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This is as sad as anything else I have seen in a long time. A woman in her mid-thirties came in to my ER with a near-completion of a suicide attempt. Her husband reported to me that she had been diagnosed with bipolar disorder for a number of years, and had been doing extremely well on medications -- well enough to get married, start a career, and have a family.
Unfortunately, their family had hit some hard times and both she and her husband were temporarily out of work. He found a new job, but during the transition their health insurance lapsed. Her psychiatric medications, all brand-name, were terribly expensive, and money was tight around the house. So they made the decision that she would go off her meds, just for the couple of months until his new insurance kicked in. The risk seemed pretty small, since she had been doing so well for a very long time.
The first few weeks off the meds were not too bad, though she was moody and irritable. They had a fight a couple of weeks later, and then another. But other than that, there didn't seem to be any indication that she was slipping off the cliff. Then, after a fairly minor disagreement with her husband, she went and did something impulsive, with no warning.
And that's when she came in to see me.
After a short course in the hospital, she succumbed to her self-inflicted injury.
The sad thing, other than the terrible human tragedy, was how unnecessary this was. Why on earth did they think she could go off her meds? That was a bad decision on their part, but the consequence was an undeserved death sentence. Didn't they know they could apply for a free supply of meds from the manufacturers? Didn't they think of going to their church, or some other charity source for assistance? Couldn't they have gone back to her mental health provider to see if a cheaper prescription was available for the short-term?
But they were not sophisticated, medically, and didn't think of these options. They were self-reliant, figured this was their problem and they would figure out a way to get through it. They made the wrong choice, and now she is dead, and their children have no mother.
This is what makes me nuts about this whole universal health insurance debate. You have the folks on the right who deny reality and claim that those who are uninsured "choose" to be uninsured and that we shouldn't force people to pay for coverage they don't need or want. The conservative ideologues who theorize that the problem is that Americans have too much health insurance and what we really need is to let patients make rational decisions about where to allocate their health care dollars. The traditionalists who like their employer-funded health care plans who are afraid of severing the link between employment and health insurance.
This case, in a nutshell: a real, actual person whose life was lost due to our insane patchwork health care system. This case is an example of why we need fundamental reform of our health care system. One life is just an anecdote, I know, but writ large, how many times does this happen annually among the 60+million who are uninsured at some time in any given year? What is the gross morbidity and mortality that our insurance system exacts from our society?
Employer-based health care is great, so long as you are stably employed. If you lose your job, your health is at risk. Or you face the devil's choice of paying the mortgage or paying for your meds (or COBRA coverage). While I understand the general resistance of Americans to part with the known and understood health care which their employer pays for, a system which ties employees to a job for the insurance, which burdens employers relative to their foreign competitors, and which has no realistic provision for the newly unemployed to retain health care is both callous and stupid, from a policy perspective.
Despite the rhetoric regarding "patient directed health care," the truth is that patients do not always make rational decisions. Patients will, not in all cases but with a knowable statistical likelihood, forgo needed care, spend money on the wrong priorities, and generally lack the knowledge base to decide how best to spend their health care dollars. (Even if there was price transparency, which there is not.) This is not to say that patients are incapable of making these decisions, but that the consequences of shifting this burden onto patients does have a direct human cost.
It is fairly clear that, with the incoming Obama administration, the consensus is building towards a fundamental restructuring of the health care funding system. The designation of HHS Secretary Daschle, in addition to the Baucus white paper and the Kennedy committee are clear signals that the Democrats are serious about moving forward. The labor movement has found their strange bedfellow in the small business association, and even the medical lobbies are cautiously in favor. There's a lot that can go wrong, and a lot of heavy lifting to be done to transform the rhetoric into reality. I can only hope that they are successful, and that they do it right.
There are a lot of people whose lives may depend on it, even if they do not know it. It's too late for one patient and her family. Their children are eight, five, and two years old.
08 December 2008
Uninsurance claims a life
This is as sad as anything else I have seen in a long time. A woman in her mid-thirties came in to my ER with a near-completion of a suicide attempt. Her husband reported to me that she had been diagnosed with bipolar disorder for a number of years, and had been doing extremely well on medications -- well enough to get married, start a career, and have a family.
Posted by shadowfax at 9:52 AM
43 comments:
Their problem wasn't lack of insurance, it was lack of JOBS to earn money to pay for medications. I'm sure they were eligible for COBRA, but they evidently chose not to purchase it. I doubt they could have paid for "government insurance" either, so their fellow citizens would be responsible. But what if the expensive brand name medications weren't on the government list (like how Medicaid doesn't cover Zofran).ReplyDelete
You sir, are a fear-mongering ideologue.
For the first time in my life I have found myself in the position of potentially being without health insurance. My husband and I are divorcing. The divorce is not final until January, so for now I am able to stay on his insurance. After that I will be forced to pay for COBRA for as long as I can manage it. I had hoped to get a benefited job with my employer, but due to the economic downturn my employer (a government agency) is about to institute a hiring freeze.ReplyDelete
We are lucky in California (as in most states I believe?) to have free health insurance for children, so my kids are covered by an HMO under Healthy Families (I make just a smidge too much money for them to have ordinary state insurance) for a mere $12 per month of my money. This is very lucky for us, especially since my oldest has cystic fibrosis and bipolar disorder and requires thousands of dollars in medication, and multiple doctor visits, each month.
Unfortunately for me, making too much money (even though I am just over the poverty line and can't even afford to pay my rent) disqualifies me for state insurance for myself, and there is no Healthy Families available for moms unless they are pregnant. This state fundamentally fails parents... They'll cover my kids but make no guarantees that their mother will be able to have health insurance. What's wrong with this picture?
I am very fortunate that I can hang onto my ex's insurance for myself, but once the COBRA term runs out (18 months I think?) I will be out of luck. Let's hope the economy will be better by then and I can get into a benefited position. (I'm not holding my breath!)
It's true that many drug manufacturers offer savings programs. Also, many pharmacies offer prescription savings plans, but these usually only help substantially with generic medications. The fact is that people need not go without their medications even if they are uninsured, but the only reason I know these things is that I have a kid with multiple medical conditions and have educated myself about it. Many people, as illustrated in your example, are not knowledgeable about these programs, as imperfect as the programs are.
Something needs to change in our health care system for sure. I have no idea what the perfect solution is, but what we are doing right now is not working.
All the resources you note -- "The sad thing, other than the terrible human tragedy, was how unnecessary this was. Why on earth did they think she could go off her meds? That was a bad decision on their part, but the consequence was an undeserved death sentence. Didn't they know they could apply for a free supply of meds from the manufacturers? Didn't they think of going to their church, or some other charity source for assistance? Couldn't they have gone back to her mental health provider to see if a cheaper prescription was available for the short-term?"ReplyDelete
So very sorry for the outcome, especially feel sorrow for her children.
"You sir, are a fear-mongering ideologue."ReplyDelete
From you, I take that as an compliment -- indeed, praise from Caesar!
"their fellow citizens would be responsible."
I see you have finally grasped the subtle intricacies of National health care! Congratulations!
Sorry to hear about your troubles, and good luck to you in your own hard times.
Heh. Fear is the path to the dark side.ReplyDelete
If we ever have universal healthcare foist upon us, I eagerly await your "Rationing Claims Another Life" series.
What a gbreat blog so heartfelt. he comments are interesting too.ReplyDelete
Scalpel writes "they chose not to purchase it" meaning COBRA. This statement put the blame back on the family.
Quite often a mother and or father will put their children's needs before their own. I have done it several times myself in the last year. Putting medication on hold until pay day. Because I believe feeding my kids, and having enough money for my son to bus to school is imperative.
Pride, or independence can stop a person for asking for help. When a person already feels they have been a drain they don't want to be asking for more from their friends or family. In my case my father has recently died, I don't have a mother and my siblings live overseas.
I had a close friend commit suicide leaving her 3 year old daughter behind. The night before she said to me she thought she was a bad Mum.
She had not long been diagnosed with Depression and a few other things. She tried to get help, doors were closed on her for three months. She wasn't Bad enough, she had attempted suicide 3 times in this short period of time. So she hung herself. She hung herself because she believed she could no longer look after her daughter, it was a image I cannot get from my mind..
I am not condoning any of her actions. We have "free" medical care here. Well the hospital is yet people still are dying.
When people are in a desperate situation they don't always think rationally. In this poor woman's mind she may have thought her family may have been better off. I don't know. It's sad either way.
I don't though agree with blaming statements. "They could have done this, or that", "She could have left him" "He is just attention seeking". If you place blame or labels on people do you think that they will rationalise what your saying, or will the opposite happen, where they feel even worse, hopeless, or useless, and either kill themselves, or stay in a bad situation.
Society in general finds it hard to deal with a precarious situation. Instead of pulling together as a community and helping each other out we have developed a selfish, blaming, isolating attitude.
My deepest empathy to the family involved.
This comment has been removed by the author.ReplyDelete
- Anonymous12/08/2008 6:19 PM
Scapel, I'm glad that Marcia pointed out the cost of COBRA. I looked into it, last year when I nearly got laid off. COBRA would have cost me $450/month. It may not have been their choice to do without.ReplyDelete
Yes, a tragedy--I've heard of others like this, a person who ended up diagnosed with metastatic lung CA, who had back and leg apin but did not go to the doctor until a spouse's insurance kicked in, by which time the person had been walking around with widespread bone mets and only some tylenol or aspirin for pain control. And a disease for which, now, no treatment options existed except comfort care. And, yes, COBRA and state-funded "high-risk" insurance coverage is extremely expensive, and there are tons of folks who can't qualify for Medicaid but can't afford these alternatives. No, doctors do not check cost of meds before prescribing, unless patients ask them to do so. I hope that we as a country can ask tough questions about health care, because there are too many tragic stories out there, of people who are trying to do their best.ReplyDelete
"Couldn't they have gone back to her mental health provider to see if a cheaper prescription was available for the short-term?"ReplyDelete
We're talking about people who are tight on money and have lost their insurance, right? How are they supposed to afford another mental health provider visit?
I think you're right that the problem is the insane patchwork that is our health care system. Even figuring out where to get help costs money and time and effort that a patient just might not have.
The real root cause of this issue is a lack of problem-solving skills on the part of the patient/husband (maybe mixed with too much pride) as well as a fundamental non-understanding of the basic cause and effect relationship of what happens when a bipolar person stops all of her medications, not a lack of insurance. As you said, there were numerous things that could have been done in this case that were not. Even a simple phone call to whomever prescribes the psych meds could have probably landed her a couple months' worth of samples.ReplyDelete
And as many have said, not paying for COBRA insurance was a choice, ergo, they really did choose to be uninsured. If you have any saleable items in your house or a savings account that could pay for the premiums, you're choosing those things over your insurance, health etc. Take out a loan on your 401K, pay for the premiums on a credit card...whatever.
COBRA is not always available after job loss. If the employer went bankrupt, there is no right to continue to participate in the plan because the plan itself vanishes. My brother had to find health insurance for his kids in a big fat hurry because of this once. He was fortunate enough to be able to pay for it, but not everyone can.ReplyDelete
- Anonymous12/08/2008 9:39 PM
It's not as simple as choosing to keep your plasma,401k or whatever over Cobra.ReplyDelete
I am a nurse and have fallen on hard times,no job,no insurance etc.I also have a chronic health condition. I don't have a credit card with a balance on it,no 401 K and so on. Cobra costs about $500/month or more. I don't know what you have in your house but I don't have anything like that to sell to cover that kind of monthly bill. I'm having trouble paying the power bill,getting food on the table and paying for whatever generic meds I can here. I used to be in the middle class with a saving account,equity in a house,a credit line etc but all of that is gone now and I consider myself to be in better shape than a lot of people who have nothing at all. I don't have a cell phone,I have basic cable,we've already combined 3 families to try to make a go of it and are one mishap away from being out on the street.
As a person who has suffered from depression in the past but has had about 8 decent years with no relapses I myself have gone off the medications for a short while(with not very good results). It really IS a choice between food,shelter and prescription meds.
Many of those resources,those helpful assistance programs are long gone and will not be replaced due to extreme budgetary shortfalls but mostly because people who already feel powerless and shameful about their illness aren't going to speak up to try to get their return. It's like trying to run on paralyzed legs,the spirit is willing but it is impossible.
And do you think we will EVER stop blaming the victims?
I don't think COBRA would have helped this patient anyway. I was on COBRA once, and I don't recall them covering medications. Nor would a universal healthcare plan likely cover expensive (new, brand-name) medications, nor would such a plan guarantee that someone could be seen by a psychiatrist (or even a primary care doc) promptly to discuss alternative medications. Many docs aren't taking new Medicare patients now; if we pass some sort of universal health plan, do you really think the new plan is going to pay more than Medicare rates? And cover expensive meds like Geodon, Abilify, or Keppra? People will have to settle for Lithium and Depakote, I suspect.ReplyDelete
Many docs will flee to a cash system unless the Socialists forbid free enterprise in this country, heaven forbid. So the combination of fewer doctors accepting the universal plan combined with the massive influx in patients seeking their entitled healthcare will ensure long waits for appointments and more rants from concerned liberals about the unfairness of it all.
"...as well as a fundamental non-understanding of the basic cause and effect relationship of what happens when a bipolar person stops all of her medications, not a lack of insurance."ReplyDelete
And do you think it's reasonable to expect Joe Public to have this kind of knowledge? Not just knowledge about what happens when a bipolar person stops taking their meds (which, from my point of view, is a difficult question -- I wouldn't be able to say if the reaction would be immediate or delayed, or severe or mild) but a general knowledge about the medical consequences of their actions.
I mean, don't you people go to Very Expensive Medical School to learn this kind of stuff?
The general problem is that the public (even the highly educated portion of the public) is unqualified to do an accurate cost/benefit analysis of a doctor's visit: they don't know the cost, they can't find out the cost (doctors don't know, or won't tell, and act like you're insulting them if you ask), and they don't know the benefit either. And even trying to find out the cost or the benefit is often out of the budget.
And finally...
"...will ensure long waits for appointments..."
Yes, please. I would very much like to have a affordable medical appointments. I don't mind waiting.
Joe asks:ReplyDelete
And do you think it's reasonable to expect Joe Public to have this kind of knowledge?
It is absolutely reasonable to expect patients to know the basics of their conditions. The lady wasn't a head trauma patient or developmentally disabled. She had a long-standing, chronic condition. I'd bet a testicle that somewhere along the way, a doc or a nurse sat down with her for ten minutes and explained the basics.
Of course, not all patients bother to research on their own, ask questions, or retain the information, but that's not the medical establishment's fault - the blame for that lies squarely on the patient's shoulders.
- Leigh12/09/2008 3:45 AM
I think they made the best choice available to them at the time. I don't blame them for making the wrong choice.ReplyDelete
Given the choice between trying to keep your head above water and buying meds for a condition that has been stable for years is a no brainer.... you keep your head above water.The only reason we're even second guessing this is because of this horrible outcome.
My dad was recently laid off from an auto dealership, the dealership closed. No COBRA available. He and my step mom are pretty healthy so he's taking a risk, but one that he doesn't have a choice about taking. We were talking about his old insurance coverage. It sucked. He paid in a week (yes, one week) for coverage what I pay in three months in premiums. WHY? I do work for a bigger company with good benefits. Why is this OK?
Most of us have to wait for care. The kind of care that's rationed in countries with universal coverage is the kind of care most of us will never need. Access to primary care is already an issue in this country. So with more people to be seen (because more will have insurance), there will be a longer wait. So what? I would rather have a longer wait than have 50 million people without health insurance.
I live in a state that borders Canada. To have your knee replaced, you have to wait 8 weeks here at the larger hospitals in the state and 4 weeks at the smaller critical access type hospitals. In Quebec province you wait 10-12 weeks. I'm sorry, that kind of additional wait doesn't justify getting all up in arms about wait times. We're only talking an addition 2-4 week wait for a chronic condition that the person has had for years.
Emergency issues are taken care of in an emergent fashion up in Canada, so the "wait times" that people talk about are for elective things, not emergency cardiac bypass surgery and the like.
Honestly, if wait times are the only argument against universal coverage, it's a no brainer. Bring on universal coverage.
- Care for every body12/09/2008 4:15 AM
For many reasons, the approach of attaching health care to individuals' employment doesn't work.ReplyDelete
I'm sorry for this family.
P.S. Is there an add-on that sifts out specific individuals' comments on other people's blogs? Kind of a three-strikes-you're-off-my-screen arrangement? I'd like to add on that add-on.
I really feel bad for this family. I have been in this kind of situatino before. I had a kidney stone once while waiting for my insurance benefits to kick in. As a matter of fact, I working for the company who was to become my healthcare provider when the stone hit. They put me in a wheelchair and rolled me over to urgent care, where I was told that they couldn't do anything for me because my insurance wasn't active yet, and sent me to the ER. A thousand dollars later I had a prescription for a few pain medications. It sucks. I hope we can find some way to patch these kinds of holes.ReplyDelete
That said, I think that this family has to share some of the blame in this scenario (or at least based on the few details I have of it). As pointed out in the original post, they did have a lot of options that they apparently did not try. Everybody should first try to rely on themselves, second try to get help from family, third turn to church or local community aid resources, and fourth seek help from government assistance. Having worked in a doctor's office, I know that many many times we gave free samples to patients to last them through a month or two's hardships. I also know that there are multiple resources out there to get assistance straight from the makers of many of these medications. www.pparx.org is a tremendous site and does most of the work for you.
As has been mentioned by several people already, universal healthcare probably would not have paid for the medications that normalized her life in the first place, let alone keeping them afloat in a time of difficulty.
With the abundance of charities and churches and resources out there designed to help people through tough times, I find it hard to believe that there was no way to get them the medications that they needed for a couple of months, and to the commenter that suggested that she had no way of knowing the result of stopping her medications, I say that if you do not have at least a basic understanding of your chronic medical conditions, then you are irresponsibly putting your life in danger. The Very Expensive Medical School gives the doctor the ability to understand the intricacies and interactions and pathophysiology of complex diseases. Anyone with a chronic condition needs to take responsibility to understand what the disease is, how it has and my affect them, and what the pros and cons of the available treatment options are. This is the same basic idea of research you would do before deciding what cable tv service to go with, why would you not do it with bipolar disorder or fibromyalgia or diabetes?
Anyway, in the end my sympathies go out to this family who has suffered such a loss. Saying you should have and you could have will not bring this woman back, and I hope that friends and family and community resources are making themselves available for this man and his children to cope with the loss.
I too am a nurse, only I work OB. I see the opposite end of this problem. Women (girls) who know how to work the system. They know that an ambulance ride to the hospital will cost them nothing, and a free taxi ride home will be provided. They know they can get all the sonograms and "emergency" hospital visits they want. A spat with the boyfriend will result in an all expenses paid visit to my unit so she can get the attention she desires from him. And of course, she WON'T marry him, because that would end all the free medical care.ReplyDelete
It tickes me off to no end. Here was a family that NEEDED HELP. COBRA is NOT the answer. It probably would have been cheaper to pay out of pocket for the medication! I find myself more and more jaded about our healthcare system. I'm tired of paying for these 20 year olds who are on baby number 2 or 3, and so deep into the system that butts are permanently attached to the welfare system. Meanwhile, families that need it, families who have done the right thing, and paid into a system that then FAILS them.
What is the answer America? It's not socialized medicine. We already have that (for those that know how), and it's not working.
Didn't they know they could apply for a free supply of meds from the manufacturers?ReplyDelete
I'm going to make a guess that there are severe restrictions on getting a free scrip from the mfr. Like, if you earn more than $10k per year, you don't get a free script. If you are on welfare, you will make more than $10k per year, so if you are on welfare, no script. The other catch, I'm guessing, is you get one month of free meds, per lifetime. That's it. One.
Didn't they think of going to their church, or some other charity source for assistance?
I'm guessing here again, but churches don't want to fund medicines due to liability issues. Just guessing.
Couldn't they have gone back to her mental health provider to see if a cheaper prescription was available for the short-term?
The new meds they are hawking these days run $500-$700 per month. I know this for a fact.
I'd be interested what restrictions are involved with the "free meds" from the mfr, or church help.
- Anonymous12/09/2008 1:16 PM
In my humble opinion your intentions are noble, your observations are keen, and it is obvious you are an extraordinarlily well educated and talented individual. However, I also sense condescension and a vainglorious tone to many of your blogs. I wonder if you have personally dealt with an individual with serious mental illness in your family. The answers are not always obvious. Again, with the utmost respect to you and your intentions, please continue with your informative and honest blog. However, beware of potential hubris.
- Anonymous12/09/2008 9:54 PM
What a terribly sad story - I can only hope that the United States eventually starts something like Medicare in Australia, described here:ReplyDelete
In Australia, the Medicare Levy is only 1.5% of each person's *taxable* income (and there is an additional levy that high income earners if said high income earners choose not to purchase private hospital insurance). The additional high-income-no-private-insurance levy is fair enough, because *anybody* can use Medicare services if they so desire, no matter how much they earn. Nobody is barred as long as they are an Australian citizen or permanent resident.
I travel regularly between Australia and the USA, and have dual Australian/Swiss citizenship. As a non-American I have always struggled to understand why the Government of the United States does not do more to take care of those citizens who need the greatest help.
You suggest in your own writing that the family should have looked into alternative methods of paying for the meds or cheaper meds, but then go on to blame it on lack of national healthcare. It was the risk they chose to take, not the lack of government intervention that is to blame. If you've worked the VA, you'll know government is stingy with medications. Maybe she would get them, maybe she wouldn't. Just depends on the button pushers up above.ReplyDelete
And I'm sure you've met a few patients in your career who tell you they can't pay for their medications but they can afford the $4 a pack cigarettes they ask to go out and smoke or the EtOH that brings them in in the first place. I don't want to finance that sort of irrationality. And if you've worked in the VA, you'd realize the government is stingy because they have to pay for bureacracy. Button pushers from above tell you whether you can prescribe this medication even though they haven't seen the patient just so the VA can have enough money to pay button pushers to do said pushing. Maybe your patient would have gotten her medications, maybe she wouldn't.ReplyDelete
- Anonymous12/10/2008 8:24 AM
Wow. I'm really impressed by the great understanding of mental illness expressed by the majority of medical posters on this blog. NOT.ReplyDelete
Using a sob story to bash the status quo and force an unproven radical agenda in the name of the common good is a technique employed by the wild-eyed anti-vaccer crowd.ReplyDelete
You're not an anti-vaccer, are you SF? ;]
- Anonymous12/10/2008 3:24 PM
This is tragic. I only wish that the family had known about NAMI (National Alliance on Mental Illness). www.nami.orgReplyDelete
A family or an individual with a mental illness can call their local affiliate and the people there, who have the lived experience of dealing with mental illness and navigating the system, will do everything they can to help. They have knowledge of resources and places to try to get necessary meds, etc. that people who haven't had to deal with it all don't necessarily know about. There are also all sorts of free support groups.
If you ever see a patient with a mental illness, please direct them to their local NAMI affiliate. They can go to www.nami.org and find the closest office.
Our local affiliate is now partnering with the local hospitals, which are providing NAMI literature to their patients in an effort to get help to those who need it.
I'd like to point out a few things. I'm a college student, and luckily I have THE GREATEST mental health coverage I could ask for. All my visits are free, which is great when you're seeing a psychiatrist once or twice a month, and a therapist 4-6 times a month. I'm bipolar and while I spent 3 years treating depression, I'm just at the tail end of treating the ACTUAL problem. Getting stable has been a long and grueling process.ReplyDelete
But. To everyone who likes to point fingers and suggest that we should all just "give up" things in our life to pay for coverage like Cobra- which is $500 + a month, I'd like to know where you have that kind of money laying around. I know I don't. And if I was in a position where COBRA isn't available- I'm SCREWED. Why? Did you know it's pretty much impossible for anyone who actually NEEDS insurance (anyone with a mental illness, chronic problem, etc) to qualify for private insurance? I was denied private coverage by four insurance companies just because I had been (wrongly) dx'ed with irritable bowel. (This was before any psych dx, too.) It's not as simple as "Waltz on over to Target and pick up some health insurance, you lazy, selfish bastards!"
My care is free (well, I pay $125/month for insurance), but my meds are not. I pay $195/month out of pocket for my meds. I'm a student with NO trust fund, NO parental help, NO spouse... it's just ME. And I pay it. My psych staff slip me as many samples as they can, which helps. But I go without A LOT as it is to afford those meds. If I suddenly lost my insurance, that med bill would balloon to over $600/month. I already have to forgo cable, movies, clothes, professional hair cuts, eating out (sometimes eating much of anything) just to make my current payment. If I were stuck in that boat- I don't know what I'd do either. Paper work for med assistance programs can take months to go through- and that can be the difference between life and death. And being out there, alone, in all of that- it's daunting.
For everyone who wants to put the blame back on the patients, or who likes to think that it's a simple as you are making it out to be- I have a finger I'd like to show you. COBRA is not a feasible option for most people, and those of us who need our insurance are often not eligible unless they're under a group plan that can't say no.
I'm so sick of self-righteous people in this country. It makes me sick.
- Anonymous12/10/2008 6:52 PM
Heather -- doctors and nurses make good money. You practice for a while and you forget what it's like to wonder whether you should pay your rent or your COBRA. :P Also, most medical facilities have great insurance. Among medical staff, it's mostly a case of "well I didn't need it when I was young..." & of course they had it when they got older.ReplyDelete
Most ER staff have no idea when it comes to psych stuff. Well, most medical staff in general. To them, a brand name med is mostly the same as a generic med.
I was actually pleasantly surprised when I decided to switch to generics w/my psych. (In this economy...) You have many more choices than you did just a few years ago. Yet, I do best on SNRIs -- unfortunately Effexor (cheap) gives me heart problems and Cymbalta is $200 a month. You settle for second best, which is never the same...but it keeps you running.
Frankly, if you can tolerate generics, ask for them. Your psych probably won't rx them at first but you have to demand it. If generics don't work, stock-pile samples. County has the sliding scale fees -- go through them, if you can.
Obviously, the whole "she should have been edumacated!111" doesn't work. You spend /years/ stable on a med and you begin to wonder -- was it just a fluke? The worst part is that if you stop taking your meds, you don't notice shit right away. Nothing happens for a while. And then things happen but it's gradual. It's not like a diabetic who stops taking his meds suddenly. The stigma against mental illness doesn't help, certainly...
ANd, no, you're not gonna get free meds from most places. Fact of life. Google walk-in mental health clinics. Hopefully you'll have one in your area.
Thanks. Yeah, we have a decent free mental health clinic in my area, if I need it. Luckily I'm covered through school, and will be for quite a while, so I'm not concerned. But it's just that whole attitude that a few have thrown down making it seem like people are just choosing to go without like it's an easy decision. The irony of those who need insurance usually can't get it privately kills me.
As for generics. I'm all for them, as long as they work. Lamictal just went generic, and I jumped on that. The transition was pretty rough, I won't lie. The dispersal rate is very different for me. But we tweaked the dose and it's better. Unfortunately, since it's the first major generic, it's not *that* much cheaper yet, but in 6 months it will be open to more companies and it will fall again. And my adderall, klonopin, ultram... they're all generic. My one killer is Seroquel. That stuff is EXPENSIVE. Not as bad as Abilify, but it's still rough. But it works like nothing else has. I can't take depakote (I have pcos, which it has been known to cause or worsen) and we have reservations about lithium. But Seroquel/Lamictal combo has been a lifesaver (quite literally) for me. Stability isn't something I want to mess with. I am blessed that I found something that works well (many never find a good combo, period). I will forgo as much as possible in order to stay with those meds.
But I also have a pdoc that is more than willing to go generic first. It's a student clinic and our med coverage is lame, so they try to help people out as much as possible. I rode the med-go-round for a while with some generic ssris/snris before realizing they were making things worse. (Effexor made me go batshit, btw.)
I guess I just get so pissed at smug, arrogant assholes who have never been there. It's so easy to look down on people who struggle and assume that they waste all their money on stupid stuff, I guess. Perhaps that's their way of sleeping at night: if they can make generalizations and explain it all away ("Oh, they would rather buy x-boxes and stuff, they have the money, they're just irresponsible") then they don't have to face the fact that people are hurting. Kids go to bed hungry. And people can't afford the medical care they need.
I have a lot of "right" friends who bitched, and continue to bitch, endlessly about people who are leeches to the system, and how we need to abolish all of our gov't assistance programs. I told them all to pray on their lucky star that they never find themselves unemployed or burdened in some way they never expected or prepared for. No one sets out to fail or sets out to get in these terrible situations. And gov't programs don't work perfectly, but I'll tell you what- they can sure help a lot. So anyone who wants to bitch about it... Well, I hope you never need it, but if you do, I wish someone at the counter would just stamp a big "denied" on any request for help. Because, of course, when you go it will be different, right? It would be justified and special because you're better than everyone who went before you, right?
I need to go to bed before I rant all night long...
- Anonymous12/12/2008 6:49 AM
We already have rationed health care in the US. It's rationed, in some cases, by your ability to pay and in other cases, by your inability to pay. I agree with Heather (I'm also bipolar). Generic lamotrigine is absurdly expensive - and none of the $4 Rx lists I've seen include more than a few psych drugs - mostly lithium, fluoxetine, and some tricyclics. COBRA is a nice idea, but it doesn't work in practice. Heck - one of my former employers stole 6 months' worth of COBRA premiums I paid in good faith. The insurance carrier said I had to keep paying because the policy was still in force, then they retroactively cancelled me because said former employer had been pocketing my cash and feeding the insurance company a line of bull for that six-month period. There are an awful lot of people that believe life is fair and you can get care and medication you need from bene olent organizations. I hate to dispel your dreams, folks, but for people with pre-existing conditions that can't afford COBRA, are ineligible for state/federal aid and have to make choices about feeding and clothing their kids or trying to pay for medicine they need, it can truly be a life or death decision. Shadowfax, my thoughts and prayers are with you and your patient's family.ReplyDelete
- SuperBadJack12/12/2008 8:53 AM
So anyone who wants to bitch about it... Well, I hope you never need it, but if you do, I wish someone at the counter would just stamp a big "denied" on any request for help. Because, of course, when you go it will be different, right? It would be justified and special because you're better than everyone who went before you, right?
Really? You're intolerance of others viewpoints is showing.
Those right-wing friends of yours are angry because the Government is trying to inject itself into our lives.
Please, please read the Constitution for the first time in your life and show me where the Federal Government has the power to do half the things it does, and, if you think it should have the power, fine amend the Constitution, it's been done before.
People who believe in Conservatism believe that, in the end, we are responsible for our own outcomes. In good times or bad, we are the only ones to blame for our failures, and the only ones to credit for our success.
We don't think we're better than anyone, we want to work hard, and be rewarded for our work. That's all.
- Anonymous12/12/2008 11:42 AM
People who believe in Conservatism believe that, in the end, we are responsible for our own outcomes. In good times or bad, we are the only ones to blame for our failures, and the only ones to credit for our success.ReplyDelete
You're completely deluded, in other words. Most of the people who believe that (my parents come to mind) have had more than their share of good fortune along with the hard work. Other people, who work equally hard, confront more difficulties than they can handle.
We all know people who cause most of their own problems; and all of us cause quite a few of our own problems; but no one causes ALL of their own problems.
Rather than wishing you well, I hope those of you who hold the arrogant belief you're in complete control of both your successes and failures (including your good health) get a dose of reality so you have a chance to develop some humility before you die.
Otherwise, I hope you're doomed to an eternity of tacky tract housing in hell.
- SuperBadJack12/12/2008 12:27 PM
Rather than wishing you well, I hope those of you who hold the arrogant belief you're in complete control of both your successes and failures (including your good health) get a dose of reality so you have a chance to develop some humility before you die.ReplyDelete
Here's the little problem, with your "Life isn't faiiir" rant.
If I don't take responsibility for everything in my life I am powerless to change any of it.
America was founded on this idea of rugged individualism, it's allowed us to become the greatest country the world has ever seen.
So, let me ask you, if YOU aren't responsible for EVERYTHING in your life, who is? And, how will you change any of it if you don't take responsibility for it?
- Anonymous12/12/2008 2:23 PM
Hey, did *I* tank the economy? Am *I* responsible for the stock market falling so far? Did *I* put hundreds of thousands of people out of work?ReplyDelete
Is it their own fault? In most cases, no.
Is life fair? Of course not. I wasn't whining; I was saying you need a reality check.
It sounds like you'd rather see people die of starvation or lack of health care than part with any of your precious money to help those who've fallen on hard times.
What I'm saying is, you need to walk a mile or two or three in someone else's shoes, and get rid of the American Individualism Patriotic Bullshit, which roughly translates to complete selfishness.
If other people experience difficulty through no fault of their own, so can you, whether you choose to believe it or not. You could develop a devastating illness, even if you take good care of your body. Sometimes BAD THINGS HAPPEN. Not only are you not immune, you're not even prepared for every contingency. Unless you have a crystal ball, there's no way you could be.
There may come a day when you need help, and you won't be protected by your denial.
- Anonymous12/12/2008 8:52 PM
Heather --ReplyDelete
Dude, Seroquel sucks.
- Anonymous12/12/2008 8:59 PM
Also, I'm very confused.ReplyDelete
If the Constitution was written now...what would they have to say about slavery? the internet?
Why do people act like it's infallible when they fuckin' wrote the elastic clause into the constitution?
Why are conservatives so backwards?
Hannah- yeah, seroquel is a bitch on a few levels. It's expensive as all get out. What it does to my cravings and metabolism sucks. But I'd rather be broke and fat than dead. I'm incredibly thankful for it at the end of the day, though.ReplyDelete
SuperBad- wow. First- your rant on the constitution is... confusing to me. So you're saying that the gov't shouldn't be providing assistance to those who need it. Funny- we seem to give to everyone else in the world. I'm not really sure what the constitution has to do with my argument at all.
People LOVE to make your weak argument- "Take control of your life!" "Make your own destiny!" I have to agree with the person who called you deluded. You act as though people who fall on hard times did so because they failed to plan or something. Tragedy isn't something you can ever really be ready for. And many people find themselves in situations they cannot handle that they are not responsible for. We have an incredibly broken system, and it really sucks.
What I have been through to get where I am in my life is a long story. I was the victim of sexual abuse from toddlerhood until my teens- my mother stood by and watched. I was raised first by an unstable, bipolar parapegic, and then removed by the state and sent to live with an absent, alcoholic father. I graduated and moved out at 17. I'm putting myself through college without a DIME of help from anyone. I am bipolar and struggle with chronic pain from a back deformity. I'm single and I fend for myself- 100%.
People that think it's just a matter of working harder or trying harder have no idea what it's like to NOT have that ability. I was raised in poverty, abandoned and abused. I don't have anyone to fall back on, I didn't have anyone to take care of me. I'm NOT lazy. I work my ASS off going to school and working to make ends meet. And I also know that I'm much more blessed than many- so I don't look down on people who need to use the system that we have in place.
So before you go bitching about working hard and getting what you deserve- let's have someone kick your legs out from under you. Let's see you HONESTLY start from nothing (or, like some, from a deficit) and see how easy it is to make it. The honest truth is that our system is very broken and sometimes- the way out isn't easy or even possible. Some of us have many more strikes against them than others do- and that's not something you can possibly understand unless you have been there. So are you going to be like John McCain and tell me to get a second job and skip my vacation? (which I haven't taken in years.)
Sorry for the rant, OP, but that stuff just gets me beyond pissed off.
Wow! I, too, am bipolar (hypomanic), controlled very well with a combination of paroxetine HCL and oxcarbazepine, and I would sooner go without a KIDNEY than go without my meds.ReplyDelete
My condolences to the family who lost a loved one in this tragedy.
- SuperBadJack12/16/2008 6:15 AM
So are you going to be like John McCain and tell me to get a second job and skip my vacation? (which I haven't taken in years.ReplyDelete
John McCain was one of the worst candidates my party has run in a long time. The only reason I voted for him was Palin.
Now, let's take a look what you wrote, you're saying...you're in college with no ones help but your own... GREAT! That's what I'm talking about, you overcame your circumstances and are doing very well.
Also, I don't want to sound cliche here or compare bad situation to bad situation, but I lost my Father when I was a teenager, he died with no will or life insurance. It took years for the State to decide what to do with what he left, since he owned his own business. I'm 22, and I have worked my ass off, I don't have college but I am successful because I am willing to do what it takes.
So as for "Starting from nothing", yeah I did. And I made it.
My gripe is with the Federal Government being like a parent. If a State wants to go all out and be your Nanny, fine, whatever, if they can afford it more power to em.
My point about the constitution was that the Federal Gov. has very limited powers in what it can and cannot do.
"Chose" not to purchase COBRA??? Have you even a CLUE how expensive COBRA is?ReplyDelete
People who have never had to struggle, truly struggle, will never understand and will always be good at pointing their fingers.
MM...you're a realist. You seem to have the ability to think about situations other than the one you're in.
Love you blog.
Online Jobs on Blogs, Just Post a Comment on any blog site and earn $0.06 per Link, Just Like this, Visit and Click on Link RelationReplyDelete


text:
Past, Present, and Future of Laptop Computers
Laptop computers are becoming more and more popular and there is a reason for that. Laptops have advantages that can't be matched by the best computers for graphic design. Increased technology has radically cheapened the price on the majority of models. In today's environment, most everyone can afford a laptop.
Laptops are extremely versatile, portable and very lightweight. There increased RAM and space on hard drives make them much more powerful than laptops in the past. They are able to handle even the most demanding software applications and the longer life of batteries has made them easy to use when away from office or home. Many businesses have wireless spot so that a person can use a laptop while eating a hamburger for lunch.
Laptop's smaller size eliminates any need for large computer desk and printers, external hard-drives and scanners and more can be connect with a USB cable. Most units now contain built-in web cams, fingerprint readers for more protection and very refined operating systems.
Users and uses
Laptops are perfect for almost every user. Business owners, students, executives, as well as even entertainers can successfully use laptops for documents, spreadsheets, music programs, burning CDs and DVD, edit photos and balancing household budget or planning for a vacation can all be done on laptops. And since most graphic design laptops work with wireless networks, a person can work from almost anywhere in the house, in the backyard or around the swimming pool as well as bed in the evening.
There are some disadvantages also:
- More expensive that a desktop
- Smaller screens
- Navigation pad are terrible and often replaced with a traditional mouse
- Traditional mouse are awkward to use
But these disadvantages might seem like advantages to others.
In the future, laptops are only going to get more powerful for gaming, photo files and music and this will make laptops the favorite for the majority of users. Newer models will have larger screens, Bluetooth technology and a battery that will last for up to 8 hours on a single charge. Touchscreens will very likely be the rage for laptops in the future. Many of these technologies are on laptops today. Also, with the complexity of graphic design tablets have become very important to have in addition to laptops.
Once you get use to using a laptop it will be hard for you to go back to a desktop. Laptop computers have redefined "workforce mobility" in this the Information Age. They are compact, lightweight computers have all the abilities of a laptop and have been adopted quickly for both personal and professional use. Given the range and the choice of models now available, it is important to weigh several factors before making the decision on whether to buy a laptop or not. Once you get use to using a laptop it becomes very hard to go back to anything bigger. You will be hooked on having your laptop and wonder how you ever lived without one before.
College Students
Among users, this time of the year college students are the ones buying laptops. If they have never had one, they usually get one as a high school graduation present or use any money they were given to buy one.
Posted in: Computers |

subset: commoncrawl


text:
MRSA Lives Among Us
Indiana Epidemiology Newsletter
September 2007
Jean Svendsen, RN
Chief Nurse Consultant
Tracy Powell, MPH
Advanced Analysis Epidemiologist
Staphylococcus aureus, or "staph", is a common bacterium that lives on the human skin (armpit, groin, and genital areas) and in the nasal passageways of many people. Although staph bacteria are usually harmless, they can cause skin and soft tissue infections, such as pimples, boils, and cellulitis. Staph is one of the most common causes of skin infections in the U.S.
MRSA (Methicillin-resistant Staphylococcus aureus) is a strain of staph that is resistant to methicillin and other related antibiotics. The first reported U.S. outbreak of MRSA occurred in 1968 in a Boston hospital, seven years after the first reported case. Since MRSA can be resistant to several different antibiotics, infections can be difficult to treat.1
MRSA is most commonly associated with hospitalized patients, long-term care facilities, and healthcare workers (healthcare acquired or HA-MRSA). HA-MRSA infections have risen sharply in recent years. In the U.S. in 1972, HA-MRSA accounted for only 2 percent of all healthcare-acquired infections. reported to the Centers for Disease Control and Prevention (CDC). Recent data show that HA-MRSA now accounts for 50-70 percent of healthcare-acquired infections.2
In the past several years, MRSA has emerged into the community, where its incidence has greatly increased.3 The CDC defines community-acquired MRSA (CA-MRSA) as MRSA infections that are acquired by individuals who have not been hospitalized within the last year or had a medical procedure. Most CA-MRSA infections are seen as skin and soft tissue infections such as pimples, boils, abscesses, and cellulitis and occur in otherwise healthy people. MRSA skin infections often appear red, swollen, painful, and have a pus-like discharge. More serious infections may cause pneumonia and bone, bloodstream, or surgical wound infections.
In Indiana, most CA-MRSA cases originate in correctional facilities and competitive sports teams4 in high schools and colleges. Infections have been associated with direct skin-to-skin contact through cuts and abrasions and indirect contact, such as sharing contaminated sports equipment, towels, and clothing as well as crowded living conditions, and poor hygiene. Individual cases of MRSA are not reportable in Indiana, because the infection is so common. However, any suspected clusters or outbreaks are immediately reportable to local health departments for investigation.
As with any infectious disease, prevention is key. The CDC recommends the following practices to help prevent spreading staph or MRSA skin infections:
Clean your hands. Hand hygiene plays a vital role in reducing the transmission of infection. Wash hands frequently with soap and water or use an alcohol-based hand sanitizer, especially after changing bandages or touching an infected wound.
Cover your wounds. Wounds that are draining or have pus should be covered with clean, dry bandages. Follow your healthcare provider's instructions on proper wound care. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others. Bandages or tape can be discarded in the regular trash.
Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with infected wounds or bandages. Use hot water and laundry detergent to wash soiled sheets, towels, and clothing. Dry items in a clothes dryer on the hottest setting possible, rather than air-dry, to help kill bacteria.
Talk to your healthcare provider. Tell your healthcare providers who treat you that you have or have had a staph or MRSA skin infection. See your healthcare provider promptly if you have wounds that do not heal or appear red, swollen, draining, or painful.
You can learn more about MRSA by visiting the following Web sites:
ISDH MRSA Quick Facts
Barrett FF, McGehee RF Jr, Finland M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital: bacteriologic and epidemiologic observation. New England Journal of Medicine 1968; 279:441-448.
Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. Management of multi-drug resistant organisms in healthcare settings, 2006. US Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf (accessed September 19, 2007)
Chambers HF. The changing epidemiology of Staphylococcus aureus? Emerging Infectious Disease 2001;7:178-82. Available at http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm (accessed September 19, 2007)
Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus among competitive sports participants—Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003. MMWR Morbidity and Mortality Weekly Report 2003;52:793-5. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a4.htm (accessed September 19, 2007)


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Additional winners named in this year's Parade of Homes
Trilogy Partners, Raptor Construction and Pinnacle Mountain Homes have been honored for their work in special award categories in the 18th annual Summit County Parade of Homes.
Trilogy Partners and ZEH LLC received the High Country Conservation Center's award for energy efficiency. The home at 238 Timber Trail (Home #13) in Breckenridge had the lowest home energy rating system and is essentially 70 percent more efficient that a home built to code in 2004.
The Mountain Living Peak award, presented by the magazine's editor, went to Raptor Construction for the home at 1246 Bald Eagle Rd. (Home #2) in Silverthorne.
The Realtor's Choice award, presented by the Summit Association of Realtors, went to Pinnacle Mountain Homes for the home at 411 Long Ridge Dr. (Home #10).
Voting for the People's Choice award will continue through Oct. 7. Those wanting to vote for their favorite home may do so at
This year's Parade of Homes features 20 single-family, remodeled and duplex homes. Programs are available at each of the homes, Bank of the West branches and at the City Market grocery stores in Dillon and Breckenridge, as well as most Realtor offices.
Tickets also are being sold at City Market as well as many of the homes on the tour. The cost is $10 per person. Proceeds from ticket sales are donated by the Summit County Builders Association to The Summit Foundation. Bank of the West is donating an additional $2 to The Summit Foundation for every ticket sold at one of the bank's branches in Summit County.
Those who choose to purchase tickets online at blog.summitcounty
builders.org will receive a free one-year subscription to Mountain Living magazine.
The Summit County Parade of Homes will conclude this weekend. Homes on the tour are open from 10 a.m. to 5 p.m. today and Sunday. The annual event is hosted by the Summit County Builders Association and is being sponsored this year by Breckenridge Building Center, Bank of the West, Cutting Edge Woodworking, Specialty Wood Products, While You're Not Home and the Summit Association of Realtors.
Start a dialogue, stay on topic and be civil.
If you don't follow the rules, your comment may be deleted.


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sara miller
- 20
- reviews
- 423
- helpful votes
- 126
- ratings
I Am Watching You
- By: Teresa Driscoll
- Narrated by: Elizabeth Knowelden
- Length: 8 hrs and 24 mins
- Unabridged
When Ella Longfield overhears two attractive young men flirting with teenage girls on a train, she thinks nothing of it - until she realises they are fresh out of prison and her maternal instinct is put on high alert. But just as she's decided to call for help, something stops her. The next day, she wakes up to the news that one of the girls - beautiful, green-eyed Anna Ballard - has disappeared.
Creepy Thriller With Depth
- By Sara on 07-15-18
- I Am Watching You
- By: Teresa Driscoll
- Narrated by: Elizabeth Knowelden
Really Enjoyed
Reviewed: 08-06-18
This suspense novel starts in the thick of the action. Ella is on a train and bored with her reading material, so she eavesdrops on a much more interesting conversation. Over the course of the trip, Ella listens as two teenage girls meet two men (recently paroled from prison?) and the group makes plans to meet up later. Uh oh.
This leads to an internal debate... How does Ella react? Should Ella react? What would you do? The fallout from her reaction is life altering and ultimately puts her in the sights of a killer. That is the first few pages, and the story manages to stay this engaging through the last page. It is a who-done-it that genuinely keeps you guessing with reveals chapter after chapter.
1 of 2 people found this review helpful
- A Novel
- By: Mary Beth Keane
- Narrated by: Candace Thaxton
- Length: 9 hrs and 53 mins
- Unabridged
Mary Mallon was a courageous, headstrong Irish immigrant woman who bravely came to America alone, fought hard to climb up from the lowest rung of the domestic service ladder, and discovered in herself an uncanny, and coveted, talent for cooking. Working in the kitchens of the upper class, she left a trail of disease in her wake, until one enterprising and ruthless "medical engineer" proposed the inconceivable notion of the "asymptomatic carrier" - and from then on Mary Mallon was a hunted woman.
"Faction" at its best
- By karen on 01-27-16
- Fever
- A Novel
- By: Mary Beth Keane
- Narrated by: Candace Thaxton
Captivating Retelling
Reviewed: 04-22-13
I haven't written a book review in awhile but felt compelled to write this one. I enjoyed Mary Beth Keane's the Walking People and once I heard the subject matter for this book, I was sold. A historic trial? A medical mystery? I couldn't have picked a novel I more wanted to read.
I hope that is not a spoiler to note that Mary Mallon was the first well known 'healthy' carrier of Typhoid Fever. She was asymptomatic and since little was known about how sickness spread, it was hard for people to recognize the health risk she posed. She was a cook and though out breaks of Typhoid seemed to follow her wherever she was employed; she refused to believe she could be the source of the fever. Even after she was confronted with the possibility that she was spreading the fever. She refused to cooperate. She continued to cook until she was arrested and deatined. She wasn't released for two years and only after agreeing not to cook. Despite all this, she cooks again. Changes her name and continues to cook until she is recaptured.
Enter Keane to deliver an entirely unexpected novelization of her life. The tendency to sort of side with Mary and vilify her treatment and compare it with others (non-working class males who may have received much better treatment) and conclude Mary was treated unfairly. Or try and convince readers that Mary's recklessness led to unnecessary deaths even after the danger she posed to others was explained to her. Keane does something else. She seems to take both sides-- rallying a little for Mary and then highlighting her unsafe obstinacy. So the reader is both frustrated with and sympathetic towards, Mary.
Keane once again plays with time beginning somewhere in the middle of Mary's story and then hopping all around throughout her life similar to her The Walking People narrative. Maybe more successfully this time, but I am still unsure why authors belabor this technique when a simple straightforward arc would serve.
What is known about Mary seems to all be spot on, but Keane adds a lot too. For instance additional deaths, a fabricated alcoholic live in lover, and a backstory are all provided. I'm torn too to what this all adds. A historical novelization works best for me when it holds as closely to the truth as possible. However these additive also provide period detail to further set Mary's drama.
I am beginning to realize it sounds as if I am conflicted about the book which I am not. I highly recommend it for any historical fiction fans. Mary's story horrified me, disgusted me, and baffled me in turns. I was genuinely engaged in Mary's story from the very first through the last page.
And though the narrator slips in and out of an Irish accent inexplicably, she otherwise does a good job.
2 of 3 people found this review helpful
Finding Emma
- By: Steena Holmes
- Narrated by: Natalie Ross
- Length: 7 hrs and 40 mins
- Unabridged
The last time Megan saw her youngest daughter, Emma, was on the little girl's third birthday. Now, two years later, she sees her daughter's face in every blonde girl she passes - at the grocery store, in car windows, at the doctor's office. She is determined to find her daughter, but her commitment borders on obsession as she finds herself following these little girls who resemble her missing daughter. Her inability to move on after Emma's kidnapping has distanced Megan from her friends and family.
Overwrought Drama
- By sara miller on 03-19-13
- Finding Emma
- By: Steena Holmes
- Narrated by: Natalie Ross
Overwrought Drama
Reviewed: 03-19-13
While under her mother's supervision, three year old Emma disappears. Two years later Emma is still gone. Her Mother, Megan, hasn't been able to recover. She spends her time putting together "stranger danger" seminars for schools and organizing supervision for children who walk home. She also mistakes other little girls for Emma. Her husband, Peter, shames Megan for "seeing" Emma in other children. He wants Megan to focus on the present and their two other children. The novel quickly shifts and then alternates to the story of an elderly couple struggles to raise their granddaughter, Emme amongst the grandmother's declining health.
I am afraid I am in the minority on this one. I thought this book was only OK. I was expecting more of a mystery. Any mystery Holmes had, she gives away pretty quickly on in the story. There isn't really a plot other than waiting for the characters to uncover the "secret" that the reader already guessed. Holmes replaces suspense with repeated heart wrenching scenes illustrating the damage that Emma's kidnapping has afflicted on Megan's family. The story of a kidnapped child is pretty relatable for any parent, so the dozens of scenes underscoring the repercussions of this tragedy are unnecessary. I felt beat over the head with sad scenes. The marital tension seemed contrived and never fully fleshed out. A typical argument:
Peter: You need to move on from Emma's kidnapping!
Megan: I will never give up on Emma! (bursts into tears).
Ok, maybe that's a facile transcription of an argument. But they had multiple arguments to this effect and that's how they began to feel. I wanted to say: Megan, honey, if your husband's idea of being supportive is to encourage you to move past your daughter's tragic kidnapping while flirting with his attractive business partner, you may want to move past your marriage. I mean it's only been two years. But do try and acknowledge your other kids, just once and a while. He has a small point there.
Another thing that bothered me was several sub-plots that never went anywhere. I kept reading hoping they would go somewhere, but they didn't. I now see that maybe they will be picked up in the author's companion novella or the sequel. Inexplicably, I am tempted to purchase both of these? Maybe I am still hoping to uncover the novel I intended to read. AS of today, I have not purchased either.
Another note: I got a deal on the audio version via Whisphersync. The narrator baby talks Emma's lines. While I have no problem with a narrator who performs characters, I have never heard an adult do a good rendition of a small child's voice. This is a pet peeve of mine, and is so grating, if Emma had more lines, I would not have been able to listen to the audio version.
3 of 3 people found this review helpful
Wool Omnibus Edition (Wool 1 - 5)
- By: Hugh Howey
- Narrated by: Minnie Goode
- Length: 17 hrs and 53 mins
- Unabridged
This is the story of mankind clawing for survival, of mankind on the edge. The world outside has grown unkind, the view of it limited, talk of it forbidden. But there are always those who hope, who dream. These are the dangerous people, the residents who infect others with their optimism. Their punishment is simple. They are given the very thing they profess to want: They are allowed outside.
Good post-apocalyptic/dystopian novel!
- By Wayne on 01-01-18
- Wool Omnibus Edition (Wool 1 - 5)
- By: Hugh Howey
- Narrated by: Minnie Goode
Good Story, Should have READ it
Reviewed: 01-10-13
Story and premise is imaginative and definitely held my interest. Consider purchasing a paper or ebook. However, I found myself wincing at the over acted narration. The narrator feels the need to use a different voice for every character however the narrator can't do other voices, so they come off like bad impressions. A lone southern accent in an massive underground bunker hundreds of years in the future? A weasel like voice for the villain? It's too much. The pacing and enunciation are off. Bizarre giggles sporadically and then she breaks into baby talk into Part 4. It's not just distracting, it's awful. I will be avoiding Minnie Goode in the future.
89 of 104 people found this review helpful
- By: Daphne du Maurier
- Narrated by: Anna Massey
- Length: 14 hrs and 52 mins
- Unabridged
After a whirlwind romance and a honeymoon in Italy, the innocent young heroine and the dashing Maxim de Winter return to his country estate, Manderley. But the unsettling memory of Rebecca, the first Mrs. de Winter, still lingers within. The timid bride must overcome her husband's oppressive silences and the sullen history of the sinister housekeeper, Mrs. Danvers, to confront the emotional horrors of the past.
A Great Listen
- By P. Wade Thompson on 05-12-09
- Rebecca
- By: Daphne du Maurier
- Narrated by: Anna Massey
One of my all time favorite listens
Reviewed: 11-22-12
Rebecca is one of the few books that is worth the second (and third) listen. As good today as the first time I read it. Anna Massey brings new depth to this classic moody mystery. Plan to listen to again when I need to escape into an evocative novel.
5 of 6 people found this review helpful
In the Shadow of the Banyan
- A Novel
- By: Vaddey Ratner
- Narrated by: Greta Lee
- Length: 13 hrs and 19 mins
- Unabridged
For seven-year-old Raami, the shattering end of childhood begins with the footsteps of her father returning home in the early dawn hours bringing details of the civil war that has overwhelmed the streets of Phnom Penh, Cambodia's capital. Soon the family's world of carefully guarded royal privilege is swept up in the chaos of revolution and forced exodus. Over the next four years, as she endures the deaths of family members, starvation, and brutal forced labor, Raami clings to the only remaining vestige of childhood - the mythical legends and poems told to her by her father.
A Terrible Tale from A Beautiful Storywriter
- By Mel on 08-23-12
- In the Shadow of the Banyan
- A Novel
- By: Vaddey Ratner
- Narrated by: Greta Lee
Did not care for the narration
Reviewed: 11-22-12
The narrators overly sweet voice distracted from the tragic but gripping material. Some background on Cambodian history leading up to the revolution might have also better set the story's events.
1 of 1 people found this review helpful
Winter of the World
- The Century Trilogy, Book 2
- By: Ken Follett
- Narrated by: John Lee
- Length: 31 hrs and 43 mins
- Unabridged
Winter of the World picks up right where the first book left off, as its five interrelated families - American, German, Russian, English, Welsh - enter a time of enormous social, political, and economic turmoil, beginning with the rise of the Third Reich, through the Spanish Civil War and the great dramas of World War II, up to the explosions of the American and Soviet atomic bombs. As always with Ken Follett, the historical background is brilliantly researched and rendered, the action fast-moving, the characters rich in nuance and emotion.
Brilliant Sequel
- By Tim on 03-15-13
- Winter of the World
- The Century Trilogy, Book 2
- By: Ken Follett
- Narrated by: John Lee
Does anyone do it better than Follett?
Reviewed: 09-27-12
For this fan of Fall of Giants there was nothing better than hearing John Lee pick up where my favorite players in Europe, Russia and America left off. Winter of the World covers the period leading up to and the resolution of WWII. It is not necessary to read the series launch, Fall of Giants (I do highly recommend that book on its own merit).
This was maybe even more enjoyable then the first book as I had a better grasp of the history shaping the lives of the characters. Once again Follet spoils his reader with fascinating historical detail and context. My only complaint is how Follet contrives to interweave these families and puts someone at almost every import event in the time period. 31 hours wouldn't suffer from a new character or two.
Historical fiction fans should not miss this one.
John Lee is perfection. His heavily accented reads are a treat for the ears.
12 of 14 people found this review helpful
The Queen's Vow
- A Novel of Isabella of Castile
- By: C. W. Gortner
- Narrated by: Rosalyn Landor
- Length: 15 hrs and 53 mins
- Unabridged
"No one believed I was destined for greatness." So begins Isabella's story, in this evocative, vividly imagined novel about one of history's most famous and controversial queens - the warrior who united a fractured country, the champion of the faith whose reign gave rise to the Inquisition, and the visionary who sent Columbus to discover a new world. Acclaimed author C. W. Gortner envisages the turbulent early years of a woman whose mythic rise to power would go on to transform a monarchy, a nation, and the world.
Excellent historical fiction!
- By nursebettyknitting on 07-30-12
- The Queen's Vow
- A Novel of Isabella of Castile
- By: C. W. Gortner
- Narrated by: Rosalyn Landor
An Intriguing Take
Reviewed: 07-30-12
I know that Isabella is a complicated figure. Both acclaimed and condemned for her legacy and contributions to history. CW Gortner of Confessions of Catherine de Medici tackles her in his latest novel, The Queen's Vow. The scope of the novel is ambitious and attempts to cover Queen Isabella's childhood, power struggles with her half-brother, her romance with Ferdinand, the Crusades, her meeting with Christopher Columbus and on and on. The effect is a little unfocused, but allows for a varied depiction of the monarch instead of a more singular betrayal (ie, religious fanatic). The aspects of Isabella's life that are unflattering like igniting the Spanish inquisition are depicted but breezed over. Gortner allows Isabella to pretty heavily justify her positions. Much of that was hard to read knowing the consequences of Isabella's choices.
Some things I would have enjoyed reading more about her children particularly Catherine of Aragaon are so briefly skimmed it was disappointing. Juana however is thoroughly explored in Gortner's novel The Last Queen is given a bigger depiction. However, the book did include a lot of romance and though Isabella and Ferdinand appear to be a rare love match, I still felt Gortner's treatment was heavy handed.
There is no lacking in drama as Isabella led an sensational life in a tumultuous time. And though I enjoyed much of the novel, and found Gortner's Isabella interesting though complicated, a pre-existing interest in Isabella or the time helps. Because despite Gortner's kind treatment Isabella is still a thorny subject and some of her actions are unjustifiably horrific and are irredeemable to modern readers.
If you don't mind the occasional inconsistent Spanish lisping accent, the narrator, Rosalyn Landor brought really depth to Isabella's story.
10 of 11 people found this review helpful
Broken Harbor
- Dublin Murder Squad, Book 4
- By: Tana French
- Narrated by: Stephen Hogan
- Length: 19 hrs and 56 mins
- Unabridged
In Broken Harbor, all but one member of the Spain family lies dead, and it's up to Mick "Scorcher" Kennedy to find out why. Mick must piece together why their house is full of cameras pointed at holes in the walls and how a nighttime intruder bypassed all the locks. Meanwhile, the town of Broken Harbor holds something else for Mick: disturbing memories of a childhood summer gone terribly wrong.
Best in the Series
- By sara miller on 07-29-12
- Broken Harbor
- Dublin Murder Squad, Book 4
- By: Tana French
- Narrated by: Stephen Hogan
Best in the Series
Reviewed: 07-29-12
While those who have read Faithful Place were introduced to Frank "Skorcher" Kennedy, we obviously didn't scratch the surface. He starts Broken Harbor in about the same place French last left him spouting cop jargon and bragging about solve rates. Though the events from the Faithful Place novel have left his reputation a little tarnished. In a bid for redemption, Frank takes a case involving the attack on a family after which only the mom survived. He's also showing a relative newbie the murder squad ropes, the uncannily perceptive Ritchie. He's also dealing with a mentally ill sister who has shown up just in time to upend his life. When the case ends up more complicated than he could have imagined, Frank's path to the killer requires him to question everything he was certain he knew.
First, I'm a fan of the entire Dublin Murder squad series. I find that Tana French ups her skill with every subsequent book. Broken Harbor has officially replaced Faithful Place as my favorite. Second, everything I love about the series is here: complex mysteries with genuine surprises, a fascinating and layered view of modern Dublin, and some of the best interrogation scenes I have ever read. French also tackles another "partner" relationship which she hasn't touched much since Rob and Cassie in her debut, In the Woods. One of the things that stand out the most in Harbor is French's vivid portrayal of the victim's marriage and family life. Through some clever plot situations we get layered depictions of this family which makes their story fascinating. Frank's character development is also entirely honest which by the end of the book makes the reader a genuine fan. Broken Harbor is a gift for mystery fans. And while each book in the series stands alone, once you read one, you will want to read all four. I for one cannot wait for the next installment.
I listened to the audio version performed by Stephen Hogan. About 90% of Steven Hogan's reading is wonderful. However, he does a really screechy impression of Frank's sister which unfortunately puts the listener off.
99 of 103 people found this review helpful
The Orphanmaster
- By: Jean Zimmerman
- Narrated by: George Guidall
- Length: 15 hrs and 2 mins
- Unabridged
It's 1663 in the tiny, hardscrabble Dutch colony of New Amsterdam, now present-day Manhattan. Orphan children are going missing, and among those looking into the mysterious state of affairs are a 22-year-old trader, Blandine von Couvering, herself an orphan, and a British spy named Edward Drummond. Both the search for the killer and Edward and Blandine's newfound romance are endangered, however, when Blandine is accused of being a witch and Edward is sentenced to hang for espionage.
Bizarre at times
- By sara miller on 07-02-12
- The Orphanmaster
- By: Jean Zimmerman
- Narrated by: George Guidall
Bizarre at times
Reviewed: 07-02-12
In the young New Netherlands colony, orphans are disappearing. The evidence recovered suggests some may have even been partially eaten. The leading theory is a Native American beast who consumes children. Terrifying an entire community, but irrevocably changing the town's Orphanmaster, a she-merchant and an English spy hunting fugitives.
For such a dark story, I was surprised at how well it was researched. In fact some of the chapters open with headlines. You get a good sense of the politics, social protocol and economic feel of the time period. You can't help but come away with a better understanding of the origins of Manhattan.
Some warnings:
-The story is gruesome throughout
-The story's romance is contrived. It feels sort of forced amongst the rest of the subject matter.
- There are also many narrators telling the story. They are all pretty roughly sketched (but eerily memorable). The collective tells the story of the colony and it's time more than any one character. The timeline isn't fluid either. At times this ensures the reader is lost, and that the author may even be employing the confusion.
So it's not for everyone. But if you keep to it, the novel really picks up momentum towards the end of the story and even becomes focused.
The novel's narrator George Guidall was perfect. He reads the entire novel as if he's voicing over a movie trailer. I will definitely be on the lookout for more performances from him.
10 of 10 people found this review helpful


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following you will find the tested kites and the main statments about it:
Cabrinha Black Tip 9.4 and 12.2 (25m lines)
- great hangtime
- almost same high steering forces like last year
- 12.2 doesn't really turn faster than the 2001 model
- the 9.4 turns faster than 2001
- very good relaunch
F-One Mach1 18.1 and 15.1 (27m lines)
- very low steering forces for both sizes
- very good depower
- easy relaunch when enough wind, with light winds couldn't be tested
- the kite has to be depowered a little, if not the backlines will be pulled too much and than it tends to stall (backstall)
RRD Supertype 16.0 (28m lines)
- very low steering forces and turns fast
- the kite has to be depowered a little, if not the backlines will be pulled too much and than it tends to stall (backstall)
- good relaunch
- good lift for jumps
- long batten at the tips
Gaastra GXS 14.0 and 12.0 (28m lines)
- despite the stick in the middle of the kite at higher winds it will still get the typical U shape like other kites
- the kite has to be depowered a little, if not the backlines will be pulled too much and than it tends to stall (backstall)
- steering forces similar to the North Rhino
- good relaunch
- same lift and power as the Gaastra G-Spot
Wipika Airblast 8.4 and 11.8 (25m lines)
- with bridles very fast and almost no steering forces (but this way you can't feel the kite)
- disadvantage: small impulses on the bar are enough to turn the kite, you need very good control of the kite
- wide depower range
- the 11.8 doesn't create much poer at the low end compared to other kites of the same size
- easy relaunch due to bridle
Takoon Skoop 8.5 (28m lines)
- as fast as the Airblast and same easy steering
- wide depower range
- can be too fast when not experienced
- great lift for very high jumps
- difference to the Airblast: the Skoop has the last battens all the way at the end of the tips and no special valve to keep the pressure in the tube
Cabrinha CO2 9.0 (25m lines)
- good allround kite
- as 2-liner easy to handle, as 4-liner fast
- good jumping power but less hangtime than highperformer
- very good relaunch
- large wind range (also depending on the boards) from higher 3 to higher 6 Beaufort
Gaastra G-Spot 12.5 (28m lines)
- comparable to the CO2 from Cabrinha
- fast and easy handling
- same wind range as CO2
- alomost longer hangtime than the Gaastra GXS
- the riding speed is less than the GXS
- very good relaunch, considerable better than the GXS
- can't be used as 2-liner
Flysurfer Warrior 9.3 and 7.0 (20m lines)
- perfect relaunch, also good for snowkiting
- lift for jumps not comparable to tubes, but still ok
- good depower
- very low steering forces
- 9.3 can be compared to 10 sqm surface area tube kite
Naish Aero 10.0 (28m lines)
- very good relaunch
- steering forces a little bit more than the C02
- good lift, but hangtime less than highperformer
- turns slower than CO2
RRD Type 4.1 12.0 (28m lines)
- good relaunch
- steering forces like Slingshot 10.0 Fuel
- turns intermediate
- similar to Wipika Hydro
Slingshot Fuel 14.0 and 10.0 (28m lines)
- good relaunch
- 14.0 turns slow and has high steering forces, not good for jumping
- 10.0 turns fast, still higher steering forces, great lift for jumps (better than Aero)
Strongkite 8.6 (line lenght n.a.)
- turns fast and direct
- the testers only had this size which was too small to test in comparison to the others.
- relaunch couldn't be tested, which should be very interesting
Takoon Akooba 12.2 (line lenght n.a.)
- comes with a 2-line bar
- not good to fly with 2 lines
- good relaunch
- good intermediate kite with average performance
Wipika Hydro 11.0 (28m lines)
- needs longer depower than Airblast
- very good-natured, not agressive
- doesn't turn as fast as compareable kites
- good for easy riding
Wipika Inferno 9.0 (30m lines)
- very stable and constant pull for wakeboarder style
- not too fast, good-natured
- good relaunch
Naish Virus ? (20m lines)


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The Ohio Turnpike Commission is a body both corporate and politic, constituting an instrumentality of the state. The Commission is comprised of nine members, including: four members appointed by the governor with the advice and consent of the Ohio Senate, the director of transportation, the director of budget and management, the director of development, one member of the Ohio Senate, and one member of the Ohio House of Representatives. Each member is appointed to an eight-year term. In addition to serving as the issuer for the obligations, the Commission oversees and manages the construction, operation, and maintenance of the Ohio turnpike system. Ohio Turnpike CommissionLinks to Other Ohio Issuing AuthoritiesOhio Public Facilities CommissionOhio Housing Finance AgencyOhio Water Development Authority
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Barnard students have the opportunity to apply for many fellowships and scholarships which provide funding for undergraduate or post-graduate international research. Please see below for more information on select international individual fellowships and scholarships.
Opportunities for Undergraduate International Fellowships:
Tow Fellowship Travel Grants
Tow Fellowships support travel related to research for the senior thesis. Candidates apply to the Committee on Honors (CoH) in the spring of their junior year to seek support for travel that will take place during the summer between the junior and senior years. The awards generally range from $1,000 - $4,000. Interested students should see Dean Runsdorf during the fall semester. More information can be found on the Dean of Studies Website here: http://barnard.edu/dos/academic-advising/scholarships-fellowships.
Lucyle Hook Travel Grants
Lucyle Hook Travel Grants provide funding for travel related to research for the Barnard senior thesis (endowed by a late, emerita Barnard faculty member). The award amount varies, but normally ranges from $100-$500. Candidates apply to the Faculty Committee on Honors, which typically awards four or five grants each year. Interested students should speak with Dean Runsdorf by early October of the senior year and obtain the Committee guidelines for application from him at that time. Decisions will be announced by mid-December. More information can be found on the Dean of Studies Website here: http://barnard.edu/dos/academic-advising/scholarships-fellowships.
Earth Institute Travel Grants
Through the travel grant program, initiated in 2005, the Earth Institute allocates funding to support travel by students matriculated in Columbia University degree programs who are engaged in research projects dealing with issues of environmental and sustainable development. This travel can be domestic or international and is for projects directly related to degree studies at Columbia University. The maximum travel grant award is $750 per person, and students must use this to cover the cost of their travel for research they are conducting to meet specific degree requirements.
More information about the travel grant program is available HERE. The application is available HERE. The deadline to for the fall is October 19. Please contact Nathan Rudder, Senior Program Manager, at firstname.lastname@example.com for more information.
Opportunities for Undergraduate International Scholarships:
National Security Education Program David L. Boren Undergraduate Scholarships
Boren Scholarships support U.S. undergraduate students studying abroad in areas of the world that are critical to U.S. interests and underrepresented in study abroad, including Africa, Asia, Central and Easter Europe, Eurasia, Latin America and the Middle East. Preference is given to undergraduate applications proposing a full-year academic study. Summer-only programs are limited to science, technology, engineering and mathematic students. In exchange for scholarship funding, all Boren Scholars must agree to work in the Federal Government in a position with national security responsibilities for one year within three years of graduation. Awards range from $8,000 for summer study, $10,000 for a semester and up to $20,000 for an academic year. The on-campus deadline for this scholarship is around early January and the national deadline is usually in early February. Interested students should look at the Boren website and contact Dean Young for more information.
Benjamin A. Gilman International Scholarship Program
This award provides "U.S. citizen undergraduate students of limited financial means to pursue academic studies abroad. Such international study is intended to better prepare U.S. students to assume significant roles in an increasingly global economy and interdependent world." Applicants must be Pell Grant Recipients. The scholarship awards up to $5,000 for U.S. students to study abroad for up to one academic year. Students who receive the Benjamin A. Gilman International Scholarship to study abroad are eligible to receive an additional $3,000 Critical Need Language Supplement from the Gilman Scholarship Program, for a total possible award of up to $8,000. The deadline every year for the spring semester is around early October and it is in early March for the fall and full-year programs. Interested students who are Pell Grant recipients should contact Dean Young in early September or late January, depending on their study abroad plans. Applications and more information can be obtained on the Gilman website.
Recent winners of a Benjamin A. Gilman International Scholarship include:
- Natalie Hernandez, who studied in Italy in the Fall 2011
- Nicole Jabanoski , who studied in Senegal in the Fall 2011
- Jade Kendrick, who studied in Madagascar in Fall 2011
- Anayvelyse Allen-Mossman, who studied in Agentina in Spring 2012
- Charlotte Kostelic, who studied in Russia in Spring 2012
- Alexandra Lisonek, who studied in Italy in Spring 2012


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A sagging economy hasn't affected land prices, at least not in Illinois. Farmland prices actually rose slightly during the first half of 2010, according to a survey of the Illinois Society of Professional Farm Managers and Rural Appraisers.
The best land increased 1.7% to $7,665/acre. This land considered excellent averages a yield of at least 190 bu. of corn/acre. Good land that yields 170-190 bu./acre sold for an average of $6,639. Average quality land (150-170 bu./acre) sold for $5,724/acre and fair quality land (150 bu./acre and less) sold for $4,646/acre.
However, strong land prices are not attracting a lot of sellers. The group of appraisers and farm managers reported light volume of land sales during the first six months and they expect about the same volume for the remainder of the year. The buyers continue to be dominated by operating farmers. While outside investors are buying some land, farmers are still the most active investors.
The group also expects land prices to continue increasing next year. Most of those surveyed anticipate price increases up to 5%.
Cash rents higher
The appraisers and farm managers also reported cash rent trends. For 2011, they expect slightly higher rents for all types of land. Cash rent for excellent land should average $279/acre, $237/acre for good land, $199/acre for average land, and $162/acre for fair quality land.
A wide variety of rental agreements are now used and no particular lease or rent is considered standard. In fact, variable cash rent arrangements are becoming more popular. The most popular variable cash rent includes minimum cash rent with chance of bonus. Another popular agreement ties cash rents to production only.