Category Archives: 7 sins and friends

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dive

I am diving into my Saturday like this turtle, a breath of air and then paddle down into the depths, hi to the local fish and other fauna and look, lovely places to paddle and hide. I am puttering, wondering, not directed, no list, I might wander by and do laundry but some of the day I will just revel in sloth…. I hope you get lazy time, down time, undirected time, unscheduled time, dream time, time to expand and paddle around and float in the sea of dreams…..happy Saturday.

….and I submit this to the Daily Prompt: dignify….

Today I refuse to dignify the type A part of myself with any attention: I am relaxed.

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Forgiveness 2

I wrote this poem in 2009 when I was struggling with forgiveness and wanting to forgive. How do we forgive when someone does not apologize? When they do not explain nor listen to your hurt and grief? Yet forgiveness is internal in each of us. The external is reconciliation and that requires listening from both sides.

Forgiveness

I want to forgive something
Someone
In fact a group
Something that hurt a lot
I’ve tried logic
I tell myself
“It was an expression of concern”

My heart doesn’t agree
It is sullen
Immobile and grumpy
It whispers
“They have not apologized”
It whispers
“When people say you’re crazy
It could be a joke
An expression of concern
It wasn’t
It was a palm held out
At arm’s length
To distance me.”

My head argues
“That’s what it felt like to you.
You don’t know their intentions.”

I want to write
A poem of forgiveness
Hoping my heart will follow

My conscious doesn’t write my poems
My conscious wrestles with an idea
The poem comes out of this struggle
I look at the poem I’ve written
I think,
“That is what I would like
my conscious heart to feel.”
My poem is often more generous
than my conscious feels

My poems are not mine
They are a gift
From the unconscious
It is much larger
Than the small conscious me
I dream of feeling envy
I climb into a bathtub
And transform myself
To battle a trickster
We are transported
To the bottom of the ocean

In the ocean
The trickster and I are one
It is unlimited
It is not my unconscious
There is no separation
It is all unconscious

I did not think
A poem would give forgiveness
But pain drove me
Into the sea
I am connected
You gave me these pearls
Thank you

 

I am submitting this to the Daily Prompt: jiffy. I wish this could happen in a jiffy…. but it is slow….

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The introverted thinker in the garden

My second earliest memory is between age three and four. We have moved to upstate New York, Trumansburg, and are living with my grandmother. I am old enough to know that I can’t pick random things outside and eat them. However, my grandmother has a currant bush: red currants.

I am amazed to see her picking and eating something outside. Does she not have to follow the rules? And then she lets me eat some. And I do not instantly die.

“You may pick them and eat them off this bush whenever you want.” says my grandmother.

I remember the color of the currants and the taste and the miracle of having permission to go eat something on my own recognizance, outside in the great wide wild world. I was so thrilled and entranced with the currant bush and my grandmother.

Here are red, black and white currants from the farmer’s market yesterday. I put them in a fruit salad with a honey melon that was so ripe that is dripped, and added apples and blueberries and lemon juice. Mmmmm, bounty. The tartness of the currants is delicious with the sweet melon.

 

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focus

For the Daily Prompt: cringe.

I took this on the ridge on top of Mount Zion yesterday. Absolutely gorgeous hike, with the rhododendrons floating among the tall trees and tons of wild flowers. Here are little wild strawberries…. we will have to come back in September.

Cringe: I cringe when I hear the discussion on the news being about health INSURANCEΒ  and not health CARE. We need to change the focus.

We HAVE a mandate that anyone in the US can have health CARE. That is, the emergency room cannot legally turn anyone away. But the bills can bankrupt you and take your house away. Not only that, but the emergency room is the most expensive and worst way to take care of people in the world. The emergency room cannot treat cancer, cannot treat hypertension, cannot help a person with depression, cannot do the long term chronic care that I do. Per person in the US we pay twice as much as the next most expensive country and they have universal care. What is the matter with the citizens of the US? We care more for corporations protecting their profits than we do for our citizens health. And I think this will bring our country down….. we will collapse.

I am a physician but I also run my own clinic. I am a small business owner. And I really expect that health INSURANCE will force my clinic to close.

Call Congress. Say we want health CARE not health INSURANCE.

 

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bye bye doctors

stop this healthcare bill… until there is transparency… or this will get worse.

 

I am grieving, watching doctors leave.

I have been in my rural county, 27,000 people, for 17 years.

Doctors are leaving. Wake up, United States.

The trend when I got here was that we had 14 primary care doctors and 5 midlevels. For years, we lost one primary care doctor a year. I would grieve and it would mean more work, every year. We would get a new doctor, but often there would be a gap… I made up a game to help cope with grieving. I call it “Local Doctor Survivor”. I would bet on the next doctor to leave and also on their trajectory. One of three: nice doctor, angry doctor, doctor labeled nuts. Burn out.

But…in 2015 it jumped. Suddenly we had 3 primary care doctors and two midlevels leave. Uh-uh. One was a husband and wife, doctor and nurse practitioner. One switched to being a hospitalist. Another left. And another midlevel. By then, we still had 14 primary care doctors, but the number of midlevels, nurse practitioners and physicians assistants had risen to 12. Ok, 12 plus 14 is 26. One fifth left. That is a bad trend.

In 2016 another physicians assistant retired. One of the best. I stopped counting who was leaving. Until another doctor announced they were leaving in February 2017. One of the best. That doctor said that a 20 minute visit generates 1 hour of paperwork. If one works “full time” the quota of patients is 18 per day, 72 in the four day week, and that is 32 hours four days a week of 20 minute visits. Generating 72 additional hours paperwork. That is 104 hours a week. Unsustainable.

The 2016 salary information is out for primary care. The “median” family practice physician in the US makes $168,000. Ok. But every doctor given as an example works 60-70 hours a week. Maybe that salary is not as good as you think. Because they are quitting.

Our neurologist retired, in about 2010. I was bummed. The county north of us has 75,000 people. They had two neurologists. Both left in the last two years. The county south of us has 350,000 people. They had five neurologists. Two have left, including my current favorite. For the first time in 17 years I have a neurology referral refused: and not one, but two. Send them to the big city, says one. The other just says no.

I call ENT and he bemoans that now they are down to three in the county. Another left. Three there, one on the county north of me, great, we have 4 for 450,000 people.

I get a letter from one of the two neurosurgeons in Seattle that I like best. In 2016. He is leaving to go do medical administration in another country.

Our three counties are down three dermatologists. One sent a letter. “I am quitting on October 1, 2016, unless ICD-10 is cancelled.” ICD-10 is the new manual of diagnostic codes. It was not cancelled so that dermatologist quit. We have to code every diagnosis. ICD-9 had 14,000 codes. ICD-10 has 48,000. I am memorizing the new ones. I10 is hypertension. E11.65 is type II diabetes in poor control. I used to be able to write a prescription for diabetic supplies, lancets and glucose strips. Now I have to include the ICD-10 code on the prescription and often the pharmacy cites medicare and demands that I fax proof that I have seen the patient and that the patient does indeed need the prescription. I frankly have better use for my brain than memorizing the ICD-10 codes, but whatever.

Another clinic closed in the county north of us and our county. Then the main clinic closed in the county south of us. Within two weeks. 3500 patients needing primary care providers and refills and we can’t get old records because the rumor mill says it was a “hostile takeover”. That is, the person who owned the clinics quit paying the bills, so the electronic medical company won’t release the records. Great.

I have been absorbing about one new patient per day worked since March, but I am getting tired and will have to back off.

Meanwhile, our county hospital has been hiring specialists. Gynecology, new orthopedists, dermatology. Great, right? But currently most specialists won’t take a new patient without the patient having a primary care doctor. Why? Well, one of the new trends is that the specialist says the patient needs something but that I should order it. Yep. Had one of those yesterday. The specialist says I should order it. It’s a veteran. So I get to fill out the VA authorization paperwork with the ICD-10 codes and the CPT code for the study, fax that to the VA, call the patient and remind him to call triwest, because if the patient doesn’t call then triwest throws the authorization paperwork out. And the specialist makes more than 5 times the amount I do. Maybe I should retrain. I am a specialist: family practice, three year residency, board certified, board eligible. But….. I have little value in the United States.

We are seeing Veterans in spite of the extra paperwork. Triwest is sending us 5 from Whidby Island. They have to take a ferry to see me. Because no one on Whidby is taking veterans. My receptionist complains to triwest about all the doctors leaving the Olympic Peninsula.

“No,” says the triwest person. “Not just the Olympic Peninsula. The whole west coast of the US.”

 

http://www.aafp.org/news/government-medicine/20170620senatespeakout.html