I went to Portland to meet my daughter, when she was up visiting friends. I stayed with one friend for two nights and then picked up my daughter and took her to another friends’ house. They currently have an empty garage apartment.
My daughter was supposed to fly out Thursday, but the 10.8 inch snow dump happened on Wednesday night. My friends are on this road that is mostly gravel and steeper than it looks in this picture.
The tracks that you see are driveway. The line in the trees is the road.
My friend has a pickup and chains and left for work at 6:30. My daughter and I put my chains on my Scion, and tried the hill. We blew the left chain off twice and the right one was mostly off as well.
That was probably a good thing because her plane was cancelled and there were accidents all over town.
We spent 2 hours and 30 minutes on hold with the airline and got her rescheduled for Saturday at 11:30.
She left the next morning with my friend in his truck. He dropped her at the metro and she stayed with friends who live close to the airport and are on the metro line.
My friends and I tried my chains again on Saturday morning. B blew one chain off too and we figured that a link had to be locked in a certain way. He drove up the driveway and we followed in the truck. He drove along the road until we were down to where chains were not needed. I thanked them all and headed out. Down the road a little there were three more abandoned vehicles: a truck with chains on and two cars. There were still patches of ridged ice on the 405 bridge. It took from 10 am to 12:22 to get back to Washington State! So hooray for chains and friends!
I am watching a four part video from the UK about illness and trauma.
The first part is about how trauma memories are stored differently from regular memories. Regular memories are stored in files, like stories in a book or a library.
Trauma memories are stored in the amygdala and often are disjointed and broken up and have all of the sensory input from the worst parts, including the emotions.
The therapist is talking about healing: that our tendency is to turn away from the trauma, smooth it over and try to ignore it.
However, the amygdala will not allow this. It will keep bringing the trauma up. And that is actually its’ job, to try to warn and protect us from danger!
The therapist counsels finding a safe time and place and safe person (if you have one) and then making space for the trauma to come back up. One approach is to write out the story, going through that most traumatic part, but not stopping there. What happened next? Writing the story and then putting it aside. Writing it again the next day and doing this for four days. As the story is rewritten and has an ending, even if it is not a happy ending, the story is eventually moved from the amygdala to the regular files. People can and do heal. They may need a lot of time and help, but they can heal.
I am not saying that four days of writing stories is enough. That is one approach, but nothing works for everyone and people need different sorts of help. There are all sorts of paths to healing.
In my Family Practice clinic I would see people in distress. With some gentle prompting and offering space, they would tell me about trauma and things happening in their personal life or work life. Things that were feeling so overwhelming that they could not tell their families or friends and they just could not seem to process the feelings about it. I would keep asking what was happening and give them the space to tell the story. Many times when they reached the present they would stop. There would be a silence. Then I would say, “It seems perfectly reasonable that you feel terrible, frightened, horrified, grieved, whatever they were feeling, with that going on.” And there was often a moment where the person looked inwards, at the arc of the story, and they too felt that their feelings were reasonable.
I would offer a referral to a counselor. “Or you can come back. Do you want to come back and talk about it if you need to?”
Sometimes they would take the referral. Sometimes they would schedule to come back. But nearly half the time they would say, “Let me wait and see. I think I am ok. I will call if I need to. Let me see what happens.”
When a person goes through trauma, many people cut them off. They don’t want to hear about it. They say let it go. They may avoid you. You will find out who your true friends are, who can stand by you when you are suffering. I have trouble when someone tries to show up in my life and wants to just pretend that nothing happened. “Let’s just start from now and go forward.” A family member said that to me recently. Um, no. You do not get to pretend nothing happened or say, “I wanted to stay out of it.” and now show back up. No. No. You are not my friend and will not be. And I am completely unwilling to trade silence about my trauma for your false friendship.
Yet rather than anger, I feel grief and pity. Because this family member can’t process his own trauma and therefore can’t be present for mine. Stunted growth.
People can heal but they need help and they need to choose to do the work of healing.
This song is a darkly funny illustration: she may be trying to process past trauma, but the narrator doesn’t want anything to do with it. And he may not have the capacity to handle it. He may have his own issues that he has not dealt with. And maybe they both need professionals.
My feelings are not that complicated now I feel sorry for your need to be quite cruel Sorry and occasionally wonder how You justify acting like a stubborn mule a distillation of your treatment is quite clear you choose to keep the people you control promises mean nothing when you feel fear Telling yourself we’re evil takes a toll You feel free and safe when you axe another friend You feel that all your problems are at bay A new need immediately builds again Who will be the next victim of the day? Your world shrinks every day you live A stone cold heart forgetting how to give.
Sonnet 14
____________________
Isn’t it an amazing tree? Complicated and yet forming an overall beautiful shape.
On Sunday I was in Portland with a friend and went to a memorial at the Laurelthirst. It was for a musician named Turtle. Local musicians showed up like crazy. There were at least six very fine guitar players, three on stage at a time and sometimes more. They switched in and out and switched styles. It was a beautiful tribute.
My two favorites were “They threw me out of the band” and one that bemoaned everyone playing music and drinking and that he had to sing another song about another dead band member. Funny and sad.
Red Paw puts her elbows on the table and her chin in her hands. “Told you so. Been telling you for 11 years.”
The small child/angel is sitting in a chair that morphs from regular boardroom chair to youth chair as she morphs back and forth.
“Nice job with the chair.” says Red Paw.
The two split and now there is a Small Child and an angel, sitting in two chairs.
Red Paw morphs too, into a bright red angel with a black halo and black bat wings.
The White angel nods and a feather drops. The feathers are bright white. Her halo is made of gold glittery pipe cleaners and attached at the shoulders.
Red Paw’s halo floats and seems to pull at the room.
The Quiet Woman sits in the fourth chair, with a cup of tea. “Anyone else?” she asks.
The others shake their heads.
“We are discussing the diaspora. Is it time to let them go?”
“Has been for 11 years.” says Red Paw nastily.
The small child nods.
The White angel says, “They want to believe what they want to believe. Let them go.”
“T, B, S, C, S, D, A, F, N, C, T, L, K, R and then next generation as well?”
All three nod.
The small child says, “They can contact us at any time.”
“They won’t.” says Red Paw.
“People can change,” says the White angel.
“And do they always?” says Red Paw.
“No.” says the White angel.
“I agree,” says the Quiet Woman. “We are done.” She brings a gavel down on the table, which rings like a singing bowl. The other three blur and melt in to her.
“We are done.”
_____________________
The photograph was taken 2016 or earlier when Halloween was on a Sunday. I dressed up and so did the minister.
An old friend died this morning. She was a college friend of my parents and has known me since birth. I will miss her quite terribly.
She and I took a road trip in September. She had lost thirty pounds, not on purpose. I thought I had better do the road trip while we could. We went from Michigan to visit five households of old friends in Wisconsin. I lived with her and her family for a year during college in Madison, Wisconsin in the early 1980s. She is a beloved mentor.
She also introduced me to all sorts of groups. She has an amazing record collection.
I went with her to see Warren Zevon in Madison.
The painting is my photograph of one of her oil paintings. It is about 3 by 5 feet and gorgeous.
Why? The problem with templates in primary care medicine is they focus on getting a specific list of questions answered for something like ear pain or back pain. They miss the weird stuff. They miss the outliers.
I hated the templates when we got our first electronic record in the early 2000s. The doctors who liked computers spent a year picking the system. Then they trained all the clinics for one week and we all went live. One of the biggest problems was that they liked computers and talked the language. We didn’t. We quit asking questions within a week, because when we asked a question it 1. Was a user problem and 2. They treated us like we were stupid and 3. They answered in Geek, which we did not understand.
We quit asking questions. The nurses and I all filed for workman’s comp because our shoulders locked up. Our shoulders hurt. We figured out how to get the stupid thing to work. Every doctor and nurse and PAC and nurse practitioner worked to figure it out on our own.
Two years later, they set up some standards for use. We resisted again, because they gave us orders in Geek and anyhow, we had no respect for them and we didn’t care. Change what we were doing? After no support for two years? Good luck!
It took me two years and three months to get the system to write what I considered a good clinic note. I had contacted an outside specialist three months in and asked how our notes were.
“You want me to be honest?” he said.
“Yes.”
“They suck. They are useless.”
“That’s what I thought.” I went on fighting the system and hating it. I won, eventually. Parts of my note continued to suck, but I figured out how to work around the stupid templates and put in some REAL information.
Now wait, you say, is the template totally useless?
In some situations, like emergency rooms, it may be very useful. It helps keep a harried ER team with four people from a car wreck from missing something. And if you are an ENT, otolaryngologist, you do see a lot of ear and mouth and throat things, so templates may help. But I think they are terrible for primary care.
They are good for billing, though. If you have all the boxes checked, the insurance company pays, and you can move on to the next victim. The insurance companies pay more if you see more people in a day. That is why our administration said, “See people for one thing per visit.”
However, that is not ethical. Say it is a 70 year old diabetic with atrial fibrillation on coumadin with a bladder infection. You cannot just say bladder infection and slap them on sulfa. For one thing sulfa screws up the coumadin and puts them at risk for bleeding. For a second, diabetes can affect kidney function and so can age and you have to adjust antibiotic dose for lower kidney function. For a third, if their glucose levels are out of control, the infection may not be controlled by an antibiotic. It’s not one thing. And the average patient has 4 chronic disorders in a study way back in the early 2000s. That means some people have none, some people have eight or more and most people have 3-5. Hypertension, diabetes, toe fungus, chronic shoulder pain, heart disease, the list goes on and on.
In any visit, I am alert for the things the DON’T fit. One time I am doing a new patient visit for back pain and note that she is hoarse. I bug her about the hoarseness. She admits it is continuous and has been there for two months. I do two referrals, because continuous hoarseness can be laryngeal cancer.
When she returns, she thanks me. She has vocal cord polyps, not cancer, but needs laser surgery. “You didn’t have to do that but you did.” she says. And do I feel good about not ignoring it? The visit went over time, but I’d rather go over time than miss laryngeal cancer, right?
We were taught to let the patient talk. Open ended questions. They’ve done studies that doctors cut people off from telling their stories very very quickly. If you let people talk, sometimes they say something that doesn’t fit the template, and we have to pay attention. Sometimes a comment or a couple comments are the clue, the key, the thing that doesn’t fit. Don’t force it into the template. Pay attention instead.
_______________________
The very serious group of people is a county medical meeting, 2014.
Discover and re-discover Mexicoβs cuisine, culture and history through the recipes, backyard stories and other interesting findings of an expatriate in Canada
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
Refugees welcome - FlΓΌchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflΓΌchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
KO Rural Mad As Hell Blog 
You must be logged in to post a comment.