Got sick in clinic yesterday, about 20 minutes after eating lunch. Abdominal cramping and lost lunch and lay down until I could drive home. Went to sleep for another four hours. I got up to hydrate slowly, some water with a little sugar, every 15 minutes. Taking it slowly is gentler on the stomach. I went back to sleep.
I got up at 11 pm and had a few crackers. This morning I am tolerating tea, but my body feels rather like it’s been beaten up. No clinic today, but I think tomorrow would be ok. We shall see.
I am not sure of the cause. I was given some gluten free donuts and wonder if one had gluten. Food poisoning is not very common in the places I have lived. We are seeing some people with Covid who have abdominal symptoms rather than upper respiratory, so I am debating whether I should home test.
It’s been a strenuous twenty four hours!
The photograph is from the Fruita Fair a few weekends ago. I really wanted to do this with the kids. Today even looking at the picture makes me slightly nauseated! Whew! They were in climbing harnesses and then attached to giant rubber bands and bouncing. Some were able to do flips, too. Not me, not today!
I have been in Grand Junction since the end of April. The Grand Valley really has amazing visual distances from one end of the valley to another, and even though it is a valley, it is at 4600 feet above sea level. It is surrounded by higher mesas and mountains in all directions.
Soon I drive back to Washington for a few weeks. That is a distance, too, 1200 miles with Sol Duc cat. She doesn’t really enjoy the car. I wonder if she will enjoy going home. Will she like the cloud settling over us, as if the bottom of it is grazing the roof tops? I did not like those clouds when I first moved to Washington but now they feel as if they enfold us and comfort us, an intimacy with the sky.
No, not a mouse. But the lizards are timid too. They do not want to engage and they leave very quickly. These one is fairly large, a foot long, so she posed for a photograph. Let’s crop it.
The next one is going for camouflage and is really quite brilliant at it. I like the tiny blue dots.
I also catch sight of small things scurrying out of my path hiking. Also lizards, 3 or 4 cm long, and very fast.
Today I go back to the first clinic I worked at here. I am feeling mildly timid myself. Stage fright? I can’t sing a song that I know, because I don’t choose the patients. They show up.
I took these photographs on the Palisade loop trial, in July. The lizards like it.
The sky in Grand Junction is so open and big. And it is dyed amazing colors by the rising or setting sun. This is unretouched and right off my phone. Sometimes I don’t believe the colors.
The Ragtag Daily Prompt today is identity. Yesterday I went to work an hour early so I could attend the Friday morning Continuing Medical Education. It was about adult ADHD and the positives and negatives.
I do not have a diagnosis of ADHD. I have one friend who insists that I have it, but I don’t much care. However, the speaker started talking about masks and authenticity. She said that we are told to be authentic at work, but that people with ADHD often find that their authentic self is not welcomed and they learn to mask.
I asked, doesn’t everyone mask somewhat at work? She said, “Good point, and yes, people do.” It got me thinking about identity and masks. I pretty much clammed up in Kindergarten because I was too much of an outlier and culturally wrong. We did not have a television and television was pretty much what the other children talked about. I knew songs and poems but these did not interest my peers. I was interested in science, too, but that was also not popular. I think I was a geek before it was named and as soon as I learned to read, I became a bookworm. I am not sure if having a television would have made any difference, either.
Fast forward to after high school. I went to Denmark as an exchange student my senior year and then needed to make up credits to graduate. Another high school student was in my Community College classes. After a bit, she said, “I thought you were shy in high school.” I said, “No, I just didn’t talk.”
Currently I am more authentic in the room with patients than with the rest of the staff. Corporations are very weird hierarchical places. My authentic self always questions authority but I am trying not to do it all the time. At least, not out loud. The patients seem to be fine with it. I had a very difficult conversation with an elderly couple this week about memory and planning, now, before they can’t. I got hugs at the end of the visit even though we’d gone into frightening and difficult territory. They did very well. Yesterday was my last day at that clinic and next week I am in another one. Even after just four months in this clinic, I will miss many of the patients and hope they do well.
Yesterday I really did Urgent Care. My schedule only had a few people and then six more sick ones were added on. We had to call an ambulance for one, the first time I’ve had to do that here.
What is authenticity and what is our identity? Is the work mask less real than the self in our minds?
I took the photograph at a small hot springs resort. A friend that I’ve known since high school and I met there. I love the bookworm rabbit. I think she represents the happy bookworm part of me. I read about 7 novels a month, haunting the library here. Maybe I will get to know some more people over the next 6 months.
I ran my own small clinic from 2010 to 2022, working somewhere else, got Covid, was on oxygen for a year and a half, did some healing and then came back to work.
There has been a culture change in medicine that feels very strange to me. I did not notice it because I was in a solo clinic and not “part of the system”.
All the doctors, providers, are more isolated. I got a compliment yesterday when I was doing a “warm hand off” of the most sick or complicated patients, three new diabetics, a person with cancer, a person with a genetic heart problem. The doctor who I was handing off to is in the same clinic but we have barely talked since May. I don’t know her at all. She complimented me on excellent care “and calling specialists”.
I thought, huh. But I think that is a dinosaur doctor thing. I think mostly people communicate through the electronic medical record email, send messages about patients. For the decade that I was solo, I had to call other specialists because I was on a different electronic medical record. The email didn’t connect. The hospital reluctantly gave me a “link” to their system, but it was only a link to look. I could not write or send anything.
About two months ago I got an echocardiogram result. I read it and thought, ok, it’s not normal but what does it mean? Outflow obstruction by the thickened heart wall. Hmm. I called cardiology and spoke to the cardiologist who read it. He sounded surprised and said, “Idiopathic hypertrophic cardiomyopathy, most likely. It’s a classic echo.” “So, what do I do?” “Send him to me.” “Anything that I should change meanwhile?” “Yes,” says the cardiologist. He had me stop one medicine and start another. “No vasodilators and the beta blocker slowing the heart rate should help decrease the outflow obstruction.” “Got it.” I said. He also gave me two more tests to order.
I referred the patient to cardiology but it was a month before he got in. The two tests were done and they ordered more. If the diagnosis is correct, he’ll be sent to a special clinic in Denver. I called my patient while we were waiting for the cardiology visit. The medicine change had not made much difference as far as he could tell.
I was also told when I got here that I would never get a local nephrologist to see a patient, they were two busy. However, I have called two nephrologists about two patients and both took the patient and again, gave me instructions.
Two specialties have been very difficult to contact: orthopedics and gastroenterology. I have no idea why they are so difficult.
I can see that email feels faster. But there is no human contact, asking follow up questions is difficult, I don’t get that bit of further helpful education: this is what you do next. I have learned so much over the years by touching base with specialists. Once I fussed at a patient to go to hematology oncology about their high platelet count. The patient didn’t want to. He came back and said, “Apparently I have this newly found genetic problem. They put me on two medicines, not expensive. And I feel better than I have in 20 years.” I asked the oncologist about it the next time I called. He lit up, excited, and told me about the JAK-2 mutation. It is so exciting to learn about new areas in medicine and my patient says, “I have to thank you for pushing me to see the oncologist. I feel so much better.” Wow and cool.
Clinic feels like I am mostly isolated, a silo, an island, rarely talk to the other physicians unless I go to find them. I think hospital administrations like this, keeping the physicians in line by having their schedule be so packed that they almost never talk to each other. What a good way to keep physicians from interfering in the money making production! Ugh, I think it is quite horrible and unhealthy for the providers and for our countries medical system in the long run. I was seriously less lonely in a solo clinic.
The prognosis for our current medical system is very poor. The patients say to me, “Why do my doctors keep leaving?” They aren’t attached, they are isolated, I don’t think the physicians know what they are missing. Colleagues. Not silos.
Sunday I drove up to Grand Mesa, over 10,000 feet. Wow. The aspens gold and the evergreens green and the perfume of the clear air. The high temperature was much lower then in Grand Valley. A sign says that Grand Mesa is the world’s largest flat top mountain and there are hundreds of lakes on top.
I am a nighthawk, but my time is the second half of the night, not the first. I wake early, many mornings at 4:00 am. I am up and I am watching the stars because it is clear so often. I am learning new constellations: working out from Cassiopeia, I know Perseus and Aries, Taurus and Gemini. I have a street light at the south west corner of the house, so Pisces is very faint next to Pegasus. I’ve know the Big and Little Dipper and the North Star since I was a kid, and Orion, with the belt and sword. Jupiter and Mars have been out and Saturn as well.
I want to camp up on the Monument so I can really see the stars, where it is really dark.
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.
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