Category Archives: hope

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Release the Kraken!

I chose measly for the Ragtag Daily Prompt because there is a measles outbreak. Great. Another outbreak? Yes. Parents are behind on bringing kids in for Well Child Checks and kids are behind on immunizations, so measles.

Measles is way more infectious than Covid-19 and is spread by coughing and droplets. Per the CDC: “Measles is one of the most contagious diseases. Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected.” Read here. Immunizations are at 18 months and age 4-6, two shots. That will make the vast majority of children immune but not quite all. No immunization reaches quite 100%. Measles unfortunately can have some awful and serious complications including death. If your child is behind, get them immunized as soon as possible!

If some has the measles, the rash, they are measly. That is one of the definitions of measly.

Measly weasely
You are so teasely
Your heart has a rash
Our friendship is hash
You toss me like trash
Your heart just smashed
You are so measly
Weasely teasely

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I keep wondering if the earth is annoyed at the way people are behaving. Perhaps she has said, “Release the Kraken!” But the most efficient Kraken turns out not to be a giant monster attacking New York City, but Covid-19, influenza, measles and strep A. Invasive strep A is out there too. Having had strep A pneumonia and borderline sepsis twice, I very much do not want invasive strep A.

It’s the little things that get us, right? Viruses, bacteria. Measles is a virus, like influenza and Covid-19. Strep A is a bacteria. I had very bad influenza in 2003 that put me out for two months. I read about influenza and thought, oh, we will have another pandemic and in fact we were overdue. They come about every fifty years. My children heard quite a bit about it. My daughter said she wondered if I was a little nuts until the ebola outbreak and then she decided that I was probably and unfortunately correct. The only surprise for me was that it was a coronavirus instead of influenza. That and that humans behave in very interesting and often dysfunctional ways when they are stressed: and the same ways as in the 1918-1920 influenza pandemic. Logic flies out the window replaced by panic, magical thinking and rumors and people happy to take advantage of others. Selling fake cures, refusing masks, refusing immunizations and denying that it is happening at all.

For the Ragtag Daily Prompt: measly.

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Hopes rise

Our Christmas plans are busily crashing and burning. I felt ill and tested covid positive two days before my daughter was due from her city. ALERT, ALERT, DIVERT! I called friends who agreed to pick her up at the airport and let her stay for the five days of isolation. I stay out of the car so the germs will die. I call her after her work on Friday. She takes it calmly and calls a friend to pick her up. I miss her, darn it, but well, I am not on a ventilator or dead. Doing well, right?

She stays with her friend. She plans to join me yesterday but then snow. School is canceled. She and her friend sensibly leave my car at the entrance to the ridge road the friend lives on. She has to use the chains anyhow because someone has slithered off the road right in front of my car. Still grateful, because they did not hit my car.

She makes it to my house, chains on. She heads downtown to Christmas shop but the store she wants is closed. I ordered her a present that needs to be picked up, but the pick up is Tuesday to Saturday. They don’t list a phone. I ordered it on Sunday and they had emailed “Pick up now” even though it’s not “open” on Sunday. I email back, “Can’t, covid!” Now I email again and say would they contact my daughter or me so she can pick up. They do, but well after she is home. Still grateful, because they are open today. Maybe we’ll get it!

My daughter has been looking forward to time with friends but the snow has screwed this up. Maybe to time with mom, too, but mom has Covid. I am eating upstairs, she is eating in the basement, and same with sleeping. We are both masking and everyone is sick of that. It’s cold outside and the band she wants to dance to cancels. She misses meeting a friend downtown because of chains and needing gasoline. I am still grateful. Not dead yet, right?

Now I have email from our flight saying, well, maybe we’ll go. We are supposed to fly later this week. It looks like the big storm will hit Chicago and Buffalo and Boston. Cross fingers as we head for Dulles. Might make it. We discuss going to Sea-Tac a day early but that would mean sleeping in the same hotel room and no, we aren’t going to do that. Friends say they CAN get us to the airport. Super grateful for those friends!

When things are going all awry and life seems like rather a mess, we do Happy Things. That is a check in at the end of the day where we list three Happy Things each. My son was having a miserable half way through the year first grade move when we started this. The thing is, they do not have to be VERY happy. They can be more along the lines of “No one has poured boiling oil over me today.” or “Not dead yet.” It’s complaining reframed and it can be very very funny. In first grade one of his Happy Things was “We did not have the pizza that tastes like cardboard for school lunch today.”

So my Happy Things yesterday were: “I am not on a ventilator! I am not dead! We have super nice friends who will take us two hours to the airport!” If you start low enough on the Happy Things scale, there is no where to go but up.

And a Happy Thing for today: “I think the sun will rise!”

Happy Solstice.

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The photograph is Emerald, one of the Anna’s Hummingbirds, all fluffed up in the cold and guarding her feeder. There is a bird photobombing the background. I think it is a song sparrow but it was very early and the light is not great.

For the Ragtag Daily Prompt: rise.

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Heart meditation for the Solstice

It snowed last night. Covid is making me fall asleep at 4 or 5 pm which means I am very awake at midnight. The cats and I checked out the snow at 1 am.

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Avalokitesvara Bodhisattva is the Bodhisattva of Compassion. He is enlightened, yet chooses to return to earth over and over, until everyone is enlightened.

In China, he changes gender and names into Kwan Yin, the Bodhisattva of Compassion.

In college I date a lapsed Jewish Zen Buddhist and I learn to meditate. At the group meetings there are 6 or 7 of us. The Heart Sutra is recited and we meditate facing the wall, sitting on our zafus, for 40 minutes. It is easier to meditate in a group, though I have no idea why. Pride? Some connection to other’s breathing? The breathing will serve me very very well later, when I keep getting pneumonia. The ability to slow my breathing will help me survive.

When we had a group meditation, the Heart Sutra was read slowly and clearly. It has it’s own rhythm. I had lost it and finally found the translation we used. Here it is:

There is more than one translation, here: https://dharmanet.org/HeartSutra.html. I have tapes and books by Jon Kabat Zinn, who has studied mindful meditation for 30 years. He gets better results in his mindful meditation pain classes than opioids, with an average decrease in pain of 50%. His tapes have the same slow gentle speech as our Heart Sutra readers. It is hypnotic and I can relax. Though my oppositional defiance kicks in when he says firmly that I am to fall more awake, not asleep. I listened to that CD every night for a year after my father died. When he would tell me to fall awake, I would smile and slide into sleep, a happy rebel. I was comforted that I did not have to do what he said.

Where is the Avalokitesvara, the Kwan Yin of the West? What examples in the largest religions are there? Someone who stays even after they have achieved enlightenment/heaven because they want everyone there. Not only that, but they believe everyone can be there. And they will not give up until everyone is there.

I was surprised when a Unitarian Minister stated that Unitarians do not believe in Hell, because a loving creator would not consign anyone to Hell. I didn’t really want to give Hell up, but I also agree that a loving creator would not consign anyone to hell. It’s a bit easier for me to think of people as continuing on a wheel of life until they achieve enlightenment than to think of some people going to Heaven, but after all, I don’t know the whole story. No one knows another person’s whole story. I wrote DMV to figure out the Hell/Heaven thing. And the lead character wants to go back, because her work is not done yet.

I am thankful for paxlovid at the moment. I am thankful that I found this translation of the Heart Sutra.

Happy Solstice.

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The first photograph is Elwha looking very meditative after going out in the snow. Here they both are in the snow:

For the Ragtag Daily Prompt: solstice.

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Feed the birds

I fill the bird feeder, a day late, because I had to go buy more birdseed. I also buy suet and fill that feeder. I walk both cats, harness and leash, one at a time. I put both of them in the outdoor screened animal container and they crouch, riveted watching the birdfeeder. I put four peanuts along the top of the fence.

I hold a fifth peanut in my hand over my head and wait. It starts snowing, just a little.

The flock of goldfinches, in their winter more subtle coloring, shows up. I count nine. The feeder can hold 6 at a time. They ignore my hand. A stellar jay comes by, but stays high in the tree. Chickadees pop in between the goldfinches. They are rounder and a little bigger and talk to me. No one comes to my hand. Juncos come to the ground beneath the feeder. The cats would REALLY like to catch them.

And then a bird does come. A hummingbird comes to my hand and hovers right by it! It does not land. It doesn’t like the peanut. It then goes and buzzes the glass, where I used to have a hummingbird feeder up, until the ants find it.

I laugh and get the other hummingbird feeder. I make food and wait for it to cool. I fill both feeders. The Anna’s hummingbird finds it within 15 minutes and eats a lot. The other feeder is on a different window, right outside my desk window. It is soon occupied by a second hummingbird.

I hope to have more photographs soon.

I took this out my desk window yesterday.

There is avian influenza around. I have two feeders and wash one very thoroughly in hot water and soap each time. I change the feeder out every time, to try to reduce the chance of the feeder passing on infection. And wash my hands very well too.

Though it’s rather more than tuppence a bag!

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In the dark

I choose to dwell in the dark with the monsters.

I came here because I wanted to understand how people could be monsters. People turn in to monsters sometimes. Not the crazy people or the serial killers: just normal people. They have enormous fights in their families. They get drunk or use drugs. They kill themselves with cigarettes. They sit unmoving in front of the television. They fight family or close friends. Families sue each other over the parent’s will. They fight over the stuff or over mother or over who will take care of father. They disown each other. They say “I only let nice people in my life.” That leaves me out. And I don’t want anything to do with anyone who says that. That is monstrous. Do they turn the other cheek? Do they love their neighbor as themselves? No. They are monsters.

I kept studying the monsters and studying them, until I found my own. I rescued mine from a deep hole. The monsters were babies. They were filthy and frightened and crying and abandoned. I washed them and diapered them and fed them and wrapped them in blankets. They stared at me, sullen. They had no idea how to respond to being cared for. I had to learn to love them. I loved them right away, even though they were monsters. I cared for them and they grew up, loved, happy, adults.

And then I see the monsters in other people. People hide their monsters, stuff them in dungeons, neglect them, deny them, scream at them. The monsters realize that I can see them and they start crying. “Help us! Please! Let us out! We are cold! We are hungry! We are neglected!” I learn not to talk to the monsters until the person is gone. The person may never talk to me again if I acknowledge the monster. They think I am the monster. I’ve reminded them of theirs or named them! Most people hate it. I learn, slowly and painfully, that I can only talk to the monsters after their people leave. The monsters hang around. They tell me their stories. They tell me their misery. I hold them while they cry, heads in my lap, howling and breaking things. But eventually they have to return to their person, to their jail, to their suffering.

I like the monsters better than the people. Some people wear the monsters on the outside. Veterans, almost always. To keep people away. They come to clinic and try to scare me. This is very very difficult because I like the monsters. I am delighted to meet the monsters. This is startling and the veteran promptly calms down. I am not afraid. I like the people who wear their monsters on the outside: they are not hiding them. It’s the ones who hide and abuse and torture their monsters: I do not trust those people. And I feel huge grief and sorrow, pity for their monsters. I can’t fix them. The people must each turn to their own monsters. Let them come to consciousness. Face them, comfort them and at last, love them. And this is hard. It is very hard. It is a life time of work. It is emotional maturity. It has nothing to do with educational level. It is hard work worth doing.

I choose to dwell in the dark with the monsters. Because they need me most of all.

Blessings.

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Vaccination talk

My cousin asks me once, why do doctors say, “This will only hurt a little?’ when they give a shot.

I thought about it. “It’s a matter of scale. Picture this: in room one, I have a woman who thinks her lung cancer is back and it is. In room two I have a mother and daughter crying because the daughter is pregnant and frightened. In room three, I have a well adult who needs a vaccination. Scale their levels of pain.”

Room one is very high, room two is very high, room three barely registers on my pain scale.

Poll: 1 in 7 parents have not talked about vaccines with their child’s doctor

I would give out a health department vaccination information booklet by 24 weeks to my pregnant patients, especially the first pregnancy. I previously had given it later, but then I had a woman who refused the child’s vaccines at visit after visit after visit, saying that they were still doing research. The child still had no vaccinations at 9 months.

Remember the woman who refused vaccinations for her children? She had more than four children. They all got whooping cough, pertussis. They whooped for months and were on quarantine. They were not allowed out of the household, any of them, until they were no longer infectious. The mother said she now was for vaccines and got them vaccinated.

I have seen adults with pertussis. Adults do not whoop but they cough. They can cough until they throw up or until they break a rib. For months. It is not fun at all. The adult Tdap stands for tetnus, diptheria, and acellular pertussis. I have never seen a case of diptheria and I don’t want to. It sounds horrible and can kill.

Have I seen a complication of a vaccination? One in 30 years of practice. And I know a person who had a complication, but they were not my patient.

The illnesses cause way more damage and disability than the vaccine. In residency I care for a young man in a group home. He can’t talk and has an odd skull shape. His mother got measles during the pregnancy. Measles is one of the infections that can cause severe birth defects. Get vaccinated before getting pregnant, though half the pregnancies in the US are “unintended”. That usually means “unbirthcontrolled”. I do not really understand that, since the risk of pregnancy in a fertile woman is one in four every time. Twenty five percent seems a pretty high risk to me.

I’ve written about my response to my last Covid-19 vaccination. It’s not a complication. It is an antibody response and it means that my immune system is WORKING, though admittedly it is weird and annoying. I don’t like the muscle dysfunction, but I will get the vaccinations anyhow.

I have a very alternative young woman in for prenatal care once. I give her the vaccination booklet. “Oh, my child is getting every vaccine there is,” she says.

“May I ask why? I was not expecting you to say that.”

“I was in the Peace Corps in Africa. I have seen kids die from every single one of the diseases we vaccinate for. My kid will get ALL the vaccinations.”

I said, “Please would you talk to my other moms?”

She smiled at that. “Maybe.”

I hope she did and does.

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Galatea

I walked downtown in the sun the last two days. It is gorgeous with the leaves still on the trees and falling. Usually it is raining now, so the beautiful fall weather is a little disconcerting. A bit worrisome, even as we enjoy it.

The statue is Galatea, the Haller Fountain, here: https://porttownsendvirtualartmuseum.org/pages/Galatea.html.

Galatea is one of fifty Nereids, sisters, born to Nerius, the God of the Sea in Greek Mythology. The statue that was granted life in Pygmalion by Aphrodite is also Galatea. Galatea is also the fourth inner closest moon of Neptune.

If she comes to life, what will she do? I keep thinking that the earth is coming awake and shaking us to wake us up. Storms and earthquakes and hurricanes and floods. Wikipedia says “The Nereids symbolized everything that is beautiful and kind about the sea.” That seems ironic too, as the sea starts to rise more and more.

We can’t break the earth’s laws, or she will break us.

For the Ragtag Daily Prompt: law.

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sleep and defiance

Oh, gosh, CNN is making everyone panic about sleep again: https://www.cnn.com/2022/11/08/health/sleep-deprivation-wellness/index.html

Don’t buy it. It used to be 8 hours. Now they are saying 7 in this article. SLEEP AT LEAST 7 HOURS OR YOUR BRAIN WILL MELT.

Nope. The media likes us to panic because it sells papers and gets shares. Don’t buy the hoopla.

After all, I took call at night for 30 years and my brain has not melted. (Ok, if you disagree, post your own blog, heh, heh.) Starting third year of medical school. Sometimes it was every third night, sometimes every fourth. We were often up and awake and working for much of the night and then through the next day. If we had to be ready for rounds at 8 am, we had to be there earlier to see the patients, check the lab work, check any studies, drink a gallon of coffee and then be coherent on rounds, where the faculty physician might quiz us about the nineteen causes of high potassium. Uh. Taking too much potassium is one. Kidney failure, diabetic ketoacidosis, etc, etc.

I made up the number nineteen.

Anyhow, I was a sleep rather than eat person. If we got a break, I would go to sleep and skip food. The bad rotations were obvious because my weight would drop. We’d meet for “nutrition rounds” in the morning. I would skip lunch, hoping to have it at home post call, but the list might have things added even as I ran around checking things off. At last I would stop for lunch at 2 or 3 or 4 because my brain was no longer functioning.

Doesn’t sound very healthy, does it?

Here is a post on sleep from 2015: https://drkottaway.com/2015/01/08/sleep/. I sent a copy to our sleep specialist and he liked it.

When I got my flu vaccination and covid booster a month ago, it hit me pretty hard. I am sleeping as I normally do at night, for 6.5-7 hours. But I also started napping, once or twice a day. I was sleeping 11 or 12 hours total daily. I canceled pulmonary rehabilitation exercise, because it wiped me out. I was starting to feel better after three weeks, so I restarted pulmonary rehab. I promptly slept 12 hours a day again and my muscles gave me HELL.

So what in the heck IS this? Well, healing. My body is knocking me out to do repair work. It’s sending a pretty clear message that running on a treadmill is not ok right now. My immune system is busy making antibodies and is saying HEY WE DO NOT HAVE ENERGY TO SPARE FOR ANYTHING ELSE. This is sort of annoying except that having had four rounds of really bad pneumonia, the last one requiring oxygen for a year, still on oxygen to sing and for heavy exertion, I am willing to listen to my body. It is annoying, but: my mother, father and sister are dead, so even though I am struggling some, I’m not dead. It’s all relative, right?

When I had pneumonia #3 (2014) and pneumonia #4 (2021), both times part of the healing is sleeping twelve hours a day. I went back to work six months after the 2014 one and promptly slept twelve hours a night. I was seeing 4-5 patients a day and could barely do that. I went into denial about chronic fatigue, but I knew I had it. NO WAY, I AM TOUGH. Well, I am tough, but that means chronic fatigue and not dead.

I do not worry about sleeping 7 hours a night or 8 hours. I sleep when I get sleepy. Naps are fine and one gets to relearn napping after age 50 or 60 and it’s ok. If you need to stay awake after lunch, have a small lunch and no alcohol. Alcohol is not good for sleep in the long term and neither is marijuana. Benzodiazepines are worse than either. Ambien and those drugs are approved for “short term” use, meaning two weeks. Great. We don’t know what it does if you are on it for years, but some of us note that those drugs are closely related to the benzodiazepines. I think the most addictive drug is tobacco, followed by benzodiazepines and then methamphetamines. That is from asking patients and observation over 30 years. There are individual quirks though, and I have had people say, “Alcohol is no problem but the first time I was given oxycodone I wanted more.” Sometimes there is a bit of denial in those statements.

The photograph is me doing my second sleep study last week. I scored. Um, or rather, it was a positive test. Sleep apnea, darn. I am now waiting for my bipap machine. The funny bit is that I had to drive an hour to the lab. I was supposed to be there at 8. I got there an hour early because I get really tired at night. The tech let me in and wired me up. “But,” she said, “you can’t go to sleep until 9, because I have another patient and they are not here yet.” “Ok,” I said. I read for a while in the chair, put my head back and (don’t tell) fell asleep.

She came back in, did the final connections and then left. There is a ceiling camera and a disembodied voice. We tested the connections. “Flex and extend your right foot.” “Now breath through your nose.” I did and immediately fell asleep. She woke me, “Breath through your mouth now.” “Was I asleep?” “Yes.” The wires didn’t bother me much, though I had to surface part way during the night to change position.

I’ve slept sitting up in hospital meetings. I fell asleep standing against the wall in medical school. It is really a blessing to be able to fall asleep.

The year my father died, I had a terrible time falling asleep. His will was very out of date, written 40+ years before. It was a mess. His house had 13 years worth of unopened mail. I used Jon Kabat Zinn’s Mindfulness Meditation tape to fall asleep. But I used it in a rather weird way. He has a section where he says “Do NOT fall asleep.” It was a body scan. I would think, hey, you can’t tell ME what to do, and I would always fall asleep during it. So there, Dr. Kabat Zinn. Thank you.

The pandemic is enormously stressful, not to mention all of the other things. You can still relax though. What relaxes YOU? Stupid animal videos? A walk around a yard or park? Dancing in your kitchen? Knitting? Reading your absolutely most boring textbook? Put the phone and the television and the computer away at least one hour before you want to sleep and preferably two hours.

And here, to relax you, are pictures of sleep: https://drkottaway.com/2018/04/30/zzzzzz/

Blessings.