I am feeling sad and a little frustrated

I just got home around 11 pm from running errands and helping out a couple of friends, only to find a rejection letter in my mailbox for the library assistant position I applied for. Considering the position closed only last Friday and I've already gotten the letter in less than a week, I suspect they already had an internal candidate 'who met the needs of the position' better. And yes, I'm a degreed librarian, so I wasn't sure they would even consider me for the position, even as a part-time second job. But that's why I both e-mailed and left a voicemail for the director, to ask her questions regarding the hours and whether they'd consider someone with a master's in library science, because I didn't want to waste their time or mine, and all I got back was silence, until this very short, concise rejection letter.

I'm beginning to wonder if this time next year, after the hospital becomes an ambulatory care centre, and the library is phased out, if I'll even be able to call myself a librarian, or at least be working in a library. I'm getting pretty darn discouraged, as I apply for job after job without any sort of success. I have had my degree for 23 years, have had my position for 19--I have experience, but not enough supervisory experience, or it's not in the academic or public sector, so it isn't considered. And in those few cases where a medical library position opens up, I suspect they've been snapped up by younger and more recent grads, because the perception is somehow that they're more pliable and dynamic, even though I'm devoted to lifelong learning and have very good tech skills with emerging technologies. I might have better luck if I were to move away from our library school, but beyond liking the town I live in, there's the fact that my family and support system are here, and I include my friends in that, and they rely on me in many ways. And for all the talk of the greying of the profession and how so many Baby Boomers will retire soon, well, it doesn't seem to be helping me. I've never actually worked full-time in a library setting, beyoung internships, and only went full-time (with two different jobs) in my current position six years ago, when I was 43, so I've been underemployed for years, and searching for positions most of that time. As much as I love being a librarian, and the fact that it is something I am very good at, I am beginning to wonder if I should have taken this path, as I've struggled my entire career for stability, often working second or even third jobs, all the while having enough student loans to buy a house with. It's just so frustrating.

It's been a long day in general. I slept very badly last night, and was up for two hours in the middle of the night, and when I did sleep it was with weird dreams of being able to shape and manipulate any sort of rock, gem, sand, concrete, brick, etc.--but not dirt, due to the biomass. I was up by 5:30 or 6 am, and by 6:30 I was at the Kroger gas station getting $25 in gas, followed by an hour-and-a-half trip through the mega Kroger I live near, following a prepared list. The store's so big, and I had to ask several employees for things that weren't stocked yet, or other questions, so I got tired and quit at 8 am so I could run home, drop the things off, and head to work. I finished up a few things tonight at the Chinoe Kroger (which I prefer to go to, as it's easy to get in and out) tonight, after leaving YKWIA's house. I've also paid several bills and done a lot of running around with my friends, taking them on errands, too. I also worked on YKWIA's back, which was bothering him, and we watched and episode of 'Cybil' from years ago.

So now I'm home, I've eaten some bean burritos with cheese, and I'm very, very tired, but the type where you don't readily fall asleep. And yes, I feel bad about the rejection letter. I'm trying not to take it personally, of course, that would be a bit psycho, but at this point I'm wondering if I'm on some sort of list shared by librarians for something I'm not even aware of that prevents me from being hired. I keep trying to have faith that the right position is just waiting and will come along in time to save the day--but it's hard to keep that up for very long. I have 10 months left in my job. I'm starting to feel like maybe it's time to start panicking, and I'm especially afraid of losing my health insurance, especially with our new governor mucking with things like Medicaid and the Affordable Health Care Act provisions. I may have to use COBRA, which is very expensive, and I don't know if I'll be able to. And that's with 6 months of unemployment and (presumably) a severance package. Yeah, the panic's starting to set in.

I guess I should get ready for bed and try to get some sleep. Thank you for reading and 'listening'. I don't want to sound negative, but it's just been a rough day, and I feel better having written a little about it.

The system is broken; let's fix it

Creigh Deeds’s son, my daughter and my fears about Virginia’s mental health system

I was coming home from visiting my 11-year-old daughter at a Virginia psychiatric hospital Tuesday when I heard about the stabbing of state Sen. Creigh Deeds and the suicide of his son, Austin. According to some reports, the younger Deeds had been denied admittance to a psychiatric hospital the day before. I was heartbroken. This family was let down by the same broken mental health system my family depends on.

My daughter was diagnosed with bipolar disorder at age 8. When I checked her into Dominion Hospital on Nov. 15, I was grateful there was a bed available. She’d been having violent rages — punching and kicking me and her younger brother and trying to jump out her window. Although no mother ever wants to leave her child in a psychiatric hospital, I knew it was the safest place for her.

Deeds attack shows that our system is a mess

First some facts. Since the 1970s, we have been closing down state hospitals without providing adequate services in our communities to help people who are in the midst of a mental crisis. A 2010 report found that 200 individuals in Virginia who were psychotic and either dangerous or incapable of caring for themselves were "streeted" -- slang coined by emergency room doctors for when hospitals knowingly put a psychotic patient on the sidewalk.

This is a national problem. In Iowa recently, I was told that officials sometimes had to drive patients across state lines to find beds. In Seattle, which has excellent services, individuals can spend 24 hours languishing in emergency rooms until beds in a treatment center open up. Experts recommend that 50 psychiatric beds should be available per 100,000 residents. The national average today is only 17 beds per 100,000.

HMOs are partly to blame. Psychiatric beds traditionally lose money so HMOs have been closing local psychiatric wards in favor of more profitable surgical beds. In northern Virginia where I live, 24% of public psychiatric beds were shut down in 2005.

Our legal system hampers our mental health system, too. We demand a person become "dangerous to self or others" before parents and others can intervene. This forces families to wait until it's too late to get help. It's a reason why our jails and prisons have become our new asylums. Great Britain and France have a "need for treatment" standard that allows for earlier intervention but has safeguards built in to prevent abuses.

A Son's Death Reveals Chasms In Emergency Mental Health Care

Early reports said the family had received an emergency custody order from a judge on Monday, the first step in getting a person involuntarily committed to a hospital in Virginia. But then local health officials had to find a hospital bed.

For reasons that remain unclear, that didn't happen. The custody order expired, and Gus Deeds was allowed to leave a local mental health facility. The commonwealth of Virginia has launched an investigation into the circumstances, the Associated Press reported Thursday.

When space can't be found in a psychiatric hospital, Honberg says, "families are basically left to fend for themselves."

Nationwide, states have cut spending for treating mental illness in the past decade, resulting in longer waits for outpatient care and fewer inpatient beds.

A study by the National Association of State Mental Health Program Directors found that state investments in mental health dropped by $4.35 billion between 2009 and 2012. At the same time, demand for both outpatient and inpatient services increased.

By 2010, the number of state psychiatric beds per capita was down to levels not seen since 1850, according to the Treatment Advocacy Center, a group that lobbies for more access to care. That was when the movement toward humane care of the mentally ill was in its infancy, and disturbed people were locked in prison.

Starting in the 1960s, many psychiatric hospitals were closed because treatment in the community was considered a more humane and less costly alternative. But outpatient treatment can be difficult to find, especially in rural areas. And inpatient care is still needed, especially for people considered at risk of harming themselves or others.

Last year, the Virginia Office of the State Inspector General found that over a three-month period, 72 of 5,000 people who met the criteria for receiving a temporary detention order didn't get one because no facility could accommodate them. The report also says that while the state's population has increased over the past decade, the bed capacity for psychiatric patients has steadily decreased.

For more on mental illness and its effects on individuals and their families, be sure to check out NAMI (National Alliance on Mental Illness), an advocacy group.

Until we start treating mental illness on par with physical illness, without stigma, without decreased funding due to the perceived lack of profit, we can get nowhere in trying to help people. Although the mentally ill are actually much more likely to be victims of violence rather than instigators, we see every day on the news acts of mental illness. Mental illness fuels gun violence, substance abuse, homelessness, and suicide. If affects millions of people, from all walks of life, and many more when you factor in those whose lives are touched by a loved one's mental illness. Behind the statistics are real people, real families. We need to make sure people don't suffer because of system weaknesses. No one should live with the fear that a loved one will harm himself or another person. No one shoudl suffer from their inner daemons to the point where they can no longer function in society or become a danger. They need our help. An overhaul is needed. The Affordable Care Act actually took some strides in the right direction. But there is more to be done, and policy makers need to provide support for those at risk so that events like this become a rarity. At present the system is flawed and convoluted--we need progress and simplification. And there should be no shame attached to mental illness. We are way past the days of locking a relative in the attic. My interest is personal. I am myself bipolar, yet I function, keep down a job, etc., with the proper treatment. I've seen the crippling effects of mental illness in others I've been close to. Mental illness robs people's lives in insidious ways. We as a society must do everything to make sure that there is a safety net in place for those who otherwise slip through the cracks, and bolster what works, making good therapy and medical treatments available widely--including places where a person can safely stay during particularly rough episodes. And we need to bring the idea of family-centred care to mental illness treatment. So often, families find that mental illness either runs in the family, or their are familial issues which exacerbate any organic issues, such as past abuse or neglect. It's important for those around the mentally ill to understand the illness and be aware of warning signs. We would educate a family member or friend as to what to do if someone's blood sugar drops low, or if they have a seizure. Why do we not educate those caring for or who care for mentally ill persons about things like signs of mania or psychosis? That should be done, too. We have a long way to go, but I hope we get there.

Four hours and at least two downpours and a thunderstorm later...

I'm groggy, but I'm awake. I saw this and thought it was interesting:

The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures

Deirdre Yapalater’s recent colonoscopy at a surgical center near her home here on Long Island went smoothly: she was whisked from pre-op to an operating room where a gastroenterologist, assisted by an anesthesiologist and a nurse, performed the routine cancer screening procedure in less than an hour. The test, which found nothing worrisome, racked up what is likely her most expensive medical bill of the year: $6,385.

That is fairly typical: in Keene, N.H., Matt Meyer’s colonoscopy was billed at $7,563.56. Maggie Christ of Chappaqua, N.Y., received $9,142.84 in bills for the procedure. In Durham, N.C., the charges for Curtiss Devereux came to $19,438, which included a polyp removal. While their insurers negotiated down the price, the final tab for each test was more than $3,500.

“Could that be right?” said Ms. Yapalater, stunned by charges on the statement on her dining room table. Although her insurer covered the procedure and she paid nothing, her health care costs still bite: Her premium payments jumped 10 percent last year, and rising co-payments and deductibles are straining the finances of her middle-class family, with its mission-style house in the suburbs and two S.U.V.’s parked outside. “You keep thinking it’s free,” she said. “We call it free, but of course it’s not.”

In many other developed countries, a basic colonoscopy costs just a few hundred dollars and certainly well under $1,000. That chasm in price helps explain why the United States is far and away the world leader in medical spending, even though numerous studies have concluded that Americans do not get better care.

My biggest worry regarding the planned end to my job in two years isn't actually other costs; I'll get a severance and unemployment, and that will help some. It's the fact that I'll lose my health insurance that worries me the most.

One of the many things wrong with our health care system

A Hospital War Reflects a Bind for Doctors in the U.S.

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments.

But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons.

Today, Boise is a medical battleground.

Granted, I come from a mentality that thinks health care should not come down to dollars and cents, that it shouldn't be about big business corporations deciding who lives and who dies. Health care should be about saving lives, about people and their stories, their wellness and their quality of life. But that's me.

In the last couple of days, I've read two selections

from the same book. I must say, I think it would be good to read it, not just you or I, but the people who make policy, run hospitals, and generally have a business with health care.

The book is by Dr Marty Makary, is called Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care, and it was published this month.

Here is one excerpt:

How to Stop Hospitals From Killing Us: Medical errors kill enough people to fill four jumbo jets a week. A surgeon with five simple ways to make health care safer.

and here's the other:

Are Hospitals Less Safe Than We Think?

Found a super way to avoid sweets today;

Force myself to take my blood sugar first.

I'd eaten well today, but yet again forgot to take my Lantus last night (I just took it, though, in case you're interested). So my blood sugar was running high, I knew. I had two separate people point out that McGee's bakery had brought cake into the hospital, and I should go get some if I wanted it. Instead of going and scarfing down cake from one of the best bakeries in the area with buttercream frosting to die for, I decided to check my blood sugar.

368

Way high. Normal is about 60-120. Now granted, I didn't feel horrible--I'm used to being high. I actually felt shaky at about 189 the other day, even though that's not low.

Needless to say, I passed on the cake. I even went for a walk around the hospital to try to clear my head a little.

I love my doctor, and of course when I eat things I should and not things I shouldn't, it's a little better, but I'm beginning to think that I should actually go to an endocrinologist. I'll see if my A1c has improved at all next time. If not, I've already downloaded the names of the doctors in my network. I really think I would benefit from a little metformin added back into the mix. When I was on oral meds and insulin, my levels were actually normal, and I felt, well, so different.

I did make a couple of appointments today...one for a new podiatrist that was recommended by a co-worker, and another for a gynaecologist, as I need a routine pap smear. It's almost time for my mammogramme, too. Ah, the beginning of the year, when the flexible spending account is flush and the urge is to get healthy.

Another thing I learned from reading the book was just how fortunate it is that I have routine, preventative, and acute care through my health and dental insurance. It is the thing I fear losing most in terms of the job situation.

Good comes from tragedy, but how to sustain it?

Better care in post-quake Haiti, but how long?: Challenge is to make changes last, before attention, aid dollars wane

The 6-month-old baby boy was rushed to the field hospital near death in a donated ambulance, his body trembling in shock.

Before Haiti's earthquake, he wouldn't have stood a chance. His homeless 18-year-old mother could not have afforded even the 60-cent admission fee at Port-au-Prince's rat-infested general hospital.

But four months after the quake that leveled the capital, foreign volunteers, donated medicine and free hospitals are giving Haiti's impoverished people the best health care of their lives. Now the challenge is to make improvements permanent, before the world's attention and aid dollars run out.

A good visual

concerning special interests and their myths of rationed health care, from the AARP.



For more information, check out Health Action Now!

As much as I hear Americans complain about emergency rooms...

it pales to the situation in Japan, which has a doctor shortage:

Injured man dies after rejection by 14 hospitals: Case of 69-year-old man in Japan underscores country's doctor shortage

The worst case, according to the article, was a woman in Tokyo who was denied care 49 times. She, too, was elderly, although I don't know if that's a factor or not.

I'm appalled

YKWIA told me about this, and I was floored. I'm not a health professional, even though I work in a hospital. But I know you don't reuse needles without exponentially increasing the risk of Hepatitis B and C and HIV transmission.

So how could normal, licensed health professionals either not know to do this, or had such disregard for human life that they did it anyway? We're not talking about somewhere in a Third World country. It happened in Las Vegas.

Vegas Clinic May Have Sickened Thousands

40,000 people have been told they may have contracted a disease through this clinic. That's a good-sized town's worth of people.

Hepatitis C is the greatest concern, because it's not curable at this point, can damage the liver to the point of death, and is far easier to get than HIV.

Staff have apparently said they were told to reuse syringes as part of an unwritten policy. That doesn't let them off the hook. The moment they were told that, they should have resigned their positions and blown the whistle on the centre.

Amid hepatitis scare in Nevada, 5 nurses hand in licenses

According to that article, the Las Vegas Sun said Nevada 'ranks among the worst in the nation for numbers of doctors and nurses per capita, the number of uninsured patients, and the number of unvaccinated children'. (The quoted article was no longer available via link). Apparently it's not very good on overseeing these type of endoscopy/surgical clinics that operate apart from a hospital, either.

The authorities have closed two more clinics owned by the same company, leaving one other open for now.

Agh. This is something that deserves more than losing licences or being sued. This should be a criminal negligence case at the very least.

Speaking of health care and its cost

There's this editorial from the NY Times:

The High Cost of Health Care

and one's man simple innovation proves to save dollars and lives

The Checklist

Interesting, ethically and medically

Face-Transplant Patient 'Satisfied': Some Who Criticized Procedure Are Impressed With Results

One of the US centres that is mentioned in the story as being interested in doing face transplants is Kleinert Kutz and Associates, who did the first US hand transplant. The Lexington office branch of that practice did my carpal tunnel surgery. I feel a bit like I'm playing six degrees of separation. My surgeon's in a different practice now, but I'd recommend either Kleinert Kutz or Dr William O'Neill of Bluegrass Orthopaedics if you ever need hand surgery.

It's funny, I'm very lucky that I live in a very medically- and specialist-dense town, and since I live within a couple of blocks of a major hospital (St Joseph East), there are a plethora of physicians and specialists whose offices are nearly in my backyard. Not to mention the fact that I have top-notch insurance through UnitedHealthcare. They paid every penny of my surgery, which ran about $10,000 altogether. I had no idea how crippled I'd become. Now I can use my hands freely. I've heard horrible stories of how much nerve conduction studies hurt since I had mine. I had no idea. My carpal tunnel was so bad I didn't really feel any of it. So I'm glad to have my mobility back, to be able to feel my hands, and to have them not draw up in pain at night. Plus, if I were ever to have children (let's face it, it's not bloody likely), it would cost me $10. Period--just the co-payment of the first office visit. Wow.

Of course, I went for years without insurance, so I really appreciate it more. I probably had a broken foot years ago, for example, when Bill fell on me. I just hobbled around in pain for months. Not to mention the various blows to the head I've had that I never went to see about. Hmm...maybe that really is part of my problem.

I'm not out of the woods in terms of medical expenditures, though. I have a flexible account that helps with any of my co-payments. But I'm on a slew of medications that are in the upper tier of what the insurance will pay for, so my co-payments are mostly $45 a pop. My flexible spending account ran out at the end of November (so at least I used it all--you lose the money if you don't--and it was much better than last year, when it lasted until May); but for December I really am struggling with enough bills that I simply can't get all my medicines. There are 2-3 absolutely vital ones; the rest I'm not filling until January. I normally take 7-9 depending on time of year (I take Lasix and potassium in the summer, when my ankles swell). I'm taking the opportunity to chuck Avandia entirely. I haven't felt any difference than when I took it, and there are just too many studies stacked against it. If my blood sugar tests show my sugar still up, I'll see about going on Actos. Otherwise I'll keep with just the Janumet, if Dr Nesbitt concurs. I found some samples of one of my drugs 'my smart medicine' as one friend puts it, so I'm using those for now. And of course, there's one I take that can cause a horrible skin-sloughing rash if you stop and go back on it, so I'm staying on that one as a priority. :) Plus I have plenty of metformin, so I'm temporarily on that instead of the combined Januvia/metformin Janumet. And I found some extra strips so I can check my sugar levels.

I know, it's not ideal, but it means $45 in drug costs this month rather than the normal $277 I'd spend a month out of pocket (with insurance!) ($291 in summer), with the occasional albuterol ($7) and then any over-the-counter medicines I get. (I'm off the aspirin, for example, now that I'm out of the boot). That flexible spending account is a lifesaver. I opted for the same amount next year since part of the expense this year was my glasses, which I shouldn't need again. That should get me through the year okay. I do have one doctor's appointment this month, too, but I've budgeted for that.

Okay, didn't mean to make this all about me, but I guess the article was just a jumping point for my thoughts. Hopefully January will bring a new debit card (we're going with a new provider this year--I hope they're as good as the last one) and I'll get back on track again.

Cleaning out my to-blog list

Google and Microsoft Look to Change Health Care

How would you feel about being able to easily search all your health information and have it at your fingertips? Sound good? Well, yes and no...what about privacy. Two juggernauts are heading towards changing health care.

Is Parental Age Related to Autism Risk?

Oddly enough, maternal education, when adjusted for age and other factors, correlated with increased autism in children. Paternal education had no significant effect.

Democratic hopefuls grilled on gay rights

Kucinich still has my vote, at least through the primary, because he's for gay marriage. I'm not impressed with the Big Three's take on civil unions being adequate and Richardson really flubbed his chances with me with a slur which he then tried to backpedal out of.

Library Time Line

Did I post this already? It's a cool site, giving important dates in the history of libraries.

Here Come the Cyberchondriacs

More people are looking up medical information before seeing their doctor.