Monthly Archives: October 2025

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Scree dream

In September, I hike with the three friends in the Ragtag Daily Prompt photograph. I have not really backpacked into back country in years. The last time I carried the pack was in Italy with my daughter, a few years ago. She wanted to plan the trip as we went and stay in hostels. We did.

We hike in the first day, up switchbacks from the parking lot at about 3200 feet, to a pass at 5400 feet, over and down to a campsite. The sites for cooking are separate from the sleeping sites and there are serious big metal bear boxes. We are to put everything in them, including the deet and toothpaste and anything that could possibly interest a bear.

We pack day packs the second day and climb back up to the pass. We peel off there to the trail to Sahalie Glacier. After being on oxygen at sea level for a year and a half, I am beyond delighted that I can actually do this. We go up and up and the trail gets worse and worse, until it is rather nasty scree. Two other people coming down say it is even worse, slippery, unstable, if we go on.

So, like sensible people, we stop for lunch. The slope is very steep and we each find a place to perch. Lunch tastes good. Then the other three want to go on. I don’t. I want a nap. They go on, I find a slab and the view from it is the photograph: down, down, down to the lake far below.

They will get me on the way back down.

And I do go to sleep. It’s all that night time call I’ve taken over years and years. I can sleep practically anywhere, including in a noisy casino in the past. I tuck up against the rock and the sun is almost warm.

I wake up. Two other people have come by. My inner clock thinks my people should have come by. Do I wait? Do I stay? There are more ominous clouds building up and this will be much more slick and dangerous if it starts raining. And we are exposed, for lightening.

Then I see a hat, on a curve of trail below me, moving. I swear it’s one of my party. But how did they go by without seeing me or waking me. THEY ARE DITCHING ME ON THE MOUNTAIN. No, that is ridiculous. Hmm. She is not with either of the guys. I debate for a minute, shout and then grab my things and head down.

I catch her. Once they left me, there really was not a clear trail. There were multiple sort of trails. And it was tricky. They separated a bit. She lost track of the other two and then picked the least difficult way down, which seemed to be a trail. It was NOT the trail that went by me, but she didn’t know that.

We found one of the guys below us, waiting. The last came down a bit later. None of them had come on the “right” trail by me. We headed down and stopped to put on rain gear. It rained lots! We were also above the tree line, but also I would say that we were above the marmot line. We saw eight hoary marmots marmoting around on our way down. They did not seem deterred by rain at all.

So that is how I was left in the scree to dream. I would have returned by the time it started raining anyhow, and the trail was good once we got past the scree. Not all the way to the lake in the photograph, the trail ran along a ridge that is not in the picture and wound down near the lake.

For the Ragtag Daily Prompt: scree.

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Balancing act

I am working at a site in the greater Seattle area, but I am not going to say where. Why? Two reasons. One is that the patient diversity is huge: the organization is organized to take care of low income, uninsured and immigrant patients. The second is that I am still trying to decide if the balance of the organization is working. It may be working but it might not be working for me.

I am at a large clinic, with primary care, dental, behavioral health, a nutritionist, a pharmacy and three in person translators. In any one day I will probably use translators for at least six languages. English, Spanish, Dari, Hindi, Punjabi, Arabic, French, Somali and sometimes languages that I have to look up the country because I don’t know where that language is spoken. The work is fast and furious.

The overall no show rate is 20%. This makes the day very unpredictable. It can be very very fast and busy with everyone showing up and then later there are three no shows in a row. I think that the no show rate has been less than 20% but on Tuesday it was more. However, everyone showed up in the morning and there was a hospital follow up that should have had 40 minutes and only had 20 and of course then we ran later. My lunch theoretically starts at 12 but I went to lunch at 12:50 and came back 6 minutes late, at 1:06. Then people no showed while I worked to finish off everything from the morning. It did feel a bit nuts.

We are using the electronic medical record EPIC. I find EPIC epically frustrating. It is “feature rich” which means it has too many ways to do things. If I ask someone how to record a phone call to a patient, it takes eight steps. A week later I have to do it again, I ask again, and the next person shows me a DIFFERENT set of eight steps. And there have to be at least eight ways to do anything, so it is very confusing. Also, the “home” page can be personalized to the extent that people look at my version (I have not personalized it much) and say, “Mine looks different. I don’t know how to do that on yours.”

Whew. So, how to cope with the fast furious unpredictable schedule? I am “precharting”. For this Tuesday, I spent 70 minutes going through the patient charts on Saturday. Then I may know why they are coming in, if they had a heart attack two weeks ago and are following up, if it is a well child check and the last one was two years ago, if there are outstanding issues like a elevated liver tests or they have not been in for their out of control diabetes for a year. Then, of course, some of them do not show up. It is so busy that all I feel when someone no shows is some relief, like a ray of sunlight in a dark forest. Ok, the person who was horribly sick and in the hospital for a week and had surgery, they really do need to follow up. But I cannot make them, no one can.

We have live translators, outside translators who come with the patient, family sometimes translates and two phone translation systems. Our live translators cover the following. One Spanish only, one Dari, Arabic and ?maybe Russian. A third language. The third does Hindi, Punjabi and something else. I can’t tell by language who is a recent immigrant or refugee or who is a citizen of the United States for thirty years.

The clinic system has high standards for care of an often vulnerable population. However, I have not decided if it falls into a statement by my grandfather: “The higher the ideals of an organization, the worse its’ human relations.” My job in Alamosa had very high ideals, but I was fifth senior doctor out of 15 in a mere two years. A burnout job. This one has three new doctors coming in soon. My training and assistance to learn EPIC has been sparse and not up to my standards. If the new doctors are treated the same way then this is a burnout job as well. This is a place that I could work in intermittently alternating with other places in the country, but only if it is balanced for both the patients and the physicians. The jury is still out, but there are many red flags. It is a six month job and I am two months in, so we shall see.

Hugs to everyone.

_____________________________

For the Ragtag Daily Prompt: nuts.

The photograph is from Larrabee State Park this weekend. My daughter came out and saw many of her friends, stayed with me, and we camped for one night at Larrabee.

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Perspective: beneath the clouds

Beloved why?
I am glad for your love
and warmth
and connection
and my cat’s
and my adult children
friends
family
patients
work
and why? Beloved

A high Adverse Childhood Experience Score
Two alcoholic parents
One sick with tuberculosis through pregnancy
Letters from the hospital to her mother
After birth
Never mention me
As if I do not exist

She told a story that she dreamed
she gave birth to kittens
played with them
and gave them away

Not a dream of joyously welcoming her new baby
Me.
Yet I didn’t hate her or my father
My damaged parents
My damaged sister
Who followed their path, not mine
There was nothing I could do
Only three years old when she was born
Try to shield and mother her
As best I could

Why Beloved
I have tried so hard to grow
to love
to forgive
and yet I have no human lover

My cat jumps on my notebook
And interrupts this writing
She is happier to welcome me home
Than any man I’ve ever dated

My daughter’s boyfriend picks her up
at the airport and has made her dinner

If I am a failure at love with a partner
Or too smart or damaged or difficult
To love
For humans
At least my children have both found love
And if I were to choose me or them
Yes, I’d choose them

Is that why, Beloved?
Sacrifice to heal the next generation?
It is worth it.

And yet, that small child part of me
That even as a toddler thought the adults were unpredictable, dangerous, mean when drunk as they laughed.
She is angry at them, Beloved
She is angry at you, Beloved
Or at people
Or at the universe
She still believes in every cell, in her bone marrow, in the vast universe in her mind

that she too could be, should be

loved.