the medications.

"Gahhh!", I screech as both Marie and I dive to the floor to retrieve the pills. I mutter and curse myself for my stupidity as I crawl on all fours under the kitchen table.

Once again I am face to face with Tripod as I fumble amid the piles of fur and petrified cat turds. The cat has found one of the small tablets and is batting it around. With some hesitation, I reach for the pill and Tripod smacks me across the face with his paw. I jerk back and hit my head sharply on the underside of the table.

"Oww! Crap! Ohhh... that hurts." I'm seeing stars and need a few seconds to clear my head. The fog lifts and I see that both Tripod and the pill are gone. Still on the floor, I peer over the edge of the table and look at Mr L.:

"Mr. L., I'm pretty sure Tripod took off with your Ativan. It'd be awful if something bad happens to him!"

"Yeah, I'd feel real bad. I'm really sorry about all this."

Marie and I do a pill count. We're missing just the one Ativan and the cat is nowhere in sight. For now, all we can do is hope that Tripod has no interest in eating it.

Done in by all the excitement, Stan is happy to let us tuck him back into bed. Marie, satisfied with this turn of events, bids me "goodnight". So I head for home... covered in fur, smelling a bit "cat pissy" and sporting a new bump on my head.

Two days later, Mr. L. passed on and Tripod is still among the living. I'd like to say that, thanks to Ativan, he's now sweet, cuddly and anxiety-free...but I'd be lying.

The Mean Kitty Song

Pallimed: Bringing Initiative 1000 To The Front

Image via WikipediaI couldn't be more pleased to see Dr. Rosielle and Dr. Sinclair of Pallimed expanding on Washington state's upcoming vote on their "Death With Dignity Act". The publicity on this issue has, indeed, been very poor. Please take the time to peruse their posts on this very important initiative. Below is a partial excerpt from one of their articles:

 (See standard disclaimer at the end RE: Hastened Death)

"I wanted to highlight some of the editorials and articles regarding the upcoming Washington State I-1000 Death With Dignity Act. (You can get some basic info from my previous post, if you are not familiar with the proposed legislation)

The issue of hastened death and specifically physician-assisted suicide is important for the palliative care community as it highlights many of the concerns we (legally) deal with on a daily basis: autonomy, adequate symptom control, the personal nature of suffering, conflicting values among patient, family and staff, conflict of faiths, the loss of control in the dying process, the possibility for personal growth during times of crisis. These concerns are in a complex dynamic in palliative care and so the many heated arguments about hastened death highlight the turmoil involved in caring for dying patients. This allows the general public some insight into what hospice and palliative care teams would call Wednesday afternoon.

Dan Savage wrote an editorial last week titled, "In Defense of Dignity
I Hate to Play the I-Just-Watched-My-Mother-Die Card—But, Um, I Just Watched My Mother Die." Please go read it then come back here. Pallimed linked to his eulogy for his mother last April. (An excellent read with great insight into family loss.)

His piece focuses mostly on control over the dying process and the issue of choice. I think the selection of the word 'choice' is important and I am surprised more has not been made of this initiative from the national press or even medical blogs. This would seem to be a very polarizing and political issue which would have have the press salivating, no?"Drew Rosielle MD, Member, Oct 2008

You should read the whole article.