HAVE YOU HEARD THE ONE
ABOUT THE CANDOM COTHETER?
Journal of Healing – Oct. 30, 2002
By Mary Koch

When the phone rang, I glanced at the clock. Dinner time. Must be a telemarketer. To my surprise, it was a nurse from the doctor's office, catching up on paperwork.

She was reviewing the list of medical supplies purchased for my husband. For several weeks, she's been stumped by one item on the list: adhesive remover wipes. She'd called me once before and even referred the list back to the supplier. Why does he need adhesive remover, she asks. He doesn't, I answer.

John uses skin barrier wipes, which come in packages identical to adhesive remover wipes. Obviously someone somewhere along the line got the two confused. He needs the barrier wipes for use with a condom catheter.

Just like the astronauts in outer space, people who are paralyzed like my husband have high-tech solutions for bathroom issues.

The nurse repeated my words slowly as she wrote: "Skin . . . wipes . . . for . . . candom . . . cotheter."

"No," I said. "That's CONdom CATHeter. Condom, condom, condom. Just let it roll off your tongue. We weren't raised to use such words, but they're part of everyday life around here."

She gave a little laugh and confessed: "I'd never even heard of them until I went to nursing school."

* * *

A RECENT ISSUE of "Stroke Smart" magazine quotes Hollywood writer and producer Bary Kemp saying, "Comedy is a way of processing tragedy." I find it a way of processing the absurdity of our health care system.

With that last bit of confusion cleared up, the doctor could now sign off on the skin wipes. But I had another question: Why was the doctor's approval needed every time we replaced the same supplies that we'd been using for nearly eight years ?

"Oh, we do it all the time," the nurse assured me. "It must be important."

"No, it's not," I said. "It's not important. It's ridiculous. You should be taking care of patients, not doing paperwork."

Actually, by that time of evening, she should have been home in the bosom of her family, not grinding away at meaningless insurance documents. It's that kind of stuff that gobbles up 30 percent of the health care dollars in our country. Or more.

* * *

MARCIA ANGELL, former editor in chief of The New England Journal of Medicine, wrote a piece in the New York Times describing what happens to the health care dollar:

"Private insurers regularly skim off the top 10 percent to 25 percent of premiums for administrative costs, marketing and profits.

"The remainder is passed along a range of satellite businesses — insurance brokers, disease-management and utilization-review companies, lawyers, consultants, billing agencies, information management firms and so on. Their function is often to limit services in one way or another. They, too, take a cut, including enough for their own administrative costs, marketing and profits.

"As much as half the health care dollar never reaches doctors and hospitals — who themselves face high overhead costs in dealing with multiple insurers."

An example of that high overhead is the nurse spending precious time verifying for the insurance company that John really needs those wipes. Fifty wipes (seven weeks' worth) cost $12.95, minus the insurance company's $3.37 "preferred provider adjustment." After deductibles, insurance will refund, at most, $7.66. All those phone calls and all that paperwork for less than eight bucks.

Anybody know any good condom jokes?

SOME ARE MORE
EQUAL THAN OTHERS

Journal of Healing – Oct. 23, 2002

By Mary Koch

Superman is back. Christopher Reeve, our country's most famous quadriplegic, has been making a number of media appearances, timed to coincide with the release of his latest book.

Do I sound envious? That's because I am. I happen to think my husband is just as much a superman as the good-looking movie star who was paralyzed in a horse-riding accident.

I am not alone in my envy. The disabled community views Reeve's achievements with mixed emotions. Stacy S. Chastain, associate publisher of the News Observer in Blue Ridge, Georgia, said it very well in a recent column:

"I look at Reeve and his family with a great deal of respect. They have raised awareness about medical research issues and have raised awareness for those who are paralyzed. They have raised millions of dollars to help. I would be lying if I didn't admit much of my enthusiasm for Reeve's accomplishments is tinged with a little bitterness and skepticism. Both emotions are directed toward the healthcare system, not at Reeve himself."

* * *

STACY AND I have a lot in common. We're both small-town journalists. We both have husbands with "Locked-In Syndrome." Their minds are locked inside a body unable to move, speak or eat as the result of a brain stem stroke.

There the similarities end. John was nearly 62 at the time of his stroke eight years ago. Stacy's husband Jimmy was half that age when his stroke hit last November.

It isn't always easy, but we have found the financial resources for John to live at home and benefit from on-going therapy. Stacy is forced to entrust her husband to a nursing facility several hundred miles from their home and her job. Jimmy's care has been marginal to the point of life-threatening and therapy non-existent.

Stacy notes that Reeve's daily regimen includes hours of exercise each day with specialty equipment.

"My husband would benefit from similar exercise routines and therapy, but he doesn't really have access to the treatment," she wrote.

"Over the last 10 months, Jimmy has been blessed to regain some control over his head; to be able to move his right biceps muscle, thumb and middle finger; and to be able to wiggle a couple of toes.

* * *

"EACH MOVEMENT is a phenomenal accomplishment, but it isn't enough. The improvements are not enough medically to justify the cost of rehabilitation therapy.

"Jimmy's major improvements are viewed as no improvements. Therapists can't justify working with someone who can't improve by their standards. If the person can't improve by the standards, they don't get paid for their service.

"Health care is pretty much like any other business. If you have money, you get service. If you don't have money to pay for the services on your own, it is an interesting maze of arguments, appeals and battles at every turn."

Interesting maze? To say the least. What Stacy has been through on behalf of her husband has been more like a nonstop nightmare. Yet she concludes:

"Just as Kryptonite weakens Superman, the barriers established by the health care bureaucracy trap people in the system and often bar people from access. But, just like Superman, people find the strength to overcome these challenges."

Stacy omitted one cogent fact: Jimmy is a war-time veteran. It is the veterans' system that is (not) providing his care.

ENJOY THE BLESSINGS
OF AUTUMN
Journal of Healing – Oct. 16, 2002
By Mary Koch

Don't you just love this time of year?

It's me — Sadie, the people dog — who's asking. Of the five seasons, there's only one I like better than autumn. Y'know — there's autumn, winter, spring, summer and best of all, Dog Days.

Of course, if you're a dog, every day's a dog day. Every morning, dogs wake up and say, "Thank God, I'm a dog." Dogs who have been over-bred get that turned around and think, "Thank Dog I'm a god."

Either way, we dogs are satisfied just to be alive. Humans aren't like that. Most of the time they're too busy worrying about tomorrow to enjoy today.

Maybe that's why they don't understand what's so great about Dog Days — the sizzling hot days of summer. To enjoy Dog Days, you gotta stretch out in the shade, soak up the heat, and do nothin'. Ab-so-lute-ly nothin'. You interrupt your naps only on account of meals.

But humans continue to rush around in their air conditioned houses and offices. If they go out, they drive in their air-conditioned vehicles. What's the sense of going somewhere in the car with the windows rolled up? You can't hang your head out and smell the millions of aromas flying past your nose at 50 mph.

I'm sure people would enjoy Dog Days more if they'd learn to drool. Drooling is cooling.

* * *

AS MUCH AS I enjoy Dog Days, it's good to get on with autumn. The air conditioning's off, The Boss and boss lady are venturing out of the house again, and the windows are down on the van.

We're getting back to the exercise routines that were abandoned when the thermometer got stuck at 90 plus. The Boss is driving his wheelchair around town on these mellow, autumn afternoons. He even made it through the automatic doors at Gene's grocery without getting stuck sideways — the way he did last spring.

The boss lady has been a little more, shall we say, faltering about resuming our morning walks. The walks were interrupted when she broke her toe. That was months ago. The toe is fine now, but she's got more excuses than a butcher shop has bones: it's either too late or too early, she's too busy or too tired. Yaddah, yaddah, yaddah.

* * *

I HAVE MY ways of getting her to move. I plant myself at the door and give her the look. You know that look. It's the reason why we springer spaniels have those melt-your-heart, dark brown eyes.

"Remember," my eyes tell her. "You're exercising for two. How are you gonna take care of The Boss if you don't take care of yourself?" Dogs know how to motivate through guilt.

I'm continuing with my personal exercise regimen. I get a great workout chasing sticks in the river. I don't stop until I'm soaking wet and exhausted, with just enough strength left to crawl up on the boss lady's bed.

Which reminds me. That's another reason I love fall. It's the season when I go to church. Humans, they tell me, have to go to church every week. Apparently that's because it doesn't take.

We animals go just once a year — on the Feast of St. Francis in October. Francis is, among many other things, the patron saint of animals. So that's when we get blessed.

And I know it lasts. Every night when the boss lady comes to bed and sees me there, all stretched out and comfy, she says, "That blessed dog!"

GIFTS THAT GO ON GIVING – AND TAKING
Journal of Healing – Oct. 9, 2002

By Mary Koch

"That's a neat story. You ought to write that," my walking partner said as we circled the track.

The morning of our walk had erased any ambivalence about fall. It was here. Frost had hit. A bright sun provoked the lazy Okanogan River to blow steam into the chill air. Our conversation was about preparations for winter. I boasted of having two-and-a-half cords of firewood stacked up.

"Oh, you really use your fireplace," she remarked. And I told her the story of our fireplace insert.

Our old house with its many windows is difficult to heat. When John and I moved in 18 years ago, our electric bills threatened to outpace the mortgage payments. I still couldn't get warm.

We discussed wood heat and agreed on a fireplace insert as soon as the budget could handle it. Secretly, John put the project on a fast track. It was just before Christmas, and we were arriving home from a snowy trip to Seattle.

Chilled and tired, I walked into the house, surprised by an enveloping warmth. "Gosh," I thought. "This house is finally beginning to feel like a home." Then I walked into the living room. John had arranged with our friends Marilyn and Richard to have a fire burning in our new fireplace insert along with two glasses of wine, poured and waiting. Merry Christmas.

* * *

THAT'S THE STORY my friend wanted me to write. But there's more.

As a married couple and as business partners, John and I have always been equals. No gender roles. So if we were going to heat with wood, I was equally responsible for splitting it. Trouble is, when I hoist an ax in the air, it's likely to come down most anywhere except on target. Unwilling to risk seeing an ax implanted in his wife's foot, John found another gift for me: the "slam splitter." It's a combination maul and wedge that any fool can operate without endangering life or limb.

Now in winter, when I'm outside slamming away with my splitter, I smile at how clever my husband was. Paralyzed by stroke, he can no longer split wood. But he can still bask in the warmth of a fire because he empowered me to keep the wood coming.

Now, in addition to being John's wife and business partner, I'm his caregiver. Well, most of the time I'm called a caregiver. Occasionally someone will refer to me as a "caretaker." Either is correct. Both give and take are essential.

* * *

THE EVENING after my walk, John and I were having a disagreement.

"You can be a real pain in the neck sometimes," I told him.

I know. You're appalled. How could anyone talk like that to someone who is totally paralyzed and unable to speak?

I said it because it was the truth, although I'm probably misquoting myself. He was being a pain, but I probably referred to another body part altogether.

The problem with telling the truth is, you have to tell the whole truth. Inevitably, my next statement was: "I can be a real pain in the (neck) a lot of the time."

John did not disagree with either statement.

So he's paralyzed and can't talk. That doesn't automatically make him a saint. So I take care of him. That doesn't make me a saint either.

We're like any husband and wife, working on our relationship. Giving and taking.

WHAT MANNER
OF DOCTOR IS THIS?
Journal of Healing – Oct. 2, 2002
By Mary Koch

Alas, it is again time for another interview with Dr. Schlock. We apologize to readers who are confused about Dr. Schlock's credentials. Allow us to clarify that Dr. Schlock is not a medical doctor but a commentator — someone who has a great deal of expertise in areas of little or no significance.

Journal of Healing: Dr. Schlock, there have been news reports lately about medical schools putting more emphasis on teaching bedside manners to future doctors. What do you think of that?

Schlock: I think it's long overdue.

Journal: Will it improve the quality of patient care?

Schlock: Patients, schmatients! We're talking job security for docs. The way things are going, they're the next endangered species. Bedside manners could be all that separates doctors from their competition.

Journal: What competition?

Schlock: The World Wide Web. You can log on to the Internet, answer a few questions and get a diagnosis in less time than it takes to find a readable magazine in the doctor's waiting room.

Journal: How much does it cost?

Schlock: No charge. And no insurance forms to fill out.

Journal: Sounds too good to be true.

Schlock: You shouldn't be so cynical. It's a public service. Take for example, the GAD test.

Journal: GAD?

Schlock: General Anxiety Disorder. You go to the Paxil site on the Internet and take a five-question test to determine if you may be suffering from GAD.

Journal: Only five questions to determine if you have a mental disorder? Isn't that trivializing a serious problem?

Schlock: They call it an indicator. Depending on how you answer the questions, you're told you MAY be suffering from an anxiety disorder. There's also the SPIN test — the Social Phobia Inventory. It's a little longer — 22 questions, including your zip code.

Journal: Why would they want my zip code?

Schlock: Who knows. Anyway, there are also tests for panic disorder and PTSD . . .

Journal: Wait a minute! Isn't Paxil a drug used to treat these problems?

Schlock: That's what's so great about it. You go to your computer, take the test and you know right off the bat what medicine you need.

Journal: But don't you need a doctor's prescription?

Schlock: Of course, and the web site says taking the test is not a substitute for seeing a doctor. But you know how we Americans love to buy stuff wholesale. It's only a matter of time before we eliminate the middle man.

Journal: Middle man?

Schlock: Doctors! We're already well on our way to eliminating local drug stores with the advent of mail-order drugs. Doctors will be next to go. Drug makers will sell direct to consumers. I can see it now: Drug factory outlet malls with a Pfizer shop and a GlaxoSmithKline boutique.

Journal: It seems as if these Internet tests are designed to sell more drugs.

Schlock: Drug company spokespeople assure us they're merely trying to raise public awareness — like with their TV commercials.

Journal: You don't say.

Schlock: Funny you should bring that up. Drug makers are discovering what they don't say can be important. The very drug we've been talking about, Paxil, is removing some words from its TV commercials.

Journal: What words?

Schlock: "not habit forming." The manufacturer got sued. A bunch of Paxil users said the drug-maker played down the severity of withdrawal symptoms for people who stop using the drug. The lawsuit's still pending, but . . .

Journal: . . . the company decided the less said the better?

Schlock: Guess I've said enough, too.