diatribeshealth & medical

Dragging horses into Troy…

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Last night I dreamt of you, Abbie Hoffman peddling your books, I gave five bucks to you, the other kids just gave you dirty looks.

I said “I’m sorry it didn’t work out quite the way you planned.”

You said, “That’s silly boy, the revolution is at
hand.”

And if you got a ten spot brother, I got a dime,
These are desperate,
desperate times.

Last night I dreamt of you, Pepe Lopez strung out on a stage, It don’t even look like you, smiling like sawed-off twenty gauge.
I still remember the
Telecaster down around your knees,
It’s late November and I think I smell tequila on the
breeze.

And if you got the Cuervo honey, I got the lime,
These are desperate,
desperate times.
And if you got the shotgun honey, I got the crime,
These are
desperate, desperate times.–Rhett Miller

I’ve been too busy dealing with family issues to write or think or do anything really coherent of late. My wife retired from Federal Service after 35 years of helping to make the state function, if not optimally, at least better than if she were not there. The afternoon of her last day, she got the diagnosis of colon cancer…so, by mid-month she was in the hospital for surgery, and there she remains. Friday will be three weeks…the words rehab facility were spoken last night. I am not exactly happy about this — I have no complaints about the quality of her care for the most part, or the professionalism or kindness of the staff. I have concerns about the quantity of the staff…I think this is a problem nationwide, but probably more acute in Southern California because there are so goddamn many people…

Things haven’t gone well. They appear to be unable to actually get the bag to seal to her  skin, which results in constant  leaking and sometimes gushing of liquid shit all over her stomach and groin. She remains in the hospital; her surgeon was there last evening and found himself helping try to get the illeostomy bag to work. They had had five iterations earlier, all failing. Which results in linking shit all over everything. On Tuesday,  I had had a brain fart when I left the Crossroads of Opportunity to go to the hostpital after getting home at 1130 Monday night  and had to stop in Target and buy her clothes to come home with. Well, that didn’t work as planned…Had gotten her a stuffed animal for a comfort thing, and that got to come home tonight along with the socks she’d been wearing, all of it shit stained. Surgeon is confused since this is a “good stoma” since the hunk of intestine that’s leaking into the bag is what he can do with what’s available to him. For some reason, they can’t seem to get the base of the bag to seal correctly with her skin, and as a result it leaks out the sides. Now, the surgeon does not want her coming home until they get this to the point where she has some faith in it, and the topic of nursing homes came up. I noticed that they do not seem to have a standard procedure, and are experimenting. They have 1 (ONE) colostomy nurse on staff and one brand of stuff with not all the possibilities covered. Anyway, the surgeon had them get some surgical adhesive from the emergency room — if they can get that to work, and keep the base fully closed on the body, she’ll be able to come home. If not, the word nursing home was used tonight. She would prefer that to having her small intestine leak all over her home, but she’d prefer to have the bag work and be able to come home. To finish healing, so she can go back in and have the ostomy reversed and go back to a normal set of solid waste disposal equipment.
I thought that I’m pretty much ok with this. After all, I’m a tough guy, it’s not fun or easy, but I’m just lending moral support and helping her when I happen to be there. And, washing the stuffed big eyed Zebra she’s got for company. I’m starting to come to grips with the fact that it’s a lot harder on me than I thought. Just beat all the time. I go in there, help her get out of bed to use the commode and such stuff, and feel if not helpless at best incompetent.
Did I mention that getting her to eat is hard? Today she had a hard boiled egg, a piece of toast, and two bottles of Boost Clinical Strength. Well, since whatever she eats is leaking out of her side all over her within an hour or two, she’s probably not all that interested…So, at some point this will get resolved but I’m not feeling comfortable with how it’s going. She’s still in a lot of pain although a lot of it is from the irritation on her skin. They were using something as a binding agent that was largely alcohol. Great…the woman has inflamed skin caused by chemical burns and part of their solution is rubbing it with alcohol. Surgeon is getting incensed…wonder why? Shit.
Now this evening, I got to the hospital to meet a Nurse Liaison and a Nurse Social worker with a new plan. They are transferring her this evening to another hospital, one that is geared up to provide “long term acute care…” which seems like an oxymoron but actually makes sense. Acute care hospitals want you out in three to five days, and she’s been there for almost three weeks. The new hospital is geared up for these sorts of cases, has a great reputation and what the hell — it adds another 45 minutes or so to the drive, but I like driving fast and I-15 lends itself to that. Listen and reflect, while preparing to wash the zebra again. And again. And again…until they get it right.
So, thank Lyndon Johnson for Medicare. You know, most hospitals depend on Medicare and Medicaid to survive — one hospital staff I talked with recently admitted that they only collect ANYTHING from about half the patients they treat, and less than a third actually pay their bills. The reason hospitals are so expensive is because they somehow have to balance their books — yes, all the new toys cost more while enabling if not better care at least better diagnosis and faster treatment, and we’re not used to doing cost benefit analysis in health care. If we were, the obvious efficacy of  tax revenue funded universal payer system as opposed to what we have would be a slam dunk.
A retired general I served with is in the habit of sending thoughts for the week out periodically and he cleaves to the right wing line when he ventures into politics. Since I respect him as a military leader and a man, I chose to ignore those ventures, assume encroaching senility, or bite back gently depending. His most recent aphorism was “If you think health care is expensive, wait until it’s free…” Frankly, that would have pissed me off had I not been going through the frustration of this nonsense. In this case, it actually amused me because, well, consider the source. He’s a retired general officer and has Tricare for life; he is currently teaching at the CGSC and has access to whatever civil service stuff is available but he’s within commuting distance of Leavenworth. I don’t think this has been a great problem for him financially. Now, he may contend that we paid for our medical care with blood and sweat and separation and sacrifice and he’s right — but the fact is, the government paid systems , the VA and the Military, work very well. They are efficient and effective and have good to great quality of care. We have in effect got single-payer. It works.
Medicine could stand to have some statistical process control and analysis. For example, before leaving this afternoon, I got a call from a rep at one of three companies that manufacture and distribute colostomy supplies. There are drying agents, it turns out, that do not involve alcohol. If you have what are basically chemical burns over an area and they need to dry the skin to apply something, using an alcohol drying agent is a pretty bad idea. Unless you’re trying to wring out a confession….the gal apologized for the hospital, saying that “a lot of times the product works first time but a lot of times it’s a process of trial and error.” Sure, let’s look at new, non asbestos options for brake pads. Let’s start with cheese….nothing is a better stopper than curdled milk products!”
While talking with the nurses this afternoon, the one from the new hospital said that she’s seeing an explosion of cancer in the high desert in particular as well as in Southern California in particular. I suggested environmental causes — polluted water tables, microbial issues, increased UV, and so on. She added stress, unemployment, poverty which I concurred with — poverty also drives up the cost of health care while adding stress to those dependent on systems that are weakened by  the clowns running wild and free in the House of Representatives — and she said yeah, but we’re also catching it more frequently and earlier. Great, but that makes for more downstream problems…If you want lower health care costs, increase the number of abortions and do more to prevent teenage pregnancy. By do more, I do not mean more abstinence education, by the way…
I’ve always been a fan of Tiberius Caesar, pre-Capri retirement. I know that my friends IOZ and Captain Capitualtion probably prefer him at Capri, IOZ becuse of lifestyle appeal and Crispin because he just said screw government…but pre-Capri, he was kind of a Julian John Adams.  Grumpy old bastard following Augustus who just quietly went about making the state work. Would be welcome today — I think that is where dictators come from, the inability of representative systems to work adequately. Or at all, over time. http://www.veteranstoday.com/wp-includes/js/tinymce/themes/advanced/img/trans.gif
I don’t care about gay marriage.  I’m not that concerned about using predator drones, Gitmo as we sweep up the ashes of the Bush administration, and so on.  I want the state to work. Jobs,food, schools, infrastructure…I want to turn the ignition on my car and not have the fucking thing blow up because there’s no requirement to make a car that won’t blow up when the car is started. I want to eat a cheeseburger assured that it’s not made of horse or rancid meet. I want the ideal society of 1950s Eisenhower Republican America only with racial and gender equality. The curiously fucked up world that I was alienated by/against doesn’t look bad at all as a baseline.
Reading a book on my Kindle while visiting Mrs. AXE  called The Angry Buddhist. Involves California celebrity politics, dog murder, and various forms of madness. Poor protagonist is trying to use the Dharma to keep from ripping the head off a lot of people. It ultimately seems to have the theme that, well, make a list, motherfucker. And keep making it — you’ll never run out of vacuous, vicious and verminous assholes needing to have their heads ripped off.
One of my brothers sent out this note about Genesse Cream Ale going back to retro packaging. Upstate NY had some pretty good local beers. Utica Club, Genesse…Utica Club had talking Beer Steins in commercials when I was a kid — Shultz and Dooley. till remember the song for the singing beer mugs — “Brew me no brew with artificial bubbles, those carbonated beers of today/Cause Utica Club’ll still take the trouble to AGE BEER THE NATURAL WAY! Utica Club, UC!!”; Genny talked about the sparkling waters of Hemlock late. Far better than ‘Gansett or, for that matter, Coors or Strohs. Of course, there had been the Haverly-Congress line, that I still recall a joke of my dad’s after they closed down. He said that it happened because they sent a sample in to be tested in the State Lab regulating such stuff, and got an emergency call saying, “Shoot the horse, it’s got diabetes…“S

 

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