323) Of Rosie's Logic and Rodeo

January 31, 2009

Saturday

Morning:
Today I have arranged to go to dialysis at 3... allowing time for plenty of home chores, starting with homemade waffles and hot maple syrup! YUM YUM. This morning I am at the yearly task of updating my blog's Index, soon to be put up here.

El Milagro: I get here a few minutes late and find that Rosie the Tech has given my chair away and I have to wait about 5 minutes... "Ya snooze, ya lose" I think. But I do have a chance to visit briefly with Suzanne the Administrator in the waiting room... she asks if I am still a Patient Ambassador and I nod "yes" and tell her about the conference call I was on last Wednesday. She is pleased I'm still in the group... and says she will re-add me to her list.

I am in the corner chair today. Rosie sticks me and asks me to wait for awhile while my machine finishes cleaning itself. She comes back to hook me up and we get into a conversation about Rosie's Logic for setting my machine. This starts after I ask Rosie a question about eating before dialysis and entry weight.

I weighed in @ 78 today and my dry weight is supposed to be 75. Here is the question: "Suppose a person eats a big meal right before dialysis? Like, this morning I ate three waffles (made with rice milk, of course) and about an hour before coming here I was so thirsty I drank a half bottle (32 oz.) of apple juice... so why don't techs ask when you ate when they ask your weight?" Seems like it matters when a person added the weight as much as the weight itself. Rosie replies that it doesn't really matter if the tech knows the patient. For example, in my case, even though I come in here @ 78, she does the math and THEN compares it to her knowledge of me (the patient), their history, etc., before setting the machine. I come in @ 78 and she automatically thinks I must've eaten recently cause I have gained some weight over the holidays AND my BP is low, AND historically I can't take off more than 3 without cramping.

She adds that the reason I was so thirsty is that Celeste the Nurse put me on a salt profile last time, hypothesizing that it would help me get down to my dry weight. As Charge Nurse, she's allowed to make those adjustments... "Huh?" I say... having not connected my unusually mega-thirst to anything but the waffles. So, even tho I am noting Rosie's Logic as we talk, I ask her to write down her formula for me when she has time and she blushingly agrees.

Then, to change the subject, she mentions that Amanda the Lost Tech (see Post # 310) texted her and said she misses everyone. I reply, "Tell her that now she can read the blog to keep up with whats going on around here." Rosie laughs and says she'll tell her I said that.

I move on to earphoning myself to my radio and catching the last 30 minutes of Folkways on KUT. I have brought my MI book but enjoy Folkways so much as I write that I don't crack the text. Along with blog maintenance earlier today, I have been considering starting a new blog (partly so that when I open my blog the dashboard has two of my blogs). A new blog to begin... something NOT connected to work or dialysis...what could it be? Wait and see...
Poetry? Not possibly.

Kim the Nurse comes by to do my nursing eval and reports that I sound good and I quip, "I'm a clean machine!" NPR's All Things Considered comes on... I am observing the clinic from the corner. There is this interesting woman in the chair right in front of me getting cannulated by Ann the Nurse. She has been on my shift for awhile now but I have never talked to her. She seems very dialysis-smart... watches Ann carefully and leans over the arm of her chair to check her BP on the machine (many patients just lay here like dead fish as the techs do their work) and conversing with Ann throughout the process. She brings some sort of Red Gatoraide so maybe she doesn't have to watch her diet like me. Is today the day I introduce myself to her? Do we have anything in common? She is wearing Tevas, black capris, and a medium colored cotton lavender shirt, 3/4 sleeves, with darker purple pin stripes. She carefully sets up all her supplies; her fuzzy tan banket over the back of her chair a nice yoga-style pillow in the corner. Her DaVita Sports bag is different than mine... its blue with gold stars trooping across the side. Although she is probably my age or so, her hair is jet black, hanging straight down to the middle of her back. I notice that she has slipped off her Tevas and put on black mid-high socks without my noticing... and it gives the appearance to me of the black footed Indian dancers in New Mexico, their feet and legs standing out sharply against the sand. She adjusts herself in the chair after Ann finishes, and turns on her TV; flipping thru the channels... what will she watch? Will I hallucinate something about her from her choice? She flips... I investigate her face...it is a somewhat weathered face... flat forehead... intelligent, blue eyes that dart around, seemingly noticing everything. When the new tech (Shawna) comes by, she asks her name. She settles her channel on Rodeo... bull riding and puts the speaker up by her ear... considerate of others cause I can't hear it over here. "Rodeo huh? Theres something to talk about..." As she watches I hallucinate that she is very comforable with dialysis and resigned to making the best of it. Of course, these are my observations... and to be confused with objective reality.

Partly I write off on this tangent thinking about Jonathan Kellerman's character descriptions and practicing my own writing style. Also, avoiding reading my book. Now, however, I tire of this write, write, writing and go on to watch some tube. Ann the Nurse stops by to inform me that she is upping my dry weight to 75.5... "Okay."

I find fascinating stuff on the History Channel today: Journey to 10,000 BC, Modern Marvels: The Horse, and most fascinating of all --> Russia's Killer Apemen, the story of Stalin's scientific attempts to put orangutan's sperm into human women in order to develop a race of killer apemen to rebuild the Russian Army. Cool!

Thus finisheth my Saturday Dialysis.
Happy Trails to You!

Notes: In at 78 and out at 75.4 kgs.

322) Homage to Kay Nowicki

January 29, 2009

Thursday

Morning: Well today is a grief anniversary for me and my family: my mom's birthday. Today she would be 87, having been born at home in Lawrence Michigan on the evening of January 29, 1922. The anniversary of her birth, as well as the anniversary of her passing on (October 19th) are dates that are forever etched in our minds and hearts. In the grief research and literature, anniversaries of special days many times bring up grief reactions that aren't evident during the year but are more apparent on these secial days. Sometimes people get into a depressed state without even recognizing that an anniversary of a loss is at hand. As with any anniversary, a celebration is a helpful way to alleviate some of the pain, to honor the loved one, and to cherish the memory. In the Jewish faith on the death anniversary (yahrzeit) we visit the grave and think about our positive memories and place little stones on the headstone to document that people have come to visit. In our synagogue services, we are called by the Rabbi to honor and remember the loss when the Rabbi invites people to say Kaddish in memory of the anniversary of the death. The Kaddish prayer, and the Rabbi's blessing afterwards, including "...and may God bring peace to all who mourn..." has given me a sense of acceptance and remembrance during the years since mom's passing.

So we honor her again on her birthday, and I am aware of finally having a picture of one of her favorite creations on this blog, the Memento Christmas Tree (see Post # 311).

El Milagro: Nancy New Girl comes over with Celeste the Nurse, who asks if Nancy can stick me and I say "Sure". I tease Nancy unmercifully throughout the process and don't really know why. Usually I am not like that with a new person.... maybe has something to do with my hallucinations about her personality. At some point she has to flip my venous needle to increase the draw and I complain to her about "jabbing that thing around up there... what're you trying to do, dig a hole?". She takes it all in good humor and finally gets the thing set right and slowly hooks me up to the machine. Celeste asks my weight (76.5) and does her math and asks, "2.5?" and I say sure and she sets the dials. Jordi the Dietician comes over with my latest labs: all is fine except for my phos-score --> 6.6... up from 6.4. She laughs at the whole thing this time, reporting that the 3rd shift has the worst phos-scores of any. I switch my teases over to her, replying, "I guess you need to do a better job young lady".

Nancy finishes and Jordi takes off and Celeste stays to argue about how the government programs are giving away all kinds of services and people take advantage of them rather than using them to actually help themselves up. I am off to the races: asking her to consider the idea that the dominant, ruling class in America has, for generations, systematically disenfranchised the minority cultures by offering financial programs that keep them in squaller and training programs that are so poorly managed that they do little to lift the participants up to mainstream. And, that as the non-dominant minorities grow in the population, we are seeing more of them enter the middle and upper classes thru the very boot-strap pulling Celeste agrees with (as evidenced in the resiliency literature). As that raising up continues the dominant culture slowly changes and hopefully as the dominant culture becomes more homongenous more is done to adjust social services programs.

Celeste finally has to move off to watch over the old guy who gets up and tries to walk off with his tubes a-dangling... and I am happy to discontinue this edition of the ongoing conservative / liberal debate. I put in my earphones for NPR ATC and what do you think is on? Alex Bloomberg from This American Life talking about Keynesian economics! I look up at the clock and realize its already 5:50 so I switch my earphones to the ABC News and hear about Obama's "relaxed way" of doing business at the White House... he wanders the halls.

I watch and begin reading my MI book. After the local news I switch over to Jim Lehrer and watch an interesting report on stem cell science and the hopes for more relaxed federal requirements now that the evangelical Bush is gone.

At some point midway thru my session Rosie the Tech comes by right after one of the ongoing regular right arm squishing by the BP cuff... her face shows some frustration that I can't describe... but I know it is related to something... "You can't do 2.5. You sat there and told her okay when she said 2.5!... I heard you." My BP is low and Rosie adjusts the amount I'm taking off... and I sheepishly reply, "UH... I thought that taking 2.5 off would take me down to my dry weight. She said, '2.5?' and I said, 'will that take me to 75 and she said yes'". Rosie looks at me and shakes her head, clearly unsure of my "excuse" and seemingly thinking "How can he not do the math?", but I never do the math. I just trust what they say. So, Rosie re-sets the machine and goes over to talk to Celeste about my normal regimen and how I can't really take off more than usual because I need my energy to work during the days, etc.
I see her and Celeste arguing over by Mr. L's chair and I know Rosie will win and Celeste will probably go on as usual. And, I note in my brain of brains that I need to question Celeste more thoroughly whenever she sets my machine.

This is one of the things I don't like about dialysis: each of the techs and nurses have their own idea about what the patient needs and although they politely ask us, they usually go on and do whatever THEY think is right. I have heard much more sophisticated patients than me complain about this over the years. Who knows right, the patient or the staff? Good question. Most of the time I trust them to do the best for me, but I have gotten better at checking certain things to ensure they aren't forgetting something (like is it my dialyzer; and do I have the right baths). And in the case of Rosie v.s. the other staff... I happen to trust Rosie the most. We patients have to find staff in these facilities that we can trust and then use that trust to our best interest. Herman the Administrator really taught me that, I think.
So it goes on my mom's birthday. May she rest in peace --> ABCL.

Notes: In at 76.5 and out at 74.7 kgs.

321) John's Aggie Adventure

January 27, 2009

Tuesday

Morning: My son, John, is moving out to Bryan, Texas today to take a new job that'll pay more and help him to pay off his college loans quicker. Oh, and also, he'll be away from his nagging parents and the party lights of Austin. Instead, he'll have the Aggies to contend with. I woke him up this morning to ask if he wanted to get up before breakfast and get an early start... and he said, "No", he'd rather wait til the crack of noon and get outa here after we are all gone to work. So, I said "Well some people may want to say goodbye..." and he said, "I will receive them in here. Send 'em in..." So, sister Shayna and the Terrier both bounded in...

Actually, I think it is a good move for John, even tho hes moving to Aggie-land. I took a truckload of his stuff out there on Sunday, met the roommate, Eric, and scoped out the mobile home that they will share. All looks fine to me.

On the drive back he shared with me the details of his plans for 1) paying double payments on his loan, 2) saving the majority of his salary, and 3) not spending so much of his disposable income partying by 4) playing soccer and 5) maybe finding an old driver and whacking golf balls. I offered to handle his financial affairs for only 3% but he wants to do it himself. We also talked about his using his GFTCU account since there is a branch out there because he can get better interest rates than from his bank. Actually, blog readers... I am not documenting this here for you... but for him. As an ongoing reader of this blog, he can come back here for a reminder of the "plan" he outlined at the optimistic beginning of his Aggie Adventure

The last few months of having John here, itinerately as it were, has been a wonderful opportunity to spend time and get to know him more as an "adult". When kids are raised in divorced families, even in the best of cases where the parents can get along and the kids spend about equal time at both homes, they are never at one's house 'fulltime' and then when they go off to college, they are basically GONE. So, having John come 'home' and actually stay at my house for most of the time over the past month has been something we wanted to enjoy and get the most out of. And, I think we did.

El Milagro: Nancy the Nurse, who is going to Moncrief's dialysis center, does my nursing eval and Rosie the Tech sticks me and hooks me up. I am thinking about John's moving and wishing we had had more time to work on the back 40 walls before he left. Dr. Venkatesh is here, making rounds with Jordi the Dietician, Ann the Nurse, and Sherry Social Worker following along behind, like a puppy watching for the scraps. When she gets to me she uses her usual happy concern to inquire how things are going for me. She always makes good eye contact, asks some personal questions, and moves to the chart review only after a bit of conversation.

She is still a little concerned about my low blood count and wants to hear about the frequency of bloody noses (HHT) and if they seem to me to be a major loss of blood. Well, how can I tell? I'm used to my nose running blood like a kitchen faucet at times... so, is that "major"? What's major to me might be different than what's major to her. So, I shrug my shoulders, review the amount of bloody noses (maybe every three days or so now that we have cedar and dry heat in the house...) and mention that I think I went to see Leary the Nose Doc since X-mas... She tells me again that they have increased my Heparin and that'll help the blood cells. She also mentions my phosphorous and Jordi reports on the new plans for binders: 1) 6 phoslo and NO fosrenol @ dinner; 2) 4 phoslo and half a fosrenol at lunch; and I added, 3) take phoslo every time I even think about food... which gets a laugh... I correct it to be "take a phoslo with each cracker, egg roll, and breakfast taco..." Doc notes these adjustments in my record and she and her minions move on down the line.

I sit back and worry about my HHT and if I have sprung a leak... and my mind immediately pulls up Bob Dylan's words: "Up on Cripple Creek she sends me; If I spring a leak she mends me; I don't have to speak she defends me; A drunkard's dream if I ever did see one" and then I drift back from that vision to the present, worries about leaking insides and finally, I rest my brain on Roseanne Rosanadana's "Its always something."

I turn on my radio to NPR ATC report on the octuplets and that knocks out my problems in one big whamo. So it goes.

Notes: In at 78.0 and out at 74.7 kgs.

320) The truth According to Jack

January 24, 2009

Saturday

Morning: I have been working on the redesign of this blog and going crazy finding the HTML code for one little item I want to change! I want to change the turquoise (00FFFF) to a more normal looking blue like you usually see for links in emails; a bright blue (like 0033FF). Somehow I just can't locate the right HTML label to change in the template. It has been driving me crazy using my hunt and peck method of searching out a label, editing it, saving it, pulling up the blog to see how it is different, and then going back to the code... over and over and over and over... until it looks the way I want it to look.

And this all started when my friend Gracie emailed me about the color of these posts... the puccoon, or deep red. On her computer the text color is completely different! Made me wonder if my changing my color was a thing I needed to do in the HTML, so when I got home last night I started messing around the the template and HTML code and then checking it on various computers. Sometime during my template investigation Rosie the Tech called and we arranged for me to come in today at 1 pm.

El Milagro: Rosie the Tech has my chair ready and she sticks me as she is telling me about John from Nashville, who arrived for visitor dialysis yesterday and said he knew all about her from reading my blog.

"OUCH" I say, almost pulling my arm away. On the venous poke she has hit a nerve right on its head... or, wherever it hates to be hit. She tries to adjust the needle and that doesn't help at all. I convince her to just stop moving it around and go on with taping it. I envision this little nerve guy in there with this spike going thru his heart and him screaming out in pain... sending a message up my arm and to my brain's pain center informing us all that we should scream out too. Another part of my brain that likes to switch subjects in such a situation, is beginning to sing, "Only time will heal this broken nerve..." and another partner brain part chimes in, "Let's board the pain reduction meditation express , pulling out of the painful station NOW" and I tell all my brain parts and Rosie, "Just go on.... you hit a nerve and there's no fixing it..." while I concentrate on my pain reduction meditation.

So, Rosie continues more gently in hooking me up and shares her thoughts on the new patient, John from Nashville. He told her he got to my blog by googling "El Milagro" and I nod, understanding how that could happen. I reply to her that I have had several emails from him and even sent him my thoughts (see Notes*) on how to make a dialysis center visit as comfy as possible, given that visitors are really putting themselves in the hands of folks they don't know and probably can't trust like the people at their own center. Rosie goes on to say that even though John had good review of my blog, she still is not interested in reading it because she doesn't want to learn any info that would change her view of me as a patient and I nod in agreement. Her reasoning is logical and I certainly wouldn't want her to read the thing and have it negatively reframe her relationship with me.... either professional or personal.

And, simultaneously my brain is thinking too that she is wise enough and thoughtful enough to take what she might read with a grain of salt (<-- now where did that saying come from?). I think of her as cognitively complex: having the ability to consider many data bits without seeing things as black or white. So, then she continues that there are still staff around here who are bothered by my blog. They read it and DON'T LIKE IT... and they argue against some of the things I write as if I was documenting the Truth, or some objective reality which I don't even ascribe to, really. BTW, these musings of mine are subjective observations not empirically validated in any way. And, there is sometimes even some poetic license in what I say in order to increase the humor of dialysis or to make a point. I write my own words and they are my own personal musings from my own skewed perspective... being something of a combination of stream of consciousness, personal observations, and mental constructs of my own thoughts. In that respect, and from the perspective of post-modernism, they are reflections of my truth, not the Truth.

So I listen to Rosie's feedback and her own reflections about how curious it was for her to hear a stranger report that "he knows her" from reading about her on the WWW. Does what he knows fit or is she a completely different Rosie than Rosie knows? I assure her that I think she would approve of my rendition of Rosie. She admits to "almost" wanting to tune in to the blog... but adds that she still won't. I stupidly try to influence her (which I shouldn't, BTW) by sharing my blogging about our FAT discussion: "You should see what I wrote about the other night..." She laughs and I'm thinking, "Stop it. It's her choice..."

When I drove over here today I was thinking of blogging about how tired I am of doing this all the time and how ready I am to move on to the cut me open and dump in a new kidney part and how I am going to plan a strategy for becoming more of an activist in this whole thing... including:
1) Writing a letter to the North Austin Medical Center Kidney Transplant Program about making quicker headway on establishing their paired exchange program;
2) Writing a stronger persuasive appeal to my readers of this blog and the WWW to come forward now and discuss offering me a kidney; and
3) Creating a "Give Jack a Kidney" campaign and find way to advertise in on the web.

I am not following up on these thoughts today however, since I already have written a lot in this post. So, maybe some other time. I tire of these writings now, set up my earphones to hear Folkways, open my MI book and begin to read on...... So it goes on Saturday afternoon.

Notes: In at 77.0 and out at 75.0 kgs.
*Email to John from Nashville on visiting new dialysis centers: "When I am on the road and need to visit a dialysis center, I try to be very friendly and observant and ask about anything that seems different than what I am used to."

I thought I said much more than the above to John. So, if I were writing up again my recommendations for visiting another center I would add: 1) work thru the social worker at your center rather than thru the national service (such as DaVita has); 2) find out the name of the social worker or charge nurse at the center you are going to visit and try to make a personal contact with them if at all possible (email or phone); 3) Ensure that you have paper copies of any paperwork your center has to send the other center: on more than half of my visits, I get there and they don't have or can't find the paperwork; 4) Walk in the door of the new center embodying the persona of "good patient"; friendly, knowledgeable, compliant, etc. ...whatever you would like to see in a tech or nurse is probably what they would like to see in you. 5) Be respectful if you have to direct them or ask for something they don't usually do; 6) Thank the staff at the end of the visit and make some sort of personal comment about their helpfulness etc.

319) I'm FAT!

January 22, 2009

Thursday

El Milagro: "It was the most wonderful speech ever..." Rosie cried with tears welling up in her eyes. She is over here at my chair beginning to poke me and can't wait to discuss the inauguration of two days ago. I agree that it was 'something' and direct her to this blog for my expanded dialog. When I report my entry weight (79.9) Rosie does her figures and arches her eyebrows: "You have to take off 5!" Well, there is no way I can do 5... so she sees I did 4 last time and she sets it up for 4. (You remember, Rosie usually says I can't do more than 3 without cramping.)

She hooks me up and turn to reading my Motivational Interviewing* book (for developing a workshop on MI for March) and listening to ATC on NPR. Pretty soon Jordi the Dietician (self called "shorti Jordi") and Kate the PA come by to visit. Phosphorous is up to 6 again and I share with Kate Jordi's recommendation that I take more Phoslo and no Fosrenol if Fosrenol makes me sick. I mention that I have tons of Fosrenol and don't want to just throw them away and we decide that, since they don't seem to bother me as much during the day as at dinner... I'll take a half at lunch. Then, take 6 at dinner. We also discuss food briefly and Jordi reminds me that my Rice Milk needs to NOT be fortified, or enriched.

Also Kate reports that my blood count is slipping down and we discuss my past problems with blood count. Kate just uses the low count to up my dosage of epogen. The lower my blood count, the higher the dose.... simple as that.

Later Rosie comes by and scolds me about the phosphorous. "You eat 4 little crackers, take a binder! Tortilla soup... 6 binders! Tamale... 3 binders! Whatever you eat, take a binder!" "Okay Okay" I say... and her demeanor shows she's not kidding right now.

I read til the ABC News and watch the news. Switch over to Jim Lehrer afterwards. Mute the TV and read awhile, waiting for Gray's Anatomy. But right before it comes on I find a James Bond movie and get sucked into it... forgetting Gray's until 10 til 9, when I switch over and catch the very end... and then back to Bond.

As I am watching I am having twitchy feet and jumping around in the chair... and then my right foot begins to cramp a little and then my left calf chimes in with some cramping... and adding the cramping to the twitchiness makes me jump like a penguin (<--? I don't know; "penguin" is just what popped into my mind.) I ask Rosie to pull up my chair so I can push my feet down on the floor, which always helps the cramps. She does, while shaking her head and declaring I'm becomming a gordo. I reply, "gordito" and she replies, "You're too FAT" and scolds me again. So then... within minutes I begin to feel faint and she nods, "well, look at your BP... down to 90 something over 50!". I say that's not too bad and I think she turns my machine off for awhile. I immediately feel better. I guess I was just on the edge of crashing out. I get back to watching my movie and Rosie moves off, mumbling about my needing to lose some weight.

A little later we unhook me, patch me up, and I finish watching the movie while holding my poke holes. As I am getting up to leave, Rosie tells me to exercise and I tell her I'll eat less.
So it goes on a Thursday night.

Note: In at 79.9 and out at 75
* Miller, W. & Rollnick, S. (2002) Motivational interviewing: Preparing people for change, 2nd Ed., New York: Guilford.

318) Inauguration Day

January 20, 2009

Tuesday

El Milagro: Celeste the Nurse hooks me up all smiley and friendly today. She asks if I watched the inauguration on TV and I tell her about our office's crowding into an empty office to watch the celebration on a computer stream through a projector on the wall. Celeste seems to be cautiously optimistic about the whole thing, as she wonders how quickly we'll see any change. I muse that we are still experiencing cuts in the programs I work with (we lost three Transitional Living Programs since September) so I imagine that it'll take several years to turn this ship around. Celeste replies that she hopes he does something quickly about the economy, as she conducts my nursing eval and finishes setting up the machine. I mention that I am confused about my weight today... 80.1 kgs. She looks back at the chart and agrees that that is pretty high for me and we discuss how that could happen and are left with more questions than answers. She calculates that we should try to take 4 off, even tho that is over my Rosie Limit of 3. I tell her, "Let's go for it!".

Even though I watched the streaming video of the actual inauguration on computer at work, and had NPR's coverage on my office radio all day, I am still curious and interested to hear more, so I set up my earphones and turn on All Things Considered to hear their take on this historic day.

"We have chosen hope over fear."

This is truly a historic day. In my life I count the days that were so monumentous that they are like bookmarks of living history that I'll always remember in detail. Unfortunately, many of these markers are like headstones that flag assasinations we'll never forget: Kennedy, King, and Lennon. The bookmarks in my mind of the more extraordinarily memorable days of historic proportion must include the day Neil Armstrong stepped on the moon, taking the helm of the Mamamia in the BVI's, New Year's Eve 2000, my wedding day with Lizzie, and the inauguration of the first black American President! I am touched by all the interviews I see and hear with folks who remark that just 60 years ago blacks were legislated as less than equal citizens. I am proud to live in a country that is moving past those times with a speed that seems to be increasing in velocity every year we evolve into the future. This is a truly historic day!

I listen to NPR's ATC, and then catch Charlie Gibson and George Stephanopolous report their views, and then on to Jim Lehrer with Mark Shields and David Brooks analyze the speech. Some say it wasn't his best; some say it was dour... and I am left with a need to see it again and pay close attention, cause I musta missed something the first time. Fortunately, I find it on MSNBC in it's entirety and watch closely this time. Here is what I think: the speech is realistic given the state of the union. It calls us to take personal responsibility for being part of the solution, with which I agree. It has some metaphorical allusions, which I always like. It is short and sweet; realistic and pulling no punches; scolding of the past administration (which is honest and needed); and yet it has a message of hope and a challenge to us all. To me, basically a good speech.

I finally am satiated with inaugural festivities, so I surf for a movie and on AMC find an ironic choice (their's not mine)... Guess Who is Coming to Dinner with Spencer Tracey and Sidney Poitier. What a choice for today... reflecting the inauguration of the product of a biracial marriage... there is this place in the movie where Tracey and Poitier are discussing whether the world will accept biracial marriages and Poitier laments that a product of this marriage cannot be president; but Secretary of State would be good enough. That was 1967... and today, only 32 years later, we actually have a black president! WOW!

And so it goes on inauguration day in dialyland.

Notes: In at 80.1 and out at 76.7.

317) Blog Expansion News & Visit from Liz

January 17, 2009

Saturday

Morning Blog Report: I have been spending some time recently adding my friends' websites, blogs, and home pages to my sidebar. Actually, over the holidays I was looking for ways to expand this blog and the expansions I was thinking of included finding more sophisticated ways to track who this blog's visitors are and to use this blog to network with the important people in my world in one way or another. I began by adding Feedjit at the bottom of my sidebar to track hits on this blog. Liz and I have had great fun using Feedjit to watch hits on this blog in real time... where folks are coming in from and especially the kinds of searches that bring them here.

Then at some later time I hallucinated that it would also be neat to list my friends who are represented on the web somehow and so I started a sidebar category called Friend's Links and have been adding them as I remember who they are. In a few situations I have asked their permission and everyone so far has agreed since being listed might get them a few new hits and in the cases they're businesses they can use some "free" advertising even tho it is on this little brainy & kidney blog. Speaking of "remembering who they are"... my hippocampus seems to work best without personal prodding and concentration. I sit and try to remember who my friends with websites, blogs, etc. are and the harder I concentrate the blanker my brain gets. Then, when I begin to think about something else, an intervening thought jumps in the back door and pops "Hans!" (the last one that popped in there). So, if you are my friend and I haven't popped your name in to my hippocampus as of yet, you can either email me or hope I don't remember you... whichever you wish. And, of course, if I have listed you and you want off the list, please let me know too.

El Milagro: I'm here about ten minutes late today. Jason the Tech does his usual cautious and procedurally correct job of sticking me and we talk about school starting and the effect on the freeways when the UT students are back. Jason sets me and machine all in synch and gives me the "thumbs up" before moving on to care for someone else. Jason is the Best Tech here!

My neighbor to the left is a woman about my age who is watching her TV without using earphones. At our dialysis center the TVs are hanging from the ceiling and each chair has a remote that is corded to the wall and has a little speaker with a volume control in it. There is also a plug for your earphones. The next chair woman's speaker is turned up so high that the noise breaks thru my earphone's intent to keep out the extemporaneous noise... so I have to turn up my speaker to a level that is LOUD and over my comfort zone in order to drown out her noise. I consider reporting her to the authorities and hallucintate them coming over and slapping her silly... but I look over and she has the speaker right up against her ear with that volume and I realize she must be close to deaf or something and I make do with the situation. It is true, according to the techs, that many of the patients do not like using earphones and prefer to place their remotes up by their ears instead. I actually end up turning mine down a bit and pretend that I can't hear her... and focus on my own sound... and pretty soon the external noise doesn't seem to bother me as much.

I am listening to Tom Pittman hosting Folkways and playing music about inuagurations and prohibition (87 years ago yesterday). He plays Odetta, who was supposed to sing at Obama's thing but died recently. Now he's playing Lenard Cohen's song about democratizing the USA... and Bob Dylan's Lonesome Death of Hattie Carroll, and then a great old song I'd never heard before about FDR by Willie Eason... a detailed account of FDR's death and the impact on Black America: Franklin D. Roosevelt: A Poor Man's Friend

I am also reading an interesting article in Science News about the recent research on placebos: basically that when folks take a placebo while believing that it will work, many times the brain functions as if the real medicine has been given, since they "...share circuits in the cerebral cortex -- the part of the brain that evaluates a situation and it's consequences ..." Therefore, it "...all boils down to expectation. If you expect pain to diminish (as in the case of a placebo pain relief med), the brain releases natural painkillers. ...Somehow, anticipation trips the same neural wires as actual treatment does."*

This is particularly interesting reading on the day after attending an all day workshop with Frank Kros from the Upside Down Institute** on ADHD and the workings of the adolescent brain. This work, including reading this article and hearing Frank speak a couple times, informs me of the importance of social workers who work with kids and especially adolescents, to know something about the new brain research and the evolution of the teen brain. Frank makes this knowledge easy to come by, understandable, and fun. I sat thru the workshop with my old friend, Little Kim, and side-whispered throughout about how our own kids paralleled the stories he was telling illustrating brain stuff with the antics of his kids. As usual, I attended to the tricks of the presenter as well as the content, since Frank is an excellent presenter and I always try to steal from the best. From him I got several little tidbits that I'll incorporate into my own work as soon as practical.

So, I'm reading about placebos and reviewing Kros data from yesterday and that completely short circuits my brain of brains after awhile so I must put the brain on hold and watch some TV... happily I surf and find the Color of Money, with good old Paul Newman and that takes me away for awhile until I doze off and come back to find Lizzie the Wife smiling down on me! WOW.

Liz comes to visit me and we talk and she tells me about her morning and she is hungry and I check my tummy and it agrees so she takes off to Texas French Bread for a sandwich for me and a salad for her and we eat in harmony during the last hour of my dialysis. I feel very special. The tech whose name I always forget comes to unhook me and Lizzie takes off and I hold my poke holes until I want out of there... and I split like a banana. So it goes on a Saturday at Dialysis.

Notes:
* Eardmann, J. (2008) Imagination medicine. Science News 174(13), 26-30.
**Kros, F. (2009) Rethinking ADHD: What works, what doesn't, and why. Training Workshop, January 16, 2009 in Austin, Texas, sponsored by TNOYS, (available online at http://www.upsidedownorganization.org/Training/tabid/62/Default.aspx)
And: See new addition on Geri Whitley added to Post # 315.

316) Good Fosrenol & Phoslo News

January 15, 2009

Thursday

El Milagro: I arrive here at 3:30 today and am a hero... and my chair is ready early too... and both Rosie the Tech and Celeste the Nurse seem delighted. I just drove in from doing a training in Pasadena this morning, shooting outa there at noon and making excellent time on the freeways of our land. I returned the rental car and didn't want to go by the office, so I came over here, hoping to get in early. Sometimes everything goes like clockwork. Jo the nurse comes by, says "Hi" and conducts my nursing evaluation.

As she is preparing my arm for my sticking, Rosie and I converse about Pasadena and I mention going over the big bridge over the Houston Ship Channel and how cool that is... and she discloses her fear of those high bridges and I ask about every bridge in Austin I can think of to assess this phobia. She reports having to close her eyes when driving over the flyway at IH 35 and Ben White and says too that the last time she had to drive over the ship channel, she had to stop the car and let someone else drive so she could hide her eyes and hold her breath. I tell her this sounds like a phobia and I can help her with it in about 20 minutes (using the NLP Fast Phobia Cure). She thinks that would be great cause it is an inconvenience to have this fear of bridges all the time. The only problem will be finding 20 minutes when I can facilitate this strategy with her. She is happy just considering not having her reaction, and after she hooks me up and adjusts my machine, she moves off whistling a brighter tune.

I turn on ATC on NPR and again have to borrow Rosie's earphones, since mine are still separated from my DaVita bag... (I let Liz use them to listen to a movie the other day). The big news item is the US Air Flight 1549 landing in the Hudson River... described by one observer as "coming in slow and level and touching down gently in the river", and later adding that it was a "surreal" sight. No deaths... all passengers waiting patiently on the wings to be picked up by various boats.

Jordy the Dietician comes up to discuss the results of my recent 'big' labs: my hemoglobin is down more, but still not serious and my phosphorous is up to 6 again and what was I eating over the weekend. At first I couldn't remember anything about the weekend, but after spending a few minutes running about in my brain of brains, I found a compartment of memories of Stuart's celebration party last Saturday night... where I ate all kinds of bad stuff.... humus (which Jordy says she thinks is okay!), Texas chilie which we agree might be the culprit, and some guacamole and corn chips. She discusses my taking my binders; suggesting the idea of taking them throughout the meal, rather than just afterwards. I let her know that I hate the Fosrenol cause they seem to make me nauscious and she says, "Well, don't take them then. Take more of the Phoslo." This is good news to me. She says that I can substitute 2-3 Phoslo for 1/2 of a Fosrenol, which I will try immediatly. Also, even though it seems cumbersome to spread the Phoslo out throughout the meal, I'll try that too.
I thank Jordy for the good news.

She leaves and I settle back to listening to NPR and snoozing. It's been a long day. I wake up around 7 enough to listen to Bush's goodbye speech and then wake up later to watch part of a James Bond movie before getting cut loose and driving home in the dark cold night. So it goes.

Notes: In at 78.2 and out at 75.2 kgs.
New Readers:
For an INDEX, click January 2008 on the Sidebar and page down to post # 207.
For A Welcome Post, click August 2006 on the Sidebar.
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Friday Note: Upon arriving at my office on Friday morning I found a phone message from Ms. Blanket at Social Security saying that she has worked my Medicare deal out the way I want it: "We can enroll you in Part B Medicare and reinstate you starting in September..." as soon as you pay the premium of $578.40. Hooray for Ms. Blanket!

315) Tuesday Tuesday

January 13, 2009

Tuesday

El Milagro: I am on time today and the chair is ready and Celeste the Nurse hooks me up and does my nursing evaluation. I settle in, get my pens and papers and radio all arranged and am continuing some work from the office today: reviewing and making notes for writing a proposal to fund a statewide research study on the effectiveness of SFBT.

Dr. Venkatesh and Jordi the Dietician come up to visit and I review with them my GERD troubles (which are gone currently). She looks over my labs and says my hemoglobin is down somewhat and other than that all looks good.

By 5:30 I am ready to watch the ABC News and afterwards put my chair back and snooze for awhile. Later I surf the channels and find two Universe episodes to watch, which attract my attentions for the rest of the session. So it goes on a Tuesday evening.

Notes: In at 78.3 and out at 75 kgs.
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Another Passing On Report from Dad: Email from Dad today on the passing of Geri Whitley. How this involves me is Geri was another of those important women of my early history. In my memory, which is implanted by stories from my mom, mostly... Geri and John Whitley lived upstairs from us in Munich in the early '50s and I enjoyed hanging out upstairs with her. Geri allowed and encouraged me to cut the tops off of pictures of cars that I cut out of magazines... to make them into convertables... whereas my mom didn't really like that idea. I think the reason was that my mom was trying to teach me to "stay in the lines" even in cutting out pictures. At any rate my memories are from stories and photos in the family photo albums... of Geri and snow and fluffy overcoats and black cocker spaniels and cutting off the tops of cars while sitting on the warm rugs of long lost times in the past. The following obituary is from the Colorado Springs Gazette

Geraldine Ruth Whitley
November 21, 1920 - December 30, 2008 Geraldine Ruth Whitley left this world on December 30th, 2008 after complications due to a fall she took on December 26th. Geri was born on November 21, 1920 on a farm near Neosho Falls, KS to Edgar Charles Campbell and Estella Mae Hall. After graduating from Leroy High School in 1938, she moved to Snyder, Texas with her family and took a job with JC Penney Company in the accounting department. Later she moved to Lubbock, Texas where she worked at the regional airport. It was there she met her future husband, John, an Army Air Corps pilot. They had a whirlwind romance and were married within three months of meeting, on February 2, 1946. That marriage lasted 62 wonderful years and included life in various places such as post-WWII Germany; Anchorage, Alaska; and many other stops in between. Geri was a homemaker in Colorado Springs until the mid-seventies when she took a job as a paraprofessional in the English Resource Center at Mitchell High School where she worked for many years. Geri was a loving wife, mother and grandmother and was devoted to her family and friends. She was kind to everyone and never met a stranger. Her life was spent "doing for others". Geri was preceded in death by her parents, sisters Bonnie Foree and Joan Maples, and grandson Patrick Niedringhaus. She is survived by her loving husband John; son Rusty (Yvette); daughter Leah Niedringhaus (Dave); and grandsons Andy Niedringhaus and J.T. Whitley. A memorial service will be held on Sunday, January 4th, at 4 p.m at St. Paul's United Methodist Church located at 2111 Carlton Avenue. In lieu of flowers, the family asks that donations in Geri's memory be made to Cal Farley's Boys Ranch, P.O. Box 1890, Amarillo, TX 79174-0001, or the Humane Society of the Pikes Peak Region, 610 Abbott Lane, Colorado Springs, CO 80905. A private internment will take place at Fort Logan National Cemetery at a later date.

314) Rodolfo's Kablooie

January 10, 2009

Saturday

El Milagro: I'm here right at 3, after informing Rosie the Tech this morning that chores were more important than coming in at 11. I am in the corner today. Ann the Nurse pokes me, sets up the machine, and does my nursing eval.

I am facing the bank of chairs along the back wall of the room and right in front of me, in the first chair, is this old guy voraciously eating a plate of food while I get set up. I can't take my eyes off his eating. His food is on one of those new-type styrofoam compartment plates, as if he had just walked in from a cafeteria. He has a baked potato (yes, while on dialysis!), some sort of meat patty with gravy, and some indistinguishable veggie in the third compartment. On the arm of his chair he also has some pre-packaged something-or-other, a square saran-wraped sandwich, and a white styrofoam cup of yellow pudding. He shovels food into his mouth and chews furiously... I wonder... is he so hungrily inhaling this food cause he's starving or is he beyond tasting food and just sucking it in for nourishment. I mention to him, "looks like a good lunch" and he replies that he enjoys it... "...for the rest of my life." and I don't know what to make of that... and go back to simply observing his wolfing. This old man I have seen here before but I don't know him and today's interchange doesn't lead to knowing him any better. He goes on devouring his food and I go on watching from the sidelines. As he is eating he concentrates on his plates and everytime he unwraps something, he tosses the wrapper over the left side of his chair, slightly missing the waste basket beside the chair. I count his chewing briefly... about two chomps a second... chomp chomp chomp chomp... chomp chomp chomp. Really! Its like watching a human chomping machine; his steely eyes looking off into nowhere ahead of him while his jaws are working overtime. He is dressed like usual; with khaki's, old penny loafers, a plaid flannel shirt covered by a gray sweatshirt hoodie and a black woolen stocking cap perched on his head so it's top almost flops over. I guess he is about 70 but I am a terrible age guesser, so who knows.

George with the new Heart is sitting to my left... he came in shortly after me and Rosie teases him and his neice about coming in later than they said they would. As Rosie walks off from George on the left she goes by the Old Eating Guy and scolds him... "There isn't no maid service here..." and scoops some of his trash into the waste basket and then moves the basket over in front of his chair.

So it goes on this Saturday, and I open my novel to read and plug my ears into Folkways... immediately all the clinic drama fades out and is replaced with Jennifer Warnes, The patriot's dream and then Bobby Bridger's Heal in the wisdom...

"there is a season, there is a time
there is a purpose, and there is a plan
and one day together we'll heal in the wisdom, and will understand"

What a way to replace the mundane sounds of a dialysis clinic. As I am reading, Folkways completes it's Saturday run with James Mcmurtry's Down on the Delaware and finally, James Taylor's Lo and behold... so I read on and listen on and all of a sudden a face from the past walks up smiling.

It is Rodolfo the Kid (see post #204; The Spanish Lesson) coming to visit. He says "Hi" to George and turns to my chair smiling and says, "How ya doin?" in his broken English. He reports that he got a transplant from his mother back in May and is doing great. I reflected to him that he looks Great and asked about his life now. Rodolfo asks about my situation... "No relatives for a kidney?" and I shake my head and briefly complain about no paired exchanges here... He is happy to be out of dialysis, is very healthy and not minding taking the few meds he reports he has to take. Since he got the kidney from his mom, he doesn't have to take as much of the usual anti-rejection drugs. I am happy to see him and tell him so, "You need to go by everyone who is awaiting a kidney and say hello to them to show them what the future is like without dialysis." Rodolfo smiles and I'm not sure he understands exactly what I just said... but he nods and smiles and moves off to speak Spanish to George with the New Heart. I muse as he moves on... "Wow... he looks so good and happy and when I finally get my new kidney I want to come back to say Hi to folks here too. It is awe-inspiring to see him looking so good! Makes me happy too."

As the time passes I also want to tell Rosie my Saturday story, and she finally comes over and we converse. She reports that when Rodolfo disappeared back in May they all thought he had gotten a cadaver kidney, but unbeknownst to all, he and his mother had been planning and preparing for this operation for some time, and then, kablooie, he's gone and they find out months later that he got the kidney from his mom. Kablooie? I wonder if that is a good word meaning fast kidney transplant. I would like mine to be a Kablooee type transplant. To me Kablooee suggests a one-word translation of wham-bam-thank-you-ma'am... or as otherwise known: a quickie. For me, Rodolfo's kidney plug in was a "quickie"... he was there... he was gone... now he's back. Kablooie! He's got a new Kidney. Probably didn't seem that way to him though.

So, my funny Saturday note that I report to Rosie is that she calls to see if I want to come in at 11 and I think, "No, I've got to get my pop-up from Bobby" and ask for a 3 o'clock chair. I am single minded about getting the pop-up in my garage by the end of fall (January is close, we decide). So, Johnny the Son and I drive out to Bobby's and with some minor glitches get the pop-up and are about to leave and Bobby says, "See ya tonight" and I remember that it is Stuart's Celebration and I reply, "Oh yeah... see ya then...". We drive on home, squeeze the pop-up into the garage, mention to Lizzie about the party tonight, and eat lunch and along about 2 I realize that there is a party at 7 and I'll be in dialysis to 7:30. For some reason I had never until this minute put the dialysis/party schedule together. Like I said, single event planning is the mark of a fairly functional ADD person! It is funny to me that I never could put chore/dialysis/party together... that's THREE things. This is how my life is complicated.
Rosie is very sympathetic and reframes my self desparaging story as "We all are so busy these days it happens to all of us. Just the other day I went off and forgot...." something or another which gets past me cause I am off in my brain trying to figure out how I ever get anything done at all. She goes on and I do respond and it is a nice little conversation about how the advanced technological society has overwhelmed us old folks, basically.

So it goes.

Notes: In at 75.7 kgs. and out at 74.5 kgs.
New Readers:
For an INDEX, click January 2008 on the Sidebar and page down to post # 207.
For A Welcome Post, click August 2006 on the Sidebar.

313) Of GERD and Diet

January 8, 2009

Thursday

El Milagro: Before Rosie the Tech is ready to poke me, Kate the PA comes up to do doctor talk. I bring up my recent self-dialgnosed GERD, describing the regurgitation in the middle of the night symptom, my use of Tums, and the extreme cough this episode left me. Kate agrees that it is probably GERD and recommends the following after I tell her I don't want to add another med to my list: 1) Read more about a GERD-reducing diet on the internet; 2) Keep an eye on the cough and talk to Venkatesh if it doesn't get better (she warned that GERD is nothing to ignore because it can become cancerous); 3) take Tums, Milanta, or Prilosec when the blotting is bothering me.

Sometime during this conversation, Jordi the Dietician strolls up and reports again that my phosphorous is back down and the and Kate are sure it was due to my changing my diet, although I maintain the high 10 was a lab mistake. Jordi does have some comments on my food chart. Both swordfish and oysters are high phosphorous! And, "How could anyone put oysters in stuffing? You must be from up north somewhere." I ponder that and dig back in my memory to the origion of oysters in stuffing... "My family came from up north but they didn't put oysters in their stuffing... I guess it came from some group Turkey day celebrations along when I was a young adult out on my own..." and I wonder if adding oysters came from Clifford from New York or someone else from my Upper Mesilla Valley Group. Jo the Nurse pipes up that she loves oysters on the half shell and we talk about the difference between gulf oysters and northern coast oysters, while Jordi wrinkles up her little nose in disapproval. Jordi goes on to mention the 'cookies' on my list and I reply that those cookies are all home-made, not box cookies, and she nods agreement about those. I ask again about the clemintines, and she reports that they are low potassium but higher in phosphorous and I shouldn't be eating a box of them! DAMN! She and Kate also want to know about my staying off rye and on to the white bread bolillo rolls and they are happy that I have integrated those successfully into my diet. Jordi opts out of the conversation with a reminder that we have BIG labs next Tuesday. She is proud that the whole clinic had comparatively low phosphorous scores this past time, and bemoans that she didn't get any positive feedback about that from administration. I take this opportunity to applaud Jordi's efforts to get El Milagro patients to follow their diets and take their binders! Hurray Jordi! Keep up the good work kid!

As they all move on to other patients, I see Sherry Social Worker and am reminded that since Tuesday's call to Social Security I haven't received the form that Ms. Blanket promised to send me... so, maybe I should stress the bureaucracy by following the instructions on the letter they sent me and write them back a letter describing my call with Blanket and my request for a different start date than they are offering. By doing this, I will be 'covered' in case my phone call with Blanket doesn't achieve anything.

As I'm writing this I remember that tonight is the BCS championship game with Florida and OU and I need to find out what time and channel... right now I'm hearing about auto show models and how they followed Marjorie Kress (?) in becomming "gearheads" in the mid 80's in order to prove they have brains as well as brawn. What? It is time to switch to network news... ABC here I come... off radio, transfer earphones to TV and here is Charlie and the news... which I watch while beginning to read my Alex Delaware novel.

Later I watch the boring game thru the first half and wonder why all my colleagues want Florida to beat OU. In my brain, a Big 12 winner of the BCS is at least a winner from our own conference... I don't get it... and the announcers don't catch on that they should clear this up for me. Oh well. I doze off a number of times during this game and then it is time to unhook and go home. And so it goes.

Notes: In at 78.6 kgs and out at 75.2 kgs.
Happy 68th Birthday Joan Baez!

312) Insurance & Medicare Blues

January 6, 2009

Tuesday

Earlier: So, I hate posting about money and insurance and such... but now it has become something to address in this blog... mostly for the considerations of others wrestling with ESRD and dialysis and such. Back in 2006, when I began dialysis, I was on the University of Texas system insurance and it was excellente'. When I came up with the PKD diagnosis, Liz and I transferred me from my TNOYS' small group (8) plan to the big University plan, where I just slipped into the stream of thousands of participants. In those days the University plan covered everything with just low co-pays and reasonable med coverage.

Well, then the state vs university issues related to caps on how much UT and others can charge students was brewing, the university was claiming that they were struggling with all their finances, and needed to find ways to save money, as well as generate new income. They wanted to break the cap on student costs, which they eventually did... causing college costs to raise by 8-29% back in 2004*, and in 2007 the university proposed raising costs an additional 13 to 22%**. So, what this is all about is that the University, in order to save money, also was looking for cheaper insurance packages for the staff and faculty. Our initial insurance thru the university had about four options and we selected one that met our needs; and in hindsight it was a very generous plan. Then, last year, the HMO plan we had was axed and the only plan available was a PPO plan with a large (to me) deductible ($250 per person) which we had to pay in the first month... that was a new costly twist for us. After that it seemed that things were okay again. We had adjustments in our outgoing costs which Liz mostly handled through her planning and socking money into her Payflex account.

Meanwhile, Sherry the Social Worker at El Milagro kept bugging me about getting on Medicare, saying that my insurance would hit a time limitation and then I'd have to be covered by Medicare. Liz said, "there is no cap on our insurance" so I just let the whole thing ride.

Now I must admit that I have NO interest and a fairly severe aversion to the insurance side of this whole dialysis medical condition thing. I hate dealing with insurance companies in general and I always feel like an idiot when I try to understand any of their financial jargon. So, when insurance things progress I usually hope that my best buddy Liz will take care of it all. She is the one who deals with insurance, prescriptions, etc. and God will surely recognize her in his Book of Life for her mitzvahs to me over these years. And, as I write this I know that this is MY own version of the story, and it is twisted by my obnoxiously fetid feelings about insurance.

Anyway, I put off doing anything and finally Sherry Social Worker said "We HAVE to Do This!" and Lizzie said, "She's right. Do it, dammit." and I filled out and sent in my Medicare application, dated whatever date I sent it in. They explained to me that it would cost me a monthly premium to have Medicare and I thought of that as a little like the flying money cartoon at the right ---> and thinking things like; "I've been paying out for insurance my entire work life for 40 years and never used a dime of it til this damn PKD thing came along... they owe me...".

So, I send it in and then about 30 seconds after it leaves my grubby little fingers, I get in the mail a bill from El Milagro for 987 dollars and 64 cents for September! Well... that must be some sort of mistake I tell myself, Liz, and everyone within earshot. Without another thought I take the bill to Sherry Social Worker and she says, "I'll check into it." and I forget the whole thing. Keeping that bill in my mind would pollute my daily happy as a clam attitude so I file it. I have this uncanny ability to file things in a portion of my brain that I don't even have a map for... they're back there somewhere, in a place similar to where they stored the arc at the end of the first Indiana Jones movie... along with hundreds of other boxed and stored thoughts that only lead to trouble.

In less time than I would have liked, Sherry Social Worker comes back to me and shrugs that the bill is "FOR REAL", my time limit of 30 months of dialysis was reached for my insurance and now El Milagro is billing me for the part the insurance won't pay anymore (20%) ... and this is the bill for September.. and I might have to pay it! My mind automatically flips to it's anarchistic channel and I think... "Sure... I'll pay it at about a dollar a month..." Sherry is very social worky about the whole thing, saying supportive things like she is sorry, she's sure something can be done, we can make an appeal to the rich guys who give money away, etc. etc. And I am vomiting brain curses and anger and bile of the sorts I can't even describe here. (This is only funny now, many weeks and solutions later, BTW)

How ironic! I put in an application starting my Medicare premium at the latest possible date and then get a bill that is nine times that amount that I should have to pay while I am trying to save the measly hunert bucks a month. And there's more to come... another bill for 5 hunert something for October and it's gonna keep going... yikes!

So, Sherry Social Worker says there might be something I can do with the Medicare folks; I should call them and ask to change the date on my application. If they'll let me change the date to September then those bills will be paid by Medicare, not Jack. And paying a hunert bucks premium now seems like a small price to pay for such coverage, doncha' think?

And before I even get a chance to call Medicare I get a letter from them saying; "We did not give you you medical insurance earlier because we did not process it timely. If you want the benefits earlier, you can choose... blah blah blah. And it seems like this whole thing may be settled before the flying dollars get too high to grab back.

But, before it is settled, I must pay my dues: I must contact the Social Security Administration by phone and talk to a bureaucrat! Here in the postmodern world we have this cool new function on our phones. We can punch in a number and then, as long as we don't call any other number, we can hit a little button named "redial" and the phone actually remembers the last number we dialed and dials it again... beep beep beep - beep beep beep beep! This is a very helpful function when one is trying to call Social Security. In fact, I kept count, just for fun... and it takes me 32 tries before getting a line into the place. I get Ms. Blanket and she is very nice and she "Hmmm"'s as I review the letter and tell my story. And she quickly assesses the situation and concludes, "You must appeal... I will send you a form". I protest, saying I don't really need to "appeal" their decision in the letter. I quote from the letter to her: "...we did not process (your application) it timely. If you want these benefits earlier, you can choose... tell us in writing..." and then I add, "all I want is to start the benefits on September 2008, not the date the letter suggests; December 2007".

"Hmmmm. Well, sir, you need to appeal and I will send you a form." I get it, so I say, "Do you have my address?" and Ms. Blanket has it covered... "Yes... we have ALL the information and I will send out your appeal form today." So, there ya go! I am all fixed up. I want to feel confident the whole thing is settled, so I make up a little affirmation to say: "I am serenely happy that my Medicare is completely settled and serving my highest interests" I will memorize this and try to repeat it a hunert times a day til I get my form and complete it and send it back. Nam Myōhō Renge Kyō***

Morning: Can you believe those Longhorns? What a game... depressing in the first half, good third quarter ending with us ahead and then high fear, loathing, and nail biting in the fourth all the way down to two and half minutes left, when McCoy threw to Cosby for the win with only 16 seconds left. Whew!

El Milagro: I walk in, weigh and poke my head around the corner to Sherry Social Worker's office to show her my Social Security letter and catch her up with my talk with Ms. Blanket. Sherry doesn't seem as enthused about 'appealing' as I was... thinks I should go for the early date and ask the Kidney Foundation to pay the difference. I reply that I think it is better to go thru the appeal process and not use the foundation unless absolutely necessary.

I move on to touch base with Jordi the Dietician, who is standing shortly at the nurses counter and has a new lab report for me. Yes, phosphorous is still high, but only at 5.7, which is more respectable than the last 10.4 phosphorous. She says again that she thinks that one was a mistake. I turn over to her my food chart (from 12/19 til today) to review and mention that it is probably not the best report due to the holidays looking different in my food behavior than more normal times of the year... like the upcoming time in January. So, I say I'll continue reporting it if that is of interest to her. She shrugs, so I'll continue.

Kim the Nurse hooks me up and does my nursing evaluation, while Celeste the Nurse sets up the machine. I settle in to reading my Alex Delaware mystery and half listening to ATC on NPR. Also floating around in the background are various images and sparks of ideas related to a new writing project I just started with my old colleague Leslie. Since I can't get those sparks to lie down, I lie back, put down my book, and concentrate on the radio news... and, of course drift off into la la land. Wake up at 7 and watch NOVA about the Brits who tried unsuccessfully to track the northwest passage over Canada and got frozen into horrible, gap-mouthed, monstrosities that would't be found for hundreds of years or so. Fascinating... and then doze some more and wake to a Frontline Report on the old man and the storm****, which is really worth watching. This absorbs me for the rest of my time and then I get unhooked by Celeste the Nurse, and truck on home.

Notes: In at 78.7 and out at 75.4 kgs
* Nazareno, A. (2004) College costs raising faster than incomes. Retrieved online from the College Parents of America website, http://www.collegeparents.org/cpa/about-in_news.html?n=1026
**Hacker, H., Brooks, K., and Rosen, A. (2007) UT, other colleges get third degree for soaring tuition costs.

Dallas Morning News, retreived online from http://www.wiche.edu/news/clips/07Nov18_DallasNews.pdf.
***Daimoku, retrieved online from Wikepedia, http://en.wikipedia.org/wiki/Daimoku... and in my own translation, from the days of the many morning meditations (circa 1975), "all things according to God's will".
**** The Old Man and The Storm, retrieved online from Frontline, http://www.pbs.org/wgbh/pages/frontline/katrina/