January 1, 2014

Mechnical ventalitation, other end-of-life medical measures for Jahi McMath? "What it buys is misery we would not inflict on a terrorist"

Thirteen-year-old Jahi McMath is dead. That's the conclusion of Paul Fisher, the chief of Pediatric Neurology at Stanford University, who was appointed by an Alameda Superior Court judge to examine the girl and make the final determination about whether this Oakland eighth-grader is alive or dead. He concluded that the child lying in the hospital bed at Children's Hospital in Oakland is in fact dead, with no hope of recovery.

He said she had an irreversible brain injury and shows complete absence of cerebral function, meeting all criteria for brain death, listed by professional societies and the state of California. 

Alas, that conclusion hasn't satisfied Jahi's grieving family, whose painful, tragic denial, fueled by what they call a strong religious faith, has been exploited and amplified by an attorney with questionable ethics, groups with a political right-to-life agenda, and media members who seem enamored with the made-for-TV-medical-drama suspense aspects of this storyline. 

If there is anything positive that can be gained from this situation is that it is prompting good discussions in responsible media outlets and in private homes about end-of-life issues. And perhaps it is encouraging people to consider carefully at how they would want to die, or how they would make decisions in regards to a loved one who is terminally ill or who has suffered a traumatic brain injury and can only stay alive through mechanical means.

Maybe the best place to look for answers to these questions are doctors and health professionals themselves. Find out what life-saving measures they would choose -- or rather, not choose -- for themselves. You would be very surprised.

"The Bitter End," is a January 2013 segment on the PBS radio show RadioLab that looks at a decades-long Johns Hopkins University study on doctors, including asking doctors about their own views on medical care and dying.

The study shows (see chart above) that up to 90 percent of doctors, surveyed for a hypothetical scenario in which they suffered irreversible brain injury, would decline mechanical ventilation, CPR and dialysis.  Up to 80 percent would say "no" to a feeding tube.  Of course, they know things we lay people don't know, including what it really means to get CPR (only about 8 percent of people survive, and the rest are in pretty horrible shape) and what it means to be kept alive by a breathing machine.

"What it buys is misery we would not inflict on a terrorist." 

This quote comes from Ken Murray, a doctor was interviewed for the RadioLab report and who has written several articles about how doctors think much differently about death than patients. 

The misery he refers to involves patients getting cut open, perforated with tubes, assaulted with drugs, and hooked up to machines -- specifically to mechanical ventilators -- in what doctors know is a "futile" attempt at care.  

"All of this occurs in the intensive care unit at a cost of tens of thousands of dollars a day. What is buys is a misery we would not inflict on a terrorist," he writes in an article "How Doctors Die: It's Not Like the Rest of Us, But It Should Be." 

He more specifically addresses the agony of mechanical ventilation in the RadioLab interview. To use mechanical ventilation, doctors need to paralyze the patient, so she can't move, though she might still be fully aware of what's happening around her, Murray said. Mechanical ventilators usually involve inserting an endotracheal tube into the windpipe. This can be profoundly uncomfortable, as sometimes, other reports say, the machine doesn't quite sync up to the patient's natural rhythm for breathing. 

When my father was on a mechanical ventilator for a few days after heart surgery in 2002, the doctors strongly suggested he be heavily sedated so that he wouldn't be mostly unconscious until it was removed. My father eventually came off the ventilator, and lived for another eight months, but had trouble swallowing and later developed pneumonia and other infections. Watching my father on the ventilator convinced me that I never want to be on one. 

In a blog post for the Center for Health and Media Policy at Hunter College, RN Mauricio Berrio Orozco asks whether prolonged mechanical ventilation causes needless suffering, especially in patients surviving a devastating brain injury. "Many of them are conscious, but a good prognosis is basically impossible. They do not have even the slightest chance of recovering their previous level of functioning."

Orozco also points out the serious problems that can arise from long-term ventilation. These patients are at serious risk for infections and ventilator-associated pneumonia, huge pressure ulcers and muscle atrophy from inactivity.

Murray adds that some of the treatments we offer to critically ill patients are often "worse than the disease. You may be prolonging life but not for very long. The life you have left is misery."

So, if Jahi is still alive, as her family and their supporters insist, then keeping her indefinitely hooked up to a mechanical ventilator carries the risk of condemning her to days and months of agony. If she is alive, it sounds like she'll need to be paralyzed, heavily sedated and constantly monitored for infections, ulcers and muscle atrophy.

The family has received support from a brain-injury treatment center dedicated to Terri Shiavo, the Florida woman whose case in the mid-2000s sparked a fierce nationwide end-of-life debate, according to the Contra Costa Times. The organization, run by a former hairdresser, revealed earlier this week that it was helping Jahi's family get her transferred to a facility in New York, that claims to be "about preserving life and treating brain-injured patients with care and dignity."

The mechanically ventilated reality of Jahi's death--or life, as her family asserts--seems a far cry from dignity. If she's alive, then it could be misery, as Murray describes. The medical interventions necessary could lead to profound suffering. Did the Terri Shiavo organization, or the facility accepting her transfer, explained those facts to her family?

But if she's dead, as all the experts say, the only misery and suffering would be to her dignity. It's time for her family, already coping with profound grief, to accept that she's gone.  

October 9, 2013

Should high schools do away with football and other sports?

Last Friday afternoon, I was sitting in the bleachers at Las Lomas High School, watching the Knights junior varsity team putting up a valiant struggle against the Acalanes Dons. It was a lovely, early October afternoon, T-shirt weather giving way to fall crispness as the sun went down and the stadium lights turned on.

That I even just wrote this sort of Friday Night Lights, American sports-speak paragraph feels a little strange to me because I never much cared about football--not until my son started playing as a freshman last year.

I certainly didn't care about football when I was in high school, and my team was the Acalanes Dons. I don't think I ever went to a Dons football game, and I didn't know any football players. As a member of the school's drama program, my friends and I considered ourselves to be something of what passed as the cosmopolitan elite in a suburban high school. Yeah, we were a bit full of ourselves. We joked about the jocks being too mainstream, and we stereotyped them as simple, "bust-heads" guys. We probably resented any primacy their team membership afforded them on campus, the fact that we had to attend pep rallies for homecoming, or the expectation that we get rah-rah about some vague notion of "team spirit."

I have a feeling this anti-football, anti-sports sensibility would have found much to like about The Atlantic's big new cover story, The Case Against High School Sports.

In the story, author Amanda Ripley argues that the American high school love affair with sports is hurting academics, at a time when our next generation of students cannot afford to get behind in terms of preparation for global competitiveness. She writes:

Sports are embedded in American schools in a way they are not almost anywhere else. Yet this difference hardly ever comes up in domestic debates about America’s international mediocrity in education. ...

... Even in eighth grade, American kids spend more than twice the time Korean kids spend playing sports, according to a 2010 study published in the Journal of Advanced Academics. In countries with more-holistic, less hard-driving education systems than Korea’s, like Finland and Germany, many kids play club sports in their local towns—outside of school. Most schools do not staff, manage, transport, insure, or glorify sports teams, because, well, why would they?

But I'm not in high school anymore, and my son plays high school football and is really enjoying it.  I really enjoy going to his games. I read this kind of story, and I find my mind grousing, almost like some Fox TV news fan, about more media attacks against the great American institution of football.

Actually, I do seriously wonder if those arguments about American high school students falling behind their counterparts in other countries is a bit overplayed, tired--and simplistic.  For one thing, can you really compare the academic achievements of students from the much more culturally and economically homogenous population samples that you would get from Korea, Finland and Germany against the United States, where students come from hugely diverse segments of society?

OK, for me to attempt to make the argument that these educational hand-wringers are comparing apples and oranges, I would need to dig into the data. But from reading the article, Ripley doesn't demonstrate she did much digging into the usual data either -- which is disappointing, considering this is The Atlantic and I expect its writers to produce better evidence.

Meanwhile, she seems to measure the "success" of American students by test scores and in terms of their potential as producers in an economy. In her argument, where do other indicators of success come in? I'm talking about students growing into adults who feel well-rounded and happy and contribute to society in other ways. Those sorts of attributes don't show up in standardized test scores.

In her narrow idea of success, she also seems to diss the argument I've developed for supporting any extracurricular activity--including sports--in high school programs by saying this about a former Tennessee high school principal:

His argument is a familiar one: sports can be bait for students who otherwise might not care about school. “I’ve seen truancy issues completely turned around once students begin playing sports,” he says. “When students have a sense of belonging, when they feel tied to the school, they feel more part of the process.”
OK, so what if it's familiar argument, if it's true for a lot of kids? When my son said he wanted to do freshman football and start practicing the summer before freshman year, I was happy. It meant he wanted to somehow get involved in school and have in place a social network before the academic year started.

He's become friends with the guys on both the football and wrestling teams. Being on both teams has given him confidence, a sense of belonging and an investment in the school community -- which I believe makes him much more engaged academically.  

But sports wasn't the only way he-- or any other student -- could find this sense of engagement. He could have found it, like I did, doing drama. Or, like other friends of his, who write for the yearbook or play in the band.

Ripley's strongest arguments come when she picks apart the huge financial investment -- which often come in the form of hidden costs -- that schools make in their sports programs.  She tells the story of a Texas rural school district, whose superintendent made an absolutely radical decision, especially in the spiritual home of Friday Night Lights. He decided to eliminate the high school's sports programs and focus on academics.  The district faced being shut down by the state due to academic failure and financial mismanagement. Football at the high school cost about $1,300 a player; math, by contrast, just $618 a student.

It turns out the school and the community missed football less than they thought. While some football players transferred to other schools, others took up club sports. Meanwhile, the rate of students passing classes went up 30 percent, and rowdiness, fights and other behavioral issues on campus declined. And, for the first time in many years, the district had a healthy operating balance and no debt. “Learning is going on in 99 percent of the classrooms now,” the school's former football coach, who also teaches history, told Ripley, “compared to 2 percent before.”

I've watched -- and loved -- Friday Night Lights. Certainly enough to know that there are places in America where sports truly overwhelms the culture of the schools and of the surrounding communities. I would have suffocated in a Dillon Panthers kind of school, and I'm sure there are a fair number of kids in those high schools who suffer because they don't care about being part of football-dominated school spirit.

Ripley's arguments probably better apply to the Friday Night Lights kinds of places.

Meanwhile, she has these curious paragraphs and bits of information near the end of the her article that undercut her arguments.

She is critical of the fact that only 40 percent of seniors participated in sports, which means that 60 percent do not. But last I checked, 40 percent still translates into a fairly significant number of kids in any school population. Then she writes:

Though the research on student athletes is mixed, it generally suggests that sports do more good [italics mine] than harm for the players themselves. One 2010 study by Betsey Stevenson, then at the University of Pennsylvania, found that, in a given state, increases in the number of girls playing high-school sports have historically generated higher college-attendance and employment rates among women.
Finally, she cites this study, by a Columbia University researcher, which backs up my earlier assertion about the overall value of extracurricular activities, including sports. This study ...
... found that teenagers who participated in extracurriculars had higher college-graduation and voting rates, even after controlling for ethnicity, parental education, and other factors.

So, here in suburban San Francisco, we're blessed with pretty good to outstanding public high schools that usually offer a range extracurricular activities.

I'm sure there are some kids at Las Lomas who just want to focus on academics -- and they can. If Las Lomas is anything like Acalanes was when I was a student, then you can, if you choose, mostly tune out the sports culture -- with the exception of the occasional pep rallies.

And then there are some kids who don't like school, or don't thrive in your typical, large American comprehensive high school. Maybe they are otherwise brilliant, or entrepreneurial, or self-starting, and they will find their own way to succeed in life.

And when they become rich and successful CEOs, they will bemoan how mainstream public education dulls the mind and fails to help our next generation stay competitive in our global marketplace. They will send their kids to Waldorf schools, or whatever new alternative education trend comes along, and they will start their education foundations and donate to programs that support charter schools or small-school communities. Such efforts are laudable considering that there certainly are kids who would thrive in those kind of education environments.

However, I would guess that a majority of students are relatively content with the blend of academics and extracurricular activities they get at larger comprehensive schools. They want the opportunity to have something besides academics to engage them creatively, socially, physically or intellectually.

As it happens, some kids will find that sense of engagement in the swimming pool, on the basketball court or on the football field.

October 4, 2013

The politics of white teeth and America's income inequality

I've been going to the dentist to get fillings and a couple crowns replaced. It's work that I've needed to have done for a while, but put off because of the cost. I have insurance but have to pay for much of this work out of pocket. I know it's a bad idea to put such things off and that good oral health is necessary for overall physical health. But, well, it seems that I'm not alone in putting off necessary dental care.

Never mind getting the kind of treatment -- professional teeth whitening --  that seems to be de rigueur among Americans trying to project an image of health, happiness and prosperity. 

When I first met with this new dentist about six months ago, I filled out a general form that asked various questions, such as what I thought of the appearance of my teeth. Well, given that's it's fashionable to have that bleached-teeth look, I noted on the form that I wish my teeth could be whiter.  But my dentist and I didn't even go over the possible cost of what is essentially a cosmetic procedure. More pressing matters prevailed -- notably the fact that, if I didn't address the problems with two back molars, I was setting myself up for a scenario in which I could one day be in terrible pain.  

Ever since that realization that professional teeth whitening would be out of the question for me financially, I've become self-conscious about my teeth. I've started to feel less than attractive and, well, poor. I wonder how my less than pearly white incisors would affect my prospects in getting work, and I start to see another doorway to opportunity closing.

It turns out I have reasons to worry.  I came across this story in the Salt Lake City newspaper the Deseret News:  

Studies show bad teeth prevent otherwise qualified candidates from getting jobs or promotions. Although the U.S. is on the cutting edge of innovations in dentistry, many Americans have poor oral health and crooked or missing teeth and don't go to the dentist because they don’t have insurance and can’t afford to pay out of pocket for care. The scope of the problem is widespread: close to half of Americans are without dental insurance, according to data from the Department of Health and Human Services.

More specifically, researchers have looked at the social and economic cost of going without dental care. We're not talking about people who can't afford teeth whitening, but who can't even deal with basics, like dealing with caries or gum problems. It's not a pretty picture for people who can't afford it:

Numerous studies show a strong correlation between appearance and income. Research by Daniel Hamermesh, professor of economics at the University of Texas, found that better than average looking people earn 5 to 10 percent more than average looking people, who earn 5 to 10 percent more than below average looking people. “Teeth are an important component of physical appearance,” Hamermesh said.


When Israeli researchers digitally manipulated the teeth on the subjects in photographs and asked people to give their first impressions, they noted similar patterns of discrimination against people with poor oral health. People with crooked, discolored and missing teeth were judged to be of limited intelligence, low class, bad parents, less professional, less physically beautiful and lacking social skills.

At least my teeth aren't crooked--thanks to my parents who paid hefty fees to an orthodontist in my childhood and early teens. Those fees, by the way, helped this orthodontist go helicopter skiing in British Columbia every winter. Yes, his treatment rooms were lined with black and white photos of his helicopter skiing exploits. 

And, I'm not missing teeth. Not yet.  And, nearly half of all Americans, I have insurance to pay for check ups, and am able to pay for the current needed treatment, which is more than a lot of people have. Then again, getting my teeth fixed means we probably can't go on vacation or various other amenities in life that other people I know take for granted.

Still, as we continue the conversation about income inequality in the United States, it's worth looking at the likely extent to which lack of access to various health services, including dental care, compounds the gap between the haves and the have-nots. The Affordable Care Act expands dental coverage to children, but not to adults. The attitude therefore persists that dental care, like mental health care, is almost a luxury not a necessity.  

Meanwhile, if I want to address my teeth-whitening concerns, maybe I'll have decent results with those teeth-whitening kits that are available at the pharmacy. It's worth a try. And, if anyone has any recommendations, let me know.

September 22, 2013

My Excellent Hacking Adventure: Life Lessons Learned from an Identity Thief

Anyone who knows me understands that I tend to be a half-glass-empty kind of gal, or have been for quite a while. I have been slowly trying to change, especially since reading various stories about the new "science of the mind," and how, through various daily practices, we can reset our neural pathways to create mindsets that allow us to be more happy and optimistic.

Writing more than a year ago, I reflected on a US Army program that tries to build mental and emotional resilience in soldiers going into combat and other dangerous situations.  The idea behind this training is that soldiers who are more optimistic are more likely to survive injury, capture, torture and other adversity. That innate optimism gives them the faith, or whatever, that the awful moment or moments will pass and life will get better. One daily exercise assigned to these soldiers is to write gratitude lists. It forces the soldiers for just a few minutes to reflect on people, situations and moments that have made their lives just a little bit better. In an an article on the army's U.S. Army's website, it is said that this daily practice of "hunting the good stuff" can, over time, reset thinking, and it's something we can all do to build our sense of optimism. 

Actually, I didn't have to do too much hunting the good stuff when this situation arose over the past few days. My email account was hacked sometime late Thursday night, early Friday morning, and someone sent out emails to various people in my contact list, soliciting money. Yes, not a good situation, a disturbing one actually, but somehow that's not how I came to view it.

Here's how it started. This is the note that went out to friends, acquaintance and work colleagues and acquaintances: 

Thanks for getting back to me, I really did not want to disturb you with this but I had no one else to turn to. I'm in Toulouse, France to see my cousin who lives there. He's critically ill and needs family support. He was diagnosed with (Acute Lymphoblastic Leukemia) - a type of Blood Cancer in 2005 and had been undergoing treatment since. The chemotherapy treatment was going fine until last week when the doctor noticed that the disease has relapsed and the only way he can survive is by undergoing a BMT (Bone Marrow Transplantation). My sister whose marrow matched his has agreed to be the donor and he shall be undergoing the transplant soon at the Claudius Regaud Centre hospital Toulouse, France . The estimate for the transplant is $5,550 USD . I have already spent approx. $3,500 US towards his treatment. Since the amount is huge, I request you to lend out a helping hand and support me with a loan of $2,000 USD.

Since I don't know your financial status at the moment, any kind of help whatsoever will be deeply appreciated. Any amount will be accepted with gratitude and paid back after the surgery. Please let me know how much you can loan me so that I'll provide you with the details to get the money sent to me and I will pay back as soon as I return. I will check my email every 30 minutes for your reply.

It was signed by me, and asked that people respond to a faux Martha Ross email address. 

It looked like the mass emails started going out early Friday morning.  By 7 a.m., I had received my first alert from a friend, via a text. Then calls, emails, Facebook messages and other texts started coming in, including from friends from various parts of the country and from different eras of my life. I hadn't spoken to some of these people in years. All recognized the email plea as bogus, though their alerts came with words of concern. Most expressed sympathy for the fact that my email had been hacked--and that someone was trying to appropriate my identity. But a few also admitted they just wanted to make sure this wild story wasn't true, and I had to reassure them it wasn't.

As I went through the ATT help desk to get my password changed and account secured, I got caught up with some wonderful friends: I learned how my Northwestern friend James has a new house in Chicago and his daughter just started first year of college at University of North Carolina. Another friend, who goes by Jim not James, included in his Facebook message the news that he was leaving a one job and starting another that sounded very cool: as a communications director for a well-known Sonoma winery. 

A Las Lomas mom and I compared notes about our son's grades and teachers, while my sister said she had received a note from our uncle in Seattle, just wanting to make sure all was OK. I also heard from a UCSF professor I had just finished interviewing for a story, as well as the owner of my gym. 

 My Chicago friend James, always one for mischief, decided to have fun with the hacker and sent an email to the faux Martha Ross account, asking for more details on how to send money. He received this response:

Thanks so much for your concern and willingness to help. He shall be
undergoing the transplant soon at the Claudius Regaud Centre hospital
Toulouse, France ) What we need now to balance for the transplant is
$2,000 USD . i do not have direct access to make  transactions on my
bank account from here. Please i need your assistance. Please find a
Western Union outlet closer to you at any Post office,or Shopping
Malls to make the transfer, any kind of help whatsoever will be deeply
appreciated. What you can help with at the moment will be accepted
with gratitude and paid back after the surgery.
The hacker gave a return address in Toulouse, which turns out to be a Western Union office near the esteemed Institut Claudius Regaud (see Google map above), where "my cousin" was receiving his life-saving transplant from my sister.  

OK, neither of my sisters is in France. I saw my older sister yesterday afternoon at my son's JV football game. Oh, and she had received the bogus email, as had another football mom who came up to me and said, "Martha, I received the strangest email from you today!"

This sounds corny, but I realized that, even in my glass-half-empty moments, my life is still pretty full with some amazing friends, family and acquaintances. 

It took a hacker to remind me of this fact.  It also took this hacker's attempt scam to inspire me to go on a virtual tour of Toulouse France! It sounds like a nice city to visit! A part of me wishes I were there. 

 Feeling a strange sort of benevolence, I emailed the hacker a note last night, at the return Martha Ross email address he/she had given out to send money. Actually, I assumed my professional journalist persona, and told the hacker I was interested in learning more about his/her business of hacking. Primarily, I was interested in hearing my perpetrator's side of the story.

I wrote: 
"I'm guessing there is little I can expect from law enforcement in hunting you down and arresting you. You're probably in a different country.  Since, you're not likely to get anything out of my friends, and I'm not likely to see you get into trouble for this, I figured I might as well see if something else constructive can come out of this. And that could be seeing if there is a story I can do about phishing and hacking. What would make the story better would be if I could hear from someone who does this, and learn from that person not only how they do it but why."

I then posed such questions as: 

--"I wonder if you're living in really difficult circumstances that make you want to turn to scamming people. Are you?" 

--"Do you work on your own or with someone else? Are you being forced to do this?"

--"Have you ever been successful with one of these scams? How much can you earn a year doing this"

--"How old are you? Are you married? Have kids? 

--"What are your dreams for the future?"

Alas, soon after I sent out these interview questions, I realized I had already disabled the hacker's phony Martha Ross account, so I had likely cut off my connection to him or her. 

Darn, it would have been fun if someone had actually responded. 

September 19, 2013

The Navy Yard shooter, and when pleas for mental health care are discounted

With Navy reservist Aaron Alexis, we're hearing yet another story about someone who was "hearing voices" and slipped into homicidal depression before opening fire in a public place and killing a lot of people.

It's very troubling news on a number of levels, including when you have someone in your family who struggles daily with a mental illness.

First of all, it's irksome to see mental illness gain extensive media coverage over someone like Alexis, who presumably spiraled into psychosis before he got ahold of a firearm, headed to his workplace and went on a violent rampage. On Monday, Alexis brought a shotgun into the Washington Navy Shipyard, where he was working with a company subcontracted to upgrade computers at the base. He opened fire and killed 12 people.

As disturbing as Alexis' acts were, they were an anomaly. Most people with a mental illness--even if they don't get proper diagnosis or treatment and even if they go off their meds--do not turn violent. The Institute of Medicine reported in 2006 that "the contribution of people with mental illnesses to overall rates of violence is small," while the American Psychiatric Association said that the vast majority of people who are violent do not suffer from mental illness.

What's also concerning is  evidence that Alexis wasn't receiving proper treatment for his increasing symptoms. In early August he told police in Newport, Rhode Island that he was hearing voices and feeling vibrations sent through his hotel-room walls. But the Washington Post also cites federal officials as saying that Alexis subsequently sought treatment for insomnia in Veterans Administration emergency rooms but told doctors he was not depressed and was not thinking of harming others.

If Alexis downplayed his symptoms with emergency room doctors,  it could be because people in mental distress often have difficulty being upfront about their symptoms. Sometimes, they are having trouble making sense of the voices or agitation. Or, they don't know how to communicate what they experiencing. Or, they are afraid of the stigma that comes from a diagnosis.

And, sometimes, the illness stops them from saying too much, especially if they are paranoid and fear being victimized. But it's also entirely possible that physicians who took his history weren't listening or asking the right questions.

There are a lot of reasons the system fails and people don't get the help they need. Sometimes it's because the patients aren't willing or able to seek help, but sometimes the system itself fails. 

In my family, we've recently been dealing with some fall-out from a psychiatrist who hasn't inspired confidence, or incompetent pharmacists, or both.

Last spring, my husband's beloved psychiatrist died, which is another circumstance that can cause a patient to become unstable. 

My husband, who has schizo-affective disorder, had excellent rapport with this psychiatrist. He felt like the psychiatrist was a good listener and was willing to be partners in the treatment. My husband trusted this psychiatrist's expertise, especially in handling the constant dance he had to do with adjusting his medications in response to his changeable symptoms.

After this doctor's unfortunate and premature death, my husband started seeing a new psychiatrist. This new psychiatrist has not entirely agreed with my husband's previous treatment regimen. In my husband's most recent appointment, the psychiatrist didn't communicate his reasons for adjusting medication levels.

My husband is willing to work with this new doctor, but is wary about making changes, since he feels like he has been taking medication that works for him. 

 In August, for some reason, my husband couldn't get his prescriptions filled in a timely way. He'd go to the pharmacy, and his refills for several medications hadn't been filled. His psychiatrist's office told one story, that they had faxed a refill authorization to the pharmacy. The pharmacy said something else, to the effect that they hadn't received faxes.
My husband started to get his medication piecemeal, with the exception of his anti-depressant. So, he was forced to go off his anti-depressant, which is widely known to be dangerous. He ended up going without his anti-depressant for nearly three weeks, despite bugging his psychiatrist's office and the pharmacy daily.
My husband's mood plummeted, and he became irritable and anxious.  It was hard for him to get out of bed in the morning.

Finally, he got his anti-depressant, and took a dose right away. The next day, he looked and felt much brighter, alert and energetic. The difference a day makes--in his case, it was dramatic. The lesson, while painful for my husband, was instructive. We always knew his anti-depressant was important but figured the anti-psychotics and mood stabilizers were most crucial. Now we know better.

The lesson was instructive in a more global way, as well.  My husband's treatment regimen temporarily collapsed, either because of an unresponsive or inattentive psychiatrist, or because of a communications snafu between the psychiatrist's office and the pharmacy. 

I hear that such treatment breakdowns are fairly common in the mental health world, and now my husband is dealing with a doctor he's not sure he trusts.

Is our system for dealing with mental illness broken? It certainly doesn't work as well as it should, for a number of reasons.

September 18, 2013

Walnut Creek moms launch campaign for Battle of the Creek supremacy

UPDATED: Alas, although, the Battle of the Creek received a stunning 41747 votes, the deranged supporters of the game between Sacred Heart Cathedral and Milpitas High outscored us, winning 45446 votes. Thanks for voting!   

OK, it's not really a formal campaign or anything. My friend Peggy Spear, a Northgate High mom, posted on her Facebook page a call for people who live in both the Northgate and Las Lomas high communities to vote in favor of KTVU televising the epic annual football showdown between the schools' varsity teams on Friday night.

So, as Peggy writes on her Facebook page, KTVU will televise the high school football match-up as "Game of the Week" that gets the most votes in a readers' poll.
I'm headlining this post as Walnut Creek "moms launch campaign." OK, it's not really an official campaign. I guess I'm the other mom, and I'm saying it's a campaign 'cause I am sharing her Facebook post and the link. 
"Hey Walnut Creek!" Peggy writes. "Vote for 'The Battle of the Creek' -- the big football match-up between Northgate and Las Lomas -- to be televised on KTVU this Friday! It's a tight battle with a match-up from the South Bay. Go here to vote...and often!"

Again, here's the link.And you can vote as often as you want.  Above is a City of Walnut Creek video of 2010's Battle of the Creek, in which the Northgate Broncos defeated the Las Lomas Knights 28-21.

September 15, 2013

Pleasant Hill to Discuss Preserving Historic and Cultural Resources

So, the Save the Pleasant Hill Dome campaign didn't succeed in saving our wonderful Pleasant Hill Cinearts Dome movie theater. But the outcry and news we generated about the tragic loss of this landmark of our suburban history got residents and city leaders in Pleasant Hill thinking that they should finally enact a longstanding municipal ordinance regarding historic and cultural resources preservation.

The Pleasant Hill Planning Commission will hold a special workshop Tuesday evening to review and discuss historic and cultural resources and associated issues within the city. The commission is hoping to discuss and get input on:

  • Policies in the city's General Plan applicable to historic and cultural resources
  • Structures of potential historic significance.
  • Other applicable state and federal laws. 
The city has had an ordinance on the books since the mid-1990s allow the city to establish a Cultural Resources Management Commission. The specific purposes of this ordinance are to "prevent neglect of historic and architecturally significant buildings, encourage public appreciation of the city's past, foster civic and neighborhood pride, enhance property values and increase financial and economic benefits to the city, and encourage public participation in identifying and preserving historical and architectural resources.

The workshop is scheduled for 6:30 p.m., before the start of the commission's regularly scheduled meeting at 7:30, in the City Council Chambers.

September 7, 2013

Is Self-Forgiveness Possible?

For a story I'm working on, I recently had the opportunity to chat with a 65-year-old woman named Linda who had many years ago been a raging drug and alcoholic addict and spent 10 years in prison for burglary -- crimes fueled by her addictions.

 She had been out of prison for two years. She was living in a wonderful, safe, nurturing community for homeless women and families, where she was getting help staying sober, finishing her parole, working, saving money, and getting back into the good graces of her daughters and grandchildren.

Things have been going well, she said. "Life is just so wonderful, and I'm so grateful every day." In fact, she doesn't regret her time in prison. The experience taught her a lot. She still feels guilt about things she did. "I put my daughters through a lot behind my drug and alcohol use."

She says she still feels guilt about her drinking and drugging and criminal choices that landed her in prison.  But she says she doesn't feel shame. 

"I found God while in prison," she says. "I learned to appreciate more things. Mainly I learned how to forgive myself with the. That was one hardest things in the world, to learn to forgive myself. I put my kids thorugh a lot, behind me doing drugs."

"I'm not proud of myself, but I'm not ashamed either."

Wanting to wrap my head around the seemingly contradictory states in Linda--feeling guilty but not feeling shame, and being able to forgive herself--I turned to the experts at the Greater Good Science Center at UC Berkeley. Since 2001, the center has been at the forefront of a new scientific movement to explore the roots of happy and compassionate individuals, strong social bonds, and altruistic behavior. The sponsor ground-breaking research into social and emotional well-being. 

One of their core areas of research is forgiveness, which psychologists generally define as a conscious, deliberate decision to release feelings of resentment or vengeance toward a person or group who has harmed you -- regardless of whether they actually deserve your forgiveness.

Forgiveness is said to bring the forgiver peace of mind and frees him or her from corrosive anger, letting go of deeply held negative feelings. This process is supposed to empower you to recognize the pain you suffered without letting that paid define you, enabling you to heal and move on with your life. 

That all sounds reasonable, doing, practical, and healthy. 

But what if the person who need to forgive is yourself? 

In an article on the Greater Good Science Center website, "The Healthy Way to Forgive Yourself," UC Berkeley doctoral candidate Juliana Breines writes that self-forgivness, for transgressions large and small, is critical for psychological well being. Among her suggestions for healthy self-forgiveness, she addresses the usefulness of guilt but the pointless, toxic effects of shame: 

Don’t get rid of guilt, Breines says. 

Feeling bad when you do something wrong is natural, and maybe even useful. Without it, where would we find the motivation to do better next time? But not all bad feelings are equally beneficial.
Shame is a much different matter.  
 Shame, which involves negative feelings about the self as a whole (i.e., feeling worthless), is associated with defensive strategies like denial, avoidance, and even physical violence. Feeling like you’re just a bad person at your core can undermine efforts to change, as change may not even seem possible from this perspective. Guilt, by contrast, involves feeling bad about one’s behavior and its consequences.

To truly forgive yourself and to experience the benefits of it, Breines says, we should always own up to our transgressions, make amends, take responsibility, pay our dues. 

Her last suggestion is to foster empathy for the victim. 

Research has found that self-forgiveness is negatively associated with empathy for victims. As self-forgiveness increases, empathy decreases. This disconnect is understandable: it’s difficult to have compassion for oneself while also having compassion for those one has hurt. 
But self-forgiveness is not supposed to be easy, and without incorporating empathy it seems more like a form of avoidance.
Finally, Breines says, self-forgiveness doesn't have to be all or nothing, and we may never ultimately release the negative feelings associated with a certain event. Self-forgiveness should not be a form of self-indulgent, rather "elf-forgiveness might be better seen as an act of humility, an honest acknowledgment of our capacity for causing harm as well as our potential for doing good."