Have I ever told you about the neighborhood ice cream truck? I can't recall, but if I have, feel free to stop reading. The ice cream truck has become something of a legend (and a joke) in our family. It's like the yeti - one of those things that people have seen but they can't actually get evidence that such a creature exists.
In our case, the ice cream man for some incomprehensible reason drives his ice cream van as fast as humanly possible down our street, seemingly to avoid selling any actual ice cream, something that continues to frustrate our son and perplex and amuse the heck out of the rest of us. A sighting occurs something like this:
We'll hear the jack-in-the-box music of the ice cream van as it begins its trip down our street. Ragsy will brighten - at last, he'll be able to get ice cream from an actual ice cream truck, right in front of his house! But alas, before we make it to the door, we hear the music temporarily peak in volume, then quickly subside. Foiled again! We might see the back of the ice cream truck as it races down the street, then the confused faces of other parents watching it zoom away.
I can't help but snicker. The last time I discussed this with my mom, she said that she was lucky - their ice cream guy was on a bike and the neighborhood kids could easily run him to ground for the privilege of purchasing treats. Sadly, our ice cream man comes better equipped. The ice cream stays cold and plentiful, away from the prying hands of children and the cash of their parents.
Oh, well. Maybe someday we'll get him.
Sunday, August 30, 2009
Friday, August 28, 2009
Beach!
We just got back from a too-short but long-awaited vacation to Hilton Head Island, where we met my sister and brother-in-law. It was fantastic. We had hoped to take Ragsy somewhere before the baby came so we could spend some time together as a family and enjoy ourselves before I got too lethargic to do much, and since Ragsy had never had a chance to play in the ocean and we wanted to see my sister and brother-in-law, we settled on someplace closer to them and got a condo for a few days.
We went to the beach every day for several hours, rented some bikes and rode all over the island and played tennis until we all wanted to drop. Then we ate tons of junk food to make up for it, then went on walks afterward to work it off again. I think I can safely say that I got around 2-3 hours of exercise a day. Which worked out well since I had a doctor's appointment the day after.
Fortunately, I was able to get over any modesty I might have had, despite being nearly six and a half months pregnant. Though I do find myself wondering - why on earth are all maternity suits in two pieces these days?
Anyway, here are some photos.
My son and his dad looking at a "pirate ship" at Seven Pines Harbor Town.
Me and Ragsy in front of a statue of Neptune at the Disney resort (if you've never been, Hilton Head is an island made up almost entirely of resorts, so we visited several, but stayed at Palmetto Dunes).
Ragsy toward the end of a long day running up and down the beach.
You'll notice that there are no actual photos in this blog to prove that I wore a swimsuit, so you'll have to take my word for it (I do have evidence, though).
We went to the beach every day for several hours, rented some bikes and rode all over the island and played tennis until we all wanted to drop. Then we ate tons of junk food to make up for it, then went on walks afterward to work it off again. I think I can safely say that I got around 2-3 hours of exercise a day. Which worked out well since I had a doctor's appointment the day after.
Fortunately, I was able to get over any modesty I might have had, despite being nearly six and a half months pregnant. Though I do find myself wondering - why on earth are all maternity suits in two pieces these days?
Anyway, here are some photos.
My son and his dad looking at a "pirate ship" at Seven Pines Harbor Town.
Me and Ragsy in front of a statue of Neptune at the Disney resort (if you've never been, Hilton Head is an island made up almost entirely of resorts, so we visited several, but stayed at Palmetto Dunes).
Ragsy toward the end of a long day running up and down the beach.
You'll notice that there are no actual photos in this blog to prove that I wore a swimsuit, so you'll have to take my word for it (I do have evidence, though).
Thursday, August 20, 2009
Miss-Information
I just finished watching The Daily Show, and I think my head is going to explode. Their guest was Betsy McCaughy, PhD. She was arguing against the most recently-proposed health bill. I was so astounded at her misreading of the bill that I wanted to reach through the TV and smack her. Additionally, it's amazing that people are so outraged at this proposed bill because the bill is not law.
My responsibilities at my previous employer included researching and making technical rebuttals over proposed legislation back to the federal government on provisions we disagreed on; assisting clients in making such technical rebuttals; understanding Congressional intent in my own little corner of the regulatory world; and implementing and assisting clients to implement such technical and overarching operational guidance. I also worked with our lobby to change legislation and even managed to do so on some occasions. After that experience, my biggest beefs with Dr. McCaughy's points were:
1. First and foremost, the bill is not law. The way bills generally work in Congress (at least my understanding) is that one person proposes something (or sponsors it, anyway). The bill makes its way through the chain. People hate it. They send back their comments. The people who created it make changes to it and send it back again. Then rinse and repeat until they get a final bill everyone can live with. So if everyone would shut the hell up for five seconds and realize that, perhaps we can get something through Congress to help people.
2. The overarching Congressional intent on Medicare is to protect its beneficiaries, which is one of the many reasons complicated fraud, waste and abuse and quality reporting requirements are implemented. Other checks are put in place as well to prevent private companies (including health plans insuring beneficiaries, their physicians, pharmacies and anyone associated with the program) from defrauding or otherwise doing anything not in the best interest of the beneficiary. Sub-regulatory guidance like this includes marketing provisions, enrollment/disenrollment provisions, reporting requirements over and above quality (such as prescription drug event, medical event, etc.) and more. In other words, don't screw with the beneficiary.
3. Dr. McCaughey was referring not to the actual provision of the issue at hand (the end-of-life discussion, whether it's required and what's to be discussed), but the reporting requirements, which indicate that the doctor must provide life sustaining care if requested by the patient and/or his/her health proxy. Nothing, absolutely nothing, is said that the physician must choose to terminate or otherwise withold treatment - it all focuses on sustaining the life of the patient. Nowhere in the provisions (see page 424 through 431 of the bill). Indeed, the physician isn't even required to have such a discussion with the beneficiary if he or she declines. Further, the discussion between the medical professional and patient must focus on factual information only. As in, these are the ways you can tell people what you want, here's who can help you do that and here are some other resources. That's it.
At this point, it appears that no one really gives a rat's ass what the bill says, but what they've decided it says. Also, Dr. McCaughey kept repeating herself like a freaking parrot, but said absolutely nothing of value. I find it completely disgusting that people like her are preying on others' confusion simply to advance some sort of agenda, and I'm sad that she was given a national forum on which she could continue to spread such misinformation.
Do I think the bill is great? Good God, no. Is it even good? Not really, but it's a place to start. So shut up and get started already. Times a' wasting and people are underserved, dying and going broke trying to ensure their families have access to insurance and healthcare. To both sides: shut your traps and get to work. Isn't that what we pay you for anyway?
My responsibilities at my previous employer included researching and making technical rebuttals over proposed legislation back to the federal government on provisions we disagreed on; assisting clients in making such technical rebuttals; understanding Congressional intent in my own little corner of the regulatory world; and implementing and assisting clients to implement such technical and overarching operational guidance. I also worked with our lobby to change legislation and even managed to do so on some occasions. After that experience, my biggest beefs with Dr. McCaughy's points were:
1. First and foremost, the bill is not law. The way bills generally work in Congress (at least my understanding) is that one person proposes something (or sponsors it, anyway). The bill makes its way through the chain. People hate it. They send back their comments. The people who created it make changes to it and send it back again. Then rinse and repeat until they get a final bill everyone can live with. So if everyone would shut the hell up for five seconds and realize that, perhaps we can get something through Congress to help people.
2. The overarching Congressional intent on Medicare is to protect its beneficiaries, which is one of the many reasons complicated fraud, waste and abuse and quality reporting requirements are implemented. Other checks are put in place as well to prevent private companies (including health plans insuring beneficiaries, their physicians, pharmacies and anyone associated with the program) from defrauding or otherwise doing anything not in the best interest of the beneficiary. Sub-regulatory guidance like this includes marketing provisions, enrollment/disenrollment provisions, reporting requirements over and above quality (such as prescription drug event, medical event, etc.) and more. In other words, don't screw with the beneficiary.
3. Dr. McCaughey was referring not to the actual provision of the issue at hand (the end-of-life discussion, whether it's required and what's to be discussed), but the reporting requirements, which indicate that the doctor must provide life sustaining care if requested by the patient and/or his/her health proxy. Nothing, absolutely nothing, is said that the physician must choose to terminate or otherwise withold treatment - it all focuses on sustaining the life of the patient. Nowhere in the provisions (see page 424 through 431 of the bill). Indeed, the physician isn't even required to have such a discussion with the beneficiary if he or she declines. Further, the discussion between the medical professional and patient must focus on factual information only. As in, these are the ways you can tell people what you want, here's who can help you do that and here are some other resources. That's it.
At this point, it appears that no one really gives a rat's ass what the bill says, but what they've decided it says. Also, Dr. McCaughey kept repeating herself like a freaking parrot, but said absolutely nothing of value. I find it completely disgusting that people like her are preying on others' confusion simply to advance some sort of agenda, and I'm sad that she was given a national forum on which she could continue to spread such misinformation.
Do I think the bill is great? Good God, no. Is it even good? Not really, but it's a place to start. So shut up and get started already. Times a' wasting and people are underserved, dying and going broke trying to ensure their families have access to insurance and healthcare. To both sides: shut your traps and get to work. Isn't that what we pay you for anyway?
Monday, August 17, 2009
Lightening?
So I'm getting into the third trimester of pregnancy. The baby is already starting to drop - I tend to carry low apparently, and Ragsy was about at the same position this one is around the same time. I was refreshing my memory on the various stages of development and pregnancy and realized once more that eventually (prior to labor), I'll start "lightening." Why this stage is somehow associated with anything other than "heavying" is anyone's guess.
Anyway, the weekend went pretty well. We kept things really low key, big emphasis on sleep and our undivided attention, and Ragsy's tic was gone by Sunday. It came back a little today because he was tired - he got very excited about going back to pre-school last night and wouldn't sleep until late. Hopefully he'll get into the swing of things soon. If he doesn't, we'll just have to figure something out, whether that entails a different room or reduced working hours and more time with us.
Work is...well, my boss had earlier called me in to make sure I was doing ok with the "grueling" pace. If the pace at work is grueling, I can't imagine how deadly boring a slow period would be. You'd think with all the political machinations going on, we'd be a little more strategic and, well, proactive. But my boss is a staunch conservative and he unabashedly allows his politics to pour into his work. He actually tried to convince me to use the term "death panel" in a press release. Didn't happen.
After this kid is born, I'd like to wrap things up and start my exit strategy. I'm receiving little to no mental stimulation. And while I don't expect people to always agree with me, I don't like having to police my boss to make sure our company isn't perceived as partisan and offensive.
Anyway, the weekend went pretty well. We kept things really low key, big emphasis on sleep and our undivided attention, and Ragsy's tic was gone by Sunday. It came back a little today because he was tired - he got very excited about going back to pre-school last night and wouldn't sleep until late. Hopefully he'll get into the swing of things soon. If he doesn't, we'll just have to figure something out, whether that entails a different room or reduced working hours and more time with us.
Work is...well, my boss had earlier called me in to make sure I was doing ok with the "grueling" pace. If the pace at work is grueling, I can't imagine how deadly boring a slow period would be. You'd think with all the political machinations going on, we'd be a little more strategic and, well, proactive. But my boss is a staunch conservative and he unabashedly allows his politics to pour into his work. He actually tried to convince me to use the term "death panel" in a press release. Didn't happen.
After this kid is born, I'd like to wrap things up and start my exit strategy. I'm receiving little to no mental stimulation. And while I don't expect people to always agree with me, I don't like having to police my boss to make sure our company isn't perceived as partisan and offensive.
Friday, August 14, 2009
And so it begins.
You know that part of pregnancy when you begin to hear such classics like, "Wow, I can't believe how big you're getting?" Well, apparently I've entered that stage. At work, anyway. I forgot how annoying this part of pregnancy was. Why must people feel so comfortable commenting on such things? My weight gain isn't particularly insane - I'm right around 16 or 17 pounds heavier than I was before I got pregnant. I'm starting to get occasional ankle and finger swelling if I don't walk around a lot - the last thing I want to hear is confirmation that I'm beginning to look like a whale.
Oh, and did I mention that everyone at work except two people - yes, two people - calls me "Mama" or "Mommy?" Even my own mother has taken to referring to me as "Mom." Well, there goes my identity again. I remember that was one of the hardest parts of having Ragsy emotionally. You sort of disappear for a while into this strange nothingness where you're your kid's mom and that's it. I know it's going to be lots worse after the new baby is actually born and I won't begrudge him or her a moment of attention or love, but it sort of sucks when you were used to being yourself to other people and suddenly you're only yourself to you.
And Ragsy's been pitching more of a fit lately, too. I don't think it's the baby - Ragsy has seen ultrasounds but so far has incredibly bad timing about actually feeling it move, though God knows I've got another linebacker in my stomach. I think it's the start of pre-school.
Even though all his school bus and party cake dreams have come true, I guess pre-school brings with it a lot more expectations (that you'll always go to the bathroom when you need to go, that your behavior is more mature, etc.) and new experiences. It's wearing on him a little. He's even developed a transient tic where he blinks his eyes really hard occasionally. At first we were concerned that it was a vision issue, but that doesn't seem to be the problem. And it gets lots worse when we mention it, so we're trying to keep our mouths shut. I'm hoping it'll ease up over the weekend after he's had some time to decompress. His doctor doesn't seem concerned, so I'm going to try not to get weirded out by it.
Oh, well. He's an intense kid and I wouldn't have him any other way.
Oh, and did I mention that everyone at work except two people - yes, two people - calls me "Mama" or "Mommy?" Even my own mother has taken to referring to me as "Mom." Well, there goes my identity again. I remember that was one of the hardest parts of having Ragsy emotionally. You sort of disappear for a while into this strange nothingness where you're your kid's mom and that's it. I know it's going to be lots worse after the new baby is actually born and I won't begrudge him or her a moment of attention or love, but it sort of sucks when you were used to being yourself to other people and suddenly you're only yourself to you.
And Ragsy's been pitching more of a fit lately, too. I don't think it's the baby - Ragsy has seen ultrasounds but so far has incredibly bad timing about actually feeling it move, though God knows I've got another linebacker in my stomach. I think it's the start of pre-school.
Even though all his school bus and party cake dreams have come true, I guess pre-school brings with it a lot more expectations (that you'll always go to the bathroom when you need to go, that your behavior is more mature, etc.) and new experiences. It's wearing on him a little. He's even developed a transient tic where he blinks his eyes really hard occasionally. At first we were concerned that it was a vision issue, but that doesn't seem to be the problem. And it gets lots worse when we mention it, so we're trying to keep our mouths shut. I'm hoping it'll ease up over the weekend after he's had some time to decompress. His doctor doesn't seem concerned, so I'm going to try not to get weirded out by it.
Oh, well. He's an intense kid and I wouldn't have him any other way.
Tuesday, August 11, 2009
Ow.
I finally finished reading all 1,018 pages of the recent healthcare reform legislation. My brain is killing me. But what's killing me more is the misinformation being spread by people who have no idea what the hell they're talking about.
"Death panels?" Seriously? "Euthanize the elderly?" How do you get that out of "provide vehicles to allow seniors to let their providers know what type of care they would like to receive?" Strangely enough, I got something closer to, "medical powers of attorney." It's like a twisted, ugly game of telephone.
Anyway, in case you care, after reading the bill from the objective of a beneficiary advocate and as someone who has actually implemented a privatized government healthcare program (focusing on the Medicare portion, of course, because that's what I do), the whole thing seems pretty sound. Yes, there are some portions of it that may be difficult or in some cases nearly impossible to implement, at least in my experience with the government-run healthcare and entitlement programs (Medicare plan sponsors, supplemental legislation and SCHIP and Medicaid and Social Security Insurance and Social Security Disability Insurance). But at the same time, at least there's a framework to start from. Kind of like when you create a first draft of copy for a novel: you have to have somewhere to start from, provide someone something to rip apart, to get somewhere in the first place.
I am so tired, though. Another big part of my job is following the media, which makes me want to scream. This is lots, lots worse than when I had to read the American Recovery & Reinvestment Act of 2009 (you know, the gigantic bill that implemented Cash for Clunkers, new COBRA extensions, extra Medicare protections and payment provisions and energy assistance). People are freaking nuts. This whole healthcare debate has significantly diminshed my faith in politicians to distribute even remotely accurate information and others' ability to distinguish truth from lies. Or to even care where that line is.
"Death panels?" Seriously? "Euthanize the elderly?" How do you get that out of "provide vehicles to allow seniors to let their providers know what type of care they would like to receive?" Strangely enough, I got something closer to, "medical powers of attorney." It's like a twisted, ugly game of telephone.
Anyway, in case you care, after reading the bill from the objective of a beneficiary advocate and as someone who has actually implemented a privatized government healthcare program (focusing on the Medicare portion, of course, because that's what I do), the whole thing seems pretty sound. Yes, there are some portions of it that may be difficult or in some cases nearly impossible to implement, at least in my experience with the government-run healthcare and entitlement programs (Medicare plan sponsors, supplemental legislation and SCHIP and Medicaid and Social Security Insurance and Social Security Disability Insurance). But at the same time, at least there's a framework to start from. Kind of like when you create a first draft of copy for a novel: you have to have somewhere to start from, provide someone something to rip apart, to get somewhere in the first place.
I am so tired, though. Another big part of my job is following the media, which makes me want to scream. This is lots, lots worse than when I had to read the American Recovery & Reinvestment Act of 2009 (you know, the gigantic bill that implemented Cash for Clunkers, new COBRA extensions, extra Medicare protections and payment provisions and energy assistance). People are freaking nuts. This whole healthcare debate has significantly diminshed my faith in politicians to distribute even remotely accurate information and others' ability to distinguish truth from lies. Or to even care where that line is.
Monday, August 3, 2009
I'll just put a bug in your ear.
This weekend was very quiet except for last night. Saturday was spent at the Magic House and going out to lunch, crowned by a quiet afternoon. Sunday Ragsy took me on an hour-long run. I was really proud of myself - I managed to keep up at a light jog the whole time, despite wearing a pair of jeans and a regular bra (poor boobs). When we got home, our little one soon collapsed for a 3-hour nap. Then came the evening.
Last night was quite an adventure. Around 9:30, our son pops out of bed and, very seriously, says, "Mommy, there's a bug in my ear. I can feel it moving around. It hurts." Yikes. That's not unreasonable; we'd spent most of the morning and early afternoon outside, he'd had a chance to throw sand before we went for our impromptu run and we have lots of bugs in the common area in the back of our house. So, we take him into the bathroom for a better look, but can find nothing. Ragsy keeps saying it hurts and is consistent - it was his right ear. So we call our insurance company's nursing hotline and are advised to get to an urgent care unit or ER tout de suite in case there really is a bug.
So, we start with Walgreens. Even though I know their Take Care Clinic isn't open this late, their Web site says they have otoscopes (something we could use to look in Ragsy's ear). We get there. No dice. And the chase is on - for a doctor or someone who can operate an otoscope for a few seconds.
Sundays are understandably busy days in most ERs and urgent care units - after all, doctors' offices aren't open Sundays, so where are the people who need medical care to go? So, we start with St. Luke's - it's closest. It also has a 3-hour wait and unfortunately, before anyone can get near our son with an otoscope, he needs to be processed and wait his turn. He wasn't exactly urgently ill, but the nurse had said that bugs can easily damage ear drums and the inner walls of the ear canal if allowed to remain in the ear. Anyway, St. Lukes' nurses tell us that there's an urgent care unit open 24 hours a day on Dorsett & McKelvey. My husband recalls one just up the street on Olive, so we swing by there first. Closed. Okay, well Barnes-Jewish West is on the way to 270. We stop there. Another 3-hour wait. Crud. But they direct us to the pediatric unit of the ER at Missouri Baptist.
We get there and are directed to the pediatric unit within five minutes. Within five minutes more, we've been visited by a nurse, who takes all Ragsy's vitals and by a doctor, who assures us that there's nothing more than standard (non-impacted) ear wax in Ragsy's ears - both of them. No cleaning necessary. He commented that there was a little sand in there, which is probably what was causing the sensation of having something crawling around in there.
I think the nurse was being nice when she told us we'd done the right thing bringing him in. But she said that bugs in kids' ears was especially common and a large problem in St. Louis City, where many of the homes are older or children live in areas that are more likely to be infested for whatever reason. She told me that one of the worst things she'd seen as a nurse was a roach extraction from a child's ear because their legs are barbed and they sink them into the lining of the ear to prevent being pulled out. Yuck.
Anyway, as usual, the process of getting out took longer than the diagnosis. We were home by 11:30/midnight-ish. For Ragsy, the whole thing had been a grand adventure. Within minutes of tucking Ragsy into bed, he was out again to inform us that there was another bug in his ear. He told us of another bug this morning when he woke up at 6:30 (what is wrong with him?), then again a few minutes ago (he's singing in bed instead of sleeping). Now I think it's time to have a discussion about crying wolf.
Last night was quite an adventure. Around 9:30, our son pops out of bed and, very seriously, says, "Mommy, there's a bug in my ear. I can feel it moving around. It hurts." Yikes. That's not unreasonable; we'd spent most of the morning and early afternoon outside, he'd had a chance to throw sand before we went for our impromptu run and we have lots of bugs in the common area in the back of our house. So, we take him into the bathroom for a better look, but can find nothing. Ragsy keeps saying it hurts and is consistent - it was his right ear. So we call our insurance company's nursing hotline and are advised to get to an urgent care unit or ER tout de suite in case there really is a bug.
So, we start with Walgreens. Even though I know their Take Care Clinic isn't open this late, their Web site says they have otoscopes (something we could use to look in Ragsy's ear). We get there. No dice. And the chase is on - for a doctor or someone who can operate an otoscope for a few seconds.
Sundays are understandably busy days in most ERs and urgent care units - after all, doctors' offices aren't open Sundays, so where are the people who need medical care to go? So, we start with St. Luke's - it's closest. It also has a 3-hour wait and unfortunately, before anyone can get near our son with an otoscope, he needs to be processed and wait his turn. He wasn't exactly urgently ill, but the nurse had said that bugs can easily damage ear drums and the inner walls of the ear canal if allowed to remain in the ear. Anyway, St. Lukes' nurses tell us that there's an urgent care unit open 24 hours a day on Dorsett & McKelvey. My husband recalls one just up the street on Olive, so we swing by there first. Closed. Okay, well Barnes-Jewish West is on the way to 270. We stop there. Another 3-hour wait. Crud. But they direct us to the pediatric unit of the ER at Missouri Baptist.
We get there and are directed to the pediatric unit within five minutes. Within five minutes more, we've been visited by a nurse, who takes all Ragsy's vitals and by a doctor, who assures us that there's nothing more than standard (non-impacted) ear wax in Ragsy's ears - both of them. No cleaning necessary. He commented that there was a little sand in there, which is probably what was causing the sensation of having something crawling around in there.
I think the nurse was being nice when she told us we'd done the right thing bringing him in. But she said that bugs in kids' ears was especially common and a large problem in St. Louis City, where many of the homes are older or children live in areas that are more likely to be infested for whatever reason. She told me that one of the worst things she'd seen as a nurse was a roach extraction from a child's ear because their legs are barbed and they sink them into the lining of the ear to prevent being pulled out. Yuck.
Anyway, as usual, the process of getting out took longer than the diagnosis. We were home by 11:30/midnight-ish. For Ragsy, the whole thing had been a grand adventure. Within minutes of tucking Ragsy into bed, he was out again to inform us that there was another bug in his ear. He told us of another bug this morning when he woke up at 6:30 (what is wrong with him?), then again a few minutes ago (he's singing in bed instead of sleeping). Now I think it's time to have a discussion about crying wolf.
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