Pain, Pills and the Pursuit of Healthcare

I've had a trying three weeks. After a laboring Labor Day, I was looking to that post-holiday Tuesday for some normalcy. But that never came. Any chance of respite was relinquished when we had to unexpectedly head back from Massachusetts Sunday night on the holiday weekend reserved for relaxing, subjecting Michael Alexander to a car and train ride extending hours past his bedtime. I abide by the old adage to never wake a sleeping baby (even if I'm miffed I can't find its origin and hate spewing jargon of unknown intent), but I've come to believe it's much worse to force a toddler to stay awake well past schedule. Our only consolation was three early 20-somethings, a lovely woman and two charming men, who made every effort to entertain our son and swap his tears for a delirious fit of exhausted laughter and manic energy. During the car ride to the train station, our perpetually cheerful son cried to convey an agony that ripped my heart to shreds and eroded any semblance of sanity I was able to muster. He's wept passionately only when physical pain from chronic ear infections strikes, so to hear blood-curdling cries brought on by a sudden (yet completely avoidable) schedule change stung deep and hard. That disruption lingered through the week, as his napping was off, making for more tumultuous times. I did my best to avoid the Facebook photos of those who spent Labor Day at the beach, soaking in summer's last hurrah. As I battled the envy of those who kicked off the short work week with sand still in their hair, I hoped I could at least shake off the stress of the last couple of weeks. Instead I faced the most arduous stay-at-home work week, with banal task after banal task for a freelance assignment that's still ongoing, all with Michael Alexander robbed of his naps and struggling to re-acclimate after that torturous journey home. I'd had dreams the week before of someone offering to watch, or at least stay in the apartment for an hour or so while he napped, giving me some time to get ahead on my work. That was a silly expectation! I know better now. What's worse is that week before Labor Day marked a major setback in my greatest personal (non-mommy) accomplishment of recent history. I'd finally started work on a novel, and had been sneaking minutes here and there to gain impressive momentum. Then that first of three miserable weeks reared its ugly head, and all creativity was lost. I haven't managed a word since.

As I trudged through last week, I made every effort to test my physical fitness and exert as much energy as possible in a last-ditch effort to lighten my dampened spirit. It was going great, until last Thursday when I stupidly took a spin class that I know I should avoid like a plague. It involves balancing in second and third position without touching the handlebars. Sure it builds core strength and burns calories, but for someone like me with a severely damaged spine, it's a prescription for pain. Like I said, I know better. I'm to blame. And I've been paying for my bad judgement. My chronic pain -- due to a degenerated spine and slipped discs, caused by scoliosis -- is dull and constant with episodes of excruciating sharp or stabbing pains. But those inexorable episodes rarely last more than a day or two. This was the longest bout of what's regarded by doctors as debilitating pain I've ever endured. Since I'm incapable of slowing down -- both because of my personality which rejects the notion of slothenly couch-sitting or bed-rest, and because I have to care for a very active 17-month-old all day without any childcare -- I have to rely on better living through chemistry.

On Monday, I went to see a spine surgeon, who advised that if I take another hands-free spin class I'll be on his schedule sooner than later. I'm already banned from running (even though I've logged some miles since giving birth), as I was diagnosed with scoliosis and the degenerated spine while marathon training in 2006. I had to see nearly a half dozen doctors back then before finding one who'd agree to treat me if I went through with the marathon. I finished, and would have had it no other way. I've since struggled with cutting out the running as it's by far the most effective cardio, and my metabolically-challenged body needs a lot of intense exercise. The first of three doctors I visited this week gave me a cocktail of three meds, a narcotic painkiller, a hardcore muscle relaxer and an equally potent anti-inflammatory, saying I'd only feel any relief if I stacked all three. True it masked some of the pain, but it took my brain, balance, motor skills, reflexes and ability stay awake past 9 p.m. as prisoners. I was barely functioning during the day, praying I wouldn't pass out while keeping up with Michael Alexander. Clearly that pharma-concoction was a short-term fix, and he referred me to a pain specialist who could better help me cope longer-term.

I should have been suspicious when the pain specialist I was referred to was able to see me the very next day, without my even droning on about the severity of my situation. I'll spare you the brunt of the saga of this horrific experience, as some of you may have read my reviews. (It's the first time I've written a negative review online, and I was very generous to not mention he was essentially trying to defraud me.) Long story short, I gave the woman who made the appointment my insurance and personal information, and she'd promised to call back that day if there was any potential problem with the insurance. She never called. Mike confirmed the doctor is in our network. When I arrived for my appointment, there was nobody at the front desk and I waited some 15 minutes before the doctor, with his name embroidered on his top, came to the desk. I had to alert him I was a patient, and he handed me a pile of paperwork. Another 20 minutes later, he came to call in the patient scheduled a half hour after me. The other patient was kind enough to point out that I was ahead of him, so the doctor called me to the front desk to inform me I'd have to pay hundreds, maybe more, up front because of a "network deductible" and refused to bill me through my insurance. He said "that's the way we do it," and that he'd "reimburse you if you overpaid." He said I could pay him and then seek reimbursement through my carrier. Naturally, I walked out. My back pain worsened by the time I left the office as my stress mounted. This esteemed doctor illegally denied me treatment. Mike spoke with the insurance provider after my failed visit, and was told we should never pay up front for a network doctor. Mike then called the doctor and left a voicemail message. The doctor called back Mike, again insisting "that's how we do it." A woman from the office called back later to apologize for her "mistake," for not calling me back about the insurance and for giving the doctor "wrong information." Of course I've never received a direct apology.

I am so grateful Mike recognized how agonizing this experience was, and that now with a drug-addled brain and rapidly rising anxiety, I was in no condition to call doctor after doctor in search of an honest one who'd accept our insurance, abide by the law and make time to see me almost immediately. After calls to multiple in-network doctors, Mike reached a woman, who after putting him on hold for 20 minutes, understood the urgency and booked me first thing in the morning. I've finally found a doctor who carefully listened to my concerns, examined me and recognized how the emotional stress was exacerbating my physical pain. For the last 24 hours, I've been truly managing my pain, with medications that don't leave me nearly catatonic. Hopefully the cortisone injection will kick in, too. I'm slowly regaining my full capacity to react and respond to sudden movements. Another day or so and I should be back to some reasonably functioning state. I'll be damned if I let another week drain my creative conscious.

Disclaimer: While Natasha Gural-Maiello makes every effort to post accurate and reliable information, she does not guarantee or warrant that the information on this blog entry is coherent due to her recent wranglings with Western medicine.

Living Between Worlds

There are so many things I've wanted to write about this week. Last week. Every day. It's been tougher than usual this week to get anything done during the hour or two each day while Michael Alexander naps because I've been plagued by anxiety dreams. Last night was the closest to peaceful rest I've had all week. Today I'm stealing a few minutes, while he naps and I wait for the laundry cycle to finish, to get something down in print.

It's when I'm most exhausted that I feel overwhelmed, and this week has been replete with myriad last-minute requests that have made my personal to-do list seem impossible. Stealing (guilt implied and magnified with second reference) these few minutes to write -- albeit with little direction or cohesive thought -- is about the only thing I can call my own.

Summertime in New York amplifies the class divide. I cringe every time I hear another stay-at-home mom (nearly always with nanny in tow) complain in line ahead of me that she needs whatever it is she needs now because "we will not be summering in the city." Summering? (Don't even get me started on how utterly offensive such behavior is to the woman behind the counter who wishes she could have a single summer day off with her kids!) Professionally it's tough to get top people on the phone, as most key decision makers -- especially those in the financial services ecosystem -- leave it to the grunts (that's Wall Street for mid-level execs) to get anything done while they jitney to the Hamptons or jet away to Bora Bora. Personally, it's painful to endure the tales of long weekends, every weekend, ahead of a full month or more of sun and surf.

I should not (and am ashamed when I do, even silently) complain, as I among one of the most privileged people in the world, what with all that food and shelter and amenities most human beings will never even taste or dream about. But Manhattan, the land of the haves and the have-mores, can transform even the most compassionate soul into a self-loathing want-more.

We're headed to the Cape a week from tomorrow. We've rented a one-bedroom efficiency on a private "resort" on Provincetown Bay. Aaaah ... I cannot wait. We flirted with the fantasy of renting a huge house in Brewster where our friends are staying a week earlier, but the expense -- without another family to share -- was wasteful at best. We pay far too much for rent in a luxury, doorman building. And even though I am a firm believer that you should never pay to stay in a hotel that's not nicer than your home as it's always a disastrous disappointment, that's often impossible -- or at least stupid -- when you take your regular everyday Manhattan expenses into account. If we were wise enough to think ahead and sublet our place for a week, we could easily afford any luxury rental on the Cape. One day, we'll plan ahead and upgrade from a three-figure rental to a four-figure one.

As I await our week of peasant (hahaha) paradise, I am struggling with my aforementioned to-do list, as the tasks I need or want to accomplish (such little luxuries as cleaning out my closet and lugging bags to the charity shop) become more and more daunting as the requests from others mount and my own goals become tougher to attain. I am trying to take deep breaths, to make it all seem doable, but that would require an expanse of time -- like 10 or 15 minutes -- without an email, text series or other digital interference with a personal request of some kind that bumps my tasks off the radar. I treat my days at home like workdays. I prefer phone and email over text, aside from a quick exchange on when and where to meet a playdate; there is NO TV during the day; and Michael Alexander's needs and my freelance assignments (in that order, of course) take precedence over any distractions.

Library story time in the East Village (and, of course, highly-coveted but informal playdates with Michael Alexander's darling friends and their dear parents) may be my only real respite most days, as I have discovered a true community where stay-at-home parents (most without a nanny in tow!) mix with nannies and other caregivers, giving me a sense that I am not alone in this terribly unbalanced world. (More on the dying breed of mommies-sans-nannies to come.) Running errands like grocery shopping can be isolating in a universe where these tasks are often delegated to the nannies while mommies attend to baby-free mommy matters, whatever those may be. Doing laundry in the daytime may be the strangest of all. I can recall maybe a couple occasions (well, not really recall them, but I am sure they have occurred) when another tenant in the building was doing his or her own laundry. It amazes me how those who never go to an office and stay at home all day still send their laundry out to a service. They just drop that red bag off with the doorman and pick it up when they return. And some complain that's too much of a hassle. Really? (In snarkspeak that's "Riiihl-Eee?") So once a week or so, it's me and the housekeepers (a few who double as nannies) in the basement laundry room.

Maybe it's because I wear my first-generation American status like a badge that the housekeepers have always treated me like a peer. It's been nearly 15 months now that I've been home with Michael Alexander, so I've come to know them well. We rarely struggle to communicate, as my Spanglish and pigeon Polish are pretty good. They all adore Michael Alexander. They all confide in me, often about my neighbors. They all offer to help me, though I would never, ever accept such help without providing proper compensation. And they have never, ever offered me their services in exchange for a fee. And I am well aware, through our conversations, that all are seeking additional work. It's as if they know I am living between worlds. A denizen of a luxury doorman building who shudders at the thought of employing sub-wage slaves.

Some days I find this living between worlds amusing. Some days I can laugh at the banal banter of the moms who shriek on smart phones while their nannies chase after their spoiled sons. Other days I am so disgusted, appalled even. And what disgusts me more than bemoaning their existence is when I feel sorry for myself. I really do not want somebody else caring for my son. (I do, however, often miss working full time, but I'll save that for another post.) I consider it a great gift that I can witness Michael Alexander's growth, especially his burgeoning compassion and desire to share with others. It's a quality strangers and playmates' parents notice. They say "it's in his eyes." For that I am so grateful, so proud. There is no greater, truer, human quality than compassion.

We're far from (and may never have access to) the five-figure rentals some of our friends can afford, but I am OK with that. I am excited to see the sea and share a pool with the occupants of eight other humble units for a week. Until then, I'll continue living between worlds, not quite certain where I fit in or if I really want to.

My Invisible Paycheck

Michael Alexander was up from 11 p.m. until 4 a.m., teeming with boundless energy. I was fighting back the tears, struggling to smile while trying to soothe him into a sleeplike state. He finally fell asleep around 4:30, after a crying fit as passionate as his five-hour overnight playfest. He was back up as soon as Mike left for work after returning from his uber-early gym shift. Mike works out and goes to work even earlier on Wednesdays so I can get to the gym on time to secure my spot in favorite abs class that starts at 6:15 p.m.

Michael Alexander appears well-rested, smiling and playing without any apparent interest in a nap. I have devoured a pot of very strong coffee just to keep up with him. I put him in the Jumperoo so I could scribble my barely coherent thoughts. He's learning as he bounces, smiling at me for approval as he meticulously places plastic fruits into the corresponding spots in exchange for a light. That smile is the only thing that's keeping me from crumbling.

My dear friend Kate suggested that maybe he's not sleeping because of a developmental milestone. That's quite possible, as he learned to clap properly during storytime Monday, and was up in the middle of the night flaunting his newly perfected skill. He's also taking more solo steps without wobbling. It is so exciting to witness his rapid progress as he quickly approaches his first birthday. I just wish I could get enough rest to match his exuberance.

Mindy Greenstein, a psycho-oncologist and consultant at Memorial Sloan-Kettering Cancer Center, last week blogged about motherhood. She calls it "the most invisible, undervalued job that I have ever had." No doubt Greenstein commands a fat salary for her work at Memorial. It is probably even more than the estimated (and of course, hypothetical) *salary* for a stay-at-home mom in Manhattan. According to salary.com, the local median for a SAHM in my zip code is $139,888, in a range of $117,583 to $169,794. Even at the low end, that's more than most executive editor jobs I'm qualified for pay. And those figures are for last year, in a report that posts increases every year.

I don't expect a paycheck for my labor of love, but even the most grueling day at the office ends. Here I am, brought to you exclusively by the power of caffeine, focusing purely on my sweet son's smile. I have so much to do around the house, which quickly transforms into a disaster zone after two mostly sleepless nights, but I am expending every ounce of energy to keep Michael Alexander entertained.

I am actively applying for full-time jobs. I've had a few interviews, all positive, until the topic of salary arises. None match the low end of my "typical" SAHM compensation. The most interesting job I interviewed for this week pays a pittance which is less than half of my average salary of the last five years. I just received an email follow up to an interview last week. I wasn't expecting to hear back, as I thought I was out of the game once I'd mentioned at the end of a lengthy interview that I have a nearly year-old son. The job requires the editor to be on call 24/7. I'm already on call 24/7.

I'm grappling with how to reply to this email. Of course I am flattered to emerge as the top contender in a hyper-competitive market. This job doesn't pay the "typical" SAHM rate, but it's enough to offset the cost of childcare. I am tempted, as I struggle with a job title that makes me "invisible," but I shudder to think that reclaiming visibility requires me to be on call when my son needs me most. I am crafting my response now, negotiating for a slightly higher salary and some flexibility over being on call 24/7.

I'm not sure what it will take for me to trade my invisible paycheck for a living wage.

The Business of a SAHP

I was excited to read the headline of Sarah E. Needleman's blog yesterday on The Wall Street Journal Online: "Can Home-Based Entrepreneurs Be Stay-at-Home Parents, Too?" Like all creative types, I have myriad business ideas percolating on a daily basis and wonder how ambitious one can be as a SAHP (stay-at-home parent.) I know people, mostly moms, who work from home in varying degrees, but have at least part-time childcare. I have nobody to help me during the day and I do some freelance work from home. Right now I am stealing the time I should be spending writing a column on stock splits and cobbling a pitch about green energy. Michael Alexander has gone down for a nap and could wake in 20 minutes so I need to act fast on the keyboard. Yesterday he didn't nap at all and woke several times throughout the night, so I am taking this precious time to write while I can, sleep deprived and all. I haven't posted to Nommersland in so long I nearly abandoned it over guilt. But reading this WSJ post irked me enough to overcome any self-reproach.

Needless to say, I was needled by Needleman's post. "Christine Perkett, a mother of two, is usually home before and after her kids go to school. But she’s not your typical stay-at-home mom," writes Needleman. OK, I'm intrigued, even if I can't yet relate to a mom with school-aged kids. I'm also confused, wondering how a SAHP can sometimes not be home and still actively parenting. "Ms. Perkett, 40 years old, runs PerkettPR, a public-relations firm, out of her family’s Marshfield, Mass., home. When she started the company, she hired a nanny to take care of the kids while she’s on the clock. 'I needed a solution to dig into my work without feeling guilty,' she says, adding that she also requires her 20 employees, who also work from their homes, to make comparable arrangements if they have young kids." OK, I am pissed off! Perkett is NOT a a SAHP! She is using her likely sprawling South Shore home (judging from the photo of her kitchen) as an office. Perkett doesn't want to feel guilty? Hope she is paying her 20 employees enough to really offset the cost of providing all those nannies with a living wage.

Needleman reveals that "Ms. Perkett says parenting and working from home don’t mix. 'People think they’ll stick (their kids) in front of the TV,' she says, but adds that the move isn’t practical or fair. 'It’s nearly impossible to work productively and watch your children at the same time. And it’s not good for the child because they’re vying for your attention and they can’t get it.'" Now I'm fuming. Perkett assumes all SAHPs who do "outside" work are sticking their kids in front of a TV? I am typing on the MacBook Pro we bought to replace the one Michael Alexander knocked off my leg while I was writing a personal finance column when he was just a few weeks old. Sure, that "move" wasn't "practical or fair," especially in terms of the cost of replacing a laptop, but I wasn't neglecting my son while working.

As someone who contemplates the possibility of really becoming a SAHP entrepreneur (sans full-time childcare like Perkett), I'd like a breakdown of the startup costs and where she got the capital to pay 20 people's salaries. Launching a business like Perkett's isn't a reality for most people.

I am not out to vilify Perkett or any other entrepreneur or business owner. But I am calling out Needleman for classifying Perkett as a SAHP. Perkett gets props for her
savvy by saving on overhead and office costs by running her business from home. The blog post, which features a photo of the PR maven with her elementary school aged son and nanny, is raising kid(s) who spend most of the day in school, according to the lede. I know Needleman is banging out a couple of grafs on the quick just to fill a page, but by serving us just this little slice of Perkett's life, she dis-serving SAHPs like me who grapple with the guilt of "not working" by identifying Perkett as a SAHP.

Needleman also mentions "Jason King, also a home-based entrepreneur, (who) says his wife is a stay-at-home mom and takes care of their two kids during the workday. Still, he says he wouldn’t get much work done if he didn’t have a solid door blocking his basement office from the rest of his Odenton, Md., home." A solid door? I guess that means a hollow one wouldn't work. The founder and CEO of Accella LLC, a website and mobile-application developer, tells Needleman that “Being able to create some type of separation and a way for the kids to know their boundaries is important," and that without the door, his kids “would feel the freedom to come and go as they please,” adding that they’d also be a distraction if the door was made of clear glass. "They’d always be sitting outside looking in.” I guess you need to have a basement and live in suburbia where you can create a fortress from your offspring in order to build a business from home.

Needleman who signs off by asking "Readers, if you run your business from a home office and have kids, is a nanny or daycare necessary?" raises an important question with her lede, but falls short by giving us two examples of people who work from home but are anything but SAHPs. Instead of asking her readers if this is possible, perhaps she could have sought out someone who has actually tried to be a SAHP with a career or business venture. Instead, Needleman has simply produced another self-promoting link for Perkett's "In The News" section of her website. I'm not begrudging Perkett for her headline-hoarding, but I do knock Needleman for false advertising.