Monthly Archives: April 2024

by

You can have some of the things some of the time

My father’s name is Malcolm Kenyon Ottaway. He went by Mac. He died in 2013. I miss him and I still follow Mac’s Rule.

Mac’s Rule is simple: You can get one third of the things that you think you can get done in a day.

I played with this on my days off for quite a while. I would write a list of all the things I wanted or needed to get done. Once I write the full list, it looks silly. Soon it is clear that he is correct.

When I am working full time in Family Medicine and have a five year old and a new baby, I think about getting something done on the weekend. Clear my desk, organize photographs, that sort of thing. After a while I realize that the weekend was more like this: Meals. Get kids clean and dressed. Laundry for the next week. Clean the house a bit. Do some fun family things! Read to kids and put them to bed! My list changed and instead of the ambitious “organize photographs”, I would think of something very small. Perhaps take one roll of developed photographs, pick some of the duplicates, send them to the grandparents. That was it for the entire weekend.

If I apply Mac’s Rule to my life and list all the things I want to do, which third will I pick? For years I write lists for a day off and then pick the top third that I want to get done. If something is added to the list, a friend calls to go to coffee, I take something else off. I make sure that the list always has something that I need to do on it (and often don’t want to: start taxes, pay bills, clean a bathroom, whatever). And something fun.

I don’t try to do it all. It’s very satisfying to get that 1/3 done on the list. And I feel like superwoman if I get an extra thing done! I get to choose which third to do and think about it. And the stuff that I don’t want to do slowly gets done over time. It isn’t that awful to do one of those duty jobs, thank you letters, tax information, dental appointment, mammogram, every day and then it gets DONE.

I am working with someone who puts RUSH at the start of every single email subject line. I have to say that it makes me want to dig my feet in and not even read the email. What kind of rash haste are they working under and why would I pay any attention to the RUSH by the ninth email? It is annoying and ludicrous. I move those emails to the next day list and don’t read them on the day of arrival. No pressure, so there.

Blessings on my father, for Mac’s Rule.

For the Ragtag Daily Prompt: rash.

The photograph had to be taken before May 2000, because my mother died on May 15 and she is on the boat. I don’t know who took it, another group sailing. Both my kids are there, my father with the tiller, and I am tucked behind the friend facing the camera. Why haven’t we pulled the motor up? This is Sun Tui, the boat currently in my driveway on a trailer.

by

The finger box

Ho hum. Mom is on the finger box again. She sits and stares at it and her fingers tap it all over. Sometimes it is noisy, too and she sings along!

My sister and I know how to lock it with the tiny fly thing, just like they look up in the sky. Much to our dismay, Mother has figured out how to unlock it. She got frustrated the first time.

We don’t want her to spend too much time on the finger box!

For the Ragtag Daily Prompt: Ho hum.

by

Tenacity

Two skills needed in primary care are tenacity and listening. That is a combination that can make a diagnosis. Here is an example.

In residency, many years ago, I have a patient with developmental delay. He lives in a group home. He can’t talk though makes some noises. The group home staff bring him to me. His head is misshapen because his mother had measles in her pregnancy.

The staff says, “We think his head hurts. He just isn’t behaving right.”

“Did he fall?”

“We don’t think so.”

“Fever? Nasal congestion? Cough?”

“No.”

“How long?”

“Over the last week.”

I do an exam. I really can’t see his tympanic membranes because of his skull shape.

“Maybe he has an ear infection. I can’t see. We’ll try antibiotics, but if he is not improving, bring him back. In five days.”

They bring him back. “He’s no better.”

I get on the phone. I need a CT scan of his head and the group home say he won’t stay still. I need anesthesia to sedate him for the CT scan. It takes two tries and quite a bit of phone explaining with both the anesthesia department and the radiology department. Persistence. I am looking for a subdural bleed in his head from a fall, or a sinus infection, or something.

It is done and I get a call. Not from radiology or anesthesia but from the ear, nose and throat surgical resident. He is very excited. “Your patient!”

“Yes,” I say.

“He has a pseudocyst! In his sinuses! He has abnormally large sinuses and this is the biggest pseudocyst anyone here has ever seen!”

“Um, ok.” Honestly, I’ve never heard of a pseudocyst. It turns out to be packed nasal drainage in the sinus. Bad ones can erode through bone into the brain. Certainly that seems like the cause of the headache!

“We are taking him to surgery!”

Residency can be pretty weird, when someone gets really excited about a rare disease or interesting trauma case or whatever. I found that I was entirely happy just doing health maintenance exams and encouraging people to quit smoking and exercise and drink less. However, I was also good at finding weird things.

The ear, nose and throat surgeons in training were very happy about the surgery. The group home staff were happy too. “He’s back to his old self. Thank you!”

It took tenacity to set up the head CT. It’s important to listen to the families and caregivers too, because they know the person better than I do. They were right: his head hurt. And we found out why and were able to treat it.

For the Ragtag Daily Prompt: tenacity.

Water is tenacious too, wearing down stone and wood and glass.