PSA: Scope Update

You probably don't remember this, but back in 2009, I had two colonoscopies in one summer. And because the pricing was radically weird, because one of them happened in the hospital and the other in the doctor's office, I had to write about it. Go on, read about it. Come back when you're done.

A couple of years later, Elisabeth Rosenthal (a writer for the Times) started a series of investigative articles about medical care pricing, called Paying Till It Hurts. Her first piece was about ... colonoscopies, and my expensive hospital based scope made it into the second paragraph. It is probably the last time I will be on the front page of the New York Times.

Sometime last summer, I got a note from the gastroenterologist reminding me that my five years were up and it was time for another. Oh the joys!

I duly scheduled an office visit, and had the scope, only to be told - when the propofol wore off - that I needed to have another in six months. So, if you're keeping track, this is four colonoscopies in about five years.

Since 2009, the Affordable Care Act has come into play, and my office's insurance carrier has changed, and my co-pays and deductibles have skyrocketed. But at core there's this: the doctor's office charges some wackadoodle number, and gets paid a negotiated rate. So, as a public service, and to aid in transparency in health care costs, here are the prices for my four colonoscopies:

#1 - 2009 - in the hospital

Charges billed by doctors and hospital	$9,143
Amount paid by insurance	$5,743
Co-pay due from me	$125
TOTAL PAID TO MEDICAL PROVIDERS	$5,868

#2 - 2009 in the doctor’s office

Charges billed by doctors and lab	$5,323
Amount paid by insurance	$2,923
Co-pay due from me	$30
TOTAL PAID TO MEDICAL PROVIDERS	$2,953

#3 - 2014 - in the doctor’s office - diagnostic

Charges billed by doctors and lab	$9,022
Amount paid by insurance	$2,812
Co-pay (deductible) due from me	$1,243
TOTAL PAID TO MEDICAL PROVIDERS	$4,055

#4 - 2015 - in the doctor’s office - screening

Charges billed by doctors and lab	$7,711
Amount paid by insurance	$3,995
Co-pay due from me	$75
TOTAL PAID TO MEDICAL PROVIDERS	$4,070

So what have we learned? In five years, the contracted rate for a colonoscopy at the medical practice I visit has gone up by a third (from $3K to $4K). What else? Even though the Affordable Care Act and the insurance companies make a distinction between a diagnostic colonoscopy and a screening one, the doctor ends up getting paid the same amount. Screening scopes are supposed to be covered in full under any ACA compliant insurance; diagnostic ones are subject to deductibles and co-pays and what not, so the patient ends up paying more. [I'm not sure why both #3 and #4 weren't coded as diagnostic...that may have been a coding error. However, since I'd met my deductible by the time #4 rolled around, it may not have made much difference in my co-pay.]

The issue of medical billing, and the prices paid, is an interesting one, which is why I am putting this out there.

If you too are interested, the New York Times series spun off into a Paying Till it Hurts Facebook group - "a forum for conversation, analysis and insight into health care pricing and costs in the United States".

And, by the way, I'm fine. I just seem to have a propensity towards polyps.

There Is No Horse But Polo

The girl is off in the woods with a bunch of other girls, and I am amusing myself by mailing things to her. It might be my favorite part of having her gone; as we all know, I love mailing oddments and notes.

So far, this is what's been sent. I wrote her a card, on Tuesday, the day before we dropped her off. I rambled on about the weirdness of writing to her during the day on Tuesday, when I was going to see her that night, and knowing that she wouldn't get the note until Thursday or Friday. Yesterday, I mailed a little game from the crazy Danish store near my office. Next week, I'll get Amazon to ship out a book called Nimona that got a wonderful review in the New York Times.

My favorite, though? We confiscated her cellphone before we left her in that other state, and I stole a photo off of it - she'd taken a picture of a horse, looking completely demented, and has had it as her screen background.

I transferred the picture to my phone, signed up for a postcard app, and for $1.99, mailed her the picture with a with a note from the horse.

If she didn't think her mother was nuts before, this will seal the deal. Unless, of course, she thinks Polo is cleverer than he really is.

What The Parents Do When The Kid Is Away

We dropped the child off at camp today. It took an hour and half to get there, because she was not interested in dawdling. It took us three and a half hours to get home because it was a beautiful day and we stopped for lunch in one little town and stopped for ice cream in another little town and detoured to Goshen, NY to bear witness to the impending dismantling and "renovation" of the Orange County Government Center.

I'd never seen it before. Yes, it's stark. But it's set back off the road, behind a scrim of carefully placed trees, in a lush lawn. It's got movement about it, in the articulation of volumes, varyingly stacked and shaped.

Curiously enough, one of the first places I lived - though I don't remember it - was a Paul Rudolph building: the Married Student Housing at Yale, also known as the Mansfield Apartments. I was a toddler there, it's where my little brother was born, and my mother used to talk about the fact that there was no place to leave a stroller when you came back with groceries and had to climb two flights of stairs to your third floor apartment. But that didn't stop her from appreciating the building and its big windows, and every time she visited New Haven, she liked to detour past it and marvel that she'd lived in a building by Paul Rudolph.

History is important. Public history is even more important. Telling stories, remember buildings, these are the things that make us human. I'm glad for the detour - I don't know what is really going to happen with that building, but I know that I've seen it and that kernel of witnessing is important to me.

Nostalgia in the Target Shampoo Department, and a Digression about Toothpaste

I think I have turned into my mother. I took my daughter to Target the other day to buy some things that she needs for camp. Included on the list that she made (Uggs = NO, iPod = NO) were shampoo and conditioner (can't argue against cleanliness) but what she picked out off the shelf is called Not Your Mother's Shampoo.

[Truth be told, I think she'd seen an ad for it, because she was looking for it.]

I had to laugh. When I was a tween/teen, all I wanted was the toothpaste, shampoo, conditioner that my mother wouldn't buy. She was deep into Pathmark's No Frills brand. Price was definitely a factor, but so too was the relentlessly sterile, black and white packaging, so severe as to be - dare I say - stylish.

Okay, maybe stylish is going too far.

But oh how I longed for toothpaste that wasn't chalky indifferent mint. I wanted Close Up - not because I thought it would make me more attractive, but because that ruby red clear gel was so beautiful.

And it's cinnamon! I love cinnamon toothpaste.

I dreamed of brand name shampoo. Like Lemon Up - with its molded plastic lemon for a cap.

I made do with bottled lemon juice as a rinse.

Then again, maybe I haven't turned into my mother. After all, I acceded to the petty indulgence of Not Your Mother's Shampoo. But my daughter may be turning into me, in her rejection of my workaday, ordinary shower accouterments in favor of those she chooses. Ah, growing up.

* * * * * * * * * * * * * *

In the meantime, I'm still looking for the perfect toothpaste. I was squarely in the Arm & Hammer baking soda toothpaste camp for a long time, until I got bored. I moved on to Tom's Cinnamon Clove, until they changed the formula and made it blander and more boring. I buy the Fennel, Propolis & Myrrh toothpaste at Trader Joe's sometimes, but I don't shop there terribly often. It is a weird flavor, which I like in a perverse kind of way - and I know that my husband will never ever borrow it. I've tried Toothy Tabs from Lush, which are okay but not perfect and I am confounded by the instructions, which tell you to "Crunch one tablet up between your front teeth". Why must it be crunched up front? Molars are better for crunching. Strangest of all is the Anise & Clove Tooth Soap that comes in a lovely little glass bottle, with an eyedropper. It - literally - is like washing your mouth out with soap and I have to say that it put me straight over the edge and back to Arm & Hammer. It is still in the medicine cabinet and once in a while I use it just to remind myself that it really is bizarre. Now that I know that Close Up is available on Amazon, where all of the reviews are nostalgia-tinged, I may have to give it a try. I'll be so sad if it isn't transformatively wonderful though.

Horrified Fascination

On the one hand, this wasps' nest is about a yard away from the railing of our back deck.

On the other hand, it's endlessly enthralling. The nest gets incrementally larger and larger, day by day. If you fling a cherry pit towards it and rattle the branch, the wasps fly about, agitatedly. [No one, yet, has hit the nest itself - I don't want to be around when that happens.] The wasps have figured out that the hummingbird feeder - about 15 feet away - seeps just enough sugar water for them to use it as a food source. Sadly, they've been playing chicken with the resident hummingbird. She is bigger than they are, but there are more of them.

This is why we live in the woods.

In Which We Publish Other People's Poetry

In March, my 11yo entered a townwide Young Writers Contest, sponsored by the library. She entered pieces in each of the three categories: Fiction, Non-Fiction and Poetry.

She didn't win, but she told me it was okay for me to publish her poem.

---

Afraid

A child is afraid of the dark.
There are monsters and shadows lurking around every corner.
The child has no parents, only a limp bear to protect her.
The monsters under the bed make noises to make the child jump.
The monsters in the closet make noises to make the child run and hide.
The child has the parents’ comfort in the day,
Only their snores by night.
Was that just a shadow, or is someone there?
No child thinks this by day, most by night.
A child is afraid of the dark.

An adult is afraid of the light.
The cruelties and pains of life wait for them behind a metal desk.
They have only the night for solitude.
The monthly rent makes them jump.
The water bill is designed to make them scared.
What they do during the day makes them want to stay in the dark for longer.
Making them regret the decision to face the light.
The stack of papers not yet checked, makes them regret the choice to seize the job.
Wishing they were younger, with so much promise and choice.
An adult is afraid of the light.

A Unified Theory on Reading, or maybe just a late night ramble

Last week, I finished reading a big, chewy, absorbing trilogy - the Magicians trilogy, by Lev Grossman.

[The trilogy is so good. I liked the first book, I thought the beginning of the second book was a bit tedious, but by the end of the second book, I HAD to get the ebook of the 3rd out of the library right that very minute and I simply couldn't put it down until I was done. It's rich and complicated, and it ends beautifully - so while I'm sad to be done, I also feel like it's all tied up pretty well.]

And then we went away for the weekend, and I packed four books - all of which I was in the middle of - into my bag. And I bought a fifth book at a terrific independent bookstore that I'd never been in - the kind of bookstore that's worth a detour through Saugerties if you happen to be in that general area.

The thing is, none of them were novels. I needed a palate cleanser after the Magicians. So I spent the weekend flitting between a graphic novel, a short story collection, and a gardening book of the short literary pieces ilk.

• Fun Home (because I just saw the very excellent Broadway musical)
• The Collected Stories of Lydia Davis (which I started a year ago, but it's more than 700 pages and about 200 stories)
• The Well-Tempered Garden (by the Christopher Lloyd of Great Dixter, not Back to the Future Lloyd)

I found myself reading aloud to my forbearing husband from The Well-Tempered Garden; Lloyd writes with unwavering conviction and a delightful snarkiness. About some azaleas: "Their heavy, sweet, slightly putrid scent is a great attraction to those with a weak sense of smell, but overbearing to my way of thinking." On why you shouldn't edge your lawn: "But there is something profoundly depressing about a long, unbroken cliff of lawn edge." And reminding me that I need a cotinus coggygria: "Dew seen on this pink froth is such an experience that you'll wonder why you do not spend more time in the garden in the early morning."

Later, he talks of a combination of an orange lily and a pink alstroemeria: "They clashed well as a one-time gardener of ours used to say." I particularly liked that, given that the garden outside my bedroom was a riot of wild orange daylilies and screaming fuchsia roses.

Lydia Davis is something else. I'd never heard of her before I found her quoted in a piece in the New Yorker, by James Wood, called "Becoming Them" which is about becoming one's parents. It's a lovely essay, actually, but the reason I've been carrying around a grubby paper copy of it was because of the few lines of Davis, some of which follow:

Shall I keep a tidy house, like L.?
Shall I live alone in a large house, like B.?
Shall I give piano lessons, like M.?
Shall I leave the butter out all day to soften, like C.?

[I did a google search for that story, which is called How Shall I Mourn Them? and turned up a delightful reorganization of all of the lines of the story, by person - tidied up, if you will, like those Ursus Wehrli books where masterpieces of art get deconstructed back to their component lines and dots.]

Finally, I got around to buying the book - a thick and delicious brick of paper, oddly light for its many hundred pages. Her stories? I don't know where to begin. Many are short - a title and a sentence, or a paragraph. Most are peculiar in a particularly heartstabbing way. Every single one is savory, just so. As I read it, slowly over the past year, I thought time and again, I want to send this book to T. I want to send this story to C. I rather wish that Chronicle would take a mess of the shortest stories and publish them as a boxed set on postcards - so I could easily send a story to someone. Like this:

Companion

We are sitting here together, my digestion and I. I am reading a book and it is working away at the lunch I ate a little while ago.

Is that not odd and perfect?

Bechdel's Fun Home is a tour de force. I had, I confess, shied away from it because it's a graphic novel - it didn't seem like something I wanted to read. But I was incredibly lucky to be invited to see the musical at the Circle in the Square, and afterwards I rather wanted to experience the book. The book's broader, bigger, more detailed than the show - just like most books are more detailed than the movies they become. In retrospect, the book enhanced my experience of the show, and vice versa - both are singular experiences.

If you were keeping track, two books went away for the weekend and remained untouched. There's only so much reading one can do in three days. Margaret of the Imperfections (short stories) and Woodbrook (memoir) are waiting patiently for their turns at bat.

But what I'm thinking is that I need to start another big, chewy, absorbing novel.