Update re beds: D has decided she wants her full bed in there, at least to start, so it looks like we're not getting a temporary or new bed at this time. Thanks everyone for your suggestions! They were very helpful! Also, she has a week to change her mind about this plan.
After the signing, which was a 2+ hour process, we went out for lunch, then adjourned to her place and measured furniture.
Due to dealing with her move, I'm going to be somewhat hosed over the next two weeks. (If you have a favorite moving company that does small moves on the North Shore, feel free to mention in the comments. I have two recs already, but I could stand to get quotes from one or two more. Also, I feel nervous about trying to book movers in 14 days or less, so want a pool of leads at hand.)
I was hoping to get at least one post out this month, but right now I'm so exhausted I can't see straight, and I have lots of patients tomorrow and part of Friday, which is the last day of the month. We'll see.
The good news is that in the middle of July, whatever my availability had been, it (knock on wood) should be substantially improved. Not only will we be getting D settled, I have a bunch of patients all going on protracted vacations, so my clinical caseload will be temporarily lightened.
Once D is moved, we'll need to start worrying about what to do with her house, but there's no urgency on that. I think that while there's some minimal stuff that we'll get out of the way, G and I are planning on taking a nice break from Dealing With Things And Evacuating Houses for a little while.
Of course, all that goes out the window if D's health takes a turn for the worse – or for that matter if any other emergencies emerge. But right now I'm hopeful that later this coming month I'll be able to be around more and be shoving more posts out the door. Here's hoping.
Lindy Mechefske posts
Thrilled to be working with Ruth Wood on an anthology of transgender stories. We are interested in stories from anyone under the transgender umbrella as well as stories from the people close to them. We are looking for stories from people anywhere in the world so please share this widely. Submission details below.
PLEASE SHARE WIDELY! ( Read more... )
The clinic I work for as a contractor recently paid me, for my last pay period, an amount of money that was four times my typical earnings. Admittedly, how much I actually get paid fluctuates pretty wildly, but I figured I would have noticed having either 4x in arrears or having seen 4x as many patients as usual. But I'm paid via direct deposit, and the corresponding statement saying what I was getting paid for is put in my mail box at the clinic, so I had to wait till I was back in the clinic – today – to pick it up and find up why I was getting all this money.
The statement mystified me when I got it. It was two whole pages of pairs of canceled previous payments and replacement payments and at first I couldn't make heads or tails of it, and then I realized that I was looking at a statement where almost all the patient sessions listed had happened in 2016.
As I mentioned, last month, for the first time in decades, we got a raise. A big raise. Not big enough to be adequate, but big enough to be astounding. It was, we thought, effective starting May 1.
No. Turns out the raise was retroactive. To – apparently – Oct 1, 2016...
...The day after I posted the final sections of "Why You Can't Find A Therapist, No, Really".
Rumor has it that the raise – more properly, the increase in rate paid by at least two of the Medicaid providers – happened because MassHealth (Massachusetts Medicaid) leaned on them to do so, to fix the emergent strike.
MassHealth? Are... are you there? Are you reading my journal?
If so, thank you! (If not, still thank you!)
I have a few other suggestions for things you could fix!
For instance: I'm currently doing an amazing job (or so my chart reviewer wrote) doing care coordination with a big medical team involving four clinics, three hospitals, and family all involved in the care for a patient with an emergent psychotic illness. I can do that because the patient has MBHP, and MBHP pays for case coordination if it's extramural. I'd like to point out that it's insane that if I have a 15 minute conversation about the diagnostic formulation for a challenging and high-risk case with an in-house psychiatrist, I don't get paid for it (and neither do they), but if I do the same thing with a psychiatrist at a different clinic, I do. How wack is it that I literally wouldn't be able to afford to spend the sort of time on this case that I did (and continue to!) if the patient hadn't coincidentally decided he didn't like my clinic's available psychiatrist and went and found himself another one through his PCP. Surely this can't be the incentive system you want me or the patient (or the psychiatrist) to be functioning under – one where patients are incented to get their psychiatric care from an entirely different facility from their therapist.
And thank goodness that he had MBHP, as pretty much an amazing fluke. No other MassHealth payers pay for care coordination at all. If this guy had been on NHP or Tufts/BMC when he came down with schizophrenia... I shudder to think. Do you realize how much I've been on the phone with MGH's ER and APS and social workers and psychiatrists at local mental hospitals in the last six months?
Don't you think there should be some sort of provision for what happens when someone presents with a psychotic disorder? Like, when a provider slams the big red "R/o Schizophrenia" button, the payer has to start paying for some case coordination? (I'd also recommend that for substance abuse cases, where patients can manipulate providers around meds; and in mandated reporter cases, where you should probably have payers pay therapists for their time filling in DCF/DPPC/DES or whatever.)
I have to think that the time demands of handling such a high-risk case are part of why some – maybe many – therapist are leary of working with psychotic or other high-risk patients. I've been there. I've twice spent four hours – half a work day – keeping a patient in crisis calm and coordinating with the BEST team and then the hospital, and never saw a dime for any of it. Who wants to bring a patient onto their caseload, for whom the total compensation divided across the total hours of work for that one patient come to less than minimum wage?
And I'm just talking about care coordination – I'm not even talking about CPT 90839 and 90840 which last I checked were still universally unfunded. Funding that would be way cool.
I have many other fine suggestions – I swear many of them even aren't just suggestions you pay me more money! I'm happy to talk more about reforms in mental health care.
- Mutants and Masterminds
- Wraith: The Oblivion
- Aeon limited edition
- Star Wars Core Rulebook (dhampyresa, do you want this? I'm happy to send it to you--it's Wizards of the Coast's d20 system)
- Mage: The Ascension (we may already have this BUT I DON'T CARE)
- Changeling Storyteller's Guide (now I just have to find the core book for Changeling)
- Wraith Player's Guide
- Battlefleet Gothic 2002 Annual (I looooooooove the aesthetic of the Battlefleet Gothic miniatures and am sorry I only own one, which is still unassembled in its blister pack)
- Earthdawn (I used to own this before my stepmother threw it out)
- Ars Magica (ditto)
- and a stray issue of Playboy July 1995 because it was sitting there lonely and I am easily amused
PLEASE, VAN, CONTINUE ACQUIRING AND SELLING USED RPGs. I WILL COME BUY THEM!!!
This is like Christmas.
Since then I have made a point of reading books on game design when I can find them, and the occasional article on the web. While I have released a couple of small interactive fiction games (IFs) and the narrative game Winterstrike (Failbetter Games), I don't really consider myself a game designer. It's more in the nature of something I do on the side because I find it illuminating to consider alternate ways to approaching narrative; I think primarily as a writer of static fiction. And for the purposes of the hexarchate, it's research because I decided that one of the factions (the Shuos) abuses game design techniques in their pedagogy, and one of the characters (Jedao) is a gamer.
The Kobold Guide to Board Game Design, ed. Mike Selinker, is a collection of essays by various designers. I was originally going to read the book through and do a report on the book overall, but I liked the essays enough to do individual reports on some of them. ( cut for length )
Thank you to the person who donated this book!
Freelancer! From the distant future the Factions bring you our Mutant Chronicles Bundle featuring the 2015 Third Edition of Mutant Chronicles, the dieselpunk techno-fantasy RPG of future darkness from Modiphius Entertainment. With its fast-playing, cinematic "2d20" system designed by Jay Little (Star Wars: Edge of the Empire), Mutant Chronicles 3E is a thrill ride across a Solar System beset by megacorporate intrigue and the invasion of a terrible alien force.
How often is the thing that brings a story to life a question of grammar? And yet, I know exactly what Linda Nagata means. Here she is, explaining how verb tenses turned out to be the key:
If there ever was one bright spark, one bit of insight, one unexpected plot twist that brought The Last Good Man to life, I don’t remember it. What I do remember was how flat and uninteresting the manuscript felt to me in the earliest days.
This wasn’t an unusual situation for me. Beginnings are hard and it can take time to work out a tone and style that feels right. So I kept pushing forward, telling myself that if I kept going, the essential spark that every novel needs would eventually ignite.
It didn’t happen. Not for over 30,000 hard-fought words. Sure, the story was advancing but I wasn’t happy with the tone or with the way it was being told—and I didn’t know why.
I’d done my preliminary work—a lot of preliminary work. I’d been tossing ideas into the literary stew pot for months, revising my synopsis again and again. This was a very near-future story centered on a small private military company—contract soldiers of the sort hired by corporations, NGOs, and the US government. These were “white hat” mercenaries, choosy about their clients, working only for the good guys, and though they were a small force, that force was amplified by the autonomous robotic weaponry they could deploy. And I had an unusual protagonist in True Brighton.
Middle-aged women are not generally considered cool enough to serve as the lead in a techno-thriller, but I wanted to give it a shot—I wanted the challenge—so I made True forty-nine years old, a retired US Army veteran and mother of three who is still fit, strong, and agile enough to qualify for field missions.
All the pieces seemed right. For months I’d sensed the potential in this story, but still somehow the spark was missing.
Up to this point I’d been writing in third person, past tense. Then—30,000 words in and on the verge of despair—I chanced to read a novel written in third person, present tense and I was intrigued. Could I write The Last Good Man in third person present?
Present tense is commonly used with first person, where the narrator relates the story using “I” or “we.” I’d done a whole trilogy in first-person present. But I’d never written in third-person present. Inspired by the novel I was reading, I decided to try it.
And I liked the energy of it! It was just a technical change, but at last the tone of the story felt right. I continued to move ahead, writing additional pages every day in present tense, and at the end of the day I would revise my past work, gradually shifting it from past tense to present, adding detail as I did.
I was far, far happier with the feel of the story. The change in tense had given it the spark it needed—or maybe it had given me the spark I needed. Whichever it was, I never considered shifting back.
From the cover copy:
Scarred by war. In pursuit of truth.
Army veteran True Brighton left the service when the development of robotic helicopters made her training as a pilot obsolete. Now she works at Requisite Operations, a private military company established by friend and former Special Ops soldier Lincoln Han. ReqOp has embraced the new technologies. Robotics, big data, and artificial intelligence are all tools used to augment the skills of veteran warfighters-for-hire. But the tragedy of war is still measured in human casualties, and when True makes a chance discovery during a rescue mission, old wounds are ripped open. She’s left questioning what she knows of the past, and resolves to pursue the truth, whatever the cost.
“…a thrilling novel that lays bare the imminent future of warfare.” —Publishers Weekly starred review
Linda is a Nebula and Locus-award-winning writer, best known for her high-tech science fiction, including the Red trilogy, a series of near-future military thrillers. The first book in the trilogy, The Red: First Light, was a Nebula and John W. Campbell Memorial-award finalist, and named as a Publishers Weekly Best Book of 2015. Her short fiction has appeared in Analog, Asimov’s, The Magazine of Fantasy & Science Fiction, Lightspeed, Nightmare, and several anthologies.
Linda has lived most of her life in Hawaii, where she’s been a writer, a mom, a programmer of database-driven websites, and an independent publisher. She lives with her husband in their long-time home on the island of Maui.
Prompt: "ghost consciousness."
The house had lain ruined for decades upon decades, quiescent at the edge of the town. Once, it was said, a fine family had dwelled there, wealthy at first, much given to parties and entertainments. The oldest people in the town still remembered the parties: the music of string quartets, and cakes decorated with spun-sugar ornaments, and couples dancing gaily through the night. But now none of the windows had glass in them anymore, save for a few sharded teeth, and the wind blew freely through the rooms where people had once gathered to gossip.
Nevertheless, the house was not entirely uninhabited. A ghost remained attached to the house, and it murmured to itself during the long winter nights, singing tuneless ghost-songs of the shapes that shadows make in the dark, and the sounds that mirrors make when no one is around to hear them, and footsteps in the distant wood. The ghost did not remember the name of the person it had been, once upon a time, but neither did this make it unhappy.
In time a pregnant cat moved into the house for the shelter it offered. The ghost did not remember much about cats, except that they liked cream, and it had no such thing to give the cat. But it had other things to offer. It encouraged the old closets to throw their doors open and disgorge their rotted linens so that the cat would have something to nest in, and it offered all house's hiding places, as well as the lullaby of the crooning wind.
For her part, the cat was a pragmatist. She did not share human prejudices against ghosts, and a ruined house was as good as any other place for her to raise kittens. She merely made sure that there were no raccoons or the like already occupying the place, and then she set to building her nest in earnest.
Cats are not the most talkative of folk, but this cat was friendlier than most. She asked the ghost why it lingered in the house, instead of going to its rest the way humans usually did. While she didn't always put credence in human stories, she had heard that ghosts usually stayed in the realm of the living because they had left some task unfinished.
The ghost said to the cat, "The only task is the task of the house itself. It was my home when I lived, and it remains my home in death."
"Then I am sorry I cannot help you," the cat said, dismayed in spite of the very pressing matter of the kittens she expected to arrive in a matter of days. "A human could help you restore the house, but I am a cat. I may have clever paws and whiskers, but they are no good for building."
The ghost's laughter gusted through the house, although it tried to keep the worst of the cold from the cat. "What do I care about restoration?" it said. "Perhaps once, when I had flesh, it would have mattered to me. But now I am a creature of shadows and dust and ash, and this house suits what I am now. I can keep it safe for you and your kittens. They can play in the house's halls and grow to adulthood without fear of being chased out by human owners; is that not enough?"
"If that is the case," the cat replied, "I shall gratefully accept your hospitality, and my kittens and I will keep your house free of mice."
"It is a very old bargain," the ghost said, "and if it suits you, it suits me."
Two days later, the kittens were born without fuss, or more fuss than the usual, anyway, and in the years to come, generations of cats made their home in the house. They probably live there still. As for the ghost, it has been busy adding the songs of cats to its repertoire. The result is noisy, but none of them mind.