Given what I wrote in my last post about how many out-of-network health care practitioners I see, why do I bother having health insurance? I use it more than I let on: for every prescription drug that would be $270 without insurance coverage, I pay $40. My $1,200 lab bill ends up being $23. And God knows I couldn't afford hospitalization without health insurance.
I am supremely grateful that I have health insurance and that our premiums are very low in exchange for ridiculously high deductibles. However, I would really like to see the United States move away from this model of health insurance. Normal insurance is not for everyday things: it is meant to cover large costs when catastrophe hits. We don't get car insurance to cover oil changes, but car accidents. Health insurance as we know it is an anachronistic concept; it was born during World War II when companies had to freeze wages, but wanted to attract employees. Thus, health insurance was invented. It didn't cost the companies much since health care was so much simpler, and people were just more likely to die if they became seriously ill. Another reason to abandon our current ways is that insurance companies are for-profit entities that care above all about earning money. That's not necessarily evil, but when it comes to a contest between making shareholders happy or patients getting the care they need, insurance companies can't be expected to advocate for their customers. It's against their interests. The system is completely adversarial: I want my claims paid, my insurer has a strong incentive to dick around and deny it, or cover a paltry sum.
I would like to see health insurance function more like car, long-term care, and homeowners insurance: used to cover extraordinary, high-cost events. I would like to see all other health care priced for and offered on an open market. I'd like to be able to go to a web site for Radiology Clinic A and see how much they would charge me for an MRI of my cervical spine and compare it to the price of Clinic B. Cost is only one factor that I consider when choosing my health care, so that's not all the information I'd need. In this example, it would be helpful to know whether Clinic A or B has the most powerful magnets, and yes, they differ widely in the Washington area. One clinic in particular, owned by radiologists, has invested in higher-end MRI machines that yield clearer images. In this change that I'm proposing, clinics A and B -- and pharmacies and laboratories and every other player in the health delivery system -- would be competing for my business the same way every other part of the commercial sector does. I could use all of the resources at my disposal to compare the variables meaningful to me and make a choice about where I get my care. After all, we are not just patients: we are health care consumers, which is why drug marketing directed at the public is called direct-to-consumer advertising, not direct-to-patient advertising. Let us be educated consumers and consume!
I used to take a prescription vitamin for acne that was amazingly effective, but not covered by my health insurance. My jaw dropped when I inquired about the price at my local CVS pharmacy, and I thought, "I have to be able to do better than this." I found a pharmacy in upstate New York that sold me the same drug at a fraction of CVS's price. It was a much smaller business than the behemoth CVS, so theoretically CVS should be able to use its bargaining power to get the vitamin more cheaply; instead it imposed a higher markup, and I took my business to New York. Wal-Mart took this type of price discrepancy to heart and started manufacturing and selling its own brand of insulin several years ago to sell it at a much lower cost than even generic insulin already was retailing for.
I think the model that I'm advocating will allow the advantages of a free-market economy to prevail: health care providers who give the best service and who keep their prices competitive will be rewarded with business. It would also lift the ridiculous veil of secrecy around medical pricing. Once, I called the office of a neurologist who has opted out of insurance to ask how much a consultation with him cost. I was told between $400 and $900. That is a big, big difference. Doctors can't reasonably know everything that a new patient visit might entail, but they should be able to narrow the gap by more than $500.
Perhaps best of all, doctors would be freed up from the bureaucratic red tape of insurance companies that tie up their valuable time and resources. They would no longer be beholden to insurance companies' rules that they will not compensate doctors for visits longer than a set period of time, or bully doctors into changing their patients' medication for the convenience of the insurance companies. I'd like to think that removing the insurance barrier would make health care more accessible to all. Without our current system, don't you think it would allow clinics like CVS' Minute Clinic -- an in-store, walk-in clinic staffed by nurse practitioners (NP) or physicians' assistants (PA) who treat common illnesses -- to proliferate? Not everyone can afford health insurance premiums, but many more people can afford the $30 the Minute Clinic charges to test you for strep. I envision many stand-alone clinics staffed by PA's and NP's who have substantive medical education, are authorized to prescribe pharmaceuticals, and who are thoroughly trained to refer patients who need to see a doctor to an appropriate caregiver. Savvy operators of this type of practice would be open late into the night to accommodate people who find it tough to make it to appointments during business hours, and it's that kind of service that would make such outfits stand out from their 9-to-5 competition.
Obviously, in my proposal, insurance companies would shrink dramatically if they only covered catastrophic care, and I think that's a good thing.
Thursday, July 29, 2010
Sunday, July 25, 2010
Sorry, We Don't Take Health Insurance
"Ok Sarah, that will be $1,576 for today's visit," the receptionist at the doctor's office said. That was for a new patient consultation including labs sent to a private laboratory (not Quest or Labcorp, the only ones that have contracts with major health insurers). Granted, the appointment was for a very, very specialized doctor who is one of only 30-40 practitioners of this kind in the United States. I look forward to sharing the details about this with you once the problem is, God willing, solved.
One of the harsh realities of living in the Washington, D.C., area is that fewer and fewer doctors and other health care practitioners take any health insurance. I first encountered this with my therapist, thinking it was an anomaly, but its not. There are whole medical practices here, including gastroenterology practices that charge $3,000 for a colonoscopy that have opted out of health insurance entirely and have no trouble attracting patients. One of my friends from a country with a robust government-run health care system paid $4,000 for all of her prenatal care (minus labs and sonograms, which she got from in-network facilities) from a local pair of obstetricians after being treated like a farm animal at a massive ob-gyn practice that did accept her insurance. She doesn't regret it.
That there are healers who have opted out of taking insurance used to offend me on a deep, guttural level, and frankly, for the therapist, it kinda still does. The main thing that helped me get over resenting doctors who opted out of the insurance system was experiencing the higher caliber of care that I receive from them. At this point, most of my health care practitioners do not take any health insurance. This isn't because I love spending $200 for a follow-up visit to my Lyme doctor when I could see an internist for $10; I need the complex care that these doctors and complementary medicine practitioners excel at providing. They schedule adequate time for appointments (45 minutes) that insurance companies would cap at 10 minutes. My calls get returned promptly, instead of my message languishing at the bottom of someone's in-box.
A good example of this is the time I had a tricky problem involving a drug contraindication. I needed to take an antifungal drug for a gastrointestinal yeast infection, but the drug my yeast was susceptible to impeded metabolization of another drug I take that could kill me if not metabolized prompty. I called my doctor who prescribed the drug I was on already and he told me it was a tricky situation that would take a few days to work out. When he called me back later in the week, he had formulated a plan for me with the National Institutes of Health's lead investigator in the clinical trials of that drug. I thought at the time, "This is why I pay you $500 an hour." In an ideal world I could expect the same degree of effort and resolution from my internist who does accept insurance, but let's get real!
Besides the noticeable increase in the quality of care, the other factor that softened me to seeing docs who don't take my insurance is that I feel like its the crappy policies of the insurance companies themselves that have led to this phenomenon. They pinch pennies so hard, they scream. They will not compensate doctors for appointments that last more than 10-15 minutes, and their reimbursement rates for docs are based on what a doctor's visit cost circa 1969. Most disturbingly, all of the insurance company policies actually put them in the position of practicing medicine without a license; how else can I explain the menacing letters my doctors get asking them if it's ok to switch a prescription drug of mine for another one that is better placed on their formulary? How else can we explain restrictions on the length of appointments they will compensate docs for? One of my doctors told me that he doesn't feel that he can ethically practice medicine within the restrictions set by the insurance companies, so he doesn't try anymore.
Then there's the good old principal of supply and demand: if people in D.C. have the money to pay out of pocket, would you rather make $35 or $200 for an appointment? I thought so. The one thing that sticks in my craw about this is that although medicine is a livelihood, I still harbor some idealism that it is a calling, and that doctors should want to maximize the people they can heal. Limiting their practice to a small subset of the population means that some of the people who most need their care can least afford it. I'm sympathetic to this: my husband David and I made the choice to completely go outside the system in 1999 when money was very tight for us. We just decided that my health care was a top priority, and that we were willing to go into debt to do so. That means that quite a few doctors visits were paid for on credit cards back then. Granted, you have to be at least basically financially stable to have this option open to you; if we were living on the streets, we couldn't have charged doctors visits to Visa. Interestingly, David has had a complete conversion on this issue; he initially went along with my out-of-network jaunts begrudgingly, and now has seen the difference in my care and has come to Jesus, as we say in the south.
Another interesting twist on this is the increase in concierge medicine, like MD-VIP. My old internist joined that program. He still accepts many insurance plans and you still pay for every visit, but in addition you fork out $1500 a year for the privilege of retaining him as your doctor. In return, you're promised good customer service and communication and same- or next-day appointments. It also includes a really thorough annual physical. Of that retainer, my physician gets $1000 per patient and MD-VIP gets $500. I was one of only a few patients who declined to follow him into this program, but he still is my pulmonologist and he's an amazing doctor. When I learned he was joining MD-VIP, I wasn't surprised; not any slouch can command a hefty retainer fee. I wish I had thought of concierge care first.
After reading this, if you're asking, "Why does she still pay for health insurance?" I will tell you in my next post.
One of the harsh realities of living in the Washington, D.C., area is that fewer and fewer doctors and other health care practitioners take any health insurance. I first encountered this with my therapist, thinking it was an anomaly, but its not. There are whole medical practices here, including gastroenterology practices that charge $3,000 for a colonoscopy that have opted out of health insurance entirely and have no trouble attracting patients. One of my friends from a country with a robust government-run health care system paid $4,000 for all of her prenatal care (minus labs and sonograms, which she got from in-network facilities) from a local pair of obstetricians after being treated like a farm animal at a massive ob-gyn practice that did accept her insurance. She doesn't regret it.
That there are healers who have opted out of taking insurance used to offend me on a deep, guttural level, and frankly, for the therapist, it kinda still does. The main thing that helped me get over resenting doctors who opted out of the insurance system was experiencing the higher caliber of care that I receive from them. At this point, most of my health care practitioners do not take any health insurance. This isn't because I love spending $200 for a follow-up visit to my Lyme doctor when I could see an internist for $10; I need the complex care that these doctors and complementary medicine practitioners excel at providing. They schedule adequate time for appointments (45 minutes) that insurance companies would cap at 10 minutes. My calls get returned promptly, instead of my message languishing at the bottom of someone's in-box.
A good example of this is the time I had a tricky problem involving a drug contraindication. I needed to take an antifungal drug for a gastrointestinal yeast infection, but the drug my yeast was susceptible to impeded metabolization of another drug I take that could kill me if not metabolized prompty. I called my doctor who prescribed the drug I was on already and he told me it was a tricky situation that would take a few days to work out. When he called me back later in the week, he had formulated a plan for me with the National Institutes of Health's lead investigator in the clinical trials of that drug. I thought at the time, "This is why I pay you $500 an hour." In an ideal world I could expect the same degree of effort and resolution from my internist who does accept insurance, but let's get real!
Besides the noticeable increase in the quality of care, the other factor that softened me to seeing docs who don't take my insurance is that I feel like its the crappy policies of the insurance companies themselves that have led to this phenomenon. They pinch pennies so hard, they scream. They will not compensate doctors for appointments that last more than 10-15 minutes, and their reimbursement rates for docs are based on what a doctor's visit cost circa 1969. Most disturbingly, all of the insurance company policies actually put them in the position of practicing medicine without a license; how else can I explain the menacing letters my doctors get asking them if it's ok to switch a prescription drug of mine for another one that is better placed on their formulary? How else can we explain restrictions on the length of appointments they will compensate docs for? One of my doctors told me that he doesn't feel that he can ethically practice medicine within the restrictions set by the insurance companies, so he doesn't try anymore.
Then there's the good old principal of supply and demand: if people in D.C. have the money to pay out of pocket, would you rather make $35 or $200 for an appointment? I thought so. The one thing that sticks in my craw about this is that although medicine is a livelihood, I still harbor some idealism that it is a calling, and that doctors should want to maximize the people they can heal. Limiting their practice to a small subset of the population means that some of the people who most need their care can least afford it. I'm sympathetic to this: my husband David and I made the choice to completely go outside the system in 1999 when money was very tight for us. We just decided that my health care was a top priority, and that we were willing to go into debt to do so. That means that quite a few doctors visits were paid for on credit cards back then. Granted, you have to be at least basically financially stable to have this option open to you; if we were living on the streets, we couldn't have charged doctors visits to Visa. Interestingly, David has had a complete conversion on this issue; he initially went along with my out-of-network jaunts begrudgingly, and now has seen the difference in my care and has come to Jesus, as we say in the south.
Another interesting twist on this is the increase in concierge medicine, like MD-VIP. My old internist joined that program. He still accepts many insurance plans and you still pay for every visit, but in addition you fork out $1500 a year for the privilege of retaining him as your doctor. In return, you're promised good customer service and communication and same- or next-day appointments. It also includes a really thorough annual physical. Of that retainer, my physician gets $1000 per patient and MD-VIP gets $500. I was one of only a few patients who declined to follow him into this program, but he still is my pulmonologist and he's an amazing doctor. When I learned he was joining MD-VIP, I wasn't surprised; not any slouch can command a hefty retainer fee. I wish I had thought of concierge care first.
After reading this, if you're asking, "Why does she still pay for health insurance?" I will tell you in my next post.
Tuesday, July 20, 2010
Columbine: Everything You Know is Wrong
I read Dave Cullen's book, "Columbine," months ago, but still feel passionately enough to write about it, and it seem appropriate for Tisha B'Av. "Columbine" is a remarkable, detailed account of the 1999 shootings at Columbine High School in Littleton, CO. Cullen painstakingly combs through mountains of legal minutia, forensic reports, mass media, and personal accounts of the attack. He weaves a narrative of the events of April 20, 1999, that manages to be both riveting and respectful at the same time. Two factors kick "Columbine" up a few notches and set it apart from any other accounts you will read about this tragedy.
First, Cullen proves that everything you think you know about Columbine is -- beyond a shadow of a doubt -- wrong. For example, you probably think the perpetrators set out to stage a school shooting. You're wrong. High school murderers Eric Harris, the charismatic ringleader, and Dylan Klebold, his flunky, had meticulously planned for several large bombs to go off and cause mass fatalities at the school. Thank God, Harris was inept in his bomb-making and they failed to detonate; the killers' plans for destruction quickly were downgraded to a school shooting only at this time. That was why Harris and Klebold had only a couple of guns on them for self-defense and ran out of ammo; school shooters would have needed to pack way more guns and ammunition. The irony of this is stunning: Cullen, who read both shooters diaries (in which they foreshadowed their mayhem), illustrates that Harris had incredible contempt for school shooters, whom he thought of as wusses. These guys were planning Armaggedon, and had their plans come through, thousands, not 13 people, would have been murdered.
Cullen also sensitively debunks most of the Columbine mythology, like the myth that Harris shot Cassie Bernall after asking her if she believed in God. Cullen uses recordings from the school library (audio from the four hour ordeal was recorded in its entirety), forensics, and victim testimony to prove that this exchange never happened. In fact, we know that Harris bent down and said only "peek-a-boo" before murdering Bernall. I give Cullen huge credit for pointing out this and other myths in ways that are honest, but also show great respect for the survivors' families. Setting the record straight in the Bernall case was especially delicate because her parents chose to publish the inspirational book "She Said Yes: The Unlikely Martyrdom of Cassie Bernall" even after Littleton police told the family that the encounter did not happen as reported.
This brings me to another point that makes "Columbine" amazing: Cullen's deconstruction of what factors collided that allowed myths to be created and perpetrated. Some of these were as innocuous as the fact that the emergency alarms beeped for all four hours, leaving people trapped in the school unable to hear and hampered by tinnitus and pain (oh yeah, and how about trauma?). Some of the myths were born out of the peculiar psychological quirks of the human brain that make eyewitness testimony so unreliable, like the brain's need to fill in gaps in information. Still other myths were born of police ineptitude -- the police were way out of their league and refused help from larger jurisdictions better able to handle an investigation of this magnitude. One of the biggest sources of false information was the role of the mass media during the shooting. Klebold and Harris had TVs on in the school during the attack and used information from newscasts to determine their actions. Simultaneously, students were calling in to the same TV programs on their cell phones giving real-time updates on the situation, only some of which were accurate. This dynamic set up many falsehoods that dominated the media for weeks.
The other thing that makes "Columbine" a stand-out book is Cullen's analysis of the root causes of the tragedy. He reveals the ugly truth that none of us wants to acknowledge: that this tragedy was not preventable. We can have our talk shows, cry, spend money on school security, blame Marilyn Manson (hey, because when is it not fashionable to blame musicians?), and even blame K-Mart and the NRA if you're Michael Moore, and it will not prevent another tragedy like Columbine from happening. I bought Cullen's conclusion entirely: Harris was an angry psychopath and magnetic leader. Contrary to what you heard, he had many friends and girlfriends. Harris found a co-conspirator in Klebold, a depressed, suicidal loser who followed Harris blindly and viewed him as his ticket out of a hellacious world. The combination of the two proved deadly. These boys were raised in good homes by loving, present parents. They wanted for nothing. On the contrary to having no self-esteem, Cullen makes a convincing case that Harris' narcissism was a major player in his psychopathy (it's worth it to look at David's post about the narcissism epidemic). Astoundingly, Cullen manages to pull all of this off without sounding patronizing or seeming like an armchair psychologist. This was a gripping, informative book that reads like fiction.
First, Cullen proves that everything you think you know about Columbine is -- beyond a shadow of a doubt -- wrong. For example, you probably think the perpetrators set out to stage a school shooting. You're wrong. High school murderers Eric Harris, the charismatic ringleader, and Dylan Klebold, his flunky, had meticulously planned for several large bombs to go off and cause mass fatalities at the school. Thank God, Harris was inept in his bomb-making and they failed to detonate; the killers' plans for destruction quickly were downgraded to a school shooting only at this time. That was why Harris and Klebold had only a couple of guns on them for self-defense and ran out of ammo; school shooters would have needed to pack way more guns and ammunition. The irony of this is stunning: Cullen, who read both shooters diaries (in which they foreshadowed their mayhem), illustrates that Harris had incredible contempt for school shooters, whom he thought of as wusses. These guys were planning Armaggedon, and had their plans come through, thousands, not 13 people, would have been murdered.
Cullen also sensitively debunks most of the Columbine mythology, like the myth that Harris shot Cassie Bernall after asking her if she believed in God. Cullen uses recordings from the school library (audio from the four hour ordeal was recorded in its entirety), forensics, and victim testimony to prove that this exchange never happened. In fact, we know that Harris bent down and said only "peek-a-boo" before murdering Bernall. I give Cullen huge credit for pointing out this and other myths in ways that are honest, but also show great respect for the survivors' families. Setting the record straight in the Bernall case was especially delicate because her parents chose to publish the inspirational book "She Said Yes: The Unlikely Martyrdom of Cassie Bernall" even after Littleton police told the family that the encounter did not happen as reported.
This brings me to another point that makes "Columbine" amazing: Cullen's deconstruction of what factors collided that allowed myths to be created and perpetrated. Some of these were as innocuous as the fact that the emergency alarms beeped for all four hours, leaving people trapped in the school unable to hear and hampered by tinnitus and pain (oh yeah, and how about trauma?). Some of the myths were born out of the peculiar psychological quirks of the human brain that make eyewitness testimony so unreliable, like the brain's need to fill in gaps in information. Still other myths were born of police ineptitude -- the police were way out of their league and refused help from larger jurisdictions better able to handle an investigation of this magnitude. One of the biggest sources of false information was the role of the mass media during the shooting. Klebold and Harris had TVs on in the school during the attack and used information from newscasts to determine their actions. Simultaneously, students were calling in to the same TV programs on their cell phones giving real-time updates on the situation, only some of which were accurate. This dynamic set up many falsehoods that dominated the media for weeks.
The other thing that makes "Columbine" a stand-out book is Cullen's analysis of the root causes of the tragedy. He reveals the ugly truth that none of us wants to acknowledge: that this tragedy was not preventable. We can have our talk shows, cry, spend money on school security, blame Marilyn Manson (hey, because when is it not fashionable to blame musicians?), and even blame K-Mart and the NRA if you're Michael Moore, and it will not prevent another tragedy like Columbine from happening. I bought Cullen's conclusion entirely: Harris was an angry psychopath and magnetic leader. Contrary to what you heard, he had many friends and girlfriends. Harris found a co-conspirator in Klebold, a depressed, suicidal loser who followed Harris blindly and viewed him as his ticket out of a hellacious world. The combination of the two proved deadly. These boys were raised in good homes by loving, present parents. They wanted for nothing. On the contrary to having no self-esteem, Cullen makes a convincing case that Harris' narcissism was a major player in his psychopathy (it's worth it to look at David's post about the narcissism epidemic). Astoundingly, Cullen manages to pull all of this off without sounding patronizing or seeming like an armchair psychologist. This was a gripping, informative book that reads like fiction.
Thursday, July 15, 2010
Time Stand Still
I am not a picture person. Other people snap photos of vacations and occasions to remember them, but when I take photos I am too focused on getting the shot instead of being in and savoring the moment I'm trying to capture. When I spend my time taking pictures -- which I'll never look at again -- I always regret it. My way of remembering is to form an imprint in my mind of the event I want to remember, and writing about it solidifies that memory. So, even though it happened a week ago, I need to write about last Thursday night. If anyone reads it, that's just gravy!
David and I went to pick up a Dustbuster that someone offered on Freecycle. I am trying to be more spontaneous and romantic, so I suggested that we visit a national monument since it was such a beautiful night. It was around 80 degrees and breezy following a day of brutal sun. We decided to head to the Jefferson Memorial, because neither of us had seen it in years and never together. And, let's just be honest, because Thomas Jefferson kicked serious ass.
Let me diverge for a second: I've never understood adults talking about summer unless they had kids or took regular summer vacations. The concept of "summer," as a season during which routines change, never made sense to me. I felt like I was missing something, at odds with a culture that reveres summer. Off the top of my head I can think of several songs that perpetuate this vision: "The Boys of Summer," "Summer Nights," "Summer Loving" from Grease, "Cruel Summer," and "Stone in Love," with its chorus, "Those summer nights are callin', stone in love, can't help myself I'm fallin' stone in love." When people asked me how my summer was going, I'd think, "The same as the other three seasons, only hotter." In fact, remember those magic pictures where you had to focus just right to see the hidden image? I feel like everyone else saw the image -- the iconic summer -- except me.
But there was something in the quality of last Thursday night, where I got it: a magical, balmy feeling, like we were living in an alternate reality. The reality of summer. The windows were down and we were headed down 16th Street, passing iconic D.C. architecture like the Mason's The House of the Temple. We heard one of the most beautiful modern songs that I've ever heard, Live's "Run to the Water." It has a melodic, flowing chorus and lyrics that can be interpreted as a profound religious experience or a profound relationship. Or more accurately, both, like the Song of Songs. If you are at all inclined to enjoy rock music, please do yourself a favor and spend 4 minutes listening to "Run to the Water" on YouTube or Grooveshark. Seriously, this song is so beautiful it makes me cry and get goosebumps.
So it was in this hazy, altered mood that we drove past the White House and toward the Tidal Basin to the Jefferson Memorial. It was a good 15 minute walk from the parking lot, and David and I enjoyed a conversation about what makes a monument work. At first I thought it was a "they just don't make 'em like they used to" kind of thing because I dislike the modern FDR Memorial so much, but David reminded me that the Air Force Memorial and the Vietnam Memorial are also modern, yet totally effective. We concluded that the single biggest predictor of whether a monument is effective is whether it picks a point of view and sticks with it. The FDR Memorial tries to be all things to all people, so it succeeds in touching no one (or more fairly, neither of us).
We got quiet as we walked up the steps to the memorial, stopping to turn around and have a clear view of the Washington Monument. My heart filled with gratitude and awe as I held hands with my beloved, and then looked at my beloved, adopted city -- the place I had planned to live (and be buried in) since I was 14 because it held such a magical sway over me. I looked across the Tidal Basin at the city and back up at the pantheon surrounding the bronze statue of Jefferson. At that moment I was completely in the moment and stupendously, ridiculously happy. I totally had a moment out of the iconic Rush song "Time Stand Still," a testament to mindfulness:
"Time stand still
I'm not looking back
But I want to look around me now
Time stand still
See more of the people and the places that surround me now
Freeze this moment a little bit longer
Make each sensation a little bit stronger
Experience slips away
Experience slips away"
David and I took our time at the memorial, exploring it from all angles, and listening to a tour by a Park Service ranger. Stealing a long kiss behind one of the columns seemed like the most natural thing to do, and a ranger even moved away to give us privacy after shooting me a "get a room" look. I assure you we were not inappropriate.
It was really late and we had to be up early the next morning, so we headed back to the car, but not before paying a visit to the George Mason memorial, which neither of us had ever heard of, let alone seen. We eased back into reality, laughingly, when an Iron Maiden song came on the radio. I don't know what made that summer night so remarkable and magical, but it was, and I loved it. I felt grateful to be alive, grateful to be with David, grateful to feel up to having that adventure that night, given the delicate nature of my health, and grateful to live in this remarkable city.
David and I went to pick up a Dustbuster that someone offered on Freecycle. I am trying to be more spontaneous and romantic, so I suggested that we visit a national monument since it was such a beautiful night. It was around 80 degrees and breezy following a day of brutal sun. We decided to head to the Jefferson Memorial, because neither of us had seen it in years and never together. And, let's just be honest, because Thomas Jefferson kicked serious ass.
Let me diverge for a second: I've never understood adults talking about summer unless they had kids or took regular summer vacations. The concept of "summer," as a season during which routines change, never made sense to me. I felt like I was missing something, at odds with a culture that reveres summer. Off the top of my head I can think of several songs that perpetuate this vision: "The Boys of Summer," "Summer Nights," "Summer Loving" from Grease, "Cruel Summer," and "Stone in Love," with its chorus, "Those summer nights are callin', stone in love, can't help myself I'm fallin' stone in love." When people asked me how my summer was going, I'd think, "The same as the other three seasons, only hotter." In fact, remember those magic pictures where you had to focus just right to see the hidden image? I feel like everyone else saw the image -- the iconic summer -- except me.
But there was something in the quality of last Thursday night, where I got it: a magical, balmy feeling, like we were living in an alternate reality. The reality of summer. The windows were down and we were headed down 16th Street, passing iconic D.C. architecture like the Mason's The House of the Temple. We heard one of the most beautiful modern songs that I've ever heard, Live's "Run to the Water." It has a melodic, flowing chorus and lyrics that can be interpreted as a profound religious experience or a profound relationship. Or more accurately, both, like the Song of Songs. If you are at all inclined to enjoy rock music, please do yourself a favor and spend 4 minutes listening to "Run to the Water" on YouTube or Grooveshark. Seriously, this song is so beautiful it makes me cry and get goosebumps.
So it was in this hazy, altered mood that we drove past the White House and toward the Tidal Basin to the Jefferson Memorial. It was a good 15 minute walk from the parking lot, and David and I enjoyed a conversation about what makes a monument work. At first I thought it was a "they just don't make 'em like they used to" kind of thing because I dislike the modern FDR Memorial so much, but David reminded me that the Air Force Memorial and the Vietnam Memorial are also modern, yet totally effective. We concluded that the single biggest predictor of whether a monument is effective is whether it picks a point of view and sticks with it. The FDR Memorial tries to be all things to all people, so it succeeds in touching no one (or more fairly, neither of us).
We got quiet as we walked up the steps to the memorial, stopping to turn around and have a clear view of the Washington Monument. My heart filled with gratitude and awe as I held hands with my beloved, and then looked at my beloved, adopted city -- the place I had planned to live (and be buried in) since I was 14 because it held such a magical sway over me. I looked across the Tidal Basin at the city and back up at the pantheon surrounding the bronze statue of Jefferson. At that moment I was completely in the moment and stupendously, ridiculously happy. I totally had a moment out of the iconic Rush song "Time Stand Still," a testament to mindfulness:
"Time stand still
I'm not looking back
But I want to look around me now
Time stand still
See more of the people and the places that surround me now
Freeze this moment a little bit longer
Make each sensation a little bit stronger
Experience slips away
Experience slips away"
David and I took our time at the memorial, exploring it from all angles, and listening to a tour by a Park Service ranger. Stealing a long kiss behind one of the columns seemed like the most natural thing to do, and a ranger even moved away to give us privacy after shooting me a "get a room" look. I assure you we were not inappropriate.
It was really late and we had to be up early the next morning, so we headed back to the car, but not before paying a visit to the George Mason memorial, which neither of us had ever heard of, let alone seen. We eased back into reality, laughingly, when an Iron Maiden song came on the radio. I don't know what made that summer night so remarkable and magical, but it was, and I loved it. I felt grateful to be alive, grateful to be with David, grateful to feel up to having that adventure that night, given the delicate nature of my health, and grateful to live in this remarkable city.
Bizarre Massage Triangle
I need a weekly massage to keep my neck and shoulders mobile; they and my arms are the primary places I still ache and have stiffness from my Lyme Disease. I have a fantastic massage therapist I see every Thursday, but circumstances conspired that made me miss two weeks of massage back to back, and I knew I couldn't go another week without body work. I decided to take a chance with a massage therapist I found on Yelp, my chief source of referrals. It's generally quite accurate, but fate had an adventure in mind.
I could tell right away that Katherine, the new massage therapist, was a little flaky. She handed me an intake form asking about basic health history. As I took it I said, "The primary information you need to know is that I have Lyme Disease." About seven feet away she started to look up Lyme on Wikipedia. "There's nothing in that entry that will help you with the work that we're about to do. I get a massage weekly, and I'm happy to tell you exactly how Lyme affects my bodywork and how we can make it a good session for both of us," I said. Katherine sat down to review the intake form and asked me where the car accident that I had a decade ago took place. Here's how the rest of that conversation went:
Me: "D.C."
Katherine: "Where in D.C.?"
Me: "Northwest."
Katherine: "What intersection?"
Me: "Why do you want to know?"
Katherine: "Because I like to ask my clients questions."
This struck me as very odd and unprofessional, but she topped the weird factor by asking me who hit me in the accident. "I think that's irrelevant and it was a long time ago," I said. By this point, I was definitely not feeling the love toward Katherine, but I was thinking, "I need the massage badly. I'll roll with it and not come back to this weirdo."
So it was a huge shock to me when she shook her head and declared, "You know, I don't think you're a good candidate for massage. There are other healing things you should be doing, but not this." Incredulous, I replied, "Massage is an essential part of my care plan. Like I said, I get one every week. In fact, I have a prescription from my pain doctor for massage so I get the expense reimbursed from my flexible spending account." I was dumbfounded. Katherine answered, "You also need to change your diet. Honey will help you."
Cue Alice Cooper's "No More Mr Nice Guy." I was astounded and thinking, "Do you know to whom you speak?" But what I said was: "Ok, Katherine. That is completely inappropriate. You know so little about Lyme that you were looking it up on Wikipedia five minutes ago, but now you know enough about it -- and about me -- to give me unsolicited nutritional advice? I don't see an R.D., L.N.D., M.D., N.D., or CHC after your name that would make you qualified to give such advice. And by the way, I've lost 109 pounds, largely because I don't eat sugar or honey. This is way over the line. Give me that intake form back; I don't trust you with my personal information." To my great credit, I said this without yelling, cussing, threatening, or calling Katherine any of the adjectives and nouns I was thinking about her. I wish I had remembered to tell her that the bacteria that causes Lyme actually thrives in sugar.
"Fuck," I thought as I left. "I really need a massage. What am I going to do?" I cursed that I didn't have an iPhone for Internet access, and called the only place in the area that I knew had a massage therapist, NustaSpa. I asked if they could take a walk-in, and they could. It wasn't ideal, because I need a therapeutic massage more than a spa-like massage, but it was better than nothing. NustaSpa was gorgeous and I decided that since I was paying a fortune for a sub-par massage, I would eat it up and enjoy the spa experience. My mindfulness practice became very helpful because every time my brain slipped back into "#@#! Katherine," I could say, "Ok, focus on what Ileyna is doing to you now, in this moment." Rinse and repeat about 10 times.
The massage saga had an interesting end: I was going to call Katherine's boss the next day, but she beat me to it and called me back the night of the breakdown. She was extremely apologetic and mortified, and offered me a complementary session with her head massage therapist. I saw him Monday and he was pretty good and very pleasant, but I can't wait to get back to see Gail, my massage therapist today. I usually hug her when I leave her office, but today I think I'll hug her when I see her.
I could tell right away that Katherine, the new massage therapist, was a little flaky. She handed me an intake form asking about basic health history. As I took it I said, "The primary information you need to know is that I have Lyme Disease." About seven feet away she started to look up Lyme on Wikipedia. "There's nothing in that entry that will help you with the work that we're about to do. I get a massage weekly, and I'm happy to tell you exactly how Lyme affects my bodywork and how we can make it a good session for both of us," I said. Katherine sat down to review the intake form and asked me where the car accident that I had a decade ago took place. Here's how the rest of that conversation went:
Me: "D.C."
Katherine: "Where in D.C.?"
Me: "Northwest."
Katherine: "What intersection?"
Me: "Why do you want to know?"
Katherine: "Because I like to ask my clients questions."
This struck me as very odd and unprofessional, but she topped the weird factor by asking me who hit me in the accident. "I think that's irrelevant and it was a long time ago," I said. By this point, I was definitely not feeling the love toward Katherine, but I was thinking, "I need the massage badly. I'll roll with it and not come back to this weirdo."
So it was a huge shock to me when she shook her head and declared, "You know, I don't think you're a good candidate for massage. There are other healing things you should be doing, but not this." Incredulous, I replied, "Massage is an essential part of my care plan. Like I said, I get one every week. In fact, I have a prescription from my pain doctor for massage so I get the expense reimbursed from my flexible spending account." I was dumbfounded. Katherine answered, "You also need to change your diet. Honey will help you."
Cue Alice Cooper's "No More Mr Nice Guy." I was astounded and thinking, "Do you know to whom you speak?" But what I said was: "Ok, Katherine. That is completely inappropriate. You know so little about Lyme that you were looking it up on Wikipedia five minutes ago, but now you know enough about it -- and about me -- to give me unsolicited nutritional advice? I don't see an R.D., L.N.D., M.D., N.D., or CHC after your name that would make you qualified to give such advice. And by the way, I've lost 109 pounds, largely because I don't eat sugar or honey. This is way over the line. Give me that intake form back; I don't trust you with my personal information." To my great credit, I said this without yelling, cussing, threatening, or calling Katherine any of the adjectives and nouns I was thinking about her. I wish I had remembered to tell her that the bacteria that causes Lyme actually thrives in sugar.
"Fuck," I thought as I left. "I really need a massage. What am I going to do?" I cursed that I didn't have an iPhone for Internet access, and called the only place in the area that I knew had a massage therapist, NustaSpa. I asked if they could take a walk-in, and they could. It wasn't ideal, because I need a therapeutic massage more than a spa-like massage, but it was better than nothing. NustaSpa was gorgeous and I decided that since I was paying a fortune for a sub-par massage, I would eat it up and enjoy the spa experience. My mindfulness practice became very helpful because every time my brain slipped back into "#@#! Katherine," I could say, "Ok, focus on what Ileyna is doing to you now, in this moment." Rinse and repeat about 10 times.
The massage saga had an interesting end: I was going to call Katherine's boss the next day, but she beat me to it and called me back the night of the breakdown. She was extremely apologetic and mortified, and offered me a complementary session with her head massage therapist. I saw him Monday and he was pretty good and very pleasant, but I can't wait to get back to see Gail, my massage therapist today. I usually hug her when I leave her office, but today I think I'll hug her when I see her.
Wednesday, July 7, 2010
Book Review: "And Falling, Fly"
And Falling, Fly by Skyler WhiteMy rating: 2 of 5 stars I have very mixed feelings about this book that I randomly picked up in the library. On the one hand, it explored some interesting questions about mental health and the stories we tell ourselves about ourselves. On the other hand, it is very pretentious and preachy. The pinnacle of this is a conversation in the Garden of Eden between the snake and the lead male character, Dominic. The snake says that he has already had an apple before tossing one to hungry Dominic. "But I have seen people chewing different fruit from the same damn branch fly planes into buildings secure in what they ingested here." Oh, puleeeze! Seriously? White takes several other thinly-veiled shots at religion and believers throughout the novel.
Another strike against "And Falling, Fly" is that it is quite confusing; I'm still not entirely sure what the precise connection is between Olivia, the main female character -- literally the fallen angel of desire and a vampire -- and the godchild of philanthropist Madeline Wright. Likewise, the book hints that Gaehod, who runs the L'Otel Matillde in what is supposed to be hell, is Satan, but we never really find out.
The book has lots of explicit sex, but none of it is titillating, in part because the entire book is so cheesy and over-the-top. For example, we learn that Olivia's vagina, once stone, magically becomes fully functional with the right partner. Author Skyler White also frequently refers to this organ as "her sex," which I find pretty distasteful. Seriously, there are a few slang words that come to mind that I think are a lot better than "sex" used in this context. This is a big pet peeve of mine.
I rolled my eyes through the whole book, but it must be a success to some degree since I felt compelled to keep reading. Dominic's neuropsychology work held my interest most closely, and I was curious if Olivia would find "her loophole," the thing that might end her torment and allow her to escape the unsatisfying life of a fallen angel.
This is White's debut novel, and I'd urge her to tone down the preaching in her next endeavor.
View all my reviews >>
Monday, July 5, 2010
Team Jacob
If there was any doubt about my loyalties, I am Team Jacob all the way. I finally made it to "Eclipse" last night with my sister-in-law, Jannie. Many film critics have declared it the best of the Twilight Saga movies so far, and I think I agree: it didn't change Bella's sulky character, but did a better job balancing it with other more interesting, animated characters. Like Jacob. And Jacob. Jasper's character got a lot more developed as he trained the Cullen clan to fight the newborn vampire army, and at moments, he even lost that deer-in-the-headlights look. Dakota Fanning was great as creepy Jane.
To me, the case for Jacob is very clear: Bella wouldn't have to undergo an excruciating process to become immortal that will isolate her from her family for decades [disclosure: Edward discourages Bella's desire to be turned vampire, but that clearly is a condition of their relationship on her part because she doesn't want to age while Edward stays perfect at 18. I guess plastic surgery, laser and Botox won't cut it]. Jacob is warm-blooded, not frigid; Jacob can make love to Bella with abandon without having to worry about literally tearing her apart; and Jacob is far more industrious and way less creepy. And let's not forget that Jacob is way hotter than Edward, who looks like Cedric Diggory who smoked some skanky weed.
I understand that there would not be a Twilight phenom if Bella chose Edward over Jacob, and it would dramatically change an important part of the last book and last two movies, but I can't help but sit there and think, "Go for Jacob!" I realized for the first time last night that Edward v. Jacob is really the fight between the privileged upper class and the salt-of-the-earth working man. Looking at the Cullen's ultra-sleek house and luxury cars, they're a stark contrast to Jacob's exposed studs on his bedroom walls and refurbished motorcycles.
Another thing that struck me last night: Stephenie Meyer, a member of the Church of Jesus Christ of Latter-Day Saints, which is vested in a very traditional family structure, makes one of the best cases for polyamorism that I've seen in mass media. This comes through in the "Eclipse" novel, but is particularly glaring in the film, where Bella clearly has romantic love for both Jacob and Edward. She admits to herself and to the guys. "Nu? Go for it!" I thought. Unfortunately, our culture makes her choose, when -- assuming Edward and Jacob didn't otherwise detest each other -- they could've lived as a happy poly family. Of course, one reason that monogamy has won out in most circumstances is that it rarely does end up being a happy family; it's one of those ideas that sounds better than it actually is, according to reliable sources. Ah, but that's another blog post. I wonder how many other people thought of the "Eclipse" poly angle. Then again, I am the girl who thought of sending an email to True Blood's producers begging for a Sookie, Eric, and Bill three-way. When I thought through the plot ramifications, I ditched the idea.
To me, the case for Jacob is very clear: Bella wouldn't have to undergo an excruciating process to become immortal that will isolate her from her family for decades [disclosure: Edward discourages Bella's desire to be turned vampire, but that clearly is a condition of their relationship on her part because she doesn't want to age while Edward stays perfect at 18. I guess plastic surgery, laser and Botox won't cut it]. Jacob is warm-blooded, not frigid; Jacob can make love to Bella with abandon without having to worry about literally tearing her apart; and Jacob is far more industrious and way less creepy. And let's not forget that Jacob is way hotter than Edward, who looks like Cedric Diggory who smoked some skanky weed.
I understand that there would not be a Twilight phenom if Bella chose Edward over Jacob, and it would dramatically change an important part of the last book and last two movies, but I can't help but sit there and think, "Go for Jacob!" I realized for the first time last night that Edward v. Jacob is really the fight between the privileged upper class and the salt-of-the-earth working man. Looking at the Cullen's ultra-sleek house and luxury cars, they're a stark contrast to Jacob's exposed studs on his bedroom walls and refurbished motorcycles.
Another thing that struck me last night: Stephenie Meyer, a member of the Church of Jesus Christ of Latter-Day Saints, which is vested in a very traditional family structure, makes one of the best cases for polyamorism that I've seen in mass media. This comes through in the "Eclipse" novel, but is particularly glaring in the film, where Bella clearly has romantic love for both Jacob and Edward. She admits to herself and to the guys. "Nu? Go for it!" I thought. Unfortunately, our culture makes her choose, when -- assuming Edward and Jacob didn't otherwise detest each other -- they could've lived as a happy poly family. Of course, one reason that monogamy has won out in most circumstances is that it rarely does end up being a happy family; it's one of those ideas that sounds better than it actually is, according to reliable sources. Ah, but that's another blog post. I wonder how many other people thought of the "Eclipse" poly angle. Then again, I am the girl who thought of sending an email to True Blood's producers begging for a Sookie, Eric, and Bill three-way. When I thought through the plot ramifications, I ditched the idea.
Friday, July 2, 2010
Beshert
Last weekend, David and I accidentally ended up watching an indie movie called "The Timer" that really struck me. The story takes place in the near-future, but half the population has a timer device implanted on the inside of their wrists that starts counting down to the days when they're going to meet "The One" -- Mr. or Ms. Right, soulmate, beshert (Hebrew word referring to your intended -- your One), whatever you want to call it. In the make-believe science of the film, the timer works by reading levels of oxytocin output. When you and your intended make eye contact for the first time, your timer beeps, so you know your match.
"The Timer" follows 30-something year-old Oona in her desperate quest to meet her One. Along the way, she ends up falling for a grocery clerk. What ensues leads to a movie that is original, entertaining, and yet, profound. The film explores the societal consequences of the device, including:
*What happens when a 13 year-old (the youngest age at which you can get a timer implanted) meets his One when he is that young? How does it impact the families of both kids?
* Is being alone worse than being with the "wrong" person?
* Can we ever be sure about love? What do we do when our hearts and our heads conflict?
* What do you do when you're waiting for your One? Enjoy random hook-ups at will? Stop hooking up? Hook up, but only a couple of times, since you know it's a dead end?
About 10 minutes into "The Timer," I couldn't help but notice the parallels between Oona's desperation and the straits that many Orthodox Jewish singles find themselves in. I don't think this is a phenomenon unique to Judaism, but I think it is very pronounced in the Jewish community, where family is given the highest priority and young people worry about meeting quality Jewish singles past their mid-twenties. In this paradigm, people lose themselves in their quests to find another. They mistakenly think life will begin or that problems will disappear when they meet their partner. Instead of looking inward, they look to external sources like Rabbis, educators, or shadchanim (matchmakers) to validate that another person is their beshert.
Few people stop to consider the implications of the term beshert anyway. It implies that there is just one other person on this planet, which I just don't believe. I think it's more like there's Mr./Ms. Right Now instead of Mr./Ms. Right. If there is only one person for everyone, how do we explain happily married divorcees and widows? I saw how much this beshert concept falls short when I introduced my husband to a childhood BFF of mine. They were so alike (same geeky, obscure books on the shelf and everything), and got along so well, I sat there and thought, "If I weren't married to David, I'd set these two up!" It was a little surreal.
Back to "The Timer." The movie was a good reminder that many paths lead to happiness; there is not one way to travel life any more than there is one beshert for you in life. Different paths lead to different outcomes, but they can all be happy outcomes. I find that both liberating and scary, and I hope I can recall this when I am trying hard to make the "right" choice in a situation, fearful of choosing the wrong path.
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