Friday, April 30, 2010

Another time

I was driving to work this morning and it seemed to strike me suddenly when I was listening to some old music that my generation, not just my generation but my specific age cohort (the one that graduated college in May of 2001) was the very last group of young people to pass the final hurdle to adulthood in a pre-9/11 world.  I was listening to some of the music from that summer and it came back to me what a vibrant and interesting time it was.  Right before the attacks the whole world was a vastly different place in a thousand ways, most of which are better than what we've got now.  A few things were worse.  There was no Facebook or iPhones and wireless broadband internet was still a difficult, clunky proposition.  But it's becoming more and more clear to me as I get older that virtually everyone younger than me has little or no memory of a pre-9/11 world. 

For them, the adult world has always been a place of limited opportunity and from the time they entered the workforce it's been a hellishly competitive, uncertain place.  They don't remember walking into a job interview and not even bothering to ask about benefits because even small companies would have retirement funds, paid time off, and some form of available medical benefits rolled into their hiring package.  They don't remember when your ability to rent an apartment, your automobile insurance, and a hundred other things weren't tied to your credit rating, which was fine, by the way, because credit cards only offered you a $2000 maximum and had interest rates under 10%.  They don't remember when gas-guzzling SUV's were just a douche-y status symbol that had hypothetical, far-future environmental consequences instead of being a very-immediate genuine economic liability because, though it's still not cool to own them if you don't need them, fuel then in some parts of the country cost $0.97 a gallon.  They've never known, and probably never will know, the freedom that cheap, economical air travel brought.  They've never known what it was like to board an airplane without having to take their shoes off and face down a Nazi-ish TSA squad rifling through their bags.

Bush had taken office then, but had only been there for about a year and a half.  Not really enough time to fuck things up too badly yet and he was still largely riding on the wave of Clinton's administration.  We all were more or less puzzled by the bizarre election that had put him there, but since at the time he and Gore were so similarly positioned, not too offensive, not too different, both a little younger and implicitly hipper than George HW and Ronald Regan had been, that most of us who had the vote for the first time in our lives just shrugged our shoulders and voted for whomever we thought would be more fun to get drunk with.

But the kids, the young people that came after us, they don't remember any of this the way we do.  They don't remember our glib expectation that the government would forever be certain to follow the constitution and even though the faces might change the ideas wouldn't.  The Clinton era had seen a liberalization of the media to reverse the uptight conservative Moral Majority nonsense of the early 80's.  Movies and music from the mid to late 90's entered a phase unequalled since the cultural revolution of the 1960's.  They wouldn't remember when shows like MTV's "Sifl and Olly", a hilarious, incomprehensible show which was unapologetically just something to stare at when you were stoned at 2 AM, could get a greenlight.

Free speech was catapulted into the twenty first century on the back of a wild-west Internet, which (if you could get access to it, which wasn't the easiest thing in the world at the time) offered virtually limitless avenues for expression and idea sharing.  People younger than our cohort wouldn't remember Napster, the first Napster where you could find MP3's of virtually every song ever recorded, downloadable for free.  For months universities banned it during the week not because it was illegal, but because it threatened to slow down the networks so severely that regular school business was curtailed.

If course, that's back before universities had completely sold out to corporate America as well.  When the first students started getting hassled by the RIAA, the schools actually went to bat for the students and their rights.  I have a sinking feeling that, despite the advantage of ten years of history to improve on the quality of their educations, college students today can't even imagine their school having their back like that.

It really hit me when I thought about it for a while how different that time was.  You could see it and feel it in everything from the movies and music of those years to the attitudes everyone had in their day-to-day lives.  I wonder if in thirty years people will talk about the late 90's the way they sometimes talk about the late 60's.  A time of humanistic confusion antecedent to a time of dreary, sober reckoning.

Tuesday, April 27, 2010

Stephen Hawkings has it all wrong

My wife mentioned this to me yesterday, hip as she is, several hours before the interconnected sci-fi community I'm part of caught onto it.  I had a while to think about it and I've gotta say I disagree with the general concensus that he's right.

Maybe, I thought, just maybe Hawkings isn't being imaginative enough.  There's not much water or oxygen in the universe, but there's tons of carbon and nitrogen and solar rays from a billion stars.  Why isn't it just as likely that we'll meet aliens who are photosynthetic or whose metabolism requires a constant influx of nitrogen?  They could drink our sewage and lick the sweat off of our bodies!  Ok, ok, I'm being gross now, but think of it: they're basically living plant organisms because that's pretty much all that can exist on a place that's not-Earth, and they come from a planet full of useless, choking oxygen and they're starting to look for places that gaseous carbon dioxide is present in abundance.  Whammo!  Suddenly no more global warming on Earth.  They can just slowly siphon off the excess carbon dioxide from our planet and replace it with all that waste oxygen they produce.  They could move here and mingle with us in our cities, their photosynthetic respiration would slash the smog and air pollution numbers down to their pre-industrial levels.  It would be like a rain forest within a city, cleaning and gradually scrubbing the air.  Who cares if they get sick from the sulphur and mercury and lead and other toxins we dump into the air?  If they could metabolize carbon monoxide somehow, we could pipe the exhausts of our cars into pressurized tanks and sell the waste-exhaust to them for a few bucks!  Or maybe not sell it to them, maybe trade it to them in exchange for the cures to cancer and the common cold and for the schematics to cold-fusion, faster-than-light travel and female Viagra.  I'm telling you, Hawkings, you've got it all wrong man; it's just as likely that these aliens could be our friends!

What if (stay with me here), what if because their world is so polluted with oxygen that they've stopped singing and they don't allow open flames on their home planet?  They sit around all day in a silent, uninteresting stupor where all their food is raw and they can barely get enough energy built up to have a conversation.  Their last-ditch effort to find a planet capable of sustaining their species finds Earth.

Holy smokes is right.

They'd forget all about their ray guns and interstellar warships the first time they set foot on our CO2-rich planet where their life-giving smog pours out of every smokestack and industrial cooling tower.  What's junk food to us would be like vitamins for them.  They'd flock to McDonalds for their charred, carbon-rich, trans-fatty hydrogenated deliciousness.  Imagine such an alien getting their first earful of rock and roll music and their first bong hit.  Carbon dioxide and cannibanol, mana from heaven.  A typical college rock concert would be like going to church for them, and they'd worship the band Phish as living gods.  They'd reveal that an advanced scouting team made up of Jimi Hendrix, KISS and Marilyn Manson had been sent to Earth decades ago to determine that we wouldn't immediately try to blast them out of the sky.  They'd usher in a new era of music and share their starship technology with us so we could put a Taco Bell and a Starbucks and one of those grimy bodega-style gas stations where the attendant is behind a sheet of bullet-proof plexiglass on the planets circling Alpha Centauri.

They could teach the plants on Earth how to talk and after the roars of "STOP CLEAR CUTTING US, YOU ASSHOLES!" settled down, we'd have a whole population of sentient beings on earth that we could converse with and learn from and tax and charge college tuition to and marginalize and exploit. 

You need to lighten up, Hawkings.  How could our civilization encountering aliens possibly go wrong? 

Thursday, April 22, 2010

Things not to say to your massage therapist. Part III: Taking your clothes off.

(Today's entry is Part III in my series describing an insider's view of a medical office and how to make your experience as painless and simple as possible.  Check out Part I and Part II for more.  As I mentioned before I want to include a disclaimer:  Please note- The opinions I'm expressing here are my own and not those of my past, present, or future employers. This is meant purely for entertainment, doesn't constitute official or licensed-though I do have two licenses-medical advice, and isn't a reflection of any official business policy I've ever had, spoken or unspoken.  That said, I will be as flatly honest with you as possible.)

Whether you're getting under the sheets for a massage or dropping your trousers for the old turn-your-head-and-cough routine or getting your annual pelvic exam or showing your doctor a rash in a hard-to-see place or even just putting on one of those paper gowns that makes you feel more naked than when you're actually naked, chances are at some point in your life you'll need to take your clothes off at the doctor's office.


Don't panic.

I get asked all the time if it's awkward to have strangers take their clothes off around me.  It's not really easy to answer because there are lots of different sorts of nudity I experience in my day-to-day job, and they are not all equivalent.  In general, no it's not awkward at all.  In a sense, the people I work with aren't even strangers.  If you liken me to a car mechanic, it'd be like saying Toyotas were "strangers".  I may not know everything about you, but I've got a chart full of basic demographic info I can glance at for clues, and the chances you have a problem or a condition or a physical piece of anatomy I've never seen before are slim to none.  I've been at the work of healing people in one form or another for almost fifteen years and I think as far as nakedness goes, I've seen pretty much all there is to see at least two or three times.  But this isn't about ME, it's about YOU, and this is all new to you.  In fact, the idea of getting naked in a doctor's office is often petrifying to many people. 

There are a few things to keep in mind when doing so that will make your experience a lot easier.  I'll get to the "do's and don'ts" in a bit, but I think we should discuss for a moment the environment you're putting your naked body into.  First of all, virtually every medical worker with more than a year or two of experience, from attending physicians right down to the lowliest nurse assistant or patient tech, has seen hundreds of naked people.  Hundreds.  I'm not exaggerating.  Up close, and in full real-life HD.  It's not as scandalous as it sounds.  Of those hundreds, most of them were either very young children or elderly people, because those are the groups that get the most medical attention.  In between, however, you can be guaranteed that any experienced professional medical person has seen every size, shape, age, sex, and condition of human body there is at least a half a dozen times, and while your naked body might seem pretty darned unique and special to you when you're home looking in the mirror, it's really nothing new to us.

And I have more good news: in this context, it doesn't matter one bit if you're obese or trim, tall or short, attractive or not.  We will not judge you in the slightest for having the body you have.  Yes, for real.  It's trained into us from almost the moment we set foot in whatever training programs we went through to do our jobs, and it's reinforced by our work environment.  We feel no different around your attractive or unattractive body than a car mechanic feels around a Jaguar and a Datsun.  They're just different, and for the most part they work (or don't work) just like every other body does.  The Datsun owner's money is just as good as the Jaguar owner's and it's our job to fix them, and to do the most professional job we can doing it no matter which sort of car comes in.  When was the last time your car mechanic made you feel either especially good or bad about the type of car you own?  This means there's a certain level of expectation you should feel perfectly comfortable having, and other expectations that you might as well just leave at the door because they're either impossible to meet, meaningless, or both.

That said, there are a few things you can do to make absolutely certain that you and your body will become the stuff of water cooler or break room legend, and not in a good way.  I'll let you in on these, too, so you can steer clear.  In the spirit of my last, post, I'll frame this advice and explanation in the context of what's appropriate and what's inappropriate.  We'll start with the appropriate first.

Let's say you have a rash on your groin.  Not making any judgements here about anyone, but just for a place to start, let's say you have a rash there.  We've all had this, right?  When we were children at the very least.  Feel free to substitute whatever problem you want here as long as it theoretically involves taking your clothes off in front of a medical professional.  Here's a few helpful hints just as guidelines, with the most important one first:  You do not need to take all of your clothes off unless specifically directed to do so! 

This seems like an intuitive concept, except you wouldn't believe the number of times I've handed someone a pair of paper shorts to check their knee incisions or given them a gown to look at their shoulder or told them to go ahead and climb under the sheets for a massage and I come back in the room greeted by a completely naked patient.  People mistakenly strip down completely for things like X-rays and shots in the arm all the time.  When I hand people gowns, I always include some specific instructions about how to put them on and how many clothes need to come off.  I don't say this just to hear my voice rattle off of the inside of my skull.  

So, if you're taking notes, there's the first "inappropriate" flag.  If you're unclear about how naked you need to be for a certain procedure or treatment, just ask.  Medical people get these questions all day long.  Being ultra-confident and going buck-wild commando on us will probably not ruffle our feathers much at that moment, but you can believe once the moment is over you'll be thought of as a bit of a wingnut.

In most cases pants only or shirt only is perfectly fine and unless you have a problem directly concerning your genitals, you can keep your bra/underwear on.  Exceptions to this include some forms of complete physicals, emergency room visits, and dermatology visits where they're checking your entire body for lumps/bumps.  In these cases, you will be told that you need to disrobe completely and you should get a gown.  The doctor generally will leave the room while you take your clothes off.  Here's the second "inappropriate" flag, and this one has to do with your medical/massage staff.  If they ask you to disrobe completely and (1) don't leave the room while you do it or (2) don't give you a robe or gown to cover up with, you should ask them why.  State laws vary, but professional standards really don't.  If your doctor, clinical staffer, or massage therapist asks you to disrobe and stays nearby watching, this should be a red flag for you.  I'm not talking about taking a shoulder out of a bra strap or shrugging your pants down low enough so they can get to your lower back.  I'm talking about getting completely naked, because like I mentioned above there are only a few cases where this is ever necessary and when it is you should be able to do it in private and replace your clothes with something like a gown to keep you comfortable.

A massage is something a bit trickier than an exam because the rules are a little different.  When you're getting a massage, you're generally welcome to take off whichever clothes you feel comfortable taking off.  Since it's usually your dime, it's your prerogative.  All medical people eventually reach a level of comfort with handling bodies in one way or another, and massage therapists get the master course.  We learn how to move and manipulate people's bodies in virtually every way you can imagine while simultaneously keeping you feeling comfortable and modest.  We are trained to work on people fully clothed, fully unclothed, and people in every state of dress between.  We are trained to use strategic towel and sheet placement so that we more or less only expose which part of the body we're working on.  Therefore even if you decide to get completely unclothed to get a massage, it's important that you do, in fact, climb under the sheets before the massage therapist comes back into the room.  Again, I say this as if I'm talking to a ten year old, but you'd be amazed how some people get this mixed up when it's their first time.  In fact, here's a fun insider massage therapy tip: if it's your first massage and you're nervous or you don't want it to be distracting and ruin your relaxation, just wear a pair of shorts and (if you're a woman) a workout tank top or sports bra.  This way you can be assured everything that needs to stay covered stays covered and you can just focus on getting worked on.  Once you're comfortable with the person that's working on you, go for the real deal the next time.

I want to stress that it's relatively unlikely you'll offend your massage therapist or doctor even if you get something mixed up and pull a "hello, I'm completely naked".  So if this was you, don't worry.  These sorts of understandable mix-ups are just par for the course and we usually shrug them off and forget them.  There are a few things that will offend them, however, and they are: (1) refusing to correct your error and (2) having very bad personal hygene. 

The second one is just aggravating because no one wants to touch someone who obviously hasn't bathed in days or wears oppressive scented cosmetic products.  I've been a shower everyday man since I was a kid, but I'm well aware that many of you are not.  You're robust!  You shower right before you go to bed at night and then not again for three or four days because your bed is clean, right?  Wrong.  There is no hiding it.  Even if you have a really, really strong cologne or aftershave or perfume.  Just.  Take.  A.  Shower.  Hot water and soap.  It's not rocket science.  This also counts for after you workout and you're getting a massage.  Hit the showers first, please, even if it makes you a minute or two late for getting on the table.  If you want to live like that the other 364 days of the year that's your business, but if you're going to be in an eight by nine foot room with us for an hour we'd appreciate it if we could breathe freely. 

The first problem, refusing to put clothes on when directed to by your doctor, is a bit more serious.  It's something I haven't come across except for the overconfident folks or Euro-types that insist it's easier to just take their shirts off and be "modern" about it instead of fussing with paper shorts or a gown.  This is perfectly understandable, but half the time we give you the gown for lots of other practical reasons than just to keep a barrier of cloth between you and us.  Gowns can keep you warm in cold exam rooms, keeping a barrier between your wounds/suture lines and the floor/furniture, and they can maintain a communal modesty when you walk down the hall to go to the washroom.  Just because you're ok with nakedness and generally so are we doesn't mean the entire world is. 

When I was in orthopedics I would occasionally get first-generation foreigners that would completely disrobe upon entering the exam room just because that's how it's done in the Soverign Nation of Wherever.  This is an honest mistake and they brushed me off matter-of-factly when I tried to insist on them using the gowns.  In a medical environment, this is usually not a big deal and most doctors will be sensitive about cultural differences except for maybe a roll of their eyes at their nurse, but you should know that in some cases in order to recieve massage you MUST be covered to a certain extent.  This is a law and there's no way the therapist can or should bend the rules for you.  Even if you're perfectly comfortable being bottomless or (for women) topless in a massage and rolling over without a towel, it's actually illegal for the massage therapist to continue the massage if you do.  So keep that in mind, and don't push their professional boundaries. 

In a similar vein, it's also not appropriate to wear suggestive or inappropriate clothing in a doctor's office.  So that means your plunging necklines, bikini tops, shorts with no underwear beneath (this means you, too, guys), protruding thongs coming out of your jeans, etc, should be left at home.  No matter how attractive you are (or think you are), remember you're still just at best a Jaguar in a car repair garage.  It's not a place for showing off so save it for the club or whatever.  In addition to being fashion trainwrecks, it makes everyone around you including the doctors, nurses, staff, and other patients uncomfortable and ultimately also falls into the general behavioral category of "not being a douchebag". 

Now that all the heavy theory is out of the way, here's seven things to not even worry about:

-I didn't shave my legs! 
No one looks, or cares.  In fact, we wouldn't even notice if you didn't point it out.

-I need to hide my bra/underwear in my purse!
Again, if you feel embarrassed about your skivvies, feel free to stash them somewhere, but it's not necessary.  No one looks, or cares.

-I have loads of body hair!
So do medical people and everyone else on earth.  Not a problem.

-I haven't brushed my teeth!
Only an issue if you've got pathologically bad breath.  In fact, it's 1000 times more likely that your doctor or massage therapist is more concerned about his or her breath than you are about yours.

-I farted!
A little awkward, maybe, but only for you.  It happens to us all the time and it's no big deal.  Just press on and it'll be forgotten a minute later. 

-I accidentally got an erection!
More awkward than farting, but not the end of the world.  When men lie on their backs, their bladders sink down and directly apply pressure to their prostate.  It's involuntary and though a first year twentysomething massage therapist might get slightly flustered by it, a real professional will realize you're probably mortified and just ignore it.  If you want to avoid the possibility of this happening inadvertantly during a massage or medical exam, be sure to empty your bladder before beginning.  If it becomes a recurring problem, you'll most likely get politely referred out or our schedule will become suddenly too full for us to see you again.  Ever. 

-I have bad acne on my back/shoulders, athlete's foot, warts, or severe dandruff!
This actually a good doctor or massage therapist should pick up on and may suggest you see a dermatologist or aesthetician.  This is a medical issue all its own and derserves some attention, if only to make you more comfortable.  Nothing to be embarrassed about, but perhaps cause for concern nonetheless.  Don't be embarrassed if your doc brings it up, they're just trying to help and a lot of people genuinely don't know how to go about fixing things like this.

That's about all I can think of at the moment from my own experiences that's relevant to your next trip to the doctor's office, so I'll wrap this segment up with a funny little side-statistic that might cheer you up:  In fifteen years, I've only met a few people that were completely melt-down neurotic about taking their clothes off around medical professionals and chances are you fall into the category with most of the rest: where it's something slightly awkward that you want to do right but there doesn't seem a "cool" way to do it.  Don't worry, there isn't a "cool" way.  I've tried to outline the background subtexts going on as well as I could, but if you still leave feeling a little sheepish, take heart.  For every person I've met that was visibly afraid to disrobe for their doctor, I've met fifty who were absolutely mortified to take off their shoes and socks so a doctor could examine their feet.  People are much, much more nervous in general about their feet than they are about any other part of their body.  I have yet to figure out why, but I could almost write an entire article on the awkwardness I've experienced trying to talk, cajole, and coax people into taking off their socks and shoes.

That's it for this week.  More soon!

Sunday, April 18, 2010

Damnation update

Working on the most recent revision of The Damnation of Memory, my new novel, and I've completed the first third of the manuscript.  This is thrilling because for months and months I've been trying to come up with a scene that would fit between two other scenes and I finally wrote it tonight!  I began it last night around 2AM and I just finished it tonight at 2:48 AM.  This is a book meant to be written in the middle of the night, apparently.  This was one of those parts of writing a book where I knew I was going to just have to wait around like some schmoe at a bus stop for the inspiration to finally arrive so I could finish it the right way.  If you try to push through parts of a good story like that, you'll just end up with shit, so I waited it out.  It was worth the wait!

Thursday, April 15, 2010

Things not to say to your massage therapist. Part II: Appropriateness

This June will mark my fifteenth year in the medical field, and I've managed to collect a pretty sizeable trove of stories (some inspirational, some cautionary) regarding medicine in general.  Many of you may remember this post from back when I worked at Peak Performance about how to act when you're getting worked on by your massage therapist.  Since it's one of my old favorites, I figured I'd start a semi-regular column on the subject. 

Today I'd like to say a few words about appropriateness when visiting your doctor's office.  I've worked in musculoskeletal medicine for my entire career, but the same concepts hold true across disciplines.  So let's just jump right into it.  Please note: The opinions I'm expressing here are my own and not those of my past, present, or future employers.  This is meant purely for entertainment, and isn't a reflection of any official business policy I've ever had, spoken or unspoken, though I will be as flatly honest with you as possible.

So let's start by going through a typical office visit and what's appropriate for each stage.

Appropriate: Asking "how much time should I leave myself for the appointment?"
Not Appropriate: Asking "how long will I have to wait?" 

The Logic: Doctors and their staffs have little control over their daily schedule once it's underway.  They can occasionally bring things to a screeching halt or they can speed it up (usually by skipping their lunchbreaks or walking around with a full bladder for a few hours), but in general there's not much they can do once the day starts.  It's fine to want to know how long your appointment will take, but please understand that this is, at best, a rough estimate.  You're just as likely to be in and out almost immediately as you are to be stuck running behind.  Every day is different and there are always unforeseen problems.  If you ask how much time you should leave for your appointment, the receptionist should be able to calculate in their head the amount of time it will take you to get settled, get paperwork filled out, wait, see the doctor, and check out, and give you an estimate that will approximate the entire visit length.  If instead you ask how long it will take to see the doctor it (1) makes you sound like you have better things to do than seeing a doctor for your excruciating pain.  You don't.  Plus if you wouldn't waste your time getting yourself well, why should your doctor?  It also (2) doesn't take into account extra time spent doing administrative things, scheduling follow-ups, or if the doctor decides to spend extra time with YOU, which they often will during their first appointments.  A receptionist should be able to tell you these things immediately.  Which leads me to the next part...

Reception Desk
Appropriate: Schmoozing, bantering, and having fun at the front desk.
Not Appropriate: Being a douchebag to the receptionist.

The Logic: The reception desk actually has a surprising amount of control over the day-to-day operation of a medical office, and their job is one of boredom and tedium punctuated by putting out the fires of pissed-off people either in the waiting room or in the actual office.  While I would strongly advise against flirting openly with front desk staff (who in addition to their experience are in truth often chosen for their attractiveness and social aptitude), it is perfectly OK to show them pictures of your kids or chat about American Idol or tell them about the Marathon you think you're going to try this Spring.  In fact, virtually any conversation about food, vacations, or pop culture is a welcome break from being shouted at and/or taking care of an endless stream of brain-numbing administrative tasks.  If you can talk to the receptionist about something other than their job, they're much more likely to give you extra consideration when you need an emergency visit or a last-minute reschedule.  We also are only human.  We love funny jokes, videos, cartoons, etc.  Keep it clean though.  If it wouldn't appear in a newspaper or magazine, don't bring it into a doctor's office.  We occasionally tell off-color jokes or watch videos of people lighting their farts, too, but it's indescribeably  awkward if it comes from a patient.

It's absolutely not ever OK to give your receptionist a hard time.  Yes, I have worked with some collossal assholes that represented an office from behind the front desk, and I've experienced some appaling behavior from them as a patient myself, so I know they exist and it seems sometimes even as if they're pervasive.  The person to tell this to is your doctor, and no one else.  Smile, and deal with them, and then tell your doctor exactly what you think of them.  The doctors in private practice are ultimately the ones in control, and believe me, they are VERY concerned about how their practices are being represented by their staff.  While truly great receptionists are rare and coveted by both doctors and patients, lousy receptionists are legion, and can be replaced easily in a week.  And they often are.  This is doubly true if your receptionist is good at what they do. Tell your doctor this, too, and the fast-track to easy medical experiences awaits you.  Which leads nicely to the next point...

What do doctors/clinical staff like?
Appropriate: Food, small thoughtful gifts, compliments, and referrals
Not Appropriate: Large or expensive gifts, invitations

The Logic: Let's say you've got your appointment scheduled and managed to meet a doctor that you really like.  You dig their credentials, their office is convenient, their front desk staff seems professional and this doctor communicates with you in a way that makes you feel very seen and heard.  In short, you like this doctor and you want to stick with them.  You want your experiences with them to continue being as painless as possible, perhaps you even want to bypass some of the scheduling wait-times or waiting-room boredom that pervades their office.  This is perfectly understandable.  Many (not all, but many) great doctors like this have hideous wait times both to see them and to wait for them in their waiting room.  This is misery, we know, and we absolutely do NOT want you associating our office with misery because for 99% of medicine early treatment is dependent on you coming in sooner rather than later. You coming in sooner is dependent on our office not being a hateful pain in the ass to come into.  So you're patient and you understand that sometimes a long wait can't be helped, but what can you do to speed things up?  Be friendly, of course, and make yourself somewhat special to your doctor!  We're people too, and we try hard not to play favorites, but we do inevitibly have patients that are special to us.  People we like immediately, or who make us glad that we chose the career we did.  Those patients get the medical equivalent of a business-class flight upgrade.  The waits are a bit shorter, the rules can be bent ever so slightly for them.  So how do you become one of those patients?  The answer is as close as your nearest Panera bread store or Einstein's Bagels.

Medical people have a variety of interests, but none quite so consistent as golf and food.  We fucking LOVE golf and food.  Some of us like music and nice pens, too.  So let me break this down for you:

You go to a doctor to have them help heal your (insert nasty persistent problem here) and they treat you well and give you a cure that helps immediately.  You feel like they've done you a solid service and you're going back for a follow up or to have them look at something else and you want to show them that "hey, I'm not just a nobody, I'm a happy customer and I think you're doing a good job, and by the way can I please have an appointment this month instead of next season?"  When you go in for your next appointment (NOT the first appointment), take them a bag of bagels from Einstein's with some cream cheese.  It's like $10, but you will never be able to buy with cash the sort of goodwill that bagels can get you.  Here's the kicker: don't give it to the doctor, give it to the front desk and tell the doctor that you gave it to them to share.  This is a no-lose situation.  The front desk will never refuse this.  If your doctor doesn't want bagels, they'll just let the front desk have them and it's still a good showing on your part that you took a minute to think about them as human beings, which they very much are. 

If your doctor does something particularly special for you (saves your life, cures some bitchy-miserable disease you have), it's also appropriate to give them a small gift.  Remember, though, the key here is thoughtful, not expensive.  Doctors and most clinical people have everything they need, and it's foolish to think that you could buy them something they couldn't buy themselves (except lunch, lol, because that's often the hardest thing to get during a busy day).  It's just the thoughtfulness they appreciate.  Hence, a nice small box of golf balls for a doctor that enjoys golf is appropriate.  Golf clubs are not appropriate.  The same is true of food to a lesser extent.  Bringing them bagels for breakfast or a pizza for lunch is absolutely perfect, but inviting them out for lunch is not appropriate.  It's not that we don't want to go out with you or that under different circumstances we'd refuse, but our jobs force us to keep a certain personal distance from you when it comes to socializing.

A lot of doctors and medical people are into music and a $10 iTunes gift card is a great, great gift.  That's a great one because if you give it to a doctor and they're not into music, they can easily re-gift it to their staff.  You cannot go wrong with pens.  Every clinical person likes pens, and we go through them constantly.  Go to Things Remembered and have their name (including the M.D. or whatever their suffix is) engraved on a $10 stainless steel pen.  Virtually every doctor and medical person I know has at least one of these and it's like a medal of honor for them.  They get lost and stolen sometimes but then other times I see them in the pockets of clinical people who say they've had them for decades.  If they say "you didn't have to do that.", just say "ah, it's nothing, I insist."  Suddenly, you've gone from "another pleasant patient that comprises 80% of my patient base" to the person that pinned that particular medal of honor to their lab coat.

Medical people love this, and there's a damned good reason why.  Virtually everyone else with only a few exceptions in today's service economy can expect some sort of gratuity tacked on to the cost of their services.  Except the people who work the hardest for you, like doctors.  Those folks are just supposed to get by without it, because supposedly their lives are all Gucci and Polo and lunches at the golf club and it's understood you're grateful, right?  Wrong.  Buy them some bagels and make sure they know you're grateful.  You never know, if the office is chaotic that day, those bagels may be all that doctor gets to eat that entire morning.

Let's say for a second though, that you don't have an extra ten bucks or you didn't think ahead of time to get something.  This is also perfectly fine because two of the most potent gifts you can give doctors and clinical staff are totally free.  Compliments, and referrals.  Compliments are music to the ears of both doctors and staff, and if you want to REALLY get on the good side of a receptionist, tell the doctor they work with how much you liked their office or their front desk staff.  The only thing that circulates around an office faster than a complaint is a compliment.  Don't be self-conscious.  Just do it.  We didn't get into this career to have people bitch at us for thirty years every day.  We got into it to help people and because it's pretty gangster to heal people that are in bad or desperate shape.  Compliments make us remember why put up with people bleeding/vomiting on us or calling us at 2 AM the rest of the time.

Finally, referrals are the ultimate compliment.  Sending someone you know or love to a doctor is the highest compliment you can pay them.  You're so confident that they're good that you want everyone to know about it.  This actually can change a doctor's life.  Going to and leaving them a glowing review or talking about them at a party or sending them even just one patient is the lifeblood of their practice, and referred patients are a thousand times easier to work with than people just off the street.  A loved one or friend that you've sent them comes in already knowing that they're competent and ready to help, and any goodwill your doctor has toward you will extend to them.  This is an incredibly powerful thing you can do for a doctor and it's the sort of thing medical people do for each other when there's a significant mutual respect.  No doctor will ignore or misinterpret this as anything but a very high compliment.

So we've got that, right?  Small gifts, food, compliments and referrals are perfect.  Expensive or large/awkward gifts are a no-no and invitations are awkward and inappropriate.  Wow, now you're a high-roller and you can call the office and they know you by your voice alone and you don't have to wait three months to get in and if there's an opening the receptionist will actually CALL you instead of just saying they will.  How about that?  All's going well until...

The Bill
Appropriate: Asking a coder/biller for a detailed explanation of your bill after your appointment is over.
Not Appropriate: Calling or directly asking your doctor about your bill.

The Logic:  Remember in the film The Matrix when the characters were stuck staring at a screen with cascading flourescent green coding on it.  "What's that?" Neo asked, "The Matrix," the other shrugged.  The doctors that perform your healthcare have something like that going on in their heads at any given time.  A long string of combinations of drugs and symptoms that looks like the most complex NYSE stock ticker ever invented.  They're thinking about four or five things at once for most of their workday, and generally none of them involve your finances.  Unless the practice you go to consists of just a single doctor and no support staff at all, they're not going to know the answers you want.  Coding, billing, and collections are the part of medicine that everyone, including the people who do it, loathes.  This is a job that's usually either given to the front-desk staff to slog through or a support person called a Coder or Biller.  A Coder/Biller is the person you want to talk to, if one exists, because they can tell you in very fine detail how the process works.  Yes, it's incredibly confusing, even for them, and there are times when the best they'll be able to give you are estimates of what you'll owe.  Nonetheless, it's the Billers/Coders you want, not the doctors, and only AFTER your appointment.  Unless they suggest it, don't try to spend your waiting room time talking to the billers.  It's sort of a dick move and chances are there's someone already talking to them right that moment.  If you tell them you're going to talk to them after the appointment they'll have time to finish whatever they're doing and pull up your account so they can go through it themselves before you start grilling them.

All right, that's it for today.  More next week!


Well, I've managed to finally sort my wonky main page out, including getting my profile picture working again and adding some nifty quick links to the top bar just beneath the title to check out my books and short stories as well as a new About Me page that replaces the horribly self-indulgent one that used to be there.  Ok, so it's still a little self-indulgent...  The books page also has a helpful function where if you click on the picture it takes you directly to the page for each title, saving you the trouble of looking them up.

More to come.

Tuesday, April 13, 2010

New music

It's been a few months, I figured it was time for some new tunes. Here's what I'm listening to now:

"Empire State of Mind" by Jay-Z and Alicia Keys
"Apologies" by Grace Potter and the Nocturnals
"Messages" by Xavier Rudd
"Keepsake" by State Radio
"Knock 'Em Out" by Lily Allen
"Romeo and Juliet" by The Killers (Dire Straits cover)
"Midnight Special" by Creedence Clearwater Revival
"Thinking of You" by Katy Perry (yes, I realize this one's still on here from last time, it's just good)

Sunday, April 11, 2010

And here I've meant to keep up

It’s been something like four days I’ve been trying to find a moment to sit down and write this entry, and try as I did I just couldn’t bring myself to fight off the rest of my life to bring it to you. Some things are just more important, and that’s all there is to it. Just the same, it’s been literally months since I’ve updated and I’ve been giving some significant thought to what I wanted to do with this page. I’m currently about 37,000 feet above Pennsylvania and barreling toward Chicago from a weekend trip to upstate NY to visit my grandmother and attend my cousin Ryan’s wedding and since they still don’t have broadband aboard planes (despite it costing $300 for a ticket and involving more security procedures than entry into the Pentagon) I’ve discovered that I’m myself a captive audience and in the perfect frame of mind to make a decision about where I want to go from here.

Some of the better bloggers I know commit themselves to updating their page once a week on a specific day, and that sounded like a great idea. I have most Thursdays off and it would be a perfect opportunity to catch up with writing my own blog along with a host of other responsibilities. The execution of it, however, just seemed inordinately difficult this week. Thursday I literally fell asleep at the keyboard trying to type this and it just didn’t work out. I usually update my status on Facebook every day or every other day and I think for a time (especially now that I have a nifty iPhone and can do it from anywhere) that I used Facebook as a sort of substitute for the writing fix I usually get from keeping this blog. At the end of last year, however, I found that the process I usually go through of searching through my back posts to see how far I’ve come just wasn’t the same. In an internet landscape currently dominated by the Twitter mentality, I felt this odd sort of emptiness that I was trying to reconstruct the last six months of my life in the form of incongruous faux-witty, three-line quips. There’s a place in my psyche, I think, for short-form remembrances, but at heart the process of blogging has always been one of narrative for me, and there’s just no narrative in that short format.


Back I come, to this. Diary-keeping. Blogging. Whatever you want to call it. It’s story-telling after a fashion, and because I’m quite certain that only a handful of my 400+ Facebook friends will even bother to read this it’s story-telling with myself as the primary audience. And I’m OK with that. I think that after some consideration that the reason I didn’t just shit-can this site is because it’s hard to do. Like I mentioned earlier, when I get myself set to write something down here, it’s almost as though life itself bends around my in order to get in the way. But that’s the very value of it. It’s difficult. It requires consternation and sacrifice. In the end, having a coherent narrative of my life has always been the goal of this page, and this it continues to be. In one form or another I’ve kept an intermittent long-form diary for almost twenty years, and I wasn’t about to just give up on that, especially since so much of my life these days feels like a disorienting blur.

Here is my promise to those small few of you who still read this: I will update this page every Thursday for six months without fail. Come hell, or high water. And that includes the promise to myself as well.

But now, onto more pertinent things. I spent the weekend in Watertown, visiting my mother’s mother, whose health is failing. I saw her approximately a month ago when I took the train to NY to visit. As many of you know, this has been extraordinarily difficult for me since for virtually my entire life she has been a guardian-angel-type presence for me. Which is not to say I qualitatively love her any more than anyone else in my family but that instead she was a person that she has gone thousands of extra miles for me and made me feel loved in a special, additional way. I’m sure you all know what this means. Even in the most loving and drama-free of families there are always those special bonds. My niece Katy has one with my nephew Charley, my niece Lucy with my son John. They are the kindred souls within families for which understanding and mutual affection are as natural as breathing. This is the sort of relationship I have with my grandmother Laura. She has been a fixture of virtually every important event of my entire life, even after I’ve spent the last decade living halfway across the country. Despite any other hardship or inconvenience it might cause me, I invariably take the time to visit her even if it’s just for an hour if I’m in that part of New York. I’ve received a Halloween, Thanksgiving, Christmas, Valentine’s, and Easter card from this woman every year of my entire life, without fail, even into adulthood and right up to this current Easter.

She is quite ill now, and the idea that possibly before this time next year her phone calls and photos and holiday cards will fall silent forever has been a devastating reality check for me. Living as far as I do from the Brand family in NY, I feel constantly as though I’m living two lives. Like the protagonist of a bad sci-fi channel time-travel movie, I occasionally get into a plane like I’m doing now and warp from one to the other, only to once again experience the same halting culture-shock I did the first time I moved away or set foot in Chicago. Once I become comfortable again with Chicago being “home base”, I take a trip back to NNY and the process of wrapping my head around it begins all over again. Chicago offers the lifestyle I want, replete with professional and personal successes of every variety. Intellectual fulfillment, opportunity to burn, entertainment to fit my tastes, and most importantly, the Chicago branch of my own new little Brand tribe. Northern New York offers the people I miss most, though, and are completely irreplaceable even in a gigantic city full of virtually every convenience (for a price) you could imagine. This means my extended family, but not only them. I have friends there still, as well. Friends. That legendary class of human being that once held a prominent place in my life and have been hunted nearly to extinction by geographic distance, responsibility, and increasingly by the awful low-grade poverty imposed on my generation by the clash of expectation versus available resources.

All of these things have been sharply present in my mind for these past four weeks as I prepare to face the day when my grandmother is gone. The little kid in me whom she had such endless love and patience for in a thousand ways I’ll probably never even know about is steeling himself for the loss of his lifelong guardian angel, but the adult in me is facing an even more intimidating thought looming just out of the frame: No matter how much of a fixture a person seems they may be in your life, they are not ultimately immortal. And this also goes for a large number of other people I love dearly who seem also not to get any younger year by distant year.

Meanwhile I’m not getting any younger either, and I’m starting to feel a little bit like Gandalf from the Lord of the Rings must have felt. I’m forever showing up either just in time or at random intervals in the lives of people I love with always something pressing and important that I need to accomplish, then I vanish off to deal with something else in the other part of the story that’s happening halfway around the world. I’ve often had a thought when reading those books: how different this story would have gone if Gandalf could have just focused on helping Frodo and Sam take the ring or preparing the defense of Helm’s Deep, instead of shuttling like a badminton birdie across all of Middle Earth putting out fires. I feel like when I go back to Chicago or off to New York, I leave the people in each of these respective lives behind, scratching their heads as if to say “well that’s nice, now what?”

Despite the difficult and sometimes bluntly pointless nature of life in the Northern New York region in general, I do not judge my cousins in the least when they move away from it and move back a few months or years later. As much as I’ve said myself to a number of them “if you want to bring yourself the success you want, you’ve got to get out of this town”, I am just as vulnerable to the crushing home-sickness that it brings when we’ve been away long enough to realize how special it was to grow up in a large, loving family in a small town. It’s only recently that I’ve been able to talk to them about it, particularly the ones who have left and returned, and gotten a sense that I wasn’t alone in feeling the way I do.

As I sit here on this little commuter plane it occurred to me that ten years ago, before 9/11, I could have almost hoped for a life where I could have come to NY for a weekend virtually any weekend I wanted if I was so inclined. Wages were sufficient for most jobs I was qualified for. Homes were affordable, at least to rent, and the airfare for the last trip I took from Florida to Chicago to visit Beth when we first met was $79 on ATA round-trip. Now it’s such an ever-fucking hassle to travel anywhere for any length of time by virtually any means that I find myself scheduling trips from one place to the other around binges of caffeine, comfort food, and doses of Advil for the headaches it gives me. I haven’t for a moment stopped loving being in both places, but I’ve come to loathe the shifts between and how miserable they are in almost every way.

I don't have much more to say on the subject at the moment, and I do realize that this leaves off the blog on a down note, but hey: I promised to update it, I never said it would always be fun.