Does it have to be a circus every time?

One of my doctors routinely orders labwork through a big local diagnostics center. Let's call it Enigma Phlebotomy Incorporated.

Theoretically, Enigma Phlebotomy serves our area through a number of participating hospitals and small lab centers. You're supposed to go on the Enigma website and punch in your zip code to find the "service center" nearest you. I've done this a couple of times and always gotten two results: a tiny hospital down the street from my house and a little lab in a strip mall.

I used to go to the little lab in the strip mall for bloodwork that doctors had ordered through them specificially, but when I'd show up with an Enigma order they'd say, "This isn't us." That's when I started trying at the tiny hospital, with mixed results. The hospital channels you directly to a registration desk inside the front doors, where your insurance info and script are taken before you're given a number and allowed to proceed any further. Yesterday the registration clerk (who was coughing and hacking uncontrollably, by the way*), told me what I'd been expecting...that they didn't honor Enigma scripts.

Since I hear this every other time I go, I was prepared with the printout from the Enigma site listing them as a service center. She glanced at it and made some phone calls. Long story short, they went ahead and did the hour and a half of labwork, but it was a struggle every step of the way. The registration people had to call my doctor for a different script. They told me that the phone number that Enigma listed as their hospital number went to an unanswered phone in Sterile Supply. People kept poking their heads in as I was getting my blood drawn to give updated orders and information.

I'd been fasting, had one hell of a headache, was not looking forward to drinking the nauseating diabetes-test stuff I knew I'd have to drink (it tastes like Triaminic cough syrup, and you have to chug a bottle of it in 5 mins), and just wanted to get my stupid bloodwork done.

Now I guess the onus is on me to call Enigma and see what's up regarding their service centers in this area. I'm guessing that they will just as steadfastly declare the hospital's participation as the hospital steadfastly denies it, and that we'll get nowhere. I keep telling my doctor's staff that I need the labs ordered differently, but they keep sending Enigma orders. If I can't get it sorted out, that means a 45-minute trip to an inner-city area every single time I need bloodwork. And I can't drive.

I just want to go to a lab, sign in, get my bloodwork and go home :( That doesn't seem like so much to ask.

Not an unbearable amount of frustration, but more added to the mix.



* working sick is not uncommon in hospitals, where resources are stretched thin and percieved shirking is frowned upon. I once worked a Fourth of July evening shift with a 104 degree fever, completely delirious, because our policy was that if you couldn't find your own replacement you had to work. None of my coworkers were willing to give up their holiday off, and that's how I ended up at work. I remember nothing about that shift. The official story given out by hospitals now with the H1N1 scare is that fevered workers need to stay home, but given my personal experience, I doubt that's how it actually goes. Sounds good to the public, though.

OCD and Depression

As with everything else here, what I say is more of a personal experience thing than a Learnèd Authority thing. I think that the bigger the pool of honest shared experiences is, the better.

Joey Ramone, OCD sufferer and an unofficial patron saint of mine, used to complain to those close to him: "I've got a lotta stuff I can't fix." It bothered him, and I know why because it's something I deal with too.

It sounds a little pejorative to call it "obsessive", as in "it puts the obsessive in obsessive-compulsive". To me, that conjures up images of bug-eyed psychotic stares, unfathomable pettiness and wildly erratic behavior. My parents had an almost irrational fear of obsession and raised me in an atmosphere of tight neutrality; too much interest in or excitement about anything was considered obsessive and undesirable. So it's weird that I'd end up with an issue that has such a negative label to me on a gut level. I don't feel any more obsessive than I feel like a rampant arsonist or an unrepentant shoplifter or anything else our parents taught us was a bad thing to be.

The "obsessive" part of OCD isn't some sort of scary psychotic mania. Rather, it's a memory that you can't get rid of, or a gap in your memory that nags at you. It sticks to you and you can't flick it away and trust that it'll stay gone. It's some experience you have that gets red-flagged in your memory, and then put in a frequent-reference file where it can't be discarded. No matter what else you're trying to do, you keep consulting the file to see what it was that went wrong.

I believe that it's the quiet urge behind the classic OCD "compulsions". You're getting ready to go to bed for the night, and you try to remember if you turned off the broiler after you made those steaks for dinner. When you try to access recent experiences regarding the broiler, you pull up the mental picture of turning it on, seeing the hot coils in the oven, flipping the steaks, feeling the heat on your face. But when you look for the memory of whether or not you turned the broiler off, it isn't there. You're sure you turned the broiler off, but the fact that you don't remember bothers you. Maybe you didn't; you've left the stove on before and caught it minutes later.

So you go back and check the broiler. It's off. Satisfied, you turn away and try to access the memory of the knob turned to "off", just to reassure yourself. But the memory isn't there. Again, you see yourself turning the broiler on, seeing the coils, feeling the heat, but there's no followup where the knob points to "off". But didn't you just check? The fact that there's a gap in such short-term memory is unnerving. You turn around, just to make sure the broiler is off, and it is. You turn back, and the memory of it being off is gone. And that's how the behavioral loop gets started; when you try to satisfy yourself that the problem is now "fixed", the red flag on the file is still there.

Day-to-day, it's merely annoying. I don't understand why the critical gap in my memory is always of the most dangerous possibility...as in, why do I always remember plugging hot rollers in, but never unplugging them? Joey Ramone once got off a plane in London and became horrified by the thought that he might have left his apartment door unlocked in New York. He became so worried that he was ready to turn around and head back to New York immediately; he had to be talked down.

I know the feeling. God help me if I try locking my door, test it and it opens...that resets the whole experience, and I know that every time I try to access the memory of locking my door I'll see the knob twisting in my hand and the door opening instead.

Anyway, that's the mechanism, and as I said it's usually irritating at worst when you're talking about day to day events. But the problem is, not only the little stuff gets red-flagged. When there's a negative or traumatic event in your life, that gets red-flagged too. To throw another analogy at it, it feels a little like being stuck on a racetrack and hitting a pothole of wrongness over and over again. You keep reliving the experience, and desperately trying to fix whatever it was that went wrong to make things right somehow. If things were only "right", maybe you could finally move on.

So you try to patch that pothole, but with every additional negative experience associated with the event, it just gets bigger. You hit the ever-expanding pothole of wrongness over and over, and each time the jarring is a little rougher and unsettles you a little more. Soon it's so big you can't swerve to avoid it. And maybe it's something you can fix, or something you need help to fix and someone else isn't willing to meet you halfway. It gets to where you see the pothole coming, you know how much it's going to suck when you hit it, and you get sad and resentful that you can't seem to patch it enough to satisfy your brain.

Meanwhile, in Saneville, all anyone sees is that you're stuck on something that is no longer important to them.

It sucks. And OCD sucks.

Overheard...

...and quite against my will, but the people involved were shouting their conversation.

Turns out that someone (don't know who) couldn't have cancer because:

"I know a woman has breast cancer and had a vasectomy. She didn't have not a stitch of hair on her head."


Simply too much information to process, right? Anyway, I've learned something new. A couple of somethings!

My "disappointment in humankind" moment for the day...

I was standing in the fountain drink line at Chipotle, waiting for the guy in front of me to finish so I could get my drink. He finished and stepped away, and I stepped up with my cup out for the ice. At that moment, a boy of about 8 or 9 barged in from the side with his own cup as if I weren't even there.

He took his time making some sort of lemonade concoction, going back for more lemonade, more water, more ice. Every time I said "excuse me" and stepped forward to get my own drink, he casually edged me back out of the way, still ignoring me completely, and added lemon wedges and sugar packets. I stood and watched as he individually stirred in 10 sugar packets, then suddenly needed more ice as soon as I tried to edge back up.

It was all very rude and obnoxious, even for a kid as he was definitely old enough to know better. I was sort of standing there in disbelief, wondering what sort of upbringing might have been responsible for this, when I was shoved out of the way from the other side by his mother, intent on getting her own refill. Yes, shoved. The woman shoved someone with an obviously advanced pregnancy aside to get a refill on a stupid fountain drink. Then, as I tried to edge in again (because I was dumb enough to follow the rules and wait in line?), she stepped between me and the counter to supervise her son in a very leisurely lid selection.

There was a very obvious line for the drinks, and neither mother nor son was in it.

And that was my "disappointment in humankind" moment for the day.

Four years and three children later...

...we're finally engaged.


We have no immediate plans, mainly owing to my bizarre life-situation and the necessity of doing everything correctly to avoid losing healthcare coverage. In my situation, that would be absolutely catastrophic.

If I were a little more bitter, I would add that to the list of things my cancer has taken from me...the ability to celebrate life and love without worrying about what it's going to do to me healthwise, and the ability to make decisions that aren't dictated by health needs. But bitterness won't change that, so we have to get through as best we can.

Some interesting logic from my local medical center.

I was rushing around this morning when the phone rang. My local hospital's business office was calling to argue with me over a medical bill that had been going back and forth for a month or so.

I had some pregnancy-related labwork there. They said Medicare wouldn't cover it, which I'm fine with and used to because your average Medicare patient isn't pregnant. So I signed an ABN, which is a paper that says the patient acknowledges that Medicare may not pay this amount. I signed it because I have supplemental insurance that WILL cover pregnancy-related issues, and I knew that the bill would bounce over to them. And I gave them a copy of the supplement card. And they ran it through their system.

So then I got a bill for $111, the amount of this test. And I saw on the bill that Medicare had been billed but the supplement hadn't. So I made another copy of the card and sent it in, with a note that said "please bill this supplement, they should cover it."

Then another bill came telling me my $111 was overdue. The supplement still hadn't been billed. And I called and left a message saying that I had sent in a copy of the supplement card and please bill that.

Yesterday, a bill on their special canary-yellow paper telling me I was really in trouble now. So I called their business office and left another message saying please call me back so we could discuss this.

So when the woman called this morning, I tried to explain. I had my card out ready to read the number to her again. I told her that on none of these bills was my supplement ever billed, and the whole reason I had the supplement was to cover this sort of testing that Medicare wouldn't pay for. And the woman was just absolutely inflexible. She kept telling me that I had signed a paper, I had signed a PAPER. And I kept telling her that I knew I'd signed a paper, and I did because I had this supplement that would cover the test.

And that's when she came up with the real gem:

"If Medicare isn't going to pay it, the supplement isn't going to pay it."

Really? Really? Because I was under the impression that the whole point of supplemental insurance was to help pay what the primary insurance would not.

And that was her reason that the supplement had never been and would never be billed...if Medicare wasn't going to pay it, the supplement wouldn't, therefore they wouldn't even bother billing the supplement. She bulldogged me until I had agreed to a payment plan to pay off this stupid $111.

There is something very wrong with this. I am not very happy.

Another good resource on grief....

I was poking around and found an organization called "Now I Lay Me Down to Sleep", which provides the wonderful service of professional photography for grieving parents.

Of course, there is an element of self-protection that kicks in when I deal with anything remotely touching the subject of my daughters. As I initially clicked the link, knowing full well I was going to see pictures of infants who were dying or had just died, I was hearing that mistake guy from Scrubs in the back of my head. But it's ok.

I'm not an expert on grief, only on my own experience. I've dealt with others' grief since and it's so personal, varies so widely, that there's no way anyone could call him or herself an expert. Grief can be stoic or it can be twisted, damaging and ugly; it can be gentle and sad or it can be wild, vicious and angry. "Stages" don't happen in some neat procession. It's unreasonable to expect it.

And I guess it's unreasonable to expect those around the grieving person to behave appropriately. I didn't know what I should be expecting from other people, but I understood that sometimes people say thoughtless things without meaning to and I didn't especially hold it against them. Some people do seem to have full cognizance of what they're saying, and I don't know that I'll ever be able to forgive them. Case in point, a woman who asked (almost immediately after my infant daughters died), why any money was wasted on a funeral. Why didn't I just have the hospital throw them away?

That's the sort of thing that settles into a bitter spot in your heart and you can't really control your own emotional reception. You can just try to get through it...in my case, I tried very hard to realize that this was an aging woman, whose filter that normally kept selfish inappropriateness at bay was wearing away. Such feelings and attitudes are not unprecedented for her personality. But no, I can't and won't forgive her for suggesting that the practical thing to have done would be to chuck the bodies of my infant daughters in the trash. I don't think anyone should expect me to.

I've seen from past blog stats that people come here looking for answers on how to deal with the death of a child, and with that in mind I would like to share this .pdf I found on that website. I particularly like the dos and don'ts on pages 13 and 14, although you should know going into this that the author is writing from a Christian perspective and there are lots of Christian references.

Helping Bereaved Parents

I hope that helps out somewhat.