gone to earth
Category Archives: rural doctor
hold me
hold me, Beloved
hold me
I long for you
to be reunited with you, Beloved
to return to you
it is the children who hold me
here
the children
my children, grown
the hope of grandchildren
the damaged children
the new and young children
the old children in adults
who are so sad
it is the children who hold me
here
sometimes I am so sad, Beloved
I long for you
I do and I don’t
long for you
to call me home
and hold me
I know
that you hold me, Beloved
every moment
even when I cannot feel your touch
I know, Beloved
you will call me home
and hold me
now and forever
in your infinite embrace
What I learned from my first doctor job
When I started my first job, I had a nurse and a receptionist within a bigger clinic, all primary care. Fresh out of residency. One month in I asked to meet with my nurse and the receptionist.
The receptionist brought the office manager. I was surprised, but ok.
I started the meeting. “I am having trouble keeping up with 18-20 patients with fat charts that I have never seen before, but I think I am getting a little better at it. What sort of complaints are you hearing and how can we make it smoother?”
The office manager and the receptionist exchanged a look. Then the office manager excused herself.
Weird, I thought.
The three of us talked about the patients and the flow and me trying to keep up. About one third were Spanish speaking only and I needed my nurse to translate. That tended to gum things up a bit, because she could not be rooming another patient or giving a child vaccinations.
I thanked them both and the meeting broke up.
Later I found that the office manager had been brought in because another doctor tended to manage by yelling and throwing things. And another doctor had tantrums. So the receptionist was afraid of me and had asked the office manager to stay. The moment they realized that it was collaborative and I was asking for feedback and help, the receptionist was fine without the office manager.
That was an interesting lesson on working with people. I had been very collaborative with the nurses and unit secretaries in residency. As a chief resident, I told my Family Practice residents to treat the nurses and unit secretaries and in fact everyone, like gold. “They know more than you do and if you take care of them, they will save your ass!” The unit secretaries would go out of their way to call me in residency. “Mr. Smith is not getting that ultrasound today.”
“Shit. Why not? What the hell?” I would go roaring off to radiology to see what the hold up was.
The unit secretaries did not help the arrogant residents who treated them like dirt.
I thought it takes a team. I can’t do my work without the nurse, the pharmacist, the unit secretary, the laundry, the cafeteria workers, the administration. It takes the whole team. I value all of them.
harbor
sometimes when
we are alone together
and just talking
wandering from topic to topic
and you say I always disagree
and I say …(I don’t say no I don’t)
and I say I like to think about things
from all sides
and you listen some too
sometimes when
we are alone together
and just talking
it is as if we have reached a harbor
and feel at home
Wings
I try out
for a solo
singing
my director
is pleased
I am growing
she says
I am beautiful
she says
I look like a different person
she knows
a little of what I have weathered
my patient
is 86
and her husband died
in December
she misses him so
as she comes into the room
one day
she says
you look as if you have wings
and are ready to take off
and I freeze
for a moment
in surprise
that she can see
my wings.
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.
I am sorry about the wings
the problem with angels
the problem with angels
is that they aren’t grey
nor do they have color
they are black
or white
sort of boring, really
pick one side
good or evil
night or day
male or female
I would rather be fluid
I want to be able to transform
liquid to solid
solid to gas
gas to solid
gas to liquid
flow around things
seep into the earth
always always
return to the sea
keep your wings
project black or white
as you choose
on me
while I flick water at you
and go for a swim
_____________________
written 2014
writhe
You are sick as shit.
You go to the ER.
You finally feel safe, on a bed, they will save me, you think.
The nurse is on autopilot. He does not seem concerned. You are shaking a little as he arranges you on the bed. He puts the heart monitor stickers on and hooks you up. Blood pressure cuff, pulse ox. Blood pressure is fine, pulse is a bit fast, at 110.
You notice he is not making eye contact.
“I’m cold.” you whisper.
He doesn’t reply. He keeps messing with the wires. He puts the call button next to your hand. He leaves and returns with a warm blanket. It feels wonderful. He doesn’t say a word.
You feel better under the warmth.
The respiratory therapist wheels in the ECG machine. You smile at her but again, no eye contact. She puts more stickers on you. “Hold a deep breath.” The ECG spits out. She takes it and leaves.
The radiology tech wheels the portable xray machine in. You watch his face but don’t bother to smile. He looks everywhere but at you. It’s a bit creepy. Are they all robots? It’s 3 pm, not 3 am. “Lean forward,” says the tech, putting the radiology cartridge behind you. “Take a deep breath and hold it.” He takes the cartridge and leaves.
The nurse is back. Puts in the iv and draws 5 tubes of blood. You are shivering a little. He doesn’t seem to notice. You think about another warm blanket. The iv fluid starts and you can feel it running cold into your arm.
There is a child crying in the ER, in some other room. You start noticing the noises. Machines beeping. People typing on computer keyboards. No one is talking. The kid gives a howl of protest, rising and then is abruptly quiet.
Your hands and feet are tingling and burning. You writhe a little under the blanket. Sensation is returning to your hands and feet. It hurts but it is also good. You were at the point where all your feeling had shrunk to a tiny spark in the center of your chest. As the iv fluid runs, feeling slowly spreads out from that.
The doctor comes in. Grumpy, clearly. “Lean forward.” Listens to your chest. “Sounds clear.”
“It’s been hurting for 5 days. It hurts to breathe. Burns.” You are anxious as hell. BELIEVE ME.
The ER doc gives a little shrug. “Oxygen sats are fine.” He does a half-assed exam. He leaves.
You look at your feet, taking your socks off. Because he didn’t. There are two black spots, a couple millimeters across, old blood. Those are new.
You press the call button.
Time goes by. The nurse floats back in.
“Look. Tell the doctor to look. These are petechiae.” You point to the black spots.
If the nurse had laser vision, your feet would be burned. The nurse glares at your feet. He goes out.
The doc comes in and looks at your feet.
“They are petichiae. I have an infection.”
He gives a tiny shrug. “Your chest xray looks clear. Your labs are normal. You are not running a fever.”
“I am on azithromycin for walking pneumonia. I suddenly felt like all the fluid was running out of my arms and legs. I am worried that I am septic.”
“Blood pressure is fine. You are really really anxious.”
You are furious. It probably shows on your face. You are terrified.
“Could it be an antibiotic reaction?”
Shrug. “No rash.”
“Except the petechiae.” A sign of sepsis.
“I will change the antibiotics. Clindamycin.” He leaves.
You lie back, terrified. He doesn’t believe you. He is sending you home, septic. You will probably die.
The nurse comes in. Removes the iv and unhooks the monitor and the blood pressure cuff. You get dressed, numb and frightened and cold. The nurse goes out and returns. He recites the patient instructions in a bored voice and gives you the first dose of clindamycin.
You walk shakily to the door of the emergency room. To go home. While you are septic and they don’t believe you. You know what happens with sepsis: your blood pressure will drop and then organ damage and then IF you survive you could have heart damage or lung damage or brain damage and you might not anyhow.
You go home.
Covid-19: working in healthcare
So, should healthcare workers be required to have Covid-19 vaccines?
Yes.
What is the precedent?
Take tuberculosis, for example. Airborne, very contagious. I was born in a Knoxville, Tennessee tuberculosis sanatorium, because my mother coughed blood a month before she was due and got quarantined for active tuberculosis. Yes, the state could quarantine my mother. I was removed immediately at birth because tuberculosis doesn’t cross the placenta. The antibodies do, but the infection doesn’t. However, newborns usually catch it and die very quickly. I was lucky. My father and grandparents took care of me for 5 months. Then my mother was allowed out (after 6 months total) but was not strong enough to take care of me. So I was taken to my maternal grandparents for the next four months, and did not touch my mother until I was 9 months old.
My mother was taking 36 pills a day at home, because you have to use multiple drugs to kill tuberculosis. It develops drug resistance very very quickly.
Well, so what, you say?
Healthcare workers in the United States are routinely checked with a ppd for tuberculosis. If it is positive, you cannot work until further testing. If you have latent tuberculosis, you are treated. If you have active tuberculosis, the treatment is longer and more complicated, here: https://www.cdc.gov/tb/topic/infectioncontrol/default.htm
My cousin then said, “Well, you don’t have to show the tuberculosis test to go in a restaurant!”
Well, not right NOW, because currently tuberculosis is under more or less reasonable control in the US. Remember that guy who came in to the US with active multi drug resistant tuberculosis and knowingly exposed everyone on that airplane? Great. I remember reading about that and thinking what a selfish jerk he was. And then the group of unimmunized people who went to India and all got measles. The US at that time did not bar anyone from returning, but asked them to finish a 3 week quarentine before returning to the US. One person did not do that. There was a measles outbreak in the midwest which cost the CDC (and therefore you and me because those is tax dollars) millions to trace, quarantine and clean up. So there was discussion at that time about whether the policy should be changed and we should not allow US citizens with known infectious diseases to come in on airplanes. We DON’T allow immigrants in with infectious diseases: they are tested for tuberculosis if coming from countries where it is endemic.
So, if we had a huge outbreak of tuberculosis, we WOULD have quarantines and shut downs.
I have tested a patient for tuberculosis, about two years ago. Her son had been diagnosed with active tuberculosis. We tested her with a blood test and then repeated it in three months. Negative, hooray. In residency I also saw a case of miliary tuberculosis. That is where the tuberculosis is growing so well in the lungs that it looks like little grains of rice in the lungs on imaging. Not a good thing.
My cousin: “You shouldn’t have to put something in your body to work.”
If you have tuberculosis, you do not get to work in healthcare, because you can kill your patients. I think that this is a good thing, to not kill our patients.
I am submitting this to the Ragtag Daily Prompt: starspangled. Keep America Healthy, how about that?
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