Our native maples are Big Leaf Maple and Vine Maples. There are Red Maples all over town now and they are exquisite and spectacular. Rain is supposed to start this Friday and since we still have bad air quality from the fires in Eastern Washington, I think we will all be glad for rain.
I took this yesterday at Chetzemoka Park. I went to see if the air was ok to beach walk. It was not ok.
The panoramic photograph shows the smoke obscuring the Seattle area and the hazy sun. It is worse there than here but it is not good here either.
I wonder if the trees have trouble breathing too? I am wearing a N95 mask any time I step outside. The cats don’t want to go out right now. They don’t like the smoke.
This is a sunrise, not a sunset, two days ago on Marrowstone Island. The air quality was deteriorating and I am mostly staying indoors today. We are at high particulate matter and high fine particulate matter, coming from the fires to the east. The recommendation is to mask outside, keep windows closed, use an air filter and mask outside. Also to not exercise heavily outside.
It looks sunny out now, but the air looks wrong. Dirty. My lungs don’t like it at all, not surprisingly. I hope people are taking care of themselves. Stay in, take it easy, mask. Our air is supposed to improve tomorrow.
In Practicing conflict, I wrote about practicing conflict by arguing different sides of a topic inside my head. I wrote that I donβt fear conflict and have learned to enjoy arguing with myself. I am a physician and physicians argue all the time.
What? No they donβt. Well, the doctor persona does not argue with the patient much. Some doctors give orders to patients, others try to negotiate, some try to convince. But behind the scenes, doctors are more like the Whacky Racer Car with the Cave Guys, running with their feet and hitting each other with clubs.
In residency in Family Practice at OHSU in Portland, Oregon, I start on General Surgery during internship. This is in the early 1990s and there was not much in the way of “disruptive physician” rules. I have to cover Trauma and Plastic Surgery and General Surgery at night on call. The resident is present but I get paged first for patients on the floor. I learn that I should go to all Trauma pages in the emergency room. If I know what is happening with the new Trauma patient, itβs a lot easier to handle the phone calls for more drugs and so forth. Also, the resident is less mean to me.
We attend the Trauma βGrand Roundsβ. These are unreassuring to a new intern. A resident presents a trauma patient, giving the history in the accepted formal order. The Faculty Trauma Surgeons interrupt, disagree with management of the patient and yell. They yell at the resident and at each other. The upper level residents yell too, being well trained. The Trauma Surgeons do not agree with each other. They are inflammatory and rude. I am shocked initially: medicine is not a cookbook, is not simple and it appears that it is a controversial mess. It turns out that medicine IS a controversial mess.
There is not as much yelling on the next rotation. At that time Trauma Surgeons yelled more than any other set of doctors that I ran across. They yelled in the ER, at each other, at the staff, at the nurses, at the residents. The culture has changed, I suspect, but that’s how it was then.
I take Advanced Trauma Life Support as a third year resident. The Trauma Surgeons at OHSU helped write the course. They donβt agree with it. On some questions the teaching Surgeon says, βThe answer to this question is (c), β followed by muttering loudly, βthough I totally donβt agree with that and I would do (b).β Another Trauma resident or surgeon then might start arguing with him, but they moved on pretty quickly, to teach the current agreed best practices in the book. Which change every few years. Great.
Years later (2009) I join the Mad as Hell Doctors, to go across the US talking about single payer. They are a group from Oregon. Physicians for a National Healthcare Program are a bit cautious with us the first year: we might be whackos. We have an RV with our logo and we have a small fleet of cars and what do you think we do in the cars? We argue. Or discuss. Or whatever you want to call it. We spend the driving dissecting issues and how to present things best and tearing apart the last presentation and rebuilding our ideas. The group does 36 presentations in 24 days. Each presentation takes an hour to set up, two hours to do and another hour to break down and debrief. We get more and more exhausted and cranky and um, well, argumentative, as the trip proceeds. Even though I think of the Whacky Racer Cave Guys running with their feet and bonking each other with clubs, this is the most wonderful group of doctors I have ever been with. A common goal that we all want to get to, discussing and disagreeing on strategy all the way! I feel closer to those physicians in a week then I feel to any of the physicians that Iβve worked with for the last 9 years in my small town. Conflict with a common goal.
Doctors are TRAINED to argue, even with themselves, to document every decision in the chart with reasons why they have reached that decision. And that they have thought about all of the reasons for say, a low potassium, thought of every possible cause and worked their way through testing. The testing always has two strands. One strand is rule out the things that could kill the person NOW, even if rare. The other strand is what is common? You have to think about both at the same time, always. And argue with yourself about which tests should be done, in what order, what is most important, how do you treat the person while awaiting results, and have I missed anything? And if we arenβt sure, we call another doctor, run it by them, wait for them to shoot holes in our logic or to say, no, I canβt think of anything else.
We can deal with conflict. We must deal with conflict. The world is too small not to deal with conflict, with disagreements, with different viewpoints and positions and ideas. If doctors can do it every single day at work, then everyone else can too. Trying to see all the positions and possible diagnoses saves lives in medicine. We need to extrapolate that to everything else. Try to see other positions, try to understand them, to respect them. We can and we must.
The photograph is from my clinic once we had stopped seeing patients and were selling everything. Mordechai was our clinic skeleton, made of plastic, from China. This was in January 2021.
The tent in the center is mine. I took this two days ago as soon as I had it set up. The big deal is that pulmonary rehabilitation is WORKING.
My friend B from the east coast invited me to hike with him and two other friends. They were going up the Hoh River trail. The initial hike was five miles and then camp. They will go up to Glacier Meadows.
I looked the hike over. The first five miles starts at around 500 feet and stays near the river and fairly level. I bought a pass for the campsite and loaded my pack. I took the pack to pulmonary rehab on Monday and carried it on the treadmill. I went for 25 minutes at 3mph, loaded. My heart rate went to 110 (normal at rest is 60 to 100, though mostly cardiologists don’t care if it’s below 60 unless bad symptoms or heart block) and above, but I held my oxygen sats. I decided I could GO! We met in Port Angeles and then drove up. We didn’t start hiking until 3:30pm but got to the campsite, ate and set up tents.
The next day I hiked back alone. A couple coming in stopped me and said, “There is a bear. It went up a tree when we saw it.” The next trio said that the bear was on the ground and seemed undisturbed. I had my whistle out and kept hiking, a little cautious. I did not see a bear.
As I reached the parking lot, I reread the signs. “Cougar area, hiking alone not recommended.” Oh. Well, but I really was rarely alone. I counted the people hiking up and there were 147 in that 5 mile stretch. Some out for day hikes, some with packs headed to Glacier Meadows or beyond, some with almost no equipment.
Anyhow, I am so delighted that my lungs have recovered enough to hike! I don’t think they are ready for altitude and the climb to Glacier Meadows. Maybe by next summer. Hooray for lung pizazz!
My pronouns are now per and pers. And that’s what I am going to call you and you and you over there too. Because I don’t care what is in your pants unless I have personal interest (rare and unlikely) or unless I am working as a physician. Per and pers are short for person. Generic. Nongendered because I don’t care. I suppose we could use Pee and Pees for People, which would amuse small children and immature adults (which includes me).
As a physician I need to know if someone is XX, XY, XO, XYY, or any of the other variations because it affects health. I need to know if the XX is of childbearing age or before that or after that. I need to know if the testes are undescended or have been removed because of prostate cancer. But otherwise I don’t need to know and I don’t care what is in your pants.
Get over gender. Everyone can wear kilts or carhartts or makeup or glitter or boots or toe cleavage sandals (ok, the five inch heels are really bad for your feet) and I don’t care. The first time I met my future husband was in a contra dance line where the people coming up the line were upset or rattled. I wondered why and there he was, wearing his mother’s wrap around lavender flowered skirt and dancing the “male” part. Now the parts are often called “lead” and “follow” because the callers don’t care what is in the dancer’s pants either.
When I saw my future husband in a wrap around lavender skirt, it was not love at first sight. What I thought was, “Well, that is not your routine Beltway Bandit. Bet he’s not an attorney.” This was Washington, DC in 1985 or 6 and the place was crawling with attorneys. I was correct. He is not an attorney. I thought, well, at least he’d be interesting to talk to and I found the consternation in the contra dance line amusing.
I did not talk to him that night. The next time I ran into him was at a square dance at the Washington Cathedral Nunnery. (You now may be wondering if this is true. It is.) He was wearing pants. After the square ended, I said, “You look different from a week ago.” He laughed. “The woman I am here with hates it when I wear skirts,” and he promptly invited me out. Ok.
Marge Piercy published Woman on the Edge of Time back in 1976. The pronouns in one of the two futures were per and pers. I am fine with that and I am not fine with having every single person pick their own pronouns. If we are going to pick our own pronouns, I am going to be “Mother Superior”, because I think it is stupid. Make it generic and non-gendered and I have no issue with generic. I don’t care what is in people’s pants or shirts or whatever, nor do I care what gender they are born nor their present identification nor their future plans. Except, as I said, if I am romantically interested or if I am working as a physician.
And since I love words and wordplay, my reply to the next query about my pronouns will be in a very sexy voice. “My pronouns are puuuurrrr and puuurrrrrs.”
In college at the University of Wisconsin, I dated a gentleman who was following the Zen Buddhist tradition.
He meditated daily, for forty minutes, facing a wall.
I was quite intrigued. I did not think I could do that. I am a fidgety person and can’t sit still. I promptly tried it.
Forty minutes is a long time facing a wall at age 19.
I would fall asleep. I would start tilting to one side or the other on my zafu and jerk back up. I knew I was not supposed to follow thoughts, but I couldn’t not think. It is more subtle than that: I slowly figured out that I can let the thoughts pop up from the toaster brain, but try not to follow them. Wave at the thought. Let it go.
One day there was a small hole in the wall when I faced it. A tiny spider came out and went back in. I was very happy about the spider.
The next day the spider came out and waved one leg at me. Then it went back in the hole. The end of the 40 minutes is signaled by a chime. I got suspicious afterwards and went back to the wall. Not only was there no spider, but there was no hole, either. I did not see any more holes or spiders.
I meditated regularly daily for two years. After that I would return to practice intermittently. Meditation trained my breathing: my breathing slows way down during meditation.
I use that breathing when I have pneumonia. In the worst episode, I was in the hospital and disbelieved. I slowed my breath way way down to calm myself and so that I could think. Eight counts in, eight counts out. Then ten, then twelve. I needed to focus and figure out what was causing sepsis symptoms. And I did figure it out. The provider sent me home that morning, septic and 6 liters behind on fluid, but I was able to survive.
Now the pain clinics are teaching slow breathing. Five seconds in and five seconds out. Start with a few minutes and work up to twenty minutes. “Almost everyone goes from high sympathetic nervous system fight or flight state to the parasympathetic relaxed nervous system state.” I think we need more of that, don’t you? This is being taught for anxiety, for chronic pain, for fear and depression. I asked a veteran to try it. His response: “I hate to admit it but it works.” Also, “I’m not used to being relaxed. It feels weird.” I laughed and said, “I think it might be good if you get used to it.” He reluctantly agreed and continued the practice.
The gaseous state of a substance that is liquid or solid at room temperature.
A faintly visible suspension of fine particles of matter in the air, as mist, fumes, or smoke.
A mixture of fine droplets of a substance and air, as the fuel mixture of an internal-combustion engine.
So vaping is smoking. It can be called vaping, but that is to trick us into thinking that it is not smoking, that we are not sucking chemicals into our delicate lung tissue. We only have one set of lungs. Lungs are like a tree, either the roots or the leaf parts upside down. Air is drawn in by our muscles expanding the chest and diaphragm, down the trachea, the bronchi, the bronchioles and at last to the alveoli, where tiny veins wrap each alveoli, trading carbon dioxide for oxygen.
I think of smoking as every cigarrette distroying an alveolus.
Vaping too, vaping is smoking. The nicotine is suspended in a solution and the vaporizer heats up until it is in vapor form. I started reading about vaporizers at least a decade ago. There were over 500 different types, mostly made in China, and there are all sorts of solutions. I was horrified to read that ethylene glycol was one of the solutions that held nicotine. When a dog drinks antifreeze, ethylene glycol, it is poisonous to the brain. Does anyone think that we should inhale smoke with antifreeze and nicotine in it? Really?
There is no control of what is put in the solutions. We don’t know what they will do long term but we know that nicotine is addictive and damages the lungs. Some of the vaporizers get so hot that the metal is also vaporized. Heavy metals are clearly bad for the lungs and poisonous as well.
Here is an article from the U of Colorado Medical Center with further reasons NEVER to start vaping. Because vaping is smoking: don’t let the term fool YOU. 4 reasons why you should stop vaping.
I took a very long nap after pulmonary rehab yesterday, pushed myself on the treadmill. I was tired. So then at midnight I can’t sleep, feel sad and sappy, get up, write Sorrow.
Then my own brain starts making fun of me.
It plays a soundtrack:
Yeah, ok, so my OWN BRAIN is making fun of me feeling heartbroken. Ok, ok, I am over it for this night. Let’s move on, I think I will manifest this instead. Yeah. I need a skintight dress and some heavy makeup, so there.
The header photograph is from Centrum’s Blues Fest on Saturday. Fabulous and fun!
Most of the time I am fine (I miss you I miss you I miss you). I am busy during the day (You said I needed my own life). What shut you down, I wonder (the family event). You said I always try to learn daily (you say you refuse to change). I have friends that love me and my kids (you say you do not love me). I don’t think I know what love is (your actions felt like love sometimes). Mostly I don’t think about you (sometimes it is very dark). I hope that you are well (I wish I wanted you to be happy without me). I am patching my heart again (for you I use elk sinew). The deer remind me (life goes on, even when one doesn’t want it to).
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 
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