On my way to LA from Newark, I sat next to a woman who must have weighed 350 pounds. I had to sit sideways in my seat to accommodate her. Why should I have to do this!
As we took off, I wondered, With all the overweight people on this plane, will we be able to stay in the air?
Then it hit me that the reason airlines are charging for checked bags is that they are too chicken to ask the overweight to pay for their poundage. After all, the airlines claim that this is to offset fuel costs, and most Americans are carrying around a lot more extra weight than the weight of my checked bags. Just think that my checked bag maybe weighs 40 pounds, but many Americans are way over 40 pounds overweight.
Helene told me that in all her years with Air Canada, only twice did she charge a passenger for two seats--and it was the same passenger.
What would be so hard about every passenger standing on a scale when they checked in. Their weight would only be displayed to the clerk, so that information would remain private. Then they could do one of the following to mitigate the increased fuel costs of these hefty passengers:
* Set a cap for female and male weight, perhaps 160 for women and 190 for men. Anyone over that weight would pay a surcharge. Passengers who were grossly overweight, perhaps 280 and up, would have to buy two seats.
* Have a graduated fee schedule, say, $25 for up to 25 pounds overweight, $35 for up to 50, and so on.
* Charge $1 per pound of excess weight.
* Those people who are, say, 100 pounds or lighter would receive a break on their ticket.
* The excess-weight surcharge would not be based on body mass index. True, body builders and other athletes might be more than the cut-off weight and, true, their weight would be due to muscle not to fat, but if the surcharge is about excess weight, it doesn't matter whether the weight takes the form of fat or muscle.
Instead of everyone, fat and skinny and in between, having to pay for the excesses of some, why not make those who are responsible for the extra weight pay? This might have the added benefit of giving people an incentive to lose weight. Money is a great incentive.
Sunday, June 20, 2010
A Narrow Focus on Physical Well-Being
When I first realized that dialysis was inevitable, I thought that the peritoneal dialysis clinic would be a helpmate, a resource, a place where I could turn if I had questions. Very soon I saw how naive that kind of thinking was. I received contradictory advice or nurses were afraid to give advice or they had the blanket response for everything--go to the emergency room. So I have tried to figure things out for myself and avoid the clinic as much as possible, except for my required monthly visit.
Let me cite one example of the craziness of dealing with the PD clinic. When I was training to do home dialysis in early February of last year, I must have asked a dozen times what I was supposed to do in order to get to the bathroom at night, as I was attached to the dialysis machine by a 9-foot cord. Nine feet was not nearly enough length for me to get to the toilet. All I kept hearing was that I should not disconnect myself as this would be unsanitary. I asked if I could put an extension cord on the electrical outlet, but that idea was nixed as it could shortcircuit the machine. So what I was left with was pulling the therapy cart as far as possible toward the bathroom, stretching the electrical cord and the patient line to the max. Once this resulted in the dialysis bags falling off the cart and pulling out of their connective tubing. This of course created a major risk of infection, plus I had to stop the treatment and start all over with new bags.
As part of the work-up for the transplant, I had to undergo all kinds of tests, including a colonoscopy. What was I supposed to do about going to the bathroom now? I'd be getting up many times during the night before the procedure. Finally, a nurse told me that there were patient extension lines that could be attached to the normal patient line, thereby extending it another 12 feet. Why hadn't this ever been mentioned before! Since then I have continued to use the extensions.
Then a month ago I was in a hospital in Fontana. I had to stay overnight, so dialysis supplies were provided. The nurse gave me a cassette that had an extra long patient line built in. This way I would not have to connect an extension, a good thing, since with every connection that is made, there is a potential avenue for infection. Why, why, why hadn't my own PD clinic told me about this over a year ago!
The answer I have come up with is that most health care professionals don't think of the patient as a real human being. Rather, they think something like, "Well, she should be happy she's alive. She doesn't need to have mobility, comfort, a social life, a sex life, a relationship, etc. She's alive. That's enough." And so they are very narrowly focused on the patient's physical well-being. What drugs can we give her to stop this symptom? What change in her dialysis solution do we need to make? They never take the time to wrap their minds around how they would feel if they were hooked up via a 9-foot cord to a machine for 10 hours every night. They think of their job as very narrowly about pills and protocol and covering their ass.
Let me cite one example of the craziness of dealing with the PD clinic. When I was training to do home dialysis in early February of last year, I must have asked a dozen times what I was supposed to do in order to get to the bathroom at night, as I was attached to the dialysis machine by a 9-foot cord. Nine feet was not nearly enough length for me to get to the toilet. All I kept hearing was that I should not disconnect myself as this would be unsanitary. I asked if I could put an extension cord on the electrical outlet, but that idea was nixed as it could shortcircuit the machine. So what I was left with was pulling the therapy cart as far as possible toward the bathroom, stretching the electrical cord and the patient line to the max. Once this resulted in the dialysis bags falling off the cart and pulling out of their connective tubing. This of course created a major risk of infection, plus I had to stop the treatment and start all over with new bags.
As part of the work-up for the transplant, I had to undergo all kinds of tests, including a colonoscopy. What was I supposed to do about going to the bathroom now? I'd be getting up many times during the night before the procedure. Finally, a nurse told me that there were patient extension lines that could be attached to the normal patient line, thereby extending it another 12 feet. Why hadn't this ever been mentioned before! Since then I have continued to use the extensions.
Then a month ago I was in a hospital in Fontana. I had to stay overnight, so dialysis supplies were provided. The nurse gave me a cassette that had an extra long patient line built in. This way I would not have to connect an extension, a good thing, since with every connection that is made, there is a potential avenue for infection. Why, why, why hadn't my own PD clinic told me about this over a year ago!
The answer I have come up with is that most health care professionals don't think of the patient as a real human being. Rather, they think something like, "Well, she should be happy she's alive. She doesn't need to have mobility, comfort, a social life, a sex life, a relationship, etc. She's alive. That's enough." And so they are very narrowly focused on the patient's physical well-being. What drugs can we give her to stop this symptom? What change in her dialysis solution do we need to make? They never take the time to wrap their minds around how they would feel if they were hooked up via a 9-foot cord to a machine for 10 hours every night. They think of their job as very narrowly about pills and protocol and covering their ass.
Ego Puts Patient Lives in Danger
When I was in France, I received an email from Janet, my neighbor who is my unmatched donor. She said that she had spoken with her coordinator at UCLA, who claimed she knew nothing about the paired donation we had arranged with Bob and Maria. I emailed Bob. What's up? I wondered. He wrote back that Maria had been told the same thing by the coordinator--that she knew nothing about our arrangement, nothing about Heidi and Janet. Under further questioning, however, she said that it was her job to arrange donations, not the patient's job and that we should have let her make the arrangements.
Can you believe that! Instead of saying, "Oh, how beautiful that you four found each other! That makes my job easier," she was prepared to thwart the arrangement because her ego had been bruised. It's like c'mon, lady, people's lives are at stake!
Once again, if the four of us were not on top of this, we could have been placed on the bottom of everyone's to-do list. It's amazing, with all that patients have to put up with, with the physical, emotional, and social challenges of being on dialysis, that we also have to deal with difficult health professionals who supposedly are being paid to help us.
Can you believe that! Instead of saying, "Oh, how beautiful that you four found each other! That makes my job easier," she was prepared to thwart the arrangement because her ego had been bruised. It's like c'mon, lady, people's lives are at stake!
Once again, if the four of us were not on top of this, we could have been placed on the bottom of everyone's to-do list. It's amazing, with all that patients have to put up with, with the physical, emotional, and social challenges of being on dialysis, that we also have to deal with difficult health professionals who supposedly are being paid to help us.
On the List!
Finally, finally, finally, I am on the transplant list! As of June 16, I am on the national kidney transplant list.
I was told on April 29 and a few other times after that, that the only thing UCLA had to confirm was that I have health insurance. It took them 48 days to do that! Unbelievable. This just goes to show, once again, how the so-called health care professionals are just doing a job, not thinking about the emotional strain that they are putting on patients. They could care less if it took 48 months to verify that I have insurance. It also points out again how a passive patient, one who just waited for other people to act, would still be waiting for an intial appointment with UCLA. If I weren't as assertive, if I didn't make all the phone calls I have to get people moving, to get people to do their jobs, I would never have gotten on the list. Whether you're on the list perhaps has more to do with chutzpah than with your overall health.
I was told on April 29 and a few other times after that, that the only thing UCLA had to confirm was that I have health insurance. It took them 48 days to do that! Unbelievable. This just goes to show, once again, how the so-called health care professionals are just doing a job, not thinking about the emotional strain that they are putting on patients. They could care less if it took 48 months to verify that I have insurance. It also points out again how a passive patient, one who just waited for other people to act, would still be waiting for an intial appointment with UCLA. If I weren't as assertive, if I didn't make all the phone calls I have to get people moving, to get people to do their jobs, I would never have gotten on the list. Whether you're on the list perhaps has more to do with chutzpah than with your overall health.
Trip Recap
First, I am so thankful for Helene's invitation. She used her 25th anniversary of service to Air Canada award of guaranteed first-class tickets. I also appreciate her arranging for the apartment in Paris and her muscle power in carrying my suitcases. And an especially big thanks to her for introducing me to her friends Marie and Stefania in Paris and for introducing me to Khadidja last summer when we were both in Nova Scotia.
Marie, Stefania, Khadidja, and Helene are all terrific women. They pick up and travel to exotic locales without a male escort. They are intelligent and multi-lingual and fun to be with. They're open to new ideas and new experiences. They are all pretty and stylish in their individual ways. Like so many wonderful women, they do not have a steady man in their lives or any man at all. Unfortunately, not many men are interested in confident, intelligent, self-sufficent women. Most men still would prefer a woman who is needy in some way. I sometimes wonder if the 2012 transition will also issue in a shift in men's consciousness, that they will begin to appreciate a relationship that is formed between two strong and amazing people. God, let's hope so!
Marie, Stefania, Khadidja, and Helene are all terrific women. They pick up and travel to exotic locales without a male escort. They are intelligent and multi-lingual and fun to be with. They're open to new ideas and new experiences. They are all pretty and stylish in their individual ways. Like so many wonderful women, they do not have a steady man in their lives or any man at all. Unfortunately, not many men are interested in confident, intelligent, self-sufficent women. Most men still would prefer a woman who is needy in some way. I sometimes wonder if the 2012 transition will also issue in a shift in men's consciousness, that they will begin to appreciate a relationship that is formed between two strong and amazing people. God, let's hope so!
Architectural Tour
Sunday, June 13, our last morning in Monton. We toured Khadidja's sister's house, a few houses away from Khadidja's. Amina's cellars were given an award for the best cellar in Monton. Three levels deep. She still stores wine and vegetables there, though not as extensively as in the old days.
Here's a photo of one of Anima's bedrooms in which the old beam figures prominently.
Khadidja's mom's place was right next door to Khadidja's. In fact, the two houses are so close that you can hop from one exterior staircase to the other. Jeanne is quite a gal--83 and still gardens every day. Just as in medieval times, the gardens are located outside what was once the city walls. She's also caring for a distant relative on her late husband's side. The 12-year-old girl is a little slow, and so her family sent her back to Algeria to fend for herself. When Jeanne rescued her, she was working under slave conditins as a maid.
Jeanne's house contains walls that were part of the castle built in 1060. This page from one of her childhood books shows the castle that became her house.
The houses are so close together that Jeanne's kitchen protrudes into Khadidja's house.
And here's a cupboard that was hollowed out of the wall.
The timbers in these old houses have been used many times over for many different purposes. Jeanne has one timber in her living room that has rungs on it, what was no doubt once a ladder. The beams are also of various widths, as shown here.
L to R: Jeanne, her cousin who is staying with her for a month, Heidi, Gabriel, Helene
L to R: Jeanne, Khadidja, cousin, Heidi
Before we left for the train station, Jeanne gave us a cherry custard she'd made from the cherries in the garden. That is the kind of easy back and forth between people in Monton, as the day before a neighbor had given us some cherries.
We then took the 12:45 train from Clermont back to Paris. I for one was sorry to leave this beautiful area. Khadidja had been such a warm and attentive host. She is quite a gal too.
We spent the night at Marie's, then flew from Paris at 1 p.m. the next day.
Here's a photo of one of Anima's bedrooms in which the old beam figures prominently.
Khadidja's mom's place was right next door to Khadidja's. In fact, the two houses are so close that you can hop from one exterior staircase to the other. Jeanne is quite a gal--83 and still gardens every day. Just as in medieval times, the gardens are located outside what was once the city walls. She's also caring for a distant relative on her late husband's side. The 12-year-old girl is a little slow, and so her family sent her back to Algeria to fend for herself. When Jeanne rescued her, she was working under slave conditins as a maid.
Jeanne's house contains walls that were part of the castle built in 1060. This page from one of her childhood books shows the castle that became her house.
The houses are so close together that Jeanne's kitchen protrudes into Khadidja's house.
And here's a cupboard that was hollowed out of the wall.
The timbers in these old houses have been used many times over for many different purposes. Jeanne has one timber in her living room that has rungs on it, what was no doubt once a ladder. The beams are also of various widths, as shown here.
L to R: Jeanne, her cousin who is staying with her for a month, Heidi, Gabriel, Helene
L to R: Jeanne, Khadidja, cousin, Heidi
Before we left for the train station, Jeanne gave us a cherry custard she'd made from the cherries in the garden. That is the kind of easy back and forth between people in Monton, as the day before a neighbor had given us some cherries.
We then took the 12:45 train from Clermont back to Paris. I for one was sorry to leave this beautiful area. Khadidja had been such a warm and attentive host. She is quite a gal too.
We spent the night at Marie's, then flew from Paris at 1 p.m. the next day.
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