Month End Week…

So, without violating any HIPAA or trade secrets, I’ll let you in on a little bit I do for work.

I work on a team of about a dozen people.  First thing in the morning, after I log into the computer, punch in for the day, and open up my seven applications, I check my email to see if I’ve received any documents overnight.  Then I flip over to Internet Explorer and log into SalesForce.

True story – in  2000/2002, I worked for a company that was something of a competitor of SaleForce. Rather than relying on “The Cloud” and the internet for our data storage, we made a product that ran on top of Microsoft’s SQL Server and, in a particularly nice (and odd) twist (the oddity comes from the side of me where I’m pretty much disposed to dislike web sites coded to particular browsers – read on though), your traveling professionals could also access their data through their laptop, and because we know that their skills are in different areas, they need only pull up their own Internet Explorer and without any sort of connectivity at all, view the copy of the database which they have on the laptop.  They’d review their customer data, and then meet with their customers.  Then they’d get the opportunity to go on line, click another button after connecting (through VPN) to their home network, and (in my own personal bit of glory, I suppose), they’d use a tool which I helped to build to synchronize the data between their computer and their home server.

But I digress – which is what I do here.  Anyway, I fire up my browser.  The first window I open looks at my current open cases – patients for whom I’ve requested authorization for their services they’re receiving, and I’m waiting for someone to tell me yea or nay.  My second tab is opened to what we call our “expiring” queues.  I’m solely responsible for two of our offices – when a patient begins therapy, we follow along.  And as most therapies are for the purpose of making the patient better, we hope they end.  Some of these therapies are designed to sustain, rather than improve, the patient’s life and quality thereof, so they go on – some for the rest of the patient’s life.  I have a number of patients who, for whatever medically diagnosed reason, can’t eat.  They can’t put food in their mouths, chew, swallow, and process it internally into the nutrients they need.  So there’s a service called Total Parental Nutrition, or TPN, which we give the patient to provide those pre-processed nutrients into their blood stream.  It’s incredibly complex, difficult, and when it comes to the youngest patients, it changes sometimes multiple times a month.

But that second tab I open pulls up a list of patients for whom their authorizations – that is, their services – should be running out.  In some cases, they are, and the folks are aware of that – they just haven’t gotten around to letting me know.  In others, they know the patient is going to continue on therapy, and they just haven’t gotten the necessary documentation from the patient, the doctor, or whomever.  And in some cases, we’re just waiting to find out.

My third and fourth tabs are only slightly different.  In my third tab, I pull up a list of every single patient who has services pending in any of the twenty or so offices for which my team is responsible.  In my fourth tab, every patient in every branch shows up.  But because the application – SalesForce – has some significant limitations I can see how to correct, but no one listens to me, I have both tabs open.  The “whole company” tab list is sorted by a column we call ASAP.  These are high priority patients who come up because for whatever reason, they want the authorization quickly.

In a lot of these cases, it’s because the insurance company that’s going to pay for the service – we hope, anyway – will not recognize the fact that life goes on.

In my very own life, there’s a very specific example, and at the time, I was not aware of the situation.  When my son was born, some 23 years ago now, he was three weeks premature.  And his doctor, who saw him as her very first patient for the practice, sent him from the hospital where he was born to a specialty hospital about twenty miles away.  He made it through those first nights, and shortly thereafter, had improved enough to return to his place of birth.  Because he was still requiring health care, we couldn’t take him.  He needed to go back by ambulance.

And the hospital called the insurer to get authorization to move their patient.  It didn’t have to be done for his first transfer because it is an industry-accepted standard that states that if the service is for emergency situations or needs, authorization is not required.  If the service is considered “elective” – and by that, they mean “the patient isn’t in immediate danger” – they require authorization.  And so, on the particular day in question, the insurance company took several hours to decide the transfer was necessary and approved.

Stupidity of the situation, part three – the hospital had called for this authorization shortly after 8 am.  The authorization was issued at 6:30 pm.  So here’s the part where you smack your forehead – though I’m not sure who precisely is to blame.  In mid-November, the weather here can range from nice, moderate, decently warm days to “are you kidding me, where did that two feet of snow come from?”  And this day was one of the later.  Because of the insurance company’s delay, the cost of the ambulance went from “daytime transfer” and less expensive, to “evening transfer” – and done on a day when there were a number of road crashes that took a number of ambulances out of ferry service to instead respond to actual, you know, life-threatening emergencies, the cost of my son’s hospital transfer had gone up.

And here’s where my job is somewhat important.  Because the individual who called the insurance company failed to do so, at least.  When I prepare to call for a service, when there’s the slightest bit of doubt that something might occur, I include those potential situations in my request.  If, today, I would have to ask for authorization for an ambulance transfer (and I never will have to), I would request from the payer authorization for the transfer for both the regular-hours and more expensive hours rates – and I would be sure to inform the insurer that, unless the trip crossed from regular hours to more expensive hours, we would bill only one of the requested rates, because I would want to make sure the patient didn’t get charged, later, when the insurance company comes back and says “no, we’re not paying that, because you didn’t ask us for it first.”

The biggest irony is that, after they initially denied paying for the ambulance, and I used the attorney route to get them to pay for it anyway, the company I work for now owns that insurer.  So go figure.

Anyway, back to my days, my third tab lists all of the patients in my offices, while my fourth tab is sorted to show me the ASAP tasks.  And I refresh both lists all day long.

But after I have Explorer loaded up (there are two other tabs of job-specific information), I then use Chrome to back up the search functions with a few other tools – things like a tool that will confirm that the date range I need to ask for is actually that many days, and the doctor who signed the orders I have is actually a doctor registered with the government, is allowed to do that, and is verified.  Then I have several other tools, but that’s my toolbox.

And when we come to month-end weeks, our goals are always to clear the decks.  That is – we look into the queues, and make sure that every patient in the system who needs authorization has it requested for them.  So, yesterday, when I left at damned near my normal time, my team – and the rest of us in the office – had managed to clear every single patient out by 6 pm.  Sure, there are another 90 people in my office’s queues who haven’t yet started therapy, or aren’t going to be receiving therapy, or went with another provider.  It is what it is.

But the interesting thing about the whole process is that, as we lead up to the end of the month, we’re allowed, and encouraged, to assist with overtime.

That’s right.  In my previous job at Target, Overtime was a mythical thing.  Actually, for some rare functions, it was allowed.  In my standard function, that is, standard floor-stocking retail dweeb (that’s the actual title for the job function, though I think my proper technical title was “associate”), I was closely monitored come the end of the week.  My boss would schedule me close to, or up to, 40 hours a week.  They knew they could trust me not to hit that limit, much less exceed it.  Though, in my six year career at Target, I did manage twice to clear that hurdle – once was a whole fifteen minutes, once was only 3 minutes.  I usually managed to get a few full days of time-and-a-half rate each year, because I would volunteer to work New Year’s Day, Memorial Day, Fourth Of July, Labor Day, Thanksgiving, and Christmas Eve.  I wouldn’t volunteer to work Easter, because it was one of three days – well, now, two – that Target is closed.  Those two being – for now – Easter and Christmas.  It used to include Thanksgiving, but I’ll never ever shop on Black Friday, if I can avoid it.  And I usually can.

But this past week, I think I managed to get somewhere around 12 hours of overtime.  Which, at my pay rate, is pretty nice.  I mean, my overtime pay rate is very nearly twice that of what I had been making at Target.  To be fair, my Target pay rate did more than double over those six years, but considering that I started working at that job at minimum wage, that isn’t saying much.  I should be much closer to my wife’s rate than I am, but she’s a professional with twenty-plus years of experience.  I’m a dweeb newbie.  So it is what it is.

But the other point here is that my content did – and usually will – drop around the end of each month.  Because, this week, I average 11 hour days.  When you combine that with the fact that I like to get to work early, it adds up.

My morning commute is usually about 20 minutes.  This is four times longer than my previous commute, but it also starts – for me, anyway – a little before 6 am.  That is, I’ve discovered that if I leave after 6 am, that same commute takes another ten minutes.  If I leave after 6:30 am, it can take up to 45 minutes.  If I wait to leave at 7 am, it takes over an hour.

I’m not sure whomever coined the term “Rush Hour” but I’m usually bemused by it’s lack of existence in every collection of oxymorons I’ve seen.

It is what it is, I suppose.

As to deeper thoughts, I’ll have those – once we get through some other stuff.  So keep watching this space…

Grief Is Weird…

I’m hoping it’s grief, and not me generally going to hell in a hand cart…

I found myself at my desk this afternoon contemplating the past.  Today was my son’s first day of technical school.  He is attending a nearby technical college to get his degree in automotive maintenance.  On the one hand, I’m very proud that he knows what he wants to do, and has chosen a career path he’s excited about.  I’m a bit worried that some of my own prior difficulties have played into his decisions, as there have been times that we as a family have had to go without, or make major sacrifices when a vehicle breakdown occurred as they always do, at the very worst possible time.

But then I thought back to those days when he was five or six years old, leaving him in the care of a teacher who did not yet know what they were confronting.

And shortly after being reminded of mental images like the one on the right here, which came some sixteen years ago, when he started first grade, I was reminded of one of the stories my wife told about her mother, who would dance in the front yard, in her robe (what we used to call a “housecoat” I suppose), banging a wooden spoon on a pot, rejoicing as the bus removed my wife and her brother from the premises for the first day of a new school year.

And I started to tear up.  In part for the loss of the little people who have grown into stunningly competent and impressive adults, nearly all of which they did on their own, with me only standing behind them to catch them as best I could.  In part for the loss of my mother-in-law, and in part for the difference we obviously had, as I continue to enjoy the adults my children have become, but at the same time I mourn the loss of that little hand that would reach out to take mine, or that voice that would ask the question that you enjoyed hearing because it showed how deeply they were already thinking.

I’ve been blessed so many ways in this life, and I’ll never forget that.  But I still miss some moments, and regret the many mistakes I made.  While they helped to turn these people into the adults they’re becoming, I wish I could have spared them much of the pain that I ended up causing through my own incompetence or sheer bad luck.

I’ve been blessed.  And I’ve made so many mistakes.

Battered And … Alive

Well, physically, I’m fine.  Emotionally, I’m just … clobbered.

The blasts back and forth in the loss of my mother-in-law have been, as grief usually is, wearing.  A little over ten years ago, my father and my first dog passed away within a few months of one another.  And to be blunt and honest with you, the loss of my father was not as difficult as the loss of the dog.

Before two of you go over to the whack-doodle side, the point I want to make is that the loss of my father was not something that I was confronted with every moment of the day (I had been recently laid off from my employer, and so was spending my time at home).  At home, I had only one dog for a while.  Yes, we rather quickly replaced Daisy with another dog of the same breed.  But that wasn’t the same dog.

And while there were moments where I’d think to pick the phone up and call my father, then remember he was no longer there, it wasn’t constantly in my face.

So there’s that.

And the loss of my mother-in-law follows on with a major car repair and other financial issues surrounding the loss of a loved one, and while none of it will put us in the poor house, the truth is that, over the last six months, we were hemorrhaging money rather quickly.  And now we need to dig out of that hole.  We can, and will be able to, eventually.  The problem, right now, is just the short-term bump in the road.

We’ll get there.  But once again, I’m reminded of the fact that no savings account was ever big enough.  Just sayin’.

So off to see if I can generate some additional income using other skills.  See ya later…

It’s Been A Week…

For 88 years and a few months, my mother-in-law Mary (Cahill) Cook graced this planet.  And the number of people who knew, loved, respected, and will miss her and have communicated that to us is still stunningly large.  Mary lived her entire life in one small eastern Iowa Town.  Some people will look at that sentence and think “oh, what a shame.”

She traveled with her family, and enjoyed her life. She maintained contact with her high school friends and helped to organized reunions for sixty years.  She worked a few jobs outside of her home before raising her children, and one of those – as a telephone operator – also led to reunions being planned and many of those friends who survived the time passing came to the wake.

She was also involved in the American Legion and the VFW as a loyal member, thanks to her late Husband’s service during the Korean war.  So many of us said that she so loved selling poppies to raise money for their various projects, including the scholarship fund.

But her greatest legacy is her family.  And not just the two children she adopted with her husband, but the number of cousins, all of whom had fathers who suffered with the same disease her husband had – Fabry’s – which caused them to die at a heartbreakingly young age.  But she and her husband would open their homes to these young men and women and show them the family time and build a family relationship that would, fifty and sixty years later, bring them from across the country to say goodbye to the final member of the pair.

For me, it’s been a reminder of a far simpler, easier time in my life – a lonely time, before I found a best friend who still reminds me every morning how lucky I am – not by anything she says or does, but I’m so blessed to know that next to me is a person who, every morning, decides life would be better by sticking with me.  I know that those thoughts aren’t always correct – the days have their ups and downs, and while I work and hope every day to make that true, I know that there have been some spectacular downturns that have been quite a disappointment to both of us.  But she stays.  And I do my best.

And as I left the cemetery yesterday, I made one more promise to my mother-in-law to take care of that most precious possession of hers that she entrusted me with, those thirty years ago.  I can’t stop now.

Hopefully, later this week we shall have improved and back-to-normal content here.  Life goes on.

Improving Outlook, I Hope…

So this morning, after a whopping 5 hours of sleep, I dragged my son out of bed and we traveled back to St. Paul.  He, being the mechanic and much younger and smaller than I, worked his way under the vehicle and was able to determine that yes, the end of the drive shaft was fine, the connection to the transfer case was where things came apart.

This meant that shaft was dragging on the ground, and would be a real problem if I tried to back up the vehicle without dealing with it.  So I had come prepared, and we used ratchet straps and rope to lift the drive shaft off the ground.  We then used the Verizon service we’ve paid for every month since we got the phones to get a tow.

Before you go all insane pointing out that if I’d placed that $10 a month into a savings account, over the past 20 years, I’d have managed to save a whopping $2400.  Except that in that time, I’ve relied on their services five times.  In a recent update, the towing changed from 50 miles to 10 miles, and as my mechanic was a little over 16 miles from the spot where I broke down, I needed to pay an additional fee to get the vehicle towed.  Which was, I suppose, reasonable.  I ended up paying a little under $29 for the tow, but the driver was prompt, professional, and got the vehicle up and down on the truck quickly.

Actually, I wasn’t there to see him take the vehicle down, but I did see the truck sitting in the lot outside our mechanic when we passed a few minutes after he removed it from the truck.  So I guess that counts.

And now, we just hope that it can get fixed by Wednesday so we can get to Iowa for the funeral.

Murphy And The Bad Luck Fairy Found…

It’s been one of those kinds of weeks.

This past Thursday, my mother in law passed away.  So of course, we had plans for Saturday.  Going back to ten months ago when the concert was announced, my wife and a friend of hers cooked up the plan to get tickets for us to do something fun.  And that actually happened.  So last night, I was able to go see Queen and Adam Lambert in concert.

Getting there was … a problem.  We live about 25 miles southwest of the venue, which was the Xcel center in downtown St. Paul.  Fortunately, for us, the city is fairly well known by my wife, who has worked downtown for over twenty years now.

But yesterday, I had decided I wanted to do something fun with my son, as we are both going to confront a pretty difficult couple of days come the end of the week when I have to bury my mother-in-law.  So we went into St. Paul, found a couple of places, and generally had a wonderful afternoon.  I’d come home, cleaned up, and my wife and I hopped into the car and drove to St. Paul.  After dealing with an absolute downpour that made driving very difficult, we reached St. Paul.

We pulled into the entry for the Lawson ramp – a parking ramp literally about a block and a half from our venue.  It had not been my primary choice, but was chosen because it was a little further away from the venue, and more importantly, laid between the venue and the hotel our friends had chosen for the night.  I was sitting in the entry lane while some fellow a few cars ahead of us struggled for some 5 minutes to pay for his parking.  Then came my turn – and my driver side window refused to open.  This was a known problem, so I just opened the door, leaned out, and grabbed the ticket.  Then I pressed the accelerator and a loud bang and thumping began.  I was … not expecting that.  I pulled a little way up, got out of the vehicle, and looked underneath.  One of the drive shafts (it has four wheel drive, so there are two drive shafts, apparently) had snapped off at the U joint.

So there’s that to deal with.  Hopefully before we get to Wednesday and have to drive to Iowa to prepare for the funeral.

Rest In Peace, Mary Cahill Cook

My mother in law Mary Patricia Cahill Cook, passed away last night.  She was 88 years old, was genuinely happy with her life in recent weeks, and really peaceful.

The manner of her death was quick, with no gory stories or heroic efforts to sustain her, which she did not want.  The fact that it came so quickly was a combination of blessing and curse.

And I have perhaps a thousand little stories about Mary that capture her spirit and her life.  And I don’t have the emotional or physical capacity at the moment to relay any of them.

We are devastated – but we’re also as happy as you can be regarding the manner of her death.  She did not suffer a long, slow decline into the darkness, she had all of her faculties and was as physically active as an 88 year old woman could hope to be.  So we were blessed in that manner.

Her wake is next Friday evening, and her funeral will be next Saturday morning.

And tomorrow night, I’m going to a Queen concert.  If that isn’t the oddest combination of events, I really can’t come up with one that’s more confusing.  It is what it is.

And Another One…

I know.  I’m going to steer into political thinking.  Some of you are going to run screaming.

I have to state this here.  The fundamental problem we have in America today is not just the guns.  It’s the rhetoric.

When you have a cesspit as President (no, I will not offer respect to that pile of trash) who feels it is acceptable to say the things he does, we have clear causation for the behavior we’re seeing this past weekend.

And by that, I mean, very simply, anyone who de-values life – as in the current rhetoric that the Asswipe in Chief pronounces about his very own mother – then it becomes acceptable in the marginally sane, marginally intelligent, to kill those people, or those who look like they might be immigrants, because someone is legitimizing their thinking.

I would like to think that once voted out of office, Dingbat Donnie The Draft Dodging Dirtball will be arrested as an accomplice in some of these mass murders – because his choice to pander to these animals allows them to think what they are thinking and doing is acceptable.

It’s been said before, so I shouldn’t have to, but yes, the bottom line is that unless a majority of your ancestry is Native American, you will have to trace back your very own lineage to an immigrant.  Which means you are the idiot about whom you spew the hate you do when you go off about anti-immigrant policies.

And I suppose it could be overstated that America’s current dominance in the world, it’s very existence as a Super Power, is owed to immigrants – that is, there was the physicist who left Germany when he saw what was happening and encouraged the President to throw in with some pretty weird research that did, finally prove that an extreme form of explosion could be made from material that was, and remains, very dangerous.  Indeed, without the atomic weaponry that ended World War II and kept quite a few small-scale wars from erupting into planetary-wide conflicts AGAIN, we might not be here.  And yes, I’m fundamentally aware that the mere existence of these weapons still threatens our existence.  And that’s the catch-22 of the 20th and 21st centuries.

If we survive to make it to the 22nd century or beyond, it will undoubtedly be because the incompetent and inexcusable are finally driven back to the fringe where they, at best, belong.  We can’t yet kill people for the way they think, and I don’t think that is ever going to be acceptable – but when they demonstrate through action that they are a danger to their fellow man, then we need to find some way to segregate these people in a place where they simply cannot harm anyone else.

As Australia is no longer available as a destination for prisoners, we need to develop some other form.  Perhaps some machine that pulls plastic from the oceans and turns it into floating islands.  When we, as a population, determine that the individual in question is beyond any hope of reform, we should store some of their genetic material – eggs or sperm – and then sterilize the individual, and deport them to this floating island so they can, among their own kind, spew their hateful rhetoric and behavior – and do it to one another.

Sure, this is a terrible fate, but it is in their control.  If they wish to continue to live, they’ll find a way to live with one another.  If they choose to continue to push their misguided agenda, and take the lives of those who do not believe what they do, then one can reasonably expect that the end result is a rather bloody experiment in population control.

And one that I’m in favor of supporting, for only those who have been judged guilty will exist on the island.  They cannot procreate, thus no innocents will be captured on the island to be the focus of the bad behavior of the condemned.

And yes, if the committed individuals happen to have any form of money/wealth in their own name, it is forfeit to the country they lived in, and harmed.  And to the families of their victims.

Just Trying To Stay Caught Up…

I live a pretty boring life.  I know.

But when my wife tells me “you hate change” I smirk inwardly.

I used to work in an industry for whom change was fuel.  And I very much enjoyed it.

What I do purely hate is shoddy workmanship, planned obsolescence, bad design, and deliberate stupidity.

For example, some ten years ago, I had a cell phone with removable memory I could upgrade, removable batteries I could charge while in the phone or in a charger, and it was purely adequate – it met my needs.  I chose to upgrade from it because I wanted a larger screen.  So I upgraded.  To a phone with removable memory, but the battery was built in, not replaceable – well, without voiding any warranty.  Before I could reach a point where I could have the battery replaced, I dropped it.  And so it was no longer functional.

So instead of choosing a phone I wanted – for there were none with features I felt I needed – I simply “upgraded” to one of my son’s older phones.  It had a smashed corner of the screen, a dark spot on the screen, many cracks across the screen surface, but it worked well enough.  In fact, it did one thing I didn’t know I wanted – contact charging.  I could set it on this pad and it would simply charge.  Which was a good thing, because I could not connect it to a cord because the small socket would continually clog with pocket lint and dust.  Which was exactly what I thought would happen when some idjit decided that “standard USB is just too damned big.”

And so the phone worked well enough for 18 months that I “got by” with it.  Until one day I picked it up from the charger and it was extremely warm.  It was fully charged, but too hot to put in my front pants pocket where I carry my cell phone.  So I set it in the console in the car when I drove to work, and then started using it when I got into the office (I was there early – plenty of time).  And the wee sensor inside of the phone which could detect if I was holding it vertically or horizontally (which came in handy when I’d switch from regular use to playing Solitare, so I could use the screen in wide-mode – a convenience, but not really critical to me.

Then the other day, I left it on the charge pad – but it wouldn’t charge.  So I took it to work where my other charge pad was.  And I set it on that. And it didn’t charge there, either.  So I took it into the store – and they said it was time.

So I chose my newest phone based on one factor only – price.  I grabbed the second-cheapest phone there (there was a $4 a month phone, but I went with the $5 a month phone because it was big enough to use).  It has many of the same problems my old phone did – non-removable battery, non-removable memory, and it won’t charge from a contact charger.  Of course, of the fifty or so USB cables I have in the house, not a single one of them will work.  The three battery backups I have to add power do not work, because this phone uses yet another type of USB connector – larger, rounded, and utterly impossible to plug in wrong – as it’s dual sided.

Apparently some people were so utterly stupid that they could not figure out how to insert a USB plug because it wouldn’t go in either way.  I am old enough to remember when plugging in every single electrical appliance worked that way – but now, someone has decreed that, in order to keep electricians employed, one of these little prongs on the electric plug has to be wider than the other.  So that prong has to be inserted in the wider slot.  Go figure.

So yeah, I suppose I’m cranky because of change – but can we take a step back in both distance and time, and remember how, some twenty five years ago, a cellular phone was only for people who had a crap-ton of money, needed to be in constant contact, and was the size of a brick?  Sure, they also cost about as much as they do today, but then again, we didn’t need laws telling people “put your damned phone down when you’re driving.”  It wasn’t the mass problem 25 years ago it has become today.

I drive a pretty heavily-traveled corridor locally.  I go into work early because I purely, absolutely hate traffic.  I hate sitting in a long row of cars, not moving.  Or moving very slowly.  I tolerate it in the evening, because, well, I’m going home.

And it’s in those evening commutes I see people in front of me talking on cell phones (which is, unless you’re using hands-free mode, illegal in my state as of last Thursday), playing on tablets, and a few utter morons were working on their laptop computers.

In this state, the first offense for your being caught using your cell phone, you pay $50 for the ticket, but court costs can bring that total all the way up to $120.  I think that’s far, far too low.  I think the first ticket for this sort of stupidity should be $250.  The second ticket should be $500.  The third ticket should be $1000.  The fourth ticket should be $2000.  If you are foolish enough to be caught a fifth time, the fine should be capped at $2500 – and confiscation of your vehicle.  If there is a sixth time, you pay $2500, lose your vehicle, AND lose your license for one year.  If you are caught driving without a license, and, yes, using that cell phone again, it should result in jail time.  Because if you’re caught seven times using your phone while driving after it is absolutely clear it is illegal, you have paid $8750, and lost two cars – and your ability to drive.

You are, therefore, a danger to the public – for whatever it is that is going on with the phone should not and cannot be more important than the lives you continually endanger.

I am seriously considering getting one of those small cameras you can mount in your vehicle and put it on my dashboard.  I’d really love to send to law enforcement videos of people on their tablets and laptops, with their license plate clearly displayed, in heavy traffic.  I wonder how much trouble that would cause them.

All of it utterly deserved.

So yeah, that’s my cranky moment.

Ruminations On Management

I cannot count how many managers I’ve had over the years.  I do, however, remember a number of them.  And for different reasons.

For me, the best managers were good communicators – not necessarily the best speakers, writers, or stand-up comics – but they were able to clearly communicate their expectations, standards, and goals.  Their communication also included their respect for the people who supported them and those expectations, standards, and goals.

Some of the very worst people I’ve ever worked for were the people who were absolute, outright hypocrites.  They would state that they respected you and your experience, and then promptly demonstrate their lack of respect by talking over, distrusting, picking your work apart, jumping to conclusions that you were wrong when you were, in fact, right, and then failing to acknowledge their mistakes.  One of the worst managers I ever worked for would tell me daily that he was glad I was there, glad to see me, and that I was very valuable to him and the company.  He would then demand to know what it was I was working on (even in the middle of phone calls with clients), tell me I was doing things wrong, explaining things poorly, or just a general trouble-maker (when he assigned me to train the new people – where I had 5 years of experience doing the job, and he had six months of experience in the entire industry).  Can’t imagine why he was laid off after I left – of course, them selling the company (not because of me leaving, though I am sure it did not help).

My current managers rank incredibly high on that scale.  Among the very best – and not because they’re my current managers.  The work I do is not particularly physically challenging.  However, I’m coming to learn that the job is far, far more mentally taxing.  It’s difficult – and not because it’s detail-oriented, requires working with people and systems that are changing by the minute, dealing with information that is often critical – but primarily because if you do the job, you will find yourself exposed to people who are often in the worst moments of their lives, trying to recover and make them well.

Some months ago I had a patient who was, due to the job, suffering from a number of medical issues which were going to kill them.  Their goal was to get out of the hospital and go home to spend time with their loved ones, and in order to do so, they wanted to be sure the insurance company would be paying for the therapy that would hold back the infections and cancers they had.  And the payer was an extension of the federal government – and there are many thoughts of how government can do almost anything, but it is rarely done quickly, on your timetable, and to the level which you need.  And the truly frustrating part was that I was continuously speaking to people who would say that the patient was their primary focus, purpose, achieving their goals were the reason they got out of bed in the morning (one nearly exact quote from one of the people I’d been dealing with), and yet to reach a simple decision that “yes, we’ll probably cover this service” took three weeks.

A few months before that, I had a small child who needed service.  I always push a little harder when it’s a kid, because I remember my own infant son laying in a specialty hospital Intensive Care Unit, surrounded by other babies who had other medical needs, and worrying not only about that life in front of me, but of his mother, in another hospital some 20 miles away, the bills we would undoubtedly receive, his sister, who wanted to see him but had not yet, and countless other weights.  So I was on the phone with the insurance company, who were looking into the patient’s records – then they informed me, without prelude, that they had just received word the child had passed away some half-hour before – about the time I called them and began the 25 minutes sitting on hold.

That child’s name is on a post-it note on the bottom of my keyboard.  I keep it there because the name was memorable, simply because it was unique, but it also serves as a reminder that we are a small part of a system, but very often, what we do has as critical an impact as what the doctors do.  It does no good for a patient’s life to be saved if they then have to sell their home because they have to pay for the treatment.  Often, my employer ends up on the hook for some of those costs, but I do my damnedest to limit that impact to everyone.  We pay for insurance in order for it to be there when we need it – that’s the idea, the premise, and the purpose.  So when it is needed, it needs to do what it’s there for – and not make me or others jump through unnecessary hoops.

As to how that affects management, I can tell you.  My managers are always genuinely glad to see us come into the office.  We have some pretty terrifying responsibilities.  On an average day, the group of people whom I work with end up having to average 350 people a day receiving authorizations.  And as the insurance company will tell you repeatedly, authorization is no guarantee of payment, simply a review of the patient’s present circumstances, the physician’s ordered treatment, and in their best judgement, the treatment is appropriate.  Now, on occasion, I find these reviewers are not even competent enough to note dates.  I had one authorization denied because the clinical documentation submitted – which was done two weeks before the same doctor wrote the orders – did not say anything about the treatment.  Given that the clinical documentation detailed (right down to pictures) the surgeries the patient experienced and showed the amputation of four toes, thus explaining the open wounds which had become infected, and were even referenced in the orders which stated “surgical site is not healing well after MM/DD surgery due to infection.  Will treat with…” – some of the most explicit and long-written orders I’ve run across in the 11 months I’ve been doing this job.

So the mental demands aren’t things you get to walk away from.  I left my desk last night with 32 cases pending in my queue, awaiting authorization.  Several chemotherapy cases.  Ten veterans – several of whom have been waiting for 90 days to find out if the VA is actually going to pay for the therapy the VA itself said they couldn’t provide it because they do not have the equipment or expertise, and so they relied on us.  They referred the patient to us – but somewhere in the vast monolith that comprises the VA Bureaucracy, one of the wee cogs hasn’t turned enough to say “oh, yeah, tell them they’ll get the services paid.”

And those people weigh upon me.  And I know, coming in on Monday, my managers will be happy to see me, I will get a smile and a cheery “good morning” and during the day, I’ll get at least one email of clear communication on how we did the previous day or week, what the expectation is for the day and week, and how we’ll be configured to address the work load.  And most importantly, those people will be supportive and encouraging.  I’ve made a few mistakes, but some of that is expected – I’m still learning.  But I’ve also received clear, supportive corrections.  I don’t feel like an idiot, I feel like I’m a valued member of a team – and it’s been a long time since that’s happened.

And I’ve also had recent exposure to a business owner whom I initially thought was a fairly good person – and I’ve come to reconsider that evaluation.  When your job is to do things for other people, you really need to rely not only on the professional and technical skills you have, but how people perceive you.   Not just the customers, but your staff, as well.

And this individual made statements to the effect that he deliberately chose to live well over an hour from the business – because they did not want to run into their customers.  I’m an introvert – so I understand not wanting to run into people.  But I don’t get the “look, I don’t want to see anyone I might have worked for” because the owner didn’t want to have to talk to people who might not be happy with the work done.

I see the problem here.  But the bottom line is that, if you are worried about the quality of work, then you do one thing – a better job.  If you’re concerned about the quality of work, you hire, train, supervise, and manage the best people you can afford, and you trust them to do their best by giving them yours.  Make sure they’re supported, know they are valued, and know that you are doing your best to treat them best.

But then again, we all learn at different rates.  And some people simply never learn.  Of course, then they wonder why they’re not as successful as they think they should be, either.

There’s a lot of things we can do in the world today.  But you can’t fix deliberate and willful stupidity.  Or, I suppose, you can’t correct it.  Eventually, it will be fixed by the same resolution that has existed for millennia.   Death.