January 1, 2014

Hit just now with a wave of depression as I sit here at a dark desk deep in thought and condition.

Passing slowly through into the year 2014, another done and gone.

I guess this is how many feel through the pursuing lives that we hope are worthwhile but in the end amount to little- mere specs on a grand spectrum too vast to indulge or include us as anything of any real value. And yet there's plenty to be thankful for along on the way, at least on my end. Crowds of friends gathered to congratulate us on our engagement; proposals made, weddings to plan. Guesses to be questioned in pursuit of oft futile answers. More questions just to drown out fears of getting older, growing painfully aware of many others. Trying desperately to grasp at the open air rushing by through open windows. Fleeting lives lost in the fray, others still swimming through the torrential torrents of commitments, contributions and court dates. Worthy or not our demands and constructs construe dreams and realities for yet another year, so here we go.

The Guide has this to say about the Z'g'r'l:

"The Z'g'r'l are a newbie race of creatures in the pangalactic ecosystem. Their evolution began a scant 13 years ago on the surface of an undistinguished neutron star at the edge of the Sombrero Galaxy. Within 17 nanoseconds of their origin, the Z'g'r'l had developed intelligence and society. In another 5 nanoseconds, they had built a grand city and were looking spaceward. Three nanoseconds later, they had worked out how to encapsulate their grand city and propel it out into intergalactic space, which is quite the feat as you might know had you ever tried to escape the insane gravity of even an undistinguished neutron star.

Once in intergalactic space, the Z'g'ri'l city, which was composed entirely of neutrons, as you must know, quickly sucked up all the subatomic particles it needed to convert itself into ordinary condensed matter. Things then slowed down a lot for the Z'g'r'l, and they found themselves with a lot of time on their hands, which of course is figurative, as they had no actual hands. It took the Z'g'r'l society a full three seconds of intense consideration and debate to come up with a plan of what to do with themselves, which was to 'roam the universe and do good'.

In their roaming over the next year or so, they learned that many of the varied creature civilizations they encountered were self-destructive, engaging in decimating wars over matters that are quite trivial and silly once you think about it. So the Z'g'r'l narrowed the focus of their collective purpose from 'doing good' to 'invading war-disrupted planets to provide the factious inhabitants with an external threat, thereby uniting them against the common enemy and making them all get along better with each other'. It was a brilliant decision and the plan worked brilliantly.

Typically, the Z'g'r'l would go to the planet and hide their grand city behind a convenient moon or something and then send a fleet of robot ships to blow up stuff all around the planet. The inhabitants would at first panic and run around screaming and demonstrating the various specific silly behaviors of their race, until some leaders and spunky fighters with popular, uplifting attitudes appeared, often outcasts or minorities favored by the liberal wing of the society. They would promptly manage some small but hope-inspiring defeat of the robot fleet, and rally ... well, you get the picture. In the end, the inhabitants defeat the Z'g'r'l robots decisively and gloriously, despite an immeasurable inadequacy of everything, and they cheer and hug and feel good, and more to the point of it all, they stop killing each other for a while. 

All that time, the Z'g'r'l are in their grand city enjoying the entire history of this world from formation of the planet up to the moment of the invasion, all presented as a neat three-part miniseries, interspersed with live-coverage highlights of the on-going invasion. When the show is over, the Z'g'r'l move on to another warring planet to do more good."

In clinic a week or two ago, I had a new patient. He wanted a prescription for insulin so that medicare would pay for it.

I started asking the usual doctor questions. How long have you had diabetes? What is your dose? Past medical history, history of present illness, allergies, family history. First I tried to understand which kind of insulin and what dose he was taking.

He responded with anger and impatience and wouldn't tell me.

I said, "This feels hostile."

He said, "It IS hostile." and he left.

I thought about charging for the visit, which I could do. But he might have a deductible and it would just make everything worse. I thought, well, maybe the pharmacy can help me understand.

I called the pharmacist. The insulin that this man was on is available over the counter. I did not know that any insulin is available over the counter. This patient was at times difficult in the pharmacy; the pharmacist said that I should not take it personally.

I wrote the patient a letter. I explained that for medicare to pay for the insulin, I have to document in the chart that I am monitoring his diabetes regularly. There are guidelines for labs and physical exam and counseling and eye exams and blood pressure parameters and so forth. I have to write the dose on the prescription. If he wants medicare to pay, we have to meet their requirements.

I also said that I did not know that insulin is available over the counter, so the visit confused me from the start. I said that if he doesn't want monitoring, he can continue as he is doing.

I wrote off the visit.

A man was at the counter scheduling a visit a few days ago. He winked at me. I didn't know who it was, but I was surprised at a friendly wink from this person.

He came in this week. He answered all my questions. I explained the diabetes guidelines. His blood pressure was too high, but I tend to ignore that on the first visit, particularly if it is someone who is not very fond of the medical profession. He is willing to do the lab work. He is adjusting his insulin, as he is having too many lows.

He's coming back in a week or two, to go over the labs.

I am so surprised.