Joanne’s Journal : Is the two party system dead?

I think young people, in particular, really don’t care about the two party system. But as you say, we have “a process” for our elections, and if you enter as a party candidate and you lose the primary, then, you’re done. Unless you want to run, from the start, as an independent. We are seeing a complete overhaul in the 2 party system…led at the national level…stay tuned, it will be interesting to see if changes become permanent and if a 3rd party or 4th party or independents can become viable. Of course, it’s all about the money and campaign financing.


img_2801I just don’t get it. You run in a Primary election either as a Democrat or Republican.  You file your Declaration of candidacy papers during three days in June. Yes, there is a deadline on the this. But you make sure you are there on time filing your intention to run for office in Little Rhody!

You pick up your nomination papers on the first week of July at the Secretary of State’s office so you can qualify to get on the election ballot. You need 50 registered voters in your district to sign your nomination papers if you are running for State Representative and 100 registered voters to sign if you are running for State Senate.

So you are out in the dead heat of summer going door to door to get signatures.  You need to make sure your voters are registered voters in your district so the signatures…

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First….fix the harm we have done.

The opioid crisis.  It could have been predicted, after all.
Today you hear the smart young health advocates talk about setting up “pain clinics” as the “NEW” answer to the opioid crisis. You have already seen holistic wellness centers and alternative medicine practices cropping up on almost every corner.  But, let’s remember the ’70s.  When you had unlimited visits to chiropractors and physical therapists; when doctors could take their time to talk to you and treat you – when triple booking patients was not an industry best practice – but reserved for flu epidemics and such?  If you’re under 45 years old, you won’t have any idea about this – unless you are a medical history buff.  If you’re a physician you won’t even get this “old school” information taught to you in med school.  But this was before managed care – before big pharma, big health-insurance-business, big hospital-business, and big government regulation – when these things weren’t just tried here and there – they were a staple of medical care.
In the early ’80s a severe sciatica problem had me going dutifully to my chiropractor 3 times a week.  The most I did for pain outside of those visits was Tylenol and an ice blanket.  I was re-educated about how to not cross my legs at the knee, but instead at the ankle, when I sat for long periods of time; how I should get up and walk around about once an hour at work; and why carrying a heavy pocketbook and briefcase over one shoulder was no longer advisable.  I also learned about anti-inflammatory foods, and got advice on the proper exercise to do – and not to do.  It was a struggle, and it didn’t go away quickly, and there was one bout of a prescribed muscle relaxer for a few days – but, slowly, I learned the triggers and the treatments.
What would that treatment look like today?  What would the pill of choice be that I would be prescribed?  And how many would I get?  Would I get beyond 5 to 10 office visits to a chiropractor?  Would physical therapy be covered at all – and what would the wait time be to get in to see someone?  Would there be some counseling provided as to a good diet and proper exercise – and preventive techniques?
90% of pain clinics ceased to exist – yes, they were closing up shop, except for those serving the more well to do – out-of-pocket patient base. Other than that, compensation and reimbursements were drying up.  People were still in pain – and there was no miracle new drug that had been discovered.  Big-everything changed all that.  Managed-everything was faster, cheaper, and less holistic. And, today we find ourselves in an addiction and overdose epidemic of epic proportions.
I agree with this article, by Cindy Perlen, LCSW, and posted on
Now that we are in this crisis – in 2016 – what are we talking about to deal with this opioid prescription crisis and a population increasingly in need of pain control? We’re talking about opening pain clinics, and encouraging (not paying for) people to seek alternative methods of dealing with pain – get a massage, go to an acupuncturist, utilize exercise.  Only if you really get hurt will it be paid for, and then, that treatment will also get restricted as to numbers of visits and/or costs.  We’re also talking about limiting pills doctors can give their patients.  We’re investigating doctors.  We’re criminalizing the medical system – and people who get hooked. Of course, there are real reasons to do some of that.  But in our rush to criminalize, to sanction, and to walk government right into the hallowed privacy of the doctor patient examining room, we have forgotten what got us there.  We have forgotten that we already know much about how to fix people in chronic pain.
For those who, because of their brain wiring, being prescribed opioids was the worst possible treatment. Now, they are on an addiction spiral, and we struggle to know what to do.  We have never seen a crisis like this.  Our drugs won’t take care of it.  Our prisons won’t.  Our mental hospitals won’t.  For now – it is our graveyards that are.
It is time we face this square on.  Pay for proper treatment of people in pain.  Open the pain clinics.  Pay for “alternative” care.  Re-educate the medical specialists who know so little about other ways to treat – other than pills and surgery. Stop the problem from continuing. And figure out how to clean up the mess that has been left behind.
Put the blame where it belongs.  We did this to ourselves.  I swear if you live long enough, you really do begin to see everything “old” become “new” again – functional exercise replacing use of complex equipment; simple, real foods replacing fast food grazing; custom-made anything replacing manufactured goods; “made in the USA” a better brand than the magic of manufacturing “made in China”, natural materials over plastics, organic over GMOs.  Eastern medicine looked at with new eyes, as Western medicine struggles to keep the healthy healthy, but has a pill for every ailment.
Don’t blame the doctors. Don’t blame the patients. Blame big pharma, big business, big medical-training, and big government…
Retraining and new curriculum for medical professionals. Healthcare for all might be the only answer – with a prevention and holistic focus – that’s two places to start.  Pay for proper treatment of people with pain.  Invest in prevention.  Help the addicted and the overdosing.  Sometimes it seems as though the plan is to wait until they all die away, and we can hit reset.  Sometimes it seems that we are on that road. We simply can’t do that. Nor can we fail to address that as we live longer, and are more active, people will have pain.  Intense pain.  Pain that we already know much about treating.  And we’re only offering half the treatments that are out there. Or will we only stoke the science machine to develop that next new pill?

Terror at Christmas


Christmas past…

Every Christmas I waited for one gift.  It would usually come a few days before Christmas, and it was never wrapped.  But I knew it was coming, when I heard my uncle bound up the stairs, rather than plod one step at a time. “Is she here?” he’d bellow.  I was always there. Where else would I have been?

As the only boy in his family, growing up with two sisters, one my mother, and a father who was more into gardening and puttering, than hunting or big physical exercise, I imagine he was thrilled when my mother was having a baby.  I imagine he was a little disappointed when it was a girl.

But quickly he figured that it made no difference at all.  And he would simply treat me like a boy.  So, gifts of clothing, of which there were very few, were often blue sweaters or orange and black gloves and brown boots bought in the boy’s department. As I said, he didn’t buy clothing very often.  What he did buy, though, was pretty spectacular.  Especially for an “only child” being raised like a princess (as a recall). Barbies!  Carriages!  Baby dolls!  All were plentiful. But they never came from my uncle.

No, when my uncle would come bounding up those stairs, I would just wait for it!  What magical toy would it be?  Lincoln Logs.  Those little plastic Indians and Soldiers in their war stances.  We’d play and make forts and have some big battles! Sets of tinker toys. And we’d build giant spaceship type structures. One time there were racing cars, complete with a curving roller coaster track.  There was the police car, all black and white and heavy, that you could rev up by running it back and forth and then letting it go and the red light would shine and the siren would shriek.  There was the police gear. And a badge I could wear. And we would play and run around the house. Never for very long, though. We’d start to play and then he’d run off to do some adult thing that he needed to do.

My mother would say “Sonny!” (what we always called my uncle) “Sonny! She’s a girrrllll!” But, I loved it all.  The gun shot caps.  Then he bought me real caps – the kind you stepped on and it sounded like pistol shots.  There was a science kit or two, and then, one day, there was a “pearl” handled silver gun.  It was big and heavy.  You could cock it back and it would snap out a loud POP.  I can still remember how it felt in my hand and how there were ridges on the inside of the hammer.  Better, yet, this gun went into a holster – a black holster that went around my waist.  Eventually I got a cowboy hat to go with it. And bullets on a cross strip.  And boots.  I was banned by my mother from playing outside dressed up like that because the neighbors might see.  So I played inside.  Lost in a world of Gunsmoke and Bonanza. Even Andy Griffith carried a gun!  And, for that matter, Ellie Mae Clampett from the Beverly Hillbillies prided herself on her shooting prowess.

As growing up will do to you, it changed things.  And the Christmas came when the boy-toy didn’t get such a gleeful response from me; and it stayed unopened.  “Hey, you didn’t open it… yet” he said, a few days in a row. Eventually the boy-toys stopped coming.  Eventually we didn’t play together anymore.

These memories are vivid this year; the same year my uncle passed away at 92.  I remember it because of how things have changed. And also for how they have not changed very much at all.

Christmas present…

Today, gun toys for young children are not cool.  But yet, they are on our shelves…waiting to be bought for little boys and little girls this Christmas.  The violent video games target the slightly older children, whose unformed minds bounce between fantasy and reality. This December begins with terror. Terror from San Bernardino – but living inside all of us today. When we’re shopping at a crowded mall.  Eating in a restaurant. Attending a concert.  Now, when we’re at work at a holiday party?

Gun control.  It seems an impossibility.  The little tweaks are purposeful, but in fact, all the guns we will ever need are already out there.  Guns are forever, but ammo degrades. It has a shelf life.  Ammunition is gun food. If we can starve the guns a bit, or change the way ammunition sales are regulated and controlled, perhaps we can change the way guns are used. As Marc Ambinder wrote in The Week in 2012, “Guns need food. Starve them”.  We can be distracted by all the focus on gun control – let us ask ourselves, what else can we do?

Here’s another thing we can do – we can ask to have these toys removed from our shelves. We can stop buying them. These are some of the gun type toys available for purchase on this one day in December in Rhode Island. They are at Benny’s, K-Mart, Toys ‘R Us, and Walmart stores.

The first store I visited was Toys R Us and while there were a few gun-like, nerf-type toys available, I didn’t see the more realistic looking, AK-47 types.  When asked, the department manager told me, “I haven’t seen them here in this store in about 10 years.  We stopped carrying them after Columbine.”

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Christmas Future…

What will be our Christmas future? What terror will hold us close?  How will we harden and adapt?  Is this our new normal?  I think about my children.  My grandchildren yet to be. I hope they can find the answers.  And we – the elders now – must stay engaged.  Let us bring our memories of our own childhood and see what we can do to our tenuous hold on happiness and peace in our loved ones’ future.  As Scrooge said at the final ghost appearance, “the shadows of the things that would have been, may be dispelled. They will be. I know they will!”  Let us pray there is truth in this tale.



I saw Jesus again today.

little-boy-walks-road-curb-sepia-high-definition-video-fps-sec-please-look-another-footages-my-train-arrival-account-45180160-1The first time had to be about five years ago.  He was walking slowly down a city sidewalk, parallel to the four lanes of traffic – he walked against the two lanes closest to him. So, the drivers could easily see his face as he walked.  You couldn’t overlook him or let him meld into the background, much as we often like to do when we’re disturbed by a person’s physical appearance. This man walks with his head slightly down, long, black, slightly wavy hair, parted in the middle.  Thick black eyebrows.  He is slim and tall.  He wears khaki cargo pants, the kind with lots of pockets and a little polyester so they have a bit of a swish to them as he takes his strides.  They fit close to his body, and hang low on his hips.  A black jacket hangs from his broad shoulders, past his thin waist. He did not walk on the main part of the sidewalk, but similar to the cars being driven in their thin lanes, he walked on the cement curb, one foot in front of the other.  He is barefoot.  The walk reminds me of that of a runway model and how they place the toe of one foot precisely behind the heel of the foot in front of it.  He didn’t totter.  Not at all.  Neither did he raise his hands out to the side to balance like a tightrope walker. He simply walked, in a steady, strong, slow cadence.  He walked with – grace. I remember thinking that the straight posture and balance came from something – dance classes? Fitness or core strengthening exercises? Gymnastics? Modeling, perhaps?  It was a trained walk.

Years before I had seen this man in my neighborhood. The neighborhood is not known for having homeless people walking about. Almost never. There was an occasional disheveled looking person walking to a bus shelter, carrying a white plastic bag, with little in it. You could tell by the way it hung from the wrist. I’d imagine toothpaste, toothbrush, maybe a bottle of water? Over the last few years there were just a few people with these white plastic bags. You knew only a fraction of their story by seeing them – the part of their deep, convoluted, complicated story – the part they could no longer hide.

This man stayed in the neighborhood season after season.  He would just appear one day. If the weather was cool he wore that long black coat – similar to an oilskin duster worn on a ranch – and work boots.  In warm weather he would walk without shoes. That’s when he took to walking toe to heel on the cement curb rather than the sidewalk.

One day my daughter said she thought he looked like Jesus – Jesus walking so gracefully, so quietly, with a presence that belied his obvious present lot in life.

There have been a few times when his eyes have met mine as I looked out from behind my steering wheel. And there was the unexpected meeting in the supermarket.  He was picking out a few pieces of fruit and I saw his eyes as he looked up at me with his head still bent downward. I was startled. Kind, deep, filled with “knowing” – and, somehow, familiar. I did not know him, yet the familiarity factor was there, and it startled as it commanded to be seen.  It wasn’t like the wild eyes of the deranged, but a kind and steady, sure look. A “don’t look over or around me” look. A look “at” me look.

I watched him walk through the fresh produce section, and maneuvering slowly around displays.  Grace.  An athlete’s grace.  A dancer’s grace.  Maybe an angel’s grace. This Jesus was food shopping.

It was then for several years that he was absent .  When I would see a person panhandling for donations at the end of an off ramp, I would often think of Jesus. Where had he gone?  Had it been time to move on?  Had he died?  Was he sick, in the hospital, or more likely, in prison? He would never have been standing at an off ramp. That I knew.

My daughter recently moved to the city over from mine.  This morning it was quiet in my kitchen as a text message came over my phone from her.  “I just saw Jesus! Walking near TGI Fridays – he’s down the highway. He’s making his way south!!” So, he was back, but had moved on a little further away from me.  It isn’t warm enough yet for him to walk barefoot.  Will he stay close by, or is he steadily moving south – a little late in the season for a RI snowbird migration. Do the nomadic homeless go south for the winter? Do they walk all the way to Florida?

Now my daughter will look for him, this Jesus walking.  A little more disheveled, and looking a little bit older. With the perfect posture and the dancer’s cadence.  Walking with grace.  Maybe she will see Jesus food shopping.  And he will look up at her with his deep kind eyes – eyes that held his life’s story behind them. Eyes that simply say, “I am here.”


“I am fearless now….”

th-2There are different kinds of memories. Events and happenings. Climactic moments. Hallmark days, such as a wedding, a funeral, a graduation. There are other memories that run deeper.  Memories of…scents…sounds…sight. Memories of emotion and feeling are perhaps the strongest.  The overwhelming moment when something happened inside of you; it changed the way you thought or felt about something. Like you could almost feel your brain morphing. The light bulb went on. The “aha” moment. The door shutting – for good this time – on a path of the past, a path that had been worn down and was going nowhere, and you struggled to get out of its rut, and now you can. These moments are, as they say, more ’emblazoned in our memories’ – because they go to our core – our heart and soul – they become more memorable because we were changed in that moment, that moment that we’ll always remember. We are different going forth.

This week the President gave an interview on radio which was somewhat controversial – but he stood rock solid, with a smile to his critics.  Something had changed in him.  A light bulb moment. An “aha” moment. A door shutting, or perhaps opening.  He put it simply when he said it: “I’m fearless now.” With that familiar jaunty full-faced smile we see more of these days.

This week I listened to a speech made by our new “fearless” President, this new Barack Obama.  And as he was expected to do, but no one could have truly anticipated, he gave a rousing one. But he went beyond rousing. He made a substantive one. He used high emotion, tragedy and deliverance to talk about issues that our country has yet to solve – poverty, poor educational systems, unfair housing, gun control, mass incarceration, jobs, racism, subtle prejudice – and he couched it all in the word “grace”.  Not “hope”, but “grace”.

And as natural as the gently waving program books in that church of 5,400 people – and in our homes and offices as we listened – our President began to sing. Low and deep he began. With the words, “Amazing grace. How sweet the sound…”.

Amazing-GraceI closed my eyes. I wanted to remember this day. Friday, June 26, 2015.  I wanted to emblazon its memory into my mind. I wanted it to change me. I wanted to call my children to gather and listen, but I was frozen watching this all transpire.  And as I thought of my children, grown and working now, I remembered Tuesday, January 20th, 2009.  My daughters were 20 and 22. Just coming of age in this adult world. We sat in the living room with snacks. Dip and chips, Guacamole, Nachos, and fruit. We wore our baseball caps of red, white and blue – one for each of us – with the word “HOPE” stitched right on them. And we watched our President take the oath of office. He delivered another speech that day – and it was a rousing great one, too.

getPartI remember thinking back to another day – September 11th, 2001.  The day when hope died. When ‘future’ seemed grim and hard to imagine. My daughters were 12 and 14. I knew on that day as I watched them come home from school, that their lives had changed. Forever. 2001 began a time of war and fear in our country – faded only somewhat into the hope and change promised to us in 2009.  Things seemed so bright. There was hope again.

Six years we have walked this path with the first black president in our country’s history.  We have seen polarization and stagnation – and yes, we have seen change, and progress. Healthcare. Immigration. Employment. Yesterday we watched as same-sex marriage become the law of the land – and in a moment of glory and grace it became – just – “Marriage”.

We have watched our President age and turn grey. The memory of that promised hope has tinged grey, too.  But he has moved beyond hope. As legacy looms in his mind and for history, he has moved the conversation along and called upon ‘grace’.  He says he’s fearless now. He carries this new state of being with him, as he carries forth with a song from deep inside. He’s making new memories. With new words. Grace. Fearless. Legacy. He says he would have been a better president – today – than he was. Self-awareness is not lacking here.

520976963_295x166But what can we learn? Have we learned that “hope and change” is not a plan? Do we need to conjure up some grace to lead ourselves along? And, if we can conjure up being fearless…think what we might do? Legacy looms closer at my age. The older-agers that 20 year olds grow weary of having around, are so important to moving hope and change along. The young-invincibles with a lifetime ahead of them, with things we need in this country – spark, energy, new ideas, and yes, hope.  But fear stalks the young. It limits them. It holds them back. Fear of speaking out. Of repercussions. Of loss of friends, colleagues, or opportunities. Of career short-circuiting. Of brass-ring missing.

But with the legacy years comes a sense of fearlessness. And that is power. Yes, it’s time to perfect the chocolate chip cookies – to be remembered forever for.  And to try for that hole in one.  But let’s not drift away too far. Together, wrapped in hope, wrapped by grace, together, think what memories we could make. Think what legacies there could be, not just for us as people, but for these United States.

Everything I needed to know about patient care I learned from my vet

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My “Bella” is a long-haired, black-and-white “Tuxedo” rescue cat. Her veterinarian, Dr. Cathy Lund, opened an all-cat practice in 1998 in Providence, RI.  As her website states, she thought being an all-cat vet was just “purr-fect for her”.

DrLundI work on the fringes of healthcare, now, usually in promotions or marketing for a particular advocacy initiative or to raise funds for the cause du jour.  However, I spent over 25 years engrossed in healthcare – most of it in the marketing end of a large, national nonprofit.  Some of it as a communications professional for a small local hospital in an urban setting.

I spend a great deal of observation time these days looking at healthcare and its changes, improvements, and fragmentation bringing those professional perspectives to bear.  A year or so back I looked at these issues from the inside, when my daughter had a short and sudden illness.  But, a few times a year I look at it from the perspective of a cat.  A black and white perspective, you might say.  And each time I wonder, what lessons can be learned from the world of vet care to the world of human health care about a more patient-centric system.

First, I imagine how her medical record “notes” section might read:
“Bella is now in her 13th year, and is relatively healthy, though has struggled with mild obesity for most of her life. Her weight-loss attempts appear to have been exacerbated by a psychological need to overeat, perhaps as a coping mechanism resulting from post traumatic stress disorder of unknown origin, occurring early in life. Genetic traits are unknown, as Bella was taken in as a homeless stray at a few months of age. Our family accepted Bella into a home that had experienced a recent loss of two adult cats to old age.  Bella’s earliest days included gender confusion, as she was first thought to be male and referred to as Mason. She was also aware of early desires to take her to a shelter and adopt her out to another home. However, these additional early traumas soon resolved themselves, and Bella acclimated well into her forever family. “

Bella, which translates to “The Beautiful One,” aptly describes the prominent place she has taken in the family.
While Bella has not had any extraordinary illness, other than a mini-surgical procedure for a five-foot long piece of string down her esophagus and the extraction of several teeth, she is not an easy patient. Her unknown past, and suspicion of being feral, has meant a delicate handling. All eyes are on prevention. Preventive care has meant regular check-ups, shots, nail clipping, and blood work. It has also meant dealing with a progressively standoffish attitude, which has deepened with age into full-blown rage at invasive examinations and the sight of any other feline. Her “mental health problem” has exacerbated the provision of her medical care. Bella does not take well to invasive procedures, yet requires regular examinations of nails, teeth, and ears. Inoculations. Blood work. Cautionary procedures include full-length protective gloves for all medical staff. Mild sedation is recommended. Experimental prescription of valium proved to be ineffective and was halted.

Throughout her years of care, reminder postcards and e-mails are received when it’s time for a check-up. Appointments are made on the phone or by request over the website. You can even request an appointment on Facebook; there’s an app for that. Waiting time is less than a week [same day if there is a crisis, and phone calls returned within an hour, if needed].  Appointments are confirmed by e-mail, and again, a few days before the appointment, there will be another e-mail and a phone call, along with any special instructions, such as nothing to eat and drink after midnight. The day of the appointment there is no waiting, and because Bella is a mild-sedation patient, a first-in appointment is always available, so the distress of not eating or drinking since midnight is not too discomforting. When she is brought in, given her mild state of a building mental health crisis, she is talked to calmly and gently by staff. They pet her paw through the gate of her carrier and she is quickly taken in.

In an attempt to take care of her quickly, due to her sedation, one can only envision the Mario Andretti racing team pit crew being called to her tableside. They swoop down and, in quick order, in less than half an hour, the care is done. Using sedation on an older cat is a concern that grows with age, so the quicker, the better. Their specialists have come together, each taken his/her turn – nails, teeth, ears, shots, blood work, a little shaving here and there, and good to go. Recovery is almost immediate as the sedation wears off. With a groggy “hisssss”, we know all is well.

There are follow-up instructions and education at the front desk. A quick checkout and then the next appointment is set. There is the constant reassurance, explanations, and calm demeanor. There is even a pat on the back for me, when I’ve needed it. We are good to go.  Within a few hours of being home, City Kitty will call to see how Bella is doing and if I, her caretaker, have any questions. They refer to her by name and speak in an unhurried manner. Later that afternoon I will get an email. It asks us to submit a review: how did we do, and are there any suggestions? A few days later, there is another call. How is Bella? We’re thinking of her. Here is the result of her tests. Guess what? She is at her ideal weight! May she live long and well, and just call us with anything.

I am often struck by the quality of the “kitty care” provided to Bella – and what we could learn from it that might be applied to “health care” provided to humans.


Slow down might be a start. Look the family and the patient in the eye. Call the patient by name. Speak as if you genuinely care, because I assume you do. Don’t be afraid to touch the patient, or put your arm around a family member or caretaker. Repeat instructions. Ask if there are questions. Ask again. Provide information. And, educate and follow up, in several ways, by e-mail and again on the phone. Have a website that has a picture of the patient and their information, too, so they can see their records.

Keep good records. Have a resource link that is tailored for different types of patients and conditions. Tell us about who works there – not just their medical credentials, but a little bit of the personal, too – and perhaps show us their photo. Include a way on your website, or by e-mail or on social media, for us to ask you to call us, or to make an appointment.


Bella’s birthday is in February. She will be 14. She will receive a birthday postcard from City Kitty – and an email greeting, too – just as she has every year.

As published in the June 8th issue of ConvergenceRI,158