flooded

I wrote this after the tsunami in Japan. I was thinking about PTSD and triggers and being overwhelmed. And the flooding now in Texas….

Flooded

I cry because
the laundry overflowed
the sewer blocked again
we might have to pull up the floor
and lay it down a third time
I hate the laundromat
water runs across the floor
as fast as the tsunami
crossing the fields
crushing the houses
catching the trucks
in Japan

I cry because
I have to ask for help again
Help comes
but the memories of asking
when it didn’t
help didn’t come
and I was abandoned or humiliated
rise up and overwhelm me
I am flooded
I am helpless
someone help those people
The shaking earth is bad enough
But the ocean rolling inland
Over all
Breaking all
Beams to toothpicks
Those are the memories that rise up
And flood me
I think of the soldiers
and victims of wars and disasters
and PTSD
tsunami
of memory

 

previously published on everything2.com

For the Daily Prompt: memorize. In PTSD, the memories are not what people want to memorize.

music  Randy Newman Louisiana 1927

 

book door

Here is a photograph of my book box doors for Norm 2.0’s Thursday Doors. I have a library box and books come in and go out. Everything from textbooks to Dostoevsky to Louisa May Alcott to mysteries and romances.

Sometimes I put coffee out, too, and have my coffee in the yard in the early morning. My daughter wants to know how people will know I am not going to poison them, but if I am out there drinking the coffee, I think they will be reassured.

We have at least 6 Little Free Libraries in town, including one in front of our grade school with lots of kids’ books. Hooray for books and for sharing and exchanging them!

without earbuds 3

Oh! My mystery bird lands in a tree. A big tree. And I zoom in.

Is this a bird that you think of in trees?

I am walking without earbuds, watching and listening.

I take pictures and walk closer. This bird is silent, but I try to imitate it’s call. It knows I am watching, though I am a block away….

For the Daily Prompt: enamored.

without earbuds

Here is a mystery.

This picture is for scale. I went for a walk three days ago, without earbuds. I walk without earbuds so I can listen to the birds. And I mimic their calls.  I have a series of photographs of the latest bird who flew closer to see who the mimic was. See if you can guess the bird. She is not visible in this picture.

When I started the walk, a person ran by with earbuds. I feel so sad, seeing that they are cut off from nature even when they are outside. I grieve for the disconnect. And then I have a magical mysterious interaction with a very unexpected bird and joy returns…

the tide going out

I am thinking about the term “white trash” and choices.

Is “white trash” a discriminatory term? A derogatory term? Is it a type of person or is it a “lifestyle choice”? Or is it a sum of choices?

A friend tells me that it is not discriminatory. Not an insult. A lifestyle. Then the friend says, “Some people would assume that I am white trash because I live in a trailer (manufactured home) and don’t own my own land. I rent.”

Would this person be white trash to you? Does it make a difference if they are male or female? Over 60? Under 30? Single? Have children? Would you feel differently about a single male parent than a single female parent? Would you feel differently if they are widowed instead of divorced?

And at what age do we become responsible?

If I am a child growing up in a household with alcoholism, verbal abuse, parents with mental health issues or grave illness or abandonment, where is the line where I become responsible for myself?

I surveyed my smokers for years, what age did you start? The men mostly said age 9. There was more cultural pressure on women, but the youngest started at 11 or 12. And then the horrific stories, where the parent is offering whiskey to a child under 10. My sister and I wandered around peoples’ houses in the dark when we were under ten. She was three years younger. I was a kid who did not trust adults and was careful. Scared. So we did not get into drugs or alcohol and I hated my father’s unfiltered camels. My parents would not touch illegal drugs, thankfully. I took care of my sister, but we were entirely unsupervised in barns and houses and outside….

I think that our teens are making choices at far younger ages than parents want to admit. I see parents check out when the child is fourteen or even younger. Teens who are nearly living at friends. Teens who already seem lost. And sometimes the parent is wrapped up in a divorce or a parent is sick or dying or a parent is in jail or abandons the family.

What age did you make choices? Did you make good ones? And is white trash hate speech? If you made bad choices, were you able to change later on?

What is the line between free speech and hate speech? And what is the line between love and enabling?

I am still searching….


Over the Rhine: Fool and Let it fall

For the Daily Prompt: rhyme. No, it doesn’t rhyme. But I am thinking of the phrase: no rhyme or reason….

primary care medicine: schedule

I see patients from 8:30 or 8:00 am until 2:00 pm.

We have people say, “You are off after 2:00.”

Well, no. Most days I work for 2-3 hours beyond the patient contact time. Sometimes I come in early and sometimes it is from 2pm to 5pm and sometimes it is the weekend or into the evening.

So what am I doing?

  1. returning phone calls
  2. doing refills. To do a refill I check when the patient was last seen and whether they are due for laboratory.
  3. reading specialist notes and updating medicine lists, diagnoses and contacting patients to get tests or follow up that the specialist has recommended
  4. reviewing lab results and sending a letter or signing to be scanned and to be available at the follow up visit or calling the patient
  5. reading emergency room notes and hospital discharge summaries and setting those patients up for follow up, updating medicine lists and adding to diagnosis lists.
  6. dealing with multiple stupid letters from insurance companies questioning the medication that I have prescribed. Mostly I mail these to patients.
  7. running my small business: long term planning, short term planning, advertising, commercial insurance
  8. 50 hours of continuing medical education yearly
  9.  Updating my medical license, medical specialty board eligibility, business license, CAQH, DEA number, Clia lab waiver, medicare’s shifting rules, medicaid’s shifting rules, tricare’s rules, and 1300 insurance company’s shifting rules and medicine rejections and prior authorizations even for a medicine a person has been on for 20 years.
  10. Worrying about small business costs as reimbursement costs drop: health insurance. Retirement. L&I. Employees. Malpractice insurance, small business insurance, the lease, staff costs.
  11.  Discussing and updating medical supplies and equipment, office supplies and equipment
  12. Updating clinic policies and paperwork per the change in laws. Have you read the Obamacare Law? Over 3000 pages. HIPAA. The DEA. Recommendations from the CDC, federal laws, state laws, internet security, patient financial and social security security.
  13. Trying to track what we collect. That is, say I bill $200.00. Since I accept insurance, the insurer will tell me what is the “allowed” amount per me contracting as a “preferred” provider. The “allowed” amount is really the contracted amount. Then the insurance company either pays it or says that the patient has a deductible. This could be $150 per year or $5000.00 per year. With medicare I then have to bill a secondary if the person has it and then anything left is billed to the patient. Oh, don’t forget copays, if they don’t pay that we have to bill it. So to get paid the complete contracted amount, aka “allowed” we may have to submit bills to two or even three insurances and the patient. We might be done two months after the patient is seen.
  14. Trying to convince recalcitrant computers and printers and equipment that indeed, it doesn’t have a virus, oh, or maybe it does, and fixing them.

My goals are to give excellent care AND to work 40 hours a week. Half of my patients are over 65 and many are complicated, with multiple chronic illnesses.  When I saw patients 4 days a week for 8 hours, with an hour hospital clinic meeting every day, I also spent at least an additional 8 hours and more trying to keep up with most of those things above. The average family practice physician makes more money than I do. But they also report working 60-70 hours a week on average. I do not think this is good for patients or doctors or doctors’ families or their spouses or children. The primary care burn out report rose from 40% to 50% of the doctors surveyed.

We need change, we need it now, and we need to be realistic about how much work is healthy.

When I was still delivering babies, women would ask if I could guarantee doing the delivery. I would explain: “We do call for up to 72 hours. If you go into labor at the end of that, you would rather have a physician who is awake and rested and has good judgement. Besides, I’m a bit grumpy after 72 hours. ” And they agreed that they really don’t want an exhausted burned out physician.

I took the photograph of Mordechai, our skeleton, today. She is genuine plastic. I wish she would do some of the paperwork, but at least she lightens things by making us laugh. She gets various wigs and outfits and sometimes comes out to show a patient a hip joint.

I am NOT attracted to paperwork. I think I am repelled. For the Daily Prompt: magnetic.