20

Giant Party at the Brandenburg Gate

20 year ago tomorrow, the Berlin Wall was breached.  The first East Berliner to make it across – legally – was a woman named Angelika Wachs (news to me…old hat to everyone over here).

Algelika Wachs

My favorite band of all time – U2 – performed a live show in Berlin this past Thursday to start the festivities, which will continue through this week.  We live 3 hours from Berlin, and may as well still be in Olympia, unfortunately.  The celebration isn’t history…but it will get close and I’d love to be there.

The U2 show was free.  All you had to do was get a ticket via the internet.  And you had to do it within a 3 hour time-span because that’s how long the 10,000 available tickets were available.  Being a free concert, you might find the need for tickets a bit ironic.

Even more ironic:  if you didn’t have a ticket, you couldn’t see the show.  Why?  Because MTV (the show’s producers) had erected – you guessed it – a WALL to obscure the performance.

What Price, Integrity?

2000 Euro, apparently.

Through a housing allowance loophole, I could have almost certainly been approved for an extra 1000 Euro per month for the next 2 months.  The arrangement would have been a classic “kick-back” scenario between me and the owner of the house we’re buying.

However, in a last-second surge of some strange amalgamated emotion at least distantly related to those of guilt, honesty, obligation and craven fear, I killed the deal.

We are, in fact, buying this house, but will rent it for 2 months until the financing officially comes through.  During this time, my housing allowance will cover the rent – nothing more.

Quite honestly (since we’re on this honest kick), I feel sick about it.  I feel like I walked by $3,000 cash in a bush, and left it there.  I also feel it was the right thing to do.  But believe me, I had all the paperwork set up to take advantage of the oversight up until the final hour.

I should mention that the stakes are high right now.  The move to Europe is turning out to be much more stressful than I imagined.  This place is UNBELIEVABLY expensive.  I don’t understand how anyone can afford to even breathe out here.  I need to get my family out of debt…not go further into it by moving out here.

Let me quickly describe a government “housing allowance” as it pertains to me.  Termed the “LQA” or Living Quarters Allowance, anyone approved to live “off base” (most of us civilians are) is put on a scaled allowance.  You get more money for your status on the hiring scale (I’m waaay up there), and your number of “dependents” (pretty thin air on that one too).

So, when initially told of my housing allowance, I rejoiced!  I’m allowed thousands of dollars a month to spend on housing and utilities.  What a sweet deal!  In deciding if I could afford to take this job, I added my allowance ceiling (close to 50,000 per year!) into my yearly salary.

Keep in mind that my government pay as a doctor is very low in comparison to my private colleagues.  But when I added my LQA – viola! – my salary magically became competitive with the rest of the new-entry family docs in the country.

Then I arrive here to find that, essentially, it’s impossible to spend my LQA.  The arrangement is a “use it or lose it” kind of thing.  If you only spend half of your allowance, you can’t have the rest in cash.

The allowance, really, is a virtual amount that allows me to live pretty much wherever I want during the time that I’m here.  But even the nicest places in the area don’t rent for anywhere near what I’m approved for.  It’s like being told that you just won 1 BILLION DOLLARS!  Buuut, you can only use the money on M&M’s, and they can only be eaten, not sold.  Effectively, I’ve been given a lifetime supply of all-I-can-eat M&M’s.

I can’t have the cash, and, as you might imagine, I also can’t go to a landlord and say, “You’re charging 1100 euros a month for rent.  I’m approved for 3000.  How ’bout you and me split the difference every month?”  A housing office has to approve the rent amount based on an inspection of the house, and it won’t pay above that amount.

This thinking is classic for government, where everything is about sustenance.  Nobody is supposed to capitalize on government money.  You can only be sustained by it.  If you’re important, you can be sustained in really nice conditions.  If you’re not important – crappy conditions.  But either way, you aren’t to actually make money.  It’s unapologetic communism.

Getting kickbacks from your landlord is considered unethical.  And, effectively, this is what I had the ability to do for the two months until we buy our house.  As mentioned, I didn’t go that route.  I feel sick about it.  Not noble.  Not honest.  Not righteous.  NOT cool.  And pretty dumb.

Here’s a few reasons I pondered to justify the choice:

-The unethical thing is that doctors are paid so little in government work. They should have a program that either pays salaries commensurate with the private sector, or add an actual and functional loan repayment component to the salary (most current guv repayment programs are worthless – at best – and complete deception at their worst).  I really, truly, don’t care about money.  But the debt I carry sickens me.  I’m left to fend for myself on their paltry salary and a lifetime supply of M&M’s.

-I was deceived about the LQA.  Sure, it wasn’t deliberate…probably.  All the details and stipulations were simply left out.  But I came out here thinking my salary was 50k better than reality, when it’s really only about 15k.  Yeah, it’s cool to pick virtually any place I want to live.  But not really.  I’m chained to my debt.  And those chains are pretty heavy…too heavy to allow for much swimming in my rented pool in my rented German villa.  I need to make financial choices that will free me and my wide-eyed children from this financial prison.  The system should allow for that and it doesn’t.  I need to exploit loopholes wherever I find them.

-Also as a wealth-building strategy that I would HAPPILY forgo were I debt-free, we are choosing to buy this house. This puts added pressure on me to be happy in my job, and to stay in Europe for 5-10 years, rather than my stipulated 3.  If I want to leave, owning a house highly complicates my exit strategy.

-My mortgage is nearly $600/month more than the housing office has approved for the house in its current condition. So, if I want to rent the house to someone, I can only charge the max amount approved by the Housing Office.

However, the house has an extra bedroom that was not counted during the last inspection because it needs renovation.  We could pour 2000 extra Euro into renovating that bedroom and adding a bathroom next to it.  This would increase the allowed amount I can charge to a renter. I’ll bet the house would get approved to an amount very close to my mortgage with some good renovation.  Then, I can go to work every day in the freedom that if I get fired, or if funding for my slot dries up, or if I hate the job and want to go home…I can rent the house out without going broke (houses don’t sell well in Germany…sometimes sitting on the market for years, but the rental market is hot because of the military activity).

-I won’t get caught. People do this kind of thing all the time.

-I’m only using what I’m approved for. Not more.

-The Realtor did it. I didn’t think this up.

-Maybe it’s ok in my case, since the loophole doesn’t exist for most others (my rental contract doesn’t need approval from the housing office).

Reasons Against:

-My Dad’s face in my mind: The guy works every day.  Supported me every day since he adopted me.  And pays taxes, every day.  He got behind on taxes once, and getting square with the IRS nearly killed him.  But he did it.  Little by little, he gave them every dime they demanded of him.  My housing allowance is paid for by guys like him.  I’m not ripping off millionaire Senators with health care for life…I’m ripping off honest, real Americans who believe that their taxes are being used appropriately.

-Professionalism: Frankly, many of my generation’s colleagues, myself included, hate this word.  What once was a sterling understanding between every member of my profession has become an strategically ill-defined mechanism for manipulation, money-making and power-plays by Boomer Gen on Gen X/Y.  Happens all the time in residency, but banks play the game, insurance companies, lawyers too.

Still, a fundamental element of professionalism is a high standard of honesty.  We say what we mean, we mean what we say, we stand by our word and play it straight.  Doctors regard trust as immutable currency in the most sacred component of our profession, the doctor-patient relationship.  This is the very fabric of our livelihood, and it all is built on trust.

-My training: Let me be discreet here in saying that during residency, I had a few moments where I was *ahem* mildly cavalier regarding my whereabouts on certain mornings.  This lackadaisical approach to the exact truth led to some harsh responses from those who oversaw me.  I got my ducks in a row pretty quickly.  Now, the stringently honest approach is the only one that feels right.

-Sleeping well: Also a lesson learned in residency: if you didn’t do anything wrong, you don’t have to worry about getting caught.  In the movie, “The Hunt for Red October”, a submarine captain prepares to fire torpedoes at an enemy ship…but first he puts a safety on them so that they can’t explode until they have been swimming around for awhile.  ”I don’t want those fish comin’ back on us!”  He says.

For me, the same thing is true.  I don’t know – really – how closely they’re watching what I do.  Maybe this is a big problem right now.  Maybe they’re working on closing the loophole and will be auditing everything once they get the new policy in place.  Maybe, maybe, maybe.  I can go to sleep tonight not worrying about the maybes.  I played by the rules.  If something is messed up, I know it’s an honest mistake – that I’m not “busted”.  Makes for an easier thought life (allows me to wring my hands about foreclosure without any messy distractions).

So there you have it, folks.  The emotional undulations I’ve endured over this weekend, mulling the ethical conundrum over and over in my mind.  I feel sick about it.  Improving the house doesn’t just help our investment.  It gives me freedom in my job, freedom to enjoy Europe, freedom from worry.  The pill has been a bitter one.

My brother told me recently that now, as a doctor, I’m not really going to care about a few thousand bucks here and there.  Sure, I’ll be careful with my money, but a few grand won’t be something I’ll break my back for like I would have in the past.

I hope he’s right.  Because that 3000 bucks sure feels like a lot of money at the moment.  I’d work pretty hard for those extra thousands right now because of how much they could help us.  But apparently, I won’t lie for them.  One day, finally out of debt, I suppose I’ll look on this choice as a good one.

For now, I regret it….although I am looking forward to a good night’s sleep.

Comrade Bush

My dear readers – please prepare yourself for some rather feisty political and religious ranting (below).  I’ve largely avoided politics on this blog, as well as religious issues.  But not today.  This blog is about catharsis for me as much as it is a record of my observations and experiences in the medical world.  Therefore, today is a day to respect this former purpose.

To add some background to the entry, you should know that I was raised in a politically-conservative home that also was highly religious and active in the Protestent, non-denominational Christian belief system.  We had a picture of Newt Gingrich on our fridge.  We strongly supported Amendment 2 in Colorado a few years back – a hyper-conservative law disallowing gays to claim discrimination in hiring (since declared unconstitutional).  We hated Bill Clinton and constantly lauded Ronald Reagan.  Since voting-puberty, my presidential votes went: Bush I, Dole, Bush 2, Bush 2.

Since my second vote for Bush 2 however, things in my mind have changed dramatically.

I welcome your comments, condemnations and replies.  Or, perhaps, you’re already bored since this post is political rather than medical.  But, for better or worse, here ’tis:

I can’t  believe how much I hate W.  I’m so pissed that I voted for him…twice.

Hugo Chavez is calling him “comrade” because his vacuous and impotent bailout plan is so communistic.  He calls it ‘Communism for the Rich’.  And, lest we forget, McCain VOTED FOR BUSH’S BAILOUT…never even condemning the 1.5 billion in moronic pork projects that the second plan required to eventually pass the House.

There are no conservatives anywhere near D.C. anymore.  I largely blame Christian Conservatives for this because they have let social-control issues dominate their thinking so much that they’ve totally lowered their standards on genuine conservative governmental policy.  With the takeover of the banks, our government is bigger and stronger than the centralized government of the Soviet Union.  What happens when our government (vastly different every 4-8 years) is taken over by atheists, or radical islamists, or strict anti-religion nuts?  Imagine Hitler at the helm of a government as capable of oppressing its people as ours has become.

Christians should vote to keep the government WEAK, not moral.  They voted for W. because they thought he was a moral guy who opposed abortion…he then used his 8 years to make the government more capable of persecution than ever before in American history.  Ironic that Christians fled to these shores because of an overbearing guy named “George”.  Now another George has put them right back in the same place.

EVERY conservative Christian in America should have been marching in the streets for a little guy from TX named Ron Paul during the primaries this year (although Obama shows a reasonable respect for constitutional rights as well).  Paul is the only strict fiscally-conservative constitutionalist who had a shot at the presidency.  Instead, they rallied for Huckabee – called “The Huckster” by his constituents for his renowned inability to pass up shady financial deals – because he promoted himself as hyper-opposed to abortion.  But opposition to abortion is nothing more than support for extremely invasive nearly-omnipotent governmental oppression of civil liberties. Please understand that I say this as one who is totally and completely opposed to abortion for birth control at any trimester. Other than in life-threatening situations, I will never perform one under any circumstances. This, for the moment, is within my civil rights.

Christians have lost their way politically because they put the singular issue of forcing others to believe as they do about abortion on such a pedestal that it has become an idol.  Dreaming of a government so powerful it could literally monitor and control the genitals of women and the doctors who care for them, Christians have allowed government to grow into a terrifying power.  They should have been vigilant about protecting their right to worship, which requires robust civil liberties.  Instead, they voted to force others to see issues they way they do, no different than Muslim extremists.  Not only are they losing on those issues (abortion will NEVER be outlawed.  EVER.), they are now in a position to lose their freedoms, too.  Thanks to GWB, the U.S. Government is geared for total and horrific oppression of Christians…and other religions or belief systems as well.

The only question is when it will happen.

Given the way Christians pillory the press – the only remaining vanguard against oppressive government – I am convinced that politically-active Christians are the single greatest threat to civil and religious freedom in America.  They urgently need to go back to their Bibles, their families and their jobs…and shut the hell up.

Politically-active, conservative Christians are destroying America.

Hopping The Border

I cultivate a keen interest in politics in spite of myself.  Every election cycle I look on with – I’ll admit – bated breath.  My horse this time is Obama.   Last time it was McCain.

So I’ve been a little surprised at myself when it comes to the immigration debate.  I know conservatives are REALLY into this one, but I just never cared about it.  Who cares?!  My ancestors probably hopped a fence (or Ocean, as it were) to get here, and they probably didn’t meet with much of a warm reception when they arrived either.  So let ‘em come, I figured.  They’ve got as much right to this place as me.

Today, my lackadaisical opinion on the matter was surely challenged, if not changed.  I was called to see a patient in antepartum early this morning.  She was 26 weeks along in her pregnancy with cramping and reports of bleeding.  I was told to hurry there because she had 4 kids in the room who all needed to get to school and she needed to know if she was staying in the hospital or going home.

It turns out that this woman speaks only Spanish.  She doesn’t have 4 kids, she has 7.  She lives in a shelter.  So do some of the kids.  Others are in foster care.  She is pregnant again, with her 8th.  While seeing her, we notice a significant deceleration of the baby’s heartbeat.  The baby recovers, but it could be an ominous sign so we decide to keep her for another 2 hours to see if there are more problems.  There is also concern that although she has stopped bleeding, she will start again.  So we order an ultrasound for fetal viability and placenta placement.  We add a biophysical profile to that – another test.

Antepartum is basically a set of exam rooms that function like an ER for pregnant patients.  The cost of running an antepartum unit is eye-poppingly expensive, especially with all the tests we ordered.  Also, to make sure our communication with this patient was perfect, we made sure an in-the-flesh translator was in the room with her.  Since we decided to keep the patient for an additional two hours, we made sure the translator also stayed with her.  The cost for this whole thing was probably in the range of $4000-$8000.  Maybe more.

This woman has no insurance of any kind.  Not even state funds for her kids.  This is because she is here “illegally” and has no documentation to allow her to get support for her kids.  Furthermore, she refuses birth control, and has lots of children.  She effectively has state employees working just for her to get her kids shuttled off to public school, which is also not paid for or contributed to in any way by her.

This patient had no further decelerations and was sent home.  But if she had bled significantly again, she probably would have needed to deliver the baby.  The standard of medical care in this case is to ship her by helicopter to a higher-level hospital with a neonatal ICU where the odds of her 26 week baby surviving are better.  The level of care required to save a baby that age is tremendous.  The cost would rival my medical school debt.

Last week, more school levies were proposed for our neighborhood.  I want to support them, but property tax in this area is already a heavy burden.  Trying to support 4 kids on a resident’s salary, paying taxes even on the loan repayment grants I get because I’ve sold my soul to the Army Reserve, I found it hard not to be resentful toward this woman.  I’m happy to say that I didn’t really come to this conclusion until after she had left and so I think I treated her with equality and good medical judgment.  But after she left, and I thought about how much she is taking from this system that really does survive on actual dollars from real humans like me, I was angry.  My daughter has been asking me to teach her to ride her bike now all week long.  This is because her two other friends just got bikes and are starting to ride with their Dads.  I leave my house in the dark in the morning, and come trudging home still in the dark, usually late for dinner.  I missed it altogether tonight.  Patiently, my sweet little girl hasn’t continued to ask me about bike-riding lessons.  She knows it’s hopeless.  Her dad works from dark ’till dark and if she wants to learn how to ride a damn bike like her friends, it’s up to her.

I work this hard because I – yes – generally like my job.  But it’s also true that I work this hard because to really build a community of mutual benefit is expensive.  Nobody can freeload.  The whole thing falls apart if everybody doesn’t do their part.  This is how the kibbutzim failed in Israel.  Freeloaders – the achille’s heel of communism.

So, I know, I’m complaining instead of proposing a solution.  Do we build a HUGE fence?  Seems inhumane, somehow.  Do we brand undocumented immigrants, give them some sort of societal scarlet letter?  Do we round them up and deport them?  I want to be fair to everyone who needs help.  But I want to be fair to me too.

I guess I don’t know the answer.  I do know that staying home and playing with my kids, teaching them to ride bikes and read and do math while other people provide food, housing, transportation, cable T.V. (high-def, if possible, please), education and clothes is in many ways an enviable life.  It is the life of a king.  But to provide this to thousands of people pouring into this country every day is impossible.  It is certainly demoralizing to me.