Dear Dan:

I have a confession to make. I like you just because of your name. I have a character named Dan. His full name is Daniel Phillip Parker and I can tell you just about everything about him. What he likes, how he smiles, the things he would say given a certain set of circumstances. I love Dan Parker. I love the kind of person he is. He’s an artist. He’s outgoing. He’s attractive, witty, kind and funny as hell.

When I started writing I wasn’t looking for Dan Parker. My initial idea was to write about things that I knew something about. One of my sisters told me I should write about nutrition. I used to be the biggest nutrition Nazi there was. Dan’s mother-in-law Rita is the food fascist in my stories but her over the top concern with nutrition stems from an over-whelming, over-powering love for her children, her family and it truly bothers her when she sees other people who don’t eat good nutritious meals.

I know Rita feels that way because that’s how I feel. It bothers the heck out of me when I see people making poor food choices. I shouldn’t say Dan Parker couldn’t care less about food because that’s not the kind of person he is but he’s much more interested in people than he is in food. Dan likes to get to know people he finds interesting. He doesn’t write poetry but he admires others who do. Dan is an artist. He's an artist in the three ways that people become identified with vocations and avocations. He knows art, he loves art and he becomes lost in the production and contemplation of his craft.

Dan Parker gets pulled into his future wife’s family by a very good friend of his. Her name is Lana. I’ve written about her in other places and what I love about Lana is how she can see talents that other people possess. I gave that ability to her, her character is very loosely based on one of my sisters. I’m not like my sister. I’m not like her at all so I have to admit that when I first met you I didn’t see the artist in you. Now that I’ve gotten to know you a little better I can see some of the things I was missing before. I know that people can come across one way and be feeling something very different from what’s being perceived by other people. That’s a game I play. If you act like things are superficially okay then people don’t know what’s really going on in your life.

It’s very difficult for me to try and explain how I feel about what happened the other day. I feel like I let a friend in need down and I…

I can’t finish this. All I can say is I never meant to let you or anyone else down. Your reaching out to me means more than I have words to express it with so just like I’m awestruck standing before magnificent works of art I’m rendered speechless by the gift of your friendship.

Wishing you more better than worse but glad you’re around to share both with.

Gratefully yours,

j

So, Gary has plantar fasciitis. For him, what this means is that these quarter-sized, inflexible, painful knots have grown on the tendons that run along the undersides of the arches of his feet. If that sounds like fun, boy, it is! So, he went to his GP about it, and his GP referred him to a podiatrist who's supposed to be the best in the city, treats the OSU football team, etc. And so kindly Dr. Fancypants said, "I can fix this with surgery!" And so Gary went through a painful surgery that involved a Z-shaped incision across the bottom of his foot, and involved not being able to walk for weeks, and then ... three months after the surgery, the knots started to grow back.

Dr. Fancypants, of course, dropped him like a hot rock after Gary's recovery (or lack thereof) didn't go as expected. This seems to be a distressingly common physician reaction -- if at first you don't succeed, ditch the patient and don't answer their calls. I am no longer surprised that people sue for malpractice, because there seems to be a whole lot of really shitty practice going on. Gary made do on pain meds, and recently went back to his GP for another referral.

So, he went to a new podiatrist, who I'll call Dr. Hope. Hope said that he only does surgery as a last-ditch attempt to fix the problem because, tah-dah, the knots come back. Dr. Fancypants never once mentioned this as a probable outcome. Dr. Hope put him on Lyrica, which makes him thunderingly stoned but does actually seem to be reducing the size of the knots. Fingers crossed that this guy has the clue he claims and this will help Gary be able to walk to the grocery store.

Today, Gary got referred to another place to test his foot for nerve damage. So we went from the podiatrist up the street to a different clinic -- which doesn't take the university's insurance. So back to the podiatrist's, where we got another referral to a hospital on the other side of town which doesn't have an opening for another month.

This system is completely fucked up. Health care is so wildly expensive you pretty much have to do what your insurance dictates, so if it's not seen as an emergency you don't get treatment on time, and you're discouraged from getting a second opinion because you've waited so freaking long and jumped through so many hoops just to see a specialist in the first place ... bah. We should not have had to leave the clinic today and wait another month for a routine test.

Rant over. Oh, wait, it's not over. I don't place all the blame on the insurance companies -- out of ten people I knew in college who were premed, one of them was interested in helping people. The other nine were mostly all interested in being able to drive Ferraris. That's a lot of the problem right there.

Reading Lucy-S's story about her honey's problems with medical insurance (this is US centric) reminded me I had recently read a very well done article here by a hand surgeon called "Managed Care and your hands, What you need to know". It talks about managed care and its restrictions causing "a war of attrition from micro - mismanagement and poor flow of care" and how it can make a difference in the outcome of hand surgery even if the patient has the same procedure by the same surgeon. This can easily be generalized to most sorts of surgery.

It is difficult to know what to do about this as an individual. Certainly we should lobby for regulatory control of insurance companies as their excessive profit is the big impetus behind many of the problems. Those of us who can should lobby for the purchase of better insurance through our employer but the option for that level of input is not available to many. Some companies offer choices, maybe a good PPO, adequate managed care and suboptimal managed care with the employee paying through the nose as quality increases. If you can, it is worth it to purchase better insurance.

Some/many don't have the ability to be insured at all.

Think about these things as you cast you votes and even as you make decisions about where you work and where you spend your medical dollars. The time when it was best for someone else to make the decisions for you was always a fantasy. It is difficult and sometimes impossible to wrench that control back but we need to give it our best effort.

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