Food Policy: Who Cares? (We All Should).

A while ago I came across a whitepaper that decimated a notion I’d harbored for a long time: that farm subsidies were a key enabler behind our national problem with obesity, and, therefore, many chronic, preventable health conditions. It seemed to be a logical (if factually flawed and highly simplified) flow: subsidies encourage overproduction of certain commodities, especially corn and soy, which, because they’re so abundantly over-produced, end up as meaningless livestock feed and unhealthy fillers in processed foods; processed foods, made mostly from these unhealthy ingredients, end up being significantly cheaper than healthier whole foods, encouraging over-consumption.

It turns out that the very first part of that flow – the part where subsidies encourage overproduction –presented the surprising (to me anyway) flaw in my logic. This whitepaper isn’t new – it came out in 2011. I’m sure it was widely discussed in food policy advocacy circles at the time. Sadly, from what I have seen, the policy changes advocated in the paper (which appear to be based in quite a deep and sound body of evidence) have yet to take root.

I haven’t been able to do further research (yet) into why it is that we haven’t made any significant strides on the food policy front, but I have a few hypotheses: 1) Disengagement. As I’ve surmised in prior posts, the long-term negative health impacts of poor eating habits simply aren’t particularly evident, usually until it’s too late, so most people just aren’t paying attention – they have bigger fish to fry (so to speak!) in their lives, or so they think. It’s a little like engaging with our democracy – we take it for granted until things get too painful for us, then we start writing our Congressmen. Maybe. 2) Food policy is a double-whammy. Not only is its importance not evident enough to enough people, it also does get into politics. Changing policy requires changing minds at the legislative level, a challenge for even the most fired-up consumers, especially in light of the lobbying power of 3) “Big Food.” The whitepaper makes a clear point in its third finding: “The food industry has been the main driver of commodity policy, not farmers.” The evidence shows that “the deregulation of commodity markets – not subsidies – has had a significant impact on the price of commodities. Deregulation also has provided benefits and incentives to the food industry, including processors, marketers and retailers, and is one of a number of contributing factors impacting the availability of high-calorie processed foods in the marketplace.”

The paper is very much worth the read if you’re even remotely interested in addressing public health issues and the cost of healthcare. If you don’t have the time for the full 13 pages of content, there’s also this issue brief that distills it all down to 3 pages.

The impact of blaming subsidies also tends to demonize farmers, which I suspect most of us don’t want to do. There’s been a definite resurgence of small, local farms in various places around the country in the past decade, but it’s incredibly difficult for them to make a consistent living from growing things we can actually eat (as opposed to mass production of the commodity crops noted above), and it’s especially difficult for them to price their products at levels that lower-income households (who are disproportionately impacted by those pesky preventable chronic diseases) can justify spending. What if there were a way we could incentivize farmers to go back to growing actual food, in places that are relatively local to most of us, and make real, fresh, healthy food accessible and affordable to everyone?? The paper concludes with a short list of recommendations for policy solutions:

  • Engaging in the long-term campaign to reform commodity policies;
  • Increasing consumption of fruits and vegetables, whole grains and other healthy foods;
  • Expanding the supply of healthy foods by helping farmers diversify their production and supply local and regional markets with healthy food;
  • Building the infrastructure needed to better link farmers and consumers and aid in the delivery of healthy foods.

We can keep burying our heads in the sand and ignoring this problem, arguing over “healthcare reform” that’s focused only on treating symptoms, or we can focus on things that will make us, our children, and our grandchildren truly healthier.

There are many organizations out there who are doing this work at national, state, and local levels, and they are always delighted to have extra voices and resources to help. The two who collaborated on the whitepaper, Food and Water Watch ( and The Public Health Institute ( are great places to start, but nearly every state and major city also have food policy organizations addressing things at more local levels if you’re so inclined. (There’s a wonderful one in the Hartford, CT area for which I served as a board member for 6 years, Hartford Food System ( Their work and the work of their counterparts around the country will make you smile. Check them out.

Happy Food Friday!

Jackson Farmers Market_Natalie Maynor
Photo of Farmers Market, Jackson Mississippi by Natalie Maynor

The Call of the Wild

It’s spring in New England – at least astronomically, if not always corroborated by meteorological evidence. The warmer days bring us out into the yard to re-do everything we did 5 times in the fall: namely, leaf cleanup. Again. In our yard, this is a large, labor-intensive, time-consuming task, because we have no fewer than 100 oak trees on and around the property, many of which desperately clutch their brown, crispy leaves through most, if not the entire winter, dropping them, stealthily, a few at a time, leaving us by late March or early April wondering how they find their way so efficiently back into our once pristine, leaf-free landscape.

This provides us (i.e. Tim) with no shortage of distracting side-projects to waylay the elephant-in-the-hallway effort going on in the bathroom. Gratefully, nothing disastrous has yet befallen us, despite the nightmarish specter that once loomed (as of 1 – 2 weeks ago) over the proper pitching of the shower floor, or the painstaking additional tile layout efforts I conceived by insisting that I wanted a black border around the entire floor perimeter. I have taken heat that most ceramics couldn’t withstand over that choice, even though I told him that if it was really going to be so impossible (as his early protests would have had me believe), he could just skip it and lay the “field” tile right up to the walls. He hasn’t yet declared defeat at the border, though, so I think this may yet work out as I’d envisioned.

Last week was mostly dedicated to shower drain installation, floor-pitching, and stressing out over floor pitching (which, if it’s done properly, will ensure that the water from the shower will flow down into the drain; if done incorrectly, the water will just stand, or worse, flow out and across the rest of the bathroom floor – not the desired outcome). Lo and behold, when we hauled the hose through the front door and dining room and into the bathroom on Saturday morning for our first pitch test, it performed pretty much as it was supposed to, inching us ever-closer to the dreaded, hideous task of tile layout, which is turning out, thus far, to not be quite so hideous. (FYI: I just knocked on wood).

Yesterday and part of this morning were expended putting the final layer of waterproof membrane on the floor and 2” up the walls, followed by the near-ceremonial setting up of the tile saw and its accompanying water table today. When I returned from an appointment mid-afternoon, 1/3 of the field tiles for the floor were laid out in their future homes and I started getting excited.

Regardless of the fact that this week is only supposed to get warmer with each successive day, the call of the wild (a.k.a, the yard) won out over the call of the floor this afternoon, so I’m in the familiar position of reining in my galloping excitement once again as I listen to the melodious strains of the leaf blower. At least the yard will look nice when I get back from my networking dinner later tonight.

Stupid Oak Tree
The Stupid Oak Tree in my Backyard, leaves still intact, 3/26/19

Parenting the Parents – Part VI. Adventures in the Hospital. And Rehab.

(**Language Warning** – from actual quotes, so I had to keep it for the proper effect.)

Dad’s stay in the hospital for sepsis went on for 7 days. It took 5 of the 7 for the team to finally find a combination of antibiotics that beat into submission whatever rogue bacteria was afflicting him. The first night I actually came home (the Thursday after Christmas – the 27th), I broke down as I told Tim I really wasn’t sure he was going to make it: he’d seem to be OK for a while, but then his fever would spike or his blood pressure would tank. That night it had happened again in the early evening – he tried to eat his dinner but he was tremoring so badly that he couldn’t get a utensil to his mouth. He wasn’t able to hold a drinking cup with a straw steady – his arm jerked so violently that I was afraid he would poke himself in the eye. It was devastating and heartbreaking to see him try, yet not be able to do a thing that had been so simple and rudimentary only a couple of days before. So I sat there with my mom and I fed him – as much as he would eat.

I was friendly with every PCA (Patient Care Assistant? Associate?) and nurse who came onto his coverage, which helped when I was obsessive about knowing his vitals every time they were taken. I was vigilant on the timing of his Tylenol, his Midodrine (blood pressure booster) and watched his IV bags like a hawk (though truth be told, the PCA’s and nurses were equally vigilant). After a few days, the word must have telegraphed, because then every morning when I came in, they would fill me in on the latest of everything as soon as they saw me. Everyone was wonderful and kind and as attentive as they could possibly be considering that he was far from the only patient in their care.

I lost count of the number of times I drove mom back and forth to the hospital; how many trips we made to the cafeteria or the Au Bon Pain in the lobby, or god knows to the bathroom. I figured out after the first day that if I wanted hot water to wash my hands in the sink before I left the bathroom, that I had to turn the hot water on when I walked in the door – by the time I was done, it would be hot.

On New Years Day, my neighbors throw an annual open house party with a huge brunch, so I asked my mom if she’d like to join us there for a little while and to my delight she said yes. I figured a little socialization and change of scenery would be good for her, and we could head to the hospital after that. It was a beautiful, sunny, uncharacteristically warm day – I went down to pick her up and when we got back I tossed out the idea of walking to the neighbor’s. She liked that, so we made our way down the hill. She said she was feeling like she couldn’t get her legs going right and she’d been a little dizzy, so we went slowly. I introduced her to the neighbors and we had some brunch, and after another 45 minutes or so, I asked if she was ready to go. She said yes, so we began our trek back, which is a lot more taxing since it’s all uphill. Tim was on the neighbor’s back porch and had a clear view of us as we moved one careful step at a time. He texted me to ask if he should drive us up (he’d gone down in his truck) and by then, that seemed like an excellent idea. My mom usually got around great, so her inability to walk, and the dizziness, seemed strange, but I chalked it up to fatigue and stress.

Dad was discharged to rehab the next day. His stay lasted just about 2 weeks. Sometimes I brought mom to visit him; sometimes Hannah (their caretaker/companion) brought her, and early on, I made sure that Hannah got to see the work that the physical and occupational therapists were doing with him so she could help him once he came back home. He made remarkable progress, somewhat impelled, I think, by his roommate, Bob (not his real name), who was clearly not a short-term rehab patient.

Bob was sullen, cantankerous, and often paranoid, though he had his glimmers of sociability. I could see from some of the evidence in his space that he was a Vietnam Vet. It was apparent that he was at a much more advanced stage of dementia than my dad: verbal communications were trying – he was incapable of staying on point through a sentence, leaving his conversational partner working hard to infer where his thoughts were going. One morning, he engaged me, which was surprising since all I’d ever felt from him up to then was a malevolent energy. At first I was excited, but the “conversation” quickly devolved into an accusation that I, or my father, had stolen something of his (I could never quite get to what the missing item was); then we spent a disproportionately long time discussing a framed painting that hung on his wall, which he said a friend had done. Despite it not being my artistic cup of tea, I feigned admiration to shift the ground back to something closer to positive, and away from whatever it was he was missing.

He had an impressive collection of “coffee table” books featuring local history and architecture, which, that day, were spread out in a jumbled hodgepodge on his bed. He began to show me some of the photos, which I was finding intriguing, but we didn’t get very far, as his narrations meandered off to unrelated and disjointed places. There were one or two other male residents who would sometimes roll in to visit and chat with him and I was astonished at how their conversations seemed to flow – they still made no sense to this outside observer, but they appeared to make sense to them, like twins with a secret language. It left me wishing I knew more about how best to communicate with people with more advanced dementia. It also left me groping for a way to extricate myself and get the hell out of there. I hoped my dad wasn’t having too much of Bob’s suspicion and ire directed at him. It was hard to ask with them sitting in the same room. He hadn’t complained about it, so I presumed he hadn’t.

Late in the afternoon on the day before my dad was to be discharged, moments after arriving home from a visit with him, dad called me, clearly irritated: “Marcia? It’s your father.” (He always began phone calls like this. Even though for years we’d had the miracle of caller ID, and when he called, I answered the phone saying, “Hi Dad! What’s up?”)

Me, with my, “I’m making a little bit of fun of you now” tone to my voice: “I know it’s you! What’s going on? I just left you 15 minutes ago!”

“Marcia, I’m not sure what to do.” (Pause)

Me (thinking, “Oh, god. What now?”) “Well, maybe I can help – what’s happening?”

“I gotta take a leak, and my roommate Bob is sitting there in his wheelchair, and he won’t let me get by.”

Me (first pressing my lips together, really hard, to flatten my voice and stifle the smile tugging at the corners of my mouth): “Did you press the call button for the nurse?” (I also know that a catastrophe likely isn’t looming because they have him protected with adult diapers due to his advancing incontinence.)

“Yeah but they haven’t come IN yet.”

“Okay – let me see if I can call the nurse’s station and get them to come in and help.”

I hang up and call the facility, explaining the situation. They transfer me to my dad’s nursing station, and I relay the predicament that seems to be unfolding in room 234. The person on the phone calls out to the others on the floor to ask where Bob is. They know Bob. I hear an answer that he’s in the hallway. I ask if that means the hallway *outside* their room – I get an affirmative, though it sounds less than solid. I’m perplexed, but say, “OK – the situation must have already resolved itself. Good.” I hang up, deciding I’ll give it a few minutes before I call dad back to be sure he’s been able to get to the bathroom.

Three minutes elapse. Dad calls again: “Hello Marsh? It’s your father again.”

“Yeah dad. Is everything all set?”

“No! I gotta take a damn piss and my roommate Bob won’t get out of my way!”

(Now I’m confused, and I tell him so) “But I just talked to the nurse’s station. They said he was in the hallway. But you can’t get by him to get into the bathroom?”

(He responds loudly enough that if Bob is anywhere within 30 feet he can definitely hear. I experience a momentary beat of worry for dad’s safety that night.) “He’s blocking the damn door and I gotta take a leak! If he doesn’t get out of the way I’m gonna piss all over him!!”

A giggle briefly escapes but I tamp it down, forcing a couple of tears into my eyes, which I blink away and clear my throat. I don’t want him to think I’m not taking this seriously. I say, “I’m sorry dad – you should probably avoid doing that if you can. You have Depends on, right?”

(He doesn’t answer – he’s just revved up now.)

“Let me call the nurse’s station again. I can’t quite figure out why they think he’s out in the hallway.”

(Conceding slightly) “All right. This is the last time I’m going to call you about this.” (I get the sense that he thinks he’s been calling me about this for the last hour.)  “If I have to piss on him, I’ll *piss* on him!!”

“Okay. I’ll call them again. Hang in there dad. One more night. You only have one more night. Tomorrow you come home. I’ll be there when they told me to, at 11 a.m. sharp.”

I call them again, to plead for someone to just go and double check – my dad seems truly agitated. They say they will. I choose to believe them, because I don’t want to drive back over there to play lavatory referee between my dad and a guy who seems to think I’m capable of pulling off an armored car heist. Tomorrow can’t get here soon enough.

The balance of the night apparently passes uneventfully. As promised, I’m there, actually 5 minutes early the next day, at 10:55. I walk into his room, where he’s sitting in his wheelchair, fully dressed, sneakers and jacket on. Bob is AWOL. Dad looks at me with something between true and mock annoyance: “Where you been? I’ve been sitting here since 8:00!”

“Whaddaya mean?” I respond with my own mock annoyance. “I’m here right when I said I would be – actually I’m a few minutes early! They told me I couldn’t get you until 11:00, remember? If I came earlier, they wouldn’t have let me take you!”

I’m not sure he believes me, but now I’m just focused on trying to be sure I have everything of his – clothes, toiletry items, etc. I’ve discovered that things have a way of disappearing around here, but if you put some elbow grease into it, you can usually find them. “I’m just gonna make sure all your clothes and everything are all here, okay? I have the list I filled out on your first day, so I’m just going to go through to make sure we have it all.” After a fair bit of searching and gentle staff interrogation, I track down all the clothing items, or at least, all the really important ones. I retrieve his Ziploc bag of toiletries from the bathroom, glad that Bob is out on recon so I don’t have to absorb any grand larceny accusations.

It takes me about 15 minutes but finally I feel like I have everything. I sign the discharge paperwork and add another packet of information about my dad’s diagnoses, medications, and activities to my backpack. One of the PT team wheels him out as I walk alongside them. When we get to the car, he locks the wheelchair, reminding dad what they’ve been teaching him about how to use his arms and hands on the arms of the chair to help himself up. I brought dad’s new walker and stashed it in the backseat, but don’t need to take it out – the PT just steadies him for the 2 steps to the car, carefully ensuring he has his balance as dad then reaches up for the grab handle inside the passenger door – such an important feature that never meant anything to me until I began transporting my parents everywhere over the past 8 months. He does a pretty fine job of lowering himself onto the passenger seat and coaxing his legs up over the bottom of the door opening – again, an unconscious bit of body mechanics that I’d never thought much about until I saw the effort and energy dad always had to expend for such a seemingly simple motion, every time he entered or exited a car.

As we made our way home in the cloudy but bright January glare, I made some pleasant small talk:

“So, you glad to be going home dad?”

(With a little sarcastic laugh): “Yeah – that roommate of mine – Bob. He’s a lunatic!”

“Yeah – he was a challenge. You were on the short-term rehab side of that place, but I don’t think he was a short-term patient. I think he’s been there for a while, and I think his dementia is pretty advanced.”

“It’s a good thing there wasn’t a baseball bat in that room. I’d have hit him in the fucking head!”

Now my laugh flies out of my mouth, full force: “HA!! Yeah – good thing, dad. Good thing.”


Surviving Kitchen Warfare on the Homefront

There is seemingly no end to the things that can tax a marriage if you let them, and in my household, for a long time, food, especially “what to have for dinner” was another version of shoes left in the middle of the hallway (or, pick your spousal pet-peeve: dried toothpaste in the sink, hair in the shower drain, dirty dishes languishing mere centimeters from the dishwasher; snoring – ohmygod would you JUST. STOP. long enough for me to fall asleep?!?). Allow me first, though, to lay down some baseline facts:

1) My husband is an amazingly talented and funny person, one of whose stated goals in life 30 years ago was to become his own version of “Mr. Mom;”

2) In addition to being talented and funny, he also has ADHD. If you know or love anyone with ADHD, you know, and may live with the characteristics of distractibility, lack of organizational/”executive management” brain functions (a.k.a, “filters”), and hyper-focus that are typically included, out of the box, at no extra charge, with the ADHD mind;

3) He is wildly self-critical. His inner voice is an ambitious, rampaging jerk – often unsatisfied with ravaging only *his* psyche, and requiring additional fuel from others as well, namely, yours truly;

4) I was more than happy to accommodate my husband’s Mr. Mom goal, and for the most part, it worked out pretty well. Except, for a long time, around the kitchen.

Actually, it was fine for a while. And by “a while,” I mean several years. When the boys were young, I barely remember meals, to be honest. There were some periods when I worked from home and I must have done more of the regular cooking; I always tended to do the weekend cooking, which, many times, morphed into weeknight dinners. We held steadfastly to the notion that we were NOT going to become one of those families whose kids’ dietary range consisted of pizza, chicken nuggets, mac & cheese, tater tots and ketchup.

I really enjoy cooking – the process sometimes feels a little bit magical – like alchemy – and it consumes me in the happiest way. Usually what I cook turns out well (though heaven knows I’ve had my share of fails, like the time I inadvertently mixed too much lemon juice into a marinade for sole and ended up with a dish I look back upon as “Ceviche Involuntaria,” which, not recognizing what chemical process had taken place, I then put in the oven anyway. Giant yuck). I can easily while away a full day in the kitchen indulging my inner Mark Bittman, whether just because, or for a planned get-together. There’s usually way too much, so if it turns out well, these days I text the neighbors and throw an impromptu party around the bounty. (I love my neighbors, and they’re brilliant guinea pigs to my culinary experiments). However, many times we end up getting tired of having repurposed Sunday dinner leftovers and food gets thrown away, which bothers me.

As the years rolled by I kept cooking, and experimenting, sometimes working my own version of an old Food TV (now Food Network, of course) show where a chef would come into someone’s house and whip up a meal with just what they had in their fridge and pantry. But that wasn’t happening regularly, and it left my poor ADHD husband with the task of figuring out most of the weekday meals. The good news: the range of dinners we ultimately settled into didn’t consist of pizza, chicken nuggets, mac & cheese, tater tots, and ketchup. The bad news: the repertoire instead included grilled cheese (often accompanied by Campbell’s Tomato Soup), hot dogs and beans, pierogis with caramelized onions, mac & cheese and pizza. And steamed broccoli. There was lots of steamed broccoli, though for one of the boys, gag-inducingly, it was dipped in ketchup (no joke). It had become a routine of convenience and speed over variety and health, and it made me crazy.

For whatever reason, but I’m going to blame my husband’s inner voice introduced in item 3 above, at the times when I *would* be contentedly creating away in the kitchen, he’d blow in like a dark thundercloud over my picnic, insinuating an annoyed weariness on *my* experience: “Doesn’t it bother you to be in the kitchen all day?” (Translation: “it bothers me when you’re in the kitchen all day,” or, “I have no desire to be in the kitchen for longer than 10 minutes, so how can you possibly enjoy it? Here, let me ruin it for you.”)

He also took to questioning essentially everything I created, from selection to preparation techniques, and no matter how many times I pleaded with him to just let me be me and have my joy; no matter how many times I turned out something good, he found a way to criticize it (though he never saw it that way – for him, it was just benign observations, unencumbered by any “I’ve learned from experience that I probably shouldn’t do this” filters). He would then fail to understand how or why this could possibly upset me, despite my repeated explanations that his criticism *really* pushed my buttons. To be honest, he probably never tuned all the way in to my “explanations,” partly because of his distractibility, and partly because they were usually screamed angrily at him, often while I happened to be gripping my chef’s knife.

It made my blood boil, and no matter how I rationalized that I shouldn’t let it get to me, I felt like I put my heart and soul into my cooking, and he was stomping on it. Plus, he rarely made any effort himself, and worst of all, his questioning would often occur in front of the boys (no filters!!), predisposing them to turn up their noses at whatever the meal might be, rather than encouraging the adventurousness we’d imagined early-on.

After a while, every time he came at me with his “thundercloud offense,” I would testily remind him that cooking was supposed to be part of the Mr. Mom job description, and yet here I was, picking up his slack (yeah – I can be mean), and all he could do was criticize. I had tons of cookbooks; I subscribed (or had subscribed) to and retained virtually hundreds of issues of a few different cooking magazines; then there was the internet. He could read, and I had seen him follow recipes successfully. So he’d try: he would attempt to put together plans for the week, though ironically, as much as he could breezily cut down my meal choices, he agonized over making decisions about what to put on the menu himself; at one point I even found and signed up for a service that would send weekly menus and shopping lists. He’d stick with something for maybe a few weeks at a time, only to fall victim to the thundercloud offense, turned on himself.

If you’re wondering how this story could possibly conclude in anything short of divorce, you’d be justified; but take heart, oh lovers of happy endings: there was a solution, and we’ve been enjoying it for well over a year and a half now. Back in the summer of 2017, without telling him what I was doing, I subscribed to a meal service (think Blue Apron, though that was NOT the specific provider). It was a gamble, and I knew I’d take heat for it, but I’d found one that I was really excited about. A chef with global culinary experience; 18 meal selections to choose from each week; organic and/or seasonal and locally sourced ingredients wherever possible, including everything needed except oil, salt & pepper (and equipment); minimal packaging that was nearly 100% recycled/recyclable. A day before the first box showed up, I casually mentioned it. Naturally, Captain Thundercloud thought it was a stupid idea, but then we cooked the first meal. Together. Then the second, and the third. He was enjoying it. The boys were enjoying it.

After 2 or 3 weeks, he was hooked, to the point where he was actually telling people about it, unprovoked. We cooked together, each of us at our own station flanking the stove – divvying up the prep (which was typically fairly minimal). Was it more expensive than it would have been to buy the ingredients for the same meals? Yes. However, we had a variety and healthiness to our meals that had been missing for a very long time. And I was no longer guiltily throwing away heaps of uneaten leftovers and bags of slimy, decomposing produce that we had no choice but to buy in quantities much greater than what was really needed. The meals often yielded a bit of leftover, but just enough for lunch for a day or two. My refrigerator was Konmari’d – staying cleaner, less cluttered, and gloriously free of the mystery aroma of rotting oh-god-what-was-that, and I was spending less on food than I ever had. (One element: we now hardly ever felt like we had to go out for dinner to compensate for the fact that we weren’t moved to eat what was in the fridge, or to come up with something to make).

Our days of kitchen warfare were over, freeing up precious time to argue over more pressing things, like shoes left in the middle of the hallway.

crossed knives

Zen and Managing “Type A” Expectations, a.k.a, “Pele’s World”

I’ve felt for quite a few years that I had conquered my “type A” personality: as I consider it, probably not surprisingly, I think I’ve felt that way for about as long as this house project has been going on (go figure!). For fun, let’s call my “type A” personality “Pele” after the Hawaiian goddess of volcanoes and fire. Mind you, reducing Pele’s influence was never a conscious goal for me, but it turns out that controlling, if not truly conquering her was a necessary evolution.

For approximately half of my adult life, Pele ruled. She had to, really. I was the breadwinner, so her fire was crucial. However, being married to someone with ADHD, and later, discovering that both of my children were also simultaneously gifted and cursed with it, caused me to slowly realize that I needed to cultivate patience, and, in effect, do something to manage her, or her demanding nature would be the undoing of everything I was supposed to be working for.

Enter yoga. I started practicing back in about 2003. I had tried it many times prior to that, always giving up in utter frustration when things got uncomfortable, which usually happened about 5 – 7 minutes into any attempt. Yet, something in me (maybe Pele herself and her unquenchable need to overcome failure? Maybe some deep-seated, but unconscious self-awareness?) kept coming back to it, despite my rather abysmal track record. In partial hindsight, though, I believe yoga might be the thing I’ve done in my life that has been the most beneficial, and the most life-altering.

Wait a minute – isn’t today’s post supposed to be about house stuff? Why am I writing about this? Mainly, it’s because the current bathroom project has taken *so* much longer than I originally anticipated, for a host of extremely valid reasons. Valid or not, it’s testing me, or rather, it’s testing my ability to manage Pele, so she’s today’s muse.

You see, my Pele struggles on a near-daily basis with the validity of the reasons this effort has been so protracted, despite clear evidence to the contrary. Frankly, if I were to have given Pele her voice every time she flared up inside me, I’m about 98% certain that the entire house project would have been abandoned along the way, as would my marriage (which, for those new to this, happens to be to my contractor, Tim, though the marriage happened long before the 9+ year renovation project).

So back to yoga for a moment: the evolution of my entire practice has been a microcosm of this larger house project. I noted above that my earlier fails with this previously unreachable art were about my frustration when things got uncomfortable. Well, guess what? This project has been a 9+ year series of uncomfortable moments, interspersed with triumphs, interspersed with sometimes seemingly interminable periods of inactivity – those are the toughest for Pele.

I was finally able to trick myself into sticking with yoga when I serendipitously stumbled upon a particular yoga DVD, in a style of practice that Pele could handle. As a result, over time, my strength, and especially, my flexibility, improved and I arrived at a place where I actually craved certain moves (a.k.a, positions) that used to reduce me to angry tears. I guided myself into types of practice I would never have been able to manage when I began – ones that required true patience and focus and the ability to discern between genuine pain and the discomfort of pushing boundaries. I discovered that my flexibility (or lack thereof) and discomfort were far more mental than physical.

Thankfully, I was coming to that point at around the time that we were kicking off the house project in earnest. I had learned how to breathe, which might sound stupid, but in the realm of yoga, breath and *awareness* of breath are the keys to centering yourself amidst trials of all kinds. At first it was a subtle shift that happened in my body, but eventually, it became an almost magical ability with which I could turn a challenge into the sometimes gentle rain, and other times, the fire hose I needed to turn on Pele to douse her inferno.

She is a constant presence in my life – like the molten iron core of our planet – always ready to burst through a fault line that’s weak enough. Lately the fault line is this last bathroom. Aside from the work to be done outside, most of which is more within my direct control, this bathroom is the last horizon of the overall renovation project. Most of the time, the fault line holds, but the tiniest shift (which could be triggered by coffee stains left in the sink with dirty dishes and hardened bits of lunch, one-too-many balled up socks lying around where it shouldn’t be, a dried glob of joint compound in the shape of half a footprint on the entryway carpet as I arrive home from an unexpected appendectomy . . .) can result in an eruption. Sometimes, I just have to let Pele erupt. But most of the time, my Zen, in the form of my yoga mind, appears when I need it, like my very own emotional volunteer fire department. It’s good to know it’s there. 🙂


Parenting the Parents, Part V. Expect the Unexpected.

Unless you work a job with very strange hours, a ringing phone at 5:45 a.m. rarely signals anything good. Our cell signal at home was perfectly awful, so I should have been keeping our regular landline phone in the bedroom, but I wasn’t. Both of the portable handsets were somewhere downstairs.

Normally I woke up no later than 6:00, so I was in that foggy, not-quite-sleep-but-definitely-not-awake state; radio-alarm tuned to the local NPR station with the news stories playing into the plot lines of my nonsensical dreams. In a deep recess of my brain I heard a far away sound that jogged something in my subconscious, but it was so faint (and the bedroom door was closed) that by the time I was awake enough to register it as “maybe the phone ringing,” it had stopped. Was I dreaming that? I was alert now, though, so when, about 10 seconds later, it started again, I was out of bed, down the hall and down the stairs in a few seconds of sheer panic. (Even as I type this, that same sensation of heart-pounding dread is welling up in me).

I hardly had to look at the caller ID screen to know who it was. I picked up the phone, mustering as much composure as I could, but without saying hello; instead it was, “what happened?”

Mom, sounding extremely upset: “Marcia (also *never* good when that’s the first word out of her mouth). It’s dad. He fell in the bathroom and I can’t get him up. I don’t know how long he’s been there.”

Me: “Is he awake?”

Mom: “Yes.”

Me: “OK. We’ll be right down. Don’t try to move him.” I hung up and in the same instant yelled for my husband, “Tim!! Tim!!! We have to go to my mom’s. My dad fell in the bathroom and I can’t lift him myself.”

Trooper that he is, he was down the stairs in less than 30 seconds, and we were out the door in our pajamas, slippers, and winter coats. We bolted into the condo 3 minutes later and found dad on his right side, stuck between the toilet and the wall in their master bathroom, unable to muster enough upper body strength to right himself. I ran through the litany of questions/commands: “Did you hit your head? Does anything hurt? Let me see your eyes.” We carefully slid him out, away from the wall and the toilet, and gently sat him up. I ran my hands along his right shoulder, arm, side, and hip checking to see if he winced for evidence he’d broken anything but was being too stoic to admit it. Assured that he hadn’t done any major physical damage, with me holding his feet steady so they didn’t slide, Tim got behind him and lifted him to standing. We got on either side of him and helped him over to the arm chair that sat next to the bed.

While I asked him more questions about what had happened, Tim went to join my mother in the kitchen. I could hear them talking – not well enough to know what was being said, but enough to hear the emotion in my mother’s voice. Tim came back in and stayed with him in the bedroom, while I went to the kitchen to get him some water (I suspected that he, like many older people, was pretty chronically dehydrated, which couldn’t be helping him). I had been fine and solid during the previous 5 or 10 minutes getting dad out of his predicament and back to vertical, but now that the immediate adrenaline had worn off, I was shaking.

When I got to the kitchen, I gave my mother a long, teary hug. She was distraught over not having heard him, unsure of how long he’d been there. I reminded her that starting today, things were going to get easier with Hannah (their new caretaker) coming. I filled the water glass and brought it to dad and told him to drink it, knowing that if I asked him if he was thirsty, his answer would be no, but that if I told him to drink it, he would.

When we were sure dad was OK and everything had simmered down, I reminded them I’d be back later when Hannah arrived, and Tim and I went back home. I forced myself back into my normal morning routine for a few more hours until I would go back to welcome Hannah. We’d also been talking for a bit about getting dad a lift/recliner chair, and a better walker than the crappy standard-issue aluminum one he’d been using. I resolved that once Hannah was settled in that morning, I was going straight to the home medical supply place.

We’d been looking forward to this day for what felt like years already, so I was happy to see Hannah slide comfortably into a routine with them which, even after 15 minutes, seemed as if it had been in place for months. Feeling optimistic, I headed to the home medical supply shop on a mission. I found a great chair that seemed to be a good size for dad – it even had a little side-table accessory. I tested it out (comfy!!). I took pictures and grabbed the brochure. I bought several different sizes of quilted, waterproof pads that we could put down on chairs and in bed in case of accidents. I got them a portable, suction-attached grab handle for the shower, and a super-duper new walker with rubber tires (the larger ones were fully articulating, to help with maneuvering in tight spaces), hand brakes, and a built-in, fold-down seat with concealed storage underneath.

I piled it all into my car, drove it back, and pulled into their driveway feeling like one of Santa’s elves on a post-holiday follow up assignment. Mom was truly grateful and approved of the chair. Dad also seemed to like the chair, so I installed the grab handle in the shower, then returned to the store, bought the chair, and scheduled delivery for Friday. I stopped at the condo on my way home to update them.

Sometime around 5:30 or so, the phone rang again. I saw that it was my parents’ number, so picked up, expecting a happy recap of “Hannah, Day One.” It was my mom, but this was not her “happy recap” voice. She began again with “Marcia.” My heart lurched. She was barely able to articulate a full sentence, but the gist was that something was wrong with dad – he was shaking. He wasn’t eating, and he wasn’t answering her. I told her I’d be right there.

Tim came with me again. When we got there, dad was in the chair next to his bed, and “tremoring” is the best way to describe what his body was doing. I was thinking I needed to run through the checklist for a stroke, so Tim Googled it and prompted me through. I asked him to smile. (Even on both sides). I asked him if he could raise his arms. (He nodded, but then didn’t do it). I asked him if he could repeat a sentence after me. (He nodded again, but again, didn’t do it). I told mom I was calling 911, and did. They had me run through the same exercises while they dispatched an ambulance. They arrived quickly, and Tim helped guide them in. They ran through all their checks and vitals-taking. Their opinion was that it was probably a fairly severe urinary tract infection (they’d seen them countless times). I remember his blood pressure was quite low but not much else (fever? pulse rate? blood oxygen? I’m sure they gathered all of that but I don’t recall any of the readings). I decided I needed to ride in the ambulance to the hospital with him and told Tim he could drive my mom there in my car.

The beauty of having an ambulance as your transport to the Emergency Room is that when you get there, they’re ready for you. No waiting around in the waiting room to be seen, worrying that whatever you have might kill you before you get in. We’d had the presence of mind back at the condo to grab all his important info – Medicare and other insurance cards, photo ID, etc, so I had everything ready when the admitting person wheeled her cart and laptop over to me as I sat on a bench near my dad on his guerney in the hallway. We were in a private room in the Emergency Department soon thereafter with all manner of support staff and doctors coming in and out, asking questions, checking vitals, hooking him up to IVs and an oxygen feed. I think we were moved later to a different room in the ED, because Tim had come back to the first room, then went back out, and I remember directing him via text to a different room to come back again at some point that night. The staff brought us snacks, water, ginger ale. Tim was too fidgety to stick around, which was OK, so I told him he could go home. Thankfully I had my e-reader app on my phone and occupied myself with my latest book club book.

Around 1 a.m., a tall, gray-haired, very serious-looking doctor came in and introduced himself as the head of the hospital’s infectious disease unit. He explained that my dad was in sepsis, also suffering from pneumonia and a UTI. He told us they were working on figuring out what bacteria was doing this; they had him on 2 different antibiotic drips and would continue to do everything they could, but he needed us to know that this was serious, and there was a chance my dad may not make it.

At that moment, I wasn’t dwelling on a planet where acceptance of that was possible, but worry and fear were suddenly etched on my mother’s face and tears welled in her eyes. The doctor, seeing her reaction, acknowledged it, spending another few minutes to explain the protocol they’d follow, which, thankfully, took a little of the edge off her panic. We spent the rest of the night twisting ourselves into momentarily restful positions in molded urethane visitor chairs against the wall in his room, separated by the rolling tray table we couldn’t be sure he’d use for its intended purpose, but which was serving as our headrest for the night.

Food as Medicine (and Health Care Cost Control), Part II

Why is it that we can so easily recognize the importance of understanding and structuring policy regarding the dangerous addictive properties of opioids, but we have such a hard time recognizing the importance of understanding and structuring policy regarding food, which, in many cases, plays along the same addictive pathways in the brain?

There are numerous studies showing that certain foods (sugar, for example), can be at least as addictive, if not more so, than cocaine or heroin, activating the same receptors in our brains as the drugs. (This article is a great read, and provides links to a few such studies if you’re so inclined. There’s also this study regarding highly processed foods and “food addiction”). Some studies suggest that the impact of sugar on those receptors could be even *stronger* than the impact of cocaine.

We’re enraged to the point of proverbial torches and pitchforks at the pharmaceutical companies who produced and marketed opioids literally to death. (According to the latest figures – January 2019 – from the National Institute on Drug Abuse, approximately 130 people die from opioid overdoses each day – over 47,000 per year).

Yet, with the clear links between poor diet and chronic preventable disease (mentioned in my Food Friday blog last week) and related deaths, which number approximately 1.4 *million* annually in the US (I had to go to a few different sources on the CDC website to compile this number, but roughly, it’s comprised of 600,000 deaths per year each from heart disease and cancer; 140,000 from stroke, and 80,000 from diabetes), up to 40% of which are preventable (much higher, actually, for Type 2 diabetes), where’s the outrage? Where are the lawsuits?? What are we thinking???

I find it fascinating how we humans (especially we freedom-loving Americans) rationalize things like this, and how outraged many people become at the suggestion of policy (such as consumption-based taxes) that can begin to shape longer-term, truly beneficial changes in our food and beverage habits. We cling to them like a tattered blankie from childhood, assigning all sorts of mythic autonomy to our “rights” about our choices for what we eat and drink, and, in the process, choose a clear path to disease, premature death, and billions and billions of dollars in healthcare spending that are truly avoidable. We *all* then pay the price in higher costs of “delivery” and upward-spiraling insurance premiums. And then we punish the providers by continuing to squeeze them to deliver an ever-increasing volume and quality of services at lower and lower cost. It really pisses me off.

As it stands, in 2017, $3.5 *trillion* was spent on healthcare in the U.S., representing 17.9% of GDP. In 1970, in inflation-adjusted dollars, we spent $400 billion, which represented 6.9% of that year’s GDP. The rate of healthcare spending has been increasing at a considerably steeper rate since the late 1990s, and even though it’s slowed down somewhat in the past couple of years (as of the date of the latest Peterson-Kaiser Health System Tracker), the links between preventable chronic disease, death, and dietary choices remain.

We need to get more aware of what’s influencing our “decisions” (our own brains’ pleasure receptors gone wild; willful and active ignorance by food manufacturers as they continue to produce and heavily market products with addictive ingredients – remember the tobacco industry 40 and 50 years ago? Yeah, that. But with your FOOD.) We need to stop acting like petulant children, stamping our feet and declaring in effect, “it’s my body and I’ll eat what I want to.” We need grow up and instead, plant our feet firmly in the soil of true self-worth (as opposed to misguided notions of self-determination masquerading as “choices” we think we want to make) and start taking seriously our own roles in our individual and collective health.

Rant over. Happy (Food) Friday!

Zen and . . . Dust.

Everything here – positively *everything* – generates dust. The winter, and the sand, and the various chemical salt compounds everywhere. . . When they dry? They create dust, which we track in every time we leave the house and come back in. Sheet rock compound? Fun when wet. Dust when dry.

This morning  (a bit yesterday, too) “we” battled (Tim physically, me psychologically) with Schluter Kerdi waterproofing membrane, which is adhered to the wall with a special “mud,” which needs to be at just the right consistency, as does Tim’s temperament when he’s troweling it onto the walls above chest height and gravity is doing its tireless job, causing large blobs of it to plop onto the floor and his sleeves and the tops of his shoes. It eventually dries. And chunks of it fall off, gritty and gray, camouflaged against dark floors and patterned carpets, to be trod upon, crushed, and turned to. . . dust.

Today’s special, not-bathroom-related project was the ceiling speakers to complete (I think?!) our surround sound system. Perhaps not shockingly, installing ceiling speakers requires cutting holes in the ceiling, and something about the properties of sheet rock dust allow it to move much more freely on the slightest of air currents in a house than you’d ever imagine.

It didn’t occur to me to shut the ceiling fan off until after the first speaker was done and I was obsessively vacuuming its aftermath off the floor, the baseboard, the dark brown leather couch, the palm tree we’d moved across the room to avoid exactly this effort, the console table with the rough, reclaimed wood top that’s fully 12 feet away, and the kitchen chairs that were acting as ladder stand-ins. Ceiling fans are an excellent dust-dispersion mechanism. We just dusted everything on Saturday. It’s freaking Tuesday.

Also, somehow, it seems to me that the dust from “established” sheet rock (such as that which is part of the living room ceiling, which has been in place for over 2 years) develops a slightly different, stickier molecular structure than the dust that comes from sanding newly-set compound, but that might just be because it’s been a few months since my last encounter with new sheet rock compound dust (a fate which is quickly closing in on me once again). You can’t just vacuum this stuff up. It floats around and adheres to every conceivable surface as if held by a glue with approximately the adhesive property of the back of a sticky note. Not crazy sticky, but enough to cause a nervous tic to develop in your left eyelid after the 5th swipe of the vacuum nozzle leaves a translucent, slightly fuzzy white streak on every surface you thought you’d just cleaned.

Tim, bless his heart, had pulled out one of my old flour-sack kitchen towels, which, in some earlier iteration of its service, had been used to clean up after either a red wine spill or a murder, and had now been relegated to dust rag status. He wet it, wrung it out until he nearly tore a hole in it, and apparently used it to wipe up some dusty surface. I know this because once I realized that I wasn’t going to get off with an easy 5-minute vacuuming sentence, I discovered it, laying in a damp-dry heap on the island countertop. Thinking, “wow, that saves me a step,” I grabbed it and used it to wipe up the dust streaks that were clinging stubbornly to the arm and side of the leather couch. Clearly, it was harboring a universe of wet dust particles that had been magically transformed into a murky slurry, which dried in a few seconds on the leather to a dull, chalky sheen. I took a deep breath, brought it over to the kitchen sink, and rinsed and wrung it out several times until I was sure the dust was gone, then trudged back across the room and tried again, more successfully this time.

Gently, I held my twitching left eyelid closed, exhaled a silent “oooooooohhhhhhhmmmmm,” and spent the next 45 minutes fully consumed by my task, ultimately emerging, victorious, in today’s Battle of Dustville. Bring on the sanding of the bathroom sheetrock. I’m ready.

Parenting the Parents, Part IV. Moving Toward a Solution.

I’ve told many people along the way that I wasn’t sure which was more challenging: helping with everything with my dad now that he was officially diagnosed with vascular dementia, or trying to figure out how to help my mom manage this. Mom had been minimizing dad’s challenges for years, and regardless of the reason, I understand. It could have been because of the whole not-wanting-to-be-a-burden thing. Maybe it was denial. Perhaps it was fear. It could even have been a subconscious way to channel otherwise unresolved anger that had built up over decades for any number of other reasons – I think my mom followed the expected path that most women of the late 1950s and early 1960s did, burying any barely-formed imaginings of who *she* was, and getting pulled along in the slipstream of gender norms: first wife, then mother, then . . . what? It could have been a combination of all of those things, maybe even more.

My dad was always a pretty open book: a straightforward guy who made it very clear that there was nothing more important to him than to be a good provider for our family. He was an only child. When he was quite young (sometime, in the 1940s I believe – my grandmother always told us he was 8 years old), my grandmother (who was, in just about every conceivable way, the opposite of my mother – a brash, opinionated, dyed-redheaded, 2-pack-a-day smoker), divorced my dad’s father. This was no small deal for a Sicilian-Italian catholic woman of that time, but she had her principles, and my dad’s father had violated them. He, according to her, had pledged his financial allegiance to his own mother ahead of my grandmother and my dad, and that was the end of it.

I’m certain the real story was considerably more nuanced, but that was how she told it, and that was the only story we ever knew. At some point later, she met and married the man my sister and I knew as our grandfather, who was a wonderful, kind, generous, loving person. He was, from all indications, a perfect step-father to my dad, but I don’t think I’m going too far out on a psychological limb to suspect that my dad’s experience with his own father (probably relived mostly in a mental rear-view mirror through his mother and the tellings and re-tellings of the divorce story to friends and family) played a rather significant role in his desire to become the kind of person whose own devotion to his family would right those perceived wrongs. He succeeded magnificently.

Mom is more complicated. She was also an only child. As a kid, based upon the stories told by her younger cousins, she was a consummate tomboy and the leader of their little clan. She fished; she hiked; she climbed trees. She used hollowed-out half-watermelon rinds as makeshift summer “sleds,” rocketing down the huge grassy hill up behind my grandparents’ house, and, if I remember the stories correctly, even down paved streets near the house they lived in before that one. She played softball. She had a cat named Yogi, after Yogi Berra.

When my sister and I were young, mom expressed a lot of creativity. She took art classes; she painted and drew. She made the coolest Halloween costumes. She could sew like a professional. She did needlework. One Christmas, she built scale model dollhouses for my sister and me. As a mother, she had her rules – not too many, really, but to the logic of my kid-mind, they didn’t always add up, so I tested boundaries and got my comeuppance when I got caught, which was often. Other than that, she let us be kids. We were lucky enough to live in places where we could be “free range.” Even into high school and beyond, she basically let us make our own decisions, and make our own mistakes, a quality that I didn’t come to fully appreciate until many years later.

Somewhere along the way with mom though, something shifted. She always had a fiery streak (which was evident during those times of “comeuppance”), but as we got older and more independent (and, to be honest, consumed with our own lives, and more distant) a deeper anger seemed to bloom. Most of the time she was fine, but occasionally I’d be on the receiving end of a passive aggressive sideswipe.

Fast-forward to 2018, once they decided to move, my sister and I (and often my dad) found ourselves navigating a near-constant emotional minefield with mom. My sister and I took on all the logistics of the move, but mom was easily overwhelmed by it all, which would manifest mostly in the form of an angry paranoia – that the movers would steal something; that we were somehow plotting against her if we had a conversation about anything at all when she was out of the room. As the move drew closer, I learned that usually the best response was just a hug, even if her anger and negativity pushed me to my own limits.

As the move neared, I measured their furniture, and measured the new spaces. I ran around in the empty condo with my list of furniture and measurements and a tape measure, figuring where various pieces might fit. I labeled all the furniture back at their house with post-it notes bearing the names of the rooms in which it would be placed, and had my sister video me walking through the condo to describe to mom where I envisioned that the furniture could all go, even putting corresponding stickies on the floor in the empty rooms.

My sister and I had noticed, with all the time we were now spending with mom that the stress of it all seemed to be impacting her: she was having a hard time getting her thoughts into words and we often had to repeat stories or instructions that had more than a few parts because she’d get confused.

I had high hopes that the visit to the geriatric psychiatrist would make it more clear to mom what dad’s new primary care doctor had concluded over the summer after meeting him, administering a “SLUMS” test (St. Louis University Mental Status) and sending him for an MRI: the “symptoms” he was experiencing (shuffling, incontinence, confusion) were a part of his vascular dementia and not something he could control. They recommended a medication, donepezil, that might work to slow the progression of his dementia, and possibly provide some cognitive improvements in the meantime. They were clear, however, that it wouldn’t be a cure – there was no cure – and that over time he would get worse. To help to combat this, they also strongly urged that he start doing more physical activity, and that we look into some local programs that were specifically intended to do that in safe and supervised settings.

Dad was never a very social guy, so my sister and I were doubtful we’d be able to get him to agree to join any program where a bunch of “old people” gathered to play games, but I reached out to them anyway, figuring we needed to at least explore them, and cajoled him into going by telling him that if he hated them, we wouldn’t make him go. After a couple of false starts (no doubt precipitated by his complete lack of interest in doing this), I got them out to both programs. Not surprisingly, mom was far more intrigued than dad was. By the time we got to our second follow up appointment with the geriatric psychiatrist, it was clear that this wouldn’t be a path he was going to follow.

They were mostly settled into the new place, but mom was still given to bouts of anger, blaming dad when he’d have an accident, often berating him with mean outbursts that worried my sister and me. This wasn’t good for either of them. We had to do something. While mom and dad both had talked about eventually bringing someone in to “help,” mom was resistant, insisting that she couldn’t understand how anyone *could* help. What could they possibly do? I suggested that we talk about it at the follow up with the geriatric psychiatrist – I was sure she wasn’t the only one in a similar situation who was feeling overwhelmed by this, and that there were agencies out there who existed for this very reason. Every time I’d witness an incident that would anger or frustrate her, I’d tell her that help was coming – we were going to find the right solution to lighten her load. Slowly, she warmed up to the idea.

At that next geriatric psych appointment, we asked for referrals for some good agencies in the area, and once again, my sister leapt into action, researching all of them, looking up not only client ratings, but employee ratings. She had preliminary conversations with 2 of them that had the best ratings, suggesting that I also speak with them.

By mid-December, I was making an appointment with the agency we’d decided was the best choice, to get their “Community Liaison,” Dave, out to meet with mom & dad. The plan was to explore getting a caretaker for dad, but I knew with one simple question Dave asked when I spoke with him that we’d truly found the right place: at the end of a conversation that had mostly been about dad, he asked, “and how is your mom with all of this?” I told him that while she had evolved to a point of cautious optimism, her jury was still out, and that he could be dealing with someone who at best wasn’t convinced, and at worst, could go completely negative.

As the time for Dave’s visit drew closer, I took every opportunity I could find to offer subtle encouragement around the idea of having a caretaker come in. And when Dave walked into the condo that day, mom welcomed him like an old friend, shocking me when she gave him a hug almost as soon as I took his coat. He was wonderful and thorough, and spent well over an hour talking with my parents, working a long list of questions seamlessly into the flow of their conversation. I was as giddy as I’d been on Easter night the previous spring when mom told me they wanted to buy the condo.

A week or so later, after several follow up conversations, we arranged to introduce my parents to Hannah, the caretaker and companion Dave and his team (and I) had determined would be the best fit for them. I had told my parents everything I knew about her: she’d emigrated here from Ghana about 15 years ago; she was married with 2 sons. She’d lived in North Carolina for about 10 years before moving here about 5 years ago. She loved to cook, and she had been a caretaker for nearly the entire time she’d been in the country. I wasn’t sure what to expect when they met, but from the minute Hannah walked in the door with Dave, my mom was sold. She greeted Hannah with the same warmth she’d shown with Dave on his initial visit. Hannah had a wonderfully sweet disposition; she seemed a bit on the shy and quiet side, but my mom (and by default, my dad) took to her like a fish to water.

The plan was set that Hannah would start during the week of Christmas. Christmas fell on a Tuesday, so we figured we’d have her come that Wednesday, Thursday and Friday for 6 hours each day; she’d then come back the day after New Year’s day for another 3-day week (we were going just with weekdays to start) before launching into full-time, 5-day weeks during the week after that.

We were all excited and enjoyed the holidays, though our plan to have dinner at my house on Christmas Eve with my sister, her husband, step-daughter, and my mom and dad got a bit re-worked when dad was feeling a little off that day. My sister and her family came and ate dinner with us, and after dinner, we packed up plates for mom & dad, along with their present (a new compact stereo for mom to play her CDs). My sister headed back home on Christmas day with my mom and dad opting to lay low and relax at the condo while my family and I drove down to spend the day with my husband’s brother and his family.

I awoke the morning after Christmas, the day Hannah was starting, to my phone ringing at 5:45 a.m. In  ways I couldn’t begin to really imagine, things were about to get more than a little crazy.

Food as Medicine (and Health Care Cost Control), Part I

Call me (still) crazy, but back about 10 years ago when people were fighting like cats and dogs over the  Affordable Care Act and political liberals and conservatives largely fell into nice, neat lines on either “side” of the debate, I, who consider myself to be largely a social liberal and a fiscal moderate, was trying to invent a completely different line whenever the issue came up in conversation. That line invoked my deep and pretty much unrelenting conviction that when you’re dealing with any significant, systemic issue, you do yourself (and any impacted constituents – in the case of healthcare, that’s more or less all of us who aren’t super-wealthy) a huge disservice by only addressing symptoms. Rather, analysis of, and solutions for, the root cause(s) of an issue are the path to a longer-term, more effective answer.

In this case, the “symptom” was (is) the skyrocketing costs of healthcare (duh!), which, per the main focus of the ACA, would be addressed by a turning of the regulatory screws, mostly on providers and payers. My point (then, and still) was that we already knew at the time, and we have an even greater body of evidence now, that there are a few *significant* drivers behind healthcare costs in this country. One of those drivers is spending on chronic preventable diseases (which also impacts some of the other major levers of spending, including “service price and intensity,” a significant proportion of which is driven by increasing costs of pharmaceuticals and acute interventions to *treat* the chronic preventable diseases).

My essential argument is this: we’ll *never* rein in the costs of healthcare if all we focus on is the cost of delivery of healthcare. We need to get serious (as serious as a heart attack, maybe?) about making the deeper changes we need to make as individuals, a country, and as a culture that will influence our collective health. And I’ll be the first to admit that diet isn’t the only issue, but it’s my soapbox, and I’ll focus on food if I want to, because it’s a big one.

Here are some sobering statistics from the Centers for Disease Control and Prevention (a.k.a. the CDC – though this language is quoted from “The Nutrition Source” on the website of Harvard’s T.H. Chan School of Public Health):

  • Chronic diseases are the leading causes of death and disability.
  • 70% of annual deaths are due to chronic diseases.
  • These *preventable* (emphasis added) conditions not only compromise quality of life, they add to rising health care costs—*75% of our health care dollars are devoted to treat these diseases* (emphasis added, again).
  • Among adults ages 20 to 74, diabetes remains the leading cause of kidney failure, blindness, and non-traumatic lower-extremity amputations.

“Chronic diseases —*including heart disease, stroke, diabetes, and cancer* (emphasis added)— account for some of the most common health problems in the United States . . . yet many of these chronic diseases are preventable, as they’re linked to poor diet and lifestyle choices including tobacco use, excessive alcohol consumption, and inadequate physical activity.” Let me repeat: 75% of our health care dollars are devoted to treat these diseases.

This isn’t simply about making changes to our diets, though. There’s an entire undercurrent (more like a riptide) of culture that needs to evolve as well, and I’ll be talking more about that in future entries, but allow me close this post with one simple example, as this particular policy is certain to whip up controversy wherever it’s proposed: a tax on beverages with added sugar. People invariably FREAK. OUT. over this (though I think it’s a freak-out that in large part is manufactured by political action/interest groups representing beverage manufacturers, whose “ads” on the horror of the idea are intended to sow discontent). But this is what I mean when I talk about the riptide of culture, and I’ll come back to that next time.

Cheers for now, and happy (Food) Friday!