Archive for the ‘Jones Family News’ Category

I’m a small businessman.  Have been for pretty much the whole of my life.  The largest organization I’ve ever worked for, since I left the employ of BYU when I graduated, was a presidential campaign, which technically has a couple of hundred employees but functionally has less than 20.  I currently run a branch of a mortgage company which has a varying number of loan officers, never (so far) exceeding 5.  I think of it as my own company, and I run it that way.  I have 20 years of small-business experience in several different industries, and I’ve been in leadership of the local Chamber of Commerce for a good while, which gives me that much more contact with all sorts of businesses large and small.

This thing with Gabriel has put me in contact with a huge number of enterprises that I’ve never had any dealings with before.  One thing that has absolutely rocked me is the whole hospital/health care thing.  Hospitals, I discover to my shock, are not businesses.

I’m talking about all hospitals, even nonprofit hospitals, which are many, because honestly there isn’t much difference between a nonprofit enterprise and a for-profit enterprise, in terms of how it operates.  Where the money comes from, yes, but otherwise no.  There are certain characteristics of businesses that hospitals lack in entirety.  One is a general connection between profit motive and sales.  Another is a cost basis.  Since I’m dealing with those up close and personal right now, those are all I’ll address, but there are more.

Here’s a core sample of the insanity currently running rampant in hospitals, and what you will see when you go there.  This list isn’t exhaustive, and it is, by necessity, restricted mainly to my experience with my child, but I’m told it isn’t atypical in any respect.

No matter what it is you’re there for, through the whole process, every time you ask about how much something costs, you’ll get a blank stare.  This means two things:

1. It means that you’re a heartless bastard that cares more about money than his child.  This is a monstrous accusation, but it was leveled at me several times.  It’s going to get worse, I’m certain, because I’m going to keep worrying this point.  While it is laudable and noble to put the life and health of a person above financial considerations, the fact is that no one’s life and health are beyond financial considerations.  Gabriel does not exist in a vacuum.  He is one of ten people in the family.  Thousands of dollars spent on his care means thousands of dollars less to spend on the care of the other seven children in the family.  It just does.  One thing impacts the other.  There is not an infinite and unending supply of money.

This is not only poorly understood, even by adults, it is actively sneered at as being unworthy of consideration.  This leads to union protestors in Wisconsin, among other things, that seem to think that there is a bottomless fountain of money to pay for whatever they want.  There isn’t.  Money that is forked over by the state to pay for first-dollar medical coverage is money that cannot be spent on roads, or schools, or policemen.  There are tradeoffs.  We’re starting to see some of those on a state and federal level.

They’re much easier to see on a personal level, because the amounts are not hidden by billions of other dollars of spending.  When they put a morphine drip in my son’s arm, they’re taking away money I need for car insurance.  When they transport him 50 miles by ambulance, they’re wiping out my ability to makes six months of mortgage payments.  I see the tradeoffs everywhere, and though sometimes I might be willing to make those sacrifices, I’m never given the opportunity to decide.  Once you’re in the system, it is assumed that you want every possible convenience, even if the truth is that you’d prefer to eat next month, and you’d be willing to forgo heated blankets to make sure you could.

2. It means – and as a businessman, this was the most incredible to me – that nobody knows how to answer your question.  Yes, the staff is aware that things cost money; what they’re not aware of is how much.  They can’t tell you, because they don’t know.  You book the OR for a surgical procedure, there are seven hundred pieces of that procedure and nobody – absolutely no one – knows what they all cost.  Most of the hospital people don’t even know what THEY cost, except in hourly or annual terms.

So it isn’t as simple as getting a handle on what I’m paying for, even, because nobody can tell me even if they didn’t think I should be shot for asking.  Because the medical billing is routinely handled by another department, and that department usually send the bill to a monstrous, faceless corporation that will write checks without thinking about it (we call this “insurance” as if that’s what it really is), and THAT corporation is getting its money from another corporation (we call this an “employer”), that takes medical insurance premiums as part of a “benefits package” that has half a dozen other moving parts, we have divorced the consumer from the consumption to such a degree that normal free-market cost controls are absent.  Try this on:

You run a grocery store.  You have to pay for meat, then re-sell it.  The meat comes to you with no price tag.  How do you know how much to charge for it?  You can’t know.  You can find out what people will pay, simply by putting the meat out there at $50 a pound and dropping the price until some of it sells.  But what if every grocery store has the same problem, and they all sell meat for $50 a pound?  Oh, wait, it’s worse.  Because the people that come in and buy the meat don’t pay for it.  They pay a grocery insurance premium increasingly (and with single-payer programs, known as socialized medicine, completely) divorced from how much meat they actually buy.  In consequence, they buy all the meat they can, no matter how much it costs (which, as I said before, they can’t know even if they’re curious).  When the grocery premium goes up, it goes up for everyone, whether they bought meat at all.  And there you have the US medical billing system.  Absolutely guaranteed to drive up costs.  You couldn’t have designed a system that would do it better.

The hospital sells all sorts of things under the heading of “care”.  In fact, EVERYTHING the hospital does as “care” sells me something that I have to buy.  Rarely, exceptionally rarely, am I given any choice.  Sticking with the grocery analogy, I am required to have carrots if I have beef.  Never mind if I want to have green beans instead (although if I want them in addition, that can sometimes be arranged).  The grocery store has determined that in my best interests, I have to have carrots.  So I get them.  They are placed in my cart.  And I get to take them home, while the grocery store figures out what to charge me for them.  This isn’t a business.  I know business when I see it.  It isn’t a charity.  I know those things as well.  This is something…else.  I don’t honestly know what this is.

What is the actual cost of an MRI?  I mean, the real, amortized cost of the procedure to the medical institution so that it can recoup the value of the machine during its useful life.  No. One. Knows.  How is this possible?  A construction company knows to the penny how much it has to charge in order to meet its costs, including replacing equipment when it wears out.  A copy store knows that it has to charge a certain amount for copies in order to cover toner, paper, and wear on the machine.  But a hospital doesn’t know how much to charge for basic medical procedures?  No.  It doesn’t.  There are no pricing signals.

This does not, however, make the costs go away.  What happens is one of two things: either the costs express themselves through the “insurance” system or they express themselves in rationing.  There’s no other way.  If there isn’t enough meat to go around, then either the race is to the strong and the lucky, or you develop a lottery system, or both.  See National Health_Great Britain.  It’s simply the way things are.  No politician, no demagogue, no think tank, no well-intentioned billionaire can make these things not be true.  If the new health care law restricts insurance premium increases – and it does – then the artificial constraints placed on price increases will mean rationing of care.  Period.  You can stand in the rain, or you can stand under an umbrella, but if you stand in the rain you WILL get wet.

This is the outline of the problem.  I’d outline a possible solution, but I’m tired and I bet you are, too.

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Gabriel isn’t sleeping.  I mean, he sleeps, a little, but he never sleeps more than an hour or so at a stretch, and last night he cried for about 2 hours starting at 10pm and going to midnight before he finally fell asleep, then he woke up every hour or so for the rest of the night.  Nicholas did his best to help Jeanette and I get some rest, but eventually at 2 I ended up down there with him until morning.  Jeanette, because it was closing night for my play, had him for the Hell Watch of 8-11pm.  I’d adore suggestions that did not involve powerful narcotics.  I’m starting to think I’ll drop that condition here in another day or so.

*********

We are literally brought to tears by the generosity of our friends, and even our casual acquaintances.  We’ve seen Paypal money almost every day for a while now, in all sorts of amounts, each appreciated as much as every other.  We’ve gotten baskets and packages of toys and food.  There’s some discussion of a benefit concert, a family fundraising dance, bake sales, all kinds of things.  I can’t possibly express to you what this means to us.  It’s more than the money – though as those bills roll in, that’s becoming critical – it’s knowing that so many of you are praying for us or, as my good friend Sara says, sending peace and patience our way.  We feel it.  We rely on it.  What a miracle you all are.  May God bless you tenfold, as He has promised to do.

Since today we got to talk about how screwed up the medical system is, tomorrow I’ll tell you how unutterably fabulous the medical people are, and I mean that sincerely.

No pun intended.

Gabriel didn’t sleep much at all the first night home.  He doesn’t sleep on his back, and he’s been sleeping in a crib for the last two years, so now that he’s downstairs on the couch and sleeping spreadeagled on his back, it’s not particularly conducive to rest.  Someone has to be there for him, which at night usually means Jeanette or myself.  Since Gabriel didn’t sleep, neither did we.  Well, okay, one of us didn’t.  One of us slept down on the couch with Gabriel, or on the Luv Sac that Kevin and Dianna Field brought us, God bless them and their posterity forever, and the other got to sleep in bed.

Mostly, Jeanette takes the night shift, because she’s tougher than I am.  She says it’s because I work all day, and she can take a nap, and this is a great attempt at spinning the situation, but we both know she’s full of it.  She’s not going to take any nap.  My work is mostly sedentary.  I’m actually the guy that should be taking the hard shift at night, but I can’t do it.  She can get 4 or 5 hours of often-interrupted sleep and still be fresh and productive the next day.  Me?  No.  Not so much.

So Jeanette didn’t sleep much the first couple days, then I spelled her and that night Gabriel slept 4 hours straight for the first time.  Karma, that’s what it is.

Mundanities.  Gabriel was on heavy Lortab for the first couple of days, and he hated it intensely.  It tastes so bitter that you can’t hide it in juice or milk, so he has to take it straight. The only way to get him to do that is for one person to hold him down, pinning his arms and squeezing his mouth open, and the other person squirts the stuff in his mouth and blows on his face, which causes and involuntary swallow.  And then he screams.  And then you can let him go.  It’s fun for the whole family.  We ‘ve gotten good at it, but the first couple times, dang, that was one sticky mess for nothing.

After the first couple days, though, somewhat out of fatigue, we stopped giving him Lortab and just gave him periodic doses of Motrin and Tylenol – DO NOT GIVE LORTAB AND TYLENOL TOGETHER (Lortab contains acetaminophen already) – because those tasted okay and could be hidden in juice.  After four days, we stopped that, even, and for the last three days he’s been drug free, except last night, when he wouldn’t settle down at night so we Lortabbed him again.  Today, so far, he’s been great.

He can’t move around, so toys have to be brought to him.  He throws them, then cannot reach them.  Anyone have solutions to this?  Or is this just one of those things we have to deal with?  We haven’t really got a lot of stationary toys.

He doesn’t eat.  As in, he eats, but about half to a third of what he used to.  Now I know he’s not expending a lot of energy, so that doesn’t worry us a lot, but I thought I’d mention it.  He’ll eat candy and fruit, but not a lot of protein, and he drinks a lot.  Which means, drumroll, that he pees.

The first couple of days, he didn’t poop.  They told us this probably would happen because of the narcotics they gave him in the hospital.  Then when he did, it hurt him.  Be aware of that, those of you that are going to go through this.  He still peed, though, and that’s a serious problem.  He’s got a squarish hole in his fiberglass pants that allows a diaper to be affixed to him.  I say “afffixed”, because the diaper next his skin is a size 1 crammed up into the hole to try to stop the pee from getting onto the padding of the cast.  Then you wrap the whole thing up in a size six, which is too big ordinarily for Gwen, our nine year old.

But you can’t cover everything.  It’s now been one week since he got the cast, and it stinks to high Heaven.  I mean, it smells so bad that you can’t tell if he’s messed his diaper just by smelling.  There is no way to wash the cast.  Baking soda is our first attempt at stench control, and it’s not had much effect.  We’ll try lemon oil tonight, but please, if you have suggestions, we’d love to hear them.

The rest of him smells, too.  We can’t wash him.  Moving him a lot hurts, so we try not to do it, except to pick him up every couple of days to change his shirt and clean all the crumbs out from under his spot.  We’ll pretty soon have to washcloth him over all the area we can get to, but that’s not very much, and I fear what will have happened is that a full four-course meal will have gone down the top of his cast, which is belled outward to give his torso some movement capability.  In a couple weeks, I bet we can hang him by the bar between his knees and let some of that stuff fall out, but he’s still tender, so that’s not an option now.

But people, he’s doing really well.  he plays with us, and we are having a great time inventing games to keep him occupied.  Jeanette played hide and seek with him the other day.  Gabriel would put J’s cell phone up to his eyes to cover them, then count one, two, thirteen, sixteen…ready!  Jeanette puts a couch cushion up between them, and Gabriel pulls that down and yells “found you!”  So if you can play hide-and-seek while lying in one spot on your back, then life is pretty good.

We can’t do much around the house, so we’re grateful for meals and vacuums and friends and all the rest.  And Thursday, Nicholas took the first shift, and Jeanette and I slept in the same bed for the first time in a week.  Small blessings, gratefully received.

I write a lot of fiction.  It’s fun.  But fiction, as the adage goes, has the disadvantage of having to be realistic.  Reality has no such constraint.

We talked with the American Fork Hospital billing people a couple of times this week.  And honestly, you can’t make this stuff up.

They called us Tuesday, wanting to talk to us about payment arrangements.  We were expecting their call.  They asked us the usual questions about how much we could pay every month (we don’t know) and whether we were going to apply for Medicaid (we are not), etc.  We told them we were going to be paying for everything ourselves.

That pleased them.  The gal said “you get a 25% discount for paying in cash.  You also get a 15% discount for paying within five days.”  That pleased us.  We asked, “so, is that 5 days from the day we get the final bill, or five days from Friday?”

“That’s five days from Friday.”

Now, get this, people.  We checked in on Friday after 11pm.  We count that hour as a day, apparently.  Then we have Saturday, Sunday, and Monday was a holiday.  This was Tuesday.  It was five days right that minute.

“So we have to pay you today?” we asked.

“Well, <reluctantly> I guess I could let you have until Friday.”

“What’s the final bill?”

“I don’t know.  It’s still being prepared.”

“So even if I wanted to pay you today, I couldn’t.  When will you have the bill ready?”

“Probably by Friday.  Maybe not, but probably.  Definitely not before then.”

And Jeanette laughed into the phone.  This didn’t faze whoever this was.  Apparently patent absurdity is so normal that they can’t even hear it any more.  We asked them what happens if the bill isn’t ready by Friday.  Did we lose our discount?

VERY reluctantly, they said, “I guess I could extend it to Monday.”

“So, if you don’t have the bill on Friday, you can extend the time to pay until Monday?”

“Yeah.  I guess I could do that.”  As if she were granting us a great favor.

Now, at this point I should have said “No, no.  I don’t want any favors.  I’ll pay you Friday.  I’ll make a number up, and put it on a check, and deliver it to you, and you can give me my discount.  If it’s not enough, I guess that will teach you to get you bill together faster, or develop a billing procedure that makes some sort of rational sense.”  But I didn’t.  Alas.

So here’s where we are.  They’ll knock 25% of our bill off even if we have to pay in three installments over the next couple of months, interest-free.  They will also take monthly payments, but in that case they’ll add 8% annual simple interest.  And it will take them more than a week to get their bill together.

This is not because everything is billed separately.  The radiologist will bill us separately for the x-rays (2 thereof).  The ambulance will bill us separately.  THE ER DOCTOR will bill us separately.  The hospital cannot, in under a week, figure out what to bill for inserting a line and administering saline and morphine, and splinting Gabriel’s leg.

People have asked me why I’m taking so much time blogging about all this.  Well, this is the reason.  I think most people haven’t the vaguest clue how completely cocked up the entire medical system is, and I’m not, in the main, talking about the medical part, which is complicated but that’s because bodies are.  The billing part is far, far more screwed up than any other piece of the system, and it is on this that I’ll focus more attention as we go along here.

They see several hundred people a month in the ER.  Yet they cannot produce a bill in less than a week for a procedure they perform HUNDREDS OF TIMES A YEAR , even if we take out all the other moving parts.  This is roughly like a restaurant taking a week and a half to send you a bill for a hamburger, even if they don’t have to bill you for taking up table space, for the waitress, or for drinks and fries.

It’s not stupid.  It’s worse than that.  It’s evil.

I was, in fairness, warned.  But I didn’t believe it could be as bad as people said.  And it isn’t.  It’s worse.

It’s incredibly offensive to be accused of child abuse after nineteen years as a parent with not one trip to the emergency room.  We’ve been parents now for a total of 82 child years, and we have three broken bones (this makes four) and four stitches.  Total.  We have bikes and trampolines and skateboards and ripstiks and skates and our kids play basketball and do all the stuff kids do.  They almost never get hurt.  We’re not the most careful of parents; we’re just very lucky and/or very blessed, whichever you like.

But the one thing you can’t say about our parenting is that we abuse our children.  We make them work, and do not believe in the Nintendo DS, so THEY think they’re abused, but by no possible adult definition of abuse are we committing any.

Bad news for us, then, when Gabriel’s injury happened to be consistent with having been abused.  The break, as I noted here, is not a typical one for that bone.  The break ran along the bone diagonally, not across, as would be consistent with a blow.  This break is more like what you get when you put torque on it, as in when you grab and twist, rather than strike.  Striking is what you’d expect from normal play.  The femur is a very strong bone.  It supports a lot of weight and is quite hard to fracture.  Gabriel, being 2, has fairly soft bones at this point, but even still this would have to have been something unusually violent to cause the break.

The Primary Children’s Hospital sees as much abuse as any medical facility in the world, I would think, and they are fairly attuned to it.  By “attuned”, I believe I mean, “they see every injury as potentially an abusive situation”.  And on its face, I don’t have any quibble with that.  I’m no more in favor of child abuse than anyone else.  On the other hand, being the father of eight children, and being the oldest of seven, I’ve seen my share of spanking, whacking, tossing, and forcibly restraining done by parents to their children.  I’ve done some.  Like many other things, how you do them is far more important than what you’re doing.

Three different nurses/doctors were involved on our abuse investigation at Primary.  The first one was apparently (I’m translating for my wife, who was the one on site) just asking questions about what happened.  As I previously mentioned, we don’t know.  This is not, perhaps, the most defensible position to be in.  It is perfectly possible to construct a negligence charge, or worse, out of what we know about the injury, because we just don’t know anything.  We weren’t, strictly speaking, there at the time.  I personally was in another city 40 miles away.  Jeanette was one room away, not looking at the incident, which she couldn’t have seen from where she was anyhow.

Note to those that aren’t parents: it is not only impossible to watch your children every second of the day, it is wildly undesirable, for you and for them.  Modern society seems to believe that an adult’s personal hedonistic fulfillment is the purpose of life, and simultaneously that every child has the right to expect constant, round-the-clock vigilance over his well-being.  The only way these two things are compatible is if there are no children at all, or if your aim is Brave New World.  Having had my share of discussions with possibly well-meaning but certainly ignorant non-parents on this subject, I can tell you that I think both of those outcomes are fervently desired by large chunks of the population.

Therefore, being a parent, I am under constant suspicion of wrongdoing.  All parents are.  We are unlicensed childcare providers.  We serve food from uninspected and unlicensed kitchens.  We drive our children around in unsafe vehicles, and again, we have no special training in child transport.  Seriously, think about it.  We are bus drivers with no CDL.  We are restaurateurs with no licensing or education.  We provide day care in overcrowded and unsafe environments that would never pass any state inspection.  If we were constantly watching OTHER people’s children in this manner, we’d be in jail.

It is a good thing that Jeanette was the one that was at Primary instead of me, because by 3 or 4 am “pleasant” was no longer an available emotional state for me.  I’d have been hauled off in handcuffs for challenging the doctor to a duel.  She asked all the usual questions about what happened, then said she’d need to do a full body scan.  She prodded and poked everywhere on Gabriel she could get her fingers, which by this point (by ANY point – Gabriel does not like to be poked) he really appreciated, as you can imagine.  Nobody found anything, because there was nothing to find.  He has a couple of bruises.  That’s about it.  Can I swear that he’s never broken anything before, and we didn’t think it was a big deal?  No.  I can’t.  I seriously doubt it, because we do pay very close attention to our children’s physical health, but I couldn’t swear to it.  Kids get hurt.  I WANT them to get hurt.  It’s part of being a real person.  If they spend all their time playing only games where no physical injury is possible, we kick them out and tell them to go ride bikes or jump on the trampoline.

They were talking about full-body x-rays and turning him over to see his back.  Jeanette flatly refused this.  The child has a broken femur, BREATHING is a chore for him because of the pain he’s in, and you want to turn him over on his back?  Which one of us is the abuser here?  Thankfully, I was in bed 35 miles away.  Jeanette is much more restrained in her response to this sort of thing.

After the first nurse left, Jeanette texted my sister “that nurse has just gone to call DCFS”.  She clearly did not believe a word Jeanette said.  By the time we got the third doctor, a Dr. Campbell, apparently they had pretty much given up the abuse idea.  Dr. Campbell not only contradicted what the first two nurses had said repeatedly, which was that this injury was very rare, but herself constructed a plausible way for it to have happened.  Maybe the staff is trained in investigative technique, so that they send in a stream of people to ask identical questions, hoping for contradictory responses.  Maybe they intentionally disbelieve everything you tell them, hoping for a giveaway reaction.  If so, they’re very good.

A word to the wise, then, for you parents in similar circumstances.  You are going to be suspected.  You are the enemy.  The child is of paramount importance (this is self-evidently stupid, but it’s the default position for our society), and you are only a caretaker that can be removed at whim.  Do not treat this lightly.  The system can and will take your children from you with little provocation.  When you go to the hospital, and you will, at some point, have to go, understand that you’re going to have to go in armored and vigilant.  Tell the truth, but volunteer no speculation.  Insist on being treated fairly and with respect (except for this one part of the experience, I doubt you’ll have any trouble with that).  If a particular investigative line threatens the health of your child, as when the nurse wanted to roll Gabriel over to look at his back, refuse politely and don’t back down.

If you are an abuser, God help you.  You’re going to get caught.  Get help before that happens.

For us, we passed through the gauntlet and survived.  This time.

So, since Christmas has expanded to fill the known universe, and Hallowe’en is about to fill up the unknown part, I thought I might try striking a blow for my favorite holiday of the year, one that gets no pub because it has no significant music of its own – Thanksgiving.

Thanksgiving carols may be a rare as turkey’s teeth, but Thanksgiving does have one thing to make it stand out above all other holidays – pie.  Pie is, as everyone knows, the True Meaning of Thanksgiving.  So I am, in my own small small way, expanding the holiday to be three days, and calling the new, improved holiday the Three Days of Thanks.

Here are the festivities, and the rules.  Don’t carp.  All holidays have rules.

Tuesday before Thanksgiving, the First Day of Thanks, is a day for giving out pie.  Today, for instance, I am giving free pie to every one of my clients that wants one.  Not a slice of pie, a whole pie.  You want good Karma, give good gifts.  The Lehi Bakery has made me a huge number of excellent pies, and I’m giving them away cheerfully, except the one strawberry rhubarb pie that met with an unfortunate accident when it ran into my knife and fork on the way in from the car.  Tragic.  So I have to eat that one.  But the rest, they’re all going to good homes and stomachs.  We’re also taking donations for Sub for Santa, a project of Lehi City and the Lehi Rotary Club.  Go, and do thou likewise.

On the First Day of Thanks, as for all days of the festival, all Facebook updates and all tweets have to include gratitude or thanks.  Tweets should be hashtagged with #3DaysofThanks.  It’s a great time to be thankful for the great followers and friends you have, as well as those you follow and befriend.  You have a huge number of things to be thankful for.  Three days really isn’t enough to get through them all.  But it’s what we have, so go with it.

The Second Day of Thanks is marked by my favorite part of the entire festival, a little thing called Pie Night.  This was begun many years ago by Gordon Jones, the Patron Person of Pie, who, while reading Harold and the Purple Crayon, by Crockett Johnson, was struck by Harold’s lunch of all nine kinds of pie that he liked best.  So, to commemorate that blessed event, Gordon staged the very first Pie Night, an evening when the family gathers together and eats pie.  Pie, he thought, had been getting lost in the commercialism of Thanksgiving, and it needed to be restored to its rightful place at the center of the holiday.  And Pie Night was born.

Our family celebrates this event with acts of humanitarian service, making gifts and packets for less-fortunate people around the world, which we donate to the LDS Church as part of their global humanitarian work.  Choose what you will.  But give, and give freely.  And eat pie.  Don’t forget that part.

Then the Third Day of Thanks arrives, known in most of the USA as Thanksgiving.  I think you know what to do here, so I will only add a couple of things:

1. No complaining.  This is a day of Thanks.  Go the entire day without being frustrated or angry or whiny.  You can do this.  It’s only one day.  The next day is Black Friday, so save all that angst up and use it then, where it can score you some awesome deals at BestBuy, or your hedonist altar of choice.

2. Don’t forget the pie.  This is a good day to catch whatever pies you didn’t get a slice of on Pie Night.  Turkey is good, and stuffing, and mashed potatoesandgravyandsweetpotatoesandcranberrysauce.  But don’t forget the reason for the season.

Then the three days are past, and you can resume your regularly scheduled lives, already in progress.

So happy Three Days of Thanks.  Today is the First Day, and you know what you have to do.  It will change your life, and your waistline.  Go to it.