Category Archives: joy

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Panoply

I took this for Photrablogger’s Mundane Monday #79 and then am delighted with Jithin’s post. I love the row of pans, a panoply of pans. Also the breakfast was fabulous. We were the second table occupied on Sunday morning, and many of the pans were in use by the time we finished!

I was in Bellingham just Saturday and Sunday to wish my daughter happy birthday. Who can identify the restaurant?

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Jump blues

Jump is the daily prompt today  and that makes me think of JUMP BLUES!

I have been dancing jitterbug and swing and zydeco and salsa for more than 30 years. Met my kids’ father swing dancing. A friend made us a tape of Jump blues: It ain’t the meat by the Swallows is one of my favorites. GREAT song to dance too as well as being appreciative of all sizes and shapes of the opposite sex…Here is a more Jump blues: http://www.allmusic.com/subgenre/jump-blues-ma0000002678

I took the photograph at  Synchronized Swimming Nationals in 2012… speaking of jumping. This double lift is done by the other six swimmers under the water, never touching bottom.

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Slow medicine

I am practicing slow medicine, just like the slow food movement.

It took a year to set up my clinic, because I wanted time with people more than anything. And how could I do that?

Low overhead, of course. The lower the expenses, the more time I would have with patients.

I did math and based it on medicare. I estimated what medicare would pay. I dropped obstetrics, can’t afford the malpractice and anyhow, the hospital was hostile by then. That cuts malpractice by two thirds. And I chose not to have a nurse, because people are the most expensive thing. Just me and a receptionist. And a biller once a week and a computer expert who rescues us when we kill another printer or need new and bigger computer brains for ICD 10.

My estimates were on target except that it took three times as long to build up patient numbers as I thought. Ah. Oops. I was advised to borrow twice what I thought I needed and that was good advice, because I had not counted on my sister dying or my father dying or me getting sick for a while…. but so far the clinic remains open.

Slow medicine. I schedule an hour with a new medicare patient or anyone new and complicated. People who say they aren’t complicated are lying, but we schedule 45 minutes for them. And for the really complicated, we have 45 minutes for follow ups. Most visits are 25 minutes: the only visit that is less is to take out stitches.

What does slow medicine allow? In the end it allows people to speak about things that they don’t know they need to talk about. A friend dying. Fears about a grandchild. Family fighting. The dying polar bears. The environment. This difficult election. And sometimes I think that freedom to speak about anything is the most theraputic part of the visit.

I had one woman last year who established care. Complicated. I think she was in her 70s. And the medical system had made mistakes and hurt her. Delayed diagnosis, delayed care. But she was laughing by the end of the visit. She stood in the hall and said, “This is the first time I can remember laughing in a doctor’s office. This is the first time in years that I can remember leaving with hope. And you haven’t DONE anything!”

….anything, except give time and listen.

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Diagnosis is only half the job

In clinic I have two jobs.

The first job is to diagnose. Chief complaint, history of present illness, past medical history, allergies, review of systems, medications (and vitamins and supplements and herbs and any pills or concentrated substances), social history including addictive substance use, family history, physical exam. What is my diagnosis? A clinical portrait of the patient.

The second job is to communicate and negotiate. I have to get a snapshot of the person’s medical belief system, their past experience with MDs, their trust or lack of trust, whether they are willing to take a prescription medicine. I have to try to understand their world view at this visit, at this moment in time. And it’s not static and may change before I see them again. If I can understand the person well enough to communicate with respect, with concern, with understanding, then we may be able to negotiate a treatment.

In clinic the other day I had a new patient who said, “I am not going to be pushed to take prescription medicine.” I responded, “That’s fine. I am not going to be pushed to do medical testing that I think is inappropriate, either.” She actually laughed and said, “Ok. That’s fair.” This is a patient who is coming from alternative treatment but wants medicare to cover her tests. After the visit she called and said that her provider wants a certain test before they feel comfortable proceeding with a therapy. I responded that I need a note and an explanation of the planned therapy before I will order the test. (Honestly, it’s an increasing trend that I get calls from patients with messages like “My orthopedist wants you to get my back MRI prior authorized.” and “My physical therapist wants my hand xrayed.” Our new office policy is: the provider has to communicate themselves, not via the patient. Also, it ain’t always so….)

I had patient once in the emergency room who said, “I have an antennae in my tooth. Get it out.” Her roommate nodded, looking terrified. This was after a fairly confusing complaint of tooth pain. I needed to think about an approach. I said, “I need to check on another patient. I will return.” I left the room in the emergency room and considered approaches. I went back in and said, “I am not a dentist. I can’t take out the tooth. BUT I can call a doctor to help with the sounds that you are hearing until we can deal with the tooth. The doctor is a psychiatrist.”

“Ok. Call them.” said the patient. The roommate practically collapsed with relief. Psychiatry said, yes, looks like psychosis and we have a safety contract and she will come in Monday. People HAVE actually had metal in their mouth that picked up radio sounds, but psychosis is much more common. Also, if you can say the station call sign that is a lot different than voices that are telling you to harm yourself.

I thought about my approach carefully. I did not want to argue about the tooth. I wanted her to agree to talk to psychiatry. So I told the truth: I can’t fix the tooth. It’s Saturday night. Here is what I can do. I never said, hey, I don’t think it’s the tooth, I think it may be a psychotic break. She may have known that it was not the tooth but been too terrified or too disorganized to tell me. And there was a small chance that in fact, it WAS the tooth.

It is not worth trying to “fix” or change someone’s world view. If they trust their naturopath more than me, that is ok. But it’s a negotiation: I am a MD and I will do treatments that I think are appropriate and safe and I may or may not agree with the naturopath or chiropractor or physical therapist or accupuncturist or shaman. But the goal in the end is NOT for me to be correct: it is to help the patient. Half the therapy is respect and trust and hope. And kindness.

The biggest problem with ten minute visits and the hamster wheel of present day medicine in the US is that the second job is often not possible. Complex diagnoses are missed or patients leave feeling unheard, not respected and frustrated. Time to make the connection and to understand is very important and is half the job. Physicians and patients are frustrated and it is only getting worse.

 

The photograph is my daughter and her wonderful violin/viola teacher, right before my daughter played for a music competition.

 

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I will marry only he who defeats me in battle

he
I am not really that attached to gender.
I’ve always thought that love is love
and who cares what birth sex or chromosome arrangement
people have
since nature’s diversity
is beyond insane

marry
I am not sure I would marry again
there is so much attached to the archetype
of a married couple
and no two are alike
in their conscious
much less unconscious
and then project the unconscious expectation
it makes me tired just thinking of it

battle
I agree that we are all fighting a battle
but I think it is always with ourselves
avoid avoid avoid
things that we fear
when we should go towards them
and embrace them
for our fears are the demons
we’ve chained in our unconscious

defeat
what is defeat?
loss of money?
loss of power?
the only defeat I have
is when I try to avoid myself
my true self
my dark self and my light self
there is no defeat
except my own failure
to admit my true self

I love who I love

whether they love me back

or not

 

I took the title from here: http://everything2.com/title/I+will+marry+only+he+who+defeats+me+in+battle and published there as well

 

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Unconditional 2

I think the hardest thing in the world is to love unconditionally. And we can’t love unconditionally unless we love ourselves in that too. Including our faults, our mistakes, our dark corners, our anger and grief, pettiness, unkindness, stupidity, jealousy, greed lust… if we only love our “good” side then we will attack others when they show the same weakness and faults that we know, deep inside, that we are capable of or have acted on. If we cannot love someone who is a sinner, we cannot love anyone, because we are all guilty. Love people anyhow and wholly and yourself too.

I went through a period after my mother died, where I felt I’d entirely failed. My marriage was disintegrating, and I was looking at myself very carefully. How had I gotten here? What mistakes had I made? I felt unlovable and stupid.

I found a letter from my mother written to herself when my father asked me to clean out her clothes. It was two or three years after she died. Here is the letter, with a few things left out for the privacy of the living:

____________________

Sept 18, Friday
1987
Seattle

I don’t want to go home. I want to stay here in Seattle. With the mountains that lift my heart. And clear air and only good memories. What is there to go home to? Struggling with X and his alcohol. I don’t want to try to do something about it. I don’t think it will work if I do. I think will only go on as it is and trying to get help will only lead to fight. I don’t think I have the strength, the courage or the wisdom to help myself or him.

What else am I going to? A house that needs a great deal of work that I only moderately like. A climate I loath. A landscape I find boring. I’m tired of living in a crowded suburb. And that house needs so much work.

People. What people do I go home to? Nearly all have problems. Y, wounded bird, so foolishly enamored of Z or thinks he is. And I have little sympathy or patience with it. And his propensity to failure which I’m tired of also.

A who I dearly love but her household is such chaos with those ill-behaved children and one crisis after another.

B who I like very much but really have so little in common with. I fear all that spiritual stuff may eventually bore me. Maybe not.

C. Another wounded bird, really. And not dependable.

D, barely around, anymore.

Mother, older and frailer. Who needs my care and patience.

E. There is one person to go home to. Thank God she’s there. Not wounded anymore. But so busy and it isn’t fair or wise to dump my troubles on her.

Who else? Why don’t I know any successful (in the best sense) sane people. People who are intellectuals, interested in ideas. F is. But not a fully successful human being and not when G is with him. Ugh. Besides he lives far away and he and X don’t like each other.

I don’t really want to have that show at H’s Church. I don’t like H very well. Oh dear.

I maybe have a job which if I get will be very hard work and if I don’t will be a great disappointment.

Winter’s coming and things cost more and we don’t have quite enough to live on. So that means digging into my inheritance.

I am sick of D.C. I am sick of being a struggling, unsuccessful artist. I am sick of worrying about X, about his moods, his acting the fool when half drunk and acting cruel and crazy when fully drunk. I’m sick of being afraid, of his depression, of his refusal to talk to me about anything of importance.

Of doing dishing. Of all the mess in our house. The mess on my desk, the mud room, the kitchen, the study, the basement. The dirty paint. The back yard. Oh God! How can I change things? Well there are a lot of bad things.

Oh, & I’m sick of being anxious, 10 lbs overweight, biting my nails, having bad teeth/gums. Life get tedjous, don’t it?

Any good stuff?

____________________________

For me, this letter was the key to finding myself lovable. My mother wrote to herself because she felt that she could not share these feelings with anyone. Terrible feelings. And I thought about it for a long time: I thought: my mother was charming, loved and an entertainer. But a child knows the parents’ hidden feelings. So I knew about my mother’s darkness and the letter confirmed it. And I thought, my mother didn’t need to hide that because I knew about it and I loved her anyhow. I love her more knowing that she was human too.

And if she is lovable whole, so am I. So are you. We all are. And we all make mistakes and are guilty of anger (sometimes appropriate but sometimes not!) jealousy, greed, lust, sloth and pride. Love people anyway and wholly and yourself too.

 

I have a view of Puget Sound if I stand in the road in front of my house. I took this with a zoom lens on solstice morning at sunrise.