Another Falling Angels poem.
quit
Another Falling Angels poem.
I wrote this in 2010, after I worked for three months at Madigan Army Hospital. I really enjoyed working there. It was the first time since residency that I had worked in a big hospital — 450 beds — and in a not rural setting. I kept asking to work with residents and eventually the Captain and I worked it out to both our satisfactions.
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During my three months temp job at a nearby Army Hospital, I am asked to help the Family Medicine Inpatient Team (FMIT) whenever a faculty member is sick or out or deployed, which turns out to be fairly often. I enjoy this because I want to work with residents, Family Practice doctors in training. It is very interesting to be at a training program, watch the other faculty and work at a 400 bed hospital instead of my usual 25 bed one.
Two patients need to be admitted at the same time on our call day, so the second year resident takes one and I take the other. The report on mine is an 82 year old male veteran, coughing for three weeks, emergency room diagnosis is pneumonia.
The resident soon catches up with me because her person is too sick and gets diverted to the ICU. Mr. T, our gentleman, is a vague historian. He says that he has always coughed since he quit smoking 15 years ago and he can’t really describe his problem. He’d gotten up at 4:30 to walk around the assisted living; that is normal for him because he still does some o the maintenance. He had either felt bad then or after going back to sleep in a chair and waking at 10. “I didn’t feel good. I knew I shouldn’t drive.”
He’s had a heart attack in the past and heart bypass surgery. Records are vague. The radiologist reads the chest xrays essentially as, “Looks just like the one 3 months ago but we can’t guarantee that there isn’t a pneumonia or something in there.” He has a slightly elevated white blood cell count, no fever, and by then I do a Mini-mental status exam. He scores 22 out of 30. That could mean right on the edge of moderate dementia, or it could be delirium. I get his permission to call his wife.
“Oh, his memory has been bad since he spent a year in a chair telling them not to amputate his toes. And he was on antibiotics the whole time. He wasn’t the same after that. This morning he just said he didn’t feel right and that he shouldn’t drive.” So his wife called an ambulance.
The third year chief resident comes by and wants to know the admitting diagnosis. “Old guy, don’t know.” is my reply. “Either pneumonia or a urinary tract infection or a heart attack maybe with delirium or dementia or both.
The second year is helping me put in the computer orders, because I am terrible at it still. She could put them in upside down and asleep. “Why are we admitting him, anyhow? We can’t really find anything wrong, why not just send him home?”
“We can’t send him home because he can’t tell us what’s wrong. He might have an infection but he might not, and he has a really bad heart. If we send him home and he has a heart attack tonight, we would feel really bad. And he might die.”
I was getting a cold. I had planned to ask to work a half day but half the team was out sick so I just worked. But by morning I had no voice and felt awful. I call in sick.
At noon the phone rings. It is the second year. “You know Mr. T, who we admitted last night?”
“Yes,” I say.
“He had that heart attack during the night. Got taken to the cath lab. You made me look really good.” We had worked on the assumption that it could be early in a heart attack though the first labs and the ECG were negative. I had insisted on cardiac monitoring and repeating the enzymes. The resident had finished the note after I left and the night team had gotten the second and abnormal set of enzymes.
82 year olds are tricky. With some memory loss he couldn’t tell us much except that “I don’t feel right.” He was right not to drive and we were right to keep him in the hospital. And if it had all been normal in the morning, I still would not have felt bad about it. The residents are looking for a definitive diagnosis, but sometimes it’s “Old guy, don’t know,” until you do know.
I touched base with the psychologist
not one I know
just one who was around
asked if I could talk
for 15 minutes
indeed, he said
a difficult situation
you know that the person won’t change
echo
won’t change won’t change
I believed this
for two days
then I remembered
why I am a doctor
my secret weapon
my healing talent
I always have faith in change
everyone
has choices
“I can’t stop smoking.”
says the man
“My father quit three years ago.
55 years of two packs a day,
unfiltered Camels.”
“Camels!” says the man
“Those are bad!”
“You can quit too.
It might take more than one try.”
Why would I go to work
to talk about hypertension
exercise, birth control
obesity, heart attacks
unless at my core
I believe each person has choices?
Sometimes the choices
are between miserable
and horrible
life and death
still
whether a person is 9 or 90
they are graced
by choice
The photograph is from May 2012, at the memorial for my sister. My father is on the left, sitting, wearing oxygen.
Today is PANS/PANDAS awareness day. I wrote this a couple weeks ago.
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No pandas
I don’t have PANDAS because in the United States we barely believe in it in children and we don’t at all in adults.
I don’t have PANDAS because even though one psychiatrist said I did, he retired, and the next one says I don’t. Then not sure then no. They don’t agree.
I don’t have PANDAS because my primary care doctor won’t read the guidelines even after I have been her patient for seven years.
I don’t have PANDAS because my pulmonologist has never heard of it.
I don’t have PANDAS because it would be a lot easier to put me on a mood stabilizer to shut me up than listen to me.
I don’t have PANDAS because I am labelled difficult because I am afraid to take a mood stabilizer because I do not get a fever or a white count so my main symptom of infection is that other doctors think that I am manic though I am hypoxic and short of breath. They want to fix my mood while I want to not die of pneumonia, so our goals are at odds.
I don’t have PANDAS because I am a doctor and if I had PANDAS my fellow local doctors would feel guilty that they have told each other that I am bipolar and manic for the last 18 years and have shunned me at the county medical meetings and won’t even send me the invitations, except for the one that forwards them. He says he has given them my email and he doesn’t understand why they don’t send me the invitations.
I don’t have PANDAS because Seattle Children’s doesn’t allow the Cunningham Panel to be drawn and they say there is not enough evidence yet.
I don’t have PANDAS because I can’t afford to pay $925 on my own for the Cunningham Panel and anyhow my antibody level is back to whatever is my new baseline, higher than before no doubt.
I don’t have PANDAS because the other doctors are frightened: if I have PANDAS then who else does and if I have chronic fatigue caused by hypoxia and fibromyalgia and it’s related to PANDAS then who else would they have to test and neuropsychiatric is a whole different thing from psychiatric and we swear that we don’t know what causes chronic fatigue and fibromyalgia.
I don’t have PANDAS because I am an adult who lives in the US though if I was in Canada or Europe I could in fact have PANDAS.
I don’t have PANDAS because in the United States we barely believe in it in children and we don’t at all in adults.
I do not think of emotions as bad or good. None of them are bad or good. They are information, controlled by electrical impulses and hormones, evolved over millions of years (or endowed by our creator, for those who swing that way).
I don’t dismiss emotions. I listen to them.
I think of myself as an ocean. There is all sorts of stuff happening in the depths that I don’t understand. Probiotics, for example. I don’t take them. If not for penicillin, I’d be dead many times over, from strep A pneumonia twice and other infections. I don’t think we understand probiotics yet. We don’t understand the brain, either.
The emotions are the weather in my life. I don’t really control them but they don’t control my ocean, either. Some days are sunny and gorgeous and then a storm may blow up. I am afraid of hurricanes, one destroyed my grandparents’ house in North Carolina, on the outer banks. I think all the cousins still mourn that house. And I miss my grandparents too, all of them. And my parents and my one sister.
See? The weather got “bad” there for a moment, but it isn’t bad. Storms have their own beauty though we hope to batten the hatches and that not too much damage is done. Maybe there is rain, scattered showers, sun breaks, a lenticular cloud. In the Pacific Northwest on the coast, the weather can change very quickly and we have microclimates. My father lived 17 miles away, but inland from me and in a valley. It was warmer in the summer and colder in the winter.
My goal with my weather emotions is to pay attention to them, let the storms blow in and out, and try not to harm anyone else because of my weather. When my sister was in hospice, we had a sign up in my small clinic. It said that my sister was in hospice with cancer and that clinic would be cancelled at some point with little warning. Patients were kind and gentle with me. And then it was cancelled, when she died. I got cards from people. They were so kind, thank you, thank you, and I could barely take it in. My maternal family then dealt with grief by having lawsuits. I don’t think that is a good way to deal with grief, but we just see things differently. Maybe it’s the right way for them. I don’t know.
Whenever I was having internal emotional weather that stirred me up, I would tell my nurse or office manager. Because they will sense my weather and need to know what is up. I had enormous support from them during a divorce, while my partners treated me horribly. My nurses and office manager knew me and my partners didn’t. My partners distanced me as if a divorce were catching. Whatever. Their loss.
Sometimes patients sensed that I was upset. I could tell by their faces. If they didn’t ask, I would. Bring the emotions out. Reassure them that I AM grumpy but not at them. Stuff in my own life. No worries.
Sometimes clinic is about a patient’s weather. They ask if they can tell me something. Often it is prefaced by “Maybe I need an antidepressant.” or “I feel really bad.” When they tell the story, usually I would say, “I think it is perfectly reasonable and normal that you feel angry/hurt/shocked/horrified/grieved/upset.” And then I would ask about an antidepressant or a counselor and most of the time, the person would say, “Well, I don’t think I need it right now.” What they needed was to know that their weather was NORMAL and REASONABLE.
I am seeing things on Facebutt and on media saying that mental health problems and behavioral health problems are on the rise. Maybe we should reframe that. Maybe we could say, “The weather is really bad right now for everyone and it’s very frightening and it is NORMAL and REASONABLE to feel frightened/appalled/angry/in denial/horrified/confused/agitated/anxious or WHATEVER you feel.” This weather is unprecedented in my lifetime, but as a physician who had very bad influenza pneumonia in 2003 and then read about the 1918-19 influenza, I have been expecting this. Expecting a pandemic. Expecting bad weather. This will pass eventually, we will learn to cope, be gentle with yourself and be gentle with others. Everyone is frightened, grieving, angry, in denial or in acceptance. The stages of grief are normal.
Hugs and prayers for all of us to endure this rough weather and help each other and ourselves..
I took the photograph in color. My program made a black and white version. It looks like the back of a stegosaurus to me, a dinosaur now living as a mountain.
For the Ragtag Daily Prompt: rainbow. Because sometimes the rain and sun combine to make a rainbow.
Malene’s apple crisp
Preheat oven to 350 degrees F.
Slice apples and place in baking pan.
Mix:
1/2 C. flour
1 C brown sugar
1 C oatmeal
1 stick butter
dash cinnamon
Mix the flour and etc and put the mix on the apples in the pan.
Cook in 350 degree F oven until brown. 30 minutes in my oven.
You can peel the apples or not.
You can add some apple juice.





I have been in Rainshadow Chorale since 2000. My father, Malcolm Ottaway, was one of the eight people who started it in 1997. He and my mother moved here in 1996. My mother, Helen Burling Ottaway, died of ovarian cancer on May 15, 2000. Rainshadow agreed to sing a Byrd Mass for my mother’s memorial. My father asked if my sister and I could sing in the chorale for the memorial. We were told yes. I had moved to Port Townsend at the end of 1999.
After the Memorial, I asked if I could stay in the chorale. The answer was yes and I have been in it ever since.
Our director, Rebecca Rottsolk, is retiring from the chorale after our next concert. She has picked favorite pieces. I have sung in nearly every concert since 2000, though I couldn’t sing in the one right after my father died in 2013. He followed my sister, who died in 2012. My throat wouldn’t let me sing that one.
So Rebecca, thank you for the music and thank you for being a wonderful director and forcing us to level up over and over. I am sending you peace and love and joy.
And everyone else, put this concert on your calendar.

For the Ragtag Daily Prompt: thanks.
It is easy with you
All the places you’ve been offended
Where you haven’t been treated right
A bike shop
Food co-op
Coffee shops
Restaurants
It’s easy to hide my physical body
Where you can’t find me
But what of my mind and heart
You always feel it when I go
I go to the Beloved
I give up
I cast myself into the abyss
Grief, denial, loss, bargaining, abandonment, hopeless grief
I throw myself over the cliff
Over and over
I resist
And then let go
It’s not wings
Because the cliff is a waterfall
I don’t want wings
And the Beloved laughs
Wings form
I refuse to fly
I won’t I won’t I won’t
I fall towards the water
Each time I wonder
If this time the Beloved will not shift
I hit the water
Safe again
Scales and tail
And I can breathe
And swim free
To the sea
For the Ragtag Daily Prompt: vessel.

I took the photographs recently, from North Beach, second one zoomed all the way.
I go in the sea
of dreams
open the chest
the trunk
the saddlebags
Empty the dirty laundry
Of emotion
On the floor
Grief and joy
Fear and hope
Mine
All mine
There is a place
Beyond words
I see you in that place
It is very old
And very young
It is so frightening to go there
Lose words
The first time
It is haunted and hunted
Are you aware
Of that place
Do you go there
Of your own volition?
Or do you struggle
Fight and suffer in the
Choppy boundary between air and water
Fear drowning
Water surrounds you
Above you too
You are in the wordless place
Over your head
Are you too deep?
Open your eyes
In the green water light
A mermaid waits to lead you
To a rope to a raft
And me
But first you must open your eyes
BLIND WILDERNESS
in front of the garden gate - JezzieG
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All those moments will be lost in time, like tears in rain!
An onion has many layers. So have I!
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Some of the creative paths that escaped from my brain!
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spirituality / art / ethics
Coast-to-coast US bike tour
Generative AI
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imperfect pictures
Refugees welcome - FlΓΌchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflΓΌchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
En fotoblogg
Books by author Diana Coombes
NEW FLOWERY JOURNEYS
in search of a better us
Personal Blog
Raku pottery, vases, and gifts
π πππππΎπ πΆπππ½π―ππΎππ.πΌππ ππππΎ.
Taking the camera for a walk!!!
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Homepage Engaging the World, Hearing the World and speaking for the World.
Anne M Bray's art blog, and then some.
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