Affordable Healthcare wasn’t affordable for us.

As the deadline for ACA signup loomed, I was reading articles from all kinds of news sites with all sorts of opinions on why Millenials and the “Young Invincibles” were avoiding the healthcare sign up.  I learned that we were “uninformed” about healthcare and how we would all benefit so greatly from it.

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Well, my dear pundits and writers, the sad truth is: we can’t afford Affordable Healthcare.

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To be fair, I have insurance through school.  And it is really wonderful.  I actually got to go to Urgent Care guilt-free when I couldn’t walk.  I don’t have to worry about how I’m going to scrounge up money for the lady doctor.  Even seeing a therapist is covered.  So insurance is wonderful.

Boyfriend, however, does not have insurance.  Through his work, it is about $250.  Even through the ACA, it’s $145 a month.  Now, we do not make much money, even though we both work full time.  I’m on intern pay, meaning shit.  And we live in Chicago, meaning we pay outrageous amounts for everyday things and rent is out of control.  We’re homebodies and rarely go out.  I cook most nights.  I grew up in a big family, so I’m well versed in making cheap ingredients into big delicious things.  We’ve never taken a vacation together.  I get my hair cut 2-3 times a year and have never had my nails done.  We drive a 12 year-old car.  Point being: We’re simple folk.  There isn’t much for us to cut back on.

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We know that it would be a good thing for boyfriend to get insurance.  He’s in really good health, but accidents happen and insurance is happy!  When we got the quote, however, we had to wrestle back and forth with our budget.  Could we cut anything and where.  And believe me, we have  spreadsheet of our expenses down to our dog’s denta-bones.  We wrestled with this for weeks, until the deadline for sign up.  And when it came down to it, we can’t carve out $145 a month.

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This is the reality that the news coverage is not recognizing.  I talk to our friends, most of which are in the same situation. The plans that are affordable don’t really cover anything, or only kick in after you spend several thousands of dollars.  So pretty much, stay in killer health or approach death are the plans that are offered that are affordable.

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We want health insurance.  We know that we would be better off with it.  However, we also need to eat and pay rent.  Many of us are stuck working low paying jobs, without the hope of a raise or promotion.  Job searches go on forever with no hope.

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So boyfriend is forced to opt out.  Not because he doesn’t want insurance.  Not because we hate Obamacare.  But because, not matter how much we work and how much we try to cut back, we can’t afford this.  Sorry, Obama.  Sorry, media.  But we’re not obstinate.  We don’t think we’re invincible.  We don’t think you’re an evil socialist.  We’re just broke.

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And it may sound stupid.  And we know that we’re rolling the dice here.  But we have been for awhile, and there’s no other choice right now.

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Love/Hate Relationship with Electronic Medical Records

When I first posted this, I realized it was too serious for me.  So I decided to add a ponderous Bowie.

When I first posted this, I realized it was too serious for me. So I decided to open it up with a ponderous Bowie.

I recently started my Pre-Doctoral Internship.  Much like my previous training site, I’m in the Community Mental Health (CMH) world.  Unlike my previous site, I have Electronic Medical Records! (EMR)

I am actually excited about this fact because paper record keeping was absolute shite at my old training site.  Things got lost, accidentally shredded, or re-done a thousand times because it had a minor error.  Everything was constantly a mess.  Intake appointments were up to 3 hours long and required over 50 pages of documentation, most of which had to be hand-written.   Even after that 3 hour intake appointment, there was at least 2-3 more hours of cleaning up and re-checking paperwork before it could be sent off and *hopefully* approved for billing.  You can imagine how exhausting this was for both the staff and the clients.  And of course none of that paperwork time was billable.  So a 40 hour work week for staff (therapists, respite workers, case managers) would usually consist of maybe 15-18 billable client hours (I know this because I’m obsessed with counting and quantifying things and looking at charts of things).  It took up to 3 months to get feedback on this crazy paperwork.  If things did not get into the record immediately, there were often massive miscommunications between members of the treatment team.  A psychiatrist would change a client’s medication and the therapist would not know about it for weeks.  A client would skip therapy or skills or job training and the psychiatrist would know nothing about it.  Crisis alerts for clients were often mis-filed or not provided to the client until days later.  If paperwork expired and we weren’t on our toes about exact dates and made sure to schedules ourselves a few extra hours to update paperwork on the plucked-out-of-thin-air medicaid-demanded dates (all of which were different between treatment plans, evaluations, updated consent forms, etc), we lost billing, meaning we lost the only funding that keeps the doors open to the only mental health resource available to most of the people we served.

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Overall, it interrupted treatment.  It interfered with the ability to provide treatment.  So much time was spent completing paperwork and ensure that medicaid would pay for the work that was done, that client need often had to be put aside for the time being while we made sure we were compliant with governmental demands.  And of course when client charts or information got lost, it was always the one with pre-existing paranoia ideation.  Serendipity, bitches.

And this was not because of poor management of the site.  They honestly did the best they could trying to stay on top of everything.  But it honestly felt like every month or so medicaid was demanding more documentation.  We were overloaded, understaffed, and underfunded for what was placed on the agency.  Because of these outrageous demands, we were forced to keep relatively small client loads, which lead to an overflowing waitlist.  This means that both adults and children with mental illnesses, developmental disabilities, trauma, and other problems demanding mental health care were forced to wait up to 6 months for services.  This includes people released from the hospital following a suicide attempt.  People with active psychosis.  And those with a history of violence and aggression.  These are all people that are in desperate need of care, low-to-no income, and are struggling to meet the demands of their daily life.  However, they are all also people who had the potential to succeed and contribute with the right help and resources.  Many of them are children and adolescents whose potential you could feel if you could just get them and their families in the door and on your caseload.  This is the story of many CMH’s out there.

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Oh, and did I mention that, because CMH is so underfunded that nearly every staff member has to travel between multiple sites and rarely has a consistent schedule?  So communication between treatment providers is difficult to say the least.  A CMH psychiatrist (that’s the one that prescribes meds but does not provide skills training or psychotherapy) may work at 4 different locations throughout the week and see upwards of 50 clients per day (10-15 minute appointments).

So, my at my new site we have EMR.  Which is so much more convenient.  Everything is right in front of us on a single website, from Treatment Consents to Intake Assesssments to communication forms between treatment providers.  Because everything is in one location, you get alerts for when things are coming due.  If a client misses an appointment, the entire treatment team can be alerted immediately.  Rather than 3 hours, intakes are about 1 hour.  I have constant access to everything in my clients’ records, no matter what office I’m at, or even if I’m doing a home or school visit.  It is infinitely easier to get my work done and move on to focus on my clients’ needs.  I can instant message my supervisor or other member of a client’s treatment team the moment there is an issue or just to alert them to progress made.  A client can review their records easily with me and helps fill out progress notes, which feels more open and honest, and opens to door to discussions about how they view the therapy and their progress.  If a client’s medications get changed or they are assessed by the crisis team, I know immediately that a change was made to their record.  It’s golden.

Unfortunately, the Orwellian in me cannot fully embrace this.  Being CMH, it is a government agency, funded primarily by medicate and overseen by the Health Department and everything that goes with that.  I’ve been on a bit of a paranoid kick myself lately–how could you not be in America right now?  I’ve been following the NSA/Manning/Snowden stories and I’ve been appalled by what I’ve been reading.  How much information is viewed and stored about people.  How many emails and searches are read.  There is no guarantee that any of my emails are secure and everyone that comes in the door is made aware that their information is reported to various agencies.  Most clients, though, are in too great of a need to worry about confidentiality and governmental information gathering.  How do I explain confidentiality to a client when I know that nothing is really confidential because it is being reported to various agencies.  There is nothing so great about out EMR that makes it hack-proof.  Do I think that the NSA really cares that much about a 15 year old girl’s depression?  No.  But the fact is, nothing about EMR really is secure.  But with the massive integrating of all of this information, is it really that outlandish to believe that this information could show up somewhere else in the future where it might hurt the person?  What if the 15 year old girl later decides to apply for positions in the Military or CIA and they have access to these mental health records?  Could that affect them?  I really don’t know.  I am being told that this information is secure and confidential, but to be honest even my supervisor does not sound that convinced of it.  What if I do have to write a report on a client having paranoid ideation regarding the government?  What if I have to email my supervisor regarding a client’s flight of ideas about militias and terrorism?  How secure and safe are these mental health records?  (Our voice mails also go directly to email)

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So, I am still torn over the EMR thing.  It is amazingly efficient and leads to better record keeping and communication within the treatment team and therefore more effective and ethical treatment.  However, I have significant concerns over confidentiality and how long this information is kept and for what purposes it can be used.  My fears being heavily influenced by the happenings within my country.

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Fucking Pundits–my reaction to the Newtown coverage.

The news is all still a flutter about the Newton tragedy.  As, I suppose, it should be.  Lucky for all of us with any intelligence level, the conversation has moved away from violence in video games and the media to something substantial, mental health.  Unfortunately, the conversation about mental health, causes of mental illness, and access to mental healthcare has been disgustingly shallow.

When I turn on the TV and find myself watching any news about this event, I begin to hear about how we need to address the “causes of mental illness” and “increase access to mental healthcare.”  My issue with this is how flippantly it is said by people with no understanding of mental illness and no understanding of how difficult it can be to get mental health care, or even what mental healthcare entails.

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What causes mental illness?  Truth is, a million things…we think.  Trauma, genetic abnormalities, poor social structure, inherited diseases, poor models of behavior, neglect, abuse, malnutrition, neural abnormalities, lack of concrete resources such as food, neighborhood violence, drugs, in utero toxins, anything…bad luck.  I’m sure every psychologist,social worker, etc. can think of more.  I would love to see how Congress and the powers that be would address each of these and more.  Short of eugenics and parenting licenses, you can truly prevent all mental illnesses.  And as a big believer in Positive Psychology, Resilience, and Prevention, that takes a lot for me to say.  There will always be mental illness, no matter how hard we work.  There are things that we can do to prevent or lessen the impact of mental illness.  We can give families, school, and communities more education and resources to understand how to respond and live with mental illness.  We can fund better research to understand the origins, process, outcomes, and interventions (community-wide) to address all different disorders.  We can make it easier for mental health professionals to practice, by which I mean lessening their load of bureaucracy so they can focus on the treatment aspect and not on checking off the right boxes.  We stop closing mental health facilities.  We can make real services available in schools, rather than the shit they get right now.  We can recognize the effect of neighborhood trauma on children and intervene.  We can build more community mental health centers to prevent 6 months wait lists.  We can do more than medicate people.  Again, I’m pretty sure everyone that reads this can think of more things.

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My point is, every time I hear pundits talking about “we need to address the causes of mental illness” “we need to address the issue of mental illness” “we need to asl;dfalkdfjla!”  I want to throw the TV across the room because they have no idea what they are talking about.  I want to strangle everyone from the NRA president to Rachel Maddow.  You can’t make mental illness a sexy issue like media violence.  So stop.  Fuck off.  Get out of my field.  Or at least talk to someone with some fucking intelligence and background in the area.

**Oh, and BTWs, lack of god in school does not cause mental illness.  Fuck yourself., Huckabee.

The State of Mental Healthcare


I currently work in the community mental health setting.  A setting that is primarily funded by state and federal dollars and primarily serves low income, high need clients.   Clients that seek community mental health are usually those that are ill to the point their disorders and symptoms interfere with their ability to function in a work or school setting, many with a history of incarceration or hospitalization (in my experience there is little difference between these two, both revolving doors of shitting care and overmedication), but with regular care and appropriate support would be able to live like “normal” people.  Unfortunately, rarely is this care ever provided consistently or appropriately.

Since I started working in my field, I’ve pretty much rotated between working in schools (alternative and traditional) and community care.  But my disgust at how the system fucks some of, not only the most needy clients, but some that could have massive potential if they were given proper care.  Children with learning, behavior, and sensory integration disorders are routinely put on the back burner in schools, not receiving proper assessments or interventions.  They fall behind a little bit more every year until they are failing, their sense of self and identity become defined by failure.  The risk factors add up, one after another until they become absorbed by the mental health and education systems that failed them in the first place.

For individuals with chronic mental illness, thought disorders, personality disorders, severe emotional disorders, or developmental disabilities the bureaucracy  that is mental health is worse.  Wait lists of many community mental health centers number in the hundreds.  Social workers, whose caseloads should be no larger than about 20 in order for them to actually help the individuals they serve, are usually closer to 50-60.  Psychiatric hospitals deal with overcrowding by over-dosing clients on sedatives.  Hospitals rarely provide treatment, instead the have settled for assessment, stabilization, and providing guardians/family with a list of recommendations so vague they can hardly be followed.  That list usually includes a recommendation for individual therapy, psychiatric medication consultation, and case management….at those community mental health centers with the hundred person wait list.  This leaves a 3-6 month gap in treatment in which clients are left to their own devices.  Some, depending on the severity of their symptoms and the level of dedication of their support systems, can manage to go back to some semblance of a life, perhaps a job or school.  Others, however, cannot.  They will cycle in and out of crisis care and hospitalization, most end up in prison.  Millions self-medicate with street drugs, leading to addictions and worsening of the core symptoms.

Then you get to the systemic problems caused by this failed system.  Families are effected, parents, children, siblings, grandparents.  Because lack of treatment leaves them so ill they cannot hold a job, they are forced to go on disability.  Not only does that have an economic impact, but it leads to boredom and decreased motivation to get better.  Mentally ill individuals are viewed by others as lazy, dangerous, or stupid, which has an impact on their own self-image and sense that they can do something more with their lives.  Constant failed attempts at getting help lead many to give up.  Institutions and psychiatric hospitals that could have provided treatment (the level and kind of treatment provided is a completely separate issue) have been replaced by prisons.  Most mentally ill are still placed in general population, provided little to no treatment outside of medication, and eventually released with no resources.    Again, we cycle back to economic and family impacts.  The cycle repeats year after year.

Our culture likes to put mental health on the back burner.  As a society, we think the mentally ill are mentally ill.  They cannot be helped.  We think this because it is what we see.  Chronic mental illness equates to stupidity, laziness, and criminality.  But this comes from what the system has done to mental health care.  And it is also self-perpetuating.  If we think about the mentally ill as dirty, stupid, homeless criminals, we can accept their lack of care.  They are the “other.”  They’re not like us and they don’t deserve our federal dollars because they will always be that stupid, gross, crazy person.  So, it become easier for us to ignore or be okay with the lack of mental health care.  The media’s portayal of the shooter from the Colorado spree is perfect.  He was crazy, therefore he was dangerous and must be locked up.  This must also apply to all other crazy people.

There are thousands of trained therapists and social workers dying for work.  People go into this field wanting to help.  They have ideas and dedication, they just need the funding.  Every time I see a mental health center or service be closed down, funding cut, etc, I go a little crazy inside.  Where do politicians think this will save money?  They are leaving high need adults and children without care and vulnerable to everything I already talked about.  Funding cuts for mental health will lead to an increase in crime and dependence on federal disability money.  Many of the clients they put out want to work and want to contribute to society, but they need continuous support to be able to function.  With that support, they can do amazing things.

So, fuck you bureaucracy.  And shitty run around that causes crime and death.

Addendum to last post.

I had to add an addendum to the previous post because something was really bothering me when I was with the doctors.

 Again, I preface this: I know ER docs and such are super busy and it’s hectic and Clinic docs are just as busy.  But, they are still doctors and if they are understaffed, that needs to be addressed.  They should be providing the best care and addressing all patient questions.

During the week I had my stitches in, I got a bit of a cold.  Nothing terrible, just some bad coughing, lethargy, sore throat, stuffy head, and the like.  I still had the cold when I went in for the follow-up.  They asked me if everything was ok with the wound and such.  Now, FYI: every time I get sick I think I’m dying, even though I never go to the doctor.  I just lie in bed and complain and drink tea, essentially waiting to die.  But, I figured since I was there I would make sure I didn’t have MRSA or something else terrible.  So I told the triage nurse, the med student that took out my stitches, and the attending, “I am kinda sick.  Is that a problem?”  The nurse said: “hrm.  No fever. Down the hall to the left, second door.  The doctor will be in in a minute.”  The student said: “Your stitches look great.  My attending will be in here to look it over real quick and you can go home.”  The attending said: “Looks good.  Have a good day.”

At no point did any of them address my being sick or check anything other than my temperature.  I do have a history of giving myself viral infections.  Essentially this just means I stress myself out enough to kill my immune system and allow normal viruses that should be easily killed to make me uber sick.  I assume that is what this is.  Meds don’t really work, you just have to be okay with feeling super sluggish for about 5 days.  But come on docs!  I could be dying!  Respond to my concerns!

What I learned at the ER…

So, last Monday I had to go to the ER because I’m mildly stupid and extremely clumsy.  Now, I am not a doctor going person.  The only doctor I go to is the Optometrist, because that’s more like a shopping trip for people who love glasses.  The last time I was at the ER was when I was about 2 or 3, which I obviously don’t remember but I assume a lot has changed since then.

So, I first learned that everyone talks very quickly and you’re not allowed to read anything you sign.  In fact, you’re lucky if they even tell you what you’re signing.  I first signed my Consent to Treatment, which I’m pretty familiar with thanks to my job.  So no problem with that.  After that was signed, I wasn’t really paying attention to what was going on, perhaps it was the blood loss that was distracting me.

Fast Forward to my discharge. I’m handed a bunch of insurance papers and such.  The woman at the desk mumbles something while she hands them to me.  I flip to the first page to figure out what is going on and what I’m signing.  The woman says “It’s insurance.  If you want your insurance to pay, you sign it.” I felt really pressured and ill-informed about what I was being given.

I went back today for my wound check/follow-up.  Once again, they take my ID and insurance and such and quickly take me back to do the check up.  But while I’m waiting for the docs, this guy comes in and says something hardly comprehensible about my insurance and when do I want to pay my co-pay?  He tells me the amount and I say I can pay before leave, at which time he offers to take my credit card then and there.  I’m really taken aback because I feel like that is an inappropriate offer.  I was fully cognizant and I’m well educated in paperwork and such, so I declined saying I’ll wait and I ask his name to make sure I remember.  However, I feel like people in this situation could be very easily taken advantage of.  I think it is inappropriate and far too easy to take advantage of someone in a medical office by taking their credit card.  It would be too easy for a staff member to steal the information or overcharge you.  IDK, but it wasn’t okay with me.  Then, when I go to leave and make my copayment, the doctor comes out and says “oh, wait, you need to sign this before you leave.”  Again, I ask what I’m signing.  His very disturbing response: “Uhh, I don’t know.   Hold on.  Oh, this is your wound cleaning instructions.  Oh, this just said that we explained to you how to take care of the wound.”  Even though he actually didn’t do this, I signed it.  I wasn’t about to give him shit and cleaning a cut isn’t difficult.

In addition to not being able to read things, I would like to talk about the lack of informed consent for procedures.  As I said, I don’t go to doctors a lot.  My experience was pretty simple, clean, x-ray to check for class, clean, stitch, wrap, and go.  But even for this, they had to give me meds, local anesthesia and such.  But, other than asking if I had any allergies, I was never given any info about the medications I was being given.  I understand that I was in an ER, but again I was fully cognizant once I stopped bleeding, I was calm, I like to think I was pretty chipper for an ER patient.  But no one talked to me about what they were doing for more than 30 seconds, never was it asked if I was okay with what was happening.  The doctors and nurses were nice, but as far as Informed Consent, it was totally absent.

Last year, I also had to go to the ER with the bf, who was super sick.  They did SOOOO many tests on him!  Ultrasounds, CT scans, X-rays!  Shit son, they threw the whole battery at him.  What did this result in?  A bottle of antibiotics and an $8000 bill.  Never, at any point was he asked if it was okay to do all these tests or if he consented to them or even what they all meant.

I have been told (yeah, this feels like I’m going to tell you a myth about Leprechauns or something) that you can refuse certain treatments.  But, the catch is, they never ask you if you’re willing to do them in the first place.  Essentially, you have to jump up and down like a child or go on a rampage in order to get your medical treatment explained to you.

So yeah.  I am a better person now for knowing what being an adult hospital patient means.  It means being forced to sign things without being able to read them and having no understanding of what’s being done to you.  Oh, and for some reason, you can never see your medical file.  Doctors are really resistant to this for some reason, even though it belongs to you.  I really want to stress that:  YOUR MEDICAL FILE BELONGS TO YOU AND YOU HAVE THE RIGHT TO SEE IT WHENEVER YOU WANT.

Get Rick Santorum Out of My Fucking Vagina!

Everytime I read the news I see some new article about Rick Santorum thinks he owns my lady bits!  In all fairness, this is not entirely him.  The anger and agitation and proposed legislation that inspired this post comes from a plethora of sources, including Obama’s caving to a 5 man “expert witness panel” on Healthcare Access.  (And yes, contraception is a matter of healthcare).  However, I like to put a face on my Rage–a Rageface, if you will–and this issue’s Rageface is Rick Santorum.

I feel like I’m in a fucking time warp/Twilight Zone whereI have to go to a back alley to getan abortion.  Where I have to prove I deserve an abortion because I was raped–though in fairness, Santorum still wouldn’t let me have one.  This was only reinforced when Foster Freiss told me to put an Aspirin between my legs, and I will get back to this un-joke later.  Oh, yeah, and in case I wasn’t put in my placed enough as it is, Virginia thinks I literally must be raped before being allowed to have an abortion.  Fo realz.  Viriginia wants to force a woman to have an invasive ultrasound which will require the use of VAGINALLYPENITRATING MEDICAL INSTRUMENTS AGAINST THE WOMAN’S WILL before allowing her to get an abortion.

The whole issue of contraception blew up because of two things:  the Susan G. Komen issue and the Healthcare Reform.

The Komen issue/scandal, I like to look at as a huge, awesome victory for women and for the common person in general.  Komen, although a well meaning institution and one the does a lot of good, is a huge political and corporate institution.  They make a ton of money and cannot avoid being effected by politics.  Their initial choice to stop providing funds to Planned Parenthood was a bad one and one completely motivated by personal politics.  I was so excited that PP clients themselves were the ones to put the pressure on Komen and that it was enough for them to reconsider their position.  I felt it was such a great victory!  Yay little people!  That’s how the system is supposed to work!  No violence, no burnings, just change!

The next issue *le sigh* is still going on.  Fucking.  Fuck.  Is all I have to say about this whole issue of whether or not religious institutions should be required to provide women with contraception.  I just want to scream every time I think about it.

Contraception is the one reason why women have been able to make the grand strides they have in the last 60 years.  Because of contraception women are able to CHOOSE to pursue and education and career and whether or not they want to have a family–an yes, there are women who do not want children.  GASP!  Women who work in parochial schools, private hospitals, etc. have every right to that same choice.  98% of Catholic are currently or have in the past used some type of contraction, yet their voices have not been heard in all of this.  I want to see a sea of Catholic women and women who work in Catholic institutions to march in front of the church saying “FUCK YOU!  I want my no-baby pills!”  It is the rightof a woman to make decisions about her reproductive health, uterus, and other lady bits, not the right of her boss.

I also think I need to point this out, because apparently people think that women only take birth control pills because they want to have tons of crazy non-committed, non-baby making, sadistic, dirty dirty sex:  birth control serves many other purposes for many women.  It is a hormone pill essentially.  It really serves many functions including helping cramps, balancing of hormones helps many other physical, biological, and emotional functions, it can help many women with weight control, back pain accompanying menstruation, migraines.   So yeah, can we get like a doctor to speak on this fucking issue?  One who knows what they’re talking about.

Ok.  This is getting really long and I have actual things to accomplish.  More to come on this same issue. Foster Freiss and his idiotic self as well as the 5 man panel testifying on birth control (because that somehow made sense to our backwards ass country).  Until then, I present you with The Sacred Whore, Sheela Na Gig!

I also didn’t edit this, so yeah.