Thinking About Nicknames

When I introduce myself to my patients, I usually have to repeat my name at least once.  Hell, when I introduce myself to anyone, I usually have to correct away from "Melissa, Marissa, Clarissa, etc."  I've gotten used to throwing up an "L" with my left hand when I'm wearing a mask, to help emphasize on the repeat.  I even have catchphrases around the reply, the first being "Yeah, I don't meet too many of me," and if they compliment my name, I say "thanks!  I got it for my birthday."  Either of them might earn me a chuckle.    

It can be annoying sometimes, but I take it with a sense of humor.  Yes, I never did have pencils or pre-made tiny license plates with that name on them.  After thirty-five years, I'm prepared.  At Starbucks, I'll either say "Andy" since we share a rewards account there anyway or say my name and "however you spell it will be close enough."  In places where it needs to get correct, I have reverted to the phonetic alphabet more than one time (Lima Alpha Romeo India Sierra Sierra Alpha) for absolute clarity.  Every now and again that there's a friend or family member with my name, we have a small bonding point.  I am the only Larissa employed at the hospital, which means that I literally called in to pick up a shift and only had to say my first name.  On the other hand, I cannot blame another Larissa if they were not particularly fond of me.  

My parents have always told me that they chose my name because it means "laughter," which I like to think has proved fitting.  I appreciate my name, spelling corrections aside.  However, that is not to say that I have not found different expressions of it.  I have had many nicknames in the course of my life. 

I can tell a bit about where I knew a person from in my past based on what nickname they call me.  Anyone that calls me "Roo" knew me as a small child.  A couple friends in later elementary called me "L.Roy."  "Rissa" was a lot of junior high through high school.  Both "Rissa" and "Ris" through a lot of college and with some adult friends.  "Lar-Lar" and its derivative "Larizard" came from working at a summer camp.  "Reesie" came from a particular friend.  And then as a professional at Skyward and the hospital, mostly "Larissa."  Sometimes still "Ris," but the folks I met from work still mostly use my full name.  

I'm curious what nicknames I might acquire a little further into my career at the hospital, if my name will organically shorten or change here, too.  I can think of one body from work that has been calling me "Rissie-Ris" which has added to my sense of community, and for others I suppose we simply haven't talked about it yet.  When Andy and I started dating, he very intentionally switched from "Ris" to using my full name, as if marking the transition in his own way.  I don't necessarily have a preference to or away from nicknames, but I recognize the places I have been given them over time, acknowledging the sense of belonging either way, by being given a name or simply by being invited to join.  

And that's the kicker for me, really:  I am not terribly picky about what I'm called (within reason) provided that I am included.  There are unspoken ways that others want to be included, sometimes designating those terms by a preferred name and sharing their pronouns.  I can think of a couple of hurtful names I've been called, too, and how that was exclusionary in itself.  One of the first questions I ask my patients is what they prefer to be called, not taking liberties with the information I already know about them without some degree of consent, a small concession in the power differential between us as clinician v patient.  Sometimes, the answer is "Mrs. Smith" or their middle name or something else that had not been yet updated to my paper, but either way I allow them space to frame how they are to be met in that space.  I choose to include them how they want to be seen.  To that degree, I subconsciously use my full name at work as a way to create space professionally, to mark the role and also help set the space for myself, establishing which version of myself I choose to project.  

My name and its derivatives are snapshots of different facets of me.  Additional ones may spring up in the future, as I continue to meet new parts of myself in new contexts.  And I'm excited to see that growth.

A Rant about Healthcare Costs and Insurance

So, while I was in nursing school, Andy was still working at Skyward, and we had our health insurance through there.  It was some solid health insurance, ya'll.  And I knew how to work the ins and outs of managing our specifics, including rough time estimates and when to expect to have met our deductible.  Nearing the end of the nursing program, I set up a half dozen appointments for August, knowing that I wouldn't have to work around my normal schedule for those.  

...And then Andy got a shiny new job at Rivian.  So, my thoughts in that moment went "Hooray!...dammit."  So excited for Andy and his new adventures; I was simultaneously not looking forward to having to readjust to new insurance.  

Two things:  firstly, Andy's options were better than what was available to me at Carle; we did consider them.  In one of my final nursing classes, the instructor was trying to give us collective advice on how to consider our insurance and made the assertion that persons with chronic illness should go for a particular kind of plan--yeah, most peoples' advice in these categories do not consider my actual circumstances, how the math is actually going to work out.  Which brings me to point two:  It's life and death for me.  That is not an exaggeration.

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Let's walk through that process a bit.

Component A:  I call each doctor I am expecting to see to let them know about the change.  This involves waiting on hold, relaying the information including official start/end times and a couple of stops to the offices to allow them to scan the card after services, once the card has arrived.  For my major medication, prior authorization letters need to be sent off immediately, in order to be approved.  I also received a couple of calls needing additional information from my insurance that wasn't printed on the card, which led to led to more time on hold and another morning of back-and-forth phone calls.

Component B:  Officially under the new insurance, meaning a whole new deductible to meet.  The pharmacy tech takes my name and goes to find my prescription.  They then pause, they go back to the computer, and they start to have a conversation with another tech sometimes.  Other times, they'll ask if I have a second insurance.  They apologetically and/or hesitantly tell me that my bill today is about $250.  I say, "Yep," and pull out a credit card, explaining, "It's always this way before we hit our deductible."  Sometimes I'll add "That's what the HSA is for."  $250 for a prescription for me makes me say "oh, that's cute."  I've gotten to a point where I interrupt the staff member at the pause, asking "Has insurance been applied?  Yep, that's right then."  I've had prescription pick-ups from Walgreens where one was $800 after insurance and another was $230, again after insurance.  So when they say hesitantly that it's $100 today and asking if that's okay, I don't even blink.  Historically, then, we hit our deductible and then out-of-pocket maximum by March, and it was either covered 100% or we only paid $20, depending on where the plan was.  What else can I do?  Say no?

Recent Explanation of Benefits Document
Note the cost of the infusion is 15K, but the
plan negotiated price is less than half.
Prices are artificially inflated in our medical system
in order to make the insurance rate look that much better.

Component C:  I call my doctor's office to ensure that I have a prior authorization before a minor procedure point.  I had already had it approved for the old insurance.  Now I had to call and ensure it was ready for the new one instead.  My provider called back that afternoon, explaining to me that since I hadn't hit my deductible yet, that it would be full charge to the deductible amount.  In my head, I'm saying, "yes, and water is wet," but I don't interrupt her.  She finalizes her speech by saying what the overall cost would be, about $1.5K.  I agree, and I ask whether they want that at the time of service or at billing.  She asks that I pay half there that day.  I clarify that a credit card is acceptable.  My point of contact has been reassuring and gentle in breaking the news to me and in the course of my responses switched to mild confusion by my direct acceptance of the information.  We always sprint toward the deductible.  Always.  And the last few plans we've sprinted toward the out-of-pocket maximum shortly after.  If I'm going to survive, I have to be emotionally ready for that, able to spread out the fees or have it stored away in an HSA.  

Component D:  This is the big one, broken into multiple parts.  This is the experience of managing my infusion medication when considering insurance processes in this switch.

D0:  I have a medication that I get every eight weeks that is $15,000 a dose (it was $9K last year and $8K the year before that)--for easier math, I can make blanket statements like "I'm a minimum of $2,000 a week to keep alive," also considering that there are office fees and such, but the medication itself is $15K (see above).  This is given at my doctor's office mixed in saline and delivered intravenously, billed as chemotherapy.  So, yes, I get an IV started in my doctor's office, as I do not have those kinds of supplies at home without some creative stealing...nor do I see myself wanting to start an IV on myself any time soon.  The majority of patients in my doctor's office that receive this mediation pull from the stock they keep there (there can be some really stupid insurance situations that have an extra hoop of procuring it and bringing it in).  

D1:  I am decent at reading insurance plans at the point.  They go through the $16K test.  I walk though how if I was covered under this plan or this plan that first infusion cost would work out.  The best case scenario through my work offered insurance would be paying $3,200 each subsequent infusion after hitting the deductible, because only 80% was covered after that point and hit the out of pocket maximum of $12Kish.  Andy's offered plan had us also hitting our deductible immediately, then some coinsurance until we hit the max out of pocket of $4,500 at which point everything is fully covered.  Ya'll:  I'm expensive to keep alive.  Rivian offered a more stomachable out-of-pocket max.  We're regrettably but thankfully well-prepared in our HSA.  

D2:  I began harassing both my doctors' offices and the insurance company with polite insistence.  For a while, all I had were the numbers with no physical card to work with.  After a couple of days, once our presence was finalized in the system, I was able to get an electronic card, which I was able to print off and take to respective offices around town, literally running this to various offices.  And then there are multiple phone calls, sometimes actual hours' worth of phone calls.  It takes a great deal of emotional energy to push through this.  And it all needed to happen within the same two-week period to honor all of those upcoming appointments or reschedule everything around a new work schedule.

D3:  I had roughly twelve business days to push through some approvals.  No one feels the urgency that I feel in this space--my provider might have sympathy or empathy for me, but I'm the only one that suffers (mentally and physically) if we fail.  Literal suffering, because my medication is delayed because my doctor's office won't infuse a $15,000 medication without having the prior authorization in hand because they don't want anyone to be on the hook for it unexpectedly.  Since I've been on schedule for a while now, a day or two doesn't matter as much to me, but at other points, I was a special kind of exhausted at the tail end of the meds cycle, debilitated even--a day was everything.  Once, a small piece missing on one form delayed my medicine for a week, at a point where I did not have the physiological reserves to adjust.  Never again.  I don't wait for a letter clarifying what's missing; I don't wait for my doctor's office to replay with confirmation; I'm on top of each step, ensuring that each piece is moving and that everyone has what they need to push through the paperwork.  

Component E:  Our deductible and parts of the refiguring will start over again in January.  Everything starts again.

Component F:  The prior authorization letters are good for one year, from the authorization date.  At the beginning of this year, the insurance vendor for Andy's job switched from Blue Cross/Blue Shield of one state to Blue Cross/Blue Shield of another state.  These are COMPLETELY DIFFERENT and required a whole new letter.  This was not immediately clear in our household, and required some emergency scrambling two weeks before an infusion date.  

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If we did not have the credit, the money saved in our HSA, or insurance coverage that meets our needs, I do not survive.  Full stop.  We would go into massive debt that we could never recover from or I waste away trying to stretch out my care needs.  It's personal.  It's terrible.  These are numbers and situations that no one should have to get used to.  And yet, here we are.  It's infuriating.  

The consequences of this, they are fiscal, sure, but emotionally taxing in some complex ways.  Andy and I are aware that we will always need sufficient insurance coverage to protect me, which ultimately locks us into jobs.  Whether we like our insurance-provided employment is irrelevant:  we feel trapped, knowing that we cannot leave without significant safety nets or a new plan solidly in place.  Any potential new situation, too, requires pointed queries into the nuances of all of the offerings.  This weighs quietly but resolutely in every conversation with management, in airing any grievance or concern.  I cannot quantify the grief and stress toll worrying about medical fees has wrung out of us over the years, literal days' worth of phone calls, tears, and all else.  And when we factor how much is collectively paid out of paychecks toward insurance, taken out into the HSA, and paid separately, the amount is both staggering and painful, to think about what we might have been able to do with that, in a system that was not so rooted in exploiting people.  

In other words, our current system robs us of life, liberty, and the pursuit of happiness under the guise of beneficence to those most in need.  I would love to understand what it feels like to live in a world where Andy and I do not have to worry about this.  I genuinely cannot imagine what it would feel like to not always hold that burden.  I want that freedom for us and everyone, to know that if they lose their job they are also not at risk of losing their health, that one diagnosis or one small accident is not going to wipe out everything.  Social determinants of health with related disparities, limited access to services, even the luxury of time when waiting to hear back whether insurance has decided they will cover services (which they may not have anyone with medical knowledge involved in the decision, by the bye), I see my patients go through the same struggles.  More than once I have questioned the wisdom of involving myself in a career so close to my own pain points, but I find that the compassion I can express from it is important to have in those places.  

It is a big problem, and I would rather try something than nothing.  We all deserve better.  

About Consent

Consent.  We talk about consent in the colloquial sense as it relates to bodily autonomy, specifically that of sex.   However, there are many, many facets of this concept that are much broader than that.  I've talked about it obliquely in enough blog posts that it is time to discuss it directly.  I saw this comic/video on the internet ages ago, and I think it still encapsulates an important understanding of consent and sex in a specific analogy, comparing it to offering someone a cup of tea.  

But about that broader sense.  Let's set a scene:

You've just clocked out for the day.  It was a long day.  An exhausting day.  There are still a number of tasks that have to be done yet before you can rest, including making something to eat, a few time-sensitive discussions, and a couple of home-related needs that need doing.  You decide to lift your spirits by running through the drive thru, only to find that they are out of the necessary pieces for your favorite pick-me-up.  You drop your keys trying to unlock the front door.  Clearly, the universe must hate you today.  Someone important in your life (significant other, parent, close friend, etc.) then arrives in front of you and starts to talk about a heavy topic without preamble.  

How would you feel in that moment?  This person is important, and in this hypothetical you care about what they have to say, but the timing, the timing is just terrible.  They did not check for whether you were open to listen at that moment, simply demanded your attention and your energy without confirming whether you were available to provide either.  There's the recognition that you want to be available and that you simply don't have the emotional bandwidth existing in the same space.  

A two-second question of "Hey, is now a good time?" can make a huge difference, when choice is introduced back.  The previous events of the day do not disappear, but an ask where I have the opportunity to agree, to care for and with that individual because I care and not because I was not offered a choice, that allows me to invest more fully.  Asking for attention or time or empathy or any other resource (tangible or intangible) instead of demanding feels better, recognizes the humanity of the giver, that they are not simply a service to be utilized.  I am more willing to give when I am asked.  I like to give when I'm able to, but the joy vanishes when it becomes an expectation.  If it's a demand, I may acquiesce but with a degree of anger in the back of my mind, severity depending on the situation and any established pattern.  For example, a bigger ask without checking tends to generate greater resentment, yet a person who consistently demands even small pieces, there's a gentle but real grudge there that accumulates.

Yes, this means that the person being asked has every right to say no.  This is important.  If the question is asked and the answer cannot be no, then it isn't a question--it's a demand, just prettied up.  One can be disappointed that the answer is no, but they should still respect it.  Otherwise, it's not consent.  Coercing and cajoling someone to make the "correct" decision is not consent.  And if I have a question that cannot be no for some reason, it's important to pause and ask myself why, not the person who said no.  My need is not their responsibility.  

At work, I find that this is a tricky element to manage.  Alarms all around me and all at once are always demands.  I have had patients that only speak in demands, either because I am only a service to them or they are heightened enough to forget.  Sometimes, it is death by a thousand cuts, where by the end of the shift I have a great deal of resentment toward that person, situation aside.  On the flip side, I have had patients that are so worried about bothering me that they neglect their needs--I make sure to invite these patients to call out, giving them consent in advance to have their needs met, because they have made the acknowledgement that I am a person and have demands on my day that they don't know about.  Sometimes, I have to make clear boundaries, such as "I have two people ahead of you, and then I can bring your water," or "I cannot help you with that at the moment, but I will let your tech know and they will get there when they can" or "I am not in charge of when your food tray comes up and cannot make it come any faster."  

This happens with peers, too--there are some people who are better about asking if I'm available to talk or can help do X or Y than others.  Naturally, there are situations in a hospital that have some real urgency where it is appropriate to demand help; there are also places where urgency is felt but is more flexible.  I try to emulate the behavior I would want, setting qualifiers like "Are you available," or "Do you have space for," or "When would be a good time to," or prefacing the conversation with "the answer can be no" before making the request.  The latter in particular helps stop the flow of excuses when all I need is a quick yes or no so I can hang up and call someone else if need be.  I try to ask if people have space for a question when I need a sounding board, before launching into the specifics while someone is trying to catch up on charting.  If it's a longer phone conversation, I try to ask if they have a moment to discuss before jumping into the larger part of things.  And again, sometimes the answer is no.  At this point, I find another body or wait until that availability is there or sometimes help them complete their task so they are free to help me with mine.  

The days I feel most tired from work seem to be the days that consent has been violated the most.  A demanding patient wears me down differently than one that is needy or emotional or even confused. I find, too, that the best thing I can do for myself on my days off to truly recover is to make it clear to my household that I am setting my own schedule for the day, dictating my own rhythm.  This might include doing tasks for the household and meeting appointments, but I still set the order and pace for the day without waiting on another body.  A day off where I'm waiting on one thing to happen so that I can do X or Y (e.g. waiting on a package to arrive so I can sign for it before going about the rest of my errands for the day), that is not very restorative to me.  I need a clear space to re-establish my own autonomy again, to fight for consent only with myself.  

Looking back, I think I've always been sensitive about this to a degree, but I have not had the vocabulary to pinpoint the exact reason, just an underlying frustration that I was unable to name.  And, it crosses into my PTSD experience, where threats to my autonomy are particularly heightened, a hypervigilance to potential threats resulting from trauma-informed thinking and survival patterns that served their purpose for a time but have since turned those patterns into difficult, deep ruts that the wheels cannot easily deviate.  Now I can recognize some things that are happening, name them, and pause to honor the feeling.  There is still more work to be done, and sometimes that means taking myself away from activating spaces to regroup.  At home, I tell folks that I need space for a bit and listen to my body for guidance on whether I need to move (likely exercise in some capacity) or be stationary (distraction through a movie, blog, etc.).  At work, I acknowledge aloud to myself that I am activated in the moment and find a small task that I can check off, redirect to a single task rather than multiple, designate a boundary (particularly to patients), find a reason to step off the floor, and/or go to the bathroom to lock to door, if only for a moment.  In other words, at work I find small pockets where I can let off enough pressure to keep moving.  I am still finding what strategies work best:  it is a comfort and a curse that no two days are the same.  

I want to invite and be invited to interact, to be a part of the group, to be helpful.  I want to be asked and exemplify what it is to ask others.  I want to honor choice and consent beyond the colloquial usage, as I want mine honored in return.  Even friends who "don't want to be a bother," the ask is the only way to find out.  Introducing an earnest question back into our speech will bring a whole new dimension into our mutual communication.

Fledgling Nurse, Part 13: Holes in the System

Nursing is a field where caring is expected, where the character of the persons participating in it is expected to be nurturing.  This can be expressed in many different ways, in a gentle washcloth on the mouth or some harsh but honest truths or reexplaining how to perform an action for the umpteenth time or any number of things:  the core is that the expression may not be "nice," but it should be kind.  

And that takes a degree of emotional energy, to use both the training and that base compassion into a combined demonstration of "kind."  It makes complete sense that we have emotional connections to some situations, where we are frustrated on the patient's behalf.  Yes, sometimes because of the patient's decisions, too, but that is not the focus today.  

We have social workers on our team:  truly, I cannot fathom what we would do without our case managers and social workers.  They submit all the right paperwork, follow-up with facilities, arrange home healthcare, talk to families about their options, and wear so many hats.  There are so many needs that they are working to meet, with literal hours on the phone.  They manage the next steps so we can focus on the current ones.  And still there are places where their hands are tied.  

I cannot tell you how many times I hear discussion about insurance in my workday.  We talk about placement in nursing homes, home health care, new medications, in terms of waiting for insurance and/or Medicare to respond back.  I cannot fathom how many extra days of hospitalization happen in a year because the patient's case is pending with insurance in one hospital let alone the country.  It affects their care.  It affects their options.  This waiting adds to collective suffering.  The worry over the burden of cost is its own suffering, especially when you factor in the remaining cost even after insurance has been calculated.  And if the patient is covered by the VA, that's a whole other regulatory body and then we get into some fun specifics about what hospice elements are and are not covered by Medicare.  And then we have a patient that needs a locked dementia unit wandering around our floor for a month or so because there is no place for them to go that will accept them (this has happened multiple times) or the family has decided against the place that would for one reason or another.  There are persons who are denied may have no other resources to pull from--sometimes, we have to send people home.  And if they have no home, sometimes there is a shelter and sometimes there is not.  

The cost is measured in time.  The cost is measured in hospital resources (including staff and space) that cannot then be spent elsewhere.  The cost is measured in pain.  The cost is measured in stress.  And, yes, the cost is also measured in money.  

There are many, many needs that are being met; there are also many needs that fall through the cracks because the system is not built to support them.  There are more gaps to fill.  Make no mistake:  if we did not have to contend with insurance--or, more specifically, the bloated prices of the American Healthcare System--what a different world healthcare would be.  I won't claim that this is the ONLY problem, but it does seem to be the loudest.  There are other countries with better healthcare outcomes that do not cost nearly as much as we pay here.  We do not have to imagine what the alternatives look like:  they already exist.  

There are many, many people in this country that are one bad day away from complete bankruptcy, just one accident or one diagnosis, even if they've done everything "right."  No one seems to understand these costs until they are faced with that first terrible bill, the one that opens a chasm where their stomach used to be and swallows them whole in a deep, impossible dread.  It is hard not to despair in these places.  I know these places.  I have been one of the lucky ones, one of the persistent ones that has been able to argue successfully with insurance and plan ahead in other spaces--this is purely luck, that we had the right series of compatible insurance coverage, where the egregious totals somehow whittled down to just a few thousand dollars.  I have seen patients where that has not been the case or a surprise thousand dollars was not something that could be found.  

If their routine doctor's office visits had been covered, they could have avoided the entire hospitalization.  If they were able to afford their medication, their condition would not have exacerbated to this degree.  If their hours had not been cut in COVID, they still would have been able to afford all of their medication instead of only some.  If their dental insurance covered anything outside of a single cleaning a year, they would have been able to get the dental work necessary to avoid endocarditis.  If they had a job that allowed them actual sick leave, they would not be leaving the hospital AMA.  There are so many "ifs," and they are measured in suffering.  

How can I not carry righteous indignation when I see how others are suffering in this way?  It is the antithesis of "kind" to watch people simply slip through these holes.  I have many thoughts about the system as it stands, how I would wish it fixed.  I reject the idea that it is unfixable--better is still better, and there will be a degree of discomfort as we adjust to changes.  So sometimes the best I can do is swallow the indignation until it's ready to be used, vote, recognize that I cannot fix everything in the twelve hours I have the patient that day, express the needs that they make me aware of, and otherwise take specific gratitude in the places I see our case management and social work teams find solutions.  

Melvin & Me, Part 37: Trusting the Body

I have said before and I'll say again that I have many reasons to not trust my body.  It's a very particular grief, processing that kind of betrayal--most people are unaware that it's even an option until it happens.  There is a difference between wanting your body to do something it cannot do and being betrayed by one's body.  I identify with a lot of my older patients discussing this problem, particularly the patients that were faced with needs significant enough to require nursing home placement (temporary or permanent).  There are many things that they feel their body should be capable of doing--simple things--that are still somehow not possible.  Arthritic hands that cannot open a bottle; knees giving out crossing the living room; waking up to find that it already too late to make it to the bathroom; all of these force a cumulative change in how an individual can look at themselves and there is some inherent grief to it.  

I carry a lot of that conditioning still.  I had multiple years of it.  I have many good reasons to not trust my body.  I adjusted to those expectations.  I have to remind myself that the conditioning and habits I needed to survive are not necessarily the skills I will always need.  I mentioned offhandedly at work the other day that it was a matter of time before I was hospitalized again--with any luck, not for many years--and watched as they thought about how to react to that.  It's a bald truth, but a truth nonetheless.  I've had a chronic illness for twenty-three years at this point; I know a few things deep in my bones because they have been etched in.  

Ten years later, ten years from the pinnacle event, I am starting to get to a point where I can take some things for granted again.  And it is an odd thing.  There is a permanent hole in my abdominal wall, and yet there are still some things that I can take for granted.  I am trying to unlearn.  

The first time I worked three twelve-hour shifts in a row, I was low-key terrified.  I was prepared to break in some ways, to need a full X days to recover.  I did need some recovery, but not the kind of lingering recovery that I used to need, where borrowing against tomorrow's energy required literal weeks of recovery.  There are a number of ways that I am in the best shape of my life.  

So lately, I've been trying indoor rock climbing.  I have never done a pull-up in my life; I have zero reason to think I could be good at this.  However, not all elements of rock climbing are brute force--there are places to finesse and trust your toes more than we would think is normal.  It does not have to look like a ladder to be something that has enough elements to ascend thirty, forty, fifty feet up a wall.  

Raring to go!

Raring to...

Erm...
Ah, beans.

And this is why it has been so freeing.  I don't know what my body can or cannot do in this situation, so I have to let it show me.  I have the delight of being able to surprise myself while simultaneously not feeling defeated when I tumble off:  it's a learning space.  It's a new adventure.  I am genuinely frightened up in the air.  It's a new space to explore trusting my body without preconceived notions.  As such, it is allowing me to find spaces to better listen to my body again.  I am learning how to push without overstretching.  I am learning how to be mindful in hearing what my body needs in this environment and that then reminds me that it is okay to ask in other spaces.  Because I am pausing to listen again.  Because I am finding safe ways to ask and engage.  

To ask, to listen, and to honor the answer.  To transpose that experience into other places where I similarly need to check in with my body.  To honor the gut as a source of insight rather than an albatross; at best I would see my gut feelings as good advice from an untrustworthy source.