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Health Update – The Colonoscopy and More

Here’s the tl;dr – I had my no-anesthetic/no-painkiller colonoscopy. We weren’t able to complete it, but did get about halfway, and it revealed issues I’ll have to deal with, which is going to mean meeting with a lot of doctors over the next few weeks. It’s serious, but we remain hopefully it can all get handled.

For the longer version, CW – blood, cancer, pain, polyps, and poop.

I had assumed my rectal bleeding was unrelated to my pulmonary embolism. Looks like I was wrong.

The prep period for this was difficult because I already tired easily, and going through hours and hours of cramps and body-emptying trips to the restroom was leaving me so shuttering exhausted I had trouble even standing. But I got through it, and got in to the colonoscopy today.

The first half hurt, but was manageable, But there was a point past which the pain was enough to make me unable to breathe, and see sheets of blinding white. Also, my heartrate and blood-pressure kept spiking at that point, soo the doctor and I agreed that was as far as we could go.

However, in the section we could check, I had two polyps the doctor described as “very large, very suspicious.” They could not be removed under those circumstances, but the doctor did get material for biopsy. That said the bigger one was bleeding, and “clearly undergoing changes.” We can’t say they are cancerous until the biopsy comes back, but the GI doctor is convinced the larger of the two is definitely cancerous.

In any case, they have to go.

First, of course, they either are or soon will be, cancer. But, secondly, the gastroenterologist said their size and definition mean they are very likely to be responsible for instigating my blood clots. If we don’t remove them, I run the risk of more and more clots, another embolism, stroke, and so on.

He also noted that these are things that have been around for years. Certainly if I had gotten a colonoscopy at 50, they’d have been visible already. (I cut myself slack due to the pandemic, but still.) And there’s a good chance that if I had gotten one at 45, we’d have seen them then. (When I was 45 the recommendation was still 50… and by the time I was 50, the pandemic was in full swing. I made a call to wait, and it was the wrong call.)

The doctors confirm to me that the fatigue, lack of focus, listlessness, and even brain fog I have been suffering in increasing severity since 2017 are in all probability the symptoms pf the polyps, and the blood clots they’ve been creating. I have been seriously ill for 6 or more years, slowing down, losing jobs, having trouble meeting my own expectations, and we couldn’t ever figure out why.

Well, now we know.

And let me be clear, knowing is huge. No matter how I tried to eat better, exercise more, take more antidepressants, for six years my life has been a slow-and-apparently-inevitable slide into disability. I have been disappointed in myself again and again over the past several years, because no matter how hard I tried, I could not work in the level of volume, quality, or even enthusiasm I expected. My life felt over, and part of my depression was seeing that things always got worse, and my life was losing it’s value to me.

Well, fuck that. I have literally seen the enemy now. I have a cause, and can focus on eliminating it, and recovering. There’s is a fight I can get into, and win my life back.

So, this process is going to go as fast as it can, but that’s still a matter of weeks rather than hours or days. Surgical removal is an urgent necessity… and complicated. I must be on blood thinners for the pulmonary embolism, and I still need supplemental oxygen when I sleep or exert myself. Those factors put the risk of me dying under general anesthesia at around 10%, even for something minor like a colonoscopy, much less surgery. But if the polyps are, as expected, cancerous, we need to get them while they are still stage 1 (assume we haven’t missed that already), so we can’t wait.

There are options, and I will be seeing a cardiologist, hematologist, and oncologist over the next few weeks, as well as my primary care physician. The hospital staff all agreed we’d have to “get creative,” but we can do that. We’ll gather all the info we can, consult, form a course of treatment, and carry forward.

This is, obviously, going to be tiring, time-consuming, and expensive. But my life is on the line, so I’ll handle each of those hurdles as necessary.

And I’ll try to keep everyone posted.

Methods of Support
So, a lot of people have offered a lot of support, and I deeply, deeply appreciate it. There are plans moving forward to try to help cover medical bills and loss of income, and when they’re ready, I’ll announce them here. I may end up needing to turn to extraordinary measures, such as a GoFundMe, but I won’t be doing that until I know for certain I have to.

However, if you DO want to offer immediate support, I won’t refuse it. You can join or increase your membership tier at my Patreon, or if you prefer do one-time support through my Ko-Fi.

Thanks, folks.


The Seminar Files 01: Publishing ttRPG Material With Little or Not Art Budget

The Seminar Files is a new branding of an old idea: to provide the kind of information, thoughts, and answers I would once have given during a gaming convention seminar in a more accessible format. Not every creator or potential creator can afford to go to conventions and industry events to attend seminars, and that can create a barrier to entry that disproportionately impacts lower-income creators, creators with disabilities, creators that don’t feel safe in traditional game industry spaces, and creators in physical or social spaces that don’t even hear about game industry events.

Obviously those are serious issues that won’t be solved just by putting up blog posts–which themselves have some issues with limited accessibility–but every tiny step helps, and my hope is that not only will my own Seminar Files help get information to people who wouldn’t ever have a chance to hear me give it in a live seminar, but that it may encourage other veterans of a range of creative endeavors to also strive to make this kind of advice available in alternative formats.

Publishing ttRPG Material With Little or Not Art Budget

One of the hardest parts of being a one-person shop or small press publisher is what to do about art for a project. Many independent creatives have the skills to write and edit themselves, and can either learn to do layout or find someone who will do layout for a few dollars per page. Often elbow grease or a tiny budget can handle all the text and graphic design elements of a small project, keeping the barrier to entry lower the the bottom position of a limbo competition.

But art? Art is tougher. Good art is (quite reasonably) expensive. Few writer/developer/publishers can do their own art (though there absolutely are a few who can). Several low-to-no budget projects in recent months have turned to AI-generated images, but between the US Copyright Office declaring AI-Generated images not being eligible for copyright in a recent case and a number of companies (Chaosium and Paizo, in particular )declaring their community content programs do not allow the use of AI-generated images or text, that solution is less appealing to many of them.

Way before AI generated images or text were realistic options, publishing on a budget and having decent art was a challenge. But the very fact that challenge goes back decades means there are other potential solutions than AI, and I have enough experience with several of them to speak to their pros and cons. Obviously a lot of this advice can apply to projects outside the game industry, but that is where my own expertise lies, and thus is how I have framed this article.

Let’s look at some specific art-on-a-budget strategies.

1. Stock Art

One extremely cost-effective option is to use stock art for your project. There is a ton of very reasonably-priced stock art available at DriveThruRPG, and there are also professional stock art sites such as Adobe Stock Photos, Shutterstock, and Getty Images. Now, some provisos.

First, read the license before you pay for or use any stock art image. That’s simple for the specialty stock art sites, their licensing is normally easy to find well before you sign up (and they usually have better search engines, though they often have less game/speculative fiction-specific images). For DriveThruRPG the licensing is determined by each artist individually, and sometimes you have to search around a bit to find it prior to paying for a piece. If you can’t find the license, contact the publisher and ask for it.

Second, while many sites have policies stating that AI-Generated images must be marked as such, they don’t all have such rules, and even those that do lack a perfect method of detection and enforcement. In many cases a practices eye can pick put AI-generated images, but it isn’t always as easy as looking for characters with a weirdly large number of fingers. If you need to avoid AI-generated art (either for your own ethical guidelines or licensing requirements of the project you’re working on), you may need to seek out stock images from artists with a recognizable name and track records.

Third, really good, cheap stock art is likely to be used by a lot of projects, which can reduce the impact it has when you use it. There’s no perfect solution for tis, but older stock art is less likely to get used for a similar product around the time you release something with it than brand-new art everyone is excited by for the first couple of months its out. Also, some stock art allows you to modify it, which can increase customization. I personally am a big fan of art patreons that produce stock at and take feedback from backers (such as Dean Spencer’s Art Patreon), produce material anyone can use for free (such as Fantasy RPG Cartography by Dyson Logos), or have tiers that let you order specific images which become stock art for everyone after a certain period (such as Jacob Blackmon Illustration). Those require spending some monthly money, of course, but you still get a lot of visual impact per dollar spent.

Fourth, the more unusual the concepts of your project, the harder it is to find stock art that fits it. If you’re writing a cyberpunk setting, or a list of options for fantasy wizards, it’s not hard to find appropriate stock illustrations to match those concepts. But if you specifically need art of cybernetical-augmented anthropomorphic sharks with stun-gun-equipped mancatcher polearms… chances are you won’t find stock art to meet your needs.

There are a few ways you can handle that issue. First, you can just leave the unique elements of your product unillustrated. That’s not ideal, but a good cover combined with a title and description that spells out what’s interesting about your project is often better than no art at all. Secondly, you can find the coolest stock art that interests you, and write a product that is inspired by that art. Yes, this means writing something based on someone else’s ideas rather than your own, but if you do one such project, you can take the money it makes to pay for more custom art for your next, more you-centric product.

2. Public Domain Art

Want an even cheaper than stock art? Well, then it’s time to look at the Public Domain.

(Art by Gustav Doré, now in the public domain)

Public Domain art is available for anyone to use in any way they want. Of course,  you need to understand what is and isn’t Public Domain,

For finding Stock Art, I’m a big fan of OldBookIllustrations. It’s a big collection, has a search engine, and provides info about artist and publication for each art piece (if known). The British Library has also released a huge Public Domain collection on Flickr, which for my purposes is less well-organized, but has stuff hard to find elsewhere (including maps).

Public domain art has all the subject-matter and style issues of stock art, but as long as you are sure it’s actually public domain, none of the licensing problems. And while a ton of public domain art is woodblock prints from centuries ago, there is other content out there if you look hard enough. Learning some image editor skills can be a huge help in turning what is available into something you can use, and there are good free image editors out there (I often use Pixlr when I just need to crop or touch up something for a blog post and don’t want to take up the time of my professional graphic designers and their greater skills and more powerful tools).

3. Other Licensed Art

In addition to commercial art and public domain art, there are other ways art gets licensed that makes it viable for commercial use. One big example of this is art released under the Creative Commons License, especially the CC-BY license. Most of the notes about stock art and some about public domain art apply here, but the most important one is to make sure you know which Creative commons license you are dealing with, and that you understand it.

4. Skip the Art

Yes, it’s a well-accepted truism that ttRG products must have art, especially cover art. And I believe an attractive cover is crucial to sales, and good interior art helps break up “walls of text” that can otherwise be daunting and unattractive to many readers.

But you don’t have to use illustrations to accomplish these things.

Raging Swan Press is a great example of a successful company that has attractive, informative, and even eye-catching overs with no illustrations beyond their logo. Obviously you shouldn’t duplicate their trade dress, but being inspired by it to create your own illustration-free cover design is a huge budget-saver, especially when you consider the impact of not paying for cover art over the life of entire product lines.

Similarly, there are things that can break up pages of pure text in the same way art does, without actually being illustrations. Chapter and section headers, charts, tables, sidebars, bullet points, scholar’s margins, and similar treatments of text that’s in any way different than the main prose can help break up the visual monotony of page after page of pure text.

5. Partner With An Artist

I’m going to open this section with a quick anecdote.

In 2014 Adam Daigle and I were guests at Comicpalooza, and we spoke about breaking into the games industry in a panel with easily 1,000 attendees. Most folks were interested in videogames, but there was still some basic stuff we could discuss that was relevant for them. At one point, a person wanting to be a writer for video games mentioned they were having trouble making a good impression because writing for a video game fell flat without art, level design, and programming, and they couldn’t afford to pay people to do those jobs just to make a working example of their writing.

Adam asked if there were any artists who wanted to have a sample video game they could use as part of their resume, and dozens of hands went up. then he asked about level designers, and then programmers, and in every case there were dozens of hands. So, Adam suggested, maybe those people should all get together and form groups, each looking to create a small playable example of their work. When the seminar ended, there were circles of people from different disciplines gathering, talking, exchanging business cards, and picking places to go and talk more right there at the con.

The moral of that story is that there are other people who want to break into the games industry, and some of them have exactly the skills you need to shore up your own weaknesses. They may not have the level of polish you’d prefer, and partnering with people means figuring out (and writing down!) how ownership of the end product works, how everyone gets paid, and how creative input is shared, but those are all solvable issues. Again, compromises are going to be called for, but if you work with other folks at your experience and success level it can both serve as a stepping stone to having the budget you need to hire professionals to match your specific vision, and help make contacts (and friend) that may well be a huge part of your process and success in later years.

6. Decide What You Are Trying To Do

One of the pieces of advice that I don’t think is discussed enough is “Decide what your goal is with your work.” Do you want to be a publisher, one-person or otherwise? Great, then work on finding ways to publish material even if it’s not your magnum opus. In that case, for early projects you may have to find stock or public domain art first, and build products around it.

Do you want to be a professional writer, developer, or editor? Okay, then maybe you don’t need to self-publish at all, or should do so specifically for the goal of proving you can do the work, so you can point at that work when asking publishers to give you a shot. In that case you may not need art at all, since you aren’t trying to get work as an artist or art director. Just make sure your text is as clean as possible, and understand that being a professional paid ttRPG writer working for other publishers is mostly about writing the projects someone else wants to make happen, not getting paid to do the projects you want to make happen.

(And if you DO want to get work as a ttRG artist, by all means see if you can find a writer and publisher who is looking for an art solution and partner up with them for a few projects. Just make sure your ownership and cut of the profits is covered in writing when you do.)

Do you just want to publish the one thing you are dying to show the world, make sure it’s true to your vision, and don’t want to turn this into a career or even side-hustle? Well, most likely that means you are a hobbyist, and there’s nothing wrong with that. But if you want custom art, high-quality layout, and someone else to do the boring parts of developing and editing your text, and aren’t willing to compromise or build a line of other projects to slowly build to a bigger budget, you likely are going to have to pay for it. Like most hobbies, publishing at a professional level primarily for fun and bragging rights takes money.

Even if you aren’t sure what your end-goal is, deciding how you want to proceed initially can help you figure out what low-to-no-budget art strategy to begin with. As your experience grows and your goals shift, you can pivot to projects and plans that better match your evolving needs.


This post represents more than two weeks work at my current capacity, so I can only manage them if they earn support. If you want to see more longer, more advice- and industry-focused articles like this, please join my Patreon. Even a few folks throwing in less than the cost of a cup of coffee is a huge sign that I should keep making this type of content. (Speaking of coffee, if you’d prefer you can buy one cup worth of support for me at my Ko-Fi.)

About My Pulmonary Embolism (Pt. 2) – The Diagnoseificationing

This is a follow-up to my post describing the events that lead to me being admitted to the hospital with what turned out to be (amongst other things) a pulmonary embolism. There’s a tl;dr version near the top of that post, so I won’t repeat the abbreviated account here.

CW – ambulances, breathing issues, health issues, hospitals, blood and IVs.

Storytime: My Pulmonary Embolism, Part Two – The Diagnosificationing

This post picks up with me already admitted to the hospital, but with no diagnosis as to why I couldn’t breathe without oxygen, why just standing up left me trembling with exhaustion, or why my heart rate — once raised — stayed elevated for an hour at a time.

I really wanted to get diagnosed, get a pill that fixed the issue, and get home. But as the staff drew 6 vials of blood, hooked two different sets of wires to my chest (one for keepsies throughout my whole stay, one just for a specific set of tests, which they applied and removed three times during my stay), drew 4 more vials of blood, stuck an x-ray plat under me, drew 4 more vials of blood, listened to my chest, drew 2 more vials of blood, and shuffled which “machine that goes PING” they had in with me at any one time, it became clear I wasn’t going home that night.

Eventually, a doctor confirmed it. Their then-best guess was severe pneumonia, with its stress and overexertion leading to tachycardia and arrhythmia… which is just a fancy way of saying “You’re sick, you were dumb, and your heart freaked out.”

And, to be fair, it turned out I DID have pneumonia. And was suddenly anemic. But those were just frosting, not the true Bad Health Cake.

So that night, they finally admitted me to the hospital. I had to wait from a Bariatric Bed to be available (fancy term of “partially inflatable fat-person crib”), did one final set of ER-based injections into my I.V., and took me up an elevator.

Oh, lord, the I.V. You know, I’m going to take a quick aside to talk about my I.V.

I have tiny little fuckers for veins. They hide, dodge, dry out, and are generally difficult for phlebotomists to deal with. When I was in the ambulance the paramedics tried to get an IV in my left hand… and gave up. Then they successfully started one on my right hand… and it stopped working while they were hooking up a bag. So they decided to try on my left arm, and (with a team effort) got one working.

That was the IV I had when I got into the ER, and within a few minutes, it stopped taking the fluids they were pumping into me. So the young nurse called the old nurse, and the old burse wiggled it, got it working again, and decided to tape it down more. We’ll that IV Mark 2.

Then they decided I needed multiple antibiotics, because my x-rays showed I had pneumonia… and the Mark 2 IV stopped taking in fluids. So the old nurse called a SNTTFST (Specialist Nurse Trusted To Fix Such Things), and he wiggled it, re-lay the tubing, used tiny shims of tape to keep it in just the right position, and then added more tape.

A LOT more tape. Like, a “this ductwork needs some tape” amount of tape.

We’ll call this IV Mark 3.

That survived until I got up to my actual hospital room, where a new set of injections has to be made directly into my IV and… it did not go. So the nurse wiggled it, and added some tape, and could flush it, and got my injections in through it. That was IV Mark IV, which I liked the sound of, and it lasted a full day.

But a little more than 24 hours later, my drip stopped feeding into my IV again… and the nursing staff was Not Having It.

So the Entire Nursing Staff On My Floor had a conference, held an exorcism, threatened by veins at gunpoint, and decided everything but the needle Had To Go. They reworked the entire tube looping, juggling, shimming, and taping process, and slapped a patch with a clear section right over the insertion point. I called this IV Mark V, also the Window of Horrors.

It lasted until I was discharged… but was visually gross. Below is a picture. You were warned.

(It’s not as comfortable as it looks. … Nope, even less comfortable than that.)

The only issue we ever had with the Window of Horrors was, once, a new nurse let the blood pressure cuff slide down halfway over it, and then turned on the machine to squeeze the hell out of my harm. And, in this case, the “Hell” that got squeezed out included a tiny stream of my blood, like a crimson water fountain for ticks.

Okay, enough of the aside.

My wife Lj had to go home to get the things we’d need for a stay of, we had been warned “a couple of days if it’s pneumonia, or up to a few weeks if it’s sepsis.” I got hooked into the wall-mounted oxygen, and a few banks of monitors checking my blood 02 levels, my heart rate, my respiratory rate, my blood pressure (originally set to take itself every two hours, eventually downgraded to a nurse doing it every four), my IV fluid intake, and I am sure a half-dozen other things I never know about.

For me, the main thing I hard to remember about the oxygen and monitors was, if I had to go pee, that required unhooking three sets of wired sensors, unplugging the rolling IV stand, and curling up enough oxygen hose to play out in the slow, daunting, exhausting, trip from the fat-cradle-bed 5 feet to the bathroom. It took planning, perseverance, and patience to go pee.

Lj wanted to stay in the room with me, but I saw the chairs they had in there, and began to tell her not to. An overnight in one of those not-padded-for-spit, kinda-reclines-but-not-really, hard-arms-that-dig-into-your-sides chairs would leave her back aching, her legs cramped, and her so sleeplessly tired she couldn’t safely drive. Trooper that she is, she refused to budge and insisted on staying.

Until about 3 am, when she had to go home before she was so pained she couldn’t. My wife is determined, not stupid.

The next 24 hours was hard on me, maybe the hardest of the whole time I was hospitalized. Lj got stuck at home trying to catch up on things left undone, and a thunderstorm, and other issues, and I told her not to come see me the next day because it was going to be too much for her. I cried a lot, because I couldn’t sleep (getting your blood drawn every four hours, and a nebulizer strapped to your face every 4 hours, and your blood sugar checked every four hours, but all by different people on different schedules, makes sleep tricky-at-best), and because no one could tell me what was wrong with me for sure, and nothing was getting better, and I was afraid this was what I had to look forward to for the rest of my life.

It was a dark place. The nurses noticed, and got me some anti-anxiety prescriptions, and that helped.

Thurs-Fri-Sat were better, though the longer I was stuck in the bariatric bed I was at war with, and went without a shower, the grumpier I got. But I finagled a better chair for Lj so when she did return, she could (and did) stay with me. And the diagnosis began to firm up. In addition to the pneumonia and the anemia, I almost certainly had a pulmonary embolism (that’s doctor-talk for “blood clot in your lungs choking you like an evil little chest-gremlin), which led to testing for and confirmation of a Deep Vein Thrombosis (doctor talk for “don’t sit in a chair for 12-14 hours straight each day or you’ll die”). Blood thinners were added. I began to be able to walk a bit.

Walking 35 feet while on oxygen before collapsing in a chair sweating like a Thousand Sons at a big Emperor of Mankind’s Birthday party may not sound like much, but it was a far cry from only being able to go 3-to-5 feet.

(Yes, that’s a 40k reference. I have a specific friend I snuck that in for.)

My doctor wanted to confirm my pulmonary embolism with a cat scan. … he wanted to, but couldn’t, because I was too fat to fit in any CAT scan they could get me to. But the proof of the clot in my leg, combined with the blood thinners showing improvement, finally convinced him to let me go home.

It was, as I noted at the time, victory in the tactical battle… but a strategic war remains to be fought. Pulmonary embolisms are serious, can be deadly, and this one nearly got me. And there are still unknowns — my lung x-ray suggested, inconclusively, possible lung scarring which would mean permanent lung capacity loss. I need physical therapy, occupational therapy, respiratory therapy, follow-ups with cardiologists and various other specialists. I have a serious bleeding issue that needs to get addressed, and it’s exacerbated by my being on blood thinners for at minimum the next 6 months.

I have to learn how to sleep again, learn how to sit again, learn how to moisturize my sinuses again (nothing with glycol or petroleum… but I finally found an option and I do NOT want to set my nose on fire), learn how to eat again (and not the way I’d expect — I need more iron, magnesium, and protein), and it still takes significant planning to pee. (Especially if I need to pee at night — I have to either unplug the oxygen from my CPAP and reattach its own nose-valve, or have the separate oxygen tank nearby so I can swap from CPAP to tank…)

Doctor’s visits every couple of weeks, maybe for months. Bruising at the drop of a hat, maybe forever. Laying down every few hours to elevate my legs, BUT standing every hour to move them around. And every time my breath runs even a little short, I have to fight a wave of panic. The long stretches where my heart pounded for hours, and my lungs were on fire, and my brain was screaming that I was going to die with silent, gasping screams my final act on this Earth… they have left a mark on me.

Even if I was at full health, it’d be exhausting. But I’m not. I can sit totally calm without oxygen, but need it to do anything or stand and go anywhere. My reserves do not exist. If I do too much at 10 am, I’m still feeling it at 10 pm. Focusing on anything is tough, and thinking (or writing, which I admit does not always involve me bothering to think) tires me at a frightening speed.

I’m alive, but my life is radically changed. My capacity is reduced drastically. Maybe this is just-for-now. Maybe it’s forever. Most likely, it’s somewhere in the middle.

As my journey goes forward and evolves, and I figure out what I am doing about my career, my place in this industry, my total-lack-of-retirement-options, and my current health challenges (especially how they relate to this blog and outstanding projects of mine), I’ll let you all know.

Methods of Support
So, a lot of people have offered a lot of support, and I deeply, deeply appreciate it. There are plans moving forward to try to help cover medical bills and loss of income, and when they’re ready, I’ll announce them here. I may end up needing to turn to extraordinary measures, such as a GoFundMe, but I won’t be doing that until I know for certain I have to.

However, if you DO want to offer immediate support, I won’t refuse it. You can join or increase your membership tier at my Patreon, or if you prefer do one-time support through my Ko-Fi.

Thanks, folks.


About My Pulmonary Embolism

Hey folks. You may have noticed that I haven’t posted to my blog much for the past week, and there’s a pretty compelling reason for that.

CW – ambulances, breathing issues, health issues, hospitals, and frank discussions of how fat people are treated by some healthcare professionals.

I was hospitalized with a pulmonary embolism. It wasn’t fun.

(This is me on Feb 16th…not having fun.)

For the tl;dr crowd: I was taken to the hospital last Tuesday (2/14/2023) with a blood clot in my lungs, kept there until Saturday, and am home now but still extremely week. I’ll need weeks, maybe months, to fully recover, and it could all happen again without warning.

Okay, that’s the extremely short version. Now, it’s storytime.

Storytime: My Pulmonary Embolism, Part One – You Should Go To The ER

I’ve been having health issues since 2014. In fact, I’ve gone to the ER once a year on average since December 2014, and have been suffering some infection or other literally 25% of my life for the past 8 years. A lot of that was colds, but I have also had pneumonia 4 times, bronchitis twice (once concurrently with the pneumonia), the flu 6 times (yes, despite getting a flu shot every year), the super-generic sounding “upper reparatory infection” five times, had long periods (weeks or months at a time) where I suffered apparently random sudden-onset fatigue that could shut me down as if someone had flipped a switch in my brain to make me unable to think to do anything except fall asleep… and had staph infections. A LOT of staph infections, involving more than half those ER trips I mentioned, and hospitalizing me once in 2019.

In short I have become, as a dear friend noted to me shortly before the pandemic, fragile.

The early days of the pandemic were actually a break of health for me, for about 4 months. I got more done, had more energy, and was never sick. But by the end of 2020, I was exhausted all the time, often with no explanation, back to getting pneumonia and staph infections, and often had trouble focusing on tasks.

So when I got a bad cold last December (having dared to go outside my social bubble to see tiny groups of people in well-ventilated areas, like my in-town family), and that turned into a bacterial lung infection, and that turned into pneumonia that took two courses of antibiotics and a course of steroids to get rid of the worst symptoms, I was not surprised. And when that left me with extremely low endurance, I chalked it up to being a morbidly obese man in my 50s who had been sick for six weeks. I mean, that pneumonia had been so bad my doctor had told me if I ended up having trouble breathing, “you should go to the ER.”

Sure, walking across a room left me slightly short of breath, but that was something I could fix (as I always had) over time. I wasn’t “having trouble breathing,” right? Just getting winded easily. I’d recover my endurance.

But oh, no. Not this time.

Unbeknownst to me, I have developed Deep Vein Thrombosis in my right thigh. This is a fancy way of saying I had a blood clot. And a bit of that blood clot had broken off from the mothership, moved to my lung, and begun reducing oxygen flow to my heart.

This is bad.

But I still had no idea what was going on. So I struggled along for another week and a half… and things got worse. I went from being slightly winded if I crossed a room to beginning to wheeze the moment I stood up. This freaked me out, and I made an appointment to see my doctor, and got some bloodwork done. I mean, I could breathe, so the ER wasn’t necessary. Maybe just one more round of antibiotics, and my doctor would need to see my lab results to know what to try this time.

I ran a game on Saturday the 11th, despite being unable to walk more than 5 feet at a time. I had to bow out of playing in a game on the 12th. I cried about how weak and tired I was on the 13th, and had to plan any moment requiring me to stand very, very carefully.

So, yes, something was obviously very, very wrong. And, equally obviously, I should have gone to the ER. And I didn’t. And there are multiple reasons for that, ranging from the expense (even with the insurance I scrimp and scrape t pay for, an ER trip is a bit hit to my budget) to my CPTSD (I can get panic attacks in any circumstance where I don’t understand what is going to happen). But a big one is… I’m fat.

Very, very fat.

Fat people have problems with healthcare professionals. A lot of that can be mitigated by finding one who actually treats you like a person, but at an ER you don’t get to pick your doctor. I have been told at ERs that my fever was “normal” for someone my size when I actually had pneumonia. I’ve been told a staph infection was weight-related acne, shortly before I began vomiting from it. My rheumatoid arthritis has been dismissed as weight-related osteoarthritis with a glance and exactly 0 testing. And, many, many times I have been told by a doctor, without talking to me or looking at my records, that a given problem is a side-effect of uncontrolled diabetes.

It’s worth noting, as part of that story, that I’m not diabetic. Never have been.

So, yes, I needed to go to the ER for days, and just muddled along in pain, short of breath, and constantly exhausted rather than face dismissal, insult, and misdiagnosis yet again.

And that brings us to February 14th. Valentines Day. And boy, did I have a heart-shaped surprise coming.

I had trouble sleeping (no shock, I’m an incurable insomniac, even with my sleep apnea well-treated and managed), so I got up late. My wife Lj was, as she often does, taking up the slack in what needed to get done and was herself exhausted. Since I was up to deal with things like expected deliveries, she lay down for a nap. And I decided to freshen up with a shower.

Showering had been a chore for days, but I was determined to push through it. My breath got short, and my legs got weak, but I’m already nearly a shut-in thanks to the pandemic. I was determined not to be an invalid. No matter how much I gasped for breath, no matter how much my heart began to hammer, I forced myself to push through it. And when it was done, I sat down to catch my breath.

Minutes passed. I was still wheezing and my heart was still pounding. My vision was filling with spots. I nearly passed out.

“So, Owen, you finally went to the ER, right?”

Oh, no friends. No such thing.

No, I went and woke my wife and told her I couldn’t be the one to stay up to deal with things. I had to lie down. And, to be frank, she was pretty ticked about it. But she saw I was panting, thought I’d just done something requiring exertion despite being chronically short of breath and seeing a doctor about it the following week, and let me lay down. I strapped on my CPAP… and kept gasping for air.

I’m not sure I can accurately describe the nightmare that followed. Not only was my heart not calming down or my breathing easing, it was getting worse. My vision blurred. I waited. And waited. For 30 minutes. And then when I decided to call for help… I couldn’t. I could barely choke out words one at a time. Thankfully, we have a smart speaker system, and I used it to cough out a housewide cry for aid.

My wife heard, came and saw me, and asked if I needed to go to the ER. I finally said yes. So she started to get ready, and we discovered I couldn’t stand.

THAT is when we both started to get really frightened. I am slow. I tire quickly. I’m fragile. But I have always, always been able to get up on my feet and do the crucial thing when it mattered.

But not that day. Happy Valentine’s Day, honey. Call an ambulance.

The 911 call went well. Upon discovering I had some bleeding issues (another thing I was to discuss with the doctor a week later), the emergency operator made sure they *didn’t* give me the aspirin otherwise called for in this case. Eight firemen showed up, took my vitals and, to their eternal credit, never assumed anything about why I was unable to breathe and my heart was beating hard, fast, and unevenly. Then the paramedics showed up, took my blood oxygen, strapped an oxygen mask to my face, and it was immediately time for me to go to the ER.

The firemen rolled me back and forth to get two traps under me… and carried me out of the bedroom, around an immediate 90-degree corner, and out the front door. Now, I am a BIG guy. When I walk through a doorway, there’s no spare space. But somehow these 8 calendar-worthy men surrounded me, 3 to each side, one at my head and one at my feet, and walked me through doors I barely fit through by myself.

Which is not to say it was easy for them. They were carrying me out head first, when one of them noticed the gurney outside was set to receive me feet-first.

One panting fireman; “Hey, we’re bringing him out head first. Turn the gurney.”

One calm paramedic: “No, we’re set up feet first. Turn the patient.”

Eight panting firemen: “TURN THE GURNEY!”

They turned the gurney, and the firemen got me into the ambulance. My wife Lj was right behind them, sitting in our car.

For minutes. It took them a long time to consider me stable. The paramedics were monitoring my blood 02, my heart, my mental state… and had to decide which of the two Emergency Rooms in range was better qualified to handle me. Lj has to sit for long minutes, knowing I was in the ambulance, and for some reason it wasn’t moving yet.

But eventually, they made a call (the right one, to their credit, we’d work out days later once my issue was actually diagnosed), and I got my first ambulance ride.


Residents of Norman, Oklahoma may recall there was a high wind advisory that day. As I rode in the ambulance to the hospital, I got to hear the dispatch report downed wires… then reports of smoke, then brush fires. Then MORE downed wires. And a flipped car. It sounded like a busy day.

It was.

When I got to the hospital, there were no slots open in the ER. So I was parked, along with the paramedics, still on the not-designed for-7XL-scale-humans gurney, in a hallway.

For an hour.

During which time my wife couldn’t come see me. But eventually they got me in, and she could sit with me… and worry. All we knew was that if they took the oxygen off my face, by 02 level dropped like a rock. From 97 to 70% in the seconds it took to switch me from the paramedic’s tank to the ER supply. And we did not know why.

Thankfully, our good friend Carl had, as soon as Lj had notified friends I was headed to the ER, told her he was on his way. They let him come into the ER bay I was in, and stay with her. And for a few hours, we all waited, while they took blood, strapped electrodes to me, ran machines in and out, slid x-ray plates under me, and said they’d try to figure out if it was an infection, covid, an as-yet unknown virus (yeah, they called that out as a specific possibility), sepsis, heart attack, or something else.

But at least I could breathe… shallowly, with the help of a machine.

We’ll get into the move to a hospital room, the diagnosis, and my eventually discharge in Part Two… which will be out when it’s out. [Edit: It’s out, find it here.] This post represents all I have been able to do over Saturday, Sunday, and Monday, and I have no idea how long the next post will take. I’ll do my best to update y’all as soon as I can.

I DO want to say that from firemen to doctors to nurses to account reps and outpatient services, everyone I dealt with was professional, efficient, never dismissive and (with the exception of one grumpy nurse who was at the tail end of an 14-hour shift) polite and considerate.

Methods of Support
So, a lot of people have offered a lot of support, and I deeply, deeply appreciate it. There are plans moving forward to try to help cover medical bills and loss of income, and when they’re ready, I’ll announce them here. I may end up needing to turn to extraordinary measures, such as a GoFundMe, but I won’t be doing that until I know for certain I have to.

However, if you DO want to offer immediate support, I won’t refuse it. You can join or increase your membership tier at my Patreon, or if you prefer do one-time support through my Ko-Fi.

Thanks, folks.


“Batman” is a Brand, Not “a” Character

(This article is not covered by the OGL)

I enjoy a lot of Batman stories. But I am ever-cognizant of an important truth.

Batman is not “a character.” Batman is a brand. This has been true for at least decades, and has likely been true since Detective Comics #32, published August of 1939.

Now, a LOT of characters owned by corporations are brands rather than cohesive individual characters. Maybe even “most” such corporate-owned characters are actually brands. But I’m going to stick with Batman in this essay, both because it’s easiest to cover this concept with a single specific example, and because Batman is one of the Brands I most see fans and even professional writer’s treating as a single, unified character. Analysis of the totality of such characters is best done as an analysis of Brand Management, rather than as analysis of the fictional traits of a single person.

The Batman brand happens to include a lot of characters who are all presented as “the” Batman, who may have the same origin stories and costumes and names and rogues galleries. But a character named “Batman” in a Justice League Comic is not the same character as “Batman” in Detective Comics, or “The Batman” in a live-action movie, or “Batman” in a cartoon about super-pets.

Oh, Warner/DC will often pretend it’s the same character. That’s part of the Brand Identity of the Batman Brand.

But universal questions about a theoretical “Batman,” as if every Bruce Wayne Dark Knight character was part of a single unified characterization, are pointless. You can analyze a specific Batman character, calling out the character within the Batman brand as presented in a specific story with a unified medium and creative team, and analyzing what the expression of the Batman brand was like within it. But discussions about Batman as some kind of consistent entity across even all of one medium (say, comics) is a waste of time. There is no one true ur-Batman we can use as a point of universal comparison.

That’s actually a really freeing truth. The claim “Batman would never do [some specific thing from some specific story]” is pointless. Batman is fictional, his corporate owners are the only ones that can say whether an official Batman(tm)-branded character would do a specific thing, and if it happened in an official source, there’s no debate to be had. “Batman” would do that thing… he just did. But, there is legit criticism space to discuss both “I feel this specific, ongoing Batman-branded character (who happened to be named Batman) is not a good fit for the Batman brand.

Imagine, for example, if McDonalds added floats to their menu, and to kick it off ran a TV commercial where Ronald McDonald lurked in a sewer with a red balloon, and promised children “We all get floats down here!” There’d be no one claiming “Ronald McDonald doesn’t live in a sewer,” because it’s accepted Ronald McDonald is corporate mascot rather than attempt to faithfully portray a specific clown’s life, fictional or otherwise. But there would be a LOT of people pointing out (correctly) that it was VERY “off-brand” for Ronald, and a terrible choice for the McDonald’s corporation.

I picked on Batman for this essay in part becaue discussion of what Batman would or wouldn’t do, or could or couldn’t do, come across my social media a lot. Perhaps more than any other corporate brand that happens to focus on a series of fictional characters. And those debates often seem built on media consumers claiming they understand “the” Batman character, and acting as if they had some ability to veto the inclusion of a Batman element they dislike from the “real” Batman they portray as existing in some combination of media appearances.

Now, if someone wants to discussion their “personal head canon,” I’m all in favor of that. And if they want to discuss what are good or bad specific portrayals of Batman, that’s a reasonable analysis of the Batman Brand, even if not couched in branding terminology. Trying to form some universal singular “correct” view of Batman as a character which anything that violates should be

Not that there’s ever much point to pointing that out to people invested in such arguments. The purpose of this essay is not to call out or shame any specific Batman fan, or even their view of what “Batman” is in modern media. Batman, and his corporate owners and his fans and even his critics, are just useful specific examples to illustrate a different way of viewing some creative endeavors that it’s tempting to see as specific characters (or worlds, or ongoing stories, or game brands, or even the output of specific creators) rather than as a Brand, with all the implications that branding brings as a concept.

This blog, and making most of the posts freely available to the general public, is a big part of my personal brand. If you’d like to support that brand, please consider joining my Patreon.

WotC Cannot Deauthorize the OGL 1.0a, and That Matters

There’s a new OGL draft, 1.2, which WotC has released for discussion.

It still claims WotC has the power to stop people from using the OGL 1.0a by “de-authorizing” it. That’s not a term acknowledged by the OGL 1.0a, and it’s not one with a legal meaning.

WotC is still trying to take away the promises of the OGL 1.0a, and that is 100% unacceptable. (The short version of why is if someone gives you 20 things for you to use however you want, and promise never to take any away, then they say they are taking back 18 of them anyway, it is NOT a victory if they decide to only take 12, or even only take 1. And WotC should be well aware of this.)

First, while some base set of rules is supposedly going to be released on a Creative Commons license, that explicitly does not cover things like Magic Missile and Owlbears. WotC opted to release those concepts under the OGL 1.0a, and did so multiple times over the years. They don’t now get to claim can force you to use a new license rather than follow the old one.

Second, their claim they “have to” to prevent “harmful, discriminatory, or illegal” is spurious at best. If you publish *illegal* content, obviously they have legal options to stop you. As far as “harmful” and “discriminatory” go, a huge part of making something Open is to prevent a corporation from getting to decide what is in good taste.

The license specifically forbids “obscene” material, without defining it. If you decide to include a happy gay owlbear couple, Wotc can say that it’s obscene under OGL 1.2 and cancel your license. That’s not a power they reserved for themselves under 1.0a, and given big corporations’ track records, there’s no guarantee they won’t abuse the power if it is given to them.

Third, they restrict the OGL 1.2 to “any content in the SRD 5.1 (or any subsequent version of the SRD we release under this license) that is not licensed to you under Creative Commons.”

So WotC is claiming you can’t do *anything* with the 3.0. 3.5, and d20 Modern SRDs. They are not part of the CC release. They are not allowed under OGL 1.2. Also, of course, they’re shutting off OGL products built off Open d6, Fate, Fudge, and other game systems released under OGL 1.0a that WotC had absolutely no hand in creating.

So when the survey opens? If you can fill it out without making a D&D Beyond account, do so and tell them this is 100% unacceptable. The only reason to attempt to invalidate the OGL is to steal back rights that were openly and freely given, which WotC has significantly benefited from, and which entire careers were built in reliance on.

That bad faith effort must be refused and fought.

And if you can’t fill the survey without making an account? That’s also a bad faith measure, and will call for strenuous protest to keep this debate in the public.

And ALL of those efforts must focus on the actions of WotC itself, NOT on attacking WotC staff or spreading rumors. At this point, WotC is telling use exactly what they are planning to do, and that’s the ground to fight them on.

Support This Blog
Because I need to encourage people to sign up for my Patreon to pay for the time I take to write the material in this blog, I have taken to making Tuesday and Thursday posts Patreon-exclusive. But the issue of the safe continuance of the OGL 1.0a is too important to paywall my thoughts, so I’m breaking my own rules and making this freely and publicly available.

Obviously, community support is crucial to my making these posts, and is much appreciated. So if you can spare the cost of a cup of coffee each month, please join my Patreon.

Now On Patreon: “In Times of Wars,” The Pros and Cons of Being on the Outside

My Tuesday posts are currently Patreon-exclusive. That’s an intentional carrot to get more people to join my Patreon, and once it’s risen to $1,500/month, I’ll both go back to posting Tuesday posts for free here on my blog as well as on my Patreon, and I’ll make and maintain some article index for my Patreons (the carrot to encourage Patrons to see if their friends want to join).

So when I do Tuesday posts at the moment, I try to give enough information on what it is about and where it’s going that people who read my free blog can decide if they want join up for a few bucks a month to read the end.

I’m doing the reverse, this time. The premise on why and how I can to the following conclusion is the meat of today’s Patreon-exclusive article. The tl;dr I ended with I’m going to post here, for everyone to read if they wish.


War is messy, and people are going to get hurt. Consider that very carefully before taking the first shot, or joining some brigade.

But not opposing wrongdoing when your best analysis of a situation says it’s coming allows bullies to win.

I don’t believe there’s a perfect answer here.

OGLpocalypse: WotC’s Response To The Public Wrath At Their Bad Faith Is Not NEARLY Enough

I have talked about OGL facts before, but not previously written an opinion piece here on my blog about the bad faith efforts WotC prepared to try to force people to give up the OGL 1.0s, which has driven the creation of tens of thousands of products over 23 years, in favor of a draconian “OGL 1.1” which would bad for anyone who agreed to it.

If you aren’t up to speed on this, check out Linda Codega’s articles here, here, here, and here. They are at the front of this developing story.

So, here’s the big kicker on why today’s official WotC response is unacceptable. A non-starter that even with the tiny concession they want to use to turn down the heat of anger directed at them by the community doesn’t even begin to address the root of the real problem with what they are trying to do. Taken from the very first paragraph of their response today.

“And third, we wanted to ensure that the OGL is for the content creator, the homebrewer, the aspiring designer, our players, and the community—not major corporations to use for their own commercial and promotional purpose.”


Fuck you, WotC corporate. You DON’T get to ensure that, and the fact you want to means you still think you can change the rules on how people interact with and use the OGL.

You released SRDs for 3.5, d20 Modern, and 5.1 under OGL 1.0a. That license was NOT released with any restrictions on who could use it, and you know it.

The OGL 1.0a was designed to be something you couldn’t force people away from — could NOT force them to used a changed version of it — and you know it.

The OGL doesn’t allow anyone to make “D&D” products with content you object to, as they can’t even mention the name of your game, much less use its logo, and you know it.

You’ve benefited from the ubiquity of each edition of D&D you released an SRD for, reaped profits as a result, and you know it.

You don’t get to bully or bamboozle people into changes now, because you don’t like what the OGL 1.0a means for your current business plans.


I feel it would intellectually dishonest not to include this, written 12 or so hours later. I’m not walking back anything I said above, but I have to acknowledge that writing the above happened on the same day I wrote the below.

“The ttRPG industry is small.

One thing that means is that dozens of people asked me to be one shows, consult on the future, or lead on the OGL issue. I have done my best.

But ANOTHER thing it means is I have hurt friends and family-of-choice in the process.

That was never my intent, but some soul-searching tells me I didn’t give that possibility the weight of consideration I should have.
Would I have done things differently? I don’t know, but I should have given it more thought.

Apologies don’t undo harm, but I’m sorry folks.

That said, I need to step back and ponder the current reality very, very carefully.

So, I’m taking the next few days off from any OGL-related news, links, or posts. I’ll wake up Tuesday, and see what I think I need to do for my career, industry… and friends.

ALL my friends.”

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Writing the things that appear on this blog, be they game material, worldbuilding, thought experiments, or insight into the game industry, takes time. That time is solely paid for with the support of people who join my Patreon, or buy a cup of funding for me through my Ko-fi. If you find any of my content useful or entertaining, please consider adding your support so I can keep doing this.

Some Facts About the OGL (1.0 and 1.0a)

With the excellent article written by Linda Codega, and the video released by Roll For Combat that brought in a contract lawyer, there is a lot of news about WotC’s (Wizards of the Coast) plans for a “OGL 1.1” and why it is an act of bad faith on the part of WotC if they go forward with it.

So I’m not going over all that again here.

What I DO want to do is present some groundwork for what the OGL is, and isn’t, and what WotC have said about it in the past. This is an editorial by me, based in factual information, and is not itself part of the OGL content on this blog.

1. WotC themselves wrote an FAQ about how the OGL was to be used, back in 2004. This is important, because it shows (for example) that they were of the opinion if they changed the OGL publishers could ignore their new version, and that the OGL could be used for software. Obviously WotC doesn’t host that FAQ anymore, but the Wayback Machine has the original archived for us to all read and draw out own conclusions.

2. There is a huge difference between the OGL and the various SRDs (System Resource Documents). The OGL is not tied to any one game system or product release (see Point 3, below). For example, none of the D&D core rulebooks has ever been released under the OGL. Instead, pared-down versions of the rules for D&D 3.0. 35, D20 Modern, and 5e had SRDs released (and the Psionics handbooks back in 3.x days).

3. The OGL does not just cover products that are designed for use with D&D. For one thing, there are game systems that have been released under the OGL that were not created by WotC, and have no ties to any edition of D&D, including d6 Adventures, Fudge, and Fate.
There are also numerous complete RPGs that are their own things, separate from D&D, including Pathfinder, Starfinder, Mutants & Masterminds, and 13th Age, just to name a few.

4. It’s entirely up to WotC whether or not they release a One D&D SRD. If they don’t, those rules aren’t open. And they could release it under a totally separate license, unrelated to the OGL 1.0a. So, WotC is not under any threat from people using genuinely new rules from One D&D using the existing OGL. (Of course they have said One D&D will be compatible with 5e, so that raises a question if they are *new* rules, and if there aren’t, that might speak to motive on their part.)

5. The OGL does not allow anyone to mention D&D, WotC, the Forgotten Realms, or any other trademarks, or emulate any trade dress. So WotC does not need to worry about the OGL allowing people to associate repugnant material with D&D — all the brands trademarks, characters, and stories, of D&D are off-limits to OGL users, as are many even iconic creatures such as beholders and mind flayers.

6. WotC always knew the OGL would be used by their major competitors to make big profits. The OGL was shared with numerous representatives of various companies before it was made public. I was part of the email chain that was used by Ryan Dancey to do that. And it’s why Sword & Sorcery Studios (a newly-created division of White Wolf, a major ttRPG publisher at the time) was able to put out the Creature Collection in October of 2000, *before* the official 3.0 Monster Manual got published.

7. WotC benefitted from the existence of the OGL. They crafted it, with the knowing intent it would last forever, as part of their D&D relaunch business plan.

But don’t believe me. Believe Keith Strohm (and learn about why you care about his opinion on it in this fireside chat with Peter Adkison, president of WotC when the OGL was created). This is from a comment Keith made on Facebook, and is shared with his permission.

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My Insurance Drove Up an RX Price by 100%

So, late last week I got my bivalent Covid boost (just in time for new variants to dodge it, of course), and flu shot on the same day. And, as I expected, I felt crappy. I expected that to last a day, and had the liquids and OTC I needed to cope. And when it lasted longer than expected and got worse, I just assumed the double-dose was kicking my ass.

Saturday I crashed into bed in the middle of a game session. Sunday I was only alert for short bursts. Monday morning, I realized both my ears hurt the way they do when I have an ear infection. And since I had self-misdiagnosed for the whole weekend, it was suddenly at the constant-pain-and-occasional-icepick-in-the-ear-level-agony stage of ear infection.

No bueno.

So, off to my local favorite urgent care, who have always taken great care of me when I can’t wait a few days to see my Primary Care Provider, but don’t need the E.R. It was one degree above freezing, awful slush was falling from the sky, and my wife had to drive me. The Urgent Care was nonstop back-to-back with children with respiratory infections, but got me safely in a waiting area by myself, took my vitals when a medical assistant had a spare moment, and eventually a nurse practitioner managed to see me. She checked, confirmed I had ear infections in both ears (and quipped “How do you DO that?” as they have seen me for this more than once), and that it needed immediate antibiotics, and sent me to pick up a prescription they called into my pharmacy. Eardrops, because they’d be gentler on my system than an oral. But, the nurse practitioner assured me, if I didn’t feel better in day I should let her know, and she’d write a new script.

This had taken a few hours, much of it in the feeing dark, but normally this is the point when we can pick up the RX at a drive thru pharmacy, go home, and begin to recover. But if that had been how it shook out, I wouldn’t be making a bog post out of this.

So we went to the pharmacy, and waiting for the prescription to be ready. And when it was, the pharmacy tech asked if we knew how much it would cost, and we noted we did not.

“$180,” she said.

“What?! For eardrops?!”


“Did you run our insurance?”

“Yeah. Let me double check for you.” [Click, click click.] “Yes, I double checked your insurance is current, and ran it. It’s $180. Do you want me to fill this, or put it on hold so you can call the doctor or your insurance?”

We put it on hold, and called the clinic. We explained, and the assistant said she’d go talk to the nurse practitioner, and could we hold.

We held. Sitting in a packing lot, in now sub-freezing temperatures, ice slowly forming on the car, we held. Thank goodness I *could* afford $180 for eardrops if I had to… but I couldn’t afford to do so unless I really did have to. And I love my wife, and love spending time with her. But this was eating my entire day.

The assistant came back on the line, and explained that the eardrops were only $90 without insurance… but yes, she had checked, and they cost $180 with our insurance.

Wha… what? We could get it at half the cost if we DIDN’T use the insurance I had spent hours selecting, and paid for out of pocket every month as a freelancer? It was MORE EXPENSIVE with my insurance?!


But, she was sure that was still more than we wanted to pay, so they had called in a new prescription. Let them know if there was any problem with it.

So we waited a bit, drove through the pharmacy window to see if the new RX was ready. It wasn’t. So we waited a bit more, hoping roads weren’t getting slick. (They weren’t, thankfully.) We drove through again, and this time they had it.

“How much?”


“How much without insurance?”


“Great, just checking.”

And, apparently, while the double-cost/$90 upcharge is rare… prescriptions in the US costing more when you use your insurance is NOT rare. “Clawbacks” may affect close to 25% of US prescriptions, often running $5-$10 higher than the uninsured cost. That doesn’t explain the huge difference for me, which may be a result of a pharmaceutical manufacturer offering a huge discount to uninsured customers, and my insurance not covering the drug at all, so I both have the higher price and no help covering the cost.

So, yeah. The system is broken. And, when getting a new RX, check both the insured and uninsured price.

Speaking Of Money
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