Monthly Archives: September 2023

What Annoys Jeff this Week?

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1. The good idea fairy. The GIF is a pernicious feature of life in the bureaucracy. Its mission is to take projects or programs that are perfectly fine, even serviceable, and sprinkle them at the last possible minute with pixie dust and render them stupid, painful to execute, or optimally both. Having great ideas is fine, but when your idea of the week generates a minimum 80-hour per year manpower requirement when you’ve just lost one of three employees, it might not be a particularly good time to launch this new crusade. But hey, if the powers that be want me to spend my time following grown ass adults making sure they’ve cleaned up after themselves, I’ll do it all day long… but they shouldn’t be surprised when a whole laundry list of other “very important activities” just doesn’t get touched.

2. Data mining. My insurance company partnered with a company doing “free” A1C testing at home. Fine. I’ll share a bit of medical privacy for a free test. But dudes you’ve got to make it easy. I walk into the doctor’s office every six months (or more often lately), they jab my finger and my A1C number appears in my online patient portal before the doctor has even walked into the exam room. By contrast you gave me two columns of instructions that included “let the sample air dry for 3 hours before packaging” and then “it must be shipped the same day.” Either make it easy to go along with your data gathering scheme or bugger directly off.

3. Breakfast on office days. On days I’m stuck going into the office, I used to just swing through McDonald’s and grab an egg McMuffin. It was the definition of quick, easy, and simple. Now I’m making breakfast at home. It’s not that I don’t make a tasty breakfast so much as the process is a massive time suck. Instead of scarfing down my egg sandwich at my desk or in the car, I’ve got a full meal to prep and clean up before I’ve even left the house for the day. It’s reduced my morning reading time on office days to practically nothing. That makes it a pain in the ass with very little ROI besides a vague “healthiness” that doesn’t do much to improve my general mood in the mornings.

It’s what happens when the giants are all dead…

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The Republican controlled House of Representatives has about five days to prove that they can find their ass with both hands and a flashlight before the government runs out of money. They’re just coming off a three-day weekend so who at least they should be well rested while they do whatever passes for “work” in the halls of the United States Congress.

I’ve been at this a while. I’ve been through shut downs, furloughs, and an endless amount of legislative fuckery. We’ve been down this road so often that a previous Congress put in place a little section of public law that guarantees government employees back pay for any time spent sitting on the beach during a shutdown. Knowing the back pay is coming doesn’t quite offset not getting a regularly scheduled check, but it does help take the edge off… Not to mention a three or four week shutdown would get me out of a couple projects that are lining up to be a real pain in the ass.

Make no mistake, a government shutdown is bad. It’s bad for people who work for the government. It’s bad for the army of contractors who won’t be receiving back pay. It’s bad for travelers, people who eat food, or take medication, or want to visit a National Park. Perhaps more importantly, it makes the Congress look like incredibly huge douche nozzles who are incapable of doing one of the very few things the Constitution identifies as part of their job description.

I don’t have much faith in Kevin McCarthy’s leadership based on his past performance. I have even less faith in the hard right extremist wackjob wing of his party not standing around cheering while the whole thing burns. We are in a problematic era of republican government and I’m increasingly convinced that we’ve gotten precisely the kind of government we collectively deserve. 

I grew up in an older world of political deal making where compromise was part of what kept the great machine running. Getting half a loaf simply meant the other half was left to go after the next time. The great pols of the 20th century understood that… and the system, with all its faults, worked well enough to do big things – like build an interstate highway system, land men on the moon, and win a long Cold War. 

It seems the giants of American politics who could manage that kind of heavy lift are all dead and we’ve been left with third stringers who can’t even be bothered to keep the lights on. 

What Annoys Jeff this Week?

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1. Results. I’m a reasonably intelligent man with a fairly analytical mind, but I’m at a loss for what to do when results from something like an MRI drop into my online patient portal long before my doctor has a chance to look at and comment on them. As wide as my academic interests are, it’s never ranged as far as internal medicine, so the reports end up being a lot of gibberish with lines, arrows, and color codes that mean precisely nothing to me. That, of course, doesn’t prevent me from using Google to try gleaning a bit of understanding… which never results in anything other than low grade panic or mild confusion. I can’t believe I’m saying this, but I almost miss the olden days when the doctor received the report and the patient didn’t know dick about it until the medical professionals called to explain what’s what. I’m not at all sure this current model of complete transparency is helping me in any way.

2. Retirement. In my little slice of Uncle’s big green machine, there are 3 people who do more or less what I do. We’ve been a decent little team for the last half a decade or so. One of the three (lucky bastard) is retiring in a few days. His backfill is nowhere in sight. With three people, in all but the most extraordinary circumstances, we could work around everyone’s schedules and keep the trains running on time. With two, well, I’ve already identified two days that’ll be listed with “no coverage” in the next two months. That number will explode when the other guy adds his scheduled time off to the mix. All of that’s before we’ve even talked about the week or two gap for Christmas and New Year’s. None of those issues should be surprising. We’ve been warning the bosses about it for months. But not to worry… there’s allegedly a “temporary” fill-in coming and the bosses are going to hire a permanent replacement with all the speed and agility the U.S. Government is famous for displaying. With the pace at which the bureaucracy moves, I don’t expect to see either of those things happen until well after the new year, if ever. The only thing I know for sure is that for the foreseeable future, there’s going to be 24 manhours per day of work to do and only 16 manhours of personnel on hand to do it. The math, as they say, just doesn’t math. I know I won’t magically be doing an extra 4 hours of whatever every day, so I reckon the powers that be should probably get prepared for a diminished baseline of productivity and discovering that they’re just going to have to wait until we get around to some things. That’ll go over like a fart in church, but this was an issue that could have been addressed any time in the last six months…  so, I’ll be damned if I’ll be treating the inevitable result of bureaucratic fuckery as any kind of emergency for me. 

3. Exercise. Everyone on the internet loves to tell you that “once exercise becomes part of your routine, you’ll love it.” Maybe that’s true for them, but for me, I can assure you that no, the fuck I will not. Every daily walk or session on the exercise bike is 30-40 minutes I’m allocating under protest, because it’s sucking up an incredibly finite resource that I’d much rather put towards reading, or writing, or anything that I might even partially enjoy. Maybe it’s better than being stabbed in the kidney, but as something to pass the time, exercise is easily the least enjoyable part of my day. I’ll do it because it’s being required of me by someone who has far more knowledge about modern medical theory and practice than I have. Still, there isn’t a power on earth or in heaven that can convince me I’m having a good time. 

Diagnostic tests, doctor shopping, and medical snobbery…

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Since my original diagnosis of “probable SVT” way back in July took place under the umbrella of the ChristianaCare hospital system over in Delaware, my first appointment with cardiology was also made within their system. That was fine. Their main campus is reasonably well reviewed and I could get seen by a cardiology nurse practitioner in August, which I’ve found out through this process is a fast turnaround for a new cardiology patient who isn’t inactively laying in a hospital bed. 

In the intervening days and weeks, though, I had a follow up with my primary care doctor, who operates as part of the Johns Hopkins system. He was less enthused about my decision to use Christiana for my cardiology needs – explaining that their cardiology department, while fine, is “not ranked” whereas Hopkins cardiology is currently ranked 13th in the nation with the hospital consistently ranking very near the top of any list of “America’s best hospitals” that’s ever put together.

Yes, my primary care doctor is a medical snob.

Despite his cajoling, I kept my original appointment, which led through a series of tests and reports that I was going to need anyway. I also reached out to Hopkins Cardiology to get myself on their waiting list for new patients and ended up with an appointment scheduled deep into October. It wasn’t ideal, but since I was going through all the preliminary tests and could then hand over a pretty good sized file, the timing wasn’t a major issue for me. I was able to take advantage of their wait list option to get my first appointment in the books last week – with a guy who has been practicing for 40+ years and has the look and feel of someone who has seen just about everything. In other words, he’s exactly the guy I want even if all we’re doing at the moment is preventative and exploratory. 

With all other things being equal, if being able to access some of the best cardiologists in the country means driving 45 minutes west instead of 25 minutes east, ultimately it feels like not much of a decision at all. 

It turns out, like my primary care doctor, I too am a medical snob.

So, I’m going all in. My optometrist recently retired. Instead of going over to the doctor that took over his practice, I’ll let Hopkins run the show for my eyes too. I’ve got my first appointment set up with the closest branch of the Wilmer Eye Institute later this year. That puts all but one doc under a single banner… and when the time comes sometime in 2024, I’ll bring that one into the fold too.

All of these new faces on my medical team are a little further away than I’d like, but I feel like what I’ll lose in adding a few minutes of extra travel time, will pay me back in the convenience of having them all working under the same organization. I was woefully unprepared for the level of coordination I’d need to do myself when my primary care doc and everyone else had electronic records systems that refused to communicate with each other. 

I’m in no way fool enough to believe that being “nationally ranked” is any guarantee of better outcomes. For now, it appears that most of my problems are fairly benign, but should something become more involved or I develop a novel condition over time, I’m going to put my faith in the big name going forward. Hopefully they’re not just riding their 135-year-old reputation. 

Some people would take this opportunity to rail against the American healthcare system. Undoubtedly, it has challenges – but I’ve been absolutely amazed by the level of services and the array of options that have been presented to me over the last three months. Don’t think for a moment I’ve failed to realize my great good fortune to have both the geographic proximity to one of America’s great medical centers and an insurance plan that makes walking through their doors possible. There hasn’t been a day go past recently when it hasn’t been at the forefront of my thoughts.

What Annoys Jeff this Week?

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1. Decaf. I’ve forsworn a lot of things I enjoy over the last couple of months. I’ve given up my evening gin and tonic. I’ve banished additive salt from every recipe. There’s a dozen or more other small changes I’ve made, even if not exactly happily. Throughout the turbulence, I kept up one simple personal tradition – morning coffee and afternoon tea. I even gave up the milk and sugar there in the name of caloric reduction. Now I’m adding caffeinated coffee and tea to the list of embargoed items. That was a personal decision rather than doctor ordered as I was feeling just a touch too twitchy a few times this week. I’m a man with a tremendous ability to endure ridiculous situations… but I have my limits and it feels like they are quickly approaching if not already appearing somewhere astern.

2. Kevin McCarthy. If ever there was a man not up to the challenge of being Speaker of the House, it’s the current holder of the chair. I could make this a laundry list of his failings, but what’s the point? The old boy is too busy trying to figure out how to hang on to his speakership than he is to focus on any real legislative efforts. I doubt his conference will even be able to muster the votes to keep Uncle Sam’s lights on after September 30th. The right wing of the party might not care, but it truly makes them look like the rankest of amateurs. The Republican “lead” House would be farcical if they weren’t so damned injurious to the republic.

3. Mitt Romney. I was proud to vote for Mitt Romney many years ago when he ran as the Republican candidate for president. I was proud of Mitt Romney when he stood up against a grasping former reality TV host who was hell bent on defying the Constitution to stay in office. He’s a throwback to a politician of a different age – what passes in Washington, DC for being a gentleman in an occupation and certainly in a party that doesn’t put any value on that sort of behavior. I hate to see his voice being lost among a party that is increasingly unhinged… but I can absolutely understand why he isn’t looking to spend another six years consorting with the absolute clowns running the show.

Security blanket…

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For the last five weeks I’ve had an electronic security blanket. Far away, wherever Philips giant data center is located, computers monitored the output from their Mobile Cardiac Outpatient Telemetry (MCOT) devices, and their algorithm has been plugging along keeping a remote eye on my ticker. 

The only feedback this little wonder device gave me was that occasionally one of the leads came unstuck and needed to be reaffixed. I’ve just been operating under the assumption that if there was something catastrophic happening, someone might have called or cut the testing short. I have no idea if that’s true or not, but in the absence of clear guidance, I’ve created my own. 

I hate to admit it, but I felt just a little bit better with this little bit of plastic and silicon chips quietly doing its thing in the background.

The fact is, these last two months have been the only time in my adult life I’ve honestly been bothered by living alone. The only difference from June 28th to today is the fact that I now have evidence that something could go horribly wrong rather than simply knowing it as a purely intellectual exercise. That evidence is enough to leave me feeling decidedly uneasy now that my security blanket has gone away. 

Taken as a whole, the last two and a half months have been disconcerting in a way I’d haven’t previously encountered. I don’t know that there’s anything to be done about it other than to accept that I’ll now have a new nagging thought in the back of my head for the foreseeable future. Moving someone in just to make sure I haven’t accidentally dropped dead as I go about my day-to-day activities, feels like it’s probably a wildly excessive overreaction… but don’t think the thought and a hundred other derivative ideas haven’t been banging around my head this weekend. 

Anyway, I kind of miss my security blanket. 

What Annoys Jeff this Week?

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1. Shitshow. There’s a shitshow coming. It’s going to arrive in just about seven weeks. Although I’m nominally facilitating this burgeoning fiasco, you’ll find that I have little or no enforcement power. Sure, I can tell people when something needs to happen, but when they blow through the deadline without so much as noticing, I’m allowed no stick with which to beat them. To be sure, I can consult, encourage, and warn, but my powers of making anyone do anything are entirely fictional. As the walls close in, the best I’ll be able to manage is telling anyone who’s interested that it’s not going to be pretty. About the only tool I have in my kit at this point is to try lowering expectations to the point that anything more than not setting the building on fire will be considered a successful showing. Even managing that feels like a crap shoot. If this thing manages not to fall apart between now and the time the certain goes up, I’ll be entirely surprised… but if it shits the bed, at least I’ll have the pleasure of saying “I told you so.”

2. The equal application of justice. Here’s the thing… I don’t care if you’re the former president, the son of the sitting president, conned a bunch of little old ladies out of their retirement funds, or the crackhead who just knocked over the local liquor store, if there’s sufficient evidence that you have committed a crime to convince a grand jury that indictment is justified, I’m all in favor of the case being brought. I don’t need more information than that. I’ll never understand why that’s a contentious opinion just because the individual indicted happens to be from “your” side of the ideological spectrum. God, but don’t I miss the days when disgraced public figures had the barest degree of shame and would slink off quietly and never be heard from again. File it under the headline of “we were a proper country once,” I guess.

3. Snacks. I used to have proper snacks – chips, crackers, big hunks of cheese, pretzels (both hard and soft), the occasional Little Debbie cake, or quality Amish baked goods from neighboring Lancaster County. My “snacks” now are fruit or if I’m feeling particularly froggy, pre-measured portions of nuts or M&Ms. Have you ever really measured to see how small a “1 ounce serving” of peanuts is or how few M&M’s make the ounce? It’s goddamned embarrassing to even call it a snack. I’m not so much annoyed as I am enraged. There simply aren’t enough herbs and spices in the known universe to make a rice cake or a plum taste as good as a Snickers Bar or properly salted soft pretzel. At this point, I’m not sure if I’m actually doing anything to extend my life or whether it just feels longer because bit by bit we’re extracting every small bit of joy from it.