My week of R and R...

Well...much has changed since my last post.  On Thursday evening, a week ago, I suddenly experienced excruciating and immobilizing pain in my leg.  I was screaming.  Somehow, I managed to get into my bed, and get my leg into a position that was comfortable.  My daughter came in, in response to my yelling and asked what she could do. I did not know.  I lay there for a little while, crying, trembling, and anxious, not knowing what to do.  Finally, I picked up my cellphone and emailed my doctor. "I am having excruciating pain and I cannot move", I wrote.  He responded, "Come to the ER at EinKerem".  I was so befuddled I had to ask him how I should get there.  He told me either with a friend or in an ambulance. I realized very quickly that there was no way I would be able to go with a friend. I could not move.  

Having never had the experience of having to call an ambulance before (in Israel) I was unsure how to do this. I asked my daughter to call my friend, Robin and ask her to come over.  But Robin was not answering her phone.  So then I asked her to call Pam.  Pam was home, and she came over immediately. It seemed to me that she must have FLOWN she got there so fast.  She came to me and I was crying and shaking and told her that I needed to get to the ER.  She knew just what to do, and she called Hatzalah and in less than one minute Hatzalah was there!  

I was so terrified because I could not see how they were going to manage to transfer me from my bed to the gurney without causing me pain.  But they did!  There were so professional about it I was able to relax a little bit and to know that I was in good hands.  One of the EMT's was a friend, Sergio Geralnik.  He was extremely considerate of me, and he even asked the other EMT to drive instead of himself, so he could sit in the back with me.  He did that because he knew me, knew about my hearing impairment and knew that I did not speak Hebrew so well.  

We made it to the hospital in pretty good time.  I was then brought into the ER and transferred to a hospital gurney.   Again, it was done pain free.  Pam had followed them in her car and came in to give me my things that she brought with her (that my daughter had put together for me).  She was only able to remain for a few minutes because she had to get back to her children. And then Robin walked in.  She had food for me (yummy sesame noodles) and she stayed with me for company and moral support until the wee hours of the morning.  

I had remained in contact with my doctor the whole time via email - "Hatzalah is here", "We are leaving now", "We are on the way", "We are at the ER", and "my X-rays were taken".  My doctor was performing surgery at Hadassah Har HaTzofim.  He came to me as soon as he was done, which was not long after I had arrived. He looked at my X-rays, he looked at my leg, and could not see anything wrong.  But he had me admitted to the hospital for "pain management".  He also informed me that he would be away for three days (it was Purim, a holiday weekend).  

So, I spent another Shabbat in the hospital only this time it was not so bad.  I had a better expectation of what would be.  I was also too emotionally and physically exhausted to care so much.  On Sunday another set of X-Rays were taken.  On Sunday one of the nurses came to me and urged me to get out of bed and into a wheelchair.  I was terrified but I finally agreed. I agreed because I was in pain -- I needed to use the bathroom.  I had been given a diaper to wear but we are so conditioned to only relieve ourselves when we are sitting over an open hole, so I was unable to do so.  After much cajoling I agreed and he helped me into the special bathroom wheelchair  I took a book and went into the bathroom and sat.  Later when he came to take me back to my bed he inquired as to my "success" -- I answered him with a smile, and his entire face lit up and he laughed and he was so proud of himself for having persuaded me to get up and into the bathroom!

On Monday my doctor came to see me.  He again checked my x-rays and my leg and examined me.  And what he told me stunned me. He said, "I'm stumped.  I have no idea what is going on with you."  And then he said, "I will figure something out" and he left me.  Now, you can only IMAGINE what was going in MY mind.  I was in tears, terrified, and my anxiety level was through the roof.   After I managed to calm myself down, I turned to my computer and logged into Facebook and went to a Facebook support group to which I belong for people who wear frames such as the one I was now sporting. I had been sharing my experiences with them and finding the group to be quite supportive.  This time I wrote about the pain I was having and asked about them and what pain they might have experienced. I asked about nerve pain and what that was like.  I was able to ascertain that the pain I was experiencing did indeed seem to be nerve pain.  I further inquired about whether the pain continued when the frame was removed or if it went away.  Those that answered me said it went away.  So feeling a bit more relieved I resolved to bring up nerve pain to my doctor the next day.  

The next day he showed up, with two other people and they examined me and discussed my leg, with me.  Again, there was a sense of know really knowing what was going on.  I asked him if it could be nerve pain and he said no. I said how do you know it is not nerve pain?  He said, because he has seen nerve pain and he knows what it looks like and this is not it.  But when it seemed that all they were going to do was increase the narcotics I was taking I interruped them and said, "are you sure that something like gabapentin would not be better?"  At that point he turned to his colleague and ask her to put a request in for the Pain Clinic to come by.

Shortly thereafter, the pain clinicians came by. They looked at my records, my x-rays, and asked me a lot of questions.  Then they prescribed Lyrica (pregablin) which is similar to gabpentin and is used for nerve pain.   I started on that two nights ago.  It is supposed to take about a week or two for it to take effect. In the meantime I am slowly feeling better.  

A retrospective look at how I managed myself after the surgery reveals that I was probably doing too much and had too much stress in my life.  I was working, working OUTSIDE the home, and going up and down the stairs outside my house on a daily basis, I went away for the first two Shabbatot I was home, I went to a late night wedding, and to add to all this, life in my home was rather stressful.   I was having to care for myself without any help whatsoever, while at the same time I was privy to the vicissitudes of my daughter's family. I love my family, and grandchildren very much but I really needed a peaceful, loving, and warm environment in which to recuperate.   I was not getting that and my stress level was climbing higher and higher.  

I was also becoming depressed.  I was feeling sad, and lonely, and crying all the time.  So, it should have come as no surprise that I "fell apart" by having a major painful episode.  The pain was real.  I still have it.  I do believe that all the factors above contributed.  I felt that there was a stunning lack of compassion for me by the players in my life - including my daughter, son in law, mechutenet, and my boss.   It was all just too much for me.  Perhaps it was MY fault.  I played things down. I tried to smile and go along. I tried to be valiant.  It simply did not work. 

I have been in the hospital now just over a week and have been given the opportunity to rest, to relax, to heal, and to even treat my anxiety.  We are planning for me to go to a rehab center when I leave here.  I do not know if that will happen.  The decision is ultimately out of my hands.  It is up to the nurse from my Kuppah to decide that.  If I cannot get into a rehab center, then I will go to my sister in law in RBS.  It is not ideal -- their bathrooms are not at all "accessible", even though they are on the same floor as my bedroom and the main rooms of the house.  But it is preferable to my only other alternative which is home -- and that is not an alternative for me at this time.  

Next update will include news about whether I was successful in getting into a rehab center...

My post surgery life...

Mornings are the best, but by the time noon rolls around, I am wiped out. My leg either hurts me or is extremely uncomfortable.  I am quite helpless.  I cannot stand or walk on my own and must use a walker.  This means I cannot carry a damn thing.  We considered putting a basket on my walker but that did not work because my walker does not fit through the doors to any of the bathrooms unless I go sideways and even then it is a "just fit" with no room for a basket on the walker!!

In the kitchen I can manage a little bit -- I can get food from the cabinets or fridge and place them on the counter which is close. I can even prepare some food.  I can slide my prepared food over to the part of counter close to the table and I can sit down, reach over the get the food and sit down and eat.  But I cannot carry anything over to my "office" -- which has now been moved to a corner of my living room as I cannot get down the stairs to where it normally is.

I can do stairs, albeit with humongous difficulty but there must be at least one railing for me to hold onto.  There are NO railings on the half flight of steps at the end of the hall which leads to my office.  The only way in and out of my home is to go down or up a flight of stone steps.  There is a railing, but only one one side of the very wide staircase.  I use the railing with a crutch to make my way up or down.  Up is excruciatingly difficult. Down is less so.

I have exercises I am supposed to do daily.  I finally got smart and started doing them first thing in the morning rather than heading straight for my corner with the computer and cup of coffee.  So, now that I am doing them I hope it will help to strengthen the leg so I can start putting more and more weight on it and less on my hands, arms, and pectoral muscles.  Speaking of my pectoral muscles -- they HURT -- from using them!  It makes moving around ever that much more difficult.  OY!

I am taking drugs aplenty.  Targin, Optalgin, Percocet, Cephalex, Vitamins C, D and Calcium, a drug to prevent blood clots (injected into my abdomen daily), Xanax (prescribed as a muscle relaxant when the calf muscles of my right leg were cramping -- but Xanax is also helpful at reducing my anxiety a bit and helping me sleep, nice side effects).  I am taking Arnica (sublingually) to help my bone and muscle tissue to heal, eating a banana a day for the cramping.  

I do not have much of an appetite, but I eat.  Yogurt and granola for breakfast, soup or pasta for lunch, or maybe a sandwich.  Dinner is whatever my daughter decides to make.  Could be chicken, or meat, or soup or something.  I miss cooking.

I am keeping my leg elevated much of the time but I alternate and sometimes sit normally with my leg down.  My PT told me I should vary my position a lot and I should get up and walk a bit.  Hard to do with the upper muscles in pain!

Everything I do takes SO MUCH longer to do. I have to plan ahead because if I forget something it means another long painful walk to get it (esp if no on else is home or if my daughter is pre-occupied with caring for the kids).   I was recently invited to spend a Shabbat at the home of a friend who is getting married, for her Shabbat Kallah.  The plan was to make the "party" time of the Shabbat Kallah at her neighbor's house. I told them that I cannot do that kind of walk and their response was, "it is only one house over".  They have NO IDEA that "only one house over"  FEELS like a hundred houses over for me.  It is too much for me yet.   The plan was changed, however, when they learned that the forecast is for rain.  Now it will take place in my friends home where I will be anyway.

Taking a shower.  Now there's an experience!  The shower in my private bathroom is a small stall with a very narrow aperture through which to access it.  So, I cannot use that.  That means I have to use the shower/tub in the main bathroom. As I mentioned above. access to the bathroom is sideways, the only way I and my walker will fit through the door.  Once in, I shut the door and then:  I place a large towel on the floor.  Then there is a folding chair I open on top of that, and I place the chair so it is facing the tub, up against the side wall of the tub.  (Bear in mind, I am doing this standing on one good leg and one bad leg with my walker next to me in case i need to grab it.)  I get undressed (I actually get undressed in my bedroom, and I have to remove all the surgical dressings from the pin sites before I shower,  I put on a bathrobe and hobble out to the bathroom.)  I drape my bathrobe over the walker (where I have two towels waiting for me there as well).  I sit on the folding chair, and then very carefully lift up my legs and bring them down over the tub wall and into the tub.  Then I shift my body forward until I am sitting on the tub edge.  The folding chair remains in place behind my butt.  I turn on the water and using the hose and shower attachment I get myself wet and then soapy and then rinse and then shampoo my hair and rinse that.  Then, I carefully go back onto the folding chair and move my legs out of the tub.  I cannot use a shower chair in the tub -- it is too narrow for any tub chair to fit. (no matter which way we face it).  I cannot use a tub bench -- the tub edge next to the wall is far too narrow for that to be secure.  I do not OWN the place so I cannot invest in adding accessible fixtures to the tub.  So, this is what I am stuck with.  It works. I get clean.  It is just a bit more work than ideal.

I am back to work already, which has its good points and bad.  Good in that it forces me up and about and out of the house and up and down those stairs. Bad for the same reasons and it both tires and stresses me out.  No choice for me really, as I need the moolah, even if it is really a pittance.  I get home about 2 PM from work and I am exhausted. I eat lunch and then I either take a cat nap or a shower, depending on the day and how I feel and what else is planned.  If the PT or OT is coming that is a consideration.

I have at times been so exhausted that all I could do is cry - not the tears of emotional overwroughtness, but tears that stem from a physical organic source that I cannot stop even if I wanted to.  Similar to the post partum tears I shed after I gave birth to my daughter Chloe.  But there IS some emotional fallout for me.  I am so independent and am trying to be so strong, wanting to be strong and not to fall apart -- it is at times overwhelming for me to feel this way.  It is a new way of being for me and I am NOT used to it.  My surgeon tells me, he is glad I am so independent. He likes that I am being so strong.  And, I want to tell him, "but I am not. I am weak. I am feeling totally dependent."  And I want to cry about that -- that I may not be living up to his perception of me as a strong person, someone who is so independent.  Because I do not feel strong. I do not feel independent at this moment.

This is my life -- for now.  I know it is temporary. I know it will change -- for the better. I know I have to go through this.   And I am blessed -- I was given the opportunity to do this, to have this surgery, and in the process I am learning so much more about myself and what I can tolerate and what I can do, and what I cannot do.  The hardest part for me is to forgive myself when I feel I am being weak and scared and stupid.  It is hard to allow myself that.

I was framed!

On January 29^th I entered Hadassah Ein Kerem hospital for a major surgical procedure to correct a deformity in my right leg.  You may read my previous posts for more information about that deformity and about my travails dealing with the medical system here in Israel where I now live. 

I went to the hospital by taxi,(costing me a pretty penny), armed with a walker, all my medical records, a few changes of clothing and underwear, some toiletries, my cell phone, and eReader.  And of course, a certain amount of confidence mixed with trepidation.

I went alone as I was unable to arrange for a family member to accompany me.  This is Israel and life in Israel can be rather inconvenient under the best of circumstances, and this was not one of those times.  However, I was able to arrange for a very good friend to be there for me when I came out from under.  I chose her not only because she is a good and dear friend and because I trusted her implicitly, but also because it so happens that by avocation she is a health information management expert, and by experience she has intimate knowledge of the Israeli medical establishment and system.  It also did not hurt that she speaks Hebrew fluently.  I have a pretty good grasp of conversational Hebrew, and she would later write in an update to my friends and family that “her Hebrew is good enough for her needs”.   As promised she was there when I came around. 

After I arrived at the hospital and went to the Orthopedics ward I was checked in and assigned a room.  I was shown where to put my things – there was a safe in the room with an electronic keypad with which I was to create my own passcode.  Unfortunately, the safe’s locking mechanism was broken and I was unable to lock it up.  I thus refused to leave the room until it was either fixed, or I was moved to a room with a working safe, or some other viable alternative was offered to me for the security of my cellphone, eReader, and cash/credit cards.  I left my jewelry at home.  The aides came with the gurney to take me to the OR, but I refused to go.  They kept telling me “but they are waiting for you in the OR”.  I would not move, and said, not until my belongings are secure.  One of the nurses suggested I leave the stuff in a bag at the nurse’s station.  I asked if she would take responsibility for my things to which she replied, “no way!”.  Again I refused to move.  Finally, they brought in security.  After a failed attempt to fix the safe’s locking mechanism, they used a key to open and then lock it.  But they would not give me the key (it is a master).  But, they agreed to take responsibility for my things.  And so, I agreed and then was on my way.

Interestingly enough, I was still pretty calm and not so scared at this point.  Last month, when I had been originally scheduled for the surgery, I had been far more nervous.  (Read previous post to learn why that surgery was cancelled at the last minute).   I was brought to the prep room that is directly before the OR.  There, I was prepped for the surgery.  Connected to IV.   Last minute vitals read.  Then the anesthesiologist arrived. We spoke briefly and then I was brought into the OR and placed on what I can only describe as a board.  People refer to this as the operating table but it was little more than a board.

Since I had elected to use regional anesthesia, an epidural, I was first instructed to sit on the board, legs hanging over, hands on my knees and then to lean over a bit while the lumbar puncture was made.  After successful insertion of the catheter for the administration of the epidural, I was told to “sit up straight” and then I began to feel an icy cold liquid begin to course through me. 

Before I move on, I want to remind my dear readers that I am severely to profoundly hard of hearing and wear hearing aids.  But for the surgery I’d been told to remove my hearing aids and they were locked up in the safe. (At a cost of appx $8000 USD of course they would be locked up!) Without my hearing aids I am functionally deaf.  So all of the input I was experiencing at this point was visual, or via my sense of touch, or smell.  Taste was not on the menu here! 

Shortly thereafter I was told to lie back on the board.  By now I was shivering uncontrollably, teeth chattering audibly.  My arms were placed on boards perpendicular to the one on which I now lay, and strapped down – a surgical cross or crucifix, if you will.  Then, I began to feel slightly “woozy” which indicated to me the beginning of the administration of a sedative, as per agreement I had with the anesthesiologist. I had told him that I wanted to be as unaware as possible of what was going on.  I thought it would be too scary for me otherwise.  After that moment I remember nothing of the surgery (although I discovered some vestigial memory, about which I will write a bit later on).

My next memory is of coming around, becoming conscious, and feeling weird, and some pain, and seeing a hustle and bustle of nurses and doctors around me, and then seeing the smiling face of my good friend, Yocheved Golani – the aforementioned good and dear friend who would be there for me when I came out of surgery.  As promised, there she was.  I vaguely recall checking under my blankets to see my new body piercing. Here is what it looks like:

My memory of being in the recovery room is somewhat vague.  I do know that I was after a while somewhat lucid, I vaguely recall my surgeon coming to check on me, and I recall talking to Yocheved, and being shown my PCA –although perhaps that did not happen until I was safely ensconced in my room.  I will have Yocheved add to this to fill in the gaps where my memory has lapsed.  I also do remember being told that the anesthesia stopped working at some point but everyone was quick to tell me that it was already after the surgery had been completed.  But I fear I went through some real trauma beyond what was expected in terms of pain that I was feeling.  That fear is fueled by some of the “nightmares” I have had subsequently in which I seem to be in a dark, cold place and I experience the feelings of my body being yanked and clamped and invaded – and during which I experience a real full body “jerk” in my sleep that wakens me. 

As mentioned before, I was given PCA (Patient Controlled Anesthesia) of morphine.   I think it helped me.  It is hard for me to know.  I was still bedridden and suffering the indignity of wearing a diaper.  Gosh those things are HUGE!   Initially I seemed to be unable to urinate—which I was told is a “side effect” of the medication.  I felt enormous pressure on my bladder and it was overwhelmingly uncomfortable.  I found that I had to “help myself along” by using my hands to press down on my bladder.  (Is this TMI?  If so, sorry – but I feel that these are details that no one discusses and so the reality of what one can expect to experience remains a secret.  The unknown can be very scary, at least for me.  I prefer to know more rather than less.

Some of my memory in terms of the sequence of events is a bit hazy.  My friend went home early Tuesday evening (at my urging as I knew if she stayed longer she would have a harder time getting home – she was dependent on either public transportation, or “tremping”, the Israeli term for hitchhiking).  I think I slept well that night.  In the morning I woke in pain but a few presses of the “pain pump” helped me with that.   I do not recall if it was on Wednesday or on Thursday that I asked to be taken to the bathroom using the special wheelchair with a hole in it that can be wheeled right over the toilet.  I THINK I did that on Wednesday. I do remember that when my surgeon came round to see me and I told him that I was using the toilet and not a diaper he was quite surprised.  He had not expected that I would attempt being “up and about” so quickly.  It was not until the next day, Thursday,  that the physiotherapist came around to see me and to begin his treatment with me. I remember I was terrified of it.  I had, at that point been taken off the PCA and given a round of drugs which I could (and would) take.  The main pain drug I was given is Targin which has oxycodone and naloxone.  I was also given Optalgin (dipyrone- an analgesic).  I have limited my intake of this and I may substitute Tylenol for this.  The third drug for pain I am given is Percocet.  That has Tylenol in it and more Oxycodone.  I guess I have to be careful of the amount of Tylenol I ingest.  I only take the Percocet “as needed”.  I have been limiting myself to taking it only once a day.  I think I would deal better with the pain if I took it once in the morning and one at night.  I might do that and stop the Optalgin altogether.   Other meds I am taking are Clexane, an injected drug once a day that is an anti-coagulant to prevent blood clots, and vitamins D and C and Calcium, and Cefurax, an antibiotic.  I have added the homeopathic Arnica to this. Arnica is supposed to promote healing of muscle and bone tissue.  I also must change the dressings on my pin sites 2x a day. 

Anyway I made sure to take Percocet about a half hour before the physiotherapist was due to see me.  I figured, rightly, that it would make it easier for me to do the exercises which he would surely give me.  It was VERY scary for me to take those first steps, albeit with a walker.  I am not putting full weight on my leg, I cannot do that, but partial weight.  It is scary and, without the Percocet, painful.   But I am doing it and putting myself through more exercise by taking “walks”.  I would walk the length of the corridor and back.  It might take me a half hour or more to do it and I would be EXHAUSTED at the end, but I feel that it is very important for me to remain active. 

On Wednesday morning, when my surgeon came to see me, he told me, upon examining my leg in the frame that the rotation looks good, but the angle may need some correction.  On Friday morning  when he came I told him that I agreed that the angle did not look right.  He said he would fix it on Sunday morning.  I said no, I wanted him to fix it right then and there.  He told me it would hurt a bit and I smiled and said, I just took Percocet. Strike while the iron is hot.  He went and got his wrench and made the adjustments.  It did not really HURT, it just felt like a lot of pressure on my leg and was not comfortable.  But I am glad I insisted on his making the correction sooner rather than later.  It made it easier for me to straighten my leg at the knee – I would not be able to have x-rays until I could do that satisfactorily and I would not be able to go home until x-rays could be taken and they were satisfactory. 

On Sunday morning I was taken to the X-ray dept. I was told I would need to stand with my knees straight for the x-ray.  No problem, or so I thought.  Upon arrival I was asked to “please step up onto this (little itty bitty) stool” for the x-ray…!  Well, there was no way I could do that.  I had not brought my walker or crutches with me – I had not been told I would need them and there was nothing for me to grab hold of, to put my weight on so I could LIFT myself into that position.  Finally, the aides there were “helping” me get up but they were so inept that I inadvertently wound up putting my FULL WEIGHT on the broken leg!  I SCREAMED, and nearly passed out, but hyperventilated instead.  Finally, though I was in the right place and I stood there, stony faced and ANGRY.  There was NO REASON I should have had to endure that. 

I also asked to be brought to the offices of Yad Sarah.  Yad Sarah is an organization in Israel that helps to provide medical equipment and supplies to patients who need them.  They actually do it for free, but one must pay a nominal fee to borrow an item – a fee which is reimbursed to the patient upon return of the borrowed items.  I needed crutches as I had thought only to procure a walker prior to the surgery.  I knew I would need the crutches to learn how to navigate stairs.  An aide brought me down to the Yad Sarah office where I not only arranged to borrow a pair of crutches, but I also arranged for purchase and delivery of a showering chair.  I could not borrow one as they did not have the kind that would be good for my needs and that would fit in my bathtub or shower!  It was not so expensive (about $63 USD) and when I no longer need it I will likely donate it to a “gemach” here on the Yishuv in which I live (a Gemach is similar to the Yad Sarah service but they do not always require a deposit for borrowing.  A Yishuv is a village.). 

Later that afternoon, my surgeon came by and told me that he saw the x-rays and told me “they are PERFECT” and “you can go home tomorrow”.  Of course, I was ecstatic about the return home but still worried about the issue of the stairs.  There is a double set of wide stone stairs that leads (down) to my home.  I still had not learned how to manage them. 

The next day, in the morning, the PT came by and I told him he had to teach me to use the crutches and do stairs.  He brought me to the PT room and began to teach me.  In the hospital the PT is allotted only twenty minutes to spend with each patient.  He stayed with me for a half hour.  It was TERRIBLE.  I absolutely could NOT manage the stairs.  Believe me, I tried hard. So hard that I was DRIPPING sweat, I was SOAKED with sweat.  In the end, I collapsed, crying.  I finally realized that I was going to have to ask for a couple of friends to physically help me down the stairs to my home.  My very good friend Moshe Fuld came.  Upon arrival home I discovered that my memory had been faulty and that there actually was a railing on the stairs, albeit on only one side.  Using one crutch and the railing I was able to make it down. At the point where the staircase took a turn, the railing disappeared.  My friend Moshe was my “railing”. I leaned on him for each step the rest of the way (about 6 steps).  It turned out not to be as bad as I had feared.  But I knew that would not be able to manage the stairs inside my house – a half a flight down to the laundry area, guest room, and more importantly, my office.  I spoke to my son in law and just this morning he moved my computer and phone upstairs to a corner of the salon.  It is not ideal but it will suffice until such time as I am able to manage the stairs.

And this is where I am at now…I am home.  Figuring things out, best ways and means of accomplishing my daily tasks, managing my pain, etc.  

I fell through a big hole...

Baruch Hashem, I am blessed with much intelligence, and a reasonableness that enables me to weather the vicissitudes of Israeli life, both socially and professionally, and most importantly in my dealings with any or all of the bureaucratic “systems” in place here.  I place the word “systems” in quotes, because quite honestly, I do not see any real system.  The words “streamlined processes” are not heard here, and have no meaning here.  

I was prepared to accept all this.  But my most recent experience tells me that there is much change needed.  I think a Patient’s Rights should also be about being treated with dignity and respect and about there being open lines of communication between the various “parts” of the “system” which the  Patient is required to navigate when in need of medical care.  Perhaps my having grown up in the US where processes are streamlined, where everything seems happen smoothly and seamlessly has spoiled me.  The health care system in the US, while unaffordable and unattainable for many (Obamacare notwithstanding), is at least streamlined and patients are treated carefully, and lines of communication appear to be more open and used. 

Here is my story:  (it is long, but please read to the end.  The issues I raise have to do with both the bureaucracy of the financial aspects (Sharap/Kupah) and with the lines of communications between doctors.)

I made aliyah in August 2011.  About six months ago I began a search for an orthopedic surgeon who could correctly diagnose and treat a leg deformity of mine that was causing me pain.   The first two doctors I saw, with hafnayot from my family doctor, were unable to do this.  I then, on my own, searched out a top notch doctor – by looking through the Hadassah profiles of medical personnel.  I found Professor Meir Liebergall, who is the head of Orthopedic Surgery in Hadassah.  I contacted him and described my problem. He then put me in touch with Dr. Vladimir Goldman. Dr. Goldman is the head of Limb Lengthening and Deformities.  Within two weeks I had an appointment with Dr. Goldman.  He was very thorough in his examination of me, even accompanying me to the X-ray department to provide oversight for the x-rays he requested – he wanted to be sure they x-rayed exactly to his specifications.   His diagnosis was spot on and he then requested a CT scan.  For that I needed a hitchayvut.  A request was sent to Maccabi via my family doctor for the hitchayvut.  It was initially denied, requiring my family doctor to supply more information, and then it was approved.  I took the hafnaya and hitchayvut and went for the CT scan.  Even though I had gone to the wrong Hadassah center, the personnel there were nice and arranged for me to have the CT scan there – right then and there!  I was , as you can imagine, quite impressed with this. 

I then made an appt. with Dr. Goldman for a follow up to review the CT Scan.  It was at that time that I met Professor Meir Liebergall who was providing oversight for Dr. Goldman.  Together, the three of us looked at the CT scans and Dr. Goldman explained everything to me and then described the surgery to correct the deformity.  I remember being a bit shocked initially as I learned the  scope of the surgery – it would involve making two cuts to the bone – one long vertical cut and one short horizontal one.  The bone(s) would be moved into the correct place, and pins inserted to hold them together which would then be screwed to an external device – a Taylor Spatial Frame.  I would wear this frame on my right lower leg for three months.  I agreed to have the surgery.

About a month later I was given a date for the surgery:  December 25, 2012.  That was four months out at that point.   I immediately was in touch with the Sharap office of Hadassah Medical Center, as I knew that since I had chosen a private doctor, I would need to make my arrangements for payment through Sharap.  It was my understanding that if I chose a private doctor, my kupah (Maccabi Magen Zahav) would cover a portion of it (less than if I chose a non-private doctor) and I would have to pay the balance out of pocket.  Sharap informed me that everything would happen a few days before the surgery.  I then explained to them that I needed to know sooner the amount my share would be as I would need to make arrangements to get that money in hand to pay it.  They understood and told me they would be in contact with my kupah to ascertain what that amount would be and they would be in touch with me.  BTW, I wear hearing aids and using the phone is VERY difficult for me, in English which is my native language, and impossible in Hebrew which is not.  Throughout all this I succeeded in requesting and receiving all communications via email.  In this, the service was good.  Shortly thereafter, Sharap informed me that they had been in touch with Maccabi, and that my share of the payment would be 5,491 NIS.   At this point Maccabi was now aware, that I , Rachel Stern, a participant in their Magen Zahav supplemental coverage, was scheduled to have surgery on December 25, 2012, with Dr. Vladimir Goldman, as the primary surgeon.   There were no secrets here. 

I made the arrangements necessary to ensure I would have the money available to pay for my share of the surgery.  I put all the wheels in motion arranging things in both my personal and professional life to accommodate up to three weeks of being “out of commission”.   And then I waited.

About three months before the surgery, I took ill.  It started as a cold, turned into a sinus infection, and then wound up as bronchitis.  This has been a normal pattern for me with regard to upper respiratory infections/illness.  For about 25 years of my life I was exposed to second hand smoke by my mother who was and still is a heavy smoker.  I have always felt that it is this that made me susceptible to upper respiratory infection.  I usually wind up with bronchitis, and a cough that lingers.  Only this time, it lingered far longer.  I saw that the cough would likely be with me at the time of the surgery.  I was very concerned. I felt that it could be dangerous for me, with regard to general anesthesia. 

EVERY DOCTOR I saw on my way to the date of the surgery was informed by me that I would be having this surgery.  I asked every doctor about this issue.  Every doctor informed me that it would not be a problem.   I emailed my surgeon and told him about my cough.  He, too, assured me this would not be a problem.  My family doctor, the pulmonologist, the ENT, my surgeon, all knew about my coughing.  I had done bloodwork, x-rays, eeg, ekg, spirometry, and other bedikot – all either as routine in preparation for the surgery, or in effort to cure the cough (or both).   On Monday, December 17^th I went to Hadassah to the pre-op clinic for a pre-op workup.  There I met a nurse, an anesthesiologist, and an orthopedic doctor.  I told EACH one about the cough and asked if it would pose a problem.   Each one assured me that it should not.  I saw them writing things down in my charts and forms (albeit in Hebrew) and I assumed they were making notes about the cough as well.  I still am not sure if they did so or not. 

The day before I went to the pre-op clinic I was informed by Sharap that Maccabi would NOT cover my surgery. They were claiming that on the day of my surgery I would be six days shy of one year of participation in Magen Zahav.   I immediately understood what had happened.  When I arrived in Israel, at the airport I chose Maccabi as my kupah.  About a week later, I attended a NBN klita fair in Jerusalem.  Maccabi had a booth at the fair and I went over to it and sat down with a Maccabi representative.  She and I discussed the options for supplemental health insurance and I ultimately choose to sign on for Magen Zahav.  I filled out the forms and went home, feeling secure in the knowledge that I was “covered”.   A couple of months later I was sick and needed some medication. I had gone to the Maccabi pharmacy to purchase the needed medication (prescription).  When the price was stated to me I was taken aback at the cost and said as much to the pharmacist.  His reply to me was, “Well, if you participated in Magen Zahav, it would be less expensive”.  I explained to him that I was indeed a participant and he double checked and said, “No you are not, according to the computer”.  I then went to the Maccabi office to check this out.  I was told that I had never been signed up.  The woman who helped me signed me up right then and there. I erroneously thought I was signed up “retroactively”.  Hence, by my reckoning I was in my second year of participation for the surgery, but by Maccabi’s I was six days shy.  Sharap told me I would have to go into the Maccabi office and request a “kitzur” of my account.  This I did and was told I would need to write a letter to Magen Surgery to ask for this.  This I did (in Hebrew with the help of two friends).   On December 18^th I sent the letter to Magen Surgery.  This was just 7 days before my surgery!  Two days later, I received the response from Magen Surgery that they would forgive me the six days and would cover the surgery.  

That same day, I received a call from Sharap, again telling me that Maccabi would not cover the surgery.   This time the reason give was that Dr. Goldman was a “private doctor” and they would not cover him. I would have to choose a different doctor.  I argued, unsuccessfully, that they had known this since FOUR MONTHS AGO, I was given an amount based on them covering him, and that at the last minute they should not be changing their tune.  Finally, I turned to Dr. Goldman and explained what was going on.  Dr. Goldman then told me to give Maccabi the name of the doctor who would be assisting him in the surgery, Dr. Naum Simanovsky. This I did, and Maccabi agreed to cover him.   By the time I got this resolved it was Thursday afternoon, just four days before the surgery.  Now suddenly, the amount of my share rose by 2000 NIS.  As you can imagine I was none too pleased to discover this.  However, I decided to suck it up and just pay it.  I had been told I could pay it the day of my surgery.  (I had also explained to them that I was paying in CASH (mezumanim).  (Let’s leave out of this story WHY I was doing that).

On Monday, the day before the surgery, at 4 PM I get a call from Sharap that I have to come in right away and pay.  Well, even though I have a car, I could NOT just drop everything (my grandchildren whom I was babysitting) to go to Sharap.  So Sharap tells me that if I am paying that day, then my surgery is being moved from first thing in the morning, to the third slot.  Of course I was not happy about this. I wanted to have my surgery early, when my surgeon would be alert, fresh and awake.  Again, I turned directly to my surgeon (he is a real mensch, by the way) and informed him of what was happening.  He assured me my surgery would take place on time.  I should show up at 6:30 am as planned.  This I did, and my sister came and met me there. First I was sent down to the Miyun Kabbalat Cholim where I paid for my surgery – 5,491 NIS in cash!  Then I returned to the fifth floor.  Everything happened very quickly. I was given gowns to change into, placed on a gurney and wheeled to the OR.  I was in the prep room in front of the OR and already hooked up to an IV.   We were waiting for the anesthesiologist.

Now before I tell you what happened next I want to refer to my state of mind.  I was very nervous, very anxious, and scared.  I was about to go under anesthesia which can be dangerous under the best of conditions, and my leg was about to be cut open, cut in the bone, and metal screws inserted into me.  I would wake up in pain, and on PCA Morphine (Patient controlled analgesia, morphine).  In the days that led up to this point I was stressed to the max in my dealings with Sharap and Maccabi – dealings which to my mind could have been taken care of MONTHS in advance.   All the information that Maccabi need to process my coverage, they had from the very beginning.  None of it was hidden or secret.  But they chose to deal with my account only days before the surgery, needlessly stressing me out when I was already stressing with worry over the actual upcoming surgery.   Now, I was sitting on a gurney, a black mark on my leg (courtesy of my surgeon), a white bracelet on my right wrist, and a catheter and IV hooked into my left hand. 

The anesthesiologist arrived.  He was none other than Dr. Alex Avidan, Senior Anesthesiologist.  I coughed.  And then I coughed some more.   He questioned me about the cough.  He was frowning. This was not good.  I told him everything about the cough that I had told all the other doctors I had seen on my way to that point!   He then went and had a  conversation with Dr. Goldman.  He came back to talk to me.  He told me “he is very worried about that cough”. He told me that he did want to put me under General Anesthesia.  It was too dangerous with that cough.  I asked about regional anesthesia.  He said it was an option but not a good one. Why?  Because if, G-d forbid, anything were to happen, he might have to administer General Anesthesia, and again, that would not be good.  So, long story short, the surgery was not performed. 

But I did ask, ALL the doctors that were there – WHY was this not addressed sooner?  My coughing was not a secret. I told everyone about it. I asked if it were a problem.  Why did it have to wait until I was sitting on the gurney, butt naked except for a flimsy hospital gown, already hooked up to an IV, just minutes away from having the surgery to learn that it was NOT okay?? From beginning to end the lack of communication along all lines from Sharap to Maccabi, from doctor to doctor, FAILED.

This is no way for a patient to be treated.  Patients are already stressed out, worrying about their health and trying to take care of themselves.  I had wanted to spend most of the week before my surgery relaxing and calming myself down so I could go into surgery, and under anesthesia in a good state of mind.  I know how crucial this is to healing.  It is one of the great intangibles of health care, that costs nothing, is for patients to be able to “self heal” using various methods of positive imagery, calming and de-stressing, and of course, laughter. 

Throughout this entire ordeal I tried to remain calm.  I tried not to stress too much.   But by the time I was on that gurney, I was stressed to the max.  And then,  MY concerns were confirmed and the surgery did not take place.  I now have to figure out how to get rid of this cough – which to date has stymied everyone – my family doctor, my ENT, and the pulmonologist.  I will be seeing an allergist soon.  Dr. Avidan says I must be 8 weeks cough free to have the surgery.  I will have to go through this process  ALL OVER again, needlessly!  I will once again have to make accommodations in both my personal and professional life to accommodate a new surgery date.  I have plans to move this summer, and now I have no idea if and how all this will happen. (I HAVE to move, I will no longer be able to afford to remain where I have been living for the past year and a half.)

I do not know if sharing my story will have any impact whatsoever. I do not even know with whom I could or should share it that it would make an impact.  But what I just went through is something that NO PATIENT should have to go through.

I think my doctors are terrific doctors.  I have asked for and received the promise that Dr. Alex Avidan will be my anesthesiologist when my surgery is re-scheduled.  He is a doctor who CARES.  I was blessed to have him come to me. Dr. Goldman is a mensch of the highest sort, an amazing person.  Everyone I dealt with – doctors, nurses, people in Sharap, people at my kupah, were all wonderful.  But that does not make up for the huge gap, the huge canyon, through which I fell.  

Jumping through the hoops of the health care system in Israel...

I go in for my surgery on Tuesday and I am nervous as hell.  The process of getting my surgery to be paid for by my insurance, here in Israel, has been rather daunting.  Just so you all understand:  I am from the US and I moved to Israel just over a year ago.   In the US even though health insurance is ridiculously expensive, and does not cover enough of costs, it is a remarkably streamlined process which can be effectuated months in advance and can take a few days to get set.  Here the process is NOT streamlined in the least and everything takes place at the "last minute".  That can be quite hairy for someone who may not have enough moolah to cover anything that may not be covered.   So here is how it panned out for me.

It was about six months ago that I initiated the process of diagnosis and getting recommendations for correcting the issue.  As soon as I learned it would take surgical intervention, I agreed to the surgery and began to put the wheels into motion to enable it.  First, I had to wait to receive a date for the surgery.  That took about a month of waiting and it was scheduled for December 25th - four months out from the time I received the date.  I immediately asked what the procedure was for getting it covered by my kupah (health insurance).  I was told that since my surgeon is a "private practitioner" I would need to contact the "Sharap" office at Hadassah Hospital, where my surgery would take place, and the Sharap office would be in touch with my kupah and then they would contact me.  But, I was told I would not know anything until a few days before the surgery!!!  At that point I explained that I needed to know at the very least how much my share of the cost would be, due to the fact that my funds are tied up in the States and it would take me some time to arrange for the release of the funds to pay for it.  So Sharap understood and contacted my kupah and got me the info.  In effect, they "neogiated" with my kupah about this.  Ok, fine. 

Last week, I was contacted by Sharap and told that my kupah was refusing to cover the surgery because I was not a participant in their Gold plan for a full year -- I would be shy by SIX DAYS on the day of the surgery!  That is by THEIR reckoning, not by MY reckoning – what happened is this:  when I arrived in Israel, just off the plane, I was met by an agent from the Jewish Agency and told to choose a health insurance provider.  I had done some research before I arrived and I chose Maccabi.  Then, a week later I attended the NBN Klita Fair in Jerusalem.  I knew there would be a booth there for Maccabi and I would be able to select a supplemental health coverage plan.  I went to the Maccabi booth, sat with a Maccabi representative and chose Maccabi Magen Zahav. I filled out the forms, and then went about my way, feeling secure in the knowledge that I was covered. I had been assured that all my info would be “put into the system” the very next day. 

A couple of months later, I was ill and needed prescription medicine.  I went to the Maccabi Pharmacy to fill the prescription.  The price seemed rather steep and I said as much to the pharmacist.  His reply to me was “If you were a Magen Zahav participant it would not be so expensive”.  I told him that I am indeed a participant in Magen Zahav. He double checked and no I was not. So I went down to the Maccabi office to find out what was going on.   There, I spoke to a lovely woman named Nochi (just so you know, I have found EVERYONE in the Maccabi office in Modi’in to be exceedingly nice and helpful).  She confirmed that I was NOT a participant and there was no indication that I had ever signed up.  But she signed me up right then and there.  I erroneously thought my participation would be counted as retroactive from when I signed up. 

So, back to Sharap informing me that Maccabi would not cover it due to my being six days shy of a full year of participation in Magen Zahav.  The Sharap office suggested that I needed to go into the Maccabi office and ask them for a “kitzur” of my account (shortening of it) to allow me to have the surgery and for them to cover it.  This I did, that very evening. (Yes, they have evening hours!)  There, I was told I needed to write a letter explaining all this and requesting the kitzur. 

With the help of friends I wrote a letter which I then sent to Maccabi Surgery.  It was an excellent letter, even my surgeon said so when I shared it with him.   It did the trick and Maccabi agreed to cover the surgery.  Great! Or so I thought.  That same day, I was contacted by Maccabi and told that they will NOT cover the surgery because the doctor I chose is a “private practitioner”.  I was kind of surprised (although not so much because now, I was used to expecting the other shoe to drop!).  I told them that I had addressed that issue by dealing the Sharap office which had already been in touch with Maccabi and had already negotiated the fees.  It was to no avail.  So, I explained this to my surgeon, not knowing what else to do.  Maccabi wanted me to choose another doctor – and I would NOT do that.  My surgeon is the top doctor in the field and I trust him implicitly.  I would not choose any other doctor. 

Well, he came to my rescue.  He told me that another doctor who will be assisting him would be the name we would give to Maccabi.  Maccabi would cover him.  So, I did give that name to Maccabi and sure enough they agreed to cover him.  I suspect this is a game that is routinely played by the doctors and insurance companies here.  

But now, Maccabi requires a new hafnaya (referral) naming the new doctor.  Again, I turned to my surgeon who told me “No problem, we will get a hafnaya to them on Sunday.”  Mind you, my surgery is now four days away and on Sunday will be two days.  When I was told initially that everything gets arranged at the last minute, I realize now that was the honest truth!!

Personally, I think it is a very bad way of doing things.  An individual who is facing major surgery, scary and painful surgery is already stressed out about that and working hard to be calm, relaxed, and positive – which is crucial when one is about to undergo anesthesia and surgery – does not need the added stress of worrying about whether or not the surgery will be covered by their kupah at the very last minute!  It is something that should be worked out WELL in advance of any surgery that is PLANNED.

In any case, it appears that everything is working out as it should and as always I give my thanks to Hashem for His hand in it.  I know he is orchestrating much of this for me! 

Fitting In

Last night I went to a Bar Mitzvah.  It was lovely and I truly enjoyed myself, with the exception of the thirty minutes I spent coughing!!

It is interesting.  When I lived in ---, I wanted so desperately to "fit in" and to be accepted. I have had trouble "fitting in" most of my life.  It is due, in part, to my hearing loss which rendered me at times "socially inept".  Speaking out of turn, or out of context, mis-communications or simply missing communications would do that to me.  But one would think that as an adult I would not have such problems. 

But --- is a suburb of NY and thus, in a way, part of the greater NY metropolitan area.  People in that area of NY and NJ tend to be more snobby, more clique-y.  Barry and I were very active in our community, we were founding members, literally of our shul and involved in many of the shul efforts and activities.  But, that did not buy my acceptance into that society. For the most part, I was snubbed by many of the members of the shul, in particular the "rich" people.  I saw it, felt it, but for the most part, I ignored it.  To my way of thinking, if I ignored it, I would not give it any validity or credence.  But, that did not mean I did not feel it, that did not mean I was not hurt by it. I was.  Deeply.  My late husband also saw it.  For himself he did not really care.  He had never really concerned himself with fitting in, because growing up he DID fit in, easily.  He did not have the social issues that I had growing up which later made social acceptance so important for me.   He and I did not speak of it much, he had the same attitude about validating it as I did.  But he did speak of it with his sister, Karen. She told me, after his death, that he told her how much he loved me and how it pained him to see me treated with disrespect by the snobby members of our shul.  Since Barry died and since I moved away from ---, I actually became closer to one woman there, who, like me, has been "shunned" by the snobby members of the "rich elite".  Barry and she were close when he was alive but she and I were like oil and water back then.  But now we are close. We are very alike in many ways.  I have spoken with her about this issue of my "fitting in" in ---, and she agreed with me that we have been snubbed.  So I know I am not imagining it, I have not imagined that I have been slighted. 

I moved to --- not knowing a soul and I had talked myself into "not caring" if I would be accepted or not.  Of course, it was a lie to myself because of course, I did want to be accepted. But I needed not to have worried -- I was welcomed with open arms by everyone, without reservation, without judgment, and without care for my socio-economic status. It was a totally new experience for me and I enjoyed it.  But I also considered it to be anomalous within the religious Jewish community at large.  

After living in --- for 14 months, I made aliyah to Israel and went to live in Hashmonaim.  For most of my first year here, I have not really felt a "part of the community", but just living in the midst of one.  I did not feel snubbed, I did not feel disrespected.  At times I felt disconnected or even forgotten, but not snubbed, and not disrespected.  However, I am now in my second year here and I have been noticing that I am feeling more a part of the community, in a way I had not felt before.  I find that people come up to me to converse with me and include me in their discussions.  It is very nice. 

Last night I went to the Bar Mitzvah with a certain amount of trepidation.  I knew it would be a big, fancy affair and that many of the attendees to the event would be from the wealthier people on the Yishuv.  I wondered if I would experience the same snobbery I experienced when I would attend these type events back in ---.  In ---, I would find that women would either ignore me, or talk over or around me, or more directly, titter at me.  I remember the despair I would feel when I was in those situations, especially if there were separate seating.   I knew that last night's affair would not be separate seating, but then I was also going it alone, without a spouse, so it really made no real difference to me.  In --- I would find that I would be seated with people who were the "odd ones out" rather than with my true peers.  It was very hurtful for me. 

Well, last night I arrived at the event, and the host of the party was very happy that I showed up.  There was at first a sumptuous smorgasbord and the inevitable mingling and schmoozing. I used to keep to myself during the mingling and schmoozing parts of these events.  Last night, I could not have done that had I wanted to. I found myself mingling and schmoozing, and WELCOMED into the little discussion groups that sprang up here and there throughout the hall.  It was a very nice sensation, to know that I was not being snubbed.  Then it came time to be seated at our tables. I was assigned to Table Five and wondered who I would be seated with.  I found myself seated with people I know, amongst couples rather than amongst the "odd ones out".  I was included in all the conversations, and in fact, asked to tell the story of my "amazing reunion" with Judy M - I had attended ulpan in 1977 with her and her twin sister -- I believe I wrote about this.   I was invited to sit at other tables to schmooze in between courses.  When I went through my thirty minute long bout of coughing, I was made to feel the concern of others -- for ME, and not for themselves.  A high point of the  night was when I returned to the table from the ladies room and suddenly all the women got flustered. Why?  Because they all thought I had left for the night and had given my shawl which I had left on the chair to another woman to take back home with her to give to me the next day!  It was very funny and it turned out that she had not left after all and one of the women went sprinting after her (in HEELS) to get my shawl.  I followed her and we all had a good laugh about it.  It was a laugh of inclusion and it felt SO GOOD TO ME!!

I know I am going on a bit about something that is really much ado about nothing.  But for me, after YEARS of trying to fit in and finally feeling like I do, it is not nothing, but very much a lot of something!! 

Powerful Women

This morning I participated in a meeting of a group of women.  It is a group of 

women formed originally on Facebook.  The group was formed to allow the women in the group to enjoy morning and afternoon chats with friends around a nice, warm cup of coffee.  (The idea being that we are each enjoying a cup of coffee while we are chatting on Facebook!).

This meeting was to take the virtual concept out of the group and to make it into reality.  We would all be able to meet one another face to face and get a better sense of with whom we were interacting online.  It was a success!

We are all English speaking olim, some who have been living in Israel for many years, others  (myself) who have been here just over a year, various ages, from various places in the US, and different backgrounds.  We are all religious Zionist Jews.  The one thing that did come out, that I found rather interesting, is that many of us, if not most of us, write. We write either professionally, or for fun.  It should not actually be all that surprising, since after all, the main (only?) mode of communication on Facebook is TYPING (the modern day form of writing – I no longer do longhand writing – due to lack of practice it has been rendered ILLEGIBLE!). 

Each woman in turn introduced herself to the group and told her “life story” – or at least the salient points of her life, those which were apparently important enough to her to warrant sharing with the group.   I learned so much this morning. 

Several “salient points” were drilled home in this meeting to me. Most are concepts which I have already formed and this morning’s meeting simply lent more credence to those concepts. 

Everyone has a story.  For many years I have often believed in the “first impression is a lasting impression” credo.  There is truth to it, and it has guided my choices in dress and appearance, in particular for job interviews or first dates.  It still guides me somewhat.  However, I no longer use it to judge OTHERS.  These days, I (try) to make no judgments about other individuals until I have heard their story.  I must have become pretty good at listening, or at getting others to open up to me, because these days I seem to COLLECT stories.  I can point to nearly every person I know and say, “that person has a story.  It is sad”, or “it is amazing”, or “it is inspiring”, or “it is laughable”.  And, knowing these stories, each person is very real to me, very dear to me, and I am able to thus empathize and to CARE. 

Miracles do happen.  But we cannot just sit back and ask for a miracle.  We have to do our part, our hishtadlus.  Then, Hashem will shower miracles on us. 

Hashgacha Pratis, closely related to miracles is evident in nearly every facet of our lives.  One of the participants in the meeting described a particularly amazing piece of Hashgacha Pratis which she experienced.   I too, have had NUMEROUS amazing experiences of Hashgacha Pratis in my life.  There are no coincidences, unless by coincidence one means “an act of G-d”! (My list of Hashgacha Pratis can be a blog entry in itself (or several!)). 

The last concept that I felt was strongly supported by this meeting is the concept of “powerful women”. Let me explain:

Back in the 80’s and 90’s I had my own business.  It was a “woman owned” 

business which was a “thing” back then.  I remember I surrounded myself with other women who either owned businesses or held positions of power – whether in business, politics, or in civic organizations. 

I would attend meetings with these women and always came away from these 

meetings feeling rejuvenated, alive, energetic, powerful, and just plain happy.  I felt validated both as a woman and as an individual.

After I sold my business and I returned to frumkeit, all of that kind of changed.  Maybe it was because I was not in the right place at the right time, I was not exposed to women, and the kind of women I call “women’s women”.  I think I might have thought they did not exist in the frum world. 

I joined the sisterhood at my parent’s shul.  Every year the sisterhood would put on a performance – a “musical” in honor of the kallot and banot mitzvah. The performance used well known songs from well known musicals, only we changed the words to suit our needs.  I had a lot of fun doing that.  I also designed props and décor for the annual dinner for Chessed of New Square.  I worked exclusively with women in that effort.  But it was not the same.  It was enjoyable but very limited and limiting.

When I married Barry I felt like I had something to prove.  I needed to prove that I could manage a kosher home – keep it organized, clean, cook healthy and delicious meals, and work full time as well.  I would be a great mother, a great wife, and involved in our community.  And, I DID all those things.  Initially, I worked as the registrar for the Bnei Akiva Mach Hach B’Aretz program, I was involved in our shul, I chauffeured the kids to and from after school programs, and I cooked healthy meals for dinner (we sat down as a family at the dinner table every day!).  As far as the cleaning goes, I hired a cleaning woman.  I loved my job.  Even when I left Bnei Akiva and went to work for American Friends of Shalva I continued with all aforementioned activities and I enjoyed my work.  

But in the last two years before Barry died, something changed for me.  I no longer was enjoying the job.  I felt like I was burnt out, I was listless, I had no energy and I had no relationship with G-d.  Something was wrong, and I knew it.  I remember spending some time looking for what I was missing – trying to daven with more kavanah, reading books that were supposed to be inspirational, wanting to sign up for some shiurim (only all the shiurim which I really wanted to sign up for were in the middle of my work day!).  

None of this helped.  I went to my doctor to be tested for I do not know what but nothing showed up. He gave me a Vitamin B shot.  It did not really help much.  By the time Barry died I felt wrung out.  (A year after his death I would be even more wrung out from the litigation to which I was unwillingly subjected.) 

Not once during my marriage to Barry was I able to find and be part of a group of “women’s women”.   It certainly did not exist within the religious community in Teaneck.  Most of the women in my age group, in my community, or rather in my shul, did not work. They stayed home. They raised their kids. They fixed up their houses. They remodeled their kitchens.  They cooked fabulous (and costly) meals.  They went shopping at Riverside Square Mall which is the opposite of a discount mall.   I felt I had to compete with these women.  The difference was, I worked.   I never felt like I really fit in. 

After Barry died, and I moved to Baltimore, I encountered a completely different group of people.  There, I was accepted – immediately and without needing to prove to anyone who or what I was!  There, I met several women, “women’s women”, with whom I struck up close friendships.  It so happens that several of those women made aliyah and so I am thus able to continue my close friendship with them without geography in the way!

Since making aliyah I have been growing my network of friends, acquaintances, co-workers, colleagues and even family, by leaps and bounds.  Through this network I was invited to join a special group of women.  Meeting some of them this morning awakened in me some of the spirit and energy that I find being with other women opens up. 

It was my birthday recently and I invited a group of women to help me celebrate at a restaurant one evening.  There were ten of us at that celebration.  Near the end of the evening one woman remarked to me that “all the women here are ‘powerful’ women”!  That is how I felt at the meeting this morning:  we are all ‘powerful’ women.

Thank you all for being there with me.

Facebook and Linked In, Useful Social Media

Usually when I meet a new person with whom I wish to stay in touch I will ask for their email address, and I will ask if they are on Facebook or Linked In.  Responses to these requests/questions will run along the lines of “I will give you my phone number” or “I hardly use my email” or “Facebook?  I have no time for Facebook” or “Linked In?  What is that?”.

These responses are a cause for anguish for me.  Let me explain.

Remember the big “networking” fad of the eighties?   I do.  Huge “networking fairs” were organized.  I was invited to many at the time – I had my own business and it was a “thing” to be a female business owner.  I went to ONE such event.  Only one.  Why?  Because it was a NOISY affair.  I was in a room with some 100 or more participants, everyone was talking, and I simply could not hear what was being said to me.  Due to my hearing impairment I could not network.  I remember despairing of the ability to be even more successful than I already was.  It was a bit of a blow to my self esteem.  I considered myself rather socially adept despite the disability.  But in that environment – forget it.  And so I considered myself a lousy networker.   That is factor one in my explanation.  Read on.  You will get the point eventually.

 Growing up I used the phone with the same ease as a hearing person.  I was a regular chatterbox, talking to my friends on the phone as a teenager.  I used the phone both socially and professionally.  I had no hesitation when faced with having to pick up the phone and place a call.  Then, in the mid-90’s all that changed.  No, my hearing had not changed.  But technology did.  Cordless, wireless, digital, cellular technologies invaded the telecommunications industry.   Phones were no longer all analog. In fact, analog phones were going the way of dinosaurs.   Hearing aid technology was also changing.  HA’s were also using the same technologies as telecommunications.  BUT – the changes were not occurring in tandem or with any kind of cooperation.  Thus compatibility between hearing aids and telephones, which were 100% between analog phones and analog aids, dropped to nearly nil.  Since then, it has gotten better, but nowhere near the previous 100% rate.   Not only that.  Clarity of sound in analog technology is far better than in digital technology.   The result of all this was that I lost the ability to use the phone with ease.  I became MORE disabled as a result of technological advances, not less disabled!  That is factor two in my explanation. 

Along with the technological advances in telecommunications came the internet explosion.  Back in 1995 the internet was still raw, the wild west of the technoworld.  But I recognized in it the possibility of replacement – I realized that instant messaging and email could replace for me somewhat what I lost in using the phone.  It was then that I began using email and IM as a replacement.  Of course, it was a limited replacement – many people still did not have email, and were not using Instant Messaging (IM).  However, over the years, the usage of email and IM has grown exponentially.  Now, nearly everyone I know has an email address, and most people use IM some of the time.  

Then along came Linked In and Facebook.  I joined Linked In first, since in the beginning Facebook was not open to everyone.  I did not see any immediate benefit to joining Linked In but I stuck with it.  As soon as Facebook opened up to me, I joined.  Facebook gave me an immediate benefit. Suddenly, I was better able to network socially.  All the stuff I missed in social interactions, the subtleties such as “overhearing” someone say this or that, was right there in front of me, in print, in black and white!  As Facebook improved over time, and as I grew my social network on Facebook, my social ability also grew.  It was quite amazing and gratifying for me! After all these years of struggling socially, I suddenly felt as if I had finally “come into my own”.  In the meantime, I was also quietly growing my Linked In network, and fine tuning my professional profile on Linked In.  I was not finding it particularly useful and so long gaps of time would go by between the times I would check in on my Linked In profile or network.

After moving to Israel, and spending some time fine tuning my Linked In profile further, I found that suddenly, I was receiving more invitations to connect on Linked In and also was invited to interview for jobs or invited to consult.  It was quite amazing how Linked In has done so much work for me since I am living in Israel. 

Much of this is all thanks to Hashem’s Hashgacha Pratis – but it is said that He helps those who help themselves.  I do my hishtadlus, and then He helps me along. 

But I digress.  Back to my introductory paragraph, wherein which I describe encountering people who tell me they do not use Facebook or Linked In.  Not only that they tell me they do not use those services, but many of them tell me this with a disparaging tone, and say they “don’t have time for that kind of stuff” and seem to indicate to me that Facebook in particular is a “waste of time”. 

What I have attempted to do with this little essay of mine is to explain to my readers why Facebook, for ME is NOT a waste of time, and how Facebook (and Linked In) have improved my life, both socially and professionally. 

Both have provided me with a network of friends, family, acquaintances, co-workers, employers or potential employers, and professional relationships.  Those networks have allowed me to read and learn about what is going on in the world, in my neighborhood, in my town, in my country, in other countries, amongst my friends and family.  Those networks have allowed me post questions, requests, and information that may be beneficial to those who read my posts.  Those networks have provided the ability for conversational discourse on an infinite number of topics. While I know that the printed word cannot always adequately convey the sense or context of a person’s emotions that the human voice can,  it is still a great substitute for someone like myself. 

There are those who state that these new social media are loaded with lies, lashon hora, and have great potential be hurtful.   They are correct.  But that has been true of all media, for MILLENIUM.  The big difference is, I will acknowledge, is that social media is immediate, explosive (exponential growth or propagation of posts), and far more easily exploited.  But just as one does not throw out the baby with the bathwater, we should not dismiss the positive benefits of social media.  I believe Facebook and Linked In have been extremely beneficial, not only to me and others like me, but to all who use them.