Sanity Claus

Hi honey, I'm home! Well, as homey as Dallas can be, anyway. It was a spectacular holiday, if for no other reason than it's the holiday that in all possibility should never have happened. A split second here, a seat belt there, but who's counting? The fact is, we all gathered in south-central Texas for another pleasantly small, low-key event (I even endured a full run of "A Christmas Story", which is like the "Better Off Dead" of the 1950s). I'd say it was quiet and peaceful, but Fox News and Peace are mutually exclusive and guess which won? I'm betting the farm: Fox is the new crack. People get very edgy, even downright hostile, when you try to divert their attention away from their addictions. I'm fairly certain that I'd go for the jugular myself, if anyone came between me and my Whole Foods organic chocolate truffles, but conveniently, this isn't about me. Now, my mother has the legit-est of excuses; I mean, how healthy would you be if you had tissue still inside you that had been dead since May? Such is the lovely socialist medicine (make no mistake: no matter what they tell you, "public option" is essentially the same thing). I digress. My father, on the other hand, flirts with a combination of dry drunkenness (sober 25 years but I think he holds us responsible for Mom's highly-justified us-or-it ultimatum), early dementia, and borderline mental illness. I mean, having bare cement floors in your house and those god-awful greenish fluorescent light bulbs to read by would f*ck with anyone's psyche, but to want to paint your ceilings (in your house, mind you) black in an effort to emulate the decor of Willie Nelson's Texas Roadhouse?? (No shit.) Come on. "Ambiance" is not the correct term here, padre.

Don't get me wrong; I love my parents, even--sometimes begrudgingly--my father. As much as we are locked into various levels of on-again, off-again estrangement, we still share our share of good times and plenty of laughs--even when the sense of humor is not exactly up my alley. As screwed up as parts of my childhood were, and as often as I can still be found licking the wounds therefrom, and as deeply as some of the aftereffects have penetrated and unfortunately shaped who I am, I still can't exactly hold a strong grudge. He did his best, after all. It's just that there is a sort of relief that can be felt upon entering your own (carpeted) house (with white ceilings) (and being able to take your shoes off) and watching (not Fox News) Family Guy's new full-length spoofs of Star Wars Episodes IV and V (backlit by normal, everyday incandescent lighting).

Which brings me to another thought or ten: we're about to move into that same house, long term; is this a good idea? Does it bode well for the mental health of all involved? Obviously, for whatever reason, I single-handedly have this knack for setting my father off and driving him crazy. I can't, for the life of me, figure out why I serve this special function in his life, but I do. I've spent a bit too much time trying to devise coping strategies to minimize direct contact (I mean, we will essentially be using the place as a crash pad to recoup from all the long hours spent 75 miles away, right? And there is, after all, that attic upstairs, complete with its own bathroom and temperature control. And maybe if we move this furniture in and that furniture over here...) I oscillate back and forth between feeling like I'm being a spoiled little ingrate and the realization that hey--I have been living on my own (and on my own terms) for the last 14 years and I've basically become a completely different person since I last shared a roof with my 'rents. I'm 32 now, not 18, and I also come with a whole package of complicated accessories: a husband, 2 habitual cats anchored to their daily routine, a politically independent paradigm, special dietary needs, my own truck, a big couch, tons of other furniture, an entire book library, you get the picture. I hardly have the heart nor the energy--nor is it even my place--to enter into a pissing contest with the incorrigible, especially when my existence there is graciously governed by said incorrigible as nothing but a favor to me. As adult as we are, I'm not exactly sure we could suck it up and lease a living space of our own at this point in time. One more (semi-staggering) bill isn't all that appetizing to me. Then again, neither are the inevitable debates-turned-arguments that invariably mushroom cloud between Dad and me after any more than 3 whole days together (which is often a liberal estimate). Because thus far, I've gotten by, by biting my tongue and holding everything back, even when I'm right, a strategy that only works for so long. Eventually my desire to set the record straight is going to win out over any sense of diplomacy I ever might have possessed. With any luck, we'll have an escape route in place by the time that happens, because much like abstinence being the only fool-proof birth control, the only surefire long-term crisis-intervention strategy is to maintain a healthy geographical distance. Until that possibility becomes reality, however, I'll just have to suck it up, be grateful like I should be, and hope that someday soon, there is a 12-step Fox News recovery program. I'm not holding my breath just yet...

Don't look back in anger: Stories from the Upper Echelon

When you go to the tally office for your final clinic checkout, they'll verify your clinic numbers and send you to a little-known office next door. This, my friends, is actually typically the most time-consuming part of checkout. The reason? Because beforehand, they give you surveys to fill out. These don't take much time, but they have comments sections. They're supposed to remain anonymous--they even go so far as to tell you not to sign your name anywhere--but those comments are used as the outline for the Exit Interview [insert Dr. Eckhardt's voice booming "emmmbrrryyyooo" into his lecture mike]. We heard stories of some people being tied up in there for as long as 3 hours, but if there was space for comments I filled it, and my interview didn't even take an hour. That interview got me thinking back....way back...

Undergrad: Ah, yes, undergrad. The year 2006 was the last year in Parker's existence that anything at that school would make sense. After that, the school would not make a single good decision, but we'll save that for later. Undergrad rocked. I learned more about chemistry in the first day of Mr. Fick's Organic Chemistry (O-Chem) class than I had in the previous 2 semesters of Gen(eral) Chem(istry). Dr. Perryman prepared us for no less than 8 future classes (we counted).

Tri 1: The first trimester seemed to take the entire first year. Dr. G said they were going to put us under some stress, and he wasn't lying. I alternated between constipation and excessively soft stools for the first month. My body scent changed. I became sleep deprived. I stressed out and subsequently turned inward. I tried to write everything down. I tried to hang on every word. I tried to memorize every detail. I literally drove myself nuts doing this. Between the stress and an undiscovered gluten problem, I didn't feel like I learned much new info at all. It didn't help that a still-busy massage practice encroached on my study time, and it often won. So much for getting off to a good start. I did learn, during this tri, how to say no. I was still trying to adjust to all the new school demands, and my friends and family weren't used to this yet; in fact, they didn't really know what we were going through, so they didn't know exactly how much stress we were under, and people made innocent requests that I simply couldn't fill. My plate was full--too full--and I learned how to push things back off when I felt overwhelmed. I learned how to set boundaries and say no and not feel bad about it. A piece of advice: palpate EVERYONE! You'll be glad you got that practice later. Oh, and you'll probably have an Ipod (or something similar) by the end of the tri. Ditto with a newer model cellphone.

Tri 2: This trimester was all about TESTS. Sure, we had plenty of tests in Tri 1, but we had more in Tri 2, more than practically any other tri. They weren't nice tests, either--Gross Anatomy, Biochem, Biomechanics, Microbiology, etc. Braham made the tri bearable. Cadaver dissection was AWESOME. There was an art to it. I learned something, and I surprised myself: that I CAN dissect a cadaver, without fainting, and that it's a blast. The characteristic smell of a cadaver lab has faded from memory, but I'm sure it'd come snapping back should I ever step foot in one again. I also learned that it's good to cover up from head to toe, including a hat for the hair and disposable booties for your shoes. I won't say much more but let's just say that Gross Anatomy got its name for a reason. Main learning opportunity for Tri 2: how to cram for finals efficiently. You see, this trimester's final exams were about 80-90% old test questions verbatim, and they let you keep your old exams to study to boot. So studying for finals was actually kind of a no-brainer. Oh, and keep palpating!

Tri 3: Finally, you get to adjust! Or so you'd think. A lot of the classes are a continuation of subject area exploration begun in Tri 2. You have Physio 2, Public Health (which is basically a continuation of Microbiology), Gross Anatomy 2, complete with a continuation of the cadaver lab, etc. You have some blasts from the past like Philosophy 2 as well. Newcomers on the scene are Neuroscience and an actual adjusting class. Don't, by any means, think that just because you pass Diversified you'll be a competent adjuster. You're not actually trying to adjust. Yes, that is going to freak you out, as you imagine yourself 8 years down the road, after having had all this training, and you still don't know how to adjust. Well, that has happened; unfortunately, that's not an unrealistic scenario. Parker does indeed have a reputation (not only among its own graduates but also among field docs who graduated from other schools) for graduating students that don't have a clue how to adjust. So, carefully, start honing your skills on other students. You didn't hear it from me; I'll deny I said it. Main knowledge gained in Tri 3? This was the tri in which I learned how to take serious, efficient, effective POWERNAPS between classes. Despite the bright fluorescent light overhead and people talking and milling about all around me (sometimes even trying to get my attention) I learned how to make a pillow out of my afghan, put my head down, and will myself (successfully) to go away for 10 minutes.

Tri 4: Hope you enjoyed Tri 3, because it was kind of a break. Finally, they're nice to you, figuring you made it through Tri 1 and 2 and now you're now "in". Top secret: the other reason they go easy on you in Tri 3 seems to be because they're apologizing in advance for the buttkicking you're about to receive this trimester. Yes! Let's take Tri 1's volume of material, plus Tri 2's testing battery, and there you have it: Tri 4. Let's take the most important--and also time-consuming--classes and put them together in the same tri (despite the fact that we have several other trimesters to choose from). Tri 4 is not a cakewalk, not that any part of chiropractic school is. It's your first hands-on adjusting lab, and you do it in the clinic, with staff doctors, which is cool. You learn a few more things, too. Now, don't get your adjusting hopes up yet, though; you get to adjust 8-10 whole times during the entire trimester, which does not a manual medicine expert make. But keep practicing. Call it "deep palpation", wink-wink, nudge-nudge. What did I learn this tri? Near the end of the tri, I was slowly starting to realize that I could no longer ignore the evidence that the school is pretty much just money-hungry, with questionable (at best) intentions and priorities. Up until this point, I had been a benefit-of-the-doubt kind of person.

Tri 5: Ahh yes. For me, this was a party tri. Not that I partied all the time (I didn't). Hell, not that I even went to the official Tri 5 party (I didn't). But I loved the classes and (most of) the profs. Some people hated this tri. I don't know why. Maybe it's because it's the halfway point--we'd already been there so long and we were so beat up and burned out already and yet as far as we had come, we had just as much more to go, and there just didn't seem to be any light at the end of the tunnel. Hell, we were wondering if the tunnel was even going to end. But no, I enjoyed it. I loved having Perryman and Dr. G again. I loved Brown's Wellness class and--call me crazy--Guest's Lab Dx class. I loved Pearson and I think we had Strader again for something. I also LOVED Thompson (finally, I could move bones with confidence!). The drawback was that I had to adjust Gonstead (and only Gonstead) in the adjusting lab, but what the hell. Neither my lab partner nor myself liked it, so we did as best we could and got signed off anyway. Hall (not Marty) is also a cockbite--you've been warned. Lesson learned this tri? Find outside seminars! They'll preserve your sanity, your motivation, and offer some important clinical application you just plain don't get at school.

Tri 6: If you did not have an emotional breakdown at least twice a week, you simply were not registering vital signs in Tri 6. This tri was a complete downer, which could usually be traced back to a combination of Bodnar's Business class (i.e. crappy insurance and Medicare guidelines that reduce us to glorified PTs without the good PR or MD lapdog status--and thus healthy referrals) and Student Clinic (paperwork, paperwork, paperwork, all of which reinforces Bodnar's depressing class material). Suddenly, the dreams of helping ADD, autism, pregnancy, ear infections, and everything else, get dashed and (temporarily, hopefully) replaced by treatment plans that are "transparent and defendable", meaning that you pretty much treat only back pain, neck pain, and headaches. They strip you and tie both hands behind your back by conveniently omitting the "neuro" part of neuromusculoskeletal and leaving you to compete with the PTs for that sliver of patients. Activator class is cool but boring. You now have some afternoon classes and morning labs, so that really messes with your chi. Don't discount or blow off Communications. It's actually very important. Instead, blow off Philosophy 3; it's completely POINTLESS. BTW, Kearsing is not nearly as much of an asshole as people think he might be. By the time everyone got to know him, they liked him. His PT class, even if outdated, is still very good. Tri's 4 and 5 left you with exhaustion; Tri 6 you're starting to feel a bit brazen due to the burnout.

Tri 7: The burnout gives way to "we don't give a shit anymore". And you don't. And, you're not afraid to say so. All frontal lobe inhibitions are simply gone. You simply don't care anymore, because you've been through the ringer already. This tri *should* be great; after all, the classes are (a lot) easier, testing schedule is (much) lighter, and you've transitioned from the junior high that is Tri 6 Student Clinic to the High School equivalent of clinic: outpatient. You're one of the big kids now. Yes, depending on your staff doc, you just might get treated as an adult, maybe even with respect. But the truth is, even though Tri 7 should rock, it doesn't. Contrarily, it's actually an emotional beating, to use an upper tri student's consoling words at the time. And here I was thinking it was just me. No, it's not. What brings Tri 7 down is clinic, because you typically start off with zero patients. And as a lowly Tri 7, your staff doc's priorities are the Tri 9's in your pod, because they're close to graduating. They get all the new patients off rotation, they get fed all the exams, etc. Meanwhile, you get jack, and you're left wondering why you're waking up with clenched teeth every morning. Relax. As hopeless as it looks, it will pick up for you and you will get through. The only other part that sucks is, you still have a full class load, so your only available clinic time is 3-7. Here's a suggestion: don't go home at 3p every day when you don't have patients. Instead, clock in and stay. Study. Get your Grand Rounds case type written up while it's still fresh. Look over the material from the day's classes. You're gonna have to study anyway, might as well get clinic time for it. Trust me, you'll thank me later when you don't have to come back after all your requirements are done and sit and do nothing because you didn't put the time in now while you have it. What I learned this tri: be in your pod if you can, in front of your staff doc. That way, when someone is needed to sub for a PT or an adjustment (or even--eek!--a new walk-in patient), you're right there, ready to go, and picking you is a no-brainer. (Yes, admin recently sent out a memo prohibiting this. See, whenever too many people finish on time, the school gets disappointed that they don't have enough students paying full tuition to go through a 10th trimester and they start arbitrarily throwing you curveballs, hitting you where it hurts most. Lay low for a few weeks and then gradually start disregarding the "rule", which is not, by the way, an official policy in any of the clinic handbooks. Eventually, no one will notice.)

Tri 8: This tri is MUCH better. Classes still start at 7am, but you have about half the class load this time around, and except for 2 2-hour morning labs, you can treat patients pretty much any time the clinic is open, because you otherwise don't have any regular classes scheduled during clinic hours. Also, if you were smart last tri (and this one) you hung around during your staff doc's rotation day and with any luck you picked up a patient or two, so maybe you'll start Tri 8 with a patient or a handful. So, not only do you have to study even less, but clinic is at least starting to look, well, not bright, but less grim. Learning opportunity for this tri: I learned (at the beginning of the tri as my patient load started picking up) how to schedule efficiently. You'll quickly learn who your most reliable patients are; give them first pick of the times. Schedule everyone else around that, filling up the times immediately before and immediately after first. Schedule your least reliable patients at the end of the day (you have a lot of M-F 9-5 patients and those end-of-the-day slots are in high demand for you). This way, should the unreliable patient cancel with short notice (or just plain not show up without calling), you get to go home early without having anyone else to wait around for. I wouldn't put an unreliable patient at the beginning of the day; otherwise, you hurry to get to the clinic by a certain time, only for that patient not to be there. Also, as the tri goes on, patients will drop back on frequency, whether it's because they're getting better and no longer need to come so frequently or they decide it's not working as well or money gets tight and elect to drop back or drop out altogether. Get additional people in there, whether off rotation (although never count on this) or having your own people in mind (preferred). Two classes NOT to let get away from you: AK and Rad Positioning. They're not hard and it's easy to forget about them, but if you do, they'll sneak up on you and they're impossible to cram a couple days before. BTW, you probably won't start feeling super-good about your clinic numbers till the second half (or possibly the very end) of Tri 8. By the end of Tri 8, most people feel like they've hit their stride and they're in their game, but don't feel bad or panicked if you don't feel this way. Many people get practically all their numbers in Tri 9.

Tri 9: Where had this tri been all my life?? There are NO more academic classes, so you barely ever see the main campus or even that whole side of the street, except to park. No more 7am mornings; I tried not to schedule patients before 9.30. I really preferred 10am, if it worked for them, because it pretty much kept me out of rush hour completely. I didn't mind staying late, because afternoon rush started before 4pm and if I had any afternoon patients at all, even one at the earliest afternoon time slot (3pm, and I almost always did), I was going to end up stuck in afternoon traffic. Best to schedule some more patients and resign myself to staying the whole day, and not leave till 7p when traffic has a chance to clear out. Nah, this tri is a sleep-in, study-free, get-your-life-back kinda tri. You get to pick up the odds and ends that got let go and neglected during the last few years. The carpet gets cleaned, the car gets fixed, the dogs get their shots, you dust, you vacuum, you clean out your closet and take carloads to Goodwill and other charities. Try not to spend much money, though; this's the last tri you get any student loan check, and remember that it takes 3-4 months to get your license and be able to start practicing. Unfortunately, by this tri (when I would've had time to start massaging again,) the preceding trimesters had all but killed my massage practice and I had to devote so much time to school in Tri 3-7 that I really didn't have time for any massage clients and so I had referred them all to other therapists and had barely any left by Tri 9, so supporting ourselves doing massage therapy is going to be trickier now without the client base. However, I'm more human again. The burnout and brazen-ness I had felt before is gone and my lost inhibitions have been found again. I've returned to the status of a civilized being. Hint: even if the State Fair falls in Tri 9 for you and you think it's a mute point and useless with only about 7-9 weeks left till graduation, go anyway. Some people get all their recruit numbers in Tri 9, a good chunk from the fair alone.

A Sidebar Extra: During the long, arduous process of checking out of Tri 6 Student Clinic (a fiasco I won't revisit, but let's just say that we were supposed to be out by 1pm or so and we weren't able to leave campus till 8pm), a fellow student Josh and I came up with various songs that should go on a soundtrack CD dedicated to Parker. Well, I had also been thinking of something along those lines (as is a way of life for me), and the soundtrack CD turned into a double CD set. The listing would be as follows... (this list--unlike most of my lists--is in order, for the most part)

CD 1
1. Bon Jovi - "Mister Big Time"
2. Our Lady Peace - "Tomorrow Never Knows" (Beatles cover)
3. Republica - "Ready To Go"
4. REM - "Shiny Happy People"
5. Duran Duran - "Too Much Information"
6. Crystal Method - "Busy Child"
7. Scorpions - "Winds of Change"
8. Pink Floyd - "Money"
9. Smashing Pumpkins - "Bullet With Butterfly Wings"
10. Hoodoo Gurus - "Axegrinder"
11. Don Henley - "Sit Down, You're Rocking the Boat"
12. The Who - "Won't Get Fooled Again"
13. James - "Born of Frustration"
14. Meat Puppets - "We Don't Exist"
15. Alan Parsons Project - "Eye in the Sky"
16. Tori Amos - "Crucify"
17. Twisted Sister - "We're Not Gonna Take It"
18. Pink Floyd - "Another Brick in the Wall, Pt 2"
19. Rolling Stones - "19th Nervous Breakdown"

CD 2
1. Don Henley - "Dirty Laundry"
2. Information Society - (Why are we) "Still Here"
3. Dire Straits - "Settin' Me Up"
4. Pink Floyd - "Us & Them"
5. Hanson - "Where's the Love?"
6. Jackson Browne - "Runnin' On Empty"
7. Eurythmics - "Would I Lie To You"
8. Rolling Stones - "Between a Rock and a Hard Place"
9. Queensryche - "Anybody Listening?"
10. Gloria Gaynor - "I Will Survive"
11. REM - "Draggin' the Line"
12. Fleetwood Mac - "Don't Stop Thinkin' About Tomorrow"
13. Mike & the Mechanics - "All I Need is a Miracle"
14. Pearl Jam - "Alive"
15. Pink Floyd - "Run Like Hell"
16. Eagles - "Hotel California"
17. Third Eye Blind - (Can I) "Graduate"
18. Tom Petty - "Don't Come Around Here No More"
19. Queen - "We Are the Champions"

Yep, that about sums it up. So in case you've ever felt alone in your confusion, frustration, incompetence, insignificance, etc, take at least some comfort: you're not.

Somebody make that CD, make several copies and slip them under key admins' office doors. Heh...

Great day for freedom

Yes, it's a reference to the Pink Floyd song. Really.

So anyway, today was our first day as doctors, as graduates-in-limbo (as we're not yet fully licensed, nor do we have our hard-copy diplomas yet). Whatever we are, however, we are no longer students. For the first time since January 2002 (for me) and September 2001 (for Jay), we're not enrolled anywhere, or having to plan a class schedule at any particular school. Yep, that's right. After 8 years (they're not lying--it does take that long), we finally don't have anyone to answer to, any assignment to complete, any book to crack, or any exam to cram for.

I felt the difference in weight as I left the tally office yesterday after checking out of clinic. I had not realized how immediate the feeling would be. I had walked in there with that perpetual weight, after all. The difference was so profound that I wonder if I really am any lighter. Maybe I got lucky and it came right off my abs and butt. I can only hope.

In my life, wherever there's sweet, there's at least a hint of bitterness lurking somewhere (and to be fair, vice versa). Nobody told me about the grief process, the loss I would feel over having transferred my patients off of my roster and onto someone else's. The end approached so fast that for some of my patients, it hadn't dawned on me that I was treating them for the last time, and so I never really did get to say a proper goodbye. For others, though, I knew it was the last time and that made it harder, emotionally. I have my sweet elderly couple on Medicare in mind when I say this. We were all almost tearful when we said our final goodbyes. When I thanked everyone for coming in and allowing me the opportunity to treat and care for them, I meant it. Each of them found a little place under my skin where they will live forever, never letting me forget, not that I would want to.

Last night and pretty much all day today was a mixture of elation and uselessness. To be fair and accurate, today was indeed a very productive day; we placed the order for our single most important tools: our chiropractic tables. We also have in our possession two new members of the family: a diathermy machine and an Erchonia percussor. But other than that, we've done jack shit. OK, I downloaded a ton of rock en espanol (the commute from south Austin to central San Antonio will be long, after all), we diathermied and percussed my chest to finish breaking up the gunk from last week's bug, and we did, after all, watch a History International documentary on snow. Now I know how my Medicare couple felt when I said, "Happy Friday!" to them; they said that they lost track of which day it was because they all were pretty much the same. Now I understand.

There's the pure glee that comes from a combination of finishing school, the prospect of leaving Dallas, the joy in moving to south Texas and being in San Antonio, the dream of starting our own practice, and the fun it'll be to make contacts with friendly people for once (my Dallas friends and family aside, of course). I also look forward to the end of the massage days of simply rubbing on people, using oil, asking how the pressure is, and providing services in silence for an hour or two on end.

There's the excitement of picking out our equipment, browsing commercial real estate listings online and dreaming that one day one of them will be ours, of imagining life in a different place.

There's the sadness of leaving our Dallas friends and hangouts (not that we had many of either, but what we had was quality over quantity), of leaving our house (it was such a perfect fit), of leaving our way of life as we know it. There's the grief in saying goodbye to my patients and knowing that the next time they come to the clinic, they'll sign in for another intern and that I'm no longer a part of their care.

There's a sense of urgency as well. The self-applied pressure of studying, learning material, and getting through school is no longer there. We no longer have test dates and deadlines to worry about. Those have been replaced instead by a need to REALLY buckle down now, in a way I hadn't (been able to) before. It's time now to work out, to really learn Spanish, to learn and perfect our mentor's protocol, to research tools and equipment for the practice, to get quickly acquainted with San Antonio and its people and local businesses and its events, to study up for real on subjects like physiology, neurology, endocrinology, immunology, active care, muscle physiology, pathology, adjusting techniques and protocols, and a lot more.

And there's the apprehension. We're considering selling the house, except that property values are seriously low right now and we'd lose out on a lot if we sold now. We're considering renting it out first, but there's a lot of hassle with that from a lot of different angles, compounded by the fact that we've never owned any rental property before, so we'd be shooting in the dark. We're moving into a house that isn't ours, that is owned by someone else, and what it all comes down to it, they call the shots. They have their way of life, and there are customs they share with their neighbors like coming over unannounced, that we don't share and wouldn't approve of. Having lived on my own for 14 years (and Jay a bit longer), we've formed our own patterns and culture and we're fairly set in it. How do we reconcile that?

There is also the uncertainty that comes from starting your own business. Here we are, already six figures in debt, and we're looking at going further into debt by trying to buy a small building. In the long run it's a good lot better than leasing, but still...that much debt scares a lot of people, including me.

And then, there's the optimism. I'm confident that eventually, everything will work out, and if history repeats itself, our future will be better and brighter than I ever imagined. I'm positive that we'll be steered into the right thing at the right time, and led away from anything less. I'm sure that in years to come, we'll have a comfortable, fun, fulfilling practice with fun, pleasant, common-sense, reliable patients. I have the feeling that no matter what curveballs the Universe throws at us, we'll come out ahead, having dodged the bullets and emerging as stronger people. I'm sure we'll have a blast and help a lot of people. The path is steeply elevated; let's face it--two chiropractors, deeply in debt, opening their own practice from scratch, in a city we've never visited very long, let alone lived in.

But it's been my experience that with us, that doesn't seem to matter. I'm reminded of a time 9 years ago when we were buying our house (jobless) in a city we'd never even been to, we found ourselves running across the parking lot of the realtor's office, hurrying to get in before closing to sign the purchase agreement. It was then that the realization of the fact that we were about to quit our good jobs, move 930 miles away and drop a lot of money (for us) on a house we'd seen one whole time in a city we knew precious little about hit my husband. He started to chuckle and said, "my God, what are we doing?" And in all seriousness I grinned and said, "I don't know but we better hurry up and do it!"

What I do--and don't do--to save money

There's probably one thing worse than finding yourself jobless with ongoing bills to pay...and that's being $150k+ in non-bankruptable debt, while also being jobless with ongoing bills to pay. Even tough I'm part of the Gotta-have-it generation that became conscious of the world in the Decadent '80s and came of age in the Decade of Denial (the '90s), I'm still not too young to have been exposed to plenty of the GI generation that went through the Great Depression...and lived to tell about it. I imagine that subconsciously, I took a few cues from them, some of their fundamental concepts seeding themselves in my head and germinating just when I've needed them most.

I don't drive with the tailgate down, nor do I drive with the A/C off or the windows up when it's 100 degrees outside, just to save on gas mileage. Lots of people torture themselves, sweltering in their vehicle because they think they'll reduce engine load or wind resistance/drag. I haven't found these to work in my favor. Instead, I do stick to about 60-65 mph on the main highways, even if the actual speed limit is higher. I do stay in the right-hand lane when doing this, especially if the general traffic flow is traveling faster. Right away this saves me anywhere from 10-25% in fuel costs. I started doing this during the $4/gallon days, and I haven't looked back since. Bonus: your stress level goes down. Even though you deal with more tailgaters who don't understand that the right lane isn't for hot-rodding or passing other vehicles, you still find yourself calmer in general.

I don't automatically buy larger sizes of a bottle of vitamins, for example, just because it's there. A lot of people do this, automatically thinking they'll get more value for their money for buying in bulk. Increasingly, larger sizes are not a bargain at all. What's worse is, some stores will try to disguise this by comparing apples and oranges; on the shelf label, some stores break down the price per ounce or whatever. I've seen math errors, or different units used (thus making it tougher to compare directly, or whatever. Instead, I crunch numbers. Yes, I actually bring a calculator, and I look on the packages themselves to get size and content information. This way, I can caculate an accurate unit price per pound, per capsule, etc.

I don't clip coupons. For some people this is almost a religious ritual without which their day would not be complete, but I disagree. Coupons hardly ever include anything I would actually buy. Usually they "discount" a pre-packaged item that is so over-priced that the value for the money is still rather low, even after accounting for the "discount". I also think twice before simply stocking up on something just because it's on sale. Too many times I've burned myself by stocking up on a shampoo, deodrant, or type of cereal, just to switch brands, leaving me with a lot of useless leftovers...and money wasted. Instead, I only stock up on something when I already have its use planned, or perhaps it's a perishable item but I've been using it every day forever and I have a freezer to store it in. This is especially true for fruit; I try to buy organic fruit when it's in season and freeze it. Sure, I may lose some vitamin content during the freezing process, but at least I don't waste food due to spoilage, and I can buy organic fruit when it's more affordable, and keep it longer. To keep Whole Foods affordable, I try to buy my dietary staples--and their accompanying spices--in the bulk section, instead of in little prefab packages. It's more work to combine the ingredients myself, and it's not as glamorous as buying a cutesy little dinner in a hip designer box, but it costs much less, and as a nice bonus, I have more control over the ingredients. And we do try to cook at home instead of eating out. When we do eat out, I try to order something that reheats well on the stove, because if I can't finish it in the restaurant, then I can get a take-out box and reheat it later. Two lunches for the price of one, and I don't overeat. When I go out, I do not take my thriftiness out on the service staff if I've gotten decent service; they have to make money too, and tipping is a custom that is understood and automatically agreed upon by the very fact that I have chosen to eat at that restaurant. If I can't afford to tip according to custom, then I can't afford to eat there. Those of you who don't want to tip, get over yourselves and go to Burger King.

I do not shop at Walmart--at least, not if I can avoid it. Yes, it's possible. There is life outside of Wally-world. And it doesn't even have to cost you an arm and a leg. The asterisk to those everyday low-low prices is that the stuff is junk. I thought I was saving money by buying a skillet for $40 that would've cost me $150 elsewhere. Well, after going through 3 or 4 of those in a single year or 2, I got sick of teflon coming off in my food and having to replace the thing every few months, and I buckled down, sucked it up, and invested in a product with some quality. Sure I paid more, but 7 years later I still have the thing. (The beauty is, it's not even Teflon--which is all I could find at Walmart.) Instead, to save money, I try to buy quality products locally, if I can. Local mom-and-pop shops are more likely to give cash discounts to promote a turn away from credit cards and the fees they carry. I do not buy extended warranities, especially from large chain stores, or for my truck. I've been suckered in to several in the past, and none of them have ever come out in my favor. Each and every time, I could've survived very well without them. Invest in decent products from decent companies at decent stores, and you do away entirely with the problem that an extended warranty pretends to band-aid. I also don't usually buy generic products. Some store-brand items are fairly good, but others simply don't live up to the pricier brand name. Experiment, because it's a mixed bag.

For things I can't get very easily at mom-and-pop stores like clothes, this is where chain stores come in, and there are plenty of good ones. Some, like Kohl's, sell great styles of decent quality (even if it is made in China, which is indeed a black mark), for a decent price. I also like Ross; sometimes, a lot of last season's Kohl's or even Dillard's or Macy's overstock ends up there, with slashed prices. In these stores, head to the clearance racks first; don't underestimate last season's leftovers. This works in the malls, too, which is how we can afford to shop at malls. In a crunch, don't overlook Goodwill; there's no shame in shopping there. I might check Plato's closet or TJ Maxx, but in my experience, while Plato's closet has good selection, it's a bit pricey for used clothes, and TJ Maxx doesn't have a lot of style--or wonderful prices. Ross is better. In the Dallas-Ft Worth area, Dillard's has a little-known national clearance/overstock store in which the clothes there are regularly 70% off the regular Dillard's stores. During holiday weekend sales, the savings are even greater. The DFW store is the only one I know of its kind, so if anyone else knows of one in their area, speak up. The drawback is, there are no returns, refunds, or exchanges, so try everything on and make sure you're in love with it before leaving the store. It's worth it, though; we bought about $2300 worth of good quality clothes for about $260. We do not, however, frequent any kind of outlet malls. They're practically full retail and sometimes the actual clothes lines are of inferior quality than those found in the regular stores. And the return policies aren't real friendly, despite the retail pricing. I also would never shop at Walmart or Sam's for clothes. We used to, and the shirts would start coming apart as early as the first or second washing. For non-clothing items I can't get locally, I try places like Amazon, Half Price Books, or Movie Trading Company.

We don't go to the State Fair on Pay-One-Price day (you know, where you get the bracelet that you pay a flat price for and ride unlimited all day). We also typically don't get season passes to any parks. Instead, we do other things, like bowl during non-league times or mini-golf during off-peak hours. It's cheap and just as fun. Although it's less glamorous, there's also less to go wrong. We also go to dollar theaters instead of regular ones. If we travel at all, we try to take trips during off-peak times and if we need to fly or stay in a hotel, we've had good luck booking online with sites like Priceline. I've heard less-than-good things about Orbitz, though.

I don't buy into the so-called "green" light-bulbs or low-flow toilets or low-usage shower heads. Why? Because the light bulbs have toxic chemicals like Mercury in them (how "green" is that??) and to flush or wash my hair requires a certain amount of water no matter what, and limiting the amount of water capacity won't change that; it'll just force me to have to flush again or use my shower head longer to get all the shampoo out of my hair. Instead, I do save money (and the planet) by turning lights off when I'm not in the room (what a (lost) concept!!) and turning the water off while I'm working shampoo or conditioner into my hair.

I don't buy used CDs to save money, unless I'm really into the cover art or I simply want to have the hard copy in my collection. Instead, I download music for free. There, I said it. Before anyone goes getting all holier-than-thou on me about starving artists or starts trying to scare me into the consequences of my breach of the law, understand that the artist gets NONE of the revenue generated during the sale of a used CD, and don't worry; the way I do it, I'm not going to get caught. There is pretty much zero chance. I've been using the same method for over 7 years, so have countless others, and I have yet to hear of a single charge being brought upon the users of our system. Besides, I already have a helluva CD collection, legitimately purchased. Oh, and I'm a starving artist myself, on the side.

I don't try to pinch pennies by carrying liability car insurance only. I get full coverage; that way I know I'm generally covered no matter what happens. I do try to save money by shopping my car insurance every year, taking the defensive driving course (online, and it brings your premiums down by 10%), and avoiding accidents and tickets. I also try to minimize my driving by combining trips and not making special individual trips, and carpooling when possible.

Other things? Check with phone/internet/cable companies about package deals. If you're an avid user, look into unlimited plans. If you make international calls, check out those plans. They have them, but they'll never tell you unless you ask. Also, instead of going to a gym, I work out at home. Sure, it's not the same, and there's a lot that I can do, but if you're looking for an aerobic workout, you don't even need a treadmill. Instead I invested in Power 90 and other exercise tapes. I went to used sporting good stores and picked up small sets of free weights. I get a plenty-good workout, without the monthly gym expense, having to drive, or even having to front a lot of initial capital for expensive home machines. It's also good to scrutinize your bills, especially your credit card bills, and especially this time of year. Unauthorized charges should be questioned, investigated, and reversed. Pay everything off every month to avoid interest and other fees. Also, instead of going to the MD for every little thing, I save money by getting adjusted regularly. It seems more expensive, until you realize that it's been forever since you've been sick and you think about all the medical doctor bills you've saved. Instead of succumbing to pharmaceutical medications, I opt for natural supplements and preventive care instead. Don't skimp on a good CPA to do your taxes, either. Chances are, they'll save you more than they charge you. Don't pay unnecessary taxes; seek out a pro. (Note: H&R Block does NOT count!) And above all, I avoid anything that has a monthly charge, like memberships and automatic deductions. I carry one credit card and I have a second one for online purchases only. I refuse to sign up for any store credit cards, no matter how high the pressure to do so, or how tempting the discount is. They don't offer these discounts for nothing - the average discount is 15% off that day's purchases; well, they'll probably get that 15% back in fees, and probably more.

Saving money isn't tough, but to really do it requires common sense. What people think they're doing to save money (i.e. opting for cheap products, or scaling back on a server's tip, etc) often isn't the way to go. In reality, you need to think before you purchase and exercise long-lost virtues like discipline and resisting the temptations of instant gratification.

Why San Antonio kicks Dallas's ass

Dallas and Houston (and to some extent, Austin) walk around with noses in the air, either sincerely believing that they are all that and a bag of chips, or wanting everyone else to think that...or probably both. But pride indeed goeth before the fall, verdad? Truth is, these cities aren't so great. Plagued by aggressive drivers, frustrating traffic congestion, horrible water treatment, choking smelly air, and alpha-male temporal lobe-dominant attitude, it's getting to the point where you couldn't pay me to live there. At least, not anymore.

Enter San Antonio. San Antonio edged itself into my life by way of a combination of intuition, logical natural progression, the egging on from other people, and some basic research. San Antonio is cool for all the reasons the wrong people say it's uncool. I've encountered several people who, well-meaning as they may have been, have expressed a disgusted surprise when we answered their post-grad questions with "San Antonio". They genuinely wonder why we would want to go there. How badly I wanted to answer, "because people like you say things like that". You see, I want to go exist in peace, where the alpha-types couldn't stand to be, because that means they won't be there.

In all actuality, San Antonio, with its un-flashy humble pride (an oxymoron that only San Antonio can pull off successfully), quietly kicks the ass of any other US city, especially those cities that think they're all that, like Dallas, Houston, Chicago, LA, and practically any other city on either coast, especially the west coast. Sorry, that's just the way it is. My physical body returned from San Antonio just today, although I swear my brain is still down there, somewhere on Blanco. Said notes are shared henceforth...

The People. You've gotta be a real special snowflake asshole to not like the people here. They're friendly and commonsense, with an uncanny ability to walk a delicate line between proud/loyal and respectful/humble. They're friendly, with a long fuse and a tendency to give you a break or at least the benefit of the doubt. They'll let you in on the freeway, even when it's obvious you don't know where you're going. They don't sit on your ass, kissing your back bumper. They don't keep a trigger finger on the horn, waiting for you to make the slightest mistake. They actually use their turn signals and they give you plenty of room after they've passed you before they try to merge back in your lane again. The servers at the restaurants smile, help you out with the menu, and don't try to practically push you out of the table by bringing your bill before you're completely finished with dinner. Even Black-freakin' Friday at the golldang mall was surprisingly benign, polite, and non-electric. No need to go in with boxing gloves on, ready to swing. It was a delightfully painless experience. And no, I didn't need a traffic report on the radio to warn me about how full the mall parking lot was; there was plenty of parking.

The Culture. Unfortunately, it's not for everyone. That's not saying anything bad about SA, that's saying something bad about the rest of the people everywhere else. The culture is a laid-back amalgam of a vast array of ethnic backgrounds, all seemingly dwelling together in amicable coexistence, without so much as a skirmish. Mexican, German, Asian (especially Vietnamese), and Native American are all represented. What's especially cool is, these cultures weave together, remaining strong and pure, without compromising themselves. They don't tiptoe around some timid political correctness, they just are what they are and they're not hiding, afraid to be and express what they are. Despite this, comes the coolest part of all: there's hardly any racism. No matter what you are or where you come from, as long as you don't walk around like a pompous prick and make an ass of yourself, you're welcome here and you can just be yourself.

There is also a more thorough integration of classes in SA. When driving through a particular part of town, you can't write off a whole neighborhood by having seen only one street, you have to consider each building or house individually, evaluating the area on a house-by-house (or building-by-building) basis.

The part that is not for everyone is that it is very laid-back, and very simple-minded (which I mean as a compliment!) small town, with simple priorities and philosophies. There's not much nightlife. Aside from the Alamo, the Riverwalk, and a handful of other tourist attractions scattered around downtown, there aren't that many highlights (although the attractions we have simply just plain rock). It's a small town, with every quality that a small town has--it's just that it's a small town dozens of times over, a bunch of small towns laid end-to-end so that together, they form a large spread out area. But it's not a fast-moving, flashy, happening, A-list type of place with hip, trendy digs at every turn. You don't have to be on the guest list, because all there are are some neighborhood hangouts. Some people want more action than this. Some people want to play, to patronize dance clubs and arenas. Some want to meet hot singles and play. San Antonio is a calm family town full of people whose priorities are more mature. Don't get me wrong, there is still plenty to do here, and a lot of it is low cost or free altogether. But it's not the kind of town that values shallow status symbols. Put the I-want-to-impress-everyone-at-the-office-water-cooler conversation away, because it'll get you limited mileage here.

The Scenery/Environment. Like the people and the culture, the physical surroundings rock. Many parts are full of hills and trees, and people from Dallas and Houston will experience a nice surprise: they can breathe here. Why? Because the brown layer that hovers over the horizon in Dallas (which sits in a bowl, and I haven't heard anything better about Houston, either) is refreshingly absent in San Antonio. Maybe this's why we can actually fill the truck up with real gas here--the pollution is low enough that the EPA hasn't put the smackdown on the city/county to force less-than-real gas upon us. The views can vary from excellent to non-existent in the hilly parts, and the terrain can be flat and treeless in certain parts of town. But for the most part, it's twisty-windy streets, a tree canopy over the yards and roads, and relatively decent air. The water is awesome, too. Why our north Dallas suburb water (which is supposed to be quite well-to-do) literally reeks the second you turn on the faucet, of both mold and chlorine at the same time, I will never know. It takes an act of something special to pull that off. San Antonio, though, tastes no worse what you'd expect city-treated water to taste like. And it doesn't stink.

The Infrastructure. I spend an obscene amount of my life behind the wheel and as such, it's important that I evaluate the infrastructure. One of my greatest stresses is traffic, and bad drivers top my list of pet peeves. It's a blessing that SA has, for the most part, decent drivers who are generally waaaay more courteous than practically any other major city. This is more than I can say for Dallas. Thirty minutes in Dallas traffic is more stressful than 3 days of nonstop all-day driving in San Antonio or even a week of the same in Saskatoon, Canada. As for SA? This city had a bright idea: let's build infrastructure to actually match the traffic it's going to hold. How's that for an idea? Bonus points: SA's freeways don't even need an HOV lane, because traffic doesn't back up quite that bad on quite that regular of a basis. And yeah, you heard me...freeways. There are no tollways--at least, not yet.

The Atmosphere. It's interesting. Malls? There are a few of them, and they have a good mix of the national staple chain stores and those few-of-a-kind dives that the tourists don't recognize. Parking is plentiful and most stores don't try to nab you for every upsell (except maybe New York & Company, which was as annoying as a Disney DVD in which you have to get through 15 minutes of preceding ads before you actually get to the real movie), and for the most part, the kiosk salespeople behaved themselves. Restaurants? There are plenty of them. They're generally one-of-a-kind or close to it, and they often make their food from scratch and sell a decent portion for a reasonable (or even downright cheap) price. The ambiance is fine, and you can almost always carry on a normal conversation. One restaurant even has an celiac-friendly menu, complete with all the appropriate substitutions so that someone with Celiac Disease can eat out without worry, and enjoy it, without having to make all kinds of picky substitutions. Other entertainment? Tons, and it's affordable. There are a gazillion places to go bowling or mini golfing. There are dollar theaters, too, a couple of gyms (although no Massage Envys or other discount massage facilities, thankfully), and some decent neighborhood parks. Like I said, these are simple people (and I mean that strictly as a compliment, by the way). They are low-maintenance and don't need to be constantly entertained throughout life.

Other miscellaneous ways that San Antonio whips Dallas's ass:
* SA is actually trying to revitalize their more rundown areas.
* SA has the Spurs, and not the Mavericks or the Cowboys.
* Evangelists do not have nearly the stronghold on SA that they do in Dallas.
* SA is known for its thunderstorms...and not its tornadoes.
* SA generally displays "Support Our Troops" bumper stickers instead of Obama '08 ones.
* Bexar County is infinitely more animal-friendly than Dallas county ever was.
* In SA, shopping is not a powersport.
* I did not have the "Green" movement shoved down my throat in SA like I do in Dallas.
* SA drivers favor common-sensible cars and trucks instead of BMW and Mercedes.
* In SA, you can watch the restaurant server make your guacamole fresh at your table. And, get this--it's priced very reasonably!
* Even the Fox affiliate is less flashy and obnoxious in SA. Now that takes an act of God(dess)!

Thanksgiving, or Forgiving?

There are your plans, and there are some higher power's plans....and in the end, yours don't count. You see, I had today all planned out, a year ago. Yep, we were going to start a tradition. Remember how, last Thanksgiving, my mother, my husband, and I all went to the Texas Renaissance Festival just outside Houston? My dad was out of town so he couldn't be with us, but we simply assumed that this year, we'd be doing the same thing and this time, Dad had planned to join us.

Not so fast. You see, some geriatric whose mental faculties warranted the stripping away of his license years ago managed to slam his big-nuts all-steel pickup truck into my parents' Fisher-Price Ford Escape (not meant to criticize the rents, but merely to impress upon y'all the inequality of the vehicles involved and the subsequent disadvantage assigned to my parents), throw my father 30 feet into a concussion that would ultimately cost him 80% of the hearing in his right ear (permanently), and my mother one of her kidneys among many other serious injuries, all of which involve chronic sequelae and thus long-term care.

It's amazing how fast one second changes everything. In a parallel universe somewhere just out of reach, I'm walking around with my family, bodies intact, throughout the RenFest grounds. I'm dressed up as the custom-made bad-ass warrior princess with ancient Turkish accessories and a semi-functional sword. My mom was planning on she and my father dressing as a pair of pirates. But somewhere in Saskatchewan, there is a stop sign that needs to be twice the size that it is. As it stands, they're at my sister and "brother"'s house, awaiting my mother's surgeries (her kidney's been dead since May and she developed a hernia in July but she's been on a surgical waiting list since August, she's had multiple consults, and the earliest surgery date they've been able to get her is January 19th. How's that for healthcare "reform"? Do you really want government-run medicine? If so, fine. But be prepared to wait, and do not deceive yourself into thinking, for one second, that you'll get the standard, quality, and timetable of care you receive now. Off soapbox).

Funny thing is, though, aside from the healthcare atrocity, I sense a peace that shouldn't be, considering everything that happened this past year, and everything that's slated to happen this next year, but it's there, big as life. We packed a truckload of books and unopened packs of twin sheets to use for massage therapy, and we strapped it down under a huge green tarp and went. Coming into the small rural area in which my parents live, an area that up until now had always been one of slightly oppressive isolation and extra-sensory astral murk due to my uncle's slow, agonizing neoplasmic death several years ago, I still felt a warmth and peace. Something told me that it was OK to be there. It felt slightly strange unloading our stuff from our truck and into the workshop near the house, a feeling that could easily be attributed to the fact that after what seems like forever, we're leaving our house, the house that was supposed to be home until the end of time, because of how perfect a match for us it is, and the fact that I would have liked to have moved for the last time. (Well, we could've succeeded had we made a more palatable decision, someplace--in Texas--other than Dallas.)

But still, it feels oddly comforting. I can't describe it. It's infinitely more palatable than I had once thought. Hell, it's beyond palatable, I'm downright out-and-out LUCKY. We have a place to live and a great setup at that, and an open invite to stick around a while. We can now begin to realize our dream, several years ahead of schedule. I'm quite thankful.

I'm also thankful that although I don't get to spend Thanksgiving with blood relatives, I do get to spend it with an incredible husband, who has parallel visions and identical thought patterns when deciding on what we want to do. I'm thankful that we're thisclose to finishing school. I'm thankful that we're not being forced to move or shed our house due to being financially strapped or in an otherwise bad situation. I'm thankful for being able to eat food, the fact that someplace was open--even if it was Dairy Queen, it was something.

Above all, though, I'm thankful that my parents survived their accident, walking and talking like they were almost their old selves again. Sure, some innocence has been lost (let's face it--there are still stones unturned, even in middle-to-later adulthood). They now have memories that no one should be stuck with. But when all is said and done, they're still functional and they can live independently, enjoying pretty much all the activities they took part in before. Once their bodies are repaired, they'll be able to go on with their normal lives, almost as they were before. (Maybe then I'll be able to forgive the bastard that hit them; until then, he can burn in hell for all I care. But...) Time will heal...eventually. And when it does, maybe we'll get to go on a little jaunt to the RenFest grounds north of Houston over next year's Thanksgiving weekend. And we'll start our tradition after all. Dressed as warrior princesses and pirates of the Caribbean. Or something like that.

The "P" is for Purgatory (or Plan of attack)

Now that you know what you're up against and what to expect, it's time to plan a strategy for getting through it. At over 9,000 bucks for the privilege of working for free for 4 months, and so many requirements to meet, you've got to be proactive if you plan to finish on schedule. Here are some gems that were handed down to me. Some of them are rule-benders (if not outright breakers), but they're "the way it's done" in order to get out on time. Because I'm selective about who I tell about this blog, I'm OK sharing this stuff here, but don't go blabbing it to just anyone, because it will inevitably get around to the Unfriendlies In High Places, who will predictably close any loopholes and insert new obstacles just for good measure.

First things first. Day 1 of Tri 1, they spring the 10-Recruit requirement on you and advise you to start getting them in right away. Right? Well, yes and no. Recruiting patients to outpatient clinic before you're actually an outpatient intern is a double-edged sword. You should do so because the profs are right: you can start getting patients in early. Not to mention that it's easier (they forget to tell you this part), because if I understood right, all the new patient has to do is show up for an exam and poof! They're a recruit. Once you're in outpatient clinic and you're recruiting them as your own patient at that time, getting the recruit credit isn't quite as easy. There's more to it, more steps to go through. However, be very, very careful who you refer your prospective patients to. Ideally, seek out an upper tri (the best way is through clubs that meet over lunch--that way you know you share some common interests) and form an alliance with them. When your prospective patient wants to come in, have him/her call you first and (ideally) set up the appointment through you. Act as sort of a liason. That way, there's no question in the upper tri intern's mind about the source of the patient. Most importantly, make damn sure your name and ID number appear all over the patient's intake paperwork (supply them with this and instruct them to specify that it was you who referred them). I never recruited patients in this way but I know some who did. Some got burned, but it was usually a lack of instruction given to the new patient, and a lack of following up on (and tracking) the status of the credit to make sure it goes in your name. I know others who did get almost all of their recruits in even before starting in outpatient clinic and they did quite well. It was nice to have that (often big) stress behind them.

So yes, we have to recruit patients. They're not kidding. People have indeed been held back from graduating simply because they didn't meet the minimum number of recruits. People who struggled through clinic saw that I was getting through OK (even though I did not broadcast this) and asked me how I did it. Patient recruits come from anywhere, as long as it's from the heart. Yeah, it sounds cheesy, but you have to operate from the right headspace in order for this to work. You can't act from a state of desperation, because patients are not stupid--they'll pick up on it in a heartbeat. So what to do? Be confident without being cocky, and step just a bit outside of your comfort zone. The most successful interns I saw pulled in fellow church members or fellow gym/healthclub members. One was a teacher at a massage therapy school and had a captive audience of 20-30 people over the course of 4-6 months with whom to build trusting relationships with, and a lot of them came to see her and/or referred massage clients to her. I was a massage therapist myself, with my own low-volume private practice. People were already criss-crossing north Dallas suburbia to see me, whether from home or from work, so it wasn't a big deal for most of them to drive out of their way to the clinic.

Parker also has a booth at the Texas State Fair. One word of advice: go. Sell the vouchers. Talk up chiropractic. However, make sure the other party is actually interested; I watched some of my (unfortunately) soon-to-be colleagues get obnoxious about it and start practically accosting anything with a pulse. Don't listen to those who say you won't get anyone at the State Fair. You have to operate from the heart and from a place of confidence, because if you are truly ashamed to be there or you think you're wasting your time, then you probably are. You won't get anyone that way. Be real, talk in plain terms to anyone interested, and see if they'd like to sign up. If you handle people nice and easy without putting on the pressure to "sign up today! But wait! There's more!..." then people will feel comfortable with you and if they were ever thinking about becoming a patient, you might just clinch the deal because you now own the most important part of their decision: trust. Another word of advice if you do the State Fair: dress nice (no polos) and when you sell a voucher, try to schedule them right there. (Yep, that means plan ahead and bring your available appointment times with you, written down. Cross them off when a patient schedules for that time so you don't double-book yourself.)

Most of my recruits were people I already knew. You can definitely go this route. If you have friends in the area, or family with a different last name, you can pull this off well. I brought in 3 friends and 4 massage clients. The hiccup was, the school suddenly enacted a rule (shocking) that patients had to attend the health talk after they'd had their exam, so that meant they could no longer attend the health class first and buy the voucher to use themselves. This means they'd have to pay full price ($100 plus) just to jump through all the hoops that finally got you recruit credit. How to circumvent: Line up a bunch of people interested in buying vouchers to be available to do so about 2 weekends from now. Go to the tally office and get the blue voucher kit request form. Fill it out (put your phone number as the contact and make up a location and health talk subject), make sure to check the box that you're doing a health talk ONLY, and NOT a screening (which requires a staff doc). Turn it in. Check back on the availability of the kit a couple days beforehand, because they won't hunt you down to tell you it's ready. Now you have the voucher kit for the weekend--make the rounds among your friends, sell the vouchers (following the instructions in the kit), and schedule the first appointments right then (take your calendar with you). Return the voucher kit on Monday. Not only did they get the voucher for the discounted package, but they also filled out the 1-page health survey that serves as their evidence that they attended a health talk. Now you don't have to rope them into attending one at the school.

Speaking of, let's talk about that little health talk/class every new patient has to sit through. The school claims it's a CCE requirement (nice cover, great excuse, and you'll hear this one a lot), but I don't buy it. Regardless, it's required in order for you to receive recruit credit (I'm not sure if this is the case if you're Tri 1-6, but I know it is if you're an outpatient intern). Some interns had some trouble getting their patients to attend one. (They only have to come to one, and they can choose among various times - usually 8.30a, 2.30p, and 7p.) Patients didn't mind showing up for their adjustment (a plus), but some had no interest in the care class. How to circumvent: the intern who told me about this said that she would schedule their appointment to begin at 3p, but tell them that it was at 2.30p - once they showed up, the clinic was not open, but they would already be there...just in time for the health care class to start. Then the appointment would take place right after that. Problem solved.

Speaking of non-compliant patients...let's talk about reeling them in and keeping them on track. First, take (gentle but assertive) command from the very start. Patients are looking to you for your lead and direction, so deliver the goods. Take the reigns when scheduling that first appointment. Avoid open-ended questions like "when would you like to come in?" Instead, ask if there are any particular days of the week that are good or bad. If you get the gist that they can only do a certain time of day or a certain day of the week, work with that. Offer them specific appointment times.

The next opportunity to set the tone comes from the Report of Findings. Keep it short, real, common-sense, and down-to-earth. Make it about them. Address their questions and concerns. Explain what's wrong with them and tie it in to the symptoms they've mentioned. Without fear-mongering, tell them what's likely to happen down the road if they don't get this treated. Patients are visual people, so conjure up some imagery--again, I stress: keep it real, keep it honest. Here's your chance, don't screw it up. Once they realize what their situation is, impress upon them that you've seen (or heard) of this before, and it has responded well to chiro care (if it has). Explain that at first, you'll need to see them more frequently to get ahead of their condition so you're not going so long in between visits that you're starting from Square One each time, so that would typically require "x" number of visits per week for "y" weeks, to start off. Emphasize that as they get better, the frequency will drop off until eventually they're just mainenance (here's a good time for a dental checkup analogy). Once you've indicated the treatment frequency, they know the score. They get the big picture.

Then, you reinforce compliance with each visit. If they're even 3 minutes late, call them. If they no-show, remind them of your personal cancellation policy, explaining that it's only fair to the other patients who may have wanted that spot but got turned away because it was already reserved for the person who ended up not showing up. Each time you treat them, schedule the next appointment before leaving. Most of the interns I saw struggling through clinic had a tough time taking control of the scheduling and they let the patients schedule themselves. That's like letting the inmates run the asylum. When setting that next appointment, have several specific time slots in mind, and have them choose. Even if your day is wide open, don't let on as much.

Finally, if a patient starts to become unreliable, schedule them either at the end of the morning or the end of the day. This way, if they're scheduled at noon and they don't show, you get to take a long lunch. If they no-show for their evening appointment, you get to go home early instead of having to wait around for a patient after them. If a patient becomes a chronic no-show, do your part by attempting to call them and note your attempts in their file. Finally inform them that since their file has been inactive for "x" number of weeks/months, you'll need to close their file, but let them know they can start care under another intern at a later date anytime they'd like. And then let them go. Walk away from them, especially emotionally. Don't take it hard; it's probably not you.

Another piece of advice given to me was, recruit in waves. Get a couple of patients in. Get them examined and start them on a treatment plan. Then, as they get re-evaluated and their frequency starts tapering off as they improve, bring in a couple more people and examine them and get them started on treatment. This keeps you steady, so that you're not too overwhelmed with a ton of patients from the get go, nor are you freaking out later like some other interns I talked to because all their patients evaporated at about the same time, leaving them with a lot more adjustments to get and no one else to readily recruit.

Let's talk re-evals. This is probably the iffiest part of the post, but it was one of the most valuable insights someone gave me. Every time a patient is due for a re-eval, do an SRU. Protocol assumes you'll do an RRU--how nice of them--they effectively soak up a large chunk of your time for something you don't get exam credit for, and they do make a little money off the patient to boot. Wow, you'd think they did that on purpose. Oh wait... Meanwhile, you've got 24 required exam credits to get, so what's an intern to do? Here's the deal: when you re-eval your patient, make sure they have a different chief complaint. You need not change the underlying diagnosis; their condition is still the same. But if the main area of complaint is different, then you can do an SRU, which counts as exam credit. Make sure to code for 99213. You might get told to code 99212; do NOT do this, you will NOT get exam credit for this code. Also understand the dirty secret about extremities: extremity exams are also not credit-worthy, and neither are extremity adjustments (although they do charge the patient for these too...and as far as your credits are concerned, they are worth absolutely nothing to you). Warning about SRUs: don't attempt them on patients who are faculty staff doctors. They know what you're trying to do and will bust you. Also, do NOT do this with Medicare patients. Their chief complaint can't change or you'll be losing credit for a whole whack of their adjustments somewhere down the line.

Yeah, while we're on the subject of coding, do your patient a favor and fix pretty much everything you find wrong with them, but when it comes to the fee sheet, mark the 98940 if they're private pay. I fail to see the point in charging people more just because you adjusted more areas. To me, that feels like nickel-and-diming, and your patients will see it that way, too. Everybody does it this way. Now again, faculty don't pay for their care, so go ahead and mark 98941. In fact, it's probably best to do this, because statistically, you should have a certain percentage/ratio of 98941's, but I don't know any specifics on that.

On the subject of Medicare patients, be very, very careful in how you code. Do NOT rely on your staff doctor, no matter how competent they are or how much experience they have in the field doing Medicare, or anything else. The school has a printout of the guidelines for coding, and they're at least clearer than mud (which is more than I can say for most of the school's other policies). Know these guidelines inside and out, because a Medicare adjustment is NC (No Credit) until proven otherwise. Make damn sure your Medicare patient has a spinal chief complaint--no extremities allowed for a CC--and make sure your exam and DX codes are all spine-related. Medicare will not cover extremities, so you'll get NC'd (I know a student who got 40 adjustments thrown out for this and had to spend an extra 1-2 trimesters making them up). Make sure there are 4 legitimate DX codes in the blanks, too. You'll need them because technically, your staff doc is supposed to do the first adjustment for their first 2 codes, and then you do the rest, pertaining to codes 3 and 4.

A note to all of you coming of age right behind us: try to take as many x-rays as you can in student clinic, because those patients don't pay for x-rays, so it's a lot easier to talk them into getting films when they don't have to pay for them. Try to take full spine as much as you can. You have 15 interpretive reports to write, and each series is a separate report, so you can get 3 report credits on a single person's full spine. You could do 5 of those and technically be done with those before you even enter outpatient.

Let's talk lab work and radiology recommendations. There's only one caution I can think of here, and that is that several interns that graduated before us were held up from graduation due to the fact that they hadn't properly addressed any existing lab or rad recommended follow-ups (or they had, but hadn't documented as much). These recommendations are flagged in the reports you get back about a week after the x-ray or blood draw. These interns had to have the patient come back and sign the report indicating that they knew about the recommendation and whether they elected to or not to follow up on the flag. Yes, the patient apparently had to physically come back to the clinic to sign. Don't get caught in this situation; it can delay your checkout!

That's all I can think of for now. Our Thanksgiving trip will come too early as it is :)

Be careful, my pretties--it's a jungle out there.

The "P" is for Purgatory (or Pain)

I've written some "getting through Parker"-themed entries before, but this deserves its own post (or several), because clinic is its own beast. If you're in Tri 6 or above or you're close to someone who is, you know what I'm talking about. When our class had just started outpatient clinic and we dared to compare notes with each other, I quickly realized that as alone, awkward, incompetent, and overwhelmed as I felt, I was actually not alone. In fact, more people had parallel experiences than not--many more than I ever imagined. As I progressed through clinic into the top tri's, I found myself giving pep-talks to the under-tri's--the same ass-saving words of adviced I had received from senior tri students just a few months before--in an effort to introduce some peace and comfort into the prevailing vibe of anxiety and desperation. And when I started making half-joking noises about writing an unofficial, unauthorized Parker Clinic Survival Guide of sorts, I actually got a lot of encouragement, and they were serious. So, here it is...

The first thing to keep in mind is a very simple concept: they want everyone to have to spend an extra trimester there. No, you're not imagining things. With tuition on the automatic increase every January, it seems as though December graduate-hopefuls are under just a bit larger of a microscope when it comes to scruitinizing credits, and the Axe of No Credit seems to swing just a bit easier in the house's favor. Or so I've been told. Understand and accept that everything you do has to be waterproof and airtight, because they will nullify the entire superbill, and all of its accompanying credit, on a simple technicality, even if that technicality had no impact on either patient care or the school's revenue. Understand that there is indeed a motive hard at work here, penetrating and motivating every decision made. If, despite all of the speedbumps and roadblocks, you're rocking and rolling your way through your requirements, you'd best keep it on the down-low, because if too many people do this, admin will indeed add another hoop for you to jump through, and chances are you won't be grandfathered in.

Now, that's the administration. Enter the attending staff/faculty doctors that oversee and approve what you're doing. They are usually on Team You, at least to some extent. They want you to succeed. They want you to meet your numbers. Their job depends on it; your numbers are their numbers. Part of their salary is based on the productivity of their interns. (Kinda adds validity to the conspiracy theory; if you're not able to adequately meet your numbers, they extract another trimester's worth of full tuition from you, and they need not pay your doc as much. What about the extra revenue they'd generate from patients if the clinic is nice and busy, you ask? Ha. PALE, in comparison to your tuition. Think a patient will ever end up paying $9200 worth of care in 4 months?) So anyway, the staff docs want to see you make it. They want to mould you in their image. Well, some of them do. They all have their reasons for being there, as opposed to real world practice; some, like mine, burned out of uber-successful megapractices, while others couldn't hack private practice and also couldn't admit as much, and came running back to their alma mater. The latter category could give two shits about your success; they're just happy not to be bagging groceries for 8 bucks an hour. But as for the good staff docs, pick their brains. Have them show you some of their tricks of the trade. As far as numbers go, while they can't wave any magic wands and make patients appear out of thin air, they just might could pull you a few strings come crunch time. So keep them in your back pocket.

Now that we know the players, let's set the scene. Opening Act, Tri 7. There are no two ways about it: Tri 7 is an emotional beating. Rationally, it shouldn't be, because the pressure cooker classes are starting to open the release valve, and you're out of Student Clinic (thank God). You can now treat real people and start etching your groove, laying down the foundation you will draw from, quite possibly for the rest of your career.

But in Tri 7, you're missing a very critical component in making that dream come true: patients. Make no mistake, they're scarce, and you're generally on your own, at least for now. If you're going to get any numbers at all this Tri, it's because you made it happen. (Hint: spend as much time as possible in your pod, in front of your staff doctor.) Nobody else is helping you out or holding your hand, and you're going to feel largely ignored and passed over. As hard as it is not to worry, don't. I know, it's easier said than done, but seriously, everybody around you is going through the same thing.

Don't feel shortchanged by your brethren who brag about hitting the ground running with five appointments scheduled the first week. I've personally seen natural law do funny things, like five appointments become zero. So, don't count any chickens before they hatch, because it ain't truly over until all is said and done, and even once it is, don't go bragging about it. On the flipside, don't freak out when you realize that Tri 7 is almost done and you don't even have 20 adjustments yet. Don't start doing the math at this point and wake up clenching your teeth because at this rate, you're only going to have 60 adjustments by graduation, which is less than half of the 200 needed to graduate. If you remember the fairy tale about the Tortoise & the Hare, good, because I see it alive and well every day, and it'll help you to keep it in mind. If you're not familiar with it or you've forgotten, look it up. You'll be glad you did.

Tri 8 gets better. At the tail end of Tri 7, you may (or may not) have been thrown a few bones (i.e. upper tri students pass hand-me-down patients to you). Keep in mind that many of those patients were personal friends of the previous intern who may have been under care for the sole purpose of helping that intern through school, and now that the intern is done, the patients may not have any intention of continuing care. A few transfer patients, however, may decide to come in for you; most of those have already been patients forever. The more time you spend in the pod around your staff doc and upper tri interns, the better your chances of scoring transfer patients. Any help you get by way of patients will probably come from other interns and not your staff doc; in fact, you'll probably wonder when you'll start to get any help and you'll feel like people all around you--even those in your class--are passing you up. My own experience was similar to what I'd heard from others; I didn't hit my stride until the latter part of Tri 8. That's when I finally discovered there was light at the end of the tunnel.

Don't be surprised if you still feel incompetent. Some things will start to come together for you (particularly if you're an experience-based, hands-on learner), like paperwork, clinic procedures, diagnosis and differential diagnosis, and some of the common "chiro" conditions like whiplash and degenerative disc disease. Life in general gets smoother because you really start to feel the tapering off of the academic classes and you now have morning and noon availability that you didn't have before.

Tri 9, in a way, is cake--at least compared to the other tri's. Classes have now disappeared completely off your radar and they fade into the rearview mirror surprisingly quickly. Your evenings become yours again, for the first time in 3 years or so, as you now only have one task: get through clinic. That's it. You treat patients, do your paperwork, and then you get to go home and actively choose what you want to do with the rest of your evening. Now, I have to warn you--there is more to clinic in Tri 9 than there ever was before this. With nearly carte blanche autonomy over your own schedule, you can now see patients any time, and you'll get the bulk of your numbers this tri. So again, don't sweat it if you're coming into Tri 9 with a light tally sheet--here's your chance to shine. Don't forget about rad rotation, arbitrarily inserted into your requirements just when you need that time the most for other things, but alas. And of course, there is always paperwork. But everything else is behind you, you're starting to gain solid ground, and it's a nice feeling. And before you know it...

What your massage therapist wants you to know

Hi-ho, it's your favorite massage therapist, even if it's for a limited time only. And I've been doing a lot of reflecting lately, as we get ready to close one huge chapter of our lives and venture out into the pitch dark to open another. I feel like a neuron (nerve cell) who knows it's about to cease functioning (at least, in this particular capacity, as a massage therapist and med student living in Dallas) and sends out that last sacrificial lamb burst of energy to the surrounding neurons to give them one final boost. Relax, it's symbolic.

In the grand scheme of things, I wasn't involved in therapeutic bodywork for all that long, but with the average massage therapist leaving the field after merely 2 years, I'm practically a veteran with my 5-6. I don't necessarily feel like one, because the massage therapy field is so vast one could actually maroon themselves in it, and I haven't even scratched the top surface. Regardless, I found myself accumulating a collection of pointers that I started to impart practically every massage client that graced my doorway, and now I will share them here, in case anyone stumbles across this--therapist or client--and it happens to help. So this goes out to all the dear past, present, and future clients out there, no matter which massage therapist you see...

First, I need to get some semantics out of the way. We massage therapists are massage therapists. We are not masseuses, and we tend to cringe visibly at the word, because that word, no matter how legitimately it started out, now has an entirely different--and illicit--connotation, one that the legit licensed therapists out there have strived and struggled to distance themselves from. And that is the land of the happy endings, the backroom services, you get the point. By calling me a masseuse, you are essentially reducing my status, education, training, services, and value, to that of a hooker. I am licensed, educated, and legit, and I find the word highly offensive. There are some therapists that don't, but the majority of us do. So please don't make yourself look stupid.

Whew. That's out of the way. Second: massage therapists aren't psychic. I wish we were. Some of us have 6th senses and extra-sensory perceptive abilities, and a handful of us just might be downright psychic, but that's more the exception than the rule. Thus, if something is on your mind, please do speak up. You won't hurt our feelings. If the room is too cold or the pressure is too deep or the music too loud or soft, we won't know unless you tell us. If you say nothing, we're assuming all is hunky dory. Most of us will check in on you periodically during the session, and when we do, there has never been a better time to tell us if something is bothering you. There are some things we can't control, especially if we're working in a shared space or a facility we don't own, but we can control a lot of factors. (If you are more particular about your environment, I do recommend you see someone who works out of their home, because they can control everything from the room temperature to the cleaning products and laundry detergents they use.)

Next, please be truthful on your intake forms. Those forms are not meant to shove a microscope up into your business or track every move you make through the FBI's Carnivore system. When I ask you about your occupation, it's not like I'm going to charge you more because you're a high-level sales associate or think less of you because you bag groceries at Tom Thumb. See, I'm not looking for demographics so much as I'm looking for what your work environment is like: stressful deadlines to meet? Long hours at a computer? Lots of driving around all day? Pressure from the boss? Physical hard labor? And please--putting "entrepreneur" on your intake form obviously tells me nothing. Some people put this to try to impress others. It doesn't impress me. I'm an entrepreneur, too.

Now for please-be-truthful-on-your-intake-forms Part B: yes, I need to know your medical history. I know that from your perspective, I'm simply rubbing oil into your skin and making your muscles feel good, and all these questions about health conditions and previous injuries and medications are unecessary overkill. My job and its effects go a lot deeper than you might think. What I do can have a profound systemic effect that affects multiple major body systems. I need to know if you have high blood pressure. I need to know if your car rolled over 6 times on its way into the ditch, even if it was 5 or 10 years ago. I need to know if you have a contagious disease so I can protect myself and the rest of my clients. I need to know about that hip replacement or the reconstruction surgery or that herniated disc. And yes, as embarrassing as it may be, I need to know about any male enhancement supplements or medications you're taking. Because I need to know if I need to make any modifications to your massage so that you get as much benefit as you can and I can accomplish that as safely as possible. Yes, I know how to do this; it's part of our training. And here's the deal, y'all. At the end of my treatment form is a sneaky little statement that says something to the effect of, "I haven't left anything off or lied about anything", followed by the signature line at the bottom. And if you sign it, you're promising me you told the (whole) truth, and should the unthinkable happen and something goes wrong and you blame it on me and you had a pre-existing condition that you withheld from me and now you want to sue me because you think I caused this, you're outta luck.

Massage therapists have been known to work miracles. That's why people swear by us. But let's face it, we don't do everything. We can't "crack" your neck. We can't prescribe anything. We can't diagnose, so we can't tell you for sure what's wrong. Assessment of various conditions can be part of a therapist's training, so those of us who have learned how to assess can give you an idea of what might be going on from an overall muscle point of view, but we can't say for sure. Some of the aches and pains you feel might be tight muscles, or they might be some various bones slightly out of place, or they could be some vascular problems. Sometimes it's really hard to tell, because a joint slightly out of alignment can feel like a muscle ache. Massage therapists work muscles only, and they haven't been trained deeply beyond that. This means that you might come in for a certain ache or pain and after the session, the same problem is still there. This doesn't mean that the therapist wasn't good or didn't do their job or work the right area, it means that it wasn't a muscle problem to begin with.

Let me clear up a myth, and this one has two parts: One is, you typically can't get every ache or pain completely worked out in one session. It's going to depend on a lot of factors, like how long you've had the problem, how bad it is, if it's inflamed or not (inflammation impairs healing), your overall health condition, how often you get massage, how long a massage you get, the skill level of your therapist (hint: don't go get corrective massage from Massage Envy after your rollover car wreck; seek someone with more experience), and more. I've had countless clients who come in and they want me to work every single area, deep and detailed, because it all hurts, and they only sign up for an hour. I can understand this if they don't know better, but after a session or two, it becomes apparent, and I'm talking here primarily to those who should know better. I'm not Wonderwoman and I can't possibly address every body part in a single session. If your neck has a chronic crick in it from sleeping wrong but you also want a full-body deep relaxation massage also, you're going to need a lot longer of a session than 1 hour.

The second part is, if you're in chronic pain or stress, you can't survive on one or two sessions a year. I had clients who, despite my best attempts at client education, I would only see them about every 6 months. Every time, they came in only when they were in enough pain that it started to affect not just their work life but their hobbies and sleep as well. If you haven't been in in a while, by the time I finish working on you, I've only begun to scratch the surface. There is a whole lot more follow-up bodywork (i.e. additional massage sessions) that needs to be done in order for us to actually make any progress. If you've got chronic issues, you probably actually need once a week, maybe more in the very beginning.

Next. let's talk pressure and deep tissue for a moment. First, don't judge a therapist's ability to go deep based on his or her size. Sure, it makes sense that the therapist who is also a bodybuilder can probably go a bit deeper than someone small, but don't bet the farm. And do not, by any means, make any assumptions based on the therapist's gender! Some of the smallest, thinnest female therapists can bring the biggest male clients to tears on a regular basis.

Second, there is no "no pain no gain" when it comes to massage. Get that myth out of your head, because it just makes you sound outdated...and wrong. Some of the gentlest techniques pack the most musculophysiological bang for the buck. Lymphatic drainage, gentle myofascial release, light pressure on a trigger point, Reiki, Cranio-sacral, etc, have all been known to work wonders for even the most chronic of problems. It's all about working smarter, not harder. Please don't be one of those strange people with something to prove (to themselves or the rest of the world) who have contests with themselves to see how deep a pressure they can take this time. It's not a contest. It's not the stock market, where it has to keep increasing to do any good. If it's doing you some good, it's doing you some good, even if the pressure is actually lighter than last time. Just go with it.

And on a sidenote, please don't be one of the occasional sick douchenozzles who don't think it's deep enough pressure unless they see the therapist squirming and hurting him- or herself in the process. I actually have heard stories of clients who didn't think it was good enough if their therapist wasn't struggling. I don't know what kind of sick psychological profile it takes to be that weird and pathetic, but I certainly refuse to work on that kind of client in my office. To those people: straighten up and be normal. Take your little fixations elsewhere. And please, adopt out any animals you have.

Now I'm going to talk about business and money, because to our un-credit, too many therapists are too chicken shit to do so, and some things need to be said. First, if your therapist is self-employed, it's OK not to tip. Tipping is appreciated by nearly all therapists, but seriously, they (should) have set their prices at a level they already think is fair and can live with. Tipping with me was always optional, but I felt uncomfortable for those I knew weren't made of money that felt an internal pressure to tip. Please, never feel pressured to tip me. I am seriously not going to think any less of you. I am spilling my guts in complete truth when I say that I would rather you save the money to use on future sessions (especially if money is an issue and you can't come in that often), or when I say that I would rather you talk me up to your friends and family and refer them in, instead of tipping.

That said, please understand that the tipping-optional rule is for self-employed therapists only. If they work at an establishment, chances are they keep less of what they make (due to mandatory overhead contributions or lower pay scales, and some establishments who pay MTs on a split percentage basis may require the therapist to take an even lower pay rate on a discounted massage, such as with a coupon or a special), and thus they'll depend more on tips than someone who is otherwise self-employed. Sure, one could argue that it's technically "their choice" to work at those places, but still - it may not be their first choice. They may have preferred to open their own business but perhaps they live in a location (neighborhood with strict zoning, or an apartment) that prohibits massage therapy (or running any home-based business, for that matter), and storefront flats are prohibitively expensive. So, if you have the money to frequent an establishment (which generally caters to those with greater means anyway due to their higher prices), please do the decent thing and tip them a little extra if you appreciate the service you received.

And please don't do the slimy thing and schedule a lower-priced Swedish massage and then once back in the room, request an advanced technique that would otherwise carry a higher pricetag. I had many a client try to pull this one when I was working at another massage establishment, and it only made them look trashy. The scenario went like this:

Receptionist: And would you like Swedish, Deep Tissue, or an advanced technique?
Client: Hmm...what's the difference?
Receptionist: Swedish is a basic relaxation, Deep Tissue is good for working out knots and going a little deeper into the muscles, and those are the 2 most popular. However, we also have Neuromuscular Therapy for targeted work, and Shiatsu and Pre-natal massage.
Client: Hmmm, OK...is there a price difference?
Receptionist: (states the prices, the Deep Tissue being only $10 more than Swedish, and any Advanced modality being $10 more than Deep Tissue)
Client: (hemming and hawing, and finally): I'll just stick with the Swedish.

Of course, I was around the corner, working on paperwork where I can't be seen. I heard the whole thing. I greeted the client and took them back to the treatment room.

Me: OK, so we're doing an hour-long Swedish relaxation massage today?
Client: Well, yes, but I need a little extra on my back, and I like firmer (read: deeper) pressure there, too.
Me: (now in the uncomfortable position of having to break it to them tactfully that they cannot get what they really want because that's not what they signed up for. Actually, it wasn't uncomfortable to have to do, it was just that I had to be ready for any of the various reactions that could arise from the truly special snowflakes as they went from semi-Jekyll to outright Hyde.) My biggest tip-off was when a male would sign up for a Swedish (yeah, right - most males wanted Deep Tissue and specified as much). In short, don't try this at home--or anywhere else.

Lastly, I want particularly my clients to know that I've had a lot of fun with y'all and that I do hope we cross paths again. After all, it's a small, small world.

(Stay tuned for an eventual Part 2, specially for those I call Massage Virgins)