Saturday, December 20, 2014

A Christmas Story and A Rant

Every year, my former bosses, C-level execs at a financial management firm, volunteer at an annual Help the Poor People event. (It has a fancier name, something about Christmas and cheer and not being poor.) 

Overall the timing couldn't be better, since the time of year poor kids need underwear and their parents need groceries coincides perfectly with the season that wealthy kids need a reminder to be thankful for their iPads and bottomless allowance. And food and shelter and stuff.

So one Saturday a year, the University Park families line up at a large warehouse on the other side of town, to congratulate themselves on caring for the poor, earn volunteer merit badges, and give their kids a firsthand look at what happens when you're not responsible enough to be born into a trust fund. Oh, and they also pass out toys, clothes, and food to the poor families of South Dallas.

"Ho-ho-ho, Merry Christmas! Excuse me while I leave this scary part of town before dark."

They pass out skinny white Barbie dolls and bags of groceries to poor families, enjoy the high of being oh-so-full of Christmas spirit, and then hurry home to willfully-naive holiday parties, where simple hors d'oeuvres cater at $200 a plate and valet parking for guests costs more than the entire budget of this year's Help the Poor People event. 

If rich people want to get their Christmas spirit highs by passing out cheap presents to poor people once a year, then I have no problem with poor people returning those gifts to Wal-Mart and spending the store credit on beer and cigarettes. They know what gets them through a day, and it's not more crap for their kids to lose at the homeless shelter. Or another bike to get stolen from outside their apartment door, or left behind when they're evicted for not having rent money again.

There's this temptation to label poor people as morally inferior, poor because they make bad choices or aren't as innately virtuous as their financially stable counterparts. But rich people and poor people pretty much live out the same vices and virtues, in parallel lives.

So what that it's a couple dollars on cigarettes versus a couple thousand on a spa vacation? Both are selfish indulgences that take the edge off a day. (Not that I'd be above either.)

What's a Platinum-level donor for the Charitablest Charity versus babysitting kids for a friend who can't afford a nanny? Both help out people in need. 

The cushion of wealth can distort vices into easily-excused minor character flaws. If you're habitually late as a wealthy person, it's assumed you're tending to important matters, whether that's finishing up a call with the president or picking up your daily Starbucks. If you're habitually late as a poor person, it's assumed you're irresponsible and disorganized, disrespectful of others' time, whether your car broke down or you needed to pick up a friend on the way. 

In the same way, wealth can turn a simple act of virtue into heroic sainthood. It's not the volunteers who put in the most hours or perform the least popular jobs who are honored at charity award banquets. It's the highest monetary donors. 

For the wealthy, we polish up lust and adultery as having affairs, divorce, and alimony. But a poor person trying to recover from an irresponsible significant other gets labeled as easy, sleeping around, and somehow deserving of unpaid child support and hard times. Don't be fooled: we're all doing the same crap here. The luxury of money just lightens the consequences to years of expensive therapy instead of homelessness, hunger, and the cycle of poverty.

Anyway, don't let my rant get you down. Go do something nice for someone for Christmas. And maybe the week after too. And the week after that. 

Tuesday, December 9, 2014

More Adventures in Healthcare (The Medicaid Experiment)

When I started receiving medical bills from two-and-a-half weeks of hospital bed rest, an operating room delivery of twins, and two weeks of NICU, I knew something wasn't right. 

From what I'd been told, Medicaid patients aren't responsible for any part of their medical costs, and don't even see their bills, but in the few weeks since bringing home our twins, I received calls and letters from the hospital, my ob-gyn, and the anesthesiologist, informing me that Medicaid had denied their claims.

Up to this point, we'd been using a healthcare co-op of sorts that's great for minor emergencies, for childbirth, and even for catastrophic events, but I just couldn't imagine recovering from birth caring for two new babies as well as our other kids at home, while compiling and processing medical bills and reimbursement checks, which is part of the co-op process. 

So I looked up Medicaid -- mainly out of curiosity -- armed with the sudden free time of mandatory bed rest (which incurred the unexpected partial loss of salary that prompted the curiosity), and I came to find out that our modest income, combined with the unique ability of the American healthcare system to bankrupt anyone, qualified us for Medicaid. 

I called Amerigroup, one of the private health insurance companies through which Medicaid disperses coverage, and asked if there was a problem. Yes, they informed me, there was. 

Despite my indication otherwise on the 12-page application, supporting documents, and a follow-up phone interview, they had somehow dug up a record from 2012 that showed I was already covered with private insurance through Aetna. So rather than call me to check on the apparent disparity, they just denied all claims. 

I shook my head. Yes, in 2012, I was covered by private insurance through Aetna. But didn't their records also show that I was dropped from that coverage in 2012? No, they don't have that information. (But they can fill out an incident report and have their insurance team research it. Yes, please do that.

I called back the hospital, ob-gyn, and anesthesiologist to give them an update. They were surprisingly unsurprised. Apparently it's a thing for Medicaid insurers to automatically decline the first submission of bills. 

So while Amerigroup was working out whether they could dump financial responsibility on a two-year expired outside party, I tried to keep my blood pressure down as I read through the bills. Here are some highlights: 

Each day in the room: $2100.00
Each prenatal vitamin: $3.68
Each dose of Miralax: $25.00
Each time they listened to the babies' heartbeats: $766.00
The USE of the ultrasound machine: $1500.00
The doctor who used the ultrasound machine: $1500.00
A 10-minute consultation with a NICU nurse: $278.00
A 5-minute visit from my doctor to check my vitals: $275

The list goes on and on, mostly with coding and medical terms I can't interpret. But the Miralax is what I really can't get over. How did this 14-dose, $10 bottle of medicine get marked up 3500% when administered in a hospital? 

Did I do that math right? 71 cents per OTC dose versus 25 dollars per hospital dose?

I've been an advocate for a national healthcare system for years (note: not a national system that lines the pockets of private health insurance companies without providing any actual healthcare, which Obamacare seems to have inadvertently created, but an actual healthcare system). 

I was picturing something that could match the functionality of the postal service: slow, even when there's not a line out the door, but effective and affordable. And if you want something better, just stop by a UPS or FedEx store and pay a little bit more. 

But the bureaucracy we've discovered in Medicaid likens more to an unsolvable maze or never-ending roller coaster. 

It would seem I'm ungrateful, to complain about free medical care. But here's the problem, and why I have to validate my frustration and complain about Medicaid healthcare: it's not free. This crappy system is costing tax payers about 25% of our state budget! Our tax dollars are disappearing into a bureaucratic rabbit hole of paperwork, call centers, and ineffective checks-and-balances.

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We couldn't check out of the hospital until we scheduled pediatrician visits for our sons. It took nearly two hours of phone calls.

I called the pediatrician, but they needed the Amerigroup ID numbers for the babies. I called Amerigroup, since the twins had automatically been covered under me at birth, but they couldn't assign numbers. I called Medicaid, but the option to add a dependent to a plan wasn't in the five-minute options menu, so I waited in a 17-minute queue to speak with someone directly. I finally reached a representative who spent 20 minutes entering their names into the Medicaid system and adding them to the Amerigroup plan. I called Amerigroup back to confirm they had a record of the twins, and to get their insurance ID numbers. We spent another 15 minutes entering their pediatrician's information as the primary care provider on their account. I called back the pediatrician's office to provide Amerigroup ID numbers and schedule appointments. 

Two months later, I took the twins back for another wellness visit. Somehow, one of the twins had been dropped from Amerigroup and transferred to another insurer contracted by Medicaid. I hadn't even heard of this other insurance company, had received no communication from them, and worse yet, the babies' primary care pediatrician wasn't even in-network for this other company. 

Another hour working through the Medicaid roto-dial, calling Amerigroup then Medicaid then Amerigroup, and we get nowhere. The representative can't figure out how one of the babies was moved to a different plan, but they can't move him back, because there's a 90-day waiting period to change plans. (But they can fill out an incident report and have their special situations team research it. Yes, please do that.)

Two weeks later, I receive the first communication from Molina, this new insurance company that the baby was mysteriously and untraceably and irreversibly transferred to over six weeks earlier. It's a little paper insurance card that tears as I attempt to pull it from the perforations in the middle of the page. I give them a call. They won't reimburse me for the cost of the baby's two-month wellness check-up, because his pediatrician isn't in-network. 

I call Medicaid, work through the endless options menu, and wait for the next available representative. She pulls up our case, sees there's a problem, can't help me with it, but will file an incident report and have their special situations team research it. I let her know that an incident report was filed two weeks earlier, but she doesn't see any record of it in their system. She's unhurried and unapologetic, and tries to reassure me: don't worry, because she's creating a new incident report RIGHT NOW. When will it be processed? She doesn't know. Will I be contacted? She doesn't know, but I should call back in two weeks to check. Is there anyone I can talk to that could do something about this? No. Can I submit a written account to go with the incident report? No. 

I began this Medicaid experiment as a competent, resourceful woman. But the experience has broken me. Somewhere between their unaccountable happenings, endless phone menu options, piles of unsolicited mail directing me back to their phone menu options, and helpful representatives that can't actually help at all, I've realized that helplessness can be as learned a trait as resourcefulness. 

It's good to be back with Samaritan Ministries, our healthcare co-op. This option might be paperwork-heavy, but at least someone takes my calls at the other end, and I can rest assured our money is supporting a non-profit that's transparent, affordable, and effective. 

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Thursday, November 13, 2014

They Should Offer a College Course Or Something For This.

All I wanted to do was take out the trash.

But the dumpster was three apartment buildings over, and it was 30 degrees out, and I knew I couldn't leave the sleeping newborn in the crib, because the whole place would inevitably burn down in the four minutes it took me to return. But he was sleeping. And the doctor had said not to take him out in public until he was 2 months old.

I bundled him up, awkwardly carried him with two bags of trash across the parking lot, and [thankfully] tossed the correct two out of three into the dumpster.

Anyway, parenthood's proven more a learned skill than an intuition of wisdom. I thought getting pregnant came with a blast of holy pixie dust, and whatever virtue it is that kept Mary from yelling at Joseph for falling asleep at the Nativity. 

The logistics of every day life and kids should be a course in college. A legit course, not some joke elective for those of us pursuing the MRS degree plan. (Yeah, I'll own up to that, as well as admit it was the dumbest use of college funds ever, perhaps secondary only to being a Communication Studies major. No, for real.)

Raising Kids could be a logic course for philosophy credit: is it more ethical to cut your grocery list in half and leave the store with a crying toddler, or just forge on, to the annoyance of other shoppers? What if it's two crying toddlers? What if it's the day before your husband's birthday and cutting your losses means no chocolate in the brownies?

Or it could be a dual credit course for statistics: discuss the probability that your three-year-old is actually having an emergency and must pee on a tree right off the sidewalk, or is just faking it, because peeing on trees is the coolest new skill in his set. (There's something about yuppy suburban bike trails that pushes preschoolers and pseudo-pro cyclists alike to want to show off.)

Then there's the logistics of having kids. Why are we even doing this? There are costs to consider. Sure you might be able to afford diapers today, but what about driver's ed, car insurance, college?! (Our four-year-old attends part-time Catholic preschool that's somehow four-freakin'-thousand dollars a school year. It's hard for me to grasp spending that much per year per kid on education, even though it's on the low end for private schools. Except now that I've used the F-word euphemism as a tuition descriptor, we might not be invited back. Problem solved.)

I've heard that caring for children is a way to holiness -- just as any vocation or life-calling, but I expected a kind of innate and instant holiness. It turns out that tiny, needy babies bring out my worst, and I'm not the calm, cheerful, easy-going, generous, thoughtful woman I can make myself out to be. (Fact: I'm super grumpy. Like, humorless to the core. Except with coffee, when I can at least muster up enough goodwill for dry witless wit about TMZ being the only real news source in America.)

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But even with kids revealing my worst, they're also bringing out my best. Our utter unpreparedness humbled me with our first baby. The health needs and care for our second baby emboldened me. The subsequent surprise of twins has caused me to abandon all pretense and search out our intentions and second-guess our expectations.

Everyone's striving for something better, to have a better life than our parents, that our kids will have a better life than us. But what do we mean by "a better life"? More stuff from Ikea? More prestige in our work titles? More house in our homes? I don't think most parents mean any of this. We mean happiness. We want our kids to be happy, and we fill their lives with all kinds of opportunity, experience, and stuff to make it happen.

A line from my favorite Rich Mullins' song keeps relaying through my mind -- "they worked to give faith hands and feet, and somehow gave it wings," alongside images of his family of seven in a car that seats five, and a line down the hall for the single bathroom in their house. But they were happy. 

And I'm reminded there's really no preparing for any of this. And man, it's not exactly the life we planned, but it's so, so much better. 

Tuesday, November 11, 2014

A Birth Story (for people who like this kind of stuff)

"We brought chocolate!" Wally announced, holding up a large basket of candy bars and Laffy Taffy.

It's not the normal way to announce your arrival at Labor & Delivery, but after several weeks of living at the hospital on mandatory bed rest, I wanted to thank all the nurses for waiting it out with me.

Just before reaching 34 weeks, I was released to continue bed rest at home, after assuring Heather, my nurse practitioner midwife, that I'd return at the first sign of labor. (Pre-term labor had been stopped at 32 weeks with magnesium sulfate, this awesome, terrible IV drug that made me go kind of crazy. From that point, I was already dilated 4 cm, so we anticipated a fast labor when the time came.)

Four days after being released from hospital bed rest, on an early Tuesday afternoon, I felt a strong, definitive contraction. With Heather's advice fresh on our minds, Wally insisted we leave for the hospital. I insisted we unload the dishwasher and fold the last load of laundry.

Months earlier, we'd found out that our baby boys were sharing a placenta, and after the pregnancy was recategorized to "high-risk," we hopefully counted up each day in utero, relieved to make 23 weeks, then 28, 32, and now 34 weeks and 1 day.

I didn't feel any additional contractions, but I did have this weird physiological feeling, the same sensation I'd felt about 12 hours before each of our other kids were born. So with nothing but one good contraction an hour earlier and a vague physical intuition -- which I interpreted as a 12-hour RSVP from the babies -- we dropped our preschoolers off at my parents' house and joined late afternoon Dallas rush hour on our way to the hospital.

After our strangely celebratory check-in ("Hello!" "Good to see you again!" "So you think you're in labor?" "Eh, I don't know, but maybe, so we're here..." "We brought chocolate!"), I spent the night in an observation room on the Labor & Delivery floor.

When Heather came in early the next morning, she said one of the babies had a couple of decelerations of his heart rate overnight, which could indicate a failing umbilical cord. It was David, the same baby who had stopped growing in utero the week before, the first indication of a problem with the placenta or umbilical cord. We agreed it would be best to get the babies out that day.

I was already contracting regularly, if not progressively, so we scheduled induction for that afternoon. Since twins are delivered in the Operating Room, I joined the queue behind an emergency C-section and two scheduled C-sections that morning.

Contractions picked up through the morning, and around 11 am, once I reached a pain level of four, I requested an epidural. I could have held out and grunted through the pain for awhile longer, but the epidural was mandatory anyway (since twin deliveries more often turn into emergency C-sections), so why not keep the whole experience cool and calm?

I'd heard that it hurts to get an epidural. No, it was wonderful. So, so wonderful.

An epidural meant we could watch "How I Met Your Mother" and Wally could eat lunch.
Since the babies needed to come that day, a small dose of Pitocin was added to my IV at 1 pm. By 3 pm, I was dilated to 8 centimeters and on the way to the OR for delivery. Everyone was calm, but getting wheeled into a room with weird lighting and 14 people in scrubs (two NICU teams and a delivery team) felt overwhelming, and I almost lost it.

Heather asked if I felt like pushing, but gloriously, I couldn't feel a thing. God bless that epidural.

"Well, go ahead and push anyway during this next contraction," she encouraged. I let her know that I had no idea when contractions were happening. (God bless that epidural.)

"Ok, I'll let you know," she said, watching the monitor. "Push now."

One push, and David entered the world! Four pounds, crying out with strong lungs, and peeing everywhere. I couldn't have been happier.

Wally was allowed out of his corner in the OR to cut the cord, and then Heather passed David over to one of the NICU teams. She pulled over the ultrasound machine to make sure Jonathan was still head-down, ready to come out next.

At this point, some doctors force the second baby out quickly. Or sometimes, the back-flow of blood into the placenta, from the first baby's cut umbilical cord, causes an overflow of blood into the second twin's system, and an emergency C-section is needed.

Thankfully, Heather just watched the monitors to make sure Jonathan's heart rate was normal, and said we'd wait as long as needed.

While we waited, Heather told the delivery team the story of our last birth experience. And we all laughed and were grateful this time around was going so smoothly. (Laughing during delivery? God bless that epidural!!)

Heather interrupted her own story: "Did anyone check the clock? Do we know what time David was born?"

Everyone looked around, surely someone had checked the clock. Where was the clock anyway?

"Okay, well, it's 3:23 now, so let's just say 3:18 pm. Birth time for David -- 3:18!"*

As we continued to wait, Heather told the story of how we found out it was twins on April Fool's Day. I had thought the ultrasound tech was joking. I told them it was an awful prank to pull on new moms. "Um, Charlene, we're not pranking you. That's twins." 

Since this was Baby #3, Wally didn't skip work to come to appointments anymore. So he missed the ultrasound showing we were getting Baby #4 with Baby #3. So then I had to convince him by text message, on April Fool's Day, with no history of twins on either side of our families, that we were having twins.

At 3:32, Jonathan had dropped into place for delivery. Two painless pushes later (okay, I was a little out of breath, but anyone who's given birth naturally can just laugh at that), and Jonathan was born! Four pounds, eleven ounces, also crying and peeing. He had a little more difficulty breathing consistently, so they put something on his nose to help regulate it.

The doctor on standby for C-section rolled his eyes at having wasted 20 minutes of his life on standby in the OR. The anesthesiologist, on hand to knock me out, gave me a hearty congratulations and said he was glad not to be needed. The nurses all smiled and relaxed and said it was the easiest, smoothest twin delivery they'd ever seen. 

And we were so, so happy to have our babies safely into the world. They spent two weeks in NICU and then came home. 

*David's godmother was praying for us during the delivery. She said she prayed the Chaplet of Divine Mercy at 3 pm -- when it's traditionally prayed -- and I don't think it's any coincidence that David entered the world just as the chaplet concluded!

Wednesday, November 5, 2014

The Nicest Thing I Ever Did For My Cat

I didn't clean the cat's litter box. It really needs to be cleaned. I didn't clean it last night either. But I filled the dog's water bowl. Eh, close enough. 

"Tomorrow... tomorrow..." and then I'm asleep.

When Wally and I started talking about maybe, possibly having a third kid, I was really apprehensive. I kept saying, "We can't bring a baby into our already crazy lives!"

There's no guarantee the baby's needs would rank above the dog, in the sleeplessness of newborndom. Everything just kind of exists in time and space and what gets done is done and then undone and what doesn't get done floats around until it absolutely seriously for real has to get done like now like yesterday. And the cat, the poor cat.

But I was wrong. 

As it turns out, having a baby -- or two babies at once, as it turned out -- was the nicest thing we've ever done for our cat. I'd recommend it, for cat lovers everywhere.

First there was the maternity pillow: 

The buggy by the backdoor (with the best view to watch birds in the yard):

The changing table (with the best view to watch babies in the crib):

A new chair, just for her: 

Truly, they've become the kittens she never had. (Wally's going to kill me for writing that.)

Thursday, October 16, 2014

The First Week Home (re: Twins Aren't So Bad After All)

Surprisingly, twin newborns are not as life-shattering as I expected. We have our moments of chaos, to be sure. But these babies together are actually way easier than either our first or second kid!

It's not that there are fewer diapers, less laundry, more sleep, or easier work. I just think our parenting philosophy has relaxed a little, and now we can enjoy our kids, instead of freaking out to get every detail of family life "right" (whatever that is).

Here's the plan that's currently working in our houseful of crazy:

I will drink coffee every morning. And still nurse the babies. I might have a beer after the preschoolers go to bed. And still nurse the babies. I could eat nutella and crackers for dinner with ice cream for dessert. And still nurse the babies. Or maybe, if I get tired of nursing the babies, we'll switch to homemade formula (not to be pretentious, just because it's cheaper than store-bought formula). But actually we won't, because --
Seriously, you know why we breastfeed? It's not all the research that guilts exhausted moms into more and better motherhood via "breast is best." (And really super moms should buy this breastfeeding/pumping system of $18 nipples and $120 bottle warmers, because it will make you the best breastfeeding mom ever, and help you love your baby best of all and then register for a thousand-million necessary accessories to go with it, because how did small humans ever get fed before corporate America?!!) Seriously, we breastfeed because it's free. And I like a good deal. That's it.

We will let our kids stay up after 8 pm for special events. 

We might skip a nap for a playdate. 

We might co-sleep, if I'm too tired to put a baby back in the crib. We might not co-sleep, if I'm too tired to get the baby from the crib.

We'll probably eat the same thing for every meal, because it takes zero brainpower, and the kids like it. And take daily vitamins to make up the difference. 

We'll cloth diaper once their little bottoms are big enough to fit the cloth diapers. Again, not because they're better (maybe a little), just because it's cheaper. Unless the laundry gets overwhelming, and then we'll stop. 

I might "sleep while they sleep," but I also might use the downtime to take pictures of my cat with the tiny babies. 

And we'll all be just fine.

Because Everyone (Apparently) Wants To Know

As the admitting nurse in the Labor & Delivery wing of the hospital filled out my paperwork, she casually asked, "Do you want your tubes tied?"

It took me a moment to realize this is a real question, on the admitting paperwork for moms in labor, about to give birth. "Have you had prenatal care?" "Will you want an epidural?" "Do you want your tubes tied?"

WELL, GEEZ! What woman in labor, in her right mind, after 9 months of carrying around baby(ies) and extra hormones, and an inevitable future of no sleep and more budgeting DOESN'T want her tubes tied?! What a terrible time to ask someone to make a life-changing, long-term, irreversible, expensive decision!!! 

It's like asking a marathon runner at mile 25 if they're ever going to run again. It's like asking the winner of Nathan's Famous Fourth of July Hot Dog Eating Contest if they'd like another hot dog.

Congratulations! Do you ever plan on eating a hot dog again? You know where hot dogs come from, right?
I guess if I'm audacious enough to have two kids at once, I shouldn't take offense to strangers wanting to know about our future family plans. 

And they all ask. Every nurse through 3 weeks of bed rest. The anesthesiologist giving the epidural. All our usual best friends around town -- grocery store checker, post office clerk, other parents at the park, the pediatrician, the pediatrician's wife (whom I don't know, but happened to be at the office during the babies' first wellness visit), and the random neighbor I've talked to twice (the second time about whether or not we're "done.")

After giving birth to the twins, my mid-wife reminded me every single day for four days straight that there should be no sex for four weeks. I heard her on the first day, but I guess I laughed too many times about Irish twins and how funny it would be if we had two sets of twins nine months apart. So I got the "no sex" talk for three more days in a row.

So here's the deal. Since everyone (apparently) wants to know, I will share our future family plans right here, on my blog, for the world to see! 

Today, this 16th day of October 2014, having no assurance of anything for the future (as no one really does), we will uncompromisingly commit to the following as the definitive and right number of children for our family (also with the clear intention that no more of them come as sets):

I don't know. We'll see.