AMA

Two weeks ago, I had an ER visit due to left arm numbness and heart palpitations. The visit was prompted by a phone call to our family doctor because these symptoms are not conclusive of a heart attack or heart issue. My doctor’s nurse that we spoke with said her computer spat out the answer: See doctor within four hours. The urgent care clinic closed in about fifty minutes and always has long lines, so that left the ER.

We would be in the ER for seven hours. Much of the experience was waiting around. The waiting makes sense in the context of having a test (blood work, cat scan, ct scan, and chest x-rays) and then waiting for the test to be processed and interpreted before the next test is given. Having a context makes the waiting tolerable, instead of annoying.

All the tests proved me normal.

But—you knew this “but” was coming—the doctor would not release me even though the heart palpitations had gone away and the numbness was reduced by half. She wanted to run more tests for which I would have to be admitted into the hospital for the night (it was 10:45pm by this time), because no one could run the tests until morning. The hitch was the hospital had no beds and I would have to go by ambulance twenty miles to a different hospital in a different town, but part of the same healthcare system.

I thought to myself this a bad plan. My belief was that I would not be checked into the far-away hospital until 1:00 a.m. with little likelihood of getting any sleep. Also, I thought it would be real expensive and, because it was an ER visit, there is no pre-approval by the insurance company that any of the ER visit is covered.

I asked the doctor to order the tests and I would come back in the morning after sleeping in my own bed for the remainder of the night. The doctor said no. That is not allowed. I do not understand this process. I assume this is a hospital legal department decision learned through the hard experience of lawsuits.

After a discussion about runaway medical costs and the travesty of modern American health insurance, the doctor explained to us our option of going home, instead of being admitted to the hospital. To go home would require us to sign AMA forms. AMA stands for Against Medical Advice. On the form the doctor spells out the worst case scenario and that they advised me to be admitted to the hospital for further observation and tests. In my circumstances her predicted worst case scenario was death from heart attack or disfigurement from stroke. The AMA is a good cover-your-ass form. I signed it, thus officially shifting legal responsibility of my health away from the doctor and hospital, to myself.

I find it sad that over the years I have had to learn to say NO to doctors, especially when costs are unknown and insurance payments are not guaranteed. I have had a number of unnecessary tests that, according to me, were cases of doctors covering their liability rather than reasonable medical decisions. Also, I do not understand why four tests that reported normal caused the ER doctor to want to order more tests, instead of considering other non-heart-attack or non-stroke factors. I assume my history of panic attacks (which if severe can cause numbness in my left side) and previous injuries were available to her via computer, but I do not know if she had the time to read my health record since an ER is busy and chaotic by nature.

Another thing I have concluded over the years is that doctors are very smart in the box of their knowledge, their specialty, but their box may be very small and they may have little faculty to think outside their box.

One specialist I saw many years ago ran five tests on me that proved me in the normal range and cost a lot. I asked why the doctor kept running tests and wanted to run more. He told me he believed that the referring doctor must be right about my problem, so the answer must be in his field. He never considered the referring doctor may have been wrong to send me to his specialty. Insurance covered the first two test, but not the last three claiming they were unnecessary—costly bummer for me.

A third thing is that the worry about cost and the worry about doctors ordering unnecessary tests just to cover their legal exposure, forces me, the least trained in health care, but the person who knows my body best, to make impactful decisions. I have grown accustom to this over the years, but it would be a blessing if I could count on the doctor during the high stress hours of an ER visit when my thinking is not always its most limber to make reasonable medical decisions.

My fear (annoyance) of unnecessary medical tests comes from a past experience of losing my health insurance coverage due to excessive testing, too large a medical history. Living without health insurance is doable, but it introduces a low level stress to daily life, knowing anything that goes wrong medically will hurt personal finances and may bankrupt a person.

The hospital did not do its customary phone call check the day after. I assume this is because I signed an AMA and left their care. The hospital did send a customer service survey for me to fill out—which I did fill out and return.

My answer to the health care issues of the U.S. are to have universal health care and reform doctor liability. I would also insist that a doctor who loses license to practice in in one state has lost it for all states.

I wish hospitals, especially the ER, had to post prices of procedures like McDonalds posts the prices of burgers and shakes. The idea that a hospital is part of the free market economy is stupid from every angle.

I am happy to report I have been doing well since the ER visit. The bill has not yet shown up in the mail, so that may elicit a howl audible across the continent, but we’ll see.

Love & Light

Kenneth

 

16 July 2018 poem

Solitary

To befuddle people
a feather suspends
its generally downward flight
and remains at eye level
a little left of the swings
in the park with the century oaks
and three daffodils that sprouted
on a frosty, ex-girlfriend, July morning.

After much debate by the gathering crowd
the feather is proclaimed a dove’s tail feather
halted mid-waft.

More debate ensues about miracles
and temporal distortion of time
and the destruction of world peace
and other symbolic meanings
imaginative minds attach to such transgressions
of Newtonian physics.

No telling what might be made of this occasion
if it took place in Roswell, New Mexico.

The three daffodils remain ignored
by the crowd, by the ducks that appear to be part of the lake,
by the dogs busy sniffing a birch trunk,
but not by a solitary carpenter bee
who vanishes inside each daffodil
and reappears yellow tinged.


copyright © 2018 Kenneth  P. Gurney

 

9 Jul 2018 poem

Magnified View

Someone in Chicago, Illinois
thinks the Southwest is beautiful.

A lot of people agree with him
whether they know him or not.

He thought this six months ago
and still thinks it today.

A lot of people fail to remain that constant
except when their belly is pressed to the bar.

He used a telescope to spy the Southwest
and has never actually visited.

A lot of people actually visit the Southwest
but fail to see the unfamiliar beauty.


copyright © 2018 Kenneth P. Gurney

 

2 July 2018 poem

An Incomplete History

To prove I was as good as my European ancestors,
I walked into my neighbor’s house,

planted a big, bright poetry flag
and declared what was theirs mine.

They stood little chance with their steak knives
against my chrome plated Smith & Wesson.

They stood little chance against the small pox I brought with me,
since they belonged to an anti-vaccine group.

It did not stop with that first neighbor.
Having once gotten a taste for conquest, I hungered for ballads.

Since I, alone, was too small to think from sea to shining sea,
I thought from river to river within the city limits.

I wrote a constitution that gave all the power
to poets six feet tall and taller.

I wrote ten amendments that guaranteed
tall poet privilege through an unequal application of the laws.

There should have been a whiskey rebellion by the short poets,
but they were too busy brushing up on Skeltonic verse.

There should have been a Nat Turner rebellion
but those poets practiced an open verse beat al la Sekou Sundiata.

The civil war was uncivil as all civil wars happen to be.
The academic poets were first contraband, then emancipated,

but they re-enslaved themselves to the ivory tower
debating in minute detail the meaning of Howl and The Wasteland.


copyright © 2018 Kenneth P.  Gurney

 

The Sky Is Falling?

Last Wednesday, 27 June 2018, Justice Anthony Kennedy let the country know he was going to retire. He is 81 years old and has earned his retirement no matter how it changes the supreme court.

As I perused the news websites the morning after, I was surprised at all the doom and gloom on all the eventualities that talking heads claim will (or may) fall upon our heads. Huffington Post has an article about the end of Roe V Wade front and center this morning. Politico has an article about the five issues likely to be affected by Kennedy’s exit. Washington Post has an article about possible loss of Roe V Wade and an article on Kennedy’s deciding 5-4 votes. The Guardian has an article about the political earthquake of the retirement. There are opinion pieces on who the President should pick as a replacement for Kennedy, though I have not read them at this point.

I am not doubting that the President will nominate a white male conservative and that a mostly conservative bench will alter our lives. Those Americans who lean liberal will feel losses. Those Americans who lean conservative will feel they gained. According to Gallup (via Wikipedia) 31% of the population are democrats (liberal/progressive), 24% are republican (conservative) and 42% of the country is independent. (That leaves 3% unaccounted for, so I place them in the pizza and beer party.) Neither of the two major political parties represents the majority of Americans.

I understand the fear my more liberal, more progressive, and LGBT friends express. But I couple knowing their feelings, with the knowledge that progress toward a goal, especially long term goals, usually proceeds two steps forward, one step back. To me, since I lean progressive, a conservative supreme court is that one step back. Yes, I understand the court lasts a long time, but changing a society takes a lot of time and has changing pains as well as some big blunders along the way.

America is always evolving. That evolution swings liberal some decades and swings conservative others. I just hope it is not swinging criminal with the current batch of republicans and democrats and the administration. I am still pissed off at Mitch McConnell for preventing Merritt Garland’s hearing for the Supreme Court. How that precedent affects the upcoming conformation process, I do not know. Are the democrats too few in number to slow things up? Or is there a real possibility that the conformation process is broken? (Plus, there is the possibility the President will nominate someone I believe neither party will get behind, like Rudy Giuliani, and that will slow the conformation process up until after the midterm elections.)

Equal treatment under the law. In the US we have competing visions on what are rights and where lines are drawn to define those rights. That is what we live, and as good citizens endeavor to live in civil harmony.

Now that the supreme court ruled a Colorado baker does not have to bake a wedding cake for the LGBT customers due to religious beliefs, it seems to me the associative properties of math and life and the universe and everything should allow me to not do business with white supremacists, clan members, NRA members, and so on, through the long list of people-groups I find morally objectionable. If we all get to pick and choose who to treat as non-citizens, non-deserving of equal treatment, our society is not in a good place for the goal of maintaining the Union. So I declare that court decision half baked.

Worst Supreme Court decisions in history: Dred Scott is number one (1857) and Korematsu v. United States (Japanese internment) is number three (1944). So the courts  have made what hindsight and history decided are terrible decisions over the years (Citizen United [2010] came in at number 13). The supreme court is a group of human beings who have lived in bubbles and have their own prejudices and interpretations. Don’t we all. It is my experience that most people truly try to do their best and do what is right to the best of their ability to determine what is right.

It is up to us, the people, to work to set things straight as we see straight. Setting things straight takes a lot of work. Consider how hard and long conservative Christians have worked to get a supreme court that will overturn Roe v. Wade to protect fetuses that they see as deserving full constitutional and legal protection from harm that breathing human beings receive (equal treatment under the law, a redefinition of where a protected life beings).

There are liberal / progressives working very hard to overturn Citizens United at this moment. Equal treatment under the law and what / who deserves the protection of free speech. And what exactly comprises free speech.

Our competing visions of America should be, in my mind, a friendly competition, not life or death, not chicken little, not spew-filled animosity. The great thing about the United States of America is we have our competition in the open. In the open is messy. We are part of the great American family. Families are messy, but everyone sits down at the supper table together and gives thanks at the end of the day.

I think about the African American communities and how they continue to persevere, first out of slavery, then past Jim Crow, then through equal rights legislation, and now through the shootings that inspire Black Lives Matter. They still strive for that equal treatment under the law and equal treatment within our society. The point is their dedication and persistence to improving their lives and standing in the American society. Although I am sure it goes slower than they wish.

My feeling is that from any change that goes against what you believe is right, take new devotion to your causes and apply steady persistence to achieving your goals. In the RBG documentary, justice Ginsburg relates that getting angry does not help win the argument, so she learned not to verbally blowup at people. If we take her advice where does that leave us who are angry? My thought is anger should be directed to fuel effort to the good fight, the good cause, and especially the good deeds. And when the anger burns itself out, good habits will be in place for persistence to continue to apply pressure.

Love & Light

Kenneth


Post Script

A couple weeks back I watched a TED talk on replacing elections with random selection that selects government to represent the entire population, not just the rich white part of the population (an intentional exaggeration). As the idea has mulled in my mind over the couple weeks since I saw it, I think it a good idea if true representation democracy is your stated goal. Think about it. The one percent would have, at most, only one percent representation in congress. Those living in poverty would have 13.5% of the representatives, since that is the estimated percent of citizens living in poverty. That in itself is a good start to my way of thinking.

 

 

25 Jun 2018 poem

Whole

A woman bent over a wheel,
wet clay spinning, her hands manipulate
the earth into a vessel
to carry the dead
as if the dead require portage
to move past the veil to god’s love.

It is for the living, she knows,
that this vessel carries the dead
to a new manner of living
as the void of loss
fills or remains empty
as each person chooses.

A woman bent over a wheel,
believes with all her heart
we are just as god wants us to be,
despite the atrocities,
despite the self-deceptions,
because creation led to us
and will move past us
as the living continue
and the dead—
the dead rejoin the whole
that they never really left.

Bullies

When I was four years old and not paying attention to the bigger picture, my home town school district convinced my parents to place me a year ahead in school, because I was already bigger and taller than all the other kids. The school district feared I would become a bully if I had another full year’s growth on me before my started kindergarten. Size equaled bully in their minds.

The principal was aware of this school district decision and kept an eye on me. So did my teachers. At least that is my modern spin on the case as I look back. I remember there was a period of a couple months that other kids could punch me, they would cry, and I would get hauled off to the principal’s office to be punished for being a  bully by a paddling. Yes, a paddling. A paddling with a real piece of wood, one inch thick and in the shape of a paddle with a leather thong through a hole in its handle to help insure grip.

Through my school years I remained larger and taller than most of the other kids, but I never became a bully. Fighting did not work for me since I was not very good at it and I did not have a pugilist father who intended to teach me that type of fighting. My father preferred reason and scientific method. He might have encouraged me to join debate club, but I do not remember.

I made it through university without becoming a bully. My six-five frame and two hundred twenty pounds never leaned into intimidation. We did learn to … (Oh my god! I just used the royal “we” in reference to myself and my body. You should stop reading this entry right now.) … run very fast. My speed did not come from being chased by bullies, but learning to chase down fly balls on the baseball field in my customary left field, with my dreams of being Billy Williams (not Ernie Banks) repeated in every sprinting breath.

It occurs to me the school district did both a good thing and a bad thing in teaching me not to be a bully. Bullying is wrong and should not be done, but they deprived me of learning to use one of my god given advantages: my size. The gym teachers taught non-contact sports. No boxing. No martial arts. Watching Kato do his karate thing on the Green Hornet television show was the closest I came to studying martial arts.

I bring this up, because there are plenty of physically small people who use their business position, their money, their lawyers to bully others everyday. And I find I regularly ask myself, Why are they socially allowed to be bullies with their assets, but I was taught not to be a bully with my god given asset.  In fact, some of these people are applauded for their ability to apply power to a situation and get their chosen result.

Slum lords are bullies.

Minimum wage employees are often bullied by their supervisors.

People who do not tip good service waitresses and waiters properly are bullies. (At Denny’s and its type of eatery, not at some 5-star, Micheline rated posh-ness where the waiters and waitresses make more than teachers or nurses.)

Every woman and man who has posted a hash-tag-me-too story has suffered bullies or worse.

Our government violating human rights of undocumented peoples proves itself a bully. (Our government has a long history of being bullies. So this current episode might be the evolution of governmental moral thought and practice in America from being slavers at the inception of our country to our fumbling through to equal rights and LGBT rights.)

President Trump demonstrates everyday he loves being a bully as he fantasizes bigger dictator type—Putin or Kim Jong-Un—bullying. (My opinion from what I see of our President’s actions in modern media, not some insight hacked from his psychiatrist’s records.)

In business bullying is used as a matter of course. It is called Leverage—to use (something) to maximum advantage. Where is the line that delineates leverage from bullying in society’s eye? And if leverage is simply bullying with an acceptable name because the rich and powerful employ it, why does society tolerate its daily use? Or tolerate the rich and powerful? Why do we consider bullying in any way, shape or form civilized?

Why was I not taught by my schools to leverage my physical size against others for my own advantage?

Love & Light

Kenneth P. Gurney


Post Script

While on the topic of bullies, our government’s current policy of separating children from parents I find quite enraging. As in, I feel RAGE!!! in spurts throughout the day. I wish some district attorney to show up at an ICE detention center with plenty of cops and SWAT. Once there, I wish them to arrest the ICE agents who have kidnapped these children.  Yes, I said kidnapped. I mean that. That is how I see it. I want the government prosecuted for this offense against humanity and all the child endangerment and abuse that goes with ripping children from their parents arms and storing them in cage-like pens.

All of this is being done without external review or oversight or transparency. And now the paper reports that the ICE has no plan to reunite children to parents. What happened to morals? What happened to common decency? What happened to human rights? Why have not the ICE agents quit in protest? Why have not the ICE agents refused these orders for being immoral orders? Are ICE agents the brown shirts of our time?

Okay. That is off my chest and not off my heart. I have written all my congress people at least once, since I became aware of this ICE child separating atrocity. I have donated to non-profits that help migrants / immigrants. I have donated to the ACLU. I have donated to the Red Cross, only to learn they wish not to get involved with the border. How disappointing.

The November poles are too far away. What do we do today, tomorrow and all the following days leading up to November to bring this to a reasonable, golden rule reflecting, solution?

Here is an article from Money on how to help.

Here is another article – this one from Elle magazine – on how to help.