One Sick Mother

Flares and Comments

Well, we were away for a couple of days with one of Himself's relatives. We had a nice Thanksgiving. I didn't even want to kill anyone! Joe discovered mince pie, which is now his new favorite thing in the world. That kid is developing quite a sophisticated palette. He was going through dinner on Turkey day asking about the ingredients, herbs and seasonings. I think he has the making of a great cook. 

I returned home to decent internet access to find a bunch of e-mails and comments to which I really want to respond. Unfortunately, my hands are flaring pretty bad right now and I cannot type for long, so I am writing this quick update before I go to spend an unproductive morning sathering Voltaren on my hands and wimpering.

I want to acknowledge and thank the "new" people who have commented recently. I do appreciate your taking the time to read and especially to comment.

I have heard from a few people via e-mail that they cannot post comments here at the moment. I think it has to do with having a Typepad account vs none. I was having trouble commenting on my own blog. I had to sign out of Typepad and put in the requested information manually. That worked for me. I don't think this is true of all Typepad blogs. However, I -to my now chagrin- signed up to be a beta tester. Therefore this  blog appears to be in a constant state of "tweak".  I think that is why the commenting facility is so erratic.

When posting comments here -because it is so weird right now- I recommend you copy comments into memory before attempting to post. That way, if the comment gets lost, you can try again using the "paste" feature without having to re-type anything.

My old cat had her checkup at the vet. Her foot is all healed and she is doing fine. She is still very needy -she is sitting on my lap as I type, and the other cats are mean to her. But she doesn't seem to care one jot.

She's a chip off the old block... ;)

Of Doctors and Geeks: Part 2

I am still thinking about this subject . In part one, I discussed how a geek never quits and a doctor will. In this installment,  I will attempt to explore why these differences exist, and what patients can do to ensure a higher quality of care.

Lets take an example from my life: My right arm has suddenly and without warning stopped working. This has happened to me twice in my life. Needless to say, it is a very disturbing thing to have happen, especially if one happens to be in a business meeting taking notes at the time.  That was the first time. I tried not to panic and tried not to cry, and my hand slowly regained function a few minutes later.

The second time it happened was much more recently and I happened to be in the hospital at the time. I mentioned my non-working hand to my roommate, she observed that the non-functioning hand was a completely different color to the working one. She called the nurse; the nurse called the Head Nurse and the Head Nurse called the doctor.

Now, here is how a Geek would approach this problem:

Problem: Hand doesn't work

It this a local or general problem? Local - owner appears OK.

Establish integrity of basic hand subsystems:

    Communications (nerves)
    Power (circulation)
    Structure (muscular-skelatal)

Then a geek would go though each of these, checking first that the communications were intact, and the hand was sending and receiving signals from the brain.  Actually I tried to do this. I -trying to keep as calm as I could- checked to see if I could feel touch in that hand. I could.

Next a geek would try and check the power -which in a hand would be the circulation.  If circulation checks out, she would go along muscularskelatal; checking for breaks or any problems in the joints where power or communication might get cut off.

If all that checks out OK, she would probably look at the central control system: i.e. the brain.

So there I am, sat on the bed of the hospital, unable to use my hand at all. I am telling  my fingers to move, and they are sitting there like five little lumps of meat, My roommate is freaked out. One nurse is clearly freaked out and the other is quiet and thoughtful. I am trying not to panic, but the tears start despite my best efforts. However, I stay calm.

The doctor comes in.
"What's the problem?"
"A chorus of "I/She can't move my/her hand" from the -now four- women in the room.

"When did this start?"
"A few minutes ago. I can feel sensation, but I cannot move it."
"And her hand is a different color" -piped in the roommate.

And the doctor stares. He is quiet, then sighs. He doesn't touch me. He looks at my tear-streaked face, perks up and says-half accusingly, half-hopefully: "Are you depressed?"

Four women in that room look ready to punch him.

Looking back, I realize now that this doctor had no inclination or interest to deal with my non-working hand. He was trying to pass me -like a hot potato- off to a shrink. Or ANYONE. Then I would be Somebody Else's Problem and he could go back to whatever he was doing.

Thinking back on that incident, and on many like it I realize that that's another big difference between geeks and doctors:

Ownership and the willingness to take it.

It was drilled into me during Geek training, that if my client had a problem, then it was MY problem and MY responsibility to fix it. We were encouraged to take ownership of problems and to see them through to their conclusion. Even if I could not fix the problem myself; if I passed it to a programmer or someone else, I still owned the problem, and I was responsible for its resolution.

It is Management 101. You can delegate tasks, but you cannot delegate responsibility.

Doctors never went to Management school. They never had this pointed out to them.

Neither did most patients.

Most patients think that -like the geek, the doctor is responsible for finding and fixing the problem.
This is often NOT the case. In the United States at least, the patient usually holds that responsibility. Yes. The patient has ownership of their own problem. They may delegate the task of finding and fixing the problem to the doc. Now, many doctors will step up and take in upon themselves to manage the problem. But this just niceness, or good manners. it is not protocol (that I can tell) or their obligation. Their only real obligation is to do no (further) harm. So they are not obliged to fix the problem -just to not make it worse. Most regular people don't understand this. It is never explained to people that the responsibility to fix the issue lies with the sufferer, not with the physician.

Most people grow up with their own notion of that a doctor is or should be, probably based on books or TV shows. I thought they were all like that old dude in "The Little House on the Prairie". My family doctor in Ireland was like that. He was a kindly man involved with our lives, as much as he could be, considering we only went to see him if someone was at death's door, or if blood was gushing or something was hanging off. He understood the family history. He made house calls and everything.  If there was a problem, he would do his best to find and fix it.

Of course the reality today is very different. Nowadays medicine is a business like any other, and most doctors don't answer to themselves or even to their patients but to Insurance Companies.   This is never explained to patients. They are left to figure it out on their own.

It took me forever to work out this fundamental break between doctor and Geek ideology. And it is not the only one. Many geeks -even if they don't own the problem, will hunt it down to the bitter end for the sheer intellectual challenge. Or they will want to find the error or the break in their code for pride in their work. 

I sometimes wonder why many doctors do not have this same curiosity and drive?  I wonder if it is a personality thing?  I wonder if there is a particular type of people who are recruited or accepted into medical school; a type far different from those in Engineering school?  I don't know, but it is an interesting question.

Next up: Advocacy.  This probably won't be until after the Thanksgiving break, during which I will probably be loudly giving thanks while silently praying for the strength not to kill someone...

Aaaahhhh: Holidays...

Forbidden Pleasures

I miss food. I particularly miss breakfast and brunch.  I used to love cooking and/or eating Sunday brunch. I made great crepes. We  used to invite people over for brunch every Sunday after Joe was born, when we still lived in the city. It was a great way to maintain a casual social life.  I still haven't forgiven C for arriving two hours late with the bananas tho...

The thing about not eating food during the day is not just that I miss it. I do miss food. But more than missing food I miss the having the option to eat and indeed, to eat what I like.  There was a time once, when I could rise and choose anything I wanted to eat: A full Irish breakfast. Port and Stilton (OK never chose that), Pancakes, Egg and chips, Cereal, donuts, chocolate, whiskey.  There may be prices to pay with potential weight gain, daytime drunkenness, halitosis or indigestion. But the choice was there if I was willing to pay the price. And there is always some price. it used to be low, is all.

Choice is nice.

Later, when I found out about the hypoglycemia,  the sugary choices were removed. But there was still the option of breakfast, and many fine choices within that option.

When the seizures started, I knew there was a direct link to food, and I tried lots of different eating plans. The one which seems to work best for me is to not eat during the day at all, so I stick to that. I suppose, technically, I do still have the option of breakfast. But now the price has climbed very high. Now the likely price is a seizure and then several hours lost, so I choose not to exercise the breakfast option.

I often choose so reluctantly.

Last week -as I moaned to you already, I felt horrible.  I felt like 15 different kinds of shite. One morning, after getting the monsters off on the bus, I figured why not make it 16 kinds of shite?  I was feeling awful anyway and planning to go to back to bed, so -sheep as a lamb; I decided to go mental and eat some breakfast. Feed a cold and all that.

Once I had decided to do this, the breakfast became a Big Deal. This would be my first breakfast in awhile and for awhile, so I should make it count. What to eat?  I looked through the fridge, freezer and cupboards before finding the perfect thing. Oatmeal. Not rolled-oats or (God Forbid) your Quaker processed shite. Real honest-to-God steel cut oats to make proper porridge.  And so I made porridge: oats, water, a little salt, boil it up then simmer to a thick gloop.

Then comes the fun part: The fixings:  And more choices! Maple syrup or honey (honey).  Milk or cream?  (Fookit! cream!). I demolished a big bowl of tricked-out porridge and enjoyed every nutty speck.  Food of kings! OK: actually it is the food of Celtic peasants. But I am descended from them, too (on me Da's side) so I enjoyed my forbidden breakfast thoroughly.

Yes, I did pass out for several hours, into my stiff seizurey sleep. But my right leg, which had been numb for two days regained some feeling that day. I don't know if that is coincidence, psychosomatic or what, but it was nice to feel my foot.

And it was very nice to eat breakfast, just once.

Of Doctors and Geeks: Part 1.

As I mentioned recently, I was a diagnostician. My "patients" were systems: hardware, software and networks of various sizes. I usually worked for the small company who wrote the system, and very often my job was to go to the client -usually a fancy-pants bank or Wall St firm and fix a problem on-site, with a stressed-out IT manager flapping nearby wanting to know if it was fixed yet, or when would it be fixed, if the data was salvageable, who was to blame, if I was single,  what the markets might do tomorrow... etc. etc. Not high stress at all, so.


One of my techie colleagues became a good friend. She is a doctor's daughter and said that she had once had a detailed conversation with her dad about the similarities and differences in their respective professions. About how they were both required to find and fix a problem in a pretty complex system.

My friend and I spoke about this recently (unfortunately her dad has since died), and I have been thinking of the subject a lot.  And while medicine and technical troubleshooting cannot be directly compared –the human body and mind is much more complex than anything even NASA or the Department of Defense could put together, there are a lot of parallels, especially when it comes to methods of troubleshooting: i.e. finding the problem.

Having dealt with many, many doctors in the past several years, both for myself and my kids,I have had much more opportunity than most to observe how they deal with troubleshooting complex systems and to note several differences in the approaches used between the medical and the computer world. In fact, I think there is a lot of methods in troubleshooting procedures that we geeks do slightly better than doctors.

I took a step back and tried to analyze why this could be? Doctors have been around far longer than techies have. Even if you include the Industrial Revolution, and apply this experience to tech, doctors still have several hundred years of practice in which they should have honed their craft. I think that is part of the problem. Actually: -I just re-read that last paragraph and realized I used the word “craft”. Very telling. That in itself is another problem. Medicine is not and should not be a craft. In my opinion we have two primary problems:

1. The evolution of medicine over hundreds of years, into which a lot of pomp and bullshit became enmeshed.
2. That medicine is still considered partly a craft or an art –an almost mystical entity, as opposed to pure objective logic and science.

Geeks and techies are not weighted down with that kind of baggage.

So your computer system isn’t working and you are a large bank:  A techie will come in, quickly assess what systems and subsystems are in use, where the (first) break is, and then start to check a bunch of stuff: She will first check that all the bits are connected properly and that all the components needed to run are in place. Then she will run a complete set of diagnostics for all the components. If she does her job properly, nothing is left out of the reckoning.  She will find the first problem (there may be more than one, and start to work outward from there, tracing the interconnecting bits until the system functions again. Then she runs a full set of tests to ensure it is working optimally.

She doesn’t finish the job until it is done. You cannot walk out of a bank saying “I’m sorry. I cannot fix it”. You get on the phone. You bring in more techs. You speak to the programmers. You get patches and fixes made. You stay and fix it until it is working again. Or you replace the broken components.

Failure is never, EVER an option. Period.

A doctor, on the other hand, immediately starts with exclusion based purely on assumption. There are probably tens of thousands of tests that a doctor could potentially run on a human being. There is no way he can run a full set of diagnostics. Therefore he has to start excluding the instant he claps eyes on you. You walk into a doctor’s office and immediately –almost subconsciously, the doctor is assessing you already: height, weight, hair, skin, hands, how you walk, move, how you are dressed, how you present yourself. It all goes into the some internal Patient Processing System: Overweight will probably merit a cholesterol test; underweight may require some vitamin testing, and careful prodding about eating habits.  As you explain the problem, more tests may be included and excluded.  There is a physical examination, further determinations made.

With each subsequent visit and various findings; determinations may be made. And maybe he will find the problem. For 90% of patients this may be the case. But you always have the ones who defy the odds. There is always the other 10%...

People like myself, who looked perfectly healthy, ate well, but actually had mild scurvy. And a bunch of other vitamin deficiencies. A techie wouldn’t have missed that. A techie would have run full vitamin diagnostics, knowing that you can’t tell from the outside (after all, white boxes all look pretty much alike) what the power status actually is.

You may stay a year with this doctor, coming back month after month, trying different medications to see if it helps (and if it does, when we will know it is ____” –don’t even get me started!), dealing with the side effects and with not getting better until the doctor finally does what no technician would EVER do.

He gives up.

He says “I’m sorry. I can’t help you. Perhaps you should see a (insert specialty here)?” 

…and the whole process starts all over again, with nothing lost except a year of your life and a few pints of blood.

If you’re lucky.

Big Baby

I have a bad cold. Or a chest Infection. Or something.  Basically, I am sick. I am a sick Sick Mother. 

"Big whoop!" I hear you say. "Being sick is your shtick".

Good point.

But you know; it is funny how I can soldier through chronic pain, slipped discs, dislocations and inflammation and I don't lose my sense of humor. But slap a cough, a sore throat,  a runny nose and a slight fever on me, (with or without the chronic stuff) and I turn into a mewling, miserable baby.

OK, the coughing and sneezing I should do without. I have syringomyelia (SM), -a  fluid-filled structure in the spinal cord- which is mostly asymptomatic now, but valsalva maneuvers such as coughing, sneezing and blowing up a balloon are Bad when one has SM. These things mess with the fluid in your spinal cord (who knew?) and can increase symptoms and may even cause the structure to expand.

...but If I am being TOTALLY honest, I am making excuses here  talking about Syringomyelia. Really. Fuck valsalva maneuvers. Whatever! I don't care... The simple truth is I just feel miserable, my top half is hot, my bottom half freezing, I am stuffy, coffy and miserable, I have regressed to about 8 years old and I WANT MY DADDY! 

WAAAAAHHHH!

(how's that for a mature and insightful post? <wink>)

Why I Want a Correct Diagnosis

I watched with horror on the local news tonight the story of Tabitha Mullins, a 32 yo single mom who went to the ER with pain and was sent home with painkillers for a suspected kidney stone.

It wasn't a kidney stone.

It was a systemic infection. However, because she was not tested properly, it was not caught in time. Ms Mullins ended up losing BOTH hands and BOTH feet AND the sight in one eye.  In less than a month.

Here is a link to the full story.

Now my story -once figured out- is going to be nowhere near as dramatic as hers. But I hear stories such as this and I am even more determined to get to the bottom of my own health issues.

I mean seriously, something bad is happening to me. What if something dangerous is going on? Something that over time could seriously harm me? I owe it to myself and my children to keep advocating for myself and pushing for answers and even (hello?) a solution.

The "Why?" Trap

...and I don't mean the average three-year-old's fondness for serially asking  "why?" to everything.

This is a more subtle trap, and one I fell into a few times before I learned about it. And I thought, because I got Queen Slug all riled up with my last post about not lying, I would have another go with this topic... -just for badness ;) 

Now this is a topic for another day, but I am a trained diagnostician. I was a technical troubleshooter for computer software, hardware and networks for many years and I was very good at my job. One of the things I learned as part of this was how to spot patterns. 

Since I got sick, I have applied a lot of the techniques I learned for troubleshooting computers to myself, and I spotted a few patterns. Like if I eat a meal, I usually feel awful about an hour later. OK I probably didn't need special training for that one. But there were a number of more subtle patterns and observations I have made over the years. I have dutifully relayed those to my doctors.

I have noticed the reaction is usually very similar, they nod, purse their lips -sometimes the tented fingers go to the lips and they ask "Why do you think that happens?"

That's the trap.

If you answer "Well, I wonder if it might be because of..." and present a comprehensive, well researched, well-thought-out theory... Or indeed, any theory at all; you will get a squinty-eyed look from the doc, and probably some snide remark about being your own doctor and why do you need him at all?

The trick is to act a bit stupid.

I have learned, when you are a patient, the correct answer to the "Why?" question is "I don't know why. I was hoping you could tell me. I just noticed it is a pattern and it is consistent. But you are the doctor, I was just hoping that my identifying the pattern might allow you to pinpoint the underlying mechanism."

Of course they often suspect you are trying to lead them to some foregone conclusion of your own, even if you are not (and granted, sometimes I am). Doctors are a suspicious bunch.

I have tried to turn the tables and set my own "Why?" trap.

The thing that gets me is how doctors seem so able to wiggle out of the why trap if you try and set one for them. Here is a simple example, which is demonstrable: I am slowly losing the use of both hands from the pinkies in. I have no clue why and no theories why.  I just know that it is happening, and that my rheumy has agreed that it is happening and has said that I will probably lose the use of my hands unless it is stopped.  If you look at my hands, you can see how the ligaments on the pinkies have slipped off the knuckles. You can see on my right hand, the ring finger is going the same way.

I have showed this to several docs. "Why is this happening and how can I fix it"

The most common answer is some variation of the following:  "Wow. That is weird! It is probably because of the Ehlers-Danlos Syndrome, but I don't have a clue what to do about it. You might need to see a hand surgeon."

That's what gets me the most. Doctors seem to think that phrases like "I don't know" or "It is probably..." are acceptable answers.  I wish I had been able to do that in my old job!

Why is that OK?  I mean really.  I am losing my hands. Why is "I don't know" considered an acceptable answer in the medical community?

Why?

Pants Not On Fire

Ah-ha! I bet I got you with that headline! Go on, admit it, you came here to find out about the fire in me pants. (or indeed, the lack thereof).

But what I mean is I'm not a liar (so me pants are not on fire).

You know, I get very tired of That Look.  You know the one I mean: The raised eyebrow, slightly incredulous "Oh come ON!" look you get from doctors or indeed veterinarians when you relate some entirely true and unexaggerated medical history to them (the vet gave me That Look today when I told him I have Syringomyelia.  Probably because I am definitely NOT a King Charles Cavalier Spaniel).

My PCP does not believe that I have NOT been eating during the day because I have not lost any weight. I have not lost any weight (and I told him this) because I have been eating carbohydrates in the evening.  If I chose to stick to my low-carb diet, the weight would fall of me, but I chose not to do this for a few reasons.

1. I don't want to lose weight rapidly.  I don't want to develop any saggy bits, thank you.
2. It is hard enough to get through each day fasting in the daylight hours (it's like I have a permanent Ramadan going on here). If I throw low-carb into the mix; well, I feel I have very little to live for. I mean, really: What's the point in having a stomach and digestive organs if you are going to fast during the day and then at night just eat meat and green vegetables? For the level of enjoyment that would bring, I could just get a feeding tube and do the white sludge diet.

3. see #2. (it is worth counting twice)

Reactive Hypoglycemia is one of those conditions that cause a "Can not compute" error in the brains of most doctors. They cannot get that a person like me can eat very few calories, but if those few calories are in the form of carbohydrates, they are applied directly to my ass and I gain weight. However if I eat TONS of calories in the form of protein and fat, I lose. It all has to do with Insulin, a hormone I produce in spades due to a rather overeager pancreas. 

The process is simple and has been understood for years  A person eats carbs, such as sugar or starch, the blood sugar rises. Now we all know that high blood sugar is BAD, so the body produces Insulin to take out the excess sugar. The insulin very efficiently converts sugar to fat, which it then kindly puts into storage (on my ass). 

Excpt I produce a little too MUCH insulin, it removes too much sugar from my system. That makes my blood sugar plummet, making me hungry for ... carbs.

And we start all over.

It is not hard to understand. Especially if one is Board Certified in Internal Medicine (or anything). Come ON!

Unfortunately, doctors have had it hammered into their skulls that low-fat, high fiber (and often high sugar/carb) is the way to go with diet these days. And that might be true for 90% of the folk out there. But it is NOT true for me.

But how come I am the one being treated like my pants should be on fire?  I'll tell you why:

1. Because I am not in the 90%. Doctors are trained to deal with statistics and the laws of averages, not with symptoms and real logic.
2. Because doctors are taught to assume first that a patient is LYING if they do not fit into these neat buckets of statistics and averages, not that they may have something slightly unusual going on.

And even my own doctor, who has known me for 12 years and has never once had any reason to doubt me, will choose to believe I am lying, rather than look at the function and logic of my own proven and documented medical history: i.e. reactive hypoglycemia.

That hurts my feelings.  It really does.  I can handle some young arrogant ER doc making that assumption because he doesn't know me from a hole in the wall. But my relationship with my PCP is the single longest uninterrupted relationship I have had with a man other than my father or husband.  I do expect a level of trust and respect at this point. I don't think it is wrong of me to expect that.

My pants are quite cool, thank you very much.  Deal with it and let's move on.

Corner

I think the cat has turned it, that is.

She is walking a little, eating more, seems much more oriented and is basically her querulous little self again. I never thought I'd be happy to say that.

Hmmm.  I wonder was some kind of reaction to the antibiotics?

I had forgotten to give her her pill yesterday morning when the vet called. During the call, we discussed changing the antibiotic anyway, and I figured if it was wasn't very effective against the bacteria, and was going to be changed -or she was going to be euthanized on Monday, why put us both through the hassle of shoving pills down her throat? So I made an executive decision.

It's OK. I used to be an executive.  I can do these things.

I stopped the antibiotics.

Late last evening -AFTER I posted my little tale of woe, Rascal started to look perkier and I -feeling kind of mean, but knowing it needed to happen, coaxed her into walking a few steps with the cunning application of cat treats (I got my finger accidently bit for my trouble, to Joe's unending merriment).  Funny, once she did that (walked, not bit me), it was like a switch was thrown and she remembered how to use her back end. She has been much more ...composed since. I mean literally. She now looks like she actually lay down. Previously, she had looked like someone had smeared her across the cat bed.

This morning Himself arrived down to find she had walked all the way into the kitchen, was standing where her old bowl used to live and was loudly demanding breakfast.

That's my girl.

I know I am going to get a bollocking from the vet about the antibiotics, but I don't care.  Maybe she was going to get better anyway? But I really think the difference came when I stopped those meds.  I could test this theory and give her a pill, but I don't want to put both of us through that stress.

I have suffered enough strange meds reactions for myself to know nothing is impossible, no matter how much "they" try to say so.

A 'Quality of Life' Question

"...then it becomes a 'Quality of Life' Question."

That was the vet on the phone to me today. We had been talking about Rascal, the 17yo cat who has apparently responded rather badly to General Anesthetic.   We had both been hoping she would recover.  But she cannot stand, has little control over her hind end, and is apparently incontinent and hypothermic.  I had just related this to him when he made the above statement.

Other than that, she is fine.  In fact, she is being spoiled rotten: Eating, drinking, meowing loudly to get ...stuff delivered to her bed, which is now in the place where the poor dog's bed used to be, -the best spot in the house- purring contentedly most of the time, with her own heating pad, clean sheets, and food and drink delivered often. Grace and Joe bring her treats and fuss over her, the other cats are staying well away, and Grace even knit her a special fluffy blanket.  She seem doesn't miss activity at all. Cats sleep about 20 hours a day anyway, and at 17, she has no desire to climb trees, jump on counters or chase ...anything

In fact, from her standpoint; right now her quality of life is probably the best it has been since we adopted her about 8 years ago.

Now I know she is at risk for pressure sores, atrophy (physical and mental), infection and a host of other stuff. I am not discounting that. But right NOW her QoL is fine. If I could just sit with her for 7 hours a day and scratch behind her ears, and maybe organize a little pool of sunlight into her spot, all would be perfect... 

It is MY quality of life that has suffered.

I spend a lot of time in this room anyway, but I have been loathe to leave it in case Something Bad happens. I slept down here the first night, which messed up my back. I have been squatting down to give her food and water, change bedding, and clean her. Squatting for some reasons makes me feel very faint. I don't generally have orthostatic hypotension, but  squatting seems to do the trick nicely.  Who knew?  I could just sit on the floor to do these things, but that aggravates my back even more. My hands are flaring; -I think from the stress.

She is happy as a clam and I am a mess.

Now this is only a tiny example in a little house in suburbia. A teeny,  weeny example involving a cat.  But it got me thinking about the whole "Quality of life" question, in light of recent news.  Because that is something I always wanted to know. When people talk about "quality of life" whose life do they actually mean?  It is implied that it is the life of the disabled person. But I really wonder.  Do they really mean the carers QoL?  Or is it a more general thing, like they QoL for the whole family? 

And how the fuck does one measure "Quality of Life" anyway?

I really want to know.