Bad timing

So this whole bar mitzvah thing...the timing seems to be off.

This is my problem. When J was a little kid, he loved all the Jewish stuff. He loved Shabbat at preschool. He loved the wine, the candles, the challah... He loved saying the blessings. He loved being the Sabbath King. He loved Chanukah. He loved Purim. He loved the seder at Passover.

So we sent him to Jewish day school because we loved how seamlessly his preschool had moved between our two worlds, the American/secular world and the Jewish world. And he loved kindergarten, and he learned to read English, and then in first grade he learned to read and write Hebrew, and he learned some Hebrew words. He liked the bible stories, and he liked learning the morning prayers. He liked the Hebrew songs and Israeli dances. And we went to temple, and he liked the kids' services. And it continued this way, through about fourth or fifth grade.

But now J is 12-1/2, in sixth grade, in middle school, on the brink of adolescence. Currently, he loves 1) basketball 2) x-box 3) his friends, especially if he is playing either basketball or x-box with them. (And playing basketball on x-box with a friend is the ultimate.) But what he isn't really interested in anymore is school, or Judaism. Those things are, to quote J and all his friends, are "boring."

And now it's time to prepare him for his bar mitzvah. He's not resisting, but he's not really into it, either.

So here we are. Now what do we do? How do we make this meaningful at this time in his life?

Non-adherence and mail orders

I've always been somewhat peeved by the term "non-adherence," as in "the patient is non-adherent to his/her medication." It puts the blame squarely on the patient. It's as if someone is saying: "Why won't you just take your medication? I told you it's good for you! I told you that you need it! What is wrong with you?"

So here's a little story...

I take two medications, one prescribed by my PCP and one prescribed by my oncologist. For some reason, my PCP will not give me a prescription for a year, and insists on giving me a script for 6 months or even 3 months. (This is a medication I've been on for years. It's not like something is going to change.)

My new job has a mail-away drug program, and you can get 3 months of your prescription for a slightly lower cost than ordering it from the local drug store. So the last time I was in to see my PCP, I asked her to send the prescription to the mail-away drug program. She assured me that it would go through quickly and that I'd receive the medication in a few days.

I checked the mail-away drug program's website and my prescription didn't appear there. After about 10 days, I heard from my PCP's office: there had been some problem with getting the mail-away drug program to accept my prescription. They think it has been resolved.

Next, I get an automated call from the mail-away drug program, asking me to confirm my zip code and address. They say that the address in their system and in the PCP's system don't match. I'm starting to realize that my doctor's office probably has my zip code entered incorrectly (there are 2 zip codes in my town and people tend to confuse them). This has caused all this delay.

So now the prescription is on the website, and everything looks okay. Except it hasn't been filled or mailed.

What the hell is going on? And my medication supply is dwindling.

Probably a week later, I get another automated call from the mail-away drug program. There has been a delay in my order (no explanation for the delay). Am I running out of medication? If I am, I should call them.

So by now I really am running out of medication. I call my PCP's office. Since I'm calling about a prescription, they transfer me to the nurse's voice mail. I explain the situation and that I need a refill from the local pharmacy because the mail order one is being delayed. The voice mail says that if you are running out of a prescription, you should call the pharmacy and have them fax a request to the PCP's office.

I call the pharmacy, and they tell me that they can fax a refill request to my PCP's office. So I have them do that. And then I leave another message at my PCP's nurse's voice mail.

Finally, I take my last pill. Now I am starting to get very nervous because if I miss these pills for more than a day, I'll start getting side effects.

I decide to call the mail order drug program. (I don't know why I am protecting them: Medco is the company.) A very polite woman says that my prescription was sent 2 days ago and should arrive soon. I tell her that I am now out of medication. She offers to authorize a "bridge" prescription of my medication, but...my PCP has to authorize it before the drug store will fill it. Also, since I've already run out of medication, do I want counseling?

Counseling? No, I want my prescription. Thank you very much.

I call my PCP's office again. This time I am able to talk to a human being who discovers 2 interesting things while looking at my record: 1) my zip code is incorrect in their system (as I suspected) which caused the delay in the first place with the mail order company, and 2) the nurse did indeed already call the prescription into the local drug store. I am relieved, and plan to pick up the prescription at the drug store when I get home.

When I get home from work, the medication has arrived from the mail order company. I take my pills. All is well with the world.

Or is it?

Why did I have to jump through all these hoops just to get my prescription filled? This is absolutely ridiculous.

So back to where we began: non-adherence. It's easy to see how people get off-track with their medications when you have to deal with #$%@ like this. Sure, some folks probably don't take their medications for other reasons. But I'll bet that a lot of the non-adherence now-a-days is due to ridiculousness like this. It just isn't right.

P.S. As a final nail in the coffin, I just tried to pick up my prescription at the local pharmacy. The emergency prescription that was supposed to hold me over in case my mail-order prescription didn't arrive soon enough? It was denied by the insurance company.

Chanukah: done

Listening to the Manic Mommies complain about Christmas preparations (via podcast) on my ride home today, I couldn't help but compare their preparations to my own. My Chanukah preparations. (You can stop laughing now.)

I have attempted to buy presents for my family, I really have. I requested a list from both my husband and son: no lists have appeared. J will periodically (i.e. daily) tell me about this or that thing that he wants me to buy him, but he does that even when it isn't Chanukah. A just says he doesn't want anything, as usual. So I've been trying to find some creative things for them. I've been somewhat successful - we'll see when I actually give them the presents. The stress is that you are supposed to give something every night. And J doesn't want small things anymore. So what are you supposed to do?

I sent my parents a small gift. I need to send something to my niece and nephews. That about does it.

And tomorrow night is the first night of Chanukah. I need to get out the Chanukah menorahs, dust them off, and dig out the wax from last year (if you are Jewish, you know what I mean...). I need to make sure we have Chanukah candles...I'm pretty sure we do, as we tend not to use them all, for some reason. We have a box of old Chanukah decorations in the attic - I should get that down, although many of those things are too child-like for J now. And I should make sure I have potatoes so I can make latkes tomorrow night. And...that's about it. Chanukah: done.

Too soon

J attended his first bat mitzvah party last Saturday night. All the kids from his class were there. The girls were dressed in party dresses, some in heels, some in strapless outfits. They looked beautiful, and very grown up. The boys were mostly wearing button-down shirts, some had on ties, some even wore jackets. They looked good -- handsome, even -- but vaguely uncomfortable.

This party came right on the heels of J's first middle school dance last week. Most of the bar/bat mitzvah festivities for J and his friends will take place in 7th grade, but there are a few kids having celebrations in 6th grade. So this party, and the dance, are the first time these kids have been in this situation. I'm thinking they may be a smidge too young for this sort of thing. Most of them are barely in puberty. Or "pubertized," as J likes to say.

But there's another issue, too. With these dances and parties, J is being asked to look at the girls differently than before. They are supposed to now be objects of desire. But he doesn't feel desire for them. They are the same girls he's gone to school with since kindergarten. They are friends. How is he supposed to make this transition?

"Slow dancing is stupid," he commented. "All you do it put your arms around the girl's waist, and move back and forth. It's boring."

Well...yeah. Until it isn't.

Trouble is, he's just not there yet. These kids are 12. Some are still 11. This is too soon.

Maybe next year.

Sperm donors and ethics

I can't stop thinking about an article I read in the Globe yesterday. It was about a lawyer in his 30s who was a sperm donor for about 3 years while he was in law school. Now he finds out that his sperm was used to father 70 children. 70! And because people are so much more connected these days, many of the families have connected with each other and with him online. So now he has a dilemma: what is his relationship with his biological children supposed to be? It's fascinating, and scary. You can read the whole article here.

What I don't understand is: why isn't there a limit to a number of times that a single sperm donor's sperm can be used? If a woman is an egg donor, is there no limit there, either? I can't believe that no one has thought of this before.

The thing that fascinates me is that kids really do have a need to know where they come from. I'm seeing this more and more with J as he gets older. He was thrilled to meet a bunch of cousins in Chicago this summer who share his last name. I think it helped him feel more grounded, connected. So I can understand why the kids, whose fathers are nothing more than a sperm donor number, are interested in learning about these men.

I tried to bring this topic up at breakfast this morning, and A gave me a look. I think he knew where it was going before I did.

I explained the situation to J, and he thought about it a minute. He wasn't at all interested in the ethical dilemma.

"How does the man get the sperm out of his penis?" he inquired.

A looked at me.

"Um, he masturbates, and then the sperm comes out," I replied somewhat vaguely. J has recently learned about masturbation, although I don't think he fully gets it. Yet. At least I didn't mention the pornographic magazines offered at the sperm bank.

"Where does the sperm go?"

"Um, in a cup. Then the sperm bank saves it and uses it if people want to get pregnant and for some reason they don't have sperm."

J thought it was pretty funny that men would go somewhere to masturbate into a cup, but he was impressed to find out that they could get paid for it. I'm afraid my discussion of the ethical issues of sperm donation didn't go very far.

Oh, well. I tried.

Life on the fifth floor (part 4)

Many, many years ago -- I guess it was probably around 1986 -- I was just out of grad school and temping at Emmanuel College, and a friend was going to school at Harvard Medical School. I remember meeting him on "the quad" one day, and thinking: this is lovely! It's a huge field of green grass surrounded by stunning, impressive, white buildings with enormous columns.

Now it's 2011, and here I am. It's still beautiful.

On Wednesdays during the summer, there is music (see the little white triangle?) in the quad for everyone to enjoy, put on by Berklee students.

This is the email that goes out on Wednesdays:

... take a break from your research, patients, paperwork and other tasks to enjoy a series of concerts on the HMS Quad and in the Kresge Courtyard. The concerts, featuring musicians from Berklee College of Music, take place on Wednesdays from 12:30–1:30 pm. Sit back, relax and enjoy some music with your colleagues.

Today's concert wasn't spectacular, but it was nice to sit in the sun for a few minutes. There's a nice focus on "quality of life" here. I like it.

Life on the fifth floor (part 3)

My new project -- and Harvard in general -- uses a lot of acronyms. A LOT. Some of them absolutely crack me up.

KFC. What does that mean to you? Well, to me it means Kentucky Fried Chicken. Here, it means "Key Function Committee." But every-time someone says KFC I think of chicken.

CHIRP. What does that mean to you? To me, it's the sound that a bird makes. Chirp, chirp, chirp. Here, it is (embarrassingly) the name of my program. Community Health Innovation and Research Program. CHIRP. Not sure how we will ever get anyone to take us seriously with that name.

R-Nav. Pronounced "ar-nav." It probably doesn't mean anything to you -- yet. It's actually a pretty cool thing. The Research Navigators (or R-Navs) are "PhDs who serve as scientific liaisons to facilitate clinical and translational research." They connect people to each other and to research opportunities. There are 4 R-Navs, and they are very nice. And very smart.

Translational. What does that mean to you? Here, it isn't about translating something into another language. It means translating a scientific discovery into something that can be used by people. Everyone's always talking about translational this and translational that.

TAP is the tuition assistance program. HUGHP (pronounced "hug-up") is the Harvard University Group Health Plan. PeopleSoft is where you log your time, and ASPIRE is where you apply for a new job (if you ASPIRE for a job...get it?). PMP is the performance management process. Although at the Med School, we do PPR - Performance Planning and Review.

And now...back to the 5th floor. Here is a photo of my wastebasket. Have you ever seen anything like that? It's a little teeny tiny waste basket that is hooked onto the side of a blue recycle bin. The message is: recycle most things, throw away just a little. Of course what I end up doing is completely filling the little tiny waste basket, and not putting much of anything into the recycle bin. I guess I'm lucky, though. My friend, K, over at the School of Public Health, doesn't even HAVE a wastebasket. None. At. All. They take recycling very seriously over there.