What's wrong with health care in the US?

If all businesses or services operated like a doctor's office, they would soon be out of business.  Where else can you have an appointment for 1:30 and be seen by the doctor at 3:00...for less than 5 minutes for the cost of $210?  I am telling the absolute truth, with no exaggeration.  When I was in private practice as a therapist, there is no way I could have made an appointment for a client at 1:30 and think he or she would still be sitting in my waiting room an hour and a half later, or return for services.  And yet, that is the routine in almost any doctor's office nowadays, and they think nothing of it.

I was in for my annual check up a few weeks ago and my regular physician was most upset with me that I had not gotten a colonoscopy like he advised me to do last year.  Why did he advise it?  It has been more than 10 years since I have had one.  There were no findings at my first screening, and I have no risk factors other than the fact that I am now 10 years older.  Okay, so I yielded to his urgent recommendation and they scheduled me for a consultation for a colonoscopy.

I arrived at my appointment 10 minutes early, to allow time to fill out the paperwork.  I returned it to the front desk at 1:30--my scheduled appointment time.  Now, I am not naive enough to really believe that the doctor was going to see me at 1:30, but I really did think it would not be one and one-half hours.  The waiting room is full--about 10 or 12 patients in front of me.  Time drags on.  Finally, at 2:30, they called my name.  A nurse weighed me, took my blood pressure (and said it was high at 151 over something, which is basically impossible.  I have never ever had a reading of high blood pressure in my entire life under any circumstances, plus, I take a beta blocker for my heart arrhythmia which lowers my normal blood pressure even lower than normal), had me stand against a wall to take my photo for the electronic medical records (another scary idea) and led me down the hall to a room that was only about 2 degrees warmer than a meat locker.  She said, "Do you get cold easily?"  No, not usually.  "This is the coldest room in the building."  She handed me a brochure on colonoscopy, and the consent to treatment form and left me to entertain myself for the next half hour.

I am telling the absolute truth again--I swear it.  For the next 30 minutes (I know, because in my annoyance and semi-blue state from the freezer in which I was housed, I kept looking at my watch) I entertained myself by looking up "is a colonoscopy really necessary, and when?" on my iPhone.  You know what?  Turns out that it might not be.  I was on the National Institute of Health website, as when I do research, I really want real academic research, not "Joe Bob's One Stop Colonoscopy and Essential Oils and Other Holistic Health Care."  Out of the 9 studies I had time to read in those 30 minutes, every single one of them found anywhere from 25-33% of colonoscopies are inappropriate and unnecessary. As many as 50-64% of them are "uncertain" meaning we don't know if they were needed or not.  Not unsurprising, gastroenterologists are far more likely than an "expert panel" of physicians to say a colonoscopy is necessary.  In those unnecessary colonoscopies, very rarely did a screening reveal cancer.

So what are the criteria for a colonoscopy, other than a routine screening every 10 years after 50 and until 80?  (The physician explained that after 80, the benefit does not outweigh the cost, so they don't recommend them.  Why, because they expect you to die before you can pay for the colonoscopy, or just that you won't extend your life enough to make it worth the cost if you do have cancer?)

Risk factors: constipation, bleeding, diarrhea, pain, nausea, vomiting, history of colon cancer in family, positive blood occult colo-rectal smear. Nope, none of those.  In fact, no history of cancer of any kind on either side of my family, all of whom live to be in their upper 80s and upper 90s, barring a car falling on them, which is no respecter of age.

Just as I am really getting into this research, the door opens, and the doctor walks in.  He said, "Wow, you don't look 62.  So you need a colonoscopy?"  I don't know if I need one or not; Dr. X just thought I should have a consult since it has been 10 years since I had one.  So, I am consulting with you.  "At your age, and over 10 years, you need one."

That's it, folks.  No discussion of my family history, no discussion or questions about any of the risk factors that I do not have, or any suggestion as to why this expensive and time-consuming procedure is going to improve my life.  I just "need it" because I am 62 and haven't had one in 10 years.  Now, I get the need to have my mammogram every year.  I get the need to have my teeth cleaned every 6 months. But I don't get the need to have a colonoscopy with absolutely no history of concern, and my general good health, and the research results.

"When do you want to schedule it?  I do them on Tuesday mornings and Wednesday afternoons."

By 3:05 (Yes, I know, because I looked at my watch when I got in the car), I was through check-out, with a request to call and schedule my appointment (I said I would have to decide when), and a bill for $210 for a "screening consultation" that lasted less than 5 minutes, but for which I waited 1 1/2 hours.  A screening consultation for which I provided all the "screening" information, the doctor asked me no questions, and essentially disregards my question as to whether or not, or why, I need a colonoscopy just because of my age.  The research indicates that in colonoscopies when there are no symptomatic criteria, the screening rarely reveals cancer, polyps, or other disease.

I am a believer in preventative medicine, and I don't take unnecessary risks with my health.  I confess to struggling with this, remembering all the women with whom I worked at the community mental health center who would go to the state psychiatric hospital where pap smears and mammograms were required, receive a diagnosis of abnormality and in some cases, cancer, and then be discharged and unable to afford follow up health care because they had no insurance.  I on the other hand, have insurance that will pay the full amount for this "screening" to determine when (not if) I should have the procedure. (Note: My insurance will not pay the full amount on the procedure; that will require a $1,000 deductible and will pay only a percentage of the procedure).

If this process of health care doesn't bother the rest of you, consider the following:

• In the World Health Organization rankings, considered reasonable by most health experts, 
• the US ranks 37 out of 191 in overall health efficiency;
• all of Europe, Japan, Iceland, United Kingdom, Columbia, Saudi Arabia, Canada, Costa Rica, Australia, and Chile rank higher than the US
• US ranks only 2 above the oft-maligned Cuba
• life expectancy ranks 29th, tied with South Korea and Denmark; Japan, is the highest, and Costa Rica, Chile, and Greece are higher than the US
• the US spends 2 1/2 times as much per person than 30 other industrialized countries, and yet our health outcomes are among the worst
• the best predictor of health in the US is whether or not you are wealthy.

The issue deserves serious research, reflection, and problem-solving in order to "promote the general welfare" of the people.

Abby Part II

 It's been three weeks since Abby came to live with us...three weeks in which I have seen the sunrise from the front yard every single morning.  My life is not my own these days, it revolves around a puppy's schedule and needs.  She is getting more acclimated to life in the household, and seems to be a happy dog who has adjusted to the frequently chaotic life here on our Taylor hillside.  At least for now, her corner of the world has structure, order, and consistency: morning walk, breakfast, play-time, nap; noon walk, lunch, play-time, nap; evening walk, supper, play-time, nap; bedtime walk, bed.  Like clockwork, at 9 pm every night, she conks out and is gone for the night.  Most times, she falls asleep next to me (like she does every other juncture in the day) and I have to pick her up and put her in the kennel because she doesn't want to get up and get in her box.  Treats are used with the phrase "Abby in the box" which we started when we had Jack, and Jack-in-the-box became the magic words for bedtime.  She will happily run into her kennel, and is even now beginning to go in when she hears Abby in the box, and then turn around and wait for her treat.

 She has entered her "terrible twos" stage where everything is a game of defiance requiring consistent redirection until she settles.  She is learning her cues: off, down, sit, her potty words (I figure you don't really need to see them to get the gist), paws up, release, and leave it.  She is really smart, and when she wants to go outside, she runs to the door, puts her paws up on it, and then turns around and looks at you.  If you say "outside" she then runs back to you to wait for her leash.

 The second or third day she was here, she almost pulled a vase of flowers off the table, so I moved those.  She still likes to pull on the table cloth, but is slowly learning to leave it.  She came to us with two toys: her piggy, which had little chenille strings all over it, and her alligator.  The alligator was the first to go after she performed a squeakerectomy.  Miss Piggy has had to be retired as those strings are just too tempting to rip out and chew on.  Substitute Piggy--just a little pig head--worked well, but suddenly Piggy has disappeared.  I can't find it under the chair, cushions, etc, but one day she was playing with it and then I could not find it.  I am certain it is under something in here as it did not just roll itself on out the door.

Last night after she successfully opened up Miss Hippo and was in the process of destuffing in search of the squeaker (and yes, all four of our other dogs have been successful squeaker-surgeons as well), Miss Hippo has now been retired.  Abby has graduated to Baby Kong and a very tough-skinned squeaky bone, which is already showing signs of wear and tear around its edges.

And now, Miss Abby is ready for her nap.

The Upping Block

Although the Oxford Convention and Visitors Bureau calls the Sullivan, Stone, and Freeland Law Office

...Victorian Gothic...thought to be the oldest law office structure in Mississippi...built prior to the Civil war...

the Mississippi Department of Archives and History, Historic Resources Inventory lists it as circa 1870, Queen Anne, Second Empire.  Victorian includes Gothic, Queen Anne, and Second Empire, all of which are part of the broad term Victorian.  The oldest law offices in Mississippi are Senator J. Z. George's law office, constructed 1838, in Carrollton, the Stennis Law Office, circa 1838 in Macon, and the Wohner Law Office, circa 1840 (MDAH, HRI).  The history of the building on the Freeland law firm's website, calls it the

...oldest continuous (emphasis mine) law office building in Mississippi.

I am surmising that 'continuous' is the distinctive difference, although I don't get how circa 1870 can be considered "prior to the Civil War."  The building apparently has been used as a law office for the duration of its life, whereas the George office reverted to use by the Cherokee Rose Garden Center, the Wohner office was formerly a dentist's office, and I cannot discover any information about the Stennis office.

When I first spotted the stone to the left of the walkway, I wondered if it had been the base of a monument or headstone.  I spent a while looking at it, trying to figure out why it was embedded in the lawn.  It is the "upping block" used by Phil Stone's father to mount his horse (Snell, 1991, as cited on Freeland website).  Growing up in West Texas, with western saddles and mounting up in pastures and rangeland, I had no idea what an upping block was.  We learned to mount by placing our left foot into the stirrup and then pulling ourself up and into the saddle, swinging the right leg over the saddle.  My uncle Tommy would use his hands to give us a boost until the day we were tall enough to do a standing mount from the ground.  That awareness of cultural difference sent me off on a hunt for the difference between plantation saddles and western saddles.  My friend advised that in the absence of an upping block, slaves were also used in Mississippi to assist the rider to mount.  In West Texas, an assisted mount was acceptable only if you were a child, or possibly a woman of refinement.  The rest of us were expected to get on the horse by ourselves.

To be fair, I will note that my currently 87-year old father now has to use an "upping block."  He walks Rio over to the deck and mounts from the top step.  I think at 87, that is a fair compromise for a man still able to sit in the saddle.

Luster Bayless Hollywood Movie Costume Museum

The Luster Bayless Hollywood Movie Costume Museum is housed in an 1898 former dry-goods building in Ruleville, Mississippi (Hollywood flair visits impoverished Mississippi Delta, CBSNews, 2009).  Bayless, a costume designer in Hollywood, was born in Ruleville in 1937.  He was the personal costumer and wardrobe person to John Wayne (Judge Thomas Givens, usadeepsouth.com) and his film credits include a number of TV movies and other movies in addition to the Wayne films.

Bayless returned to Ruleville at retirement and opened T.H.E. Ole Place Cafe and museum, modeling the interior of the former store to resemble an old West saloon (Hollywood flair..., 2009).  He also purchased the Victorian mansion known as the old Wiley Place and restored it for use as a bed and breakfast (Givens).  

Based on this circa 1950s photograph (I am basing that on the style of the vehicles parked on the street),  the museum building has not been altered from that period, though it may have been changed after its 1898 construction.  Other buildings on the street are no longer in existence, or have been altered in some manner.  Two buildings are visible to the left in the 50s photo that are not extant now.  The photo is blurred, so I cannot make out the name of the building on the corner.  It is followed by a building called Baker's, and then the bank that still exists and the museum/former dry-goods store.  The Masonic Lodge building has clearly had a "facelift" since the early photo, as the facade has no windows.

 Ruleville, just another quiet little town in the Delta, with shops around a central square, and the railroad running through the middle--but this one is home to Luster Bayless.

Meet Abby

Abby is about 4 months old, a lab mix, and was rescued from near-death when she crawled up onto a deck, covered in parasites, too weak to eat or drink.  Her benefactress took her to the vet for treatment and began seeking an adoptive family.  I was really just kidding when I told Rand that I said we would take her.  For whatever the reason, black dogs are the last to be adopted from shelters, and more likely to be euthanized.  Rand said if she could not find a home for her, we would take her before sending her to the shelter.

So, a couple of weeks later, and here is our new family member, Abby.  We picked her up Saturday.  Her "finder" had generously taken her to the vet again for a check-up and immunizations, and provided her pop-up sleeping tent, blanket, toys, food, collar and leash, comb and brush, shampoo, ear cleaner, food bowl--wow, kind of like the goodie baskets you got at the hospital when they sent you home with your new baby.

And it is indeed like having a new baby in the house.  We are introducing our dogs slowly in small doses, while Abby is in her crate.  So far, all tail wagging and looking to make new friends.  I am taking her outside in the front yard on leash for now, and she delights in playing with the cats who reside in our front yard.

In two short days, we have established our routine.  I am up at 6 to walk her, then feed her, then it's play-time, then another walk, and now down for her nap.

This is our "dog chair"--the one where we allow the dogs to get on the furniture.  It is a chair and a half size, so perfect for sitting with room for a dog.  I just moved my morning routine by bringing the laptop into the living room so I can give her some playtime and time with me.  After our second walk, I brushed her before we came in, and she could not decide if it was playing or petting.

She is very sweet-natured, although in her puppy stage, biting at everything.  I use redirection, giving her a toy to chew, and reinforce her compliance.  Wow, I had forgotten how much work it is to train a puppy.  One thing about it, the sleeping late days are done for a while.

Ruleville Depot

The Yazoo and Mississippi Valley/Illinois Central Depot in Ruleville is on the National Register of Historic Places.  The "railroad vernacular" depot was constructed in 1930 by an unknown architect/builder (Neal, 1998, nomination form for NRHP).  Described by Neal in the nomination form:

...hip roof with overhanging eaves encased in beadboard...beadboard skirt, grey asbestos shingle exterior walls with irregular fenestration...all windows and doors are unevenly spaced and unequal sizes, but all still in place...double leaf loading doors...

The building as seen in 1976 in a photograph in the Mississippi Department of Archives and History shows the asbestos shingle and beadboard references.

The railroad was built in 1897 from Inverness north to Ruleville and was known as the Yazoo Delta.  Locals referred to the train as the Yellow Dog, and there have been several blues songs that used phrases about where the "Southern crosses the Yellow Dog."  You can check out the legends of how W. C. Handy first heard some blues man singing about the Southern and Yaller Dawg in the Tutwiler train station, as well as other lyrics for the Southern and the Yellow Dog at "This Cat's Got the Yellow Dog Blues"-origins of the term Yellow Dog by Max Haymes.

The Yazoo and Mississippi Valley Systems bought the branch and extended the line to Tutwiler; in 1930, the Illinois Central bought the railroad and built the depot.  Two passenger trains ran each day until the 1950s, and freight service continued until 1978.

Old Masonic Lodge Hall in Sardis

John Wright Johnson, son of Andrew Johnson (born Anders Johnsson, "Big Swede"), followed in his architect father's footsteps.  Andrew emigrated to the US from Sweden in the late 1800s, and moved to Mississippi to design depot stations for the Illinois Central railroad stops between Memphis and Grenada (NRHP nomination form for the architecture of Andrew Johnson, Holland & Gordon, 1983).  The Johnsons worked primarily in Panola County, although John also designed heavily in Memphis (Holland & Gordon, 1983).

John W. Johnson was the architect for the Sardis Lodge # 307, constructed in 1923. According to the NRHP nomination, John

...lacked his father's certain flair for ornamental embellishment.

While the building itself may lack Big Swede's propensity for the ornamental, the portico seems like an "embellishment" to me!

Looking up through the hole in the roof of the portico, I spied this pigeon watching me.  This would lead me to believe that the top floor of the hall is most likely covered in pigeon poop.  The other openings in the upper floor have exposed the building to weather and other varmints as well.

Even though rusted and peeling layers of paint, the iron work is striking.

Every time I see an external stairway on the side of a building, I always picture "Doc Adams" from Gunsmoke.

Meanwhile, the remnants of the lighting (a sign?) hold on above the portico, clinging to the wall and looking rather like a forlorn little ladder upon which pigeons might perch.  Sardis # 307 was merged with Panola # 66 July 11, 1996, so most likely, this building has been vacant since then.

Alexander Hotel

 Alexander Hotel on DeSiard Street, just a couple of blocks from downtown, dates from 1906.  According to Lee Estes (Downtown Monroe--Some Visual Highlights, Louisiana Road Trips, February 2010, p. 7 & 8), the hotel was on the second floor, and a bar at ground level.

 Estes referred to the bar as the Shamrock.  Most recently, it is the location of a singles group from a local church (no alcohol, just dancing lessons).

 It bears some similarity to another corner building a couple of blocks up the street on DeSiard, although the other building was much larger, and was apparently a department store alongside the Woolworth's.

I was entranced by the green and white trim around the top of the building.  According to Estes, the east side of the hotel did not have exterior windows and was illuminated by "lantern skylights."  The rooms were partitioned with 10 foot walls, and one skylight illuminated two rooms.

Each room had a stove for heat, a pitcher and bowl for bathing, and a potty.

DeSiard Street Storefronts

Downtown DeSiard Street is part of Monroe's downtown historic district, which bears

...architectural significance as the finest historic central business distort in Northeast Louisiana...(Monroe, Louisiana comprehensive plan for historic culture).

 I don't know about the objectivity of that statement, but the limited section that I observed was certainly interesting.  According to the assessment to nominate the nearby residential district for the National Register of Historic Places, there was no published history of the city of Monroe, making assessment difficult.  Apparently, however, the history of the community was largely associated with the opening of the oil and gas fields in 1916.  

This entire block is owned by the same family, and includes a candy store, a clothing store, and the Southern Soul club.  The buildings have also housed other clubs throughout the years, including the Club Eschelon.

During the 1930s, the 200 block of DeSiard was home to the Morgan & Lindsey 5-10-25 and Woolworth's 5-10-25, both side by side, and bearing store fronts similar to these.  I puzzled over photographs taken by Griffin Studios in the 1920s and 1930s.  At one point, Morgan and Lindsey were to the right of Woolworth's, and later, to the left, if you were standing facing the block as I was here.  At some point between the two photographs (Griffin took a series of photographs of DeSiard Street during the two decades; you can see them here), Morgan & Lindsey relocated.  Check out the link to see the fashion models from the Palace Department Store, 1924!

On Going Home

Of course you can go home again...the question is, "How long is the recovery period?"  Unlike minute surgery these days, where you spend 45 seconds on the table, 30 minutes in the recovery room, and drive yourself home to go back to work after lunch, "going home" can take a toll on you.  If you have been "home" twice within two months, you have not even recovered from the first trip before you are subjecting yourself to the second deployment.  When I was serving as responder on the coast of Mississippi following Hurricane Katrina, I think it was easier to shower, although I do readily admit, the water was not hot.

We made it home last night, having unexpectedly departed a day earlier than planned.  I say unexpectedly, but Rand is never surprised when I suddenly say, "I am ready to go to Mississippi."  It can actually not truthfully be called "suddenly" since early departure usually begins to cross my mind about the same time we cross the border from Mississippi into Louisiana.

Of all the hardships associated with traveling to our parents these days, I think showering is on the top of my list of things that are best put off until you can find a garden hose and it's dark.

The shower at my father-in-law's was installed when my mother-in-law reached the point she could not get in and out of the tub any more.  It is one of those little plastic hose, plastic head temp showers that attaches to the side of the faucet.  (Temp, but it has been there for around 15 years now).  The shower head has holes the size of a straight pen, so when the water comes out, it is sharp enough to peel skin.  Frankly, it hurts.  I find myself turning the faucet so low that only a dribble comes out.  It takes an hour  and a half to shower, but that is less time than a visit to ER for failure to use precautions.

In an amazing coincidence, Mom has one of those showers consisting of a plastic hose attached to the side of the faucet.  It doesn't remove skin, but you actually have to sit in the tub while showering, unless you intend to mop up water afterwards as there is no shower curtain.

There is actually a real, honest-to-goodness shower in my dad's bathroom.  When they bought the house, someone had added on a bedroom and bathroom, and installed one of those metal pre-fab showers.  It rusted out many years ago, and Dad built a ceramic tile shower.  Years later, he rebuilt that shower with the current version.  The problem is not the shower.  The problem is no one ventures back there (not even sure if the housekeeper goes there) but I try to avoid it unless I am packing a snake-bite kit and wearing hip-boots.  It is better to sit-n-shower.  I am renting one of those harnesses that sky-scraper window cleaners use for my next trip, and hoping I can hire someone to stand outside the bathroom and operate the winch line to raise and lower me pre and post showering--it's either that, or I have to start packing a shower rod and curtain.

We turned off the highway onto our road late last night, and Rand turned on the wipers to clear the sudden fog from the windshield.  The mist was rising from the road and the kudzu jungle beyond as it can only do in Mississippi after dark in the summer.  Now, I'm really home.

Because it just is, that's why.

I am so ready to go home to Mississippi. I always get that way fairly quickly anymore. You know the story: my own bed, dog, Internet, air conditioning...

I have only been one place out of five where it has been cool enough since we arrived in Texas. It's not that I think people should accommodate me if they want their house to be 76, or 88, or 80, or 65 (yes, this was the place where I was comfortable) or 92. It's just that right now, I cannot really tolerate it warmer than 70 without being sick and miserable. It is related to medication adjustment and I hope it passes soon;in the meantime, cold is the only thing making it tolerable.

Mississippi was in the three digits when we left J and Rex in charge of the dogs and house and headed south west. Those three digits were numbers like 102 and 104, however. We are in triple digits here, too: today, I watched the thermometer on the back deck crawl its way to 127 by 5 pm before it began to drop. It was a chilly 97 by 10 pm.

Growing up in the arid hot summers of west Texas, this is not a surprise, but somehow I was not really prepared for it. As a matter of note, the first day did not seem all that bad--not humid like Mississippi and I was handling it fine. Then the non-stop headache from bright sun unfiltered by the tall green pines--a scrubby little mesquite provides little shade,and while welcome as rain in August, highly insufficient to cool 112 or more degrees--and the heat nausea were next. Continous consumption of water, but still feeling hot and dry because of excessive perspiring, and I am ready to head east to the piney woods. Green grass (not brown and withered like little bits of straw) and shaded yards (not sun beating down mercilessly baking everything until the shimmering heat rising begins to seem surreal), sleep in a room that is 68 degrees, shower without breaking a sweat, and only need my normal 8-10 glasses of water: now that's what I'm talking about.