Category Archives: rural doctor

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Austere choice

What could be more austere than rock?

Taken in Echo Canyon in the Colorado National Monument, Thanksgiving, 2024.

Austere choice

Why do I still feel sad when I think
that I am best off with my cat
and that I should eschew dating.
Why do I feel like I am rejecting love?
I don’t have that sort of love.
It’s not like I am rejecting anything.
I am rejecting looking for it.
I am rejecting active interest in a partner
other than my cat.
What is wrong with that?

I do not ever want to reject hope.
I am not trying to reject wanting.
Hope and want are the deep and terrible ache
for the Beloved. I do not reject that.
I am still open, Beloved, to what you send,
though getting more particular in middle age.
A writer says that he uses a pencil and a pad,
because no better tool has been invented.
I take the same approach to wanting love.
If the relationship is more work than my cat,
for less love, why bother? It seems silly
and until I go home to the Beloved,
so far, I am best off with my cat.

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The first thing Sol Duc does when we go out for a walk, is roll on the sun warmed dusty sidewalk. The house faces south.

For the Ragtag Daily Prompt: austere.

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Surreal failure

I am still thinking about Friday’s Ragtag Daily Prompt: failure. Now that I am middle aged (by my clinic definition, which put over 90 as older), I think the biggest failure of my generation is a peaceful world. For me, a peaceful extended family. I am good friends with my father’s family and my ex-husband’s family. But the maternal family, well. I have thought about that for the last two days: could I have changed that?

Yes, but at what cost? My sister followed the “family rules” on that side. She is dead from cancer. My mother also followed the rules and died younger than me from cancer. I can’t say that the rules cause cancer. But doesn’t our culture say over and over, be yourself? To fit in the family diaspora, I would have to play the triangulation game and gossip about others as they have gossiped about me. No, thank you, no. I don’t want to. They seem to need a family member to hate and have chosen me and labelled me and call me angry. I think they are silly and emotionally immature. At the very least, I would have had to keep my mouth shut and accept them gossiping about me.

The family failure and untrue gossip, with no one ever asking for my viewpoint, mirrors the US culture. Split and needing someone to hate. At this rate, we’ll need the hippies back, with flowers and joy and counter culture and dropping out. Someone fun, at least until the drugs wear off. Someone to say, we need joy back, we need friends, we need love.

It’s not just my failure though. The family failed. They make cruel choices and target people. It happened in my generation, my mother’s, my grandparents. I wonder if it is happening in my adult children’s generation. Who is the next target? Who will refuse to counter-gossip and fight with each source? My adult children are not part of it at all, because I had less and less interest in spending time with mean gossips and I did not want to expose my children.

Lies and drama and meanness and gossip. I hope my adult children’s generation does better. We went to Wicked on Thursday. I did not like it much. Too much drama. Why do we want drama? The world seems more and more surreal. Give me the lovely hike we did on Friday instead, Echo Canyon.

For the Ragtag Daily Prompts: failure and surreal.

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Print or cursive?

My father’s father was a pressman and the head pressman when he was in Knoxville, Tennessee. This is back in the lead type times, when the type had to be set before printing the newspapers. Before they moved to Knoxville, they lived in Connecticut. My father said that my grandfather helped develop the four color process for the comics. My father would get the new comic books, Superman, straight off of my grandfather’s press. Too bad those were thrown out!

I started cursive in school in about fourth grade and I did not like it. I learned, but I thought it was ugly. My father knew how to write in italics. I liked italics much more and asked him to teach me. I adapted the capital letters to make them easier and then I wrote my papers in italics when we were not allowed to print. The teachers objected but I pointed out that we weren’t allowed to print in the papers, but it did not say, “No italics.” I imagine that some teachers found me difficult.

My cursive is still stuck in about fifth grade and I almost never use it.

Meanwhile fast forward. A law is passed in Washington State that prescriptions cannot be written in cursive. However, it does not say that we have to print. The same loophole. I usually printed prescriptions anyhow, so that the pharmacist could read it. I got compliments occasionally for printing in a legible way. I didn’t spell certain medicines correctly, but the pharmacists never seemed to care about that. Now it is all by fax and since Covid started, even the controlled substances go by fax.

For the Ragtag Daily Prompt: print.

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From Washington to Colorado

Whew! My daughter and her friend leave Denver to drive here Tuesday night. They hope to beat the storm. I am anxious. After 4 hours they are past the second pass, but the bottleneck is the visibility. It is exhausting to try to peer through the blowing snow and the lines on the road are covered. They stop at a motel. Whew! I can sleep!

They got here yesterday and made pies while I was at work. No bottleneck Wednesday, clear road and clear skies.

Half-Fast at halffastcyclingclub asks how I ended up working in Colorado.

I work in Colorado fresh out of residency. I did residency at OHSU in Portland. My now ex says, “Let’s go somewhere sunny, I am sick of the rain.” I reply, “Fine, find me an interview.” He does. One of his co-op housemates from Madison, Wisconsin is working as an emergency room doctor in Alamosa and directs us to a group there. We go.

In 2000 we move to Port Townsend because the Alamosa job is making me miserable, my mother has ovarian cancer, I have a job offer, and my parents are in Chimacum, Washington. Our clinic folds, as do nearly all the primary care clinics, into hospital employed clinics in 2002. I work for the hospital until 2009 and then start my own small solo clinic. This makes the hospital very grumpy. I close in 2021 because Covid and I am not comfortable signing another lease. I go to work in a town north of Port Townsend, in the next county. However, I can’t enforce the mask rule there. I get Covid in 5 weeks and am on oxygen for a year and half, and out for two years. I start some part time work.

I did not think I would get better enough to work but I do. I contact a couple locum tenens companies and start looking for another position in Washington. A less abusive one. The town north of me had only twenty minute visits, no administrative time to read laboratory results, xray results, specialist notes, notes from the previous doctors and honestly, the patient charts were a mess and looked like hoarder houses. So now I knew what to look for and avoid.

At some point, the locums representative says, “What about Colorado?” “Where?” is my reply. I do not want to go too high in altitude after having to recover for three years. Alamosa is at 7500 feet. “Grand Junction.” I look it up and it is at 4600 feet. I have already visited my daughter in Denver and was fine, so I think it will fly. “Yes, let’s try it.” In the interview I am much better at scoping out the schedule and how they handle controlled substances and whether there will be time to do the work. I bargain for slightly shortened days. Being close to my daughter is one attraction and I have read about Grand Junction and the fabulous hiking and mesas and mountain biking.

And that is how I came to Colorado.

For the Ragtag Daily Prompt: bottleneck.

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Snew

“Knock knock.”

“Who’s there?”

“Snew.”

“Snew?”

“I don’t know, what’s snew with you?”

I will have to pull out my patience cards today because, yes, it’s snowing. And I have family supposed to come from east and apparently that atmospheric river is dumping in the mountains. It’s supposed to snow in the mountains until midday Thanksgiving. I’m not sure I can have the whole meal all ready for them to arrive.

Ok, but patience, and let’s get creative. We could always do the cooking and have the meal on Friday instead of Thursday.

It is supposed to turn to rain here and the snow will be gone by noon. I jumped out of bed like a little kid, though, shouting “SNOW!” Sol Duc is unthrilled. The roads don’t look too awful and I wonder if anyone will cancel in clinic or it will be as usual.

Yesterday was a bit of a zoo, mostly because over 100 people realized that they are nearly out of some prescription and called for a refill. I knocked my message box down from 48 to 31 in the first 25 minutes and then it kept piling back up over 50. I also wish that if an 87 year old has a serious emergency room visit, they’d give me a longer follow up, because it can’t be done WELL in 20 minutes.

I expect that today will continue a bit nuts. Getting ready for Thursday and Friday off, to lie around pooped!

It’s all good.

For the Ragtag Daily Prompt: patience.

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Shim Sham Shimmy

I had to choose shim as my Ragtag Daily Prompt today because I am relearning the Shim Sham!

I learned it years ago, but forgot it. Now the dance group that I hang out with on Fridays does the Shim Sham as the end of their dance evening. This is a line dance but it’s a line dance from Harlem in the 1920s and 30s. It started from tap dance. “At the end of many performances, all of the musicians, singers, and dancers would get together on stage and do one last routine: the Shim Sham Shimmy.” Here.

I am learning it from this teaching tape. The individual moves are not that hard, but it is fast and it’s the transitions that I really have to work on. It is fast enough that it has to be memorized and automatic, I can’t think about the next step.

Frankie Manning was an American dancer, instructor, and choreographer. Manning is considered one of the founders of Lindy Hop, an energetic form of the jazz dance style known as swing. I got to take lindy hop classes with him in the 1980s in the Washington, DC area, when swing and lindy hop were having a revival. It is still going on, and what better exercise is there than dance?

And the photograph is Jonathan Doyle and friends playing in late March 2023. I love dancing to live music!

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Sad about the cows

The first photograph is Sol Duc. She is lying on my jacket to object to and obstruct me going to work. She has learned the new schedule, but things are a little different. In the three weeks we were gone, the night time temperatures have dropped into the 20s, so it is frozen outside. Yesterday it warmed to a high of 53 but not for long. It is dark in the morning and dark at night when I get home and we have not been walking with the harness and leash as much. Brrr, cold. We had a long walk yesterday at 10 am because it was my administrative day and I was caught up.

Sol Duc can’t find her pet toad any more. I think the toads have dug in for the winter and there are fewer and fewer insects. I think she is a bit bored. I’ve been building cardboard box puzzles for her, with the cat food ball inside. She has to roll the ball around to get the dry food to fall out. Maybe now she misses Elwha a bit, too. My work days are a bit long, leaving at 7:00 am and sometimes not home until 6:00 pm. Right now I have to drive to the other end of the valley.

The second picture is this morning’s sunrise. Gorgeous, yes? But that is the field across the street from us and that changed while we were gone too. They are building roads, all of the wild plants are gone, and it is staked all over and has large machines. And kitty corner, to the southwest, no more cows! The cows are gone! Are they inside for the winter or really gone? I think that they are really gone, because I see cows in other fields. The hay barn is still in use, but the cows have been moved. The city of Grand Junction is building and encroaching on the farms. We are right on the western edge of Grand Junction. No more early morning roosters, either.

I am not sure how to tie this to the Ragtag Daily Prompt, circular. Sol Duc is pretty circular when she curls up. The earth and the sky are circular. Emotions circle, happy to sad to surprised to worried and back. I am a little sad about the loss of the field and the cows, sigh, but happy Saturday to you.

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Conserving energy

I was out of clinic for two years and then very part time for a year and now not quite full time as a temp. I bargained to not quite be full time.

The electronic medical record is having a consequence, along with the pressure to see more people faster. The primary care doctors, at least the younger ones, do not seem to call their peer specialists any more. (Family Medicine is a specialty, just as Internal Medicine and Obstetrics/Gynecology are.) I called a gastroenterologist and left a message last week about a difficult and complex patient. The patient had cried three times during our visit. The gastroenterologist was very pleased I had called, was helpful, agreed with my plan of using the side effects of an antidepressant to try to help our patient, and thanked me three times for calling her. Wow. I am used to calling because during my first decade in Washington State, our rural hospital had Family Practice, General Surgery, a Urologist, Orthopedics and a Neurologist. For anything else, we called. I knew specialists on the phone for a one hundred mile radius and some knew me well enough that they’d say a cheery hi.

Now communication is by electronic medical record and email on the medical record and by (HORRORS) TEXT. Ugh. I think that there is quite a lot of handing the patient off by referring them to the Rheumatologist or Cardiologist or whatever, but the local Rheumatologist is booked out until February for new patients. That leaves the patient in a sort of despair if we don’t keep checking in on the problem. If I am worried, I call the Rheumatologist and say, “What can I do now?” I’ve had two people dropping into kidney failure and both times a call to the Nephrologist was very very helpful. I ordered the next tests that they wanted and got things rolling. One patient just got the renal ultrasound about three months after it was ordered. Sigh.

I have one patient who is booked in February for a specialist. I called that specialist too, they did not want any further tests. I told the patient, “You aren’t that sick so you won’t be seen for a while. It isn’t first come first serve: it is sickest first. We all have to save room for the emergencies and sometimes those are overwhelming.” The specialist agreed and the patient is fine with that and I think pleased to know that we do not think she’s that sick. She feels better. If things get worse, she is to come see me and might get moved up. Neither I nor the specialist think that will happen.

Is this conservation of energy, to communicate by email and text? I don’t think so. I think sometimes a phone call is much more helpful, because the other physician knows exactly what I am worrying about and they can tell me their thoughts swiftly. Sometimes they want me to start or change a medicine. Things can get lost in the overwhelming piles of data and the emails and labs and xrays and specialist notes all flowing in.

My Uncle Jim (known as AHU for Ancient Honorable Uncle Jim) used to sing part of this:

Yeah, that’s just how I call my fellow specialists.

For the Ragtag Daily Prompt: conservation. Don’t cats win at conservation of energy?

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Tool

I don’t wear livery at work
and anyhow that’s a uniform for men
or a place to board horses
though the horses can be male or female.
Once I go to my daughter’s second grade
for a bring your parent day
and bring part of my uniform,
or perhaps it is a tool or instrument,
my stethoscope. The children all want
to listen to my heart
or at least touch this magical tool.
Afterwards I receive thank you notes.
I think that every one, except my daughter’s
thanks me for bringing the stethoscope
to their classroom. I did not know how
special and magical a tool can be.

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For the Ragtag Daily Prompt: livery.