Cancer In America Democracy

A diagnosis of cancer is frightening. Pain, suffering, disfigurement and loss all come to mind. Cancer is an insidious disease that is present long before the symptoms appear. We know that cancer cells are present in everyone all the time, but the immune system destroys them and keeps the body safe. However, if the immune system is challenged too much without support it breaks down. America has cancer or should I say American democracy has cancer. The immune system of American democracy, so long the pride of the nation, has failed. Many things cause immune systems to break down, but poor diet, lack of exercise, lack of knowledge, lack awareness, poisons absorbed through constant exposure to toxins, lack of self-care and many other factors contribute. In America we have been ingesting a diet of ignorance, greed, fear and deception fed to us by self-serving political PACS. Self-care has been ignored. We have chosen to allow our education system to be weakened by special interests and demagogues. We have chosen to believe lies about others in our communities, fueling hate and division. The civic responsibility to vote and be engaged in self-governance lags and isn't thought to be necessary or meaningful. When the visible signs of our cancer manifested in 2016, we went through many of the stages of grief seen in newly diagnosed cancer patients. We couldn't believe it was happening to us; we cried and blamed god; we claimed it was a mistake; we let fear rule our every thought. There are many who claim this cancer is a good thing; it will weed out the weaker body parts. Others claim in won't last and/or it won't do much harm. Still others remain in denial while those who want to resist are doing all they can, but fear it won't be enough. The cancer is metastasizing. Defenses against further destruction of the body democracy are at risk of being lost (EPA, ACA, civil rights, education, free speech and a free press). Plans are suggested which threaten to "update" our constitution to suit the cancer's needs. Unfortunately, many of those responsible for keeping our democracy healthy (Congress) have chosen to join the cancer out of greed, choosing power, influence and politics over country. As all of us who have fought cancer know, it is a long struggle; it takes every part of the system to fight cancer and promote healing. Joining together as a community to support each other is crucial. RESIST

Who Is Restricting Your Choice of Health Care Provider?

Opponents of health care reform scared people with a Boogie Man which had the federal government coming between you and your doctor. Now for over 20,000 people in the Seacoast area, that is exactly what is happening. But it isn’t the government; it’s an insurance executive at Anthem forcing them to give up their primary care provider. Anthem subscribers who receive their care from providers affiliated with Exeter Hospital have been notified that they must change their primary care provider or specialist, and can no longer be treated at Exeter.

Most of the press reports have implied that this is merely a problem brought on by Exeter Hospital and CORE providers being accused of charging too much; a business decision about the bottom line. For Anthem, whose parent company, Wellpoint made $4.2 billion in 2009, that is true. When they talk about cutting costs, it’s not overall health care costs they are concerned about, it’s their own costs. Negotiating lower reimbursement to care providers allows them to continue to keep a healthy profit margin for their stock holders and to keep their triple A stock rating on Wall Street.

However there may be another aspect to this story. Recently passed health care payment reform will require insurance companies to spend 95% of what they bring in on your care (Anthem only spends approximately 84% currently). This would mean Anthem wouldn’t have that 11% of your money to do other things with, like high executive compensation, and contributions to candidates who work in their favor both at the state and federal levels (see recent Supreme Court decision Citizens United v. Federal Election Commission, No. 08-205). You can also Google “Anthem profits” to see many stories about what Anthem has tried to do in many other states. We are not unique.

In our state this appears, however, to be a test case. Exeter Hospital and its affiliated providers are the only ones whose contract is up for negotiation this year. If Anthem succeeds, next year this will occur in many more places in NH since Anthem controls a 70% market share in providing group health insurance (in my mind an unhealthy monopoly situation). If Anthem does succeed and is able to decrease their costs, their subscribers should receive a rebate check for those savings, yes? (Personally I won’t be holding my breath waiting for it). Let your imagination run free thinking about where that money will go instead.

This is just business, right? Unfortunately, the pawns in this game by Anthem are real people, who count on continuity of care to maintain their health. Anthem has told patients there are plenty of primary care providers in the area to absorb these 20,000 plus patients. (ask anyone who has recently changed providers what the wait is or how difficult the process is to make sure you have all of your medical records). Of course you could self pay as long as your health problems don’t make it prohibitive. One provider is just as good as another, no long term relationship counts, correct? Someone who has known your history or your whole family doesn’t matter. What happens while the change is in process and you need a medication refill, can’t get in to see the new provider who knows nothing about you or your problems? What happens if you get sick while you are waiting to change? Does this mean an ER or Urgent Care visit? Will you end up in the hospital because your chronic illness now isn’t being managed effectively, like it has been for the last however many years by the provider you know and trust? Remember, insurance companies have never treated you, held your hand when you were in pain or received bad news, identified a life-threatening disease or prevented an illness. They are a payment mechanism, which doesn’t know you personally and doesn’t have any idea of what happens to you unless it costs them money.

Anthem says they have no further interest in negotiating. Governor Lynch says he won’t get involved (perhaps he has no constituent voters in this area?). The Insurance Commissioner says he won’t make an additional sixty-day extension to force further negotiations. Seems no one in NH government has any particular concern about the needs of over 20,000 people in the Seacoast area. The message is clear. This is about an insurance company, a business, not about maintaining the health of people in the Granite State. This is for Anthem, not you.

I have two stakes in this situation. I am being forced to give up the provider who has provided me with quality care for the last ten years, and I am a Nurse Practitioner comforting patients who are being told they can no longer be seen in our practice. One patient told me recently that she feels like killing herself (after counseling she agrees not to). It had taken nearly a year to find our practice where she received top quality care, had a chronic condition identified and effectively managed, and where everyone was caring. Now she is being forced out. She must start the search again and we, in frustration, can only wish her luck.

I was surprised and saddened to learn the word "suddenly" had been banned from the language available for use in literary writing. I don’t know who is allowed to make these determinations, but it is always good to know that someone is in charge. Moreover I now have a better understanding of what will classify one’s writing as either erudite or unscholarly.

I decided to look up this fallen word just to be certain I knew what I was giving up. According to Webster’s New Twentieth Century Unabridged Dictionary it is an adverb meaning “in a sudden manner.” Wanting to be thorough, I read the definition of “sudden” which yielded the following: 1. happening without previous notice; coming or appearing unexpectedly; not foreseen or prepared for. 2. done, coming or taking place quickly or abruptly; hasty. 3. violent; rash; precipitate; impetuous. 4. rapidly effective; prompt in effect.

That first word in the definition notation was a dead giveaway since I additionally learned adverbs have been removed from literary writing. Adjectives are suspect as well, but I did hear in the presented literary readings many still in use. I wondered if these new rules were a fad or had they been around those many, many years ago when I was taking high school English classes? Perhaps I missed a day or was daydreaming during that part of the lesson.

This news has definitely affected me because I have been known to use that expelled word when describing an unexpected, violent, rash, precipitate or impetuous event. I will need to scour my writing to remove this proscribed word. Fortunately, the computer will make this easy as I put out a search for the offender.

My newfound knowledge will additionally help me decode whether I am reading learned material or just common, popular writing. It is always a relief to be given the hard and fast rules whereby one’s creative outlets are governed. However, after this most recent addition to my literary knowledge, I worry about how many more of these rules there are I don’t know about.

The Art of Seeing

This time of year, my farmer/gardener persona comes to the fore and I spend a couple of hours every morning in my garden. First and foremost the unkraut (German for weeds; what a great word since it specifically means anything that isn't kraut, a food staple) must be cleaned out between the rows and around plants. This is a very satisfying work since half of it is done on hands and knees, a meditative way to spend time.
It is exciting to have the garden start to yield its produce. To my delight there are also wild black raspberries at the edge of one corner which on a small scale remind me of the stands of wild black raspberry bushes we had on the farm where I grew up. To get to those we had to ride on the tractor with our berry buckets past the wheat, hay and corn fields to the very end of our property where there was, at the edge of the woods, a large hollow full of berry bushes, instead of walking a few feet. On hot days, picking berries can be pretty miserable because you need to have on long pants and a long sleeved shirt. The reward, of course, is the luscious, sweet, half orbs eaten fresh or baked in my favorite kind of pie. As a child, there was also a certain amount of competition for picking the most, which I am certain my mother encouraged so we'd get the job done sooner. Now that competition is to get as much of the fruit as possible.
The art of picking fruit or produce requires a willingness to see the plant from all angles. This morning as I harvested my first of the black raspberries, I fought my way through the prickers, cleared out weeds that had grown up, and proudly filled my bowl with ripe fruit. I looked carefully from different angles, pushed aside leaves and stalks, and felt satisfied with my efforts. Moving to the next job, I began weeding the area immediately in front of the berry bushes. While on my hands and knees I was surprised to see that from this perspective there were many berries I had missed. I got my bowl and began to harvest again. I hope I got them all, but if I didn't, the ones I missed can be considered toll berries for the birds and mother earth.
Once again on my knees weeding, my mind turned to the life lessons I have learned in my garden. To reap the sweet bounty that nourishes, you need to clean out the unkraut, wade through the prickery areas, and look at the situation from all angles, and in many different lights. Only then, can you attain your reward.

Mother's Day evokes varied memories for most people. For me, one of my strongest is of peonies. When I was five, we moved to the first farm my parents owned. One of my earliest memories were of the red, pink and white flowers along the driveway. I don't know at what age I learned they were peonies and I don't know who originally planted them, but they were an important part of our spring. By Mother's Day, they were in bud and by Memorial Day, my sister's birthday, they were in bloom. My mother always took them to church to decorate the alter on Sundays. We had them in the house as well where the scent permeated the dining and living rooms.

One summer after the blooms had passed, my father was mowing with the cycle mower and cut down all of the peonies. My mother was very upset, but got over it when the following spring they came back better than ever. From then on, they got cut back each year.

Over time, they owned several more farms and at each my mother would plant peonies. I never gave my mother a bouquet of peonies. She had them in her garden and giving flowers wasn't something I thought much about. When my parents died, they were buried in a small cemetery near where my mother grew up. They didn't allow live flowers to be planted because it hindered mowing, so each year since I have planted two more peonies in my gardens. Unfortunately our growing season has always been behind that of the Midwest, so they bloom a lot later. For Mother's Day around here, I have had to content myself with tulips. Fortunately, both blooms have always made me smile whenever I see them.

The scent of of the peonies, when they do finally bloom here, transplants me back to being a barefoot, five year old going from peony bloom to peony bloom. The many petal layers unfold slowly going from fresh new buds to old, wilted, fully bloomed flowers, and finally they litter the ground in a colorful blanket.

Thought for the Day: Thank your mother for the flowers she has introduced into your life.

On Sunday, I attended the Maine Writers and Publishers Alliance's Business of Writing conference. There were good tidbits about the reality of the business side of writing, which were both encouraging and discouraging.

Because I have been a Nurse Practitioner for over 25 years, I don't think much about the amount of study and work that went into getting to where I am in competence and skill. It is easy to think that writing is something anyone can do. In this day of instant communication there is a lot of writing out there, but most of it isn't professional writing for which someone should be paid. While talent is a part of the equation, publishing and selling writing requires polishing the craft and lots of hard work. I don't think anyone assumes that becoming a brain surgeon can be accomplished by going into an operating room and starting to saw open someone's skull.

As I rewrite my memoir Loving Hannah: Childhood Cancer Treatment from the Other Side of the Bed, I take hope from what I learn at conferences like this. Since I first wrote the introduction at Pyramid Life Center Women's Writing Retreat, I have continued to learn how to hone the craft of writing. The process of becoming skilled takes time and lots of AIC (ass in chair) discipline, as one presenter told us. It didn't take me 25 years to attain the knowledge to be a Nurse Practitioner, but during that time, to be good at it, I had to keep learning. Good writing takes that same dedication and commitment.

Thought for the day: Balance isn't just staying upright without tilting side to side, it is feeling centered inside one's own body.

Change

It’s not that you can’t go home again; it’s just that when you get there, you find someone completely changed the scale and perspective of everything you thought you knew, making it unrecognizable. The fanciest house in town looks worn, the lush hedge moth eaten and the thriving corner store across the street has its sign hanging by one hook. That solid brick bastion of authority and education is gone. The gravel lot in front, home to so many dare base games by day, looks so small you can’t imagine there was any thrill to the game at all. The baseball diamond is barely large enough to host a beginner’s t-ball game and the only permanent part of the playground still there is the swing set which they must have been moved closer to the back of the E.U.B. church because the grassy area around it is really small.

In the surrounding area many of the farms you pass boast half collapsing sheds and lone sentinel silos bereft of their barns. Neatly painted houses, barns and outbuildings are weathered and look as if they may slowly sink into the land. Roads that used to wind through valleys whose fields were rich with river silt no longer go anywhere. Dams for water conservation have turned the valleys into lakes, their shores lined with vacation houses each with a speed, pontoon or house boat parked at its dock.

Towns which had vibrant downtown shopping areas are deserted, most commerce having moved out to the interstate exits. You watch children coming out of an elementary school to their waiting buses and wonder what their childhood is like here. Would they think you are some weird old geezer type if you told them that where they go to school used to be the egg factory you worked at to get through college. There’s no trace of the land’s former purpose nor does there seem to be any trace of your ever having been here either. Time has moved on and you wonder if the memories you have of these places were real. Maybe yes, maybe no.