Going, Going, Gone

Last Thursday my husband drove both my son and me to JFK airport.  I was leaving on a routine flight west to San Francisco for a neurosurgery meeting.  My son was departing on a bit more of adventure.  Early that evening,  Daniel would begin his full day journey to Accra, Ghana and then on to the remote village of Akropong where he will live with a Ghanian family and work on building projects (schools, community buildings) for three months.  Like many late teenagers, Daniel had been been nothing short of challenging for much of the last few years and I had long anticipated the day he would depart for Africa-a chance to gain a little corner of peace and quiet.  So I was unprepared for the emotions that flooded through me when I had to finally hug him and say goodbye.  I spent much of the first part of the journey to California completely unable to complete any of the work I desperately needed to do.

A week has passed and we have received a very brief communication that he arrived safely and another with some very rudimentary details about his placement (he is an hour from the nearest internet cafe and cell phone reception is inconsistent and very expensive).  We do know it is very hot and that the work proceeds slowly as a result.  He has met many other volunteers and in one of those amazing coincidences, one grew up in the same town as his British father!  Perhaps he will make his way to an internet site this weekend and we can see some photos and hear more about his existence there. For now, I have made the decision-for reasons I can't really explain-that I will only communicate with him via hand-written letters.  Perhaps I think he will enjoy getting mail and perhaps it seems more personal and appropriate given where he is living.  It is strang being 2010 and having a loved one be away for a really extended period of time (7 months total) with little means of communication.  It takes me back to when I was growing up and even long-distance phone calls were unusual and very short.  It also reminds me how dramatically communications have changed in a relatively short period of time!

Daniel wanted to get away and to do something completely different that also helped mankind.  It seems he has accomplished that geographically.  I hope the emotional change will also be all that he seeks.  For me, I will be in New York waiting...yes enjoying the lack of mess, late nights, and overly boisterous behavior but also wondering what will great me when we reunite in May 2011.

Daniel leaving home for Ghana

My Oxford Challenge

My son is going to do volunteer work in Africa for 6 months and was prescribed malerone to protect him against malaria.  He obtained the prescription, took it to the pharmacy AND...we were told it would cost nearly $2000, even though my health insurance policy carries an expensive prescription drug benefit.  Thus began my odessey with Oxford.

First Call: (32 minutes): Informed it was not a covered medication because it was for travel.  They agreed that there was no such provision in my policy but that was "Oxford's general policy".  Informed I could ask for an APPEAL OF COVERAGE, expedited with an answer in 48 hours.  Great.

Wrote appeal, sent to provided address with registered mail.

Second Call: (48 minutes): Requested response on appeal, informed after some time that in fact medication was covered and what I needed was a QUANTITY LIMIT OVERRIDE APPEAL since he had 6 months of pills ordered and was only entitled to one.  Again told an expedited appeal would be answered in 48 hours.

Faxed appeal as instructed.

Third Call: (32 minutes) Couldn't find my appeal, couldn't find anyone who could tell status of appeal, tried to get through to a medical department and was told they weren't answering their phones I could continue to hold or call back later...as I had to go back into the operating room, I concluded the call.

Fourth Call: (36 minutes) Got lovely woman who apologized profusely for all the calls and trouble but after invetigating informed me in fact malerone was NOT a covered medication! After I got a little angry, she put me on hold, and ultimately agreed I needed a QUANTITY LIMIT OVERRIDE APPEAL and gave me a different fax number and instructions how to use the facesheet to prompt a definite response.

Re-faxed appeal as instructed.

Fifth Call: (49 minutes) Kind man said the pharmacy stated I could only get 2 months worth-I tried to remain calm and ask why the appeal had been rejected and who could I speak with as the whole point of the appeal was to OVERRIDE this limit and I though as he would be far from a real pharmacy and even a reliable postal service I had good grounds to request this.  I was put on hold again and when he returned he apologized profusely and said I was misinformed...what I needed was as VACATION OVERRIDE APPEAL-this process means I have to purchase the medication out of pocket and then after I complete 5 pages of paperwork (without leaving out a single crucial item), Oxford will decide if I am entitled to reimbursement that they can send me at their leisure.

And we wonder if our health insurance system is broken?

Bon Voyage!

My Nudge Contest

nudge 
tr.v. nudged, nudg·ing, nudg·esTo push against gently, especially in order to gain attention or give a signal.
nudge or nudzh or noodge Slang (Yiddish)
n.  One who persistently pesters, annoys, or complains.

Of these definitions, my Yiddish-flecked childhood reflected primarily the latter. So, thanks to Howard Luks for first bringing the notion of using the nudge (ie first definition) to medical use and studies that have shown the clear effectiveness in areas such as diet and exercise.  For those who haven't had the time to absorb the ever-expanding global world of nudges, I can recommend the nudge blog by Thaler and Sunstein devolved from their book of the same title.  The concept has acquired so much traction there has been a serious call for research into the effective use of the nudge in medicine.  Already in Australia, when filling a prescription, an Aussie can enroll in a nudge club that will prompt proper use of the medication.  The daily nudge is a service you can use to create your own health inducing nudges.

So here is my challenge: Submit you best idea on how to use THE NUDGE  to promote health!  Think big or small, technical or spiritual, systems or individual.  Humor welcome.  Please submit to: womenneurosurgeo@aol.com

Autumn High

The cool air assaults me as I step outside

The dogs lope gracefully in anticipation

The sun glints against the coloring leaves

Some trees already ablaze in glory

The trail is firm and welcoming

The dogs throw caution and romp

Light filters and flickers through thinning leaves

Our feet crunch on already fallen

Apples crisp and pears, too

Cider bracing and sweet every morning

Still produce in great abundance

Meals a treasure like no other time

My autumn high