Killer Copays

Most of us seem to enjoy complaining about our so-called health care so-called system, but not a lot of clear paths for improvement have been put forth. I have come to think that above all, we have a failure of imagination. We cannot envision another way of doing things, or at least a way out of the present situation, and so we continue to put up with a reality that is increasingly insupportable. We tinker around the edges, but nothing more. As Dr. Dean Ornish put it, “We spend so much time in medicine mopping up the floor around the sink that’s overflowing without ever turning off the faucet.”

Much of what I’m writing today will focus on a small aspect of the system, copays, and will not offer grand visions for the future, but I would like to drop this idea into your head so you can let it grow in the background: We created the present situation. We can create something else. What we have now is not ordained by God or nature. It hasn’t even existed for a very long time, only a few decades.

After you’ve read this post, please look up the 2012 film Escape Fire, which outlines just how completely screwed we are and what we can do about it. You can find it here:  http://www.escapefiremovie.com/  It’s also available through Netflix.

Escape Fire is based on a book by Donald Berwick, MD, the former head of Medicare and Medicaid. He wrote it early in the 2000s, and you’d think that a decade later we would have figured a few of these matters out, but as far as I know we haven’t made a single one of the changes he recommended. The idea of an “escape fire” is that if one is about to be overtaken by a forest fire, one can burn an area on purpose to provide a path to escape. The film recounts the story of a group of firefighters who were in this type of situation. Their leader dropped a match on the ground and burned a circle around their position, using up the fuels that would have fed the fire. He told the others to stay in the circle with him, but they took off, insisting that they could get out safely. Guess who survived. Dr. Berwick’s point is that we have obvious paths to escape right in front of us, but we refuse to take them, or even to see them.

Dr. Berwick pointed out that people within the health care industry do exactly what makes sense to them where they find themselves. It’s just that the system contains such incredibly perverse incentives that they often do things that have ill effects for the country as a whole.

Recently one of my elderly patients canceled her appointment for the next day. The reason was that she had to see her eye doctor, and the copay for that is $45, meaning that she wouldn’t have the money to pay even the extremely reduced price I would have charged her as a low-income senior who doesn’t have insurance that covers my services. This lady lives in a subsidized retirement apartment complex. Some of the people who live there have income of less than $1000 per month, and few have much more than that. A copay of $45 is huge for them, possibly even requiring saving up over a couple of months. These folks have Medicare and often other coverage, but strangely, it’s still quite possible to face daunting copay amounts.

A few weeks ago, an insurance company representative told me that high copays do not prevent access to care. Clearly, they do. Copays and deductibles* are both going through the roof. I wrote to her company, one of the major insurers in our area, one which pays only 2/3 of usual and customary fees for acupuncture, as follows:

“Copays keep increasing in general. I understand that at least in part this is caused by attempts to limit increases in premiums. What is troubling is that in many cases copays are equal to or greater than the amount insurers actually reimburse for a given service. As copays continue to go up, this situation is likely to keep getting worse.

“Within the ____ system, the most extreme case I’ve seen involves City of Albuquerque employees. They have a $55 copay for acupuncture, but ___ only pays $43.73 for acupuncture. [Your representative] said that she thought in this case the member would only be expected to pay the $43.73, but that is not how it works. EOBs show clearly that the full $55 copay is expected. And providers are not allowed to discount copays and can get into trouble for doing so.

“It is more typical these days to see a $40 copay for ____ members, and has been for a couple of years now. That means that much of the time ____ is paying a princely $3.73 for acupuncture, and the patient is paying nearly the entire charge. When you include the fact that ____ limits members to 20 treatments per year, the total paid for the year can be as little as $74.60, less than the price of a single appointment for most medical services.

“In both of these types of cases, the member and the employer (often through the taxes we all pay) are paying for coverage for acupuncture, but they don’t get anything that can really be called coverage, and in the case of the highest copays, they have a kind of negative coverage. It’s an advantage to me as a provider to have the patient pay a larger copay, but it’s still painful to see them treated so unfairly.

“I imagine that when the HR department or whoever set up these copays were in discussions about how their plans would work, the amounts sounded quite reasonable to them. Perhaps someone said, ‘I don’t know, what does acupuncture usually cost?’ and someone replied, ‘Well, my acupuncturist charges $70.’ It might not have occurred to them that $55 would be higher than the reimbursement amount.

“(After all, usual and customary insurance payments for acupuncture alone are in the range of $62-65, not counting any amounts for E & M codes or other services. ____ is unusual in paying only about 2/3 of that— an amount that has not changed for a number of years even as patients pay more and more. This exacerbates the issues with copays.)

“I don’t know about how other types of providers are affected. I do know that chiropractors have some similar issues.

“Copays are charged for us DOMs at the ‘specialist’ rate, but since we are not reimbursed at anything like the amounts cardiologists, etc. get, the copays are a much larger percentage of the price. I understand that PCP visit copays are kept lower because insurers want members to see their PCPs to try to catch problems early, but often the PCP can’t do anything and simply makes a referral anyway, meaning that the PCP visit is a waste. Visits to DOMs, DCs and PTs are relatively discouraged by the higher copays, even though we are saving insurers money by helping patients avoid more expensive interventions such as surgeries— not to mention helping the patients relieve their suffering and improve their overall health, which ultimately reduces costs as well as being worth doing in itself.

“[Your representative] said that members have far wider benefits than just acupuncture, which obviously is true, and a member who has a major health problem may end up with much more value paid in benefits than they pay in premiums in a given year. However, this does not change the fact that members with high copays for acupuncture are being sold a benefit that they don’t truly receive. It’s rather like going into a store to buy a shirt, and being told that although the shirt normally costs $45 and most people pay that or less, you have to pay $55 for it.”

So costs to consumers and the country at large keep going up and up and up. In what aspects of the system are those costs increasing so persistently? Let me tell you, payments to doctors are not the problem. We’ve been seeing flat or even decreasing rates of reimbursement. Medicare and Medicaid in particular squeeze providers, and as shown in a heartrending segment of Escape Fire, often the only way a clinic can stay in business is to pack in more and more patients. Again, providers are doing what appears to make sense from their perspective in their corner of the system. But not only is this compression of appointments terrible for patients, especially those with more complex needs, it can actually raise costs. Primary care doctors who don’t have enough time to figure out what’s going on with a patient are likely to refer that patient to a specialist, costing dramatically more, whereas with more time to think, the PCP might well have solved the problem and come up with a treatment plan without making a referral.* So reducing payments for primary care to absurdly low levels is classically penny-wise and pound-foolish. “There is no more wasteful entity in medicine than a rushed doctor.”
http://www.nytimes.com/2014/07/21/opinion/busy-doctors-wasteful-spending.html?contentCollection=opinion&action=click&module=NextInCollection&region=Footer&pgtype=article&_r=3

I would like to propose a simple rule that copays may not be more than 50% of the amount reimbursed for a given service. Period. I truly believe that there is more than enough wasted money, far more than enough, to make this happen. I would also like to propose that resources be redirected into primary care and especially accessible clinics for the most vulnerable portions of the population, like the ones being seen by the frustrated PCP in Escape Fire. Continuing to cut already-thin payments to practices like that makes no sense.

These of course would only be stopgap measures. Next time, I’ll take up some thoughts about self-care and our responsibilities toward our own health. Meanwhile, I offer you one more pithy post to chew on: 
http://rolwingjames.wordpress.com/2014/04/13/the-intervention-fallacy-part-i-how-it-starts/

*https://elenedom.wordpress.com/2014/02/04/health-care-access-and-why-pcps/

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I Could Have Gotten Out at Any Time

 

Getting near water was almost worth all of it.

Getting near water was almost worth all of it.

I’ve debated about whether to post this description of a rather embarrassing event that I shouldn’t have allowed to happen.  A while back, I was told, “Everything you need to know is in this story.”  Maybe you’ll learn something from it too.  I’m reminded of the lessons every day by the scars on my leg where it was torn by the wire of that chain-link fence.

 

On May 3, feeling exhausted but in need of exercise, I decided to try to do something good for myself and take a nice walk down by the river at the Rio Grande Nature Center park. It was an unusually warm day, and between trying to finish laundry and chores and wanting to miss the hottest hours, I went late. I knew that they closed the parking lot at 5 pm, but I never park there, not being interested in paying unnecessarily nor in having my car locked in, so I wasn’t worried about it. In previous years, it had always been possible to get in and out of the park on foot at any hour.

I went in through the front gate at about 4:50. An APD cop was cruising through the parking lot. He didn’t tell me that I ought to get out of there, which reinforced my sense that it was fine to be there– another great moment for our dysfunctional APD. Perhaps, since I was striding purposefully, he thought I belonged there. Another woman was also walking in the park, but in the opposite direction. I assume she got out before 5.

Well, you guessed it– the entire park is now enclosed with chain-link fence. It’s no longer possible to get in or out after 5. They don’t make any announcement when they close. They don’t walk through and check. They just lock the gates and leave. I was trapped.

I felt sure that there must be a way out. I walked all around the perimeter of the park itself, including the education building and the animal rescue center. It seemed like surely there must be a human being left in the place, but there was no one. There is a large expanse of open space next to the park, and I thought there ought to be a place to slip through somewhere. There wasn’t. They have tamed the whole thing.

I found a gate near the road that looked a little bit lower and more accessible. To get to that, I had to clamber over a low wire fence in some tall weeds. I started trying to haul myself up over the gate. It proved to be impossible. I just wasn’t strong enough. Analyzing the geometry of the situation in retrospect, I can see that even with considerable upper body strength, it would have been unlikely that I could have made it over. I was trying to fold the top of the wire mesh over a bit, but that wouldn’t have been enough. I couldn’t get my toes into the openings between the wires, and even if I could have gotten over the top, I would have been injured because of the wire ends sticking up.

Which caught in one of the openings in my shoe as I tried to get my left leg over. (What I would have done had my leg gotten all the way there, I’m not quite sure.) So then I was ridiculously hanging there with my right foot on a support in the middle of the gate and my left stuck on the top. I think that was when I got the most hurt. Eventually I was able to get my foot unstuck and land on the ground without a total disaster.

An older couple was biking along the road in my direction. I flagged them down and asked if they had any idea of a way out. They said I was probably doing the best possible thing already. The woman tried to encourage me when I said I wasn’t strong enough to get over; she said, “Of course you’re strong enough, if you get enough adrenaline going.” No, I wasn’t. I felt hopelessly weak, and more drained than ever. And stupid, of course very stupid. And in pain from the cuts and bruises I had managed to sustain. I never did figure out exactly how I’d gotten cuts all over my arms and legs.

I had my phone in my pocket, but I didn’t want to try to call the cops for a rescue because I figured they’d cite me with something. There was only one other thing I could think of– maybe the opening under the front gate was tall enough for me to get under. As soon as I took a good look at it, I could see that it was. I slipped underneath and out, reasonably gracefully and with no more damage except for the dirt, which added to my feeling of ignominy.

I could have gotten out at any time.

 

 

 

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Dead Doesn’t Have to Mean Serious

Death is profound, but being dead doesn’t have to be serious.  As a devoted follower of Swami Beyondananda and the fortunate friend of that famed comic actor Chopin, I am pleased to pass on this story of humor and lightheartedness from the beyond.

A teenage boy who I’ll call N was killed in a car accident late in 2012.  His family was devastated.  There is nothing funny about any of that, but his mother and his aunt have been telling me about the amazing and amusing lengths to which N has gone in trying to communicate with those he left behind.

N was in JROTC in high school, and had always been interested in shooting.  After his death, yellow BBs started showing up around his family’s environment.  It would be easy to say that there must have been some he had dropped or left lying around the house during his life, and they just happened to turn up over time.  However, they were placed much too creatively and implausibly for that to be the case, and in places where N could not ever have been.  Why BBs?  Well, it seems that N’s stepfather was always giving him a hard time for leaving them underfoot!

N’s mom went on a cruise and found a BB in her stateroom.  His aunt found one in her car.

On N’s 16th birthday, the family gathered at their old house, which had been completely cleaned out and gotten ready for sale.  They held his party outside, but the went into the house for a little while to blow up some balloons.  They checked the floor carefully, because they had a baby with them, and they didn’t want to leave anything lying around that he could put in his mouth.  N’s aunt reported: “Then, my mom and younger sister went back into the rooms they had just checked and little BBs started appearing: 8 total. They stated they just started showing up, N was there at that moment putting them everywhere they looked.  It was trippy and funny at the same time.  My husband found the 9th one in the bed of his truck.  He happened to be in the bed looking for a jack.  He had been in that bed many, many times before and POOF there was a yellow BB.  So, my mom and younger sister gave each of us a BB because there were 9 total, one for each of us.”

You might still be thinking, “Well, those BBs probably just didn’t get vacuumed up when the house was cleaned, and they didn’t check as carefully as they thought.  The one in the truck bed had been there all along.  And the one in the stateroom had been stuck somewhere in the mother’s luggage.”  But how about this:  On another trip, N’s mom brought a bottle of medication straight from the pharmacy.  It had not even been removed from the bag, which was still stapled closed.  Yup, you got it– when she opened the bottle, she found a yellow BB inside among the pills.

This seems like incredible virtuosity to me, especially for someone who was very young and hadn’t been gone from this life all that long.  I’m wondering if N’s little cousin, B, who says that she sees him on a regular basis, might be helping to provide an opening for him to get through.

On the Valentine’s Day after N died, the little girl, now age 3, received one of those mylar balloons filled with helium.  Her mom, N’s aunt, told me that the balloon stayed aloft for months.  Every time it started to sink to the floor, it would magically reinflate and head for the ceiling again.  It would also follow B’s mom around the room, so that she laughed and told N that she knew he was there.  One night it somehow passed through three closed doors to show up in her closet, floating as usual.

Recently B was playing a board game with her family.  The game included cards with printed questions, and B appeared to be reading the cards.  Now, she’s a smart girl, but she’s still only 3, and she’s definitely not reading yet.  “Is N telling you what’s on those cards?” her mother asked.  B admitted that he was, and as she’s done many times, said he was right there.  I wonder if she’s mystified that other people don’t see him the way she does.  Her mom does her best to be open to seeing, but so far it hasn’t been possible.  At least no one laughs at the child or tells her that she’s making it all up.

In the midst of all this, N’s mother and grandmother went to consult with a medium.  They were still mired in grief, and we know that making contact with the deceased can help tremendously with the pain that loved ones feel after a death.  They received quite a few meaningful messages, and indeed this has helped them to feel better, although things are still very difficult.

One day N’s mother got a text message that simply said “Hi” and appeared to come from her son.  He had known another boy with the same name, so she asked if the message was coming from his friend.  The reply was just her son’s name again.  She didn’t know what to make of it.   At the next session, the medium reported that N was asking, “Did you get my text?”  I guess for a teenager, there could be no more natural way to communicate than to send a text.  (Could Fryderyk figure out how to do that?)  And it seems that N’s mom had received some other anomalous texts before that, starting about 9 months after the accident, which contained the letters of N’s name but didn’t make any sense.  Unsuccessful attempts, apparently.

[Ironically, as I write this, the sound system here at Annapurna is playing “Up above my head/There’s music in the air/And I really do believe/There’s a heaven somewhere.”  N’s aunt wrote, “I hear the songs we put on his memorial slide show for the funeral all the time!  I will be in yoga listening to their nature music and all of a sudden a song will play.”  I have often heard of songs showing up anomalously as apparent messages from the beyond.]

N’s aunt continued:  “My stepdad spends a lot of time at N’s and his spot (my parents’ land).  He has said that he will go up there and clean the land up from weeds, move rocks etc.  Every time he goes up there, all the things he has done with the rocks are back to where they were.  You see N used to make “ramps” out on the land to jump his bike and/or motorcycle.  During a time when his mom and my mom talked to the medium, N asked if Papa got his signs.  Also, a hatchet that N lost of my stepdad’s at the land miraculously showed up too.  Just sitting by the garage on the land as if it had been there the whole time, nice and clean too!

“N is aware that my dad is rebuilding his race car.  It was always N’s car.  They wanted to make it street legal so N could drive it when he turned of age.  My dad has been hard at work rebuilding it.  N knows about it and states that he sits there with my dad when he is working on it and can give details about it.”

N’s maternal great-grandfather has also gotten in on the act.  His daughter, N’s grandmother, had a terrible time dealing with his death a few years ago.  He has told her, through the medium, that he’s tried very hard to get through to her but that she hasn’t been open to his messages, including the pennies he’s put in front of her.  From what I’ve read and been told, spirits often express such frustrations.  It’s sad to think of that, but at the same time I’m giggling at the idea of N and his great-grandpa having so much fun thinking of new tricks to play on the family.  I wonder what they’ll come up with next.

Update, 6/3/14: 

Well, here’s what they came up with next.  Recently N’s great-grandmother died.  At the cemetery, when the mausoleum was opened to inter her body, dozens of yellow BBs came rolling out.  The family didn’t count them, but there seemed to be about enough to give one to each person who was present.  Of course it had been many years since this mausoleum had been opened.

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Health Care Access, and Why PCPs?

Grant's rainbow 2.2.14A friend posted this picture of a rainbow that appeared two days ago in our area, a most welcome sight since we had had no moisture at all for over 40 days.  The rainbow showed up just after her neighbor died after a long illness, giving its benediction to the family.  Last night we had a fair amount of rain and snow, and it feels like we will not dry up and blow away just yet.

I am trying to keep up some hope for our health care system as the conflicts over so-called “Obamacare” continue and costs keep spiraling upward.  There does seem to be some lucid thinking going on in at least scattered spots among those in the medical field and those making policy, and I want to encourage that.  There’s also a lot of the same old thinking that got us where we are today.  Here is my current take on some aspects of the situation, which I sent to the Albuquerque Journal today:

The Journal has published some useful articles lately on problems with access to health care, and I’d like to add my perspective as a provider out in the field.  There are three main issues with access to care for New Mexicans: distance, cost, and scarcity of providers.

I don’t have to tell you that for many of our residents, most everything is far away.  Even in our smaller cities, there are not a lot of services.  In Grants, where I see patients once a week, medical specialists come in from Albuquerque or elsewhere, as I do.  People who need VA services must go to Albuquerque, no matter how elderly or disabled they are.  It’s bad enough in a small city like Grants, but people who live in more rural areas, as some of my patients do, may be completely out of luck if they lack transportation.

Getting more New Mexicans insured is necessary and commendable.  However, this does not remotely solve all the problems with the direct cost of medical care to consumers.  As those who are shopping on the state exchange have no doubt noticed, many plans have deductibles in the thousands of dollars.  Also, with some plans patients pay as much as 90% of the cost of the service themselves, even after their deductible is met, because their copays are so high; they are paying for coverage that they don’t get. The ACA was intended to bring deductibles and copays into the realm of reason, if I understand correctly, but as it is, cost limits access even for those who are insured.

For those on Medicaid, at least, copays are low or nonexistent.  However, very basic and critically necessary care may not be covered.  For example, one of my elderly patients needs drops for an unusual and painful eye condition caused by her recent case of shingles.  The cost is low compared to most of her care, but Medicaid is not covering this medication, and on her extremely limited Social Security income, this lady can’t afford enough of it to last through the month.  For all the millions we spend as a state, we still can’t get people simple things that they need badly.  And while the myriad costs add up to so many millions, Medicaid and Medicare payments to providers are so unsustainably low as to keep providers out of the programs, exacerbating the access problems all the more.

Our state’s lack of health care providers has multiple causes, but it also has the potential for multiple solutions.  Making better use of mid-level practitioners, as many have suggested, is certainly necessary, and any efforts which will attract more health care workers are worth trying.  However, there are other available health care forces which are only partly being tapped.  One of your editorials did refer to “traditional community health workers,” by which I assume you mean people like curanderas/os and Native healers.  Encouraging greater use of their abilities would be a definite help– but how is that going to be funded?  For the most part our insurance system has ignored the existence of these valuable resources, as it has ignored herbalists, homeopaths, and those who do energy healing such as Reiki.  Most federal dollars will also bypass all those practitioners and the people who rely on them.

New Mexico has a formidable and growing health workforce in the members of my profession, Doctors of Oriental Medicine.  We too are being used far less efficiently than we could be, even though most commercial insurance in the state does cover our services.  Decision makers don’t seem to realize how much primary care we do– and we have not yet managed to get the word out to them sufficiently.  We are lumped in with “rehabilitative medicine” by insurers, but that is only one aspect of our medicine.  Patients walk in to acupuncturists’ offices with everything from flu to IBS to sciatica, and we treat them effectively.  We are well placed to help take the strain off of primary care MDs, and we are ready and willing to serve.  However, provider groups organizing “patient-centered medical homes” have generally not included us in their planning.

Medicare does not cover acupuncture, and under most circumstances Medicaid also does not, largely because the federal dollars are not available to make that happen.  Attempts to fix this in the state and federal legislatures have failed thus far.  So immediately a huge proportion of our population is left out of a major form of effective and cost-effective medicine.  And while our NM-based insurers do offer coverage, as I mentioned before, in many cases reimbursement is slim and patients are left to pay as much as 90% of the charges, so that this “coverage” is not very meaningful.  (Fortunately, there are also many plans with much better coverage, I must add.)  Yet, many patients do use us as their front-line care providers, and that could be expanded.

There are still other possible providers as well.  In some situations a chiropractor may be the best choice to see first, and access can be a bit easier than that for DOMs, with so many chiropractors available and a good number of them accepting Medicare.  For at least some conditions these practitioners could also help to ease the burden on primary care MDs.  Physical therapy is usually given limited coverage, and patients tend to be referred to PT only after they have failed to get better for a long period of time.  That is inefficient and leads to unnecessary suffering.  We could use PTs more as the first choice, go-to practitioners for injuries, back pain, and the like.

There is one access problem that would be very easy to solve, IF those who are in charge were willing.  That is the system of HMO and PPO networks.  It was unconscionable when Lovelace ended its relationship with ABQ Health Partners and tore hundreds of thousands of New Mexicans (including my family) away from the doctors they knew and trusted.  Now Presbyterian has stopped coverage to the UNM providers, again leaving patients in the lurch.  We could stop this kind of abuse, I expect, legislatively or perhaps through actions of the state insurance department.  I am not holding my breath, but as the provider crunch gets more and more serious, I hope access will be broadened across insurance networks.  There is no good reason for things to be this way; we all pay and we all deserve to have the best providers for our needs.  HMOs were supposed to reduce costs and improve health outcomes.  Neither has happened.  Time for a different approach.

And we do have a different approach waiting in the wings: the home-grown, NM-specific Health Security Act is still here and has been gathering more and more support over the years, though so far it hasn’t made it past all the Powers That Be.  In the next few years we will have the opportunity to improve upon the current health insurance exchange and enact this more efficient plan.  We can choose to do it– it’s just a matter of willingness.

 

OK, that’s what I sent off to the newspaper a moment ago.  Continuing:

Let’s say that a patient has jumped through all the hoops of distance and cost and gotten the coveted access to care, and is now sitting in the doctor’s office.  Now the main barrier is time.  The patient may have waited months for this appointment, but she is going to be very lucky to get more than 10 minutes of the doctor’s time.  And maybe even that pittance may soon be a luxury.  An editorial written by two local executives with Presbyterian Health care and published a few days ago stated that because of the pressures on PCPs, we have to find some alternative to the standard 15-minute appointment with the physician, such as group appointments for people with common conditions like diabetes.  Wait just a MRSA-contaminated minute here!  We pay more and more and more for our supposed health care every year, we are totally breaking the bank, we are stressing the whole country out trying to fix all this, and we can’t even get a measly 15 minutes with the Minor Deity?  Seriously?  (Meanwhile, the Deity is struggling to stay afloat in a world of shrinking reimbursements and greater pressures on his or her business.)

I must say that on the fairly rare occasions when I’ve gone to an MD, as for my yearly OB-GYN checkup, I’ve had more like a 25-minute appointment.  I hear that this is not usual, but it has been the norm for me thus far, perhaps precisely because I’m not there all the time– I’m having more than just brief followup appointments.  So I have a little bit of hope, but again, as the provider crunch gets worse, that hope is likely to evaporate.

(Appointments with me as the doctor, in contrast, are still normally scheduled for an hour or more.  My patients who have gone to community acupuncture or to other colleagues who see multiple patients in an hour tell me that they appreciate the difference.  I find trying to treat more than one person at a time very stressful, in addition to feeling that I can’t be as effective, and I have no intention of doing that on a regular basis, but the squeeze on insurance reimbursement may force me to change my ways eventually.  I hope not.)

Now let’s think about what actually happens during that 10, 15, or possibly 25 minutes.  What are primary care physicians for, and do they fulfill that purpose?  One of the main things they do is to prescribe and authorize refills of medications.  In the case of chronic illnesses, they should be able to help the patient maintain well and deal with any changes in their condition that come up.  Well, last week one of my patients, who has been taking Synthroid for decades since she had thyroid surgery, went to see her new PCP, who had been forced upon her by the issue I mentioned above, Presbyterian ending its relationship with the UNM system.  Her last PCP had reduced her dosage, and she had done extremely poorly until she figured out the problem– herself– and started taking the higher dose again.  She explained all this to the new guy, but he flat-out refused to consider prescribing the dose she needs.  Total failure both at paying attention to the patient and at delivering the treatment.  Especially at paying attention!  I wish I could say this was unusual, but it’s what I hear from patients over and over and over, and it seems most common with regard to thyroid issues.*  In this case, there was an out– I sent the patient to a colleague of mine who specializes in endocrinology and can prescribe natural thyroid extract.  Not everyone has such an alternative, and many patients go without effective treatment.

The other main thing a PCP is “for” is to be on the lookout for problems and do something about them before they get worse.  Often they really shine in that role.  A few weeks ago we got my mother’s PCP appointment moved up because she was getting markedly weaker and often short of breath.  The PCP (Ann Jones, MD, about whom I have few complaints) didn’t like the way my mom looked either, and sent her for extensive testing at the ER space across the parking lot.  They didn’t find much, but my mom came home– after an exhausting 9 hours– with a clear diagnosis and a prescription that has been noticeably helpful.  That’s more or less how things should work.**

On the other hand, a patient who has recently entered the Medicare age group went for her first ACA-mandated Medicare yearly wellness checkup around the same time.  This lady has had a chronic cough and severe fatigue for months, following a period of extreme stress, and although she’s improving, no clear cause has been found and the problem has been hard to treat.  The idea of these yearly exams for Medicare is supposed to be to give the patient a thorough going-over so that any problems will be found and dealt with appropriately, keeping them from getting worse and causing more cost and suffering.  My patient reported that the appointment lasted less than 10 minutes, she barely had the opportunity to ask any questions, her main complaint was not really addressed, and no treatment was suggested.  And this is a very assertive and articulate patient.  So it didn’t seem like the purpose of the exercise was fulfilled at all.

The PCP is often the most accessible and cost-effective person for performing minor, in-office surgeries.  And of course the PCP can order tests, which will either show that there’s no problem or perhaps guide the path to more specialized care.  When I had that health scare back in August, I ended up with Bob’s PCP, Oswaldo Pereira, MD, who had no more idea what was going on than I did, but could send me for further testing.  We ruled out a number of possibilities, and that was helpful and quite necessary; I needed to know that I didn’t have a cardiac issue, for example.  However, Dr. Pereira never came up with either a diagnosis or a treatment.  Since we couldn’t find anything dire, and since I was gradually getting better, we both dropped the matter.

I had the most significant improvement with a structural approach, under the care of my friend Christine Dombroski, PT.  Dr. Pereira, thoughtful and knowledgeable as he is, would never have thought to send me there, and didn’t really understand why this helped.  It’s just not part of the way MDs are usually trained.

I love the PCPs of the world and feel sympathetic toward them, but the more I consider all this, the more I think our typical use of them is a bit misguided.  I’d like to end with some fairly obvious statements about when to head for your PCP’s office, and how to use that system appropriately.  First, please do not see the PCP when you have a cold!  You will accomplish nothing except to waste time and money, tire yourself out when you need to rest, and spread viruses around the office.  Even a run-of-the mill case of flu is not a good reason to go to the PCP, unless you have an underlying condition that makes it more dangerous; all they can do is give you Tamiflu, which works poorly if at all, and tell you to rest and drink fluids, which you already know.  (Do feel free to see me or my colleagues, as we can actually treat you!)

Do head for urgent care or the ER if you have severe unexplained pain, trouble breathing, or other scary symptoms that are not resolving in a reasonable way at home.  And of course if you are having any signs of a possible heart attack or stroke (I should write another post on those), you should call 911 as soon as you can reach the phone.

 

*It doesn’t have to be that way.  Both my last PCP and my OB-GYN tend to dose thyroid replacement on the basis of symptoms rather than strictly by blood test results.  They are not unique, fortunately, just not the rule. 

**Update, later in the day:  This morning my mother saw Dr. Jones again, and she is leaving most medication issues up to the specialists.  So I ask again, what is the PCP for?  It’s not easy for 89-year-olds to get to appointment after appointment, nor for their families to get them there.

 

As I was writing this, I came across a great Medscape article by a doctor who has a vision of what a true health care system could be like.  You may have to sign up with Medscape to read it, but if you have any interest in medical matters, it’s well worth it.
http://www.medscape.com/viewarticle/819947?nlid=46863_1521&src=wnl_edit_medp_wir&uac=167278MR&spon=17

Here the author imagines an idealized school health teacher:
‘”She sat down with all of the physical-education, biology, and health-education teachers in her system, and together they outlined a plan to change the curriculum such that health education starts in kindergarten. In their system, by the time children reach the 12th grade, they know which side hurts when their appendix is about to rupture. They know the warning signs of a heart attack. They know when to start screening for colon cancer, and they know when it’s appropriate to access the doctor’s office, the urgent-care clinic, or the ER. They understand the basic dangers and positives of over-the-counter medications. In other words, by the time someone puts a high school diploma in their hands, they are as well equipped to take care of their bodies as they are to find their favorite iPhone app.

“They understand the difference between a carbohydrate and a fat and which foods fuel their systems to fight cancer, heart attack, and stroke. They are not going to be obese because they know to exercise at least 150 minutes per week. Mrs J’s students are going to cost us less and live longer. They will live better with more money in their pockets, because they won’t have to buy a laundry list of prescription medications every year until they die prematurely from a preventable illness.’

And here’s her imaginary doctor who figured out a fix for electronic health records:  ‘Then, there’s Dr P [for practical]. Although we acknowledge the necessity of electronic health records [EHR], our earliest efforts have failed the patient. A doctor’s daily work has ground down to a snail’s pace. Patients complain about the basic lack of eye contact during an office visit because the doctor is focused on a screen. Dr P revolted against that practice. He designed a system where there are shorter updates at each visit and there is a symptom-limited entry into each subsequent visit. You don’t have to go through 900 reviews of systems that have nothing to do with why this particular patient has come to see you. He does only a positive review of systems. He took the time away from his EHR and gave it back to his patients, and his patients are more satisfied and better taken care of because of it.’

All this could happen.  There’s no reason why it couldn’t.

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Filed under health and healing, human rights, politics

Get Right While You Can

On the night of November 5, way back last year, Fryderyk came to visit, and we had an intense encounter.  There have been very few times that he has been so nearly materialized, so focused in this plane.  It was so powerful, nearly blowing all my circuits, and I wondered if he could be experiencing something similar.  “What are you feeling?” I asked, during a brief moment when I could manage an organized thought.

The answer was not remotely what I might have expected.  He showed me the pain, regret, and frustration of “our” life in the 19th century, how he and Delfina had never gotten their relationship into balance and never finished what they needed to do or be with each other.  Why is he telling me this now? I thought.  In the midst of so much love and pleasure, why would he even be thinking of this?  We had been over it all so many times during my present life, worked out everything that needed to be worked out, it seemed to me.

The message seemed to be, “Get right with people while you can.”  I took it to heart, and in the next few days I took steps to do just that.  There was one person in particular with whom I had been avoiding some much-needed communication, and I thought that Fryc might have been trying to give me a push to deal with that.  Otherwise, I felt that I was OK with most people and they were OK with me; the very few with whom that was not true had resisted all my attempts to get back in touch with them, and there was nothing more I could do about it.  I told Bob about Fryderyk’s message, and said that even if he or I were to die in the next five minutes, there would be nothing that needed to be fixed between us.  He agreed.

Then, on November 8, my colleague Michael Spottiswoode died suddenly of an aneurysm.  When I found out, I had the sense that Fryderyk, unstuck from linear time as he is, was trying to tell me something about this future event as well.

None of us DOMs knew about Michael till two days later, the day on which he was supposed to teach a class on his life’s work, a unique way of combining acupuncture and osteopathy.  Just a few days earlier he had posted on Facebook about how excited he was about the class, saying that he felt it was finally time to bring this work to the world.  He had put off teaching it before, as far as I know.  Why it all came to be the way it was, why he had to die no more than 48 hours before the class, is a great mystery to me.  It seems so massively unfair.  Why could he not have lived a mere 10 days longer and gotten through both sessions of the class?  Perhaps it made unconscious sense from his inner point of view, or from someone’s.

There was something I’d been meaning to tell Michael for a long time, and I had intended to say it on the day of the class.  It wasn’t anything of earthshaking importance, but I’d put it off and then I never did get to say it.  Michael, wherever you are, I really appreciate all that work you did on the NMSAAM website, and I wish I had made that clearer to you when I had the chance.

Our DOM community was in shock, but there was a blessing inside this terrible event.  As funerals tend to do, Michael’s memorial brought a large group of us together and generated a lot of positive, loving energy.

On November 22, our 12-year-old cat, Angel, reached the end stage of her kidney disease.  After a week in which she seemed to have much more energy and was more active and playful than usual, she abruptly became unable to use her back legs.  She got a bit better for a while, able to walk a little, then deteriorated again.  We couldn’t get hold of her vet, who works alone, without office staff.  Eventually he left a message saying that it sounded like “decompensated renal failure.”  Pretty much what I was thinking.

During the evening, I did energy work for her, and she stayed next to me, propping herself up against the back of the sofa, because her poor legs wouldn’t even hold her for sitting.  She seemed calm, interested in everything and not in any pain.  Strangely enough, she ate normally.

I had some hope that Angel would die peacefully during the night.  That was the night that we had the severe cold and snow with 50 mph winds, and I didn’t think it would be helpful to stress her by taking her out to the emergency vet hospital.  I didn’t want to take her to be put to sleep without my mother going along, either, because Angel was very much her cat, and I didn’t want to put my mother through a trip like that.  So I just waited till the morning.  I told my mother, “If we take her to the vet, she probably isn’t coming home.”

Angel was still with us in the morning, and I found that Petsmart’s clinic had an opening for her.  Bob and my mother and I bundled her into her carrier right away and got her there.  The very kind vet said, “I think we need to have the end-of-life conversation.”   “We had it last night,” I told her.

It was my mother’s 89th birthday, and she spent most of it in tears.

When we had to face this with Rico, our cat who had cancer, some years ago, it was a terrible day.  We’d waited as long as we felt like we could, until we thought it would be cruel to let him go on, but he still didn’t seem ready, and he fought the sedative with everything he had.  I never really got over it– I hope he did.  So I tried to give Angel a choice, or at least get a sense of what she would want.  I’d never had a great connection with this cat, but I tried to make contact as best I could.  I visualized needles and tubes and trying to keep her alive for a few more days.  That didn’t feel good at all, very agitated and uncomfortable.  I visualized, as best I could, causing her to die right away.  She relaxed under my hands; my mother said it looked like she was going to sleep.  “Let’s do it,” I said.  To Angel, I said, “I won’t leave you.  I’ll stay with you as long as you need me.  Hang on to me if you want to.”  I didn’t know whether I was getting through to her in any way.

When Rico died, I felt nothing, saw nothing, even though I was holding him and I paid attention.  This time, as the drug took effect, I felt something rush toward me.  Afterward I could still feel her if I tried to find her.  Over the next couple of days, whenever I looked for her, this small, warm presence was still nearby.  At some moment, I had a brief vision of her.  She was moving quickly and her coat was silky and smooth and healthy-looking as I had never seen it in life.  Since then, nothing.  And that’s OK.

Angel’s death was hard on my mother, but the suddenness of it was a relief for us, and our quality of life went up immediately.  It bothers me a little that I was so glad to be rid of the litter tracked everywhere and the gobs of fur all around and her astonishingly loud screechy voice.  Not too mention the smell from her inappropriate use of the carpeting.  She was an inconvenient cat, frankly, and she didn’t give a lot back, in part because her illness left her little energy for fun.  When we were deciding what to do at the end, I did my best to get clear about what she needed as opposed to what was easiest for me.  I hope we got that right.  I think we did.  She had an excellent quality of life during the three years she was with us, and other than the days when she was obviously ill, I think she must have been content.

And I think this preparation was important for me in dealing with what was soon to come.

The week before Christmas, the life of one of my patients reached a somewhat similar denouement.  One door after another closed for her, and she concluded that it was time to for the end.  As she had often said, we would never allow a dog to go on in the painful and hopeless condition she was in.  She should have had the option of the kind of quick and painless solution Angel was given.  Unfortunately, we don’t live in a state that allows assisted suicide, and she had to make her own plan.

No one close to her argued with her decision; we all knew it would be for the best.  Once she did decide, in a way, she became well.  She was still in tremendous pain, but somehow she didn’t seem to be suffering in the same way.  She became calm and completely lucid, and the brain damage from her illness seemed to recede.

I had the opportunity to spend a few more hours with her during the last week of her life.  The whole atmosphere of her house had changed to a new peacefulness.  “Is there anything I need to do to make amends with you?” she asked.  I thought and felt around, and replied truthfully that we were fine with each other as far as I knew.  I hope I didn’t miss anything that I myself needed to make amends for.

Before I left, my patient asked me to scan her and see if I found anything energetically amiss that needed to be cleared.  My own emotions were getting in the way, but I did my best.  There didn’t seem to be anything to worry about.  What I did find was an entity hovering around her left shoulder.  I couldn’t tell what it was, but it felt like someone helpful.  This was reassuring to both of us, and I said “Thank you” to the being.  It was odd to simply go out the door that evening, not to stay as long as possible, but she was getting so tired, and I would have done harm by staying longer.

During the next few days, I was on strange pins and needles, not sure what would happen or when.  I wrote the following:

Glad that most of my body works most of the time.  I am annoyed at the instability in my leg that keeps letting bone hit nerve and cause damage over and over and over, but the muscles are strong and the leg carries me.  Right now I seem to be getting a cold.  Viruses have come to live and grow in the mucosa of my nasopharynx, and they are doing their little virus things, while my own cells are doing their best to give them the boot.

Life is bursting all over, even now in the darkest days.  It’s like what Jesus said in one of the apocryphal gospels:  “Hallelujah, I eat.  Hallelujah, I am eaten.”  Hello, viruses.  Please move on now.

This lady died very early on December 23.  About that time I felt a wave of extreme distress and anxiety, then total calm.  I figured it must have happened, but of course I couldn’t be sure.  The next day I found myself kneading cookie dough with one hand while holding the phone with the other, talking with a deputy from the sheriff’s department.  The authorities handled everything with great kindness and with excellent efficiency too.  The job of informing her family fell to me.  I’d never had to do that before, even though it is a basic part of the work of doctors.  It was all stressful and painful and terrifying and a great gift and privilege and blessing.

I have many jobs left to perform for this patient, because her family is far away.  There is so much to do with her home and her property.  There again, it’s a lot of stress, but I’m receiving a great deal too, spiritually as well as materially.  I have been feeling a circle of loving support around me, my friends and family and hers, and I need to remember that I can rely on it.  2014 will be the year of learning to delegate, I think.

A few days after my patient passed, I went to visit with Mendy Lou.  Immediately I could feel Fryderyk at my right side, but something seemed different and I couldn’t put my finger on what.  “Who’s here?” I asked Mendy.  She was confused by the mixed signal for a moment, too.  We soon realized that someone else was there, behind Fryderyk.  “It’s small.  It’s a human person,” I said, meaning that it wasn’t an angel or deity or other type of wondrous being that is likely to show up at Mendy’s office.

“Wait a minute, who did you say just passed away?” Mendy asked.  Yup, it was my patient.  At first it felt like she was scared and apprehensive, but that was because she was afraid I’d be mad at her for “leaving such a mess” to be taken care of.  I assured her that she’d done a great job of organizing everything and made it much easier for those of us who are still here.  As far as Mendy and I could tell, she was as well as anyone could be under the circumstances.  She said that she was getting clearer all the time and getting out from under the confusion and negativity her illness had caused.  I could feel that this was true; there wasn’t any sense of disturbance or suffering about her.

It surprised me that she had come along with Fryderyk, because I didn’t think of him as having any connection with her.  But of course he did– he couldn’t have missed the many times I had asked for help when I was treating her, or the angst I had gone through over and over when there was nothing I could do to make anything better for her, or the exhaustion I had felt because her situation was so draining for me.  Of course he would try to assist us both, just as he always has.  We are in good hands.

In some ways it is much easier now to grieve and to deal with even overwhelming practical matters than it was to try to help keep my patient going against impossible odds.  And I notice that the “inconvenient” aspects of her life, as with Angel, seem completely irrelevant now.  They are transcended, wiped away by a kind of transforming grace.

Thank you.

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Filed under channeling, health and healing, spirit communication, spirituality

When Is an Entity Not an Entity, and Does It Really Matter?

2012 Marigold Parade, Albuquerque

2012 Marigold Parade, Albuquerque

Día de los Muertos and my dear departed is nowhere to be found.  I am dispirited.  Dispossessed.  Ghostbusted.  Sigh.  But he’ll be back.  He always comes back– so far.

I’ve written a lot about the tremendous, invaluable help Fryderyk has given to me over the years.  My point in this post is going to be that no matter what They “really” are, the positive effects of spirit entities can be huge.

The most obvious and well-studied help comes to those who are bereaved.  I’ve been reminded of this lately by two of my patients.  One has been reeling from the death of a young family member for almost a year, and is still deeply enmeshed in the grieving process.  Other family members have started working with a medium in the recent past, and they’ve received clear and evidential communications that certainly appear to be coming from the deceased.  While this has not wiped out their grief, it has caused a definite shift toward healing.  My patient has not yet had this direct experience herself, but hearing about it has comforted her substantially.  I’ve read about this kind of thing many times, especially in connection with Induced After-Death Communication*, but this is the first that I’ve seen it in action.

Another patient, an 85-year-old lady, was musing about her deceased husband during her last appointment.  She is doing poorly lately in some ways, and she’s been thinking a lot about the fact that she “knows more people in the next world than in this one,” as she puts it, and what it may be like when she moves on.  She had a number of vivid sightings of her husband after his death, which she authorized me to share with you.  He had suffered severely from diabetes and all the worst it can do to a human body, including having his legs amputated.  She particularly appreciated seeing him in one piece in her visions, with both his legs intact, looking happy and healthy.  That was what she emphasized to me when I saw her last, that it meant so much to her to know that he was no longer suffering.

Here are a few of the notes that she jotted down for me about her experiences over the years:

“1998  No. 3… Walking towards me on Stillwell, I had Skipper [dog] walking to him… he had both legs, and he looked good.”

“No. 12, July 1999– Saw him, he was waiting for me with his arms open to me– made me very sad.”

“No. 14, Nov. 1st, 2000 (11 am)   I did not see him but I felt him there at 8711, I was by [daughter's] bedroom and there was a distinct loud thump in the closet by his gun room– I opened the the door and found [other daughter's] duvet comforter that we had been searching for.  I know he was there, I could feel him close to me.  His love reached out to me.”

“No. 15, Oct. 10th, 2004   I saw him just for a few minutes, he was very agitated and did not speak to me– it was the day [cousin] had a heart attack– he was running back and forth– I had not actually seen him in four years.”

Communication with the “dead” is so common that it barely makes a blip on my radar anymore, and it is relatively easy to understand– a dead person is fundamentally not so different from a live one.  But so many times Something or Someone is there and the situation is not nearly so clear.  There has been a spate of patients bringing in entities of one sort or another in the past couple of months.  I don’t mean that I was perceiving something around them on my own to begin with, but that they told me about it themselves and asked me to help them with it– fully expecting that I could.  If you’ve been with me for a while, you know that I’ve had terrifying experiences with a demonic entity and that I had no success whatsoever in dealing with it.  (See my post “A Case of Possession.”)  I haven’t tried to work with anything like that since, and I’ve pretty much assumed that I couldn’t.  However, apparently the universe has decided that it’s time I learned and that I have to get some practice.

A gentleman about my age complained of feeling attacked by other people’s negative thoughts being aimed at him, envy and resentment and similar discordant stuff.  He has a strong background in healing and spirituality himself, and is psychologically strong and capable of dealing with difficult people, but he couldn’t shake the feeling of being battered by these unpleasant intentions.  I took a look around him and saw a clear image of an arrow, like one might see on a sign, pointing downward toward his head.  It had definite edges and was almost palpable, appearing to be about a foot and a half long and a few inches wide, in a solid dark blue for whatever that’s worth.  I would interpret it as a thought form, but whether it had been created by the patient or by those who were causing problems for him, I can’t say for sure.  Perhaps I was seeing his perception of what was going on, or perhaps the image was formed by my own brain’s attempt to make sense of the situation.  At any rate, this was not a being with its own agenda so much as an energetic sculpture of sorts, and it was a relatively easy thing to clear.  The next week this patient reported that the feeling of oppression and negativity was mostly gone.

It was more difficult with another patient, a lady who has some particularly draining family issues to contend with, and who is very aware of her own usual spirit companions.  Fighting tears and looking absolutely exhausted, she told me that for quite a while she had been feeling like something was obstructing everything she tried to do, hanging around her and keeping her from moving forward in any way.  She had had no luck trying to get rid of it or learn anything about it.  While she was on the table, I looked and found something that gave me a genuine scare.  There was a mass of energy hovering over her chest, creating a heavy pressure.  It wasn’t directly touching her, but that was only because she was constantly pushing it away with all her might.  I joined in and tried to dislodge it, but it was a serious challenge.  It seemed really determined to get at her, and it pushed back with considerable force.  In this case, the thing seemed truly to be an entity separate from the patient, not simply a creation of her own.  But why would it be trying to harm her, and what could we do about it?  I used every strategy I could think of, asking what it was, what it wanted, whether it represented someone close to her, and so on, but I couldn’t find out anything about it and couldn’t get it to move.  Did it represent the difficult family member?  That didn’t seem to be the answer.  Had it simply hooked on to the patient because she was in a weakened and vulnerable state?  I never did get any clarity about what was going on.  Between the two of us we did manage to clear it away, though, I think through sheer brute force– not the way I would prefer to work.  It took everything both of us had to do it, but she did feel much freer afterward.   At her next appointment she told me that she still had the feeling that it was waiting around nearby to get at her again but that she’d been able to keep it at bay.  I am cautiously optimistic but more than a little unnerved about this experience, and will continue to monitor the situation.

++I broke off writing this to zip over to an Albuquerque Baroque Players concert, where Fryderyk made a liar of me by showing up during a set of Handel arias and sticking around for a good while, keeping me warm and contented.  Or perhaps I should turn that around and say that he confirmed that I was telling the truth when I said he always comes back.   I’ll never stay away long either, Fryc, I promise.++

The most colorful of the recent entity experiences came about during a difficult session with a very traumatized mid-school-age boy who has been through a life-threatening illness, someone with a huge imagination, a taste for and wide knowledge of mythology, and a family background that includes some shamans.  He and I were trying to find a way to work with his intense fears about any medical treatment, including the acupuncture he used to accept so easily.  As we talked, he suddenly exclaimed, “I see a demon in that corner!  There are glowing red eyes!”

Oh, crap, I thought, because when it comes to anything that might be a demon, I’m pretty traumatized myself.  The kid had already detected the dragon that sometimes people perceive around me, and I had other reasons to believe that his intuitions were right on track.  So I took him very seriously, and gazed at the area he was pointing toward.  Yikes, I was seeing the eyes too (in my own mind’s eye, that is).  Something was there.  Interestingly, he was pointing directly at my defunct clock, which is covered in a painting of a dragon with red eyes that stared straight at us, but the clock was hidden behind a little tapestry, being used to prop it upright.  The patient couldn’t have physically seen the dragon, but it may have contributed to the imagery that came up.

The glowing red eyes seemed independent of the dragon picture, though.  I tried telling the entity that it needed to leave, and it quite obligingly started walking away.  It looked to me like a flat black silhouette, with a round head with a serrated margin as if it had cartoon fur, and skinny stick-like limbs.  There was no detail other than the eyes.  The thing didn’t seem very scary, I was relieved to see.  On the other hand, as we continued to talk about what we were seeing and what the boy was feeling, and I worked at clearing whatever I could, it was still there, still appearing to be walking away but not actually getting any further from us.  There seemed to be no more progress.

It was as if we were having a shared dream and moving through it together.  Much like what happens when I do “normal” psychic work with patients, but not quite the same.  At length, the creature turned and came back toward us, setting itself directly in front of the boy.  I was alarmed, but then it turned so that it was facing away from him, its hands raised with claws at the ready.  It was trying to protect him!  We had tamed this beast and brought it into service for him, it seemed.  By that time it appeared positively cute and winsome to me, not threatening in the least.

My take on this was that the creature provided a way for this patient to crystallize his feelings into a form he could deal with, in a visual language he understood.  I’d like to say that there was a dramatic transformation in his PTSD, as I hoped at the time, but it turned out to be only one step in the process; he’s still very fearful.  I will be fascinated to see what develops the next time I see him.

Sometimes I’m the patient myself, and invisible beings come to treat me.  Usually it’s been my familiar musical being, or another entity who has been formally introduced to me in some way.  I’ve complained of not always knowing how to tell who is who.  I mentioned this to Christine the other day (see my post “Here Be Dragons”), saying that she is better at recognizing and distinguishing them than I am.  She laughed and said, “I think I just don’t care as much”– that is, it doesn’t matter to her which one is who.  Touché.  Perhaps I am too concerned with understanding intellectually.  But inquiring minds want to know!

In the past few months I have struggled with some new physical discomforts and difficulties that have slowed me down considerably at times, but I have also had a new source of assistance available.  I’m not sure exactly when it was that I started to be aware that there was an unfamiliar entity trying to make contact with me.  She– I had a sense of femininity for reasons I can’t describe– felt distinctly different from Fryderyk, who can come in with a good deal of force.  There was a feathery softness in her touch that wasn’t quite like anything I’d experienced before, surrounding me in the gentlest imaginable way.  I wondered if she might be defined as an angel.

One night in August, not long after my mother had been hospitalized and I’d been ill enough myself to make a trip to the emergency room**, I came home from an unusually long day of seeing patients in the western part of the state with my personal fuel gauge on E.  I’d been OK most of the day, but at that point I realized I had really done myself in and was in a state that was starting to get me a little worried.  It was hard to breathe and my chest hurt.  The angel or whatever she was made herself apparent and went to work on me right away.  Almost instantly I was out of the scary state and becoming much more comfortable, starting to feel normal again.  After a little while Fryderyk came in as well, and I was interested to see how distinct they were from each other.  Whatever they did, it put me completely to rights, and I was deeply grateful, especially since I was scheduled to go out to see my most fragile and difficult patient, an hour away out west again, the next morning.  I feel certain that I could not have managed that without their help.

I can hardly describe how momentous this was, despite my years of experience with Them.  What did I do to deserve this near-miracle?  How did I attract this wondrous being?  I have no idea.  I can only say that there is a kind of healing circle or chain in which someone supplies me with energy and I pass it on to patients and they pass it on to the people in their lives who are in need, and it goes on and on.

The next time I encountered this being, I tried my best to get a look at her and to ask who she was, but I got no insight whatsoever.  Within another week or so, I again had an energetic crash, not as bad this time, with the chest discomfort very prominent.  She touched a spot there  and the discomfort vanished instantly (and then was completely gone for weeks).  It didn’t even feel like she had done anything in particular.  Pretty slick!  By this time I was extremely curious, and I asked again who she was, dropping into a channeling state as best I could.

“I am she who is the embodiment of wisdom,” I heard.  Oh!  I thought.  Sophia!  I already knew someone who channels the goddess of wisdom.

OoooKkkk… here we are again with the same problem I had over contacting Kuan Yin.  A goddess.  Uh huh.  Right.  I don’t really know what to do with that concept.  Maybe something Mendy Lou told me when I described this experience will help, though.  She wrote, “But as for Wisdom, I think that it is not something that we can possess, but rather a thing which we allow to enter into us or perhaps come upon us….”  Maybe personifying Wisdom is not so strange.  But Sophia, as I am choosing to call her, seems very much a person in her own right rather than a personification.  I await further enlightenment on this matter– still, having made little or no progress with understanding it since I wrote about Kuan Yin and the beginning channeling class a couple of years ago.  I try not to worry about it too much.  I have Friends in High Places, and that’s worth a lot whether I understand it or not.

Wisdom and discernment are always needed and in all too short supply, but I think I can benefit from an infusion of wisdom even more than usual right now.  One thing I know is that I can’t run my batteries down to nothing all the time and expect someone to swoop in from the heavens and save me.  I still have to show some sense.  I am infinitely glad to know that They are watching out for me, though, and helping me to watch out for others.

Thank you.  Thank you.

*Information on Induced After-Death Communication can be found at the site of the originator, Al Botkin, http://www.induced-adc.com/ 

You may also want to look at my posts on IADC from March 2010.

**Nothing serious was found and they were able to reassure me a lot; my symptoms have been inconvenient and uncomfortable but there is no major threat to my health.

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Filed under channeling, health and healing, spirit communication, spirituality

“Equality Has Gone Too Far”?

“Women lactate, men dictate.” – Swami Beyondananda

My good friend Mike Tymn wrote a thoughtful response to my September 4th post, as he has often been so kind as to do.  You can find it in the comments.  I was going to reply in another comment, but so much related material has appeared in the news recently that I’ve decided to add another post.

Mike asked why gay people feel the need to get married, as opposed to just living together, especially since marriage seems to be less important to straight people these days.  “Why is it so important to gays, other than the tax advantages? If that is the case, why not let brother and sister living under the same roof marry so that they, too, can get a tax break? Or father and son living together? Where do you draw the line?”

The first question is very easy to answer.  It’s a matter of being treated as human beings like everyone else.  I used to have a similar viewpoint to Mike’s, that civil unions or some other legal framework would be fine, as long as the financial and other rights were the same as marriage.  I imagined that if such a system could be put in place, the fight over the issue of marriage itself might settle down, and people might be able to get on with their lives.  But it became obvious to me over time that marriage, as such, called by that name, is crucially important to an awful lot of people.  People want to make that public commitment to each other, and they want to feel that their families, friends and the larger society recognize it.  They may fail at being married, and same-sex divorce does come along with same-sex marriage, but they want the same chance as everyone else.  Or as some wag put it, “Gay people should have the same opportunity to be miserable as straight people.”

I’m fine with Mike’s idea of family members forming an economic unit that would bring them tax advantages– though they already have rights to inherit and such that are unavailable to unrelated couples outside of marriages and civil unions.  When my daughter was a teenager, she suggested that pairs, or even groups, of friends ought to be able to form units similar to marriages too.  As the population ages and we especially have more and more elderly women around (see that longevity contest above), perhaps we could develop some kind of framework to make it easier for people to band together for mutual support.

Mike brought up another point that is perhaps a bit stickier.  “As with racial equality, I think gender equality has sometimes gone too far in the other direction,” he wrote.  “Sports is a good example. Seemingly, equality should mean no separate divisions for women, i.e., they should compete with the men, just as they want to in the workplace.  But, no, equality means having separate competition for women. That’s all well and good, but why should prize money be equal for women, as so many women argue in my favorite sport, long distance running?  As an example, the Boston Marathon offers equal prize money to the top 10 men and top 10 women. But there might be 200 men finishing ahead of the 10th place woman and 190 of those men will receive no cash prize.  Is that equality?  It is certainly good for sport and good for the health and fitness of the nation, to have separate categories for men and women, but I think the reasoning conflicts with the reasoning in the workplace. In other words, women don’t want to be treated differently in the workplace, but where they are not equal they do want to be treated differently.  It makes sense, but it doesn’t make sense.”

Frankly, I think it makes perfectly good sense, and while the above strategy may not produce absolute, ultimate fairness, I think it is the best solution available.  No one is arguing that men and women are physically the same.  While individuals vary greatly, and some women are bigger and stronger than some men, in general men are larger and have more muscle mass.  Providing equal opportunity in sports takes that fact into account.  If a contest were held that gave prizes to those who lived the longest, or those who could survive longest without freezing to death, on average women would win handily.  Expecting women to lift the same weights, etc., as men would make no more sense than expecting men to lactate (which, to be fair, they can do under certain circumstances, but it sure ain’t easy).  I doubt that Mike or most other athletes would want to return to the days, not so long ago, when women could not even enter the Boston Marathon.  And there’s no reason to keep men out of synchronized swimming, either– nor my own “sport” of belly dancing, where a few of them are doing some quite interesting work these days.

Soon after Mike wrote, I saw an interview with Billie Jean King, and then the following article:
http://msmagazine.com/blog/2013/09/10/the-king-and-her-court/.  Among many other things, it addresses the extreme disparity in earnings between the genders in sports.  One thing  we see is that a lot of promotion and education was necessary to find sponsors in order to get that prize money going:
‘And her feminism only grew when Wimbledon became an “open” tournament (with prize money) in 1968 rather than remaining “amateur” (or “shamateur,” as players still received money under the table). After winning the 1968 Wimbledon singles title she learned that while she was given a check for £750, men’s champ Rod Laver earned £2,000. Talk about “that’s not right.” [Which she had thought at age 12 when she realized that most of the players were white.] Some tournaments had a male-female prize ratio of as much as 12 to 1 in those days.
‘Next thing you know, with the guidance of Gladys Heldman, the founder of World Tennis Magazine, a group of 9 women players formed their own tennis tour in 1970, the Virginia Slims Circuit, and worked like crazy on-and-off court to gain sponsors and an audience.’

And the rest is history.  Lack of equality and opportunity in the non-sports workplace is typically quite a different matter.  Most jobs these days do not depend on size and physical strength, and for those that do, such as firefighting, many women are able to qualify.  In my profession, there is absolutely no reason that gender should determine anything at all; men and women are entirely equal in their ability to be healers, and in general we charge and receive similar compensation per treatment.  Even when we are discriminated against as a group (as when Medicare refuses to recognize us, or when Presbyterian Health Care pays us 30% less for acupuncture than other insurers), that has nothing whatsoever to do with whether we are male or female.  We move forward or backward as an entire profession, all together.  That’s exactly as it should be.

But none of that is quite what I was talking about in my post on misogyny.  I was complaining that women are still raped, beaten, killed, and in every way disrespected around the world, every day, typically with complete impunity.  And women are judged and criticized for the shape of their bodies in a way that men rarely are.  For example, a disgusting button directed at Hillary Clinton was available at the California Republican Convention a few weekends ago.  It read, “KFC Hillary Special: 2 fat thighs, 2 small breasts… left wing.”  You may have noticed, also, that no matter what Hillary wears, she’s not OK– either her pantsuits are too covered up and frumpy, or her blouse is unbuttoned too far and she’s not frumpy enough.  This is par for the course for prominent women, and it simply does not happen to men in the same way.

Back to Suzanne’s question about the differences in the way women are treated in various countries, and the possible reasons for that.  Jimmy Carter is working on a book that takes up this issue.  “I am convinced that discrimination against women and girls is one of the world’s most serious, all-pervasive and largely ignored violations of basic human rights,” Mr. Carter, 88, wrote in his book proposal, adding: “It is disturbing to realize that women are treated most equally in some countries that are atheistic or where governments are strictly separated from religion.”
http://www.dailykos.com/story/2013/09/19/1239894/-Jimmy-Carter-To-Pen-Book-On-Global-Abuse-Of-Women-And-Religion-s-Negative-Impact-Videos

A friend of Suzanne’s, when she asked the question that instigated my other post, actually suggested that the fact that the US is a Christian nation, so that God loves us more, is the reason that things are better here for women.  Um, no.  Although if we were following the earliest Christianity, or the behavior of Jesus himself, women would have leadership positions within the Catholic Church and other sects.  Religion does not have to include discrimination, and the most enlightened religious leaders have not made it so.  Even Muhammad changed divorce laws to make them fairer to women.  But somehow as time goes on, the tradition of suppressing women always seems to reassert itself, and I return to my hypothesis that it is driven by fundamental biology and so is difficult to get rid of.

Another telling presentation that came up was a set of shockingly sexist ads from decades ago:
http://www.purpleclover.com/money/694-sexist-ads/  They’re hilarious, but deeply disturbing, full of images of wives and girlfriends flattened on the floor or kneeling in front of their lord and master.  One of the ads even asked, “Is it always illegal to kill a woman?”*

Much bias is so pervasive and institutionalized, so much part of our everyday background, that it becomes invisible.  A while back I picked up an application for the Manzano Mesa Multigenerational Center.  The 50+ application (sigh) asked whether I was disabled or frail.  It also asked whether I was a female head of household.  ??  Not sure on that one; some years ago my family voted me “queen,” agreeing that they wanted me to be the main decision-maker.  Bob’s is the first name on the tax documents and the mortgage, though.  One way or the other, the assumption is that heads of households are always male, unless there is no adult male present.  Why is this the default condition?  I can’t really think of a solid reason for the modern world.

Meanwhile, bigotry marches on.  (I’m not going to address the question of racial equality here; anyone who looks around for a few moments can see that it’s still a huge issue.)  Vladimir Putin, continuing his tragicomic standup act, made a pronouncement that masterfully combined misogyny and homophobia into one nauseating mess when he said that Italian prime minister Silvio Berlusconi wouldn’t have been prosecuted for having sex with a minor if he’d been gay.  Around the same time, Selena Gomez was banned from performing in Russia because she had expressed support for gay rights.  Yup, she’s seriously dangerous.

*Well, yes, unless it’s like that recent case in which a man was acquitted of murder even though he had in fact killed a woman, although, to be fair, he said he didn’t mean to kill her– that makes it OK, right?  It seems that she was a professional escort that he had hired, and when she refused to have sex with him, he felt within his rights to shoot her because, in his view, she was stealing from him.  ‘Cause $150 is totally worth taking a life for, especially if the victim is a thief or scammer.  She lived, paralyzed, for months before succumbing to her injuries.  http://voices.yahoo.com/man-kills-chaste-craigslist-escort-acquitted-under-12185381.html

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