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Dear Leverage,
There are lots of reasons to love you.
But one of them is this: that you regularly put your end-of-season cliffhanger on the second-last episode, and I can go into the last couple of episodes confident I won't want to scream at the end.
Love,
Sami
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Yay, SOPA/PIPA are dead for now! That's awesome.
Imagine how much better life in America could be if the good people of the country could be stirred to speak up this way about trivial issues like health care reform, as well as vital matters like internet access?
I'm not saying that SOPA/PIPA weren't important, by the way. But America's current health care "system" is literally killing people, and metaphorically killing the American economy in very real ways.
I'm not going to go into details about that, but what I am going to do is talk about my recent experiences with the Australian health care system, and invite Americans to compare this tale with their own experiences and expectations in the USA.
On the 27th of December, I slipped on the stairs and, it turns out, broke my leg in three places.
We went off to Sir Charles Gairdner Hospital, I think the biggest emergency (and teaching) hospital in the city. (The other major one is Royal Perth; there are smaller hospitals dotted around the suburbs, of course, but those are the big ones. (Charlie's is the one nearest our house.))
We arrived at the emergency room at around 8:30 or 9am, I think. There were one or two people in the waiting room, but after a brief interview at the triage window, I was taken inside for examination, having been designated Fast Track.
Fast Track means your case is not critical, but *is* simple; when there's a free spot, you're taken to another room, inside, where doctors treat you promptly. From the times I've been there, usually everyone in Fast Track has some kind of painful, yet not life-threatening injury. If your case is likely to be more complex, you go to Observation, where there are many more doctors, and many more beds, and they're going to work out what exactly is up and how to treat it. (If you've arrived with a broken bone, or anything similar, there is a well-established protocol for how they're going to treat it.)
There's a big poster in the waiting room about their targets: the designated performance target for the Emergency Department is to have 85% of patients either admitted to the hospital or discharged from Emergency within four hours of arrival. Underneath, they write in how they're doing; when last I saw the board, they were at something like 76% overall, with 96% of patients who weren't admitted to hospital being released within four hours.
So. If you turn up at the busiest emergency room in the city, if your problem doesn't require hospitalisation, you've got a 96% chance of getting to leave inside four hours. If you do require admission, you've still got a 76% chance of being out of Emergency and in the hospital proper within those four hours, even taking into account time they may spend observing you and whatnot to make that decision.
Note that this does not mean that, if you require serious medical care, you are denied it - it just means that if it's not something that can be treated quickly and turfed out, the patient should be admitted to the hospital proper.
This is what happened to me. X-rays of my leg showed that I had snapped both my tibia and fibula just above the ankle joint, and the fibula again just below the knee. This qualified my injury as an "unstable fracture", which would require surgery to treat. A visit from the orthopaedic registrar followed. The ortho reg explained the surgery to me, and I signed some paper formally acknowledging my informed consent to the process, and I was wheeled out of Emergency to the fifth floor.
Sadly, I didn't get a private room - the hospital was under a fair amount of pressure for beds, as the private hospitals to which many private patients might have been transferred were all largely closed for the Christmas holidays.
Still, I was put into a room, a Jones Pillow was fetched to hold my ankle well elevated, and there I was in hospital.
It was three days before I had surgery - an ORIF procedure can't be done before the swelling has gone down, because you need enough loose skin to be able to close the incisions again. During those three days I was given gluten-free food that was really quite edible, and a steady supply of pain relief medication from friendly and pleasant nurses.
While I was waiting, I had a visit from a lovely woman from Occupational Therapy. She was there to discuss my equipment needs - what I'd require to be able to go home, and live my life safely. Around Thursday, I think it was, someone from OT went to my house to survey the situation - measuring distances, herself hopping from toilet to sink to couch, and suchlike, to calculate how exhausting it would be and what would be necessary in a given day.
Several of the people who passed through stays in my room were from outside the city - they'd been injured in deeply rural areas, and flown to Perth for treatment.
On the Friday I had surgery. I was wheeled to the OR's anteroom. Surgeons came over to introduce themselves, then the anaesthetists - two qualified doctors and a bashful-looking student. A few minutes later, I was taken into the OR itself, where more people introduced themselves - nurses, from the surgical an anaesthetic teams, mostly, giving me a sense of who this crowd of strangers was.
There were friendly, reassuring comments at my visible nervousness, people warmly telling me that it was okay, they did this every day, they knew this was strange and scary for me but it was totally normal for them, I'd be fine.
And then I was put under, and I woke up back in my room on the fifth floor.
Back there, the nurses supplied me with more painkillers, through the initial phase of post-surgical pain, than I would have thought possible. I had slow-release oxycodone, quick-release oxycodone, paracetemol, ibuprofen, and some tablets that I don't know what they were that you put under your tongue and wait to dissolve. They taste horrible, but they take effect really quickly, and are on a separate cooldown from the rest.
Thanks to this raft of medication, I was almost never in very much pain at all. Most of the time my freshly-drilled-into bones were a faint, easily-ignored ache in the distance.
On Sunday, it was decided by the doctors that I could go home. But, as the woman from hospital administration who came to see me explained, the physiotherapists and Occupational Therapy were refusing to sign off on my discharge.
"Yes, they talked to me about that yesterday," I said. "They want to make sure I'll be safe. They're coming later this morning to make sure I have the equipment for home, and the physio is going to be making sure I'm able to move around like I need to."
And so they did. The OT and physio brought a mobile wooden platform, so that I could, with assistance and supervision in the hospital setting, practice using a walking frame to hop up a low step - because there is a low step to be navigated in order to enter my house. Once I'd managed that properly, they assembled the equipment I was being assigned to take home with me.
This included:
- a seat with rails and so on to go over the toilet
- a shower chair
- a walking frame
The only thing they weren't supplying was a wheelchair. The hospital only provides those if you can't move without one at all, because they don't really have enough to do otherwise.
After that, all that was left was to wait for my medication bag. This was a plastic bag the size of a small pillow, containing a sharps container, thirty Clexane needles, and boxes of my anti-inflammatories and various painkillers.
Once that arrived, I was officially discharged. An orderly came to wheel me down to the hospital doors, while Dean, who had come to collect me, pushed the trolley loaded with the equipment and my bags, and so on.
A couple of days later a letter arrived, giving me the date of my next appointment at the orthopaedic clinic. I went to that, and got my stitches removed and a shiny new cast applied. In a few weeks I go back again, and get the temporary screw removed.
All of which amounts to a really quite excellent standard of care, I'm sure you'll agree. But would it bankrupt me? How much did I pay for all of that, you might wonder?
The answer: Absolutely nothing.
Not a cent. I was not presented with a bill, in person or by mail. Not even for the bag of medications to take away with me. No-one asked for anything except my name, my date of birth and my Medicare number.
And if you're American, don't be mistaken about what it means to have Medicare here. Medicare is not some special subset of care for old people, or poor people, or whatever it is there. In Australia, everyone has Medicare. Everyone. If you are a citizen or permanent resident of this country, you have Medicare. (If you're a tourist, the emergency room will take care of you anyway, by the way.)
How is it funded? Easily enough - when additional money was needed to pay for Medicare costs, the government introduced the Medicare Levy, which is paid alongside income tax, but is separate, because the Medicare Levy is only paid at all once you get above a certain income threshold. Effectively, the wealthy, who can afford and often have private health insurance, subsidise health care for the poor.
When this was introduced, the general reaction of the Australian population amounted to: "... That's fair."
The fact that the Australian government has a vested interest in health care costs has a raft of added advantages. Various medications that are sometimes necessary for people's survival, but which are very expensive, are subsidised by the Pharmaceutical Benefits Scheme; there are drugs which cost thousands of dollars a month, but which Australian patients will pay perhaps thirty dollars a month for - or less, if they have a pension or low-income Health Care Card. (Most of my meds are covered by the PBS; now that I'm on a pension, they're three or four dollars a month, where before they were over thirty.)
So if, for example, you're unemployed, the government further subsidises any health care costs you may be incurring.
Meanwhile, Medicare has a heavy market power with which to negotiate drug prices with the companies that manufacture them, which helps keep the costs down in the first place.
As of the latest statistics I can find, as a percentage of GDP, Australia spends 9.5% to America's 14.6%. Per capita, we also spend much less money in straight dollar costs. And our costs aren't rising as fast.
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THE MEGA CONSPIRACY
MEGA CONSPIRACY
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Idly
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Jan. 19th, 2012 @ 07:51 pm
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The Daily Show has a new correspondent - Jessica Williams.
I have no idea what her accent is - American, obviously, but, that's all I can pick offhand. But I really like it for no reason I can place specifically.
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So, the lurkers do *not* support me by e-mail - at least one person was somewhat annoyed by my suggestion that the SOPA blackout thing is annoying to we lesser races of the world.
This, in turn, is also making me annoyed. How bloody US-centric does your worldview have to be to decide that something like en.wikipedia.org, for example, is totally America's and that therefore if America has a political problem, then we have no right to be irritated by having Wikipedia blocked off?
Because obviously no-one from outside the USA has ever contributed or donated to Wikipedia.
And we're all absolutely obligated to believe that it's our problem that the American people have spent the last two hundred years selling their political process more and more completely to the highest bidder, even though we can't do jack shit about it, and Americans could but, on balance, don't.
Obviously.Current Mood:  annoyed
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SOPA/PIPA is a problem. I get that. I don't have a huge problem with the sites that are throwing up things about it which then let you get to the actual site.
However, as a non-American citizen who therefore can't actually do anything to encourage American lawmakers not to do this stupid, stupid thing, the sites that are blacking out completely can bite me.
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I'm not really reading my reading list at the moment, mostly because I'm spending a lot of time being really grumpy and I fear saying something I'll regret when I'm not.
I'm grumpy, of course, because of ongoing pain and inconvenience due to having a broken leg, as well as all my Hilarious Cast Adventures.
Put it this way - I broke my leg less than a month ago, and I'm on my sixth cast.
( Hilarious Cast Adventures, explained. )
Number six is doing okay so far, thankfully - but I'll be getting number seven on Thursday, at my next ortho clinic appointment. It's projected to last a few weeks before it has to come off too. After that, though, I should get a "removable boot", which will be awesome, because the prospect of being able to have a shower, a proper shower, without having to worry about keeping a cast dry is thoroughly appealing.
Not as appealing as the prospect of being able to stand on two feet or walk again, but that's much further away, and too depressing to think about. On the bright side, the muscles in my arms and my right leg have strengthened enough now that moving about as needed is no longer so painful and exhausting. (I'm not as fit as I'd like to be, but I don't really count it against my fitness levels that my muscles did not appreciate the radical changes to my methods of locomotion in the last few weeks - I was never going to be accustomed to hopping and/or holding my weight on my arms this much.)
This experience has brought home to me, mind you, the notion that the "not disabled" are better referred to as the "not yet disabled". I wasn't significantly physically disabled, but right now, I am, and it is, in fact, incredibly frustrating to deal with even when everyone around you pretty much couldn't be nicer, which I've been lucky enough that they have been. And it really is awfully easy to find yourself abruptly shunted into the Disabled category.
Accordingly, "poor wheelchair accessability" has become an issue about which I no longer am concerned with in the "Strongly, But Somewhat Impersonally" sense, but rather in the "No, Really, And With Personal Anger And Rage" sense. Because I used to just think it was important on moral and ethical and justice-type grounds, but now I have experienced the nature of life when a one-inch-high step that, walking, I wouldn't even notice, is actually a source of pain, exhausting effort and massive inconvenience, and really, it does make it all a lot more visceral.
I now feel, just a little bit, that anyone who gets pissy about providing proper wheelchair access to things should be provided with an unstable ankle fracture. Once you're a few days past surgery, they're not that painful - most of my pain now is muscle, knee and tendon-related, and a carefully administered break could avoid wrenching everything as badly as my fall did, and also avoid the extra broken bone I collected - and you don't get to walk for months.
I think it would serve as an excellent demonstration injury. Obviously, it doesn't cover anything *like* the full scale of what wheelchair-prompting disability can entail. After all, you can still move pretty well otherwise, and you have one working leg which makes a lot of things much, much easier. For example, I can get up off my wheelchair, using my working leg, and swivel around to get onto a toilet that has no lateral transfer access. I imagine that this is making my life vastly, inexpressably easier than if I couldn't.
Nonetheless, I do feel that it would do much to convey the point.
I was going to go on to the post I want to make about health care systems, but all this has gone on long enough that I think the other one needs to be a separate post. (I always prefer to make posts about Serious Topics separate from personal ones, in case people get linked to them.)
Especially posts in which I have been advocating the deliberate injuring of annoying people.
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Just below this, in the cut tag for this post, there is going to be a warning. I cannot stress enough how much I mean it, so I'm also going to say it in the actual post:
If you are squeamish, particularly about injuries, bruises, cuts, stitches, or anything like that at all, I advise against looking at the photos in this post. At all. Just don't do it, you don't want to see it. I used my phone to take pictures of my broken leg when the cast and stitches were removed, and they are pretty appalling, as far as legs go.
However, if you are not squeamish, and are interested in looking at the effects on the outward appearance of a human leg caused by breaking bones and surgical repair, then click away.
( No really I mean it if you are squeamish do not look at the contents of this cut. I'm serious. Don't. )
I now have another cast, a proper all-the-way-around one with the higher grade of plaster. It's even blue. I keep this cast for a month, and then it gets removed, everything gets checked, and then I get some kind of boot cast that's even removable so I can wash my leg and stuff. In the meantime, I'm to keep my foot elevated, so... yeah, I still live on the couch.
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My mother and I were just discussing a leaflet campaign she read of, wherein PETA allegedly asserted that the consumption of meat is responsible, among other things, for conflict in the Middle East, claiming that kosher and halal methods of animal slaughter were vicious and cruel and therefore made the conflicting parties more likely to slaughter each other.
Yes, I know.
Anyway, I remarked that, to the best of my knowledge, halal meat must be slaughtered humanely, or it's not halal. But then I realised that I don't know anything about kosher animal slaughter - despite having read quite a bit about it.
You see, the descriptions I read, which did claim to be fact, were 1930s Nazi anti-Semitic propaganda pieces, which you might say don't constitute a reliable source.
And I realised that I have quite a lot of data in my head that I've acquired, in the course of studying history, but which is mentally flagged as propaganda and which I therefore assume is probably not true. (Or, if it contains a kernel of truth, is nonetheless mostly not true.)
It's odd.
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So, in idle conversation today, possibly partly inspired by the fact that I was beating up many mans in Arkham City challenges, ![[personal profile]](http://s.dreamwidth.org/img/silk/identity/user.png) velithya and I semi-plotted a moderately cracktastic DCU AU.
In this one, Tim Drake, rather than simply being a heroic young badass, is in fact a badass young supervillain.
The reasoning goes like this:
Tim Drake is sufficiently awesome that, while still a child, he successfully stalked the goddamned Batman until he'd learned pretty much everything about him - including details that Batman's legitimate supercriminal enemies have yet to work out.
Tim Drake, essentially, out-Batted the Bat before he was old enough to vote.
Which means he could be a terrifying villain.
Since we're dealing with events surrounding Teen Titan types, clearly it has to be Kon who takes him on. (And because we're fangirls and adore Timmy, he'll have to redeem him with the healing power of his cock good and true heart, etc.)
(You have no idea how long I hesitated about that sentence, because as a joke it amuses me - remember, narcotics - but my mother reads this occasionally.)
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So, once again, I have a queue of posts to write in my head, that I haven't yet.
Right now, a brief musing on love and friendship and music and... things.
I have two truly amazing friends in Chas and Dean. And no matter what happens in my life - if things turn around and my life becomes tremendously awesome, if I go into politics and become Prime Minister, or anything like that, I will be loyal to no-one and nothing above them. (If I do go into politics, that will be a very good thing - they're both truly good people, and wouldn't let me be corrupt or corrupted. I'm Not Allowed to be immoral.)
It's sometimes hard to explain to other people why it's not that they're in charge of me, not my bosses or my parents, that it can be that I'm Not Allowed to do things they disapprove of - it's that they've earned the right to tell me what they think will be bad for me, and saying I'm Not Allowed is a shorthand for: if I do that, it will make Dean and/or Chas sad, and that will make me sadder than doing this thing will make me happy, so I cannot bring myself to do it. It's not that they control me, it's that they care about me, so they don't want me to do things that are unhealthy or dangerous or risky.
There's a Marilyn Monroe quotation, the key part of which is: "If you can't handle me at my worst, you sure as hell don't deserve me at my best." Chas and Dean have seen me at, and handled me at, and forgiven me for, my worst. (Forgiveness is part of it. For instance, yesterday I was miserable, and in pain - I had a fall, and everything hurt, and I was just in a foul mood, all upset in ways that manifested as directionless anger and resentment. I spoke sharply to both of them, and got annoyed at them for being concerned and sympathetic at me. They forgave all of this as a manifestation of pain and depression and general I-have-a-broken-leg malaise. This is not, in fact, the worst in me they've handled.)
I started thinking about all this because I was listening to Melanie Safka's People in the Front Row. I love the lines at the end.
These chords that I'm using are usually sad,
I had to use them they're the best chords that I had
Oh yeah, this progression is usually sad,
But it felt my sorrow and I wanted it to feel me glad
This is, in some ways, how I feel about my closest, most beloved friends: I want a better future, and I want to bring them with me, because they've felt my sorrow and I want them to feel me glad.
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So, prior times of major pain, I've been prescribed Panadeine Forte, a paracetemol/codeine mix. Which makes me loopy and pretty much high, because I am chemically sensitive and shit.
This time, I've been given Oxycontin. This is vastly, VASTLY better, because it just makes me sleepy and dopey. Mostly, it's safer.
Panadeine loopiness gets me all manic and IT WILL BE FINE, WHEE! about things. Oxycontin dopiness has me all sleepy and, "Uh, I don't think I can manage that safely, I'll stay here on the couch. zzzzz."
Apart from anything else, this is far less stressful for my loving friends and housemates.
For example, I wanted to put a DVD into my PS3. I decided that leaning down and reaching to do it was a little high-risk of losing my balance and falling, so I notified velithya of the situation and that I would appreciate her doing it for me when she has a chance. On the other drugs, she'd probably have had to be all "SAMI don't do that you're about to fall over" and have to yell at me over my protests until I stopped, and would probably have to interrupt her current activities to stop me.
An important part of integrating taking care of me into our household routines without being unfair to housemates is to maintain appropriate urgency levels. Changing the disk is not urgent and can wait until she's not busy doing something else; on OxyContin I recognise this and wait, rather than recognising that it's not urgent enough to interrupt her and therefore deciding to do it myself.
zzzzz.
Also, so far, Oxycontin does not annihilate my short-term memory.
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I will start replying to all the lovely messages soon, I hope, but I'm still pretty shattered.
Just made it to *my own bed* for the first time in what is technically just under a week, but feels like much, much longer. Pain and annoyance, oh yes, and trivial tasks have never been quite so exhausting.
There needs to be a word for those moments when you realise that, in the past couple of seconds, your life has just undergone a massive, massive change that you had not expected or wanted and which is irrevocable - those moments when you desperately wish life had save points, or even just an undo button.
For example, the moment when you realise that that sudden blur of motion and pain where you broke your leg in three places means that for the immediate future, everything is absolutely fucked.
Tomorrow's plan: moving as little as humanly possible. Tuesday: That, but also phoning around, working out how best to go about hiring a wheelchair. (Crutches aren't an option due to chronic shoulder injury already being aggravated by use of walking frame.)
At least they gave me a couple of boxes of Oxycontin to bring home, even if I don't get to have all the painkiller options available at the hospital.
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I AM NOT IN HOSPITAL ANY MORE
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Update
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Dec. 30th, 2011 @ 10:00 pm
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velithya here, just a quick note that Sami had her surgery today. Things went smoothly, although we're not sure exactly what kind (and quantity) of metal is in her ankle because the nurse couldn't read the doctor's handwriting and the orthopod himself didn't stop by yet (presumably because coming out of a GA tends to make one somewhat forgetful). Tomorrow morning we'll have a better idea of the specifics and when Sami can come home.
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Update
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Dec. 28th, 2011 @ 05:32 pm
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velithya here again. Sami wants to thank all of you for your kind words and well wishes - she's having trouble logging into Dreamwidth on her phone so she can't post or reply properly, but she's always found hospitals tough and your words have really helped keep her spirits up. Thank you!
Sadly things were too swollen for surgery today, so we have a new tentative date for Friday. We'll see how things go I guess.
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This is velithya updating on behalf of Sami. This morning she slipped coming down the stairs and broke her leg in three places - both bones at the ankle and one of them again up towards the knee. She's currently in hospital awaiting surgery; we're hoping that will be tomorrow morning but they can't operate until the swelling goes down, which could potentially take several more days. The top break should heal fine on its own, but she's looking at screws and potentially a plate inserted into the ankle (depending on how stable things are in the ankle when they get her into theatre).
At this stage she's doing okay, she has enough pain relief, and we're all crossing our fingers that the swelling is down enough for surgery tomorrow. Good wishes are appreciated!
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Idly: just short of a week ago, it was my birthday. The evening featured a full lunar eclipse.
Omens and portents, goodness me. It will either be the Best Year Ever or I am going to die spectacularly.
Meanwhile, modern operating systems need to get off my goddamn lawn.
When I was a kid - okay, it was the 80s, and most people didn't actually have home computers, but my dad was a programmer and we did. The OS of my childhood was DR-DOS. Later Windows 3.11 came into our lives, but I resisted using Windows until we got the Internet at home, because I've always hated change anyway and I just didn't like not having a command line. If I wanted to run something, I told the computer to run it, I didn't have to find it and click on it with this clumsy, awkward thing that was the mouse.
However, whether Windows was loaded or not, one thing remained true: if I hit alt-ctrl-delete (twice, depending), the computer would stop everything, kill all processes, and reboot.
These days? Modern OSes take alt-ctrl-delete as a suggestion, as a mild request for it to call up a response when it gets around to it, and dammit, that pisses me off no end.
When I press alt-ctrl-delete I want the computer to take that as a divine command. If I press it twice, that's an order to reboot, right the fuck now, and it never fails to annoy me if it doesn't.
Somehow, the almost inconceivable increase in power between the computers I used then and the computer I have now doesn't quite make up for the degree to which modern computers have attitude.
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So....
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Dec. 9th, 2011 @ 04:46 pm
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The man who played Draco on Xena: Warrior Princess is now on Play School.
I imagine this is a popular choice with Australia's mums - he was and remains very, very pretty.
Georgie Parker is also on, and she has a surprisingly lovely singing voice, but I'm watching for Draco.
Because he's still pretty.
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