Category Archives: transformation

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Last photo

From Bushboys world, a “last on the card” contest, with the last photo on the phone or card.

I knew exactly which photo was there. I took it last night after spending a couple hours trying to remember how to set up the tree tent. Got it, though should still mess with it a little. It’s tricky if the trees aren’t an equilateral triangle. Which is nearly always.

I lay on the platform in the sun for a while yesterday before the tent part was up. It’s supposed to rain today. I really got the wrong tent when I got this one, it’s not really suited to the Pacific Northwest. I still love it.

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Revolution in prior authorizations

I had a small one doc family practice clinic for ten years. Spent more time with patients. The trade off was that if they need a prior authorization, they had to come in for a visit. I would call the insurance company from the room face to face counselling and coordination of care and all that crap. This did a number of things:

1. I could bill for the time.

2. The patient saw how the insurance company treats us and our offices. The rep on the line would try to call me by my first name since doctors rarely call. I would say, “No, please call me Dr. Ottaway.”

3. The patients sometimes had called their insurances already and been told “Have your doctor call.” When I would call, the company rep would sometimes say, “We don’t cover that.” The patient would be outraged and say, “But I called YESTERDAY.” The rep would say, “I only talk to doctors. The part of the company that talks to patients is a different part.” The insurance companies can’t triangulate their way out of that.

4. I would end the call by saying, “This has been a face to face with the patient call, you have been on speaker phone and I am documenting the call and the time in the patient’s chart.” At first the calls took 25-30 minutes. Some companies apparently flagged me, and would say “Yes.” if I called, and get me off the phone as fast as possible. They really do not like it being documented in the chart.

5. Insurance companies sometimes drop patients on purpose because the person has gotten more expensive. I had a snow bird from Alaska whose insurance had dropped him. He said he’d paid on time. I said, come in if you want and I will call them. I spent 45 minutes on the phone where they made multiple excuses, lied (we can’t send you a copy of his insurance because we don’t have a fax after they’d said he was not allowed to leave Alaska and I said, “For how long? What do you mean? You don’t insure him if he’s out of the state? Send me a copy of his insurance contract!”) I finally realize that they have dropped him on purpose because he’s been diagnosed with diabetes. I say “Ok, look, I am staying on the phone until he’s reinstated and I don’t care how long it takes. And if you hang up on me I will contact the insurance commissioner in Alaska and Washington states.”

6. Patients are truly outraged at how a physician is treated when she calls an insurance company herself. I have to give my name, my NPI number, my address, my phone number, my fax number, the patient name, the patient address, the patient phone number the patient insurance number and sometimes have to do it every time someone transfers me. When they see me spend 25-30 minutes on the phone to get a prior auth, especially if it is refused, they are up in arms.

I think it would be truly revolutionary if every doc in the country called an insurance company with a patient in the room and documented the conversation in the chart. Wouldn’t that be fun?

Gonna be a revolution, yeah…..

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tracery

For the Ragtag Daily Prompt: tracery.

This is the dream that wakes me this morning. Before I went to sleep last night I asked for a dream. It’s when I am writing the dream out this morning that I realize that it’s my sister’s birthday. She died of cancer in 2012. Memory and dreams as tracery.

I am in a group of people on a platform. It is dark around us. It reminds me of a platform from a ropes course. In the ropes course we had to balance it. A rectangular platform on a log roller, held somewhat at the corners to keep it from dumping us entirely. A group version of a balance board. The trick is really that everyone has to stand still and only one person moves, very small amounts, until it is balanced.

But we are dancing in the dream. We are dancing, but people are uncomfortable. I am not sure why. Perhaps because we were dancing all together but individually and now there is a couple dancing. I realize that people are halting, worried.

I want them to be comfortable. I gesture to an older man. He comes towards me. His wife is there. He and I start dancing but I realize right away that this doesn’t make people more comfortable. They are less comfortable and even the other couple dancing stops. We are lit from above with darkness all around. No spot light follows us, so we move in and out of the light.

As soon as I realize that nearly everyone is uncomfortable, I stop my partner. He is an excellent dancer but that is not what is important here. I move with him back towards his wife and I sit on the platform. They sit as well. The other people around us relax. That is what they want, to sit, to talk quietly, to listen. That is what will make everyone comfortable. The others are settling around us, relieved.

I wake up.

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questions for equality

For the Ragtag Daily Prompt: book. My second entry for the prompt today.

Skimming the reader’s guide at the back of a book today, I read one question and halt. Here:

“You’ve managed such an extraordinarily successful writing career along with being a full-time father. What has it been like to juggle the two?”

Yes, what has it been like? Because I changed the gender. I can’t imagine this question being posted to a male author. The layers and the sexism in this question are spectacular.

First of all, what is a full-time mother? Does it mean one who is “home” with the kids? Not working “outside” the house. Maybe we should call it at work with the kids if it’s full-time. If she is a writer is that work but it’s not work if she is a housewife? Is she a “full-time” mother with a writing hobby unless it’s successful and then she’s a “full-time” mother with a successful career? How are they defining success?

What is a full-time father? Does it mean the same thing?

Are there part-time mothers? Is a mother who goes to work outside the house a part-time mother? I work. My husband was the househusband. We also had some daycare. Was he a full-time father? Was he a slacker because he took care of the house and the kids and played golf? Our son was six months old when I started my family practice residency. Was I a part-time mother?

The question feels to me like more of the same gender discrimination and devaluation of both genders. A woman who is a “full-time” mother AND a successful writer, wow, that is made noble. But I have never heard a man called a “full-time” father or any questions of a successful man about how he juggled his fatherhood and his career.

It remains infuriating.

The book is Anna Quindlan’s every last one, Random House, 2011 and the Random House Reader’s Circle asks the questions.

Well, gentle readers? Are you a full-time or a part-time parent? Why? Was your father a full or a part time father and was your mother full or part time? And do they mean the same thing?



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PETS

Not pets, right? PETS here stands for President Elect Training Seminar. We are gathered to meet each other, exchange ideas and prepare for a year as president of our local club. Yesterday the president elect for Rotary International spoke to us, amazing. We also had a flag ceremony with the flags you see, from nearly 200 countries. How amazing!

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places in the world

I am thinking of the phrase “Places in the world a woman would walk.” I know it’s by Grace Paley. A short story? A line in a story?

Do you feel safe walking in your neighborhood? Or on a beach near you or in a forest? If you are male, do you thinks it’s safe for a woman to walk alone in your neighborhood? Do you feel differently about a male? And the same questions to woman.

And is there an age limit? Is it safe for me to walk the beach alone because my hair is mostly white? What about my son and daughter, both in their 20s?

Safety is relative. One of the unsafe things about our beaches is the warnings about an earthquake and tsunami. We have sand cliffs that will most certainly collapse. I walk the beach and eye the cliffs. There is some luck involved and I accept that.

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new again

I get to start again

I have always seen the monsters under the bed
I have to
to survive

you don’t tell people about their monsters

I learn that early

they get angry hit punish send away
and anyhow they leave you even if they love you

when I am alone
we play
the monsters and I

they are so happy to be seen

they cry often
why doesn’t he love me?
why won’t she hold me?
why does he throw me out?
why?

I hold them
dry their tears
cuddle them
wrap them warmly

they cheer up
and play

they never forget
they alert
their person is near
they rush back

sometimes one rejected
returns with seven friends
hoping to storm the person

that doesn’t work

the monsters never lose hope
never

sometimes I see
a person see their monster
let it be conscious
the person is grown enough
to love

I am so used to the monsters
I work with them in clinic
visit after visit
the monsters weeping on my lap
while the person refuses refuses refuses
and sometimes a crack opens
like a portal light blinding
and the monster
is loved

that’s why I am here
what makes it worth staying
Beloved

now I think
I am new again
it’s hard to date
when the monsters are yanking at my skirt
crying howling distracting
and I am hopeful
but it is not my role
it’s not ok
it’s antisocial
to ask about the monsters

I am new again
I won’t date anyone with monsters
that I can see

they must love them first


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light on water

For the Ragtag Daily Prompt: security.

How can light on water be security? What is secure?

When I think of security, I think outdoors. The ocean will change and change and change, moment to moment and day to day. The light changes with each wave and the wind. But the ocean is still present. And water also represents the unconscious for me. All the things under the surface, all that depth, an infinite place of exploration: the water, the earth, the sky, the universe. For me, security is the internal exploration and the outdoors, which is so vast, there for me always. The poetry of nature.