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Care Package

yearly. To stay ahead of the curve, we kept switching to policies with higher copays and higher deductibles; the business picked up employees' out-of-pocket costs after the first $200. In our penultimate year in business, three employees met the $2,500 deductible. It was a very lean year for us.

It was also a year of more than usual staff illness and absence from work. So in addition to my management duties, I was filling in wherever I could. Some patients loved it when I answered the phone and enjoyed chatting with the doctor's wife; others, understandably, didn't want me involved in their care. And I didn't want to be there.

When we married, Tim and I made a pact not to stifle each other. Once the kids were in school, despite the demands of the medical practice, I had managed to draft two novels, publish a number of articles, and teach on a limited basis. Those were things I was good at; I was not as good at answering the phone. And posting payments and processing paperwork only heightened my awareness of how fragile our finances were again becoming.

But it wasn't just the finances. We probably could have accepted the grim realities of declining income, unpaid vacations, inadequate retirement savings, and expensive health insurance if it hadn't been for two things: summers and HIPAA.

Summers had always been difficult. The kids, home from school, needed us. Even if we could have afforded summer-long camps, we didn't want to send our kids away. While the problem of finding good summertime child care is not unique to medical families, the unpredictability of Tim's created both an extra challenge and a tension, since that meant the logistics and transportation devolved on me. So that I could continue to manage the office, we enrolled the kids in local day camps, creating a daily puzzle of play-

Shafer today, in front of Grace Cottage Hospital in midsummer—high season for ER visits there.

dates and carpools. With the coming of good weather, Tim and I also wanted to get out and play, enjoy time with the kids, or at least get ahead of the weeds in the garden. But summer also brought an influx of tourists to Vermont—all of them hell-bent on having a good time, which often landed them in the ER. Not only was the ER busier in summer, but the on-call rotation was compressed, as at least one doctor would be on vacation each week.

The summer of 2002 was the worst.We took our three kids on a service mission, helping to run a drama and arts camp for orphans in Russia. It was a three-week trip, the longest we'd ever been away from the office. Our wonderful nurse practitioner and a skeleton crew saw patients in our absence, and I had paid bills and written the payroll checks in anticipation of our absence.

The trip was a busman's holiday, with Tim practicing medicine and me mothering a

The RHC program was designed for small, struggling, rural practices, but we had to write a policies and procedure manual befitting a Fortune 500 company.

horde of children in addition to our own. When we returned, a snafu in the call schedule had Tim on call six days out of 12 and it took us another three weeks to recover. August, easily the busiest month in the ER, was made busier still the evening Tim was admitted.

He had wanted to check on the bee hives that we'd neglected most of the summer. It was too hot and sticky, I told him.Not good bee weather. I went for a walk. Tim looked in on the bees by himself. Despite his suit and helmet, the bees mobbed him, triggering anaphylaxis. By the time I returned, Tim had injected himself with epinephrine. He gave himself a second injection as I drove him to Grace Cottage, where he got further treatment. The next morning, he was back at work and on call.

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