The Affordability Crisis Meets the Bitter Sweet Symphony

I was a Florida resident for just 18 days before I was rushed to the ER with septicemia. I am the family cook and grocery shopper. I barely had a chance to do either before my system shut down and I spent four weeks at AdventHealth Daytona. I did shop once at Publix in Ormond-by-the-Sea but mainly, during the turmoil of moving cross-country, we had a lot of food delivered. My wife fended for herself during my hospitalization with the help of family and friends. I awoke from a medically-induced coma after five days and was put on a restrictive diet due to the after-effects of sepsis and my chronic cardiac condition. My orders to the hospital cafeteria hotline were filled with “you can’t have that” and “no.” 

The food I did get was tasteless mainly because it was without taste and the meds I was taking robbed me of my taste buds. I know this because once I could order a hamburger, I did. “Your brother and I had them for lunch and they were tasty.” I tried it. Tasted like cardboard. I hadn’t eaten any cardboard in a long time but that was what the food tasted like had I sampled cardboard in the past. Only once did I cheat. My sister-in-law brought me dumplings from the favorite bistro and I got a shot of salt and Asian spices. Yum. But I was caught cheating and nurses read me the riot act.

I started dreaming about Publix. You know that TV ad where a beautiful young woman flies across the store on a grocery cart triggering the lights in the frozen food section while “Bitter Sweet Symphony” by The Verve swells? (you can see the long version on YouTube). I didn’t have that dream. My subconscious put me in my bed which was transformed into a car and I drove to every Publix in town which are legion. I told that dream to the morning’s first wave of med staff and they thought it was funny. A nurse looked up my diet. “I’d dream about Publix too if I had to eat hospital cardboard.” She didn’t say that part about cardboard but she appreciated my dreams.

After my October 4 release, I received daily in-home care for more than a month. Nurses tracked my ingoing and outgoing. PT helped me exercise. I ate simple meals , shopping done by my wife Chris. She can shop and cook. As for shopping, where I enter the store door, I hear a symphony playing. But Chris is assaulted by the sights and sounds I so enjoy. She has a solid case of ADHD and she limits herself to a few items and is out ASAP. Her cooking skills are limited due to nobody, not her mother or sister or teachers, had the patience to teach a left-handed hyper-kid how to put a meal together. I was the oldest of nine and often cooked for my siblings. I cooked when I was a college student and served food at various fast-food joints. Now I cook for my family. Chris, bless her, likes to clean. We’ve been married now for 43 years.

This brings me to the issue of affordability. Three weeks ago, I shopped at Publix with my adult son who is living with us. He has ADHD but it is a different strain from his mother’s. He is an amazing shopper. He can look at my handwritten grocery list, disappear into the aisles, and return with our heavier and bulkier items such as toilet paper, multi-packs of Kleenex, Diet Coke twelve-packs, kitty litter, laundry detergent. I will be puttering around the store in my e-scooter with a few BOGO items, a rotisserie chicken, a packet of deli chicken slices. “What else?” Kevin says.

This leads to a quandary. I don’t mind spending two hours in a grocery store. Kevin thinks a half-hour is way too long. This leads to a question: Should I have Chris drop me off and return when summoned later in the day? Or should I snag Kevin and go team-shopping?

Publix is like Disney World to me, a carnival of foodstuffs. I’m in those TV ads. At least I was until last month when the shopping bill went over five hundred dollars. That’s 10 days of food for three, sometimes four (daughter Annie drops in for an occasional meal). I have never spent that much on one grocery trip. There were many times in my life when I clipped coupons to afford the basics at Albertson's or Safeway for a family of four. I joined shoppers who clicked on their coupons and had the store computer ring up the savings. I would get to the receipt’s final line and boast, “I saved 75 dollars." "I saved 101 dollars.”

I save money at Publix with the BOGO items. Sometimes I get BOGO items just to get BOGO items which will add to the savings line.

Ormond Beach old-timers offer advice. Shop at Wal-Mart. Yes, I know, but it’s Wal-Mart and the Walton family supports Trump and right-wing kooks and yes, I know that one of the sisters has opened an incredible art museum. My sister Mo is a CostCo fan. She talks up the place all the time even though her three children have flown the nest and she shops for just two. She is the only person I know with a CostCo puzzle. She brought it to me in the hospital. It has a million pieces and I barely completed the CostCo hot-dog stand before I gave up. Mo and her husband Ralph took me for an initial foray into CostCo Daytona. The front-of-store display was a massive 100-inch television for an incredible price. I later saw a young man pushing one in a cart across the parking lot. I was entranced by the bakery section. They make their own bagels! Multi-packs of cookies still warm from the oven! Pies the size of 1955 Buick hubcaps (remember them?)! I signed up right away and got a 20 dollar discount on the joining fee. I could go out there right now and pay one dollar and 50 cents for a gourmet hot dog with all the fixins and a soda.

We conducted our Thanksgiving shopping at Wal-Mart. Yes, Wal-Mart. I brought Kevin with me as a defense mechanism to thwart the pre-holiday crowds and the sheer size of the place. It wasn’t glorious. I saw no pretty young women soaring on winged carts sailing through the frozen food aisle to “Bittersweet Symphony’s” opening violins. I did see a pair of youngsters shouting “Marco” while their mom yelled at them and then came the distant response of “Polo!” I asked Kevin if that was “a thing” and he replied “Sure.” We bought Great Value products (breakfast bars, pasta, ice cream) and spent a tad over four hundred dollars and I was tempted to remove enough items to go into 300-something but did not. The checker had already yelled “This register is closed” at the poor people behind me. I kept out my receipt as we made it out as that is demanded at Wal-Mart, checking the receipt against the items in your cart. Can’t be too careful during this “fake affordability” crisis.

Cue “Bitter Sweet Symphony,” the Publix ad not the original video which is kind of creepy. The song’s opening lines: “ ‘Cause it’s a bitter sweet symphony, this life/Trying to make ends meet/You’re a slave to money, then you die.”

Did I really need that ambulance on the September night in question?

Most Americans, it seems, have been following the hunt for the murderer of United Healthcare exec Brian Thompson. But it’s not the manhunt that has received most of the attention. Instead, it’s the deeply flawed American healthcare system which, to most people, represents the American Healthcare Denial System beholden to Wall Street. Valid medical claims are turned down because they hurt Healthcare United’s bottom line. I shall throw my insurer in there, too, as my family has been denied payment by CIGNA for medical claims. Much of that is related to mental healthcare for my children. I could write a book on our experiences with various insurers as we worked to save our children. I will not write a book -- what’s the point? Inequalities of our system have been going on for decades and will continue.

My experiences with my healthcare claims and those of my wife have been great. Heart attacks, it seems, ring a bell with insurers. Near-death experiences with septicemia also resonate in the corridors of both CIGNA and Medicare. Those were claims made by me, the Widowmaker in 2014 and the septicemia in 2024. Seems as if I have a major malfunction every ten years.

The latest issue took me by surprise. I got a bill from Volusia County Emergency Medical Services for an ambulance transport to Advent Health Hospital in Daytona. They write that Medicare has turned me down for the $894.80 ride and said it was a “ ‘non-covered service’ because it does not meet Medicare’s medical necessity requirements.”

This seems quite odd to me as Medicare has partially covered at least one ambulance ride. In January in Cheyenne, Wyoming, I caught Covid and one cold January night I couldn’t breathe from the congestion and an ambulance took me to the local hospital where they got me breathing again and sent me home five hours later. That met Medicare’s medical necessity requirements.

At the ER on the night of Sept. 9, the Code Blue team was called out as my heart stopped twice  after I had two seizures. Chris said it was quite a sight to see as medical personnel rushed into the room and saved me. My vitals were wacko (medical term) and staff guessed I had a massive infection of some kind and they placed me in a coma for four days.

Pause here to let readers know that my dear wife took a photo of the comatose me and I will share it if you ask nicely and agree to publish my next novel. 

When I came to in ICU, I didn’t know where I was and what had happened. To read the full experience, go to my previous posts here and here. Turns out I had septicemia from an unknown source and it blasted my bodily functions such as walking and talking, eating and defecating. I was moved from ICU to a medical floor and then the twelfth floor which Advent devotes to physical therapy for stroke victims, the partially paralyzed, and mystery cases like me. I made enough progress by Oct. 4 that Advent released me back into the Florida Wilds and that’s where I’ve been ever since.

I am a lucky man. I am blessed more than I should be blessed. There is one thing I will not be and that is almost $900 poorer because I didn’t meet Medicare’s requirements for sick people. Twenty-five days in the hospital? A quick survey of my hospital history: I spent five days after my heart attack, three days after knee-replacement surgery, and two days following a spinal fusion. I am so glad I wasn’t sick enough in September and decided to take an Advent Health cruise.

Volusia County Emergency Medical Services sent me a list of items I must file for an appeal. They include all of my medical records from the hospital (“you may be required to pay a fee") and “a letter from any physicians you may have followed up with in regards to your ambulance transport.” I can see how daunting this might be for someone, possibly a retired someone recovering at home from a near-death experience.

There is some irony here. It wasn’t the bad guys at CIGNA that turned me down. That mega-insurer is my secondary and they haven’t had a crack at me yet. I pay too much of my pension for that coverage. I also paid for Medicare which is a government program. I should be railing against the stinkin’ gubment, right. Old Joe Biden let me down.

But during my recovery, I’ve noticed that Medicare is concerned about higher costs and wants all of us to use its new reporting system. This addresses higher costs and the millions, maybe billions, of fraud claims by people who should be strung up on the highest yardarm (archaic Navy term). One of the highest costs for patients and Medicare is the abuse/overuse of ambulance services.

Trump’s Project 2025 may be behind Medicare’s new cost-saving initiative. But wait – Trump is busy enlisting nincompoops to head government agencies and getting his ass kissed at Paris’s Notre Dame Cathedral and hasn’t yet assumed the mantles of power.

The only thing left to blame is the USA’s antiquated and rapacious healthcare system. The death of a healthcare executive is a tragedy. And it is tragic that some find humor in it.

Delighting in the suffering of others is a MAGA trait, is it not? What in the hell are we doing?

On the ghost trail to Lulu City

I am caught between two worlds.

In one, I am at the beach or in a park or lunching with friends at Inlet Harbor.

In the other, I tense up, stare at the wall, and wonder where I am and who I am.  I drift off, imagine I fly over the Laramie Range. Below are the convoluted rock shapes of Vedauwoo. On one of the heights is my son, waving up at me as he used to wave down at me on the flatlands as I wondered how in the hell a 12-year-old scrambled to the top without falling. I soar above the beach and see the waves I no longer ride or no longer even stand calf-length in since I can’t walk unaided to the water.

I almost died twice during a four-day hospital span that I can’t remember. I awoke a mess, unable to walk or shit or even talk. “What month is it?” I haven’t a clue. The medicos gave me fentanyl to let me float through the trauma and it worked as a mind-eraser. I float through those four days that I don’t remember.

Yesterday I sat for three hours in the nicely-appointed customer waiting room at KIA HQ. The people there seemed human enough as did I. I read a non-fiction book about Japanese fliers who flew airplanes into American ships in a last-ditch effort to halt dreaded defeat. Kamikaze, Divine Wind. In Korea, where my SUV was made, Japanese troops rounded up young females to serve as “comfort women” and worked to death Allied soldiers my father’s age of 20 in 1943.

I live on a thin thread. We all do. I didn’t want to die from septicemia but almost did and it was nothing that I did or didn’t do. An occupying army of bacteria invaded my bloodstream and began to switch off my organs, one by one, like you walk through the house turning off lights, eager to get to grandma’s house for Thanksgiving. Antibiotics stopped the massacre. And medical staff on a mission. And time. And something undefined. Something blessed.

I sometimes see the world’s forests on fire. Other days, I peer down into Rocky Mountain National Park and see me hiking with my wife and kids. That is just one part of one summer day. It’s frozen in my memory. I am always on the trail to abandoned Lulu City, walking past falling-down cabins with a ghost in each doorway. One of them looks just like me.

I didn't see any heavenly white light but someone held my hand

Aug. 18 was the last time I posted to my blog on my PC at my Cheyenne writing desk. Chris and I moved out of our house in Cheyenne on Aug. 22. New owners took over and we shuttled down to Denver Aug. 24 and got on a plane to Orlando. My PC was packed in a U-Haul trailer with many of my other valuables and my son and his girlfriend embarked on a road trip to Ormond Beach. We unpacked and Kevin and Luisa stayed with us a couple days and we took them over to the Orlando shuttle and said farewell, for now.

On Sept. 9, I made a detour to La-La Land (a.k.a. Advent Health Hospital) for a medical journey that I partly chronicled via my cellphone at https://hummingbirdminds.blogspot.com/2024/10/homecoming-ormond-by-sea-oct-4-2024.html. I cross-posted it on my Facebook page and my friends said WTF or something like that. I had numbness in my arms and legs and urged Chris to call 9-1-1 and the ambulance took me to the E.R. where I promptly had two seizures and they coded me twice. The very good ER crew intubated me, put down a feeding tube, and stuck with an assortment of IVs. I spent the next four days in I.C.U. none of which I remember. My wife took a picture of me as I was transported and I swear I look like an old man who almost died. Which I was. When I awoke in I.C.U. the next day, I was a bit fuzzy on the month and the day of the week and struggled with my name and birthdate. I would have been scared but I was too high (Fentanyl the E.R. notes said) to be scared.

Read more in my earlier post. I had to relearn how to pick up a spoon and walk. Reality set in and I got very scared. I asked to read the E.R. notes on the hospital's MyChart. A total of 11 staff worked on me, Doctors and nurses and techs and X-ray people. My story sounded like someone else's story They gave me a big dose of antibiotics because they detected a bacterial infection of unknown origin and it caused sepsis which is really bad and sometimes people die of it -- some call it blood poisoning. If it sounds as if I was in a remote region of Indonesia and stirred up some bad juju, I was not. Cheyenne was the most exotic place I'd been and then meandered through construction at the Denver airport (I was nowhere near the giant red-eyed horse or the Illuminati types who haunt the basement), but then I did get on a plane and you know know how many germs one finds there and then I was in the Orlando airport with many sneezing children and spirits from the Pirates of the Caribbean. 

But it was none of those. The nearest I could figure was the staph infection I had in a leg wound that was treated with antibiotics and skin grafts were applied. Maybe the antibiotics didn't do their job or the grafts were somehow infected. This is all conjecture. I was a sick puppy who spent 25 days in the hospital, half of that time in the 12th floor Therapy Center which takes only stroke patients, the partially paralyzed, the fully paralyzed and some Dementia patients. I received four to five hours of OT and PT five days a week. 

A few days in, PT Adam asked me to see far I could walk with the help of my walker. 5.5 feet was all I could do. Later, he had me try again and I got my Irish up and went 10 feet. He gave me an attaboy and I kept moving the line 5-10 feet a day. I wanted to cry sometimes but I pushed those tears deep inside and used them for fuel for my damaged leg muscles. My last day, I walked 50 feet, rested, and walked 50 more, squeezing out the last few steps. 

Chris was with me the whole time although she only spent two nights with me -- the last one during Hurricane Helene which wasn't much of a hurricane at all in our part of Florida. We had to wait for MIlton for that. A big thank you to all of my family members, especially those who yearned to bring me some white shrimp from Hull's Seafood, But I passed as the tasteless hospital food was all I was supposed to eat. The infection or all the drugs took away my taste buds. They are back now after several dosings of hot salsa and Extra Flamin' Hot Cheetos. Damn, those things are hot. I loved the Cheetos TV movie, by the way.

One last thing. I talked to my Evangelical Christian daughter and told her that someone or some presence was holding my hand while I was not fully there. Might have been one of my brothers, Pat or Dan, or my parents. No, she said, God was holding your hand. All you have to do is ask and He will be here for you. I didn't ask, but he might have been there anyway.

Homecoming, Ormond-by-the-Sea, Oct. 4, 2024

I returned home yesterday, Oct. 4. It was day 25 of my stay at Advent Health Daytona Beach. The fresh air was bracing, although the temp was a warm 85. It felt like heaven to me.

Chris was driving. It will be awhile before I’m confident enough to get behind the wheel. I have my Florida driver’s license and about 58 years experience behind the wheel. I just don’t have my wits about me. I just got over a nasty case of septicemia or blood poisoning. I read all the physician and nurses’ notes in my online chart. A potent staph infection from a leg would had entered my bloodstream and propagated until it caused my body to seize up and stopped my heart – twice. Due to quick action by my wife Chris, The ER staff came running, pulled me back from the brink, and I began what I guess I can call my healing journey. It really was a giant shit sandwich that’s still going to take a couple months to recover from.

First the good news: Here I am. I need a walker to get around but I’m getting around, slowly. Seems that when my body got whacked by microscopic bugs, it forgot how to take one step after the other. I’m one of the lucky ones. First, I will walk again probably with help. Second, I’m still on Planet Earth to do so. Maybe that’s first, I still get a bit confused by priority lists. When I first awoke in ICU, I had no idea where I was nor who I was. Well, I knew my name but that’s about it.

Nurse: "What month is it?"

Me: "Uh..."

Nurse: "Do you know the month?"

Me: "August?"

Nurse: "Close. September."

The last half of my hospital stay was in the excellent Advent Health Therapy Center which occupies the entire 12^th floor of Advent Daytona.  The staff is first-rate: physicians, nurses, techs, physical and occupational therapists. When you go to the twelfth floor, you sign up for OT and PT for four to five hours daily. You’re assigned exercises to do in your room. The nurses are always there to help and a more empathetic yet stern bunch would be hard to find. I love them all.

My first task after I got out was to round up a seafood meal that was on the healthy side and sit down with my wife at home and enjoy. My choice was the planked salmon dinner at Stonewood Grill & Tavern with shrimp and scallop skewers on the side. I didn’t so much eat it as swim through it. A pleasurable swim to be sure, one topped off by Key Lime Pie. It was a big deal because Chris and I arrived in Ormond Beach on August 24 and were busy getting organized until Sept. 9 when venomous bacteria came to call. I had not had a single seafood meal nor had I been to the beach. There was a big old ocean out there but it might as well have been Wyoming’s Red Desert.

So I’m home. Now what?

We Young, at Hospital

We young orderlies, CNAs, techs, nurses fresh from graduation. Voices blared from loudspeakers: code blue ortho, code red ER, code pink nursery. We razzed each other, lunched on cafeteria burgers, one fragment of attention listening for our color, our next emergency. The call came. Chairs abandoned, lunches half-eaten. We reveled in the action. Legs flexed in sprint, adrenaline pumped. We ran the corridors, took the steps two at a time, spurned the vators those were for old people like the ones in trauma. We aged as we ran, furrows formed on faces, arms and legs, brains. By the time we reached the coded sites, we were the elders in crisis who needed rescue by the summoned helpers, who ran to us, strangers who helped strangers. They ran, abandoned lunches, wondered will I ever stop running?  It awaits you around the next corner.

Orderly disorderly orderly

Jerry Lewis played a hospital orderly in “The Disorderly Orderly.” In it, he’s a bumbling idiot with a heart of gold, a type he’s played before. I am not a Lewis fan but did laugh at some of the “Orderly” hijinks on YouTube film clips. He mixes up two skeletons bound for the research lab. His supervisor warns him not to mix them up. He asks his supervisor how to tell the difference. Her reply: “You don’t know the difference between boys and girls?” He makes a goofy face,. “Yes, but I like my girls [wait for it] upholstered.” Laughed here and shook my head. Let’s face it, not a bad joke, good enough for a laugh. Typical Lewis humor, one which he parlayed into many films, Vegas stage shows, and TV specials.

You don’t need orderly experience, disorderly or not, to appreciate Lewis’s shenanigans. But, with a little research, you find all sorts of info under the topic of “orderly.” Merriam-Webster Online cites two meanings for orderly the noun: a soldier who carries messages and performs services for an officer; a person who waits on others, cleans, and does general work in a hospital.

I have never been the first variety and don't even know if they exist any more. You can find orderlies in war movies especially those focused on the British army. "Orderly, get me a cuppa. Sorry sir, the Huns have blown up all our teacups. Blast." Orderlies in the world wars provided all sorts of services at The Front. In WW1, orderlies often were stretcher bearers and spent some of their time under fire rescuing wounded from No Man's Land. Very dangerous duty indeed. Some were COs who resisted shooting other people and wound up being shot at anyway. A very interesting and readable memoir of this side of the war was written by a member of Evacuation Hospital No. 8, Frederick Pottle, who taught in the Yale English Department after the war. "Stretchers: The Story of a Hospital Unit on the Western Front."  Published by Yale University Press in 1929 and available to read at https://net.lib.byu.edu/estu/wwi/memoir/Stretchers/PottleTC.htm

I have worked as the second kind of orderly, although my duties went beyond those described. Hospital orderlies are now classified as nursing assistants and you get training for that. There still exists men and women in medical facilities who wait on others, clean, and do general work.  

During college years, I worked as an orderly in a succession of three different hospitals. I think of the patient populations I served in this way: one for dying old people, one for critically burned children, and one for the crazy drunks who also were dying slow deaths.

I was young, 23 at my third and last position minding alcoholics at a county hospital. I could be irreverent with my coworkers while still doling out empathy for patients. Face it, I was never going to grow old, turn into a homeless alky, or get caught in a raging fire. That’s the joy and curse of youth, ignorance of what’s waiting down the line. Blessed, blessed, cluelessness. I dated nurses, went to some wild parties, and made friends. Because I could not envision old age, I couldn’t fathom the fact that some of my youthful experiences would be forever burned into my memory. Therein lies the joy and curse of old age: there is no forgetting.

Ormond Beach Osteopathic Hospital was across the street from a nice beach break. When I got off my 7-3 shift, I checked out the surf. If it was good, I would borrow one of my brothers’ boards and go out. If not, I’d call one of my friends and we’d get high while driving along a usually deserted wintertime beach. I was killing time, waiting for my draft notice to arrive. I was 20, just the right age for Vietnam. I’d lost my ROTC scholarship and dropped out of a university I could no longer afford. At the hospital, retirees kept coming in and passing away. They were my grandparents’ age, born at the turn of the century, now in their 70s. A Mr. Fanchon came from Montreal to bask in the sunshine and now was bedridden and developing bed sores on his back end. He moaned all the time, announced his pain in French. My fellow orderlies and I were tasked with turning him every two hours. His moans came from a deep place, a place that me and Jim and Sharon and Marlene had never been, not yet. We said calming things to him in English and he moaned and then barked out a French expression. We were kind. During smoke breaks (we all smoked), we parodied Mr. Fanchon’s French, made up our own expressions. The nurses came in the break room and asked what was so funny. We told them. They jumped right in with their own fake French lines. There’s something about working around the dying and near dead. We needed humor to keep the dreads at bay. Mr. Fanchon was on his way out but we were not. There was a morning when I came in and Mr. Fanchon’s room was empty, already made up for a new patient. I asked about him at the nurses’ station. “Old folks home,” they said. I couldn’t think of anything funny to say. I worked my shift, went home to see what was in the mail.

During my six months working the graveyard shift at a Boston children’s burns center, two patients died. The nurses and doctors worked frantically to save them but could not. We orderlies and nursing assistants were on the periphery, going about our appointed rounds. We knew. I brought water to the boy who had been messing around and fell on a downed high-voltage cable. He now had just one arm and no penis. Electricity has to find a way out, it seems. I brought ice cream for a little boy with bandaged hands. I sometimes changed his dressings when the nurses were busy. The burns on his small hands were in concentric circles. I asked a nurse about the burns, asked if he climbed up on a stove and fell, or something. She grabbed my hand, told me to spread my fingers, then she pressed my hand on a table. She released my hand. “His mother,” she said. “His mother.” I was never the same after hearing that. On that death night, staff waited until the unit was quiet and the other kids were asleep. That’s when they moved the body. A few weeks later, the nursing supervisor took me aside , said the hospital would pay for me to get my nursing degree. I was flattered. It was good to be far away from home and wanted. I turned down the offer, and thanked my boss, told her I wanted to be a writer. A few months later, I was back in Florida with new plans, thoughts already fading of my live-in girlfriend, the one to whom I’d plighted my troth but would only see twice more before she called it quits via long-distance telephone.

The 1200 Ward at the county hospital housed people the cops peeled off downtown sidewalks and brought in the sober up. It was a locked ward, staffed by one orderly of sufficient bulk to corral anyone in DTs and ring the buzzer for help. That was me. The orderly. I took temps and filled water pitchers. I carried a soft plastic tongue depressor for those times when patients suffered seizures. Scar tissue on the brain, that’s how it was explained to me. Again I summoned the nurses and they gave the patient something to settle them. The usual cocktail was paraldehyde mixed with orange juice. Paraldehyde is a relative of formaldehyde and was, into the 70s, used to treat DTs. Nurses demonstrated its power by pouring a shot of P into a Styrofoam cup. It always ate its way through the cup, pooling on the nurses’ station counter. “Orange juice first!” Mrs. D was tiny and weathered but had been a nice looking women in her youth. I worked in 1200 for a year as I eased my way through community college. During that time, Mrs. D was inside the locked doors three times. As we gathered in the break room to play cards, Mrs. D told the best stories, the most disturbing stories. They were funny too in a twisted sort of way. She’d been married and divorced a couple times. She traded sex for booze. Slept in crash pads or on the beach hidden behind hotel seawalls. A week before I quit to go off to the university, she came in with a black eye and broken finger. “You should see the other guy!” When I walked out the locked doors for the last time, she wished me well. “Be good, hon.” Well, Mrs. D, I haven’t always been good. But I did OK. And I remember you."

Even cyborgs need periodic battery replacements

I’ve been recovering from heart surgery since Feb. 16. It was Valentine’s Day Week and it seemed like a good time for it. Heart surgery has an ominous sound. Thoughts go to quadruple bypasses and aortic valve replacement. I just needed a replacement generator in my chest to stop any signs of ventricular fibrillation which can lead to death. The gadget is filled with microchips and wires that connect to leads that snake down into my heart. I got my first one ten years ago after a widowmaker heart attack that almost did me in. Because it took too long to get help for my stopped-up heart, it sustained some muscle damage which in turn made my heart less effective. Up until January 2013, my heart had been very good to me. In high school, it pumped like a champ as I ran down the basketball court or when a girl looked at me in a certain way. Got me through my adult years until I hit 62 then BAM! Damn…

So the first one wore out and I needed a new one. I am on Medicare and have secondary insurance that pay for the $23,000 gizmo and attendant expenses such as doctor’s fees, OR fees, nursing services, etc. I am lucky to have health care insurance that keeps me ticking. Health insurance is a right and should not be optional. I see that our esteemed GOP state legislators have once again torpedoed Medicaid expansion that would insure thousands of Wyomingites. A widowmaker strikes and you need help? Tough luck, buddy. For the GOP it’s all about the cruelty. They didn’t used to announce their cruelties for all the world to see and hear. Now they shout it from the rooftops.

Back to my trip to the operating room. It’s called the CRMC Cath Lab and it’s where the electrophysiologists work their magic. I was under conscious sedation, like the kind you get for your colonoscopy. In this case, the surgeon applied a topical anesthesia and then pumped me with Fentanyl but not too much. He then cut into my chest, removed the old battery and in with the new. Then he sealed me back up. Before you know what’s going on, I'm being whisked off to recovery.

So how does my electrophysiologist keep track of the signals beamed from my Abbott Laboratories ICD? I used to have a Merlin Home Transmitter the size of the big black phones you used to see in 1940s movies. It sat by the side of my bed and beamed my readings to the CRMC Device Clinic. My new monitor is a Samsung device, smaller than a smart phone, that I can take anywhere. Pretty slick.

My new machine should last 5-7 years, according to the pamphlet that accompanied it. I plan on lasting at least that long. Seven days post-op and I’m doing fine.

Thank you, modern technology and surgical expertise. 

Two years ago I reviewed a nonfiction book about ICDs on WyoFile. It's "Lightning Flowers" and written by Wyoming author Katherine E. Standefer. She needed a device while still in her 20s and then set out to find the its origins. A great tale, whether you're a cyborg or not. 

Night of the Widowmaker, ten years on

Ten years ago on these pages, I regaled my readers with stories of my heart attack. It was an exciting misadventure. Nobody in my family had heart issues and neither did I. I was struck down in the middle of a working day. The scientific name for my affliction is anterior ST-segment elevation myocardial infarction or STEMI. It’s commonly known as “The Widowmaker.”

I didn’t hear the term from a cardiologist until I was recovering in my hospital room. Such finality. It seemed so 19th century. "Night of the Widowmaker" could easily be the title of a thriller novel. Its shock value was too tempting for a storyteller to ignore. I used it hundreds of times in place of heart attack. When I took the time to describe it in detail, tossing in an encyclopedia of medical terms, I could see my listener’s attention begin to wane. Simply described, the left anterior descending (LAD) artery gets blocked by a clot or plaque and the heart reacts.

The signs are there should you pay attention. Chest pain, shortness of breath, excessive sweating, jaw pain. Mine was a belly ache. Since it happened during norovirus season, I figured I was getting ready to blow chunks and/or get the runs. I got neither. It was Dec, 17, 2012, and the eve of my birthday number 62. I might have to lay off the cake and ice cream. I was off work for two weeks so I could lie around and see what happened. After a week, I went to my GP and he thought I might have pneumonia so sent me for an X-ray. He had a perfectly good EKG machine out in the hall but that never entered into the conversation. The X-ray showed congestion and the doc prescribed an antibiotic and bed rest.

On Jan. 2, I headed to work but only made it as far as my front door. I couldn’t open it. I called my wife. She decided to come home and take me to the ER. When she arrived, she saw I was in pain so called 911. The EMTs got there quick, took my vitals, and said I was having heart failure. They bundled me onto a gurney and sped, sirens blaring, to the hospital. Tests and X-rays showed the heart attack and also congestive heart failure. Dr. Khan wanted to get me to surgery right away but held off because I couldn’t breathe. So he stashed me on the telemetry floor and prescribed Lasik to rid my body of fluids. The next day, I had an oblation which opened the LAD and I began to recover.

Then I started telling my story. My heart, left to its own devices for two weeks, lost some of its pumping power. They filled me full of drugs, sent me home with orders for several rounds of cardiotherapy. Six months later, I got the bad news that my heart had only partially recovered and that I was a prime candidate for Catastrophic heart failure. To avoid further drama, I needed an Implantable Cardioverter Defibrillator or ICD. So I got one. Its battery eventually ran down, so this last Thursday, I got a new one.

The ICD lasts from 7-10 years. I pushed mine to the end so Medicare and my insurance company would agree to foot the bill. Medicare reimbursement for an ICD is 23 thousand and change. That doesn’t include hospital and physician and other associated fees. That will quickly eat up my deductible so my out-of-pocket costs will be manageable.

Someone with a heart condition shouldn’t have to worry about affordability. Someone with breast cancer – my wife – shouldn’t have to worry about treatment costs. My son and daughter, both with mental health and medical needs, shouldn’t have to up their angst to find affordable treatments. Alas, that’s where we are in 2023 in the United States of America.

Next time, I'll explore the status of my heart ten years on.

For some of my ruminations on the widowmaker, put "heart" in the blog's search bar.

Hair stylist at the Cancer Infusion Station

Lorna of the luxurious brown hair. The first time I saw her. Not a streak of grey in it. I knew it wouldn't last because she's right here in the Cancer Infusion Center waiting room. This is where hair goes to die so the patient can live even if it's a little bit longer. Lorna hasn't yet stopped at my station to talk about styling options or maybe a wig; we have orange and blue ones. Stylin' scarves too, and caps with funny sayings, funny to all of us anyway, women of the lost hair -- yeah me too, and mine grew back curly and seal brown with silver tips. "Kissed by the sun, I said. "Touch of grey" said my husband, a Jerry Garcia fan. "I will get by," the song goes. "I will survive." As the weeks went on I missed seeing Lorna and wondered if she'd given up. She finally came by, hair strands sticking up in a topknot and tied in a bow. Reminded me of Zippy the Pinhead from those days when hair meant everything. Lorna walked by alone, as always. "Like my hair?" She tended it with her right hand, twirled around so I could get a good look. We both laughed. I saw her weeks later, head shiny as a baby's bottom. "Just a comb-through," she said. I held up a bare hand. "Got my comb right here." For the first time, she cast her burden aside and sat in my chair. I massaged her scalp with some feel-good ointment that smells of lavender and vanilla. I feel the ridges of her skull beneath the hairless skin. Cancer started in her breasts -- they've been banished the damn troublemakers. Lorna and I reminisced about the touching that went with them. When done right, it lit us up. My touch on her bald head is one small thing, a tiny pleasure. Small things are what's left when the big things go.

GoFundMe for my brother, Tim Shay

My brother Tim the postman/father/grandfather is undergoing radiation treatments at the Mayo Clinic Hospital in Jacksonville, Fla. The docs successfully operated on Tim a few years ago to remove a non-cancerous brain tumor. It grew back, this time with an unwelcome surprise of "atypical cells." Tim's large family depended on his paycheck but now he's on disability and things are a bit tight. If you've a mind to, please contribute to our family's GoFundMe site

I pray for Tim daily and keep sending him goofy cards to lift his spirits. 

Hospital stories on Nurse Appreciation Day

On the one side, you have Trump and his narcissistic minions.

On the other, you have nurses.

I align myself with nurses. They are on the front lines of the fight against coronavirus. They run toward the danger and, thanks to the Trump administration's incompetence, lack the necessary PPE to keep COVID-19 at bay.

Today is Nurse Appreciation Day and it launches National Nurses Week which ends on Florence Nightingale's birthday on May 12. They should be celebrated everywhere and every time. Mostly nurses are taken for granted until we are gasping for breath with COVID-19 or, in my case, from a heart attack.

I lie in the hospital bed in the ER. I am hooked up to oxygen and poked and prodded by doctors and nurses and techs. Chris is with me so she holds my hand when she can. When she can't and the nurses are tending to me, I feel a strange sense of calm.

I see my mother's face in theirs. She was a nurse from 21 to her early death at 59. Tomorrow, May 7, is her birthday. Happy 95th birthday, Mom. She took care of strangers and she nursed her family. I was born in December of 1950 at Denver's Mercy Hospital. Mom trained there at the tail end of the war thanks to the U.S. Navy and the Sisters of Mercy. She worked there when I was born. Later she joked that she was working the night I was born and took off a few minutes to deliver me and then was back at her job. The truth is that Mom took a week off to chill in the hospital after each birth. It was important the first time out with me. It was even more crucial in the 1960s when she had 5-6 kids at home and needed a break as the new ones arrived.

She could have been the poster child for nurses' week. We came to her for our miseries. As a nursing supervisor at a Florida hospital, staff members came to her to unburden themselves. For awhile, I was both -- son and employee. A university dropout with a low draft lottery number, I figured that I would surf and work as I waited for the inevitable. I worked an as orderly or nursing assistant, now known as Certified Nurse Assistants (CNA). People actually go to school for this now and I'm glad of it. Me and my coworkers got OJT. The nurses were patient and, at times, stern. There were a couple nurses we didn't challenge. We didn't mess with Mom, either, although her management style was more encouragement than stern lectures.

I do admit here and now that sometimes, taking temps and inserting catheters, I was a bit stoned. When my coworkers Jim and Sharon picked me up at  6:45 a.m., a smoke cloud greeted me when I opened the car door. When we abandoned the car for work ten minutes later, the cloud followed us inside. It's a wonder we never were caught. We tried to cover up our shenanigans with after-shave and perfume. One day I heard a nurse proclaim that she always liked Jim to work at her station because he always smelled so good. A blend of Jamaican herb and Hai Karate. I can still smell it 49 years later.

My youthful indiscretions faded at my next job as orderly. I worked the graveyard shift at Shriners' Burns Institute in Boston. It was a serious place. All patients were children under 18 who had sustained bad burns. House fires, electrocutions, accidents, and, yes, child abuse. The staff of nurses and nursing assistants were all young and energetic even at 3 a.m. Some of the NAs were enrolled in nursing school. My girlfriend Sharon (the same Sharon) was making plans to return to school, this time for a nursing degree. I was thrilled when the nursing supervisor brought me into her office one day and offered me a nursing school scholarship paid for by the hospital. I was doing good work, she said. I thanked her and said I would think about it. It felt good to be noticed. I talked about it with Sharon and on long-distance calls with Mom from the corner pizza parlor (we didn't have a phone). But I already knew my answer. My practical side urged me to do it. But I was just beginning to explore my creative side.

I blame it on the Boston Phoenix and The Real Paper. Both were distributed weekly on Boston streets I always snagged both of them and read them from cover to cover before I settled into my daytime sleep. The writing, at turns, was spectacular and sloppy. The subjects tended to revolve around the counterculture which is where I placed myself. Music, books, politics, wacko cults and conspiracy theories. I also liked reading Boston's daily papers. They were in their heyday in 1972 and 1973. Dynamic political coverage and great sports sections. But they ignored most of the topics the Phoenix reveled in.

The alternative press ruined me. I wanted to be a writer. Nursing was a great calling and would provide a steady income. Maybe my girlfriend and I could attend the same nursing school and work at the same Boston hospital..

But I wanted something else. I quit my job, returned to Florida, and went back to school as an English major. Write and teach, teach and write. That was what I wanted to do and that is mainly what I did.

Mom is just one generation of nurses in the family. My grandmother, Florence Green Shay, was an army nurse in World War I and two of my sisters are nurses. Another sister works at a Florida hospice center. I am so glad that nurses are getting their due during this plague. Let's keep them safe and pay them what they deserve. .

Part VI: The Way Mike Worked -- How I Almost Became a Nurse

The five-year-old boy from New Hampshire didn't talk much. He held up his right hand as the nurse dressed his wounds and I stood by to assist. The tiny hand was imprinted with concentric circles and looked as if someone had given the boy a special tattoo, although he was much too young. The reality was much worse. An adult, his mother, had punished the boy by pressing his hand into a hot electric stove burner. Third-degree or "full thickness" burns. The top layer of skin (epidermis) is destroyed as is the bottom layer -- the dermis. So are the nerve endings. Because the epidermis and hair follicles are gone, new skin cannot grow. The burn must be treated and then skin grafts are applied. This boy was a long way from skin grafting.

He would be in the burn unit for awhile, which is OK because everything was paid for. This was a Shriners Burns Institute (now Shriners Hospital for Children's--Boston), supported by millions raised by the guys with funny hats who drive funny cars in your local Fourth of July parade. I lived with my girlfriend Sharon in a walk-up one-bedroom on the poor side of Beacon Hill. It was winter and very cold. I wished I was on a Florida beach where I had been this time last year. I was cold yet fascinated by the work I did and observed as a nursing assistant/orderly at the hospital.

One morning, as I was getting off of work, the head nurse asked to see me. She asked me if I was interested in becoming a nurse. The hospital would pay for my education. I was stunned by the offer. I was torn, too. Just recently this dropout and former marine biology major had decided to go back to school and major in English and become a notable writer or at least one who got his stuff published. What to do? A secure future in the medical field? Insecure future with the other thing? I chose the other thing.

But not before I discussed it with Sharon. She was pondering the same thing, going back to school to major in nursing. Maybe we could go to the same school, University of Connecticut in Storrs, the place where she'd started college three years earlier -- she also was a dropout. Most of the people we knew were dropouts who went on to do interesting things with their lives. The Shriners staff wanted me to go to school in Boston. What to do?

As I pondered, I walked to my graveyard shift at the hospital and Sharon rode the MTA to her graveyard shift job at Deaconess Hospital in the burbs. She looked good in white. She looked good in anything. She told me stories of "rubbers," the guys who rubbed against women on the subway. One day she waited for her train when a young guy emerged half-naked from the shrubbery and began to masturbate in front of her. Those stories made me want to punch somebody, anybody. It made me want to ride with her every morning and every evening, to protect her. She was good at what she did and knew it. I was good at what I did but didn't know it. The die had already been cast. I just didn't know it.

Two years earlier, I had screwed up my chance of a military career. I know now that it was an act of sabotage. My mentors had lined up to promote my brilliant career. I failed them, on purpose. I didn't want to tell them no. Inside, I said no-no-no. Had I also failed myself? I guess, at 22, I didn't know. Here was another opportunity. It looked mighty good to a young man with no prospects.

When the night was slow, I gathered in a break room with the other nursing assistants. We stayed awake by drinking tea and eating chocolate. Some of the others were already in nursing school and spent the time starting IVs on each other. It kind of creeped me out but who was I to judge? I ran blood samples over to the Mass General lab through a spooky underground tunnel. I'm sure that it was well-used during the day. But at night? There was a camera and squawk box at each end. I pushed a button at the Mass General end and someone would eventually come on the line and asked my identity. I was admitted into the hospital basement. I skipped riding up the freight elevator because it smelled like formaldehyde. "That's where they bring up the dead animals, you know, for the med students to practice on. Human corpses, too. The morgue's down in the basement" The graveyard shift guy in the lab liked to pull my chain. At least I think he was pulling my chain.

Some of our young charges died at night. Burns can be horrific. House fires. Electrocutions. Accidents. Burns do terrible things to a body. Third degree burns with lung damage were bad. Very, very bad. Sometimes children are trapped in fires. Old people, too. Not only are their skins less dense, but their lungs are especially vulnerable. Kids' lungs are still developing. Oldsters' lungs are sensitive to everything.

I bugged out of Boston in March. Sharon and I pledged our love and promised to keep in touch. I hitched up to Connecticut a month later to see her and we drove out to the Cape. She came down to Florida in May and we drove to the Keys and camped. By the end of the summer, we were no longer a couple. I went back to school at the local community college. Sharon went to UConn. I sometimes wonder if she became a nurse or something else. What long and winding road did she take? 

That old guy peeing in the chair still has stories to tell

The certified nursing assistant (CNA) named Ashley pulls me out of my chair and leads me to the walker so I can get to the handicapped accessible bathroom. It's 4 a.m. on an August Friday and she and the nurse make their rounds. The staff has pumped fluids into me all day and dosed me with diuretics. I fell asleep in the chair so I could be close to the john. The joke was on me. I pissed into my Depends and my gown and into the chair.  I had spinal surgery and have trouble walking. I am as helpless as the baby I hear crying over on the pediatric side of this surgical floor.

"Sorry," I mumble.

"It's OK," the CNA says. "It happens."

Not to me it doesn't. That's what I wanted to say. I am a 20-year-old CNA -- we were called orderlies then -- working in a Florida hospital. I peel 67-year-old old men out of chairs they have peed in. I clean them up, help them dress, sop up the mess, and get them back into bed.

"Sorry " they say.

"It's OK," I say. "It happens."

I am a 20-year-old college dropout. I'm not old enough to drink or vote. As I do my chores, I think of the cute blond 20-year-old CNA named Sharon whom I helped earlier in the day. We laughed as we made the bed in an elderly woman's room. The woman sat slumped in the corner as we talked about movies we liked. I wished that this co-worker was not dating my good friend Jim. I sure would like to take her out to one of the movies we talked about. Maybe a drive on the beach. Maybe the surf would be jazzed after work. Maybe I would take some time to think about what to do with the rest of my life.

I'm 67 again. The hospital staff has put me back in my chair, turned off the lights and left. The young CNA is thinking about Friday night, just 12 hours away. The nurse with the braids could be contemplating a weekend with her family camped by a mountain stream. You can see the jagged outline of the Rockies from my fifth floor room.

I am a 20-year-old in a 67-year-old body that is failing. My wife sleeps in the pull-out bed near the window. Some of us suffer in silence. Some of us like company. I wonder what the other young people who keep this hospital working are thinking about tonight. I wonder who other old men are remembering tonight.

I remember this. That cute nurse's aide from that hospital long ago broke up with my friend and I took her to a movie. We spent the next 18 months together. In the summer of 1972, we hitchhiked 10,000 miles around the U.S. we ended up living in Boston where we both found hospital jobs we liked and decided to become nurses together. She became a nurse and I decided to pursue my love of writing. End of our story.

Thursday morning, about 3 a.m., I found myself awake and still a little buzzed from Wednesday evening's surgery. A nurse named Dusty asked if I was ready to pee.

"Need to urinate eight hours after surgery or..."

"Or what?"

"You know what a catheter is, right?"

Dusty accompanied me and my walker around the quiet halls, thinking that might shake up my system. She took me by the veranda that looked over the sleeping town. We chatted. When we got back to the room, she ran water in the sink and I voided. Dusty took a look at my bladder through a scope and found I had urine in there just looking for an excuse to come out. I eventually squeezed out enough to keep the catheters away.

The next night, I turn into Niagara Falls.

At one point, I thought about spending my working life in hospitals. Not peeing in chairs but taking care of those peeing in chairs. In an alternate universe, that is Mike's life. There are many alternate universes. My reality is now.

This won't finish me off. I will be older and incontinent somewhere else. My wife of many years will be gone. My friends will be gone. My grown kids will live far away. I once asked a hospice nurse if people died with their loved ones around them.  "Most people die alone," she said.

I leave stories.

Do odd things happen to writers, or are writers just odd?

A question for my writer friends: Do odd things happen to you, or are you the odd thing?

The answer is important. The world is odd, filled with strange happenings that call out to be translated into poems and stories. But I may be the odd one for noticing and then spending hours/days/months on writing a story to make some sense of this odd occurrence. Maybe it doesn't have to make sense, it just has to be entertaining or thought-provoking. It may never be published, never. read by more than a few blog fans. 

To get on with the story...

I had a weird experience Tuesday at a Colorado hospital that will remain nameless. I was the subject of a Cervical CT Myelogram procedure. The docs and nurses in Radiology were supposed to start in on me at 1 p.m.. And then it was 2 and then 3. Finally, the head tech explained to me that the computer had hijacked the hospital. It mistakenly booked me in the fancy Radiology room next door and wouldn't acknowledge that I was waiting in the plain vanilla Radiology Room. I said why don't you put me in the fancy room. He said it was expensive, only used for the difficult cases. I was glad that I wasn't a difficult case. 

The IT guys stormed the premises. They were not like the "IT Crowd" technos who told frantic operators this: "Have you tried turning off  the computer ans turning it back on?" They came to rescue. The problem seemed to be a tough one. The IT guys figured out they had to discharge me from the hospital and admit me all over again, trick the computer into thinking I was a new patient suited only for the cheap room. 

They did that and thought they had it licked when the computer changed its mind and put me back in the fancy room. There must have been ten people in the room, some working frantically on the computer, others preparing the room for the medical procedure that was sure to start any time now. I talked about books with a nice nurse who was writing a children's book in her spare time. Earlier, as she checked me in, she found out I was a writer and said that she thought that I looked like the creative type. I was flattered, as people usually think I look like Colonel Sanders. 

After two hours, they tricked the computer for good and the Radiology team jumped into action. The doc pumped me full of contrast, which one of the techs described as a "sticky oil" which, when scanned, highlights the details of my cervical spine. Once they pumped me full of sticky oil, one of the techs got on with tilting me at various angles on the table while another tech shot images on the scope. They tilted me head first and then prone. They tilted me forward for a second time to make sure the contrast reached into the furthest reaches of my upper vertebrae. I didn't object. I only wanted to do this once. They took some other pictures with me on each side and one of my neck and shoulders. Satisfied, they sent me over to the CT room where another tech scanned me. 

When I got back to the recovery room, a new nurse turned on her computer and looked for my chart. "You don't exist," she said. 

Odd, but I was lying right there. A few minutes later she found me.

"Looks like the computer discharged you" 

Of course. 

The nurse got me readmitted and discharged me again, because that was part of her job. 

As my wife Chris drove me back to Cheyenne, a few things occurred to me. It wasn't a bad way to spend five hours. It was 95 hot degrees outside, cool inside. Chris had taken the day off so we spent some quality time together. The staff was kind and patient. It made me wonder if they were this nice to all patients. The nurses admitted that many who come through their doors are very sick and usually older than me. Some of the procedures involve a lot of physical pain. Pain, as always, turns your attention inward and you are not always aware of others feelings. Me, well, I was in a little bit of pain but didn't want to be a pain. So, after lying around two hours waiting for the multimillion-dollar computer system to recognize me, I decided that resistance was futile. I could have told them to forget it and make me another appointment. But I didn't want to come back another day.  

It was very entertaining. The staff gave me a handful of cafeteria food coupons to make up for the delays. I hope I'm not back at that hospital any time soon, not even for chicken-fried steak night.

Forget Christmas -- 'tis health care insurance selection season

It's that time again.

Christmas season. Or holiday season if you are a damn liberal like me who doesn't believe in saying "Merry Christmas" to every Tom, Dick, and Donald I meet. I even like the new Starbuck's Christmas cup that shows two cartoon women holding hands, at least that's how paranoid Evangelicals see it.

More importantly, 'tis the season to Make A Decision on Health Care for 2018. The U.S., in its wisdom, has the most screwed up health care system in the world and bound to get worse with Trumpists making the rules. Our family has a triple layer of coverage from private insurance, Medicare, and Medicaid. Cash, too, in the form of deductibles and co-pays.

For most of us out here who live amongst Trump voters in Flyover Land, the situation is made worse by indecision. The Republicans sabotage Obamacare in any way possible because they want to totally wipe out any sign of an African-American president. Trump's Ministry of Truth will soon create an America that is all-Trump all of the time.

Meanwhile, the American people are left in limbo. Will the ACA remain or will it be dismantled bit by bit since Repubs can't seem to muster enough votes to kill it outright? This affects millions.

I am 66 and my wife Chris is 61. I am on Medicare and she is not, covered instead by my allegiance to CIGNA via Wyoming State Government, my former employer. I pay $1300 a month to keep my CIGNA policy for me, Chris and daughter Annie, who is younger than 26, the cut-off date in family insurance created by Obamacare. For me, Medicare is primary and CIGNA is secondary. \Once I meet the deductible, I am covered like a blanket through my investment in Medicare and private insurance.

Let me pause here and say that I have no quarrel with CIGNA. While corporate-fueled insurance is expensive (must pay stockholders and CEOs a princely wage to afford those gated communities they are building for the apocalypse), it provides great coverage. When I inconveniently suffered a heart attack on Jan. 2, 2013, I ended up paying less than $1,000 for a bill that totalled $150,000, when you factored in ambulance, ER, oblation, stent, a week in telemetry and great cardiac care at CRMC. That summer, I received an ICD courtesy of  Syrian ex-pat cardiologist Dr. Obadah Al Chekakie. Since I already surpassed the $100,000 threshold, I paid spare change for a Made in the U.S.A. gizmo that monitors my heart 24-7 and sends results to master control at CRMC. It also includes a defibrillator which can kick me back into life should I ever experience Sudden Cardiac Arrest, which is as bad as it sounds.  My heart needs this assistance because it suffered damage during the long-term 100 percent blockage of my LAD artery, the so-called widowmaker. At a recent funeral, a long-term heart patient said that he had never met someone with a LAD who lived. I was pleased to hear that. I am pleased to hear almost anything. Except Trump is on Twitter again -- not that.

Chris is a diabetic so she benefits from plans that guarantee coverage for pre-existing conditions. That could go away too. So she's worried that the ACA will go away along with all of its guarantees and she has to shop for health care on the open market which may not cover a diabetic. I am worried with her, as Medicare is three-plus years away for her and we will have the clowns in the White House and Congress during that time. A dangerous time.

This brings us to our daughter. She is 24. She has been in and out of mental health treatment centers for 11 years. With some exceptions, most care was covered by CIGNA. You think our health care system is a mess? Just try to figure out the mental health care system. Annie, fortunately, moved to Colorado and got on the state's Medicaid program and when I received Medicare, she did too. So she is covered. Republicans threaten her coverage. One saving grace is her Colorado residency. It's a blue state south of our very red border. Not too far-fetched to think that we will have health care refugees in the near future, diabetics and cardiac patients and the mentally ill leaving their backward red state to find sanctuary in places such as Colorado and Oregon and Massachusetts. Canada, maybe even Mexico. Wouldn't that be ironic?

I am a retiree with a pension. Half of that goes to health insurance. In 2018, Chris will be covered by ACA and Annie will be covered by Medicaid/Medicare. I will be covered by Medicare and CIGNA. All of these programs (except for CIGNA) are in the sights of Congressional Republicans. They aim to reduce or eliminate these programs to give tax breaks to their corporate masters. We no longer live in a democratic republic but an oligarchy. It will truly be a country run by the rich for the rich if all of these lame-brain actions come to pass.

So it's decision time. You make the best decision you can under the circumstances. I have to remember to be thankful for what I have as there are millions who suffer from inadequate health care or none at all. Those ranks are certain to grow in the next few years. So be thankful -- and fight like hell to stop the Republican assault on "the general welfare" of the U.S. and its people.

Portrait of a poet as a young man

Back when I was a poet...

I worked as an orderly in a county hospital. I took classes at the local community college. I walked or road my bike from campus to hospital for my 3-to-11 shift. I changed into my scrubs in the restroom. Then I set off to take care of the alcoholics recovering in the 1200 ward. They weren't so much recovering as being refortified to resume their lives on the streets. The hospital staff did its Sisyphean duty. Feed them, keep them locked up and out of DTs for as long as possible. and then release them back into the wild. We had drug cases too -- it was 1973. A young longhair tripped out on LSD and ran naked down Main Street. I had plenty of empathy for him. Two years earlier, I had OD'd on acid and spent the night in the university infirmary. Bad trips were nothing to laugh about.

I gathered plenty of material for poems and stories as I watched over my charges. I wrote on yellow legal pads. I hadn't yet discovered the ubiquitous and portable composition books. One day I emerged from behind locked doors to take a break. The break room was also the meeting room. I looked for my legal pad but couldn't find it. A nurse eating her dinner pointed to the trash can. The head nurse had seen the poetry scrawled on the legal pad, the same kind that nurses used for notes on their patients. "She said that she'd like to know who had the time to write poetry -- then she tossed it in the trash can."

I was mortified. My poetry in the trash. It was probably the most concrete critique I ever received. I hadn't published anything yet. My curious friends asked me what I wrote in my legal pads.

"Poetry," I said. "Observations."

My roomie on Graham Avenue in Holly Hill, Florida, was Bob the Biker. He was saving up for a new Harley. His old Harley had met a bad end which he didn't want to talk about. I just knew that it involved the Hells Angels in Milwaukee and a statutory rape charge. He was a big dude, a fine mechanic who was helping me rebuild a 1950 Chevy truck which I bought on a whim. My dream was to get it fixed up and use it for beach trips with my dog and surfboard. We never finished it. I sold it for parts after Bob moved on, replaced by an old high school friend, Ned.

"Are you observing me?" Bob asked one night when we'd polished off a case of PBR.

"And what if I am?"

"I'd like to see it. See what you think."

"You're not in it," I said. "I do have some poems."

"That's OK. Poetry is not my thing."

Not a critique. Just a rebuff.

The 1200 Ward was a spooky place. I carried around a soft tongue depressor for patients who went into seizures. I used it more than once. Alcohol caused lesions and scars on brains that led to seizures. A seizure is an awful thing. Eyes roll back in the head and muscle spasms cause the patient to bite down hard on his/her tongue. I got called in to plunge the plastic tool into the mouth so he wouldn't bite his tongue in half. Once the seizure fades, the patient is lethargic and disoriented. I reported the incident and let the nurses take it from there.  I usually returned to the ward break room where I played cards with the patients. We drank bad coffee and played cards. They told harrowing stories of life on the streets. Most patients were middle-aged males. Some were WWII vets, but we hadn't yet seen many from Vietnam. Some were women, who had their own room. Part of my job was to keep the men and women separated. We joked about it but the women often turned tricks for a bottle. One of the women had a college education and a good job before she went into the tank and hit the streets. During my year on the ward, she was there three times, once with a black eye and a missing front tooth.

One patient came in with cirrhosis of the liver. A black man with yellow eyes and a distended belly . No insurance. None of them had insurance -- it was thee county's charity ward. The cirrhotic man was shuffled off to a room of his own. The supervisor closed the door and let him die. That seems odd to say. But all of our patients were on their way to death, some slowly, some quickly.

How did we keep the patients from all going into delirium tremens? The nurses fed them paraldehyde. What's paraldehyde? Here's a quick description from the Mayo Clinic web site:

Paraldehyde is used to treat certain convulsive disorders. It also has been used in the treatment of alcoholism and in the treatment of nervous and mental conditions to calm or relax patients who are nervous or tense and to produce sleep. However, this medicine has generally been replaced by safer and more effective medicines for the treatment of alcoholism and in the treatment of nervous and mental conditions.

To demonstrate its toxic qualities, nurses demonstrated by pouring a dose directly into a Styrofoam cup. It dissolved the cup in seconds. The nurses cautioned that you must put juice in the cup before the paraldehyde. I was impressed, but knew I would never been serving up this potent cocktail. I wondered: if it does that to a cup, what does it do to your body?

Never found out. The bodies of the patients on the ward were already compromised. The drug stopped convulsions and helped them sleep. I had already seen what the DTs could do.

"The dog! The dog!" The man's eyes were with with fear and he pointed at his feet.

"What dog?"

"He's eating my feet. The dog!"

"It's OK. I'll get the nurse."

I did. The nurse brought a healthy dose of peraldehyde and a calming voice.

"The dog," the man said. "My feet."

"There, there," said the nurse. She urged to lie down and go to sleep. It took awhile but that's what he did.

I returned to the break room and the continuing card game. Nobody said anything. They had been there.

Sometimes a call went out on the hospital address system. "Dr. Blue. Please report to 1400. Stat." Translation: "All available orderlies run to the psych ward. A patient is freaking out and we need help." In 1973, all I knew about psych wards came from "One Flew Over the Cuckoo's Nest." Nurse Ratched. Bull Goose Loony. Electro-shock therapy. Lobotomy.

I know a lot more now. My daughter has been in psych wards and treatment centers in five states in the past decade. I have seen patients freak out during visiting hours and the call go out for this generation's version of Dr., Blue. I have seen my daughter freak out in a Casper, Wyoming, treatment center. You look at these events differently when it involves one of yours.

The charge nurse in 1400 was Mrs. Berry. Nobody knew her first name. She was good-looking in a middle-aged sort of way -- that was the view of this 23-year-old. She reminded me of my mother, who was the director of nurses at a hospital across town. Mrs. Berry had a harder edge, maybe because of her charges. She also had a secret. She was fated to become the mother-in-law of my sister-in-law. My future sister-in-law's sister, my future wife, lived a block over from Mrs.Berry and her sons, frequent visitors at my future wife's house. I didn't know them then.

I worked at Halifax Hospital for a year. I resigned to go off to the University of Florida, where I eventually became a prose writer. My first published work was a poem about a break-up. I do not have a copy of that poem. I'm sure it was tragic and filled with a young man's angst. I began publishing stories in newspapers. I joined the staff of the Independent Florida Alligator. I covered city council meetings, trustee meetings, campus events, etc. I was going to be a journalist although I really wanted to be a best-selling author. All I can say about that is I worked as a writer and editor for most of my career. I blog. Bestsellerdom has eluded me. I still write.

I never worked as a hospital orderly again. I was a cashier in the Shands Teaching Hospital cafeteria one summer. I was the only white employee. The African-American staff gave me a hard time but I won them over by September, or so I like to believe. One of the cooks introduced me to grilled cheese and tomato sandwiches. That was what I had every day for lunch. That and chocolate milk.

Back when I was a poet...

When AFib comes to town

The Cheyenne Regional Medical Center Telemetry Lab staffer called me Friday. She wanted to know how I was doing. I said "fine" but knew that this wasn't a courtesy call. The Telemetry Lab monitors my Implantable Cardioverter Defibrillator (ICD) remotely. I have a home transmitter at the side of my bed. It picks up my heart signals and transmits them to the lab, which then takes a look to see if I am in sinus rhythm, which is what we want, or in atrial fibrillation (AFib), which we don't want.

The lab said I was in AFib on Thursday morning. "Did you feel anything?"

"Yes," I said. "I was light-headed all morning."

"Anything else?"

I had to think about it. "I just felt weird all morning. Had a hard time at physical therapy, was tired and out of sorts all afternoon."

The Telemetry Lab person (sorry I don't remember her name -- blame it on the irregular heartbeats and lack of oxygen to the brain) told me that I needed to be aware of these symptoms as a long-duration AFib is dangerous. "Next time you're feeling that way, please send me a manual reading from your monitor."

"OK," I said, feeling a bit scared. I tend to ignore my heart difficulties most of the time. I exercise, take my meds, maintain a good attitude, am kind to animals, etc.

She made me an appointment with my cardiologist. She is able to access my MyChart files at CRMC which shows a calendar of my appointments. She puts me down for a March 15 appointment with Dr. Nienaber. As long as I'm dealing with a CRMC physician or group, my records are online and we can carry on these types of conversations. It's a bit spooky, all this electronic data-keeping and accessibility. My fiction-writer self thinks of all the ways that this system can be abused. Let's say a U.S. politician has an ICD with a bedside monitor and someone, say, an ISIS terrorist, wants to murder that politician. He hijacks the signal and causes the ICD to shut down. Even scarier, he causes that ICD to activate its defibrillator. Bam! -- a big shock to the heart to get it back into rhythm even when it doesn't need it. And another shock and another and pretty soon, the heart gives up. Remote-control assassination. Because I am postulating this as sci-fi means that the possibility already exists and the U.S. or the Russians or even ISIS may be preparing an attack.

For me, though, right now, the threat is more from AFib than it is from some shadowy hacker. AFib can cause strokes, blood clots, heart failure. My heart attack of three years ago created the cardiac scar tissue that sometimes misfires as AFib. My pacemaker activates to get me back into rhythm. If catastrophic heart failure threatens, the defibrillator will kick in with a debilitating jolt. This has never happened to me, and I hope it never does.  I could be driving down I-80 at the time. Or I could be napping. Anything is possible.

A big thank you to the CRMC Telemetry Lab. A big shout-out to the researchers and engineers and technicians who put these gizmos together. I freakin' love science.

To watch AFib in action, go to the American Heart Association web site. You can compare an AFib animation to one of a normal heartbeat. My heartbeat was normal for 62 years. Cholesterol and inflammation and stupidity led to my heart attack, which almost killed me. I was pulled back from oblivion by EMTs, cardiologists, surgeons, and nurses. I'm 65 now, retired, someone who knows how blessed he is every day. Or almost every day.

Part VII: Mudder's World War I diary

On Oct. 24, 1918, nurse Florence Green ("Mudder" to her grandchildren) received orders to go to Evac 8 on the Meuse-Argonne front. This is from information provided by Dr. Marian Moser Jones of the University of Maryland after reading Florence Green's diary:

As she notes in her diary, Florence was sent to evacuation Hospital number 8 during the end of the Meuse Argonne Offensive in late October, after stints at Evacuation Hospitals 1 and 4. Evacuation Hospitals were nearer the front than base hospitals. Green served near the front during the final push of the war and was part of a group regularly exposed to large artillery fire and aerial bombardments.

Evacuation Hospital No. 8 and its wartime operations were also described in detail by Dr. Arthur Shipley, a prominent professor of Surgery at the University of Maryland, in a series of articles published in the Bulletin of the University of Maryland School of Medicine between 1919 and 1920. Florence mentioned meeting Shipley and working with him in her Oct. 26th diary. [Frederick] Pottle worked under him as an orderly. He later wrote a supplement to Pottle's book, The Officers and Nurses of Evac. No. 8. Although Green only served at this hospital for a short time, Shipley lists her in the supplement.

Here's Dr. Shipley writing about the details of evacuation hospitals:

The Evacuation Hospitals were usually up to 10 miles from the front. They were well out of reach of the light artillery but within the range of the "heavies" and, of course, were subject to bombing. The difficult thing was to place them along the lines of communication, and at the same time far enough away from ammunition dumps and rail heads not to invite shelling or bombing. They were plainly marked with big crosses made of different colored stone laid out on clear space, so as to be easily seen from the observation planes and to show up in photographs. If there were buildings in the hospital group, red crosses were often painted on the roofs. This was most important, as wounded men in large numbers could not be moved into dugouts if the hospitals were subjected to much shelling. During the Argonne offensive, we were at the top of our strength. We had about 1000 beds for patients, 410 enlisted personnel, 65 medical officers and 75 nurses.

Florence Green of Baltimore was one of those nurses. Her diary continues....

October 26
Dr. Shipley from the University of Maryland here. I made myself known to him, several other Baltimore people here. Worked all day.

October 27
Nothing exciting to relate, worked the entire day.

October 28
Goldie came to see me today, brought me four letters all from home too. Miss Martin made some good taffy, the best I have had for many a day.

October 29
Not so busy today.

October 30
The girls are trying to have a party for tomorrow night, it is Halloween. I hope they succeed. Made some real good fudge.

October 31
Had a wonderful ride today in a Cadillac and with a Lieutenant Colonel, but not the one I would of liked to of been with. Also had a dandy walk. Halloween night, but no dance.

November 1
Cleaned house today and wrote a pile of letters. Had a very nice walk. I think patients will soon come in by the barge this am.

November 2
War news is encouraging if it only keeps up. Heard today that Evac#4 had been shelled, poor Goldie, I bet she was scared to death.

November 3
Today is Sunday, but I never know one day from the other. Worked all day.

November 4
Well, Austria is out of the war; I do believe it will be over soon.

November 5
Nothing new, the war is still on.

November 6
No mail, no nothing, wish I was in Baltimore, tonight. Rain for a change.

November 7
Heard today, the war was over, another wild rumor I suppose but if it is true, how wonderful it will be.

November 8
Had the whole day off today, went about 3-5 miles from here, rode in four different vehicles, had a good lunch and dinner and a dandy ride in a Cadillac, a dandy time.

November 9
The Germans have until Monday 11am, am crazy to know how every thing is going to turn out. Am waiting to go on a candy making party but looks like we won’t go tonight as the officers can’t come, such as life, just full of disappointments.

November 10
Busy as could be today, tomorrow is the day which decides about the war, am so anxious to hear the return.

November 11
Am some happy tonight to think the war is really over. I cannot believe it. Haven’t heard a gun since 11am. Great celebrating everywhere. Can almost hear the city hall in Baltimore ringing, and what a wonderful time for Paris.

November 12
Nothing exciting happened, patients coming in slowly. Took a walk. Our orders came. We go Evac to #15, hope from there to #2.

November 13
Gee, but I had a good time today, went to Verdun and then way up to the front, saw lots of sights. Came back and went to Evac #3, since they are having no work there at all. A dandy little Lieutenant took us there and then later met us later and took us to Evac #4 where I saw Goldie, some mud there. On arriving home, we hear there is to be a big dance in the Citadel at Verdun, went up in a huge truck, just had lots of fun. Got home about 1am. The most exciting thing happened during the day I forgot to relate, met Captain R from the 346 and now I know where Lieutenant Colonel S is, hope I see him soon.

November 14
Stayed in bed late and at 11am, the chief came in to give us our orders; we left at 2pm, to take the train. It only takes 5 hours so Miss Martin and I thought we could make it quicker. We got permission from Captain Cahill so we beat it. A colonel was delighted to take us; I think we made it in ¾ of an hour. 30 miles at least, but we enjoyed it, but don’t say it was not cold. Had a dandy dinner and met the train from B. Oh yes, we are going to Paris, am tickled to death, took the night train and oh the ride, no sleep, about 9 people in the compartment.

November 15
Such a wonderful day, arrived at the Continental, got a beautiful room had breakfast in our boudoir. Went to the Red Cross, did some shopping, from there to the Marlboro Tea Room and such a good lunch, soup the best chicken, first I had had in France and real ice cream, well it was delicious. Did some more shopping. Eva met a captain from her home, so he went around with us, bought a dandy looking pair of shoes, had my suit pressed, I feel very much dressed up, to dinner and theater tonight with Captain Hinton and K, we saw ‘Tales of Hoffman’ mighty good show.

Musical interlude: Violinist Mery Zentay: Melodie in F and Barcarolle from "Tales of Hoffmann" (1917), https://youtu.be/OvJcjiDNZpo. A pupil of Jenö Hubay, Mery Zentay successfully toured Europe 1910-1914. She made her American debut in 1915 and became a popular recitalist as well as an Edison recording artist. She died on Oct. 3, 1918, at the age of 21, a result of the flu epidemic.

L’Infirmière (The Nurse), 1914–1918, by René Georges Hermann-Paul. Collection of Spencer Museum of Art, The University of Kansas. Gift of Professor Eric Gustav Carlson. This work was part of the exhibition “The Second Battlefield: Nurses in the First World War” at the National World War I Museum and Memorial in Kansas City, 2015-2016.