A Frank Discussion

My husband and I were discussing the health care problem and the proposed reforms. Aside from the problem of illegal immigrations added expense to the system, which we are all aware of, there are serious issues about end of life decisions. Please stay with me, because I may go in a different direction than you might expect.

The majority of health care dollars are spent on the very elderly and the outcomes are very poor. We can prove that, statistics show it. Most of the frail seniors that fall and break a hip usually succumb to some other problem even if they survive the surgery. So does that mean they shouldn't have it? Who is elderly? Is a 59 year old person elderly?

I think the real problem with this is recognizing when the end of life is happening naturally. While I was working in the ICU I educated the other nurses there about the signs of dying. You would think that ICU doctors and nurses would know that, but not all of them are familiar with the signs of impending death. We can see signs from 6 months, a few months, weeks, days, and hours.
Just as we know the signs of labor and delivery and imminent birth; so are the signs of dying.

No one wants to perform CPR on a frail elderly person and hear the sound of bones breaking with every compression. If they don't have a DNR order on the chart we have to do it, it's the law. It's gross. The first time I actually had to give a patient chest compressions this was the case and Icould feel and hear the bones breaking, it was awful. This little lady had already "coded" once and since she was in her late nineties she did not have a successful resuscitation. Her family let us know later that she didn't want one. She had expressed her wishes to the family but it wasn't on the chart. That happens all the time.

Are you picking up on the problems as we go along?

What about when you know the outcome is going to be bad, say a person who has never been ill but presents with life threatening illness and a whole host of problems all inoperable and most likely fatal; but the patient and the family need time to absorb all of this. What do you do?

Your patient is a young person in their late thirties they are in end stage alcohol disease and they have AIDS, they have no family that you can locate. They are in denial of their impending death and are basically in your ICU for pain drugs. They have been in hospice and discharged themselves out. They are too sick for the floor so they must stay in the ICU until they die which can be weeks. What do you do?

These are real scenarios. I can write up hundreds of them. My point is that THESE are not the issues of government. Legal intervention and government intervention have made the nightmare we are in right now. The doctors and nurses DO have ideas about the right way to solve these problems but it is so cloudy between malpractice and RIGHTS that it is usually the last thing that can be done if ever.

How do we solve it?

One thing we need to do is educate everyone about natural death. I am very comfortable with helping a family accept that a person they love is leaving this world. I am in a place in my own practice where I can see what is going on and when to call it quits. I am very pro life. I do not believe in withholding treatment. BUT there are times when the treatment becomes cruel. There are times when the best treatment is to comfort and to relieve pain. It takes a tremendous amount of teaching for families and also for staff.

My husband asked me if I wanted the job.

I just looked at him.

It isn't a job for the government that is to be sure. They have already made a big mess of it. We can't mandate who gets what. If you knew the mess that medicare laws are, you'd see how that is ALREADY happening. If you don't meet medicare criteria you need to go home. Your sick? Sorry you don't qualify, can you private pay? No, well then you have to leave.
I am dead serious about that too.

What would you do faced with these ethical dilemmas? Have you had discussions with your loved ones about end of life issues? Have you really investigated this beyond table talk? Do you have it in writing? Does your doctor have a copy? Are there people in your family who oppose your thinking? If you don't want heroics when do you want them stopped? If you could be on a ventilator for a short period of time and then recover do you want your DNR in effect or not?
Just for the record if your going to the OR you are not a DNR.(do not resuscitate) You really have to be at the end of your life to have a DNR. If your healthy we are going to save your hiney, you can count on it.

Do you want to talk about this for a bit? I have time. Bring your questions to the blog table and lets talk about them.

Do You Want This?

I got this in an e mail. Having the government have direct access to my bank account by electronic funds transfer is enough for me to freak. I thought I didn't want the OBAMA plan now I am sure of it. What do you think?

A Few Highlights from the first 500 pages of the Healthcare Bill in Congress

Shared Yesterday at 10:20 pm

If you are a senior citizen, you especially need to read from page 425 to the end of these highlights.
Bottom line, they want seniors dead and out of the way....( it would solve the social security issue and the majority of money spent now is on the elderly and they have very poor outcomes) What is amazing is that the cut off seems to be age 59!

Subject: Fw: A few highlights from the first 500 pages of the Healthcare bill in congress
Contact your Representatives and let them know how you feel about this. We, as a country, cannot afford another 1000 page bill to go through congress without being read. Another 500 pages to go. I have highlighted a few of the items that are down right unconstitutional.

• Page 22: Mandates audits of all employers that self-insure!
• Page 29: Admission: your health care will be rationed!
• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
• Page 42: The "Health Choices Commissioner" will decide health benefits for you. You will have no choice. None.
• Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
• Page 58: Every person will be issued a National ID Healthcard..
• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
• Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)
• Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.
• Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of 20 private plans)
• Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
• Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.
• Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
• Page 124: No company can sue the government for price-fixing. No "judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed.
• Page 127: The AMA sold doctors out: the government will set wages.
• Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.
• Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.
• Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll
• Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll
• Page 167: Any individual who doesn't have acceptable healthcare (according to the government) will be taxed 2.5% of income.
• Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).
• Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
• Page 203: "The tax imposed under this section shall not be treated as tax." Yes, it really says that.
• Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected.
• Page 241: Doctors: no matter what specialty you have, you'll all be paid the same (thanks, AMA!)
• Page 253: Government sets value of doctors' time, their professional judgment, etc.
• Page 265: Government mandates and controls productivity for private healthcare industries.
• Page 268: Government regulates rental and purchase of power-driven wheelchairs.
• Page 272: Cancer patients: welcome to the wonderful world of rationing!
• Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.
• Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.
• Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!
• Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.
• Page 321: Hospital expansion hinges on "community" input: in other words, yet another payoff for ACORN.
• Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.
• Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.
• Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.
• Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).
• Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?
• Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time.
• Page 425: Government provides approved list of end-of-life resources, guiding you in death.
• Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.
• Page 429: Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT.
• Page 430: Government will decide what level of treatments you may have at end-of-life.
• Page 469: Community-based Home Medical Services: more payoffs for ACORN.
• Page 472: Payments to Community-based organizations: more payoffs for ACORN.
• Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.

Is Confession Really Good for the Soul?

I don't cry much. Somewhere along the way I learned to buck up and stand up. When you work with people who are really sick it changes you. How big of a problem can I have when I am working with a terminally ill child? Especially when they are the bravest of all.

I guess some where along the way I decided that what happens to me is not of significance in comparison. That is true. But it is also true that just because it's not a matter of life and death doesn't mean that it isn't difficult. And having problems isn't a sign of weakness nor is having feelings about them. But it is embarrassing.

The embarrassing thing is to be up in the night and pour your guts out on the world wide web. You know in a moment of severe emotion. I have been crying a lot. It's weird, I can't remember the last time I cried and now that it's started I can't seem to stop it. You know when your eyes sting that it's been quite a bit. Lucy will think that I am having a nervous breakdown and going crazy, but it isn't that bad. There is something to be said for the momentum of keeping on keeping on. When you stop and stand still a lot can catch up with you. You stop and take inventory when there is no where to go.

I really appreciate the comments that you all have left. I feel the support and the care, even friendship. I am guessing that maybe some of you might be wondering about my faith. Wondering why my faith isn't carrying me better. It is. What I know the best is that Jesus understands my fears. He was a man of sorrows acquainted with suffering. I don't have to measure up, all I have to do is lean. I learned that real faith is honest, that when I am weak He is strong. He will show up mighty on my behalf inspite of me, not because of me. That's why I love Him so much. It's not about me or my performance. It's about how faithful He is.

I am not really sure why this upcoming surgery has me in such knots. I think it is because I have worked for so long and know all the crap that can happen. It's the idea of them taking power saws to my bones. It affects me about the same as cutting a leg off. And then there is the question of my feet and that they have new fractures. Well, that wouldn't have anything to do with me working like a maniac half the time; OK all of the time. So we have established that I am nuts and need to cry.

There are so many questions. This isn't a good time to not have a job or go backwards. Will I be able to work again? If not what will I do? I don't really need an answer, just to say the question because it can't be answered right now. The answer is in the future. Right now I am in a holding pattern of waiting. My LEAST favorite place to be. You would never have guessed that right?
I think when we go threw tough stuff we look for what has been our comfort in the past. For a big part of my life that was my dog. He didn't hold a place above God, or my husband, or family or friends; it was just different. He was my buddy and when I looked into his eyes I felt something , he understood me without words. It's a new lesson to learn to walk threw dark places without an old friend.

You know what I hope? I hope that when this is all over I am embarrassed to say that it wasn't so bad. That all that anxiety was for nothing. Worry never works, I think it's 99% of the things that we worry about never happen. There are two ways to look at that, either it works or it doesn't. NOT. So now what? It's August I have to wait to meet the surgeon until the 13th and then we set the date and get this over with. I need to keep a positive attitude KNOWING how health care really works. I'm going to have to work at this.

Tonight I can cry more if I want to. Tomorrow I am getting up and getting dressed and am going to find something interesting to post about. I am going to find a cool picture to take. I may even bake something. That's long enough, a full day of bawling ought to be good enough for anybody. I am such a big baby, I can't even believe this. Am I really going to hit the publish button on this one?

Sleepless

Depression has struck me. I fear I am behaving like a spoiled child but I cannot seem to do anything about it. My husband says I shouldn't look at dogs and then this wouldn't happen.
He is not like me. He doesn't want another dog. I don't understand because he loved Rasmus so much. You never heard a grown man sob so wildly when we lost him. Sometimes I think that is it, but then no, it is not.

How can two people be so different? He does not understand me and I do not understand him.
The day we buried my dog a big part of me went down into that grave with him. It freaked my family out. I quit cooking, I quit talking. I never experienced such a loss. Is it wrong to love a dog like that? I never had that in life before, that connection that runs so deep. My dog wasn't really like a dog. He was more human, he knew every word you said to him. I rarely ever "commanded" him. We had a connection of respect and love. Sometimes I lost my patience with him if he pulled the leash, and a tear falls for every time I ever was cross with him. He was a magnificent animal. Watching him move with so much grace used to thrill my heart. I loved to see him run and leap. I would take him to the lake and turn him loose just to watch. He was totally trustworthy. The leash was never needed it was required by these laws. I long to live where you can let your best friend have the freedom to just be. Now crates are the thing. I wouldn't have one in my house! My dog was stuck to my hip and his obedience without fail. He listened. He also loved my husband a great deal. In fact he chose him in his last years. It didn't help that they got to hang out together all the time while I worked. It didn't help that he played ball and petted him constantly, the thief. He has been dead for two years and still the grief is so fresh, sometimes it is unbearable. I question this.

How can a person grieve for a dog so intensely? I have lost people and have more peace about their loss. Is it the way he died? Is it that I had to make the decision to send him to his death?
He wasn't ready. He tried to tell me to take him home. I knew what he was trying to say. I knew he didn't feel that bad yet, but it was coming fast. I couldn't bear to have him go through all the grotesque horrors of melanoma. I knew it was aggressive and that it had metastasized already to several areas in his head and body. The tumor in his eye had doubled in size in just a few days and it was bleeding. It was so hard. He looked so magnificent so alive. People were looking at me with questioning looks, why was I there to put THIS dog down? I never saw a more sorry face than in that vet. I didn't know him. He looked so sadly at me and said that yes it was right. There isn't a meaner cancer for a dog to have. What hurts me so much is that Rasmus wanted to go home. He stood facing the door at full attention ,"LET ME GO" and I put him on the table. When I did he quietly submitted in full grace. The vet muzzled him which killed me. He just submitted. We were no good for him clinging to each other in sobbing grief. Rasmus knew he was going to die, he knew we were saying goodbye and he just bowed his head in great majestic grace and died; and a big part of me went with him. Maybe I will never get over it.

I thought if I got another puppy it would help. From the first moment I saw Lu I knew I had made a mistake. I couldn't love her. She was beautiful and I felt nothing for her. I would look at her and cry. That brought up a whole host of issues. I finally gave her away and made sure she got a very good home. All dogs should have that. So what makes me think I could love Riley?
It's just a photograph. I am an idiot to fall so hard for a picture.

I am an idiot. My husband says no and the rescue says no and I am heartbroken all over again. I know in my heart what could be. I can see in him that he is right, and it makes my heart sick.
So I am a spoiled rotten child crying for what I want and can not have. Sometimes life is so stupid. It's just stupid. This should be simple. I need him and he needs me, it should be a simple happily ever after and it isn't. That is just stupid and I am depressed.

When the cleaning is done- BAKE!

This is a little glimpse of an apron from "at home with the farmers wife" I was trying to take my own picture and my arms are too short. But you can see the details in the bib. Suzanne makes lovely aprons, out of recycled mens shirts and vintage fabrics. She even makes her own custom bias tape, very nice. I felt very elegant grinding grain and baking today.

The cupboards have been washed and tidied. This one was full of canned goods before.

I had everything crammed down here now we are all spread out nicely, it's so much easier to get to the things I need to use. Kayla helped a lot she did the scrubbing.

I took my cupboard doors off to see how I would like that farmhouse look. The idea is to recycle them into the laundry room. Hunny makes cabinets but not door fronts and they are expensive. I'm trying it out for a bit, what do you think? Look how clutter free everything is. I am beside myself.

It's been raining every day. I haven't taken a picture of the garden in awhile but here is some of the okra, and some apples. The apples are from Krogers, no false advertising here.

Today I did one of those things I do well. I baked. I made a batch of regular wheat bread. I also filled up my bin with the artisan dough to let it start getting sour.

As long as all this dough is happening might as well make some pizzas for dinner.

I actually managed to get the crust on this one thin and crispy. Pepperoni is a favorite here.

This one is pesto and sundried tomato as well as some fresh sliced tomatoes. It tasted sweet because the tomatoes are so ripe. Hunny and Kayla liked the pepperoni the best. Good more of this one for me.

The living room is back to normal. Wow. It's been weeks of work. Good things that you work hard for are so satisfiying. My kitchen is getting happier every day. It was so much easier to work in today. I had plenty of free counter top to work on, and it was easy to get at pans and racks. I was grinning like the cheshire cat.

The rescue that has Riley won't adopt out of state. I understand there concerns but isn't the whole point to get these dogs good homes? They are a bit over the top with their wanting to come and inspect your house and also they want you to cook for the dogs all organic food.
Actually I really don't care what they want. I want to give that adorable dog a home. He can sleep on my bed and that's as good as it gets.

I didn't mention it to the hunny until after I found out from them. He never had that moment of elevated blood pressure, except for the painting he is doing today. He hates painting. I used to do all of our painting every bit of it until I found out that he CAN paint. He just doesn't like to paint. Guess what? I don't do all the painting anymore.

Anybody for some pizza?

LOOK!

It's done. He should get a gold medal. There should be an Olympic medal or a medal of honor or some kind of huge award for being my husband. There should be a reward for making someone else dreams a reality. He's magical. Not really, he worked HARD! There is no price tag on this. I couldn't afford to pay.

Amazing. It all fit! Look at all those buckets of grain, beans, rice and yes the old evil white sugar. I have 45 pounds of sugar. I need to bake some pies for this man! He loves dessert. Tomorrow the cook is getting cooking.

You'd never know all the effort that just went into this. Scroll down for the before photos when this was a laundry closet and had dirty carpet in the hallway.

Kayla and I worked hard today. We cleaned up in here.

Way better. Way way way better. There is still a little bit left to do, but not much.

Next thing to do is move Kayla upstairs and me down stairs before my surgery and maybe go to Georgia. I'm looking into that doggie in the rescue. OK bear with me here but in a divorce you have 2 people, neither of which wanted to keep their dog? I got divorced once and replaced that bum with a dog and was way better off. Well, then the hunny came along. I loved Rasmus so much, the worst thing that ever happened was for him to get cancer. He was so beautiful and so graceful, he even showed his grace with that terrible disease. We can learn a lot from dogs. We can learn a lot about doing the right thing, about not being selfish and self serving, about loyalty and kindness and play. Dogs make life so good. Now cats? I'm teasin....you know we have two cats and I just wanted to get you riled up. Riley. Perfect name don't you think?

wishful thinking

This is Riley. He is in a rescue. due to a divorce. This dog just kills me. Can you fall in love with a photograph? It would take me 7 hours to drive to where he is. Then you know they have to approve you. I'm crazy about him. I think he's the cutest thing I ever laid eyes on. I'd let him sleep on the bed. He looks like a leaner and a grinner and just the right kind of a guy. How am I going to ask my husband if I can go on a 7 hour trip and look at a dog and hope that we fall madly in love at first sight? But you know it's only with dogs that it happens that way. I sure wish there was a real Santa Claus or a good fairy or some magical genie in a bottle. I just can't quit looking at him. Riley.