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.