Saturday, November 18, 2017

A Random Act of Kindness

I was born in Maine.

In about 1991 I needed a copy of my birth certificate to renew my passport, and I needed it fast.

I called the Sagadahoc County courthouse, and after 3 calls and dozens of rings, someone finally answered.

I started explaining my situation to the courteous man that answered the phone, and he interrupted me with:

"Ma'am, I'm sorry, but the State of Maine is closed."

I didn't understand what that meant, so I asked him, "What do you mean, 'the State of Maine is closed'?"

"Well, we ran out of money, so the State is closed.”

“YOU’RE there.”

“ I'm the janitor. I was just up here sweeping and answered the phone because it rang so long."

Hmmm... "Well when is the State going to reopen? I need a copy of my birth certificate."

"We don't know. Could be a week, could be a month, or could be a year. But I know the lady who is in charge of the birth certificates. I can call her at home and have her call you."

Wow... What kind of state is this that I was born in?...But more importantly, what are the odds that 1) the janitor would be in the area when I called, 2) he would answer the phone and 3) he would just happen to know the very person I had to talk to, and knew her well enough to call her at home???

Within an hour the Maine Birth Certificate lady called me. I explained what I needed, and told her I would pay lots of money for my birth certificate, because I needed a passport fast.

She said, "No problem. I'll go up to my office this afternoon, make you a certified copy of your birth certificate and overnight it to you. You should have it by tomorrow."

"Great! You just don't know what this means to me. I will overnight a check to you. How much?"

"Oh it's free. I have no way to deposit a check because Maine is closed. I will just do this for you."

"Well I can send you a personal check for your time and effort and the cost of the postage."

"No thanks. I wasn't doing anything today except drinking tea and watching TV. It's a good excuse to get out of the house."

The next day my certified birth certificate arrived in the mail. I never knew anything but this lady's first name, but whenever I think about "random acts of kindness" I always think about her and pray a little prayer for her. 

And I did get my passport.

Sunday, October 22, 2017

Pharmacogenetics

                Recently I attended a fascinating lecture on pharmacogenetics. WAIT! Please read the rest of this paragraph before you dismiss this subject as boring! Have you ever been prescribed a medication that you took for a month or more, before your doctor finally admitted it wasn’t working for you? Do you wonder why a pain pill works great for your wife, but doesn’t touch YOUR pain? Have you known someone who had a severe adverse reaction to a medication? Well, pharmacogenetics solves all those questions/problems.

                If we are looking at only the last question, the one about adverse drug reactions (ADRs), research tells us that ADRs cause almost 200,000 deaths annually, and account for over 10% of hospital admissions. So ADRs alone should make us take notice of pharmacogenetics! The official definition of pharmacogenetics is “the study of inherited geneticodifferences in drug metabolic pathways which can affect individual responses to drugs, both in terms of therapeutic effect as well as adverse effects.”  (That reminds me of a Liberty Mutual commercial: “Page 5 says blah blah, blahblahblah, blah.”) In plain language, it means that our genes influence our response to medicinal drugs, as well as our potential adverse reaction to them.

                Pharmacogenetics is being used extensively at St. Jude Hospital, a hospital that specializes in treating children with cancer. Testing leukemia patients for the gene that produces the enzyme responsible for metabolizing the drugs used to treat leukemia has produced amazing treatment changes, and saved many a child’s life in the process.  There is optimism that St. Jude will soon have a clinical program that allows genetic information to be routinely used across all their patients, not just the ones with leukemia.

                Gene tests are normally performed only when a drug needs to be prescribed, but at St. Jude, every child with leukemia is tested preemptively, because the results impact not just which drug is used, but the dosage as well. Out in the rest of the world, the challenge is to educate clinicians in the available testing, results, and how to use them. Currently, there have been around 20 genes identified that can provide useful predictions of reactions to about 100 drugs (about 7% of all drugs approved by the FDA).   For proponents of testing, it is frustrating that the tests are usually not done until after a patient has had a problem with a medication, at which point it may be too late to serve any useful purpose.

Among the medications that we know, for a fact, would be influenced by testing are HIV and Hepatitis C medications, antidepressants, anticoagulants, and a few specific drugs like Plavix, Isoniazid, cocaine, procainamide, and Vitamin E. Looking at antidepressant drugs alone, many times the patient for whom they are prescribed must take a medication for 2 to 4 weeks to determine its effects. If there is no effect, another drug must be tried for another 2-4 weeks. Theoretically, a depressed person could spend a year taking one drug after another before the “right” one is found, and furthermore, find the right dose.  In fact though, the testing can be done across all categories of drugs, whether it be for high blood pressure, gastrointestinal, urological, psychotropic or anti-anxiety drugs.  Results can show which drugs the individual’s system is capable of breaking down normally, versus the drugs the body cannot break down normally. The test needs to be done only ONCE in a lifetime, because the genes don’t change.  Imagine how useful that information would be in a situation such as being a patient in the emergency room!

                Unfortunately, like most things in healthcare today, it comes down to MONEY.  Although testing would lower the costs that come about due to ADRs and trial-and-error-medicine, and would also lower the number of deaths that occur due to ADRs and ineffective prescriptions, the test still costs $1000-$2500, beyond the bank account of most of us, and certainly beyond what most insurance carriers will pay.

                HIPAA (Health Insurance Portability and Accountability Act) is also a factor. HIPAA controls everyone’s accessibility to healthcare information, which means there has to be secure storage of your information, so it would not be readily available when needed.


                Sometimes we become so up to our necks in alligators, it’s impossible to drain the swamp. 

Wednesday, October 4, 2017

Living Will

If you were not glued to your television back in 2005, when Terri Schiavo’s feeding tube was removed, you should Google her and read the whole fascinating story.

Briefly: Terri Schiavo was 26 years old in 1990, when she had a heart attack at home and temporarily died. She was resuscitated, but had suffered oxygen deprivation to her brain for so long that, although her eyes were open, and she could slightly move her arms, her EEG recorded almost no brain activity.

For 15 years, she “lived” in what Florida called a “Persistent Vegetative State” (P.V.S.), with a feeding tube keeping her bodily functions going, and her parents visiting and caring for her, while her husband, Michael, fought in the courts to have her feeding tube removed. At the same time, Michael was increasing his bank account through courts awarding him caregiver money, etc. There was lots of activity by both the Right-to-Die and the Pro-Life movements, with lots of inflammatory language on both sides: “Brain-dead woman”, “Slow, agonizing death by dehydration and starvation”, etc.

When Terri Schiavo was first determined to be in P.V.S., the doctors asked Michael, “What would she want done?” Michael’s answer: “How the hell would I know? We never talked about that. We were only 26.”

Ten years later, Michael suddenly remembered several conversations in which his wife had said, “I wouldn’t want to live like that,” or “Let me go,” when discussing that kind of what-if situation. Michael’s brother and sister-in-law had a convenient burst of memory and also recalled such conversations with Terri.

Those are the basics. But again, I encourage you to read it for yourself.

If you have a heart attack, or a stroke, or an accident that leaves you in a P.V.S., with essentially no brain function, what would YOU want done? Your Advance Directive, sometimes called a “Living Will”, completed and signed, tells everyone EXACTLY what your wishes are. It can be changed anytime you wish. It does NOT require a lawyer.

A “Living Will” is valid ONLY while you are LIVING (hence the term LIVING WILL). It has nothing whatsoever to do with your Final Will and Testament. Your Final Will says what you want done with your property and money AFTER you’re gone. Your LIVING Will says what you want done with you while you’re still alive.

When I was a real nurse, working in the hospital, I was, too many times, witness to arguments among family members about what “mama would want”. It took about two of those arguments for me to realize that if I were lying in a hospital bed in P.V.S., that exact argument would erupt between my 2 sons. The issue would involve their opposite personalities. The gentle, compassionate son probably would want to maintain my body on life support for 50 years, and the other loving, yet pragmatic son, arguing for turning off the machines and filing for my life insurance.

My Advance Directive says “turn OFF the machine, but if I continue to breathe without it, give me plenty of drugs to keep me comfortable, ‘even if it shortens my life’”. (The wonderful thing is that you can choose to be maintained on life support indefinitely if that’s what you want.)

The second thing your Advance Directive does is to appoint a Durable Power of Attorney for Healthcare. This person has ONLY ONE JOB, and that is to assure your Advance Directive is followed. (Of course, I named my pragmatic son to be my Durable PoA for Healthcare.)

Once your Advance Directive is done, make copies. Give your doctor a copy, give copies to your family, and keep one with your other important papers. Do NOT put the only copy in a safe deposit box where it isn’t readily available to all parties involved.

The free fill-in-the-blank forms, along with simple, yet comprehensive instructions, are available at the Alabama Hospital Association website http://www.alaha.org/hospital-topics/advance-directives/


Read Terri Schiavo’s story.  You will be motivated to print out those forms.

Tuesday, September 5, 2017

Homeplace

Last week I was talking with an old friend, who bemoaned, “Mom is selling our old house and moving into a retirement community. That makes me sad, and a little angry.”

“Do you mean you’re sad because your mom will be further away?”

“No. Not that. It’s like she is stomping on all my childhood memories. I was raised in that house. It has always been my HOMEPLACE.

Robert Frost defined “home” as “the place where, when you go there, they have to take you in”. There is profound truth in that. But homeplace takes it to an area of nostalgia, warmth, and memories. Your homeplace is where your family gathered every evening over dinner and discussed and solved the troubles of your world. It’s where Dad told you how to handle that school bully, and where Mom reminded you to take your cap off at the table. It is where you prayed, “God is great. God is good…” and “Now I lay me down to sleep…”

Your homeplace is where your dad met that scared boy that knocked on the door to take you to a movie, and did a thorough assessment before he let you go out with him. And it’s where you wrote in your diary and cried yourself to sleep when he didn’t call you.  That is the place where you dressed for graduation, and where you spent hours practicing lipstick application in the mirror. It’s the location of magical Christmas mornings, and of Easter baskets and dying eggs with Mom.  Baking cakes and cookies, and licking the beaters.

Your homeplace is the storage place for all your childhood memories. It’s where you played with your first puppy. For my friend “That back yard is where all our pets are buried. Oh Ginger, do you remember when my brother’s hamster died, and we had that elaborate funeral for him? The little rock headstone he made is still there.”

Oh yes. I do remember. We had our own pet cemetery in our side yard. Her house was just across the street from ours, and that is where I learned to dance, and where I got my first awkward kiss.  The street in between is where we rode our bikes, skated, and drew hopscotch patterns with chalk rocks.

But, as Thomas Wolfe observed, “You can never go home again,” because your homeplace is about the people you shared your life with. My friend could buy the house from her mother, but without family and old friends, it’s just a house, albeit a house full of memories.

I believe your homeplace is where, when you go there, you find that part of you never left.

Sunday, July 30, 2017

Specificity

Several things have happened in the last couple of months that led me to think about this.  A good friend was sent home from the hospital on Hospice care, which means he had little time left to live.  That was the precipitating event that started me thinking about this topic of specificity.

Have you ever lost a loved one, and well-meaning people say, “Let me know if you need anything,” or “I’m here if you need me,” or something of that ilk? Maybe you’ve even said something like that  to someone. You probably really meant it, too. When people who are grieving hear that, they are too overwhelmed with emotion at the time to respond with anything more than, “Thank you.” And they really mean that too. But what do they need? They usually don’t know. And even if they DO know, they might not know exactly what you mean by “ANYTHING”. 

When I was a new widow, I was in the position of hearing “Let me know if you need anything,” many times just before and during Keith’s funeral. I’m sure those people really, really meant it, too. But what did I need? I didn’t know. In retrospect, I needed someone to come clean my house, which had been neglected for months during Keith’s illness. I needed someone to bring me some firewood for the fireplace, since I had used most of what I had. For that matter, I needed someone to clean the ashes out of the fireplace. I had food in the freezer, but didn’t have the energy to thaw it and cook it. It would have been nice if someone had come over and done a couple of loads of laundry. I needed someone to go get milk and bread and coffee – all of which was gone/depleted.  But I couldn’t think of any of that at the time.

It didn’t occur to me until after Keith’s death that I literally(and I mean LITERALLY, not figuratively for you grammar nerds) hadn’t had a break in over 2 months, and was physically and emotionally exhausted. During the last month, I needed someone to say, “I’ll come over and sit with him for several hours and let you sleep, or shop, or sit outside and read, or visit a friend.” I just didn’t know who or how to ask for that kind of help. Everyone was just, “Let me know if you need anything.” I didn’t think of that at the time. And probably wouldn’t have asked if I HAD thought of it. But if anyone had offered, I gladly would have jumped right on it!

Pardon me for spending so much space on ME and MY thoughts, but I’m the only one whose thoughts I can really know for sure, and it is directly related to the topic.

So anyway, I wanted to let my dying friend know that I cared about him, and that there were specific things I could do for him during his last days.  So I wrote him a note, telling him that I knew he was sad and disappointed that the treatment he hoped for hadn’t happened. I told him that I was available any time of the day or night,  and that I could read to him, talk to him, listen to him, pray with him, or just sit with him in silence and hold his hand. I could prepare meals for him, watch TV with him, wash dishes or clean house for him. I could write notes to his pals and mail them for him. I reminded him that I’m a nurse too, and I could also use those skills to help with medications, back rubs, phoning doctors, and changing bed linens.  I’m just a phone call away.

So think about this: Instead of offering to do “anything” for someone, think about specific things to offer. Or if it is a close friend, just show up with food, an emery board and hand lotion, and a willingness to see for yourself if there are dishes in the sink or clothes in the hamper. 

Thursday, March 30, 2017

Prince Charming is NOT A REAL PERSON

It’s a mystery to me how people can still fall for the same old scams that have been around for decades now. Every time I get an email from a Nigerian prince, wanting me to shelter millions of dollars for him, in exchange for a percentage, I am amazed that I still get these offers! But I know I get them because this scam is still working on somebody somewhere.

The newer scams are more insidious. They apparently appeal either to the less educated, mostly lonely older people whose children don’t visit often enough, or to na├»ve young people with minimum wage jobs desperate for a way to pay for their children to play football or be a cheerleader. Not that anyone with a caring heart  can’t be swindled, but somehow almost everyone else recognizes the inherent “cost” to the victim of these hoaxes.

I’ve known several people in the last year who have been swindled by auto leasing. Making an exorbitant car rental payment every month, that is double or more what a car payment on a good used car would be, should be criminal. I have a neighbor who is pushing 78 years old, and should have retired years ago, but who says she can’t afford to live if she does, is making a $450/month lease payment on a 2016 Honda Accord that she drives a mile and a half to work every day.

“Ethel!” I say, “You could get a CAB or an UBER to work cheaper than THAT!” (Or really, on nice days, walk It’s not that far.)

“Well, I have to have a way to get to the grocery store on Saturdays too.” Is her reasoning.

A couple of weeks ago, I learned of a disabled veteran who is on V.A. Disability, which is not even enough to pay rent and utilities. She has no food, but that we could furnish. When talking with her about budgeting, etc., we discovered that she is leasing a car for – GET THIS - $500/month! We have access to several older used cars we could give her, but her car lease is ironclad. She can’t legally get out of it. She signed a contract. Kinda like trying to get an early out of an apartment lease.

That’s just two examples. There are several more that I know of. If I know of them, there must be hundreds if not thousands of car leasing victims out there I don’t know of.

Another racket is reverse mortgages. I wasn’t sure about that, so I called one company that offers these, so I could get more information and find out how that works. That was 6 months ago, and they are STILL calling and emailing me every couple of weeks to see if  I’ve decided to do a reverse mortgage yet. In my last conversation with them, I said, “I would be a total MORON to do a reverse mortgage! You people are con men, and what you’re running over there is a total sham! You should be ashamed of yourselves. I’ll bet many people actually fall for your hustle. UNBELIEVABLE!” and hung up on them. But they are relentless in their continued onslaught.

Here’s how it works: People who own a house, or who have equity built up, and who need money now, or who can’t afford their house payment any more (because of retirement, job loss, etc.) can give their house to the bank. Well, it’s more like loaning your mortgage to the bank. The bank gives you a little lump sum “down payment”  for your house, and you can also set up payments he bank makes to you every month. They call it a “reverse mortgage” because the bank is making small mortgage payments to you, instead of you making payments to them. Remember that when YOU make a mortgage payment, most of it is interest payment. When the bank pays you, there is no interest payment, so while you aren’t making a house payment, the bank is paying only a few hundred dollars a month to YOU.

But like all scams, there’s a “catch”. The bank owns your house. Kinda. They let you live there until you move out, move into a nursing home, or die. Then the jig’s up. Your family has one month to clean out the house and sell it to pay back the money the bank gave you. If they fail to sell the house in the month, the bank owns it free and clear. Your family is out whatever equity you had in the house, and is out any profit that might have been gleaned from the sale of it.

Maybe the most cunning and heartbreaking scam of all is a phenomenon that is happening on Social Media – in particular facebook. It seems to be an extension of some of the fraud we used to see on dating sites.This is how it works: You get a friend request from (in my case usually) a middle aged male veteran. (I hear the jerks who perpetrate this hustle first study your home page, to see what kind of person you are likely to be sympathetic to, or attracted to, or vulnerable to.) Men are not immune to this scam. A man might get a friend request from a slapout gorgeous woman. My female friend got a scam friend request from a very handsome man in his late 60s, retired business owner, and living in Paris. He messaged her that he was blown away by her beautiful profile picture, and would LOVE to get to know her. She is single, and almost fell for it.

These scammers play to whatever emotion they think will pull you in. They are EXPERTS at it. If you answer their messages, or befriend them, you have swallowed the bait, and they easily reel you in. One woman I know befriended a  man who messaged her, emailed her, loved her, and flattered her for over a month before saying that his mother was ill and was stranded in Mexico. She needed money to get back home. Would she send $3000 to his mother? He would so appreciate it, and he would pay her back as soon as his stock dividend check was deposited the end of the month. The woman was so moved by the man’s love for his mother, and so upset that the sweet old lady was stranded in Mexico, sick, and with nobody to help her, that she sent $5000! She told her newfound friend that he didn’t have to pay her back. She was just happy she could help.

Of course, that “friendship” was over as soon as the money left her bank. BAM!!

Understand, I’m not against making new friends. But let me warn you: If you get a friend request from someone with whom you have no mutual friends, be smart. DELETE it and mark it as spam. If you get a friend request from someone with whom you have only one or two friends in common, ask your already friend about him/her before you accept the friend request willy nilly. Ask yourself about motive. Why is this person, who doesn’t know you from Adam’s house cat, and who doesn’t know anyone else you know, except maybe that one person you don’t really know, but with whom you play Criminal Minds, or with whom you are in a common interest group, so is therefore your “friend”,  wanting to be your facebook friend? It can’t be honorable motives.

That’s enough for now. Use your common sense. Don’t be a MARK (victim).


Guard your heart and your money. 

Friday, February 10, 2017

Charlie

Sometimes something… a smell, or a picture, or a song… floods your soul with memories. 

A couple of years ago, an old friend from high school found me and reconnected. 

In my senior year of high school, I was chosen to be in the Alabama All-state Orchestra. What an honor! Because I was in the Birmingham Symphony Youth Orchestra, I was a candidate. I was THRILLED! I was first chair in my high school orchestra, and kinda full of myself.  In the Youth Orchestra I was second chair, but I knew I was better than that. Well, in the Allstate Orchestra, I was still second chair – to first chair Fleetwood McAllister.  Seriously. That was his name. His dad taught music at the University of Alabama, so I figured it was political.

The first viola was Charlie. His dad also taught at the University, and he was totally ADORABLE!

  It’s not a great picture, but good enough for you to get the idea.

Anyway, Charlie was my first mature crush. My first real “puppy love”.  Besides being an accomplished musician, he was handsome, smart, kind, funny, fun, and a gentleman. Opened doors, called my mother "Mrs. Galloway", and held my chair at restaurants. He held my hand, back when handholding was intimate. Although he lived in Tuscaloosa, before I20/59, he drove all the way to Birmingham to take me out to eat, to movies, and to Vulcan, back in the day before an elevator, where we climbed to the top, looked out over the Magic City, and where he kissed me – gently and timidly. Our first kiss. At the gift shop that day, he bought me a necklace, that I wore for many years.

I came from a firmly middle class family. My dad was a scientist and my mother a teacher. Charlie was way out of my league. But I was a teenager, and oblivious to those limitations.  I did the normal things any teenage girl did back in the day. I wrote in my diary. I wrote our initials in crossmarks inside hearts. I wrote my first name with his last name. I hugged my pillow at night, and I dreamed. That’s what girls did back then.

I graduated high school and went to college. He gradually stopped coming to Birmingham so often, and I filled my days with bridge games in the Student Union building and parties ... on yes, and some studying. We eventually lost touch.

Several years later, I happened to buy a piano from his brother, who had set up a used piano store in Birmingham. I asked about Charlie. He said, “He joined the Navy.” And that was that. End of that story.

Until 50 years later. Charlie found me. He had married. They had a couple of children, and now he is a proud grandpa. He sent pictures of his adorable grandbabies, and I was joyous with him. He crafted baby cribs, because now he no longer played the viola. He was an accomplished craftsman in woodworking. (His sister, by the way, married Fleetwood McAllister. Really.) And for 3 years we relived old times, and got re-acquainted and got to (virtually) know each other’s families. We talked on the phone. He was still the Charlie I had known all those years ago. He was gentle, kind, intelligent, talented, and loving. He bragged on his kids, and I bragged on mine. I would know his kids anywhere, just from his descriptions, and from the pictures he shared, as he would have known mine. Both of us had smart, beautiful, talented children, and we shared bragging and stories through emails and pictures. As if we were two old folks in a nursing home.

Then there was a snag… in his words:

“Just a note from a high school drop out about a life moment.

In 1964 a viola player at Alabama AlState Symphony met a cellist from Birmingham.  He was smitten.  She was a Sr in high school and he a Jr.  He really liked this young lady.   A whole lot.  Well she wouldn't want to date a high school kid next year.  As he was a terrible student and might well not graduate next year.  What's a guy to do.

 He found that if you got a GED that the U off A had to accept you like a HS grad.  So, he took the GED, applied, and got accepted.  No money, but had a job.

Well they drifted apart, both married and had two children.  They meet again on line fifty years later.  The cellist had lost her husband to brain cancer.  Now the violist has it.  His second surgery is scheduled for Thursday noon.  His faith is deep.  His spirit’s good.

Thanks to all for prayers and encouragement.”

Charlie passed away last year, and is buried at Arlington National Cemetery.

Rest in Peace, my old friend and SALUTE.  I hope we meet again someday in the hereafter. I want to kiss you one more time.  Gently and warmly.