Category Archives: mental health

Healthcare is Confusing Part III: The Uninsured and Serious and Terminal Illness

So, this is one of those mega questions that I think all of our discussions about how we pay for and organize healthcare should boil down to: How does someone who is uninsured pay for treatment for serious, progressive or terminal illness? Guys, this shouldn’t be a hard question. The answer should reflect the value and theoretical framework that our healthcare infrastructure is based on. But, no surprise here, this is not the case in America. Our currently healthcare system is not based on valuing health, but on valuing profit. American healthcare is concerned more about money made than lives saved, and the answer to this question isn’t easy or simple.

can-amp-039-t-afford-health-insurance-then-go-make-drugs-to-pay-them-off-and-later-kill-yourself_o_3802805

I mean, it’s not that crazy of a premise these days. 

I’m a social worker at a free clinic for those who are working but are uninsured or underinsured. Rita (not her real name) came into my office a month ago. She had short, gelled and spikey brown hair, stood about 5’4” and couldn’t have weighed more than 100 pounds. She was wearing short sleeves that showed off her barbed wire tattoo around her right bicep and a faded rose on her left arm. She didn’t have an ounce of fat on her, and looked closer to 25 than her actual age of 45, with the exception of her tired eyes. She was the assistant manager of a local 24-hour gas station and once refused to give up her drawer to a man who was robbing the store. This didn’t surprise me.  Rita reminded me of a few tough women I’ve known in my life, a few women who have been through some real hardships in life, and I immediately liked her- I immediately cared about her.

As soon as she sat down, Rita warned me that she was “a bitch”, and started to tell me about herself. She just moved back to the city a year ago after spending the past five years with an abusive boyfriend, living in a trailer park in rural Pennsyltucky. Once she got the courage to leave, she moved into an apartment in a housing project that her elderly mother and deteriorating aunt lived in so that she could help take care of them. She loved her job as the assistant manager, especially finding and firing the “scumbag thieves” who stole from the store during their shift.

Rita’s gynecologist, who is a volunteer at our clinic referred her to me. “I found out two days ago have cervical cancer and I don’t have insurance”. My heart dropped. I asked her how she was dealing with this news, which she replied that she couldn’t do anything but keep up her normal routine. She hadn’t told the few people she had in her life- her aunt, mother, and co-workers, and wasn’t planning on telling them anytime soon. She had no support group and was trying to figure out what to do on her own. She explained further that she didn’t have insurance from her job- she started as part time and once she moved to full time status they never offered her health insurance. She would be able to enroll in two months when her job offered open enrollment, but even then, the actual coverage wouldn’t start until January 2018. The cancer was progressing fast and her doctor needed to start treatment now.

I didn’t know what to tell her. I knew she made too much to qualify for Medicaid, but I didn’t want to discourage her. I told her to go home and I would call her as soon as I could with a solution. The truth was that I had no idea what the solution would be and was overwhelmed thinking about how this woman who was so full of life was going to die because she couldn’t afford stupid insurance.

Luckily, the answer in this case scenario came easily enough. Pennsylvania’s Medicaid program contracts with The Healthy Women Program which offers a medical assistance to women diagnosed with breast or cervical cancer. The paper work was simple enough- send in 2016’s tax filings, proof of income for this year, and proof of the cancer. I made phone calls all day, and by 5:00 I was able to tell Rita that I had begun her application for medical assistance. I spoke with a representative from the managed care company, who The Healthy Women Program sub-contracts, after I filled out her application and was informed that the processing time would be 5-10 business days. I spent the next day completing the application for Rita, getting all of her paperwork in check, and pestering the Healthy Women Program to send the final application to the County Assistance Office for final approval. I checked in with Rita throughout all of this, and she was a fucking warrior. The weekend went by and Monday morning, Rita told me that her doctor informed her that she was going to need to get a procedure done ASAP and start treatment for the cancer- apparently, the cancer was worse than they originally thought. When I got off the phone with Rita, I got in my car and drove to the County Assistance Office to see what was going on with her application since no one had returned my phone calls. Luckily, I was able to speak with a reluctantly kind case worker and I pleaded for her to expedite Rita’s application. The case worker told me that they didn’t expedite any applications and she couldn’t talk to me at all about Rita’s application due to confidentiality, however the caseworker asked me for Rita’s phone number and called her right there to finish the application process. This caseworker didn’t have to do this, and I am so grateful that she listened to my pleas.

Rita was able to get medical assistance and started treatment by the end of the week. I’ve been keeping in touch with her, and she’s still working even though she’s really tired. She’s going to take FMLA, but wants to wait until she absolutely needs it. The cancer is progressing, but she’s not letting this get her down. I keep telling her that she’s a warrior, and she ends each phone call with thanking me for saving her life. I don’t know if Rita is going to live, but I’m so grateful that she was able to get treatment- it’s the happiest ending I could realistically picture of this scenario.

This wouldn’t have been a happy ending if Rita had a different type of cancer or any other serious or terminal illness. There wouldn’t have been a happy ending if Rita lived in a different state that didn’t have a program like the Healthy Women Program. Not to toot my own horn, but Rita was lucky to be referred to me- had she not had someone who was familiar with the confusing systems of American healthcare, and someone who would advocate for her, I guarantee her application wouldn’t have been processed so quickly. Rita got lucky that there was a program that could help her, and see, that’s the problem right there. No one should have to be “lucky” enough that their progressive illness is one of the few that is covered by specialized, state-administered, programs. Someone who is diagnosed with cervical cancer in Arkansas should be able to receive the same healthcare as a person who is diagnosed in Pennsylvania. People who are dying should automatically be eligible for medical assistance and obtaining this assistance shouldn’t be as complicated as it is now.

So, what is the answer to what happens to people who are uninsured and are diagnosed with a serious, progressive illness? There’s a small chance that there may be a specialized program to help pay for their specific illness. There’s also a small chance that they will be picked as out of thousands of other applications for a scholarship, grant, or charity care from large non-profits and foundations. There’s also a small chance that magic Jesus is gonna skateboard down from the heavens to lay hands and miraculously cure the person immediately. The more likely answer is that they person suffers and then dies. People who are uninsured are already unhealthier than those who are insured. Poor people are at a higher risk for serious illness than the middle class. People who are uninsured aren’t able to access preventative care, and thus will more likely have poor and deteriorating health. This is all such a bummer and such a fucking problem. This is the huge question that should be answered based on a collective value, but there are very few people of power who will admit that America healthcare values money over health. I don’t know what the answer is, and I pray that I don’t have to help anyone else in Rita’s situation who isn’t as lucky as she, but I know that I will, and that that patient is on their way.

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Healthcare is Confusing Part II: The Opioid Epidemic

I live in Northeastern Pennsylvania, an area that has been affected by drug addiction and rampant alcoholicism for as long as I can remember. I personally know more people who have died from drug overdoses than any other type of death. And almost all of these people were under the age of 35 when they died. I lost one of my best friends to a heroin overdose in 2008 when she was only 19 years old and a freshman at Penn State University. I lost a close family member to an overdose in 2011 who left four children and two grandchildren (along with many others who loved her creative and beautiful spark). My response to all of this is: Heroin (and prescription opioids) really suck.

There is no clear answer on what will end this “epidemic”. People are quick to make judgement on what should be done based on their personal worldview, which can be dangerous when forming any opinion. Recently, DAs have been charging people who have provided drugs that caused a person to overdose with homicide and manslaughter. I’ve been hearing the rallying cry crescendo over the past few months- “DEATH TO DRUG DEALERS!”.  In my opinion, although this may dissuade a few people to stop selling drugs, it isn’t the answer. And holding someone responsible (the person who sold the drugs) for the person who overdosed decision is an area that has the potential to create a dangerous precedent. We don’t hold gun owners responsible for people who kill themselves, right? We don’t jail Nabisco executives for those who died from diabetes or other sugar-causing illness, right? Now don’t get me twisted, I don’t think that we should be okay with people selling illegal drugs (or selling legal drugs illegally), but holding them responsible for this epidemic isn’t going to stop it, because it’s not looking at the real problem, the dangerousness of addiction, the availability of opioids, and both the lack of availability for drug and alcohol treatments and effective models to help people live sober lives after they’ve been addicted to drugs.

So what does the opioid epidemic actually look like? Someone only needs to visit the twin cities of Northeastern Pennsylvania, Scranton and Wilkes-Barre, to see an example of an area affected by addiction. People used to line up at a walk in Ready-Care clinic at 7am in downtown Scranton in order to be the first to get their script for Suboxone, a medicine akin to Methadone, which acts as the bridge between addiction (originally created for treating heroin addiction) and sobriety. The problem with Suboxone is that Suboxone has a high-risk potential for abuse, like all opioids. And, like all opioids in impoverished, rust belt cities, it is easy to get.

A few years ago, one of my friends was struggling with addiction to Suboxone and other opioids. Instead of the constant worry about getting in trouble for buying these drugs illegally, she wanted to get her own prescription for Suboxone. She also wanted to eventually get off of Suboxone, so having her own prescription would hopefully help her start the journey to living life without opioids. I ended up giving her a ride to a different walk-in clinic (about a mile from the one that people used to line up in front of), that appeared innocent and legitimate enough from the outside, but was actually just another pill-mill for those who wanted Suboxone. While in the waiting room, I spoke to a few other patients who were there for their “check up” with the doctor. I was told by one young man who was waiting for his routine check up to get his prescription filled, that all I needed to get a script of Suboxone for myself was to schedule an appointment (if I didn’t have insurance, that would be okay too, because the clinic had really good payment plans) and make sure I had some type of opioid/opiate in my system because they would give you a drug test. As long as your drug test came back showing that you had an opioid or opiate in your bloodstream to prove that you were addicted to an opioid/opiate, then they would start you on Suboxone. Easy as pie.

suboxone found outside my house

Suboxone wrapper I found in my yard. It’s everywhere.

I was in shock. That’s all I needed to do? Just take a Vicodin or Percocet or whatever and bam!- I would have a script for a month for my own Suboxone. This really troubled me. My friend who I brought to the clinic was proof of how easy it was to get a script of Suboxone. That’s all she did- took a drug test that showed she had opioids/opiates in her system and she was all set. No more worrying about buying drugs illegally because now she could buy them legally. No type of psychotherapy or AA/NA attendance was required and her appointment with the doctor lasted less than 10 minutes. It was clear that this Ready-Care only cared about keeping their waiting room packed with drug seekers than actually trying to help these patients dying in addiction.

Now that was a few years ago, and I do know that the clinic where people used to wait in line outside was raided by the FBI and two doctors were charged with Medicaid fraud, conspiracy, theft by deception and insurance fraud for submitting false claims. They also directed unqualified people on their staff to write prescriptions for controlled substances. I guess this is  a start for holding prescribers accountable, but I’m not sure how much that will dissuade other doctors from over prescribing opioids and opiates. And as far as I know, the other clinic where I took my friend is still operating as a pill-mill.

The Center for Disease Control lists the number one group of people most at risk for heroin addiction are those already addicted to prescription pain relievers. We know that people who become addicted to their pain pills turn to heroin when they no longer can get their medication. To personalize this a little- think about all the people who used to wait outside the walk-in clinic I mentioned above that got raided. Once that raid happened, and those doctors were charged with fraud, the people who were dependent on getting their pain pills or Suboxone there had to find a new way to get their drugs- and when the medical institutions won’t provide them, there are drug dealers with heroin that will do the trick.

The Center for Disease Control lists the number one step for preventing heroin abuse by reducing prescription opioid abuse. The CDC calls on doctors to implement better prescription practices. Now this seems pretty logical, right? If doctors know how to better understand pain and treat pain in ways that don’t involve medication, or at least limited use of medicine, then of course the number of people abusing opioids and opiates will drop. However, I have observed that this is a real point of contention for doctors.

Back in May I held a panel discussion about opioid abuse in NEPA, with the focus on speaking about solutions. I had the Scranton Police Chief Graziano, Democratic State Senator for the 22nd District, Senator John Blake, and two direct practitioners who work with opioid and heroin abuse in our area- Doug Albertson and Ricardo Horn. The panel was very well attended, and I was so happy to get so many different people in a room together to talk about one of the biggest issues in Northeastern PA.  However, when the discussion started to move towards prescription practices, an attendee decided to take over the panel and made sure that those in attendance knew his opinion on the matter. He walked right up to the podium, took the microphone away from the professional moderator, and went on a rant for about 10 minutes. What he had to say really opened my eyes to the need for better prescription practices. He was a surgeon who works for a small hospital in rural Pennsylvania. His tirade included blaming the audience, and not physicians, for people abusing opioids (that didn’t go over too well- any “you people”, literal finger-pointed statements don’t tend to bring positive discourse). He went on and on about how doctors aren’t the problem, and that it’s the people who don’t throw out their unused medications who are the real contributors to the opioid epidemic. He went on to say that when patients want opioid prescriptions, he will give it to them, because he can’t risk having a patient fill out a patient satisfaction survey negatively. tBut again, he reiterated, that it wasn’t doctor’s faults for overprescribing pain meds.

I very rarely get mad. I’m a pretty calm person, and my anger has always manifested in sadness or self-destructive behaviors towards myself. But I can say truthfully that when that doctor took over my panel that I worked months on organizing, that I spent countless hours researching the epidemic in order to write the best discussion questions that I could, well, I was really mad. After his initial tirade, he continued to stand at the front of the room next to the panelists until I had to walk up and ask him to sit back down. After I calmed down a few days later, I was able to look back on the experience and saw how this doctor is a perfect example of what is wrong in our medical milieu when it comes to prescription practices. He refused to see himself, and fellow doctors, as adding to the problem in any aspect. He diligently defended himself, although there was no reason to do so- he was never under attack, in front of about 100 people. My theory now is that he needed to absolve himself by taking over my event. And I think this is where the real problem lies. No one likes to be wrong, especially when it comes to a serious issue like opioid addiction. No one wants to take any type of responsibility for being a potential factor that is adding to the problem. This doctor refused to see the part he and fellow doctors played in over-prescribing opioids, and that sucks. I really had to question the ethics of this doctor as well- he was more concerned with getting a positive patient satisfaction survey back than the safety of his patient.

The blame game doesn’t work. The doctor blamed everyone but himself for adding to the opioid epidemic, and I see a lot of doctors and physicians unwilling to look at how it might be beneficial if they changed their prescribing practices. Nothing changes if nothing changes, and that’s a scary fact when we’re talking about people’s lives. There is no easy answer to fixing the opioid crisis, however we must start to be honest about what works and what doesn’t work. This applies to all things healthcare (and I guess, all things in everything). We aren’t going to make any progress in reducing the amount of people addicted to opioids/heroin until we examine to why it’s so easy to get addicted in the first place.

Pill bottle

“You just got your wisdom tooth pulled? Here’s 45 vicodins, make sure you take them with food and fill out a positive patient survey, let me know if you need anymore!”

I think a good place to start to try and figure out how to combat the opioid crisis is what the  CDC recommends- looking at how we prescribe pain pills. One thing that I found very surprising and alarming is the minimal education students receive in med school about addiction. The Association for American Medical Colleges and the Liaison Committee on Medical Education (the accrediting body for Med Schools) have no clear requirement of hours for studying addiction. This is also true for other health provider trainings and education. I recently spoke to a physician assistant student who is in her last year whether she had any training on addiction or working with people with addiction. She told me that she thinks there might have been one lecture on the subject, but she couldn’t remember it. This is a big freaking problem.

We need our doctors and medical providers to understand addiction on a micro level, on a direct-practice level. They need to treat addiction and be aware of the potential for addiction risk in their patients. Medical schools need to increase and mandate hours of learning focused on addiction in their curriculum. Although opioids are obviously a money maker for Big Pharma, my hope is that one day we can treat addiction and pain in a holistic approach. Studies on mindfulness have recently shown how practices like mindful breathing and meditation can be effective for treating pain and in helping guide people towards a life without pain meds and addiction. Teaching patients about the risks of the medicine the doctors are prescribing can also be helpful so patients know what they might be getting themselves into. I hold a hope that one day healthcare in all of its aspects will embrace a holistic approach and look at how integrating the mind, body, and soul into treating pain is more effective than writing scripts after scripts for opioids.

When will any of this happen? When will we see any change? When will the line graph finally show a decline in overdoses and addiction? The answer is, I don’t know. But I think the only thing we can do is hold our prescribers accountable. How we do this is isn’t clear yet. But at least the conversation is starting, and that’s a good place to start.

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Social Media Isn’t Real (And That’s Okay).

Two quick reminders: Social media isn’t real and I write this blog from a female feminist perspective. My views may be completely off the wall compared with yours (isn’t that cool?!), and whatever the next few paragraphs say, they are no means an attack on anyone I personally know- I feel we can all relate to this shit, na’mean?

i like you more than the instagram you

This is probably true, unless ur a garbage person in real life but super sweet online.

So recently, a few people have commented on pictures of me and my finance on social media, saying things along the line of “perfect couple” or whatever. And I’m not gonna lie, that attention is kind of a nice feeling, but nonetheless I’ve been really, really taken back by these statements. Because a picture alone cannot tell you much about our relationship. I’m not saying that my relationship with my partner is bad or anything like that, but it’s definitely not “perfect”, and I don’t want people thinking that about us, because, well, it’s not true! Also, just real quick: no one’s relationship is perfect.

I know a lot of people have been feeling less-than lately because of internet culture, and I just want to reiterate that social media is not real, and perceive people’s “realness” based on their social media persona can be super toxic, yo. What we see online of people is just part of their cultivated digital personality. Ok, wait a minute. Let me back up real quick. What we see online is of real shit, but the meaning we infer from it is not real. I like social media. I get to see pictures of my friends kids, of my family that lives far away, and just funny shit that my friends post. However, thinking that these pictures are actually a true, complete representation of these people’s lives is way misleading.

Yo, you wanna know the real kicker is? It’s that our feeling of less-than in comparison to someone else’s social media life actually has everything to do with our own perceived inadequacy. Feeling envious of anything or anyone is totally based in how we feel about ourselves, right? We can’t be envious unless we are comparing ourselves to someone else, and if we feel shitty about ourselves in the first place, than jealousy is gonna come around a lot quicker. It sucks that social media makes people think that their lives have to be a certain way because their “friends” lives look that way. Also, this is a pretty big realization that I had to learn the hard way, through years of being jealous (including being jealous of people online). I totally was in the camp of “I suck at life because my house is always messy, I don’t know how to be super crafty/good at makeup/athletic/rich/someone who travels a lot/insert whatever here, plus I have split ends and acne on my face”. It wasn’t until I learned that it is freaking impossible to compare my true, authentic personality to anyone else’s, that I started to feel better about my less than perfect life. We are all unique, and that’s a freaking wonderful, crazy, amazing thing! If my house was spotless, and super beautifully decorated from shit I made, and if I went surfing every weekend after having a brunch of grass-fed grass, well… I probably wouldn’t be super thrilled because that’s not being authentic to myself! It honestly took me basically my whole life to understand this- that there is no reason to compare myself to anyone else because it’s comparing apples and anti-freeze. We’re all different and that’s dope.

Ok, ok ok, I’m being a little overzealous. I totally still get jealous sometimes. I look at people’s Instagram posts and that thought will come in my head- the “I’m not worthy” thought. The thing is now I have a following thought that is, “oh shit, social media can’t communicate what the real truth is behind this picture, and this person strategically picked this photo to post”. ALSO, I don’t know what your motive was for posting that photo, just like you don’t know what my motive was for posting another picture of my dog (it’s because my dog is the fucking cutest and I want the world to know).

And also- it’s totally okay to post whatever the fuck you want. Who gives a shit. And if you post something like a selfie because you are feeling shitty, and want some superficial attention- dude, that’s okay. Or maybe you’re really feeling yourself and that’s why you post a selfie. Dude, do you. Sometimes, when I’m down, I’ll take a selfie and filter the fuck out of it because it makes me feel better. But here’s the deal- it’s still not real, and once we all start realizing that about social media, I bet you $5 that a lot of people will start to feel better about their lives. I think social media can be a really great thing. We just have to keep in mind that it’s not real before actual, real emotions develop in response.

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anxiety, insecurities, and sunshine

Thank you, sweet universe, for giving us hope in the form of such a beautifully sweet spring day! Ahhhh, I’m so grateful that it’s nice out and jeez louise, how powerful a change in weather can be to our psyche.

flowers are a'bloomin', there's hope, y'all!

flowering bush is a’ bloomin! there’s hope, y’all!

That past few weeks have been really hard. I feel like I’ve been tirelessly running the final stretch, for like a whileeee now, and I thought that the finish line might have evaporated…but, …hey! today the sun shined! What a good, glorious thing! I don’t want to get too personal, but I’ve been really stressed lately (hello final semester of grad school! hello not knowing what the future will bring!), and I allowed myself to get tired. I stopped trying to proactively find good things in my life. Everything bad and cold and stressful seemed to be snowballing in my life, but maybe, if it gets warmer, these things will melt away; that life can be good. I know this much: the future will not be better, if I am not better. If I am better, the future will be better. Better said then done, am aright,? 😉

When I worry about things, I sometimes let these worries (see: self-hatred, negative thoughts) get the best of me. I get anxious and I bring that anxiety-fear with me and it can make me really uncomfortable, especially in social situations, (sometimes I’ll apt to duck out of social things because of this anxiety, whatcha know ’bout dat?). But you know what helps me to feel better, what helps me to experience life in a more loving way? When I don’t worry about things in the first place. I’m not saying to suddenly stop worrying about your life, but I urge you to try to worry less about things. It’s hard to be totally fearless, but life is way better when you at least try to inch away from the fear-end on the life continuum. And I know, I know, who am I to say “worry less, your life will be better!”. I don’t know your struggles, I don’t know how heavy your heart is. My experience in life is different than your’s, so there’s no way that we’ll ever be able to comprehend exactly what it is like to be in someone else’s shoes. I’ll never be able to see out of your eyes, to know what it feels like to hug your mom, to experience your life. Our own experience of life is totally subjective. So, I don’t know. But I promise, just try to not be so mean to yourself about the things you don’t like about yourself and you’ll feel better, a little better, at least.  I mean, it doesn’t hurt to try.

So where does anxiety come from? I think it comes from our insecurities… and insecurities are ugh, so painful, right? It sucks to think about them, they make us feel sad, especially when we dwell and ruminate on them.  So how can we shed the things we don’t like about ourselves? How can we rid ourselves from the things that we can’t think positively about in ourselves? First, we need to recognize their existence. I know what mine are and where they have come from (hello, being called ugly in freaking elementary school; hello, not getting into my first choice college), but figuring this out for yourself might take a little bit of time. (And if you have trauma in your life or childhood, you should process your feelings with a counselor or therapist or even a trusting friend, if that’s at all a possibility. Just ‘cause trauma can really fuck up cognitive development and processing. Dealing with deep deep sludge takes time to really deal with- to really accept. It’s not easy, no matter how far removed you may be from your past.)

So once you recognize what your insecurities are, you can start to change your perception. Once you get rid of those insecurities, you start to let go of your ego. Ego is hard to define. I don’t mean ego as in confidence or over-confidence, I mean it more as like the onion layer analogy. I like to think about ego as a shell made of fear which surrounds us, and the more you grow in this shell, the harder it is to believe that it can be shed. It can become like a second skin, and won’t let any good things in or negative feelings and anxieties out, unless we consciously work to chip away at it.

Dude, none of this is easy. It’s really hard. I’m just figuring out this shit. And I’m so used to not dealing with feelings and letting my ego overpower me. I’ve spent so much of my life constantly worried about what other people think about me, but once I started to understand that life is life, and my insecurities aren’t making my time on this earth any more enjoyable, I was able to become a little more fearless and a little more loving. I still think about what other people think about me, but not nearly as much as I have for almost my entire life. And that’s progress, and that’s good. So I urge you to try and be a little tiny bit more loving toward yourself today so you can break off a little bit of that ego shell and let some sunshine in.

 

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