toxic people

Are there toxic people?

No, I do not believe so….

I think there are toxic interactions.

Toxic behavior. And it takes two to tango, really.

Do I have to stay away from someone who behaves badly? Do they set me off? Well, that’s about me, isn’t it? I need to go look in the mirror and see what is bothering me. What does this remind me of? Are they getting under my skin? So what part of my skin needs better boundaries?

I realized that my father drank too much when I was in college. I read about it and went home, ready to intervene. My mother and my sister refused, much to my surprise. And slowly I realized that my mother was enabling the drinking.

I set boundaries with my father. I said that he could not come to my house drunk and he could not drink at my house. I refused to sleep in my parents’ house because he was falling asleep and there were cigarette burns in the floor and an 8 inch diameter one between the couch cushions. I told my mother I was having nightmares about fires. She joked that she would be mad if he burned a hole in the waterbed. I told my father I was afraid to sleep upstairs and moved to my grandmother’s, two doors away. I was lucky that I had that option.

My father stopped drinking a decade later. I took my young son to visit, and found that my father had started again. I asked my mother, “Why didn’t you tell me?” She replied, “I told you I would leave if he drank, but I am not going to leave.” I said, “We are not staying with you.” and we moved to my mother-in-law’s house.

As a family doctor, I try to help each person. My clinic and I do have boundaries. If they no show for three visits within one year, we ask them to change to another doctor. People call for referrals often. I can’t do a referral without documenting a diagnosis and doing an examination, so they need a visit. “But you’ve seen me for hip pain!” “Yes, and that was a year ago. Time to reevaluate, right?” And all doctors here are swamped: they want to save their over busy time for people who truly need them. The orthopedist does not want to see that hip unless I agree that they need to: if physical therapy and discussion can fix it, one less person that they don’t get to operate on.

I recently had calls for an emergency referral. I left a message with both the patient and the specialist. I had not seen the person for five months. I have no idea what is happening. If it’s an emergency, they need to contact the insurance, not me, because I have not seen the person: no diagnosis. And insurance should cover if it is an emergency. If it is not an emergency, well…

There is behavior that I prefer not to be around. There is behavior I will tolerate in clinic but not my personal life, since I get paid in clinic. There is behavior I won’t tolerate in clinic. But think of the great ones that are still spoken of: the Buddha, the Bodhisattvas, Jesus. They had boundaries to where any person was allowed to approach them and was received and was sometimes changed by that reception. When I say “I can’t be around him or her,” how do I need to change? Ok, not the crazy person shooting into crowds, no tolerance. But day to day, the things that get under our skin, it’s our skin that is fallible.

I do not want to label anyone toxic. I hope to make a small difference in the world through my clinic. And add to the joy in the world.

For the Daily Prompt: saintly. I am not there. 

Sweet Honey in the Rock: Would you harbor me?

Advice to a college daughter

I am submitting this to the Daily Prompt: Careful.

I talked to a young woman recently who left the college that my daughter is going to.

And then I gave my daughter advice.

“If you are attacked or assaulted, sexually or otherwise, do not go to the campus police. Go to the city police. Or better yet, a State Trooper.”

Because, you see, the Campus Police work for the school. It is a conflict of interest.

If you are attacked, get a friend. Have them help you get to the City or State Police. Have them record your initial story on their cell phone. Have them photograph any injuries, torn clothes, you crying while you tell them. If you are raped, have your friend get you to the City or State Police and then to an emergency room for a rape kit. This is documentation of your story. Write out what happened the next day. Keep all of it. It is admissible in court. Name names. Tell every word that you can remember that the other person said. Try to figure out if there are any witnesses.

Because too many men lie. Men lie in our culture and the system dismisses what women and girls say, dismisses domestic violence, dismisses assault, dismisses rape. You do not want to be Cosbyed or Trumped. You will not stand for it. None of us should stand for it.

Fight back. Stand up. We will not tolerate this culture and we will make it stop.

Unconditional 2

I think the hardest thing in the world is to love unconditionally. And we can’t love unconditionally unless we love ourselves in that too. Including our faults, our mistakes, our dark corners, our anger and grief, pettiness, unkindness, stupidity, jealousy, greed lust… if we only love our “good” side then we will attack others when they show the same weakness and faults that we know, deep inside, that we are capable of or have acted on. If we cannot love someone who is a sinner, we cannot love anyone, because we are all guilty. Love people anyhow and wholly and yourself too.

I went through a period after my mother died, where I felt I’d entirely failed. My marriage was disintegrating, and I was looking at myself very carefully. How had I gotten here? What mistakes had I made? I felt unlovable and stupid.

I found a letter from my mother written to herself when my father asked me to clean out her clothes. It was two or three years after she died. Here is the letter, with a few things left out for the privacy of the living:

____________________

Sept 18, Friday
1987
Seattle

I don’t want to go home. I want to stay here in Seattle. With the mountains that lift my heart. And clear air and only good memories. What is there to go home to? Struggling with X and his alcohol. I don’t want to try to do something about it. I don’t think it will work if I do. I think will only go on as it is and trying to get help will only lead to fight. I don’t think I have the strength, the courage or the wisdom to help myself or him.

What else am I going to? A house that needs a great deal of work that I only moderately like. A climate I loath. A landscape I find boring. I’m tired of living in a crowded suburb. And that house needs so much work.

People. What people do I go home to? Nearly all have problems. Y, wounded bird, so foolishly enamored of Z or thinks he is. And I have little sympathy or patience with it. And his propensity to failure which I’m tired of also.

A who I dearly love but her household is such chaos with those ill-behaved children and one crisis after another.

B who I like very much but really have so little in common with. I fear all that spiritual stuff may eventually bore me. Maybe not.

C. Another wounded bird, really. And not dependable.

D, barely around, anymore.

Mother, older and frailer. Who needs my care and patience.

E. There is one person to go home to. Thank God she’s there. Not wounded anymore. But so busy and it isn’t fair or wise to dump my troubles on her.

Who else? Why don’t I know any successful (in the best sense) sane people. People who are intellectuals, interested in ideas. F is. But not a fully successful human being and not when G is with him. Ugh. Besides he lives far away and he and X don’t like each other.

I don’t really want to have that show at H’s Church. I don’t like H very well. Oh dear.

I maybe have a job which if I get will be very hard work and if I don’t will be a great disappointment.

Winter’s coming and things cost more and we don’t have quite enough to live on. So that means digging into my inheritance.

I am sick of D.C. I am sick of being a struggling, unsuccessful artist. I am sick of worrying about X, about his moods, his acting the fool when half drunk and acting cruel and crazy when fully drunk. I’m sick of being afraid, of his depression, of his refusal to talk to me about anything of importance.

Of doing dishing. Of all the mess in our house. The mess on my desk, the mud room, the kitchen, the study, the basement. The dirty paint. The back yard. Oh God! How can I change things? Well there are a lot of bad things.

Oh, & I’m sick of being anxious, 10 lbs overweight, biting my nails, having bad teeth/gums. Life get tedjous, don’t it?

Any good stuff?

____________________________

For me, this letter was the key to finding myself lovable. My mother wrote to herself because she felt that she could not share these feelings with anyone. Terrible feelings. And I thought about it for a long time: I thought: my mother was charming, loved and an entertainer. But a child knows the parents’ hidden feelings. So I knew about my mother’s darkness and the letter confirmed it. And I thought, my mother didn’t need to hide that because I knew about it and I loved her anyhow. I love her more knowing that she was human too.

And if she is lovable whole, so am I. So are you. We all are. And we all make mistakes and are guilty of anger (sometimes appropriate but sometimes not!) jealousy, greed, lust, sloth and pride. Love people anyway and wholly and yourself too.

 

I have a view of Puget Sound if I stand in the road in front of my house. I took this with a zoom lens on solstice morning at sunrise.

Fraud in medicine: medicare application

Medicare quit paying my clinic at the end of July, on the 31st.

I was still half time in clinic, we were interviewing a new receptionist as my receptionist of five years wanted to retire by August first. We got some sort of notification from medicare, but their letters are very cryptic.

My new receptionist was needing orientation and help and I was really tired after July. I redid the medicare application and sent it in. We continued to see medicare patients and turn in the bills.

Our medicare contractor is noridian. They sent us a cryptic letter saying that something was wrong with the application. This was, mind you, a renewal. I had been seeing medicare patients for five years in my clinic.

I call them. I am given a name and a number to identify the call. I have two Ptan numbers, one for me as a physician and a second for the clinic. The first call said that my personal Ptan application was correct but the clinic one wasn’t.

I did it again and mailed it. Second day air. He said that our payments should be released in 10-14 days.

Ten days. Nothing. Fourteen. Nothing. I am pulling from savings to run the clinic. I call a second time. Again I am given a name and a number. She said I had to CALL to get paid once the application was received. I said the first guy didn’t say that. She said another 10-14 days.

We wait. After ten days I call. A third number and person. Once again I have a cryptic email. I ask about the PTan number on the email, which is not my clinic’s Ptan number. Oh, says the man, that is what is wrong with your application. He says to do form (numbernumbernumber B) not form (numbernumbernumber A). And it will be 10-14 days after they receive it.

I do it AGAIN. I do notice that all of the old copies of the form in our file have the PTan numbers wrong. Weird. They have been paying me for five years.

Ten days. I call a fourth time. She says that it will be 30 days not 10 to 14 until medicare lets me know if my application is correct. Or they might pay me after 10-14 days. They aren’t, so I argue that something must still be wrong. What is it? She can’t tell me. I want a supervisor. She says that I can talk to a supervisor in 10-14 days. We figure out that the Ptan number on the application is correct. I say, “I am writing my congresswoman.” and hang up.

So I do. I find my Senator’s email and I write to her. I have been a rural family practice doctor for 25 years and I saw a 98 year old yesterday and a 91 year old today and I LIKE my elderly patients, but I have HAD it with medicare, at least with the contractor noridian that is running medicare for my state. I list the phone call dates and names and identifying numbers and I say FIX IT because otherwise I am for the first time in 25 years seriously considering quitting medicare.

Two days later noridian sends an email saying they are releasing my payments.

The next day we get a direct deposit for $9000.00. That is a START.

One week later we get a call from noridian explaining what is wrong with our application. Not just one thing. Noridian doesn’t seem to have a copy of our business license from five years ago. We have to put the personal Ptan on page xgyb-14. They want details about the nursing home. Do I do home visits?

The noridian person explains that our application has actually been wrong for five years, but now they are getting audited so they have to get everything cleaned up.

So THEY have KNOWN it was wrong for five years, but held my payments since July, while they try to get their act together and tell me what the hell is wrong with it?

I want to be paid INTEREST for all the time I have spent on the phone and redoing the cryptic application.

And many thanks to my congresswoman, for keeping my clinic open.

I took the picture at the Kinetic Sculpture Festival here in September. The outfits make more sense than dealing with noridian, that’s for sure….

first posted on everything2.com on 11/30/15

Through storm and fear

This is for photrablogger’s Mundane Monday #34.

I was downtown in the early morning for coffee and a walk. I walked out to Port Hudson. The wind was blowing very hard and the rigging was singing that eerie whistle wail. There are giant cleats out as both seats and advertising. I put one of my earrings on the cleat and took the picture. The earrings were my mother’s. After she died I looked at her jewelry. She loved little boxes and I was trying to understand the organization of the earrings. It was not by value, since plastic and gold were all mixed together. She was an artist and organized the earrings by color. These little plastic eiffel towers were in the box with red and pink earrings of all sorts. They are probably at least 30 years old. The tower looks so small against the black cleat with the rainwater. I hope that we can all care for each other through storms and fear.

Shadows

S is for Shadow in the Blogging from A to Z Challenge.

I wrote this poem in April of 2014 after hearing a sermon based on the bible passage that if you cast one devil out, it will return with 7 more.

Mathew 12:45 “Then goeth he, and taketh with himself seven other spirits more wicked than himself, and they enter in and dwell there: and the last state of that man is worse than the first.”

My minister was talking about how feeling virtuous can make us behave worse than ever, and that we don’t acknowledge our own bad thoughts even to ourselves. I thought about how hard it must be to be an unloved shadow or feeling who is cast out or denied.

Shadows

I.

I am happy today
Because I let the shadows alone

I see them
I did not name them

They aren’t mine
Unless I name them
Then I add to them
They stick to me
Their owners disavow them
Their owners recoil in horror
from me, a huge talking shadow

Their owners disavow them

Poor shadows
They are so lonely

But it doesn’t serve if I name them
Their owners think they are mine
Their owners think they are gone
Relief
Freedom
Evil named and cast out

Once I am alone, the shadows roil
They cry for home
They cry for their people
They are fearful
They gather into gangs
To face the terrible journey home
To their owners

When the shadow is offered
I don’t reject it
I don’t name it
I wait

It is in the room
Manifest
Between us

And mostly the owner
Speaks of something
Else

And the shadow sinks
Waits
Bides

I hear the shadows weeping
To be loved

II.

I hear the shadows weeping
To be loved

I thought if I named the shadows
They would be visible
Freed
Loved

I was wrong

I am so sorry, shadows
I am so sorry, owners

I was wrong

I send you all my love
and tears

I hear the shadows weeping
to be loved.

4/5/2014