On hospitalization: Advocate for yourself

Over the course of three surgeries starting in May, I've had the honor of spending 17 days in the hospital in recent months. Before this, I'd not spent a night in the hospital since I was five years old, so I had to learn a thing or two about how best to take care of myself.

What I learned is this: I had to be an advocate for myself.

My second visit to the hospital, in July, was the worst. Part of that was a function of the surgery itself--I was opened up along the entire length of my belly, and surgeons had a difficult time once they got inside. The result was more pain--and more pain medication--than I have ever experienced in my life.

An additional problem, for me, is that I am what's known in the medical industry as a "bad stick." Hospitalization is an unending series of 1 a.m. blood draws--the better to deprive you of needed rest--and what became clear during that second visit is that it was hard for medical personnel to find a decent vein to tap. On one particularly unpleasant evening, the phlebotomist stuck me five times, fruitlessly, leaving an ugly and long-lasting bruise. I warned subsequent needle-bearers they would get two opportunities, tops.

I was ready for the problem this time. Every time somebody new approached me to draw blood, I told them: "I'm a bad stick. It's hard for people to find the right veins. I know you're trying to help me, but I'm not inclined to sit still for repeated stickings." And the results were good: One young lady stuck me three times--once in the hand! digging around!--but everybody else seemed to take extra time and care to finding and preparing the right vein. For the most part, the blood draws were a smooth process this time around.

My other problem during the second visit was room-sharing. I'm not above the company, but I realized--thanks to a nasty panic attack on my last day--that I needed better air and light than I was generally getting. So I told the people in charge of my care that if I shared a room, I needed to be next to the window--which, in addition to providing natural light, also happened to be closer to the air-moving unit in the room. With light and moving air, I could survive better. It's probably not a coincidence that I was moved to a private room after one night during this last visit.

I'm sure I seemed snotty and a little precious in laying down the ground rules to the (really!) great team of medical professionals who were helping me recover from a devastating illness. But the truth is that this hospitalization was the easiest of the three. That's partly because the surgery was less invasive and painful, but also--I think--because I knew how hospital conditions affect me, and what conditions provided the best level of comfort (and thus the least stress) in that setting.

I'm grateful for every single person who attended me during my hospitalizations. I hope I never offended them, though I'm sure I did from time to time. But there's no point in becoming a passive slab of meat once you enter the hospital. Once I figured out what I needed, I asked for it. And generally got it. That made the process much, much easier to endure.

On pooping

A couple of months ago, I took my son to the French cafe down the street, a lovely place full of coffee, brie, and accordion music. He had his usual croissant, I ordered a sandwich and soup, and we were well on our way to enjoying an atypically mild Philadelphia day.

Under my shirt, though, activity was brewing. The seal on my colostomy bag had come loose--and when the poop started flowing again, there was little resistance between it and the outside world. I heard a farting sound and looked down in horror as a dark brown stain spread across the front, the smell of shit muscling aside the aroma of green lentil  soup that had made the cafe so inviting.

I quickly paid my bill, hustled Tobias home, and cursed furiously as I cleaned myself up. And I spent the rest of the day feeling sorry for myself.

Last week, my colostomy was reversed. Early Monday morning, I pooped in the regular fashion for the first time in roughly seven months. For me, 2011 has been the Year of Poop--with much thought given to how it's done, what it's made of, and what it means. I never really made my peace with the colostomy bag, but I'm far more conscious of my poop now, and I doubt that will ever really go away.

Let's back up to where it started. In mid-April, I started feeling lethargic--energy-less, and no appetite to boot. I started to neglect work. I thought I was merely depressed, but soon realized I hadn't pooped in days. Noticing made no difference--additional bran, coffee, water, and other natural aids did nothing to get the flow started. I made a doctor's appointment, even had an X-Ray done: Nothing was found. I was sent home with some home enemas and a particularly powerful laxative.

Instead of pooping, though, I began to vomit--a development that prompted a rush to the emergency room. I sat mostly unattended for a few hours, interrupted only now and again by doctors trying to ascertain my problem. After I was sent for a CT scan, though, I was suddenly surrounded by doctors prodding my midsection: My intestinal tract was swollen and almost entirely closed off; I was in danger of perforating. I needed emergency surgery, a colostomy, to relieve the pressure--and only after the inflammation subsided would doctors be able to search for the underlying cause.

I've already written about the colostomy bag, how it frightened and offended me. But I haven't really talked about the poop. Because the colostomy--situated right under my sternum--transformed my relationship with the stuff.

As a society, we're actually pretty good about making it easy not to think about poop. The process generally takes place behind you, after all, and if you're generous in your use of toilet paper, it's possible to take a good dump, cover it with the TP, and flush it down the tubes without ever really seeing it. Those tubes are something to think  about, though: To a large extent, cities are built around the complex process of moving your poop somewhere else--countless tax dollars are spent on sewer systems, after all, and the intricacy of some urban systems must count among the greatest works of man. If we had to handle our own shit all the time, society would be a much different place than our flush-it-down-the-drain culture.

Well, I did handle my shit. Every day. I'd wake up every morning; soon--often after coffee--the bag would begin to fill. There was nothing subtle about the process: It became a nasty brown balloon that billowed under your shirt, creating social anxiety if you were stuck out in the city without a public bathroom nearby. Two or three more visits to the bathroom would follow during the morning, then usually pipe down in the afternoon and into the evening.

A couple of things to note. First: The placement of the colostomy had the effect of parking an anus directly under my nose. I could smell shit all the time, no matter how much time I spent clearing and cleaning the bag--a considerable amount of time, by the way--and even my wife became hesitant to be affectionate the way we usually were, with her parking herself in the crook of my arm and burrowing her face into my chest. The odor never went away.

Second: I became familiar with how much stuff there actually is in poop. This is partly the result of the colostomy--it expelled food that, under usual circumstances, might've been more digested. But lots of unexpectedly identifiable stuff came through: I learned that some foods were probably easier for my digestive system to process--and thus, probably better for my health. And plant evolution began to make sense to me, as well; seeds that survive digestion often carry their genes to new and unexpected places.

I did develop a gross, nervous habit during this time: I became fascinated with the transparent plastic colostomy bag. It let me touch the poop without getting messy. And so I began to thoughtlessly sift my shit with my fingers, feeling around the bag--the way one might with bubble wrap--in search of a seed, or a grain of rice, or a pea or a peace of corn, to hold between my fingers and crush. It was satisfying. It was awful.

The bag is gone now. There is a zippered line of staples holding my torso together. For the last two days, I have been pooping roughly once every waking hour. My anus, so silent for so long, has been experiencing a sort of fecal firework as the ship relaunches.

Already, I don't see the poop as much. But I can't stop thinking about it; I'm afraid that I'll fail to notice my health failing again. It's ok--good, even--that I won't be experiencing quite so directly anymore. Now, I know, though: Shit is real. And it really stinks.

OK, for real this time

I report to the hospital at 8:15 a.m. for my final surgery. This blog will be silent, by necessity, for at least a few days. Please don't break anything.

Other online products, besides chickenpox lollipops, you should avoid

In light of the chickenpox lollipops scare, here is a list of other things not to buy online:

• Hershey bars laced with syphillis.

• A rack of ribs dipped in dysentery.

• Twinkies covered in vomit.

• Sweet potatoes. I hate sweet potatoes.

Poverty: It's worse than you think

Remember how the New York Times said the other day the Census Bureau's new, fuller accounting of poverty would likely reduce the poverty rate in America? Remember how I bought it?

I was wrong:

There were 49.1 million poor using the SPM definition of poverty, more than the 46.6 million using the official definition of poverty with our universe. For most groups, SPM rates are higher than official  poverty rates.

So that's embarrassing.

The Times' logic wasn't crazy: By adjusting poverty estimates to include more than cash income—things like food stamps and other government-based assistance, and adjusting for regional cost-of-living differences—it seemed likely that the poverty rate would come down. What's a welfare state for, after all?

But the new estimate also improves on the older count by more fully reflecting how people must spend their money. The official definition of poverty from 1964 to this year reflected the cost of food for a small family; the new measure also includes things like taxes, work expenses, child care costs, and out-of-pocket medical bills. On, roughly, the necessities of life—not frivolities.

And it turns out when you actually have to factor in the costs that people have to pay to actually be productive members of society, the poverty rate goes up. This shouldn't be a surprise. (Those medical costs, actually, take up a huge chunk of the bill—which I, about to have my third surgery of the year tomorrow, find not even mildly surprising.)

As Kevin Drum points out, this new measure would be more useful if we had a sense of the trend over time. The country has grown more urban over time, and cities generally cost more to live in than rural areas—they also have more job opportunities—so I wouldn't be surprised to see poverty rates track with the citifying of the nation. It would also be interesting to see what the '90s-era welform reform bill did to these numbers.

Final thought: One conservative line of thought is that if poor people would just get married and have babies, they'd be more likely to enter the middle class. I think that confuses correlation with causation. The new Census measure seems to view kids, economically at least, as a drain on the family resources. It's a good reason not to view everything in economic terms, but I also can't think of any way in which my 3-year-old son actually adds to my income. The new Census figures suggest that kids are less impoverished because of welfare-state programs—and the new methodology suggests not that poor people can escape poverty by making babies, but that people who have escaped poverty are more free to do so. In any case, this report should be fodder for a whole new round of debates.

This is why there's an Occupy Wall Street movement

Because government helps banks, but it doesn't help you:

The largest banks are larger than they were when Obama took office and are nearing the level of profits they were making before the depths of the financial crisis in 2008, according to government data.

Stabilizing the financial system was considered necessary to prevent an even deeper economic recession. But some critics say the Bush administration, which first moved to bail out Wall Street, and the Obama administration, which ultimately stabilized it, took a far less aggressive approach to helping the American people. 

“There’s a very popular conception out there that the bailout was done with a tremendous amount of firepower and focus on saving the largest Wall Street institutions but with very little regard for Main Street,” said Neil Barofsky, the former federal watchdog for the Troubled Assets Relief Program, or TARP, the $700 billion fund used to bail out banks. “That’s actually a very accurate description of what happened.”

A recent study by two professors at the University of Michigan found that banks did not significantly increase lending after being bailed out. Rather, they used taxpayer money, in part, to invest in risky securities that profited from short-term price movements. The study found that bailed-out banks increased their investment returns by nearly 10 percent as a result.

Spanking, revisited

My last post on spanking generated quite a bit of discussion at my Facebook page. My position—then and now—is that I have spanked, but within a very strict framework that limits spank-worthy situations. And, I added, not everybody has control enough of their emotions that they should use spanking; it's too easy to let anger take over and turn a swat on the behind into something abusive.

Let me revise and amend my remarks, in light of this New York Times story about spanking advocates Michael and Debi Pearl, and their followers who apparently killed their child.

Debate over the Pearls’ teachings, first seen on Christian Web sites, gained new intensity after the death of a third child, all allegedly at the hands of parents who kept the Pearls’ book, “To Train Up a Child,” in their homes. On Sept. 29, the parents were charged with homicide by abuse. 

More than 670,000 copies of the Pearls’ self-published book are in circulation, and it is especially popular among Christian home-schoolers, who praise it in their magazines and on their Web sites. The Pearls provide instructions on using a switch from as early as six months to discourage misbehavior and describe how to make use of implements for hitting on the arms, legs or back, including a quarter-inch flexible plumbing line that, Mr. Pearl notes, “can be rolled up and carried in your pocket.”

Spanking advocates? I think "beating advocates" is more like it.

Listen: The subject of child discipline is highly fraught, and it's really easy to sit in judgement of people who do it differently than you. But let's be plain: If you read books about how to make weapons to hit your child, you are probably an asshole who doesn't have sense or compassion enough to be a parent.