Category Archives: 7 sins and friends

by

Integrated behavioral health

The buzzwords now in Family Medicine. Integrated behavioral health in primary care. I am finding it a bit annoying.

Integrated does not mean race in this context. It just means the clinic should have a behavioral health person.

I suppose that is a good idea maybe, or might seem like one. But what do they think I have been doing for thirty years? Ignoring behavioral health?

Really, primary care is half or more behavioral health, if a primary care doctor gives people time and pays attention. People have an average of 8 colds a year. Why do they come in for cold number 4 if it is no worse than all the others? Because the cold in not really why they are coming in. The cold is the excuse. Notice that the person is there, that they are not that sick, that they do not care that you are not going to prescribe antibiotics.

I have my hand reaching for the door when an older patient says, “May I ask you something?” She came in for something that she didn’t seem to care about, so I am not surprised. I turn back. “Yes.”

“I have friends, in another state. They had a baby. The baby is very disabled.”

I sit down. This is more than 15 years ago, so I do not remember what the baby had. Hydrocephalus. Cerebral palsy. Something that requires multiple doctors and physical therapy and the parents are grieving.

“What bothers me most is that they have to struggle so much for services. There is very little support and very little money set aside. One of the parents has quit their job. It is a full time job taking care of this child and they are frightened about the future. Is this really what it’s like?”

And that is the real reason for the visit. “Yes,” I say. “It can be very difficult to access services, you have to track down the best people in your area, some physicians won’t pay much attention and others are wonderful. And the same with physical therapists and everyone else. Tell them to find some of the other parents of these children. Get them to recommend people. And the parents have to be sure to take care of themselves and each other.”

She frowns. “It’s a nightmare. Their life completely changed from what they thought. First baby. And it is overwhelming.”

“I am sorry. You are welcome to come back and ask me questions or just talk.”

“Thank you. I might.”

“Do you need a counselor?”

“No, I’m fine. I am just worried about them and feel helpless.”

“It sounds like staying in touch is the best thing you can do.”

“Ok.”

The true reason for the visit is often something entirely different from what the schedule says. Sometimes people are there without even knowing why they came in. “Can I ask a question?” That is key. Saying to see people for one thing is criminal and terrible medicine and makes behavioral health worse. There is so much we can do in primary care just by listening for these questions and making time for them.

I have nothing against adding a behavioral health person to the clinic. They talked about “embedding” a behavioral health person in each group of soldiers back in 2010, when I worked at Madigan Army Hospital for three months. I always pictured digging a hole in my clinic floor, capturing a counselor, and then cementing them in the hole. I would have to feed them, though. I always thought that was sort of a barrier. One more mouth to feed. I found it more useful to contact counselors, ask what they wanted to work with, learn who knew addiction medicine, learn who was good with children or families or trauma. And ask patients to tell me who they liked and why. I integrated behavioral health in my community, not just in my clinic, because there is no one counselor who is right for everyone.

by

Caramel

Warm and tan and sweet

but you don’t like sticky, heh.

I buy gummi bears and forget to bring them
over and over for months
forget to bring them to the beach.
When you teach me
how to find chalcedony nodules
clear agates that let the light through,
you say, “They look like gummi bears,”
and you are right.

In the early morning when the tide is low
and the sun is low too
angled and polarized light
the nodules, agates we call them
light up like stars, catching the sun.
Sometimes I see one just after you
and you are diving down to get it
and I am too late again

You find three to my one
The gummi bears are a bit hard
when I finally bring them along
I choose a red one, the small kind
tuck it between two fingers
when you aren’t looking
I’ve gotten my fingers a little wet first
so it will light up
the same way as the agates
I wait until we’re a yard apart
and you aren’t looking at me.
I jump forward and reach for the sand
“Look at this one! So red!”
You move towards me and I flash it.
“Almost bear shaped!” I say
and drop it in your hand.
Your face changes from envious
of the clear red to mildly horrified:
“Sticky!” you say, and shake it off your hand.
I laugh and pop a yellow gummi bear in my mouth
and you are laughing too
and shake your head.
“I don’t want one!”
“Got you!” I say.
“Yes,” you say, “You did.”

____________________

For the Ragtag Daily Prompt: caramel.

by

Living together

Lichen are a lifeform formed from algae and fungi, which is amazing. Apparently they join forces when they can’t survive on their own and form a different creature. And it’s not just one kind of algae or one kind of fungi, but lots of them! I am reading Entangled Life: How fungi make our worlds, change our minds and shape our futures, by Merlin Sheldrake. It’s really quite amazing. I love science, it opens up the world!

For the Ragtag Daily Prompt: lichen.

by

Sterling

Mary and Nissa are at the fundraiser. Only $100 each!

“I am the man for the job,” says Joe. He is elegant in a suit and tie and crisp white shirt. “I don’t lie. I don’t break laws. I don’t even speed! I am a man of sterling character!”

Mary and Nissa enjoy the fundraiser very much. Nissa is driving Mary home afterwards.

“He’s so wonderful! And that meal! Did you see all the silver? He is the man for the job!”

Nissa turns the car into Mary’s driveway. She turns the car off and looks at Mary.

“What?” says Mary.

Nissa pulls a spoon out of her pocket.

“You stole a silver spoon?” says Mary, appalled.

Nissa breaks it in half. It splinters.

“Wood. With silver paint. Don’t be fooled, Mary.” Nissa hands Mary the two wooden halves and Mary stares at them. Nissa gets out to help Mary in to the house.

After she is situated, walker within reach, Mary says, “I may rethink that donation I was going to make. Thank you for coming with me, Nissa.”

Nissa smiles. “You are welcome. Thank you for taking me.”

__________________________

The woman in the picture is new to my home. She has a tag that reads “Chubby Purple Mama”. She was made by an artist in town, Karen Renee Page, who died in September. Many dolls were given for a fundraiser. This doll has crystals and a piece of wood in her belly. Without them she is not balanced. I added one of the chalcedony nodules that I find here on the beach.

For the Ragtag Daily Prompt: sterling.

by

set by

Let me set hatred by for this one day
let each feast with family full of joys
leave that empty, no anger or dismay
and maybe keep that chamber empty save for toys
Let there be no bombs down from the sky
let no one fall to firing with a gun
let no flogging make any children cry
let no one need to cower or to run
I don’t know what to call this day right now
Guilt day or day we stole this gorgeous land?
I give thanks for love and wonder how
We can heal the past, what demands?
Two friends will come to feast and sip eggnog
My cats will be surprised: they bring their dog.

by

Blessed

You needn’t worry that I will importune you.
Words explode and swirl upon the page.
It’s more likely that I’ll say blankly “Who?”
Since I enlarge upon a fascinating stage.
Approaching two years since I was taken sick,
on oxygen I wrote a poem of farewell.
Career ending injury: nature can be such a dick.
Breathing is important. Absent it is hell.
I am still healing. I hope that I can ski.
I am lucky that my fatigue is relatively mild.
My oxygen can go 9000 feet up where I’ll see
muscle dysfunction truly makes me wild.
Friends and family gather close and gather far
I feel blessed beneath a lucky star.

________________

Sonnet #2 for the Ragtag Daily Prompt: sonnet.

by

defiance

I am listening to the Offspring today. Because I have a friend who is not behaving like a friend.

It is what people do that matters, not what they say. They can say they are my friend all they want, but if they treat me badly, I will walk.

The Offspring are fabulous for defiance. Though I need to change the genders on this one.

And not only that: they are fighting opioid overdoses and death:

Bravo, Offspring. Blessings and peace you.