I don’t remember who he was other than a prominent doctor with a public platform, but I definitely remember what he said: that 75 is the age most people should die. I’m 76 and I think he’s right.
Samuel Moyne just wrote the book Gerontocracy in America: How the Old Are Hoarding Power and Wealth—and What to Do About It. He doesn’t advocate killing yourself at 75, but he does think we should all retire, sell our houses, and go into old people’s living communities—with the caveat that the government would spend the money to support these communities—so that young people can have our jobs and houses and get a better start at life. I haven’t had a paying job in 10 years and I’m ready to let my younger son, who has almost nothing, live in my house. But since there’s no nice, gentile living community in Santa Fe that I can afford, my other option is death.
I’m hoping that I just drop dead out in the woods while walking the dogs—they can find their way home without me—or not wake up one morning. But that seems like a long shot. While my outside body is falling apart, my inside body seems to be strong: low blood pressure, good lung capacity, digestive system that works well enough, etc. The outside body is ravaged by arthritis that manifests in bad knees—full knee replacement in one knee—a bad arm, lower back pain, and swollen hands. While my heart and lungs keep me on the trail, my back and knees—they damaged a nerve in my surgery that’s never healed—tell me those days are numbered.
My cultural life is practically non-existent. The only live music I’ve heard in years are the local musicians who play at various venues— small wineries and restaurants—on weekends and special occasions. They’re pretty good and because they’re all old, too, they mostly play the music of our generation: Americana, rock ‘n roll, blues, and a little jazz. I don’t think Samuel Moyne would worry that they were taking away young people’s opportunities: one of the main musicians who plays in several of the bands is the retired local dentist. The rest are longtime residents of these land-based communities who made their living as catch-can, finding work wherever they could while they built their own houses. The houses may have appreciated quite a bit over the years, but they’ll leave them to their children as an enticement to come back to the land.
I didn’t plant a real garden for the first time in probably 50 years. Partly because of the drought—we had no snow last winter—but mainly because I seem to have lost my gardening ability. Last year’s garden was pathetic and this year’s meager plantings in the hoop house are also pathetic. Tomatoes I started inside are tall, straggly looking things and the bell peppers are about six inches tall with tiny little fruits. Only the cucumbers look healthy. And they were all planted in the same organic soil enriched with some store-bought garden soil. So, it’s a pretty sorry sight; somehow those years of institutional knowledge have slipped away.
The only plane trip I’ve taken since my knee surgery was to Oregon, to visit my best friend from high school. She lives on a bay near the ocean so we can go to the beach, eat fish, and experience the cool, humid coast air that keeps my hair curly and hers frizzy. Driving more than three hours in the car is miserable. I have to sit on a donut, as my “pudendal” condition, which I won’t go into, makes sitting on anything soft without the capability of movement, extremely painful. I can be a passenger in the car, as I can move around at will, so when my son asks me to go camping near Silverton, five hours away, I’m game. Camping is my main summer adventure, with my little camper that I bought about six years ago when sleeping on the ground and peeing and pooping in the woods became more difficult.
I’ve been to England once and Spain once and don’t think I could stand another overseas trip. So New Zealand is out. I’ve been invited to go to Mexico with the family at the beginning of next year, which I’ve accepted, assuming I’m not dead before that. Mark and I traveled extensively in Mexico and I’m always up for another visit. I made a couple of trips there after he died, which were just fun, beach adventures, but I wouldn’t mind spending time in Mexico City and maybe taking a couple of side trips to the surrounding colonial cities.
So that’s about it. I’d like to see my grandchildren fledged, but I think the cost is more than I’m willing to pay. I’m not going to make any pledges or predictions, but like I said, 75 is a good number and something to bear in mind as that mind begins its own decline and the body continues to fall apart. There was plenty of living before that—the good, the bad, and the not too ugly—so you can go gently into that good night.
Saturday, August 1, 2026
Sunday, June 28, 2026
Medigap Woes
Scrolling through Facebook there’s often a good looking “senior citizen” earnestly addressing the rest of us senior citizens on Medicare that we’re tired of the recent increases in the cost of our Medigap policies. And they even mention Medigap Plan G—the plan I’m on—as the target of these price gouges. For those of you who aren’t senior citizens, Medigap means the private insurers—United Health Care, Blue Cross and Blue Shield, Humana—who cover the gaps in Medicare medical payments. Yes, Medicare has many gaps that need to be filled in if you don’t want to end up paying a lot of money after a hospitalization or a doctor’s visit.
Let’s quit lobbying for “Medicare for all!” Let’s call out, “Single payer health care for all!”
I clicked on one of those posts, worrying that I’d be sent to a sales person hawking an insurance company, but instead I ended up with Mitch, a friendly senior citizen himself in Florida who works for a company helps you apply for a different Medigap provider. My United Health Care monthly premium just got raised to $325. Remembering back 16 years I think the price was about $175. Mitch went through his list looking for companies that charged significantly less than $325.
My first choice was HealthSpring—formerly Cigna—whose monthly premium was in the low $200s. Mitch walked me through the company’s evaluation form, asking me about any illnesses, surgeries, and medical conditions that ran the gamut from heart disease to diabetes to cancer, none of which, other than arthritis, I answered in the affirmative. Mitch and I were pretty confident that I’d get approved quickly. He said he’d call me as soon as he heard back.
I waited a week with no response from Mitch but I did get a call from a HealthSpring person who asked me a few more questions and the one that stuck out was Sjögren’s. It’s an autoimmune condition where the immune system attacks the moisture producing glands. It primarily causes dry mouth and dry eyes but can sometimes affect internal organs. I was diagnosed with secondary Sjögren’s 40 years ago: My rheumatologist used to check me out for any underlying conditions but nothing has ever manifest except the dry eyes and dry mouth, which I treat with eye drops, water, and lots of sugar free lozenges.
I decided to call the Medigap company again and this time I got Melissa, who told me that Mitch no longer worked for the company. I thought that was odd, wondering what happened to Mitch, but Melissa took over and told me that HealthSpring had denied my application. I asked why. She said they told her Sjögren’s. She’d never heard of it. I was dumb struck. The only treatment I’d ever received in 40 years was dental (dry mouth causes tooth decay), which Medicare doesn’t cover.
Melissa then put in an application for Omaha of Nebraska, which has a monthly premium in the $200s. She asked them straight out of Sjögren’s was a disqualifier. They said no, not a problem. An examiner called me right away and asked some questions, never mentioning Sjögren’s or any autoimmune disease. Again, I didn’t have any of the conditions on their list. The next day they called Melissa and said I’d been rejected. When she asked why, they said it was based on the phone evaluation. Melissa then sent an application to another provider, I think it was Aetna, and they also turned me down.
In the meantime, I got a letter from HealthSpring notifying me that I was ineligible for coverage based on my “medical history of Sjögren’s Syndrome,” which use was obtained from the rx database.
Did you know that there is an rx database, which is a consumer report, like a credit rating report, that contains all of your medical history? I certainly didn’t. HealthSpring said the consumer reporting agency didn’t make HealthSpring’s decision to reject me and told me how to obtain a copy of my rx report, which I then requested, and that I had 60 days to dispute the accuracy of the rx database. HealthSpring also told me I could appeal their decision to refuse me with a signed letter from the treating physician “ruling out any declinable conditions.”
I’ve got an appointment with my primary doc next week who I’ll ask to write the letter. He’s not the rheumatologist who I’ve seen only twice since my longtime one quit, but he knows everything there is to know about my medical history and health and will probably write the letter (he’s a good guy).
All of this has taken almost a month so my next payment of $325 will be due shortly. Is it worth going through all this bureaucratic bullshit with greedy, corrupt insurance companies to save a hundred dollars a month? I don’t know the answer to that question yet. I’ll follow through with the appeal and if I miraculously succeed in eliminating Sjorgren’s as my declinable condition, I still won’t know why the other companies denied my applications.
Remember, it was the CEO of United Health Care who got shot down on the streets of New York. Unfortunately, there’ll be another United Health Care CEO who steps right up and decides that next year $325 a month isn’t return enough for the stockholders and decides to shoot (pun unintended) for $375, or maybe $400. As our beloved Kurt Vonnegut would say, “So it goes.”
Let’s quit lobbying for “Medicare for all!” Let’s call out, “Single payer health care for all!”
I clicked on one of those posts, worrying that I’d be sent to a sales person hawking an insurance company, but instead I ended up with Mitch, a friendly senior citizen himself in Florida who works for a company helps you apply for a different Medigap provider. My United Health Care monthly premium just got raised to $325. Remembering back 16 years I think the price was about $175. Mitch went through his list looking for companies that charged significantly less than $325.
My first choice was HealthSpring—formerly Cigna—whose monthly premium was in the low $200s. Mitch walked me through the company’s evaluation form, asking me about any illnesses, surgeries, and medical conditions that ran the gamut from heart disease to diabetes to cancer, none of which, other than arthritis, I answered in the affirmative. Mitch and I were pretty confident that I’d get approved quickly. He said he’d call me as soon as he heard back.
I waited a week with no response from Mitch but I did get a call from a HealthSpring person who asked me a few more questions and the one that stuck out was Sjögren’s. It’s an autoimmune condition where the immune system attacks the moisture producing glands. It primarily causes dry mouth and dry eyes but can sometimes affect internal organs. I was diagnosed with secondary Sjögren’s 40 years ago: My rheumatologist used to check me out for any underlying conditions but nothing has ever manifest except the dry eyes and dry mouth, which I treat with eye drops, water, and lots of sugar free lozenges.
I decided to call the Medigap company again and this time I got Melissa, who told me that Mitch no longer worked for the company. I thought that was odd, wondering what happened to Mitch, but Melissa took over and told me that HealthSpring had denied my application. I asked why. She said they told her Sjögren’s. She’d never heard of it. I was dumb struck. The only treatment I’d ever received in 40 years was dental (dry mouth causes tooth decay), which Medicare doesn’t cover.
Melissa then put in an application for Omaha of Nebraska, which has a monthly premium in the $200s. She asked them straight out of Sjögren’s was a disqualifier. They said no, not a problem. An examiner called me right away and asked some questions, never mentioning Sjögren’s or any autoimmune disease. Again, I didn’t have any of the conditions on their list. The next day they called Melissa and said I’d been rejected. When she asked why, they said it was based on the phone evaluation. Melissa then sent an application to another provider, I think it was Aetna, and they also turned me down.
In the meantime, I got a letter from HealthSpring notifying me that I was ineligible for coverage based on my “medical history of Sjögren’s Syndrome,” which use was obtained from the rx database.
Did you know that there is an rx database, which is a consumer report, like a credit rating report, that contains all of your medical history? I certainly didn’t. HealthSpring said the consumer reporting agency didn’t make HealthSpring’s decision to reject me and told me how to obtain a copy of my rx report, which I then requested, and that I had 60 days to dispute the accuracy of the rx database. HealthSpring also told me I could appeal their decision to refuse me with a signed letter from the treating physician “ruling out any declinable conditions.”
I’ve got an appointment with my primary doc next week who I’ll ask to write the letter. He’s not the rheumatologist who I’ve seen only twice since my longtime one quit, but he knows everything there is to know about my medical history and health and will probably write the letter (he’s a good guy).
All of this has taken almost a month so my next payment of $325 will be due shortly. Is it worth going through all this bureaucratic bullshit with greedy, corrupt insurance companies to save a hundred dollars a month? I don’t know the answer to that question yet. I’ll follow through with the appeal and if I miraculously succeed in eliminating Sjorgren’s as my declinable condition, I still won’t know why the other companies denied my applications.
Remember, it was the CEO of United Health Care who got shot down on the streets of New York. Unfortunately, there’ll be another United Health Care CEO who steps right up and decides that next year $325 a month isn’t return enough for the stockholders and decides to shoot (pun unintended) for $375, or maybe $400. As our beloved Kurt Vonnegut would say, “So it goes.”
Thursday, June 18, 2026
The Yuppie
Listening to the yuppie’s rant about cows impelled me to write a blog in Unfucking Believable, which I haven’t visited since February of 2025, when my dog Paco died. I didn’t get into an argument with the yuppie, I just said, “I like cows,” which set him off even deeper into degradated cowdom. The answer that rose up but I repressed was, “So, you want to turn New Mexico into Colorado, do yah?
Maybe he does. He and his family moved to El Valle about five or six years ago, after spending a lot of money remodeling Jacobo and Lalo’s adobe. I will grant him a little leeway, as he missed the apex of El Valle life, when Tomás and Arsenio and Orlando were still alive and cow culture was well integrated into village life. Now, the only ones who have cows are Adam and Adrian, and neither belongs to a permittee association, so they keep their cows in the village, moving from pasture to pasture, and sometimes running wild.
But the yuppie’s main complaint is cows in the wilderness. He’s hiked most of the trails in the Pecos Wilderness, climbed its peaks, run long distance, biked hundreds of miles, and cross-country and downhill skied. He hates the cows in the watersheds, he hates them on the trails, and thinks they have more privileges than people: “It’s ridiculous that you have to fence the cow out of your field, instead of the owner fencing it in.” Part of my response to him would be, “Do you want to have to get a permit to hike in the Pecos Wilderness and then get a reservation to go to a certain area? Do you want to hike with hundreds of other hikers on the trails outside the wilderness? Do you want to drive in miles of traffic to ski Taos or Santa Fe and then pay hundreds of dollars for a ticket? Well, that’s what you do in Colorado and that’s what’s in store for New Mexico if you turn over everything to the recreationists.
Northern New Mexico has to preserve its rural funkiness or we’ll fall prey to what I just described. And cows are an important component of that funkiness. They’ve kept a land-based culture alive but, unfortunately, not so well, as demonstrated in El Valle with the loss of Tomás’s generation. We’re just on the cusp of being able to keep these lands in agricultural production, be they hay fields, orchards, organic gardens selling to the local restaurants, or grazing for horses and cows. There’s a paucity of young people to take over management of the acequias. The mayordomo in El Valle lives in Santa Fe! There’s only a couple of families in the village with young children—Tomás’s great-grandchildren—and the yuppie, with one young son who goes to day care in Santa Fe.
When the cows go so go our hay fields, our getting up at 6 am to irrigate them, our contentious acequia meetings where everyone in the village gets to vent at the commissioners or all their neighbors, our relationships with vecinos of land-based knowledge and contemporary contrariness, and our slower paced life than that of our urban based children. So I think the yuppie should move on down to Santa Fe to enjoy a cow-free life—I think there are fewer cows on that side of the Pecos Wilderness—and the fruits of that lovely, gentrified city. We may be slowly dying up here but we’d prefer to do it on our own terms.
Maybe he does. He and his family moved to El Valle about five or six years ago, after spending a lot of money remodeling Jacobo and Lalo’s adobe. I will grant him a little leeway, as he missed the apex of El Valle life, when Tomás and Arsenio and Orlando were still alive and cow culture was well integrated into village life. Now, the only ones who have cows are Adam and Adrian, and neither belongs to a permittee association, so they keep their cows in the village, moving from pasture to pasture, and sometimes running wild.
But the yuppie’s main complaint is cows in the wilderness. He’s hiked most of the trails in the Pecos Wilderness, climbed its peaks, run long distance, biked hundreds of miles, and cross-country and downhill skied. He hates the cows in the watersheds, he hates them on the trails, and thinks they have more privileges than people: “It’s ridiculous that you have to fence the cow out of your field, instead of the owner fencing it in.” Part of my response to him would be, “Do you want to have to get a permit to hike in the Pecos Wilderness and then get a reservation to go to a certain area? Do you want to hike with hundreds of other hikers on the trails outside the wilderness? Do you want to drive in miles of traffic to ski Taos or Santa Fe and then pay hundreds of dollars for a ticket? Well, that’s what you do in Colorado and that’s what’s in store for New Mexico if you turn over everything to the recreationists.
Northern New Mexico has to preserve its rural funkiness or we’ll fall prey to what I just described. And cows are an important component of that funkiness. They’ve kept a land-based culture alive but, unfortunately, not so well, as demonstrated in El Valle with the loss of Tomás’s generation. We’re just on the cusp of being able to keep these lands in agricultural production, be they hay fields, orchards, organic gardens selling to the local restaurants, or grazing for horses and cows. There’s a paucity of young people to take over management of the acequias. The mayordomo in El Valle lives in Santa Fe! There’s only a couple of families in the village with young children—Tomás’s great-grandchildren—and the yuppie, with one young son who goes to day care in Santa Fe.
When the cows go so go our hay fields, our getting up at 6 am to irrigate them, our contentious acequia meetings where everyone in the village gets to vent at the commissioners or all their neighbors, our relationships with vecinos of land-based knowledge and contemporary contrariness, and our slower paced life than that of our urban based children. So I think the yuppie should move on down to Santa Fe to enjoy a cow-free life—I think there are fewer cows on that side of the Pecos Wilderness—and the fruits of that lovely, gentrified city. We may be slowly dying up here but we’d prefer to do it on our own terms.
Thursday, February 20, 2025
Updates: Paco, my surgery, the chaos
Paco died in the backseat of the car at the vet’s office. She tranquilized him and then administered the lethal injection. It was short and peaceful. We buried him down by the hoop house, under the willows. He has a view of the Truchas Peaks. I’m very sad.
It’s been five months since my knee surgery and I still can’t walk up the road. I don’t have Paco to take with me, but it’s not my sorrow that prevents the walk. It’s the fact that my knee is so swollen that without taking anti-inflammatories, lyrica, and 10 milligrams of oxycodone twice a day I would be in constant pain. I can do squats, ride a stationary bike, and bend my knee backwards close to its before surgery position, but I’m atomized by pain. A trip to Santa Fe to do errands leaves me exhausted. I couldn’t attend any of the hearings on the Sitewide Environmental Impact Statement for LANL in person, to cover for La Jicarita (they had zoom). And filling in for my neighbor Nancy at the ReUse Center at the dump, on my feet for two hours, just about killed me. The surgeon doesn’t know what to do to help but he wants me coming back “until the scar on your knee is almost invisible.” I’m not quite sure what that will indicate, but either because of guilt or compassion or a combination of the two, he’s taken me on as entire being who suffers other chronic conditions that may be contributing to my failure to heal.
The chaos that is Trump/Musk (T/D) has hit home here in New Mexico with the halt in hiring of Forest Service workers, especially fire fighters. They were supposed to be part of some emergency exemption but they’re not. The so-called winter of 2024-5 has been one of, if not the, driest winters on record. We had one big snow storm at the end of November that had everyone slapping on their skis—Jakob climbed up the backside of the Sandias three days in a row—and then we had nothing. The rest of the winter? A couple of smaller storms in January and February, a week of below zero temperatures with no snow, and several weeks of 60 degree weather. The last I heard we’re at 40 percent of normal precipitation in the Sangre de Cristos.
What this means for our forests is extreme fire danger with no additional fire fighters on board. Crews are already stretched thin from years of not only forest megafires but fires burning down urban areas from Colorado to California. It also means that unless the money was already allocated under Biden’s massive public spending bills like Infrastructure Investment and Jobs Act, the forest restoration and thinning projects that help prevent megafires are torpedoed.
What this means for our rivers is restricted irrigation seasons on the middle and lower Rio Grande and probably water sharing all summer long in El Valle. To add insult to injury, this was the year that I finally challenged the acequia commission on its lack of transparency and due process—see May 31 blog in Un*#!ing Believable —to meet and discuss parciante input and complaints. Now all we’re going to do is worry over water and due process will evaporate into thin, dry air.
The chaos that is disrupting the rest of the world is beyond the reach of this particular blog post, but unfortunately, there will be others. It looks like this time around no one will be unscathed.
The chaos that is Trump/Musk (T/D) has hit home here in New Mexico with the halt in hiring of Forest Service workers, especially fire fighters. They were supposed to be part of some emergency exemption but they’re not. The so-called winter of 2024-5 has been one of, if not the, driest winters on record. We had one big snow storm at the end of November that had everyone slapping on their skis—Jakob climbed up the backside of the Sandias three days in a row—and then we had nothing. The rest of the winter? A couple of smaller storms in January and February, a week of below zero temperatures with no snow, and several weeks of 60 degree weather. The last I heard we’re at 40 percent of normal precipitation in the Sangre de Cristos.
What this means for our forests is extreme fire danger with no additional fire fighters on board. Crews are already stretched thin from years of not only forest megafires but fires burning down urban areas from Colorado to California. It also means that unless the money was already allocated under Biden’s massive public spending bills like Infrastructure Investment and Jobs Act, the forest restoration and thinning projects that help prevent megafires are torpedoed.
What this means for our rivers is restricted irrigation seasons on the middle and lower Rio Grande and probably water sharing all summer long in El Valle. To add insult to injury, this was the year that I finally challenged the acequia commission on its lack of transparency and due process—see May 31 blog in Un*#!ing Believable —to meet and discuss parciante input and complaints. Now all we’re going to do is worry over water and due process will evaporate into thin, dry air.
The chaos that is disrupting the rest of the world is beyond the reach of this particular blog post, but unfortunately, there will be others. It looks like this time around no one will be unscathed.
Monday, January 27, 2025
A Horrible Year Redux
My January 1 post of 2024 was titled “A Horrible Year.” The Israeli army invaded Gaza and began its slaughter of the Palestinian people. Now there‘s a tentative cease fire in our second go-round of Trump presiding. God knows what will happen. I guess I have to title my January 2025 post the same: A Horrible Year. For many reasons, personal and political or personal is the political.
Paco is dying. Remember, the vet calls it Cognitive Dysfunctional Syndrome, or dog Alzheimer’s. It’s come back with vengeance. He’ll be lying on the floor when suddenly he jerks up as if a gun shot just went off. Unfortunately, the gun shot is in his head, some sinister signal that evokes trembling and panting, as he clings to me for comfort. This is mostly in the middle of the night, of course, as he pushes against the bed or scrapes his cone against my nightstand, endlessly, seeking something—me— to quell his anxiety.
That’s probably what’s killing him relatively slowly. The real culprit is more likely what we thought was a harmless lipoma on his front leg but is actually a tumor with an abscess that formed from his constant licking a slight abrasion into a bloody mess. We keep trying to medicate it into a scab but it keeps erupting with blood, so once again he’s wrapped up in bandages that he constantly tries to unravel. Removing the tumor is beyond our vet’s ability and presumably beyond our financial ability as well. So he wears a cone that thankfully, is flexible. We borrowed it from a neighbor who had searched for an alternative to the wide-brimmed, inflexible type you get at the vet.
Paco has been my boon companion for almost 14 years. I found him in La Junta Canyon, running up the forest road behind our caravan of parciantes and Picuris Pueblo tribal members inspecting one of the dams that takes water from our watershed, La Jicarita, over into the Mora watershed. But that’s another story. I guessed that this three-month old puppy who’s mostly blue heeler, probably jumped out of a rancher’s truck—they’re the dog of choice in el norte—or was dumped, into my reluctant arms. I already had two old dogs near the end of their lives who didn’t need a puppy yipping around. But Paco was an excellent puppy—no destroyed shoes or slippers, no pooping in the house, no barking at the sky—and an excellent adult who went everywhere with me.
I fervently hope that Paco will drop dead on my living room floor. Most pet owners probably wish this as well, when their dogs or cats reach the age when they can barely get up, when they are in pain from a chronic injury, when they have late-stage cancer, when they have any condition that makes their lives miserable (that’s our assessment of course), so we want them to drop dead before there’s a trip to the vet. Just a few minutes ago I thought I’d lost him after his wound poured blood, I re- bandaged his horrible mess, he briefly stood up, and then flopped over onto the floor. But he’s alive. For now. For not much longer.
Paco is dying. Remember, the vet calls it Cognitive Dysfunctional Syndrome, or dog Alzheimer’s. It’s come back with vengeance. He’ll be lying on the floor when suddenly he jerks up as if a gun shot just went off. Unfortunately, the gun shot is in his head, some sinister signal that evokes trembling and panting, as he clings to me for comfort. This is mostly in the middle of the night, of course, as he pushes against the bed or scrapes his cone against my nightstand, endlessly, seeking something—me— to quell his anxiety.
That’s probably what’s killing him relatively slowly. The real culprit is more likely what we thought was a harmless lipoma on his front leg but is actually a tumor with an abscess that formed from his constant licking a slight abrasion into a bloody mess. We keep trying to medicate it into a scab but it keeps erupting with blood, so once again he’s wrapped up in bandages that he constantly tries to unravel. Removing the tumor is beyond our vet’s ability and presumably beyond our financial ability as well. So he wears a cone that thankfully, is flexible. We borrowed it from a neighbor who had searched for an alternative to the wide-brimmed, inflexible type you get at the vet.
Paco has been my boon companion for almost 14 years. I found him in La Junta Canyon, running up the forest road behind our caravan of parciantes and Picuris Pueblo tribal members inspecting one of the dams that takes water from our watershed, La Jicarita, over into the Mora watershed. But that’s another story. I guessed that this three-month old puppy who’s mostly blue heeler, probably jumped out of a rancher’s truck—they’re the dog of choice in el norte—or was dumped, into my reluctant arms. I already had two old dogs near the end of their lives who didn’t need a puppy yipping around. But Paco was an excellent puppy—no destroyed shoes or slippers, no pooping in the house, no barking at the sky—and an excellent adult who went everywhere with me.
I fervently hope that Paco will drop dead on my living room floor. Most pet owners probably wish this as well, when their dogs or cats reach the age when they can barely get up, when they are in pain from a chronic injury, when they have late-stage cancer, when they have any condition that makes their lives miserable (that’s our assessment of course), so we want them to drop dead before there’s a trip to the vet. Just a few minutes ago I thought I’d lost him after his wound poured blood, I re- bandaged his horrible mess, he briefly stood up, and then flopped over onto the floor. But he’s alive. For now. For not much longer.
Friday, December 20, 2024
My Dog Paco
My dog Paco, aka Buddy Guy, is 13 years old going on 14. Before I had knee surgery—see my previous post, The Emotional Cost of My New Bionic Knee, I walked him every morning through the village up the llano so we both got a little cardiac workout. As the date of my surgery got closer it got harder and harder to make the climb, but I persisted. Paco lives for his walk.
When I came home from the hospital I was sleeping downstairs in a bed I’d borrowed and walking with a walker. Paco couldn’t figure out either change: why we weren’t upstairs, me in my bed and he on his pillow, and why he couldn’t get next to me with this metal thing around my legs. My caregivers all did their best to give him short walks while attending to me, but I could see the confusion mounting as these impingements on his routine increased. And why were so many people coming in and out of the house at all times of the day bringing stuff or sitting around talking to me while I lay on this strange bed in the living room.
After about 12 days my caregiver friend left. I’d moved back upstairs and was going to physical therapy two days a week and seemingly progressing from the surgery. Then three weeks into the rehab, the bottom part of my leg caught fire. From my knee to my ankle the nerves erupted to the point where anything touching the skin—hand, clothing, bedding—turned on the electricity. What the fuck? My physical therapist didn’t know what to do about it, just that it had to be a nerve reaction to the surgery. It hurt so much at therapy that I couldn’t do my exercises and one of the other therapists told her to just massage it. Which hurt like hell.
Paco’s confusion turned into anxiety attacks, or at least that’s how I interpreted them. All of a sudden he would jerk his head and look straight out, as if there’d been a loud noise somewhere that grabbed his attention. Then came the panting and trembling and the pawing—on anything near him, including me. At night while I struggled to sleep with my leg hanging out from the bed covers Paco would have an attack and start pawing me or the dresser next to the bed, endlessly. We spent many sleepless nights as I struggled to calm him down by petting him, talking to him, or in despair, tying him up on the leash where he couldn’t do any damage. The dresser is scarred with his paw marks. I made an appointment with the vet.
I called my son Max and he came home to help me. The nice vet at the office where I’ve gone for years in Taos listened to our description of Paco’s behavior, asked a few questions, and said, well, what I think Paco is experiencing is cognitive dysfunction syndrome, which is essentially dog Alzheimer’s. The attacks that we were witnessing were signals in his brain setting off the anxiety and confusion. We went home with $67 worth of gabapentin, the go to drug for just about anything, and the advice that if he continued to decline he’d write a prescription for Prozac.
We didn’t have to get a prescription. When one of our neighbors heard the diagnosis she came over with what looked like a year’s supply of it. I didn’t ask why she had so many, just thanked her.
In the meantime, I saw the surgeon who told me the peroneal nerve in my leg must have been damaged during the nerve block (a nerve block, which if you recall from my previous blog post, didn’t block the pain in my knee post surgery) and that considering my orthopedic history—it took me a year to recover from surgery for a bone spur in my wrist that froze my shoulder—I was an “at risk” patient. He finally put me on lyrica, the drug everyone goes to when gabapentin doesn’t work. We gave the rest of my gabapentin to Paco.
Paco’s drugs worked. He’s much calmer, with only an occasional episode. Max walks him and his dog Anka twice a day. My drugs, on the other hand, haven’t worked. One of my La Jicarita readers sent me St. John’s Wort tincture and oil to try to settle my damaged nerves. Another friend told me to take a much higher dosage of lyrica than what the surgeon prescribed. So that means an appointment with my primary doc.
It's endless. Now I have to bake cranberry bread for Christmas gifts for neighbors and get through Hanukkah—I gave up Christmas years ago—with the grandkids. But the question remains. Will I ever walk again without pain and resume a life limited by age but undergirded by years of physical activity. That post is for next year. Happy New Year everybody.
After about 12 days my caregiver friend left. I’d moved back upstairs and was going to physical therapy two days a week and seemingly progressing from the surgery. Then three weeks into the rehab, the bottom part of my leg caught fire. From my knee to my ankle the nerves erupted to the point where anything touching the skin—hand, clothing, bedding—turned on the electricity. What the fuck? My physical therapist didn’t know what to do about it, just that it had to be a nerve reaction to the surgery. It hurt so much at therapy that I couldn’t do my exercises and one of the other therapists told her to just massage it. Which hurt like hell.
Paco’s confusion turned into anxiety attacks, or at least that’s how I interpreted them. All of a sudden he would jerk his head and look straight out, as if there’d been a loud noise somewhere that grabbed his attention. Then came the panting and trembling and the pawing—on anything near him, including me. At night while I struggled to sleep with my leg hanging out from the bed covers Paco would have an attack and start pawing me or the dresser next to the bed, endlessly. We spent many sleepless nights as I struggled to calm him down by petting him, talking to him, or in despair, tying him up on the leash where he couldn’t do any damage. The dresser is scarred with his paw marks. I made an appointment with the vet.
I called my son Max and he came home to help me. The nice vet at the office where I’ve gone for years in Taos listened to our description of Paco’s behavior, asked a few questions, and said, well, what I think Paco is experiencing is cognitive dysfunction syndrome, which is essentially dog Alzheimer’s. The attacks that we were witnessing were signals in his brain setting off the anxiety and confusion. We went home with $67 worth of gabapentin, the go to drug for just about anything, and the advice that if he continued to decline he’d write a prescription for Prozac.
We didn’t have to get a prescription. When one of our neighbors heard the diagnosis she came over with what looked like a year’s supply of it. I didn’t ask why she had so many, just thanked her.
In the meantime, I saw the surgeon who told me the peroneal nerve in my leg must have been damaged during the nerve block (a nerve block, which if you recall from my previous blog post, didn’t block the pain in my knee post surgery) and that considering my orthopedic history—it took me a year to recover from surgery for a bone spur in my wrist that froze my shoulder—I was an “at risk” patient. He finally put me on lyrica, the drug everyone goes to when gabapentin doesn’t work. We gave the rest of my gabapentin to Paco.
Paco’s drugs worked. He’s much calmer, with only an occasional episode. Max walks him and his dog Anka twice a day. My drugs, on the other hand, haven’t worked. One of my La Jicarita readers sent me St. John’s Wort tincture and oil to try to settle my damaged nerves. Another friend told me to take a much higher dosage of lyrica than what the surgeon prescribed. So that means an appointment with my primary doc.
It's endless. Now I have to bake cranberry bread for Christmas gifts for neighbors and get through Hanukkah—I gave up Christmas years ago—with the grandkids. But the question remains. Will I ever walk again without pain and resume a life limited by age but undergirded by years of physical activity. That post is for next year. Happy New Year everybody.
Monday, October 14, 2024
The Emotional Cost of my New Bionic Knee
I filed a formal complaint against the Presbyterian Española Hospital last week. A surgeon there gave me a bionic knee that will allow me to irrigate, hike, cross-country ski, and maybe downhill for a few more years. For that I’m truly grateful. But in order to get that new knee I had to participate in the medical industrial complex that is, as so many of us have experienced, diving deeper and deeper into disfunction and chaos that leaves the patient confused, ill-treated, and feeling abandoned. My story is illustrative of this defenestration, but may also provide some insight on how better to prevent that fall from happening to others.
There is no exact time at a hospital; there’s only “waiting.” Arriving at 8 am I waited until 3 pm for surgery. First, the anesthesiologist gave me a nerve block, which is an injection that targets a nerve or group of nerves to provide pain relief. Secondly, she gave me a spinal anesthesia block, which numbs the lower half of the body. I don’t remember anything after that (they also give you versed, a great drug that induces sleepiness, decreases anxiety, and provides amnesia about what just happened to your body) and she also gave me general anesthesia, meaning you’re not conscious during surgery. The actual surgery lasts only an hour or so but then you wait in recovery for someone to come get you and take you to your room in the hospital. A one-night stay is normal for my kind of surgery.
The first indication that the nerve block hadn’t worked came around eight o’clock that night when all the other meds in my body dissipated and I started writhing around on the bed at level 9 on the pain scale (10 is torture). First the nurse administered Tylenol (yes, this is the first drug they give you post-surgery); then oxycodone; then two doses of morphine; then a call to the doctor for permission to use tramadol (I’d never even heard of that one), until three hours later the pain abated and I dropped off into something I called the night’s wrestle: intermittent pain mixed with exhausted sleep.
I’ve had two previous orthopedic surgeries: a meniscus repair and a rotator cuff repair, in which I distinctly remember two days of nerve block pain relief at home before it became obvious it was time to take the oral oxycodone. I wasn’t in need of validation that the nerve block hadn’t worked but I got it anyway the next morning when the doctor came in for a brief visit: “Have you forgiven me?” The good news was that the surgery was successful. Then I waited a few hours and the physical therapy people came in and that‘s when I noticed I couldn’t bend my foot at the ankle. As I pointed this out, there was a brief silence and then someone said “foot drop,” and someone else said, it’ll probably come back, but by then I was imaging walking down the street with my foot dragging along the ground like Ratso Rizzo. When I got home I looked up “foot drop, caused by an injured nerve during hip or knee replacement surgery.”
So there I was: a nerve block that didn’t work on my knee but froze my ankle (it may have been two different blocks). After waiting another couple of hours I found out another alarming fact: Mountain Home Health, a company that provides home health care and physical therapy to Taos County residents, no longer serves El Valle (they were bought out). I’d based my decision to do my rehab at home because of these services. Because I live alone, now I have to find someone to take me to physical therapy, an hour away. It was too late to change plans, so home I went with a friend caregiver and others lined up for the first 10 days.
Around 10 o’clock that first night home the pain arrived again at level 9 and I woke up my friend with my moans and cries. She didn’t know how much oxycodone I could safely take. The good news was that I’d made sure I had some pills on hand left over from a previous prescription so that we didn’t have to stop and fill a prescription in Española on our way home from the hospital. My son would pick it up at my regular pharmacy in Santa Fe the next day on his way up from Albuquerque.
I’d already taken 10 milligrams in hourly succession and the pain wasn’t touched. My care giver called the hospital. Someone actually answered but when she identified who I was they told her because I wasn’t covered under their Presbyterian insurance (secondary insurance, as Medicare was primary) I needed to call my insurer to speak to a medical professional. No one answered the phone, of course. No nurse ever answered a nurse hot line number,either. In desperation we called 911, saying “I don’t know if this is an emergency or not but . . .” They sent out the EMTs from Peñasco, who were very kind but unable to administer pain medication (only paramedics can). They did get a doctor on the phone, however, who said we could safely increase the dose of oxycodone to a certain level. Just as we were trying to decide whether to have the EMTs take me to the emergency room, the pain started to abate and we sent them on their way.
The next day, Friday, I called the hospital to try to get some advice on pain relief. When you call the hospital you only get through to a main switchboard. There is no direct number to a clinic, a nurse, a physician’s assistant, or a doctor. You leave a message with whomever answers the phone and request that it gets delivered to the right person. The person who answered my call said she would send it to the clinic with an “asap” note on it. No one ever called me back. Then my son called to say that the pharmacy was “out of oxycodone” and because it was Friday night there was no one to call to ask for a prescription to a different pharmacy.
I had enough leftover oxycodone to make it through the weekend. I called the hospital on Monday and told them to get a new prescription sent to a pharmacy in Española that I could get when I went down for my first PT appointment on Tuesday. There was no Rx at that pharmacy on Tuesday. I called the hospital again and a nurse called me back saying the prescription had been sent to my primary pharmacy in Santa Fe. I told the nurse, “No, I requested that it be sent to the pharmacy near the hospital.” She said she’d ask them to send it to the correct pharmacy. Finally, on Thursday, when I went down for another PT appointment, the Rx was at the local pharmacy: six days after my surgery.
If I review what happened, step by step, each one becomes an indicator of the systemic problems that need to be addressed in not only the specific facility where I experienced them but in the larger medical industrial complex. Let’s break them down into bullet points:
• Pain management is crucial. If a nerve block doesn’t work or isn’t sufficient to help reduce post-surgical pain patients should remain at the hospital until a pain protocol is established.
• Communication between health care providers and patients is crucial, particularly for pain management. A hotline for post-surgery advice could provide the information needed to manage medications at home.
• Communication between health care providers and patients is crucial at all times, not just for pain management. With no direct access to the orthopedic clinic, a nurse, a PA, or a doctor a patient has to hope that messages are delivered in a timely fashion—or even at all!
• If it’s after business hours or the weekend a patient has no way to request a transfer from the prescribing physician. Pharmacies should be allowed to transfer opioid prescriptions to sister stores if they are out of stock.
• Case managers need to be assigned at the outset. She or he could help the patient navigate all the issues raised above: pain management (delayed hospital release); communication with medical staff; and prescription oversight.
I don’t have the qualifications to assess why these remedies aren’t enacted: I’m just aware of the anecdotal evidence supplied by those who’ve suffered in similar situations: insurance bullying; lack of staffing, from doctors down to MA’s (medial assistants); bureaucratic “efficiency” that makes things less efficient (never getting to speak t a person); opioid restrictions that increase patient pain; or there are just too many of us old people getting new knees and hips and shoulders. Think New Mexico’s latest publication, "How to Solve New Mexico’s Health care Worker Shortage” attributes the problems to the high cost of malpractice insurance that discourages doctors from practicing in New Mexico.
At a follow-up appointment at the orthopedic clinic when I told this story to the attending medic, he told me this was not the first time he’d heard these complaints (and he had a record of all the phone calls I’d made to the hospital), especially the one about not being able to speak directly to a medical professional when questions and situations arise that need immediate attention. So I walked down the hall to the administration office and filed my complaint. It will be sent to the Presbyterian headquarters in Albuquerque and then someone will “give me a call.” I’m not holding my breath.
There is no exact time at a hospital; there’s only “waiting.” Arriving at 8 am I waited until 3 pm for surgery. First, the anesthesiologist gave me a nerve block, which is an injection that targets a nerve or group of nerves to provide pain relief. Secondly, she gave me a spinal anesthesia block, which numbs the lower half of the body. I don’t remember anything after that (they also give you versed, a great drug that induces sleepiness, decreases anxiety, and provides amnesia about what just happened to your body) and she also gave me general anesthesia, meaning you’re not conscious during surgery. The actual surgery lasts only an hour or so but then you wait in recovery for someone to come get you and take you to your room in the hospital. A one-night stay is normal for my kind of surgery.
The first indication that the nerve block hadn’t worked came around eight o’clock that night when all the other meds in my body dissipated and I started writhing around on the bed at level 9 on the pain scale (10 is torture). First the nurse administered Tylenol (yes, this is the first drug they give you post-surgery); then oxycodone; then two doses of morphine; then a call to the doctor for permission to use tramadol (I’d never even heard of that one), until three hours later the pain abated and I dropped off into something I called the night’s wrestle: intermittent pain mixed with exhausted sleep.
I’ve had two previous orthopedic surgeries: a meniscus repair and a rotator cuff repair, in which I distinctly remember two days of nerve block pain relief at home before it became obvious it was time to take the oral oxycodone. I wasn’t in need of validation that the nerve block hadn’t worked but I got it anyway the next morning when the doctor came in for a brief visit: “Have you forgiven me?” The good news was that the surgery was successful. Then I waited a few hours and the physical therapy people came in and that‘s when I noticed I couldn’t bend my foot at the ankle. As I pointed this out, there was a brief silence and then someone said “foot drop,” and someone else said, it’ll probably come back, but by then I was imaging walking down the street with my foot dragging along the ground like Ratso Rizzo. When I got home I looked up “foot drop, caused by an injured nerve during hip or knee replacement surgery.”
So there I was: a nerve block that didn’t work on my knee but froze my ankle (it may have been two different blocks). After waiting another couple of hours I found out another alarming fact: Mountain Home Health, a company that provides home health care and physical therapy to Taos County residents, no longer serves El Valle (they were bought out). I’d based my decision to do my rehab at home because of these services. Because I live alone, now I have to find someone to take me to physical therapy, an hour away. It was too late to change plans, so home I went with a friend caregiver and others lined up for the first 10 days.
Around 10 o’clock that first night home the pain arrived again at level 9 and I woke up my friend with my moans and cries. She didn’t know how much oxycodone I could safely take. The good news was that I’d made sure I had some pills on hand left over from a previous prescription so that we didn’t have to stop and fill a prescription in Española on our way home from the hospital. My son would pick it up at my regular pharmacy in Santa Fe the next day on his way up from Albuquerque.
I’d already taken 10 milligrams in hourly succession and the pain wasn’t touched. My care giver called the hospital. Someone actually answered but when she identified who I was they told her because I wasn’t covered under their Presbyterian insurance (secondary insurance, as Medicare was primary) I needed to call my insurer to speak to a medical professional. No one answered the phone, of course. No nurse ever answered a nurse hot line number,either. In desperation we called 911, saying “I don’t know if this is an emergency or not but . . .” They sent out the EMTs from Peñasco, who were very kind but unable to administer pain medication (only paramedics can). They did get a doctor on the phone, however, who said we could safely increase the dose of oxycodone to a certain level. Just as we were trying to decide whether to have the EMTs take me to the emergency room, the pain started to abate and we sent them on their way.
The next day, Friday, I called the hospital to try to get some advice on pain relief. When you call the hospital you only get through to a main switchboard. There is no direct number to a clinic, a nurse, a physician’s assistant, or a doctor. You leave a message with whomever answers the phone and request that it gets delivered to the right person. The person who answered my call said she would send it to the clinic with an “asap” note on it. No one ever called me back. Then my son called to say that the pharmacy was “out of oxycodone” and because it was Friday night there was no one to call to ask for a prescription to a different pharmacy.
I had enough leftover oxycodone to make it through the weekend. I called the hospital on Monday and told them to get a new prescription sent to a pharmacy in Española that I could get when I went down for my first PT appointment on Tuesday. There was no Rx at that pharmacy on Tuesday. I called the hospital again and a nurse called me back saying the prescription had been sent to my primary pharmacy in Santa Fe. I told the nurse, “No, I requested that it be sent to the pharmacy near the hospital.” She said she’d ask them to send it to the correct pharmacy. Finally, on Thursday, when I went down for another PT appointment, the Rx was at the local pharmacy: six days after my surgery.
If I review what happened, step by step, each one becomes an indicator of the systemic problems that need to be addressed in not only the specific facility where I experienced them but in the larger medical industrial complex. Let’s break them down into bullet points:
• Pain management is crucial. If a nerve block doesn’t work or isn’t sufficient to help reduce post-surgical pain patients should remain at the hospital until a pain protocol is established.
• Communication between health care providers and patients is crucial, particularly for pain management. A hotline for post-surgery advice could provide the information needed to manage medications at home.
• Communication between health care providers and patients is crucial at all times, not just for pain management. With no direct access to the orthopedic clinic, a nurse, a PA, or a doctor a patient has to hope that messages are delivered in a timely fashion—or even at all!
• If it’s after business hours or the weekend a patient has no way to request a transfer from the prescribing physician. Pharmacies should be allowed to transfer opioid prescriptions to sister stores if they are out of stock.
• Case managers need to be assigned at the outset. She or he could help the patient navigate all the issues raised above: pain management (delayed hospital release); communication with medical staff; and prescription oversight.
I don’t have the qualifications to assess why these remedies aren’t enacted: I’m just aware of the anecdotal evidence supplied by those who’ve suffered in similar situations: insurance bullying; lack of staffing, from doctors down to MA’s (medial assistants); bureaucratic “efficiency” that makes things less efficient (never getting to speak t a person); opioid restrictions that increase patient pain; or there are just too many of us old people getting new knees and hips and shoulders. Think New Mexico’s latest publication, "How to Solve New Mexico’s Health care Worker Shortage” attributes the problems to the high cost of malpractice insurance that discourages doctors from practicing in New Mexico.
At a follow-up appointment at the orthopedic clinic when I told this story to the attending medic, he told me this was not the first time he’d heard these complaints (and he had a record of all the phone calls I’d made to the hospital), especially the one about not being able to speak directly to a medical professional when questions and situations arise that need immediate attention. So I walked down the hall to the administration office and filed my complaint. It will be sent to the Presbyterian headquarters in Albuquerque and then someone will “give me a call.” I’m not holding my breath.
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