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Social Policy 2

My current social work course for my Masters in Social Work, is Social Policy 2. Social policy 1 was a history of social policies in the United States, from child protective laws to voting laws, to Medicare and Medicaid, to civil rights and food stamps. The current course, though, is about advocacy: learning how to advocate for changes in policy when you notice a problem in the system. First we have to choose a particular problem area, then we research endlessly, and articulate the problem and who is impacted by it, and then (we haven’t gotten to this part yet) we figure out who to badger to successfully make change.

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“I can badger! I’m a really good badgerer!”

I have been overwhelmed by the research part so far. In one week, I read thirty articles, wrote eighteen pages, and did at least ten drafts to whittle that down to a two (and a half) page proposal for my project. My focus: the gaps in Medicare, both as a result of the 80/20 split between what Medicare covers and what the beneficiary is responsible for, and in what is covered (not dental, vision, hearing aids, or long term care). Why is long term care designated to Medicaid (the health coverage meant for low-income individuals), rather than to Medicare (which is meant for the elderly and disabled)?

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“This is exhausting.”

This all led me into the weeds of Medicaid, which is one of the primary targets for budget cuts, both of the current presidential administration and the Republican House and Senate plans to replace Obamacare. Many of the billions of dollars they plan to cut from Medicaid will inevitably come from long term care services for the elderly and disabled.

This led me to the backdoor legal schemes people are allowed to use to hide their income and/or assets, in order to qualify for Medicaid, and the difficulty of those low income people, who are not low-income enough, to afford the elder care lawyers who can competently advise them on the different types of trusts available.

If you have absolutely nothing ($845 a month income, for 2017), Medicaid will catch you when you start to fall through the safety net. But if you have even a drop more than nothing, you are screwed. There is the option of a spend-down plan, where you must incur medical bills in the amount of the difference between your income and the Medicaid income cap every month, in order to get Medicaid coverage, a month at a time. But publicly financed advisors (AKA Free) are not allowed to advise you on the trusts that could hide your extra income, and don’t have enough hours in the day to help each person who needs help to organize a viable spend down plan.

This leaves a lot of seniors without dental, vision, hearing aids, long term care or medical transportation, and in fear of the 20% of any doctor visit or procedure that is not covered by Medicare. Which leads people to skip even the services that Medicare covers, because they can’t afford the fifteen dollars for a cab, or the fifty dollar copay for even routine appointments.

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“You mean I could skip going to the doctor?”

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“I really don’t want to go to the dentist, Mommy. Ever.”

There is a campaign slowly going around the United States called Medicare-For-All, with a version that passed in Vermont, and one that made it through the New York State Assembly three or four times now (but has not been able to pass the state senate), and one in California too. What interests me is that what they are calling Medicare-For-All is really not Medicare as we know it. Someone decided that in order to create universal health care, we’d have to fill in the gaps in Medicare as it is, adding dental, vision, and long term care, and limiting co-pays.

So my question is, even if we as a country are not ready to pursue universal health care for everyone in the form of Medicare for all (and it seems obvious that we are not there yet), could we be ready to fill the holes in the health care system that covers the elderly and disabled among us? Is that a step we could tolerate?

Once I fix Medicare and Medicaid, my next project will be to figure out how to add pets onto our existing health insurance plans. Because, really, my dogs are family members. If human children get to stay on their parents’ health insurance until age 26, to make sure they can earn a living on their own before they have to buy their own insurance, surely my puppies, who will never be allowed to work for a living (anti-puppy prejudice!), should be covered by their family’s health insurance too. No?

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Cricket is not excited by this idea.

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The Secret Keepers

 

One of the primary concerns in social work is confidentiality. It is important for clients to feel secure enough with their social worker to share difficult information, and many social workers make a point of telling clients, right away, that anything they say will be kept private, expect in cases of danger to self or others. In the case of a social work intern, though, confidentiality has to include a few more caveats: What you tell me is just between you and me, and my supervisor, and my coworkers, and my teachers, and my classmates. You don’t mind, do you?

I read instructions from a social work class, at another school, where they specifically told the students to camouflage not just the name of the client they were writing about, but also identifying details in their physicality, personality, and life circumstances. We were not told to be that thorough in our classes. My fellow classmates and I tend to use initials in our assignments, if identification of a client is necessary, under the assumption that since we do not work at the same agencies the initials will not be identifiable to fellow students. But some people choose to use false names instead, to make the prose flow more smoothly. I’ve been tempted to go whole hog and use “Cookie Monster” or “Voldemort” for some of my class assignments, just to see if people are actually paying attention, but I haven’t done that, yet.

I don’t think dogs care about confidentiality, but I’m not sure. I’m hoping my dogs don’t care, because I share an awful lot of their personal information online. Cricket doesn’t seem to experience shame when her behavioral quirks are uncovered, like pooping on the mat by the front door overnight, or peeing in the quilting area in the back of the living room (though that could be because she believes it is my fault, because I failed to get up when she asked for an outing at three o’clock in the morning). Butterfly is unconcerned with her missing teeth, or any leftover poopy on her butt, when she goes outside to meet new people.

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“The pee was up to my eyeballs, what did you expect me to do?”

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“What? I think I look great!”

Dogs are the ultimate secret keepers, actually. Cricket has never told anyone information she alone was privy to about me. And Butterfly lets people think that I am strong and confident and secure, even though she knows different. The dogs accept me as I am, with all of my facets intact. They’ve never suggested that I should be fired as a dog Mom because I have this or that imperfection, though they do expect me to make it up to them in extra chicken treats.

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“Secrets are yummy!”

Maybe we should all go to doggy therapists, instead of the human kind, and then we’d never have to worry about confidentiality (unless you believe that dogs are capable of speech, and are just barking to keep up the ruse that they are dependent on us, and there is actually a secret network of doggy spies collecting information about their humans to send to the doggy version of the NSA, or the real NSA).

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“You’ll never know.”

The fact is, humans are not built for unconditional positive regard, even though that’s what therapist’s try to offer to their clients. Even the most generous-hearted therapist will find herself looking askance at a client for one or two of his decisions. Most dogs, though, have unconditional positive regard down pat. Human therapists carefully guard their boundaries, conscious of how physical behaviors, and offers of support, can be misconstrued by people in desperate need. Dogs don’t do this. Human therapists are also taught to hide their own needs and vulnerabilities from their clients, both to protect themselves and to protect clients from feeling responsible for meeting the therapist’s needs. Dogs have no problem walking up to someone, even someone in deep and unrelenting pain, and asking for affection, and offering affection in return.

Dogs listen openly and without an agenda, whereas most human therapists have a goal in mind for each session: to find out the client’s story, to uncover the blocks in their life, and to offer healthy options for forward movement. Dogs don’t interrupt; they are more classically Freudian in their approach, allowing the client to free associate, and just know that someone is listening to them.

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“We’re listening.”

But, there are a few ways that human therapists can be more helpful than dogs, especially when you are ready to move past the venting stage of the work. It’s possible that, while the unconditional positive regard of a dog can be healing, you may take the positive regard of a human more seriously, because you know that their regard is conditional and you must have done something right to be winning their approval. Human therapists are also more knowledgeable about problem solving, unless the problem you need to solve is where to find the best place to pee, or how to fully appreciate the sounds of the backyard.

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“I can help with that!”

 

The fact is, human therapists are more than just secret keepers, or a safe place to confess the things you don’t want anyone else to know, they are bridges and teachers and support systems to help you make the connections to the life you really want to be living. A life in which, hopefully, you will have a faithful dog at your side to give you unconditional love.

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Phone Calls

One of the things I dreaded most about going to school to become a social worker, were all of the logistical details I would have to deal with: looking for resources, making phone calls, filling out forms, and doing general paperwork. I’ve never been good at those things. When I get a letter in the mail, I get nervous; even if it’s a regular bank statement, or a credit card offer, I worry. And when I have to make a phone call or look at bills, I want to hide under the bed, but Cricket is already there and she growls at me for invading her space.

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“This hiding spot is taken.”

This year, I’ve had to do a lot of paperwork and phone calls for clients at my internship. At first I wanted to hide under the desk – which was wide open because Cricket is not allowed to come to work with me – but I didn’t want to let people down, so I made the phone calls and helped with the paperwork. After a while, probably months, these behaviors started to seep into my real life. I didn’t try to make deals with my Mom anymore, like, I’ll clean the whole apartment and scrub the bathtub with a toothbrush, if you will just call this doctor’s office for me and find out why they sent me a bill for fourteen dollars.

There was a time, not all that long ago, when I refused to even have a telephone in my bedroom, for fear I might accidentally answer it, and end up having to talk to an actual person. Caller ID has reduced some of my anxiety. I get at least a few seconds to prepare before picking up the phone, instead of feeling like I’m playing Russian Roulette each time the phone rings.

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“I don’t think you should answer the phone, like, ever.”

I still hate making phone calls, don’t get me wrong. I worry that every word I say on the phone, and every word I write on an official form, will make the world blow up, or get me sent to jail; but now I take the risk and do it anyway, fingers crossed.

Butterfly tries to help me with my paperwork phobia by offering to chew any difficult letters I might receive. I have to make a point of not giving in to that pleading look in her eyes – Oh, that paper looks so tasty, and I’m sure you don’t really want to answer that Jury Duty summons, Mommy. She’s never offered to make a phone call for me though. Cricket, on the other hand, would love to be the one to call an insurance company and dispute a charge. If I would just dial the number for her, place the phone on the floor, and step back, she could handle everything. Though I might end up with lawyer letters next, and those, I’m sure, would make Butterfly’s eyes explode. Oh my God, is that a MANILA envelope?

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“You wanted me to eat these papers, right?”

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“I can make phone calls?!”

            I’ve always been braver fighting for other people than for myself. I feel like I’m on more solid ground with altruism (which explains my choice of second career). My hope, though, is that all of this fighting for other people, and reminding them that they matter and deserve the help, will eventually sink in to my very stubborn brain. Maybe if I wore my work clothes at home when I made phone calls for myself, some of that work bravery would rub off on my home-self. But Cricket is skeptical. Work clothes are a very bad sign in her world.

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“Where are you going, and how will I survive?”

The Work of Memory

 

One of the most anxiety producing parts of being a social work intern is having to write process recordings every week. Some schools have moved onto a much simpler format for these, with two pages of basic description (and evaluation) of a meeting with a client, but my school, and many others, still use a long form that includes: a word for word (approximately) transcript of the conversation, a column to point out the skills the student tried to use, a column for the analysis of events that happened, and a column for the feelings and doubts of the student throughout the interview. On the first page of the process recording, there’s also a section for a description of the who, what, when, where, and why of the meeting, and on the last page there are questions to help you analyze the meeting’s success overall.

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“What is she talking about?”

My early process recordings averaged 13 pages, for one client meeting, and one was up to eighteen pages (my supervisor was not in love with that). The hardest part, for me, is the word for word transcript. Obviously it’s not an exact record of what the client and I said, because I don’t tape my meetings and because I don’t have that kind of memory. In fact, each transcript takes me three or four passes, at least, to get it into the semblance of a back and forth conversation similar to what really happened (though, given that each of my meetings is an hour or so, a lot still gets left out).

I can’t imagine Cricket or Butterfly trying to reconstruct a word for word, or bark for bark, transcript of their day. Their sense of time is, to say the least, imprecise. Cricket forgets how long it’s been since she last saw Grandma. A minute could have passed since Grandma went downstairs for the mail, but when she returns, Cricket greets her as if she’s been gone for days. If she tried to record that event, there would probably be twenty pages in the middle, filled with despair and resentment, as if she’d been lost in the desert without water, for years.

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“Oh my God! Oh my God! Where were you?!!!!!”

For official purposes at my internship, I have to write out a summary of each of my meetings, and that gives me a general record to start from for the process recordings. For those reports, I describe what we talked about in the meeting, and what we resolved for the client to do by next week, etc. But to get those notes into dialogue form, I need to pull a lot more from my memory, and fill in the transitions between topics, and focus on particularly difficult moments: how we get from topic A to topic Z; what order things came up in; Did I say something to bring this up, or did it come out of nowhere; when I was overwhelmed and unsure what to say; when I thought I did well.

I often wonder if the work of remembering is this hard for everyone, or if it’s a specific problem for me, because my brain seems to store things out of order and scattered in various corners instead of in a more linear fashion. I dread doing these process recordings every week, but once they’re done, I feel like I really learned something, about myself, about the client, and about how I want to proceed. I resent having to do them, and yet I hope we don’t switch to the short form, because this method has been my best learning tool, and the best way for me to really resolve the leftover feelings I have after a session with a client.

Ideally, I would become so practiced that I could knock off a process recording in an hour. Then I could do one on every client meeting, or on my own therapy sessions, or on the news shows that drive me nuts. I could write out each of my interactions with the dogs to see where I’m going wrong: like, why is Butterfly still so stubborn about who should be in charge of her leash (I think it’s me, and she thinks I’m wrong)? Maybe there’s a secret hidden in plain sight, and if I could just diagram every moment, I could figure out what I’ve been missing.

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“I will stay right here, looking adorable, until I get what I want.”

Maybe that’s what Cricket is really doing while she seems to be chewing on her feet: she’s processing, and analyzing, and deciding how she wants to handle things the next time I do something that bothers her – like when I say No, or Quiet, or I fail to give her treats when she wants them. Maybe she’s doing this all day long, and sharing her realizations with her sister, and that’s why they keep outsmarting me. That could also explain why they are so exhausted all the time.

It’s a theory.

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“Getting Mommy to do everything we want, every day, is exhausting.”

Understanding Statistics

 

In my Research 2 class (in graduate school for social work) we have reached the dreaded world of statistics. There’s a lot of math involved in this process, and even more incomprehensible data-to-Math-to-Greek-to-Computational-Tables-to-English translations. And what I’m realizing is that a lot gets lost in the translation from reality to statistics.

It’s not that I think research is a waste of time. It matters. But not enough time is spent on elucidating the data, and remembering the anecdotal evidence that makes up the data. Anecdotal evidence (or individual stories told to the researcher) is often considered unreliable, but masses of data, detached from its origins as anecdotal evidence, is considered reliable. We end up taking a lot of valuable information, and turning it into numbers and graphs, and forgetting where the data came from in the first place. People.

As we have discovered over the past year in the United States, polling is only as valuable and legitimate as the questions asked and the answers recorded. If people are asked the wrong questions, or distrust the person asking them, then the data that results will be incomplete, if not completely wrong.

If we looked at certain data about Butterfly, like: heart disease, diabetes, aged twelve out of a 13-14 year expected lifespan, few teeth and those that are left are not good, persistent cough – you’d think she was at death’s door, and miserable. But she has the biggest smile in the world, runs like the wind, comforts her sister, loves to be petted, loves food, licks me to death, and I could go on and on. You wouldn’t know any of that if all you asked was “What’s wrong with Butterfly?” or “Describe Butterfly’s health.”

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“What’s wrong?”

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“Absolutely nothing!”

The reliance on big data, and mass polling, has developed (as far as I can see) as a good faith effort to get a sense of what’s going on with everyone, instead of just with the easiest people to access. A doctor who sees a hundred patients on a regular basis may have a very good sense of the health issues of those hundred patients, and no clue whatsoever about how her patients fit into the patterns of the population at large. They may be anomalies – because they can afford her fees, live in a certain geographical area, and have certain specific symptoms – or they may be average, she can’t know. That doctor needs access to a wider swath of the population, in order to put her patients into better perspective. But what is the quality of that data? Who chose the questions to ask? What biases were at work? Which questions, that she would have known to ask based on her experience, were left out of the questionnaires filled out by all of those anonymous people that she cannot call and follow up with?

Recently, I heard about research done on the question of abortion. It’s a thorny area to begin with, but the way the polling is done can make it even more confusing. If the question is, do you support abortion? Or, would you have an abortion yourself? A lot of people will easily, and quickly, say no. But if the question asked is, do you think abortion should be legal? Many of those same people will say yes. It turns out that, on this specific question, people have different opinions about what they themselves would do, than on what they think others should be able to do in their own lives. The people setting up the poll would need to understand that gap in order to ask the right questions and really understand the data they are receiving.

This kind of gap can exist on any subject, and it requires open-minded researchers with a willingness to question the data and look deeply at their questioning process. Without those extra steps, the data can profess things that are not actually true, or that are, at best, incomplete.

If I asked Cricket if she prefers peanut butter or chicken, chicken would win every time. And if that were the only question asked, you might come to the conclusion that she doesn’t like peanut butter at all – especially if you could see the way she sneered at the peanut butter on her way to ripping the chicken from my hand. But the fact is, she loves peanut butter. She will take any medication offered, as long as it is covered in peanut butter. But we didn’t ask her the right questions, so we never found that out.

When we hear about study results in the news, especially on TV or from the mouths of politicians, we rarely hear about the context of the study, or the methods used. We are given simple numbers, or better yet, bar graphs and pie charts, to make the point very clear. But once a study’s results have been translated into numbers and graphs, our ability to determine for ourselves the validity of the study’s methods, questions, and analysis, disappears. In fact, people rarely take the time – or even get the chance – to read through a full study report, even though researchers put a lot of effort into examining and going into detail about the choices they made, why they made them, and where they may have gone wrong.

What if, after hearing the results of all of these polls and studies, and staring at bar graphs and pie charts and news anchors for hours and hours, we come away believing that we know each other perfectly, and can therefore dismiss each other? And what if we’re wrong?

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“We’re never wrong. Right?”

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“What a relief.”

Cultural Competence

 

I seem to have developed a growl reflex. It started a few weeks ago. At first, I thought I had a cough, or some kind of breathing disorder that would kill me at any moment. Butterfly looked at me with a wait-a-minute stare, as if I had finally spoken in her language, but it was my Mom who noticed that it only happened when the news was on.

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“You finally learned my language!”

There’s something dissonant about studying to become a social worker, with all of the inherent multi-culturalism and looking out for the vulnerable and oppressed that comes with that, and then turning on the news and being told that all of these values are passé. There’s a free-for-all feeling to the news in America since the election, as if no one’s quite sure how to cover the President-elect and still be “objective.” Every day is unpredictable.

For a long time now, we’ve lived in a country where white supremacy and neo-Nazi propaganda was beyond the pale, and now, not only is it main stream news, TV news people are tying themselves up in knots trying to discuss these people and their beliefs “objectively” and “without prejudice.”

Note the irony.

Since when did objectivity require the removal of your backbone and integrity? When did this mass surgical procedure take place, and can it be reversed?

I’m trying to find out when we as a society decided that talking about racism became “identity politics,” and therefore something to be avoided. There seems to be a consensus in the main stream media that the Democrats lost the presidency because they were too focused on identity politics – aka the needs and issues of minorities and oppressed and vulnerable groups within our society. The solution offered seems to be that we should not think in terms of groups and differences at all, but only of society as a whole.

This, pardon me, is nonsense. We come together in groups when we have shared issues that need to be addressed, and know that the larger our group, the louder we can be, and the better chance we have of being heard. If we can’t come together and speak as a group, we are effectively being silenced.

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The lessons people keep trying to take from this election are bizarre: it’s Hillary’s fault, because she wasn’t likable enough; it’s “identity politics” fault, because it made white people feel left out; or, it’s Black Lives Matter’s fault (a group which, by the way, has become invisible on the news since the election, though I can’t imagine that unfair treatment of black and brown people at the hands of the police has suddenly vanished in the warm glow of the anticipated Trump presidency).

The backlash against the Black Lives Matter movement may be as realistic an explanation for the election of Donald Trump as any, because while some Americans woke up to the reality of unfair treatment of minorities by the police and criminal justice system, because they could finally see the video evidence with their own eyes, many other Americans saw the resulting protests as a threat to peace and safety, and they wanted to shut it down.

The media has decided to take Trump’s election as a mandate to stop covering certain issues, and to stop advocating certain values, that had seemed to be universal in America. The media also seems to have decided to take Trump’s word for it that Steve Bannon, despite being the voice of the Alt-right, in his own words, is really not a racist, misogynist, anti-Semite. No, he’s just misunderstood.

My only consolation is that I have the loudest, most aggressive protester in the world living in my own household. Her name is Cricket, and she is a fourteen pound bundle of fluffy outrage. If things continue to get worse, I may have to pack Cricket into the car and bring her to Washington, DC to have her voice heard. I’ll just put her at the front of whichever march is underway at the moment: the women’s march (she is female, after all), or the rights of immigrants march (as far as I know, there is no such thing as legal citizen ship for canines, so her outrage would be real). She’d be willing to fight for a lot of different groups.

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“I have something to say!”

But watch out KKK. Cricket may be a white dog, but she does not like bed sheets. You have been warned!

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The Research Class

 

The administration at my online Social Work program decided to change the hosting format, right before the new school year began. The previous format for our classes was a bit stodgy, yes, but you could find everything you needed. The new format is not just new to the students, but also new to the teachers, and there hasn’t been any time to work through the bugs and figure out how to manage the new layout. So it’s a mess.

And maybe that would have been okay, if I were taking a less stressful class to start the semester, but I’m in Research One, and each assignment involves group collaboration and has to be finished in less than a week. I have bad memories of working in groups in high school and college, and having to either do all of the work myself, or spend all of my time gently, nicely, pushing my classmates to do their share of the work, or editing their attempts before the rapidly looming deadline. Some people think that ten o’clock the night before it’s due is the perfect time to start working on a project. I don’t. I really, really, really, don’t.

I want to use my insight and imagination and empathy and creativity, and none of those are allowed for a research class. It’s all about formatting and organizing other people’s work. I feel like a marathon runner forced to do finger exercises for hours on end, in a seated position. Every once in a while I may be allowed to move my whole hand, but rarely.

I want to scream. I want to throw things. I resent that it feels like the online faculty at my school is running a secret experiment on us – testing the impact of unpredictable stressors on student work quality and psychological wellbeing (I wrote that to my teacher in an email, and he seemed to take me seriously instead of getting that I was, sort of, joking).

My anxiety about the Research class and the new online format is making me obsessive. I’m overworking and under-coping. I feel a desperate need to control everything that feels chaotic to me. I can’t find restful or fun books to read. I can’t find anything decent to watch on TV. My mind just keeps filling the gaps with more work.

I need to take a nap and rest and recover and focus on other things, but my brain keeps telling me to re-read research articles, and do more searches, and try more databases, and do the whole group assignment by myself. But I know myself, even if I managed all of that, I’d just start obsessing about the reading and possible assignments for next week. It would never end.

It’s frustrating to have to see all of my flaws so clearly – my impatience, and rigidity, my temper, and need for control. I don’t want to know that there is so much still to fix.

For relief, I’ve been watching for the feral cats in the yard, and communing with them as much as they will allow. Hershey actually let me within five feet of her the other night, but then she scooted under the maintenance shed (her palatial estate). I also had a chance meeting with the neighbor-dogs, George and Zoe, and it made me unreasonably happy for a few minutes. Zoe barked a lot, and Cricket stared at her, in silence, as if this behavior, this barking at nothing, was completely alien to her. Then George clapped his front paws at me and asked for pats and a hug, and I willingly obliged. Zoe stood in her perpetual ballet first position and allowed me to pet her too. I even got to walk with the baby next door – or with his nanny, who was holding him as he slept – for a few minutes, and breathe in the utter, unspeakable cuteness of him.

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Hershey, hiding out.

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“Are you taking my picture again?!”

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Zoe and George

But mostly I work. I read and summarize and research, and I attempt to keep my emails to my fellow group members polite and reasonable. I try to follow the conflicting instructions from the teacher, and the disorganized new formatting, but all I want is for the class to be over, and for all of this self-knowledge and hitting-my-limits to end.

Cricket is doing her best to distract me by barking at every moving thing, and Butterfly has doubled up her requests for scratchy sessions (for my sake, of course), but it’s not enough to calm me down. Clearly, I don’t have enough dogs.

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“I’m doing this for you, Mommy.”

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“I work so hard to protect you, Mommy, and you never adequately appreciate my efforts.”

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“We do not need another dog, thank you very much.”