All of my patients are smart

I am a rural family practice doctor for over twenty five years and all of my patients are smart.

All of my patients are complicated.

I don’t mean that they all have degrees or PhDs or are intellectuals. I mean that they are smart in all sorts of ways.

I was talking to the UW Pain and Addiction Telemedicine Team four years ago. I said that when I had a new chronic pain patient who is angry about the law in Washington, I would give them the link to the law: http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PainManagement.

“You give them the link?” said one of the faculty. “But they can’t understand that.”

“Why not?” I replied. “I did.”

This was met with silence. My attitude is, well, I am a physician. I am not a lawyer. Yet I have to follow the pain law. Actually we all have to follow all the laws in our country. We say ignorance of the law is no excuse. Yet then the attitude of the pain specialists at UW was that the law is too confusing for my rural patients.

I think UW is wrong and I think that it is disrespectful to patients. Treat them as adults. Treat them as smart. Treat them as if they can understand and you will get respect back. And if they trust you they will then tell you when they do not understand or need something translated from medicalese to english.

I worked with a patient who works every day. She is in a wheelchair, a motorized one. She has cerebral palsy and can’t talk much. And she is smart too.

This election is about the United States population being smart. They know something is very wrong and they want it fixed. I think that Citizens United needs to be taken down. Corporations are not people, unless the CEO can be the physical representation of the corporation and go to jail when the corporation lies and steals. Wells Fargo, I am talking to you. I am taking my money to another bank. Pay reparations. The United States population is sick and tired of the rich getting richer and corporations stealing from people for profit. Democrats and republicans are sick and tired of it. We are not going to take it any more. If you have gotten rich from corporate underhand theft, lies and confusing regular people, give the money back. Because you can buy an island, but if the United States population rises up to hunt for you, there is no where in the world you can hide.

It is time for corporations to give the United States population the government back. Or we will take it. Because every patient I have ever taken care of in over twenty five years is smart. That is not to say we don’t all do stupid things. And some people won’t change. But in the end, everyone can learn and everyone can change.

I took the photograph in Larrabee State Park in September. This tree is down: but it is not a nurse log yet. It is not dead. The roots are still providing nourishment and it is sprouting branches all along the downed trunk.

 

Playing Poker with Putin

People keep saying, “I don’t TRUST Hilary Clinton.”

And they say, “Her smile is not sincere.”

I am confused and dumbfounded. Uh, I thought that is the POINT of politics. NAME A POLITICIAN YOU TRUST.

I DON’T TRUST ANY POLITICIAN.

So here is a game: Playing Poker with Putin.

This requires three people, of any sex.

Player 1 is Hilary Clinton.
Player 2 is Donald Trump.
Player 3 is the moderator who in this case happens to be Mr. Putin.

NOW. The moderator begins to ask questions. Every time the moderator asks Hilary a question, Donald interrupts. Donald, you can be as foul and rude as you want, though you should not swear, because you are on national television. You can talk about “lady parts” and the size of your hands. And all the rest of it.

Putin: go for the jugular on everyone.

Hilary: you have to smile. The entire time. You cannot object to being interrupted, because that is bitchy if you are a girl and manly if you are a man. You cannot show anger. You cannot show any emotion at all except a totally sincere smile no matter what the two men say and no matter how many times you are interrupted.

If the person playing Hilary loses her temper she (or he if a guy is playing the part) loses. Then Donald and Putin have to stage a mock battle throwing pillows at each other and insulting each other’s wives. At the top of their lungs. Be as mean as possible. Then Donald will turn the country into a dictatorship because “I have to be equal to Putin.”

So….my definition of politician is someone who can keep their head no matter how nasty the conversation gets. No matter how many lies are told. No matter how many insults are given. And you do the best you can in office to represent the entire country and for the good of the world.

Play on, Hilary. You win Best Politician Ever in my book.

Choosing love

My sister and another writer posted essays under the title Choosing Love here: http://everything2.com/title/Choosing+Love. My sister’s was written in 2002. I posted mine there last November.

Choosing Love

I choose love
I have no enemies
I hold you close in my heart
and hug you close if I can
and if you hurt me over and over
I can still love you
I choose love
I have no enemies
I hold you close in my heart
from far far extremely far away
I choose love
I have no enemies
I hold you close in my heart
I hug you from a safe distance
I choose love
I have no enemies
I hold you close in my heart
even if I will not allow contact again
I choose love

The photograph was on the beach. The gull and the crow were interacting. After I watched for a while it was clear that the gull was following the crow and trying to take things from the crow. They were not friends.

 

guns in the house

During wellness visits I used to ask, “Do you have guns in the house?” in the safety/accident prevention part of the visit. Along with helmets, seat belts, smoke alarms and not driving under the influence.

As a Family Practice Board Certified Physician, I counsel patients. Family Practice is a specialty, just as internal medicine and general surgeon are specialties. A three year residency training after medical school and I retake the Boards every 10 years. I counsel patients in “annual exams” or “medicare wellness” visits.

A patient reported me to the state board because of that question. I then got a letter from the state board saying that I was being investigated but not why. Later I got a letter saying that the patient had complained that I had asked about guns. The state replied that in fact, I am supposed to counsel patients about gun safety.

I changed my counseling. Now I say: “If you have guns in the house, I am to counsel you to keep them locked up with the ammunition locked up separately.”

I get three responses:

1. “My guns are in a gun safe, locked at all times, with the ammunition locked.”

2. “I don’t have any guns!”

3. Silence.

It is the silent ones that worry me.

I did not change my counseling because I was reported to the state and the state did not tell me to change it. I changed it in hope that someone who keeps their guns unlocked and loaded, in the bedside table, under their pillow, up in a closet, or where ever, will think about it. The question “Do you have guns in the house?” is too loaded for those people.

I met a woman with an impressive star shaped radiating scar on her chest. Her boyfriend kept a loaded gun under his pillow. One night she was returning from the bathroom. He shot her in the chest.

They are not together any more.

When my son went to preschool, over 20 years ago, I counseled him. “If another child says they can show you a gun or they have a gun, say that you have to go to the bathroom. Go and tell an adult right away. People can get killed.”

He reported an overheard conversation in preschool between two other boys. One said that he knew where his parents kept a gun. The two boys were planning to leave the school to go look at the gun. I called the preschool. They already knew about it and had talked to both boys’ parents. I don’t know if the parents locked the guns up.

In Portland one of my neighbors chased his upstairs neighbor into the street one day during rush hour, stark naked, trying to hit the upstairs neighber with a 5 iron. Yes, a golf club. I am very glad the downstairs neighbor did not have a gun right then, because he would have used it. Any of us could have been killed. And later the SWAT team was called to deal with him: he did have a gun that time. He threatened to shoot himself in the head. Then he did: well, except he only creased himself. He went to involuntary psychiatry, supposedly for six months. He was back in three months. The neighborhood was very very nervous. The house next door was sold and he disappeared and we were all relieved. He was strong, completely illogical and terrifying. We discussed how to deal with him but mostly we hid.

When he chased the neighbor into the street, I had already called 911 because I heard screaming next door. My voice shook. The dispatcher said, “Yes, we know the address, we’ve had three calls and they are on their way.” The traffic stopped dead at the sight of a nude man chasing another man with a 5 iron. I unbolted my door and stuck my head out. “(C—-)! Up here!” The upstairs neighbor ran up my steps and into my house. I slammed the door and bolted it and crouched by the front window with a baseball bat, ready to hit the downstairs neighbor as hard as I could if he came through my front window.

He didn’t. The police arrived. The whole thing was over the upstairs neighbor “playing music too loud” and “not turning it down enough”. The downstairs neighbor had broken down the upstairs neighbor’s door with the five iron. The upstairs neighbor had tried to defend himself with a butter knife and then ran. The police explained to the downstairs neighbor as he was arrested that if someone breaks your door down, it is not assault to defend yourself with a butter knife.

We discussed which illegal drugs we thought he was on. This was in the 1990s, so we thought it was crack. There was a big article soon after that about a crack house. We said, whew, glad we aren’t those neighbors and then realized that it was within two blocks of our house. Great.

Drugs and alcohol and guns and anger and grief….. it is a toxic mix.

Please, lock your guns.

Unconditional 2

I think the hardest thing in the world is to love unconditionally. And we can’t love unconditionally unless we love ourselves in that too. Including our faults, our mistakes, our dark corners, our anger and grief, pettiness, unkindness, stupidity, jealousy, greed lust… if we only love our “good” side then we will attack others when they show the same weakness and faults that we know, deep inside, that we are capable of or have acted on. If we cannot love someone who is a sinner, we cannot love anyone, because we are all guilty. Love people anyhow and wholly and yourself too.

I went through a period after my mother died, where I felt I’d entirely failed. My marriage was disintegrating, and I was looking at myself very carefully. How had I gotten here? What mistakes had I made? I felt unlovable and stupid.

I found a letter from my mother written to herself when my father asked me to clean out her clothes. It was two or three years after she died. Here is the letter, with a few things left out for the privacy of the living:

____________________

Sept 18, Friday
1987
Seattle

I don’t want to go home. I want to stay here in Seattle. With the mountains that lift my heart. And clear air and only good memories. What is there to go home to? Struggling with X and his alcohol. I don’t want to try to do something about it. I don’t think it will work if I do. I think will only go on as it is and trying to get help will only lead to fight. I don’t think I have the strength, the courage or the wisdom to help myself or him.

What else am I going to? A house that needs a great deal of work that I only moderately like. A climate I loath. A landscape I find boring. I’m tired of living in a crowded suburb. And that house needs so much work.

People. What people do I go home to? Nearly all have problems. Y, wounded bird, so foolishly enamored of Z or thinks he is. And I have little sympathy or patience with it. And his propensity to failure which I’m tired of also.

A who I dearly love but her household is such chaos with those ill-behaved children and one crisis after another.

B who I like very much but really have so little in common with. I fear all that spiritual stuff may eventually bore me. Maybe not.

C. Another wounded bird, really. And not dependable.

D, barely around, anymore.

Mother, older and frailer. Who needs my care and patience.

E. There is one person to go home to. Thank God she’s there. Not wounded anymore. But so busy and it isn’t fair or wise to dump my troubles on her.

Who else? Why don’t I know any successful (in the best sense) sane people. People who are intellectuals, interested in ideas. F is. But not a fully successful human being and not when G is with him. Ugh. Besides he lives far away and he and X don’t like each other.

I don’t really want to have that show at H’s Church. I don’t like H very well. Oh dear.

I maybe have a job which if I get will be very hard work and if I don’t will be a great disappointment.

Winter’s coming and things cost more and we don’t have quite enough to live on. So that means digging into my inheritance.

I am sick of D.C. I am sick of being a struggling, unsuccessful artist. I am sick of worrying about X, about his moods, his acting the fool when half drunk and acting cruel and crazy when fully drunk. I’m sick of being afraid, of his depression, of his refusal to talk to me about anything of importance.

Of doing dishing. Of all the mess in our house. The mess on my desk, the mud room, the kitchen, the study, the basement. The dirty paint. The back yard. Oh God! How can I change things? Well there are a lot of bad things.

Oh, & I’m sick of being anxious, 10 lbs overweight, biting my nails, having bad teeth/gums. Life get tedjous, don’t it?

Any good stuff?

____________________________

For me, this letter was the key to finding myself lovable. My mother wrote to herself because she felt that she could not share these feelings with anyone. Terrible feelings. And I thought about it for a long time: I thought: my mother was charming, loved and an entertainer. But a child knows the parents’ hidden feelings. So I knew about my mother’s darkness and the letter confirmed it. And I thought, my mother didn’t need to hide that because I knew about it and I loved her anyhow. I love her more knowing that she was human too.

And if she is lovable whole, so am I. So are you. We all are. And we all make mistakes and are guilty of anger (sometimes appropriate but sometimes not!) jealousy, greed, lust, sloth and pride. Love people anyway and wholly and yourself too.

 

I have a view of Puget Sound if I stand in the road in front of my house. I took this with a zoom lens on solstice morning at sunrise.

Z is for zest

Z is for zest. What do you feel zest for?

The photograph is our small town synchronized swim team in 2007 at the Blossom, the last meet of the season that we went to that year. Our girls posed outside where it was very chilly, and all of the exited parents snapped photographs. Zest on both sides for the team and for swimming!

Webster 1913 here
Zest (?), n. F. zeste, probably fr. L. schistos split, cleft, divided, Gr. , from to split, cleave. Cf. Schism.

1. A piece of orange or lemon peel, or the aromatic oil which may be squeezed from such peel, used to give flavor to liquor, etc.

2. Hence, something that gives or enhances a pleasant taste, or the taste itself; an appetizer; also, keen enjoyment; relish; gusto.
Almighty Vanity! to thee they owe Their zest of pleasure, and their balm of woe. Young.
Liberality of disposition and conduct gives the highest zest and relish to social intercourse. Gogan.

3. The woody, thick skin inclosing the kernel of a walnut. Obs.

Z

from Dictionary.com here:

noun
1. keen relish; hearty enjoyment; gusto.
2. an agreeable or piquant flavor imparted to something.
3. anything added to impart flavor, enhance one’s appreciation, etc.
4. piquancy; interest; charm.
5. liveliness or energy; animating spirit.
6. the peel, especially the thin outer peel, of a citrus fruit used for flavoring:
lemon zest.

verb (used with object)
7.to give zest, relish, or piquancy to.

Zest for life, zest for writing, zest for all of the A to Z feelings that I’ve written about in the 7 sins and friends and all of the feelings that I haven’t written about. They are all part of being human! And now: zest for breakfast, I’m hungry!

Hooray for finishing and hooray for everyone who participated whether they finished or not!

Y is for yearn

Y for yearn, in 7 sins and friends. What do you yearn for? Do you ever feel yearning and if so, are you ok with that feeling?

Rumi’s and Hafiz’s poems give me permission to feel and to long. They says that all longing and yearning is praise and prayer for reunion with the Beloved.

Oh Beloved,
take me.
Liberate my soul.
Fill me with your love and
release me from the two worlds.
If I set my heart on anything but you
let fire burn me from inside.

Oh Beloved,
take away what I want.
Take away what I do.
Take away what I need.
Take away everything
that takes me from you.

Rumi (the rest here)

I Have Learned So Much

I
Have
Learned
So much from God
That I can no longer
Call
Myself

A Christian, a Hindu, a Muslim,
a Buddhist, a Jew.

The Truth has shared so much of Itself
With me

That I can no longer call myself
A man, a woman, an angel,
Or even a pure
Soul.

Love has
Befriended Hafiz so completely
It has turned to ash
And freed
Me

Of every concept and image
my mind has ever known.

Hafiz

From: ‘The Gift’
Translated by Daniel Ladinsk, here.

There is a candle in your heart,
ready to be kindled.
There is a void in your soul,
ready to be filled.
You feel it, don’t you?
You feel the separation
from the Beloved.
Invite Him to fill you up,
embrace the fire.
Remind those who tell you otherwise that
Love
comes to you of its own accord,
and the yearning for it
cannot be learned in any school.

– Rumi (From here)

I took the photograph in town….

X is for xenophobic

X is for xenophobic.Have you ever felt xenophobic?

How would I know if I were xenophobic since it is an unreasonable fear or hatred? How do we tell the difference between a reasonable fear or hatred and an unreasonable fear or hatred? Or is it only other people that can tell?

From dictionary.com:

xenophobic

adjective
1.
unreasonably fearful of or hating anyone or anything foreign or strange.

Origin of xenophobic
1905-1915
1905-1915;xenophob(ia) + -ic

Contemporary Examples

Β Β Β  His most ardent and xenophobic political ally, Umberto Bossi, looks all but ready to bail.
Β Already Vulnerable, Berlusconi Weakened by Election Results Barbie Latza Nadeau May 30, 2011

Β Β Β  The committee should avoid foreign ownership questions which will make them sound parochial or xenophobic or both. 9 Questions for Rupert Geoffrey Robertson July 17, 2011

The article raises repeatedly reported statements by some opposition candidates that are β€œbigoted and xenophobic.”  Will Scandalous Videos Topple Georgia’s President? A Rebuttal Tedo Japaridze September 23, 2012

Β Β Β  We are almost certainly hard coded to be xenophobic, which is why hunter gatherers often have such extraordinary homicide rates. Racism Isn’t Natural. But I Suspect Xenophobia Is. Megan McArdle October 17, 2012

Β Β Β  “Unfortunately these kinds of xenophobic attacks have happened in Libya before,” says Bouckaert.Β Β  Libya’s Hysteria Over African Mercenaries Babak Dehghanpisheh March 5, 2011

Β Β Β  Oh, and their attitudes towards Arabs and promised land are even more insular and xenophobic than most settlers. How Yair Lapid’s Gambit Ends Bernard Avishai March 6, 2013

Β Β Β  I started hearing rumors about xenophobic attacks in early April. Will the World Cup Start a Riot? Gretchen L. Wilson June 9, 2010

Β Β Β  Meanwhile, politicians like Tom Tancredo led an ugly race to the bottom to see who could be most xenophobic.Β Β Β  Bush Was Right Mark McKinnon April 27, 2010

Word Origin and History for xenophobic
adj.

1912, from xenophobia + -ic.
Online Etymology Dictionary, Β© 2010 Douglas Harper

It seems that xenophobic is something we say about other people. Not very nice of us, and judgemental.

Batman at the beach. A younger child at a party, dressing as Batman, a powerful archetype.

OLYMPUS DIGITAL CAMERA

 

And he catches one of the other children.

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She escapes.

OLYMPUS DIGITAL CAMERA

Batman is on his own.

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He starts to enjoy the beach.

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Batman wading.

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By the end of the party, he takes off the hot costume. He was comfortable enough that he didn’t have to be Batman any more.

I took the pictures in 2006.

 

W is for wrath

W is for wrath, the seventh sin.

From Webster 1913:

Wrath

1. Violent anger; vehement exasperation; indignation; rage; fury; ire.
Wrath is a fire, and jealousy a weed. Spenser.
When the wrath of king Ahasuerus was appeased. Esther ii. 1.
Now smoking and frothing Its tumult and wrath in. Southey.

2. The effects of anger or indignation; the just punishment of an offense or a crime.
“A revenger to execute wrath upon him that doeth evil.” Rom. xiii. 4.
Syn. — Anger; fury; rage; ire; vengeance; indignation; resentment; passion. See Anger.

 

Wrath is a sin, yet is it ever justified?

I am wrathful about this: http://www.npr.org/sections/health-shots/2016/03/23/471595323/drug-company-jacks-up-cost-of-aid-in-dying-medication

In my state a terminally ill patient may choose Death with Dignity: http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct

The person must be terminally ill, must not be suicidal and must go through a process. But one of the tablets prescribed, which only the person may administer to themselves, has had a price increase from $200.00 to over $3000.00.

I heard this from another physician, who has a patient who is going through the process.

I feel wrath and anger and hurt and rage that a corporation is choosing to make an enormous profit from terminally ill patients.

And so wrath may be a sin, but it is also an appropriate feeling at times.

In a sermon about forgiveness, hate is also discussed:

“Let me also say a word here about hatred, since I am speaking of forgiveness as being the release of hatred. ManyΒ  of us,Β  I suppose, like myself, have been taught not to hate.Β  We have been taught that hatred is always a bad thing and there is no place for it.Β  Thus, we feel uncomfortable in the face of this intense emotion and attitude.Β  Many times I have stumbled on the line from the biblical book of Ecclesiastes which reads, β€œThere’s a time to love and a time to hate.”

Can there beΒ  a time to hate?Β  Ironically, whenΒ  reflecting on the subject of forgiveness, I see that there is a place for hatred.
Β 
First,Β  yourΒ  hatredΒ  letsΒ  youΒ  knowΒ  thatΒ  youΒ  areΒ  feelingΒ  diminishedΒ  andΒ  perhapsΒ  being stepped on and treated as no human being ought to be treated.

Secondly,Β  yourΒ  hatredΒ  letsΒ  youΒ  knowΒ  thatΒ  you’reΒ  fightingΒ  backΒ  andΒ  thatΒ  youΒ  have somethingΒ  toΒ  fightΒ  backΒ  with.Β Β Β  ItΒ  letsΒ  youΒ  knowΒ  thatΒ  theΒ  situationΒ  isΒ  intolerableΒ  andΒ  you will not put up with it.

AndΒ  soΒ  hatredΒ  canΒ  beΒ  aΒ  naturalΒ  andΒ  evenΒ  necessaryΒ  responseΒ  toΒ  situationsΒ  thatΒ  threaten human dignity.Β  Says one author, β€œNot to feel resentment when resentment is called for is a sign of servility,… a lack of self-respect.”  (Forgiveness, Haber)”

From: November 15, 2009, here: http://www.quuf.org/index.php?page=2009—2010-sermons

p7
http://www.quuf.org/uploads/Sermons/Is%20Forgiveness%20Always%20Called%20For%20Part%20II%20Nov%2015%2009%20print.pdf

I took the picture in 2007. No wrath here, but three different expressions, and all complex….