Category Archives: breathe

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Sing from the sea

This is another poem where I did not know where it was going when I started it. I was thinking about the sea and sirens and singing. My poems go where my heart thinks I should go, but I don’t know where that is until the poem is done. And it’s clearly a song and next I need a tune. And chords. And more practice.

I sing from the sea, from the sea, from the beautiful sea
tied to the mast, you won’t come to me

unplug your ears, unblock your heart
before it breaks and truly stops
listen to my lonely heart
we’ll make music and never part

I sing from the sea, from the sea, from the beautiful sea
hear my voice, listen to me

our hearts melt together like stone
in the depths of my volcano home
you shut your heart down, run away
lava strings like glass, all the way

I sing from the deep, from the deep, from the beautiful deep
small child calling, she still weeps

volcano boiling from ocean floor
new island built as lava roars
small child with faith as adult caves to fear
small child holds your heart dear

I sing from the land, from the land, from the new born land
don’t be afraid, take my hand

hope has feathers, a poet said
in the darkest time, hope is not dead
I morph to dragon, to kite, to bird
your resistance is so absurd

I sing from the air, from the air, from the smoke filled air
vision dark, can’t see where

circle in flight, hope you too
listen to the small child hidden deep in you
a promise is a promise, you know it’s true
I do not give up on you

I sing in the wood, in the wood, in the beautiful wood
five elements sing as all things should

In the wood in the trees
on an island in the sea
in the heart of the volcano
my heart is free

I sing from the sea, from the sea, from the beautiful see
no matter what happens, my heart is free

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I took the photograph at the National Museum of Women in the Arts, a painting by Shinique Smith.

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abstract

This is a cell phone snap from a few days. It reminds me of Jackson Pollock’s paintings, all the complex colors and layers.

The tide was way way way out and it’s a snap of the green layer on the beach. Gorgeous. The beaches here are an endless wonder.

For the Ragtag Daily Prompt: wonder.

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On meditation and breathing

In college at the University of Wisconsin, I dated a gentleman who was following the Zen Buddhist tradition.

He meditated daily, for forty minutes, facing a wall.

I was quite intrigued. I did not think I could do that. I am a fidgety person and can’t sit still. I promptly tried it.

Forty minutes is a long time facing a wall at age 19.

I would fall asleep. I would start tilting to one side or the other on my zafu and jerk back up. I knew I was not supposed to follow thoughts, but I couldn’t not think. It is more subtle than that: I slowly figured out that I can let the thoughts pop up from the toaster brain, but try not to follow them. Wave at the thought. Let it go.

One day there was a small hole in the wall when I faced it. A tiny spider came out and went back in. I was very happy about the spider.

The next day the spider came out and waved one leg at me. Then it went back in the hole. The end of the 40 minutes is signaled by a chime. I got suspicious afterwards and went back to the wall. Not only was there no spider, but there was no hole, either. I did not see any more holes or spiders.

I meditated regularly daily for two years. After that I would return to practice intermittently. Meditation trained my breathing: my breathing slows way down during meditation.

I use that breathing when I have pneumonia. In the worst episode, I was in the hospital and disbelieved. I slowed my breath way way down to calm myself and so that I could think. Eight counts in, eight counts out. Then ten, then twelve. I needed to focus and figure out what was causing sepsis symptoms. And I did figure it out. The provider sent me home that morning, septic and 6 liters behind on fluid, but I was able to survive.

Now the pain clinics are teaching slow breathing. Five seconds in and five seconds out. Start with a few minutes and work up to twenty minutes. “Almost everyone goes from high sympathetic nervous system fight or flight state to the parasympathetic relaxed nervous system state.” I think we need more of that, don’t you? This is being taught for anxiety, for chronic pain, for fear and depression. I asked a veteran to try it. His response: “I hate to admit it but it works.” Also, “I’m not used to being relaxed. It feels weird.” I laughed and said, “I think it might be good if you get used to it.” He reluctantly agreed and continued the practice.

Peace you, peace me.

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Vape

First, the definition of vapor:

noun

  1. The gaseous state of a substance that is liquid or solid at room temperature.
  2. A faintly visible suspension of fine particles of matter in the air, as mist, fumes, or smoke.
  3. A mixture of fine droplets of a substance and air, as the fuel mixture of an internal-combustion engine.

So vaping is smoking. It can be called vaping, but that is to trick us into thinking that it is not smoking, that we are not sucking chemicals into our delicate lung tissue. We only have one set of lungs. Lungs are like a tree, either the roots or the leaf parts upside down. Air is drawn in by our muscles expanding the chest and diaphragm, down the trachea, the bronchi, the bronchioles and at last to the alveoli, where tiny veins wrap each alveoli, trading carbon dioxide for oxygen.

I think of smoking as every cigarrette distroying an alveolus.

Vaping too, vaping is smoking. The nicotine is suspended in a solution and the vaporizer heats up until it is in vapor form. I started reading about vaporizers at least a decade ago. There were over 500 different types, mostly made in China, and there are all sorts of solutions. I was horrified to read that ethylene glycol was one of the solutions that held nicotine. When a dog drinks antifreeze, ethylene glycol, it is poisonous to the brain. Does anyone think that we should inhale smoke with antifreeze and nicotine in it? Really?

There is no control of what is put in the solutions. We don’t know what they will do long term but we know that nicotine is addictive and damages the lungs. Some of the vaporizers get so hot that the metal is also vaporized. Heavy metals are clearly bad for the lungs and poisonous as well.

Here is an article from the U of Colorado Medical Center with further reasons NEVER to start vaping. Because vaping is smoking: don’t let the term fool YOU. 4 reasons why you should stop vaping.

For the RDP: vapor.

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Unexpected hero

When I first think about divorce, I call my sister.

I say, “I am thinking about a divorce.”

She replies, “YOU don’t want to be a single mom.”

I think, well, crap, that is true. Me: “I AM a single mom. It’s just that one of them is FIFTY.”

My sister proceeds to tell me how difficult it is to be a single mother.

I have to self examine my OWN prejudices against single mothers.

Then I wade in, to solo and couples counseling, for a year. My ex fires our couples counselor after a YEAR. He says the counselor is on my side. “We have been talking to him for a year!” I protest.

“I want a new one,” says my then husband.

I find a new one. I am filling out the paperwork. It asks, what is your goal?

That is the moment I decide: I write “Amicable divorce.”

The two years before that moment, I am not sure. I am trying very very hard to see if it can be fixed. But it takes two to tango and my then husband will not tango. Not one step.

We were each attracted to something specific in the other person. My then husband did not want to work at any sort of traditional job. His father would come home angry from work for years. I loved working, always.

I was a terribly serious child, growing up in an alcoholic family, and I have food insecurity. That is, at some deep level, I always worry about whether there will be food. When I meet my then husband he says that his goal is “To have fun every day.”

This slays me. Have fun? And he WAS fun. Biking, jitterbug dancing, he was a tennis and golf pro, he was smart, well read, divorced from a marriage of convenience to a lesbian to cover so she could be a small town librarian. Really? Yes, really. I demanded to see the divorce papers before we got married. My then husband thought I was very very funny and I thought he was too.

When we divorce, people tell me he will never pay child support. He won’t stay in contact with the kids. There are a lot of opinions.

Wrong, wrong, wrong. My ex returns to school, gets a “displaced homemaker scholarship” because he was a househusband (yeah, I said he was smart). He goes to nursing school and gets an RN. “You’ve yammered about medicine at me for fourteen years, I might as well.”

He gave me hell about us living in an “old person’s” town. Then in nursing school he calls. “Hey, I’m doing a rotation. Guess what it is.”

“Don’t know, what?”

“Nursing home.”

I laugh.

“I LOVE these OLD PEOPLE.” he says. And he DOES. He is wonderful with them. He works in a nursing home for years. He gives scholarships to the medical assistants when they leave for nursing school. He brings coffee to his medical assistants and the other staff. He drives by on his day off because one elderly woman will only take her medicine if he gives it to her. He gets pianos for the nursing homes. He does memory loss concerts, where he tries to engage memory loss folks. We store music as entire songs, or entire albums, so if someone starts a song, they can often go through the whole thing. He can sometimes get someone singing who no longer can string a sentence together. Families love it.

Early in covid he calls me. “I have covid.”

“Sh-t.” I say. “Are you ok?”

“Oh, yeah. Everyone at the facility has it. Two staff didn’t so we sent them home. We are working sick because there isn’t anyone else.”

“Holy crap.”

“Yeah, it’s a little depressing. My memory loss folks can look ok at the start of the shift and are dead by the end.”

A quarter of the patients die. This is before the vaccine. My ex sails through covid, says he doesn’t feel bad, for him it’s just a cold. He says, “I miss some of them.” Yeah, holy crap.

So another hero. And he paid the child support every single month and stayed in touch with his kids in his own odd way. “Mom, he tells me about his golf shots,” says my daughter. I laugh, “Yeah. Well, he loves you.” “I don’t care about golf.” she says. “I know, me either,” I say.

The photograph was taken with my camera by my friend Amelia in 2014, I think. It is me and my ex, seven years after the divorce was final.

I read this to my ex prior to posting. Posted with his approval.

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Is this a tree?

Is this a tree?

I would not call this a tree. I would call it a cone. It contains seeds. It is not a tree.

A pregnancy is called an embryo until 8 weeks after conception and then a fetus until birth. It is not a baby, any more than a seed is a tree. Here is a link to a picture of the embryo developing:

https://en.wikipedia.org/wiki/Human_embryonic_development#/media/File:HumanEmbryogenesis.svg

It’s a bit difficult to call the embryo a baby.

After 8 weeks (10 weeks from the last menstrual period) the developing pregnancy is called a fetus. It cannot survive outside the womb. A term pregnancy is 37 weeks, and the due date is at 40 weeks. The earliest survival, certainly not natural, is around 24 weeks. This takes heavy intervention and technology, a premature infant on a ventilator for months. There is risk of damage to the eyes from high oxygen and risk of spontaneous brain bleed and cerebral palsy, because the newborn can weigh half a pound. Once born, the fetus is termed a baby.

This is important from a medical standpoint and pounded into us as physicians. WHY? Because in a trauma situation, the life of the mother comes first. In Obstetrics and Family Medicine, the life of the mother comes first. In Oncology, the life of the mother comes first. My sister was diagnosed with stage IIIB ductal breast cancer at age 41. She was engaged and it turned out that she was pregnant. She wrote this essay on her blog, Butterfly Soup:

The hardest loss of breast cancer.

She had an abortion and chose chemotherapy, because it was her or the fetus. If she had chemotherapy pregnant, at that time she was told that it would probably kill the fetus or cause terrible birth defects. If she held off on chemotherapy for seven months, her oncologist thought she would die. She had a very very aggressive cancer and she already had a daughter who needed her.

She lived until age 49, with multiple rounds of chemotherapy, radiation, gamma knife radiation, whole brain radiation. And she lived until her daughter was 13. Without the abortion, her physicians thought she would have died when her daughter was 7.

My ethics in medicine are that patients have autonomy. I would NOT have wanted my sister to choose to refuse chemo and try to bring a baby to term while dying of breast cancer. However, it was HER CHOICE, not mine. It was private and no one else’s business and how dare people make moral judgements about another person’s medical choices. I give my patients CHOICES. They can choose not to treat cancer and go into hospice. They can choose surgery or refuse it. They can choose to treat opioid addiction or refuse. They may die of a heroin overdose and I grieve. I try to convince them to go to treatment and I give them nalaxone to try to reverse overdoses. I refuse a medication or treatment that I think will harm my patients, but my patients have autonomy and choices. That extends to women and pregnancy as well.

It is NOT a baby in the womb, however emotionally attached people are to this image. It is an embryo first and then a fetus. And in a car wreck, the woman comes first and the fetus second.

For the Ragtag Daily Prompt: explain.

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Achievement

My first achievement for today’s Ragtag Daily Prompt is spelling achievement. And no, I did not spell it correctly on the first try.

My daughter has finished her first two years of teaching eighth grade, during Covid-19. She taught remotely until March of 2021 and then in person. She worked on her teaching certificate the first year and finished her Masters last month. She is SOOOO amazing!

Hooray for ALL of the teachers who continued to teach during Covid-19, remotely, in person, hugs and prayers and sending love.

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Covid-19 and walking pneumonia

I wrote this essay in July 2017. Before Covid-19. It is clear that Covid-19 is also causing a walking pneumonia. People are exhausted when they get out of bed. No fever, they may not cough much, but if they get up, they can feel exhausted. The key to this is the heart rate, the pulse. If the pulse jumps 30 points faster or more, this implies lung swelling and reduced lung capacity. Right now, the only treatment we have is rest and time to heal. I should know, I’ve had really bad walking pneumonia four times: the first two times I was out for two months. The third time 6 months with 6 more months half days and chronic fatigue. The fourth time put me on oxygen.

I want to offer hope to the people with Long Covid-19. Having been through four bad pneumonias, with increasingly long recovery times, and now disabled for doing Family Medicine, I have experience to share. I will write more about that in the next essay.

From 2017: Walking pneumonia is changing.

The classic bugs are four “atypical bacteria”:

mycoplasma pneumonia
chlamydia pneumonia (this is not the STD chlamydia. Different one.)
legionella
pertussis (whooping cough)

However, streptococcus pneumonia can also be a walking pneumonia OR a lobar pneumonia. In a lobar pneumonia the person usually is short of breath, running a fever of 102-104, and they point to where it is: hurts in the right upper chest. On chest x-ray there will be consolidation: whited out from fluid or swelling instead of nice ribs and dark air. They are often tachycardic and hypoxic.

In walking pneumonia the person often has no or minimal fever, they just feel tired or short of breath when they do things, and the chest xray can be “clear”. It isn’t really “normal”, it’s just that the bacteria or virus affects the entire lungs and causes some swelling throughout and doesn’t white it out.

“Double” pneumonia is when the chest film is whiting out on both sides. We also see the lungs whiting out with ARDS — acute respiratory distress syndrome. So after trauma in a car wreck and lots of broken ribs, the lungs can be bruised too and white out. Ow. Influenza virus can cause lung swelling and in the 1917-1918 flu infected military recruits lungs were swelling shut. They would turn blue and die.

“My” strep that I’ve had pneumonia with twice is streptococcus A, not strep pneumonia. It causes strep throat mostly though it can invade and cause sepsis or pneumonia or cellulitis. There are currently 4000+ known strains of strep A, and some are resistant to antibiotics or can cause kidney damage or do all sorts of nasty things. I think that “my” strep is resistant to azithromycin.

The current guidelines say to treat walking pneumonia with azithromycin. However, a paper came out this year saying that resistance to azithromycin is rising among streptococcus pneumonia and that nearly 50% of strains tested were resistant. Uh-oh. That means that azithomycin doesn’t work and the person can get sicker and may die. I talked to a pulmonologist in Seattle when I needed help with someone. He said that he would have said there weren’t any resistant strep pneumo strains here in Washington except that he had one intubated and in the ICU right then. “I’m convinced now, ” he said.

A lobar pneumonia is easier to diagnose. Abnormal chest x-ray, reasonably healthy people run a high white blood cell count (so my frail folks, immunosupressed folks and 90 year olds don’t raise their white blood cell count), and a fever (ditto) and look sick. The walking pneumonia people come in saying they have been coughing for 3 weeks or 4 weeks or two months. I am doing more lab testing because of the resistance.

This winter I have seen 6 different causes of walking pneumonia here: influenza A, respiratory syncytial virus (In more than one person over 60. That is NOT who the books say it should affect. It’s supposed to mostly cause bronchiolitis in babies and preemies), pertussis, strep pneumococcus, strep A and none of the above. All looking pretty much the same, but with different treatment.

https://wwwnc.cdc.gov/eid/article/15/8/08-1187_article
https://www.cdc.gov/pneumonia/atypical/mycoplasma/index.html
http://www.medscape.com/viewarticle/820736
https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=79
RSV: http://kidshealth.org/en/parents/rsv.html
Mycoplasma resistance to azithromycin has been reported too: http://erj.ersjournals.com/content/36/4/969