8 Strategic Levers to Reduce Procurement Cost

Selecting and implementing procurement measures is a vital part of a holistic approach to strategic procurement. Here are 8 procurement levers to utilize.

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A Long Goodbye in the Garden

by Angel Djambazov

It was snowing when my phone politely informed me you had passed. That’s not quite right. The snow that drifted across our farm, collected on our windshield wipers, and looked like static on greenhouse plastic, was instead ash. The news of your death came on the morning of the second day of the largest wildfire outbreak since 1910 and the worst wildfire disaster in Oregon state history. The impending doom of winter that you had foretold via Labor Day text, had arrived early.

The fires and the ash lost their meaning. I sat in your part of the garden and scrolled through our text messages to hear your voice.

***** March 2018 *****

Liz: How the heck did my story get out this time? Previously, in the last episodes of my life, as we pick up the story, we’re on steroids. We discovered SBRT and used it to cast out the outcrop of a new cancer in my lung. I am starting to think the cancer has a bit of a crush.

It’s week 5 or 6 since the diagnosis of radiation pneumonitis, a condition that fulfills its name — it’s a non-contagious pneumonia-like condition that is caused by radiation treatments. Lungs lose their elasticity and breathing becomes very difficult. Stay tuned for next week’s diagnosis, oops I mean next week’s episode.

Where are you keeping your pillow for this little while?

Angel: Currently, the Angel Bingo roadshow just finished the Western states tour. First stop was lovely SF to take a tour of the Mission District and harass bartenders into making drinks not on the menu while alternating between bullying and schmoozing with clients. After a detour to pick up an errant credit card, I dodged the Chinatown parade, grabbed Blue Bottle and jumped on the Amtrak to Stockton.

Once in Stockton, I promptly ran into a junkie and we exchanged a state of the union. We both agreed it was bad and something should be done. I then headed off to Palm Springs for a women’s focused blogger conference in a hotel painted like Skittles. This time my Airbnb which had bondage hooks from the ceiling. Seemed like a waste not to use them…

I then spent three days explaining women’s underwear to women. Talk about a peak in mansplaining. Favorite quote from Palm Springs? One of the business executives exclaiming to me after hearing a story about Pirate, “Why would you take real pills from a fake pirate?!?!”

Why indeed?

I am now in Phoenix where I spent three days with my parents. I interviewed them about their life stories (so much I didn’t know about). Every time I am at an Amtrak I think of you. Our quick visit in Chicago on the Lake Shore Limited is still a highlight.

***** April 2018*****

Liz: This is sort of a good news / bad news post.

Remember the radiation pneumonitis? It’s still around. With steroids, the pneumonitis was manageable in Feb / March, but it’s gotten much worse. Now my doc wants me on oxygen 24/7. I look even more like an old lady.

The good news is that radiation pneumonitis does end. The bad news is that my doctor had one patient who had to be on steroids for a year.

Angel: You’re too popular. Any feedback from them on how to help your system balance it out? You’re supposed to get better so I can come see you in September. At least there is good pudding at the hospital. I am sitting next to MGX as she is making crayon drawings of cat butts.

Liz: This is my first time at this particular hospital so I’ll let you know about the pudding. Wish I had my crayons!

Angel: Ask the nurse’s desk. They usually have extra crayons. *hospital visit expert*

***** May 2018 *****

Angel: Just came back from a business road trip. Visited Palo Alto, Salinas, LA, Turlock, and Stockton. Slept on the kitchen counter in a very shady hotel reportedly once owned by Laurel and Hardy. Thankfully I can sleep anywhere. What’s funny is that the bathroom is three steep steps up into a tilted space where the designers in their wisdom decided to put a pole in front of the toilet. I was skinny enough to sit facing straight ahead, just barely. I figure they put it in thinking that if you passed out while pooping that at least your forehead would have somewhere to rest. Quite thoughtful really.

Also met a man who has carved out a niche in Palo Alto abusing the rich execs who drink his coffee. They can get their dominatrix fix and their caffeine. Smart business model.

We have looked at over 20 properties and finally made our first offer on a farm. It is 30 minutes from the Oregon coast and 50 minutes to Eugene. The property has a fruit orchard already in place and has water rights to a year-round stream. We will know by Wednesday whether they will take the offer.

Liz: The dominatrix thing is too funny. The kitchen counter doesn’t look so comfortable. I agree about the forehead thing. Very thoughtful. Meanwhile, they took me back. I’m now in an ER exam room waiting for a doc. Signing off for now. Hope the farm offer is accepted. Careful who you tell that you bought the farm.

***** May 2018 *****

Liz: I am back in the hospital again. The doctors are not saying much. Right now, I’m in the hall of the ER — moved out of my exam room — waiting for a real room in the hospital.

The attending physicians came by and told me that I’ve been not breathing “normally” most of my life. Apparently, my body doesn’t release all of the carbon dioxide it makes. But my body has already learned to compensate for that.

As for what’s happening, they want to check my x-ray to see if it shows signs of infection. Sounds a lot like, “is your computer plugged in? Have you restarted it?” I want them to recognize I’m not a newbie.

Angel: Control-Alt-Delete is not the right call. Hope the night nurse has some good music planned. They should be able to come in on roller skates.

Liz: My nurse said if she had to skate, she thinks she would be out of a job. I told her that when she feels herself starting to fall just dive for a bed.

***** May 2018 *****

Liz: Going home tomorrow. No big change in what I’m doing. CO2 level is still high for me, but my energy seems better and my thoughts are logical and lucid (well as much as ever). The good news for me to hear is that it could still be the radiation pneumonitis that is f-ing with me. This means that there could be an end to the CO2 level issue, leaving me with just severe COPD.

I’m a little worn from the roller coaster of diagnoses coming at me that move from “you have SEVERE COPD” to” you look so good” and back again.

Anyway, a huge surprise is that room service here is better than in some hotels. As a test, I ordered the roast turkey, fully expecting pressed meat, but I got a beautiful 1/4inch slice of roast turkey. Memory of it makes me hungry.

Angel: I have definitely had some good food at hospitals. I almost feel like I should write a guide book.

Liz: Dr. V came by just so we could talk. Because she enjoys my company as I do hers. I think she stayed close to an hour. That’s just what I needed.

***** August 2018 *****

Liz: Ice water

Angel: Ice water?

Liz: Please

Angel: I can bring some but it might be a few days before it arrives from Seattle…Are you ok?

Liz: Sick…

***** September 2018 *****

Liz: Overdue update. I’m home after two weeks in the hospital. It’s a bit of a long road coming back to normal. As it is I don’t remember whole chunks of what got me there.

Apparently, it was the only time in my life I went to the ER that I went from the car right into the waiting room without having to sit out front. And I missed it! After many hours in the ER itself, I was sent the MICU sent there because every doctor and my family believed I was going to die. I was in an acute state of delirium. The nurses/doctors told me I had been in a “coma” or “asleep.”

The operating theory is that being on too many conflicting drugs between home and the hospital caused my system to crash. The hospital docs wanted to put a tube down my throat. As you know, I have extreme anxiety about anything covering my mouth. Thankfully Dr. V intervened and convinced them that a tube would have had a heck of a time being removed once inserted because of how radiation melted my throat. If Dr. V wasn’t my doctor, we surely would be friends for life.

I went into the ER on Sunday and woke on Tuesday form what probably looked like a coma. They let me eat for the first time on Saturday. 6 days later. I’ve never been this hungry in my life! I eat 4 meals before noon and one after.

They stripped me of my drugs and have introduced drugs they tested while I was in the hospital and that they have confidence will not cause a system crash. The current list seems good.

Angel: Hello from Tacoma hospital. Pirate is here this morning about to undergo removal of a mass in his lung. They are taking out about a quarter, which will make his gravelly voice even more pirate-like. He will be in the hospital for several days. In the meantime, we will be taking care of The Wench and making occasional stops at his bedside for pudding. The pudding is good here.

The search for the farm is still ongoing. We are fairly far along on two different properties, but it will still be another 30 days before we know. Meanwhile, we’re trying to decide whether or not to bring our stuff back from CT early or to wait. We will likely wait. Not sure what is in the storage unit anymore other than books and our poof.

I am glad to hear your voice in your text. And I am glad that the drug balance has been restored and that your appetite is back. I would have been at a conference in Chicago this week, but circumstances of pirates kept me from going.

Liz: A bit of good news. Eric rented a Getaround.com car and drove out to the suburbs to see Pentatonix. In the front row, the chair got us better seats!

Please give Pirate my love. Tell him that having suffered from radiation pneumonitis, a pneumonia-like complication caused by radiation treatments has caused all kinds of issues, not the least of which is that I’m now on oxygen. (I don’t remember anyone bringing that up — do you?) Now I understand why I was told by 2 docs that surgery is the preferred choice.

I hope the farm gets sorted out early. You have been homeless too long.

Angel: I do remember an off-handed comment about oxygen. But, in hindsight, surgery may have been the easier path. That pneumonia has been a bastard. Pirate is as tough as he is leathery. Will send him your love.

I am glad Eric got to be with you for so long and challenged the doctors on your behalf. Tough independent types like you and Pirate make for the worst patients. As a doctor’s son I know these things.

I have never heard of Getaround. Sounds like a great service. Love the Pentatonix. I bet that was a great concert. Glad you two got to go and that they rolled out the red carpet.

Liz: I don’t know what sort of patient I am. A nurse in the ICU and two nurses and a tech on the cardiac floor all said I was “sweet.” I asked my caretaker what that meant and she said, “You’re never mean to us and you always say ‘thank you.’”

Angel: Pirate has twice now driven himself to the hospital while having a heart attack. Because why spend the money on ambulances? He still takes roofing gigs even though the socket in his left shoulder is destroyed. He’s also is described as “sweet” by the staff. In fact, because he is a Seafair Pirate, he has a bit of a fan base among the nurses. In many ways, you are birds of a feather.

You have this independent streak. It’s one of the things we love about you. It’s what also makes it hard to tell when you are OK versus when you are actually OK. I can hear it in your voice as you type now that you are back. And that’s a good and wonderful thing. Makes me happy.

Liz: Tell Pirate, I said I am not like him. I have no fear of other people giving me a ride in their ambulance.

And to yourself — your view of me in this world so reminds me of a friend who died in 2007. He once said my strength is that I am both brave and vulnerable. You speak softly but carry a world of wisdom. (When you’re not busy getting everyone into trouble playing Bingo)

A sentence from a piece I wrote for the friend you are so like: “We only get a few who understand us and love us the way we come packed and broken, with tears at the seams.”

***** November 2018 *****

Angel: We got the farm! If you fly into Portland, we will pick you up. The guest house is waiting. Or will be waiting when it’s furnished.

Liz: I would like that so much. Unfortunately I’m having a time organizing a trip longer than 3 hours. While I’m on oxygen planes are out of the question.

Angel: Hmmm…well, we will have to organize a road trip then! Fill the trunk with oxygen canisters and hit the road!

Liz: That’d be tanknapping across state lines.

***** December 2018 *****

Liz: Have you heard of the Inogen? I took money out of my retirement and bought one.

It’s a portable oxygen capacitor that removes the need for heavy tanks and having to measure how long a tank will last. Tanks severely restrict travel — not only no airplanes, but also for a short trip to Ottawa, we would have to take several tanks and then we wouldn’t be able to stay overnight because there’s no way to fill them. That all goes away with Inogen.

My goal is still to set aside the o2 completely. But this was still a good alternative either way. Meanwhile, I start pulmonary rehab next week.

Angel: I have not heard anything Inogen but anything that gives you more mobility I am all for. What does pulmonary rehab entail? Hopefully, a hot tub and cocktails.

Liz: Oh yeah and you can take an Inogen on an airplane — not so w/ tanks. Pulmonary rehab is about exercises that build stamina and lung capacity. I’ll be at the Shirley Ryan Activity Lab. (It’s so funded it looks like a movie set.)

Never was one for hot tubs. Maybe I can get double cocktails.

*******************

Angel: Since we last talked, my mom visited, walked into the house, opened up the fridge, and exclaimed, “You have food and a roof! Now I can sleep!” I also replaced my first set of well parts thanks to YouTube. Who knew that fornicating frogs could take down a well? Apparently YouTube.

Liz: I see the start of a country music song.

***** March 2019 *****

Liz: Time for a positive update…

It started as a bit of a test / good sign — Wed. afternoon (the 27th), I unplugged from the oxygen for a half hour to put away more things that we’d moved out of the bedroom for the asbestos testing. My energy was good, and I didn’t feel short of breath. So when I finished, I sat and took my pulse oxidation for a few minutes. (88 or below is not good. 90 and above is good). My pulse ox was at 94 for another 20 minutes.

That evening I took off the oxygen for an hour and maintained higher than 94. So that night, I did a few hours in the living room without the oxygen machine on and still maintained 91+.

My plan had been to put it back on when I went to bed, but I forgot. I realized that when I awoke at 2:30-ish and immediately took my pulse ox. It was 92. I decided to leave it off. Thursday every hour I checked my pulse ox both when resting and after activity. It stayed above 91.

Today is 4 days without supplemental oxygen and my pulse remains in the 90s, often as high as 97.

Angel: Building up lung capacity sounds like a good if painful thing. You should ask for extra cocktails. Pirate did both after this surgery. You have been an inspiration of sorts. I paint grand pictures of you to him.

Liz: Tell Pirate that I’m his team.

Angel: I already told him as much before his last surgery.

Liz: Veal tomorrow. Then work starts next week.

Angel: Is the veal mandatory?

Liz: Heh. Heh. I meant to type eval. I’ll skip the veal.

***** August 2019 *****

Liz: Today I had a bronchoscopy. They took a few bits of my lung. No real news. They are still saying that it could be:

A — cancer

B — an infection

C — nothing at all

I’ll update in a few days as I know more.

Angel: I will take a double-dose of option C please.

***** September 2019 *****

Liz: I’m sitting here with Eric, and I mentioned the Pirates. He doesn’t know about the Pirates. How is that possible? Can you (would you) text him a little of their story — who they are? I want him to know about the pirates.

***** November 2019 *****

Angel: Spent the day dragging our 100lbs river pump up our 14ft bank. It looked like I had caught some strange creature from the sea. Oh! And I used waders for the first time.

Liz: Saw the photo. The creature doesn’t look like a good hugger.

Angel: Too rigid. Sharp edges.

Liz: Don’t like folks with sharp edges. Never did.

***** February 2020 *****

Liz: Got a voicemail today from Dr V’s nurse. She reminded me that my hemoglobin levels are low -something V and I discussed as probably anemia. The message said she wants me to come in before the PET to give some blood for them to crossmatch so that after the PET I can go in for a transfusion.

And so again it starts….One visit begets three more visits — a PET and two blood procedures. How many more visits will those visits beget?

Angel: Like massive Rube Goldberg devices hospitals do tend to act as an apparatus. At least the blood steps make sense. Plus an infusion, in theory, should help your body feel better overall. That is after all the poking and prodding.

Liz: NO ONE expects the Spanish Inquisition! Love the Rube Goldberg analogy. It makes me wonder whether Eric knows what that is. I can’t ever predict with him. I’ll ask.

***** March 2020*****

Liz: Met with Dr. V this week. The spot they found first in 2017 and slightly changed in 2019 is showing up again. So we need another biopsy. The goal of this biopsy was to better pinpoint the spot they saw before so that they can get a viable sample. Imagine my surprise when they wheeled me into a room with a CT scan machine so they can scan while doing it to better see where they’re prodding and poking.

I found myself thinking of the Library of Congress concert. I forgot how much I like Lyle Lovett. Every song reminds me of you in some way. Been singing for hours. Getting my head around music helps with the poking. Eric’s advice to me because of COVID is to stay home don’t go to doctors. Stay away from hospitals. People over 60 aren’t getting enough care. Glad you’re not around to see me I look like a frail old lady.

Angel: With that strong heart? Never! Eric’s advice seems sound. Or at least a discussion about risk/benefit. You raised a smart man. Speaking of getting your head around music, I have been listening to a lot of Floyd and Tom Waits. They are comfortable friends to have at times like these. Did you see Bocelli’s concert for Easter on YouTube?

*******************

Liz: Here’s the news. No lymph nodes. My chest X-ray showed something that could be pneumonia (you guessed that) and I’m something called RSV positive. RSV is a virus that goes after infected lungs. Missed Bocelli.

Peter Townshend is easing my overthinking mind well enough today.

“When everything feels all over
Everybody seems unkind
I’ll give you a four-leaf clover
Take all worry out of your mind.”

— Pete Townshend

Angel: Sigh. That’s scary. And I know you are tired. Wish you were here and could hear the bees in the lilacs, the wind in the bamboo chimes, and the chatter of the birds as they call to each other.

And the doves! I don’t know if I ever told you this story, but it’s a good example of how much of a city boy I am. When we were first living on a farm in Maryland I heard what I thought was a hoot in the morning.

I said, “I love the sound of the morning owls.”

MGX paused and laughed, “You mean doves?”

They have been the morning owls ever since.

Liz: Daylight owls. You told me that story before. I’m exhausted.

*******************

Liz: My husband Wayne likes trains. I used to take “The city of New Orleans” to Arkansas with my mom and brothers to see grandma. I miss the dining car. Ask MGX if it’s okay for me to borrow you telepathically on Friday afternoon.

Angel: I don’t have to ask. Of course, I will be holding your hand the whole time. MGX is currently having coffee in the grass with Pirate.

Liz: Sounds idyllic.

Angel: Pirate makes it so. He has a certain perspective on life. It’s the Zen that comes from driving himself to the hospital during heart attacks.

Liz: That would, as they say, give a person pause.

Angel: Ha! Pirates will be pirates.

Liz: Won’t they always?

Angel: Yes. That’s why we love them. Equally, that’s why I love you.

Liz: You sure can pick ‘em!

*******************

Liz: Dry throat. Yogurt please to clear the throat.

Angel: Liz…I can bring it but it will take a while to get there from Seattle.

***** April 2020 *****

Liz: Remember how you used to talk about serendipity? I had the most interesting experience today. My doctor of 17 years, Dr. V, is leaving Chicago. We had our last visit today. What’s amazing is that in the course of telling me of support in Chicago she said if the doctor she was turning me over to didn’t fit she’d connect me to her mentor at Rush. Turns out I recognized the name. He was my mother’s oncologist! How wild is that?

I went for drive through COVID test this morning in prep for Gamma Knife procedure #2 Friday. Great news is they agreed to knock me out this time. Feeling better about that.

Keep sending the farm photos. I miss my gardens. Can’t stop staring at the sprouts in your greenhouse trays. It’s like as if they were right here.

Angel: What’s your favorite plant? We will set up a Liz spot in the garden.

Liz: I’m partial to a corn flower called ranunculus. They look like a rose bloom on bendy, pipe cleaner like stems.

Angel: Sound beautiful. We will find some seeds.

*******************

Liz: Not going to try to make you live it. Many days of excruciating headache in the last couple of weeks. I wasn’t sure they weren’t just a response to the radiation. I’m exhausted. Hospital again. MRI before I left. CT when I arrived. Lesions is the only word I heard. And you guessed it. Brain cancer. Go figure. Gamma knife tomorrow.

***** May 2020 *****

Liz: Keep the photos coming. They have me reimagining my gardens every spring.

Angel: You would love all the flowers through the yard. Been learning how to prune those in the greenhouses. One of the perks of pruning basis is, well fresh basil for dinner.

Liz: Sounds marvelous. You’ve got a little piece of paradise.

***** June 2020 *****

Angel: We got a farm puppy!

Liz: Looks like she means business.

Angel: Her name is Sage. She is wiggly.

Liz: Sage. How perfect.

*******************

Liz: The photo you sent of the greenhouse tomatoes looks like a display of old ladies’ purses. Hope the Pirate and The Wench are doing okay during this crazy time.

Angel: It’s like Steve McQueen said in the Magnificent Seven, “So far so good.”

Liz: Or Monty Python, “I’m not dead yet!” Should be followed up by “there’s bugger all here on earth!”

***** August 2020 *****

Angel: Angel Bingo, Fishing Edition: Go fishing on pontoon boats with retirees on a calm day. Encounter a 12mph headwind. Make no headway after 3hrs. Realize that the lush 40' banks make for an effective trap when one of the retirees has MS and the other is out of cigarettes. Contemplate where you’ve seen this movie before. Disassemble the boat, scramble up the blackberries, and head to nearby rock quarry. Get bailed out by the owner of the quarry named John Henry. Cue Johnny Cash.

Actual square:
Backwoods Pontoon Boat Medical Emergency. John Henry Saves The Day.

**********************

Angel: It has been a lovely end of summer. Sage is learning how to dog. We are learning how to be parents. The light has already changed and leaves are falling.

Liz: Sounds beautiful. Wish I could see it. Also like the impending doom of winter. Surely, Sage will teach you well.

***** September 2020 *****

Those were the last words you wrote to me. As I am standing in your section of the garden, strange snowflakes falling, I realize you were right as Sage stumbles over with an empty flower pot in her mouth, telling me that time is short and asking me to play.

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