Split 

Room in the Metropolitan Museum of Art in NYC

Shadows watched from the corners of the room… ever present, ever vigilant. 

She waited.

Footsteps in the hallway. Raucous laughter. 

The door flung open and he stumbled in, drunk, clinging to the arm of a woman.

Who was it this time? 

It was hard to see clearly in the dim light. 

Her.

Their eyes met for a long moment. Silent words passing between them. Then she turned her attention back to him, allowing him to undress her. He fumbled. The process took much longer than it should have. 

Naked.

She glanced at the mirror again, seeing the other woman once more, the one who looked like her but was more charming, the one whose laughter came more easily. She was the one who was not ashamed of being naked, the one who demanded love and attention from everyone.

The drugs made her beautiful and charismatic. She knew the flame could not burn this high for very long. It would go out soon, extinguishing her in the process.

But it was worth it. 

Every day was worth the price to avoid the loneliness again.

Shopping Around

Macy's in New York City

“She doesn’t have physical exam coverage and her insurance only allows three office visits per year. No lab coverage. No preventive care coverage. She needs her blood pressure and diabetes meds refilled but she cannot come in for a physical.”

I’ve seen this a lot lately.

“No problem. Tell her to come in for a regular office visit so we can at least check her blood pressure. I will code a 99214 and she may get a 30% discount off that as a cash pay patient. I can send her to a discount laboratory for labs that will save her hundreds of dollars. In October she can get a $99 mammogram at one of the local imaging centers. Her flu vaccination she can get cheap at the health department. We will just have to postpone her PAP another year.”

So she came in….

Crying.

“I pay over $700 a month for this insurance.  I work for myself and with my diabetes no one will cover me otherwise. I can’t afford anything else. They told me that all of my doctors were covered and my meds were covered. They lied.”

She did not read the fine print. Not that she really had any other options available to her… 

It used to be like this ten years ago. People with expensive but essentially useless policies. Here we go again. Now, at least, I have access to a discount laboratory. 

OMG. What A Day….

Some days are just…. just a crazy mad dash to the finish line. I am exhausted but I promised one of my most favorite people in the whole world, Craig Boyack, that I would invite him over to talk about his new book The Enhanced League.

I’ll let him tell you all about it while I draw myself a nice warm bath and soak my weary body in some lavender bubbles. 

*****************************************

Thanks for inviting me over today to talk about my newest book, The Enhanced League. This one is a little different than anything I’ve released before, and I’m kind of excited about it.

One short story, called The Enhanced League, was on my list when I wrote my second Experimental Notebook. I wrote it and intended to include it in that book. It had a nice twist ending, and almost a Twilight Zone feel about it.
The story wouldn’t leave me alone. When I assembled the Notebook, I left this one out and placed it in a new folder. I knew The Enhanced League had more to offer than just this story. I started making a new list of story ideas about one year in the professional baseball league where almost anything goes.

One day, while commuting to my paycheck job, I was listening to MLB Radio on Sirius-XM. They had a kind of spoken word anthem, narrated by Tommy Lasorda. If you’ve followed baseball much, Tommy is one of the legends and he has a distinctive voice. If I told a baseball fan to read the rest of this post in Tommy’s voice, it would immediately come through like that.

The piece was wonderful, but MLB Radio chopped it into sections with broadcast highlights. I wish they’d left it alone. I heard it a few more times, but never without the interruptions. This attracted my Muse, and I decided to do something on my own.

I sat down and wrote out a baseball anthem in a kind of second person point of view, just like Tommy’s. I liked it, and decided to keep writing them. Then it occurred to me that the broadcast interruptions were a kind of message to me.

The broadcast interruptions were intended to enhance Lasorda’s spoken word poetry. I don’t know what it was, so I’m calling it an anthem, and I called mine anthems too.

After I wrote the first one it became easier. My own imaginary Tommy Lasorda just wandered in, took a seat on the couch, and started talking. All I had to do was write down what he said.

My blog followers and regular readers know I’m always up for something new. These anthems were fun, and I think they enhance The Enhanced League. I peppered them throughout the book, and think they really add some fun human elements to the story. I hope you enjoy them too.

Oh, and I still can’t read one without hearing it in Tommy Lasorda’s voice.

***

cover

Blurb: The Enhanced league is a collection of short stories and anthems centered around a year in a fictional baseball league. It has a slight science fiction background. This league has a lot more pomp than you might be used to, and nobody seems to care if the players use performance enhancing drugs.

Stories involve existing heroes, up and comers, and falling stars. While there are the obvious stories that take place on the field of play, there are also human interest stories that take place around the baseball gyrations. These stories involve scouting, trades, ruthless business decisions, and even relationships.

I enjoyed researching and bringing you The Enhanced League, and I hope you enjoy it as much as I did. — CB

Click here to purchase!

boyack
I was born in a town called Elko, Nevada. I like to tell everyone I was born in a small town in the 1940s. I’m not quite that old, but Elko has always been a little behind the times. This gives me a unique perspective of earlier times, and other ways of getting by. Some of this bleeds through into my fiction.

I moved to Idaho right after the turn of the century, and never looked back. My writing career was born here, with access to other writers and critique groups I jumped in with both feet.

I like to write about things that have something unusual. My works are in the realm of science fiction, paranormal, and fantasy. The goal is to entertain you for a few hours. I hope you enjoy the ride.

Craig

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Tall and Skinny, No Whip

The Empire State Building

“Your patient is on social media Tweeting about it.”

“Tweeting about what?”

“The weight thing that prints out on the after visit summary for the patients.”

Come to find out she had also called and spoken to my office manager and my practice administrator. 

Good for her.

When we first moved to this electronic health record last fall one of the most annoying things was that on everyone that the program deemed “overweight” or “obese” got a large bright yellow box on the screen that alerted to me to the fact that I needed to add weight loss to their goals. 

I always hit the ignore button but it annoyed me that now I had to click an extra button because it stood between me and each patient’s active problem list. Not everyone needs to have “obesity” on their problem list and I would argue that NO ONE should have “overweight” as an official diagnosis. People who are “overweight” and  “obese” know good and well where they fall. They certainly do not need a computer “diagnosing” them with it, too.

I growled inside each time I saw that yellow box.

Then sometime in March I noticed that all of my “overweight” and “obese” patients were getting detailed weight loss instructions printed on their end of visit paperwork. It was going so far as to tell them exactly how much weight they needed to lose to reach a BMI of 25.

WHAT? I didn’t tell it to do that!

It was autopropagating. Someone flipped a switch somewhere which meant a good many other someones approved the change.

What were they thinking?

Shouldn’t I have control over that? Shouldn’t I be the one to decide? I am the doctor. I know the patient. 

I complained.

Nothing happened.

I mentioned it again.

Still nothing happened.

Some of my patients have eating disorders. A number of my patients have serious emotional issues wrapped up in their obesity. These people for sure should not end up with that kind of stuff on their handouts.

I messed around with the program for a while and discovered that I could manually remove it from the print outs if I clicked an obscure “X” box on the wrap up page at the end of the visit. I have to scroll down to the bottom of the screen to find it. That meant that on every patient I see every day I would have to scroll down to that area and click a box to remove weight from their goals.

I should not have to do that. There are literally 30 million other clicks I have to remember on each patient at each visit. Give me a busy day and things will slip through the cracks. This is something where the cost of human error is too great in my opinion.

For this patient, I was running 30 minutes behind. On hers I forgot to click the button. The print out told her she needed to loose over 30 pounds and detailed the diet and exercise changes she needed to make to get that accomplished. So she went to social media with it.

Suddenly, everyone downtown started scrambling. There will be a meeting now to discuss this.

And I am so very angry.

But not at her.

What does it say about a system that responds to social media pressure before it listens to its own physicians? And why would you ever pick a BMI of 25 and set it as the automatic weight loss goal for every single patient? What about the studies that show that people who are in “normal” BMI range do not live as long as those in the overweight range? That a decrease in life expectancy does not occur in obesity except for the extreme morbid obesity range?

Obesity isn’t killing people. Diabetes is. Cardiovascular disease is. We have put such a focus on weight that we have sabotaged the patients who are most vulnerable and as far as I am concerned we are killing them.

“I can’t lose weight so what’s the point of exercising and eating healthy?” 

I hear this every day.

Weight is not the point. It should not be the point. Healthy lifestyle is. But rather than use those things as the goals they made weight loss THE goal.

Fine.

Maybe I cannot change their mind. Maybe I cannot change yours. But do NOT force me to participate in a game that I do not want to play.

Next time I see that woman I am going to give her a great big hug and a high five.

Depressions

New York Public Library entrance

“I see from the medical assistant administered PHQ-2 that you have been feeling down lately. Tell me about that.”

“Uh, I am here for my knee. Why was she asking me about depression?”

“Well, we want to put a focus on mental health, you see…”

“What about my knee?”

“We’ll get to that at your next visit. Right now all we have time for is delving into this positive two question depression screen.”

“You guys never did this before.”

“I know. But here we are. Better late than never. So are you thinking about killing yourself?”

“NO!”

“Should we put you on medication?”

“I don’t like drugs.”

“Counseling then! Good choice. I’ve got a list of counselors in the area…”

“I am not paying for counseling and I haven’t got time for it in the first place. My knee is what is getting me down.”

“Yes, well. Come back in two week’s time and we can talk about the knee.”

*****************************************

That wasn’t real. But it could be….

The healthcare organization I work for is now measuring my quality based on my medical assistant asking patients questions about depression once a year right before they check the blood pressure. 

I have yet to have a patient say this was a good addition to their rooming procedure but that is beside the point. Why are we focusing on this in the first place?

To save lives.

Personally, I hate questionnaires. They are an attempt to oversimplify a very complex problem. Can we really put depression into a box? Should we?

If the PHQ-2 is positive it should be expanded into the PHQ-9. The PHQ-9 should be used to monitor response to treatment. 

I much prefer a conversation with a patient to reviewing a questionare. I can tell, usually, when a patient is having a hard time but even if I can’t I still ask once a year at the physical as part of my review of systems. And if they say they are having problems I pry, by golly. Are we talking about a chemical imbalance or did their mom just die? Is it affecting their ability to hold a job? To take care of their family? My medical assistant shouldn’t be the one asking the questions. It should be ME. That is my job. Which then brings me to documentation. Make it easy for me. Don’t hide it on a different screen. My review of systems documentation should be sufficient shouldn’t it?

It frees the physicians up to do other more important things.

What is more important than mental health? But then, I wonder, are we perhaps overemphasizing it on some level, too?

When we made pain into the “fifth vital sign” we created a whole population who became focused on feeling no pain, a pharmaceutical industry happy to create addictive drugs that prevented anyone from feeling pain, and physicians caught in the middle. Ultimately, the prescription narcotic addiction crisis was the unintended consequence.

So I worry that we will over diagnose depression. I am not sure that assigning labels like that is all that helpful for most people. I worry that those who are truly ill, who need the most help, will be pushed out of an already failing system that becomes glutted with everyone else. I am already seeing this trend. Making my very ill patients wait three to six months for an appointment with a reputable psychiatrist is unacceptable but it is par for the course nowadays.

The mental health system in the US sucks and that’s the truth. It especially sucks around here. There is a dirth of good psychiatrists in my area. Same with counselors and psychologists. What are we supposed to do? Should we as primary care just push drugs on everyone? Drugs that have side effects and risks and which are not appropriate for all patients? Who then will manage those drugs? Me? With very minimal training? And if we push drugs but cannot effectively pair it with counseling support, what have we accomplished? We are supposed to help, to make people better aren’t we?

I’d really like to know YOUR thoughts…

A Supporting Role

Bridge in NYC

“She just won’t eat healthy stuff! If I give her a cupcake and some broccoli she always eats the cupcake.”

“Think back to when you were eleven. If you have a cupcake and some broccoli in front of you, what do you pick?”

He shrugged. “The cupcake.”

“Right? Me, too. We’re not idiots. We pick what tastes best to us. As kids that’s the sugar. So you cannot put them both in front of her and expect her to pick the broccoli. That’s just cruel. She’s eleven. YOU have to make that decision for her until she is able to make it on her own and that is not going to be for a great many years. Get the cupcakes and junk out of the house. She is beautiful no matter what size she is but you and mom both have diabetes so she is at higher risk herself. Be the parent. Don’t sabotage her. Help her learn healthy habits that will last the rest of her life.”

We had this conversation every summer for five years running. Each year the same thing, like it was her fault. But this time? This time, somehow, was different….

This time he listened.

What made the difference? I don’t know.

It gets discouraging, saying the same things over and over again. There are days when I open my mouth to say, “Stop smoking!” for the millionth time and wonder if there really is any point. You never know, though, when the seeds you sow will fall on fertile ground and take hold. 

This Far and No Further

Statue of Polish king in Central Park

Raccoons are not cute

Neither are possums or armadillos or squirrels. Don’t even try to argue the point with me because it’ll get you absolutely nowhere. I used to be like you, in love with all of God’s creatures. 

Not any more. 

I am not against wildlife, mind you. I am content to share my yard. If an animal wants dig up and trash my potted plants over and over again looking for God knows what, I am cool with that. But so help me, if one decides to crawl into the attic or walls of my house and DIE, we will have words and many of those words will consist of only four letters.

Here’s the thing….

I love my house. It is not a big house but built in the 1940’s it has tons of character. It is big enough without being pretentious or too expensive to cool in the hell heat of summer. It is located in the center of a little city/town. Best of all, it’s completely paid for. No mortgage.

Now, the thing about old houses in this area is that they are built on pier and beam, meaning there is a crawl space under the house that could fit a grown man on his hands and knees. As you can imagine, animals like that area quite a lot, too. Warm or cool depending on the season. Hidden. Food nearby. What’s not to love?

Shortly after buying this house, the first hint of odor wafted through the walls upstairs. Within 24 hours it was very clear an animal had died somewhere. I searched everywhere to try to find that carcass. Never could find it. Do you know how long it takes the stench of a liquefying animal to burn off? 

About five days, as it turns out.

Now, I am certain I am not the only one this happens to. Dead animals in your walls is of those dirty little secrets no one ever wants to admit to for fear of being judged… like enjoying oral sex. But it happened to me and my house several times a year for a number of years. 

Dead animals were not the only problem, though. Hoards of bot flies would descend upon the house from time to time like a plague straight out of Egypt. You know how flies are. 2-3 buzzing about feels like a lot. This was over fifty. Inside my house. All at once. Bot flies like dead animals. They LOVED my house. I am a pretty good shot with a fly swatter now, after all of that practice. 

Almost as bad as the flies and the stench was waking up to an MMA fight in progress in my ceiling in the dead of night. And did you know that chewing sounds are magnified by sheet rock? Sounded like some sort of jack hammer. The sleep deprivation was real, people. I would hear loud noises in the yard and run outside only to find entire families of animals, specifically raccoons, scrabbling up the side of my house. 

How were they getting in?!??????!!!

Finally, I was at my wits end. My family and I had endured QUITE enough and I was ready to torch the place, paid off or not. How could I in good conscience pass off this to someone else?

I couldn’t.

So I scoured the internet for advice, all of which was most unhelpful. Those animals practically scoffed at the nauseating stench of the red fox pee that was sprayed all over the house and property. The only thing it deterred was me. You name it, I tried it.

The man of the house took to using one of those *humane* traps, thinking if we could catch them before they ended up in the walls and attic that might help. We placed *inhumane* traps throughout the attic crawl spaces that could be reached. We caught dozens of raccoons, possums, and armadillos. Animal control knew my voice well.

“Yeah, yeah. We know who you are and where you live…” the man on the other end of the line would growl.

Something tells me that they were not taking those animals *away* to release them. 

One day, whilst bemoaning the vermin issue with a neighbor who was experiencing similar issues, I was informed that an old lady down the street was feeding the raccoons by putting food out for them at night. Rarely have I felt a desire to do violence against another fellow human being but this was one of those times. She did die eventually but not by my hand…

You know what seemed to work? Chicken wire. Chicken wire all over the eaves and attic vents. Chicken wire along the base of the house. Chicken wire anywhere an animal might try to weasel its way inside.

And…. that lady down the street? She stopped feeding the wildlife….