The Day of Atonement: This One is for You, Dad

Tonight begins the Jewish holiday of Yom Kippur. It is the most important holiday of the year and really should be identified as a holy-day. The focus of this period is entirely on your relationship with God, the Divinity, the Spirit, and on asking forgiveness for the ways in which you let Him/Her down, and yourself. It is a time of inner contemplation. And whether you believe in a Higher Power, or in the need to ask forgiveness, it's pretty powerful to have one day to devote to thinking about who you are in connection to the Bigness that surrounds us all.

My father is in the hospital, in the ICU. He's 85. He might pull through this as he has the past five incidents that required hospitalization. But he might be at he point where the fabric is so frayed that every insertion of the needle to repair it just causes more damage.

I'll be thinking of him tonight. And of my relationship with him over the past 50 plus years. His basic goodness was the DNA for my model of the universe. I hope the universe returns him to his family. And I pray the universe carries him gently, always.

I love you, Dad

Grand Rounds at Residency Notes

This is the 6th anniversary of Grand Rounds, Colin Son at Residency Notes has put together a great collection of health care posts.

While you're at it, Six Until Me is hosting Patients for a Moment, a collection of posts contributed by patients. Have a read.

And the Pain Carnival is up too.

45,000 Deaths a Year Linked to Lack of Health Insurance

45 to 50 million Americans are uninsured. That's a big number and hard to get one's mind around it. A recent study from Harvard Medical School turns this number into a tragic and sadly logical reality:

45,000 people die each year in the US because of lack of health insurance coverage.

I usually don't blog about health policy, but this study was so stunning, I had to write about it. Not only does lack of health insurance contribute to 45000 individual deaths, but one has to wonder -- as a result of this tragedy, how many couples and families are destroyed?

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Here's an excerpt from an article in the New York Times by Reed Abelson:

"Researchers from Harvard Medical School say the lack of coverage can be tied to about 45,000 deaths a year in the United States — a toll that is greater than the number of people who die each year from kidney disease.

“If you extend coverage, you can save lives,” said Dr. Steffie Woolhandler, a professor of medicine at Harvard who is one of the study’s authors. The research is being published in the December issue of the American Journal of Public Health and was posted online Thursday.

The Harvard study found that people without health insurance had a 40 percent higher risk of death than those with private health insurance — as a result of being unable to obtain necessary medical care. The risk appears to have increased since 1993, when a similar study found the risk of death was 25 percent greater for the uninsured.

The increase in risk, according to the study, is likely to be a result of at least two factors. One is the greater difficulty the uninsured have today in finding care, as public hospitals have closed or cut back on services. The other is improvements in medical care for insured people with treatable chronic conditions like high blood pressure.

“As health care for the insured gets better, the gap between the insured and uninsured widens,” Dr. Woolhandler said.

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Here's a link to the actual report:
Health Insurance and Mortality in US Adults

Tips for Telling A Potential Partner About Your Health Situation

The piece below is from a site called Zikkir, which seems to be an aggregator of news stories.

I'd be interested in hearing your advice about how to tell a potential partner about your health situation.
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Here's the article:

8 Tips for Telling Your Significant Other a Health Secret

by Marti Trgovich, Health.com

1. Practice what to say
Before you drop a bomb on a potential mate, rehearse your speech with a trusted friend or visit a therapist to talk it through, suggests Ken Robbins, MD, a clinical professor of psychiatry at the University of Wisconsin–Madison.

“It’s good to have somebody as a sounding board in a situation like this,” he says. “How you handle this is not something your partner is likely to forget.”

Laurie Davis, an online dating expert based in New York and Boston, suggests asking a friend what sounds most intimidating about your condition and getting his or her advice on how to smooth it over. Getting a second opinion can help you decide how much to say (and when and where to say it), and running through your script a few times can make you more comfortable sharing your story.

“You don’t want to overwhelm your partner but you want to be sure to give him or her all of the important facts,” Davis says. “You should definitely practice before you tell your match, or you’ll most likely fumble through the conversation uncomfortably.”

Mark Snyder, a 32-year-old writer from New York City, used to dread telling a new boyfriend that he was a recovering alcoholic. “I don’t think I was ever able to shake off the feeling I was springing the information on him, usually when we were either out to dinner and he wanted to order a bottle of wine, or at a party where alcohol was introduced,” he says. “I often blurted out, ‘Oh, I don’t drink. Sorry.’”

That changed, however, as he got used to talking about his condition. “As time went on, and I got more comfortable with this side of my life, so did the ease with which I told a man not to expect a tequila-scented smooch at the end of the night,” he says. “I realize my blurting-it-out style was my own insecurities about sobriety. I celebrate it now.”

2. Never tell on a first date
“Never tell someone on a first date,” Davis says. “The results will never be favorable.”

Dr. Robbins seconds that, especially if you’re worried that your health secret “is likely to define you before the person has gotten a chance to know you at all.”

That doesn’t mean you should lie—just let your partner get to know you first. “[Revealing too much too soon] may color how your partner sees you,” Dr. Robbins says. “It defines you before you’re ready to be defined.”

Jenny*, a 25-year-old graduate student from New York, had a breast augmentation when she was 19. “I don’t really bring it up, not when I’m first dating people,” she says. “But I’ve had people ask and I’m always honest with them. I wouldn’t see a reason to keep it a secret, especially if we’re getting serious.”

If you’re worried that your health secret might be a deal-breaker, you’ll want to ‘fess up by the fourth date, says Rachel A. Sussman, LCSW, a New York City therapist and relationship expert. That way, if your secret does make a big difference, you won’t have wasted too much of their time—or yours.

“Of course it can be painful, but if that’s the case, it’s better to know before you get too involved,” Sussman says. “It’s complicated if you withhold it and they find out too late. Dishonesty can ruin a potentially good relationship.”

Jill*, the 33-year-old from New York City, is currently in a long-distance relationship. However, she hasn’t told him about her bipolar disorder —yet.

“Too much too soon is not a good thing…. [But] I truly believe when you share a life with someone, you need to be in it together,” she says. “Men go bald; women gain weight after pregnancy. It’s not all roses and Champagne.”

3. Be casual yet confident
So exactly how does one reveal a secret without just blurting it out? “It’s hard not to kill the mood with your health secret, because it’s probably not something that can be easily segued from a topic you would normally discuss,” Davis says. She recommends a conversation bridge, such as, “I feel like we’re heading in a great direction, so I wanted to tell you something.”

Just don’t overdo it: “You don’t want to frame this in a way that ends up making a bigger deal of something you don’t want made into a big deal,” Dr. Robbins says. In other words, make your delivery as drama free as possible.

Allison*, a 30-year-old marketer from Baltimore, tries to casually tell dates about her multiple sclerosis.

“Usually I’ll work it into another aspect of our conversation,” she says. “It’s a lot easier to tell someone I have MS as a side note in a conversation than to sit down and have a formal discussion focused solely on MS.”

However, even a casual, well-prepared speech doesn’t always meet with success.

“One guy just clammed up and didn’t want to say anything or go anywhere because, in his eyes, I might get hurt,” Allison* says. “And another guy became very controlling and tried to tell me what I should and shouldn’t be doing for my health. Um, you’re not my doctor, dude.”

Allison’s dates probably have their heart in the right place. “They’re trying to be helpful because they care about her,” Dr. Robbins says. He suggests that she have a confident, straightforward response about how she would like them to react; something like: “I don’t see this as something that defines me—but if I need help, please leave it to me to ask.”

4. Don’t have this conversation in bed—or anyplace you associate with intimacy
Although this is a good guideline to follow when dealing with all types of relationship secrets, there’s only one instance in which it is a hard-and-fast rule, Sussman says: “Don’t wait until you’re naked in bed with someone to tell them you have an STD.”

That’s true for any condition, Davis adds. But Dr. Robbins notes that if your health secret is a sexually transmitted disease, you’re going to have to open up to someone sooner rather than later.

“If it’s something that’s going to have a direct effect on your partner, it’s something you’re going to want to talk about sooner, as opposed to an illness that isn’t contagious,” Dr. Robbins says. “If it’s something like hepatitis C, you really do have to talk about that very early.”

Amy, a 29-year-old graphic artist from Chicago, jokes that hepatitis C is the only thing she has in common with Pamela Anderson. But she’s serious when it comes to telling boyfriends about her illness, which she got through a blood transfusion at birth.

“There is less than a 3% chance of transmission within a monogamous relationship, but I’ve always been truthful and upfront about it, whether I ended up in a sexual relationship with someone or not,” she says. “They have a right to know.”

An ideal place to tell someone about your health secret—whether it’s a communicable disease or any other condition—is a park, Davis says. Just make sure there’s no one within earshot.

“Do not tell your partner during intimacy. Telling your partner your health secret means you are opening up to them, trusting them, and becoming more vulnerable,” she says. “The place you choose to tell them should reflect this.”

5. Seek out relationships online
If you tend to meet potential partners through online networks such as Facebook or Match.com, you shouldn’t hint in your profile that you’re concealing a health secret. However, if you’re nervous about rejection or misunderstandings, you might be more comfortable dating someone with similar health issues.

There are many niche sites that cater to people with specific conditions, and they’re a great way to be up-front with potential mates who are in the same boat, Davis says.

6. Know when to give your partner space
Even if you do your best to deliver a snag-free speech, it’s possible that there could be an awkward moment. “[If that happens], say, ‘I can tell by your expression that this is a lot to digest and I completely understand, and I’ll give you the time and space to do that,’” Sussman says.

Then, offer some physical distance but stay in contact, Davis says. “Give them the following day to breathe and think,” she suggests. “Call them on the third day if they haven’t reached out to you. Let them know that they are still on your mind and you can’t wait to see them again.”

7. Don’t take rejection personally
“A good person will listen and be kind and not judge, but if [your health secret is] something they can’t live with, that doesn’t make them a bad person,” says Sussman. “It just makes them a bad match.”

And there can be multiple reasons for a rejection—many of which have nothing to do with you at all. “If your mother was an alcoholic and you date someone who’s an alcoholic, you might have to make a choice that it’s not healthy to be involved with someone in recovery,” Sussman says.

Besides, your perfect match will accept you no matter what, Davis says: “If things were going well up until the time you told them, keep in mind that they rejected your health condition, not you. At the end of the day, it means that they were not the one.”

8. Accept support
Tiffany Sanchez Conover, 28, a store manager from northern Indiana, settled into a deep depression after her grandmother died. She slept all day, stopped eating, and became socially withdrawn—even with her husband. Still, she kept her depression hidden, because she wanted to “figure it out on my own.”

“[Eventually] I felt like I had to tell him because I could feel the strain it was placing on our relationship,” she says. “A person can only take so much of their spouse not wanting anything to do with them before they start assuming the worst, an affair.”

Tiffany’s husband was hurt that she hadn’t told him earlier, but he was glad she finally confessed. “After I told him, he was as supportive as could be,” she says. “He would stay up late to talk with me just so I wouldn’t feel lonely late at night, even though I’m sure he really wanted to go to bed.”

It’s especially important for married couples to be open to avoid hiccups in the relationship, Sussman says. “In healthy marriages, people lean on each other and are honest with each other,” she explains. “You can never lose by being honest.”

Tiffany knows that now: She and her husband recently went through a series of failed fertility treatments after finding out she likely cannot have children on her own. “I probably share too much now,” she says, laughing. “But it works for us. If I didn’t tell my husband how I felt about it all every day, I probably would end up depressed again.”

A counselor also helped Tiffany to get through the initial rough patch. Therapy and support groups —whether online or in person—are excellent options, according to Sussman. “Name the illness and there’s a support group,” she says. “If you go to your supportive community, you’ll hear stories of how people have handled these things in the past.”

Has Your Partner Made You Laugh?

Laughing together makes everything better -- if only for a few moments. But once you have a good laugh, the effect is not only while you're laughing, but also when you retell the story to others, and when you remember it later by yourself. If it's a really good laugh, it becomes part of the ongoing connection you have with your partner - a shared smile that the two of you can resurrect any time, often with only a single word or phrase.

For Richard and me, the phrase is, "They're making a break for it."

Several years ago I went through a very hard period. Bad pain. Bad attitude. I couldn't work and didn't want to leave the house. I was sunk in misery, waiting for a new medication cocktail to kick in. I was Eeyore, moping and wandering aimlessly from one room to another.

One afternoon as I was heading upstairs, I noticed 9 black socks draped randomly on several stairs. Now, Richard and I have gone mano-a-mano many times about his tendency to leave objects strewn about the house. But this was over the top and inexplicable.

I asked him to join me at the bottom of the stairs and explain the mystery of the strewn socks. He said, "They're making a break for it. Trying to join their comrades in the land of lost socks."

I cracked up. Both at his explanation and at imagining him coming up with this scene and placing the socks, one by one - purely to make me laugh. That became a good day and a shared memory that still makes us smile.

How about you? Any stories about a time when your partner made you laugh?

Patient-Focused Grand Rounds

Leslie of Getting Closer to Myself is hosting the most recent patient blog collection called Patients for a Moment. It's a good read.

And while you're at it - the health care Grand Rounds is up at Suture for a Living.

How Much Should the Well, Caretaking Partner Share with the Ill Partner?

Here's a question that some comments caused me to ponder:

How much should the well, caretaking partner share with the ill partner?

The ill partner is suffering from body pain, or fevers, or headaches, or cancer, or from the side effects of treatments. He or she has had to give up full engagement with the world and can no longer do his/her old job or hop into a car to visit friends or go to the movies. Spontaneity has been derailed by the medication regimen. Freedom has been shrunk to fit within the boundaries set by the illness. And, as if this weren't enough, the ill partner is, understandably, depressed over his/her symptoms and limitations.

The well partner has assumed more and more of the couple's dealings with the outside world. He/she does the household chores, negotiates with the insurance company, oversees the kids, tries to stay on top of bills & budgets, and goes to work. And, as if this weren't enough, he/she also takes care of the ill partner. He/she helps the ill partner with the daily living activities the ill partner can no longer perform solo. This can include everything from monitoring medication to waking up 4 times a night to help the ill partner get to the commode.

The well partner is physically exhausted and emotionally bone dry. He/she is so busy every moment of the day that he/she can't stop to spare a tear for his/her own sorrow and worry. In those limited moments when there is a brief respite from the storm, he/she starts to feel choked by stress. It is a physical sensation -- as if all the air has been pulled from his/her lungs.

The well partner doesn't know how he/she can go on another minute and at the same time, he/she knows he/she will find the strength somewhere, some how, to continue. He/she doesn't talk to the ill partner about his/her depletion and anxiety because he/she is afraid the ill partner can't bear it -- that it would push the ill partner over some ill-defined edge into full bore breakdown.

This scenario may fit yours, or it may not. Whatever your circumstances are, I'd like to know:

If you are the well, caretaking partner, how much do you share with your ill partner about your situation? What are your choices based on?

If you are the ill partner, how much do you want to be protected from your well partner's state, and how much would you want him/her to share with you? What are your wishes based on?