float

I took this with the zoom all the way out. We’d argued about whether it was a log. I said it was not a log. I was correct.

This creature is definitely bouyant but is not floating in the picture. He or she is lying on a high sandbar or piece of rock. There wasn’t room with the others, or perhaps he or she eschews the crowd.

For the Ragtag Daily Prompt: bouyant.

Defiance

Ok, this is a beautiful and romantic song, and yeah, George Strait is pretty.

And then there’s the Offspring. Singing Self Esteem. Guess which I like better.

The Offspring: defiance and singing about all sorts of things that we don’t talk about: “The more we suffer the more we really care!” Some of my patients needed to listen to this song. Often the mom, with a spouse and three children, who was taking care of all of them but not herself. “Who takes care of YOU?” I would ask. “No one,” some moms would say. “Look. There are FIVE people in your family. You are one of them. You deserve the same level of care that the rest of them are getting. I want you to include yourself in the people you take care of.” “BUT” “NO BUTS. If you don’t, then you are setting expectations for your children: the boys that a wife will take care of them and the girls to be walked on. Is that what you want?” “NO.” “Change it.” They often would, slowly but surely.

And The Offspring are further my heroes because of this song: Opioid Diaries. Ok, a punk band telling opioid overuse people to get help. MY HEROES! Thank you Offspring!!! It’s not easy to watch but wait until the ending and what if offers. I treated opioid overuse for the last 12 years in my small family practice clinic along with everything else: diabetes, hypertension, whatever. I never felt threatened or frightened, but some of that is because I grew up in an alcohol family. I recognize addiction. Reminding my of my parents is not a good sign. And I had to learn boundaries at home first. This is an uncomfortable video to watch but to me it is beautiful, because it offers hope.

Friends and illness

The good thing about getting deathly ill is that you find out who your friends are. They stay by you. Even if you are misdiagnosed, labelled, ignored.

It is harder to ignore me now that I am on oxygen. It is difficult to chalk oxygen up to a rumored behavioral health diagnosis. When you have pneumonia and are confused, that is called delirium, not mania.

The bad thing about being deathly ill is that you find out who is NOT a friend. They disappear like rats leaving a sinking ship. Actually I like rats better.

I have one person who says, “I like you well, not sick.” Um, I would rather stay well too. But having seen fully 20 specialists, including four pulmonologists since 2012, a cure seems unlikely, doesn’t it? Meanwhile I seem to be getting stronger in pulmonary rehabilitation. Treadmill, classes about the lungs, stretching and weights.

Another person states, “if you get sick again, I am gone for four months.” Not a friend, right? Not a true friend and never ever will be. They do not understand friendship.

A true friend shows up at my house in 2012. I am lying on my bed using my father’s oxygen. She glares at me. “YOU are coming to MY house.” My reply: “OK.” I survive, even when the hospital sends me home with strep A pneumonia and delirium. Helps to be a physician, though I had to just trust myself, even delirious. The true friends help save me. I can’t even say how grateful I am.

I have a new friend. She is ill. It is progressive. Her husband seems so surprised that I come to see her. But I know how terribly lonely it is to be abandoned when you are ill. I have been there four times.

Blessings on the true friends.

Here is my sister’s blog. I remembered this post as “caged”, but her word is “trapped”.

https://e2grundoon.blogspot.com/2010/12/

My sister died of breast cancer in 2012.

Over The Rhine – The Laugh of Recognition

Why I hate insurance companies: 1

I had cobra from my job in 2009 and the insurance company refused my bills. Not one bill. Not once. EVERY BILL EVERY TIME: 1. my healthcare 2. my son’s healthcare 3. my daughter’s healthcare 4. my daughter’s orthodontia 5. my dentist 6. my son’s dentist. I had to call EVERY TIME to get them to pay. Calling an insurance company takes 25 or 30 minutes, right? Eventually I asked for customer service who first said it was my fault because “you probably paid the bill late”. I said, “No, I was on time every month.” Then customer service wouldn’t call me back. I finally called their COUNSELING HOTLINE, since it said I would be “paid” $30 to get counseled, and said, “MY LITTLE SISTER IS DYING OF BREAST CANCER AND THE THING THAT IS MOST STRESSING ME OUT IS YOUR INSURANCE COMPANY WON’T PAY THE COBRA BILLS AND I HAVE CALLED CUSTOMER SERVICE OVER AND OVER AND THEY WON’T CALL ME BACK. HOW ABOUT YOU COUNSEL ME HOW TO DEAL WITH THAT!” And I cried. I got a call back from the head of customer service saying “Oh, it’s a computer glitch and we had you misfiled. We have fixed it.” They “misfile” people all the time, or drop patients if they get sick, or say the person didn’t pay on time. I HATE INSURANCE COMPANIES. Anyhow, be warned that insurance companies are there to earn money and will try to avoid paying you in all sorts of ways, including ways that are illegal.

We need single payer healthcare, medicare for all. If we all have healthcare, think of how many small businesses would start up. And why don’t we have single payer healthcare? I think the big corporations don’t want it.

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

Medicare for all: https://medicare4all.org/

And my dear friends not on the road any more: http://madashelldoctors.com/

Who is the man in the photograph? I don’t know. This is an old tintype. They came from my Great Aunt, Esther White Parr, married to Russel Parr. Perhaps they are Parrs, because my Uncle Rob did not know any of the people in the four tintypes I have. My sister and I used them for portraits in our china doll houses. I hope he is not the CEO of an insurance corporation, but then, all the white collar white men tried to dress that way then.

medicine

I was thinking of old medicine bottles for today’s prompt, but I think hiking is one of the most medicinal things I do. Healing. Freeing. Feeling the changes in the air, seeing the forests and the water here, being very present. Peaceful.

For the Ragtag Daily Prompt: medicinal.

skulls

I took this on my trip in March 2022. So far no one has guessed where I was correctly. There is a wonderful Zoology and Science Museum. A mystery for you to consider, where was I?

For the Ragtag Daily Prompt: ancient.

Adverse Childhood Experiences 14: Hope

I keep reading bits about despair and about how a generation of children is being “ruined” by the pandemic.

Not so, I say. There is hope. We need to support each other to survive and then to thrive.

This generation WILL have a higher than average ACE score. If the Adverse Childhood Experience scale is from zero to eight, children in this time period will have at least one higher point than average and many will have three or four or more. Loss of a parent, a sibling, beloved grandparents during covid. Increases in domestic violence, child abuse and addiction. These are all part of the ACE score.

What does this do to children? They have survival brain wiring. They will do their best to survive what is happening. A friend and I both have high ACE scores, 5 or more, and we are both oppositional defiant. We showed this in different ways. He grew up in the same community. He escaped from home and knew all the neighbors. He walked to the local church and attended at age 3 or 4. He has lived in this community all his life.

His oppositional defiance showed up at home, where he consistently refused to obey. And in school, where he confounded and disobeyed teachers and passed anyhow.

My family moved every 1-5 years. I hated moving. I wouldn’t talk to kids in a new school for a year. It was very difficult. So my oppositional defiance was very very internal. I hid in books and in my head. In 6th grade I got in trouble for hiding novels inside the school book I’d already read. I also would just not listen and my respect for the teacher got even lower when she would be angry that I knew the answer to the question once she’d repeated it. I wasn’t listening because I was bored. She was the first teacher that I thought, well, she is not very bright. The next year they stuck me in the honors class and I stopped being bored, though I still questioned practically every opinion every teacher had. I wanted evidence and I did not believe it just because the teacher said it.

I am not saying that oppositional defiance is in every high ACE score. I don’t know that. Why oppositional defiance? Imagine you are a small child and you are beaten. There isn’t rhyme or reason. You can’t predict when the adult will be out of control. Why would you behave “well” if it makes no difference? You might as well do what you want, because nothing you do will change the adult. Or imagine you are a small child who is with one person, passed to another, then to another. You may not exactly trust adults after two or three repetitions. And you want to survive.

There is an increase in addictions, behavioral health diagnoses, and chronic illness in adults with a high ACE score. A researcher when I first heard a lecture about it said, “We think perhaps that addiction is a form of self medication.” I thought, oh, my gosh, how are we ever going to treat THIS? Well, we have to figure that out now, and we’ve had 30 years to work on it.

I was very comfortable with the oppositional defiant patients in clinic. I got very good at not arguing with them and not taking their behavior personally. They might show up all spiky and hostile and I might be a little spiky and gruff back: sometimes that was enough. I think the high ACE score people often recognize each other at some level, though not always a conscious one. With some people I might bring up ACE scores and ask about their childhood. Sometimes they wanted to discuss it. Sometimes they didn’t. Either was ok.

One thing we should NOT do is insist that everyone be “nice”. We had a temporary doctor who told us her story. Her family escaped Southeast Asia in a boat. They had run out of water and were going to die when they were found by pirates. The pirates gave them water. They made it to land and were in a refugee camp for eight years or so. She eventually made it to the US. She was deemed too “undiplomatic” for our rural hospital. I wondered if people would have said that if they knew her history and what she had been through. It’s not exactly a Leave it to Beaver childhood, is it? When she was telling us about nearly dying of thirst in the boat, my daughter left her chair and climbed on my lap. She was under ten and understood that this was a true and very frightening story.

We can support this generation of children. This has been and is still being Adverse Experiences for adults as well. Family deaths, job loss, failure of jobs to support people, inflation. Remember the 1920s, after World War I and the last pandemic, of influenza. “On October 28, 1919, Congress passed the National Prohibition Act, also known as the Volstead Act, which provided enabling legislation to implement the 18th Amendment.” (wikipedia). There were forces trying to legislate behavior, as there are now. The result in 1920s of making alcohol illegal was speakeasies, illegal alcohol, and violence. Some people acted wild after WWI and the influenza pandemic and some people tried to lock down control, by controlling other peoples’ behavior. It did not work then and it will not work now. The wildness is out of control grief, I think, grief dysfunctional and drinking and shooting and doing anything and everything, legal or not. We remember how the 1920s ended too. Let us not repeat that. Let us mourn and grieve and support each other and support each other’s decisions and autonomy.

Blessings.

angels

The Ragtag Daily Prompt is halo, and I wrote this yesterday, after a discussion with a new friend about angels and my angel dream.

______________________________

angels

light angels fall into dark

dark angels fall into light

there is no separation

we are longing for the Beloved

we are longing to be reunited with the Beloved

we have never been separate

we are one

light falling in to dark

dark falling in to light

seeing both is grace

no separation