On Informed Consent or More Aventures in Being Underinsured

The issue of informed consent is something that is important in therapy, though I recognize I may take it more seriously than some. This is likely heightened by the fact that I've been studying for licensing exams in one way or another for the last 9 months.

We had quite the interesting informed consent experience yesterday. We don't have dental insurance. It is offered through my work, but we can't afford it. I found out about a low-cost dental clinic and thought it would be worth going in for an exam and cleaning since it has been SO long since we've seen a dentist. Of course there was a mountain of paperwork for each of us to fill out and then a meeting with the registration staff to get us registered as patients and to establish our fee.

We both had problems with the paperwork and were sent back and forth between the registration desk and the check-in desk several times before we got it all sorted out. There was an acknowledgment to sign that we had received a pamphlet we had not received. The receptionist insisted we sign it; we wouldn't until she gave us the thing. Then there was the release of information. They wanted us to sign a 'general' release of information, or in other words, a blank one. We kept getting 'we just need you to sign this.' Clearly the staff is not used to people actually reading the paperwork or questioning anything. They were kind of frustrated with us, I think.

Then there was the informed consent. It had several different paragraphs each giving consent for a separate procedure. We didn't initial or date most of them. The receptionist highlighted the parts we didn't initial, gave them back to us, and requested we sign. The problem was not that we were not thorough, the problem was that we weren't giving consent for tooth extraction, root canals, bridge work, anesthesia, etc when we were there for basic exams and cleaning.

It was pretty clear that the whole process is set up for the benefit and protection of the company and not for the individuals they serve. Just sign here. Just sign here. You have to sign this. The whole thing made me very angry.

Then, when we got to see the dentist, they wanted to do a procedure I wasn't comfortable with and wanted more information about. The best answer I got was "this is what is recommended. It's standard." I know enough about the health care system to not just trust 'what's recommended.' By whom? For what reason? Based on what research? I ended up having nothing done because I wanted to do some of my own research first. Blake didn't get anything done either. The cost was more than we had expected. The back staff assumed the front office staff had explained the costs; they hadn't. Furthermore, they would have charged us a fee for the visit for the exam and then scheduled another visit for the cleaning, where we'd have to pay the office visit fee again. So much for low-cost.

Tired

I made a joke the other day. Blake laughed. He said, "I miss this side of you."

His comment got me thinking. I haven't been very much fun lately. I've been stressed with work, tired, overburdened. It's not that there's any one thing, it's a combination of things all happening at the same time. I'm hopeful change is coming, but it's not here yet.

My mom is coming to visit soon. I want nothing more than to spend the whole week with her and let her take care of me. I can't though. I have to work.

New Years Goals: Revised

We're now 2 months in to the new year. My first couple goals are going great. I passed my first licensing test; one more to go. I've been writing weekly; that's been good. I didn't quite get through my book for February, but I'm still reading more than I was in 2013, so this is also a win. My last goal was about work. I'm scrapping that goal and changing it. Quite a lot has changed at work in the last 6 weeks. I had support from the executive director on many of the changes I was trying to implement. He's pulled his support and told me we have to go back to the way things were. I see that my previous goal is not possible. My new goal is to not be working there when 2015 comes.

On developing a sense of independence and confidence in my daughter

Our little Bon is going through a helpless stage. I hear "I can't" come out of her mouth way more than I am comfortable with. We're making a conscious effort to have her do things for herself that she is capable of doing. My independence requests are totally normal, age appropriate kinds of things like pulling up her own underwear, putting on her own shoes, putting her toys in her room, holding her own tissue to blow her nose, etc. 

We got into an absolutely epic battle of the wills at 4 am a few weeks ago over pulling down her pants so she could pee, tucking her into her bed, wiping her butt, and holding a tissue to blow her nose because it was runny after all the crying and screaming she did to try to get me to pull her pants down. Overall, I like to think we are making progress on this issue. 

This is the backdrop for an incident that happened at the Safari Park on Friday. The Bon was playing on the playground, came to see me at the tables, and then hurt herself when she stepped back down into the playground area. I'm not sure exactly how it happened. She pinched or rubbed the back of her knee on the wood and started crying. Immediately another mom springs into action and is asking Bons, "Did you get a splinter? Are you okay? Where's your mom?" 

I didn't get up to rescue her because her injury didn't seem life-threatening. I talked to her from where I was sitting. "You got hurt, Bons?" "Yeah." "Are you going to be okay?" "Yeah." Okay then, we're good. It seemed to really bother the other parents that I didn't get up and run to her. The judgement in their voices when they told me that she got hurt was obvious. Then as she walked away, it looked like there was a smear of blood on the back of her leg. A different parent yells over to me now, "She's bleeding! I think she's bleeding!"

I saw it. It looked like blood. If it was blood, it was a little and just smeared. I called to Bons and asked her to walk back over to me so I could check her out. She did. The injury didn't break the skin; she wasn't bleeding. It did break some blood vessels right under the skin in a rug burn kind of way, kind of. We decided to go to the first aid station to get her cleaned up and to check for splinters. She agreed this was a good idea, got in her stroller, and off we went. She's fine.

I don't think I did anything wrong there. I also don't like judgement from others. I try not to be sensitive to it, but I am. 

What I've learned from running

Thinking about the different races I've run, I realized each one has taught me something different. 

Rangnar Napa Valley

My third leg was really rough: my right leg and knee were really hurting. After that leg we waited in line and got a free massage. The massage therapist commented on how my IT band was tight. I pretended like I knew what she was talking about and then googled it when I got home. I learned what an IT band is and how to stretch properly and haven't had problems with it since.

Tinkerbell Half Marathon

I can run. Mostly what I got is confidence that I can do it. I had never run this far before and my time was better than I expected. I've never been very confident in myself physically, and I gained some serious confidence with this run. Also, people in my life were impressed by me, and that felt pretty cool.

Disneyland Half Marathon

There is such a thing as over-hydration. I was so worried about the heat that I drank 2-3 cups of water at every station. This was too much. I had to stop at every bathroom and porta-potty. The last several miles of the race had no bathroom stop. There weren't even any bushes to hide behind, just running through a chute. I slowly peed myself the last mile or so.

Ragnar SoCal

How you train matters. I had done so well in my other races that in preparation for this one, in the back of my mind, I think I was counting on the race-day adrenaline to carry me through. Well, in running my legs I could feel when my training gave out. Not surprisingly, I got fatigued at about the distance that my training runs ended. I had other people in my van who were excellent trainers. They talked about looking at the elevation of hills on their legs and then finding similar hills near their homes to run on a regular basis. And they killed it! I did not. Another contributing factor was stress. I was too stressed and over-scheduled to really give the time to training that I should have. 

Another thing I learned is about my body's limits in extreme temperatures. My first leg was right around mid-day and much hotter than I had planned for. I was dehydrated and overheating bad. Finishing the distance was a serious struggle. My next leg was in the middle of the night. Someone around mile 1 the course took me through a golf-course. The sprinklers were on. There was no avoiding them. When I got to the other side of the golf-course I was drenched like I had just stepped out of a shower. I had to run the remaining 5 miles or so wet. I made it. I could feel my body shaking when I stopped running and knew I had to get out of wet clothes asap. I was stripping down in the back of the car before we were even out of the parking lot. The extremes in temperature really did me in. I was vomiting a while later and didn't run my last leg. 

Orange County Half Marathon

Fuel. This race had a shuttle that drove you to the starting line. The lines were ridiculous, so by the time we got off the shuttle, the race had already started. We took off running and were doing fine, eating our energy chews and keeping a good pace. A fun side benefit to starting late was that we never got passed. All the fast runners were ahead of us. We passed a lot of people though, which was pretty good for my confidence, not being a fast runner myself. We were planning on taking an energy shot around mile 9; the race had advertised that Clif would be giving them out for free. Because of the late start, by the time we got there, they were out. We didn't have any back-up fuel. And we were feeling it. We were fortunate that about a mile later some people were standing along the race course handing out apple slices and pretzels and cookies. The change in energy was instant. I would not have believed you could feel the boost that quickly if I hadn't experienced it myself. I learned how important keeping myself fueled was.

Not long after that last race I started studying for my licensing exams. (I passed the first one last week, by the way!) I told myself I wasn't going to sign up for any more races until I passed both tests. I knew it would just be too much to take on. I'm studying for the second test now. So, hopefully I'll have a new race on the horizon soon and new things to learn.

On my goals for 2014

I don't make New Years Resolutions. Resolutions are in the category of fantasy, for me. They carry about the same weight as "wouldn't it be cool if I won the lottery." Goals are another story. Goals I can do. Here are my goals for 2014:

1) Become a Licensed Marriage and Family Therapist in the state of California. This is a carryover from 2013. Who would have thought my application to take the licensing exams would take 8 months to process? I went out to my PO Box on New Year's Day and found the approval for the first exam! I am excited but also stressed with studying. If I don't pass, I have to wait 6 months to try again. I'm very tired of waiting. I want to pass on the first try.

It's been seven years since I first decided I wanted to be a therapist. Now I'm almost to the end of that journey. I've run the 26 miles of this marathon and have the .2 left. It will be so nice to just live my life, have a job (or not), without the road to licensure always weighing on my mind. There will definitely be some serious celebrating when I pass my second exam and have a license in hand.

2) Read one book per month. Having been an avid reader in the past and an English major in college, this goal seems kind of sad. One book a month is a goal to strive for? Seriously? Yes! I've been so busy with work and parenting and making sense of my distancing from Mormonism, that I haven't been reading. I spent a lot of time online in the past few years. Much of that has been salve to my soul, finding friendship and guidance from people who have walked this road before me. I'm finding I need that less and less and am ready to return to an old love: books. I also think this will be good self-care, needed regular relaxation time. I'm looking forward to this one, too.

3) Write one blog post per week. I have a lot I need to process and would like to share. The problems I experienced with Mormonism were something I never saw coming. To say it has been life-changing would be a gross understatement. This has been the most difficult and far-reaching transition of my life. I haven't said much about it. Partly that's been to protect myself while I was in a vulnerable state. Partly that's been to avoid saying things out of pain or anger I would later regret. And partly my silence has been out of respect for friends and family I love. I don't want to hurt anyone, fight with anyone, shake anyone's testimony, or cause doubt. Knowing how hard this has been for me, I'm not interested in forcing my loved ones into the same agony.

(I will say though, that the journey can be lonely and terrifying. I'm here for anyone who is wrestling with hard questions or doubts. I would be happy to be a sounding board, listening ear, shoulder to cry on. With the experience I've had at work, I'm now really good at listening to and talking about things that are hard to talk about, the things you're scared to say out loud. I can't be your therapist, but I can be a good friend. Contact me, please. Don't go it alone.)

For my faithful friends and family, don't be afraid to keep reading my blog. I'm posting once a week but not all here. I started another private blog just for me where I'll be doing some posting this year too. Some things I know I need to say but you don't need to hear. I will take my audience into consideration and post appropriately. I'm looking forward to writing. It's healing. I need it.

4) Pull my program at work out of the hole. I want it to be the best place to work in the whole company. A few months back, I got a promotion and was made Program Coordinator of the adolescent outpatient program. This was a new position just opened on the management team. Morale has been low. Adolescent therapists are constantly stressed and anxious. I think we have great people on our team and want to see them stay long-term. I'm hoping to make changes that will make coming to work happier for them. I also think less-stressed and supported employees make better therapists who give better services to our clients who then refer their friends and family our way. It's good for everyone.

~~~

I noticed a theme with my goals as I read over this post: they are all things I am excited about. That's another thing that's better about goals than resolutions. Resolutions seem like the things you know you're supposed to do but don't really want to, and that's why you've got to make it a resolution. Nah. I don't have time for that. I've got goals!

Hello again blog

The hours I put in at work are negatively correlated with the time available to me to blog. I miss writing. It's been 4 months since I last posted. I've had lots of thoughts in those months. I haven't taken the time to write them. And to be perfectly honest, I don't feel safe posting a lot of what I think about these days.

I've gone through a transition in my faith. Writing about what I have experienced would be tremendously healing, I think. I know that my friends and family will most likely disagree with what I have to say and may even be hurt by it. I don't want that.

I've thought about starting something private for my eyes only or going back to my trusty paper journal, but I really like writing for an audience. Even if no one ever reads my blog, I like the idea that someone could. I also don't like the idea that I'm censoring myself, silencing my own voice, bowing to the expectation to conform, acquiescing with my silence to the cultural norm that says certain kinds of stories are okay to tell and others are not. I don't like that my own space feels unsafe to me.

I don't know exactly where I'm going with any of this. I offer these thoughts as a preparation, I suppose, for the posts I want to write. When they will come, if they will be written is still uncertain. I am saying for the record, for my benefit more than anyone else's, that this is my space. What I have to say is valid; it's worth saying. I won't let fear shame me into silence.