Monthly Archives: March 2016

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Costume

My sister loved to dress up in costume. She died four years ago next Tuesday and her birth day is tomorrow.

The photograph is me and her daughter, in costume, at Lake Matinenda in Ontario, Canada, in 2009. I brought a rather demented flower fairy costume. The gloves are my mother’s: crocheted, uncomfortable, romantic and impractical. The whole outfit was entirely silly and impractical for the woods. My sister would bring long ball gowns up to the woods. We played dress up at my grandmothers with our cousins, in my mother’s 1950s prom dresses, in the middle 1970s. We thought her dresses were ridiculous. So were ours, of course.

I am not sure exactly what my niece is dressed as: a boy, I think, and maybe she was being a rapper.

At any rate, it is fun to dress in costume…. miss you, sisty.

 

 

 

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Influenza 2016

No influenza cases so far this year in my clinic.

I watch the flu map faithfully each week, as I try to get my stubborn patients to get their influenza vaccine. It takes up to two weeks to get them immune, if it works. It works most years about 80% f the time. When it doesn’t work, it’s because either their immune system didn’t respond or because the influenza virus has traded genes enough that the guess six months before on which way it will evolve, is wrong.

Here is the CDC weekly influenza update link: http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.

If you click on the FluView Weekly Influenza Surveillance Report, scroll down. My favorite to show patients are the Outpatient Illness Surveillance, which maps this year’s rise in influenza in the US each week, compared with past years. We are having a late year.

My other favorite is the next one down: ILIState Activity Indicator Map. It changes color each week by state as the influenza reports come in. Arizona turned red this year about a month ago, after Puerto Rico. Red is high activity level. The rest of the country was dark green, low, or light green, but has steadily been turning yellow green, yellow, orange…. Washington State is still green. But now only a few states are green and it’s still on the rise. If we continue to have unseasonably warm sunny days, like the last four days, we might avoid the influenza. But if it gets wet and cold again: boom. Like a sneeze, spreading. This is the first week we’ve had seven red states. I have been wearing a mask in clinic every time I see someone coughing. And I got a cold anyhow, but it is not influenza and I don’t think it’s strep A, thank goodness.

I said influenza is airborne but it isn’t. Or there is controversy. It is at least droplet spread, but sneezes count. Apparently influenza can get to people 6 feet away. Wear your space suit with the oxygen filter to the grocery store. http://www.cdc.gov/flu/about/disease/spread.htm — lots of information about the influenza virus. Is all of it 100% correct? Don’t be silly, this is science, not a religious text: science changes, just like the flu virus.

This year, a CDC alert was faxed to clinic on February 1: http://emergency.cdc.gov/han/han00387.asp. It is all very calm and clinical, with this sentence in the second paragraph: “CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported.” I called my son and said, “Get your flu shot now.” If you read the rest, it says ages 20-50 as the “young” and “middle-aged” adults. Not the group that we expect influenza to hit, but that is the group that got hit in the 1918-1919 influenza.

Get your flu shot… be careful out there.

 

I took the photograph two days ago with my phone: Boa was on my lap and I wrapped her in the shawl I’d knit, and she was so relaxed…. that’s how we need to take care of everyone with influenza.

 

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Under the camillia

My mother had many of her copies of Louisa May Alcott’s books, including the odd moral fairy tales. One is Under the Lilacs. I loved slipping into that world that was quite different from my own, in so many small details.

Thursday I was coughing and had no voice. I cancelled clinic and lay on the couch. In the warmest part of the day I lay bundled in the sun, under the camillia.

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Dream: loving and loved

I read this article yesterday: The rise of American authoritarianism.

I ask for a dream about loving and being loved before going to sleep.

I dream of a prison. I am there as a consultant. There is a woman there, younger than me and beautiful, and the men want to know how to get her out of the prison. It has thick walls and iron bars and security exits and alarms. It is clean, modern, bare, and smells worse than a hospital. But it is the men who run the prison and work in it who want to know how to get her out. How to rehabilitate her. She does not listen to or obey their instructions.

They will not let me talk to the woman or go in the cell with her. They hand me a tablet, where I can see her live. As soon as I have the tablet, I know that she is not trapped in the prison. I turn the tablet around slowly, so the image is upside down. Light appears in the center of the tablet. She can leave any time she wants and she frequently is gone. She walks into the light. The connection is with her all the time. I am so glad that she can walk into the light.

I do not tell the men. They built the prison. They are in the prison, though they think that they are keeping her there. The prison is built of what they think should happen, their authority, their rules.

I am sorry for the men, but they would not believe me even if I told them. I have tried many times.

They don’t see that they are the ones who are in prison.

I give the tablet back.

I wake up.

I took the picture in the sunrise mist in 2006, Lake Matinenda, Ontario, Canada.

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DIY cat fud II

This is for Photrablogger’s Mundane Monday #50.

I crack the door in the early am and this is Boa Cat’s first spring mouse. She has a particular muffled call to tell me when she has a mouse. I love this picture because of the shadows and it’s not quite straight on and the light and silhouettes… This mouse was no longer cooperatively playful….

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Dream: home surgery

Yesterday I ask a friend to drive me to pick up my son, on his way home from college for spring break, an hour to a nearby pick up point and back. I can’t walk without limping horribly: apparently the recent stress in clinic has made my muscles mad.

F. drives. He has just finished reading Reinventing Collapse: The Soviet Experience and American Prospects, by Dmitri Orlov. Mr. Orlov says that I, as a physician, should start moonlighting as a midwife for barter to have a back up plan for when the economy collapses.

I laugh. “Not very helpful where the median age is 55.”

“Not to mention people want to use their pathetic health insurance.”

Home and I go to sleep. Dream: I am at F.’s house. There are two other men, one of whom needs abdominal surgery. We argue for a long time but he has no money and finally I agree to do surgery with F. assisting. The other man is to help hold the young man down. We do not, of course have anesthesia. I go over what I am going to do, force them to pay attention, discuss sterile technique, boil everything. Not ideal….

We don’t have a cautery or suction either. But there is almost no bleeding and the two things that need to be removed come out easily, I am very veryΒ  gentle, so I don’t cause other things to bleed. Never mess with the spleen.

Now I need to close the abdomen and I don’t have absorbablesutures. I am going to do a figure 8 from the surface, in skin, out the abdominal fat, across into the fat, down through the fascia, crossing very delicately up into the fascia on the other side, out the fat, in the fat on the other side and out the skin. Then slowly pull it tight, tight, and tie it off. It’s thick nylon. Nonabsorbable. Usually you would take the nylon out in 7-10 days but I am wondering how long I would need it for the fascia….I thought that would take 6 weeks to heal. I am worrying.

But now F. and the other man are not holding my patient, they are backing off and congratulating each other. My patient gets up off the table. “Lie back down!” I say, “Your guts could fall out the opening! We haven’t closed! F!” Surprisingly his guts are not falling out, but it’s because I have done such a beautiful low abdominal incision, bikini style. “Get back on the table or I will make you go to the hospital to have it closed!”

He reluctantly gets back on the table. F. and the other guy are still being morons but are calming down….

….I wake up.

 

The photo is in my yard during sunrise last summer: spring forward today….

music: https://www.youtube.com/watch?v=aEi_4Cyx4Uw

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DIY cat fud

This is for Ronovan writes weekly haiku poetry prompt #87, words class and firm.

I try to stand firm
health insurance corporate
fraud stand firm with class

Boa cat brought her own breakfast in the other day. I am so appalled and horrified by the health insurance corporate fraud I see daily. The patients and I are the mouse and the health insurance corporations are the cat….. we have to stop them.