Four seasons

These are etchings by my mother, Helen Burling Ottaway, who died in 2000.

All four are done with the same etching plate.

Winter is done first. The zinc plate is covered with a protective layer and then she draws with tools, including dental tools. The plate is placed in an acid bath. The acid etches where the drawings are, different depths. The protective layer is removed. The plate is inked. Most of the ink is gently wiped off and the plate is placed on the press. Wet paper is laid on the plate and the heavy wool covers are folded down over that. The press is run. The wool is folded back on the other side and the paper is lifted and laid to dry.

The plate is re inked for each one.

She puts the protective cover back on the plate and adds the buds for spring. These are etched. Winter is now gone, the plate has changed. She prints all of the spring series.

Next is summer. Leaves are added. She prints those.

Last is autumn. Now there are leaves on the ground as well. She does some the plates with more than one ink color. This was one of her largest etchings. She did a small series first, where the etchings were about 4 by 6 inches. This was 18 by 24. She had a really big etching press. I don’t know who has it, my sister took it to California and it disappeared.

I have the etchings and I have all the plates. I can’t run this series, I could only run autumn. I grew up surrounded by my mother doing art, etchings, watercolors, oils, lithography, a constant sketchbook and crafts. I took a painting class a few years ago. The instructor says, “Acrylics are NOT watercolors.” I reply, “I know how to DO watercolors.” I was being quite creative with the acrylics only I automatically used the watercolor techniques that I grew up with.

The photograph doesn’t really do them justice. I will have to take some more. Plus I have her slides in some of the boxes left from when my father died. More cataloging.

Blessings and good memories of my mother.

small child

You work at healing
For years

You dive in the swamp
Of your psyche
Turn over the mud
Tunnel through it
Breath it
See lilies arise
From the muck

The Beloved is a deer
Dainty hooves
In the swamp

At last you come
To bedrock

So you rest
Bedrock
You think

Until you notice
A chink in the rock
You look away
You avoid it

At last you look
It isn’t going away

The Beloved is a bittern
In the reeds

Fluid leaks
From the chink

Foul black bilious
Acidic
Burning holes in the slanted rock
Again you look away
But not for long

You step forward
Touch the rock

I am present you say
Who is there?

The stream of foul black
Increases
Pours from a widening crack

Beloved is a tiger
Paw against the rock

You see the acid burning
Her paw
But she does not run
She stands guard

Who are you?
You whisper

The rock crumbles

There is a child

Go away” says the child
Ancient

No you say
Beloved and I
Stay present

The black is swirling around you
It’s hard to keep your footing
Beloved, an orca
Steadies you, swimming

No one stays says the child

We stay present you say

I was born I loved I was abandoned When I was afraid

We are present now you say
Swimming by the Beloved
Hand on black fin

I was abandoned When I grieved

We are here now you say

I was abandoned In my despair

We are here you say

You say
You fought
Out of love
You argued
Out of love
You gave
Out of love
Please child
Let us cradle you

The child is silent

The tide is slowing
The rock has crumbled away
A trickle of clear water bubbles

You will stay? says the child

We stay you say

Beloved is a whale
Singing in space
Singing to the stars

Am I lovable? says the child

You and Beloved
Earth and sky
Wind and trees
Moon and stars
Answer yes

Am I loved?

Yes
Yes

8/27/2007

Covid-19: Long Haul

https://www.bbc.com/news/av/world-us-canada-58918869 Some people with Long Haul Covid-19 are having to relearn how to walk and talk.

https://www.bbc.com/news/uk-england-leicestershire-59674203. Patients who were hospitalized are still affected at 5 months and one year after they are released from the hospital. Being female and obese are big risk factors. The article says “Long Covid has the potential to become highly prevalent as a new long-term condition.”

One more:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146298/ ” While the precise definition of long COVID may be lacking, the most common symptoms reported in many studies are fatigue and dyspnoea that last for months after acute COVID-19. Other persistent symptoms may include cognitive and mental impairments, chest and joint pains, palpitations, myalgia, smell and taste dysfunctions, cough, headache, and gastrointestinal and cardiac issues.”
“One puzzling feature of long COVID is that it affects survivors of COVID-19 at all disease severity. Studies have discovered that long COVID affects even mild-to-moderate cases and younger adults who did not require respiratory support or hospital or intensive care. Patients who were no longer positive for SARS-CoV-2 and discharged from the hospital, as well as outpatients, can also develop long COVID [24,30,31,41,50]. More concerningly, long COVID also targets children, including those who had asymptomatic COVID-19, resulting in symptoms such as dyspnoea, fatigue, myalgia, cognitive impairments, headache, palpitations, and chest pain that last for at least 6 months [51–53].”

And the symptoms? “The most common ongoing symptoms were fatigue, muscle pain, physically slowing down, poor sleep and breathlessness.”

Yes, the same as mine.

My initial evaluation of Long Haul Covid-19 patients will cover three areas:

1. Behavioral Health. Are they having brain fog, feeling slowed, feeling like they can’t think? Is that what happened during the Covid-19 or did the opposite happen? Were they manic/ADHD/OCD etc? What happened in the weeks leading up to getting sick? Any major worries or life trauma? Lose a job, a relationship, someone in the family die? I am looking for a dopamine antibody pattern.

2. Musculoskeletal Chronic Fatigue. What muscles work and which muscles don’t work? If they need to lie in bed for 20 hours a day, both slow and fast twitch muscles are affected. If they are short of breath, they should have pulmonary function tests, including a loaded and unloaded walk test. Are their oxygen saturations dropping? They also need a sleep study. Check for sleep apnea. Any signs of ongoing infection with anything? Teeth, sinuses, ears, throat, lungs, stomach, lower gut, urinary, skin.

3. Musculoskeletal Fibromyalgia. WHEN do their muscles hurt? Is it after eating? Do they fall asleep after they eat or does their blood pressure drop after eating? What diet changes have they made? Are there things they have identified that they can’t eat? Gluten, lactose, meat, sucrose, fructose, nightshades, whatever. I am looking for antibodies to lysogangliosides.

Treatment:

High antibody levels can be lowered somewhat just with “lifestyle changes” aka no drugs.

A. Treat infection if present. Look for strep A with an ASO, since we have an occult one that is in the lungs, not the throat. For fungal infection, even just on the skin, lower blood sugar as much as tolerated. This may mean a ketotic diet.

B. Treat behavioral health with drugs if emergent. If suicidal or really losing it (meaning job/relationships/whatever), then drugs may be needed. But not forever. Avoid benzodiazepines. Check for addictions.

C. Lower antibody levels:
a. Lower stress. Many people will resist this. Counseling highly recommended, ‘cept they are all swamped. Have the person draw the three circles: a day in the present life, their ideal life and then what their body wants. Listen to the body.

b. You can sweat antibodies out: hot baths, hot shower, steam room, sauna, exercise. Daily in the morning, because cortisol rises when we get up, and so levels should be lowered.

c. Is there a stimulant that works for this person to calm them down? Or an antidepressant if they are slowed instead of sped up. The relatives of dopamine that work for ME are coffee caffeine and terbutaline. Ones that do NOT work for me include albuterol and tea caffeine. Ones that I have not tried include theophylline, that new relative of albuterol and ADHD meds like adderall. This will be individual to the person because we all make different antibodies. We are looking for a drug that displaces the dopamine antibodies. For people who are slowed or have brain fog, the stimulants may not work. I would try the SSRI antidepressants first, like sertraline and citalopram, unless the patient tells me they don’t work or make them anxious. I would screen for PTSD. For high PTSD scores and high ACE scores, I would use the old tricyclics, mirtazapine (which is NOT a benzodiazepine), wellbutrin or trazodone. Again, avoid benzodiazepines. Also check how much alcohol and marijuana are on board, because those are definitely going to make brain fog worse. The functional medicine people are treating mystery patients with hyperbaric oxygen chambers and I suspect that this works for the people with blocker tubulin antibodies.

d. Muscle pain/fibromyalgia symptoms. Avoid opioids, they will only work temporarily and may addict. Avoid muscle relaxants, they will only work temporarily. Again, the tricyclics may help. The newer antiseizure drugs that are indicated for fibromyalgia are possibilities, though as an “old” doctor I am conservative about “new” drugs. Gabapentin, pregabalin, and if the person is sped up, antiseizure medicines that are used for mania. GENTLE exercise. The line between me having a good day today and overdoing is knife thin. On the overdoing days I go to bed at 5 pm. I went to sleep at 5 pm yesterday and 6:30 last night. I sang for church last night and even though I’d driven myself there, one of the quartet offered to drive me home. “Do I look that grey?” I asked. “Yes.” he said. I turn grey from fatigue and it can be sudden. Right now it’s after my second meal. If I am active, I will fall asleep after lunch if I can. If I go really light on lunch, I crash right after dinner. And remember, I am one of the lucky people who only have fast twitch muscles affected, not fast and slow twitch.

I am adding this to yesterday’s Ragtag Daily Prompt: hopeful.

hat trick cat tree

I am not sure that the photograph really fits the prompt, the Ragtag Daily Prompt: sleekit. But maybe a yelling rubber chicken is appropriate. I start my tree this year with a bare stick with a fork in it.

I add lights to my stick.

I add ornaments to my stick.

The cats promptly knock it over and break some.

I remove delicate ornaments and get out the plastic and soft ones.

I finally add four branches from my cedar.

This is my adult children’s fault. They told me not to get a live tree. I figured that a dead one is legit, right?

Pretty sleekit, right?

But mom, what is for?

Baby doctor

I pick up a Steffi-baby doctor while I am in Michigan.

For whom, you say?

For ME. I collect mother/baby images and statues. I have photographs, statues and toys, of mothers and babies and of pregnant women. Some family ones too. I am a Family Practice doctor, after all.

The Steffi is in with a bunch of Barbies. I am glad to see Barbie Princesses that are ethnically diverse. Next I hope the Disney will decide that adult women who are not virgins are human too, but judging by the way the second Frozen was received, I am not holding my breath. The only good Disney Queen is a dead one. The ones who survive, well, sex apparently turns them evil. It is pretty consistent in the Disney animated movies.

So, Steffi. I was thinking of Skipper, Barbie’s friend, but I realize that Steffi is not Skipper. Note that the baby has a facial rash. This apparently resolves if a cool washcloth is used on the baby’s face. I wish all babies were that easy to treat.

I look up Steffi on the internet and she is German. The packaging confirms this, with an instruction sheet in German and multiple other languages. I like Steffi a lot better than the Disney Princesses. She has tools: a stethoscope and a bottle and an otoscope and a thermometer and a rather mysterious looking caliper set. She has a green version of the white coat and a dress with hearts to reassure the babies. And LOOK! Steffi is wearing a MASK!

I love it. Up with Steffi, who can do things. I am not totally against princesses, I am just against the whole princesses are waiting for some prince to arrive and then their life will… well, they will die in childbirth if they remain nice and they will turn evil if they live. It seems like a poor choice of careers, honestly. My favorite princess is the Dealing with Dragons series, because that princess decides not to follow the usual princess path. The first thing she does is follow a frog’s advice and runs away. And the dragons are wonderful too.

For the Ragtag Daily Prompt: worry. I worry about the message of the Disney Princesses.

The Introverted Thinker in New York

The Introverted Thinker is eight. Her mother takes her out of school for a week to go to New York City.

They leave her sister and her father behind.

Her mother complains about the school paperwork. “Never let school get in the way of your children’s education,” she says. “That’s what my father says.”

The IT is not sure what all this means. But she is excited.

They go on an airplane. She gets to sit by the window. She can see the ground and it is squares like a quilt with hills. It is so beautiful! She is amazed, magic!

In New York City they go to the house of an old friend of her mother’s. The old friend is old and wears dresses to the ground and a lot of jewelry. The house is dark and there are many things in it. The IT is told that the things are antiques and she must not touch anything. She walks around carefully in the dark places, looking at all of the strange things while her mother talks to the old friend. They talk about the past and people that she does not know.

Her mother takes her to museums on some days. Some are art museums. The IT is already used to art museums because her mother is an artist. The museum is like an art gallery only much bigger and the ceilings are very high. A lot of the art is very big too.

One museum is different. Natural History, says her mother. There are dinosaur bones. The IT can’t touch them either but they are wonderful. Huge animals from the past that are not here any more! She loves it.

They fly home. First she has to thank the old friend with the house like a museum, only darker. Then they go to the plane. This time there are some clouds so the IT can’t see as much, but she still gets to see the quilt of the land.

She decides that she likes museums and she likes natural history. Especially dinosaurs.

Why care for addicts?

I posted this in November, 2015. I am reposting it.

_________________

Why care for addicts?

Children. If we do addiction medicine and help and treat addicts, we are helping children and their parents and our elderly patients’ children. We are helping families, and that is why I chose Family Practice as my specialty.

Stop thinking of addiction as the evil person who chooses to buy drugs instead of paying their bills. Instead, think of it as a disease where the drug takes over. Essentially, we have trouble with addicts because they lie about using drugs. But I think of it as the drug takes over: when the addict is out of control, the drug has control. The drug is not just lying to the doctor, the spouse, the parents, the family, the police: the drug is lying to the patient too.

The drug says: just a little. You feel so sick. You will feel so much better. Just a tiny bit and you can stop then. No one will know. You are smart. You can do it. You have control. You can just use a tiny bit, just today and then you can stop. They say they are helping you, but they aren’t. Look how horrible you feel! And you need to get the shopping done and you can’t because you are so sick…. just a little. I won’t hurt you. I am your best friend.

I think of drug and alcohol addiction as a loss of boundaries and a loss of control. I treat opiate overuse patients and I explain: you are here to be treated because you have lost your boundaries with this drug. Therefore it is my job to help you rebuild those boundaries. We both know that if the drug takes control, it will lie. So I have to do urine drug tests and hold you to your appointments and refuse to alter MY boundaries to help keep you safe. If the drug is taking over, I will have you come for more frequent visits. You have to keep your part of the contract: going to AA, to NA, to your treatment group, giving urine specimens. These things rebuild your internal boundaries. Meanwhile you and I and drug treatment are the external boundaries. If that fails, I will offer to help you go to inpatient treatment. Some people refuse and go back to the drug. I feel sad but I hope that they will have another chance. Some people die from the drug and are lost.

Addiction is a family illness. The loved one is controlled by the drug and lies. The family WANTS to believe their loved one and often the family “enables” by helping the loved one cover up the illness. Telling the boss that the loved one is sick, procuring them alcohol or giving them their pills, telling the children and the grandparents that everything is ok. Everything is NOT ok and the children are frightened. One parent behaves horribly when they are high or drunk and the other parent is anxious, distracted, stressed and denies the problem. Or BOTH are using and imagine if you are a child in that. Terror and confusion.

Children from addiction homes are more likely to be addicts themselves or marry addicts. They have grown up in confusing lonely dysfunction and exactly how are they supposed to learn to act “normally” or to heal themselves? The parents may have covered well enough that the community tells them how wonderful their father was or how charming their mother was at the funeral. What does the adult child say to that, if they have memories of terror and horror? The children learn to numb the feelings in order to survive the household and they learn to keep their mouths shut: it’s safer. It is very hard to unlearn as an adult.

I have people with opiate overuse syndrome who come to see me with their children. I have drawings by children that have a doctor and a nurse and the words “heroes” underneath and “thank you”. I  have had a young pregnant patient thank me for doing a urine drug screen as routine early in pregnancy. “My friend used meth the whole pregnancy and they never checked,” she said, “Now her baby is messed up.”

Addiction medicine is complicated because we think people should tell the truth. But it is a disease precisely because it’s the loss of control and loss of boundaries that cause the lying. We should be angry at the drug, not the person: love the person and help them change their behavior. We need to stop stigmatizing and demeaning addiction and help people. For them, for their families, for their children and for ourselves.

If

This is one of the ten poems that my mother made etchings for, the year I was just done with college. 1983-4. I wanted to write, but had no idea what to do with the poems that I was writing. My mother Helen Burling Ottaway had done a series of etchings with a family friend’s poems, so I asked if she would do the same with me. She said, “Yes, on one condition.” “What is that?” “They have to rhyme.” She did not like the free verse. Almost all of the poems were about animals, except for one about my sister. Another friend printed the poems on a lead type press and then my mother worked on editions numbered 1-50 of each, inking the plate separately for each one. This one is number 5/50. You can see the imprint of the plate on the paper in the photograph.

If I could be anything
I’ll tell you what I’d like to be
One of those small green frogs
That sails from tree to tree

These frogs can jump, they have no laps
They are not birds with wings
the have parachutes between their toes
And I am sure that they can sing

They spread their toes and jump so high
To float like snowflakes in the air
Frogs fall like rain from clear blue skies
It must be nice up there

Why they jump I do not know
Maybe escaping hungry eyes
Perhaps to catch a tender bug
Or they just like to fly

If I could be anything
I’ll tell you what I’d like to be
One of those small green frogs
That sails from tree to tree.

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.

Covid-19: Emotional weather

I do not think of emotions as bad or good. None of them are bad or good. They are information, controlled by electrical impulses and hormones, evolved over millions of years (or endowed by our creator, for those who swing that way).

I don’t dismiss emotions. I listen to them.

I think of myself as an ocean. There is all sorts of stuff happening in the depths that I don’t understand. Probiotics, for example. I don’t take them. If not for penicillin, I’d be dead many times over, from strep A pneumonia twice and other infections. I don’t think we understand probiotics yet. We don’t understand the brain, either.

The emotions are the weather in my life. I don’t really control them but they don’t control my ocean, either. Some days are sunny and gorgeous and then a storm may blow up. I am afraid of hurricanes, one destroyed my grandparents’ house in North Carolina, on the outer banks. I think all the cousins still mourn that house. And I miss my grandparents too, all of them. And my parents and my one sister.

See? The weather got “bad” there for a moment, but it isn’t bad. Storms have their own beauty though we hope to batten the hatches and that not too much damage is done. Maybe there is rain, scattered showers, sun breaks, a lenticular cloud. In the Pacific Northwest on the coast, the weather can change very quickly and we have microclimates. My father lived 17 miles away, but inland from me and in a valley. It was warmer in the summer and colder in the winter.

My goal with my weather emotions is to pay attention to them, let the storms blow in and out, and try not to harm anyone else because of my weather. When my sister was in hospice, we had a sign up in my small clinic. It said that my sister was in hospice with cancer and that clinic would be cancelled at some point with little warning. Patients were kind and gentle with me. And then it was cancelled, when she died. I got cards from people. They were so kind, thank you, thank you, and I could barely take it in. My maternal family then dealt with grief by having lawsuits. I don’t think that is a good way to deal with grief, but we just see things differently. Maybe it’s the right way for them. I don’t know.

Whenever I was having internal emotional weather that stirred me up, I would tell my nurse or office manager. Because they will sense my weather and need to know what is up. I had enormous support from them during a divorce, while my partners treated me horribly. My nurses and office manager knew me and my partners didn’t. My partners distanced me as if a divorce were catching. Whatever. Their loss.

Sometimes patients sensed that I was upset. I could tell by their faces. If they didn’t ask, I would. Bring the emotions out. Reassure them that I AM grumpy but not at them. Stuff in my own life. No worries.

Sometimes clinic is about a patient’s weather. They ask if they can tell me something. Often it is prefaced by “Maybe I need an antidepressant.” or “I feel really bad.” When they tell the story, usually I would say, “I think it is perfectly reasonable and normal that you feel angry/hurt/shocked/horrified/grieved/upset.” And then I would ask about an antidepressant or a counselor and most of the time, the person would say, “Well, I don’t think I need it right now.” What they needed was to know that their weather was NORMAL and REASONABLE.

I am seeing things on Facebutt and on media saying that mental health problems and behavioral health problems are on the rise. Maybe we should reframe that. Maybe we could say, “The weather is really bad right now for everyone and it’s very frightening and it is NORMAL and REASONABLE to feel frightened/appalled/angry/in denial/horrified/confused/agitated/anxious or WHATEVER you feel.” This weather is unprecedented in my lifetime, but as a physician who had very bad influenza pneumonia in 2003 and then read about the 1918-19 influenza, I have been expecting this. Expecting a pandemic. Expecting bad weather. This will pass eventually, we will learn to cope, be gentle with yourself and be gentle with others. Everyone is frightened, grieving, angry, in denial or in acceptance. The stages of grief are normal.

Hugs and prayers for all of us to endure this rough weather and help each other and ourselves..

I took the photograph in color. My program made a black and white version. It looks like the back of a stegosaurus to me, a dinosaur now living as a mountain.

For the Ragtag Daily Prompt: rainbow. Because sometimes the rain and sun combine to make a rainbow.