Category: Health & Wellness



I applied for health coverage offered under the U.S. Affordable Care Act (ACA) in the fall of 2015 after my position was eliminated following a merger and reorganization.  I had been on COBRA briefly but at $900/month there was no way that I could afford it.  I had no income at the time and the ACA website informed me that I did not meet the requirements for ACA coverage but I did qualify for Medicaid.  My application was automatically forwarded from the ACA website to the State of New Jersey and after a few months of waiting for coverage, with no idea when it actually went into effect, I became an official recipient of public assistance in January 2016.

I was thrilled to have free health, dental, and prescription coverage as well as receive one pair of subsidized eyeglasses annually under Medicaid.  My first appointment was with an optometrist and my second a dentist – neither required me to work through my official Medicaid primary care provider (PCP) – and I could not have been happier.  Next up was my first appointment with my PCP and I wasn’t concerned at all because my health plan said that my existing PCP was an in-network provider.  So, I made my appointment as usual and when I showed up I was informed that my PCP did not see Medicaid patients at his regular office; I was told to call the Jersey Shore Clinic and make an appointment with him there.

After two days of trying unsuccessfully to reach the Clinic, the phone just rang and rang and rang without even an answering system picking up, I decided to go there in person to make an appointment.  The blinds were closed in front of the registration desk and this is what I saw:

No wonder no one ever picked up the phone!  As I had no other option because no one who worked at the Clinic was anywhere to be found in or around the waiting area, I filled out the form (picture on the left) and deposited it in the box (picture on the right).  I wrote the name of my PCP on the form and explained that I needed to see him as a follow-up to my last appointment with him.  Several days later I received a call from the Clinic to set up an appointment and in two weeks I went earlier than my given time in case I needed to do any paperwork.

My appointment was at 1pm.  I was the last person left in the Clinic when it closed that evening.  I spent all afternoon there, saw an intake nurse, went back to the waiting room, and about 90 minutes later I met with a resident who wasn’t even being overseen by my PCP.  The resident consulted with his attending mid-appointment because what I wanted (specific blood tests following a substantial weight loss to see if “my numbers” were normalizing; an order for a mammogram; and referrals to my surgeon, cardiologist, gastroenterologist, and dermatologist) would trigger red flags from Medicaid.  I waited about 30 minutes for him to return.  Then I was told to make an appointment to come back in three months and go to the waiting room, where I would be called to retrieve my test orders and referrals.  Over an hour later, when no one else was present in the entire establishment, I was finally called in to get my documents – I was given an order for the mammogram and very basic blood work, and referrals to a gastroenterologist and dermatologist; I wasn’t able to see my surgeon or cardiologist, nor were the blood tests that I actually needed ordered even though I presented the resident with ample justification for doing them.  I was supposed to return to the Clinic this month; I’m never going back.  Instead, I just paid $2000 (thank goodness for credit cards) for a year of student health insurance through the university at which I am presently engaged in doctoral study.  Anything has to be better than so-called “managed care” under Medicaid.

As someone who worked in academic health sciences for nearly 20 years, I have heard health care professionals, time and time again, sincerely wonder with their colleagues why people on public assistance go to the Emergency Department (ED) for non-emergent, primary care.  Well, I can solve The Great ED Mystery once and for all: require all health professions students to spend one year on Medicaid and they will never again ask that question.


It’s Easter Sunday.  If you’re part of a Christian tradition then today you’re celebrating the resurrection of Jesus Christ.  Although I am not a Christian, I can appreciate the importance of this day to those who celebrate it.  After all, what’s more miraculous than rising from the dead?

I’ve been having a bit of a tough time lately.  I’m trying to figure out how to restore some much-needed balance to my life.  I took an internet self-assessment two weeks ago to measure the extent to which my job has become my life; I answered every question in the affirmative, which, on this particular quiz was not the healthy response.  However, I also remember a time when I actually had a very full life and a very fulfilling job and managed to juggle both quite well.  I’m not sure why I’ve become increasingly more focused on work over the last several years to the detriment of everything else.  But I have realized, and not a moment too soon, that I need to shift my priorities so my job returns to being something that I do rather than all that I am.

I moved to the Jersey Shore seven years ago, after the dissolution of my long-term partnership – the intimate variety, not the business type.  One of the women who I dated shortly after relocating, and who ended up becoming an important and enduring friend, gave me a tiny bamboo plant at the beginning of our relationship.  She didn’t know that I had been so depressed that I had left all of my plants outside to die once I moved because I couldn’t stand the thought of anything relying on me for its existence.  I felt a completely irrational sense of guilt over being a plant-killer so when I received the bamboo I decided, totally subconsciously, that this was my chance at a fresh start.  If I could keep this plant alive then maybe, just maybe, I could start my life over following the unexpected end of a relationship that I thought would last forever.

Fast-forward about six and a half years.  I had become unhealthy, sedentary and a total workaholic.  And my bamboo plant, which had grown from a two-inch sprout to the thriving four-feet-plus centerpiece of my livingroom, started dying.  The decline has been slow and, for me, painful.  I tried everything that I could think of to remedy the situation but to no avail.  I consulted friends, the internet and a local botanist and no matter what the intervention still the bamboo continued to die.  And still I continued to become more and more focused on work.

About three weeks ago, at a meeting with my colleagues, I let the cat out of the bag: work had completely consumed my life and I was at the end of my rope.  Speaking the truth can be risky but it can also be rewarding — if you don’t mind people walking on eggshells around you for a while.  As it turned out, I was not the only person in the room who felt that way, which I never would have known if I hadn’t spoken up.  I have returned to a practice of honest, daily self-reflection and I am making other changes to try to shift myself back into balance.  My art, which was nearly as dead as my bamboo, has just started to excite me again and I spent several days of this long holiday weekend preparing brand new images for a solo show next month.

This morning, I decided that the time had come to dispose of the bamboo; I no longer wished to be surrounded by dead things.  I wanted to salvage the vase so I shimmied the large root base out of the narrow vase opening and into the sink.  I started washing the bamboo, I’m not sure why, with cold water — the roots were slimy with black rot everywhere and all of the shoots off of the main were a droopy yellow  or a shrivelled brown.  I snapped each shoot off and as I thinned out the plant I exposed a brand new sprout off of the bottom of the main that was actually green.  I eliminated most of the roots and all shoots except for the main and the one new growth.  I returned my diminutive bamboo to the original little pot in which it was given to me all those years ago and it now sits in my livingroom again — no longer a centerpiece but still an example of the will-to-life in action.  Apparently, this is a time of resurrection after all.

Phoenix


I was fortunate to be one of 350 people at the inaugural White House LGBT Conference on Thursday.  This was the first in a series of conferences focused on topics related to LGBTQQI (lesbian, gay, bisexual, transgender, queer, questioning and intersex) Americans — this one was on health.  It was a veritable who’s who of LGBT people serving in the Obama Administration — mostly the White House and agencies within the Department of Health and Human Services.  Not everyone was queer (I’m not using that as a pejorative term) but a surprising number of folks were totally out and proud.  Being surrounded by such LGBT-positive energy made me proud to be a lesbian American.  Yes, this is a move to court LGBT voters during an election year; and, yes, the role of Secretary Sebelius was mostly to remind us of all of the wonderful forward momentum that has been achieved under Obama.  But you know what?  I don’t care!  On the day that the NJ Assembly passed Marriage Equality (the Senate did so earlier in the week) and the Governor promptly vetoed the bill, I was only too happy to hear politicos waxing poetic about LGBT Health in ways that reflected that they actually knew something about it.

Health is about so much more than heredity, environment and lifestyle.  Given my genes, the fact that I live in New Jersey and that I consider cheese to be its own food group, I expect that my days are numbered.  Looking beyond those traditional factors that influence health there are others that are just as important.  In health circles the theory is called “Social Determinants of Health” — it posits that the interplay of social, political and economic factors, compounded by the traditional factors, means that certain groups of people have worse health outcomes than the general population.  It is used widely in discussions of racism and health but when I educate people about LGBT issues, I use it to explain how systemic heterosexism and homophobia negatively impact the health of LGBT people and therefore result in poorer health outcomes compared with our heterosexual and nontransgender counterparts.

There are a host of diseases for which LGBT people are at higher risk than heterosexual and cisgender people.  However, even when our risk is exactly the same our health outcomes are worse.  Why?  Because there are other factors that are really making us sick: compared with the general population, sexual and gender minorities are more likely to be unemployed (no wonder since we can be legally fired in half of the states in this country simply for being LGB and the number increases for T); are less likely to have health insurance (most people get it through their employer or their spouse’s employer – and we’re rarely covered by a partner’s insurance); and face discrimination at the hands of health care providers who are uncomfortable treating us (to avoid the extra stress and humiliation we don’t seek care until diseases reach critical stages if we go at all).  I am a highly educated middle-class white lesbian who has spent the last 16 years working in a health sciences setting and I haven’t had a mammogram since my baseline, which was almost 9 years ago.  If I avoid health care providers like the plague then just imagine the gravity of this situation for LGBTQQI people at large.

I am fortunate to work at a school that is committed to addressing health inequities.  The Dean encouraged me to start a LGBT Health Working Group, which now has 30 members composed of faculty, staff, students and administrators from 3 health professions schools at my university.  This group has a three-fold charge: integrating LGBT Health throughout the curriculum so we graduate culturally competent providers; pursuing funding and conducting research related to LGBT Health; and addressing the needs of SGM patients through our clinical services and community programs.

America is not a perfect place by any stretch of the imagination for LGBTQQI folks in 2012.  But there are people all over the country who, in whatever ways they can, are working to address LGBT health disparities and social determinants of health — from the White House to your local public school, we are making every day better than the one that came before.  I am hopeful that one day people will look back at this era and wonder how SGM people could ever have been treated differently from anyone else, much less denied the basic human dignity of full marriage equality.  I may need to cut down on the cheese and get a mammogram to live long enough to see that day but I firmly believe that it will come.

Perspective Matters


I’ve been thinking a lot lately about perspective.  Why is it that some people seem to be very good at seeing the forest and others the trees but few can skillfully do both?  I’ll give you an example of what I mean and you’ll understand why I think this is important.

I’ve had wacky blood test results for over a year.  I have a team of four crack physicians, an internist and three specialists, and none of them have been able to figure out what’s wrong with me.  I was relieved when the hematologist/oncologist declared that I did not have leukemia but was less enthusiastic when he followed that with, “there’s definitely something infectious or inflammatory happening but I have no idea what.”  I wanted to reply, “well, isn’t it your JOB to have SOME IDEA what, Mr. Top Doc?”  Instead, I sighed and hoped that when I returned in six months my test results would be closer to normal.

I should preface this with one more piece of information: the week before this office visit I landed in the ER in tremendous pain and barely able to take a breath.  Two docs (I caught one on the last leg of his shift and the other on his first) ruled out a pulmonary embolism, told me it must be muscular, patted me on the head and sent me on my way.  I told Top Doc this as soon as he saw me and then after reviewing my test results he confessed to the absence of all ideas.

Perspective

I work in a nursing school.  A friend and colleague who was an Emergency Department nurse stopped by my office soon after my ER and Top Doc encounters, asked me to describe the pain, had me point out where (on her back – so she wouldn’t hurt me by pushing on mine) I was experiencing pain and told me that it sounded like my gallbladder.  I told her about my test results and she said that they were consistent with gallstones.  I’m white, a woman and in my forties – a prime candidate.  She advised me to get an ultrasound.  Not wanting to return to any docs immediately, and just being a generally stubborn person, I waited six months until my next appointment with Top Doc and grimaced through intermittent periods of stabbing pain and prolonged dull ache.  I also did some basic research on the gallbladder and gallstones; my friend’s five-minute diagnosis made absolute sense.

When I returned to Top Doc six months later my test results were as screwy as ever.  He was still without ideas.  I reminded him of my ER experience, listed all of the irregularities that the last year of tests had revealed, and asked if maybe it just might possibly perchance be my gallbladder.  I actually saw the giant light bulb over his head switch on – POP! – like when a stadium is being prepared for a night game.  When he recovered his powers of speech, Top Doc stammered something about gallstones being one of the most overlooked blah blah blah … and he wrote me the ultrasound order.

Gallstones.  I have my consult with a surgeon in two days.  After almost eight months of nonsense I’m really looking forward to getting rid of my gallbladder.  If they didn’t suck it out in pieces, I would have my gallbladder bronzed and present it to Top Doc as a reminder that perspective matters and the ability to see both the forest and trees should be required of anyone who holds people’s lives in his hands.  A physician who is out of ideas should be out of practice.  Thank goodness for nurses!  8)