My Health Care Solution

One of the biggest problems with my current health care plan is me.

As the the debate about health care in this country has intensified, much of my attention has been focused on questions of availability and affordability. It's an intensely personal issue, of course, and not just for me, but as such, the question of responsibility requires more attention than I've been allowing.

This realization might have come sooner if I had been better patient over the years. But, because my interactions with my doctor were so infrequent, I never took my role seriously. Like most people, I thought the responsibility for health care was the doctor's; I am supposed to stay as healthy as I can, but when something goes wrong, it's up to the doctor to fix it.

Well, as I get older, I realize quite naturally that something is always going wrong, and if I wait for or rely on the doctor to fix it, I will be disappointed. And, that's exactly what has happened to me over the years. I've never been happy with my health care because I've never taken the proper responsibility for it.

This is more than just 'eating right, exercising and staying healthy'. This means that when I do go to the doctor, I have to go for a specific reason and I have to prepare for the the visit. In the past, I've never actually gotten ready for an appointment, in the sense of organizing my thoughts, planning my questions and getting ready for what I know will be an all-too-brief encounter with the doctor.

This is not just a disservice to the doctor, but it undermines my intent to remain healthy by not taking my part in the interaction seriously. If I don't approach it with a desire to help him, how can I reasonably expect him to provide me with anything but the most superficial kind of care?

So, I began the process of taking control of my health care by changing doctors. It didn't take a lot of effort, but it did take a new determination. I went in with a new attitude, and told him so at the outset. I told him that I was willing to work harder to stay healthy if I could be assured of having someone who would work with me, instead of just for me.

The result has been a much better outlook for my health. I don't have any serious problems other than my migraines at the moment, but in the long run, I know I'm going to need a professional on my side. I'll need someone who trusts me to bring him as much information as I can. I'll need to make the best use of our time together by coming in prepared to get right to the issue at hand, and ask the questions that I want answered.

I know I should have been doing this all along, but as it fades, the arrogance of youth no longer prevents me from admitting that if I want seriously good health care, it's up to me from here on out.

How Much?

How much will you want to live
When you're in declining health?

How much will you need to earn
To have a valid sense of worth?

How much will you have to give
To have your share of wealth?

How much will you really learn
From your little time on earth?

Scab

My vision has been clouded
by angry vicious thoughts.
Even in my dreams
The madness never stops.
Even in the sun
Even in the rain
I pick relentless at the scab
I must enjoy the pain.

Too Much

I've learned too much
I've come to far
To lean upon another crutch
To wish upon another star.

I've cried too much,
I've grieved too long
To turn away another's touch
To leave unsung another song.

I've seen too much
I've peaked too soon
To fulfill youthful dreams, as such
To believe in the man in the moon.

Yes You

Yes you, dear General.
With a simple movement of your breath
A million men marched to their death.

While you kept bundled in warm clothes
On muddy roads they stumbled, they froze.
While you slept warm in comfort bound
In black waters they struggled, they drowned.

So, though you've conquered bits of foreign soils,
Who sings of the Soldier now in that ground?
I say, to the Poet belong the spoils.

***

Yes you, dear Doctor.
Much power from our health derives
You play at God by 'saving' lives.

While you took drugs to them denied
In darkened rooms they begged for more, they cried.
While your plans for a future were laid
In pain and fear they knew the price, they paid.

So though you have profited from snake oils,
Who sings of the Patient now in that shade?
I say, to the Poet belong the spoils.

***

Yes you, dear Priest.
When you for God were allowed to speak
You preyed upon the sick and weak.

While you sermonized of flaming coals
In confessionals they lost their faith, their souls.
While you promised eternal life and saving grace
They saw that doubt, in your eyes, on your face.

So though you've claimed escape from serpent's coils
Who sings of the Life now in this place?
I say, to the Poet belong the spoils.

Did You Know Her?

Life's dark secrets are almost never found.

Her eyes are eaten;
her entrails are unwound.

Her body's in a shallow grave
Placed there without a sound.

With simple savage artistry
her passion is unbound.

So much more than Life is lost
when blood is on the ground.

The Last Visit

I got my first call yesterday. The Volunteer Coordinator called to tell me that Mr. B. was dead. "He passed away", was what she actually said. I think I shall have to come to use that term with more ease if I am to continue down this path.

On my second visit, I arrived at ten to find Mr. B. sleeping. Honestly the feeling was one of relief. Although I feel confident about my ability to interact with Hospice patients, I must admit that I get a bit nervous going in, especially for the first time. Though I'd been to see him before, the first 'visit' had been so brief that it didn't really count.

He had a 'sitter' with him, a large fellow named Darryl with mutton-chop sideburns who was reading Dan Brown's latest novel. Since he was being paid to sit with Mr. B. it seemed a little awkward offering to give him a break. This wasn't exactly the 'respite' I was hoping to give beleaguered family memebers, but it was what I had come to do. He was more than happy to take a break, and I took the seat by Mr. B's bed.

The TV was on, but I muted it as soon as the sitter left. Alone in the room with him for the first time, I had my first real chance to look at him. I turned my chair toward him and focused on him for a few minutes. He was wearing a striped polo shirt. He was nearly bald, and very thin. His mouth was gaping and his skin was tight across the cheekbones.

I looked around the room, which, although it was as new and clean as a hotel room, still retained some of the institutional character associated with its actual use. Mr. B had only been there for a week or so, so the space around him was essentially stark and bare of personality. A paper bag, likely used to carry his last set of real clothes, was set in the corner. Photos of nephews and nieces were stuck to the wall with postcards along with a dozen or so 'hang in there' cards.

One of the reasons I am called to do this work is because I am interested in knowing who people 'used to be'. It's interesting, I think, how quickly people with a lifetime's worth of valuable knowledge and experiences are set aside with no thought given to who they used to be.

It almost goes without saying, but that seems to be the problem. No one wants to talk about it in that way.

No matter what the role, public or private; no matter what the job, powerful or humble; no matter how long ago it had been since they were that person, everybody used to be somebody. 'I used to be somebody' is tough thing for the aged to acknowledge, since it implies that who they are now--broken tattered physical creatures--is not who they really are. And, in truth, the final shell, the diminished social creature living at the edge of life, is not who they really are.

They really used to be someone else. Someone younger, of course, but more importantly, everyone used to be someone whose life, identity, existed in a context. That means that they used to be 'somewhere'; in a family, in a job, a place. Whether or not they admit that they are no longer part of that family, no longer that person, or in that place, most people will admit that there is much to be remembered, much to be shared.

There was no one there to share that context for Mr. B. with me, so I went on what I could see and feel. I think Mr. B. was a choral conductor, possibly a musician, but clues to his identity in that room were scarce. There were no pictures of him that I could see. I was told by his nephew, whom I met on the first visit, that Mr. B. had never married and came to Austin because he has nieces and nephews here. Most of the photos were of young people whom I assumed to be his grand-nieces and nephews.

Shortly after I arrived, I met one of his nieces. She was a woman of about my age, with gray hair and a worried smile. She was hesitant to come into the room, so I went out in the hall to greet her. She asked me what my role was, and I did my best to explain. I have not yet earned my identity, so to speak, so what came out was a bit clumsy. I'll get better at these introductions, I hope.

After we talked for a few minutes, I returned to Mr. B's bedside, and the niece spoke to the nurse for a few minutes. She left without seeing her uncle. I think she was relieved not to have to talk with him. I know I was secretly glad to be serving in silence at that moment.

My third--and last--visit was blissfully short. Unlike the second time I came, this day he was marginally awake. He greeted me with glazed half-opened eyes, through which I could still see a faint spark. It was fleeting, but I swear that he attempted a smile.

He didn't remember me nor did I expect him to. I told him it wasn't important but he tried for about a minute anyway. Then he closed his eyes to sleep, which he did every few minutes. He was a bit restless, though and every so often he'd 'wake up' or become a little more present. He never actually turned his head toward me or opened his eyes.

His sitter that day was a small hispanic woman named Maria. She told me that she worked for a home health care provider and showed me her badge. She might have been a student, since she was reading a textbook, History of the World. Though we didn't really talk, I didn't see any notes or even a highlighter. Even I can't imagine reading that book for entertainment. The TV was on (as it always is) and I muted it (as I always do) as soon as I was alone with Mr. B. This time my role didn't seem so awkward to me and Maria seemed grateful for the break I offered her.

Mr. B. was never really conscious while I was there, but he was present. He often picked at his bedclothes and several times tried to dig at the infection raging in his lower back. Each time I moved his hand up gently to his chest he didn't resist. I pulled up the covers a bit at the same time. Although he was obviously heavily medicated, he didn't seem to have his pain completely masked. Yet, he never once grimaced or cried out in any manner.

After a minute or so, I asked him if he'd like me to read. To my delight, I heard him say yes, that would be 'nice diversion'. His sudden presence surprised me. I was pleased to be able to interact with him, so I pulled a book out of my bag and began to read. As I read, he said started saying unintelligible things to himself softly, as if in resonance to my voice. To keep my voice soft, I kept it low. The sound seemed to please him. He continued to talk as well.

I'd been told he loved music, so perhaps he was 'singing' along. He had a large chest, like I imagine an opera singer might have had. It was uncovered that morning because he'd told Maria to leave his shirt off after she'd given him a shave. She said there was family wedding that week and he was epecting a lot of relatives and wanted to get cleaned up for them.

I only stayed twenty mintues. I touched his hand a couple of times and looked at him as closely as I could as often as I could. It's hard be present for this and not just read or watch TV. It's really more boring than grim. His death mask was forming but it wasn't ugly or painful at all. Just slow. With each breath the end obviously came closer, but only one breath at a time. I sat and shared a few of those breaths with him. Then it was time for me to go on to work.

I was going to see him again tomorrow, but now I can go on a walk with the dog. We'll say a little something for Mr. B. while we're out there.