Quagmire: To Laugh or Cry

Jacob wrestling the angel (from which he acquired back pain)

During the last two years I have treated a young woman who personifies my perception of the challenges of America (and our health care system).  She has limited educational and economical opportunities, landed in a threatening marriage, was injured in a car accident, and is overweight and unhealthy, now with severe pain and a resultant narcotic dependence (doctor prescribed).  Her MRI scans demonstrated significant disc herniations in both her neck and back with severe nerve compression, etc.

Ancient treatment for back pain

Despite all the factors mitigating against success, I offered her surgery hoping it might help lift her up and allow her to move forward with her still young life (she was just 29).  I was thrilled at her post-op visit after her second surgery to see a better dressed, slimmer, and much more animated woman greeting me.  She had thrown out her abusive husband, returned to work part time and lost 15 pounds.  Her progress was outstanding and encouraging.
Fast forward 12 months-she is back and the sight she cuts is not nice.  Now her skin is gray and droopy-an obvious reflection of poor nutrition, her weight has rebounded plus some, her narcotic use is higher than ever, and her back pain has returned. And then she relates a particularly distressing tale, motivated, I think, by her own guilt.
After her second surgery, her insurance company sent my professional fees to her (this is a local practice when the doctor does not work within the insurance network) a check of several thousands of dollars for this complex spine procedure.  She tells me she deposited the check in her bank with plans (when it cleared) to write me a check to cover her fiduciary responsibility.  However, because of unrelated financial problems, the money was "seized" or "frozen" by some creditor and taken to pay off some other debt she owed.
I admit, I am gravely disappointed-nothing worked the way it should.  This woman has potential that I fear she will never realize.  I have performed surgery that I have not received compensation for because of the perverse insurance system we live under. A quagmire and a failure-I feel a part but also feel helpless as an individual in a complex system. I fear that until we address the totality of these types of issues, our health care system will continue to groan and fail for many similar individuals.

Edgar Tafel and Me

Edgar Tafel 1912-2011

I learned this week of the death of Edgar Tafel-a noted architect and also Frank Lloyd Wright (FLW) Fellow and Historian.  I am connected to Edgar because I live in the first house he ever designed and built (after he left the FLW Fellowship).  After we moved in to this unique and special home, we contacted Edgar who graciously came to visit us-beginning a friendship of many years.  Over a rainy-day lunch, he regaled us with talk of building this home for his parents, architectural history, stories of FLW, and his own personal history of loves, careers, and more.  Later, we had him return to deliver an aspiring lecture at our library on FLW followed by a reception in our backyard.  We also had the privilege of visiting him in his townhouse in NYC on several occasions.  Quite by chance, when we bought a small apartment in NYC, it was less than two blocks from his home, to which he had returned full-time.  I last saw him just a few weeks ago-stopping in on a whim while walking my dog.  Last week, I again passed his door with on a canine walk and realized he had died-I can't tell you how but I did.  I returned to my apartment and furiously "googled" him without finding any news.  But just days later, the obituaries appeared.  He was 98! He had lived long and large-seeing so much of modern architecture, art and music-all things he loved dearly.  While he is not a household name, his impact on how homes, places of worship, and college campuses are built will long outlive him.  His gracious and generous endowment to Cornell University will also assure his remarkable legacy.  Tonight I will say Kadish for Edgar Tafel.

The Albert House

First Presby Church NYC (Village)

Patient Wisdom

Sometimes my patients utter wisdom that I feel blessed to share with others.  Here is a recent representation from just one day in the office:

• As to my children, I don't worry about the first 10 years (of their lives), it is the second 10 I lose sleep over.
• Parental wisdom comes in waves.  At first children think their parents the wisest humans in the world.  Then there comes a time when they know absolutely nothing.  This may last for 10 years or more.  Then the next generation arrives and suddenly the parents regain their rightful place as all knowing and wonderful.
• You may have been taking care of these types of patients for years but I have been dealing with my mother for more than 40-I think I know her well.
• If you ask the wrong question, you may get an answer you don't need nor want.
• I realize there is a price to pay for everything.
• I can only ask that you do your best and that you are honest.  No one is perfect.

Everyday, my patients share themselves with me.  I am eternally honored by their trust and the wisdom they share with me-it has enriched my life.

Health Insurance News

California seems determined to lead the country in health insurance reform.  This week, they announced emergency measures that would require that health insurance companies spend at least 80% of their premium dollars on direct patient care.  While this same provision is part of the recent health reform bill, somehow these headline stories really struck a note with me and crystalized some key thoughts about our current health crisis.
First, we no longer pay for health insurance-we pay for a health care policy.  Insurance is something you pay a smallish amount of money to pay for something that you hope will never happen.  Health insurance used to e something like that-we paid to cover the big things that might arise while we paid "cash" for everyday health care needs.
Second, as a result of number one, individuals are no longer connected to health care costs and thus have no role in stabilizing costs.  Sure, rises in premiums are hard felt but they are no longer directly connected to how individuals use their policies.  Once they have paid, they have little or no incentive to limit their use of services.
Third, having free market health policies (not real insurance) puts us all in a horrible conundrum-if it is free market, then why should their be any constraints on how much profit these companies make, how much their CEO's earn, or what services they choose to cover? But no one really feels like it should be the free market like cars or restaurants or supermarkets...because it is our and our loved ones health and we need to know there is some control, somewhere...
So in the end I find it somewhat like a Rubik's Cube puzzle-once you know how to solve it, then it is easy but until then, it seems unfathomable.

• Why should even 20% of our premium dollars go to administering the delivery of health care-I can't speak for others but what I do pay in premiums, I want invested right back in taking care of patients-not administrators who work to find every way they can to not pay doctors or hospitals or negotiate with the same in good faith.  
• Why should non-physicians get significant say in what services, surgeries, x-rays get approved?
• Why should consumers be able to demand tests, care, interventions that have no indication just because they have paid for a commercial product?
• When will partisan bickering be put aside to allow for real discussions about what ails our failing health care system?

Journey Back Poland (Germany)-Final Berlin

Berlin Wall Remnants

Berlin was ultimately the perfect place to conclude our Mother-daughter "Roots" journey for a variety of reasons.  In planning the trip, it was natural to end in a city with an international airport and Berlin was also where my grandmother and grandfather last lived in Europe before fleeing to Haifa and then on to New York.  Berlin also offered a broader view of the history of Germany/Eastern Europe/the Jews than the smaller cities and villages where we had spent most of our time. Finally, Berlin today most definitely is looking forward and this energy, enthusiasm and optimism was the perfect balm to the grief and sadness that inevitably suffused much of our looking back and connecting with our personal and ethnic history.
After driving through primarily remote regions, our approach to Berlin served as an abrupt return to the 21st century with congested, interlacing roads with the requisite confusing signs-at least when keeping up with the pace of the Autobahn.  We found our hotel, perfectly located within walking distance of nearly all the important East Berlin sites with several convenient transportation hubs available to allow more expansive exploration.  My first great surprise was learning the hotel would arrange to have my rental car returned-that I would not have to negotiate the Friday evening rush hour traffic in central Berlin after all.  With my new found freedom,  I had time to set off to stretch my legs and explore our immediate neighborhood.  Mom rested and we made arrangements to enjoy a nearby Turkish restaurant for dinner.

Alexanderplatz

The next morning we took the U-bahn to Alexanderplatz-the meeting point for our guided tour on Jewish life in Berlin.  As much as I like exploring on my own, the right guide can really unveil the heart and soul of a city and that's just what happened. We saw smaller and larger memorials to the Holocaust and to the small but meaningful efforts at resistance-hearing stories little known of bravery but also of brutality.

In the heart of the old Jewish quarter, we also saw the Hackescher Hofe which have largely been rebuilt (gentrified) since the fall of the Wall and may be one of the ultimate representations of the rebirth of what was once a bleak East Berlin.  The tour culminated at the New Synagogue-a spectacular building completely renovated to serve as tribute to the once thriving Jewish community of Berlin.

New Synagogue

Hackescher Hofe

We said goodbye to our guide, hopped on another U-Bahn and headed to (Charlottenburg), the center of my grandparent's life during their married years.  The lovely Platz (square) was ringed with inviting cafes-just what we needed.  Then we set off up Knesebeckstrasse in search of my grandfather's store.  We easily found the first address and were lucky to get inside the lovely iron doors to look around.  It was an amazing feeling to think of my grandparents selling furs right on this spot to support the family.  We then wandered on to the second address.  This one was less obvious, especially as we had one photography of my Grandpa Henry standing in front of the store so we were trying to match not only the address but the door frame.  In the end, we linked them all and felt this confirmed when we walked around the corner and found a fire station-Mom immediately recalled her brothers talking about this.  We had been to their places of birth and to places where they were raised but somehow, this felt so much more tangible-like I could reach back through time and touch the lives of my ancestors.

Knesebeckstrasse

Knesebeckstrasse

We had paid our respects to our family and now we paid homage to history.  Though we were both exhausted-physically and emotionally-we headed to Checkpoint Charlie then wandered back along the remnants of the Berlin Wall.  While little remains of the physical structure-art, poetry and historical placards remind all of another challenging time in German history.  I deposited Mom at the hotel and with just a little time left, walked up to Berlin's monument to Jewish martyrs.  An entire large city block has been given over to this memorial which is both simple and moving.  I love the fact that tourists and Berliner's alike perch on the stark stone blocks to rest and remember-with signs of a rebuilt Berlin bursting forth in all directions.  I concluded by foot wearing day walking to, through and around the Brandenburg Gate.

Berlin's Memorial to Jewish Martyrs

Now, Mom and I could share a final meal together and celebrate all that is Scharf, Benzil, and Kranzer.  After donning our best attire, we headed to one of Berlin's restaurant stars: Rutz.  There we luxuriated over a spectacular 5 course meals accompanied by the best of German wines.  Certainly a fitting end to a very special adventure.

Naomi at our final meal at Rutz

A Story I Have to Tell

She came in for her second post-operative visit right after the holidays.  As always, by her side was her cuddly husband.  After dispensing with the medical stuff (she was doing well), I gently teased them about dressing alike (they were wearing these lovely bright blue and navy clothes that seemed like a matched set!). "Well," she said,"I guess it just happens that way after 55 years-we just celebrated our anniversary." I couldn't let that go so after congratulating them I enquired further why they had married so close to Christmas.  To my utter surprise, they had soon spun out a bewitching tale that to me captures so much that is good about the rich history of our country that I just couldn't keep it to myself.
Mr. M was raised in coal country, West Virginia.  His family had been miners and knew no other life-had never left their local community nor completed any formal education.  After a year in the mines, Mr. M got his draft card-the Korean War was on and all his buddies were heading to the Army for just a two year stint but somehow, Mr. M knew that was not his fate.  He joined the Air Force, promising not 2 but 4 years.  Talking as if were just yesterday, this man then related how nearly all of his friends perished in the war while the Air Force gave him experience and talent, so much so that he became an engineer using the GI Bill.
Along the way, he met Mrs. M.  She completed college before him and when he asked her to move to his college town and help him finish by going to work, she calmly told him-"Only if you marry me!" Thus the holiday wedding-the only time they could fit in so he could complete his demanding engineering degree.  After college, he gained ever more prestigious jobs as an engineer and ultimately they settled in New York.  They have raised 4 successful children and are now enjoying many grandchildren.  They are active and engaged and clearly still in love after 55 years.
Perhaps I cheated Mrs. M during her post-op visit-we talked very little about her or the surgery but she didn't seem to mind.  She was glowing as they alternately told parts of the story, each completing the other's sentences as only long married couples can do.  The visit certainly suffused me with post-holiday cheer, I imagine every Christmas season is particularly special for Mr. and Mrs. M.

First Post: A Recipe for Health

Happy 2011 to all.  I thought I would share a recipe I recently created as part of our holiday celebrations that is quick, easy, delicious and healthy.  Certainly a good way to start the year!

Fregola with sauteed spinach and shrimp

1/2 c Fregola
1 pound spinach, cleaned and chopped
1 leek, sliced
1 red pepper, diced
1 garlic clove, minced
6-12 shrimp, shelled
1 c. stock or bouillon
olive oil

1.  Cook fregola in stock until tender but not mushy.
2.  While the fregola is cooking, prepare the vegetables.
3.  Warm olive oil in sauté pan.  Add leek and red pepper, cook until soft.  Add garlic and then spinach.  Cook just until spinach wilts.
4.  Add shrimp to vegetables and cook just until color turns to pink.  Add a little of the stock (bouillon) to create some sauce.
5.  Add fregola and toss.  Salt and pepper to taste.

Obviously there are many variations on this...you can add fresh or dried herbs for more flavor, eliminate the shrimp or substitute some sausage...onion can stand-in for leek...to make it extra festive, you can drizzle the final salad with crispy leeks...Try it my way or make it your own.

To a healthy 2011 for all.