I know before she does but maybe not maybe she knew that last year
brave front while soliciting money on the internet as the cancer progresses
she describes new treatments I forget how many rounds of chemo she endured
eight years from diagnosis to death
I stop visiting for a year after she bullies 30K more from our father
and he calls me crying
I give myself permission to change to be a physician more than a sister
because as a sister my sister is cruel
she destroys my reputation with my mother's family
or maybe they already don't like me because I think the family rules are ludicrous and stupid
and I won't follow them
I suppose each generation has someone who says wait these rules make no sense
why are we following these?
I think she will die by February 2011 but there is another death unexpected
the death of my hope for a sister who loves me for a sister who treats me well
for a sister who loves me
and I let that hope die and I rise from the ashes and I choose not to visit
and she uses this tells people I won't visit though I don't say I won't
people sent me checks
I sent them back with thanks saying
it is too soon to leave my nascent business
my sister stays in touch this year
at last in February 2012 she calls me
my oncologist referred me to hospice but I am not going
yes, I know you are refusing to go
I don't saybut the cancer is progressing and like it or not
you will go
my sister applies for a clinical trial miles away
and at last her enthralled circle refuses
they say we are so tired we cannot drive you there
daily
I fly down for a long weekend and the hospice interview
I am excluded but ask to step in at the end
I ask the nurse is this like where I live that if there is a stroke
or a blood clot or bleeding or whatever horror
hospice will keep her comfortable
but will not treat it?
yes
says the nurse
my sister stands pushing away from the table NO she says
I AM NOT READY
yes, I knew that
you are not going
I don't say but you will go willing or no
I fly down a second time and as I leave she cries
I am surprised
we have not talked really
there are so many people in and out and I've been portrayed as a villian
there is still time
I fly down a third time
she is angry, angry now in hospice angry that she is dying
I start to sing a lullaby and she says NO
I study her I sing Samuel Hall
To the gallows I must go I must go I must go
To the gallows I must go with my friends all down below saying Sam I told you so
damn their eyes damn their eyes
saying Sam I told you so damn their eyes
she smiles a vicious secret smile
she is in renal failure strange says
I have to take a trip
I say yes you do
I don't know how
You will figure it out
How will I find you?
I am surprised again the connection is still there buried deep
You said I can take the dragon home the one I made in college and gave you
You are born in the year of the dragon you will have wings find the dragon
and you will find me
oh, good she says relieved
she speaks of a bad pig
I say maybe it isn't bad maybe it's done some bad things
she shakes her head
I say shall I take the bad pig away?
she still is not satisfied
I guess: do you want me to keep the bad pig from hurting anyone else
yes she smiles yes
again we are alone
I am Bad she says
You are not bad I say You have done some bad things
Very bad
She is crying
I say I love you anyway
and she blooms like a rose soft in a dark orange blanket with matching lip gloss
forgiven and reconciled
flying home I name the dragon Bad Pig
and gird myself for death
three days later she dies
and then the fallout and the aftermath begins
_____________________
I will attach this to the Ragtag Daily Prompt "escapade", though I think of escapades as fun. The escapade is the photograph. She and I were dancing before my wedding, in 2007. I am the short one and clearly I was teasing her about something.
Old man yes, we hear you every niggling detail it used to be about X but now it's about Y yells about X and he doesn't like the internet where it has gone at the moment in his car it used to be food, shelter and a broadband connection but now that doesn't seem to satisfy as the tortured veins repurposed as arteries moved from the leg to the heart slowly close back down
the internet is not the place of glory and kindness and free exchange of ideas old man asks hates to ask for money and in spite of evil internet has a wishlist on Amazon where he directs those who do not care to donate through apple pay he is no longer allowed on Go Fund Me
I dream that my sister has drowned in the ocean. A sailboat went down. There were others on board. Two friends ready me to dive and find her. I don’t want to scuba dive, I am not trained. I don’t know how to use the equipment. I am afraid I will drown too. I see her daughter, who is four. Her daughter knows from my face that her mother is lost. My friends say, “You will be able to find her. You can find your sister.” “But she is dead,” I say. “I don’t want to find her.” I know that they are right, I could find her. But I might be separated and lost, in the depths. I don’t want to die too.
I wake up. The dream sticks. My friends wanting me to wear a borrowed wetsuit and scuba gear and go down untrained. My sister floating in the depths, dead eyes open. But she has been dead for years, I think. And this is the sea of dreams my unconscious the greater unconscious everything. So why isn’t my sister’s body dissolving? Changing to a skeleton. A skeleton coming apart over the years.
I don’t need a wetsuit or scuba gear to dive in the sea of dreams I can breathe in the unconscious I have been to the bottom of the sea many times before.
My niece is four in the dream. She was thirteen when her mother died. I think she was lost to me long before that. The dream knows. Her mother was lost to me when my niece was four. Drowned.
When the dream returns I will say yes to the dive I love the sea and the ocean and going deep I don’t need a wetsuit I don’t need scuba gear I don’t need to find my sister’s body She is gone Dissolved I let my past go.
I have not dreamed of the ocean
since.
__________________________________
I really don’t know where my sister is, because of the family schism after she died. Are her ashes somewhere?
My small child self is happy Happy inside She loves who she loves Living or dead In contact or fled Distant or close She loves who she loves And I hold her close
My adult self is happy
Happy inside
I love who I love
And the world is so wide
Living or dead
In contact or fled
Loving forever
No matter what happens
I love who I love
My heart holds them close
My small child grieved losses I hold her close She loves them all I guard her from most She stays friends forever No matter the grief She is happy in loving Her loves shine as stars The ones who are hurtful Are loved from afar She’s held and she’s loved And her love sings unmarred
_______________________________________
For the Ragtag Daily Prompt: dogwood and for Mother’s Day. Mine died 25 years ago.
My receptionist of 6 years at Quimper Family Medicine, Pat McKinney, died on February 6th. The photograph is from October, when I was in Port Townsend again for two weeks. She and I went for a walk. Well, I was walking and she was in a wheelchair. She was in hospice for over a year.
We had fun working together. Pat played music at her desk because the patient rooms were not quite sound proof enough. One day she was playing whale songs. I hear her on the phone with a patient. “The noise? Those are whale songs.” Pause. “Oh, Dr. Ottaway insists on whale songs.” I started laughing, because she was the one that picked them. So much for MY reputation.
When the covid vaccine came out, I got mine as a first responder. A few days later we had a lull between patients. I was standing in the hall near Pat’s desk. I said, “I don’t know why people are fussing about the vaccine, it seems fine to me,” and I gave a big twitch. Pat started laughing. I could set her off all day by twitching at her.
I got a letter from a family member, talking about happy memories of my father, mother and sister, who are all dead. How much fun they were and my mother’s influence taking them to museums, art museums and the Smithsonian.
It’s a bit difficult to answer, since my memories are much more complicated and tangled.
I wrote a poem called Butterfly Girl Comes to Visit a long time ago. It is about my sister. My mother could charm a room full of people and enthrall them with stories. Sometimes the stories were about me and my sister and actually making fun of our feelings: fear or grief. However, my mother was so good with an audience that I didn’t break the stories down until after she died. She was 61. That involved exploring a lot of really dark feelings. My sister and I even asked my father what our mother was really like: his reply was “Morose”.
I inherited my mother’s journals. My sister told me not to read them because they were “too depressing”. I don’t agree. They explain some things. My parents often fought, screaming at each other at 2 am while I was in high school. The family story was that my father was an alcoholic. As an adult, I wondered why she would fight with someone who was drunk. Her journal says “I drank too much last night,” over and over. Well, that would explain it, right? It takes two to tango. Or fight.
My sister could also charm a room. That is the sparkle in the Butterfly Girl poem. There was a period where she would tell me that I couldn’t talk about certain things, that she was fragile, that I was hurting her. This is after I gained control my feelings and had actual boundaries: I could refuse to fight with her. Before that, she could set me off like dry tinder. Her first husband called me once, saying, “I can’t not fight with her when she wants to fight. What do I do?” I replied, “I can’t either. I don’t know. I am so sorry!” I think it took until I was in my early 30s to refuse to fight with her and took a lot of conscious work. A fiance that broke up with me right after college told me I was an ogre when I was angry. I took that seriously and worked on it. My parents were not good role models for dealing with anger or grief or fear.
I am not much in contact with my maternal family. One person said that we could be in contact if we only said nice things about my mother, father and sister. I suggested we never mention them at all. We did not reach an agreement. I realize that our society wants to speak well of the dead, but to really be someone’s true friend, I think we have to accept that people may be angry at the dead as well. I gave this handout, Mourner’s Rights, to a patient on Friday. He is in the midst of grief and we talked about it. He thanked me and said, “I am grateful to talk to someone who knows about grief.”
My parents moved to Washington State in 1996. My mother was diagnosed with stage III ovarian cancer in 1997. I moved to be near them when her cancer recurred, arriving on Y2K. My mother died on May 15, 2000, four and a half months after we arrived.
My mother was only in that area of Washington for four years. She made such a charming impression that I had people tell me how wonderful and charming she was for a full decade. I was working though the complex feelings about her and tried very hard to thank people, even though I did not feel thankful.
I have not answered the letter yet. I want to return a gentle replay but I will not play the “only happy memories game”. I don’t mind my dark feelings. The family member would mind my dark feelings, I think. It is nice to be a physician and to be allowed to let patients talk about their dark feelings. Our culture wants to deny them, remove them, be positive. That is a disservice to love and to grief.
The photograph is of my friend Maline, me, and two of her husband’s family members. Maline was one of my alternate mothers, a friend of my parents. She died within the last few years.
Return again to friends and home and stumble My house wraps around me familiar then grief There is so much grief here: death makes us humble Mother, marriage, sister, father, time a thief Has stolen them and more to come, a long lived life Means loss on loss. Memory wells up, deeps swells We thought we would be different, wise, no strife Yet the world burns, children bombed in warring hells Our children know our failure and our malice We thought we’d be adults and show the way Our intentions of a wired on-line palace Yet anger and greed now rule the day As a child adults are drunk confusing fools Now my adult children wonder why we are such rigid tools
I ran my own small clinic from 2010 to 2022, working somewhere else, got Covid, was on oxygen for a year and a half, did some healing and then came back to work.
There has been a culture change in medicine that feels very strange to me. I did not notice it because I was in a solo clinic and not “part of the system”.
All the doctors, providers, are more isolated. I got a compliment yesterday when I was doing a “warm hand off” of the most sick or complicated patients, three new diabetics, a person with cancer, a person with a genetic heart problem. The doctor who I was handing off to is in the same clinic but we have barely talked since May. I don’t know her at all. She complimented me on excellent care “and calling specialists”.
I thought, huh. But I think that is a dinosaur doctor thing. I think mostly people communicate through the electronic medical record email, send messages about patients. For the decade that I was solo, I had to call other specialists because I was on a different electronic medical record. The email didn’t connect. The hospital reluctantly gave me a “link” to their system, but it was only a link to look. I could not write or send anything.
About two months ago I got an echocardiogram result. I read it and thought, ok, it’s not normal but what does it mean? Outflow obstruction by the thickened heart wall. Hmm. I called cardiology and spoke to the cardiologist who read it. He sounded surprised and said, “Idiopathic hypertrophic cardiomyopathy, most likely. It’s a classic echo.” “So, what do I do?” “Send him to me.” “Anything that I should change meanwhile?” “Yes,” says the cardiologist. He had me stop one medicine and start another. “No vasodilators and the beta blocker slowing the heart rate should help decrease the outflow obstruction.” “Got it.” I said. He also gave me two more tests to order.
I referred the patient to cardiology but it was a month before he got in. The two tests were done and they ordered more. If the diagnosis is correct, he’ll be sent to a special clinic in Denver. I called my patient while we were waiting for the cardiology visit. The medicine change had not made much difference as far as he could tell.
I was also told when I got here that I would never get a local nephrologist to see a patient, they were two busy. However, I have called two nephrologists about two patients and both took the patient and again, gave me instructions.
Two specialties have been very difficult to contact: orthopedics and gastroenterology. I have no idea why they are so difficult.
I can see that email feels faster. But there is no human contact, asking follow up questions is difficult, I don’t get that bit of further helpful education: this is what you do next. I have learned so much over the years by touching base with specialists. Once I fussed at a patient to go to hematology oncology about their high platelet count. The patient didn’t want to. He came back and said, “Apparently I have this newly found genetic problem. They put me on two medicines, not expensive. And I feel better than I have in 20 years.” I asked the oncologist about it the next time I called. He lit up, excited, and told me about the JAK-2 mutation. It is so exciting to learn about new areas in medicine and my patient says, “I have to thank you for pushing me to see the oncologist. I feel so much better.” Wow and cool.
Clinic feels like I am mostly isolated, a silo, an island, rarely talk to the other physicians unless I go to find them. I think hospital administrations like this, keeping the physicians in line by having their schedule be so packed that they almost never talk to each other. What a good way to keep physicians from interfering in the money making production! Ugh, I think it is quite horrible and unhealthy for the providers and for our countries medical system in the long run. I was seriously less lonely in a solo clinic.
The prognosis for our current medical system is very poor. The patients say to me, “Why do my doctors keep leaving?” They aren’t attached, they are isolated, I don’t think the physicians know what they are missing. Colleagues. Not silos.
It did not even occur to me that yesterday’s dream could be taken as complaints about patients! That was not my meaning!
I wrote the dream out because I wanted to know what it was trying to tell me. And I look at it from the perspective of all the people in the dream being aspects of myself.
So who is the whiny guy (me) who won’t cooperate with authority (me) and who wants attention and is difficult? That’s not a very nice aspect of myself!
First of all, he reminds me of my father. My father really did not like authority and did not like most men. When I was quite small, I announced that he would have to die first, because he couldn’t live without my mother, but she could live without him. I was wrong as well as being an awkward child. My father’s dislike of authority interfered with his employment and he was mostly underemployed. He finished a Master’s in Mathematics, but never wrote the thesis for his PhD. I asked him why once and he said, “I was bored.” I don’t know how much alcohol interfered with his working.
I am not brilliant with authority either, though I am trying. I notice systems and often annoy authority by asking why something is run a certain (foolish and unproductive) way. I used to study whatever system I was in and then say, “Here, I’ve thought up a solution for this problem.” Then I would get in trouble for suggesting that there was a problem and I would be the problem. I learned to go to authority first and ask, “So is this (huge problem) a problem? I find it difficult. What is your advice?” Priming the pump, so to speak.
As a temp, the authority problem is weirder. I am an outsider, short term, no one really has to be nice to me. That fast trip home and back made me realize that I am lonelier in a group clinic than I was in a solo clinic. In my solo clinic there was me, my receptionist and the patients. In this group clinic I have less people to talk to and it is lonely. My problem, not theirs. They are about to move me to another clinic and I will see what approach I can take to this. The system might have a Balint Group or I may be able to start one.
What about the frozen looking spouse? Ha, I think that’s the part of me that is trying to keep my mouth shut with authority. The kids? Some days I want to pull the system apart and fix it, but I am not in authority to do that here. The grumpy nurse? I am running behind and I can’t fix everyone. Some people don’t want to be fixed, including me.
I could go home and try another place. However, I think that the cracks in the US medical system are in the whole system. As a country, we built this. I hope that I see single payer healthcare in my lifetime, but I may not. And Martha is right too: I thought that this place was doing better handling a chronic illness than where I worked in 2021, but they aren’t, really. They apply a formula, but the patients don’t get much out of it. They just get shuffled in once every three months. I did upset that apple cart by spending more time with those people and talking to them, but I do not know what the next physician will do. Sigh. The patients are already my patients and are saying goodbye.
I’ve chosen incomparable for today’s Ragtag Daily Prompt. Yesterday I posted one version of the song Waterbound. Rhiannon Giddens does the traditional version, but then I come across this song. Wow. And yes, such courage in people enslaved and there is still slavery in the world.
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.
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