AND AFTER ALL THE TESTS … Marilyn Armstrong

After Garry and I left our car with the valet at UMass Memorial, I looked at Garry and commented: “I should have just gone to an eye doctor.”

Considering all the testing and checkups, you’d think I’d have a diagnosis. Nope. I know just what I knew when this round of medical visits began. This was one of the times when two things happened at the same time. I wrongly assumed the two events were connected.

Back again

It’s a natural reaction. I had my little seizure, or what seemed like one and my vision went all funky at the same time. One plus one is expected to equal two, except when it remains one and one and they don’t add up.

Seizures? Not exactly.

I have narcolepsy. It’s one of the many reasons I don’t want to drive. One time, a few years ago I fell asleep while driving. The next thing I knew, I had an incident with a tree. I don’t know how far I drove (asleep) before I hit the oak. I also knocked off my rearview mirror somewhere en route to the big tree and no one ever found it.

It’s possible I drove for a mile or two (there was no traffic) before I drifted to the side of the road and conjoined with nature.

It turns out that narcolepsy can produce those weird sort of seizures I had and one of the ways you can tell it was not a real seizure is that it leaves nothing behind. You aren’t groggy or muddle-brained. It’s literally as if nothing happened. I remember once in the middle of a home barbecue, I collapsed in the hallway. On further checking, I had fallen asleep and just fell in a heap on the stairwell. Everyone thought it was funny. I didn’t think it was all that funny, but I didn’t know I had narcolepsy.

It can be a difficult problem to diagnose. My shrink finally nailed it.

Ever since I hit that tree, I’ve been wary of driving. It’s why I always have a stash of amphetamines with me. It’s no big deal if I fall asleep at home — as long as I don’t hit my head or face on something on my way down. Which I have also done. In that case, I was walking, said I felt funny, but apparently kept walking (but not awake) into a door frame. That time I also woke up screaming but with good reason. I split my face open. It required some interesting stitching of nose and lips … and a missed interview for a job I wanted.

I also was a serious sleepwalker for many years. I don’t think I still sleepwalk because it’s too hard to get out of bed … but when things go really missing and I eventually find them in some strange place, I suspect I did it while asleep. My granddaughter also sleepwalks. Is it genetic?

It never crossed my mind that all of these events were part of the things narcolepsy does, but that’s what they’re telling me.

The narcolepsy is not new. I have spent many hours sleeping in my car by the side of the road because I knew I was going under, only to be woken up by the cops telling me it’s illegal to sleep by the side of the road.

I would point out that this is exactly what they tell you to do if you feel you cannot continue to drive. It’s in all the books on safe driving. Nonetheless, they immediately tell me I have to move along. Have they missed the part where I say I was too tired to keep driving and had to stop or I was going to have an accident?

Stupid is as stupid does.

So that’s the story of the seizures. They aren’t seizures. They are my narcolepsy acting up, usually on a day when I not taken amphetamines. They don’t make the problem go away, but for at least four or five hours, they keep me reasonably alert.

Finally, the strangest part of narcolepsy is that you may have symptoms of its approach (intense sleepiness), or you may be hit by waves of dizziness. Or a sudden upset stomach. Or you are fine and fall over. Asleep.

It’s not a disease, though it is a condition and while the amphetamines help for short periods when I absolutely must be awake, it doesn’t cure anything.

Nothing cures it probably because they aren’t entirely sure what causes it. They have theories, most of which seem to involve sleep apnea except I don’t have sleep apnea. I do have exactly the right kind of insomnia, though. The kind where I fall asleep directly into a dream, then wake up every two hours until finally, a nightmare makes me decide sleeping isn’t a good idea and anyway, the dogs are barking.

What about my eyes?

It’s probably (drumroll) … cataracts. My right eye is relatively clear, but my left eye is cloudy.

I’m 72. Garry was treated for cataracts when he was barely 60 and my father had cataracts years before me. Actually, everyone gets cataracts sooner or later. Dogs, cats, and horses, too. I’m just a bit late, but by age 75, everyone either has cataracts or has had the surgery. It is THE most widely performed surgery in the world. They expect to perform around 30 million cataract surgeries next year. That’s a lot of surgeries.

You get old? You get cataracts. You can also get cataracts without getting old. Some babies are born with them.

There are no eyedrops of any other form of correction for cataracts other than surgery. You get them repaired or you don’t. If you don’t, eventually you can’t see.

So my next doctor is the ophthalmologist. It would appear that I may not need new glasses. I may need new eyes. Which sounds like a good idea. Garry and Tom both have had the surgery and they LOVE their new eyes. Finally — NO glasses.

Wrapping Up: Coincidence is not a sign from the Universe

Just because two things happen at the same time doesn’t mean they have anything to do with each other. We all read too many mystery novels where everything is a clue. This is particularly important when you are dealing with physical symptoms. Simultaneous doesn’t mean causative.

And this is also what’s wrong with having so many specialists who only look at your wrists or fingers or hips, but not your spine, brain, or eyes. I think most of us need someone who will look at all the stuff going on who can then tweeze the pieces apart and figure out what is really wrong.

Dr. House, come back! I need you!

SLEEPLESS ELECTROENCEPHALOGRAM TOMORROW! THE FUN NEVER STOPS! – Marilyn Armstrong

I’ve got a “sleepless” EEG (electroencephalogram) tomorrow morning. It means I can’t go to sleep until midnight and I have to be up by four in the morning and be at the hospital by eight in the morning. No caffeine, but I can have breakfast.

I don’t know how to have breakfast without coffee. What am I supposed to eat? Without coffee, am I supposed to cook? Like … food?

I suppose it will be something to do while I have to wait to leave for the hospital. Do I need to tell you how much I’m not looking forward to this?

So please do not be surprised if I don’t make comments in the morning or write much. I am likely to go back to bed. Quite probably Garry and I will both go back to bed. Except I will have to take a shower and wash my hair first because they use a kind of glop to attach the electrodes to my head and I have to wash it out or it will turn to cement and I might never get it out of my hair.

Meanwhile, no one has called to give me information about last week’s echocardiogram. I called the office and she pointed out if there was anything wrong, they would have called me. So I can assume if there is anything amiss, I’d already know it.

I guess I’ll stop worrying.

Now all I have to do is worry about surviving without coffee and getting the goop out of my hair.

It’s going to be a really terrific day. And a great night, too. I can hardly wait. The high point of this day was that the hospital called me — a human BEING called me — to remind me about the test. A real live person called and asked me if I was going to be there. I said yes and she said “Great!” We both hung up.

Wow. A living person called me. How often does THAT happen?

WORLD WITHOUT WI-FI? – Marilyn Armstrong

FOWC with Fandango — Wi-Fi

Although we have managed to remove cable television from our lives, you just can’t do without wi-fi. As a result, Charter/Spectrum’s wi-fi now cost more than their entire cable package used to cost. $76 for a $10 telephone and the rest, wi-fi.

For the moment. I’m sure it will cost more soon enough.

Considering that wi-fi is no longer a luxury for most people, maybe it’s time to set some controls on how much it costs? It used to cost $30, then $40, $50 and now, $65. Next year, the sky is probably the limit. I bet before we hit 2020, I’ll be paying more for JUST the wi-fi than I was paying for the whole cable package. And we only have ONE source here. We can pick Spectrum (Charter) or nothing. When you live in a small town, you don’t get lots of choices.

There are at least some regulations on electricity and other basic utilities. How about some kind of regulation for wi-fi?

Photo: Garry Armstrong

I’m going to be (again) at UMass today. Transthoracic Echocardiogram. I hope I’m in and out quickly, but you never know. It depends on what they see. I would much prefer they see everything ticking along like the proverbial clock.

It’s all “ultrasonic transducer.” At least something works without wi-fi! If they let me look at the pictures, I’ll be happy. I like it when I can see what they are seeing.

A GOOD NEWS-BAD NEWS KIND OF DAY – Marilyn Armstrong

Hypertrophic obstructive cardiomyopathy.

That’s what was wrong with me.

I had my heart surgery 4 years 11-1/2 months ago. As far as I knew, I never got an explanation of what exactly was wrong with me or what was done during the surgery. I didn’t know I had TWO valve replacements until a few weeks ago and I don’t know which artery was bypassed during my bypass.

To be more technical, the surgeon apparently explained everything, but I was so heavily drugged I’m not sure if I was awake for the explanation. I know I missed the whole thing about the second valve replacement because my best friend knew about it, but I didn’t. She wasn’t floating on Fentanyl.

The good news? UMass and Beth Israel are now connected so they can get my medical records. Eventually, it might sift down to me.

The bad news? My son needs to be checked for the same problem. His father died from heart-related problems as did both of his grandfathers and only luck kept me from sharing the same fate. So he has reason to be concerned about the condition of his heart. His father was only three years older than he is now when he died.

So, you ask, what exactly is “hypertrophic obstructive cardiomyopathy”?


From the Mayo Clinic: Overview

Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle (myocardium) becomes abnormally thick (hypertrophied). The thickened heart muscle can make it harder for the heart to pump blood.

Hypertrophic cardiomyopathy often goes undiagnosed because many people with the disease have few if any, symptoms and can lead normal lives with no significant problems.

However, in a small number of people with HCM, the thickened heart muscle can cause shortness of breath, chest pain or problems in the heart’s electrical system, resulting in life-threatening abnormal heart rhythms (arrhythmias).


NOTE: I had no symptoms that I noticed — which is not the same as not having symptoms. If it weren’t for my primary doctor’s alarm at the sounds my mitral valve was making, followed by serious testing that I had done at another hospital because the cardiologist to whom she sent me suggested I not worry about it until I had serious symptoms.

In this case, the serious symptom would have been sudden death, so I’m glad I realized the man was a jerk and went elsewhere for care. Even after all the testing, no one had any idea how serious the problem was until I was already in surgery. At which point, it was oh so clear.


I did not have chest pains, but I did have serious
shortness of breath.

Since I had asthma, I assumed my shortness of breath was asthma acting up. But I was wrong. It was not asthma but my ventricle packing its bags and trying to leave home without me. This is one of the problems of having multiple issues. Symptoms can (and do) overlap.

It’s really easy to assume that the problem you’re having is something familiar — like asthma. Except — shortness of breath can mean many different things. Heart disease is only one of them.

I once badly misdiagnosed a dog who had a known problem, but her problem was not the one I thought she had but something else. She died. We never found out what killed her, even after an autopsy. We assumed it was Lyme, but we never got a firm diagnosis. Lyme is funny that way.

Moreover, I never imagined I had a heart problem because my father’s heart problem was asymptomatic. As mine was until suddenly, it wasn’t.


Symptoms

Signs and symptoms of hypertrophic cardiomyopathy may include one or more of the following:

            • Shortness of breath, especially during exercise
            • Chest pain, especially during exercise
            • Fainting, especially during or just after exercise or exertion
            • Sensation of rapid, fluttering or pounding heartbeats (palpitations)
            • Heart murmur, which a doctor might detect while listening to your heart
Causes

Hypertrophic cardiomyopathy is usually caused by abnormal genes (gene mutations) that cause the heart muscle to grow abnormally thick. People with hypertrophic cardiomyopathy also have an abnormal arrangement of heart muscle cells (myofiber disarray). This disarray can contribute to arrhythmia in some people.

The severity of hypertrophic cardiomyopathy varies widely. Most people with hypertrophic cardiomyopathy have a form of the disease in which the wall (septum) between the two bottom chambers of the heart (ventricles) becomes enlarged and restricts blood flow out of the heart (obstructive hypertrophic cardiomyopathy).

Sometimes hypertrophic cardiomyopathy occurs without significant blocking of blood flow (nonobstructive hypertrophic cardiomyopathy). However, the heart’s main pumping chamber (left ventricle) may become stiff, reducing the amount of blood the ventricle can hold and the amount pumped out to the body with each heartbeat.


Risk Factors

Hypertrophic cardiomyopathy is usually inherited. There’s a 50 percent chance that the children of a parent with hypertrophic cardiomyopathy will inherit the genetic mutation for the disease. First-degree relatives — parents, children or siblings — of a person with hypertrophic cardiomyopathy should ask their doctors about screening for the disease.


Complications

Many people with hypertrophic cardiomyopathy (HCM) don’t experience significant health problems. But some people experience complications, including:

            • Atrial fibrillation. Thickened heart muscle, as well as the abnormal structure of heart cells, can disrupt the normal functioning of the heart’s electrical system, resulting in fast or irregular heartbeats. Atrial fibrillation can also increase your risk of developing blood clots, which can travel to your brain and cause a stroke.
            • Sudden cardiac death. Ventricular tachycardia and ventricular fibrillation can cause sudden cardiac death. People with hypertrophic cardiomyopathy have an increased risk of sudden cardiac death, although such deaths are rare. Sudden cardiac death is estimated to occur in about 1 percent of people with HCM each year. Hypertrophic cardiomyopathy can cause heart-related sudden death in people of all ages, but the condition most often causes sudden cardiac death in people under the age of 30.
            • Obstructed blood flow. In many people, the thickened heart muscle obstructs the blood flow leaving the heart. Obstructed blood flow can cause shortness of breath with exertion, chest pain, dizziness, and fainting spells.
            • Dilated cardiomyopathy. Over time, the thickened heart muscle may become weak and ineffective in a very small percentage of people with HCM. The ventricle becomes enlarged (dilated), and its pumping ability becomes less forceful.
            • Mitral valve problems. The thickened heart muscle can leave a smaller space for blood to flow, causing blood to rush through your heart valves more quickly and forcefully. This increased force can prevent the valve between your heart’s left atrium and left ventricle (mitral valve) from closing properly. As a result, blood can leak backward into the left atrium (mitral valve regurgitation), possibly leading to worsening symptoms.
            • Heart failure. The thickened heart muscle can eventually become too stiff to effectively fill with blood. As a result, your heart can’t pump enough blood to meet your body’s needs.
Prevention

Because hypertrophic cardiomyopathy is inherited, it can’t be prevented. But it’s important to identify the condition as early as possible to guide treatment and prevent complications.

Preventing sudden death

Implantation of a cardioverter-defibrillator has been shown to help prevent sudden cardiac death, which occurs in about 1 percent of people with hypertrophic cardiomyopathy.

Unfortunately, because many people with hypertrophic cardiomyopathy don’t realize they have it, there are instances where the first sign of a problem is sudden cardiac death. These cases can happen in seemingly healthy young people, including high school athletes and other young, active adults. News of these types of deaths generates understandable attention because they’re so unexpected, but parents should be aware these deaths are quite rare.

Still, doctors trained in heart abnormalities generally recommend that people with hypertrophic cardiomyopathy not participate in most competitive sports with the possible exception of some low-intensity sports. Discuss specific recommendations with your cardiologist.


If this wasn’t a good news-bad news day, I don’t know what would be. The good news? All things considered, I’m doing fine. As far as I know, the valves are doing their valve-thing.

I’ve got 8 years — 5, realistically — before I’ll need a replacement battery. I also learned why I will never be able to live without a pacemaker. I had thought that maybe my heart would start doing the job all by itself one day, but that will not happen. But, assuming the rest of the tests next month indicate that all is well, I need to worry about my son, not me.

I think I’d rather worry about me.

If there is a moral to this story, it’s don’t self-diagnose. If you think something is wrong, don’t assume you have the answer. The odds are, you don’t. The internet is a good place to look up an existing diagnosis, but a bad place to get a new one. If it turns out your best guess was right, congratulations, but this is one of those times when an error can prove fatal.

I still think this problem wouldn’t have become such a life-threatening issue had I not also inherited my mother’s breast cancer. The drugs they feed you when you have cancer … well … I’m not even sure the doctor’s know what they do.

For the avoidance of goriness reasons, I decided you don’t need more pictures. You can always Google this yourself and see all the gore you want.

INTREPID BY ROAD – Marilyn Armstrong

FOWC with Fandango — Intrepid

Intrepid will always be the name of one of Horatio Hornblower’s ships. Somewhere in my 20s, I discovered Horatio Hornblower … and that’s how I learned that there was an actual use for trigonometry! If only they had mentioned this in school, I might have had a clue what I was doing instead of random calculations used to reach an answer that meant absolutely NOTHING to me.

We probably should have named The Duke “Intrepid.” He is quite the intrepid voyager. Except he likes when we come out and let him IN the yard, even though he jumped out. I guess out is easier?

Today I am off to see the wizard, also known as my cardiologist. He’s a new one. I’m trying to finally shake off Boston and get all my physicians lined up locally. Boston made the news the other night as officially (who is the official calculator of such things?) having the worst traffic of any city in the U.S. Not in the world. I think there are quite a few cities in Europe (and how about the traffic in London!) that could compete.

Boston has gotten terrible. When I moved here in 1988, traffic wasn’t great, but you could get from one place to another and generally even park when you got there. Not any more. Not only can it be impossible to get there, but if you do parking will cost the price of feeding two people for a week. Or more.

Bad. Very, very bad.

We spent something like 50 billion dollars to remodel our road and I swear they are worse than they were before we spend more than a decade redoing everything. The thing is, they move things around, but they didn’t make them bigger. Just stuck them underground (cough, cough, cough) or straightened out the crooked pieces.  So we’ve got nice straight bumper-to-bumper traffic.

Boston traffic is only for the intrepid.

We’re away shortly. As we head for UMass, a mere 20 miles away, call us intrepid. Also, please hope they don’t find anything new or interesting.

WHO IS RUNNING FOR GOVERNOR IN MASSACHUSETTS? – Marilyn Armstrong

I had to look it up. I actually didn’t know who else was running for governor. Shame on me.

Shame on us!

We were watching the millionth advertisement for Charlie Baker, our current governor. He’s a Republican, but not the kind you find in Washington D.C. Massachusetts’ spawns very liberal Republicans. They are so liberal, it’s can be hard to figure out to what party they belong.

Our Republican governors run on everybody’s money — Democrat and Republican — because he manages to be nice to everyone, or at least nice enough to keep them on his side, more or less.

Charlie Baker is not a bad governor or a bad guy. He has basically followed the path of previous governors, except he has been more parsimonious. He hasn’t done anything very different from other governors or “Republicanized” our laws. He briefly waved at supporting Trump and the Commonwealth of Massachusetts came down on him like a mountain.

He backed off faster than a speeding bullet. This is the bluest state in the U.S. and a really red Republican was not going to do well here.

Since then, he has streamlined the budget until we now have a billion dollar surplus in the state treasury. Golly! That’s a fair bit of change. I have nothing against dealing wisely with finances. But where is the money coming from?

On the surface, a billion buck surplus sounds great, right?

Except in order to accumulate that billion dollars, he simply stopped doing stuff which urgently needs doing. The roads have gone unpaved. The rails are downright unsafe. Bridges are crumbling.

We are short 13,000 nurses statewide and many hospitals have closed. There are large areas without any local hospitals and barely any doctors.

Fall at UMass Amherst

The University of Massachusetts is as expensive as many private universities — and that is for people who are Massachusetts residents. The curriculum has been cut, too.

Meanwhile, our public schools are not improving. In another effort to financially cut back, MassHealth, our state’s version Medicaid has been slashed. A lot of people who have no other medical insurance now are forced to pay some dollar amount monthly.

It usually isn’t a lot in gross amounts but it can seem an awful lot to a family who depends on it. Still, compared to other American states, it’s about as good as American medical care gets. It even includes some care for eyes and teeth! It used to have more, but each year there’s less.

So then, I asked Garry which Democrat is running against Charlie Baker? He said “Someone with a Spanish last name,” but he couldn’t remember the actual name. Jay Gonzalez hasn’t had any television ads — or at least we haven’t seen them. None.

Basically, we have a choice of voting for Charlie Baker or someone about whom we know nothing because he apparently has no war chest for getting out the vote.

This bothers me.

I should at least know who else is running. It shouldn’t be that one guy has all the money, all the advertisements, all the endorsements, so naturally, we all vote for him. That’s not how it’s supposed to be.

The thing is, with all the advertisements about the great things Charlie Baker has done, he hasn’t done anything in this part of the state. The bridges are as bad as ever. The roads are worse. The schools are mediocre, ranging to pathetic.

BOSTON, MA. – SEPTEMBER 26: Gubernatorial candidate Jay Gonzalez speaks to media at The Massachusetts Statehouse on September 26, 2018, in Boston, Massachusetts. (Staff Photo By Patrick Whittemore/Boston Herald)

All public schools teach is how to pass required tests. Students learn nothing. They memorize what teachers expect to find on the exams. Good memorizers get good grades. Not such good memorizers do poorly.

Bad teachers, not enough teachers, huge classes. A lot of kids fall by the wayside.

When money goes to “help” schools, it always goes to some “charter school” in Boston or suburban Boston where the leaves are green and so is the money. And, because the population in Worcester county doesn’t come close to Boston or any of the areas near it, we can vote our hearts out, but unless it’s a local representative, we don’t have much effect on the election. Essentially, unless it’s a very local representative, our votes don’t count. Not nationally or regionally.

Areas with very with small populations don’t get much say in American politics.

So I’m voting for the other guy.

Because when I look at Charlie Baker’s slick advertising? What I I see is Boston. I see him cutting the bottom out of our upper and lower educational systems, failing to help improve our medical facilities, not helping the nursing schools engage students or helping hospitals pay for more nurses. I’m sure we can get him to pass a law about it, but that won’t solve the problem and will probably make it worse because the rest of the issue is that we need nurses and the money to pay them. And a law isn’t going to make that happen. Laws need funding and enforcement and some concept of the potential side effects of the law.

We have a habit in this state and this country of passing laws and then trying to figure out how to make it work. On a national level, sometimes this works, but mostly, it doesn’t work anywhere. Passing laws is not a single-layer job.

Even though I’m voting “no” on mandatory nursing ratios, it’s not because I don’t believe our nurses deserve a better deal but because I live in an area where there are very few decent hospitals. If mandatory nursing ratios force another 200 hospitals to close and any of them is in Worcester County,  it’s going to be hard to get into a hospital. I’d rather have overworked nurses than no place able to care for me.

For some of us, this is a life or death set of issues in this election and I’ve decided I want to live.

WHEN THEY CLOSE YOUR HOSPITAL, POLITICS DON’T MATTER – Marilyn Armstrong

We don’t seem to be having much luck talking national politics. We have rigidified our views in these areas, so there is no conversation possible. Nonetheless, there is stuff to talk about and a lot of is hits much too close to home.

Entry

Each state has its own unique ballot questions. While these issues are statewide, the subjects involved affect many places not only in this country but worldwide. While no two places have precisely the same issues, many problems are similar enough. The states watch each others’ ballot issues — both on how they are fought and to see how the solutions do or don’t work.

This year, Massachusetts is trying to vote on government-mandated Nurse Staffing Ratios for hospitals. The Nurse’s Union put the issue on the ballot because nurses in many hospitals are greatly overworked. Not only are the nurses exhausted and underpaid, but tired, harried nurses make mistakes. Some of them are fatal.


According to a recent study by Johns Hopkins, more than 250,000 people in the United States die every year because of medical mistakes, making it the third leading cause of death after heart disease and cancer. — Feb 22, 2018

No one could reasonably argue that nurses are not overworked. Except for Intensive Care Units where nursing ratios are tightly controlled, Massachusetts does not have mandatory nurse-to-patient ratios. In the U.S., the only state that has state-mandated ratios is California.

From inside looking out at UMass Memorial Hospital

The problem is, that Massachusetts doesn’t have enough nurses. Forget, for a moment, whether or not the hospitals could afford to hire enough nurses. We don’t have them to hire.

Almost anyone who wants to go into nursing can get a full scholarship. The shortage of nurses has been an issue for many decades. Nursing was a popular choice for women when I was a kid, but by the time I was an adult, women were beginning to think that if they were going to do the work, they might as well become doctors.

In an attempt to get a better grip on the subject, we had a conversation with our doctor. Garry figured he probably had a pretty good sense about it.

He thought for a while, then he said “It would probably mean closing at least 200 hospitals around the state … most of them in areas like this one where we don’t many hospitals.” Rural areas have very different issues than big or even medium-sized cities.

There’s the fundamental problem.

Milford Hospital from the Dana-Farber

Nurses — when we have recent graduates — want to begin careers in places where salaries are better (who doesn’t?), facilities are more advanced, and there are reasonable opportunities for professional growth. They don’t choose little hospitals in the middle of Worcester or Hampden counties.

“The hospital closures would,” our doctor commented, “make it very hard to find places to put patients.” Like me, I thought.

It’s not that he doesn’t think nurses are overworked. We all think they are overworked. I don’t think that’s even an issue. The problem is (1) where are we going to get all those nurses, and (2) how are we going to pay them?

What’s the answer? We are missing approximately 13,000 nurses. If we vote for government mandated nursing ratios, will the government also provide the nurses and money to pay them? A lot of hospitals are operating on a shoestring already. It wouldn’t take much to push them over the edge.

We have the same problem with teachers, police, firefighters, and medics. They work hard and they don’t get paid well. We are short of libraries and librarians and a lot of other things, too, like functional railroads and bridges that won’t collapse. Roads that urgently need paving.

It’s not like we don’t know about the problems. It’s just that we can’t always fix them by passing laws. There are secondary and tertiary problems that result from “just pass the law and work it out afterward.”

In rural areas — like ours  — if you close one hospital, there’s a very good chance there will be no place to go if we get sick or have an emergency. Boston is more than 70 miles away through very heavy traffic. Some of our “local” hospitals are not places you’d want to be if you had a serious problem.

As I am coming to realize in our personal lives, you can’t always fix the problems. Even when you know what the problems are and what needs to be done, that doesn’t mean you can make it happen. Unlike the federal government, states can’t just raise the deficit.

Putting aside all of our national problems, we still need to bang our heads together and figure out sensible solutions to problems that face us personally.

When you live in the country, these problems are at least twice as difficult to manage as they are in Boston. Hospitals are big business in Boston — and yet even there, they are merging many of the biggest and best facilities to stay solvent. Or nearly solvent.

Out here, we don’t have many hospitals. They have already closed most of the smallest ones. Unlike Boston where they make their budgets by giving parking tickets to any car that pauses too long at a stop sign, we have to live on property taxes that are already very high … too high for many of us. We don’t have enough police and if there’s a big fire, all the towns have to get together to fight it because no town has enough professionals

We have a Fire Chief, but firefighters are 90% volunteers. And some of the smaller valley towns don’t have a fire department at all. Uxbridge has a pretty good fleet of fire trucks and a new firehouse in town … but we don’t have a professional staff. For this, we — and our nearby neighboring towns — depend on volunteers.

But sick people? We have a plenty of them.


For more information, see Nurse staffing ratios: What is the 2018 Massachusetts ballot question all about?