The April 8th opener for Saturday Night Live, “Donald Trump Goes to Kentucky,” is the latest example of what many Appalachian academics, activists, and advocates feel is outsiders taking liberties with extreme representations of our people and culture. In the skit, four Kentuckians from Boone County (not in Appalachia or the coalfields) express concerns to President Trump who is there to relish in undying support. They express their concerns. Trump replies in his vague and ridiculous manner. Each of them sit down a little shell shocked, but still wanting to believe the president they elected has their best interest at heart. Almost immediately after the skit aired, my Facebook newsfeed was ablaze with offended eastern Kentuckians admonishing the writers of the skit for stereotyping and making us out as idiots. A little later, came more blogging about liberal elitism and how the Democrats are to blame for our communities’ Trump votes.
I have felt the need to add the qualifier, I am a coal miner's daughter, to add credence to my writing or a thought I was hoping to express since the "Trump Digs Coal" slogan and his election, I've done it countless times. As far as I have been able to gather, my family ended up in this far armpit of eastern Kentucky to mine coal on all sides. We've been pioneers of the Appalachian mountains since we came over the big water, and my Cherokee family, well... this land is theirs.
The top picture is my great great grandparents on the Hansel side and where my name is descended from - Zachariah Taylor Hansel and Elizabeth Evans Hansel. The little dark headed fellow standing next to his dad is my great grandfather John Thomas Hansel Sr. The Hansels moved to Harlan from the Mount Sterling area of Kentucky to mine coal and that is where the very direct experience I have with coal miners begins.
The bottom picture is William Stephens and Amanda Sue Clay Stephens from Olive Hill, Kentucky in Carter County. They moved to Letcher County during the building of Jenkins, Kentucky which was built by Consolidation Coal Company beginning with the purchase of the land in 1911. My great grandmother who was my babysitter all of my young years was their daughter - Golda Ruth Stephens Johnson. She was born in 1912 as the first of eight children. It seems the family came around 1914 to Letcher County for coal mining. My Mamaw Johnson always told me her daddy was a Blackfoot Indian which seems kind of strange to me considering he or his family would have had to travel a long way in order get to Olive Hill, Kentucky from Montana or Canada even. Who knows though? He's definitely from somewhere.
Golda Ruth (Goldie) married Luther Johnson. Papaw Johnson was my best friend when I was small and the way we spent our days together was directly influenced by his time as a coal miner. Luther is the tall man in the second row with the pipe hanging from his lips. He was a union miner as most were in those days. Yet, he realized really fast that being in the mines wasn't going to pay him off in the long run and could potentially take him from his family and this old world. Papaw Johnson had the wit, grit, and wherewithal to find a way to get himself out of the mines and into the business of being his own boss. Weekends at the Isom Stock Sale turned into the Cowshed Trading Post, and there I "helped" him keep shop nearly every day of my childhood. The Cowshed was a kid paradise.
That brings us back to the Hansel men. Pictured below is John Thomas Hansel Sr. and Junior, both coal miners. Great Papaw Hansel lost his larynx to throat cancer, and as a kid I used to be fascinated that the piece of gauze that flapped over the open hole in his neck was the only thing that kept the outside world from seeping in to his body where it could not be rightfully contained. I will never forget the hushed sucking and choke sound that he used to create his voice with family. He didn't like the mechanical voice box to use all the time. Inconvenience, I suppose.
Papaw Hansel became an electrician in the mines and eventually took that skill and became a teacher at the vocational school in Letcher County. So, he too found a way out of the mines, but not the economy dependent upon it. When I was 8, he moved his family to South Carolina where he applied his mining skills working on machinery and such things at a fabric printing plant. He passed away of bone cancer in South Carolina just a few years ago.
So, here I am. This proud coal miner's daughter working for a place that has the commonly associated tag of "anti-coal" by some in the community. My dad supports my work and always will because he's confident in how he raised me. Here's the thing... Appalshop is not "anti-coal", we are an arts, culture, and media organization who documents and preserves life and tradition in Central Appalachia. However, you will find some related people who in their personal lives and opinions are not believers that coal mining is good for the region and especially strip mining. Yet, as with any organization, company, or workplace you will find a wide range of beliefs none of which in and of themselves represent the principles of the organization.
My dad experienced some of this directly when he worked for Enterprise Coal which was located in the building next to Appalshop at one point in time. A member of a visiting group called Mountain Justice Summer who were in Whitesburg to organize and demonstrate against mountaintop removal coal mining vandalized my dad's work truck by urinating in the truck bed and marking the paint. They were caught in the act and when my dad tried to confront them, he was spat upon. Now, someone not understanding that various organizations sometimes have to interact would leave that situation with a very strong opinion about "liberal" minded people who protest mining and because they were visiting Appalshop, direct that opinion onto Appalshop.
Fortunately, my dad knew better. He knew that many of the founding members of Appalshop were his neighbors and classmates in school. He played basketball for Whitesburg High School with one and lived down the street from another for awhile. He knew a large number of Appalshop employees were locals. Of course, he held some really strong feelings about the association and the kind of education or encouragement that would lead young people to violate the respect of their elders and personal property. I think he has mostly let that go these days. I haven't, and I won't. It's been said about us "hillbillies" that we have tribal loyalty to a fault. Maybe we do, but I plan to set this action right for the good of my community as best as I can. I want to redeem the dignity of my dad and the men and women who stay, work, and worship here.
The recent election has brought new attention of the coalfields and it seems we've become the poster children for "Trump Country" as before we were and always seem to be the poster children for American poverty. It's really laughable, but at the same time I've seen a lot of troubling behavior stem from this renewed attention. Every week, I produce a 5 minute radio news roundup of the coal industry and its place in the bigger picture of the energy profile of the United States. It's unbelievable how many ways the same thing can be rehashed with different words and published to lock in the attention of new readers. I doubt there was ever a planned "War on Coal" fueled by legislation aimed to cripple the industry. I do believe some of the legislation did not help an already failing industry.
James Higdon wrote the best article concisely explaining what I believe to actually be happening for Politico and it was published last week - The Obama Idea to Save Coal Country. He begins with the "War on Coal" and takes us through Kentucky Republican Representative Hal Rogers's RECLAIM Act which was shot down by Republican law men from the western coalfields states which is the most recent government effort to provide assistance to the barely breathing economy of the Appalachian coalfields.
I think of the information in Higdon's piece, my dad's experience with social justice activists, the media coverage of my home during the election, and the disgusting opinions of people wishing death upon Trump supporters and coal miners reflected in the Facebook comments of a radio story my colleague Benny Becker produced with Howard Berkes when it was shared by National Public Radio (NPR), and I'm embarrassed to be thought of in terms of political leanings or someone who could sit by and do nothing in response to the comments of the very people who claim to have a heart for the poor and troubled. Here are some examples from that comment thread.
"One candidate ran on improving job training and education opportunities as the means for navigating the 21st Century job market. The other candidate promised to bring back coal mining jobs. Millions of Appalachians considered those proposals and said, "I want black lung disease, too!" ~Jeff Fulmer
"West Virgina, PA, and Ohio...all solid Trump territory. They loved that the fool actually said he would bring coal back, and that he would dismantle ACA (Obamacare). For many years, people like me (considered the coastal liberal elite) fought to bring politicians into power to bring jobs and health care to these regions---services that we personally don't need in regions that we don't live in--because it was the right thing to do. But apparently, a bigoted, misogynist snake oil salesmen promising them a version of the US that looks like Berlin in 1939 was more appealing. So, this liberal American is done with the Rust and Bible Belts, and focusing on California and California only." ~Michelle Whiting
There's so much wrong with these comments and the disgusting political divide that they represent that I would have to write my own book, or create a collection of the articles already written in counter to such opinions. It boils down to the fact that a mono economy was purposefully created in the coalfields by the coal companies that wished to take the money to the bank. They wanted to make this money on the backs of people they considered as little more than property. This labor created the "coastal liberal elite" cities that Ms. Whiting referenced through the industrialization of America. When these men died under needlessly dangerous conditions and did not receive fair wages, sometimes being paid in script instead of money which could only be used in company owned stores, they fought battles against their employers and the United States government to earn Americans the fair labor laws we have today. Because coal mining was seen as a service to the nation and a vital support of the entire American economy, these men and women found their worth in mining coal and providing an honest living for their families. Americans have demanded coal to power this country for the last 100 years and now the region of America that was populated for the sole purpose of mining coal has been forgotten and looked upon with nothing less than disgusted disregard by people who would claim to be interested in the pursuit of social justice and opportunity for all. The people making these comments have no idea what our families fought for and that now, coal mining done right and well is not without risk, but fairly safe and pays really well in the $70,000 a year range with no college debt for those that go in right out of high school. Add to that, full benefits, and aside from the fact that coal has been in steady decline and these jobs have become fewer and fewer, who wouldn't mine coal? It isn't coal mining in and of itself that has caused the problems we see in coal mining. It is however, crooked politics and money that has.
Then, there was this article by the founder of Daily Kos, the left leaning group blog for those involved with "netroots activism" to further the socially progressive policies and candidates in politics - Be happy for coal miners losing their health insurance. They're getting exactly what they voted for.
That article solidified my questioning of being involved at all in journalism or anything that can be labeled left or right. I've never desired to be a career social activist, and I don't now. I mostly see it as hot air blowing. I'm more interested in the tangibles. My community is more interested in the tangibles. As my ancestors chose to make a life here, and stayed here to do a job they were told was important for the well being of the nation, we work in the hard rock of reality. We always have.
Last week, Daily Kos tried to redeem itself with An Open Letter to America's Coal Miners and America by former coal miner and company man, Mark Sumner. I wish Sumner had taken his letter to another outlet, or maybe he wrote the appeal as a prompting from Daily Kos as a redemptive action. However, the letter is quite good. As Higdon's article summarizes the realities of the down-turned coal industry well, Sumner encapsulates the feelings of a miner and his family in a pill that's hard to swallow. Voting for Trump was a hail Mary for the coalfields. No one representing the power in this country or the liberal or conservative elite has fought hard enough for the future of a people that in no small part helped build this country.
Some would argue that with the same vote for Trump that we expect to save some jobs, we screwed ourselves out of the best healthcare access we've ever had. Increased access to healthcare only does so much. Yes, it provides more healthcare industry jobs. Yes, it brings federal dollars into our economy. Yes, it brings some people who desperately need doctors into the clinics to receive care. What we know well is that as always, federal programs are subject to change and political whim whereas a good job is a Godsend. One statistic someone might share with me is how many of the people who are insured for free under the Affordable Care Act expanded Medicaid actually made it to the polls to vote. And, because our access to news is somewhat limited by poverty and lack of wide availability of broadband internet, a jaded media brought confusion by renaming the Affordable Care Act to the point of essentially doing away with the original title - ObamaCare. And then, memes like this were created.
You know what's real hillbilly of me. I wanna fist fight you people. What I want to do is scream at you and make your nose bleed. It would be wonderfully gratifying. In your social activist and liberal and segregated city bubbles, you are part of the system that have always seen my ancestors as collateral and expendable. You want people to believe that we are all lower class white people, which in my layout of my family history was disproved. If this is widely believed, you feel you have permission to publicly belittle us and make fun of us and still call yourselves politically correct. I wouldn't care if we all were the color of hospital bed sheets bleached to stiffened, you still have no right. We are human beings, and you in doing so are a hypocrite and I don't trust you to have my well being in mind or anyone else's that you see as against your social values.
When Hillary Clinton won the Democratic nomination and then said, "We're going to put a lot of coal miners and coal companies out of business." the Democratic party lost coal country. I understand that taken in context Mrs. Clinton's comment can be understood in a totality that adjusts the impact slightly, but not enough. Our region's economy is hurting so bad that such an insensitive comment could not be redeemed. Many of us became willing that very moment to see in tunnel vision as many working poor must, to where our next meal will come from and if our kids will have equal or more opportunity than we do, and take a gamble on the nutcase of a Republican candidate and businessman - Donald Trump. In case you want to know what those of us in the eastern Kentucky coalfields think about opportunities for our children, in the Spotlight on Eastern Kentucky the 2012 Kentucky Health Issues Poll, 65% of us said the next generation will be worse off than the current generation of working adults. To not expect us to fight for anything we can to fill those gaps, would be akin to us consuming our own children.
It was a two party and polarized political system that failed us by creating an environment where such a thing could occur. Both parties see the coalfields Appalachians as expendable or little more than pawns in a game of dollars. See as proof of this an article from the Heritage Foundation explaining away a government bailout for UMWA (United Mine Workers of America) backed pensions. The same government that created a situation where homeless veterans beg for money and food in Washington D.C. and 20 veterans commit suicide every day after they sacrificed themselves in service to the country is well on its way to allowing former, elderly coal miners to lose the healthcare and benefits they earned by retiring coal miners. This same government allowed an industry to push out the unions without requiring that they do anything in good faith to the miners who made their money. Here's one fine example of how coal miners are being thrown out with the sludge and coal ash in order to give company executives big bonuses in hopes they'll stick around even though their job won't last even with the down sizing of debt and assets. Alpha Natural Resources is just one of many. Corporate greed and government complacency.
I could go on and on and on trying to explain to you why so many of the people I know, respect and love voted for Donald Trump, but I think so many of you would continue to think of us as merely ignorant or stupid and will label us with your social justice buzz words like - misogynistic, anti-Islamic, homophobic, and white supremacists. That's an easy way for you not to claim your responsibility in the creation of this situation we're finding ourselves in, and your democracy's willingness to overlook a group of people hidden away in the mountains of Central Appalachia as a means to keep progress moving forward without facing the issues that progress was making.
I won't fight your ugly words with more ugly words. I won't hunt down the brainwashed kid who thought he was protesting "corporate greed-heads" by spitting on my dad and kick his teeth in. I won't even laugh out loud as I see those who identify with us either celebrating or debating the very simplistic and unthought provoking memoir of J.D. Vance just one more time. I mean dag gone ya'll, give it a rest. Instead, I'm going to listen to you when you speak. I'm going to take your concerns deep within, and I'm going to ask the hard questions of my community that need to be asked. I'm going to try to encourage people who are working with the concrete things that can offer some relief in our dying coal towns every day. Those who are offering things we can touch. Things we can eat. Words that give hope instead of tear apart. I'm going to keep talking about opioid addiction for the very fact that it's damn unpleasant and it is another way the people here have been exploited for the sake of a dollar. I'm going to give prescription drug misuse a human story because I've lost a stepmother and numerous friends to it. I don't care what anyone thinks about focusing on solutions rather than problems. Our problems haven't been faced in any real way yet, and until we do that, we won't see solutions, we'll see bandages.
I am going to love on people as best as I can with the gifts I have. I will share the story of my people with those in these city bubbles who do give a hoot and want to listen because I know there are more reasonable folks than there are hypocrites. The thing that keeps me going in radio journalism is the thought that someone is listening who cares or who is willing to change their mind when presented new facts. The God's honest truth is that I don't know that journalism is where I can best serve my community. I'm giving it everything in me I have to give, but I question the tangibles. I am going to share yoga with my community to help heal the deep generational trauma we have experienced. I'm going to share spiritual insights that have helped me. I am going to try my best to be a mediator between you folks and my community. I'm going to try to heal broken relationships related to this ugly rhetoric. Relationships that on both sides we should have fought harder to maintain. I'm going to write ranting blogs like this one, fiction, and poetry. I'm going to love people instead of ideas. I'm going to consciously choose the middle road.
Our family gathered to wait with us. It was snowing, and all the local buses were on calls. Our drivers came from Elkorn City to Prestonsburg to pick us up. We waited over two hours after getting the news. I had time to explain to Ivy about surgery. How most of the people she is close with have had surgery. How she was born and alive because of surgery. How she's strong, and I won't leave her side. I would never leave her side.
She slept on the ambulance ride. I texted with some of my mama friends and family a little, but I mostly watched her sleep. It was hard to reach her where I was belted in, but we had the kindest EMTs with us, and the man in the back also had three daughters. He'd reach over and run his fingers through her hair every now and again. He won't know how much I appreciated that he wasn't afraid to touch her for me.
Like I said, I planned. What would this look like? I had only been with my job since October 2015. I guess they'd just have to let me go. I had been a stay at home mom for 10 years and nothing like this had every happened to us then. Now, I had made the decision to change our entire lifestyle so I could find fulfillment and a purpose beyond parenting, and this happens. As my mind is always analyzing, I asked - What is Universe trying to tell me? Have I become a neglectful parent in my pursuit of engaging work? Am I a selfish mother in even considering how this all will affect me?
Thank God, it wasn't cancer! Ivy is on the mend. University of Kentucky Children's Hospital and her surgical team were amazing. She had a 6cm vascular abonormality that was a total bizarre fluke. They removed it all, and now, almost two weeks later, you can only tell that she was operated on because she has four little incisions covered with surgical tape.
We got home on a Monday evening late. I went directly back to work the next morning. I didn't want to go. I wanted to stay, but now, we are dependent upon my income. My income pays for all the new things in our life. A house that meets our spacial and privacy needs, tuition for cottage school, babysitting, food, insurance and my medical bills, my supplements and medicine, and gas money. I can't not work.
Again,because we can't do without this income, I thought, what have I done? I had to think on it awhile. I came to a conclusion that I had come to months ago as I was making the decision to go back into the workforce. It doesn't matter if I am a stay at home mom or a working mom, I'm going to have guilt placed upon my shoulders by myself and by society for all the things I'm expected to be and cannot. We cannot be everything - even to our children. Becoming a parent shouldn't mean we are expected to. Then, I realized, being at work was a kind of relief. I wanted to be both places, actually. At work, I could breathe. I could focus on something a little less heavy for awhile. I could see something through from beginning to end.
I remembered an essay in _Brain Child Magazine, online that I had read back in September before I knew I had gotten my current public affairs position. Aubrey Hirsch writes:
I’m learning a lot, too. The big revelation for me came the first time he woke up on a Saturday morning and, as we were lazily playing in our pajamas, said, “I want to go to Melissa’s!” Movies and mom blogs had prepared me for this moment to be heartbreaking, but it wasn’t. It was totally fine.
Before she ends the essay this way, she wrote, "Watching another woman cuddle and comfort my son didn’t feel bad; it felt great. I knew he would be fine and that Melissa would take good care of him." With those lines, I was reminded how I'm not a natural nurturer. When my own mother was caring for my dying grandmother, she broke down in her stress and grief and said, "I'm not good at this stuff. If I had wanted to be a nurse, I would have went to school and become one!" I realized so much watching my mother caring for my grandmother, and when she spoke those words so much acknowledgement poured through my soul. Hugging, rubbing, touching, holding... it all wore her out too. She too had to make an effort to do it in an extended way. I realized it wasn't that she didn't want to hug me growing up, but she got tapped out quickly. It didn't mean anything was lacking in her care of me or her love for me. It just meant she would show it in different ways that aren't typically associated with the act of mothering, and she did.
I hadn't thought I would be a mother up until a few months before I began trying to become pregnant with my first child. My plan was to be a writer. For various reasons, plans change. In this season of my life, I'm revisiting the dreams of my early twenties. Some would call that a mid-life crisis. Others might say I'm finally accepting myself. The biggest point is that I don't have to feel guilty for it. In fact, I have come to understand the huge contribution working mothers make, and how it actually is more difficult in many ways than being a stay at home mom. Mentally and emotionally, being a stay at home mom almost devastated me. It brought me to a very dark place after years of denying to myself that I really felt the way I did about not pursuing my interests.
You DO NOT have to be a martyr to be a mother. I wish for the life of me that society would help us convey to our daughters that you DO NOT have to be a martyr to be a woman. For if you find yourself a mother with a career or job, you may also find yourself holding the brunt of household chores, cooking, bill paying, errands, and outside family commitments. Going out and finding yourself is just another thing to add to the plate that is already spilling over the edge. Yet, it might be the most important piece in being not simply a caregiver, but a role model for your children. Being a role model can be achieved in the home and outside of it and will be particular to any given woman.
I'm still trying to find the balance of being both in the home and out of it. The truth is, I'm going to give up most of the yoga classes I teach so I can be home a few more hours in the evening. Mothers need rest and cuddles too. Even mothers who get tapped out quickly. We all need self care, but from what I see, especially women. Pursuing the interests and hobbies that help us nurture ourselves so that we can nurture our children and loved ones.
Hillary Clinton, back when I was younger was known for saying, "It takes a village to raise a child." She is right. Back in the day, the whole holler watched after your kids while they ran from house to house and hill to hill. Only since we have become nuclear families and neighbors with closed doors have we lost the village mentality. That doesn't mean that it still doesn't take a village.
Things happen, and I will be the mother who deals with them as they come. I will be the mother who seeks and finds herself. I will be the mother who shows her daughters that a woman can be whatever she wants without the permission of anyone. I will be the mother who knows and understands that we are each unique and being a good mother simply means providing an environment where your child is nurtured, safe, fed, warm, and loved however that may appear.
Today, I've decided to give up fighting. I'm on day 3 of a another migraine. I'm home alone with my girls who are getting much better from a bout of upper respiratory illness. They are giggling and horse-playing. I need to work on a radio piece for my new job, but this week has thrown so much at me, I need to clear my head first. So, I come here to write. I also took an Imitrex. The medicine hasn't been helping. I hate taking all this medicine.
A good friend's mother and a regular in my yoga classes, my chiropractor, and some folks in my online support groups for Hashimotos urged me to get my thyroid scanned. I'm on thyroid medicine and my thyroid had never been palpated nor had I had an ultrasound of the thyroid. This last year I have had a few CT scans, 3 x-rays, 2 MRIs, and countless blood tests. My main condition which I MUST have daily medicine for had never been evaluated by anything more than a thyroid panel blood test. I could write a whole other post on my frustration with this fact, but I will just say this. If you work in healthcare (medical, mental, alternative, or spiritual), listen to your patient/client. Even if you believe what they are saying is a crock, listen with all your effort. In their words, you will find the next appropriate steps regardless if their words are medically meaningful to you.
Last week, I had my first thyroid ultrasound. I had been complaining of tightness in my neck, difficulty swallowing my medicine and some food, dizziness, hearing my pulse in my right ear, and the feeling of being in an airplane taking off in my right ear as well. It's messed quite a bit with my hearing. I was prescribed allergy medicine and had an MRI for that complaint. I don't have seasonal allergies. I never have. I very rarely even get a cold. The MRI showed normal blood flow in that region. The symptoms didn't go away even when I gave the allergy medicine a chance despite feeling I didn't need it. I didn't think these symptoms were something I should have to just ignore the rest of my life. Sometimes the swooshing and pressure change in my head is impossible to ignore. Being a yoga teacher, it affects my balance and impacts my practice. It also makes it hard to talk on the phone and at times in person because I can't hear the other person. That's not normal. That's not ok.
I got a call Friday that my doctor wanted to review my ultrasound results with me in person. I went in this past Monday. These are the results. Pardon my coffee stains. I'm a little obsessive when it comes to reviewing my medical records and I had an accident.
I have multiple nodules that are small in the left side of the thyroid - "hypoechoic areas". Lo and behold, I have a complex mass of a significant size (though apparently they can also be larger) in the right side of my thyroid. The radiologist has recommended a fine needle biopsy guided by ultrasound to rule out cancer. It will also need to be assessed if my thyroid needs to be removed even if the mass is benign. If you look at the size of the mass in comparison to the size of the right side of my thyroid, you can see why it is something that needs further testing.
Many members of the population have nodules on their thyroid. Not all of these people have been diagnosed with thyroid issues. However, people with nodules measuring on the larger end and who have a history of thyroid issues, are the most likely to have a malignant nodule. Malignancies occur in few cases compared with the commonality of thyroid nodules. I'm supposed to get my appointment for the biopsy today, and at 3:16pm, I still haven't gotten the call. I'll be traveling to Lexington for the biopsy. It's a 3 hour trip.
I'm starting my first round of employment in a decade on Monday, and I am just now getting this news. For almost a year, I have been having symptoms associated with these findings. I can't begin to explain how angry I am that I am now going to have to deal with this at all. My hormone numbers were improved in my last bloodwork. I had several months of feeling better after adopting an autoimmune paleo diet and a no-holds-barred 7 days a week yoga/meditation regimen. I've added herbs and supplements, cut many of my favorite foods, and tried my best to surround myself with people and activities that feed my soul. I thought it was working. I suppose it was a little.
To me that seemed like a reasonable option. I was done with spending half of every month in pain with the headaches. I told Creator that night that I would take on anything if it helped me move passed this pain. I told Creator I'd accept cancer, brain tumor, craziness, aneurysm, all of it. I'd accept it because it would be a diagnosis and with a diagnosis I could have a plan. Whether I lived and got treatment or died, I'd have more freedom than I was currently having. After seeing the neurologist, I got some improvement in my headaches with medication, but now I have had a headache 10 of the last 20 days. Back to the headache from Hades (not that all of them aren't bad, but I literally would've downed a bottle of pills and died if I hadn't had the ER option that night). I told Creator that I'd use whatever I was given to improve my life while I am here and to try to improve the lives of as many as I can reach through my experience. I said, "Please, bring it on." A diagnosis big or small was the only way out I could see aside from death. Yes, it's a dark place to be, but it isn't a godless place.
I still don't know what I'm dealing with, but I'm closer to an answer. I don't know what road lies ahead. All I know is I am tired. This year I have lost 2 grandparents, 1 grandparent-in-law, had 2 aunts and 1 uncle diagnosed and battling cancer, 1 sister with a cancer scare, a niece with blood clotting issues in the brain, and 1 sister under immense stress and battling Graves disease. I am currently grieving another great loss that leaves me recognizing how alone I really am. Surrounded but alone. All my close friends live away from me and are busy people. None of us enjoy phone calls. My husband must work regular hours. My parents are busy working and caring for the other kids in the family. I've always preferred being a loner, but sometimes, I wish I could just sleep in someone's arms and not have to tend to anything.
breath. Strength comes from the breath and if you become a witness to your inhales and exhales and your body's reaction to the breath, you will discover relaxation and the panic mode dissipates. It is always good to concentrate on basics, and just observe the breath connection from head to toe. Just lay on the floor, stretch and breath, and be a witness. Understand you are strengthenIng inside out. We all should do this on a regular basis, but, I think we view this as no effort towards our practice, when it is the most important part. You never lose a gain...it remains with you."
I stopped and realized that all the pushing, making myself keep going, and searching for answers beyond the medical is wearing me out. I realized that I have not focused on one of the most fundamental aspects of yoga or spiritual practice - equanimity. I have not found my balance. In all the striving, I have built my willpower up so intensely that I do not know when to allow myself a break or to stop, celebrate, and live in my gains. I just plow down the next row. Start trying to fix the next biggest issue. I want so badly to be a light to myself and others that I think I have let my ego get out of control. I have overestimated the impact I can have on a life, including my own. My efforting will only go so far, if it doesn't create space for me to also take the time to live what I have learned. Sometimes, we can try to make up for the lack of self-esteem and self-worth in our lives by building other parts of the ego like self-confidence. I have been relying on my own strength and my own mind to do everything for myself and others. At this moment, I really just want to be loved and carried for awhile. I'm done fighting. I'm going to breathe instead.
I have to make a plan. I have to hone my spiritual and yoga practice. I have to re-think my self care.
"You can't fully appreciate the light until you understand the darkness." - Black Yoga Asanas Ritual Vol. 1
If you would like to read more about this particular aspect of thyroid disease, these links are where I have been doing my own research on what is to come for me.
Thyroid Nodules - Cedars-Sinai
Does the Risk of Malignancy Increase When a Thyroid Nodule is Larger than 2cm?
Risk of Thyroid Cancer Based on Ultrasound Findings
Thyroid Nodules - AAFP
Hashimoto's disease is a condition in which your immune system attacks your thyroid, a small gland at the base of your neck below your Adam's apple. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body's activities.
What makes it incredibly hard to give it my best shot is that because the thyroid gland is essential to producing so many other hormones that regulate my body functions and moods, when I am having a flare up, it can feel as if I'm completely losing control of my mind and body. Dealing with this disease is the hardest thing I have ever done. Harder than a 34 hour natural labor. Harder than saying good-bye to friends and family who pass on. Harder than running to the top of a steep hill 10 times fast with no break. You get the point. It's difficult. Honestly, I don't want to do it anymore. I know it is an endless battle.
Imagine having all the symptoms of a major mental illness such as manic depression, paranoid schizophrenia, psychotic depression, or even a bipolar disorder. One day you wake up with overflowing physical energy, even feeling severely anxious, with a rapid heartbeat, profuse sweating, trembling hands, and diarrhea, and you can’t stop losing weight. Then soon enough, without warning, your energy plummets. You feel like a slug, are constipated, your hair starts falling out, you gain weight no matter how little you eat, and you are severely depressed. You may have difficulty swallowing, sound hoarse, and feel like you have swallowed something that wont go down. And then, suddenly, your old symptoms return, and you feel anxious, sweaty, trembling, and panicky. This cycle can repeat itself again and again.
The thing is, I have to fight. I have things to do. This disease is something that I've been given, it is part of who I am, and who I will become. It doesn't have to be all bad. Sure, I just outed myself as someone who might display signs of mental illness. Is that the smartest thing in the world? I'm not ashamed. Many of us live with illnesses, mental or otherwise, that to folks we encounter everyday are invisible. We seem fine. We are hard workers. We get things done. We are driven. We seem in touch. The fact is, that we may be all of these things because everyday is a new struggle and we know that if we don't do it, we won't. There's no in between.
I don't think any of us who share about a chronic invisible illness are expecting condolences or accolades. It doesn't mean we are heroes for going on with life. It doesn't mean we need sympathy because our lives are over and we'll never see our dreams come alive. No, we share because we inspire one another to reach just a little higher. We help each other gather the information we need to take charge of our health. And, we want everyone to know that if we can do it, so can you. All we have is now. If we can make changes that will help us live our lives more fully and experience our bodies in a greater sense of freedom, why wait? No matter how challenging it is to change, why wait? Now, is the time when we can work. One step at a time.
This week I have driven my friends batty with my looping thoughts and stress. I left my beloved yoga mat at the front desk of the recreation center right within my eyesight. I forgot to grab my phone on a day when it was really important that I stay connected. Yesterday, I went about the day without taking my supplements, my heart medication, or my anxiety medication. I didn't realize it until I was overtaken by heart palpitations and feelings like I was surrounded by a strange glass box. When I'm having a flare up of the disease, it is like all my thoughts are in a fog. I get stuck on a topic with worry and I cannot shake it. It's as if I'm in a never-ending state of multitasking. This doesn't even begin to address the physical symptoms. It all can be embarrassing sometimes.
I will never use Hashimoto's as an excuse for my behavior or my physical issues. Yes, sometimes I may choose to share with someone that Hashimoto's is why I do certain things, or sometimes don't seem myself. It's not an excuse though. It's a reason. It's a reason to take better care of myself. It's a reason to deepen my spiritual connection. A reason to listen more to my body. A reason to be okay with a little comfortable discomfort in order to grow as a person and in strength. This is my body. It belongs to me. There's no disease stronger than me. The disease is just another teacher among many.
The man golfing above is my Papaw Hansel. He passed away earlier this year of bone cancer. My Uncle James is holding him up so he can take a swing and not fall. This is the blood from which I come. We don't lay in the bed until we have to. We grab the bull by the horns as they say. My last moment with my Papaw was my dad and I lifting him to adjust him in his bed. He looked at me with those sly eyes and looked at my dad. Dad said, "She's a brute ain't she, Papaw?" He smiled. He was proud of the strength in me. I have always been one to want to please my elders. Giving up isn't an option.
Yet, on days like today, when the sun is shining and the trees are calling, I just want to rest. I want someone to hold me, tell me its okay, tell me I'm doing a good job, I'm a good person, and I can rest. I want to breathe and feel. I want to cry and laugh. I want to be with those who accept me as I am and like me that way. Today, I'm again alone. Today, I'm going to my yoga mat with Warrior Workout and see what I can become for it's all I know to do.
At this point, I am angry. I want to feel like a 36 year old who exercises seven days a week, eats a clean, whole foods diet, eats no refined sugar, doesn't smoke or abuse substances, and generally tries to keep a good attitude. Why? That's who I am, but sometimes I wake up and feel like I don't want to wake up anymore. The pain from headaches, procedures on my foot that won't heal, a bum shoulder, a stomach that doesn't want to digest food, is wearing me out. Not to mention, I was told Monday that my insurance won't cover the procedure that would help my foot heal quickly. Nope, I have to a make three hours one way trip to the doctor every month and renewed pain with the treatment I receive until this is healed. Emotionally, while I try to hide it as best I can, I'm up and down. Anxiety and depression takes its toll as well. It's hard to admit you have either of those conditions when to the outside world you appear to be functioning fine. Some days, all I want is to be held by strong arms, smell damp earth, and feel the wind against my face. All day. I'm coping well though. Better than I was, and yoga is the reason. Fatigue is another big obstacle, but at the moment, I'm caffeinating strongly and taking iron to overcome my anemia as my body isn't absorbing nutrients from my food as it should.
I'm seeing three specialists (neurology, dermatology, and orthopedics) with 1-3 months between visits. I see my primary care physician at least once every 3 months for bloodwork, further testing based on prior test results, and medication updates. I have also started seeing my chiropractor regularly in hopes to spread out the visits to the orthopedic doctor. Honestly, it feels really stupid. Stupid. How did I end up here? Genetics is the simple answer. When I asked the girls pediatrician at their recent well visit if there was any way I could keep them from ending up here as well, she said, "Not really. The best we can do is watch for symptoms and catch it early."
Hover the cursor over photos for descriptions.
Because western medicine sees no cure for Hashimoto's and other autoimmune thyroid conditions, the approach is typically to manage a patient's symptoms as best as they can. For many patients, the management is not enough to allow them to live the life of a normal healthy individual. Unfortunately, as in other areas of medical breakthrough and dissemination of knowledge, most primary care physicians are not up to date on the latest information surrounding autoimmune diseases of the thyroid and a very many are not even aware of how to properly test for or diagnose them. Unless they specialize, doctors receive a basic understanding in medical school and not many take up further study in this area. Many people spend years with their disease worsening before they can even get a diagnosis. All the while, they are accused of being a hypochondriac or diagnosed with an array of issues that are not separate at all, but are related to the decline of their thyroid function. It is extremely frustrating for the patients and those close to them who know something more is wrong.
I didn't want to be in this place again. I am now overwhelmed while being in a familiar area. It reminds me of all the researching, writing, advocacy, and healthcare searching I did when trying to uncover why I had experienced unnecessary cesarean surgery and how I could go on to have a vaginal birth after cesarean. So, much of the information women need to make good decisions in pregnancy and birth is not transparent or shared among care providers and the women they serve. I had to become more involved in determining the kind of treatments and healthcare I would receive than those who were providing me that care. I had to take it upon myself to research, learn the science, and take the steps that I could to heal my body. All the while, I was sharing my journey with other mothers and becoming an advocate for the health of women and babies. When I stepped away from the career side of this advocacy, I thought that my focus would no longer have to be split between my passions and my healing. Yet, here I am again. Same thing, another issue. I'm tired.
Eventually, as I am choosing to do this one step at a time, I will be giving up many of my favorite foods and all things that I currently consider a treat - chocolate, dairy, all grain, corn, coffee, tomatoes and nightshades, nuts/seeds, soy, possibly eggs, all preservatives, and alcohol (which I have always had an aversion to). Eating out will be very difficult as will eating when friends and family cook meals. I have to be strict about the changes or it won't work. After 3 months to 2 years, depending on how my body responds, I will be able to reintroduce foods to see if I react poorly. If I don't react, I can continue to eat them if properly prepared for optimal nutritional absorption.
Another piece to this puzzle is medication and supplements. This is part of why I HAVE to adopt the diet and lifestyle pieces. I don't want to grow this mix. I want to reduce it. I will probably write more about that as I know what is helping me and what isn't. I really want to share this journey because Hashimoto's affects about 14 million Americans (along with the other health issues it causes) and no one seems to be having open discussions about it. It's another one of these dark areas where information is clouded and you can feel crazy and very alone.
I also have to make sure that I sleep at least seven hours a night, preferably 8-10+. It is recommended that Hashimoto's patients sleep until they naturally wake up and sleep until 8 or 9am as regularly as they can. This will be hard for me as I get a second wind in the night or I sleep restlessly, having wild dreams. My daughters get up at the first hint of daylight. The bodies of Hashimoto's patients need time to rebuild and to rest from the overburden.
Light exercise is also a must. It isn't recommended that we go for very intense exercise as that will cause further stress to our already taxed adrenals. I'm grateful I already have that under control with my yoga practice. I, now, practice 7 days a week and my favorite teachers have DVDs geared toward my health and fitness goals. Below are a few I'm using. I'm so thankful for my yoga!
The biggest thing I'm dealing with right now is needing to vent and not feeling like anyone wants to listen. I don't want to whine or seem as if I am whining. I'm a very proactive person and I'm not asking for pity or help. I want to be frustrated and have someone hear it, tell me I'm strong, tell me I'm a beautiful person, or simply feed me some positive about myself. Encouragement. I want pep talks. Or maybe I want my basketball coach back. The one that would make me mad in order to have me be fired up to play my hardest. Right now, I'm so worn out I don't want to fight. I just want to move on, whatever that means. It seems though that those with Hashimoto's have a hard time finding support and will often lose the support of friends and family. So, I'm going to blog for that reason too. Maybe I won't overburden those I love if I can let some of it out here.
In the meantime, I'm going to relentlessly pursue my dreams. I'm applying for jobs, seeing the girls into their new school, teaching yoga, cooking good food, and reading and writing a lot. Hopefully, spending times with friends and family will be added in there. I'm going to do my best, because I can.
That's the anger, overwhelm, and the plan.
By the time July 2014 rolled around, I was finding that I could no longer keep up with the form of workouts I had chosen. I was doing CrossFit inspired and HIIT home workouts. I was really worried because no matter my physical size, I had always been athletic and capable of pushing myself to keep up with strenuous exercise. Not only this, but the migraine headaches that I had been having since age 13 had picked up in frequency and were becoming debilitating. I reluctantly went to my family doctor. That began a cascade of testing and seeing specialists. I have seen a neurologist (and will regularly, indefinitely), orthopedic specialist, gastroenterologist, ob/gyn, chiropractor, and a dermatologist. I've had bloodwork every 3 months, MRIs, CTs, x-rays, and cultures of various sorts. Then, the ER visits.
I had to begin taking medications that would significantly lower my heart-rate in order to help prevent the headaches that were interfering with day to day life. This meant that it was now physically impossible for me to keep up with the intense workouts. That is when I took back up with a daily yoga practice. I now practice Kundalini and Vinyasa yoga at least 6 days a week. I eat real food as well as I can manage, and I try to feed my family the same way. See, I wasn't giving up. I have three daughters to raise and provide an example for. If I gave up on myself, what would I be teaching them?
All that said, leads me to why I'm really writing this post today. This region of Kentucky is known as one of the sickest regions in the nation.
Kentucky is one of the sickest states in America, a place where too many people die too soon, and many who live endure decades of illness and pain.
I must say, that what I'm seeing in my neck of the woods, currently, around health and fitness, gives me a great hope for our future. As I research and find the resources I need to receive the healthcare and access the food that I need to live the best quality of life possible for me, I am finding other eastern Kentuckians doing the same. Not only are they taking charge of their health, but they are becoming the change that they want to see in the region.
People I went to school with who are in the medical field are offering free, daily health tips via Facebook and coming back to the region to serve their communities. When I make posts about health and fitness information, I get messages and replies asking for more information or making comments that offer me more information. Area residents seem more interested in local food options. Farmer's Markets are sprouting up all over, and people are learning more about wildcrafting. Yet, the thing that inspires me the most is what I'm seeing as an increased willingness of people to use and explore the capabilities of their own bodies in outside of the box ways. I have recently started teaching yoga in Hindman and Whitesburg and have been so pleased to have no fewer than two and as many as eleven in my classes! So many express interest and a desire to learn how to take responsibility for their health. This makes me hopeful for the health of our young people.
Nick is part owner (along with Stacie Beckett and Carrie Adkins) of the new CrossFit Experior in Williamson, and Cristin instructs and works from the box (gym). I asked Nick why he wanted to make this passion of his into a career, and his answer is so much a part of the solution I envision for the positive growth of our region.
I wanted to open a gym to make a difference in the community, to help people change for the better. I think people are more interested in a healthier lifestyle these days for many reasons, like a better quality of life, to be more physically capable, longevity of life, or maybe to prevent a future health crisis. People as a whole are learning and adapting. 80 years ago everybody smoked. It was the norm. We're at a time now where healthcare and technology make things well known. We know now smoking has many adverse health problems, eating fast food, and drinking soda everyday has adverse health reactions. - Nick Potter
Simply put. He wants to make a difference in his community. Nick and Cristin saw an issue that affected them personally and in their desire to change it for themselves, they are a part of changing it for the community at large. We live in an area that is so naturally beautiful. I see it as very possible that this region can be known for health and well-being in our future. That's part of my vision as I share yoga with those who come to my classes. I know Nick and Cristin are seeing it on a daily basis as they inspire people of all ages to good health.
Jane Austen wrote in Persuasion, "I am half agony, half hope." On the days when my body and emotions feel agony, I look to hope. I'm going to fight the good fight. Others are fighting the good fight. This is just one part of the puzzle that will be rebuilding eastern Kentucky, but it is this type of revolution that makes me not give up completely. It is a clear path to goodness.
I'm going to have to live with this. There is no immediate fix, no sure cure, and no answer as to if this will ever go away except likely not. I didn't want to imagine the rest of my life dealing daily with pain. I didn't want to have to take another medication. I wanted to hear that with a snip, clip, or treatment, I'd be rid of this thing and I'd never have to feel pain so intense that I want to leave my body again. It isn't going to be so.
I spent yesterday wondering how in the world I was going to find the support I need to muster up the motivation to do the work I need to do to not just live with chronic migraine and nerve damage, but to live well. Seeing my grandparents in their transitioning to the next stage of existence, I've done a lot of thinking about quality of life. Quality of life matters a great deal to me.
The thing is, I've been fighting for something my whole life. I've been fighting to be acknowledged, respected, and for my basic human rights since I was a child. If I wasn't fighting for myself and protecting myself, then I was doing it for someone else who deserved fighting for. I'm tired of fighting. I'm tired. I'm ready to be carried some. Life is to be enjoyed as much as it is to struggle through.
Not too long ago, I talked with a life long Christian who had begun to wonder if there really would be something after death and if it would be kind. I told her that if she really believed what she professed to believe, then death is just a step into the future and not to be feared. Sure, there's anxiety anytime we are dealing with unknowns, but to really fear death can cause unnecessary pain. There is something for all of us to believe about death that can pacify fear whether or not we are faithful to a religion.
If I take my own advice, and I truly believe what I believe about life, purpose, and God, then I know this added chronic condition is an opportunity for growth, understanding, and personal freedom. I, the introvert, would like a team for this though. Me, who has always preferred to work alone wants a team. I've supported women in labor; speaking gently, massaging, seeing to their comfort as they came into their own as a mother. They transformed before my eyes and came into a realization that you cannot come to except for in the act of birth as I spoke to their strength. I would like a doula - a cheering squad - a friend.
To step back into my name and do this thing, I need to be able to have rest and reward. I'm already putting forth a lot of effort to make my body temple serve me well. The most important thing for me to do right now is reduce stress and find more effective ways of coping with the stress I will inevitably experience. As everything is an opportunity, dealing with stress has the potential to change my worldview and bring balance to my life. Stress doesn't have to be the bad guy that brings only pain. But, to experience stress in the positive, I am stepping outside of my comfort zone and asking for encouragement from others. I'm baring my heart, reaching out, and accepting that sometimes a kind word from another, a motivating quote, an ancient verse is the strength you need to breathe the next breath and be glad for it.
At this very moment, I'm fighting the urge to not erase this whole thing and think of it as whining. I'm fighting the guilt that is self imposed for not being the friend I might have needed to be for someone else. The ego is stepping in and attempting to make me feel unworthy of feeling the love of others. Maybe this whole thing is God's way of helping me learn to really accept that we are the embodiment of God's love and accept that this love doesn't always have to originate in my own heart. This may be when I finally am able to let down my guard while still being that warrior and defender I have always had to be. Who knows what this is? I only know that for the sake of my children and husband, I cannot let this get the better of me.
We stayed home and she nursed me all through the night. She let me sleep in her bed as she almost always did when I was sick. She wet wash cloths and kept them cool on my forehead. She told me stories and rubbed my back and feet. I'm sure she left the room, but if she did, it was when I was sleeping.
This past week, my Mimi, who is now 80, had a T.I.A event. My mother quickly got her to the hospital and once assessed she was transferred to a larger hospital a little over an hour from our hometown. She spent the entire night confused, sometimes knowing us and sometimes not. I was home alone with the girls and before we knew whether or not she had actually had a stroke, I worried that I wouldn't be able to get to the hospital in time to talk with her during a time when she still knew us. That scared me. While she hasn't been in the best of health, she hasn't really been ill.
I'm fortunate enough to still have all the grandparents that I have known and loved since I was born. That's a pretty big deal for a thirty-six year old. Yet, I know it can't last much longer. My grandparents have been such a huge part of my life, I'm not sure I'm ready to know what it is like not to have them a phone call away.
We lived with Mimi from the time I was about six years old until I was about eleven or twelve. She cooked for us and I rode to school with her every morning. She worked at the county Board of Education as a secretary. I walked to her office every evening after school and played until she was ready to go home for the day. She tickle-rubbed my back and feet nearly every night to help me relax and go to sleep while she watched Dynasty, Falcon Crest, or Knots Landing. When I washed my hair in shaving cream before school, it was she that put it up in a mushroom bun to make the "wet look" look purposeful like a woman from a Robert Palmer video.
I stayed with her a few days and one night at the hospital this week. The night I spent with her was hard. Her blood sugar went low and I didn't recognize it. The nurses didn't check it for several hours, so they didn't know either. She pulled and tugged at all the lines and cords attached to her. She, who always freezes, pulled her covers off. I'd explain to her why she had to have all the monitors. I'd put her oxygen back on. I'd curl up in the straight backed chair watching the same episode of Anthony Bourdain's No Reservations three times wondering if this out of character behavior was a sign of something more.
As a doula, I've attended births. I know what the thinning of the veil feels like. What it feels like when a soul is about to breathe air for the very first time. It's that electric feeling where you can act in a pinch of a moment as if you knew what to do before you had to do it. It felt that way that night. I've heard elder midwives and birth attendants say that the thinning of the veil feels the same at death as at birth. So, I worried. At least she knows it is me who is here, I thought.
My Mimi is coming home tomorrow if all goes well tonight. She'll be at home for Christmas. She'll know us for Christmas. There will be some days, weeks, months, or years left. It still feels strange though, that somehow I am to that stage in life where the tide has turned. It will be my mother, me, and my siblings caring for her now.
Mimi showed me what it meant to be fiercely independent. She was a single mother to my mom and her brothers for many years. She never dated anyone as long as I was aware, or if she did, it was not something to talk about. She had a career and was super good at it. She even seemed happy in her work. She made her own decisions and stood up for her family. She kind of did it all, and it was from my grandmothers that I learned that I was strong and capable.
I don't know what is ahead for my family. Transitions are always bizarre and filled with the unknown. When she takes that final jump of this life, she won't be alone even if she is physically alone. Even if I'm not quite ready to step into the next pair of shoes, I will. I'll do it proudly, because that's what I saw her do. I know endings are just beginnings for everyone involved. It will be for her too. Every single prayer or well wish that has been sent to our family is appreciated. My Mimi thanks you too. We're just glad that she will be back home soon, where she belongs right now.
I've been laying in bed for hours every night before falling asleep. Not completely unusual except for what is keeping me awake is not my racing mind. It's so loud my mind cannot do any thinking beyond what could be making this overwhelming noise. Swoosh, swoosh, swoosh, gurgle, pop, swoosh, swoosh, to the beat of my heart. It's the sound in my right ear. It is there all the time since September. Sometimes it is so loud I have a hard time hearing people when they talk. Other times it is subtle and barely noticeable. The best times are when there is background noise. At night, the sound is all that there is.
I Googled it. It's potentially a lot of things, some of them major things. Coupled with my terrible migraines it makes me a little wary of it not being looked into quickly. I went to my family doctor as an ER follow-up for migraine and stomach cramps a few weeks ago and mentioned it to him. He looked in there and listened to my carotid. Nothing is clogging my ear. My carotid sounded fine with the stethoscope. He recommended I try to get my neurology appointment moved up. It is scheduled for January. The appointment was made in October. I call. I tell the receptionist why I'd like to get in sooner. She explains that I'll have to go through the ER at the hospital and the ER doctor will do a consult with the neurologist. That will be the only way I could be seen by him any sooner. Thanks and no thanks. To think we wonder why the cost of healthcare is so outrageous. Don't blame it on the docs.
So, I wait. I wait and I analyze. I wonder. I wait. I wait like I've been waiting to see a dermatologist for this thing that has come up that needs examined. Again, the referral was made in October and I don't see her until December. After finding out that no dermatologist in my region of the state will accept my insurance, I had to make an appointment with a doctor in Lexington which is three hours away from home.
This isn't unusual for those of us who live in the Kentucky coalfields. I feel incredibly sorry for people who have limited transportation, funds, and are dealing with a major illness. A good doctor comes into the region and it is like rolling dice as to when you might actually get an appointment. Otherwise, you are referred to the surrounding cities for care - two or more hours from home. Fred D. Baldwin writes in an article titled, "Access to Care: Overcoming the Rural Physician Shortage": "Rural residents must often travel hours to consult specialists, and many rural communities lack even primary care physicians (physicians certified in family practice, internal medicine, pediatrics, obstetrics/gynecology, and psychiatry). In fact, rural Appalachia still labors under a double burden, according to Lyle Snider, research director in the University of Kentucky Center for Rural Health's Division of Community Programs, Research, and Health Policy: the fewest primary care doctors and the most severe health problems. These situations are related: having too few doctors means that dangerous conditions go undiagnosed too long."
The problem of physician shortage has gotten better as I have gotten older. I can directly see some of the strategies the state and healthcare agencies have used to recruit more doctors into the area. The most obvious one being recruiting residents of these rural counties into the field. I can think of my small graduating class and the class under me and point out at least seven of them who became a doctor, midwife, or PA-C and came home again to serve.
I, too often for the small number of times I have actually used an ER, have had the experience of there being cultural and linguistic barriers to receiving proper care. It seems doctors from outside of the country and/or state were at one time given incentives to practice here. That's a good thing because without them we'd have been up the creek without a paddle. However, I very much doubt that they went through any cultural sensitivity training and I know personally from experience that there is often a language barrier as well. It hasn't been unusual to hear of disappointment in a doctor's visit or a feeling like the doctor didn't take the time to listen and understand. I know people who have left that little room having no clue what the doctor ordered.
So, that said, it is wonderful to have the opportunity to see a neurologist without leaving eastern Kentucky, even if I have to wait until January. It is a step forward. However, the problem is far from being solved. A report, Rural Kentucky's Physician Shortage: Strategies for producing, recruiting, and retaining primary care providers within a medically underserved region says, "Then there is the issue of retention. One source of dissatisfaction on the part of rural physicians could be that the workload and demands placed upon them generally are greater than those experienced by their metropolitan counterparts. Those within Kentucky’s health care industry also point to decreased opportunity for professional contacts in medically underserved areas as a reason for premature physician departures from rural regions. There also are economic concerns. The federal government has become the largest contributor to graduate medical education, paying more than $7 billion annually toward that effort. Yet, federal and state governments have been criticized for failing to develop incentives that better encourage rural practice. Rural physicians typically derive a larger share of their gross practice revenue from Medicaid and Medicare patients, but these publicly supported insurance programs pay physicians at lower rates than private insurers. Rural physicians also typically have received lower Medicaid and Medicare reimbursements than their urban counterparts for performing the same medical procedures."
Well, what do we do? I couldn't imagine serving in the healthcare field here. Being a patient within it can be stressful enough. And, is just another way that living rurally is vastly different from metropolitan living. So, I wait, albeit not very patiently, to figure out what this potentially big deal thing is going on in my head. I pretend like it is no thing at all until I lie down at night and it begs for my attention.
Kelli B. Haywood is the mother of three daughters living in the mountains of southeastern Kentucky. She is a writer, spiritual explorer, and avid yogini. Haywood is the Public Affairs Director for WMMT-Real People Radio in Whitesburg, Kentucky. Connect with her on Facebook @ Confluence Mama.
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