Health Care Access: Two Stories

health care handsHealth insurance exchanges launch next week.  To honor the occasion, a couple stories feel like they need to be told.  One was a story I heard on NPR about a Yale University professor.  She cut her hand in a freak accident when cleaning a glass bowl.  She told the Yale hospital emergency room physician treating her that she was a knitter, and that fine motor control was important to her.  He assured her he knew what he was doing and she would be fine.  Unexpectedly, one of her students interning in the emergency room happened by and exclaimed, “Professor, what are you doing here?”  Her attending physician stood rigid.  “You’re a Yale professor?” he asked.  When she affirmed she was, he stopped and called in a surgical hand specialist.

Moral of the story:  We don’t have equal access to health care.  Even the affluent.

The other story I heard last night in jail.  An inmate was a passenger in a car wreck six months ago.  She was rushed to the nearest emergency room where surgeons operated on her right hand.  She needed more surgery, but she didn’t have insurance.  The day after the accident, doctors amputated mid-forearm.  The following day, she was discharged with 30 pain pills.

Nothing hurls someone recovering from addiction into relapse like fresh trauma.  That’s the arc of this story.  Traumatized by the accident and in excruciating pain, she turned to drugs.  She was arrested on a drug charge two months later.  It was in jail that her cast, bandages and stitches were removed, revealing her stump to her for the first time.  She shed a grateful tear when describing the officers’ care for her in jail.

Moral of the story:  We don’t have equal access to health care.  Especially the uninsured.

Lest we be tempted to disregard this as an isolated case affecting only the poorest, let’s look at the numbers.  It’s a sad fact that Texas inmates receive better health care than the 26% of Texans who lack insurance.  Uninsured Texans outnumber the entire population of Yale’s home state, Connecticut, by a factor of almost 2.  One in 4 Texans could reasonably expect this level of care.  Only because the woman became incarcerated did a caseworker recognize her need for additional medical care, trauma counseling and rehabilitation to help her learn things like writing with her left hand, buttoning her pants, and slicing a bell pepper.

That’s a bright spot, I guess, but I have to add, time and time again I see people in jail who wouldn’t be there if they had access to health or mental health care.  The lack of access puts a terrible strain on jails, to speak nothing of the strain on people falling through the cracks and landing in jail.  And for the cold hearted out there unmoved by the human toll (you know who you are), our de facto jail-as-a-last-resort system costs taxpayers more than access to appropriate care in the first place.  Would a surgical hand specialist have saved this woman’s hand?  I don’t know.  What I do know is recovery in jail costs more than recovery at home, and now she qualifies for disability for the rest of her life.

Access to health care will never be equal.  Some will always have more.  I don’t begrudge them that.  Here’s the salient point: starting next week, no one else has to live this inmate’s story.  That’s a relief.

Join the conversation.  Where do you draw the line between a person’s responsibility for his own health and our responsibility for each other?

Copyright 2013 Stephanie Walker All rights reserved. Visit www.AcrossTraditions.com.

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Forgiveness in Jail

forgiveness in jailWe’re talking about forgiveness in the Dallas County jail this week.  Everyone in jail has been charged with some offense, obviously, and many long for forgiveness from victims or family members who suffer consequences from their actions.  Many also struggle to forgive themselves for the direction their lives have taken.  Many are mothers who grieve not being there for their kids, and they can’t forgive themselves for falling down on that job.

A startling number of incarcerated women became victims of sexual abuse and violence long before committing any crime.  In some cases, the signs of abuse are physical, permanent, and quite visible.  Other signs are hidden.  Child abuse has its most insidious and lasting effects when children are made to feel culpable in some way for the abuse against them.  Sometimes they blame themselves for not preventing abuse against others, too.  While some trauma survivors want to forgive their abusers in order to heal painful pasts and to find personal transformation, others need self-forgiveness for being crime victims.  In short, the undercurrents nudging us to forgive and to seek forgiveness rampage like tidal waves through this group.  Self-forgiveness proves the toughest nut of all.

Many of the inmates with trauma histories are incarcerated for criminal behavior consistent with Post-Traumatic Stress Disorder behavior patterns.  When we talk about forgiveness, anger management, or any psychological issue in the jail, we use particular care not to trigger trauma memories.  Jail for most is not a safe place for processing the wounds of trauma.  Trauma memories can trigger PTSD behaviors that endanger other inmates, and that has severe consequences in jail.  Jail is not a treatment facility, after all.

Hence, the forgiveness discussion requires a “trauma informed” approach.  One way we prevent exposing inmates to triggers is not giving anyone a chance to share trauma stories.  I make it clear that the introspection exercises they do in class are for their eyes only.  Another way we steer clear of trauma triggers is to focus exercises on current resentments the participants are experiencing in jail.  Those might result from tensions with other inmates or tensions with friends or family on the outside.  It’s rare that an inmate does not have one or the other.

To be candid, I have an “elephant in the room” feeling about focusing introspection on current irritations.  On the one hand it is easier to learn the steps to forgiveness with resentments that are not deeply held or woven into the fabric of one’s life.  On the other hand, it’s also something of a missed opportunity that makes my heart ache.  When I do forgiveness workshops with church groups, the hunger participants have to be healed once and for all from old wounds is utterly compelling.  Of course, one who hungers, in all likelihood, is in a physically and psychologically safe place for confronting past hurts.  As much as I want to expose inmates’ deepest wounds to the healing power of forgiveness, our first obligation is to keep everyone safe.

An exquisitely talented therapist leading the class with me is more than capable of managing any difficult psychological situations that arise.  I’ll probably throw in a closing comment about applying the steps to process deeper wounds when one is in a safe place to do so.  Tune in next week for some observations about what we all learned.

Join the conversation.  What conditions make it safe to start the forgiveness and healing process?

Copyright 2013 Stephanie Walker All rights reserved. Visit www.AcrossTraditions.com.

Healing from Shame


The tentacles of shame can reach through decades of a person’s life, wrapping around seemingly unconnected events and wrenching the joy from life.  I have friends whose shame originated in childhoods in which they never felt up to grade.  They always felt deficient in some significant and identity shaping way.  For some it was a constant stream of criticism.  For others it was as seemingly benign as a home focus on appearances rather than on the truth, subtly but unmistakably suggesting that the truth is never good enough.

I also have friends whose shame reaches up out of childhood trauma.  That trauma might have been the sudden loss of a parent or, as the Penn State abuse scandal tragically highlights, more often than we want to acknowledge it is child sexual abuse.  The child is made to feel that he is in some way culpable for his own abuse, or in an insidious distortion of logic, the child believes the fact that the trauma happened stands as proof that it was deserved.

The truth, though, is that shame has little to do with the bad things that happened to someone or the bad things someone did.  It has everything to do with the lies that someone started believing about himself when he tried to make sense of a bad situation.  Believing a lie—that the truth is never good enough or that children are responsible for adult actions against them or that you are not credible and no one will believe you—keeps the tentacles of shame alive and strong.  Even incredibly successful people suffer from shame.  In fact, it is their unending need to prove to themselves that they are good enough that propels their success.

While some lies are memories from a long past childhood, or “childhood tapes,” other lies get constant reinforcement.  Many messages propagated in our media, particularly those that connect one’s worth to appearance or wealth, are lies.  Anyone with a TV is constantly exposed to them.  When thinking about parents who won’t forgive, I realized that elderly parents can perpetuate shame lies also.  In the case of forgiveness, people may hold on to resentment because it is the only connection to another person they think they need in their lives.  Paradoxically, the resentment is rooted in intense desire—not rejection.

Similarly, disapproving parents might ache for the time when their kids prized their parents’ approval.  As kids grow up, they find their satisfaction not from parent approval but from the mark they are leaving on the world—in their careers, relationships or communities.  Parents may perpetuate criticism hoping against hope that the adult child will respond by seeking the parent’s approval again.  In any case, it is a lie.  More specifically, it is a manipulation designed to elicit a certain response rather than an honest observation grounded in reality.  The notion that one needs a parent’s approval is a lie as well.  Is it nice to have?  Certainly.  Is it necessary for happiness and joy?  By no means.

Healing from shame doesn’t happen magically when we recall the events that triggered it.  It is when we call out those lies and speak the truth about ourselves to ourselves that true healing begins.

Join the conversation.  Are there lies that you believe about yourself?

Copyright 2012 Stephanie Walker All rights reserved.  Visit http://www.AcrossTraditions.com.