Category Archives: rural doctor

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Daily Evil: A is for Anger

Welcome to April Blogging from A to Z.

A friend of mine died in February. She has known me since I was born, because she was in college with my parents. In fact, my father got arrested for having her graduation party, though it was thrown out of court. Knoxville, Tennessee, in 1963, and the problem with the party was that it was mixed race. Luckily there were no drugs and no minors drinking. I was the youngest minor, age 2. My mother was left with me, terrified that she could be lynched.

Anyhow, this friend is an artist, like and unlike my mother. I spoke to her daughter-in-law a few days ago and she says she is in the anger stage of grief. Yes, I know what she means. And new grief brings up all the old grief. How annoying. March 29 was the day my little sister died of cancer, so that all comes up too.

I keep reading that we should be positive. I hate it and I disagree. Sometimes we can grieve and go through stages of grief. Anger can be an indication that we are in a bad relationship or that we are being mistreated. Sometimes it is connected to old past anger, though, that needs to be cleared out. Have I succeeded with that? I don’t know.

Is anger evil? I do not believe any feelings are evil. Acting on them may be evil, but it’s complicated. Feelings are information, part of our senses. This doesn’t mean that we always interpret things correctly, so sometimes we need to check. “When you said this, I interpreted it this way. Is that what you meant?” I usually have to wait a week if I am upset about something, so I can have the feelings calm. I get better and better about not acting on anger. I do not mind feeling it.

A is for Adam and Eve as well. This is one of Helen Burling Ottaway’s etchings, titled “First Valentine”.

For the process of making an etching, read here. This is from 1982, number 29 out of 35, a limited edition each run and signed by the artist.

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Who would I be?

If I have had PANS since birth, who would I be if I had not contracted it?

No one knows. We are still arguing about whether PANDAS and PANS exist. But, my daughter says, we make up all the words. The definitions of illnesses CHANGE over time, and what an illness MEANS. Tuberculosis was an illness of poets and people too noble for this world, until microscopes became advanced enough to see the tiny bacterium, and then it became an illness of the crowded unclean poor. Medicine and science continued to study it. Once we recognized that it is an airborne illness, tuberculosis sanatoriums were set up, to quarantine people. My mother was diagnosed with tuberculosis when she coughed blood 8 months pregnant, so I was born in a sanatorium and avoided contracting tuberculosis as a newborn.

Antibodies cross the placenta, even though the tuberculosis bacterium does not. Usually infants contract tuberculosis and die, at least when I was born. The antibodies can trigger PANS or PANDAS.

The antibodies prime the fetus’s immune system. This makes sense, right? The fetus has a sick mother and best if its’ immune system is ready to fight.

Did my younger sister have it? I do not know. Not as badly, would be my guess. My mother said that as kids, we’d both get sick, but I got sicker. We both had strep A many times. My sister got mumps, off from school for three weeks, and I did not get it. But I got everything else.

Now the estimate for children with PANS or PANDAS is 1 in 200. This is enormous. A high prevalence. Antibodies, that I suspect are adaptive and lie in readiness for a pandemic or a crisis. And now we have had another pandemic, with the last really world wide bad respiratory one 100 years ago. Is the prevalence rising because of the pandemic or are we figuring out some of the cause of behavioral health illness or is the definition of illness changing or all three? I think all of them.

My cousin’s mother had polio either during her pregnancy or very soon after. My anthropologist uncle took his family to Bangladesh, where he was doing linguistics. So does my cousin have PANS or PANDAS? I do not know.

And what of my children? My pregnancy with my older child was fourth year medical school and went well. My pregnancy with my second was very complicated. I was in my first year of work as a rural Family Practice doctor and working too hard. I ended up on bed rest for three months and on a medicine. Is labor at 23 weeks an illness? Does it affect the fetus? I was on medicine from 23 weeks to 37 weeks. What effect does it have?

Medicine is still changing and changing quickly. We don’t know. There is so much we do not know.

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PANS/PANDAS: https://www.pandasppn.org/guidelines/

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The photograph is me and my sister, in about 1967ish. I do not know who took it.

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The brim of the ocean

The beach is the brim of the ocean
we dabblers play at the rim
The tide overflows up the land
What to a whale is a sin?

We walk at the edge of the ocean
we run from the waves rolling in
we swim in the sea or float in a boat
What to a whale is a sin?

Leviathan live in the ocean
breech sprays to breathe at need
the brim of their home is the land
The sea is the place that they feed

The land is a tide to a whale
Boat islands sometimes approach
Do whales wander and wonder near land?
Wonder why land must encroach?

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For the Ragtag Daily Prompt: brim.

I think I need a tune.

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not really, right?

I ask a male friend of mine, older and perhaps wiser. “Um, the guys I have dated or even just hung out with are only interested in their interests. They are not interested in me or what I am doing. For example, I mention that I have a blog twice to two different males recently and they completely ignore it. I mention that I just did a poetry reading and one whips out his phone and shows me a family member’s poem. What is it with that?”

“Well,” he says, “Men are only interested in what a woman is doing, if they are in love with her.”

“Really?” I say. “Holy crap.”

“Absolutely.”

I am still chewing on this. I have dated various “gentlemen” for a couple of years each since I got divorced. One of them is still a friend. Last month he said, “I think you like writing better than I do.” Um. He has known me since 2008. Powers of observation, like a hawk in flight, heh.

I can think of seven guys since 2007, when my divorce was final, who really showed very little interest in what I was doing. Ok, one of them did read my blog and another admitted to reading at least one post, but refused to EVER comment. What the hell? Meanwhile they want to talk about their collections, their jobs, their lives, their interests.

And so I reexamine my ex-husband. He actually DID listen and WAS interested. Mostly he laughed at me, but medical school and residency were off the scale dysfunctional and ridiculous. And in turn I listened to his golf shots and watched Payne Stewart dress in NFL colors and plus fours.

But I don’t get it. Maybe the younger generations are a lot smarter and I think they are darn smart to say who cares about the XX or XY or XO or XYY chromosomes! There are lots of other chromosomes! Let’s get over race and gender! That stuff is shallow unless you are interested in someone in the pants zone.

And then men complain to me that they do not understand women. Really? I ask if they have ever read a romance novel. One said, “Those are for women. I wouldn’t do that.” So one romance would take away your man credentials? I say, well, you might understand what our culture indoctrinates women with if you did read a romance. Not to mention notice that Disney animation glorifies virginal princesses, but gosh, queens are either dead or evil. Doesn’t seem like a good career choice, breeder for the ruler. Especially if you’ll die in childbirth or turn evil.

I hope my male friend is wrong, but I am paying attention. And noticing if a man is not.


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Food needs two

Ok, so what menu did I choose for my friends with food needs, as listed in the previous post.

First course: Sweet Pea soup. The color is vivid and almost lurid. My guests look worried until they taste it. It tastes like spring! Butter, onions, broth and frozen sweet peas, just cooked. My guests go from worried to asking for seconds.

Second course:

Lentils baked with sausages. This is also not a gloriously pretty dish. Again, my guests love the taste. Lentils, a little red wine, butter, onions, bay leaf, sausages, thyme and baked. Yum.

As well as:

Roasted Ronde de Nice Squash with California rice and Early Girl tomatoes. Except I did not make the rice, I couldn’t get farmer cheese and the tomatoes were varied and from the store. And a different kind of squash! This is from a cookbook new to me: Community Table, Recipes for an Ecological Future. The sweet pea soup is from a cookbook that I’ve had for forty years and the lentils are from memory, a recipe a friend taught me in the 1980s.

Dessert is fruit salad and chocolate. With tea.

No liver, gluten, shellfish, giant rubbery cooked mushrooms, anchovies, dried fishies or grubs.

Voila! Food needs satisfied!

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You will be labeled

If you get sick
with something the doctors don’t understand
you will be labeled
unstable
mental
bipolar
crazy.

They will try to drug you.

How do you tell
when they are right
and you are crazy
brain on fire
and when you aren’t?

Don’t ask me.
I’m a Family Practice doc
and I’m rural
and I’m a girl.

I’m the one they make fun of
in the medical schools.
“The rural doctor
transferred this patient.”

Yes we did.
Because we knew it was something
different
that needed more
than we had
in our small town
in our small hospital.

Once a neurosurgeon says,
“You are transferring the patient
because it’s Friday
and you don’t want to work
on the weekend.”
“She needs an MRI,” I say
“and we don’t have one.”
and transfer her anyway.
I call two days later.
After the MRI, she is in
the operating room
for a tumor in her spine.
He doesn’t call me back
but I hope he remembers.
I certainly do, after years
and years.

If you get sick
with something the doctors don’t understand
you will be labeled
unstable
mental
bipolar
crazy.

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Sailing with my father

Sailing with my father
after I’m divorced
we take my two children.
They and I are small.
My father is frail,
55 years of Camel cigarettes
in his lungs.
“Papa,” I say, “How would we
pull you in if you went
overboard? We aren’t strong enough.”
Nor is he strong enough
to pull me in.
My father thinks. “You are right,”
he says, “We’ll make a Go Bag.”
A 3 to 1 pulley, with a clip.
We can clip it to the boom
and push it out over the water.
Attach the pulley to the life jacket
and I can winch nearly anyone aboard.
Maybe. We have it in a dry bag,
with towels and chocolate
and a set of sweats,
a space blanket
because the water is cold here,
45-55. My father knows, I’m sure,
that if he falls in, he’d be unlikely
to survive even if I did reel him in,
an unlikely catch. We wear our life jackets
and the kids do too.

One time we hit container ship waves
when my son is on the bow.
He is thrown up and drops, flat,
prone on the bow, holding on.
This boat has no railings
but my children pay attention.

We never have to use the pulley.

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At first my father said that we could unhook the haul down and use the boom, but I said, if it’s me and two little kids and I have to drop sail and get back to someone, that is too hard. How do we make it easier?

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Love sorrow

Love sorrow

There are a lot of people that I love

that don’t love me. The family that

believed my sister’s stories, about me,

my father, and her daughter’s father.

My sister died ten years ago.

I wait a decade, trying to repair it,

and now I give up. I do not want to

see them again, any of them, though

I still send them love. They may not

have my presence, after a decade of

cruelty or indifference.

Work, too. I am labeled malingerer

twenty years ago, after influenza.

“I don’t understand how you could be

out for two months from flu. I could understand

a heart attack or cancer, but not flu.”

Do you understand it now? I had

Long Covid before Long Covid existed,

after pneumonias: influenza, strep A

strep A and then Covid. Each time it

takes longer to recover. After the third round

and a year, I know that I have chronic fatigue.

I don’t bother my doctor as I am a doctor

and I know we have no cure. I can work

half time, see half the number that we are

supposed to see daily. I work anyhow.

The money ends almost meet. After a decade,

Covid closes me down. I go to work for The Man,

suspecting I’ll get pneumonia. I walk in rooms

to patients with their masks off. I react

with PTSD each time but take care of them

anyway. It only takes five weeks to get

Covid. I am on oxygen for a year and a half,

chronic fatigue magnified. How did I not get

it in my clinic? I masked everyone with a cough

or cold from 2014 on. My patients were USED

to masks and I masked too.

I am on oxygen and suddenly the doctors

who thought I lied, are pleasant and stop to

talk to me, while I think cynically, you’ve

disbelieved me and spread rumors about me

for 20 years. Do you think I forgive you now?

And one who said he’d be my friend forever

no matter what. And also said that when people

go over his invisible line, he never speaks

to them again. I think, oh, that will be me,

this is a set up. It is. But Beloved, Universe,

Earth, Sun, and Moon

why do I love them all anyway?

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For the Ragtag Daily Prompt stable, because maybe love is the only stable thing in an unstable world.

The bones of the great blue heron are so light, that I think it is standing on the floating kelp beds. I’d wish my bones were that light, but that would be osteoporosis. Maybe I could come back as a heron.