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.

sand pattern

I took this photograph yesterday on East Beach in glorious sun.

I left the house to hike at 5:30 am. I didn’t hear about Roe v Wade being overturned until later in the day. I am grieving and will fight for women’s right to determine their own health. Each sperm is alive and each egg too. Don’t tell me they should all be saved, because then we would all starve. Life doesn’t start at conception. I think that some men wanting to control women starts with conception. They certainly don’t want their sperm controlled.

In the photograph are great blue heron tracks. I saw at least three great blue herons. At least four eagles, sitting in the tops of trees along the cliffs enjoying the sun.

The beach changes daily. We go to North Beach and one day it is long stretches of sand and the next it is covered with rocks of all sizes. We have been hiking so regularly that it is really clear that the beach changes as much as human moods! Every tide is different.

Here are chalcedony nodules found yesterday. We still call them agates, but since we are getting fussier and want the clear ones, they are more correctly called chalcedony nodules.

The beach changes like US politics. The water rushes in like a new administration, removes small and large boulders and rushes out again. A new Supreme Court Judge, a new person in this appointed position or that, change, change, change, a new pattern. I am grieving about Roe v Wade, but contributing to the fight for women’s rights and for women’s health. I wish that as a country we were less dramatic and nicer and did not need to have an enemy to shout at all the time.

Maybe that change is coming, but slowly. We might learn from social media and from all sorts of lessons. I have some hope.

Meanwhile I’d rather be with the great blue herons and the eagles.

For the Ragtag Daily Prompt: patterns.

Juneteenth and Father’s Day

Juneteenth and Father’s Day, I am celebrating and thinking of both, and missing my father and my grandfathers. Yesterday was a delayed memorial for my ex mother-in-law. I loved her and we stayed in touch and I continued to visit her and also loved her second husband. He was another grandfather to my children. We had six grandparents, with my ex’s parents divorcing a year after he and I married. Now we have one living. My paternal aunts and uncle have stepped in as the parents and grandparents that are missing for me and my children.

The pressman is my paternal grandfather Kenyon Charles Ottaway. Or Charles Kenyon? Now I need to ask my Aunts. I do not know what year that was taken. He was head pressman in Knoxville Tennessee in the early 1960s. He went by Ken. My Aunt Pat adds that he was nicknamed “Inky” and that the above photograph was taken in Bridgeport, CT. On the back it says ’45, so our guess is 1945.

My father, me, and my sister Chris.

The second photograph is my father, Malcolm Kenyon Ottaway, and me and my sister. My father went by Mac.

Jubilee for freedom and for both father’s day and Juneteenth. I miss my parents and my grandparents, love to all of them. Hooray for Sweet Honey in the Rock, too.

Sending love and peace.

For the Ragtag Daily Prompt: jubilee.

peace me

peace me, loves
peace me, strangers
peace me, Beloved
free us from dangers

peace as a river
peace as a wave
peace as a verb
peace saves

peace my heart
peace all of ours
peace all the friends
peace the wars

peace a gift
peace a joy
peace fearless always
no war toys

peace apparent
peace dove
peace triumphant
peace love

peace me, loves
peace me, strangers
peace me, Beloved
free us from danger

I kept the paper cup in the picture, because the cup is animals and plants, but the cup also is a pair of lungs. Breathe peace. And breathe for all the people recovering from covid-19, short haul and long haul. And breathe love and shelter and support to all those grieving for our dead and let us grieve too.

For the Ragtag Daily Prompt: apparent. And for peace.

Lung swelling and long covid

I wrote this in 2017, about influenza. However, I think covid-19 can do the same thing. Part of long covid is letting the lungs really heal, which means infuriating amounts of rest and learning to watch your own pulse. Watching the pulse is easier then messing around with a pulse oximeter. The very basics of pulse is that normal beats per minute is 60 to 100. If your pulse is 70 in bed and 120 after you do the dishes, you need to go back to bed or the couch and REST.

From 2017: Influenza is different from a cold virus and different from bacterial pneumonia, because it can cause lung tissue swelling.

Think of the lungs as having a certain amount of air space. Now, think of the walls between the air spaces getting swollen and inflamed: the air space can be cut in half. What is the result?

When the air space is cut down, in half or more, the heart has to work harder. The person may be ok when they are sitting at rest, but when they get up to walk, they cannot take a deeper breath. Their heart rate will rise to make up the difference, to try to get enough oxygen from the decreased lung space to give to the active muscles.

For example, I saw a person last week who had been sick for 5 days. No fever. Her heart rate at rest was 111. Normal is 60 to 100. Her oxygen level was fine at rest. Her oxygen level would start dropping as soon as she stood up. She had also dropped 9 pounds since I had seen her last and she couldn’t afford that. I sent her to the emergency room and she was admitted, with influenza A.

I have seen more people since and taken two off work. Why? Their heart rate, the number of beats in one minute, was under 100 and their oxygen level was fine. But when I had them walk up and down a short hall three times, their heart rates jumped: to 110, 120. Tachycardia. I put them off from work, to return in a week. If they rest, the lung swelling will have a chance to go down. If they return to work and activity, it’s like running a marathon all day, heart rate of 120. The lungs won’t heal and they are liable to get a bacterial infection or another viral infection and be hospitalized or die.

I had influenza in the early 2000s. My resting heart rate went from the 60s to 100. When I returned to clinic after a week, I felt like I was dying. I put the pulse ox on my finger. My heart rate standing was 130! I had seen my physician in the hospital that morning and he’d gotten a prescription pad and wrote: GO TO BED! He said I was too sick to work and he was right. I went home. It took two months for the swelling to go down and I worried for a while that it never would. I dropped 10 pounds the first week I was sick and it stayed down for six months.

Since the problem in influenza is tissue swelling, albuterol doesn’t work. Albuterol relaxes bronchospasm, lung muscle tightness. Cough medicine doesn’t work very well either: there is not fluid to cough up. The lungs are like road rash, bruised, swollen, air spaces smaller. Steroids and prednisone don’t work. Antiviral flu medicine helps if you get it within the first 72 hours!

You can check your pulse at home. Count the number of beats in one minute. That is your heart rate. Then get up and walk until you are a little short of breath (or a lot) or your heart is going fast. Then count the rate again. If your heart rate is jumping 20-30 beats faster per minute or if it’s over 100, you need to rest until it is better. Hopefully it will only be a week, and not two months like me!


Feel free to take this to your doctor. I was not taught this: I learned it on the job.

I took the photograph, a stealthie, in June 2021, when I was still on oxygen continuously.

mother

It is my mother’s birthday today, May 31. She died in May 2000. Helen Burling Ottaway and I miss her daily. Hugs to all the mothers and the fathers and everyone who has lost their mother one way or another.

I took this photograph in the mid 1980s, borrowing a camera from a friend.

failure of the medical non-system

One thing that makes me gloomy, as a Family Practice Physician: the only person who has read my medical notes from the multiple specialists is ME.

Since March 2021, I have seen Family Practice, Cardiology, Pulmonology, Infectious Disease, Immunology and Psychiatry. I am in a rural area, so this involves three different hospital systems. They all use the EPIC electronic medical record, but they won’t release information to each other. I have gotten two of them hooked together under ONE of my names and passwords but guess what: my primary care physicain can’t see the notes from the other sites. Only I can. “Proprietary infromation.” Hey, you stupid medical non-systems, this is MY healthcare, MY notes, and YOU SUCK.

My primary care physician COULD request the notes from my pulmonologist but she hasn’t. I find this incomprehensible. I have been on oxygen for over a year. I guess my doctor frankly doesn’t care. Has she farmed my lungs out to pulmonology and doesn’t have to pay attention any more? My goal in practice was to have all of the specialists’ notes. If that was five different specialists, I requested them. Ok, it is next to impossible to get psychiatry notes. I keep wondering if psychiatrists really write notes. The patients never seem to know what diagnosis the psychiatrist is using. One hundred percent of the people that I have seen put on an (addictive) benzodiazepine say that it is for sleep. Meanwhile, at the conferences, the psychiatrists say that primary care should not give the patients benzodiazepines for sleep. I raise my hand: “Even when you psychiatrists have started them? The patients all say it’s for sleep. We don’t know WHAT you have them on it for.” When I try to stop the benzo, the patient has a fit and says that psychiatry said they have to have it. And the psychiatrist has retired or left or changed the phone number and there are no notes ever.

Anyhow, I am counting up specialists. I had really bad strep A pneumonia in 2012 and 2014. Since 2012 I have seen 20 specialists. That is counting the three Family Practitioners, because Family Practice is a specialty too. I thought it was about taking care of the whole person, which to me means reading all the specialists notes, but not one of the ones I have been to has done that.

So the medical system is an abject failure. I blame the US citizens. We choose the system with our votes. We need medicare for all, single payer healthcare, and one electronic medical record for all of the United States. Right now, there is a push to privatize medicare and turn it over to For Profit. We need to fight this and we need to demand better healthcare. Hospital organizations should not be refusing to send my clinic note to my primary care doctor. It is stupid and bad care.

https://pnhp.org/ Physicians for a National Healthcare Program for more information.


Love whole

I loved my liar sister
I love her still

That’s what makes them angry
that I love my liar sister
even though she lied
even though she hurt me
even though she lied to them

That’s what makes them angry
that I love my liar sister
they want to love her lies
they don’t want to know the truth
they want to hide from lies

That’s what makes them angry
they are hella jealous
they want to be loved like that
they want to be loved whole
they want to be loved entire
they want to be loved even when they lie

That’s what makes them angry
they are so afraid to be themselves
they are so afraid to tell the truth
they are so afraid to be honest with each other
they are so tired of hiding

That’s what makes them angry
one says she will be friends
if we only talk about the positive
about my mother, father, sister
I counter: let’s not mention them at all
nor your husband. Not a word.
She doesn’t answer. Silence.

That’s what makes them sad
they don’t want to feel the anger
they deny the heartache
they avoid the longing
they bargain with their souls
they refuse to feel the grief

let us feel the anger
let us feel the heartache
let us feel the longing
let us feel our grief
let us feel our souls

Beloved, we long for you so

Please, Beloved, love us whole

_____________________

My sister sent me a t-shirt from Wicked. She died of cancer in 2012. The deaths from Covid-19 and every death brings her back to me. And this song sums up our relationship.

Playful Packrat

My sister freaks out once. “Oh, my gosh. Our parents still have boxes from their last move a decade later. What will we do when they die?”

Me: “Get a storage unit and open a box a year at Christmas for the rest of our lives.”

Her: “That could work.”

I tell my sister that we could start a magazine in response to Real Simple. “We will title it Playful Packrat.” We come from an impressive line of Packr– I mean, Collectors. Collector is honorable and respected. Packrat is, well, unfashionable. Perhaps I should title it Circumspect Collector instead. I know someone who seems to be collecting heavy equipment, which is an interesting choice. One needs more property than I have for parking.

My house would make Marie Kondo shudder. The photograph is the basement: the stack is my mother’s larger artworks. I am moving stuff around now that I am home-on-oxygen instead of running around clinic like a crazy rabbit. And like this writer, https://www.architecturaldigest.com/story/maximalist-response-marie-kondo-minimalist-mandate, it ALL gives me joy. Well, ok, not the tiny ants. We are at war. My kitchen may be cluttered but by gosh it’s clean clutter because the tiny ants let me know immediately if I screw up.

Anyhow, my mother died in 2000, my sister in 2012, and my father in 2013. My parents left me their stuff and grandparent stuff, some of which I had never seen, and I still get dead people mail. The colleges and universities are the most persistent. They don’t care if someone is dead, they still mail out the Alumni Magazine. I get U of WI, Cornell, Princeton, U of Oregon, Medical College of VA, OHSU and Williston. Holy moly. U of TN and SUNY Binghamptom have lost track of us, thankfully. I wish I had kept my father’s notes on Beowulf and mailed them to Williston for their library. It would be a sort of just revenge. I still have boxes (my excuse is busy physician) so I will bet that I can find something to mail to each one of those places. Something that they want just as much as I want their Alumni Magazine. With a cover letter that says that my contribution is hidden in the documents. One dollar each.

I have too much stuff but I have now turned middle aged, that is, I am over sixty. So I now am on the downward side and decide, there needs to be outflow rather than inflow. I like my stuff but it’s time to start moving it. My mother was a prolific artist and all of the silent auctions in town will now be blessed by her art. And don’t worry, it is not awful! She has art in the Smithsonian, the National Museum of Women Artists, and a bunch of other places. See my April A to Z for details.

For my father it was books and musical instruments. I still have the guitars. I think there were twelve trumpets? A lute, a harp, a cello — the lute is in very bad shape and the others have gone to someone else and the school, respectively. Recorders, gone. I have flutes, my regular flute and then ones made out of clay, cherry, pvc pipe and bamboo, as well as a Native American flute. I am mostly playing the regular flute, Native American flute and guitar.

I am guilty of books, too. I DO want to read them all, but even if I did nothing but read for the next sixty years, I might not finish. The excuse that some are reference does not fly. Some are pure unsullied entertainment and by gosh, I am keeping those! I am not allowed to go to the book sale next week. I do have a library box but the books are not leaving at the rate they have been arriving in the last year. And it’s my fault.

Anyhow, I am enjoying my clutter. After all, we invented tables to put things on. Sometimes we do have to clear the table for the NEXT project, but no worries! There is always the floor!

Cheering up music: