Just Take It All

I am starting to think that reading the Wall Street Journal may be bad for my health. It is simply frustrating to get the news. To read about the debate of various policies, the nitty gritty details of this awful economy can be so overwhelming. I may have to stop reading it for a while.

But I can't stop reading it because of Aidan and Zoe. Before they came along, I never looked at my taxes all that closely. True, Aidan came along when I was a resident, and as a resident, I made very little anyway. Now that I am responsible for them, I want to be wise, be sensible, to plan for their educational expenses, bar and bat mizvahs, weddings, and well, to set them out to the real world.

When I pay taxes, I feel that I am doing them a dis-service. Not just because then that money won't be saved for them or spent on them, but that the money is not being spent well by the government. With increased taxation, I see that pensions are being funded, but he is now sitting in a class with 24 other kids.

As a side note, I sometimes think we should get a prospectus from the government. When one holds stock in a company, one gets these financial statements. We should get that from the government: of every dollar in collected tax, exactly how is that spent?!

With the debate about estate taxes, I am becoming more and more annoyed. I am sure we won't have an 'estate' to give them- I am going to paying off my medical education well after we pay for Aidan's college- but I do want them give them something! Living where we are, a typical middle class family can easily have an estate of over one million, including real estate, jewelry, 401(k), life insurance, IRAs...etc. Some lawmakers want 55% of that?! I also don't like how the tax is being termed "the super wealthy people tax." Sure, Paris Hilton will quite the estate, but I am just a physician who is trying to be sure that my two kids, who are probably going to be under-educated, to have a jump start.

The idea of jump start is also controversial, isn't it? That the idea of estate tax is to spread things around, so that everyone has the same. What are we, communists? We all want our kids to have a jump start, even parents who are drug dealers want their kids to do well, at school, at drug dealing, or not. Why is it so bad?

Sure, Scripture says to give to Caesar what is due Caesar. That is true, but it sure seems like Caesar is looking for new ways to take stuff. I really hope Jesus comes soon, and very soon. I am ready to go and be with my Maker, along with my Hubby and cute kids, and none of us would have to worry about estate taxes.

Last note, some folks have been telling us that if we form a trust then we can avoid being taxed. I don't think that will be the case. If a foundation is started, then that would be useful to avoid taxes, but that is rather unlikely, don't you think? Does anyone know this for sure? I think the government is looking to tax trusts. What do I know, I am just a mother who wants to take care of kids from the grave.

Lit up like a Christmas Tree

My dashboard lit up like a Christmas tree on Friday morning. I was about 1/4 a mile into my usual 2 mile commute, when the car just stalled. I pulled over and was dismayed, Hubby had just left with the children for school, and my first patient was due to arrive at the office in about 9 minutes. I tried the old trick, turned off the engine and restarted, it drove just fine, and I made it to the office in time. I knew the trick because this had happened last February, and again in the spring. The firs time the car stalled, I freaked. Zoe was with me, and we were about a block from home. I parked the car, and waited for Hubby to pick us up to get to Aidan's Chinese school performance. We took it in to our mechanic, and there were, of course, things to replace and fix. After all that money, it happened again in the spring when my friend Michelle was in the car with me, along with Aidan and Zoe. At that point, we decided to do nothing. I had secretly placed a Do Not Resuscitate order on this Volvo.

The Volvo had been trusty and faithful. We brought home Aidan and Zoe in the Volvo, we mopped up various barf in the backseat, and lots of excrement in the trunk. I was rear ended once in it, and then rear ended someone else a year later. The Volvo had heard lots of screams, Aidan's, Zoe's, mine.

But it was time for it to go.

We had discussed various options for its replacement, and was always dismayed to find that cars had only grown in size since we bought this car in 2002. We wanted something a tad bigger, but not a gigantic bus.

To be honest, I prefer a Mini Cooper. Forget the kids, and their gears, I want a car to drive off, speedily, like Jason Bourne. Actually, I think I want a Mini because when Aidan was 6 weeks old, we took him to a beautiful wedding in North Carolina. One of my best friend from college, my maid of honor, was marrying her best friend. They drove off from the reception in a Mini, while I held a screaming baby who had vomited and pooped on me hours earlier. Yup, the Mini is really about a dream of freedom.

Clearly, not meant to be, at this time.

We had realized that the car we buy will very likely end up being the car Aidan will drive in about 10 1/2 years. And when Hubby's car gets replaced in the next few years, that car will likely end up becoming Zoe's car. Totally crazy to think about it that way! Therefore, the new car needs to be safe, and frankly, a bit dowdy. No need for my flirtatious son to have a flashy car, you know what I mean.

So we decided to buy this:

It was a truly a miracle that we finished the whole process in about 2 1/2 hours. The children did great, I stayed calm, and Hubby was an awesome negotiator. The trade-in value of the Volvo started at $500. FIVE hundred. Hubby convinced them to go 5X of that. Woohoo!

I am looking forward to an unlit dashboard for a looooonnnnng time!

Hoarders

Lots of patients and friends have been talking about these reality shows featuring various hoarders. Intrigued about how hoarders are portrayed in these shows, I sat down with Hubby and watched an episode.

I have been to homes like that. I have had patients who lived like that. As an intern, there was a severely depressed woman who came to the hospital nearly mute. Initially, she only said yes and no. As she improved, more social issues came about. While she was hospitalized, her neighbors called Code Enforcement and her dwelling was pronounced uninhabitable. They found over a dozen cats, and rats, and gerbils, and of course, the usual feces and garbage. My co-intern and I were incredulous. When we asked her, "So, um, how many cats do you own?" She thought she had two. She also thought she had about half a dozen of rats and gerbils in cages. Well, according to the authority, they were DOZENS and these animals roaming. To this day, I have no idea how there were cats and rats running around the same property?! A lot of times, these homes are made aware to authorities because of fire hazards (can you imagine an apartment full of papers burning?) and of course, health hazards.

I also completed this rotation where I went to people's homes to evaluate competency. Basically, is there anyone upstairs to manage the estate/health of the said person, and if there is no one upstairs, and if it is a 'psychiatric reason' (generally, it was all psychiatric reasons,) I then filed paperwork and requested a judge to pronounce the said person to be incompetent. Once that is in place, then a conservator gets involved and theoretically, things will get better. As you can imagine, people really don't want to be conserved. There was a woman in a fancy neighborhood who refused to let us in, we called the cops and she still refused. Without a warrant, one could not go in. (Perhaps she was really with it?!)

There was another lady who lived in this neighborhood that I would love to live in, and apparently, according to the social worker who had been there previously, had no electricity, no water, no heat, and was full of garbage. This elderly woman was never home when we stopped by- we thought she was just sitting in the dark behind the door.

Then there was this family with a very strong psychotic gene, that resided in this very, very, very fancy neighborhood, where a home easily could fetch 5 million bucks. Yet it was so incredibly dilapidated.

Of course, on the other spectrum of the socioeconomic range, a man and his three adult sons lived in this trailer along the coast. It was absolutely disgusting. The toilet had not worked in a very, very, long time and was, well, brown. There was food, of all ages, everywhere. Surprisingly, there was a computer, albeit surrounded by lots of empty boxes from Amazon. The poor elderly man was taking a nap with his CPAP for his sleep apnea, and man, that CPAP was loud! Anyway, turned out, he was competent and he was aware of the mess.

Then things can get freaky at these home visits. Thankfully, a social worker typically already made a connection so I never had to go in 'blind.' There was a lady who 'collected' tarantulas. Her house had floor to ceiling full of stuff: mailings, circulars, letters, newspapers, crap. She did manage to form aisles through it, so one could get from the front of her residence to the back.

It is my opinion that there are two types of hoarders: ego syntonic hoarders and ego dystonic hoarders. Whereas ego syntonic hoarders like it, and must keep up with it, ego dystonic hoarders tend to also suffer from depression, anxiety, psychotic disorders, and do not like how they are hoarding. In general, ego dystonic hoarders are more easily 'treated.'

I was struck by several things for the episode I watched. First of all, these psychologists sound really, well, dumb. They keep saying the obvious. "Let's encourage her. It is ok, I am here to help you." Definitely not a useful portrayal for what a psychologist can do in these situations.

Secondly, some of these people really need to be medically treated for their underlying disorders. Surprisingly, that was not an intervention used in the episode I saw.

Thirdly, I think hoarding really speaks to how isolated people can be in our modern society. So often, people start hoarding behaviors after life circumstances change: after kids move out, after a spouse dies. Sometimes, I think, the prevalence of our psychiatric illnesses would decrease if people lived in more secure communities, where people got in on each others' business, with care and kindness.

Anyway, I think TLC and A&E ought to hire me as an 'expert.'

Kids

I do have two kids, although one may not be able to readily come to that conclusion based on my recent posts.

They are well.

Aidan's reading has improved so tremendously over the summer, and I am thrilled. He is doing well in first grade, making friends, doing homework, being self motivated. While he no longer chews on his finger nails, something we worked on over his year in kindergarten, he now has this weird throat clearing thing going on. I think, it started with his bad allergies, and turned into a bad habit. I have seen no improvement on antihistamines or nasal steroids, perhaps I should try him on Singulair, or send him to see a behavior modification therapist. On one hand, I think he will grow out of it, but on the other hand, man, it is annoying. The old adage in parenting is true, "If it is not one thing than it is the other."

Zoe is becoming quite a young lady. She clearly has an opinion of her own, saying things like, "Good idea!" "I told you so!" It is amusing to see her so determined to 'write.' She is independent, and just loves routine. She is just so eager to grow up and be like her brother. I am, however, not looking forward to her growing up. I can already see the wild hormones that will come our way again, in full force, in about a decade, probably less. She can be so passionate! Why sugar coat it? She can be emotional. I just need to show her how to be emotional appropriately, not an easy task, for sure. (Not that I have mastered it myself...)

Sibling rivalry is also ever present with us. Because they are at different schools, one child always gets picked up first. It does not matter which child I get first, within 2 minutes of the two of them being together, whining and attention grabbing take center stage. Whenever I have just one of them with me, whether we run errands, read a book, hang out quietly at home, it is a breeze. Whenever I have both of them, they bicker over why so and so has two crackers and "I must have the same, or more." Truly. Delightful.

Yet they can also be so sweet together. When they play "I am a dog" game, the dog so docilely follows the owner around, and the owner always so lovingly feeds the dog. Aidan chose to write Zoe a letter for a school project, and he wrote, "I love you" at least five times. (Possibly because he really knows how to spell all those words.) Zoe will save something special for Aidan too.

I hear sibling rivalry continues, forever. Dear God, have mercy on me.

Soliliquy #4

Since I started talking about decreasing health care costs, here are some more ideas.

I don't understand why MediCare and MediCal programs are so expensive and inefficient. Well, I do know why, at least partially.

Part of the problem is that they are government-run programs, and let's face it, people get government jobs for pensions and security. Perhaps this will make me hugely unpopular with my colleagues of yore, but I really think that if physicians who work for the government actually worked, they won't need so many physicians. The problem is that the physicians are salaried, and when people are salaried, in a secure position, with pensions, they are just not motivated to do work. If those doctors actually got paid for the work they do, I would say, they really only need 1/2 to 2/3 of the staff. Seriously.

For instance, when I worked at my old job, we fought tooth and nail to not see more than one new patient a week. These days, I regularly meet 2-3 patients a day. Yup, your tax dollars, hard at work.

Fortunately, or unfortunately, people are more motivated when given the right incentives.

I think, we should do away with county health services. Instead, there should be a loan forgiveness program for people who work exclusively with MediCare and MediCal patients. There are currently programs like that for serving Native Americans on preservations, or with the military. Why not expand it? I would have gladly worked in such a place if my education loans could be forgiven, even partially!

It would also help tremendously if we do away with existing pension programs. I know, it is not a popular thought, but the truth is, we can't fund them anyway, and to go on pretending is really foolish.

I think people should have options, to go into Social Security or to private programs, such as 401(k)s. For those people who just don't want to think about investing, they can opt to go into Social Security, while taking the biggest risk of "It belongs to the government and let's face it, the government is broke." Or, "Let me take this seriously, that the market can fluctuate, and I need to be responsible."

President Obama made a speech about how social security shouldn't be privatized and that Social Security, as a government program, is much safer and people need that kind of safety. I think he made the speech about 2 weeks ago- I saw it while walking on the treadmill on my cruise trip. I mean, does he really think Social Security is secure?!

I have a patient, who retired as a school teacher and saved responsibly during his career. As he neared retirement, he followed the rules and pulled out his money from stocks and bonds, and bought CDs instead. He did this in 2006, when the market was still going up and up. He locked in rates of 6% on CDs! So he is laughing on the golf course while his closest friends, who are still working as physicians slave away fighting for reimbursements.

I do think people should be made to save, just like money is sucked out from each pay check for social security, we should be able to choose where that money goes but no choice in the fact that money has to be saved somewhere.

Perhaps we can learn from China, where entitlement programs don't exist, and people save at a rate of about 40%. Is it surprising that they hold most of our debt?

Soliliquy #3

I think becoming tough can be very good for all of us.

For starters, to be physically tough will decrease the rates of obesity, hypertension, cancer, diabetes, and lots of other diseases. With decreased morbidity, the health care cost will be less, and well, that is good for everybody.

I understand that obesity can be genetic, and of course we shouldn't punish people for what nature has dealt them. On the other hand, people can be rewarded for making changes! Why not have actuaries figure out how much it does cost to insure an person with a BMI of 40 versus a BMI of 30, and each step in between? I am sure actuaries can tell us that, even with more factors thrown in, such as smoking habits and all. Then, based on the facts, we can get money back for making good choices. I really do think people want to change, they just need the right motivation and help.

I can probably count on my fingers the number of obese patients who are not interested in losing weight, that I have encountered thus far. People are very open to discussing meal plans, exercise routines, emotional eating habits...with me. And most of them do lose weight!

I don't know if talking about helping people lose weight and then rewarding them with better insurance rates makes me ultra conservative or what, but that is good for them! Why not?!

Soliliquy #2

People who live in my house are a bunch of softies.

That is my conclusion after reading two books about WWII recently. The first one I read was The Longest Winter about the Battle of Bulge, and the second one was The Ghost Soldiers. It described the POWs held by the Japanese in the Phillipines for over THREE years. (This book has some hilariously awesome writing, such as "The antiquated diseases came out of the latrines for an encore performance.")

It is amazing how these men survived. The constant hunger- having so little to eat, and over time, even less as their captors also had less to eat. The unknown- will the captors be ruthlessly inhumane, or sympathetic? What will the captors do as they face the inevitable defeat? Will they kill all the POWs or let them be? The fear- has the American military forgotten about the POWs, will they ever come back?

I imagine that the toughness of these young men, most of them were in their 20's, stayed with them. There has to be correlation between the greatness of these soldiers who went on to shape the growth of this country, and the world.

In comparison, how did I spend my 20's? I studied, ate whatever I wanted, and became entitled. It is my right to be happy, darn it! I must have my gadgets so that I am constantly distracted! I need to be entertained! What does that mean for my generation? What will we do? How will we help those who are in need?

It is not a secret that I am not President Obama's biggest fan. (Yes, really.) And I think, part of the reason I am not so impressed is because he really hasn't been through tough times.

I think about the presidents we have had since WWII, and most of them have been through something hard. They have been through the Korean War, Vietnam War, and all the financial bubbles in between. Professionally, they governed states, and really made tough choices: If I choose to fund this program, that will have to go. I do think President Clinton was a good president, and I think he picked up a lot of his skills as a governor.

My generation is now encountering something difficult- has the US actually accomplished anything in Iraq? Will we ever have enough jobs to go around? Will our children actually be educated in the schools? I think we need tough people. We need to become tough ourselves!

I don't actually know how to do that. Suggestions?