DOC IN THE BOX SAVED MY HUSBAND’S LIFE

Medical 2015
by – Sheri de Grom

I started this post several months ago and had an entirely different opinion of Urgent Care Clinics. What we’d often called ‘Doc’s In A Box,’ saved Tom’s life on March 23, and they didn’t mention BIPOLAR DISORDER one time. I have a new respect for this segment of the medical industry.

I don’t believe I’m hasty in reversing my opinion. Let’s look at the objectionable facts leading up to this incident:

I’d been unable to reach Tom’s internist for 4 days and Tom breathing was shallower by the minute. His coughing was uncontrollable and none of our old tricks were working. We still didn’t know what was happening to his feet and he couldn’t walk. I’d been pushing him in a wheelchair for the better part of 4 months and tending to his every need for well over a year. I was beyond exhausted and had become a prisoner in our home.

I’d thought nothing could be harder than procuring excellent mental health care for the man I loved, but the playing field became upside down when we each turned 65. The past 8 months had been a living hell on earth as I watch Tom suffer and I knew it was needless.

For 25 years I’d read everything possible from lay books to text books and gained useful insight about Tom’s mental illness. I’d attended symposiums meant for medical staff only and participated in round-table discussions. I’d written legislation to change existing laws and felt confident that I knew what I was talking about and even demanding.

I insisted on what I thought was right from mental health care workers at all levels (including treating physicians), insurance companies, and legislators alike. I wrote legislation and spent night after night in committees until words were chiseled in such a way they could not be changed once they reached congressional vote. I refused to give an inch.

I entered a new area of health care exploration when Tom was hospitalized Sep 22 and diagnosed incorrectly. He suffered unimaginable pain while I searched for answers. Critical functions of Tom’s body were breaking down simultaneously and his doctor of record pumped him full of antibiotics by IV 24/7 with no discernible improvement. Of course, the physician didn’t know if Tom had anything that could be fought with antibiotics. We did not have one conclusive ‘test’ stating this fact.

Tom was in unbearable pain when he was admitted to the hospital on Sep 22 and nothing had changed when he was discharged 8 days later. The doctor sent him home with more antibiotics and pain pills!

I continued my research but the progress was minimal. Seven months passed as we continued to see a parade of physicians wanting to dispense more antibiotics and pain pills. Tom was continuing to fade away and I was becoming more and more frightened. We saw 7 new physicians and not one changed the admitting diagnosis of cellulites yet we still had not one shred of evidence that was what was happening in Tom’s body. More and more antibiotics were prescribed and more and more pain pills. We didn’t want antibiotics and pain pills, we wanted answers!

I’d had enough, on March 23, 2015, one day before Tom’s 67th birthday, I bundled Tom in a heavy coat and drove him to a new Urgent Care Facility (Doc In The Box). It was probably the smartest medical move I’d made in a year when it came to his medical care.

I couldn’t take him to the local ER where we had waited for 8 hours before seeing a medical attendant and were treated as though we were second class citizens.

For several months I’d been researching the provision of the Affordable Care Act which drives the latest boom in new construction which is in free standing urgent care facilities.

On this terrible day, I saw the ‘Doc In The Box’ as a means to an end, immediate care for Tom.

Rounding the sharp edge of their parking lot as fast as I dare go, I gathered Tom from the car and screamed for help as we made our way to the clinic. I didn’t have time for that dang wheelchair. I could get him there faster in my arms.

Where does the adrenaline come from, but damn it, I wasn’t losing him now. I knew somehow this was our last stop between life and death. It was our last hope!

Yanking the insurance cards from my pocket, I tossed them toward the admitting desk and an orderly rushed to help me with Tom. We were taken to a treatment room immediately.

The doctor’s momentum demanded action. Monitoring devises were placed and she barked, “Call EMT for cardiac arrest transport.”

Getty Images

Getty Images

How long did I hold my breath waiting for the man I loved to breathe again? Please, God, not like this.

One moment I heard the screaming sounds of the ambulance approach and before I could focus my tear filled eyes, Tom was whisked away. Time ceased to exist. We were living one breath at a time.

What did I learn from this experience: No one at the Urgent Care or ‘Doc In The Box, was trying to one-up their peer. They worked as a team and were a ballet in precision. The 4 were seamless and the immediate arrival of the ambulance allowed the smooth transport of Tom into the ambulance for his life-saving trip to the ER.

Much of what had kept Tom from receiving the care he so desperately needed over the past 9 months was doctors playing the one-up-man game and political-in-fighting. There were too many egos for Tom to receive appropriate medical care.

I lost all track of time from the moment Tom left for the ER and the time I arrived at the hospital to join him. A staff member asked if I would like someone to drive our car to the hospital and they would give me a ride.

Arriving at the hospital that night, the many times I’d arrived at hospital ERs for Tom rushed through my memory bank. How many times had I feared for his life, how many times had I prayed, God’s will be done?

The ER technicians, physicians, nurses, breathing specialist, cardiologist and the entire medical team worked in unison that fateful night. The primary treating physician told me I came within 3 minutes or less of losing the man I love that day. Why are doctors compelled to tell me how delicate Tom’s health is? I know I’m the one that’s on first. I know I’m the one that must be vigilant. WHY DOES THE MEDICAL PROFESSION GREET ME WITH SUCH RESISTANCE? I’d called 8 times to Tom’s regular providers asking for help as this particular episode turned into a life or death situation.

Is this another case of doctors discriminating against those with a mental illness? Please Lord, tell me it’s not so.

I have a new respect for the new Urgent Care Clinics springing up everywhere since the passage of Obamacare. I’m not saying I agree with how it’s being accomplished or that I like Obamacare, I don’t. I loathe the Affordable Care Act and what it’s done to our health care but on March 23, 2015, it saved Tom’s life. Urgent Care helped us when no one else was interested in providing the medical care we so urgently needed.

In my earlier research, I discovered it’s the few who are making millions on the backs of taxpayers in the building of the Urgent Care Clinics, but that’s the way Obama and Obamacare works!

The intent of the new clinics being built today is to insure health care availability where affordable housing is located. [This is the basic premise of the requirement – accessible primary healthcare for those who otherwise could not reach healthcare unless it was in their neighborhood].

The argument for building and financing the clinics was that with them being built in communities where low income populations with insurance lived; the health centers would drive the cost of health care spending down. It was to be a win-win solution.

A $100 million fund has been established to build community centers near affordable housing as demand for primary-care services are expected to rise. The law includes approximately $10 billion for the creation of new, federally qualified health centers.

As reported by the Wall Street Journal, “[the fund will rely on $87 million in loans from Morgan Stanley in exchange for tax credits to build 500 new affordable housing units and eight new health centers serving 75,000 people.”]

What I’ve noticed in our city is approximately 10 – 12 of these primary care clinics have popped up in less than 18 months. Do they serve a purpose? I must say yes, they saved Tom’s life when I had no other avenue.

Does our city need or meet the criteria for the clinics. The answer is a resounding no. The clinics are being built in affluent neighborhoods when they are targeted for inner-cities. Yes, the clinics are more likely to succeed in a city such as ours where we have fewer than 10 violent crimes per year.

I was less than pleased when I first read and started researching the hidden monies going into the Urgent Care Clinics masked as Primary Care Clinics. But again, they were there when I needed them and they rose to the occasion.

On a separate note, I’ve been away from the blog for many weeks and I cannot promise I’ll be around more than in the past months. Tom has been an extremely ill man and I spend my days and nights caring for the man I love. I think about little else.

I’m delighted to report we now seem to have a correct diagnosis but in the meantime the wrong diagnosis affected his entire body.

Every good ER doc reminds his patient to follow up with their internist or family doctor as soon as possible. Of course, this very thought returned to my 8 previous attempts to do just that before these life-saving measures were required.

We finally saw Tom’s internist on March 31, a total of 6 days after he had gone into cardiac arrest but still the first appointment we could get. Thankfully, I’d advised the ER Doc we might not get in right away and that we had full pharmaceutical coverage. I was giving him permission to write prescriptions for whatever he thought Tom would need over the next week, for fear we couldn’t get an immediate appointment. The doc took my word and we had to use every medication the good doc wrote for Tom.

A miracle occurred as a result of this horrific scare and I do wish we hadn’t had to sacrifice nearly a year of our lives to arrive at the place where we are today but we now have a protocol in place for Tom’s immediate medical needs.

Many of you know I’ve always been able to call Tom’s psychiatrist cell phone direct whenever necessary. I respect the psychiatrist’s kindness but I don’t hesitate to call when we need his assistance. I also provide an e-mail with specific bullet items spelled out for his quick reference of what I’m seeing regarding Tom’s mental health.

Tom’s internist was furious when I explained to him what had happened to us over the past year, since Tom’s misdiagnosis on Sep 22, 2014. He knew the bolts and nuts as Tom’s internist but not the additional issues we’d had in obtaining the medical care Tom needed.

He told us if his nurse did not get back to me within 1 hour of my initial phone call, I was to call his appointment desk and advise them I needed an appointment within 12 hours. It didn’t matter if they told me there were no appointments available. His words, “Tell them Dr. Edwards said to double book.”

Leaving Dr. Edwards office that day, I had hope. Another private cell phone number should the occasion ever arrive when I couldn’t reach him.

Tom’s having some of the same problems today and I just called the doctor’s office. Something must have changed after he bellowed down the hall the day we left, “All staff, conference room now, everyone.”

Today the nurse returned my phone call within 30 minutes and offered an appointment less than an hour out, but I knew I couldn’t get Tom and I both ready to leave the house in less than an hour and be there on time. We have the next best thing, an appointment at 10:30 a.m. tomorrow.

Your prayers and kind thoughts mean the world to me and I try to make the rounds of reading your blogs as often as possible. I love and respect each of you and hope to get back into some routine of blogging soon. This past year I’ve learned more about this health care system of ours than I ever cared to learn. I’ve also learned much about the health care availability in countries around the world and we’ll do a bit of exploring there also.

Thanks for sticking with me. God Bless.

Tell me, what have you been up to lately? I’ve missed each of you.

Posted in Medical 2015 | Tagged , , , , , , | 159 Comments

CONCIERGE MEDICINE – IS IT RIGHT FOR YOU?

CONCIERGE MEDICINE EDUCATING THE PUBLIC GETTY IMAGES

CONCIERGE MEDICINE
EDUCATING THE PUBLIC
GETTY IMAGES

Medical 2015
by – Sheri de Grom

The emerging model of concierge medicine has its roots in both patient and physician frustration.

BASIC CONCIERGE MODEL

  • Patients pay a monthly or yearly subscription fee to join a physician practice.
  • The physician controls the number of patients in his practice and his income.
  • The patients get 24/7 access to their doctor via phone and email, same-day appointments that can last hours, and a relationship in which the doctor’s and the patient’s interests are closely aligned.
  • Concierge medicine is a growing premise of provider care. A company, MDVIP is the largest concierge medicine consulting company in the nation with more than 700 physician members and more than 200,000 patients in 42 states.
  • MDVIP is a hybrid model that provides a comprehensive wellness screening of all patients. This patient screening becomes the foundation of the doctor-patient relationship. MDVIP accepts insurance, including Medicare, and 94% of patients renew with affiliated physicians.
  • A physician with MDVIP sees between 10-12 patients a day. He has a patient panel of about 400 patients, about 10% of his former patient load. He receives about $140 a month per patient and he cares for the children of patients at no charge. MDVIP takes care of all insurance billing and reimbursement.
  • Another example includes physicians who charge by age group. Sliding scales often range from a yearly fee of $750 to $4,500. Some doctors screen patients and others don’t.
  • A concierge physician has the freedom to include as many services in his practice as he wishes. He controls every aspect of his business. He may or may not have a traditional office.
  • At the extreme you might find a doctor with a vehicle equipped with advanced testing equipment and he sees all patients on house calls.
  • Another physician might make arrangements for their patients to receive lab and imaging tests for about 10% of the cost that providers bill insurance companies.

Concierge physicians receive guidance as members of the American Academy of Private Physicians (AAPP), a nonprofit group which works with its members to build sustainable concierge medicine practices.

According to the American Medical Association there are approximately 246,000 primary care physicians practicing in the U.S. Approximately 40% are employed by health systems and hospitals. That leaves about 148,000 primary care doctors in private practice.

The editor of Concierge Today reports there are 5,500 doctors practicing concierge medicine and that rate is expected to grow by 15% a year.

The American Academy of Family Physicians kept concierge medicine at arm’s length for years, but is moving quickly to embrace the direct care concept.

A recent study by the Annals of Family Medicine projects there will be a shortage of more than 50,000 primary care doctors by 2025.

John Rother, a policy expert at the American Association of Retired Persons (AARP) wrote, “Those who can afford to pay a monthly fee will get better health care than those who cannot. Medicare patients, who universally have lower incomes, are at a disadvantage under such an evolving two-tiered system.”

After battling our current health care system for Tom’s life over the past 8 months, we would have concierge care, if I could afford additional capital outlay. An internist in a nearby city has joined a concierge team and I hope to interview him in the new two months about taking Tom on as a patient. My frustration is born of not having quick access to Tom’s internist. I’ll be the first to agree that Tom’s body is medically complex but I believe if I could achieve intervention by a physician that cared about his physical health, we could prevent much of what turns into life and death situations. [A perfect example of this is the inability of getting a timely appointment and a virus turning deadly causing last week’s emergency of cardiac arrest].

Or, is the above another example of medicine turning its’ back on the mentally ill patient and physicians continuing beliefs that a patient couldn’t be as ill as reported when requesting an urgent appointment?

My own internist has a highly-qualified Physician’s Assistant on his staff and I have 24/7 access to medical care. I know that when I call my internist’s office, I may not get to see him within 2 days but I will get to see his PA and if my situation is something she needs to consult my doctor about, she does. This has worked for me.

Tom and I used to share this internist and we should have had the same relationship with him but the internist couldn’t get past the idea of Tom’s bipolar diagnosis and thus, was not a good fit for Tom.

I’m all for everyone finding the best medical care for themselves. For the past 8 months with additional medical complexities occurring with Tom, we needed a doctor willing to take calls and guide us through the medical maze that stood in our way. Instead, Tom might have lost both legs and worse, died of an unidentified infection.

It’s hard for some Americans to wrap their heads around the concierge medicine model. Under the law, every American is required to have medical insurance – but direct primary-care patients can seek less expensive policies, because they require coverage only for hospitalizations, surgeries and other specialized care.

Concierge medicine provides a direction to primary care and a less expensive insurance policy than those currently offered by Obamacare. This new approach covers all preventive services and insurance would only be required for hospitalizations, surgeries and other specialized care.

In my opinion, there’s much to be said in favor of concierge medicine.  I wish it had come along 20 or 30 years ago.

When people get good primary care, their maladies are diagnosed more quickly and can be managed before they grow into crises. Fewer patients wind up in expensive hospital beds. Emergency rooms treat genuine emergencies, not routine infections and minor injuries. Patients receive timely advice and encouragement from a trusted physician to shed those pounds, change that diet, drink a little less and exercise more. Insurance models discourage this holistic approach. Insurance pays for treating diseases, not addressing questions about preventative care.

It’s no wonder Primary Care Physicians prefer to cut their own path in their own medical practices. The Medicare Formula guiding payments to doctors will cut payments to all physicians by 21% on April 1, unless Congress overrules it. Primary care physicians are also facing a scheduled Medicare cut of 10% on January 1, 2016, unless Congress overrules it, which would be in addition to the cut all doctors will take on April 1, 2015.

Is it any wonder primary care physicians are leaving traditional medicine when in today’s

Getty Images

Getty Images

concierge medicine the average take-home payment is $200,000 to $250,000 per year and they don’t have to worry about Medicare or any other reimbursement policy change. Neither do they have to do mountains of paperwork. These groups of Primary Care Physicians treat their patients, the very reason they went to medical school in the first place.

How about you, have you had experience with concierge medicine and if so, would you like to share?

Would you consider giving concierge medicine a try?

Medical care is changing. Can we afford to allow congress to dictate our healthcare needs? We must have give and take. What risks must we be willing to take?

For Tom and I, perhaps our ideal would include a Concierge Physician for at least Tom and we would continue to maintain the insurance coverage we have. My sole reason for the concierge — immediate access. We have insurance that provides coverage for the specialist in place as well as pharmacy and hospitalizations. I see the Concierge Physician as the doctor that just might be the one that could keep Tom alive!

Today, it’s not just a Medicare issue. Primary Care is everyone’s business.

Thank you for reading with me and as always, I look forward to hearing your thoughts on this all important subject.

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MEDICARE – RELIC OF A BYGONE ERA

Medicare/Medical 2015
by – Sheri de Grom

Have you tried to ask Medicare a simple question lately?

Have you tried to ask Medicare a simple question lately?

Medicare was created by Congress in 1965 under Title XVIII of the Social Security Act to provide health insurance for people aged 65 and older, regardless of income or medical history. Before Medicare, only half of older adults had health insurance, with coverage often unavailable or unaffordable for the other half.

Previous to 1965, older adults had half as much income as younger people, and paid nearly three times as much for private health insurance. Medicare was needed at its onset.

Medicare’s implementation of a one-size-fits-all program seemed a logical first step. Individuals without health care suddenly had access to physicians and necessary services.

Initially Medicare consisted exclusively of Part A which covered 80% of hospital and other inpatient cost. Part B was also initiated and it covered 80% of physician visits and other medically necessary services.

Today, the 80% coverage has been eliminated and all rates are negotiated with the Centers for Medicare and Medicaid Services (CMS), a component of the Department of Health and Human Services (HHS). The rates are not negotiated with physicians or other health care professionals that provide patient care but are decided upon by bureaucrats with no medical background.

In my opinion, it requires more than an MBA in accounting to successfully manage a program such as Health and Human Services and community service experience to manage the Centers for Medicare and Medicaid Services! These individuals are Presidential appointees.

The negotiated rates Medicare and Medicaid are demanding of each diagnosis makes it impossible for doctors to earn a satisfactory living treating Medicare patients. It’s no wonder these doctors who once opened us with welcoming arms no longer want to see us. We have become a deficit on their balance sheet.

The Medicare patient is still required to enroll in a Part D program, which partially covers

Part D is for partial prescription coverage.

Part D is for partial prescription coverage.

their medications unless they have a private insurance program. It’s not unusual to find senior citizens living on a fixed income dividing limited resources between medications, food, utilities and other necessities in their home – if they even have a home. This is one of the problems that sends elderly women to the streets where they join the thousands of homeless men and younger women and children already in the homeless population.

Citizens of the United States have a wide range of medical needs that can no longer exist under Medicare’s original intent. Every day 10,000 baby boomers join Medicare.

Like most of my fellow boomers, I continued working full-time after I’d retired from my career. I survived by paying the maximum into Medicare just as I paid higher income taxes.

We pay the maximum for Medicare Part B as required by law. This frequently happens when you have a second career after leaving behind a career wherein benefits begin at the end of 20 years regardless of your age. [That’s what happened to me. My career choice with the federal government required retirement at 20 years regardless of age. I was 54.] After what we’ve already paid into Medicare, not counting the $700/month for BC/BS plus dental & glasses insurance, Medicare is a scam of the worst kind.

Vietnam Wall, Washington D.C.

Vietnam Wall, Washington D.C.

What’s more troubling, Medicare is an assault on every retired military member and their families. Unless we enroll in and pay for Medicare Part B, our rights to Tricare for Life is taken away.

At the time soldiers were drafted and/or volunteered for Vietnam plus every conflict and war since then, the promise of free medical care for life for themselves and their families was guaranteed. This free medical care wasn’t of the VA variety but medical care in the civilian community upon a minimum 20 years service to their country.

David N. Walker @davidnwalker.com reminded me recently that there are only two people willing to give their lives for us: Jesus Christ and the American Soldier.

Tricare for Life is not an add-on-bonus for the soldier at the end of his career. A portion of his salary each month is allotted for Tricare. We can’t call that medical care free, can we? Now, the Pentagon and Congress require soldiers and family members sign up and pay for Medicare Part B making Medicare the main payer and then Tricare for Life the secondary payer.

My government is denying me freedom in the marketplace and I don’t like it. Tom and I have already paid in enough to Medicare to own a second home along the central coast of California [Big Sur, Carmel by the Sea, Monterey] and a third home on the Outer Banks of North Carolina.

Take Our Medicare Money and Give What Healthcare It Would Buy to Someone Else!

Take Our Medicare Money and Give What Healthcare It Would Buy to Someone Else!

Our medical expenses would be covered 100% without Medicare. Why is Medicare pushed at us when our nation is in serious financial crisis? My husband and I would be happy to give our share to someone who needs what we’ve paid. We’re far from wealthy but we’d be better off if Medicare would go away.

Medicare has made a shamble out of healthcare. It dictates what doctors must document and do to such a degree that they don’t have enough time for the patient in front of them.

If you are receiving care and are swallowed into the Medicare system, have you noticed your doctor handing you a sheet of paper or even multiple sheets to read? The information may be as basic as your hair may grow thinner as you age but nevertheless, your physician must educate you in order to check off another box to qualify for the maximum Medicare payment.

I want my doctor(s) to work for me. I consider my internist the single most important part of my health care team. Call me old-fashioned, but I believe my internist’s core obligation is to be honest with me about my medical risks and thoughtful about how I manage them.

It makes no sense that my physician is worth less to Medicare than he was before I turned 65 and was forced into Medicare.

The Affordable Care Act is rapidly changing the way Medicare is paying claims. One of the largest and one that has kept me away from blogging is the critical care I’ve been faced with in caregiving for my husband, Tom.

You may remember, in my blog of Nov. 21, 2014, I announced I was taking a much-needed blogging break and would be caring for myself until after Christmas. You may read that blog here.

Later I’ll write about how I almost lost Tom, and due to receiving the worst healthcare possible (governed by Medicare) he’s been in excruciating pain since mid-September. His pain is 24/7 and when he is forced out of bed for an appointment, he’s confined to a wheelchair [this would not have happened except for the gutted healthcare system we are caught up in].

Tom’s situation started with a physician’s incorrect diagnosis and we were further exploited by a second physician who had a God complex. It was during this 7-month odyssey that I learned a physician with a Medical Board Specialty would not treat a second diagnosis directly related to and in the same location of a more serious diagnosis. The physician may have more knowledge he can/will share with a patient and help them make more informed decisions. If the specialist extends care beyond his specialty, Medicare will reduce their payment in the form of a fine. Additionally, the patient is forced to find another specialist to address the second symptom related to the more serious diagnosis. In addition, the doctor would be using allotted time for another patient with an appointment. Doctors no longer have an extra cushion built into their schedule to allow for such events. This payment regulation makes no sense to me.

Tom was recently diagnosed with psoriatic arthritis and the rheumatologist made it clear that he would treat the arthritis but not the psoriasis.

This 7-month journey of obtaining the best health care for Tom continues in an exhausting form. There seems little time for much else these days. I will lay out all the facts of Tom’s care over the past 7-months. I’ve kept my journal during this painful journey and I’ve discovered new fields of medicine, doctors who sabotage the works of colleagues, the dangers of misdiagnoses and fear of other doctors unwilling to confront their peers’ mistakes as well as the continuing stigma we meet along life’s way. Once I sort out the mountain of paperwork, I’ll attempt to put the past months into a bulleted format.

I apologize for not visiting your blogs on a regular basis. I continue to appreciate your support. I’ve had days when I wanted to do nothing more than to stare into space but Tom’s needs have doubled. His not being able to walk has changed our lives on so many additional levels.

How about you, have you learned anything new about the state of our health care since we talked last?

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ALARMING VETERAN STATISTICS

One Woman’s Opinion/Veterans
by – Sheri de Grom

The American soldier offers his/her life that we may continue to live in freedom. I find the following numbers not only shocking but appalling. It’s no wonder that less than 1% of the United States eligible population is willing to serve in our armed services.

  • Between 529,000 and 840,000 veterans are homeless at some time during the year.
  • Approximately 33% of all homeless men in the U.S. are veterans.

    HOMELESS VETERANS GETTY IMAGE

    HOMELESS VETERANS
    GETTY IMAGE

  • Veterans are twice as likely as other Americans to become chronically homeless.
  • Veterans represent 11% of the adult civilian population, but 26% of the homeless population.
  • Veterans are more at risk of becoming homeless than non-veterans.
  • One in ten veterans is disabled.
  • 45% of homeless veterans suffer from mental illness including Post-Traumatic Stress Disorder (PTSD).
  • 37% of all veterans returned from deployment to Iraq with mental health disorders.
  • The incidence of PTSD and suicide rates among veterans is increasing at an alarming rate.
  • One veteran takes his/her life every sixty-five minutes of every day.
  • The risks of women veterans becoming homeless are four times greater than male veterans.
  • 7% of the nation’s homeless veteran population is comprised of women.
  • 23-29% of female veterans seeking VA medical care reported experiences of sexual assault within their own chain of command.

All statistics were verified with the latest available data from: The Department of Veteran Affairs, National Coalition for Homeless Veterans, National Alliance to End Homelessness and The National Center on Family Homelessness.

This woman’s opinion: all children of the President and his appointees, all children of members of Congress and lobbyist’ should be required to enlist in the military and serve a minimum of four years active duty. And, we should not forget, currently, eighty-percent of our congressional members have never served their country in any military capacity. Individuals we’ve elected to lead us have no idea what’s required to serve in the United States Military and to sacrifice so much for so little in return.

Would our government be so eager to enter into every conflict in the world if the lives of ‘their children and loved ones’ faced the possibility of coming home in a flagged draped coffin, confined to a wheel chair, withdrawn completely into him/herself so thoroughly that no amount of mental health services can seem to reach them and their lives end in suicide. And what about the service member who leaves for war enthusiastic to defend his/her country, and before graduating from boot camp, their spirit has been crushed and the only way out is to commit suicide?

Thank you for reading with me. I appreciate the viewpoint of each of you. The builders of bigger and better war machinery are in operation and one crisis after another is exploding around the world.

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FROM CONCEPTION TO DEATH, MEDICARE DETERMINES YOUR HEALTHCARE

Medicare – 2015
by – Sheri de Grom

The biggest and best commercial insurance companies have a brand new battle cry.

MEDICARE'S BITE OUT OF HEALTH CARE

MEDICARE’S BITE OUT OF HEALTH CARE

” IF THEY can do it, WE can do it” has become the medical industry’s standard with the enactment of The Affordable Health Care Act. [Known as Obamacare]. THEY refer to Medicare and THEY [Medicare] are out of control.

The numbers don’t seem large until you review them cumulatively. A frightening reality is that all other methods of medical payments are cutting their reimbursements to match Medicare’s payments. Medicare is accountable to no-one. Every provider everywhere is receiving less.

Many medical facilities are operating with a dangerously low profit margin and rotating temporary layoffs have become routine. This lower level of payment and fewer Medicare-approved days for a designated hospital stay has driven some facilities to close their doors forever.

Physicians and hospitals alike are receiving a single payment from commercial insurance companies per diagnosis. They started this payment system upon reviewing the cost savings of Medicare. Loss occurs when treatments and tests pile up for the provider of care. Laboratory tests, x-rays and other exploratory findings became a part of the amount allowed per doctor visit or hospitalization.

My husband and I have each experienced this single payment fallout.

Those of you who’ve followed my blog for a time know that during a surgery in 2012: I lost well over one-half of my blood, sustained permanent nerve damage to my right arm and hand resulting in chronic pain leading to Complex Regional pain Syndrome. This past week my Scleroderma became a direct link to the 2012 hospitalization. In addition, I acquired a hospital staph infection. Medicare didn’t care how sick I was. They sent me home. I was too ill for any skilled nursing facility or home health nursing agency to accept me as a patient. Yet Medicare sent me home from the hospital knowing I was without a caregiver in the home.

The code for the surgery I had allowed a minimum number of hospital days and out I went. My doctor and the hospital didn’t attempt to fight for the complications involved in a six-hour surgery that Medicare coded as one and one-half hours.

You may read of my experience here.

Tom’s admission to our local hospital on September 22, 2014, for an infection diagnosed as  cellulitis of the left foot, seemed to be the answer for receiving powerful antibiotics he could only receive in a hospital setting.

The admitting physician, an orthopedic surgeon, misdiagnosed Tom’s problem. I recognize misdiagnoses do occur but, seven subsequent medical specialists have also misdiagnosed Tom’s illness. Many of the doctors have been so arrogant I wanted to drop kick them back to medical school for a class on both ethics and another on communication skills.

A few days before Tom’s hospitalization of September 22, 2014, he had been diagnosed with psoriasis on the bottom of his feet and palms of his hands. I asked the orthopedic surgeon if this might have contributed to the infection in his left foot and he looked me straight in the eye and said, “Absolutely not.” With visible signs of outrage that I’d questioned him, I continued, “Tom has open wounds on the bottom of his feet and this is dangerous for a diabetic. It seems to me this would be a perfect place for bacteria to enter and become out of control.”

The good doctor in the long white coat, [the orthopedic surgeon] announced, “If you have all the answers, Mrs. de Grom, why did you bring your husband to me for treatment?”

I’ve asked myself that very question many times. At the time I thought I was making the correct decision.

Tom was released from the hospital with a prescription for powerful antibiotics, pain medication which would later lead to delirium and today, five months later, he’s still in so much pain he cannot walk.

I’ll blog in another post about the new path we’ve been on since Tom’s discharge from the hospital five months ago. At five months post the hospitalization for the infection in Tom’s left foot, he cannot walk on either foot. The pain is horrific and it turns me inside out to watch this man I love when he does his best to move from one place to another.

Tom worries about being even more of a burden on me. I urge him to let me know when he needs help.

A recent study in Health Services Research based on fifteen years of hospital data suggests that cuts in Medicare prices under the Affordable Care Act may slow the growth of overall Medicare spending. Many current hospital standard practices will not withstand the loss in operating capital.

The reports indicate that when Medicare tightens reins on its inpatient hospital prices, hospitals scale back overall capacity. This results in less hospital use by non-elderly patients, not just elderly patients, a senior policy researcher with Rand concluded.

Changes in Medicare prices affect our healthcare system broadly. Medicare is by far the largest payer of hospital bills in the U.S., accounting for more than thirty-percent of total hospital revenues.

A substantial majority of Medicare enrollees—roughly 87% have at least one chronic condition, and nearly half have three or more, compared to 21% and 7% of the general population, respectively. Forty-seven percent of Medicare enrollees have an activity limitation.

Medicare has announced that, “The party is over. The sort of money, where whatever you do, the more we’ll pay, and the more complicated thing you do, the more we will pay you, and the more risky thing you do, the more we will pay you – there’s a recognition now that, we aren’t doing that any longer.”

The above announcement would have cost Tom his life if his heart surgeon hadn’t bucked the Medicare rules for Tom’s emergency heart surgery June 11, 2014. However, as insult to the surgeon, Medicare pays more for three chiropractor visits than it does to a heart surgeon saving lives. I’m having a hard time accepting this fact!

At Mt. Sinai, the chair of surgery now demands his staff discuss hospice alternatives with terminally ill patients – and make an electronic note of the conversation that can be tracked. If it does not happen, he demands to know why.

The same chair of surgery also demands that patient’s with end-stage dementia not have three or four hospitalizations in the last three months of life or die in the intensive care unit. He closed his comments with, “This is a terrible experience for the patient and family and we lose far too much money.”

In my opinion, Medicare has become all too powerful. They have minimal oversight from any other governing body. Presidential appointees and their staff charge ahead making new laws within the administrative law division. The new laws have resulted in not only how little Medicare will reimburse providers of care but they are dead set on holding everyone seeking medical care hostage. THEY especially have their eyes set upon those ages sixty-five and over.

A physician in private practice, treating primarily Medicare patients can expect an average yearly income of $85,000. Take away the operating expenses of being in business, paying back student loans, attempting to maintain a middle-class standard of living and supporting a family – it’s easy to understand why doctors can’t afford to accept Medicare patients into their practice.

Medicare has taken away the health care I once thought I had securely protected and provided. Doctors must now fight bureaucracy to provide limited care. Often the medical care isn’t what the physician would choose for his/her patient.

Medicare is an agency brought about by congressional legislation in 1965 with the sole purpose of providing medical care for American citizens 65 and older. How has one agency within the government lost sight of the citizens it is to serve and protect?

In my opinion, Health and Human Services, [the agency with oversight of Medicare] must review the actions Medicare has taken within the last four years and the end results its had on the American people. It’s time for change!

Voices must be heard before change will come about.

Thank you for reading with me. I’d love to hear about your encounters with Medicare. Please share.

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OUR VETERANS NEED YOU

Veterans – 2015
by – Sheri de Grom

A veteran, possibly in your community, needs your help.

Veteran Affairs coordinates volunteers in their No Veteran Dies Alone (NVDA) program.

HONORING OUR VETERANS - Getty Images

HONORING OUR VETERANS – Getty Images

Their mission is that no veteran will die alone.

We promise to take care of all veterans during life and in death. Many believe the ‘death’ portion of the promise refers to the burial benefits to which a veteran is entitled.

The NVDA volunteer program is an extension of the VA Hospice or Palliative Care Programs. For a veteran to qualify for the volunteer program he/she must participate in the VA Hospice or Palliative Care Program.

Many VA Hospitals lack sufficient bed space and comfort for this end-of-life population and the veterans are placed in community nursing homes where Hospice care is available. In many cases the care is available from their homes.

Often our veterans have out-lived their family and friends or the military lifestyle itself has wounded in ways that veterans find themselves estranged from their families.

Veterans represent 11% of the civilian adult population, but veterans make up 26% of the homeless population. It’s not surprising to learn a veteran has broken ties with family members long ago and the areas of the country where they used to live are as foreign as the battlefields where they once served.

Many veterans presenting to the VA for care are fearful of the agency that’s let them down so many times before.

Many veterans have gone without medical care for well over twenty years for any number of reasons. Often they haven’t had: transportation, lived too far away, couldn’t get an appointment and had no one to assist them in fighting the bureaucracy that is the VA

By the time a veteran actually makes it in the door of a VA Medical Center, often the only treatment remaining is to make him/her as comfortable as possible. Advanced disease processes have consumed their bodies.

Volunteers are needed to sit with veterans, read or talk to them, play music and sometimes offering a physical presence by holding the veteran’s hand.

The NVDA program is about good conversation, positive interaction, spiritual support, reminiscing, life review, therapeutic touch and an overall sense of connectedness and closure.

Volunteers are needed. When our soldiers come home, they shouldn’t have to die alone.

To participate as a volunteer in NVDA, visit http://www.volunteer.va.gov/ and fill out a volunteer application.

I thank you in advance for caring about our nation’s veterans.

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ANNIE OAKLEY I’M NOT

Mental Health/Suicide/Gun Control
by – Sheri de Grom

Logo for those of us dedicating much of our lives toward advocacy on behalf of the mentally ill.

Logo for those of us dedicating much of our lives toward advocacy on behalf of the mentally ill.

Compiled from journal notes, April 27 – July 1, 1996, Washington, DC

I’d admitted Tom to another mental health unit in a new Virginia hospital. I had no choice after I discovered him with a gun in his lap. (You may read that post here).

Did I dare hope this hospital’s treatments would be superior to all the others? I would never give up on obtaining the best professional help for Tom.

I hadn’t wanted to go into the office yesterday but it wouldn’t have been fair to my staff to stay home. Our team had an exhausting roster of hot spots requiring investigation. I had to go to the office. If I looked into my soul, all I wanted was the friendship of Jack Daniel’s.

When I arrived at the office I tried to appear calm. But, Ted, my deputy, took one look at me and asked, “How can I help?”

Uncertainty and fear accompanied me everywhere. I should have been ready for this, something, anything—why God—why haven’t I learned yet how to cope with one mental illness hurdle after another?

My meetings and staff reports proceeded as planned. I rushed from building to building at

Walter Reed Army Medical Center Before Moving To Bethesda, MD.

Walter Reed Army Medical Center Before Moving To Bethesda, MD.

the largest Army Medical Center in the United States. As the director of a large division, at the pinnacle of my career, nothing had significance or held my interest.

I despaired, frozen in fear and sadness. I did not want to see or talk with anyone, go anywhere or do anything. Hiding in my office was out of the question. Policy meetings, once exciting, now seemed tedious. My life became pointless. I wanted Tom and I to live happily ever after.

I was furious when Tom’s mother gave him his father’s guns. She even provided ammunition. What could be worse? Why didn’t she just give him permission to shoot himself? My stomach muscles tightened at her complete denial of Tom’s frail existence. I rationalized that she didn’t know what she was doing.

The guns became my nightmare. Tom, with his logical intellect, would debate which gun would be the most accurate for killing himself. I had to dispose of the guns immediately, but didn’t know how. The weapons were not registered in Tom’s home state and they could not be registered in DC.

Two months into Tom’s hospitalization, his psychiatrist told me, “Destroy the guns,” Dr. Frank continued, “I can’t release Tom to day treatment until the guns are gone.”

Early one morning, two months after I’d admitted Tom to the hospital for having the pistol in his lap (you may read that blog here), I openly carried the shotguns and handguns from our home. They included: a German Luger, a pair of matching Ivory-Handled Revolvers, another Ivory-Handled Colt 36, other guns from the 1920s and 30s as well as 4 double-barreled shotguns.

It was late spring, but in my heart, there was nothing but winter ice for the task before me. The cold steel of the guns felt like white-hot coals against my skin. Repulsed, I threw the weapons with their ammunition into the trunk of my car and drove to work.

I never thought about what might happen if anyone saw me with the guns or if I were involved in an accident in the DC beltway traffic. It never entered my mind that my car might be pulled over for a random search at the military installation where I worked. The only thing on my mind was getting rid of those guns.

I moved in a stupor throughout my day at work, knowing I would visit Tom at the hospital on the way home. I was keenly aware that before I got there, I must somehow dispose of my deadly cargo. I panicked; there was nowhere in metropolitan DC to ship the guns from. Once again, I could not share my secret plight with anyone. I was on first and I accepted my responsibility.

Nine p.m. approached as I neared the last possible shipment site before arriving home. I found one parking space in the center of a strip mall that advertised a UPS.

I hadn’t covered the guns, or purchased shipping materials or anything else that I might need. I couldn’t face planning for disposing guns I had never wanted in our home. I had to send the guns far away, anywhere.

I’d never planned to perform an ‘Annie Oakley.’ I walked with confidence, twice, through the cold night air toward the store, with the deadly steel in my arms.

It’s a miracle I wasn’t attacked that night. I still wonder why no security guards approached me or why the UPS clerk hadn’t pushed the panic button beneath the counter when he saw me.

The clerk said, the guns could be shipped if they weren’t loaded.

I don’t have a clue. I signed a certificate verifying the weapons were unloaded, paid $390 and sent the toxic package back to Tom’s mother. I had no intention of buying insurance for safe delivery. I called his mother and told her the guns were being shipped. I doubt she ever understood why her only child couldn’t possess guns.

Tom was dismissed from the hospital to home and day treatment for an indefinite period of time. I became afraid to sleep. What if Tom died while I was sleeping?

I felt detached, as though I were watching someone else’s life unfold. This was denial.

I now acknowledge I didn’t have the power to save Tom’s life then and never will. If he lives it will be because God wants him alive. I play a bit role in Tom’s safety. I pray, God’s will be done.

While I like to think I can save Tom’s life, it means I must sacrifice myself. This sacrifice allows me to deflect from my own issues and emotions because I always thought Tom’s pain was more intense, more agonizing, and therefore, his needs far more significant than mine.

Almost Two Decades Later – I carry on removing guns Tom continues to purchase. THERE IS NO STATE OR FEDERAL LAW PREVENTING THE SALE OF A WEAPON TO SOMEONE WHO HAS ATTEMPTED SUICIDE.

New Hampshire Firearm Safety Coalition

New Hampshire Firearm Safety Coalition

Our routine has been the same from state to state as my career has evolved. I can’t say how many times we’ve driven, in the middle of the night, to the emergency room because Tom has decided not to live any longer. The ER admission process has not improved (you may read my blog here about stigma in the ER). We’re separated as Tom enters the in-patient mental health ward and I hear the triple-tumbler lock swing into final position. My heart is ravaged much the way a prairie is in a raging fire. The man I love has been locked away with his torment in the psychiatric unit, alone, and I travel the edgy rails of life wondering how we arrived at this junction of our lives.

Thank you for your support. My blog has become a haven where I can express how the disease of bipolar disorder has affected our daily lives for twenty-seven years.

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MAYBERRY, USA MEETS MEDICARE

Pharmacy/Medical – 2015
by – Sheri de Grom

Any Small town USA Getty Image

Any Small town USA
Getty Image

A rural pharmacy, along with a bank, grocery combination dry goods store and post office anchored small towns that were the backbone of America for decades.

Four-hundred-ninety rural pharmacies closed their doors forever between the years 2003 and 2013. This is a significant loss considering the average age of a farmer/rancher today is 65 and over.

Today's farmers and ranchers are still using equipment 20 or more years old. They cannot afford to upgrade.

Today’s farmers and ranchers are still using equipment 20 or more years old. They cannot afford to upgrade.

There are approximately 6,700 independently owned rural pharmacies operating today. In addition to providing prescription and over-the-counter medications and consulting about their proper use, these pharmacies offer other essential health care essentials. These include: blood pressure checks, diabetes counseling and immunizations.

Added value as independent pharmacist helps older patient understand medication and how to take the medicine.

Added value as independent pharmacist helps older patient understand medication and how to take the medicine.

Often, these rural pharmacies serve as a gathering place for community citizens to meet and chat. Local news is discussed and the drugstore (as it’s often called) is the only social contact for many rural and small town residents. These individuals do not, as a rule, depend on social programs or government programs to provide their needs. They find out what their neighbors (30 and 60 miles apart) need help with, and that help is provided with nothing asked in return. This may include nourishing meals provided, fences mended  and providing rides to wherever the individual may need to go. Normally, these rural communities make every effort to take care of their own.

Medicare Part D makes it more and more difficult for the independent rural pharmacist across our nation to serve the customers who’ve always depended on have coverage of some kind. This population is proud. They grew up and moved into adulthood during the great depression and they made it ‘then’ and they are determined to make it ‘now.’

The money squeeze is affecting everyone and especially our most vulnerable.

The money squeeze is affecting everyone and especially our most vulnerable.

Rural independent pharmacies have been at the mercy of two major Medicare policies related to payment for prescription medications.

The Medicare prescription drug discount cards (introduced January 1, 2004) were offered by Medicare-approved private companies (primarily large pharmacy chains and insurance groups).

The Medicare prescription drug benefit introduced (Medicare Part D, began January 1, 2006) and makes prescription drug coverage available to everyone with Medicare. [This statement is true if the individual can afford the premiums for Medicare Part D, have the income to cover the co-payments for prescriptions and are able to survive the doughnut hole when the insured must pay the full price of their prescription.

With the implementation of Medicare Part D came increased administrative efforts, payment timeliness and low reimbursement levels. Independent pharmacies cannot compete with the large chain stores.

Residents of communities that have lost their only pharmacy may adapt by driving farther to another pharmacy, using mail order, or obtaining courier service from another location, but access is always a concern for anyone with limited mobility.

HOW WILL OUR SENIORS RECEIVE THE MEDICATIONS THEY NEED ON A TIMELY BASIS?

HOW WILL OUR SENIORS RECEIVE THE MEDICATIONS THEY NEED ON A TIMELY BASIS?

With the advanced aging of rural America exacerbating the gutting of downtown America by Wal-Mart, independent pharmacies have rapidly become just another empty storefront town.

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A SISTER TO HONOR – LUCY FERRISS

The Berkley Publishing Group/2015
by – Sheri de Grom

Book Cover - SisterA Sister To Honor by Lucy Ferriss is a novel long past due.

A Sister To Honor will be released January 6.

Ms. Ferris embraces the realities of daily life for Pakistani women. By page six the theme of the novel is clearly set forth in a scene between mother and daughter and the plot never allows us to forget what is happening or what is about to happen next. The plot and characters are always in motion.

On page 6 we read, [From now on, Sobia (younger sister to Afia, a primary character in the unfolding story) would need to learn how to keep her breast covered with her dupatta.She would fast this year during Ramadan. She would no longer play in her old rough ways with her cousin, Azlan. She would walk with a new firm carriage, protecting the treasure of her womanhood.] Sobia wanted her older sister, Afia, close

Girl, very much an adolescent preparing to assume role in arranged marriage.

Girl, very much an adolescent preparing to assume role in arranged marriage.

She needed her big sister to tell her what was happening with her body. Why couldn’t she play games with the boys any longer? Sobia was just a child herself. Was she destined to prepare for an arranged marriage from this day forward? Why did Afia have to go to America? Sobia cries in her room and wishes for her sister.

A Sister To Honor quickly moves to the story of the two main characters: Shahid Satar and his intelligent, beautiful younger sister, Afia. Both are from a small remote town in Pakistan.

Shahid escaped the confines of his life in Pakistan to become a squash star athlete at a small northeastern university and holds close to his heart, dreams of going on to Harvard. Each time he returns to his small village, it’s quickly noticed how Americanized Shahid has become. Shahid cannot admit to anyone that he can’t imagine returning to Pakistan and becoming a farmer. That is his destiny as planned by the family.

Afia is the quiet, studious and oh so beautiful sister. She’s earned a scholarship to a university near Shahid’s university. Since childhood she’s dreamed of becoming a doctor but understands the cultural obstacles blocking her desired destiny. It doesn’t matter that she wants to become a doctor to serve the women of Pakistan.

Afia’s father and other male members of the extended family finally agree she may attend university in the states and assigns Shahid the duty of defending his sister’s honor.

A Sister To Honor is more than a story about a brother and sister who leave their

Woman - Stoned To Death

Woman – Stoned To Death

homeland and learn a new culture and freedom in the United States. Lucy Ferriss paints a vivid picture of a tension-filled cultural divide between family and self.

Bleak circumstances are front and center of the story. Before page fifty, I knew Shahid had failed to protect the honor of his sister and the penalty would be severe. The circumstance is textured with the first romantic encounter of Afia’s young life. She’s on her own with emotions no one has discussed with her and that she’s never encountered. She can’t talk with Shahid and the American girls in her housing unit would laugh at her. Afia was on her own.

PG 42 [He pointed to the screen. A photo bloomed into being: a rally of some kind, and his sister, his sister, her mouth open, shouting something, and her hand holding another hand, definitely, yes, he sat clutching Coach’s wrist while the photos looped through and he could see it again, a big hand attached to a muscular arm. A man’s hand.

He slapped at the screen with the back of his hand. “What the hell is this?” he shouted. He stood up. His heart felt full and tight. “What is she doing?” He looked at Coach, who had a strange, pale look.

“Shahid, calm down, she said. “That’s Afia, right? You’re upset because–?”

“Turn it off! Turn the bloody thing off!”

She peered once more at the image as it loomed up, then closed down her browser. She stood to face him, “She’s at a rally,” she said. “There’s nothing wrong. You’ve had your picture on the Enright site. She’s not being inflammatory or anything. If you want me to talk to her . . .”

“It’s not what she’s doing Coach. It’s what she’s holding.” ]

The attention to detail propelled me further into the depths of the story. Ms. Ferriss’ subject matter knowledge is trust-worthy over and over and I entrusted her version of events as they unfolded page by page. The novel is a work of fiction but the story holds true to the lives of hundreds of thousands of woman today.

Protest of Honor Killings Honor Killings Are Occurring in the U.S.

Protest of Honor Killings
Honor Killings Are Occurring in the U.S.

Each turn of the page took me into the hearts and minds of both Shahid and Afia. Additionally, the sub-characters have their own internal conflicts and struggles. Shahid’s female coach is a prime example. Her own personal crisis has her reckoning with the past to cope with the demands of working in a male environment. It’s a daily challenge for her to live her own life.

Within the pages of A Sister To Honor, Miss Ferriss provides the reader a smart, thought-provoking, emotional and compelling read. You won’t find easy gimmicks. You’ll read a novel with intricate relationships and characters to care about.

I recommend A SISTER TO HONOR, available January 6. You may place pre-orders now. I received an advance reading copy of A SISTER TO HONOR from the publisher in return for a fair and honest review.

I previously reviewed The Lost Daughter by Lucy Ferris and you may read that review here.

I’ve been away from my blog for several weeks and I’m thrilled and honored to have read your comments when I reblogged my first Morti and I post. You’ll find Morti’s story #2 here and story #3 here. Morti #4 will arrive soon.

Tom has been ill [physical doctors want to blame everything on mental health issues although mental health has nothing to do with the demise of his current condition. I’ve gathered more information during my absence about the increasing shambles of medical care than I ever wanted to know.

I’m one of the most fortunate bloggers in the universe. You’ve been so kind and so willing to stay and wish Tom and I well. I thank you for hanging in there with me.

May your New Year deliver fulfilled dreams, unconditional love and surprise you with days when all is right within your world.

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THE YEAR GONE BY COLORS THE WAY OF THE FUTURE

The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 13,000 times in 2014. If it were a concert at Sydney Opera House, it would take about 5 sold-out performances for that many people to see it.

Click here to see the complete report.

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