Category Archives: death is part of life

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Covid-19: A gentle answer

I went to have a hair cut today and went in three shops since I was downtown anyhow.

There are lots of tourists and visitors walking around without masks.

In one shop the owner asks if I am Dr. O, and it turns out her daughter babysat for my children 19-20 years ago. We had a nice discussion about our offspring. We are both wearing masks.

In a mineral store somehow the covid-19 subject comes up. I say that I am wearing a mask because I am on oxygen and vulnerable, and even though I am vaccinated, if I get covid-19, it might kill me.

The two owners are not wearing masks. The woman says, “We are both vaccinated, but I am just really confused about what to do.”

I say, “Well, I am a Family Physician. Let’s take chicken pox. If someone is exposed, it can take 21 days for them to break out in the rash. They will be contagious for 1-2 days before they have symptoms. The problem is that it can be ANY of those 21 days. After they break out in the rash, they are contagious until every pox is crusted over. So it can be six weeks that they are possibly or certainly contagious. With Covid-19, the Delta Variant is so infectious and again people may not have symptoms yet, so I am wearing a mask any time I am around strangers.”

The woman says, “Thank you for telling me about it. It’s helpful to hear from a professional.”

“You’re welcome.” I say, gathering my bag to go.

“Look,” she says, “I am putting on my mask now!”

I look and she is.

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pigs and fishes

is it ok

if I don’t make sense for a little while?

this is hard

it’s really hard
sometimes
to communicate

I never did
join the mainstream
of medicine

I went to class
to medical school
and wondered
and noticed
that the classes resembled
descriptions of cults
how they train people

and I thought
I am not joining any cult

and I kept my mouth shut

in the elevator
when another student says
“The other day
I threw out all of my husband’s plaid shirts.
I hate them.
They are too low class.”
If he loves them, you’ve hurt him, right?
and I think
I could say
“Yes, I hate it
when my husband
wears my plaid skirt
he stretches them all out
and ruins them.”
I would be outed
even more than I already am
as weird.

I don’t say a word
I just think
words

Medical school is four years
Residency is three
I am quiet there too
impression that I am shy
which is a lie
even so, the faculty fear me

I hear, 25 years later

and I am surprised

5 foot four
130 pounds

what the hell is there to fear?

though a boyfriend says
“You turn into an ogre
when you are angry.”

but I am quiet
in medical school
in residency
except when a patient
needs me
to speak

morph to ogre
morph to werewolf
if needed

as I get older
slowly
slowly
I learn
more subtelty

mostly from my children
who are subtle
and very very smart

at any rate

I never bought in to
the give opioids to everyone

and eventually
it turns out
that my intuition
or instinct
or whatever the hell you want to call it
study of addiction from the experience
and reading in college
matches
the studies
that come out

now I have another one
an intuition

the data is catching up with me

it’s funny
in my small community

I feel so lonely
after 21 years
mother’s death, sister’s death, father’s death
divorce
single mother 2 children
niece don’t go there
I am labeled by the medical community
I hear that the senior doctor
in the community
tells a woman midlevel
at a party
that I am crazy

maybe so

but I was right about opioids

pigs and fishes

is it ok

if I don’t make sense for a little while?

maybe
just maybe

they could listen to me this time

but I don’t think

they
will

that would be ok
but it is hurting people
and I can’t bear that

so I put myself
back in the traces

once in a massage
I thought
I can’t bear this
I am not strong enough
and suddenly I was in a dream world
where my back was enormous
huge
unending
and I thought, oh, I can bear this
thank you
I think

I put myself back in the traces
I am an ox
I plant my hooves

I begin
to pull
hard

pigs and fishes

even as I cry

The photograph is from 2014. Two pairs of glasses frames ago….

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practicing grandmother

My sister sends me a t-shirt years ago.

It said, “I don’t know if I am the good witch or the bad witch.”

I burst into tears and put it in the trunk of my car. I never wear it. I am the designated bad witch for half my family. We won’t go into that.

She gets a shirt too. Hers is the green one. Mine is black.

She is dead, in 2012, breast cancer. It’s hard to describe the fallout. Toxic and radioactive. But… I have decided not to be a witch.

Instead, I am a practicing grandmother.

Really I’ve been one for a while. There was a young couple who lived down the street with two children. This was in 2014. I was a Facebutt friend, so sometimes noted what was happening. The father has to travel for his job. The mother is trying to care for two kids and work and so on… been there.

In 2014 I am recovering from my third round of pneumonia. This third round it takes six months before I can return to work. Short of breath and coughed if I talked. The state medical watch doctors went to disable me but I fight them tooth and nail. I win.

I wander down to the neighbor and offer my services. She already knows me. She is instantly grateful and two year old T is introduced to me, again. He doesn’t really remember me. She explains that he is coming to my house for a little while and then back home.

T and I walk towards my house.

A nuthatch calls.

I stop and reply. In college I took ornithology and the teaching assistant could do a barn owl call so well that the barn owls would do a territorial fly over at night to see who had the weird accent. Marvelous.

The nuthatch and I went “enh” back and forth. T is amazed. This woman talks to birds. Then we see the nuthatch! I point out how nuthatches come down a tree head first. “If you hear that call, it’s a nuthatch. Look for it.” The nuthatch is very cooperative. Magic.

We get to my house. T is clutching a book. “He’s taking it everywhere,” sighs his mother. “I’m not sure why.”

So first we read the book. It is a board book about a farm. Each page has a central picture and then there are pictures around the edges with the word under each picture. On one page T says, “Haaaaay.”

“Oh!” I say, delighted. “You can read HAY!”

His face lights up. An adult who gets it! Yes! He can read HAY!

On another page he says HAY. “Oh,” I say, “That is straw. Straw is a lot like hay but it’s not exactly the same.”

He is very serious absorbing that information.

I show him my closet. There is a stick horse. Only it isn’t a horse: it’s a unicorn dragon, with a forehead horn and wings. When you press a button it’s eyes flash and it roars.

Ok, that’s pretty scary. He wants the closet door closed and he does NOT want to play with the dragon.

Next is pouring. I get out a towel and put it on the kitchen floor. I get out a rather nice expresso set. Bright colors. Orange and green and yellow and blue. I fill the coffee pot with water and invite him to sit on the towel. “You can pour the tea.”

He looks at me with surprise. He picks up the coffee pot. He looks at me again. “Go ahead. It’s ok.” He starts pouring into a cup. He pours until the cup overflows and the saucer overflows and he keeps pouring. The coffee pot is empty. He looks at me a little warily. This is technically spilling and he knows it.

“Would you like more in the teapot?”

He nods.

I refill the coffee pot with water and he starts again, with a different cup.

When I return him to mom, after two hours, he’s damp. “Sorry, he got a little wet, but it’s just water,” I say cheerfully. Mom is too harried to do much more than look resigned at a change of clothes.

Next time he comes with a change of clothes and his large stroller, in case he goes down for a nap.

And first off, he goes to the closet. Time to hear that dragon roar again.

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even if

even if

I never see you again
you never speak to me again
you never love your bearish parts
you never let yourself get angry
you never let yourself get sad
you never let yourself feel
you tell yourself you are happy
you tell yourself everything is the way it should be

even if

I never see you again

I still love you
I still forgive you

I still love you

I hope that you truly do

find happiness

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Covid-19 Delta Variant

This article: The CDC warns that the delta variant is as contagious as chicken pox and can make people sicker than the original Covid-19

Chicken pox has up to 21 days before you break out after exposure. It is really really contagious. And it is infectious until every pustule has scabbed over. And it can kill people, especially adults. It can also cause some pretty awful birth defects, which is why we ask every patient who is pregnant if they have had chicken pox or the vaccine. If not, we check antibodies. If they have no antibodies and are exposed, they are to get VZIG within 48-72 hours, an antibody to the virus to try to stop the birth defect. In my small town, it’s flown in by the health department.

So as contagious as chickepox is really bad. Chickenpox is worse than influenza. Tuberculosis is a very small bacteria and can be airborne as well.

The delta variant kills people who are unvaccinated at a higher rate than the original Covid-19. The 30-50 year olds are dying.

The delta variant can infect vaccinated people though rarely. The vaccinated people are way less likely to be hospitalized and die. However, someone walking around with delta (vaccinated or unvaccinated) apparently sheds 1000 times more virus than the original Covid-19. This means that we all need to put our masks back on unless we are in our homes with the very small groups we should stick with. If we do not do that, we may have more deaths this winter than last winter.

I double masked on the plane, one flight from Chicago to Seattle, two days ago. I kept the mask on in the taxi and waiting for the ferry. I felt most exposed waiting for the ferry because fully half the people were ignoring all of the mask signs. Ah well. I was going to travel in late August again but the prediction is for a big Covid-19 wave starting to peak in 4-6 weeks. Seems like a bad time to go anywhere, much less on oxygen.

Gather up whatever you need to get through the winter and get ready. Enjoy the August sun, but store up things for this winter. I think it is still going to be a hard one.


There is lots of detail on the CDC website.
will the unvaccinated change their minds in time?

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What do you see?

What do you see in this rock?

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Top ten causes of death: US 2020

Top ten causes of death US 2020, according to JAMA, here.

Total deaths: 3,358.814
Contrast total deaths in 2019, at 2,854,838. That number had been on a very slow rise since 2015 (2,712,630) to 2019 (2,854,838). That increase over four years is 142,208 people. Then the death rate suddenly jumps 503,976 people in one year. Ouch. I cannot say that I understand vaccine refusal.

1. Coronary artery disease: 690,882
Heart disease still wins. And it went up 4.8%. It is suspected that people were afraid to go to doctors and hospitals. I saw one man early on in the pandemic for “constipation”. He had acute appendicitis. I sent him to the ER and his appendix was removed that day. He thanked me for seeing him in person. Might have missed that one over zoom.

2. Cancer deaths: 598,932
This is cancer deaths, not all of the cancers.

3. Covid-19: 345,342
I have had various people complain that covid-19 is listed as the cause of death when the person has a lot of other problems: heart disease, cancer, heart failure. The death certificate allows for more than one cause but we are supposed to list the final straw first. I cannot list old age, for example. I have to list: renal failure (kidneys stopped working) due to anorexia (stopped eating) due to dementia. That patient was 104 and had had dementia for years. But dementia is not listed as the final cause. So if the person is 92, in a nursing home for dementia and congestive heart failure, gets covid-19 and dies, covid-19 is listed first, and then the others.

4. Unintentional injuries: 192,176
Accidents went up, not down, which is interesting since lots of people were not in their cars. However, remember that the top of the list for unintentional injuries is overdose death, more by legal than illicit drugs. If there is no note, it’s considered unintentional. Well, unless there is a really high blood level of opioids and benzos and alcohol. Then it becomes intentional. They do not always check, especially if the person is elderly. The number rose 11.1%, which seems like a lot of people.

5. Stroke: 159,050
This rose too.

6. Chronic lower respiratory diseases: 151,637
This went down a little. This is mostly COPD and emphysema. So why would it go down? Well, I think bad lung disease people were dying of covid-19, right?

7. Alzheimer’s: 133,182
This seems to belie me putting renal failure due to anorexia due to Alzheimer’s. I think they actually read the forms and would put that as Alzheimer’s rather than renal failure, because it is not chronic renal disease.

8. Diabetes: 101,106
This rose too. 15.4%, again, probably partly because people avoided going to clinic visits. Also perhaps some stress eating. Carbohydrate comfort.

9. Influenza and pneumonia: 53,495
So this went up too in spite of a lot less influenza. Other pneumonias, presumably.

10. Kidney disease: 52,260
This went up.

And what fell out of the top ten, to be replaced by covid-19?

11. Suicide: 44,834
This actually went down a little. What will it do in 2021?

So what will 2021 look like? I don’t know. It depends what the variants of covid-19 do, depends on what sort of influenza year we have, depends on whether we are open or closed, depends if we bloody well help the rest of the world get vaccinated so that there is not a huge continuing wave of variants.

Today the Johns Hopkins covid-19 map says that deaths in the US stand at 608,818 from covid-19. If we subtract the 2020 covid-19 deaths, we stand at 263,495 deaths from covid-19 so far this year. Will we have more deaths in the US from covid-19 than in 2020? It is looking like yes, unless more people get immunized fast.

Take care.

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Anomiidae

Walking the beach with a friend a couple of mornings ago, I keep finding shells with a dark marking in the center of the interior and nice shiny interior. Then I find a shell with the other half attached. The other half has a hole in it.

I look it up. This site comes up: http://www.bily.com/pnwsc/web-content/Northwest%20Shells.html. Wow. We filter through it and the shell is in the family Anomiidae. Specifically Pododesmus macrochisma, aka Green False Jingle. It attaches to rocks or other jingles or whatever through the hole. Then it disguises itself. The outside of the shells I found was diverse, some with barnacles. I found a young one, pink, and the radial ridges are visible on the shell.

Cool! Next I tried to identify the two different kinds of chitons. Uh-oh. There are LOTS of chitons. I run out of air very quickly. I will save the chitons for another day. I also returned two sea cucumbers to the sea. The second one scrunches up when I pick her up with a piece of seaweed. When I put the second one in the water, she relaxes. The first one was probably already dead.