Honey is older, nearly thirty years since that first feeling of being bitten by ants. She is back in corporate medicine, as a temp. Temporary, short term, maybe that will work better.
It is a joy to go in a room and be alone with a person and their monsters. Theirs and hers. Sometimes the younger ones haven’t experienced it, they are terrified if one of their monsters becomes a little bit visible, they hate seeing them. Honey tries to be gentle. If they only want to talk about the sore shoulder and not the stress and violence, well, she leaves the door open a crack. Sometimes the monsters cry.
Older people may be stiff to start with, but when they realize their monsters are seen, acknowledged, this isn’t another robot doctor in to say increase your diabetes medicine, lower your diabetes medicine, tell them a plan without ever connecting, the older ones lean back, sigh, and relax. The monsters play on the floor, Honey’s monsters playing with theirs, happy, engaged.
The hard part is the clinic staff. Honey is with them daily. The medical assistants are young. They kick their monsters aside as they walk down the hall. It is terribly hard and heartbreaking to work at her desk, with the medical assistants’ monsters cowering under their desks, kicked, abused, silent tears and holding bruises. Honey’s monsters mind. They climb into her lap and hide their faces in her shirt, under her jacket, peer over her shoulder. They don’t understand! Why can’t she be nice to THESE monsters?
Honey whispers to her monsters when the medical assistants are rooming patients. “I am so sorry, loves. If I acknowledge these, the monsters of the women working, I become a demon. It is very hard to share an office, no wonder I worked in a clinic alone for eleven years.” Honey has been through that. It is still inconceivable that some people don’t see the monsters at all. Is it learned blindness? Or just not developed unless someone had to learn it? Unless someone grows up in terror and seeing the monsters is the only way to survive.
Honey thinks some people learn to see them as adults, at least their own monsters. Hard enough to do that, without seeing the monsters clinging to other people.
Honey is tired of her monsters crying in sympathy with the staff’s monsters. She thinks maybe there are small crumbs that she can leave for these demons. Little gifts. Her monsters can creep under the desk when she is the only one in the room and leave something. A flower. A dust bunny. A crumb of a crisp. A small rock. A little gift to let them know they are seen and loved. A poem. A prayer. Just a tiny bit of love.
No nightmares about clinic since the one I wrote about two days ago. I do feel like a bit of a dinosaur in clinic, though. Most of my older patients seem to really be fond of dinosaurs.
I’ve heard from other docs that they don’t have time to talk to each other in clinic either. Patient time but primary care we read all the notes from everyone: specialists, PT, OT, xrays, CT, MRI, ultrasound, lab, lab, lab, lab, prescription refills, phone calls. I read that people are trying to insert Artificial Intelligence into this. I am fine with a computer learning to read mammograms, but condensing information from notes? The AIs currently can “hallucinate”, and make things up. Is that worrisome or am I being silly? Notes are often wrong ANYHOW, way more than I would like. I saw a patient yesterday who has a neurological disorder. The hospital discharge note lists the wrong one! The patient caught the error, I didn’t. I am very glad he corrected me, but the hospital note is still sitting there wrong. Having been labeled with wrong diagnoses myself, I think it is a big deal. In order to fix it, he would have to fill out a form and the form would go to the physician, who is supposed to respond and add an addendum to the note. How often do you think THAT happens?
The discharging physician suggests he see a specialist for testing. I call that specialist and they agree with me: that testing is not indicated, it won’t make one bit of difference in his treatment. The discharging physician also suggests lung testing. I don’t think it works or is useful with a serious neurological disorder that affects muscles! Think, people.
My patient is grumpy and asks how we know the medicine is working. I reply, “You’re not dead.” Which is true. Undiplomatic, but he does not mind, because he is already saying, “What is the point of this?” To explain more about the medicine working, I ask, “Is your breathing better than when you went to the emergency room?”
“Yes,” he says.
“That is because the medicine is working.” I explain how it works and what happens if he stops it.
Sometimes it makes me feel heavy, heavy, like a dinosaur.
But I think I will try discussing my clinic day with my cat. I think she might enjoy it and I can clear the grumps out. And it’s not a hipaa violation! She doesn’t like other cats and won’t tell them anything.
It did not even occur to me that yesterday’s dream could be taken as complaints about patients! That was not my meaning!
I wrote the dream out because I wanted to know what it was trying to tell me. And I look at it from the perspective of all the people in the dream being aspects of myself.
So who is the whiny guy (me) who won’t cooperate with authority (me) and who wants attention and is difficult? That’s not a very nice aspect of myself!
First of all, he reminds me of my father. My father really did not like authority and did not like most men. When I was quite small, I announced that he would have to die first, because he couldn’t live without my mother, but she could live without him. I was wrong as well as being an awkward child. My father’s dislike of authority interfered with his employment and he was mostly underemployed. He finished a Master’s in Mathematics, but never wrote the thesis for his PhD. I asked him why once and he said, “I was bored.” I don’t know how much alcohol interfered with his working.
I am not brilliant with authority either, though I am trying. I notice systems and often annoy authority by asking why something is run a certain (foolish and unproductive) way. I used to study whatever system I was in and then say, “Here, I’ve thought up a solution for this problem.” Then I would get in trouble for suggesting that there was a problem and I would be the problem. I learned to go to authority first and ask, “So is this (huge problem) a problem? I find it difficult. What is your advice?” Priming the pump, so to speak.
As a temp, the authority problem is weirder. I am an outsider, short term, no one really has to be nice to me. That fast trip home and back made me realize that I am lonelier in a group clinic than I was in a solo clinic. In my solo clinic there was me, my receptionist and the patients. In this group clinic I have less people to talk to and it is lonely. My problem, not theirs. They are about to move me to another clinic and I will see what approach I can take to this. The system might have a Balint Group or I may be able to start one.
What about the frozen looking spouse? Ha, I think that’s the part of me that is trying to keep my mouth shut with authority. The kids? Some days I want to pull the system apart and fix it, but I am not in authority to do that here. The grumpy nurse? I am running behind and I can’t fix everyone. Some people don’t want to be fixed, including me.
I could go home and try another place. However, I think that the cracks in the US medical system are in the whole system. As a country, we built this. I hope that I see single payer healthcare in my lifetime, but I may not. And Martha is right too: I thought that this place was doing better handling a chronic illness than where I worked in 2021, but they aren’t, really. They apply a formula, but the patients don’t get much out of it. They just get shuffled in once every three months. I did upset that apple cart by spending more time with those people and talking to them, but I do not know what the next physician will do. Sigh. The patients are already my patients and are saying goodbye.
I am having nightmares. About clinic. Yesterday I bolstered my courage and sat down to write my dream out. What are my dreams trying to tell me? Should I extend my contract or not?
I dream that in clinic I have a male patient with his wife in the room. He is very dramatic, saying, “I am so ill, help me, help me.” He says, “I am on quercetin. You have to help me.”
He won’t tell me what his symptoms are, so I respond to what he says: “Who prescribed quercetin? What is your diagnosis?”
“Oh, you don’t want to help me,” he says. His wife just watches.
“Do you have pain somewhere? Any chest pain? Any abdominal pain? Any pain anywhere?”
“No, no, you don’t understand!” he says, “You aren’t listening!”
“I am trying to help you,” I say. “Can we reschedule you for a longer visit?” This is one of the impossible 20 minute ones. Honestly, he doesn’t look like he’s in pain. I do a quick listen to heart and lungs and feel his abdomen.
“No, I need to be in the hospital, I can’t go home!”
“I can’t put you in the hospital without a diagnosis, but we can move you to the emergency room.” Of course, the ER won’t be happy about this.
I leave the room and call the ER. The ER doctor is understandably grumpy, since I have no idea what this is about and am suspecting a psychiatric cause. “Urine drug screen,” I say. “He doesn’t smell drunk. I do not think it’s meth withdrawal.” “Make sure you do a note,” snarls the ER doctor. Good luck, since he won’t answer any questions. “How behind am I?” I ask the nurse. She just rolls her eyes. I probably have at least four or five more on the schedule. I come back to the room. Now two preteens are in the room, looking in the drawers and taking things out. Their parents do nothing to stop them.
“Please sit down now!” I say. “Put that down!”
The teens sullenly comply. The father is moaning. He has the prescriber on his cell phone. He hands it to me. I introduce myself. “What is your diagnosis?” I say. “Why is he on quercetin?” The person at the other end mumbles. “Excuse me, what did you say?” He’s gone. I say to the mother, “Please take the children to the waiting room. Sir, are you requesting that we call 911?” It would be a call saying man moaning, no idea what he’s on about. Vitals are normal, he denies chest pressure or pain, he doesn’t have an acute abdomen, his oxygen level is fine, no fast heart rate, no fever. Drama.
I wake up, thinking that I may have to call 911 to get the wife and kids out and I have to have someone monitor him while I see other patients and we just don’t have enough staff and I am ready to just cancel the rest of the afternoon. If I were in a hospital, I could call security, but we are a satellite small clinic.
So… what the heck is THIS dream about? And do we really get patients like this? Yes, but not often and I haven’t had any like this here. I think it’s funny that this dream has so much detail, down to the supplement that the man is taking as well as the clinic room. I usually work in room 1 and 2, but this was in room 5.
I chose the word hospice for the Ragtag Daily Prompt today. Last weekend I traveled back to Port Townsend to see my friend who is in hospice. She is doing well, but I wish she had more visitors. She has a brother in Alaska, but has always been a fairly solitary person. Maybe I mind more than she does. She said that I was too far away, but no other complaints.
Last night I went to a dance and danced my socks off. This was a fundraiser for the plane in the photograph and the Commemorative Air Force that flies it and takes care of it. And I can’t credit the photographer, one of the gentlemen of the Commemorative Air Force, many thanks!
Isn’t it a fabulous poster? And a live band in a hanger at the airport, two food trucks, classic car and the plane and dancing.
Dr. Suess has a ruse
that disguises when he pats a moose
He’s teasing that the hidden reason
Is the looming change of season
Locks the box, rocks the docks
Fox in socks, equinox.
We do have concerts on the docks in Port Townsend in the summer. Not in the winter, the instruments get wet. This is the Pourhouse, which is also right on Port Townsend Bay, in August 2022.
Discover and re-discover Mexicoβs cuisine, culture and history through the recipes, backyard stories and other interesting findings of an expatriate in Canada
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
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.
KO Rural Mad As Hell Blog 
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