Wednesday, July 28, 2004

hospital stuff

this trackback is in love and honor of michelle.

i've managed to stay pretty healthy for the most part, and so has my wife. but i've learned some things about hospitals, both working in them as a contractor and being a patient at them.

1) it has been my observation that communication in hospitals is frequently piss-poor at best.

i was once working as an emergency medical courier. i got a call to go to an airport and pick up some donated organs that were being flown in from somewhere. my instructions were to take both organs (packed in sealed boxes, i obviously didn't directly handle the organs), a liver and kidney, to a major hospital in downtown big city. the boxes were to go to the transplant immunology department. i was to let the lab person there remove what he wanted from the boxes, and take what he did not want to another hospital.

tech takes blood and node samples from box for final type test and crossmatch. he says i am to take both boxes. i get in car and proceed to drive to second hospital.

emergency call comes from my supervisor: turn around and take the liver back to the previous hospital, the patient is on the table waiting on you. this one isn't my fault, it's the lab guy's fault. still, it begs the question: a patient is in the or, without a liver (an organ that can not be mechanically replaced like a heart or kidney). why didn't the tech know what body parts to grab when i arrived?

better yet -- it turns out i'd been given the liver in error. why wasn't this communicated to me, that i was only supposed to get the kidney?

so i drop the liver at the or nurse's station, and I'm off to the other hospital with the kidney. when i get to the lab at the second hospital, the lab tech says, "oh, he's got a kidney!"

the. woman. did. not. know. that. a. kidney. was. coming.

and the second.

when my wife was in the hospital with our twins, in labor at 33 weeks, it became painfully apparent that the two doctors responsible for her care (one day and one night) were obviously not communicating, and as a result we got confused about what our treatment plan was.

here's what i've learned:

0) while it's supposed to be the doctor's and nurse's responsibility to look out for the best interests of the sick patient, and to respond timely to the patient's questions, they frequently don't.

1) the patient must be his or her own advocate. if the patient isn't capable of doing this because of illness, the next of kin or local friend must do it. passivity will not get you good care. politeness might help, but firmness is essential.

2) ask questions. ask questions repeatedly if you don't understand or the staff isn't following through with their promises. if you reach the point where you think you're being an asshole, don't apologize: there's a reason it's happening, and that reason isn't because you're stupid or a bitch.

3) every hospital has a list of patients' rights and responsibilities. take it seriously. if your care providers do not, wave it in their faces. you have the right to have your pain taken seriously; you have the right to a second opinion from a qualified doctor at your request; you have the right to understand the risks and benefits of your treatment; you have the right to know the qualifications of the people treating you, including the nursing staff.

4) adult heart rates are in the 50-90 range normally. fetal heart rates are much faster. ask what the rate they're getting is. if it's in the adult range, one of two things is happening: your nurse is listening to the wrong heart, or your baby is in life-threatening distress and you need immediate intervention.

5) "what kind of doctor are you?" or "what specialty was your residence in?" is a perfectly valid question to ask any doctor. if you want a particular kind of doctor, you have the right to ask the doctor you get if he's the kind you want.

6) lying to a patient can frequently get you fired. professional staff should never do it; in many jurisdictions, doctors and nurses can be disciplined or lose their licenses over it.

7) visiting hours are a good idea, to let patients get what rest they can. however, no hospital should ever throw out the father of a pregnant woman's baby, and any hospital that tries deserves a complaint filed by the patient with the state regulatory agency. it is reasonable for the hospital to require that husbands whose wives' are in a semi-private room not disturb the other patient. it may be reasonable to ask the husband to sleep in the waiting room, especially if he snores. however, inviting him to leave the hospital is a definate no-no. that would never happen in an obstetrics unit; it should never happen in any other unit, either.

8) every hospital has an "ombusman" who is responsible for receiving and dealing with patient and patient care complaints, and acts as an independent adovcate for the patient, if necessary even against the hospital staff. you got notice of who this is and how to contact them in your admit paperwork.

9) any hospital must discharge you ama upon request unless they get a court order to hold you, and doing that is complicated, expensive, cumbersome, and must be done quickly.

a) holding you in the hospital only for medicare/medicaid paperwork in the absence of medical necessity may constitute a number of crimes, including insurance fraud, kidnapping, or false imprisonment.

b) you, as your own medical advocate, have the right to get your questions answered. you have the right to have your questions answered about your medical condition, about your care-givers qualifications, licenses, and accreditation, and about financial arragenements surrounding your care. if you or your advocate don't get answers, you have the right to insist upon them. while some of us might feel like being insistant is tantamount to being rude, the truth is that sticking up for yourself in the face of incompetence or laziness or lack of understanding is neither rude nor wrong. if the professional staff can't handle your politely worded (if extremely pointed) queries, the problem is theirs.

c) threats about lawyers are effective. they're usually not good as a first tactic, but after two or three fuckups they can be quite effective. my favorite tactic in that department is to call the nurses station and ask for "a yellow pages so i can find an attorney."

the way michelle got treated at the hospital she went to was atrocious. and while it's really the hospital's responsibility, unfortunately as often as not the hospital staff dumps the burden on the patient.

twins

this is a trackback to cec cuz think she's cool.

i speak with some authority about twins. mine turned 1 this month. And my two year old turned two in march. (That's right, folks. For a while I had three kids under age two, and all of them are still in diapers.)

This, then, is my (male) experience:

0) Children thrive on formula, even if it's inferior to breast milk. My wife chose not to breastfeed the twins, and tried and failed the older child. Our pediatrician's attitude was, "I'm here to help you," and he supported our decision. Our kids are none the worse for wear.

1) Diapers cheap in bulk good good. If you go with disposables (or even if you don't), invest in a sam's or costco card. You will save the cost of the card very quickly, and as life goes on, you will be amazed at just how convenient it is to shop at one of those places, once you learn how. DO learn how; you will spend much less time shopping and schlepping. It takes more planning, but the result is worth it. And DO get a second freezer once your kids get to the eat-real-food stage. your use of frozen food will balloon astronomically unless you're a cooking maniac. and if you're like me, the only thing you've ever been maniacal about cooking is your fix.

2) Costco has a house brand baby formula that is nutritionally equivalent to Enfamil's Lipil. Unless you have an allergy problem with it, buy it instead. A gigantic can of Lipil at sam's or costco (a size that, not coincidentally, is not available at a regular grocery store) will run you $27; a gigantic can of the Costco version will cost you $17. At the height of my formula usage, we were chewing through four cans a week. $40 is a case and a half of paper diapers (and four and a half cans of formula paid for the cost of the costco card).

3) Men can learn to change diapers. in the case of twins, men must learn to change diapers or they will find their wives across the room from them very shortly, holding a bloody knife and a pair of testicles. it isn't that hard, and once you've learned what makes them explode, it's not even all that nasty.

4) that big can of formula i was talking about? well worth the aggrivation. it's huge compared to what you get at a regular grocery store. the grocery store cans are $23; the sam's name brand is $27; the costco house brand (like i said) is $17.

5) running out of forumla in the middle of the night is way, way, way bad. don't do it. ever. get as anal with formula as you did about your dope. reason: grocery stores lock it up or hide it behind customer service counters because it's a popular theft item. in some stores, the keys go home with the manager at night, meaning you can't get it even if the store is open 24 hours. (kinda like condoms. ever had that problem?) even if the formula can be unlocked at oh-dark-thirty, it frequently takes dealing with people with less intelligence than your children to get it, and it's aggrivating when the kids are crying, whether or not they're actually with you in the store.

6) twins can frequently sleep easier at night if they sleep in the same crib, at least until they're old enough to turn over. note, however, that in some jurisdictions (texas being one), it is illegal for a childcare provider to put two children (even of the same gender) in the same crib. coordinate with your childcare provider if you have one.

7) millions of families through history have survived this. you can too.

8) this one is something i've learned from bitter experience, and is especially sent out to those new families who have members who are friends of bill w. and jimmy k: meetings, meetings, meetings. make time. you will not have time. you must make time. i failed to do so and when my twins were about two months old, i melted and spent a week in the nut hut getting patched back together. do not make this mistake. it will piss off your spouse, who will be stuck taking care of twins totally alone.

9) nausea: sucks. sorry. train your husband to look for a bathroom the instant you walk into a restaurant.

a) the first year is hell. and it is wonderful. and it is hell. and wonderful. just like with all children.

b) if you're going to start a family tradition, do it early, but keep it simple. ours is silly, and simple: in april, where we live, highways blossom with wildflowers. indian paintbrush, buttercups, and most famously, bluebonnets. they came from lady bird johnson's texas beautification program, and they make the highways beautiful, where they grow. our family tradition is that we march the family out onto the side of some highway in some picturesque patch of flowers, and take pictures. the annual wildflower shot. we've gotten them in three seasons now (and in the second the flowers we used happened to be immediately next to some prickly pares, so we have pictures of our older son in the flowers, and also [turned 90 degrees] seemingly in the prickly pares.) and it's wonderful. the successive pictures hang on our wall: the first two years our older son (and the first year when he was less than a month old), and this third year all three of our children. it's even better if you take some non-family member with you to shoot the pictures.

c) take lots of pictures. just like everybody says, you will wonder where it went. disposable cameras are great for this. and since you're a blogger, you can check the little box and pay the extra fifty cents and get them to scan your pictures onto a cd for you, and save you the hassle. the cameras are cheap, the processing is cheap, there's no running out of memory on the camera -- just use another -- and the cameras are available everywhere. buy lots of them.

d) odaat. your children will have short memories. so should you.

e) children love cats. it's even better if the cats love the children. however, cat scratches and bites infect very badly, even worse than dog bites. beware. (we've not had a problem with our current cats, but once upon a time i very nearly lost fingers to a cat incident.) even the most docile cat in the universe, like ours, will eventually bite your one year old. when it happens, it will be the child's fault (even if she doen't understand why). remember that as you deal with the situation.

f) make time for you. make time for you yourself; allow your spouse to make time for him or herself; make time for yourselves as a couple apart from your children. round up the grandparents or friends and dump the kids for a few hours two or three times a month. your relationship and sex life will thank you.

10) do yardsale organization the instant you start retiring things as too small. baby stuff, which will fall out of the sky on you for a considerable amount of time after your children arrive (so much so that even if you dress them in a new thing every day, you may not get through all of it before it gets too small), is worth a ton of money at yard sales. money that you can then use to buy more diapers. "baby stuff" on yard sale signs draws big, big crowds.

11) child safety seats for cars are a subject near and dear to my heart, and are a subject that i can write an entire blog entry about. educate yourself about child safety seats well before your baby(ies) arrive. you may need to replace your car over it.

12) despite what everyone believes, children really are not that fragile. yes, you want to be careful with them. but yes, they will survive a litthe rough handling when required to control their struggling against you when you change a diaper.

13) twins are fantastic.

14) twins are scary.

13) twins are fantastic.

14) twins are scary.

15) this can be done. i promise.

the thumbnail of my experience with twins.

Monday, July 26, 2004

more letters

so having received zero response to my open meetings requests i've sent it off again, this time by fax. we'll see what happens this time.

i expect about the same: nada.

i need some time to go down to the bookstore and actually look at books and get the info i want. assuming they have it, which is unlikely at best. still, that's unlikely to happen any time soon, since i'm working all week this week.

Saturday, July 24, 2004

why don't we stop?

the trackbacks here point to a post and an event that's stirred up some discussion in the infertility blogworld, which i admit i'm only peripherally a part of. i'm both male, not myself infertile, and have successfully completed (with the admirable help of my wife) two ivf's ending in healthy live births. read about it here.

while julie and tertia and cec proceed with their respective pregnancies apace, and they hope (and pray, as appropriate) for the best while fearing the worst, getupgrrl's world has come crashing down around her. you can read getupgrrl's description of what's happened; she's a much, much better writer than i ever could be.

but andrea asks: why don't we quit? it's expensive, after all; it's painful; as often as not, for all the happy endings, there are a zillion failures, miscarriages, horrible diagnoses, broken hearts. why not just go for the sometimes easier, if not always quicker, adoption approach? why do we keep it up?

[later, a correction: upon further review, andrea didn't ask this exactly the way i wrote it, as her comment indicates. still, what she really did write begs the question anyway.]

i'd never dare suggest anybody do one thing or another. i know why we went with ivf: my wife wanted it, and we had insurance that covered a very significant portion of it. she was not emotionally ready, at the time, to pursue adoption. she wanted a biological child; she wanted pregnancy; she was unable to understand how it was possible to go from not having a baby one day to having a baby the next with "no preparation" -- meaning, without the lead-time of a pregnancy.

there is never an easy answer. when do you quit? when you run out of money? when your credit cards are maxed and you're defaulting on them? when you've sold your house to put the money into more medical procedures? when your bathroom or kitchen looks like a crack house because of all the needles and little vials? when you realize how silly it seems to normal people that you bought a small refrigerator just to store your medication?

we got lucky. we had two successful deliveries out of three cycles. we're the winners in the unholy lottery.

i do know, though, some of the heartache and uncertainty that goes along with being infertile. there's no good answer to "when do we quit?" some in the discussion have likened it to alcoholism, a subject i'm familiar with: you quit when you can't take it anymore.

we quit when we had three children. in my qf heart, three isn't enough. i want more. but i recognize the biological reality: short of getting another wife (which is unlikely at best), i doubt we'll have another child unless we adopt. and sue isn't likely to want that soon. she's 40, and she hates being pregnant, and the works are all messed up from her surgeries (and the c-section didn't help the adhesions and scarring, i bet). not that it keeps me from trying and wanting and hoping, but i know the truth.

but like getupgrrl's husband, i wouldn't trade her in on a new, more fertile model even if it were convenient. she's the one i picked, and i'll keep her, at least until she's sick of me and wants to trade me in. (she told me that she'd trade me in for two 15 year olds when i turned 30; i replied that i'd trade her in for four 10 year olds when she turned 40.) sue's infertility is part of the game and i picked her knowing about it. even if i hadn't, i still wouldn't trade her in if i found out later.

there's never a right answer. we quit when we can't handle it anymore. and because many of us hang on to the dream of having children no matter what happens, we fight for a long, long time.

until there's no fight left.

Thursday, July 22, 2004

no response

somehow i'm not surprised that i haven't gotten a response. they would have gotten the stuff on monday or tuesday.

Friday, July 16, 2004

open records letter i

Tarrant County College
1500 Houston Street
Fort Worth, Texas 76102
Attention: Officer for Public Information
Re: Open Records Request

July 15, 2004

Dear Sir or Madam:

This letter is written pursuant to applicable provisions of the Texas Public Information Act (formerly the Texas Open Records Act).

I request book adoption information for five Fall 2004 courses:

HIST1301 – United States History to 1876
· Section 0023063 – Instructor C. Carney
MATH1342 – Elementary Statistics
· Section 0022861 – Instructor B. Tucker
GOVT2306 – Texas State and Local Government
· Section 0023056 – Instructor W. Hill
ENGL2307 – Creative Writing
· Section 0022925 – Instructor William Holt
PHED1167 – Concepts of Physical Activity
· Section 00223323 – Instructor Leigh Leonard

In particular, I would like to know the following pieces of information about books adopted for these courses:

· ISBN Number
· Title
· Author
· Edition (including sub-edition, like “expanded�)
· Publisher
· Status as “required� or “suggested�
· New and used price through the TCC Bookstore
· Price paid by the TCC Bookstore to the vendor per unit

If there are required materials other than standard books for these courses, such as software packages, self-published perfect-bound booklets, or other such material, I would like to know the relevant titles, versions, or other identifying information of such material, as well as its cost through the TCC Bookstore.

I have listed the information I wish to receive in relative order of importance. If, for example, compiling price information would delay your forwarding to me the ISBN number, titles, and authors, of the books at issue, I would prefer to receive a partial response rather than wait for completion.

I will accept your response by U.S. Postal Mail to the address at the head of this letter, or by email to [censored].

Thank you,

Open Records Letter II

Tarrant County College
1500 Houston Street
Fort Worth, Texas 76102
Attention: Officer for Public Information
Re: Open Records Request

July 15, 2004

Dear Sir or Madam:

This letter is written pursuant to applicable provisions of the Texas Public Information Act (formerly the Texas Open Records Act).

I request copies of relevant policies and procedures documents of the TCC Bookstore. Specifically, I request:

· Any documents describing in particular the Bookstore’s policy on releasing ISBN numbers of required books to students or the public.
· All documents outlining policies on disclosure of course-required book lists to students, including if available, generalized timelines.
· All documents outlining policies on deadlines for instructor selection of books for a particular course prior to the start of a term, including if available, generalized timelines. Policies on actually accomplishing the selection are excluded from this request; this request covers only issues affecting timeliness of selections.
· Any documents shedding light on why the Bookstore’s policy on releasing required book lists to students or the public was adopted, including the policy on ISBN numbers.
· The date of adoption, the date of effect, and the name and title of the officer or body who instituted, signed, or authorized the above policies.
· The name (if an individual) of the person(s) now holding that position, if different from above, as well as contact information for that individual; or, if a body, the name and title of the chair of that body, as well as contact information for that body.

This request is limited in scope to the above documents as they relate to the Bookstore’s policies on disclosure of adopted book lists to students and the public.

I look forward to your response.

Thank you,

Wednesday, July 14, 2004

the fraud of college textbooks

every time i call my college bookstore to see if the adoptions for the fall 2004 semester are finished, the answer is always no. when i ask how long it will be until they are done, the answer is always a week later than it was the last time.

day the date moved from the last week of july to the first week of august. a couple of weeks ago it was the second week of july.

why is this important?

cost.

this editorial and this story come to the same conclusion: college books are a ripoff.

here's how it works:

publisher produces book. professor adopts book. publisher sells lots of books to lots of students. many of these books are used only for one semester, yet can cost anywhere from $50 to $200, depending on the book. publisher makes lots of money. students shell out through the nose.

at the end of the semester, many books can, in theory, be resold. buying a used book is supposed to lower the cost for students. but publishers don't like used books: they don't get paid again when they're resold.

the publishers solution to this problem: print new editions, sometimes with astoundingly little new material -- or even less material -- that the old edition. because there are always fewer used books available in any given semester than there is demand, there is alwas some need for new books. but if the old edition has gone out of print, the need for new books can't be met. instead, because there are no new books of the old edition available to meet the gap in supply, professors are forced to adopt the new edition.

when the profs adopt a new edition, the value of the old books drops to the point where selling them becomes impossible. for courses that have nothing to do with your major but are required (like an algebra course for a music major), it's unlikely you'll want to keep the books. but since there's no market because editions have changed, you're stuck. you can either keep the book or throw it out, but you can't recover any of your investment.

some students (like me) are trying to turn to the internet to buy books, where used books can sometimes be had for as little as 10% of the new cover price (compared to 50%-75% of the new cover price, for books in the same condition, at campus bookstores). the downside is that frequently shipping takes two to three weeks.

this means that students need notice of adoptions so that they can order their books and have them in time for the start of classes.

however, because campus bookstores are big moneymakers for schools, schools have absolutely no incentive to cooperate by publishing adoption lists in enough time to make a difference. instead, students are faced with the stark choice of potentially falling weeks behind while they wait for their books to arrive, or buying the campus offering at unnecessarily inflated prices.

the issue is all the more stark for community college students like me. community college students fall into one of three broad categories: students who've failed elsewhere and need the fresh start a community college offers, students who are still trying to figure out what they want to do with their educational goals and don't want to spend the money it takes to figure that out at a four-year college, or (like me) students who can't afford a four year college and are instead trying to get started with a cheaper option. at my school, i typically budget one to one and a half times the tuition fees ($41 per credit hour) for books.

that's right, gang. i pay as much for books as i do for the right to attend in the first place.

this means that lowering the costs of my books significantly lowers the cost of my education.

but when my school doesn't publish the list (or even make it available to students who ask), i'm left with the choices of falling behind or paying.

publishers have no incentive to change this system because they make more money selling new books than used ones. schools have no incentive to change this system because they make a mint at the bookstore. professors have no incentive to change this system because their books are given to them for free by the publishers (who of course want the professors to adopt the books).

the only people who have any incentive to change this system are the ones who can not: the students. we can not vote with our dollars and expect to pass, and we can't change to friendlier schools because there aren't any.

something to consider once i get my law degree:

bookstores not making adoption lists available in a timely fashion (which they must have so they can stock their own books) could be viewed as an unlawful restraint of trade. and since i can potentially purchase my books from out of state, the case is federal, not state.

the next day: the bookstore will not give me the isbn numbers of adopted books. "that's our policy," they say. texas open records request to follow.

Tuesday, July 13, 2004

to the parents of amy long

no i didn't really kill her. i didn't rape and mutilate her, then drown her in her own blood, and then dismember her body and scatter the various pieces in area lakes after making a tasty pate' out of her liver and a good blood pie with her kidneys.

it makes a good story for the bill collectors that have been calling a number she hasn't had for two years now, tho.

lying to bill collectors isn't illegal, by the way. they lie to us all the time. let's turn the tables.

Sunday, July 11, 2004

twins bday

twins birthday party yesterday.

the cute girl and her brother left early. my dad's 13yo step-niece didn't say much and refused to eat. the crowd was lame. most folks who were interesting to me begged off. oh well.

the food was good and now it's over.

Wednesday, July 7, 2004

final grades

so i got a c in the art class, mostly because i fucked up and totally bombed the final.

sue's typically helpful attitude was, "i don't know how you're going to get through the fall."

big help. really supportive. love you too.

Monday, July 5, 2004

databases

i hate databases. this stems mostly from the fact that, while i understand the theory behind them, i'm none too familiar with sql, nor am i especially familiar with things like relationships between tables in a db.

even so, i've gotten the initial data dump done for work so i can php-ify all the stuff i need and turn my static pages that do things like meeting schedules into easy-to-maintain db-driven pages. blah.

why do i do things like this to myself? maybe i should just hire michelle.

Saturday, July 3, 2004

school

school is winding down and i'm thrilled. i had to drop the stupid phys-ed course. i haven't done well enough (part my fault, part timing) but i re-registered for it next semester with the same instructor, so hopefully i won't have to buy a new book.

i really hate that class.