without reason

without reason

my cat worries
as I pack the bug out bags
to hide in the woods
if food stops arriving on trucks

she hates it when I pack
and the other pound kitten of nine years ago
was killed by a car two months ago
so she is lonely

I stop packing
I hold my cat
I say, “We will not go without you.”
I hold her
She relaxes
Believes me

I get the travel cage from the garage
wash it and get my pink silk scarf
it’s been in a bag and she has been hiding there
just her face in shadow when I walk by

I put the scarf in the travel cage
leave the door open
and feed her there intermittently
I will take her in the travel cage in the car
so that she is prepared

I’ll take the fish too

I plan to put plants outside
some may survive

some say animals and plants
have unstinting happiness
but not my cat

she worries that I will leave without her

and is reassured
when I say I won’t

In my parents’ house

I wrote this poem when I was in college, I think.

We still have the family quilt that is in the poem.

My mother made two teapots that are cream colored, with the poem on the teapot.

My sister read this poem at my mother’s funeral.

A friend read this poem at my sister’s funeral, because I was in the hospital.

My sister’s teapot was sent to me and I gave it to my sister’s daughter.

I had to get the poem off my teapot, because I think that’s the only copy that I have…. or had.

In my parents’ house

love is dispensed in teacups

–  –  –  –  –

When they notice you

Pacing in some empty mood

Or with that blank deserted face,

Eyes shutters into an empty mid

They say, “Would you like a cup of tea?”

–  –  –  –  –

The warmth of the cup in your hands

And the hot liquid, sweet and milky

On your tongue works wonders

And binds your soul to your body

–  –  –  –  –

When my sister was twelve

She embroidered a patch for a quilt

In yellow flosses, a cup

With steam curling upwards

And the words, “Such a comfort. TEA.”


The photo is of a synchronized swim trio.

Only one swimmer is really visible. She is being lifted by the other two. They are not allowed to touch to bottom at all. It is all done lifting their own or each other’s bodies out of the water by swimming.

Sychronized swimming is a shrinking sport in the United States, because it is such hard work. My daughter started at age seven and had to swim three laps. She made it one length and then had to hold on to the lane divider to rest during the rest of the laps. She went under three separate times during that first practice. I nearly jumped the divider all three times, but she came up each time.

“How was it?” I asked when she got out.

“I nearly drowned three times.” she said, stomping past me in a rage.

She says that she hated it for the first year and that I made her keep going. If I did, I would feel guilty, except that she loved it so much after that. Seven years of synchronized swimming, until our very small town team folded, and then swim team. She is now a junior. What she wants most in college is to continue to swim on a team.

Back to the photo. To be lifted straight out of the water that far, you must be in the right position, you must have very good core strength, and your two partners must be in the right position underwater and lift correctly. You must practice and practice and practice and practice.

And you do this in time to music.

We need to work as a team in the world to deal with infection, to deal with ebola, to work together. My daughter loved synchronized swimming because it is so challenging and because it is above all, teamwork.

Taking care of Ebola is hard

“We may never know exactly how [transmission] happened, but the bottom line is that the guidelines didn’t work for that hospital,” said Frieden. “Dallas shows that taking care of Ebola is hard.”

From the Huffington Post: http://www.huffingtonpost.com/2014/10/20/ebola-hospitals-us_n_6018372.html

And for me, a lowly rural Family Practice physician, from the American Academy of Family Practice: “The first steps in preparing your office for a possible Ebola case are to make sure you have all referral contact information ready to go and that you educate each staff member on his or her role should a case present.”

There is only me and a receptionist. We don’t have hazmat suits. Actually I’ve been off sick, lung and vocal cord problems, for all of October.

We have masks, gloves, I do have a white coat that I almost never wear.

Also from the AAFP:”Appointment clerks and front-desk personnel taking calls for appointments should inquire about African travel history in patients calling for appointments for fever, headache, weakness, diarrhea, vomiting, muscle aches or bleeding,” said Mahoney. “Anyone with a positive travel history should be contacted by a provider to gather additional history and determine if public health authorities need to be involved before a patient even presents to the physician office.”


We are both going to get our influenza shots this week. Please get your influenza shot. There is a lot more influenza around than risk of ebola in the United States, and influenza kills many many people every year. And even if you “never get colds” and “have a strong immune system”, you might get a mild case of influenza and pass it on to someone who then dies of it. If you tell me “I got flu the last time I got the shot”, excuse me, but that is hooey. First of all, it takes two weeks for your immune system to respond to the shot, so if you got symptoms the next day it could be influenza but not from the shot. Maybe from being exposed to someone with influenza at the grocery store or your doctor’s office. Secondly, people say “flu” and often they mean stomach flu. Stomach flu is not influenza. Third, influenza changes all the time, so about 80% of the vaccinated people are protected most years. That’s right: two weeks after my influenza shot, I am about 80% protected. Not 100%.

Why are we getting vaccinated? For one thing, we are health care workers and we get exposed. And for another, the initial symptoms of influenza are the same as the initial symptoms of ebola. Actually the United States is really rather lucky that the ebola case happened before influenza really hit, because they look too much the same initially. Suppose that three of the quarentined people had come down with influenza….. confusion and panic initially.

So please get your influenza vaccine, because you not only help to protect yourself, but protect others and prevent panic.


Don’t panic, prepare

We need to help people with ebola in other countries: or else we won’t deserve and won’t get help when the United States is the center of an epidemic.

I am a member of a doctor website called Sermo. I rarely write there, especially after I found advertisements to medical equipment and drug companies saying that they could pay to put announcements and articles on the site and “reach doctors”. Also, apparently some doctors on the site think that it is “safe” to write things. Ha. It’s the internet, silly, the opposite of safe. Your words could get back to your patient, ok?

Anyhow, there was a survey and 75% of the doctors on the site who took the survey (I didn’t)  said we should stop flights from Liberia. I think they are wrong, are not compassionate, and I would cross them off my referral list as discriminatory “I’ve got mine, everyone else can go to hell.” selfish gits. I disagreed and said that the United States could be the center of an epidemic, easily. Could be. Will, some day. We need to treat our international neighbors as we want to be treated.

That being said, I am pleased to see the CDC and United States hospitals now stepping up and getting their hazmat suits on. The rest of us need to NOT PANIC.

If you want to do something, think about your communities emergency preparedness. Are you prepared?

1. Do you have a weeks worth of food, water, medicines, supplies? Do you update the supplies (ok, I have food from 2009. Time to update.)

2.Do you have a weather radio? (http://www.emd.wa.gov/publications/pubed/where_to_get_weather_radios.shtml)

3. Do you have a family meeting point? Do you have an out of state person that the family is to call to check in? That everyone knows about?

4. Have you subscribed to emergency notifications? (http://www.emd.wa.gov/publications/pubed/noaa_weather_radio.shtml)

5. Consider buying your community a shelter box. Or teaming with friends to buy one for the community and another for a disaster area. Our Rotary group buys at least one a year for international disaster relief. (http://www.shelterbox.org/   and http://www.shelterboxusa.org/)

6. Do you have skills? Can you set up a tent, cook food, do medical care, start a fire, build shelter? What skills could stand brushing up? Have you taken a first aid class recently? Have you taught your children these skills? Do you have neighbors that would need help? You would want someone to help your grandmother, who lives four states away. Adopt a local elderly person or couple that you would help……

The picture is my daughter and niece in 2009 in a 19 pound canoe that is very tippy. They only tipped it over on purpose. They both have a lot of skills, some learned at cabins in Ontario, Canada. The cabins are one room and could also be described as shacks: but the kids get to use tools, paddle canoes, start fires, sleep in a tent……

My parents taught care of the tent so well that I have a kelty tent that my sister and I set up, took down and used, and it still does not leak. It is more than 40 years old! Aluminum poles, no shock cords and a fly. Excellent.

Humans should behave more like sisters

Humans should behave more like sisters.

My sister and I played together. We’d get angry. We’d fight! We’d sulk! We’d complain to the grown ups! We’d slam doors! We’d ignore each other!

But in the end, there was often no one else to play with. So we would make up. And we loved each other.

I miss my sister so much.

Can’t we learn to love other humans and quit being stupid? Please?

The photo was taken at my wedding by the groom’s uncle in 1989.

Thoughts on the update from ICD 9 to ICD 10

I would be very interested in a tune for this poem. 

This poem was rejected by JAMA, the Journal of the 
American Medical Association. Of course, the American 
Medical Association writes the codes. I do not look 
forward to going from the present 14,000 diagnosis 
codes to 42,000. I think it's just another way for 
insurance to delay and refuse to pay physicians. I 
think our country now has a business ethic of "screw 
anyone you can" and I don't like it. 

Thoughts on the update from ICD 9 to ICD 10

They say ICD 9
Just isn't so fine
Not enough codes to choose
To keep us fungking confused

They say ICD 9
Just isn't so fine
The rest of the world
Uses ICD 10, word

But they are liar liar liars
Pants on fire fire
Noses as long as telephone wires

They are liar liar liars
Fungk ICD 10
And let me tell you fungk them
Fungk starting over again

ICD 9 is now 34
Oh what a bore
They say it's too old
I'm older and gold

They say engage a team
Establish a plan
Get focused training
Learn that sh-t from the man

They say what does your practice
See and learn just those codes
Fungk ya'll but wise
I see everything that goes

I do family practice
I'm a rural doctor
The point of the codes
Is insurance don't pay, suckers

They say ICD 9
Just isn't so fine
The rest of the world
Uses ICD 10, word

But they are liars liars liars
Pants on fire fire
Noses as long as telephone wires

I know my ICD 9
Forwards and backwards, up and down
I can code pregnant
by four circus clowns

I can code pulmonary
embolus past
I can code gerbil inserted in the a--

ICD 10
is starting again
Code left or right or other
Those sh-ts would fungk your mother

ICD 10 is starting again
Code where it happened
Or insurance won't pay
Fungkers make my day

They say champion the change
I say channel the rage
Take a book from my page
Incinerate the fungking change

Fungk ICD 10
Fungk ICD 10
Fungk ICD 10
Fungk it again.

Step off the chain

There is a giant chain, with links about two feet long each. A ship’s chain. It is lying curved along the ground. On each link is the statue of a god or goddess.

There is one empty link. I am walking towards the link. I am dressed in flowing white robes, off the shoulder, Greek. I am not a goddess.

Something hits me. It is a small square pillow, four by four inches. I made a set of small pillows when I was first married. My husband and I would throw them at each other when we were upset. They would make us laugh. They were so light that they would bounce off anything and not hurt. They also would not break lamps and decorations. I still have this small square one. It does not hurt.

There are other pillows. Larger, couch and bed size pillows. They have ornate covers, with beads, tassels, rhinestones, gems and sequins. I know that when I step up on to the chain, the pillows will be thrown at me. They will hurt, because of the ornate decorations. They won’t kill me.

I stop. All of the other gods and goddesses on the chain are represented by statues, stone. I am the only living representation. I am not going to get on the chain. I am going to make a statue to the goddess and place it on the chain. It will not be harmed by the pillows. I will make it quickly with wood, and then replace it with stone when I am able.

I wake. I think, who is the goddess?

Artemis. It is Artemis, greek goddess of the hunt, archer, sister to Apollo, midwife, protector of young virgins.

I wake and read about Artemis.