Playful Packrat

My sister freaks out once. “Oh, my gosh. Our parents still have boxes from their last move a decade later. What will we do when they die?”

Me: “Get a storage unit and open a box a year at Christmas for the rest of our lives.”

Her: “That could work.”

I tell my sister that we could start a magazine in response to Real Simple. “We will title it Playful Packrat.” We come from an impressive line of Packr– I mean, Collectors. Collector is honorable and respected. Packrat is, well, unfashionable. Perhaps I should title it Circumspect Collector instead. I know someone who seems to be collecting heavy equipment, which is an interesting choice. One needs more property than I have for parking.

My house would make Marie Kondo shudder. The photograph is the basement: the stack is my mother’s larger artworks. I am moving stuff around now that I am home-on-oxygen instead of running around clinic like a crazy rabbit. And like this writer, https://www.architecturaldigest.com/story/maximalist-response-marie-kondo-minimalist-mandate, it ALL gives me joy. Well, ok, not the tiny ants. We are at war. My kitchen may be cluttered but by gosh it’s clean clutter because the tiny ants let me know immediately if I screw up.

Anyhow, my mother died in 2000, my sister in 2012, and my father in 2013. My parents left me their stuff and grandparent stuff, some of which I had never seen, and I still get dead people mail. The colleges and universities are the most persistent. They don’t care if someone is dead, they still mail out the Alumni Magazine. I get U of WI, Cornell, Princeton, U of Oregon, Medical College of VA, OHSU and Williston. Holy moly. U of TN and SUNY Binghamptom have lost track of us, thankfully. I wish I had kept my father’s notes on Beowulf and mailed them to Williston for their library. It would be a sort of just revenge. I still have boxes (my excuse is busy physician) so I will bet that I can find something to mail to each one of those places. Something that they want just as much as I want their Alumni Magazine. With a cover letter that says that my contribution is hidden in the documents. One dollar each.

I have too much stuff but I have now turned middle aged, that is, I am over sixty. So I now am on the downward side and decide, there needs to be outflow rather than inflow. I like my stuff but it’s time to start moving it. My mother was a prolific artist and all of the silent auctions in town will now be blessed by her art. And don’t worry, it is not awful! She has art in the Smithsonian, the National Museum of Women Artists, and a bunch of other places. See my April A to Z for details.

For my father it was books and musical instruments. I still have the guitars. I think there were twelve trumpets? A lute, a harp, a cello — the lute is in very bad shape and the others have gone to someone else and the school, respectively. Recorders, gone. I have flutes, my regular flute and then ones made out of clay, cherry, pvc pipe and bamboo, as well as a Native American flute. I am mostly playing the regular flute, Native American flute and guitar.

I am guilty of books, too. I DO want to read them all, but even if I did nothing but read for the next sixty years, I might not finish. The excuse that some are reference does not fly. Some are pure unsullied entertainment and by gosh, I am keeping those! I am not allowed to go to the book sale next week. I do have a library box but the books are not leaving at the rate they have been arriving in the last year. And it’s my fault.

Anyhow, I am enjoying my clutter. After all, we invented tables to put things on. Sometimes we do have to clear the table for the NEXT project, but no worries! There is always the floor!

Cheering up music:

On The Edge of Humanity Magazine

Huge thanks to The Edge of Humanity Magazine, for publishing two essays.

The first one on May 9, 2022, that abortion must remain legal for women’s health:

The second today, about behavioral health in a pandemic and war. As caring humans, how could we NOT respond with distress to the suffering and deaths from both Covid-19 and disasters and wars?

I am so delighted to be featured on this platform. I enjoy so many of the artists and writers and poets who are featured there and I am very happy to contribute!

how doctors think, a dual pathway

A friend calls today and says that another person is bleeding and yet they have been set up to be seen Monday. Why isn’t this an emergency?

Based on the limited information the friend tells me, I agree with the doctors. It is NOT an emergency and I explain why. It is uncomfortable for the person because it may be cancer. Why is that not an emergency?

Let’s use chest pain in the emergency room as an example. Doctors have two brain tracks that are triggered simultaneously by every patient. The first one is “What could kill this person in the next five minutes?” The second is “What is common?” Common things are common and more likely. In medical school the really rare things are nicknamed zebras. You know there are a lot of horses but you can’t miss the zebra. I suppose that in Africa the common things are zebras and the rare ones are orcas or something like that.

Anyhow, the killers for chest pain are heart attacks, sudden death. But there could also be a dissecting aortic aneurysm, where the largest artery in the body is tearing. That person can bleed to death really really fast and that is a surgical emergency. No doctor wants to miss it. There could be a pulmonary embolism, a clot blocking the lung. Chest pain could be from a cancer. A very rare chest pain is from the valve leaflets in the heart tearing so that the person goes in to flash pulmonary edema. And there is Takayasu’s Arteritis, “broken heart syndrome”, where the heart suddenly balloons in size and again, heart failure ensues. Heart failure is actually pump failure, so fluid backs up in the lungs or the legs or both. It is usually slow but rarely very fast and dramatic. A collapsed lung can also cause a lot of pain. And my list is still not complete, I haven’t mentioned pericarditis or myocarditis or a compression fracture.

The common things do include heart attacks, but also anxiety, musculoskeletal problems, inflamed cartilage of the chest wall, fibromyalgia flares, broken ribs, trauma and other things. I was very puzzled in clinic by a woman with pain on both sides of her lower chest wall. In front but cutting through her chest. I ruled out many things. I thought that it was her diaphragm. I sent her to a rehab doctor for help. The rehab doctor sent her to radiology. She had a compression fracture of her spine and the nerves were sending pain messages on both sides. That was not even on my “differential diagnosis” list, because she had no back pain at all. My list changed that day.

Physicians and nurse practitioners and physicians assistants and registered nurses and licensed practical nurses and medical assistants are all trained to think of this differential diagnosis. We are alerted by the history and have to think down both pathways. Last year working as a temporary doctor, the medical assistant came to me saying, “This patient’s blood pressure is 80/60.” “Is he conscious?” I asked, as I went straight for the room. “Yes, he’s talking.” He WAS talking, which means that he’s gotten to 80/60 slowly or is used to it. His heart rate was fast, up near 120. I immediately had him drink water and keep drinking, as soon as he denied chest pain. The problem was dehydration: he was developmentally delayed and had only had one cup of fluid that day and it was now midafternoon. I spent time explaining that he needed 8 cups each day. Not more than that, because if he had too much fluid, it would lower his sodium and make his muscles weak. Most days he drank 3-4 cups. His chart graphed the problem: some days he had normal blood pressure and a normal heart rate. Other days his blood pressure was below normal and his heart rate was fast, his heart trying to make up for the low level of fluid. Cars don’t do so well when there is almost no oil, do they? His kidneys were affected as well. I asked him to drink the 8 cups a day, discussed the size of the cup (not 8 gallons, please) and then recheck labs in 2 weeks. If his kidneys did not improve, he would need a kidney specialist. It turned out that he had nearly fainted that morning in the waiting room. His group home person admitted that no one had noticed that he really was not drinking fluid. I thought that the patient understood and would try to drink a better amount of fluid.

So back to the person I was called about. Infection has been ruled out. This is blood in the urine. A kidney stone has been ruled out, but there is something in the kidney. This is urgent, but if the person is not bleeding hard, it is not emergent. When there is blood in the urine it does not take very much to turn it red. If there is a lot of blood, that can be an emergency, but from the story I got third person, it’s not very much. The emergency things are ruled out but there is still not a clear diagnosis. Yes, cancer is one of the possibilities but it could also be benign. Now a specialist is needed to figure out the next step and the differential diagnosis, the list of things it could be. They will order tests in the same dual order: what could kill this person quickly and what do we need to rule out as common? People often can be very anxious during this period, which is normal. The person says, “I don’t care what it ISN’T, I want to know what it IS.” But sometimes it is a zebra and it takes a while to get to that specific test.

Another example is a woman that I sent to the eye doctor. The optometrist thought it was something rare and bad. He sent her to the opthamologist, who ruled out the first thing, but thought it was something else rare and bad. He sent her to a retinal specialist. The retinal specialist ruled out the second rare and bad thing and said, “No, you have something very rare that is benign.” My patient said, “I have three diagnoses. Who do I believe?” I replied, “No, you have one. The optometrist knew it was unusual and sent you to an eye doctor. The eye doctor know it was unusual and sent you to an even more specialized eye doctor (a “sub specialist”. We keep them in basements.) Now you have a diagnosis. It was a scary process, but I think you should focus on the third opinion because hey, she said it’s benign and it won’t hurt you! That is the best outcome!” She thought about it and agreed. The process was frightening but the conclusion could not have been better.

For the Ragtag Daily Prompt: disquieting.