I’m Baaack!

It has been quite awhile since I last posted here. I’ve been posting on my other blog, one devoted to reading and writing, not health, wealth, and all that makes life better than the alternative. But August has been a tough month and has brought me back here, to celebrate what’s better than the alternative.

At the end of July, my husband wasn’t feeling well. I suggested we go to the urgent care clinic closest to our house where he was diagnosed with an infection. Something minor. Something easy to treat. Or so we thought.

He did have an infection. I had had the same infection a few months back, the reason I recognized his symptoms. In my case, a quick test confirmed the infection and a trip to the pharmacy to pick up an antibiotic, followed by a long nap, was all I needed to get better. We expected the same would apply to him.

But he didn’t get better. In fact, he got worse. So much worse that when he saw his primary care physician a week after that trip to urgent care, the doctor sent him straight back to urgent care, this time at the hospital our doctor is associated with.

The doctors there discovered his blood contained a very high level of potassium. They ordered an EKG to see if his heart was in trouble. It wasn’t.


But his kidneys were.

After I had hung around the urgent care intake rooms for hours, the doctors and nurses urged me to get something to eat and reassured me they would get him into a room while I was away. They told me to come back once I had eaten.

When I returned, they gave me his room number–Room 15 in the ICU. ICU. That’s Intensive Care Unit. Not exactly what I had expected when they said they would get him into a room.

My first reaction was to wonder if the hospital was so full they could only find space for him in the ICU. That’s the denial phase. He couldn’t be so ill that the staff needed to monitor him 24/7, could he?

It turns out, he was that ill. His kidneys were no longer functioning. The culprit, the doctors were 95% certain, was the antibiotic he was prescribed for that minor infection. The same antibiotic I was prescribed for the same minor infection eight months before.

Apparently, he is allergic to that drug. At any rate, we’re going to consider him to be allergic because we don’t want to repeat the exercise to confirm it.

The first week of August centered around his treatment in the hospital. They did a biopsy of one of his kidneys to rule out more serious causes. You know, like cancer. The doctors said the biopsy results were good, indicating the problem was typical of an allergic reaction. But good is relative.  His kidneys were not functioning. He needed dialysis to help his kidneys do their work. And the kidneys need time to heal.

The next two weeks of August centered around dialysis and follow-up with doctors. Twice a week we made a thirty-minute trip to a dialysis center where we sat in a room for the three to four hours needed to filter his blood through a machine.

Along with dialysis comes a limited diet. Foods with high levels of potassium were not permitted. And you can be sure that everything he wanted to eat, now that his appetite was back, was on the list of foods with high potassium levels. Vegetables were particularly difficult to work into his meals. Vegetables low in potassium are ones that have little color and even less flavor: bean sprouts, celery, cucumbers, eggplant, mushrooms, onions.  And most things he wanted to add for flavor–salt, soy sauce, salsa–are also high in potassium.

At the end of the second week and after four out-patient dialysis sessions, the doctors concluded his kidneys are functioning sufficiently to eliminate the dialysis. But his need for a daily dose of strong medicine to help the kidneys heal will likely remain for several weeks, if not months. One doctor finally used words that made us both sit up and listen. “You’re not ill,” she told my husband. “You are very, very ill.”

He’s no longer on the dialysis diet. Now we’re on the more varied diabetes diet. The drug he needs to treat the kidneys elevates the level of blood glucose, making it necessary for him to watch what he eats as well as to take insulin since most medications to treat diabetes in pill form are not advisable when kidneys are compromised.

Have I learned anything from all of this?

First, I will always step up to the Consultation window at the pharmacy when picking up a new drug. I did when I picked up my husband’s medication and am so glad I did. Not because the pharmacist warned of the side effects my husband experienced. There was no warning. Kidney failure is not a listed side effect on any of the information available about that drug. So I know I didn’t ignore a warning. Had I not taken the time to wait to speak with the pharmacists about the medication, I would have wondered if I should have known to bring him to urgent care again.

And second, I will pay much closer attention to my husband’s complaints when he isn’t feeling well. He doesn’t get sick often. He usually just plunges forward in his usual day if he feels a cold or even the flu coming on. So when he stayed in bed for days at a time, I should have realized he was really not well.

In support of that second lesson, I am happy to point to the fact that married men are healthier and live longer than single men. This Harvard study only hints, in the final paragraph, that wives insisting their husbands see a doctor is a positive factor in the health of men. Personally, I think it’s the main reason.

How to Improve Your Chances to Live Longer

There really IS something that’s better than the alternative – thinking positively about the future. This article detailing a longitudinal study by Yale researchers, reports that the brains of those whose attitudes towards aging were negative showed shrinkage in the hippocampus, the part of the brain that is important for memory formation. And the same brains also showed a buildup of protein plaques and twists associated with Alzheimer’s.

Is this another chicken vs the egg example? Well, does it really matter? Even if the correlation is that hippocampus shrinkage and protein plaque buildup come before the negative thoughts, humans can control thoughts. So think positively about what aging brings you. Freedom from working from 9 to 5. Lower costs at matinee movies. Senior discounts at many restaurants. Celebrate! Don’t castigate. Applaud the future. Don’t condemn it.

What do you have to lose?

Book Review: The Execution of Noa P. Singleton

An unforgettable and unpredictable debut novel of guilt, punishment, and the stories we tell ourselves to survive.

Book cover for The Execution of Noa P. SingletonThose words are part of the marketing package for the novel. I couldn’t have said it better myself. But I didn’t realize it would be unforgettable until I finished it. And its unpredictability explains why it took me a long time to get past the first chapter. But every time I logged on to Goodreads, I would be reminded it was still there, waiting for me to finish. I am very glad I picked it up again.

This is a mystery about a murder on many levels. Did Noa really murder Sarah? Why didn’t she say anything in her own defense during her trial? Why did Sarah’s mother change her opinion of the death penalty? Did the fact that her father was absent, and therefore unknown to Noa during childhood, play a role in the events? What does the P in her name stand for? Some of these questions remain at the end of the book, but enough are answered for the reader to be satisfied. For the story to stick and poke at memories and childhood secrets.

The most important questions all begin with Why. Why did Noa say nothing in her own defense? Why is she so determined not to satisfy Sarah’s mother’s curiosity about the event? Why does Noa lie? Why did she drop out of Penn? Those questions remain largely unanswered, only hinted at. And that is the strength of the book. Because we don’t get those answers from Noa, we end up asking similar ones about our own lives. Those questions raise thoughts of own own guilt, our own family relationships as well as our relationships with others. Those questions bring up thouhts of what we might have done differently. For those reasons, this book will stay with me for at least as long as the 450-some days it took me to finish reading it.

Non-Immigrant Visas, Visa Waiver Program, and Refugees


I watched news clips recently of Assistant Secretary for Consular Affairs, Michelle Bond, in Congress being questioned about where the 9,500 people with terrorist connections whose visas have subsequently been revoked are. She couldn’t answer the question. And Congressmen appeared to take delight in having put her on the spot. I’d like to come to her defense with one statement – it isn’t the responsibility of the Assistant Secretary for Consular Affairs or anyone else in the Department of State to know where anyone is once they enter the United States or to take action to ensure the removal of such a person. It is the responsibility of the Department of Homeland Security.

There is so much talk these days about the need to “fix” the vetting process for the issuance of visas of all types, for approving refugees for entrance, and for getting rid of the visa waiver program, but I am concerned that the discussion is based on multiple misunderstandings. I served in two countries as a consular officer – Germany and Barbados – where I only issued non-immigrant visas, including fiancee visas – and it has been a long time since I had that responsibility, so I’ve only cited examples that I know are still processed the same way today.

Checks and Balances

Department of State Seal by DonkeyHotey, on Flickr Department of Homeland Security by DonkeyHotey, on Flickr
Department of State Seal
(CC BY 2.0) by  DonkeyHotey 

The decision to allow someone – anyone – to enter the United States for either a temporary visit or as an immigrant or refugee involves multiple agencies which ensure there are checks and balances in place. Sometimes the process begins with the Department of State (State). Sometimes the process begins with the Department of Homeland Security (DHS). Agents from Customs and Border Patrol (CBP), a part of DHS, make the decision to allow travelers to enter the United States. In all cases, at least these two federal Departments are involved. There are checks and balances in place already.

Non-Immigrant Visas

The simplest type of visa is a non-immigrant visa, but simplest doesn’t mean simple.

First, there are many different types of non-immigrant visas and some of them require additional documentation before they can be issued. For example, student visas can only be issued if the applicant has an I-20 form from the school the student plans to attend. Each school has its own requirements for the issuance of an I-20. When I worked at San Francisco State University, the American Language Institute (ALI) issued I-20s for its students to be able to study English prior to attending college or university.  But having an I-20 in hand still does not guarantee the applicant will receive a visa because of the next condition.

Second, anyone who applies for a non-immigrant visa is presumed to be an immigrant and must overcome that presumption to the satisfaction of the consular officer. There is no checklist. If there were, people who wanted visas would manufacture the evidence called for in the checklist and the decision would be reduced to a matching exercise. Letter from employer to verify the applicant has a job when he returns? Check. Letter from bank to verify the applicant has enough money in her bank account to cover the trip? Check. Letter from a minister/politician/well-known personality to verify what a good guy the applicant is? Check.

Instead of a checklist, a consular officer reviews the information on the application form and passport, including the pattern of travel indicated in the passport, and evidence the applicant chooses to include to demonstrate their strong ties to their home country. If the type of visa the applicant needs requires additional documents, such as the I-20 mentioned for student visas, the applicant must have it and still overcome the presumption the individual plans to remain in the U.S.

Third, there are several types of ineligibilities. Most people who were determined ineligible could still travel to the U.S., but first they must receive a waiver of the ineligibility.

Sometimes the ineligibilities change from time to time. Who does that? Congress, of course, based on the feedback their members receive from their constituents. For example, long before I arrived in Germany to work in the non-immigrant visa section, having been a member of the SS during World War II was an ineligibility, lumped together with membership in the Communist party. Under that ineligibility, there was still a way for the ineligible applicant to travel to the U.S., with a waiver. But just prior to my arrival in Germany, a new ineligibility without the ability to obtain a waiver was added for those persons who participated in the persecution of Jews and others during the Holocaust. Understandable.

Here’s how that played out in one case. An elderly man who had traveled on a visa with a waiver to see his daughter several years earlier, applied again, aware that it would take some time for the waiver to be processed. But instead of that little bit of extra paperwork, we needed now to interview him much more closely to see if his actions as a member in the SS were so abhorrent that he would never be able to obtain a visa again or if he was a “foot soldier” and therefore eligible for a visa, this time without a waiver. That process took so long that he died before we received approval to issue him a visa.

Fourth, in all cases, a security check is also completed before a visa is issued. That check includes derogatory information from all federal agencies. Many times these checks result in even more restrictive processes must be followed, waiting for a specific agency to give the go/no go decision to the consular officer.

Fifth, since 9/11, many additional forms have been added in specific cases, such as a supplemental form for student and exchange visas and detailed travel histories.

Sixth, visas have been made much more tamper resistant than they were in the days I served as a consular officer. Visas now include the digital photo and biometric information of the individual.

That’s for the simplest of the visa types. And it’s just the beginning of the checks and balances.

Business/Tourism Visas – B1/B2

Let’s just stick with the most basic of non-immigrant visas – the B1/B2 business/tourist visa. If a consular officer is convinced that the applicant’s intentions are consistent with business/tourism and that the applicant plans to return from the U.S. at the end of the stay, a visa will likely be issued. But a visa is not “permission to enter” the United States. It is “permission to apply to enter” the United States. The agency that permits people to enter the United States is Customs and Border Protection (CBP), a part of DHS. If the CBP agent believes the person’s intentions do not match the issued visa, the agent can order a secondary inspection. If evidence is found that indicates the person intended to stay for a longer time or permanently (letters from the family in the United States welcoming him, cards of congratulations from her former colleagues, dozens of suitcases instead of the one or two most tourists bring), CBP can send the person back where they came from. And if that happens, the airline that accepted the person on the flight eats the cost. So even the airlines have a role in determining if the passenger’s visa is appropriate for the trip.

If a person has a valid visa, issued by a consular officer based on the facts on the application and as stated by the applicant, but the applicant was lying and somehow manages to get past CBP, there is still another check. An applicant who arrives on a non-immigrant visa may request to adjust their status to permanent resident or student or temporary worker or au pair, each of which has different requirements. In those cases, a copy of the application is sent to the consular section where the visa was issued in order for the consular officers to determine if there was fraud involved in the application. If the consular section staff provide information to indicate the visa was obtained through fraud, United States Citizenship and Immigration Services (USCIS), another DHS agency, uses that information, along with whatever else they have to determine if the applicant’s status is adjusted or the person is deported.

Discussions including demands that the vetting process be fixed focus on what else must be done. Adding steps to an already lengthy process for issuance of immigrant visas or adjudicating refugee requests will have the unintended consequence of increasing the number of people willing to try to get in without a visa instead of their requests being processed systematically, through multiple agencies. And I don’t think that is what anyone wants.

Thanks x Two

Happy Thanksgiving!

Thank you, Stuart M. Perkins.


On a recent evening commute, a woman boarded the bus and rushed towards me. Rather than sit, she seemed to fall into the empty seat beside mine, a mound of heavy coat, thick scarf, and several bags. She wedged a bag between her feet and dug through her purse producing a pen and ragged notepad. Flipping frantically through its frayed pages, she peered at me over glasses perched on the tip of her nose.

“I have to make a list of things I’m thankful for.” she said with irritation.

I didn’t ask why, but glanced at her notepad. She was grateful for some important things, with “health” and “job” written so far on her list. She saw me looking.

“I need ideas. What are you thankful for?” She sounded aggravated.

I thought back to when my daughter was small. I told the woman how my daughter’s eyes lit up when we…

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connect, respect, protect

tv_flashpoint01I hate to admit this about any television program, but I’ve become a Flashpoint junkie.  I never watched this Canadian television program when it debuted, but ION Television bought up the rights to the series from CBS and has been rebroadcasting the seasons nearly every day recently. I recorded them without realizing what the series was about. The title was intriguing enough to catch my eye.

Initially, I thought this series would be so easy for Second City TV, if it still existed, to parody. Instead of the three and sometimes even four black vans with dark-tinted windows and flashing blue lights making their way in single file through Toronto’s downtown streets without problems, I’d like to see them encounter normal downtown traffic, preventing the last vehicle from keeping up with the others, peeling off one more at successive traffic lights until they are each on their own. Or, instead of the six members of Team One jumping out fully covered in their armored vests, pants held tight just above the knee with a holster for weapon or equipment, and carrying high-power long guns, able to jog from the vans to the site of the emergency without breaking a sweat or even breathing heavily from exertion, I’d like to see one of them trip on that gear and fall down, knocking the others over like dominoes.

But I’m willing to suspend my disbelief regarding all their gear because I am charmed by their motto — connect, respect, protect — and by how they approach both those they are there to protect and those they need protecting from.

Unlike episodes of U.S. cop shows where the SWAT team arrives with a battering ram to break down the door so those with the long guns can start shooting at anyone in sight, Team One members follow their motto — protecting those who need it, respecting everyone in the area, and connecting with those holding guns, knives, bombs, or hostages to defuse the situation, ideally without anyone being injured. Like all law enforcement officers Flashpoint team members train to keep fit physically as well as to maintain their sharp shooter skills, but they also train to improve their negotiation skills and to recognize behavioral clues that indicate state of mind so they can adjust their plan accordingly. They use the clues to determine how to connect with victims and witnesses, to gather information to learn the suspect’s motivation, and to help anticipate what the suspect will do next.

I’ve picked up some negotiation tactics myself as a result of watching the shows.

  • First, establish rapport by telling the other person your name and asking for his.
  • Second, point out that nothing done up to this point is irreversible. It is possible to end the standoff right here and right now.
  • Third, you always have a choice, but some choices are better than others.
  • Fourth, consider the consequences of the choice you are contemplating now, and then consider the consequences of other choices so you can identify the best option, the best choice, for now.
  • Only use force when necessary, and deadly force is always the last option.

These tactics are appropriate in less than life-threatening situations as well — well the first four anyway. Imagine a situation when a friend has disappointed you, or you feel that you have disappointed a friend. First, establish rapport — with the other person or even with another side of yourself — by finding common ground, something to agree on. Second, point out that the friendship is still what is important. It is possible to close the distance between one another right here and right now. Third, you always have a choice, but some choices are better than others. Fourth, consider the consequences of the choice you are contemplating now and then consider the consequences of other choices so you can identify the best option, the best choice, for now.

Perhaps I am just rationalizing my Flashpoint habit by finding something positive, some lesson, some take away — it isn’t just entertainment; it’s educational, too! But the clincher for me is that motto — protect, respect, connect. A good story that illustrates the power of those three words is worth telling, and retelling. If you haven’t watched Flashpoint yet, I encourage you to check it out.


Our local pharmacy has already started advertising flu shots, offering bonus bargains on the day someone gets vaccinated. It seems early to me; we are still in the hottest months of the year here in San Diego. But better early than later or never.

Vaccinations for the flu, for pneumonia, for shingles can be truly life saving for seniors as the effects of these illnesses are far more serious in later years. According to a report from the Alliance for Aging Research, “[t]he risk of death from pneumonia and influenza, already higher for older adults, skyrockets for the very old: It is nearly 130 times higher in people age 85 and older than in those 45 to 54….”

The likelihood of seniors acquiring shingles increases with age as well. According to a 2013 report from CDC Advisory Committee on Immunization Practices, about half of all people who live to be 85 will come down with shingles, an extremely painful skin rash with few treatment options. Ten percent of adults who come down with shingles develop an even longer-lasting form of the disease that may continue for months or even years. If shingles rashes develop on the face, the patient may become blind.

Shingles vaccines are recommended for anyone over the age of 60 and are free for those on Medicare. Yet fewer people have gotten this vaccination than the manufacturer projected when it became available in 2006. Shingles does not spread from person to person, but anyone who has had chicken pox already has the virus that causes shingles.

Those between the recommended age of 60 and 65, the age of Medicare eligibility, may feel the pinch of price since not all insurance companies will cover the $200-$250 vaccination. Further, most doctors do not administer the vaccination in their offices, requiring patients to go to a pharmacy. As soon as I became eligible for Medicare, I asked for the shingles vaccine. I can’t understand why anyone would not. I remember what chicken pox felt like. I don’t want to experience its cousin.