In my room, where is that?
In my room, the room in my head, there is home
and wilderness, unexplored and unending, never tame.
All the wild places I have been, or seen, or heard of
or imagine. It’s a wonder that I can speak at all
words in the daily day, after wandering the wilds.
Why does anyone ever come back?
Why does anyone ever come back?
Except to explore other rooms and add them to ours. I listen to the Brahams Requiem, a painting in orchestra and voice, of his room, his wilderness, his despair and joy. I am glad to come back for this and others like him.
On Monday I walked with a group of friends. First I walked down from my house to the coffee shop, walked with them, walked back. It was cold but I was well layered. I want to see if I can up my exercise in spite of Long Covid and muscle weirdness. The initial reaction was fatigue. I took a nap on the couch from 2 to 6 pm and then went to bed at 7. I woke at 5. Fourteen hours of sleep.
That is not totally reassuring. Tuesday I did not feel particularly sore or tired. Wednesday, though, was bad. I started have muscle aches all over and I could not get my hands or feet warm. I lay down under an enormous pile of blankets and eventually went to sleep, starting at about 2 pm. I woke at 9 pm and then went back to sleep, warmer but aching, until 4 am. So that is another 14 hours.
This morning nausea and headache, but less soreness.
So, here is an article: https://www.nature.com/articles/s41467-023-44432-3 about the post-exertional malaise in people with Long Covid. They took people with Long Covid, matched them with people who have recovered from Covid-19, and then did muscle biopsies in both groups before and after maximal exercise. Results? “We show that skeletal muscle structure is associated with a lower exercise capacity in patients and that local and systemic metabolic disturbances, severe exercise-induced myopathy and tissue infiltration of amyloid-containing deposits in skeletal muscles of patients with long COVID worsen after induction of post-exertional malaise.”
Both groups were healthy before Covid-19 and physically active. The study uses many different techniques to measure muscle oxygen use and look at the muscles themselves at the microscopic level. As previous studies have shown, none of our current imaging, like x-rays and CT scan and MRI, can see the problems. This is at a microscopic and cell level in the muscles.
So I am having a post-infection or Long Covid flare the last couple of days, because I pushed too far against my limits. They have not done brain studies but the suspicion is that something similar has been going on. I have been spending a lot of time contacting temp companies and doing job searches, so I am going to take a few days off from that as well. Let the brain and muscles heal.
I still think of Long Covid as immune system PTSD, where the immune system is trying to protect me from further infection, though not necessarily in a way that I like. If the immune system makes me stay home and rest, well, I shouldn’t catch anything, right? Our immune systems are as diverse and complicated as we are, so the patterns are highly variable.
My immune system can’t bamboozle me. It wants me to stay home and take it easy. I get the message. Have a wonderful day.
Cats respond to drugs differently too. Sol Duc is quiet and contemplative on catnip. Elwha, well, guess.
Martin Luther King’s birthday and a federal holiday. To be blunt, we need to stop killing each other and hating each other. And an awful lot of hate is based on fear: fear of others, fear of losing money or status or standing.
The photograph is from September 2022, from my road trip with my friend Maline Robinson. She is second from the right in the photograph. We visited her in-laws in Beloit, Wisconsin on a road trip, going to visit her old friends and family. Her husband George Harrell had died of lung cancer in 2015. Maline died in February 2023.
I am the short one, in the skirt.
Let peace and love spread over the world, justice and an end to discrimination.
And no thanks do I get
for thirty years in medicine
for thirty years of rural work
for working alone without a net
not a whisper from officials
The thanks I get are on the street
in the shops, at live music
at Gallery Walk, at thrift stores
walking through town, from friends
from patients or spouses or mothers or fathers
who thank me and update me
Thank you, Beloved, for my odd career
for leading me rural, leading me to primary care
endless learning daily and people
they are all interesting, all different
all have depths that none would guess
all of your beautiful people, Beloved
This is one of those poems where I started grumpy and did not know where it was going until it went there. The light at the end of the tunnel photograph is on the Metro in Washington, DC last week.
In clinic, a very common complaint was, “My body has changed!” This was often with shock or annoyance or betrayal. Weight up, a knee hurting, headaches, menses behaving badly as menopause approached, gentlemen with their own problems.
My muscles are getting stronger but are really grumpy. I am starting to rebuild muscle and endurance but my muscles and joint complain. I think that pain is the pain of wisdom. I am clearly very very wise, if that pain is wisdom pain. It feels better to frame it as wisdom than as “Oh, I am old.” Also it’s fun to watch people when I say, “My wisdom is really acting up today.” They get a funny look on their faces.
Medicine changes all the time too. Isn’t that a little unsettling? Science changes, ideas change, frames change. A treatment that I used 15 years ago would not be done for the same problem now. And we can treat hepatitis B and C! Hepatitis C was still named “Non A, non B hepatitis” back when I was in residency in the early 1990s. Hoorah for some things getting better.
It’s been interesting watching the changing ideas about Long Covid. Over the last year they’ve said, “Better in nine months.” “Mostly better by a year.” “Better by two years, mostly.” Also the estimates of people affected in the US have ranged from 3% to 7.4%. There is not even agreement about the definition, with the CDC talking about symptoms staying present after four weeks. Meanwhile the World Health Organization says, “It is defined as the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation.” Here: https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition. CDC here: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html.
I hope that we vote grown ups into office. I hope we aren’t tempted by the childish want to be dictators who say, “I can fix anything, I can do what I want, I am so great. I can make YOU great too.” I think the pandemic was very frightening and the temptation is to try to hide in an imaginary past or freeze the future or think that if we make everyone behave a certain way, no further pandemics will come. I do not think that will work, people. Vote for adults.
The photograph is from the US Botanic Gardens. Here is the model, inside:
The sculpture faces are over each arch. Here is a close up.
I think the carved face will last the longest, then probably me, then the one on the model. The model looks like it would be delicious for various smaller creatures.
Happy New Year! This is from the Glenstone Museum last week. I love the spare row of trees and the subtle colors of the grasses and trees. I am still not sure if it’s nature or a garden or something in between. Beautiful.
Discover and re-discover Mexicoβs cuisine, culture and history through the recipes, backyard stories and other interesting findings of an expatriate in Canada
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
Refugees welcome - FlΓΌchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflΓΌchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
KO Rural Mad As Hell Blog 
You must be logged in to post a comment.