Category Archives: change

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Spare the rod

You say you want a partner to join in work or love
It bothers me to hear you say those words
sand inside my clothes

a partner is someone that you respect and listen to
I hear a disconnect between your words and plan
someone to improve upon

You’ve chosen your next target for this thoughtfully
I can see that your plan would work quite well
practical and logical

I do not think that he will bend to your desire
Carved and polished, obedient as wood
sanded to a shine

Earthquakes and fire shake and forge our world
I stand in awe before the forces on us all
that make us grow

There is only one that you should try to change
The stubborn foe that eyes you when you shave
will keep you busy

And God will gild the lily

I took the photo in 2012 from the Kai Tai Lagoon in one of our rare snows. It looks like a magic castle on a hill to me.
I published this on everything.com today too.

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Headache without words

When I was in residency, a staff member brought a young man to see me.

The young man couldn’t talk. He could make some sounds. His head was a funny shape, asymmetric. His mother had rubella during her pregnancy: German measles.

“His head hurts.” said the group home staff member.

“How do you know?” I asked.

“He isn’t acting right. There is something wrong. He’s different.”

“How long?”

“About a week or ten days.”

“Did he fall?”

“We’ve talked about that but we don’t think so.”

I tell the young man what I am going to do before each part of the exam. I look in his ears carefully. His ear canals are odd too and I can’t see well. His exam is basically pretty normal for him. He is not running a fever. He doesn’t have a stiff neck. He doesn’t seem to have nasal congestion.

“If he hit his head, he could have a subdural, a bleed pressing on his brain.”

The staff member shakes their head.

“Ok. I can treat him for an ear infection, though I can’t see that well. If that doesn’t work, we will have to image his head. Would he stay still in a CT scanner?”

“No.” says the staff member.

“Then I would have to set it up with anesthesia. Which is difficult.”

So we treated him for an ear infection. No improvement. He returned. Exam unchanged. The staff was still sure his head hurt. I had never seen him before the initial visit, so I couldn’t tell.

I set up the CT scan with anesthesia. Twice, because they mucked it up the first time and it wasn’t coordinated right. I had to explain to multiple people on both anesthesia and radiology what and why I was doing it. “His head hurts and he can’t talk?” I argued until they gave in.

The ENT chief resident called me with the results. Not radiology. “What?” I said.

“It’s the biggest pseudocyst we’ve ever seen!” said the ENT chief. Surgeon. “He needs surgery!” His voice said “Cool!”

In residency I’d noticed a striking difference between family practice and other residency folks: internal medicine, surgery, neurology, all the subspecialties. They got excited when there was something rare or weird. I always thought, oh, shit, my poor patient.

“What is a pseudocyst?” I actually didn’t ask, because they knew I was just a lowly family practice resident and would probably not have heard of a pseudocyst. A cyst like structure can form of snot in the sinuses and can cause headaches. It can erode through the bone into the brain. His hadn’t, thank goodness, because that can be bad. Bad as in lethal.

Because of the measles, he had some of the largest sinuses ENT had seen ever, and the largest pseudocyst. ENT happily took him off to surgery. Great case.

I got to see him in follow up. He was his normal self. His group home staff member was delighted. “He’s back to normal! Thank you so much!”

But it’s the group home staff that noticed and cared and brought him in. “Thank you for bringing him in,” I said, “I would not have noticed. And some people wouldn’t have cared.”

Differentiating pseudocysts and other things: http://www.oapublishinglondon.com/article/1266

More on pseudocysts: http://www.ncbi.nlm.nih.gov/pubmed/6595617

Pseudocyst images: https://www.google.com/search?q=maxillary+sinus+pseudocyst&biw=1366&bih=634&source=lnms&tbm=isch&sa=X&ved=0CAcQ_AUoAWoVChMIoZzWwv_QyAIVUJuICh248gGC

Rubella in pregnancy: http://www.marchofdimes.org/complications/rubella-and-pregnancy.aspx

Rubella, aka German measles: http://www.mayoclinic.org/diseases-conditions/rubella/basics/definition/con-20020067

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Thorns

Once, oh Best Beloved, there was a little girl. She went on a trip to the desert.

The desert was very different from where she lived. All of the plants had thorns. Even the trees had thorns in their bark. But just like home, there were birds.

She saw a little bird. “Hello little bird,” she said.

“Hello,” said the little bird.

“The trees have thorns,” said the little girl. She touched a cactus softly and it bit her. She pulled out the fine thorns and sucked on her sore finger.

“Yes,” said the little bird.

“Where do you live?” said the little girl.

“Here in the desert!” said the bird, happy.

“How can you live in the desert?” said the little girl.

“There is morning dew and delicious insects and nectar from flowers!” said the bird.

“But can you build a nest?” said the little girl. There were no twigs.

“Of course!” said the little bird. “Come see. My nest is in this tree.”

The little girl looked and there was the nest. The nest was built of thorns.

“It is thorns.” said the little girl, thoughtful. “If you live in the desert, you build your nest of thorns.”

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the problem with angels

the problem with angels

the problem with angels
is that they aren’t grey

nor do they have color

they are black
or white

sort of boring, really

pick one side
good or evil
night or day
male or female

I would rather be fluid

I want to be able to transform

liquid to solid
solid to gas
gas to solid
gas to liquid

flow around things

seep into the earth

always always
return to the sea

keep your wings

project black or white
as you choose
on me

while I flick water at you
and go for a swim

also published on everything2 today

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Eat food not pills

As a United States board certified, board eligible rural Family Physician, I am continually mystified by many of my patients preferring pills to food.

I don’t get it.

Today I will discuss probiotics. I have tons of patients taking probiotic pills. I ask all patients to bring in all pills, prescribed or not, fda approved or “natural”, when they come for their first visit. Many people arrive with a shopping bag. People say, “I am not on any medicines.” Then they pull seven “herbal” medicines out of the bag. A pill is a pill to me. I have never seen one growing on a tree. It’s as natural as a shoe, in my opinion. Shoes don’t grow on my feet, but sometimes I wear them. I feel the same about pills.

I hold up the probiotic bottle. “How long have you been taking this?” I ask.

“For a year,” says my patient.

I then get this internal vision. The probiotic leader in my patient’s stomach speaks, “Another load of refugees. I just don’t know where we’ll put them. Everyone is starving as it is. And dehydrated and dessicated with many dead again. Call the burial team and the grief counselors. I swear, it’s like clockwork. We had a forty eight hour break last Saturday, remember? But then we had to handle all that alcohol….”

“Have you thought of stopping it?” I ask.

“Probiotics are good for the digestion,” says my patient.

“Ok,” I say and try to gently introduce the idea of as few pills as possible. Also if they are taking four preparations with vitamin A, I total it up and ask them to consider lowering their dose a bit……

Why don’t people eat their probiotics as food? I am not talking about the expensive advertised yogurt. Live culture yogurt has always had probiotics, but now they’ve standardized, advertised and raised the price. All of the pickled things are sources of probiotics: Kimchi, dill pickles, sauerkraut and all of those interesting pickles that one gets with sushi. I am not so sure about the sweetened pickles, though my mother used to make watermelon rind pickles in a crock, and I am sure there were very many interesting organisms in them. Delicious, too. A friend said that he first got interested in fungi perusing leftovers in my parents’ refrigerator, and he ended up with a PhD. My digestion has been really really healthy, though my recent strep A was hard on it.

I got live kimchi at the Farmer’s Market recently, and hard cider. Both contain love, I mean live cultures. If you make your own beer, that has live cultures when it’s brewing.

The best thing you can do for your intestinal health is stop. eating. sugar. Quit all the junk food and anything with sugar or corn syrup and make your own food. I have some really dark chocolate or two table spoons of really good ice cream most days. I did eat one donut in the last five months. Perfection is silly, boring and stifling.

Another overlooked cheap source of probiotics that anyone can find: dirt. Yes. Dirt from your yard. It contains all manner of live microscopic things and you are focusing on local bacteria. Don’t wash that carrot quite so carefully and you will be adding to the probiotic culture in your body. If you are in a CSA (community supported agriculture) and get a box from a local farmer once a week, you are getting local probiotics. Do be sure to get your tetnus vaccine updated every ten years, too.

Lastly, think about your food. Would you rather have local probiotics from a local farm or attempt to wash the pesticides off of vegetables that have had pesticide genes added to their genome?

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Dream: Get real, Girl

I dream that I am a prisoner and being tortured. The torturers are indistinct and shadows. They cut slices into my flesh and put me back in my cell.

I am out of my cell again and I am seen from the back, naked from the hips up. The torturer cuts slices in my back with a cutlas. The previous slices have healed and scarred. I am done. I turn, grab the cutlas and slice off the torturers hands at mid-forearm. His hands are visible as they fall away, but the rest of him is still a shadow. I will win, I know.

I have a new vase. I take the white china vase out of the base, which has brass wheels and a support like a coach. Like Cindarella’s coach. I use the vase as a template to carve the base of a pumpkin to fit. I carve it into a coach sitting on the base. I find a plastic horse and the “Get real, Girl” in her hiking boots. I photograph it and caption it: “After she smashes the glass slippers, the coachmen and horses revert to mice and rats and run away. She steals a horse from her father, puts on her hiking gear, skips the ball and heads for the hills for good.”

Then I wake up.

As you can see, I haven’t carved the pumpkin yet, nor found the horse. But I will.

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Humans should behave more like sisters

Humans should behave more like sisters.

My sister and I played together. We’d get angry. We’d fight! We’d sulk! We’d complain to the grown ups! We’d slam doors! We’d ignore each other!

But in the end, there was often no one else to play with. So we would make up. And we loved each other.

I miss my sister so much.

Can’t we learn to love other humans and quit being stupid? Please?

The photo was taken at my wedding by the groom’s uncle in 1989.

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Thoughts on the update from ICD 9 to ICD 10 

I would be very interested in a tune for this poem. 

This poem was rejected by JAMA, the Journal of the 
American Medical Association. Of course, the American 
Medical Association writes the codes. I do not look 
forward to going from the present 14,000 diagnosis 
codes to 42,000. I think it's just another way for 
insurance to delay and refuse to pay physicians. I 
think our country now has a business ethic of "screw 
anyone you can" and I don't like it. 

Thoughts on the update from ICD 9 to ICD 10


They say ICD 9
Just isn't so fine
Not enough codes to choose
To keep us fungking confused

They say ICD 9
Just isn't so fine
The rest of the world
Uses ICD 10, word

But they are liar liar liars
Pants on fire fire
Noses as long as telephone wires

They are liar liar liars
Fungk ICD 10
And let me tell you fungk them
Fungk starting over again

ICD 9 is now 34
Oh what a bore
They say it's too old
I'm older and gold

They say engage a team
Establish a plan
Get focused training
Learn that sh-t from the man

They say what does your practice
See and learn just those codes
Fungk ya'll but wise
I see everything that goes

I do family practice
I'm a rural doctor
The point of the codes
Is insurance don't pay, suckers

They say ICD 9
Just isn't so fine
The rest of the world
Uses ICD 10, word

But they are liars liars liars
Pants on fire fire
Noses as long as telephone wires

I know my ICD 9
Forwards and backwards, up and down
I can code pregnant
by four circus clowns

I can code pulmonary
embolus past
I can code gerbil inserted in the a--

ICD 10
is starting again
Code left or right or other
Those sh-ts would fungk your mother

ICD 10 is starting again
Code where it happened
Or insurance won't pay
Fungkers make my day

They say champion the change
I say channel the rage
Take a book from my page
Incinerate the fungking change

Fungk ICD 10
Fungk ICD 10
Fungk ICD 10
Fungk it again.
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Powergirl takes off

The photo yesterday is of my daughter on the beach, but she is in the air. She is not touching the ground at all. And today the picture is my son airborne at the beach. I wrote this poem in 2005. When I found each of those photographs, I thought of this poem.

Why, you say, does this poem leave the articles out? I went to high school in Alexandria, Virginia. Yes, I was a Titan and graduated from there. In Alexandria when we were really angry or really passionate, the articles got dropped. I try not to talk like this in the northwest, because people get scared. I am also influenced by Walt Kelly’s Pogo and all of the messing around with language and spelling. Stephen Fry on language (https://www.youtube.com/watch?v=J7E-aoXLZGY) is a lovely comfort!

Previously published on everything2 August 25, 2009.

Powergirl takes off
Powergirl have wings
to fly
She related to
Superfly
She scared when
baby almost die
She scared and yes’n’she
do cry

Husband say she much
too strong
He say she most allays
wrong
He sing and dance de
same old song
He rather she put on
a thong
He played too much with
that old bong

Now man he working
ooh he big
He have no time for
little kid
Not that he ever
really did

She research kidses
summer camps
She study schedules late
with lamps
Pay de money, lick de
stamps

Husband say she got too
much power
He say it nearly every
hour
He grumpy sullen and really
sour

Powergirl got wings
to fly
She look with longing
at the sky
She look at husband
wonder why

She finally realize he
a pain
She take a saw to
ball and chain
Husband he whine and
complain
She wonder why he
goddamn insane
She learn divorce lawyer
nice name

Husband lie on ground and
moan
He whine and bitch all on
de phone
Powergirl leave him there
alone
He drink and fuck and get
real stoned

Powergirl have wings
to fly
She rising rising
in the sky
Kids light as she is
hollow bones
They scared to leave
familiar home
Ride on her shoulders
in the sky
She hopes that they will
learn to fly

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Cucumber love

Cucumber love

They say they love you

And they do

Sort of

One day you find yourself
Wearing a construct
An exoskeleton
Awkward
You can move
See out

You built it slowly over years
Because that’s what you were told to do
You wanted to be loved
It made you feel safe

There is praise
Or at least pressure to keep it on
You may not have known it was there
And slowly begin to feel
Who you really are
Awaken to the shell

One day you slip out

They are still saying how much they love you
To the empty construct

You watch bemused
For a while

You say “That isn’t me.”
“Of course it is,” they say

“I’m over here,” you say

Shock and outrage
“That’s not you!
You’ve changed, you’re depressed
Confused, manic, gone out of your mind!
Off the deep end!” 

You might even go back in
the construct for a little while

But now you’ve tasted freedom
You won’t be able to stand it for long
You will be out soon

Some people will see you as you really are

Some people will tell you they still love you
But as they say it to the construct
They act as if you’re still wearing it
They still think you love cucumbers
Though you ate that dish once to be polite
They hold the construct in their minds
Even after you’ve destroyed it
And behave the same as they ever did

As you walk away
You will wonder who they loved

first published on everything2 on June 9, 2009