Category Archives: grief

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moon in morning

For the weekly Photo Prompt: Ohh, Shiny!

But, you say, it isn’t shiny.

No, it isn’t. Because even shiny things today are not distracting me from my grief about our country, the lack of ethical morals in our government and twitterpated tweets going out daily.

And here is the moon watching as the sun rises and light and warmth fall over the earth. The mood matches mine: quiet and still thinking of the dark and of love and of hatred and of grief.

Moon in mourning.

 

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Forgiveness 2

I wrote this poem in 2009 when I was struggling with forgiveness and wanting to forgive. How do we forgive when someone does not apologize? When they do not explain nor listen to your hurt and grief? Yet forgiveness is internal in each of us. The external is reconciliation and that requires listening from both sides.

Forgiveness

I want to forgive something
Someone
In fact a group
Something that hurt a lot
I’ve tried logic
I tell myself
“It was an expression of concern”

My heart doesn’t agree
It is sullen
Immobile and grumpy
It whispers
“They have not apologized”
It whispers
“When people say you’re crazy
It could be a joke
An expression of concern
It wasn’t
It was a palm held out
At arm’s length
To distance me.”

My head argues
“That’s what it felt like to you.
You don’t know their intentions.”

I want to write
A poem of forgiveness
Hoping my heart will follow

My conscious doesn’t write my poems
My conscious wrestles with an idea
The poem comes out of this struggle
I look at the poem I’ve written
I think,
“That is what I would like
my conscious heart to feel.”
My poem is often more generous
than my conscious feels

My poems are not mine
They are a gift
From the unconscious
It is much larger
Than the small conscious me
I dream of feeling envy
I climb into a bathtub
And transform myself
To battle a trickster
We are transported
To the bottom of the ocean

In the ocean
The trickster and I are one
It is unlimited
It is not my unconscious
There is no separation
It is all unconscious

I did not think
A poem would give forgiveness
But pain drove me
Into the sea
I am connected
You gave me these pearls
Thank you

 

I am submitting this to the Daily Prompt: jiffy. I wish this could happen in a jiffy…. but it is slow….

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halo stealthie

In the early morning in Wisconsin, I saw a halo… I am sending the halo to all the people who stood and stand up against white supremicism. I am sending the halo to all people, all colors, all genders. And we couldn’t see the halo unless the shadow were present, could we? There is no light without contrasting dark and we must love both the shadow and the light. I am not ok with white supremicism. Please, send this halo to those who stand up for love and equality and against discrimination.

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There is no blame

This article came up yesterday on Facebook:

http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-silk-ring-theory-20130407

How never to say the wrong thing….

Well, now, wait. What the hell is your goal? To always comfort people? To always say the right thing? Peaceful and sweet and niceness all the time?

Why?

And isn’t it dishonest?

Isn’t a true friend that loves you the friend who says, hey, this guy you are dating sounds just like the last one, didn’t you say you weren’t going to do that again?

Even if it makes you mad. And you forgive them because damn it, they are RIGHT. You might not forgive them right away. It might take a while. You might shun them and then have to do some crawling and apologizing.

Our society is terribly afraid of emotion. Don’t say the wrong thing. Do not make someone angry, afraid, never ever hurt anyone.

Except…. I am a physician. And I’ve had my mother and then my little sister die of cancer.

With my mother, we did what she wanted. She was home for 6 weeks in hospice. My sister and I cried for two minutes after I told her the surgeon said feeding her iv would kill her faster. We took her home on iv fluid and morphine to starve. She was tough tough tough. We had over thirty visitors from as far away as London.

My partner was her doctor. She did a home visit and she cried. Afterwards my mother said, “I didn’t appreciate that.” So we did not cry.

My sister did one day when I was at work. She started crying after my mother was asleep in the hospital bed. She called me. “I started crying. And everyone left. Everyone left the room. Not one person stayed with me.”

Ouch. Now I can see that once my sister started, everyone was afraid that they would start too. So they all left.

I stopped talking. In the fifth week, family called and I was handed the phone. “How is she? Are you ok?” I just held the phone. I knew I was supposed to say reassuring things, I am ok, she is ok, but I wasn’t and she wasn’t. She was dying and I was broken, weeping inside. So I just held the phone, silent.

My mother died. We were all exhausted. And for the next two years I thought about it…. and one thing that I thought was, I wish she had let me cry. I did what she wanted. We all did. But in the end, I never got to cry with my mother and say how much I was going to miss her.

And maybe she would not have appreciated it. But I am her daughter! Don’t my feelings and wishes matter? There are two of us in this relationship!

Then my sister got breast cancer. At age 41. Stage IIIC. And this time I thought, I will be different.

I refused to do what she wanted. I told her I loved her, I told her when I was mad at her, I told her when she was hurting my feelings and when she was being wonderful. I held BOTH of us close. I held her close but I refused to let her go into the cancer bubble where no one was telling her the truth.

I was dating a man who complained. He told a couple’s counselor: “I want her to do what her sister wants or cut her off.” I explained about my mom. I explained about the cancer bubble, where people stop being honest and only do what they think you want. The counselor defended me.

And I think I did the right thing. For me. AND for my sister. Because our last day together, she thanked me and she even apologized for something… and I got to say “I love you anyhow.” I meant it to my bone marrow. People yelled at me for being grumpy, bitchy, not doing what she said…. but I was my real self with her. And she knew it. And she also knew I love her and stayed real with her.

In the hospital when someone is very sick, families fight. They argue. They get angry. The emotions are running high. The doctors, the nurses, the janitors, the desk people, we are used to it. People yell, they cry, they behave badly. But their hearts are breaking, why would we expect them or order them to behave well? Honestly, sometimes they work off some of the anger part of grief by fighting with each other.

In clinic sometimes I am handling a room: a person with cancer with a spouse and one or more children. Adult children. People handle death in different ways. Siblings fight before and after a death, “You aren’t doing right.” We are all different. The way I grieve is different from the way you grieve. There is no wrong, there is no blame.

My sister wanted to handle her cancer with grace. Grace, it’s complicated. For me, the greatest grace is honesty.

I want to die singing, crying, going to see the people I love that are gone, and honestly. The I Ching sometimes says there is no blame. Think if we could all accept each other’s honest emotions. The most beautiful harmony is sometimes the resolution of dissonance. Goodbye, goodbye, I will miss you so….and there is no blame.

 

For the Daily Prompt: harmonize. I took the photograph of my sister four days before she died.

 

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play

I took this in 2005. My daughter is going after our friend Sam. She is wearing glow in the dark vampire teeth. He is going along with it and playing along. Three of us are playing because they are my glow in the dark vampire teeth. I have a strong connection with that playful inner child part and so I always have some toy in my dopp kit. Glow in the dark vampire teeth. Temporary tattoos. Glue and glitter for temporary tattoo stencils. A friend once looked in my dopp kit and was very surprised. His only contains toothpaste and toothbrush and razor and practical things.

Blessing on Sam and all the adults who play when the time is right….

dopp kit: http://shop.wingtip.com/why-is-it-called-a-dopp-kit

 

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I miss your skin

I miss your skin

the planes of shoulder blades
layers of muscle overlying them
the trapezius sweeping up to the base of the skull
and down to the tenth vertebrae
like a wing pointed inwards
on your back
and attached to bones

more and more in clinic
I pull out Netter’s beautiful drawings
and show people the bones
and that the bones are not just floating
in a sea of muscle and organs
every bone is attached to muscles
to tendons to ligaments
together in an elaborate
beautiful
working system
and if one muscle is torn too loose
or tightens to protect itself
and heals scarred calcified
too short
it pulls on the other muscles
and tendons and bones

I miss your skin
your muscle
your tendons
your ligaments
your bones

and all the rest

 

I took the photograph in the boatyard in 2016. Sometimes I dream I have feathers….

 

 

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bye bye doctors

stop this healthcare bill… until there is transparency… or this will get worse.

 

I am grieving, watching doctors leave.

I have been in my rural county, 27,000 people, for 17 years.

Doctors are leaving. Wake up, United States.

The trend when I got here was that we had 14 primary care doctors and 5 midlevels. For years, we lost one primary care doctor a year. I would grieve and it would mean more work, every year. We would get a new doctor, but often there would be a gap… I made up a game to help cope with grieving. I call it “Local Doctor Survivor”. I would bet on the next doctor to leave and also on their trajectory. One of three: nice doctor, angry doctor, doctor labeled nuts. Burn out.

But…in 2015 it jumped. Suddenly we had 3 primary care doctors and two midlevels leave. Uh-uh. One was a husband and wife, doctor and nurse practitioner. One switched to being a hospitalist. Another left. And another midlevel. By then, we still had 14 primary care doctors, but the number of midlevels, nurse practitioners and physicians assistants had risen to 12. Ok, 12 plus 14 is 26. One fifth left. That is a bad trend.

In 2016 another physicians assistant retired. One of the best. I stopped counting who was leaving. Until another doctor announced they were leaving in February 2017. One of the best. That doctor said that a 20 minute visit generates 1 hour of paperwork. If one works “full time” the quota of patients is 18 per day, 72 in the four day week, and that is 32 hours four days a week of 20 minute visits. Generating 72 additional hours paperwork. That is 104 hours a week. Unsustainable.

The 2016 salary information is out for primary care. The “median” family practice physician in the US makes $168,000. Ok. But every doctor given as an example works 60-70 hours a week. Maybe that salary is not as good as you think. Because they are quitting.

Our neurologist retired, in about 2010. I was bummed. The county north of us has 75,000 people. They had two neurologists. Both left in the last two years. The county south of us has 350,000 people. They had five neurologists. Two have left, including my current favorite. For the first time in 17 years I have a neurology referral refused: and not one, but two. Send them to the big city, says one. The other just says no.

I call ENT and he bemoans that now they are down to three in the county. Another left. Three there, one on the county north of me, great, we have 4 for 450,000 people.

I get a letter from one of the two neurosurgeons in Seattle that I like best. In 2016. He is leaving to go do medical administration in another country.

Our three counties are down three dermatologists. One sent a letter. “I am quitting on October 1, 2016, unless ICD-10 is cancelled.” ICD-10 is the new manual of diagnostic codes. It was not cancelled so that dermatologist quit. We have to code every diagnosis. ICD-9 had 14,000 codes. ICD-10 has 48,000. I am memorizing the new ones. I10 is hypertension. E11.65 is type II diabetes in poor control. I used to be able to write a prescription for diabetic supplies, lancets and glucose strips. Now I have to include the ICD-10 code on the prescription and often the pharmacy cites medicare and demands that I fax proof that I have seen the patient and that the patient does indeed need the prescription. I frankly have better use for my brain than memorizing the ICD-10 codes, but whatever.

Another clinic closed in the county north of us and our county. Then the main clinic closed in the county south of us. Within two weeks. 3500 patients needing primary care providers and refills and we can’t get old records because the rumor mill says it was a “hostile takeover”. That is, the person who owned the clinics quit paying the bills, so the electronic medical company won’t release the records. Great.

I have been absorbing about one new patient per day worked since March, but I am getting tired and will have to back off.

Meanwhile, our county hospital has been hiring specialists. Gynecology, new orthopedists, dermatology. Great, right? But currently most specialists won’t take a new patient without the patient having a primary care doctor. Why? Well, one of the new trends is that the specialist says the patient needs something but that I should order it. Yep. Had one of those yesterday. The specialist says I should order it. It’s a veteran. So I get to fill out the VA authorization paperwork with the ICD-10 codes and the CPT code for the study, fax that to the VA, call the patient and remind him to call triwest, because if the patient doesn’t call then triwest throws the authorization paperwork out. And the specialist makes more than 5 times the amount I do. Maybe I should retrain. I am a specialist: family practice, three year residency, board certified, board eligible. But….. I have little value in the United States.

We are seeing Veterans in spite of the extra paperwork. Triwest is sending us 5 from Whidby Island. They have to take a ferry to see me. Because no one on Whidby is taking veterans. My receptionist complains to triwest about all the doctors leaving the Olympic Peninsula.

“No,” says the triwest person. “Not just the Olympic Peninsula. The whole west coast of the US.”

 

http://www.aafp.org/news/government-medicine/20170620senatespeakout.html