hold me

poem: hold me

hold me, Beloved

hold me
I long for you
to be reunited with you, Beloved

to return to you

it is the children who hold me

here

the children
my children, grown
the hope of grandchildren
the damaged children
the new and young children
the old children in adults
who are so sad

it is the children who hold me

here

sometimes I am so sad, Beloved
I long for you

I do and I don’t
long for you
to call me home
and hold me

I know
that you hold me, Beloved
every moment

even when I cannot feel your touch

I know, Beloved
you will call me home

and hold me
now and forever
in your infinite embrace

DMV

I really did not want a tour of the DMV.

I arrive early, just as they open the doors, and there is already a line. We file in, each taking a paper number. The people in front go straight up to the desks. One window processes two people in only ten minutes each and then promptly puts up a closed sign. I guess it’s exhausting, working so fast.

Everyone waiting looks strained or sullen or stressed at the DMV. Shoulders hunched, heads down, the ones in power suits on their phones, but the phones keep cutting off in the DMV. Some sort of special shielding, I would bet.

I have number 17 and get to go to a window after 2 hours.

The clerk smiles at me. She is pale, pale, but has horns and pitch black wings, no feathers, like a bat.

“Unitarian!” she says, grinning.

“Um,” I say, eyeing the wings.

She looks wicked and then her wings are classic white feathered. She is browner and well, I’d guess Filipino. “Worried?” she says.

“No.” I say. “Tired. Sad. Curious.”

“What would you prefer to see?” she says and morphs. Now she has one bat wing that changes to black feathers then through rainbow feathers, to the snowy white feathers on the other side. Her skin tone is very dark on her right hand and then lighter across to pale with red freckles on her left hand.

“Nice.” I say.

“Which heaven would you like?”

“Unitarians do not believe in hell. Send me back.”

“You just got here. Violently and by surprise.” she wrinkles her nose. “Riots again. Sorry about that. We have opened a Unitarian space.”

“No. Send me back.”

She sighs and pulls down a heavy paper file. All the papers have gold edges, except for those with black. “You found your true love.”

“Yes. So what. We didn’t have time to make it work.”

“Don’t you want to wait until she dies so you can head down at the same time?”

“No. She’s only 32. And there is work to do.”

She is paging through the file. She snaps it shut. “Two week vacation. The minimum required. Go to the door on the right.”

I sigh. I want to argue but I’ve done that before. She will add on an extra week for every word I say.

My memories are intact here. Of all the lives. It’s always a bit overwhelming when I first arrive.

I go to the door on the right. A small page with grey tattered wings opens the door for me. I think it is a boy but he is wearing a Tinkerbell style tunic.

“I am your guide today.” No, it is a girl. I think. They may be able to morph that too.

We go in the door. My guide is shedding feathers, one every few steps. I pick one up. “Sorry.” she says. “Puberty. So, where do you want to spend your two weeks?” We are in a half circle shape hall, with hallways branching off. The hallways have no end that I can see and there are open doors all along them.

“I just want to go back.”

She pats my arm absently. “Oh, yes, they told me. You have to take breaks. You are wonderful, though, we love you.” She is leading me to one of the halls towards the left. We go past two doors and to the third. “See?” she says. “Unitarians. Of course, they can come in and out and go in all the others and argue with everyone. We wouldn’t want them to get bored.”

The room is empty at the moment. “And I guess they are all in other places!” The room across the hall seems to be a classic hell, with demons and pitchforks and a grim rocky landscape with pits of burning tar. I can see a dinosaur caught in tar, and a really huge crowd of people. There is a lot of screaming.

“Some people insist.” says my guide. “Where to next? Evangelical? Valhalla is rather fun for males and certain females, we’ve got fluffy clouds and harps, or are you more interested in touring Asian, African, Australian? We do have paleolithic sites and many people are interested in Egyptian themes. The cliff dwellers interest many as well. “

“Atheist.”

She frowns. “Of course, but that room shuts down consciousness and you have to have two weeks of consciousness before you can go back.” She is leading me back into the central half hall.

“Ok,” I say, giving in. “I am not trying to be difficult, you know.”

“Yes, and everyone told me correctly that you are difficult. All the ones that go back over and over are difficult. And there are more every year.”

“Take me somewhere new, ok?” I am looking now at the frieze over the door that will take me back. Two weeks. I can manage. I am resigned. The frieze is cupids and then male odalisques, then female, then leopards, and then they are cupid fauns with horns on their heads, morphing towards adulthood. Yet the carved letters stay the same:

Deus Machina Verum

and I follow my guide into another hallway to find a place for my two weeks.

_________________________

This poem inspires me to post today’s story: https://narble.blog/2021/08/17/if-there-are-no-dogs-in-heaven/

I think the hell in heaven also fits today’s Ragtag Daily Prompt: scorch.

No pandas

Today is PANS/PANDAS awareness day. I wrote this a couple weeks ago.

PANDAS PHYSICIANS NETWORK: PANS/PANDAS AWARENESS DAY

___________________________________

No pandas

I don’t have PANDAS because in the United States we barely believe in it in children and we don’t at all in adults.

I don’t have PANDAS because even though one psychiatrist said I did, he retired, and the next one says I don’t. Then not sure then no. They don’t agree.

I don’t have PANDAS because my primary care doctor won’t read the guidelines even after I have been her patient for seven years.

I don’t have PANDAS because my pulmonologist has never heard of it.

I don’t have PANDAS because it would be a lot easier to put me on a mood stabilizer to shut me up than listen to me.

I don’t have PANDAS because I am labelled difficult because I am afraid to take a mood stabilizer because I do not get a fever or a white count so my main symptom of infection is that other doctors think that I am manic though I am hypoxic and short of breath. They want to fix my mood while I want to not die of pneumonia, so our goals are at odds.

I don’t have PANDAS because I am a doctor and if I had PANDAS my fellow local doctors would feel guilty that they have told each other that I am bipolar and manic for the last 18 years and have shunned me at the county medical meetings and won’t even send me the invitations, except for the one that forwards them. He says he has given them my email and he doesn’t understand why they don’t send me the invitations.

I don’t have PANDAS because Seattle Children’s doesn’t allow the Cunningham Panel to be drawn and they say there is not enough evidence yet.

I don’t have PANDAS because I can’t afford to pay $925 on my own for the Cunningham Panel and anyhow my antibody level is back to whatever is my new baseline, higher than before no doubt.

I don’t have PANDAS because the other doctors are frightened: if I have PANDAS then who else does and if I have chronic fatigue caused by hypoxia and fibromyalgia and it’s related to PANDAS then who else would they have to test and neuropsychiatric is a whole different thing from psychiatric and we swear that we don’t know what causes chronic fatigue and fibromyalgia.

I don’t have PANDAS because I am an adult who lives in the US though if I was in Canada or Europe I could in fact have PANDAS.

I don’t have PANDAS because in the United States we barely believe in it in children and we don’t at all in adults.

Adverse Childhood Experiences 12: welcome to the dark

Welcome to the dark, everyone.

When you think about it, all the children in the world are adding at least one Adverse Childhood Experience score and possibly more, because of Covid-19. Some will add more than one: domestic violence is up with stress, addiction is up, behavioral health problems are up, some parents get sick and die, and then some children are starving.

From the CDC Ace website:

“Overview:Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur in childhood. ACEs can include violence, abuse, and growing
up in a family with mental health or substance use problems. Toxic stress from ACEs can change brain development and affect how the body responds to
stress. ACEs are linked to chronic health problems, mental illness, and substance misuse in adulthood. However, ACEs can be prevented.”

Well, can they be prevented? Could Covid-19 be prevented? I question that one.

I have a slightly different viewpoint. I have an ACE Score of 5 and am not dead and don’t have heart disease. I spent quite a bit of time thinking about ACE scores and that it’s framed as kids’ brains are damaged.

I would argue that this is survival wiring. When I have a patient where I suspect a high ACE score, I bring it up, show them the CDC web site and say that I think of it as “crisis wiring” not “damaged”. I say, “You survived your childhood. Good job! The low ACE score people do not understand us and I may be able to help you let go of some of the automatic survival reactions and fit in with the people who had a nice childhood more easily.”

It doesn’t seem useful to me to say “We have to prevent ACE scores.” Um. Tsunamis, hurricanes, Covid-19, wars… it seems to me that the ACE score wiring is adaptive. If your country is at war and you are a kid and your family sets out to sea to escape, well, you need to survive. If that means you are guarded, untrusting, suspicious and wary of everyone, yeah, ok. You need to survive. One of my high ACE Score veterans said that the military loved him because he could go from zero to 60 in one minute. Yeah, me too. I’ve worked on my temper since I was a child. Now it appears that my initial ACE insult was my mother having tuberculosis, so in the womb. Attacked by antibodies, while the tuberculosis bacillus cannot cross the placenta, luckily for me. And luckily for me she coughed blood at 8 months pregnant and then thought she had lung cancer and was going to die at age 22. Hmmm, think of what those hormones did to my wiring.

So if we can’t prevent all ACE Scores, what do we do? We change the focus. We need to understand crisis wiring, support it and help people to let go of the hair trigger that got them through whatever horrid things they grew up with. 16% of Americans have a score of 4 or more BEFORE Covid-19. We now have a 20 or 25 year cohort that will have higher scores. Let’s not label them doomed or damaged. Let’s talk about it and help people to understand.

I read a definition of misery memoirs today. I don’t scorn them. I don’t like the fake ones. I don’t read them, though I did read Angela’s Ashes. What I thought was amazing about Angela’s Ashes is that for me he captures the child attitude of accepting what is happening: when his sibling is dying and they see a dog get killed and he associates the two. And when he writes about moving and how their father would not carry anything, because it was shameful for a man to do that. He takes it all for granted when he is little because that is what he knows. One book that I know of that makes a really difficult childhood quite amazing is Precious Bane, by Mary Webb. Here is a visible disability that marks her negatively and yet she thrives.

A friend met at a conference is working with traumatic brain injury folks. They were starting a study to measure ACE scores and watch them heal, because they were noticing the high ACE score people seem to recover faster. I can see that: I would just say, another miserable thing and how am I going to work through it. Meanwhile a friend tells me on the phone that it’s “not fair” that her son’s senior year of college is spoiled by Covid-19. I think to myself, uh, yes but he’s not in a war zone nor starving nor hit by a tsunami and everyone is affected by this and he’s been vaccinated. I think he is very lucky. What percentage of the world has gotten vaccinated? He isn’t on a ventilator. Right now, that falls under doing well and also lucky in my book. And maybe that is what the high ACE score people have to teach the low ACE score people: really, things could be a lot worse. No, I don’t trust easily and I am no longer feeling sorry about it. I have had a successful career in spite of my ACE score, I ran a clinic in the way that felt ethical to me, I have friends who stick with me even through PANDAS and my children are doing well. And I am not addicted to anything except I’d get a caffeine headache for a day if I had none.

For the people with the good childhood, the traumatic brain injury could be their first terrible experience. They go through the stages of grief. The high ACE score people do too, but we’ve done it before, we are familiar with it, it’s old territory, yeah ok jungle again, get the machete out and move on. As the world gets through Covid-19, with me still thinking that this winter looks pretty dark, maybe we can all learn about ACE scores and support each other and try to be kind, even to the scary looking veteran.

Take care.

The AntiDating Patch

I wrote this in 2009. I was in one of THOSE moods, where I had completely given up on ever dating anyone or anything again. There are some anatomical terms in here but I don’t think it qualifies for x-rating.

The Antidating Patch!
New from Astronomical-Zenith!

Tired of dating? No one interesting around you? In fact, are the single people around you creepy losers who make your skin crawl?

You are not alone! You need the patch. FDA approved and tested, the AntiDating Patch will repel people of either sex who normally would want to date you. People are contrary beasts, so this will make them want to date you all the more, but you will remain aloof, pure and free of sexually transmitted diseases, as if you were hermetically sealed in a plastic bag or old refrigerator.

Herbal remedies make the same claim but they have not paid the large sum of money to the FDA to fast track their product or even to evaluate it at all. Also, 35% of dating sufferers using the herbal remedy are actually unhappy about their privates turning blue. We are unsure about the rumor that parts have fallen off. The herbal company did change its’ formulation recently, but they don’t have to tell you that on the label, because it is a natural product, no FDA evaluation needed, and in fact, it is treated just like other natural foods including carrots even though we remain unconvinced that it fell off the tree in patch form!

The Antidating Patch is safer, more thoroughly tested, doesn’t turn your privates blue (except for one person) and we price it to reflect those facts! For men, choose Thong, Old Lady Full Coverage Underwear, or Bikini style patches.* Consider shaving off all that nasty hair before applying to skin. You may want to wear it on your arm, where the ladies (and gents) can see it. NO, YOU ARE NOT, REPEAT NOT, TO STICK IT ON YOUR PRIVATES. THIS MEANS PENIS, WANG, DOINK, TUBESNAKE, DORK, BALLS, TESTICLES AND WHATEVER ELSE YOU CALL YOUR PERSONAL EQUIPMENT. DON’T STICK IT THERE. WE WON’T BE RESPONSIBLE FOR ANYTHING FALLING OFF IF YOU DO. For ladies, choose Boxer, Itsy Bitsy Tight Well Hung (ethnicity of your choice here) or Speedo. Don’t put it on or in your privates, but we know you have more sense then that. This would include boobies, tits, yumyums, mams, breasts, ‘gina, down there, silver beaver, box, cunt, slit, vagina, anus, hole and anything else you learned to call it.

Side effects are rare but include and are not limited to hearing alien voices, high blood sugar, we swear that your privates don’t turn blue or really mostly not. That’s just a faint tinge. Fainting, homicidal behavior, acting like George Bush the Younger, delusions of grandeur (oh, we just said that, didn’t we?), jumping off of buildings, hating sex, loving sex, becoming pregnant (only one man so far and some ladies) and irritation of the privates. Also they can get cranky from lack of use.


*Little Girl style will not be marketed since even though many gents loved it in premarketing testing, those damn strident militant feminists** were up in arms again. We just don’t get it. Those whacko women also didn’t like the Little Boy style for women.

**I qualify for all but the militant bit.

do no harm

First do no harm.

That is part of the Hippocratic Oath and yes we did it at the end of medical school. “I will prescribe regimen for the good of my patients according to my ability and my judgement and never do harm to anyone.”

This is a pandemic. People are dying. A lot of people. I am not ok with people saying personal freedom, we don’t want to wear masks, we don’t want the vaccine. I take the oath to first do no harm: what about those people? They are putting their personal freedom first and do not care if they harm me. I don’t like them. Please don’t kill me. Please don’t kill my son or daughter or future daughter in law.

You can have your personal freedom not to wear a mask or get a vaccine: in your house. I don’t think you should be allowed off your property if you won’t put doing no harm to others first during a pandemic. Stay in your house. Don’t come out. It is selfish to put yourself and your personal freedom in front of multiple peoples’ lives. You can order from Amazon and order groceries and ok, you can associate with other selfish unimmunized unmasked people, but not the rest of us. Your personal freedom has a high chance of killing me. I am immunized but my immune system doesn’t work and I am already on oxygen. I don’t want to be around you. Stay away from me.

I think it is time for my community to give back to me and all the other first responders: medical, police, fire, grocery store, hospital, all the essential workers. Give back: either get immunized and masked or stay in your house.

Thank you.

On vaccination: rock stubborn

A friend in his 30s was working on my car the other day. “Are you immunized?” I ask. “No.” he says. “I wish you’d get immunized,” I say, “Also, I can’t ride in the car with you because if I get the Delta variant, I’ll probably die.” He responds, “I hate doing what other people tell me to do.” “Oh,” I say, “Oppositional defiant, just like me. Fine. Don’t get the vaccine.”

Two days later I text. “Don’t get the vaccine today. Or tomorrow.”

I hear back. He got vaccinated the day I sent the text. I don’t know if it was me saying don’t do it, or me getting out of the car and staying a good ten feet away after that. Please don’t kill me, not today, ok?

Maybe we should try it nation wide. “DON’T GET VACCINATED. DON’T DO IT TODAY. OR TOMORROW.”

Unvaccinated thirty year olds are getting really sick and getting intubated and dying. One in five hospitals in the US now is 95% full, on divert. I used to heave a sigh of relief when I was in residency and we were on divert. That meant no admissions until beds opened back up. We are full. But one in five is really bad. Virginia Mason in Seattle is on divert. Our rural county has more covid infections than we’ve had the whole time, mostly unvaccinated. About 15% vaccinated. We are starting to see the breakthrough infections, around 8 months after the vaccine. Makes sense, because the vaccine riles up the immune system for 8 months and then quiets down. I am 8 months out, no immune system, high bleeping risk. The head of the heart lung bypass part of Virgina Mason was interviewed. “We have been full for ten months (?or a year) and have turned away over 150 patients.” So heart lung bypass could save lives in covid. But it takes round the clock two ICU nurses and the ICU nurses are burning out, quitting, dying. If they get too tired, their immune systems don’t work, they are more at risk for covid and they could die. The nurses and the doctors KNOW this. So…. how many unimmunized people are you willing to die for? Just curious.

Kids have been at home, quarantined, small groups. So then they started school or daycare or even a few more playdates and hello: when you get them together, they trade viruses. There is an outbreak of RSV and other viruses. RSV won’t kill most kids but some babies need the hospital and it can kill premies. And the beds, remember, are full.

Now the AAFP is calling for emergency authorization for kids age 2-11 to get the vaccine. Because they are dying too and there bloody won’t be room in the hospitals at this rate. Or well, you can build a tent, but if you don’t have any ICU nurses, the tent is not too helpful.

For the governors saying “No mask mandate at school,” yeah, well, I think they should refuse the vaccine and refuse treatment and refuse intubation and refuse oxygen.

Meanwhile, I am hiding under the bed. Roll up the sidewalks, lock the doors, I am sorry not to be useful but I am not useful dead. I could telemedicine if our area gets shorthanded enough. I suppose I should call the hospital and say that. They aren’t that desperate… yet. We have four ventilators last I checked. And 32,000 people in the county and we are the only hospital. Bummer.

I am in a physician mothers Facebook group. The stories are getting grimmer and grimmer. A physician put up the list of hospitals she called to try to transfer a patient: over 30. All no. Another is in North Carolina and got a call from Texas to transfer a patient. But… they were on divert. No.

Take care. Don’t get your immunization if you are against it. Whatever.

Fuzzy Poet Doctor and the small child

I think I finally understand what I have been doing in clinic all these years. And not just in clinic. As a theory it explains both why patients, nurses, hospital staff and specialists really really like me and my fellow Family Practice doctors, particularly the males, and the administrators, really really do NOT like me.

I am on a plane flying to Michigan a few weeks ago. Double masked. N95 with another mask over it. Sigh.

A friend keeps saying that he can see into me. He can, but he can see thoughts. Not feelings. I am wondering if I see feelings. But I see the stuffed feelings particularly, the ones that people keep hidden. They are like clouds.

And then I think, oh.

I automatically scan any new person for their small child. The inner small child, who is often damaged and hidden. The small child is hidden under those stuffed feelings, which I think of as monsters. In Ride Forth, I am writing about pulling every monster feeling that I can find stuffed out and letting myself feel them. And that people do not like seeing me like that. Their monsters attack me!

Except that the monsters don’t attack. The monsters come to me and say, “Please, please, help me. I want out. The small child needs to heal.” The monsters lie their monstrous heads in my lap and weep.

Now WHY would I develop this skill? That is weird.

I develop it because my parents both drink. The myth in the family is that it was my father. But my mother’s diaries and also her stories make it clear that she drank heavily too. I think they were both alcoholics. And she told two stories about me trying to get someone to get out of bed to give me food as a toddler. As jokes. But it is not a joke. I have food insecurity. At every meal, I think of the next one and whether there is food available. My daughter has it too….. epigenetics.

I think that the only way I could love my parents was to have compassion for them. Once you see another person’s damaged small child, then how can you not feel compassion for them?

With patients I learned to be very very delicate and gentle about asking about the cloud. Just gently. Sometimes people open up on the first visit. Sometimes they shut tight like a clam and I back off. Sometimes they return the next visit or the 3rd or the 8th or after a couple years… and say, “You asked me about this.”

It’s nonverbal communication. The reason why I take the WHOLE history MYSELF at the first visit is for the nonverbal communication. When the person doesn’t want to answer a question, veers away from a topic, switches subjects: there is my cloud. That is where the hurt is. That is where the pain is.

The first cracks in the United States medical system collapse are appearing. Not doctors quitting, not nurses, but medical assistants. Here is an article about how clinics all over can’t hire medical assistants. Because there are tons of jobs, employers are offering more money, why would you do a job where you may well be exposed to covid-19 if you can do something else? And make as much money or more….

The cracks will widen. Ironically doctors are doing what I have done for the last ten years: “rooming” the patients themselves. Ha, ha, good may come out of it, after the disaster. Which is getting worse fast. If people don’t put their masks on and don’t social distance and don’t get vaccinated, I predict more deaths in the US this winter then last winter. Sigh. And in the US we will run out of medical assistants, doctors and nurses.

It is ok to gently ask a patient about that cloud. It is not polite to “see” it in a Family Medicine colleague or and administrator. I can’t “not see” it. I can’t turn it off. However, on the plane my behavior changed even before I could put all of this into words. The words are that I have to be as gentle with everyone as I am with patients.

And the trip felt so odd. I was putting this into effect before I had words. That is how my intuition works. But everyone, absolutely everyone, was kind to me on the trip. A Chicago policeman helped me in the train station and was super kind. It was weird, weird, weird, with bells on. It took me a few more days to be able to put it into words.

Problem intuited, after 60 years of study. Implementation of solution proceeds immediately. Logical brain struggling to catch up, but results satisfactory long before logical brain gets a handle on it.

Pretty weird, eh? I think so. My doctor said that an episode of Big Bang Theory could be written just by following me around for a day. I think it was both saying that I am smart AND that I have no social skills. But I have implemented the social skills program already. She’s just upset that I gave her justifiable hell two visits ago and also…. I do hide my brain. Because sometimes colleagues are jealous.

But maybe they should not be jealous. Maybe they can learn it too. Maybe I can teach. Maybe….