Mom is trying to tell us something

It’s the damn key scenario again. I dropped my keys on the ground this morning, but I found them soon afterwards. Then my father called, sounding upset, to share that he lost HIS keys. He turned his apartment upside down, checked all his pockets, even flipped his walker upside down. I reassured him that everyone loses their keys, I just did it, and it doesn’t mean he went senile. Heck, in all likelihood, the keys will wind up at the Wellness Center (I’ve learned that routine). I felt a sense of foreboding that this was going to get weirder. And indeed it did. After a nice afternoon bike ride with my friend Julie, I reached for my car key in my backpack – it was gone. Not in the café where we had lunch, not in the parking lot. I got rescued by my neighbor with a spare key. Maybe the key will reappear . . . or more likely, it’s my mother making another spiritual appearance. She used to dream about lost keys and amaze me when she called to report their location, from thousands of miles away – how will she do that now? I talked to my father about it. Is she testing us to make sure we remember her psychic skills? Is she nagging us from the great beyond? Fortunately, he laughed when I said, “Dad, mom is messing with us!” He feels a little bit better. I’m a little bit more paranoid. We’re going to check tomorrow about our respective dreams to see what Mom has to say.

Sid's Perspective on Health Care

As part of “homework” for my UCLA certification program, I had to interview someone who has struggled with some aspect of a complex health system. Who better than my 91-year old father? We sat on a bench above the beach this afternoon, watching the surfers. Here’s Sid’s perspective, all in his own words with minimal editing.


Karen: You were born in 1922, when many babies were delivered at home by midwives. Tell me about health care when you were a boy growing up in Brooklyn. How did people get services? How were the services paid for?

Sid: You called the doctor only when near death. People used home remedies; some worked and some didn’t. There were no clinics. The family doctor was only called for emergencies. I was actually delivered by a doctor, it cost $5. My father only made $10/week, he had to borrow the money. All of the childhood diseases were rampant. It was customary to have measles, mumps and scarlet fever. Classrooms were crowded and bathrooms were more like a cubicle in the yard. We all grew up on remedies from Europe. The treatment for a cold was a mustard plaster on the chest. I received primitive health care up through 10 years old. I had bad acne as teenager, the treatment was brewer’s yeast (swallowed) – it didn’t work. There was also low frequency x-ray treatment to dry up lesions. Health care was poor during the depression, there was no money. Diphtheria and polio were very prevalent. There were lotions and herbs, black salve. Some people had their blood drawn out of their bodies with cupping, similar to acupuncture today. Women had as many babies as possible, because children died so often. My mother had two miscarriages before she had five children who lived.

Karen: Health insurance wasn't widely available until the 1960s. How did people react to having insurance? What changed?

Sid: Major employers started providing minimal coverage in the 1950’s. There were pay deductions, then it became part of union contracts, then it broadened. When you and your brother were born, the company paid for the hospital and pediatric bills. Doctors formed corporations and health care became a business. Appointments rarely exceeded 15 minutes.

Karen: You worked for Western Electric for 40 years. How would you rate the coverage provided by your employer?

Sid: Up until the end of my career the coverage was good. When the phone company mergers happened (the breakup of AT&T and the absorption of Western Electric in 1989) and management changed, the executives received golden parachutes. Coverage was cut back for everyone who remained. Death insurance was cancelled first. I had retiree benefits for decades until I went onto a series of Medicare HMO plans. The first time I had traditional Medicare was this year.

Karen: Health care is complex and fragmented. What has been the most challenging part for you and your family?

Sid: Delays in appointments and treatment. Doctors were loaded with patients and had limited time. Specialists never had time to see anybody. Expertise was fragmented, and many doctors didn’t keep up with the latest advances in treatment and research. Doctors tried to give adequate treatment with limited resources. I can’t blame the doctors in managed care plans. Secretaries and administrative clerks were dictating how much care patients could get, based on tables. There was always an appeals process, but I had no occasion to appeal.
 
Karen: How is the health care experience different in your geriatric years?

Sid: I had to change HMOs several times with a loss of services each time, I had to hunt around. At about age 70-75, we (mostly your mother) started to need more care, with more specialists.

Karen: What is most important to you when selecting a doctor? When you ask questions of your doctors, how do they respond?

Sid: Most of my doctors responded well to my questions. My technical background as an engineer was respected. My issues were high blood pressure, diabetes and heart problems (atrial fibrillation). Not all doctors were respectful and some didn’t want to discuss my problems. My current doctor, who you helped me to select, is very good at listening. The doctors were technically the same, personal concern made the difference.

Karen: How would you restructure the health care system if you could advise decision makers?

Sid: Create a single payer, government-sponsored system like Britain, France and Germany. No private corporations, no investors, no highly paid executives. Medicare, as one example of this model, has low overhead and does it well.

Karen: Health care and prescription drug costs keep rising. In your opinion, what is the biggest cost driver?

Sid: More and more people are getting older, with more needs. The costs of medications are going up. For instance, for my insulin pens, my out-of-pocket allowance went from $30 a year ago to $60 now.

Karen: You've lived into your 90s. Think about your lifestyle. What did you do right? In hindsight, what would you have done differently?

Sid: I violated all of the standard rules for diet. I liked meat, although I tried to balance it with vegetables. Some genetic influence must have helped. I was very active, I liked to walk until spine inflammation became a problem. I didn’t smoke or drink – all the people I knew who did are gone. My father was a smoker and he died at age 58. My brother was a heavy smoker who died at age 64.

Karen: Any other comments or insights that you want to share?

Sid: Every effort should be made to have health care available in a minimum amount of time – treat minor ailments before they become major ones. Personal budgets should include the costs of health care, just like planning to pay for rent or food. It should be the same mentality about paying for health care. If people look for minimal cost, they will get minimal care. People have no cash reserves. I was fortunate that I had savings which were invested wisely. Regarding Obamacare, the intent to cover the full population is good. However, insurance programs rely on a huge base of healthy as well as ill people. Younger people need to enroll. They don’t expect to get sick and are resistant, they don’t see the value. I wouldn’t be here today unless my employer-paid pension plan was established when I was young. They tried to cancel the plan later on and weren’t successful. I’m sure they hate my guts that I’m still alive!

Waxing and Waning

Sid and I celebrated Tax Day with two historic events. After 20 years of denial, Dad got his hearing properly evaluated and purchased two state-of the-art hearing aids. This was a mission that I often wondered would ever be successful, and I’m basking in a waxy glow. His change of heart was mostly due to peer pressure - all the other folks at his dinner table wear at least one device. Plus he wants to hear the lectures and movies without sitting in the front row, so he can nap as he pleases without embarrassment. He also wanted a deal – and since I can access a 20% discount through my employer, he felt okay about spending $1200 (which actually is a great price). Makes sense to me.

Tonight we attended a Passover Seder at his facility, which was a cute and somewhat tortuous affair (enough talking, bring the chicken soup!). Apparently Sid’s last Seder was at age 16, so there’s been a 75-year gap since he last spread horseradish on matzos. Much to his surprise, he could still read some of the Hebrew. Much to my surprise, he did not spill Manischewitz wine on his new white shirt.

I’m visiting for a week – shuttling Dad to many medical appointments and trying to have some relaxation time with friends. It’s a good phase; he is doing well in his new environment and thriving in many ways despite occasional crises. Mom still communicates with me when I least expect it. She and I are both a little concerned that my father now refers to Ida, the 98-year wonder woman, as his “date.” I’ve put parts of my life on hold; I regularly support Alaska Airlines and Hertz Rental Car. I’m trying to do the right thing and I’m enjoying being a good daughter. Much like the Passover herbs, it’s bittersweet.

Accidental Exercise

What started as a carefully planned, relatively peaceful week on the road in California fell apart when I received a call from my dad’s facility on Monday night that he had a bad fall. When seniors fall down, it’s never good. He slipped off his chair and got caught between the kitchen table and the wall. Unfortunately he wasn’t wearing his safety necklace and he couldn’t reach the alert button, phone or bathroom. He spent 10 hours on the floor, rescued by 98-year old Ida who wandered in to ask why he hadn’t shown up for pickled herring at breakfast. She called for help – from the Wellness Center. I now understand that whenever there’s a problem Ida calls in the Wellness troops. They sent a crew to extract him, after he spent the whole day contorting his legs without success, going into shock, and passing out. When he was finally pulled out and cleaned up, he wanted to go to breakfast (at 6 pm). He was also convinced that it was March 29, which is his wedding anniversary and probably meant he was thinking about joining my mother.

I left my work commitments and drove 90 miles to assess him; I was worried about stroke. His doctor’s staff trained me by phone how to evaluate (facial drooping, impaired swallowing, slurred speech, weak hand grip). He was traumatized but mostly recovered. I bought flowers for all the rescuers. I drove back to my meeting, and had a brief enjoyable break with friends Cindy and John drinking wine at their local Yacht Club. I then drove back south to take Dad to yet another doctor’s appointment, this time for a cortisone shot in his back. However, the procedure had to be postponed due to too much blood thinner in his system. Sid was so disappointed; I had to cheer him up – off we went off to the movies at the luxury theatre with the fancy recliner chairs. I forget to tell his neighbors we wouldn’t be at dinner. So of course everyone went into red alert and thought he was in the hospital. My bad.

Dad’s pain specialist gave me his cell number, we texted back and forth, and he squeezed him in for his shot late Friday afternoon. Yes, I realize this may be the most amazing part of the story. There are doctors who care.

In the meantime, I decided that Dad deserved to get a new recliner with an electric footstool, just like the one at the luxury theatre. I needed to make it happen – quickly. I made 3 trips to Costco to arrange logistics. I wound up befriending a Mexican laborer with a truck in the Home Depot parking lot, paid him $20, and we got the chair delivered to the loading dock while discussing Oaxacan art. While Dad was getting his pain shot, the maintenance guys set it up in his apartment, removed the old one he detested, and returned it to the store with my receipt for a full refund.

The week ended with an 8 mile walk on the beach with Leigh, who took the train down from Bakersfield to support me and have a mini-vacation. He has been a constant source of friendship for the past 40 years, and he understands. We left my dad taking a well-deserved nap in his new chair. If anything goes wrong, Ida will notify the Wellness Center. Dad is a very fortunate man to live in a caring community. I am humbled and blown away by all the people who have helped me. Thank you.

When It Rains It Pours

I squeezed in a quick visit to Dad in-between work trips. Unfortunately I picked the day the skies opened, ending a year of California drought. Things started fine the night before with a nice celebratory dinner with the real estate agent. The next day with Dad was a marathon of doctor visits, chatting with the bank about private client status (special pens for both of us because I can access his now-larger account), fixing computer glitches, and lots of eating. I was running back and forth to the rental car throwing things around, including the car keys. After dinner with his friends Jack and Linda (from the brief mobile home phase 30 years ago), I realized I couldn’t find the keys – anywhere. Not in Dad’s building lobby where I thought they might have fallen from my pocket. Not in my purse. Not in his apartment. Not in Jack’s car. I had to get on a plane early the next morning and I was screwed. I made many calls – to Hertz, to AAA, to the restaurant, to the security guys who patrolled the bushes, to the lost and found, to the airlines. I walked a mile to my hotel at midnight, debating what I should do next.

No surprise that I woke up at 4 am with my mother’s voice in my head telling me that the keys were in the lobby. I lose items about once a week, have done it all my life, and Mom is still providing advice. But this time she was wrong, and I was frustrated. At 7 am I walked back to Dad’s place, now with the rain dumping sheets and me pulling my suitcase uphill. I had changed my flight twice, notified my boss that I would not be attending his meeting, and resigned myself to hanging out at least another 4 hours to debate my options. I used a wire hanger to retrieve my Kindle from the car, where I had left the windows partly open. I then used saran wrap and duct tape to block the rain, now blowing sideways, from drenching the electronic panel. Dripping and demoralized, I retreated back to the lobby. I was about to set up the towing and locksmith service when Ida appeared, asking me why I was still around. I muttered ‘looking for my damn car keys” and she piped up “oh, for the Chevy? I took them to the wellness center last night.” WHAT?! Yes, Ida found them, and decided to relocate them to the wellness center, home of the podiatry clinic. Not to lost and found, not to the front desk, and no note left in the lobby. I couldn’t decide whether to hug her or strangle her. Well Ida is 98, she rules the place, and she eats breakfast with my father every morning. So I hugged her. We sprinted together to the wellness center (no elevator, she always takes the stairs). The keys were on the counter and probably would have been there for another week. I grabbed a roll of paper towels to sop up the car and took off for the airport, only to find that every flight was cancelled or delayed due to the “reverse weather pattern.” I managed to get to San Francisco, then Seattle, 10 hours later. I had to pay some extra fees but it could have been way worse (e.g., a missing key costs at least $200 to replace).

Of course, Mom was right again. And ironically, Seattle was bright and sunny today.

Moving On

Escrow closed today, the sale was legally recorded, and the utility bills are now in the chocolate king’s name. The process was not entirely smooth. The whopper surprise at the last minute was the request for brand new plumbing priced at $9000. I then engaged in a spirited philosophical email exchange with realtors about risk tolerance and the pros and cons of plastic versus copper fittings. The only thing consistently okay in that house was the plumbing. Other than the toilet leaking once in a while, the pipes are fine. There were lots of other items noted on the inspection report we could have debated, however they ignored the little stuff. Heck, they’re probably remodeling most of the place anyway. But I didn’t give them a dime for plumbing, and I walked away from the offer and said goodbye – and of course they came back a day later and said “never mind.” This was an emotional decision so that their family can be in one place - they are relocating the wife’s mother to live with her sister across the street. I can imagine the discussion when the (rich) husband tried to squeeze more money out of the deal, and the wife threatened divorce. Trying to take advantage of my 91-year old father was not smart, and I feel vindicated. Plus little did they realize how well Sid knew his plumbing.

How is Dad taking it, is he celebrating? Not really, he’s kind of sad, he loved his house. He choked up when I congratulated him, so I’m laying low on the “yahoo” tone. By his request, the realtor took my father to Subway for a $5 hoagie after all the papers were notarized at the bank. After all, there’s no point in wasting money.

Willie Wonka Wants the House

Hard to believe, but my parents’ house was grabbed within a week by a couple with cash, ready to close in 2 weeks. They are relatives of the neighbor across the street, and they’ve been strategizing how to create a family compound just like the Kennedys. I was a bit skeptical about legitimacy until I read the paperwork and Googled the guy. He has close to a million dollars in liquid assets, not counting his current home. He has an impressive career in medical device product design. Most fascinating, he is the founder and owner of a major regional chocolate empire.

My mother had an intense addiction to chocolate in all forms – I suspect she is thrilled post-mortem and probably had something to do with this development. My father isn’t much better – he squirrels away dark chocolate from many sources and distributes treats to his new friends (by the way, 70% of elderly people have diabetes, although this doesn’t seem to influence anyone’s behavior). And let’s face it - I’m worse than both of them on the chocoholic spectrum.

A cash offer in hand is very attractive, even though it is below the asking price, which was inflated, so in the end we will get the price we wanted all along (actually slightly more). Unless inspection surprises pop up, it appears to be a done deal. If Willie Wonka and wife back out, they forfeit their deposit which can fund lots of trips for me, and lots of candy bars for Dad.

Most people who buy homes on a half-acre lot do landscaping, or they might install a pool. I’m envisioning my folks’ back yard gulch filled with flowing chocolate fountains, powered by the irrigation system that Dad built. It’s broken right now, but it will rise again.