What's Bugging Me: Health Care

I wrote this one for a scaffolding assignment leading into my English 102 Proposal Research Paper.  It needs to start with a difficult problem that affects the writer's life or the life of someone they know.  They do not need to already know the solution.  I certainly don't know what the solution to this problem might be.  I don't know that the Affordable Healthcare Act is going to be any better.  I just know that the way things work right now is very far from perfect.  

 

What’s Bugging Me About Health Care

Something that really bugs me is how hard it is to get well after a major illness or injury.  One of the arguments I’ve heard against socialized healthcare is that it will take weeks or months for people to get appointments with the specialists they really need.  People are also nervous that medical decisions will be made by people other than doctors.  Apparently, people are of the opinion that when health care is capitalist in nature, healthcare is easy and quick.  Apparently these people do not have insurance companies that are already deciding what care they can have and are afraid of something not called an insurance company doing that very thing without the goal of saving themselves money.  Supposedly, under our current system, anyone can see whomever they need to see whenever they need to be seen.  This has not been my experience.

I know people who have to stop receiving the care they need because insurance companies have decided it is too expensive.  For example, my sister is a kidney transplant patient, so she depends on a number of drugs to keep her body functioning in a way that will not kill her borrowed kidney.  One of the drugs prescribed to her was a patented compound drug that included two drugs specially formulated to work together.  A few months ago, her insurance company decided that this drug is too expensive, so they dictated that instead of taking the two drugs in one pill, she would have to take two separate generic drugs not likely to work as well in combination.  She is now, by the way, forced to pay double co-pay, and the insurance company can pay less, which was a good solution for them, even though the drug was potentially going to be less effective for her.  This was a decision made by someone paid to cut costs rather than by someone with any sort of medical or pharmacological background.  To save money, the insurance company was willing to jeopardize my sister’s health. The same insurance company illegally looked up the insurance number of my sister’s kidney donor so that the donation surgery would not fall under my sister’s 100% coverage plan and would instead be classified an “elective” surgery by the donor and therefore not covered at all.  I also know people who have been denied healthcare insurance, and therefore access to much-needed healthcare because they had health conditions when they got their new job, or when they retired, or when their husband took a new job.  Seriously, we are proud of this situation? 

These issues I have described so far can be side-stepped by paying for health care out of pocket.  However, hospitals and healthcare systems charge individual patients at least three times as much for a service as they would charge an insurance company.  So while paying out-of-pocket seems like a reasonable solution in theory, it is only possible for the obscenely rich.  The people I know who claim that our system is the best are not obscenely rich, as far as I know.  One can only assume they have not tried to receive any sort of specialized care. 

Leaving aside matters of insurance, another thing that bugs me about trying to get healthy is how nearly impossible it can be to see the specialist one needs to see, even in our capitalist system.  My sister had another near-fatal health issue which her hospital refused to treat.  They referred her to Mayo Clinic, but Mayo Clinic said they did not have time to see her.  She managed to get a life-saving appointment only when her well-connected grandfather-in-law pulled some strings to work underneath the red tape of the system.  This had nothing to do with insurance or an inability to pay.  There simply was no above-board way to get an appointment with the specialist she needed in the time frame necessary.  People level such accusations at the health care system in Canada, but everyone I know who has lived in a country with socialized healthcare opted to stay there, some staying because of the ease of obtaining healthcare. 

I am infuriated by these events on behalf of my family members, but I am also bugged on my own behalf. 

In the spring of 2012, I did something to my back.  It went from feeling not good on a Thursday to feeling like I could not find a way to move it enough to get out of bed on Saturday.  I went to see the nurse practitioner on Monday, and she diagnosed me with a sprained back.  I mentioned to her that MRIs I had had taken a few years before had shown that I had some herniated disks.  “Is that perhaps the problem?” I asked her.  She claimed the disks were not the problem and the prescription for dealing with my back was physical therapy.  Unfortunately, the physical therapist could not see me for a month.  By the time I did see the physical therapist, I was feeling a little better, although clearly something was still wrong.  I was still in some pain.  I saw the physical therapist three times a week for twelve weeks, but even when she discharged me, my back was still sore.  She was just out of ideas for how to help me. 

By fall of 2012 I was in ever-increasing pain.  My back was too stiff and sore for me to exercise.  Then it was too stiff and sore for me to load and unload the dishwasher.  It was too sore for me to sit down for more than a few minutes.  By early December it was too sore for me to walk a mile even though I had been running sixty miles a week a year before.  I made an appointment with an orthopedic doctor who, when I finally saw her three weeks later, said she did not treat backs.  She was pretty sure, though, that the problem was not with my discs.  She sent me to a physical therapist and a doctor of osteopathy.  By the time I saw either one, I was unable to do anything other than lie on the couch until it was time to lie in bed.  I was trying to still take care of my family, so I would stand up for ten minutes at a time cooking, after which the pain would make me feel nauseated and faint, so I would rest.  Thus, it took me all day to make dinner, and by the time it was cooked, I couldn’t stand up to eat it.  I could never sit.  The only silver lining in the fog created by the combination of kill-me-now pain and the peace artificially induced by strong narcotics was that I finally read Pillars of the Earth along with about six other books I’d been meaning to get to eventually. Even so, the wait was excruciating. The doctor of osteopathy said he thought the problem was the discs in my spinal column.  An MRI was ordered.  When the results of that became available, I was told to stop therapy and make an appointment with a neurosurgeon as soon as possible. 

I called a neurosurgeon recommended by a friend.  His office was in Glen Ellyn, a half hour from my house. I could not sit for half an hour, but I needed the help.  It turned out that whether or not I was willing to sit through the half hour ride, alternating between nausea and fainting from the pain, the doctor could not see me for over six weeks.  So I called another doctor who was able to see me in four weeks, but only if I could, in that intervening time, acquire large prints of every MRI I had ever had of my back.  My dad, bless his heart, agreed to drive all over the Chicago area picking up large packets of prints in case I could get an earlier appointment.  I could not.

When I finally saw the neurosurgeon in February of 2013, he was impressed by the severity of my injury. I have always been something of an over-achiever. More than half of the space in my spinal column at the L5-S1 vertebra level was taken up with extruded disc material.  It was the worse herniation the doctor had ever seen.   “I think we should operate on this as soon as possible,” he said.  “The longer we wait, the more likely there will be permanent nerve damage.”  Too bad I had been struggling with this back problem for almost a year at that point. He arranged to operate on me the following Tuesday. For this I am thankful.  Even so, the nerve to the outside of my right leg and foot had been severely damaged. I still cannot feel the outside of my right foot.

After the surgery, I went back to physical therapy.  I did not progress as quickly as one would expect, given that I am generally a very fit and healthy person, but I was devoted to getting well.  I was finally discharged from that round of physical therapy in August of 2013 with some residual numbness and tingling in my foot and some nerve pain and muscle knots in my leg.  My back was not perfect either, but I was again told it would work itself out.  It didn’t.

I gave it time.  I really did.  But around Christmas of 2013, my back went bad again for about a week.  Again in February I was getting to the point where I could once again not bend enough to tie my own shoes.  My leg was a ball of nervy knots.  So in mid-February, I called the neurosurgeon’s office for a prescription to go back to physical therapy again.  His nurse said he would want to see me first and said the first available appointment would be April 10^th.  “Is that really the first appointment?” I asked.  It was.  “The first appointment is more than seven weeks away?” I asked again, incredulous.  I was told it was.  I asked to be put on a waiting list in case there was a cancelation, and I went to get another MRI, as ordered. 

After several weeks of reduced activity, my back was feeling better, although still stiff and sore, particularly in the mornings.  I was eager to get back to exercising, but, “I can make it to April,” I told myself.  In mid-March, however, I received a phone call that the doctor was going to have to change around his appointments.  My new appointment was on April 24^th.  I consoled myself that this was not a big deal, since I was feeling much better.  Not well, exactly, but not in the kind of terrible pain I was in before my surgery.  Then I realized that when the doctor’s office called and moved my appointment, they did not ask me if I was feeling better.  For all they knew, my pain could have been progressing, as it did in 2012, as I was worried in February that it might.  It is likely that waiting for so long to see the appropriate doctor in 2012 is the reason the nerve to my foot is still damaged, the reason I am missing the reflex in my ankle and cannot feel the outside of my foot.  Am I traveling down that same road again? I was still stewing about this issue when, last week, the neurosurgeon’s office called yet again to tell me my new appointment date is May 5^th.  A few days later, the same woman called to tell my new appointment is May 12. Yes, I called mid-February, and without asking me how I am feeling, the neurosurgery practice has now moved my appointment to mid-May.  That is a twelve week wait to see a doctor for a possible spinal injury.  Something about that doesn’t seem like the sort of high-quality care that I’ve heard lauded as the best system in the world.  That bugs me.

I Believe--Teaching Edition

I haven't posted in a very long time, a fact I realized recently with some surprise given that I feel like my writing has picked up.  I've been applying to jobs, some of which want me to write two essays, some three, some seven.  One job wanted me to write a statement of teaching philosophy.  I found out about that job after they had already decided which candidates to screen, so it was always going to be a long shot, but I wrote the statement of teaching philosophy in one adrenaline-inspired evening.  Yes, that was mildly stressful, but it was also exhilirating.  Last week, I wrote a sample essay for my students because I couldn't find one that fit the assignment.  I wrote that in one longish night as well, since I wanted my students to have it the next morning for the lesson plan I was simultaneously writing.

These writing experiences have perhaps deprived me of some sleep, which is maybe why I'm battling my second cold in the last three weeks, but both times I found myself less tired than energized.  I looked up after what felt like a few minutes writing and revising to find that two hours had passed.  Writing takes me outside of time.  It always has.

Why, then, pursue teaching?  Why not just write?  Although teaching eats up all of my time (and then some I don't have--as fellow English teachers know), it inspires me.  When I spend my days being angry at the house I have to clean yet again, I have nothing but anger to write.  When I am out pouring myself out for people I care about, doing something I love and believe matters, I find myself with much more to say and more reason to write it down.  I wouldn't have written either my Statement of Teaching Philosophy or my What's Bugging Me essay if it weren't for teaching. 

Enough preamble.  Here's my Statement of Teaching Philosophy.  This is who I want to be.

Statement of Teaching Philosophy

I believe in revision.

At the beginning of the semester, I tell my students that I should display this credo as a bumper sticker, or—to show the depth of my belief—a tattoo.  At first, my students believe that I am referring to revision as a writing practice, and I am.  I believe that there is great value in teaching students that the first thing that comes out onto the paper needn’t (usually shouldn’t) be the finished product.  I force revision upon my writing students by checking off their progress in the writing process, by scheduling writing workshops and conferences, and by offering revision projects with worthwhile incentives.  What I hope my student come to understand, though, is that I believe in revision not just because it produces better writing but because the courage to experiment, the wisdom to evaluate one’s work and thoughts, and the patience to change and change again produces better students.  Revision is a lifestyle I believe in.

I believe in revision not just as a writer, and not just for my students, but also for myself as a teacher. Just as the first idea that comes to a student’s mind is not always the best or the most refined, I trust that as an educator I can be constantly improving.  Although I could just reuse the syllabus and lesson plans and assignments from the last time I taught English 102, I find that every semester I teach I have improved and rethought how I teach, and so I end up revising—often to the point of completely rewriting—how and what I teach.  I ask my students to help me in this.  I have them fill out weekly feedback forms to let me know what they applied to their own reading and writing and what I need to teach in a different way. When I turn in midterm grades, I ask my students to turn in a mid-term evaluation of my teaching.  I also seek to improve my teaching by being a student of other teachers.  I read books, attend conferences, search the internet, and sit at the feet of my colleagues, all in the hope that every time I teach, I can reach one more student or make all of my students a little more confident or brilliant.  Last semester is always my rough draft.

Although I expect to see my students grow and improve, sometimes in ways that they find astounding over the course of a semester, I never expect that a student will walk out of English 101 or 102 already a perfect writer.  Likewise, I don’t expect that every lesson I teach cannot be improved upon.  I hope, though, that through practice and by observing each other as examples, my students and I will embrace the fact that we are never done learning, growing, and revising.

 

I believe that relationships are the most important teaching tool.

I love my students.  I wish it was professionally appropriate for me to use this section of my statement of teaching philosophy to tell you the stories of who they are and where they come from and what they write about and how they make me laugh or think in new ways.  I cannot imagine a more difficult job than teaching English, but I also cannot imagine a more touching and awe-inspiring thing to do with my life.  Although I have been privileged with some personal strengths and a great education, I believe that what makes me effective as a teacher is my devotion to knowing and caring for my students as people.  I want my students to believe that their unique ideas and experiences are interesting and important and worthy of the effort it takes to express them in the best possible manner.

On one level, caring about my students is the easiest part of being a teacher.  How could I not?  I believe that students sense that I see them each as individuals through mannerisms like eye contact and facial expressions, through conversations we have before and after class, and through respectful interactions inside the classroom.  On another level, though, I think relationships a vital enough factor in the learning environment that they are worth a good deal of intentional cultivation.  I am, therefore, intentional about knowing as much as possible about my students’ struggles, strengths, and interests.  I make a point of asking them to tell me these things in questionnaires, particularly at the beginning of the semester, but I also encourage them to make these personal qualities part of their responses to literature and part of their writing.  I like to incorporate a mixture of reader response and personal connections alongside more historically, socially, or linguistically based literary theories.  I want my students to feel valued even as I challenge them to push their understanding in new directions. 

I also believe that the classroom functions best when it is a small community with a common interest in exploring new ideas and skills, and so I am intentional about cultivating relationships between students as well.  One of the great pleasures of teaching is seeing an argument circle or workshop group challenging, encouraging, and teaching each other, all while I am standing back, a benevolent observer.  I want my classroom to be a safe place for such interactions to happen, for everyone to feel confident that he/she can and ought to contribute something vital to the conversation.

 

I believe in using English to help students enter into the conversations going on around them.

In a time when a great deal of media and public policy attention is focused on STEM subjects, I continue to think that a good English education prepares a student for academic, professional, and social success.  I say this not to belittle the importance of an excellent STEM education in any way—I won’t quote Professor Keating from Dead Poets Society about the value of art and poetry, although I do believe we can incorporate beauty and passion into the classroom as he suggests—but to point out that excellent reading and communication skills are how we can integrate all of our other ideas and knowledge into society.  I believe in the value of English class.

That said, as a person who also believes in revision, I believe that English classes should look different now than they did twenty years ago.  Some may argue that what makes literature excellent does not change, and while I concede the truth of that statement to some extent (you’ll have to tear To Kill a Mockingbird and Cry, the Beloved Country out of my cold, dead hands,) the idea of one set canon for high school literature classes has rightly been replaced with the idea that literature is one method for exposing students to a variety of ideas, cultures, genres, and ways of making sense of the world.  More importantly, we educators must consider that the texts available to and surrounding today’s students are radically different than they were before the age of blogs, tweets, on-line magazines, wikis, and search engines.  I believe an English classroom should teach students not only how to read and think about all of these types of media but also how to produce and publish appropriately in them.

Finally, I believe that English class presents educators a unique opportunity to help students learn new ways of thinking.  How does the same idea subtly change when it is expressed through different media, by different authors, in different genres, in other rhetorical situations? Students can learn to consider the elements of rhetoric in order to best communicate their innovations, understandings, or ideals to colleagues.  They can and should learn the mental habit of looking ever deeper into an issue, evaluating sources and evidence, revising previous opinions or methods, and considering a claim from a variety of angles.

Anything we learn, invent, question, or believe impacts the world around us very little if we lack the tools to effectively share it. It is in all of our best interests if our students become voices in the conversations occurring in science, politics, popular culture, and our community.