Sell-outs.

I've spent the better part of the past week re-telling the medicaid administrator for this state what I had already told them.
This, for the record, is a for-profit company.  The longer they can hold onto money, the more money they make.  For instance:

• I told them that a patient had a history of running away, including from treatment, and had attempted suicide 3 times, and was once found stoned, wondering down the highway (on foot).  They asked me to "please specify the patient's high risk behaviors".
• I told them that another patient had been raped more than once as a child, was hypervigilant, tried not to think about it, avoided things that reminded her of it, had nightmares about it, and drank heavily to forget about it . I was then asked, "please specify the details regarding this patient's diagnosis of PTSD." 
• I told them about a boy with Asperger's disorder who needs hospitalization because he keeps punching himself in the face when he's angry, and if that doesn't make him feel better, he starts punching the wall and anyone around him.  He's about 6' too, so that's pretty formidable.  They wanted to know if I had "met him face-to-face."  

They do this shit to delay treatment for a day or two, that way more interest can be earned on their money, money money for their stockholders. 

There's one person in particular, who is a local, in charge of "utilization and review" for this company.  That's corporatespeak for, "try to pay as little in claims as possible" or, "hang onto the money a day or so longer"

Turns out, she and I know some of the same people.  She's got the same kind of license I do.  Things I'd like to say to her include Tell me, when exactly did you sell out? 

and: When did you decide, "hey, what I really want in life is a job where I deprive children and the disabled of the care that they need?"  


or what it: "When I grow up, I want to work for a company that sucks so badly that small health providers are forced to close their doors due to lack of payment, and the state sanctions them...and then finally tells them that they are fired as of this next summer."


Are you some kind of derranged Republican asshole who things that adding several more layers between treatment and patient will surely make things more efficient?

I'm glad the state has put your company on notice and that you'll be replaced soon.  I hope you have a real hard time finding a job.  I hope you suffer, you sell-out.  I sure as crap wouldn't hire you. I don't trust you do act in the best interest of patients.

Signed,
That hippie you keep emailing stupid questions.
...

Signs of a bad economy.

Saturday I literally, I mean literally, didn't have time to have a panic attack. Every time I felt nervous, I would fun faster. That'll teach you, panic attacks! 

Well, I have now had my car broken into and my home broken into, within weeks of each other, by motherfuckers too lazy and antisocial to go rape their sisters.  There, I said it.  Fuckers.  They stole our very nice huge flat screen TV, a blue-ray DVD player, another flat screen in the bedroom, and Himself's laptop, and they kicked in the door, breaking the doorframe and lock. We have another flatscreen in the garage that I am, for now, too lazy to move.

We bought very high deductables back when we were both gainfully and well-employed and didn't have two mortgages.  The first night after the break-in, I was okay, but the 2nd night, well, I lay awake imaging that I heard all sorts of noises. I know, wah, wah, but still.  We are hurting.  We will not have TVs for a while. 

I feel like shit because I'm the one that forgot to lock the security door on the only vulnerable door in the house, the one they kicked in to get in the house. 

Himself used this as an excuse to suggest dogs, to, you know, make me feel safer.  And I, of course, went along with it.  Why not?  How much trouble can a dog be?

Well.  So now my garage is full of dog crap smell.  The shed that I was going to convert to an artist workshop some day I WAS, I AM NOT KIDDING SOMEDAY, DON'T PUSH ME is now a dog house. 

But.  I noticed that on my first run with my pooch, I didn't have time to stop and have a panic attack.  I was too busy trying not to get jerked off my feet.  I also ran a loop I've run before faster than I ever have before.  This morning, by 6 am, I'd run a dog around the block and was WIDE FUCKING AWAKE.

At one point we had them out in the back yard, but then I happened to walk by the kitchen door and saw them both huddled together, shivering. Well, shit.  I'm not cruel.  So we had them come in.  Someone walked up to the front door, and they barked like mad, and then settled down. One of them lay on my feet while I worked on a paper. Ahhh. Safety. I like it. Even if it does smell like dog.

A person said to me recently that between the no tvs and dogs, I should lose like, a million pounds.  I'd be happy to lose the nervousness I feel when I'm home alone.  But the pounds would be nice, too. 

...

Bet you never tried it.

So.  Himself redeemed himself pretty well by telling that he never thought I'd feel that strongly, and apologizing.

Today.  Well, today was the day I do my long training run.  Twenty miles planned.  I spent most of the pre-dawn morning ringing my hands and worrying.  About what?

• What if I twist my ankle?
• What if I break my leg?
• What if I get really cold?
• What if I trip and run headlong into a tree?
• What if I fell into a ravine?
• What if I get hit in the back by a mountain biker?
• What if I can't run any more, and it's too cold to walk?

The running was impossible.  So, I told Himself that I could hike it.  Not run it.  So we hiked it.  As much as I dreaded this run, as much as I dreaded leaving the house, I knew I had to get out there.  So, I did.

Himself has the annoying habit of telling me how slowly we're going.  This is a fairly useless endeavor; it's not unlike being tailgated by a large 4x4.  I slow down.  I don't speed up.  

The panic attack got worse.  I'd already taken a Xanax, so finally, reluctantly, I took a 2nd.

WELL.

Have you ever tried to run just chock full of sleeping medication? Me neither.  At one point, I was stoned and stumbling.  Finally the real sleepiness part wore off and I finished over twenty miles.

But I finished it.

Then I ate a pizza, and drank some nice red wine.

Uh. Yeah.

I have a job that I love.

I'm good at it.

They love me.  In fact, I was told that I was awesome.

I've talked about it nonstop at home, to you: I've told you how I love it, how they think I'm awesome.  How, for the first time, I feel like a professional, and like I'm doing something that is just mine.  All mine.

Why on earth would you tell me that there's a job opening where you work, that has nothing to do with what I'm doing, and that you've had the idea that I should apply for it?  Then get all pissy when I tell you that I don't want to apply for it?

"It's double the money," you said.

So now I feel like shit, because I'm the selfish one.

Well.

I spent my kids entire childhood working in public schools so that I could be a better mother.  I picked up kids from school, went to school meetings, usually alone.

I was the one in charge of children, all day long, mine and everyone else's.  I was the one who put my life on hold, for twenty years.  Me.

When my friends were in college, I was wiping noses and changing diapers, making people feel good, and being there.  Just being there.  When my family needed me.

I watched the world around me, the people in that I knew, start their careers, change their careers.  Live their lives.  Go places.  Have experiences.
My friends went to graduate school and started doing the things they love.  When my kids were going through puberty and slamming doors at me, I was getting postcards from everywhere.

I waited until I was old enough to have to compete for jobs against girls fresh out of grad school and nearly 20 years younger than me.  I put together graduate school, and experiences, and developed an area of expertise that quite frankly, is a critical need.  I spend my days solving riddles and changing lives.

And I'm good at it.  Really good at it.  All those experiences and education converged to form a professional--me--who knows kids, can talk to parents, and has a nice wealth of knowledge to do a job properly.
People I work with, who have been in the field longer, are asking my advice.
I thought you heard the pride and excitement in my voice.  I thought you were proud of me, too.  You seemed enthusiastic.

I've had parents hug me because I told them that there kid didn't have some intractable mental illness, when some other dufus had.  I give people hope.  I've had people consult with me from places around the state.

And I thought that you heard me.  I thought that you actually respected me for being good at something important, something I loved, something I was trained for, where I was respected.  What else is there?  You've live with me for how long now?

So how could you be so thick, so dense, as to say, "hey, here's this job that is nowhere near your interest, experience, or expertise.  It's tangentially related to your line of work, but it's higher pay, and it's where I I work, so you should apply for it"

Why on earth would you even think to do that, except that you don't really think that what I'm doing is serious, or important?  How could you not see that when you did this, you clearly were not taking me and my work seriously?

Well

You're pretty fucking insensitive.

You bet I'm pissed.

....

Good days.

I have good days, and I have bad days.  Good days, I'm happy, I like me, and I feel perfectly entitled to the good life that I have.  On bad days, I fear that when the people who know me really find out how useless, stupid, what have you, that I am, I'll lose it all. 

This week, I've had good days.  I attribute this, possibly, to the increased workout schedule.  It's helped in the past.  I'm takin bupoprion, but therapeutic levels aren't generally reached for several weeks. I was a little shaky on Monday, but nothing since then.  I worked out hard for nearly two hours on Wednesday, and did a nice little workout this morning.

I like good days.  I like days that are good.

Choice.

She sat across from me, dabbing at her eyes with a tissue.  She'd been doing that almost continuously throughout the interview.  Not long after selecting the chair in the office that was furthest from her parents, she'd pulled up her knees and hugged them as she talked. 

I asked her questions.  Lots of questions.  What do you do for fun...what do you do to make yourself feel better...what do you do when you're mad, angry, or sad?

"Get high."

I asked her who she talked to when she felt like she needed to talk.  She said that she used to call her best friend, or her aunt, but then her mother took her phone away, and when she complained, her mother said, "You can talk to me."

Her mother, for the record, disagreed with anything anyone in the room said. The girl said she was closest to her father, mom said, "No, you're not, you're closest to me".  When the kid said, "Dad understands me more" and Mom said, "No, I do."  Mom always made these assertions loudly, and stridently, frequently interrupted everyone in the room, talked over people, and answered questions were weren't asked of her. 

At one point I turned to mom, and said in a gentle, friendly tone, Do you see what you just did there?  Just now?  I asked your daughter a question, and you answered it.

Mom looked surprised.  "I thought you asked me."

Nope, I said, smiling.  I said your daughter's name, and looked away from you, to her, and you answered. 

Mom was recalcitrant.  "Well, I thought you were talking to me," she mumbled.  Then she pouted a little. 

I asked mom what she thought would help this problem, and she launched into a lengthy description of how bereaved she was when her mother died, 7 years ago.  I waited patiently, and then asked the same question again.  Same answer.  Finally, I said, I'm not really hearing how you think this problem can be solved.  Mom finally said that she had learned to solve her problems, so she thought her family should solve theirs the same way.

Later, I told daughter, in private, that her screen was positive for depression.  She dabbed at her eyes.  "I didn't think I was depressed," she said.  I also told her that results of another screening showed that she was in danger of developing a substance abuse disorder, based on her feelings and attitudes.  I asked her, You've been crying the entire time you've been in here.  Does it surprise you to hear that you were depressed?

"No, I just thought that, you know, I was reacting like we all do--trying to get over living with my insane mother."

I think, based on what I've learned, and the results of your screening, that you would benefit from residential treatment here...just to have a chance to get out of the house, to think, maybe to learn to make good decisions, but I want to know what you think.

"What difference does it make?  It's not like I have a choice."

It makes a huge difference, and you do have a choice.  In our state, at your age, you have the right to refuse, unless your life is in immediate danger.  I recommend it, just for you to have a chance to get away, but we also have a day treatment option, which doesn't involve living here. 

She stopped crying for a second, and started at me, astonished.  "I get to choose?  I never get to choose anything."

Well, you get to choose this.

Mom, for the record, was furious.  In the waiting room, she said, "I thought that if I told you to lock her up, you'd do that.  Why does she get to choose? I know what's best for my daughter."  Daughter lifted her head up, and walked out of the room.  She was going to come to day treatment.  We'd shook on it.  Or banged knuckles, whatever that's called. 
Dad looked relieved, and walked out with his daughter, his hand on her shoulder . He didn't really think his daughter needed to be locked up either. 

Mom, well, she's still pissed. 

I hope she's able to get some help managing that.

,..

Anxiety.

All throughout my adulthood anxiety has found some way to poke its head out.  Generalized anxiety is when anxiety from an event, or a cause, spreads out, like a thick, black fog, until the person is anxious about lots of things.

As soon as I figure out what's going on, it finds another way to get at me.

For a while in the 90s, it was just a feeling of unworthiness, and fear that people would figure that out.  Lots of education later, I was able to talk myself out of that feeling.

Then came a time when I would look in the mirror and see a hideous troll.  Gross.  How could anyone love me? Look at that mishapen face.  Look at that stomach, those legs.  Then one day I realized what was happening, and started the self-talk, the logic.  It worked.  Mishapen me went away.

Then the muscle spasms started.  In my neck, in my legs, for no reason.  I'm working on those.  But meanwhile, now I have panic attacks.  Joy.

Hopefully, before it can turn into something else, I'll be getting some therapy.  There's this cognitive behavior place in town.  I'm hoping that someone there can use something called "Prolonged Exposure Therapy".  It is THE thing for PTSD.  Here's hoping.

~~~