Still waiting.


Our camping trip was amazing.  We met some people, including someone (who shall remain nameless) that I never in my wildest dreams would have imagined meeting at a little tiny camp out in Northern Arizona!  We also met several Arizona heathen families, some wonderful New Mexico heathens, along with a fellow mead maker/brewer, and lots of other people, all of whom were talented and giving of their time and skill.  It was, all in all, a lovely weekend.

We got an incredible amount of rain!  Mr. TF and I were married in Grand Caymen during Hurricane Michelle in 2001.  I don’t think I’ve experienced sustained rain with winds like what we had on Friday since we were in the hurricane!  People’s tents got filled with 2 feet of water!  A few tents collapsed!  We were luckier – we were camped out farther from the common ramada, but on not such a steep slope and thus avoided some of the problems others had (and that was purely by chance, I assure you).  We did get water in the tent, but it was because the wind was blowing the rain horizontally and it lifted the rain shield, allowing rain into the tent.  Not so bad, though.  Only one half was actually wet (with about an inch of standing water in places) but most of our stuff was still in the plastic totes and thus dry.  Most importantly, our bedding remained mostly dry (yay wool!) and we were cozy every night.

I took not a single picture.  In fact, our phones remained either in the truck’s glove box or charging with the solar charger on the hood.  We were pretty much technology free during our 3 days there.  I didn’t miss it much either.  I did notice I had missed a phone call from someone very important when I finally picked up my phone around 10pm on Friday night – luckily said person also sent an email and I spent an agonizing 15 minutes trying to sign into my email and waiting for his letter to load…but it was good news and well worth waiting for.  Mr. TF and I drank two drams of scotch each (LaPhroaig) to celebrate, and sat outside in the beautifully clear night, watching the meteor shower and the stars.  Other than sharing the good news with family and close friends the next day though, no phones for either of us.

I did NOT win the antler handled, hand forged skean dhu I had hoped to bid on….I was too busy running my mouth visiting and missed the auction for it entirely!  Ah well, not meant to be I guess.  There will be others.

All the crap that has gone on since January…if it all hadn’t gone down the way it did I never would have met any of these people, at a time and a place in my life when I really NEEDED to meet them.  I humbly apologize to the Universe.  Things do in fact happen for a reason.  And sometimes wyrd/karma takes really some really strange twists to get us where we are supposed to be and in contact with those we are supposed to know.

But now, home for nearly a week, I am like a caged panther.  I’m not particularly good at waiting.  But wait I must.  I guess the Powers are making sure I get some actual rest time in before I start my new job with its associated stress and all consuming lifestyle (if my fellow workers are any judge, that is).

images

Maybe some time to knit while I pet the cat….

ohkd

Or knit while I chat with friends….

 

A'Knittin' while you work

A’Knittin’ while you work

Or knit while I get this amazing craphole of a dirty house back into shape 🙂  Are you sensing a pattern here?  Of course, I also have wool tweed on the loom I need to weave off to make a vest with, and POUNDS of alpaca and wool to spin up – including a commission for lace weight suri yarn.

I’m behind on holiday gifts too…

Yep, waiting is hard, but I think I might be able to fill my time.

 

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Just hanging there…


ATU12That would be me, currently.  Just hanging there.  Waiting for a decision.

Time is running out, I have been in this limbo for six months now.  I need a decision soon.  Events have conspired to force a decision.  Hopefully it’s a positive one, or at least a neutral one.  Anyone who feels motivated, please light a candle/say a prayer/send energy to the Universe.  Closure is hopefully coming soon.

Community, Personal Responsibility, The World Isn’t Fair, Gods.


Atheist alert: this has a lot to do with spirituality and yes, religion. Deal. In my mind science and ‘woo’ co-exist in a dynamic relationship that causes occasional cognitive dissonance, but forces me to continually re-evaluate my worldview. In my view this is healthy and necessary.

Pagan alert: Not Politically Correct Commentary on our community. Deal. If it angers you, perhaps you need to take a good hard look in the mirror.

I’ve been through the wringer for the past six months. In that time I have been places that boggle the imagination. I’ve been a specimen under a microscope. I’ve been betrayed on a fundamental level by those closest to me, and by some of the very systems our society is predicated on as well. And. The truck was stolen, trashed, totaled, rebuilt. I lost a job. I spent money I didn’t have (thanks FIL for the help, more grateful than you’ll ever know) and am in debt to the tune of thousands of dollars with nothing to show for it. I have a degree for a career I can’t work in. And I’m becoming more and more convinced I don’t want to work in it anyway, the way things are moving (see going places one doesn’t want to go, or my previous post). I have discovered, the hard way, that standing up for right doesn’t always mean you will be protected, or that things will work out. Sometimes you will be punished in the worst ways imaginable, and evil WILL prevail in spite of an individual’s or a community’s best efforts.

I’ve maintained a minimal level of spiritual practice through this, even if it has been nothing more than a simple acknowledgement of Deity and thanks for getting through another day. It has been nothing approaching the level of an actual devotional practice though, and I’ve felt that lack ever more keenly as I approached the end of my degree program. Once I finished, and had nothing else to occupy my mind but the drama and tragedies of life, it became a yawning chasm that contributed to my ennui and depression.  I literally couldn’t summon the energy to pray, let alone believe it would work.  I felt as though I just wasn’t worth it, that the Gods had better things to do than deal with me.

I believe in synchronicity. I believe in the fractal nature of the universe – As Above, So Below. I do believe that there are other entities, other dimensions, other realities than our own see/taste/touch/hear/smell reality, and that sometimes we reach out to those other entities/realities – and other times they reach out to us. I believe that things often happen for a reason, and that reason sometimes isn’t readily apparent for a very long time, if ever.  This faith was seriously shaken as a result of the happenings since January.

My children are fundamentalist Christians. Two, at least, were Pagan/anarchists earlier in teenaged life. I believe that they became Christians not because of the actual religion, but because of the structure and community it offers. This is something that very little of modern NeoPaganism offers, and I have seen that over and over and over again in the nearly 20 years I’ve been a Pagan.

In nearly 20 years as a Pagan, I’ve met more people who are trying to get on disability than I ever thought possible. I’ve met people ON disability who constantly cried about how poor they were, and who were no more disabled than I am, who ran side businesses based on cash to augment their disability payments and who actually had nicer things than Mr. TF and I do. I’ve met people who can’t keep a job, who can’t keep a relationship, who can’t keep an apartment, who can’t keep a car, who are using/abusing illegal drugs – and I’m not talking about marijuana here people – or who are abusing prescription drugs. When I worked in the ER I saw more than one person – significantly more than one – I knew from the local Pagan community come into the ER for problems directly related to prescription or illegal drug abuse or as “seekers.” It made for uncomfortable questions from fellow staff members, at the very least.

Many people who are drawn to the Pagan path often tend, in my experience, to be less than reliable on a personal level and tend to make very bad choices. These bad choices are ones for which they tend to not take responsibility. They misuse magick, in my opinion, as a tool to overcome lack of personal responsibility for bad choices rather than as a tool for self-development. Or they use it as a substitute for an actual spiritual relationship with Deity. Magick does NOT substitute for spirituality. And one does NOT need to do magick to enter into a relationship with Deity. Magick is a tool, it can sometimes be a vehicle, but it’s not the object (unless you are a Ceremonial Magician which is another conversation entirely). It’s as though they are drawn to Paganism because they perceive it as the one religion/practice for which they have to take no responsibility, and they can espouse beliefs that NO ONE can tell them are wrong. Cuz personal gnosis, you know.

Because of my experience (and that of my husband as well, I am writing this as an individual but we have shared this conversation many times between ourselves) we have mostly withdrawn from participation in and organization of Pagan events, particularly events like Pagan Pride, public Pagan holidays, Pagan meetups….you get the idea. The embarrassment of being associated with the crazies just simply began to outweigh the benefits of the participation.

And yes, I know there are those in the Christian community as well. However, they tend to be reined in by those who are around them, and either drawn into the fold or shunned. They are self-selecting in their long term participation.

As a side effect of withdrawing from public gatherings, my own spiritual practice has suffered – it’s not just the business of life/school/work/stressors, it’s been that I no longer go to events where I can get my spiritual batteries somewhat recharged because I’m participating in a community of believers. The very thing my children currently have. The thing I envy, even though I do not think a patriarchal herding religion from a desert region from 2000 years ago has any relevance for them – or for me, for that matter. I do ‘get’ why they turned away from a religious practice that *did* and *does* have relevance for them (and me). Because community. It’s important.

I have suspected for quite some time that the Pagans who were serious about their practice, at least in our area, were very secretive, or at the least insular, mainly because of the above. They are responsible adults and take their religion and spirituality very seriously, and they don’t want to associate with people who don’t. So, while believing firmly they’re out there, it also makes it very hard to find or connect with them. Friends of course excepted, but because of school/work commitments it’s made it hard for us to connect with them as well. When we’re all on different schedules and none of them coincide for all of us….you get the idea.

So why am I going on and on about this? Because I am going to a Pagan event for the first time in nearly a decade next month. I’m terrified. And excited. I don’t know if Mr. TF will come or not. He’s much more laid back about his spirituality, and doesn’t feel the need to actually connect the way I do – at least to hear him tell it.  And the way I found out about this event is nothing less than synchronicity.  It’s a Rube Goldberg nest of interconnected coincidences that defy logical explanation.

It’s not just any event though. It’s a Heathen event. I’ve shied away from heathenry for my entire time as a Pagan due to bad press about skin heads and racists who identify as heathen. I didn’t, and don’t, want to be associated with those who think the color of one’s skin denotes one’s worthiness to worship the Old Gods. When I first became a Pagan (or more realistically, realized that my spiritual beliefs were Pagan and I just didn’t know it) I was strongly advised against my interest in Norse spirituality by a Pagan friend who had recently spent 10 years in prison. His experiences there didn’t encourage me to try to follow up.

But recently I’ve been forced to rethink my blanket painting of this community thanks to blogs and websites devoted to heathens, as well as books I’ve had (and read previously) in my library. A recent re-reading of them revealed nothing that actually allows for this view, regardless of the views of a certain vocal percentage of heathens. And as far as I’ve read (which isn’t a lot, but also not nothing), there’s nothing in the lore that allows for this view either. As I stated earlier, I believe in synchronicity. And I believe the Gods call who They call. Regardless of skin color.

What I do know, is that the values Heathens espouse:

Nine Noble Virtues

are the same values I live my life by, and I want to associate with people who share my spiritual outlook as well as my ethics.  ETA:  because it doesn’t embiggen:  Courage, Truth, Honor, Fidelity, Discipline, Hospitality, Self Reliance, Industriousness, Perserverance.

Illustration courtesy of   My Journey into Midgardr

I am hopeful that I can find a group of people with which to share community and spirituality. Gods know I’m ready after the half year I’ve had.

Population medicine


Obamacare treats not for the patient in particular, but for the patient on average, globally, or in the abstract

This isn’t a problem specific to the ACA; it’s endemic in national health systems all over the world, all of which are more or less in the thrall of pharmaceutical companies who control and produce most of the research that determines population medicine.

The problem with the pharmaceutical companies sponsoring research however is twofold:  1, they control who gets into the study and define the outliers; and 2, most of these studies are not appropriate for population generalizations because they are small in size or short in length.  Oh, and I guess this makes it threefold:  any results that are not favorable to their drug will never see the light of day.

Now controlling who gets into the study is related to the outliers in that, if in the pretrial part of the study, people who have adverse reactions right away will be eliminated from the study.  So people who might give a truer picture of the drug’s ill effects will have been eliminated right off the bat.  And outliers are defined as people who have reactions that are supposedly really rare and do not give a true picture of the overall study results.  For instance, take Celebrex.  It’s a nonsteroidal anti-inflammatory drug, in the same class as aspirin, ibuprofen, naproxen, etc.  Pfizer, the manufacturer, said its drug was better than those others because it didn’t hurt the stomach.  Well, as it turns out, that was not the case at all.  The reason they were able to claim that is because, if you read the link above, you will find that they only released the first six months of a year’s worth of data.  Most of the stomach problems developed in the second half of the study; because of this they were able to deceive regulators, medical providers, and the public at large into believing this drug was safer.  They altered the study’s parameters to hide crucial data related to side effects, and they explained “poor results as the result of ‘statistical glitches.'”  ***statistical glitches is researcher speak for outlier***

Perhaps the worst offender in this is Merck.  Their drug, Vioxx was taken off the market because of the substantially increased risk of a heart attack while taking it.  This was defined as an outlier in their results – which means they knew there was an increased risk before this drug ever went on the market.  Yet they chose to define a statistically increased risk as an outlier, dump all the data related to the people who had had a heart attack during the course of the study, and publish results that were very positive toward their drug.  Of course, they also paid for a study to be published that was favorable to their product without disclosing their financial relationship and were subsequently sued.  Multiple times, in multiple countries.

Regarding study length:  In the case of Celebrex, they released results related to only six months of what ended up being a six year long study.  How can one make a decision about a medication’s safety or efficacy when the study hasn’t even been completed?  Where are the critical thinking skills for those who are in charge of approving a drug?  Where are the critical thinking skills for those prescribing the drug?  The public doesn’t have the general ability to decide if a study is good or not, they rely on the government to determine a drug’s safety and effectiveness, and they rely on their providers to prescribe drugs that have benefits that outweigh the risks.  They are being seriously failed on both accounts.

Unfavorable results are related to both of the above drugs.  Data that showed there was substantial risk for certain groups of people in both cases was simply hidden.  In many cases, studies are never published at all – their data is simply buried and never sees the light of day.

So why is any of this relevant?  Well, guidelines are created based on the cumulative results of published studies.  And guidelines are what are forced on providers in order to make sure they are adhering to the standard of care.  Standards of care are based on population medicine, not on individual people.  They don’t allow for individual preferences, variability in response to a drug, differences in financial circumstances or lifestyles, religious prohibitions, or any other individual determinants of a person’s ability (or desire) to adhere to a given regimen.

If we can’t rely on the results of studies, we can’t rely on guidelines that are created from them.  And this is a big problem when reimbursement, and even licensing is predicated on adhering to guidelines.  In a local to me case, an Arizona cardiologist is under investigation because he advocates non-guideline based recommendations for his patients.  This is a huge problem.  If a physician can’t read research and make decisions for his practice, but is expected to blindly follow guidelines or face having his license revoked, how can one trust one’s medical provider that they are doing the right thing for you, the patient?

In an even more insidious fashion, the powers that be (government in collusion with the pharmaceutical and insurance companies) are requiring (here in the States anyway) that a provider have an NPI.  That’s a national provider number.  And it has to be printed on all prescriptions or the pharmacist will not be required to fill them.  So what?  Well, if you don’t follow the guidelines, and you don’t accept the insurances the government wants you to — because you prefer to offer your patients advice that you feel is healthier and safer for them as an individual — you can have your provider number yanked even if your license is not revoked.  Either way you can’t fully care for patients and are out of business.  I wish I had links for you for this one, but I don’t.  I don’t even remember where I read this, but trust me when I say this is indeed going on.

Population medicine.  Peak medicine.  Grasping for financial straws.  And you, and I, the little people suffer.

Have you ever realized after the fact that maybe you just shouldn’t be doing it anyway?


That’s how I feel about my career.  I have banged my head against a wall, struggled for so long, only to be denied at the last.  I’ve realized I just wasn’t supposed to be doing this to begin with.

I knew I wasn’t meant to do this when I was still in school.  It’s taken this long to really get it through my head that the entire field is exactly the same, from basic to advanced, and not meant for me.  Why I kept on I don’t know – Einstein said the definition of insanity was doing the same thing and expecting a different result.  I guess I thought getting my master’s degree would make it all different.  Not so.  Just more of the same.  And more.  And so, by Einstein’s definition I was insane.  I think I’ve finally come to and become sane.

When Mr. TF gets a job in his chosen field, I will resign my position.  I will not renew my license when it comes due.  After all this I have come to realize that some things are just not worth it.  This is one of them.

I’m listening now Universe.  What do the Gods have to say?

Obamacare just might be going away after all.


http://www.motherjones.com/politics/2014/11/supreme-court-just-took-case-could-gut-obamacare-heres-how-states-can-save-it

So there you have it folks – it’s from a liberal perspective, so they’re all about saving it, but facts are facts.

How do you feel, if you live in a ‘red’  state, about having/not having this?

I’m concerned from the perspective that people won’t just go back on what they had before, if they had Medicaid or in Arizona’s case, AHCCCS (pronounced access).  They won’t have anything at all.  And I can tell you, from dealing with Obamacare in residents who were on AHCCCS and are now on ACA, it’s a poorer insurance with fewer choices, higher costs, and less coverage.  This is fine for those who should really be having some skin in the game, but for the elderly who were on some form of state sponsored long term insurance under medicare/medicaid, it’s really pretty paltry, and denies them access to the medicines they need unless they want to spend far more than half their monthly income on insurance premiums and medications.

I agree in principle that ACA must go.  It’s an insurance company bailout, and a gift to the pharmaceutical and hospital industries, nothing more.  But we really need to be having discussions about what will take its place.  When I get my license, I can provide visits for a quite reasonable fee, or barter for things we both benefit from, but that doesn’t help when the person needs to be hospitalized, or if the medicine they really need costs $249 per month.  By the time they’re at a place where they need a medicine that expensive, there are not many herbs I can prescribe that will do nearly so good a job of controlling symptoms.

Once again, we really need to be having discussions about alternative ways of care delivery.  And about medication costs.  And about hospital costs.  And about the elderly’s idea that medicare should be free for them.  And about the younger people’s idea that Obamacare should be free for them.  We STILL don’t have insurance.  Why?  Because it was too expensive even with the subsidies.  For a $12,700 deductible, we’ll just take our chances.   The penalty is significantly cheaper than buying the insurance would have been.

The system is broken.  We need to look at alternatives.  When can we begin this conversation?  Without having to talk about concierge care type systems that only benefit the wealthy, or subscription systems that still don’t address medications or acute care, or the idea that some should just go without or die?

I hate living at the twilight of empire sometimes.  Hobson’s choice indeed.

Ebola.


I have been very busy with real life recently; my oldest son and his wife whom I haven’t seen in two years came to visit and to be present at my middle son’s wedding. But of course the topics in the news came up during our conversations.

My son lives in a town with a genuine Level 4 containment facility. But here’s the problem: even the staff that are assigned to that area state that they aren’t adequately trained to work in it! Why? Because it costs money, a lot of money, to have the supplies ready to use in doing the training necessary to keep people not just minimally competent but proficient at such a methodologically demanding task.

It’s something similar to Magnet status for hospitals — they all like to promote that they have magnet status, but most of them don’t live by the ethics and level of staffing a magnet status requires — they just up the staffing for the original certification and the recertifying. In between? Just like everywhere else, overworked and under staffed. I know, I used to work for a magnet hospital. And having a level 4 containment facility gets them extra government money just like magnet status does, but they don’t spend the extra money toward what it’s supposed to go toward: maintaining appropriate staff levels and training to back up those special status items.

Dear oldest son said he thinks hospitals are going to have to make a decision on whether they will care for Ebola patients or care for the community; he thinks any hospital that admits an Ebola patient is going to become ‘toxic’ to the rest of the community, especially if other patients get infected from exposure at the hospital, and they will either have to close to the public to care for Ebola patients or they will have to turn them away to Level 4 facilities if they want to take care of the rest of the revenue generating patients they would normally see.  I think he may be right.

I made a comment on another site I visit every so often on a post about Ebola. I said something to the effect that, if it did in fact become an epidemic in the US, that nursing staff were going to begin refusing to care for those patients. Or even refusing en masse to even come to work.  While I haven’t gotten any real negative feedback and plenty of “likes” for the comment, I did get a response that ended with the statement “ebolaf@#kyou I ain’t afraid.” Or something to that effect.  I am, quite frankly, much too lazy to go and actually look up the comment; it wasn’t phrased in an insulting way.

I took that to mean the author of the response thought I was afraid of Ebola, or that nurses were, and that fear is a bad thing. So I crafted this response:

I have been in medical services since 1994. First as an EMS person then as a nurse. I am used to putting my life on the line in service to others. I used to be the one who ran into the burning house you all ran out of. I’ve fallen through floors, been in flashovers, broken bones from collapsing gear, been puked on by contagious patients, been stuck by contaminated broken glass, had exposures to tuberculosis, meningitis and hepatitis among other things. It is part of the job. You just keep working, whiners need not apply. HOWEVER.

I was trained in how to deal with all of the above, and I was given the tools to do my job properly and safely. My supervisors took my safety seriously. I was trained to recognize the symptoms/signs of danger in the situations I faced and encouraged – required even – to take appropriate action to minimize the dangers to myself and my crew.

This is not the case when it comes to Ebola. Hospitals aren’t capable of handling this, just ask any nurse or doctor in a facility near you – off the record, of course. There is no training and no real plans for training. No facility is going to waste the money to purchase the gear and then waste a lot of it in training staff how to safely don and doff it, unlike the training offered to me in HazMat, fire fighting, and EMS training. It’s just not going to happen.

You want people to not be afraid? Then they need to be trained to recognize early symptoms, to be ready to err on the side of safety, and to be aggressive about taking defensive actions. Nurses in particular are held up as these Florence Nightingales with lanterns sacrificing their lives in service to unwashed humanity (even the male nurses among us).

Do you really think, when health care has become a multimillion dollar business, that image is going to be the reality? When what the WHO and the CDC say about transmissibility differs in not insignificant and potentially deadly ways? When Sanjay Gupta can’t doff protective gear without contaminating himself on live TV?

My husband also works in the health care field and had a conversation with a doctor about Ebola. The doctor said straight up that if it became an epidemic he wasn’t going to be bothering to come to work, he was going to be home caring for the safety and health of his family where he belonged. That’s the reality. It’s not pretty, it’s not what the public wants to hear, but reality is a harsh mistress.

I’m not afraid, at least not blindly so. I think one must take precautions, and protect oneself, and be able to assess risk. I have a lot more chance of getting a Norwalk type virus than I do of getting Ebola, thankfully, because one involves 3 days of wishing I were dead and one involves the likely possibility I will in fact die. It’s all in assessing risk.

This whole idea that nurses are, and should be, held to a “higher standard” than the likes of the rest of the great unwashed humanity…?  Bunk.  We’re people just like the rest of you.  Nurses are obese, smokers, diabetics, drug abusers, alcoholics, codependent, crazy, in possibly much greater numbers than the rest of the population as a whole.  As I said in my original comment, I have a license and a calling, not a death wish.

Enough said.

The perversion of pain.


oxycontin

In the late 80’s some brilliant (sarcasm in use here people) doctor, who I assume later took a position with one of the companies who manufacture hard core narcotic pain medications, or at least was paid a significant ‘renumeration’ by them, decided that “pain is whatever the patient SAYS it is” and if patients were in pain, then medical and nursing staff were not doing their jobs properly.  This, regardless of whether the patient got better, or even had a medical problem that necessitated pain medication.

Once upon a time, drugs like oxycontin were reserved for patients who were dying of cancer, or in some other profound end-of-life type of pain.  Never used for maintenance.

And now, 30 years later, we have a positive epidemic of patients who are in chronic pain – it even has official diagnosis codes:  338.2 – chronic pain (can’t get paid for diagnosing this one though), 338.4   – chronic pain Syndrome ( whoo baby you can get paid for this one!), 338.29 – other chronic pain (you can get paid for this one too).  Whenever medical ‘science’ (I use this term loosely because a lot of the science is based on getting paid by someone for something) defines a syndrome, what that actually means is a cluster of symptoms that usually go together.  They are NOT a disease.  They are just a bunch of symptoms that go together.

A good example of a syndrome that can be covered under “other chronic pain” or “chronic pain syndrome” is fibromyalgia.  This is a syndrome, not a disease. It probably has an ICD 9 code of its own, but I don’t plan to ever diagnose this so I don’t have any interest in learning it.  Fibromyalgia means literally pain in fibers – muscle fibers.  People who have fibromyalgia are usually (but not always) overweight, sedentary, eat a lot of simple carbohydrates, watch a lot of TV, are depressed, don’t get out much, and don’t sleep well though they usually spend a lot of day time napping and feel fatigued most of the time.  Because of their fatigue and depression, they often feel mentally cloudy.  They hurt all over, even when there is no obvious medical pathology. This is the cluster of symptoms.  The treatment consists of:  1.  Education on what the problem(s) are and why they are affecting the patient.  2.  NSAIDs – ibuprofen, naproxen, toradol.   3.  Exercise – the muscles hurt because the human body was designed to MOVE and if you don’t move, they not only waste away, they hurt while doing so.  4.  A combination drug that both helps with pain and depression such as Cymbalta or Lyrica.  5.  Cognitive Behavior Therapy – you have to come to grips with why you are doing this to yourself in order to make changes to how you avoid or do things.  CBT can be very helpful with this.  It has nothing to do with your childhood or that sort of therapy.  It’s purely to help you change your responses to situations in order to help you take control of your own life.  Note that I didn’t include narcotics AT ALL.  Yet I see people all the time whose only diagnosis is fibromyalgia and they are on MASSIVE quantities of oxycontin, oxycodone, or even morphine pills which they take multiple times a day.  Why?  It does absolutely nothing to help the patient, and isn’t even recommended as an effective treatment.  So why are so many patients prescribed narcotics for this?

The place where I am doing clinicals has a lot of patients who come there for nothing but narcotics, because the provider will prescribe for them.  Many if not most of them have been discharged from one or multiple pain management centers for non-compliance:  they also smoked pot, or they have alcohol in their system while taking narcotics, or they don’t have any narcotics in their system at all – every pain management patient gets urine drug screens every time they go in for an appointment to get their drugs.  Why you would be STUPID enough to smoke pot right before going to get your drugs I don’t know.  I guess you can’t cure stupid.  Why you would drink while taking sedatives I also don’t know.  Perhaps in addition to being stupid you have a death wish.  Can’t cure that either.  And those that sell their narcotics while pretending to have a chronic pain problem deserve to go to jail.  Have fun there.  And good luck with getting narcotics while in there even if you DO happen to need them for a legitimate reason like a tooth extraction.

A patient came in recently who originally complained of low back pain.  Yet when the tests were done in the office to assess his pain, they were negative.  The patient did not realize these tests were to assess low back pain, I should point out.  Otherwise they would have been ragingly positive.  And in fact were ragingly positive when repeated on him while telling him they were to assess his pain.  He was unable to get disability for his ‘chronic back pain’…wonder why??  This patient now complains of headaches.  He was told there was in fact something that showed up on the MRI he was sent for.  He states he doesn’t want to see a neurologist for this though, because he’s trying to get disability and if the neurologist can fix it he can’t get disability.  That seems to be the mentality of the average pain patient we see.  Malingerer.  If this guy spent as much time working as he did trying to get disability he would probably be solidly middle class, instead of ‘working’ poor.

Another patient came in with slurred speech and the inability to complete a sentence – she would flit from thought to thought without ever completing an entire thought through to the end point.  She said she didn’t want to go back to the pain management center she had been going to.  She was in the office to get Valium, a sedative.  She said she had gotten a month’s supply of oxycontin, oxycodone, and morphine from the pain management center and didn’t need any of those.  As it turns out, she had been discharged from not one, but SIX pain management places.  For having alcohol in her urine.  And for consistently running out of her pain medications well before the time for renewal.  Unbelievably, the doctor actually gave her a prescription for a  60 day supply of Valium.

Third patient:  came into the office complaining of low back pain, a ‘chronic’ problem.  Got a prescription for 30 days worth of Percocet with 2 refills.  Her room mate called the office later that day to say that he just wanted the office staff to know that she sold the entire bottle to a drug dealer named Don as soon as she got home.

These are entirely typical.  I am very frustrated and I refuse to bother doing any more assessments on these people because I don’t learn anything and I have no patience for these sorts of ‘patients.’

I hurt my back when I was still fighting fire.  At my original emergency room visit, I was asked if I wanted narcotics and I refused.  I did ask for a muscle relaxant that wouldn’t make me sleepy so I could function at work and at home.  The xray didn’t show anything (which it wouldn’t if it was a herniated disc).  And, while I have had some level of pain nearly every day since then yoga keeps it under control.  That injury though, and the pain it brought with it, was the impetus to change careers.  I was entirely too young to become an invalid, and it scared me to think of becoming one.  I have never pursued further testing because even if I did have a herniated disc I would not consider surgery.   I cannot imagine being unable to walk when I want, to run, to stretch, to garden.  I also have a torn rotator cuff, suffered while working as a firefighter.  That actually causes me more pain on a regular basis than my back, and eventually I WILL have to have surgery, but until then I continue to do strengthening exercises and keep it as mobile as possible.  I cannot IMAGINE living my life under the cloud of narcotics and being in the twilight of consciousness every day of my life.  What a horrible way to live.  I think the fact that I’ve suffered injuries that caused permanent pain in myself makes me even less sympathetic to those who come in wanting, not physical therapy, not surgery, but disability and a lifetime of narcotics.  As my parents used to tell me, if you’re not puking or dying you get up and go to work/school.   I would add to that list also if you don’t have explosive diarrhea.  Everybody hurts.  Deal with it and move on.

The largest group of users of narcotic prescriptions, if I remember correctly, are Medicaid patients.  Meaning they don’t pay, we the taxpayers do.  If even a small portion of the people who receive disability are anything like those I have seen in the ER when I was working there, or in clinicals, we could probably halve the national debt simply by kicking them off and making them work.  Maybe being a brick layer isn’t a good career choice for them, but surely they could answer phones, or sit at a cashier stand, or walk dogs or something.  Once again, it comes down to ‘sick care’ versus health care.  And lining the pockets of the pharmaceutical companies instead of investing in the real health of our population.  Of course, we have no economy to speak of anymore, so I guess disability takes the place of unemployment.  The irony is that those with real issues, with real medical problems, get overlooked because the system is overwhelmed with those who don’t pay for their access and so use a lot more of it.

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Pain tells us we are alive.  Pain tells us something is wrong which we need to address.  Using narcotics to mask pain, unless it’s for an end of life issue, prevents us from making changes to improve our lives.  Why would you want to do that?

The essential problems of Marxism


I was inspired to actually read some of Marx’ works, though not in the original language (I once spoke German but it’s been too many years).  With my reading material being internet sources, I’m not positive as to the exactness of the translation/interpretations – German is a notoriously hard language to translate as the feelings/ideas conveyed by one word, simply don’t have exact translations/interpretations that are less than a paragraph in length, and assume a certain social understanding that I don’t have.

That being said though, I think Marxism has some of the same essential flaws that Capitalism – in the sense that modern Libertarians and Republicans understand Marxism – suffers from.  They are in some ways more similar than they are different.  And I’m not talking about socialism!  Different beast that shares characteristics of both!

Now let me state clearly that I’m no student of Marxism but I probably know more than the average conservative in this country because I actually READ some of the original works in question.  I’m also no student of Communism or of Capitalism though again, I’ve actually READ scholarly works, and critiques of some of those works, as well as derivative works, unlike many of my fellow citizens on both sides of the political fence.  Because I read, I can’t help but form opinions that gel with neither fans nor enemies of said political/economic schools.

Both Marxism and Capitalism assume an endlessly expanding economy.  This is the essential feature of the Marxist theory of declining rate of profit – because the market expands, the value and price declines, forcing lower worker pay and higher work load in order to keep the owners’ profits at the same level.  This is true IN AN EXPANDING ECONOMY.  It cannot be true in a contracting one, or even in a steady state one.  There may be price deflation as people lower their prices to try to sell product, but deflation isn’t what Marx’ theory applies to, nor does he even address a deflationary economy as far as I can tell.

Both Marxism and Capitalism assume, along with an endlessly expanding economy, an endless amount of innovation.  This, of course, forces the market to constantly adapt as people make the same product at a lower cost with better features  and thus the above occurs – declining rate of profit.   This too, is only possible in an expansionary economy.  In a shrinking or steady state economy, there is little incentive for people to think about making things more efficient, except as directly affects their own living situation.  It isn’t something that businesses will have spare capital with which to invest, in order to increase their rate of profit.  In a contracting or steady state economy businesses do NOT invest.  That is plainly true if you look at the financial books for many Wall Street companies over the past several years.  Businesses hold onto their capital in case they need it.

Finally, both Marxism and Capitalism assume money is the sole form of exchange.  Given that Marxism is less than 200 years old, and capitalism is really only about 500 years old, this is patently not true for most of human history!  Money is only efficient as a method of trade if there are luxury goods to be had that must come a long distance:  silk, in ancient times, iphones today.  For the vast majority of regular business, there are other equally efficient forms of exchange.  Barter can fulfill quite a few needs if one is fairly self sufficient and possesses skills that are desirable.  It may not be preferred now, because our entire society is focused on money, but that has not always been true and it probably won’t be true in the future.

Now, to be fair to Marx, many of his criticisms of capitalism are spot on – and some of his solutions, such as worker owned business, simply make sense for the health and well-being of the community – but he lived in the largest age of expansion the world has ever seen, and he can be forgiven if it never occurred to him that it might someday end.

We need to realize that neither Marxism nor capitalism have the answers.  Capitalism has had a long run but it has proven to be the instinct of the lemmings, driving humanity over the brink of the biosphere cliff.  What then shall we design?  It must be sustainable over the long term, allow for both needs and wants (luxury items), fun and recreation, and not create wants that must be satisfied by any means necessary (as capitalism creates).   I have a few ideas, but they’re ideas that can’t work in the present milieu – capitalism needs to crash and burn first.

Women’s health is difficult!


speculum2That’s the class I’m currently in.  Normally an ‘A’ student, I’m floundering in this class.  Stop your snickering!  Just because I’m female doesn’t mean I understand everything about how the female body works!  I have a B, but it’s a borderline grade in my program; several programs I am familiar with require a B as a minimum passing grade.

The charting is part of what is killing me.  The SOAP format  (Subjective, Objective, Assessment, Plan) is so nebulous in many ways that what one instructor insists is the *one right true and only way* to chart will get you a failing grade from another.  Frustrating but I’m only the student so I don’t have a lot to say about it.

I am having a hard time getting my required number of pelvic exams as well; I am supposed to have 25 by the end of the program and most students get them during this class — I couldn’t get a women’s health preceptor so I am doing part of my clinicals with a family practitioner who sees a lot of young women with sexual health complaints — but it’s winter, and when it snows, they don’t show up for appointments.

I’m doing some extra clinicals with an OB/GYN also; one of my fellow students was kind enough to refer me to him and he was kind enough to accept me.  So I’m getting at least some of my pelvic exams completed.

They are difficult!  I have short fingers!  I just can’t seem to reach far enough to feel ovaries though I’m told by one of my preceptors you should be able to feel them.  Telling a forward flopped uterus from a rearward flopped one is a skill I just don’t seem to possess yet, and may never.  I just take my preceptor’s word for it.  I’m glad I wasn’t interested in pursuing women’s health as a specialty; I would have to choose another field if that was the case.

I definitely prefer the metal speculums (specula) to the plastic disposable ones.  Easier to insert, DEFINITELY easier to remove without pinching delicate tissues in the process, and more environmentally friendly.  And probably more cost effective as well, they last more than a lifetime with proper care.