Dysautonomia Awareness: You’re Not Insane, You Just Feel That Way

It’s Dysautonomia Awareness month, and I’m hereby aware.  Dr. Google can tell you all sorts of things, but my favorite link is to Living with Bob, FYI slight language warning (which I don’t approve of), but I like the assortment of information.  When you visit Dr. Google and the major advocacy organizations, what you mostly hear about is POTS, to the point that some outfits equate the two.  That’s sort of like equating “leg pain” with “broken femur.”

[FYI: You don’t want POTS.  Or a broken femur.]

Dysautonomia, aka Autonomic Dysfunction, is when your autonomic nervous system doesn’t work right.  That’s the part of your nervous system that does all the things you don’t have to think about and really don’t control.  Any underlying illness or injury that affects the nervous system can cause autonomic dysfunction (MS, diabetes, lupus, spinal cord injury, etc.), and there are an assortment of disorders that have autonomic dysfunction as their chief complaint.

Since blogging is all about self-absorption, let’s talk about me.

Complaints, Complaints, Complaints

The most dramatic and pressing element of my dysautonomia is Inappropriate Sinus Tachycardia, which drama longtime readers know all about, check the archives.  What happens is that on exertion my heart rate accelerates excessively, which leads to dramatic shortness of breath and an inability to do, well, anything.  Conveniently I’m one of the people who responds very, very well to a low-dose beta blocker, so the symptoms are under control.

Curiously, this study from 1966 recreated exactly what my heart rate does.  The difference between the “control” and “parasympathetic blockade” heart rates is pretty much me before IST vs. with IST. “Double blockade” is what I look like with IST controlled by a beta-blocker.

In everyday terms: One day on vacation last spring I forgot to take the beta blocker.  After a leisurely breakfast, about noonish I started getting ready to go out and do something fun.  Brushing teeth? HR of 120.  In the shower? 140.  In contrast, on the beta blocker, 120 would be my heart rate having just jogged up two flights of stairs carrying a full bookbag.

On the vacation story, once I noticed I’d obviously forgotten something, I went and took the beta blocker and was fine to go out and be a normal active person traipsing around the city all afternoon.

One of the things that people will say about these kinds of idiopathic tachycardias is that they must be due to “deconditioning.”  When I first started with severe shortness of breath on exertion, I had just gotten home from a trip up north where I’d spent one morning climbing up and down a snowy hill sledding with the kids, no problems.  You don’t decondition that quickly.  Likewise, once I was diagnosed and treated, I went in the space of an hour (time it takes to make propranolol start working) from unable to walk an 1/8th of a mile slowly to doing laps at the school walking track as quickly and for as long as I liked.

I assure you that if you are so deconditioned that you can’t walk an 1/8th of a mile, the lowest available dose of a beta blocker will not instantly improve your conditioning by a factor of twenty. Dysautonomia is not deconditiong.

Stupid, Annoying, Incurable

Because the tachycardia responds so well to treatment, it’s not a significant problem as long as I’ve got access to the drugs.  I would say the most debilitating and limiting symptom I have is that I will, intermittently, get lightheaded when talking.

It’s a sensation a lot like hyperventilation, and the effect is similarly cumulative — you can handle some amount of it, but eventually you have to quit.  It’s a fairly common complaint among people who have POTS (which I don’t have, but which is a different tachycardia), and one that there is basically no discussion of in the literature that I can find.

I manage this symptom by daily reconsidering whether maybe I should have been a Carthusian.  Just kidding.  I’ve never even had chartreuse.

What really happens is that if I’m particularly feeling it, I just avoid talking to people.  This is a tad socially awkward.  Alternately, I talk to people and secretly resent them for being a person that I’m talking to (tad immature); or I feel guilty for making my brain hurt having so much fun (tad scrupulous), because it does take a toll on my ability to do other things as the day wears on.

Much like the way people who get migraines or stomach aches don’t necessarily have those symptoms 24/7, sometimes I’m just fine.  So that’s even more socially awkward, because one day I might be, say, subbing teaching a class with no difficulties, and another day I might want to hide from people because they persist with this crazy idea about talking to each other.

On a medium day I can get away with pacing myself.  I do better if I’m the one choosing how quickly I talk and if I’m alternating with someone else. So a phone call to my grandmother works great; group Rosary not so much. On a medium day I might sing most of the best two hymns at church, but with a certain amount of lip-syncing interspersed because the pace is still more than the brain can take.

Simple, Manageable Paths to Insanity

The reason I’m writing today, mid-awareness-month, is not just because I’m procrastinating on other work (true) but because I was made suddenly re-aware of one of last year’s most interesting developments.

What’s happened is that we are now, thank you Hurricane Matthew, having beautiful southern autumn weather.  Lows in the 50’s, highs in the 70’s, huge clear blue skys, low humidity, you can’t ask for anything more idyllic.  This morning I dropped off the 5th grader at school and then picked up a few groceries on the way home, perfectly comfortable in jeans and a long-sleeved t-shirt.  Sitting in the shade in the early morning, you wanted a flannel shirt — remember it was in the 90’s a week ago, so we southerners get a flannel shirt pass, thanks.

But let me emphasize: This weather is PERFECTLY COMFORTABLE.  Important to the story.

So anyway, later in the day I laid down for a quick nap (because: procrastination makes me sleepy, ha).  The bedroom was a comfortable 70 degrees.  I’m wearing jeans, socks, long sleeve t-shirt, flannel shirt.  All clothing is that perfect fit for temperature regulation, not-to-tight-not-too-loose.  No gaps at the waist or ankles or anything.  On top of this, because we humans cool down when we sleep, I pull on blankets.

Not just any blankets: A down comforter, and on top of that a synthetic comforter.  You are now thinking to yourself this girl’s going to wake up a sweaty mess in half an hour.

Nope.  It’s fall!  We’re down to a brisk SEVENTY DEGREES!  So it’s time to resume . . . the thing where we wake up shivering immediately upon falling asleep.

No, Really, I Can Do Winter

I spent many decades camping in the winter.  When the huge ice storm hit twelve years ago, and we had no power for a week and the house was 45 degrees inside?  No problem.  I won’t say I enjoyed it, but we all slept great.  I know how to sleep in cold weather.

What’s happening with the dysautonomia is that my body temperature drops too quickly when I fall asleep.  In the summer, it’s not a problem — hence the fact that I had two comforters on the bed even though it was in the 90’s last week.  Humans intuitively grab the amount of bedding they need, that’s a basic survival instinct.

I don’t have persistent hypothermia (which happens to some people).  My body will eventually warm up the clothing and bedding and I’ll be just fine all night.  But because of the steep temperature drop on falling asleep, I’ll go through three or four attempts at sleeping before I can stay asleep.

This will make you feel like an insane person.

You will remember that sometimes when it’s very cold, people will wake up in the middle of the night looking for more blankets.  And then you will have to remind yourself: Those people aren’t going from perfectly-comfortable to body-shaking-shivering in the minute it takes to drift off to sleep.  Under a lot of blankets.  When it is seventy degrees in the room.

The Insanity of Dysautonomia

The maddening part of autonomic dysfunction is that every thing that happens is something that your body might also do under normal circumstances.  People get hot or cold.  Heart rates go up or down.  Something like getting dizzy talking or singing?  Hyperventilation happens.  You have to remind yourself that gosh, no one else in church is begging the organist to slow down so we don’t all pass out.  Every. Single. Hymn. in the hymnal isn’t some manic composer’s effort to see how many people have the breath to pull it off.

It’s not normal for an ordinary Sunday service to feel like some kind of survival-themed reality show.  Last Congregant Standing — Do You Have What It Takes To Sing All Four Verses?!!

But humans adapt marvelously, and this only makes you feel crazier.  You get used to the idea of needing an external heat source* in order to not be shivering on a seventy degree day.  You get used to the idea of assessing how much conversation your brain can take before you really have to stop.  You lose track of the fact that other people aren’t constantly managing all this weird stuff.

There’s more to complain about, but I’ll stop there.  To summarize: Dysautonomia is a condition whereby your autonomic nervous system has gone off its rocker and is trying to take you with it.  The end.

File:Stories for the household (1889) (14772566743).jpg

Artwork courtesy of Wikimedia [Public Domain]

 

*For an external heat source, think electric blanket or heated mattress pad.  Basically it converts your autumnal weather back into summer in the area adjacent to your body.  If you also happen to need an extra two hours of sleep in the winter months because of the energy it takes to keep your body warm, if you religiously use such a heat source whenever you are sitting or lying still, it can buy you a couple more hours of wakefulness.

Related: Inside Tired World

Effort & Illness: The Confusing Habits of Sick People

Since I surround myself with people who know better, no one’s yet given me the dreaded words You don’t look sick. Even people who do look sick often don’t look as bad as they feel*.  As Jen Fulwiler explained it last year:

I feel self-conscious that I’ve been doing better, and have no visible symptoms of being ill. . . . I worry that the folks dropping off the food are starting to suspect this is some kind of scam. The other day a super sweet lady from the parish came by with a steaming gourmet dinner for our entire family, complete with appetizers and dessert. I had just gotten back from a doctor’s appointment so I was dressed up and wearing makeup; I’d been resting most of the day so I was unusually energetic. She seemed tired from having worked so hard to cook for our entire family in addition to her own, and I used my Neurotic ESP to determine that she was wondering why I wasn’t cooking for her.

I told Joe that I should get some crutches for when I answer the door for people delivering meals, as a symbolic gesture to assure them that their efforts were not wasted. He looked at me like I was insane, and pointed out the obvious fact that my problem is with my lungs and that I would have no use for crutches under any circumstances. I said that I know, but they sell them at the grocery store, and I didn’t know where to get my hands on a ventilator — and, again, it’s all for symbolism anyway. He backed away from me slowly and went to pour himself a large glass of wine.

Yes.  This. I put a short section in my catechist book on invisible disabilities, because it’s something that comes up in religious ed more often than you’d think.  Mostly among catechists, but among students as well.  That one chapter is the one I get the most thank you letters about.

You can be seriously ill without being 100% incapacitated.

It’s pretty rare for someone to be completely felled in a single blow.  This causes confusion, because you see people wandering WalMart who look like they’re going to collapse any second now.  So if your sick person still has good balance and coordination, and manages to answer the phone in a cheerful manner, you think, “Must not be that sick.  There are people at WalMart who look much, much worse.”

The people at WalMart might be worse.  But that doesn’t cause the sick person to be less sick.

Some people are good at putting on.

I knew a lady once who would answer the phone cheerfully even if you woke her up at 4AM.  It wasn’t that she wanted you to call then.  She just had excessively good phone manners.  And thus the Perceived Illness Paradox: Some people complain a lot, other people don’t.  Some people are good at masking their symptoms, other people aren’t.  Some people are good at coming up with clever work-arounds that keep them high-functioning, other people aren’t.  You really can’t judge how someone feels inside by how they’re acting outside.

Rest makes a difference.

Anyone who races knows you manage your training schedule so that you peak when it counts.  There are days when you can ride hard and fast, no problem, and days when you can’t.  Depends on how much sleep you got.  What you did the day before.  What you did the week before.

Illness doesn’t change that, it just changes the scale.

Figuring out an unpredictable body is exhausting.

Normal people spend most of their time operating well within the margins of their abilities.  If you knew you had to ride 100 miles on your bike sometime soon, you’d have to plan ahead to make sure you could do it.  You’d strategize how to make it happen with as little trouble as possible.  But you wouldn’t feel the least bit of guilt if you misjudged: “Wow, that was easier than I thought it would be, why did I make such a big deal out of it?”  Or conversely, “I knew it would be hard, but I didn’t realize how hard!”

Sick people have to figure out the 100-mile ride about everything they do . . . and then get in trouble if they misjudge.  “Why’d you spend half an hour answering e-mails? You should have rested up so you could talk to your mother on the phone!”  Or “Why’d you put off that phone call, look, you talked for twenty minutes, no problem!”

It’ll make you bonkers.  You hear the mail truck go by, and you think to yourself, “Should I walk to the mailbox?  Or get a kid to do it for me?  What’s the best thing here? How will this decision impact my family life?”

What you like is easier than what you don’t like.

Sick people are confusing because their gifts don’t go away.  Okay, if your gift is watching football on TV, everyone will think, “Look he spends all day watching football games, he must be sick.”  But what is hard for you is effortless for someone else. What is easy — even fun — for you is difficult for someone else.  It’s not about the sheer physical energy required.  It’s the mental energy.

So my son might say to my daughter, “I see you have plenty of time for scrapbooking.  Why don’t you research computer components?  What’s wrong with you?  Just lazy, I see.”  And she’d point out to him that he received a photo album for Christmas, and he’s supposed to put his photos in it.  He had time to build a computer, and even more time for playing computer games . . . why so lazy with the photo album?

Everything costs.

There’s service to your fellow man, and then there’s letting your fellow man turn you into his servant. We live in a hyper-critical age.  What you wear, what you eat, what your hobbies are, how you spend your money — all of it is subject to the approval of seven billion self-appointed guardians.  That doesn’t change when you’re sick, it just becomes harder to please the seven billion, because you’ve got less to please them with.

Normal people might say, for example, “Is it worth it for me to give up an hour of my time to visit my crotchety uncle who invited me for dinner tonight?”  When you’re sick the question becomes, “Is it worth it for me to set aside an entire afternoon to rest, and give up getting any chores done, at all, the entire day, so that I can physically pull off the feat of visiting my uncle for an hour?”

In normal life, a dysfunctional friend is the one who makes inordinate demands on your time and energy.  In sick life, everything is an inordinate demand.  But some of those demands are very gratifying, so you organize your life to make them possible. The chief sin of sick people, I suspect, is in gratifying too many whims.

Order in all things.

Sick people are confusing because of the scale change.  With so little room for covering-over, it becomes obvious what the sick person values most.  It becomes obvious where the conflicts lie, because there’s no margin where you can quick slip in a nod towards other people’s priorities.  As in academia, the rivalries can be so bitter because the stakes are so small.  “Just a few minutes of your time” is now also, “all your time”.  How are you going to spend all that time? The way you want?  The way I want? Something in between?

The Darwins have a novena started on just this question.

*Sometimes things look so bad that you assume the other way, “It’s not as bad as it looks, I hope?”  To which I’ll observe: A badly scraped knee looks horrible.  But it feels even worse.

April 8th HHS Contraceptive Mandate Comment Period Closes

Go here to leave a comment. Go ahead and do it right now, then you can come back to read my ranty-rant if you like.

Either you believe in women’s liberation or you don’t.  Do you believe that mentally competent, grown women are capable of making their own purchases?

Then require employers to pay us a living wage, and let us make our own purchases.

Women don’t need men at the office, men in Congress, or men at the HHS to force us to spend our wages on this pill or that surgery.  And we don’t need Mama making us buy stuff either.

We’re grown-ups.  Pay us fairly, and we’ll pick our own health insurance, thank you very much.

Seven Takes: Life, Death, Warped Things Governments Do

No, I’m not back to regular blogging.  But I had approximately seven things to say, and it’s a Friday, so that makes this Seven Quick Takes, right?

1.  Why yes, that was us you saw at the National Vocations Meet-Up March for Life.

Low point:  Children in tears due to experience of being a southern-person whose mother does not know how to dress them for cold weather.

High point: Making a brief retreat into the National Gallery to go potty, rest, and warm-up, then re-emerging to a gentle made-for-TV snow flurry, taking up our signs, and falling into line with these guys.  Who sing beautifully.

Weird Point: The Metronome, as my 3rd-grader calls it, is determined not to take my money.  I kept trying to pay full fare, but the machines refused me at every turn. Fortunately the kind metro-ladies are apparently used to clueless tourists with five children in tow, and sorted me out with a combination of generosity and exasperation that I think must be the hallmark of the metro system.

2. Petersburg National Battlefield is a good place to run the kids and get your history fix all at once.  The ranger does come around checking to see if you’ve paid.

–> Touring tip:  Always ask if you’re supposed to pay.  Because they expect you to pay, even if they never ever tell you that.  And the ranger lady has a gun.  Luckily I had asked.

Discussion Question: Any Particular Reason the Union had to engage in war?  Why not just let the Confederacy secede, and work on patching things up diplomatically?  Put another way:  Did the US Civil War meet just war criteria for the Union?

My boy says yes.  I’m playing neutral professor-person.

In other US history topics: The essay “Smuggler Nation” in this month’s Harpers is really quite good. One more shovel of fodder for that pirates-vs.-privateers topic that’s always coming up around this household.

Our other airline-miles magazine subscription, Western Horseman ran a great piece a month or so ago on the troubles ranchers along the US-Mexican border are having with Mexican smugglers, and the lack of cooperation from some of the US border patrol in keeping their lands safe.  I can’t seem to find an article link.  But let me just say right now, that if you purchase approximately one plane ticket every five years, and want a family-friendly periodical to purchase with your miles before they expire, WH is the one.

3.  My son objects to the strong language in Dorothy Sayer’s Lord Peter Views the Body.  It pleases me greatly to discover I’ve reared a middle-schooler who complains about words like “damn” and “hell” improperly used.

4.  My January New Evangelizers column was 10 Ways to Support Evangelization Even When Your Parish is Falling Apart.

I picked this photo.

Apparently it grabbed someone’s attention, because the Catholic Vitamins people invited me to do an interview for their podcast.  Which is exciting, in an I-hope-my-phone-battery-doesn’t-die-while-we’re-talking kind of way.  I think I can bribe my kids into being quiet with the promise of Krispy Kreme donuts.  Also, presumably this is just one step on the long road towards true fame? By which I mean, of course, being on Rhett & Link’s Good Mythical Morning? My son doesn’t think I’ll ever be quite that good, but he puts on an encouraging face all the same.

5.  Helen Alvare nails it on the head in her analysis of the new HSS regulations.

Let me observe once again that there would be no moral objection at all if the government merely required employers to pay workers a sum sufficient to pay for the desired contraceptive services — for example, by putting the necessary funds into a healthcare savings account that employees could then use to purchase supplemental insurance if they so chose.

And how exactly is it “freedom of religion” if insurance companies and self-insurance administrators must sell (or give away, per the new iteration of regulations) products they may themselves object to?  Is there no legal right to sell insurance for some but not all health care services?  Will insurers eventually be required to pay for euthanasia as well?  Apparently there is a religious test required in order to enter the insurance industry.

6.  Speakin’ of that constitution thing . . . my boy observes that 2/3rds of gun deaths are suicides.  (Wikipedia’s citing 60%.) Which puts a certain corner of the culture in the odd position of wanting to outlaw something they’re trying to legalize.  Apparently depressed and disabled people should die, but only at the hands of licensed death-care providers?

If you aren’t from Gunlandia, you probably should not visit gunmemes.com. It takes a special red-state redness to enjoy.

7.  You know you live in a warped culture when you feel the need to clarify something like this: “For the record, I’m 100% opposed to all forms of murder and suicide.”

Ooh, oooh, want me to exasperate everybody in one single catechism quote? How about this one?  Enough to make everyone you know get all squirmy-wormy:

2269 The fifth commandment forbids doing anything with the intention of indirectly bringing about a person’s death. The moral law prohibits exposing someone to mortal danger without grave reason, as well as refusing assistance to a person in danger.

The acceptance by human society of murderous famines, without efforts to remedy them, is a scandalous injustice and a grave offense. Those whose usurious and avaricious dealings lead to the hunger and death of their brethren in the human family indirectly commit homicide, which is imputable to them.70

Unintentional killing is not morally imputable. But one is not exonerated from grave offense if, without proportionate reasons, he has acted in a way that brings about someone’s death, even without the intention to do so.

Happy February.

Will the House Do what the Senate Wouldn’t?

Here’s where you can see the text of House Bill HR1179.  Basic-model conscience protection — what the constitution promises, it just lays out in general terms as applies to the health care bill.  You can look here to see whether your congressional representative is a sponsor.

HSLDA Supports Religious Freedom

From HSLDA’s website:

Urgent calls are needed to Senate Majority Leader Harry Reid (NV) and your two U.S. senators to urge them to support Amendment No. 1520 by Senator Roy Blunt (MO). This amendment would halt the Obama Administration’s new mandate requiring all employers—including religious employers—to violate their consciences and provide free birth control and abortion-inducing drugs to their employees. . . .

 . . .  HSLDA and a host of organizations across the religious and political spectrum continue to strongly oppose the Obama Administration’s mandate. If the president can force religious employers to violate their religious views and own conscience, the president can threaten any of our liberties.

While this is not a homeschool issue, many families homeschool because of their faith. This attack against religious freedom, if not stopped, could mean the beginning of the end for the free exercise of religion for all.

I knew I liked HSLDA ages ago.  Good bunch of people doing a good work.

Don’t settle for partial freedom.

The Wall Street Journal reports the broad outline of a pending Obama-compromise.

Two problems:

  • There is still no conscience protection for Catholics (and others) who own insurance companies.
  • It is unclear whether those who own private businesses with no religious affiliation will also be allowed conscience protections.

Looks like Obama is betting that if he can just make the Catholic Schools and Hospitals be quiet, no one will notice all the private citizens whose rights are still being infringed.

A genuine compromise would be for employers to provide healthcare funding at a level that would cover everything on Obama’s A-list, and employees could then choose their own insurance plan.

These are the times that

call for zombie music.

(Same rendition of re: Your Brain that I posted before.  The kids started singing it in the truck on the way home from religious ed tonight, and I thought, “Wow, that really sums up the situation so much better than my heated anti-HHS rhetoric.”  Happy listening.)

Don’t Compromise on Freedom

Visit Ave Maria Radio’s site http://www.stophhs.com/ devoted to stopping the HHS’s unconstitutional regulations.  There’s a petition you can sign (easy – no complicated registration – but not anonymous), useful links, and suggestions on ways to help.

Freedom of Religion: The Right to be Wrong.

Several years ago a friend shared a frustration about her job as a public school teacher: She felt that in the faculty lounge she had to pretend to be pro-life, lest she lose her job.  She worked in a conservative school district, and the other staff leaned to evangelical Christian (she did not).  She felt persecuted, and she didn’t think it was right.  I agreed.

Not because I was myself on the fence concerning abortion — I had always opposed it.  But because it seemed to me that if you are a government employee, you shouldn’t lose your job for agreeing with the laws of the government you serve.

[I should clarify here: She was not complaining that she couldn’t share her views with students — she had no desire or intention of doing that; given her subject and the ages of her students, abortion was not ever going to be discussed in the classroom in any way.  What she feared was that merely holding the beliefs that she did would cost her job.]

In studying history there comes an ugly moment when you suddenly understand how hopelessly immersed you are in your own culture.  Future people will wonder why you did not have more courage to stand for what you knew was right.  They will also wonder why you did not see how terribly wrong you were about principles that, to a later generation, seem entirely clear.  But the pull of your own time and place is too powerful.

That is how I feel about the law.

Product of late 20th-century USA, having grown up on patriotic songs and the Pledge of Allegiance and trips to Williamsburg and copies of the Constitution handed out at the bank in 1987 to commemorate the bicentennial . . . I’ve got this obsession with the Bill of Rights.  I am too late-century to believe it has been flawlessly administered, but I can’t shake the idea that it ought to be.

And enshrined in the 1st Amendment is the right to be wrong.  We call it freedom of religion.

Even though Congress is not supposed to make laws prohibiting the free exercise of religion, of course it does.  If your faith prescribes polygamy or ritual human sacrifice, no-can-do for you.  Morality informs the law, and no amount of arguing that your religion required you to embezzle that money will get you out of jail.  The majority will legislate the boundaries within which you may practice your beliefs.  The majority of course, being composed of people who are sometimes wrong.

(Example: Slavery.  Big mistake that one.  No slaves were emancipated by arguing in Confederate court, “My religion tells me I shouldn’t have to be a slave.”  But religious arguments — initially regarded as crazy fringe nutcase arguments — did eventually persuade the Union government to emancipate.  No comment on the timing.)

And then there’s the taxes.  We don’t get a discount for deciding we object to the nuclear weapons program or the latest foreign war.  I suppose you shut your eyes and pretend your particular contribution is all going to food stamps, and someone else’s cash covers the objectionable stuff.  Either that or you buy in to the whole “Whose face is on that coin?” thing.

[More limits on free exercise:  We can’t even get out of the draft selectively — either you’re 100% pacifist, or you sign on for all wars at all times — no concept of just warfare as a religious principle to be actively lived by able-bodied men of military age.]

So what’s the big deal with the reproductive-services-funding mandate?  Critics of the Church observe that the law is only asking for employers to pay for services that Americans overwhelmingly want, and that the medical industry considers perfectly good healthcare.  You’ve got to be some kind of crazy fringe nutcase to object to wholesome American goodness like Sterilization and Apple Pie.  (Correction: There might be a case for raising insurance rates on the people who eat the pie.)

And the answer is this: We grew up in late-20th America.  We know freedom of religion isn’t perfectly administered, but we still believe in it.  We practice it with compromises, but we do try to practice.  Jews who actually keep kosher are not therefore excused from paying all their taxes, just because Federal cafeterias serve those scary puffed-up Not Hebrew National hot dogs.  But we don’t therefore say the government has the power to require all employers everywhere pay for pork barbecue.

–> It would be understandable if some Jewish people found it objectionable to purchase a dozen bacon cheeseburgers for the guys at the sales meeting , even if there were other Jewish people who had no such reservations.  We’d get it.  We’d think that mandatory pork-purchasing — and being fined for failing to offer pork as a choice at the company cafeteria — was a stupid law.

We don’t think Chick-Fil-A should be required by law to be open on Sundays, even though other Christian businesses operate on those days.  Likewise B&H Photo has a constitutional right not to process sales from Friday sundown till Saturday sundown.  Even if there are employees who want to work during those times (and who need the hours!), or customers who wish to patronize the company during that time.  We have a right to eat on Sundays, but the government doesn’t mandate that all grocery stores and restaurants be open on those dates.

The trouble with the contraception-sterilization mandate is that our government has decided these items are more like clean water or public safety, and further, our government has decided that every private employer in the United States is now the public agency tasked with delivering these goods.

The majority of Americans do not believe contraception and sterilization are immoral.  They find the Catholic church is wrong wrong wrong on this matter.  That is fine.  But proper response is then, “Well, this is America.  You have a right to be wrong.

From the view of the majority, the  next question is: “What will happen if we let these crazy fringe minority of people be excused from directly purchasing items they find objectionable?

Our government says the answer is this:

Not directly purchasing your employees contraceptives would be like just giving them cash and saying, “Go buy your own bacon if it’s that important to you.”

And that would be wrong.  Because there are limits on the freedom of religion.  Your religion is known for not approving of certain products, but everyone else in America loves that product.  Look, a lot of the people at your own house of worship are discretely eating the bacon, and usually the Rabbi doesn’t say much about it . . . you’re a threat to order and morality.

You must not just give your employees the cash.  You must set up an account for unlimited purchases at Bacon Is Us.  Or be fined.  If you don’t like the stuff, don’t eat it.

Note that this is not about money.  It would be entirely reasonable for the HHS to require that conscientious objectors simply pay their employees the necessary amount of cash to cover the cost of these services.  That’s Living Wage 101, which the Catholic Church has been trying to explain since before ever the HHS saw light of day.

Employees could then purchase however much bacon contraception and sterilization coverage they wanted.   Exact same amount of employer outlay.  Exact same amount of contraception dispensed and reproductive powers eliminated.  Only, it would respect the right of American citizens to practice their own religion.