DMV

I really did not want a tour of the DMV.

I arrive early, just as they open the doors, and there is already a line. We file in, each taking a paper number. The people in front go straight up to the desks. One window processes two people in only ten minutes each and then promptly puts up a closed sign. I guess it’s exhausting, working so fast.

Everyone waiting looks strained or sullen or stressed at the DMV. Shoulders hunched, heads down, the ones in power suits on their phones, but the phones keep cutting off in the DMV. Some sort of special shielding, I would bet.

I have number 17 and get to go to a window after 2 hours.

The clerk smiles at me. She is pale, pale, but has horns and pitch black wings, no feathers, like a bat.

“Unitarian!” she says, grinning.

“Um,” I say, eyeing the wings.

She looks wicked and then her wings are classic white feathered. She is browner and well, I’d guess Filipino. “Worried?” she says.

“No.” I say. “Tired. Sad. Curious.”

“What would you prefer to see?” she says and morphs. Now she has one bat wing that changes to black feathers then through rainbow feathers, to the snowy white feathers on the other side. Her skin tone is very dark on her right hand and then lighter across to pale with red freckles on her left hand.

“Nice.” I say.

“Which heaven would you like?”

“Unitarians do not believe in hell. Send me back.”

“You just got here. Violently and by surprise.” she wrinkles her nose. “Riots again. Sorry about that. We have opened a Unitarian space.”

“No. Send me back.”

She sighs and pulls down a heavy paper file. All the papers have gold edges, except for those with black. “You found your true love.”

“Yes. So what. We didn’t have time to make it work.”

“Don’t you want to wait until she dies so you can head down at the same time?”

“No. She’s only 32. And there is work to do.”

She is paging through the file. She snaps it shut. “Two week vacation. The minimum required. Go to the door on the right.”

I sigh. I want to argue but I’ve done that before. She will add on an extra week for every word I say.

My memories are intact here. Of all the lives. It’s always a bit overwhelming when I first arrive.

I go to the door on the right. A small page with grey tattered wings opens the door for me. I think it is a boy but he is wearing a Tinkerbell style tunic.

“I am your guide today.” No, it is a girl. I think. They may be able to morph that too.

We go in the door. My guide is shedding feathers, one every few steps. I pick one up. “Sorry.” she says. “Puberty. So, where do you want to spend your two weeks?” We are in a half circle shape hall, with hallways branching off. The hallways have no end that I can see and there are open doors all along them.

“I just want to go back.”

She pats my arm absently. “Oh, yes, they told me. You have to take breaks. You are wonderful, though, we love you.” She is leading me to one of the halls towards the left. We go past two doors and to the third. “See?” she says. “Unitarians. Of course, they can come in and out and go in all the others and argue with everyone. We wouldn’t want them to get bored.”

The room is empty at the moment. “And I guess they are all in other places!” The room across the hall seems to be a classic hell, with demons and pitchforks and a grim rocky landscape with pits of burning tar. I can see a dinosaur caught in tar, and a really huge crowd of people. There is a lot of screaming.

“Some people insist.” says my guide. “Where to next? Evangelical? Valhalla is rather fun for males and certain females, we’ve got fluffy clouds and harps, or are you more interested in touring Asian, African, Australian? We do have paleolithic sites and many people are interested in Egyptian themes. The cliff dwellers interest many as well. “

“Atheist.”

She frowns. “Of course, but that room shuts down consciousness and you have to have two weeks of consciousness before you can go back.” She is leading me back into the central half hall.

“Ok,” I say, giving in. “I am not trying to be difficult, you know.”

“Yes, and everyone told me correctly that you are difficult. All the ones that go back over and over are difficult. And there are more every year.”

“Take me somewhere new, ok?” I am looking now at the frieze over the door that will take me back. Two weeks. I can manage. I am resigned. The frieze is cupids and then male odalisques, then female, then leopards, and then they are cupid fauns with horns on their heads, morphing towards adulthood. Yet the carved letters stay the same:

Deus Machina Verum

and I follow my guide into another hallway to find a place for my two weeks.

_________________________

This poem inspires me to post today’s story: https://narble.blog/2021/08/17/if-there-are-no-dogs-in-heaven/

I think the hell in heaven also fits today’s Ragtag Daily Prompt: scorch.

vast

Sometimes emotions are vast. I do not think our culture deals with grief very easily. Grief then becomes a vast pit, stuffed inside us. I sent the Falling Angels poems to friends and family. One older friend said that the poems were too sad and was I that sad all the time?

I replied, no, I am not sad all the time. The sadness is in the poems because there are very few people that I know that are comfortable with sadness and grief. So I put it in to poetry, because I do not want to stuff it. We need to let grief come out and let the tears flow and let it go.

For the Ragtag Daily Prompt: vast.

Mask refusal in the 1918-1919 influenza pandemic

This is from an article about the history of medicine, about people refusing to wear masks in the 1918-1919 influenza pandemic:

“Adherence is based on three concepts: individualism versus collectivism; trust versus fear; and willingness to obey social distance rules. Jay Van Bavel opines that some countries tend to be more individualistic,16 and therefore more likely to reject rules and ignore attempts by public health authorities to “nudge” behavior change with risk messages or appeals for altruism. In collectivist cultures, people are more likely to do what is deemed best for society. Trust and fear are also significant influences on human behavior.17 In countries with political division, people are less likely to trust advice from one side or the other and are more likely to form pro- and anti- camps. This may also undermine advice issued by public health professionals. The last and most difficult to attain is social distancing. Human beings are social animals with bodies and brains designed and wired for connection. A pandemic, in many ways, goes against our instinct to connect. Behavioral psychologist Michael Sanders argues that if everybody breaks the rules a little bit, the results are not dissimilar to many people not following the rules at all.18

From another article:

“It was the worst pandemic in modern history.

The 1918 influenza virus swept the globe, killing at least 50 million people worldwide.

In the US, the disease devastated cities, forcing law enforcement to ban public meetings, shut down schools, churches, and theaters, and even stop funerals.

In total, 675,000 Americans died from the Spanish flu, named after the disease’s early presence in Spain.”

I read a book on the 1918-1919 influenza. It started in the U.S. The photograph that haunts me is the bodies stacked five deep in the hallways of San Francisco Hospitals.

And in a third article:

“The scenes in Philadelphia appeared to be straight out of the plague-infested Middle Ages. Throughout the day and night, horse-drawn wagons kept a constant parade through the streets of Philadelphia as priests joined the police in collecting corpses draped in sackcloths and blood-stained sheets that were left on porches and sidewalks. The bodies were piled on top of each other in the wagons with limbs protruding from underneath the sheets. The parents of one small boy who succumbed to the flu begged the authorities to allow him the dignity of being buried in a wooden box that had been used to ship macaroni instead of wrapping him a sheet and having him taken away in a patrol wagon.”

A CDC article about the history of the 1918-1919 influenza says this:

“The fully reconstructed 1918 virus was striking in terms of its ability to quickly replicate, i.e., make copies of itself and spread infection in the lungs of infected mice. For example, four days after infection, the amount of 1918 virus found in the lung tissue of infected mice was 39,000 times higher than that produced by one of the comparison recombinant flu viruses.14

Furthermore, the 1918 virus was highly lethal in the mice. Some mice died within three days of infection with the 1918 virus, and the mice lost up to 13% of their body weight within two days of infection with the 1918 virus. The 1918 virus was at least 100 times more lethal than one of the other recombinant viruses tested.14 Experiments indicated that 1918 virus’ HA gene played a large role in its severity. When the HA gene of the 1918 virus was swapped with that of a contemporary human seasonal influenza A (H1N1) flu virus known as “A/Texas/36/91” or Tx/91 for short, and combined with the remaining seven genes of the 1918 virus, the resulting recombinant virus notably did not kill infected mice and did not result in significant weight loss.14

The 1918-1919 influenza virus was sequenced and studied in 2005. We did not have the tools before that. Frozen bodies were exhumed with the permission of Inuit tribes to find the virus.

Later, that same article talks about future pandemics:

“When considering the potential for a modern era high severity pandemic, it is important; however, to reflect on the considerable medical, scientific and societal advancements that have occurred since 1918, while recognizing that there are a number of ways that global preparations for the next pandemic still warrant improvement.”

Let us now travel back to a worse epidemic: the plague in the Middle Ages:

“Did you know? Between 1347 and 1350, a mysterious disease known as the “Black Death” (the bubonic plague) killed some 20 million people in Europe—30 percent of the continent’s population. It was especially deadly in cities, where it was impossible to prevent the transmission of the disease from one person to another.”

I am hoping that people will awaken, get their vaccines, wear their masks and stop Covid-19 in its’ tracks, so that our death rate resembles the 1918-1919 Influenza. Not the Middle Ages plague.

Top ten causes of death: US 2020

Top ten causes of death US 2020, according to JAMA, here.

Total deaths: 3,358.814
Contrast total deaths in 2019, at 2,854,838. That number had been on a very slow rise since 2015 (2,712,630) to 2019 (2,854,838). That increase over four years is 142,208 people. Then the death rate suddenly jumps 503,976 people in one year. Ouch. I cannot say that I understand vaccine refusal.

1. Coronary artery disease: 690,882
Heart disease still wins. And it went up 4.8%. It is suspected that people were afraid to go to doctors and hospitals. I saw one man early on in the pandemic for “constipation”. He had acute appendicitis. I sent him to the ER and his appendix was removed that day. He thanked me for seeing him in person. Might have missed that one over zoom.

2. Cancer deaths: 598,932
This is cancer deaths, not all of the cancers.

3. Covid-19: 345,342
I have had various people complain that covid-19 is listed as the cause of death when the person has a lot of other problems: heart disease, cancer, heart failure. The death certificate allows for more than one cause but we are supposed to list the final straw first. I cannot list old age, for example. I have to list: renal failure (kidneys stopped working) due to anorexia (stopped eating) due to dementia. That patient was 104 and had had dementia for years. But dementia is not listed as the final cause. So if the person is 92, in a nursing home for dementia and congestive heart failure, gets covid-19 and dies, covid-19 is listed first, and then the others.

4. Unintentional injuries: 192,176
Accidents went up, not down, which is interesting since lots of people were not in their cars. However, remember that the top of the list for unintentional injuries is overdose death, more by legal than illicit drugs. If there is no note, it’s considered unintentional. Well, unless there is a really high blood level of opioids and benzos and alcohol. Then it becomes intentional. They do not always check, especially if the person is elderly. The number rose 11.1%, which seems like a lot of people.

5. Stroke: 159,050
This rose too.

6. Chronic lower respiratory diseases: 151,637
This went down a little. This is mostly COPD and emphysema. So why would it go down? Well, I think bad lung disease people were dying of covid-19, right?

7. Alzheimer’s: 133,182
This seems to belie me putting renal failure due to anorexia due to Alzheimer’s. I think they actually read the forms and would put that as Alzheimer’s rather than renal failure, because it is not chronic renal disease.

8. Diabetes: 101,106
This rose too. 15.4%, again, probably partly because people avoided going to clinic visits. Also perhaps some stress eating. Carbohydrate comfort.

9. Influenza and pneumonia: 53,495
So this went up too in spite of a lot less influenza. Other pneumonias, presumably.

10. Kidney disease: 52,260
This went up.

And what fell out of the top ten, to be replaced by covid-19?

11. Suicide: 44,834
This actually went down a little. What will it do in 2021?

So what will 2021 look like? I don’t know. It depends what the variants of covid-19 do, depends on what sort of influenza year we have, depends on whether we are open or closed, depends if we bloody well help the rest of the world get vaccinated so that there is not a huge continuing wave of variants.

Today the Johns Hopkins covid-19 map says that deaths in the US stand at 608,818 from covid-19. If we subtract the 2020 covid-19 deaths, we stand at 263,495 deaths from covid-19 so far this year. Will we have more deaths in the US from covid-19 than in 2020? It is looking like yes, unless more people get immunized fast.

Take care.

outfits inappropriate for work 3

Ok, maybe it is not inappropriate for work. But it would be a little weird for work… I was going in the woods with my oxygen tank. “Local doctor of 21 years found eaten by cougar, which then died because it couldn’t digest the oxygen tank.” Heh.

Listening to this, fabulous!!!

covid 19 two

From November 20th, 2020:

My ex called Saturday. Early, which unusual. I thought he was calling to say his mother died.

Nope.

He is an RN at a nursing home. “We’ve gone from one Covid 19 patient to 55 in the nursing home in one week. And they installed a new computer program on Tuesday that makes everything take twice as long. I quit.”

Actually he gave two weeks notice.

He called our kids yesterday. He has Covid 19. However, they are so short of staff that he is working. On the Covid 19 ward of the nursing home.

____________________

In my clinic, we are struggling with watching people travel for Thanksgiving. We have decided. If someone travels or has Thanksgiving with other households, we will offer a zoom visit or a reschedule in two weeks. We do not want them to expose others in clinic. And if we get it or are exposed, we are closed for a minimum of two weeks.

____________________

He called me. Today 60 out of the 70 nursing home patients have it. All of the staff have it. The staff are working anyhow because there is no one else.

alternative medicine

Ok, I got this picture off Facebutt. I CONFESS. But I really want a doctor kit like this: so I can practice alternative medicine. I am disabled from Family Practice and I have to apply for disability payments (miles of paperwork) and I hear that even as a contractee I can apply for unemployment (miles more paperwork) and I see my hospital bill on line for the ER visit where I had chest pain and shortness of breath and the ER doc didn’t even give me an aspirin, so I want to know why I should pay them $900 and I am going to apply for reduced payments because last year I made 42 K, less then the nurses at Jefferson Healthcare (EVEN MORE PAPERWORK FOR THE REDUCED PAYMENTS) and really, it all sounds rather exhausting and I’d rather let the paranoia rise and hide under the bed. Where the OCD and ADHD will make me arrange the dust bunnies and dust elephants by size.

So this looks like a great doctor kit. If the patient sees me and doesn’t do a darn thing that I say, I shoot them with the gun in the forehead. If they do a little but not really very much, I set up the bowling pins and shoot them with the gun while I talk about how irritating it is to have patients use MY TAX DOLLARS though MEDICARE MEDICAID ACTIVE MILITARY DUTY AND THE VETERANS ADMINISTRATION NOT TO MENTION SOCIAL SECURITY DISABILITY to get advice and not follow it.

If they are merely disrespectful and tell me what Dr. Google says, I say “Duck.” and throw one at them. If they say, “I don’t take any farmasuiticals.” and bring a bag with the 12 supplement and vitamin pills they take daily, I give them the plastic pills to replace all their stupid supplements. “Here, take this. If it doesn’t work, I have suppositories, but they are four times this size so some people complain that they are uncomfortable.”

I am not sure WHAT the thing in the lower right corner is. A hair dryer? A fentenyl lollipop? Part of an old fashioned telephone?

Anyhow, someone find me one of these kits and send it to me. Pretty please. I am not allowed to do Family Medicine any more and really want to get started on Alternative Medicine.

stealthie in the grass

Stealthie in my yard, two days ago. I like the current crop of grass and weeds.

Music: Simon Lynge Hallelujah: https://www.youtube.com/watch?v=iIHpeaHJJ9s

His website is here: https://simonlyngemusic.com/. Hey Simon, when do we get another local concert? Concert in the grass? Hugs, ya’ll.