Category Archives: rural medicine

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Veteran

My clinic has gotten three calls in the last week to take more rural Veteran’s Choice patients. One was too far away on Whidby Island. Apparently few providers will work with Veteran’s Choice: but I understand that too, because it took me a full year to get the contractor for the insurance, Triwest, to start paying me. And it took me hours, hours that I could spend doing medicine, instead of fighting with a corrupt for profit corporation.

And I am glad that I won that round.

I took the photograph at our Rhody Parade, in 2006.

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On death and feelings

When my mother was dying of cancer, she did not want us to cry.

So we didn’t. We had her at home in hospice for nearly six weeks and we did not cry. Almost.

My sister called me. “I started crying today, at the kitchen table.” My mother was in another room in the hospital bed. “Everyone left. No one stayed with me. Everyone left.”

I didn’t cry but when people called to say how were things, I couldn’t speak. I sat there with the phone, silent. Because what I wanted to say was my truth and I knew very well that that was not what they were calling to hear. So I did not speak.

After my mother died, time passed. I felt…. many things, but the strongest one was “I wish my mother had let me cry.” We did what she wanted. But I wanted to cry.

My sister got cancer and fought it ferociously. She refused hospice until the last week. I flew down three times in the last two months.

Six days before she died, her friend and I were helping her. “I’m sad!” said my sister.

“Don’t be sad.” said the friend.

“It’s ok to be sad.” I said. “What are you sad about?”

My sister started crying: “I won’t be at my daughter’s high school graduation! I won’t see her get ready for prom! I don’t want to leave her!”

“You won’t leave her.” I said. “You will be there. Not in this form.” I meant it absolutely.

“I want to stay!” she said.

“I know.” I said. “I am so sorry.”

With my sister, I did not do what she wanted. I thought of my mother and that I wished she had let me cry. With my sister, I tried to listen to what she wanted and listen to what I wanted. I tried to be honest with her. She even got mad!

But… I watched her go in the cancer bubble. Where fewer and fewer people were being honest. They were afraid. They did what she wanted. They wanted her to be happy. And she tried so hard….

When I had arrived for the last visit with my sister, she was sitting with my cousin. I hugged her. She was not speaking much. I asked if she would like me to sing something and she nodded. I started singing “I gave my love a cherry”, a sweet lullaby. My sister shook her head, angry and fierce. I studied her. “How about Samuel Hall?” I said. My sister smiled and nodded. I started singing “My name is Samuel Hall.” It is about a man who is going to the gallows for killing someone and he is entirely unrepentant and angry. My cousin looked at me, startled. “I haven’t thought of that song in years,” he said. We both sang it to my sister. “To the gallows I must go, with my friends all down below, damn your eyes, damn your eyes.” That was the right song, angry, resisting, raging. “Hope to see you all in hell, hope to hell you sizzle well, damn your eyes, damn your eyes.”

I flew back to work three days before my sister died. I am told that she was scared when she died. “I said, don’t be scared.” said a friend.

Why not? I thought. Why can’t the dying be scared, be anxious, be angry? Why are we afraid to let them? I would have said, Why are you scared? And I would have said, I am scared too. And sad. And angry.

I told my counselor once that my husband was on the couch, angry, and I had to leave the room.

“Why?” she said.

“I am afraid.” I said.

“Why?” she said.

“I am afraid he’s angry at me.” I said.

“So what?” she said.

I thought, so what? “I want to fix him. I want him to not be angry.” Even if it isn’t at me.

“Why can’t you stay in the room?” she said.

I practiced. I stayed in the room. He was angry, grumpy, acting out. It’s not my anger. I don’t have to fix it. It may be just or unjust. Does it really matter? It is his anger not mine. I can stay present.

A friend said that his friend was dying leaving small children. “He was so angry that almost all his friends stopped visiting.”

A man and his sister are not speaking four years after their father died because they disagreed so strongly about how his lung cancer should be treated.

An elderly woman in the hospital agrees to go home for care with her son when he is present and with her daughter when she is present. When neither is present she will not make a decision.

A woman says to me that she is angry that hospice didn’t tell her which drug to give at the end to keep her friend from being anxious.

I hope that we learn to stay present for the dying and for the living. For all of the “negative” emotions. I see most of my hospice patients want LESS medicine rather than more. As their kidneys fail, the medicines last longer. They do not want to be asleep. They may cry. They may be angry. They may be unreasonable. Why should they be reasonable or nice or peaceful?

We want most to be loved entirely. Even when we are sad or whiney or angry or anxious. Who wants to be left alone when they are afraid? I hope we all learn to stay present.

And when we were alone, in that last three days, my sister said “I’m bad!” I said, “You are not bad. You’ve done some really bad things.” She said, “I’m sorry.” I said, “I love you anyway.” And she lit up like a buddhist monk, like an angel. And we both cried and I am so glad I was there.

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Update on marijuana 2016

I attended the Swedish Hospital Update on Chronic Pain in Seattle two weeks ago on the stormy Friday. The power went out and we were without slides from about noon on.

The first two hours and three lectures were about marijuana. Including medical marijuana and one speaker for and one against. So here are some of my notes.

In 1960 and 1970, the marijuana had about 4% THC. Now some strains have 30% THC, so long term there is no data about what 30% THC will do to a person rather than 4%. THC in strains ranges from 0% to 30% and CBD from 0 to 3.5%. However, those two are not the only active ingredients, so to speak. 537 constituents have been identified that work at the cannabinoid receptor…. that is impressive. I think it might take a while to sort out what they do.

At any rate, we don’t know what smoking 30% THC will do, because it’s new. 4% had pretty minimal psychotropic effects. 30% has a lot more. The average now is 12%. Hashish is closer to 66% and hash oil 81% THC. A patient recently told me that she fainted within the last year. She got butter from the fridge at a friend’s and buttered her toast. Turned out it was THC infused butter and she was taken by surprise on a walk 30-60 minutes later. Luckily someone was with her and she was not hurt.

Recent data is showing that there is not much tolerance smoking 12% THC regularly. However, higher doses show tolerance in about 2 weeks in a study of HIV patients with dronabinol, which is 40% THC. Another study of multiple sclerosis patients with 15/15% CBD:THC reduced pain, reduced spasticity and did not show tolerance.

There is anecdotal evidence about seizures, but no study yet. There is some evidence that CBD reduces THC induced paranoia and/or hallucinations. THC side effects from dronabinol include drowsiness, unsteady gait, delusions, hallucinations, mood change and confusion.

The growers are being very creative in names and marketing. This is re recreational pot.
There are hundreds of names and hundreds of varieties and they make interesting claims as to effects. For example:

AK47 with 36.6% THC and 0.3% CBD ….. creative, euphoric and hungry
sage with 27.5% THC and 0.7% CBD ….. attentive
flow with 23.2 % THC and 0.6% CBD ….. happy, relaxed, alert
Super Sour Diesel 22.7 % THC and 0.8% CBD ….. attentive, giggly, hungry
707 Headband with 22.1% THC and 0.7% CBD ….. euphoric, lazy, inspired

How amazing the difference less than a percent of THC makes… oh, wait. There aren’t clinical trials on this, hon, this is MARKETING.

Onset for oral is 30-90 minutes
peak in 2-4 hours
half life 8-12 hours but sometimes 20 hours

sublingual tincture
onset 30-45 minutes
peak 60 minutes
half life 3-5 hours

Smoked onset quicker and I did not get those numbers.

The emergency rooms in Colorado saw lots of people who were “trying it” but if they had only tried smoking marijuana in the 1970s, a strain with a much higher percentage made many people sick or hallucinate or frightened. The gummi bears look just like the ones for kids, so kids got sick. More sick people with edibles, as some eat too much.

People using THC before age 25 who have risk factors for schizophrenia are more likely to develop it. Family history, other hallucinatory drugs, mental health problems. The age 21 limit should be taken very seriously.

In Arizona re medical marijuana, 90% of the prescriptions were from only 24 physicians. In Colorado, 94% of the patients applying for medical marijuana did so for “severe pain”. Two of my friends in their early 20sΒ  got medical marijuana permits in California for “back pain”, um, ok, hooey. Some people DO have severe chronic pain….

The history of medical marijuana is that Eli Lilly produced a medical version from 1850-1940 for pain. It was removed in 1942. In 1970 it became a schedule one, that is, illegal, drug. There are a few randomized clinical trials for pain, the best ones with high CBD/low THC treatments. Marijuana smoke alone has not been proven to cause lung cancer, but combined with tobacco or other smoke, the evidence is that it is synergistic and makes things worse faster. Dependence can occur, an increase in antisocial personality disorders and there is a withdrawal syndrome for dependent folks. For the small number of people I have had working hard to stop, sleep is the most difficult issue. Anxiety as well.

If people state that they use pot a small amount a couple of times a week, their urine sample should clear after a week. If it’s not clear they 1. couldn’t stop and/or 2. were using quite a bit more.

As far as Washington state law, it was described as a mess. Physicians can’t prescribe, they can only “attest” that the person has a problem treatable by medical marijuana. To attest, the physician has to sign a document saying that they are sure that not only has the patient READ the law chapter 69.51A RCW but also “understands the requirements of being a patient”. There are 24 sections. The physician doing this part of the talk said that he would only prescribe to non-driving MS patients in wheelchairs. Because he finds it hard to read the law himself, so the signing that the patient has read and understood it…. well, the driving legality issue is huge. And the provider, including NDs (naturopaths) and ODs (Doctor of Optometry) in Washington can attest. They are then immune in Washington but not at the federal level.

Every marijuana store is legally obliged to have a medical marijuana consultant present at all times that they are open. The medical marijuana consultant has 20 hours of training to get certified. Patients that are certified with an attestation can grow 6 to 15 plants but ONLY after they have been entered into a database which includes the person who signed the attestation and a photo of the patient. If they grow without being entered, they are breaking the law.

Use of THC long term, the risk of addiction is 25-50%. 17% of the addicted folks started during adolescence. Addiction is currently estimated at 9% of people who have tried it overall. About 30% of users have “problem use” and starting before age 18 increases the problem use 4-7 times. The DSM-V has diagnostic criteria for “marijuana overuse syndrome”, including not being able to stop even though the person wants to. Risk factors for addiction and problem use include early use, family history, PTSD (especially sexual abuse), bipolar diagnosis, ADHD, conduct disorder, oppositional defiant disorder. Mediating factors include parental disapproval, parental supervision, academic competence, higher perceived risk and availability.

And am I attesting? No. My MS patients get the attestation from the neurologist if they want it….

Medical marijuana consultant training: http://www.doh.wa.gov/YouandYourFamily/Marijuana/MedicalMarijuana/RulesinProgress/MedicalMarijuanaConsultantCertification
Washington State Medical Marijuana attestation form: http://www.doh.wa.gov/Portals/1/Documents/Pubs/630123.pdf
WA law: http://app.leg.wa.gov/RCW/default.aspx?cite=69.51A
And pain clinics getting closed down: http://www.seattletimes.com/seattle-news/health/pain-patients-scramble-for-care-after-clinic-crackdown/

The tree trunk is a bonsai from the Lan Su Chinese Garden in Portland. I like the thorns…..

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All of my patients are smart

I am a rural family practice doctor for over twenty five years and all of my patients are smart.

All of my patients are complicated.

I don’t mean that they all have degrees or PhDs or are intellectuals. I mean that they are smart in all sorts of ways.

I was talking to the UW Pain and Addiction Telemedicine Team four years ago. I said that when I had a new chronic pain patient who is angry about the law in Washington, I would give them the link to the law: http://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/PainManagement.

“You give them the link?” said one of the faculty. “But they can’t understand that.”

“Why not?” I replied. “I did.”

This was met with silence. My attitude is, well, I am a physician. I am not a lawyer. Yet I have to follow the pain law. Actually we all have to follow all the laws in our country. We say ignorance of the law is no excuse. Yet then the attitude of the pain specialists at UW was that the law is too confusing for my rural patients.

I think UW is wrong and I think that it is disrespectful to patients. Treat them as adults. Treat them as smart. Treat them as if they can understand and you will get respect back. And if they trust you they will then tell you when they do not understand or need something translated from medicalese to english.

I worked with a patient who works every day. She is in a wheelchair, a motorized one. She has cerebral palsy and can’t talk much. And she is smart too.

This election is about the United States population being smart. They know something is very wrong and they want it fixed. I think that Citizens United needs to be taken down. Corporations are not people, unless the CEO can be the physical representation of the corporation and go to jail when the corporation lies and steals. Wells Fargo, I am talking to you. I am taking my money to another bank. Pay reparations. The United States population is sick and tired of the rich getting richer and corporations stealing from people for profit. Democrats and republicans are sick and tired of it. We are not going to take it any more. If you have gotten rich from corporate underhand theft, lies and confusing regular people, give the money back. Because you can buy an island, but if the United States population rises up to hunt for you, there is no where in the world you can hide.

It is time for corporations to give the United States population the government back. Or we will take it. Because every patient I have ever taken care of in over twenty five years is smart. That is not to say we don’t all do stupid things. And some people won’t change. But in the end, everyone can learn and everyone can change.

I took the photograph in Larrabee State Park in September. This tree is down: but it is not a nurse log yet. It is not dead. The roots are still providing nourishment and it is sprouting branches all along the downed trunk.

 

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Ferry rider

Here I am with Mordechai, the plastic skeleton. I brought Mordechai back from Seattle in 2014, all bundled up to carry. However, I walked onto the Seattle-Bainbridge ferry and Mordechai was not in a bag. I have never had as many people talk to me on the ferry. The ticket seller took a picture. Mordechai did not have to pay. A tourist from southeast asia wanted a picture with me and the skeleton and her, and a man started asking me about the hip joint. It was a very fun and funny ride….

Mordechai is in my clinic. During October, she sits in the waiting room. Last October we had a contest to name her. I have an anatomy book in my exam room, to pull out and show people the eustacian tubes or the knee joint or the muscles of the rotator cuff. But sometimes the skeleton is more useful….

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Slow medicine

I am practicing slow medicine, just like the slow food movement.

It took a year to set up my clinic, because I wanted time with people more than anything. And how could I do that?

Low overhead, of course. The lower the expenses, the more time I would have with patients.

I did math and based it on medicare. I estimated what medicare would pay. I dropped obstetrics, can’t afford the malpractice and anyhow, the hospital was hostile by then. That cuts malpractice by two thirds. And I chose not to have a nurse, because people are the most expensive thing. Just me and a receptionist. And a biller once a week and a computer expert who rescues us when we kill another printer or need new and bigger computer brains for ICD 10.

My estimates were on target except that it took three times as long to build up patient numbers as I thought. Ah. Oops. I was advised to borrow twice what I thought I needed and that was good advice, because I had not counted on my sister dying or my father dying or me getting sick for a while…. but so far the clinic remains open.

Slow medicine. I schedule an hour with a new medicare patient or anyone new and complicated. People who say they aren’t complicated are lying, but we schedule 45 minutes for them. And for the really complicated, we have 45 minutes for follow ups. Most visits are 25 minutes: the only visit that is less is to take out stitches.

What does slow medicine allow? In the end it allows people to speak about things that they don’t know they need to talk about. A friend dying. Fears about a grandchild. Family fighting. The dying polar bears. The environment. This difficult election. And sometimes I think that freedom to speak about anything is the most theraputic part of the visit.

I had one woman last year who established care. Complicated. I think she was in her 70s. And the medical system had made mistakes and hurt her. Delayed diagnosis, delayed care. But she was laughing by the end of the visit. She stood in the hall and said, “This is the first time I can remember laughing in a doctor’s office. This is the first time in years that I can remember leaving with hope. And you haven’t DONE anything!”

….anything, except give time and listen.

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Fraud in medicine: why “help” won’t help

This article:Β  Doctors wasting over two thirds of their time doing paperwork showed up on Facebook yesterday.

The problem is that “hiring people to help with paperwork” will not help.

Why? We’ve already done that and it’s a huge mess.

For example: I was referred to an Ear Nose and Throat Specialist at one of the Seattle Mecca hospitals. I had to travel two hours and then in the waiting room I was given a four page patient history to fill out. I filled it out. I had been referred by a Neurologist, who sent a letter and note. After I filled out the forms, HIPAA and “you will pay if your stupid insurance won’t” and address and consent to be treated and yada yada…. I waited.

At last I was shown to a very luxurious room. There a medical assistant asked me many of the same questions that I’d filled out on the form and which were already in the letter and note from the neurologist. She typed these into the EMR- electronic medical record. Then she left. And I waited.

At last the distinguished otolaryngologist entered the room. He said, “I see that you are here for chronic sinus infections.”

“No.” I said. “I am not.”

Silence.

“I see that you did not read anything I filled out and I am a physician and I drove two hours to see you.”

Silence. “Um.” he said. “Uh, why are you here?”

“Strep A sepsis twice and we want to know if my tonsils should be removed.”

Right. So… all that paper you fill out before the physician saw you? Yeah, like, my impression is that physicians don’t read it until after you leave. And maybe mostly don’t EVER read it.

I plan to find out the next time I have to see a specialist. I will write “you don’t read this anyhow, so I am not filling this shit out” on page 2 and see if the specialist notices. Bet you money they don’t. Though when they yell at their staff for not entering my medication allergies or the review of systems, they might notice.

So… I am a primary care physician. What do I do?

A new patient has one form: name, address, insurance information, hipaa and “you pay if your insurance doesn’t”.

I do the health history myself in the room entering it in the first visit, which takes 45 minutes to an hour. WHOA! INEFFICIENT! Nope. Actually it is brutally efficient. For four reasons:

One — I enter it myself and ask the questions myself and I am really fast at it.

Two — now I know the person, because I went over all of it: complaint, history of present illness, past medical history, social history, allergies, review of systems, and I ask people to bring all their pills including supplements to the first visit and I enter them too. And I look at the bottles. I don’t like vitamins with 6667% of the Recommended Dietary Allowance of any vitamin, lots of vitamins now have herbs in them too and I would not recommend taking cow thymus, labeled as bovine thymus.

Three — Now I don’t have to spend time reading forms filled out in the waiting room or a history entered by someone else, because I don’t have time to do that anyhow. I did it all in the visit. I will still have to read old records and any labs or xray results or consult notes or pathology reports and hey, where do you think the waiting room paperwork falls in that priority list? Yeah, like never.

Four — I hand people a copy of the note as they leave and ask them to read it and to bring corrections if I got it wrong. They go from thinking that I am a drone staring at the laptop to saying, “Hey, she typed nearly everything I said (and she has three spelling errors).”

Because the truth is that medicine is really complicated now and it just doesn’t help to have more people “do the paperwork”. I have to read the notes and labs and reports myself, because I am the physician.

There are three things that WOULD help:

1. One set of rules. Hello, the insurance companies, all 500ish of them send us postcards and emails every week saying “Hey, we’ve changed what we cover, meaning we cover less and we have new improved and more complicated prior authorization rules! Go to our website to read all about it.” Guess how often I have time to do that. NEVER NEVER NEVER. I read medicare’s rules. So medicare for all, single payer is partly to have ONE SET OF RULES. I can memorize miles of rules, but not if they are changing in 500 companies every week. Shell game. Also, prior authorization means “your insurance company is making your doctor fill out paperwork in hopes that they can delay or refuse the care your doctor thinks is best for you.”

2. One electronic medical record. Right now there are about 500 of them too and none of them talk to each other so we are all “paperless”. Ha. It’s worse than ever, because we get 100 pages or 200 or 300 of printed out electronic medical record for every single new patient. I need two more big file cabinets for my “paperless” office. Hong Kong did it in 9 months. What, are we wimps? Make a decision.

3. Standardization of lab and xray and home health and physical therapy and nursing home and rehab and hospital order forms. Because every stupid lab form is different: not only arranged differently but also the lab panels are different, the requirements for what that lab wants to fill the order is different and the results are arranged differently on the page. Hello. Stupid, right? Any efficiency expert would laugh.

And that’s how we could really help doctors help patients.

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Does back pain mean a disc?

Does back pain mean a disc?

Does sciatica, pain down the sciatic nerve, all the way down the leg, mean a lumbar disc is out of position and you need back surgery?

Ninety nine times out of one hundred: No.

No? What? Really? Doesn’t back pain and sciatic pain mean a disc is pressing on the nerve?

Nope.

Sciatica means that the nerve is annoyed. It is sending pain signals. It can be irritated and inflamed anywhere along the entire path of the nerve. When the nerve is inflammed or there is surrounding inflamation, the nerve sends pain signals.

But… if it is not a disc, WHAT IS IT?

Muscles that are injured, inflamed, irritated, contracted or torn, that in turn put pressure on or inflame the nerve.

The sciatic nerve is made up of multiple nerve roots coming from the spinal cord: L3, L4, L5, S1, S2, S3. And then variants. The nerve roots bundle together and then dive through a group of muscles and go down the back of the leg: deep in the muscles. Why deep? To protect this very big, very important, bundle of nerves. Branches veer off and innervate muscles and bone and tendon and fascia, all the way down to the toes. There is not a spinal column in the leg, to protect this nerve.

It dives in between the superior gemellus and the piriformes muscle, deep in the buttock. Under the gluteus maximus and the gluteus minimus. Then it goes down the leg, under the semitendonosus muscle and the biceps femoris muuscle, the big hamstrings.

Now, let’s go back up to the low back. Why does it hurt? With or without sciatica? There are six layers of muscles in the back, all way smaller than those hamstrings. The top is the latissimus dorsi, down 5 more layers to the small longus and brevis rotares muscles, which connect each vertebral bone and allow subtle and complex movements of the spine.

What happens when a muscle is torn or injured? People look blank in clinic when I ask. I say, “Think of a piece of steak, what happens when you cut it?” They still look blank. “It BLEEDS, right?” When a muscle is torn or injured and bleeds, it and the surrounding muscles cramp up as much as they can, to try to prevent further bleeding and tearing. If it is an extremity, ace wrap, elevate and ice, as soon as possible, to slow the swelling and bleeding and pain. If it is the lower back muscles, ice as soon as possible and applying pressure won’t hurt. No heat for 48 hours since muscle bleeding and swelling and inflammation usually peak at 48 hours. After 48 hours apply heat, then gently stretch, then ice after stretching.

Think of the muscle fibers as torn. They take about 6 to 8 weeks to fully heal. You want to stretch them and rehabilitate them without tearing them in that 6-8 weeks. You want every muscle to be fully functional, to be the right length, to not heal shortened or scarred. Get those fibers working again…

….or….

But doctor, my back has been hurting for FIVE YEARS!

Then it will take longer than 6 to 8 weeks to rehabilitate, retrain the muscles, gently break down the scar tissue, get it all functioning. Your muscles are doing their best. They told you they were hurt and you need to listen to them.

Covering it up with ibuprofen or alcohol or any number of substances or trying to ignore what your muscles are trying to tell you is a bit counter productive, don’t you think? Pain is information. An advil can help with the pain, but it does NOT fix the problem. “Drug me so that I can go on ignoring it.”…. uh, no. That is not ethical and it also doesn’t work.

And just think, if those back muscles continue tighter and tighter… they are constricting and pulling on the spinal bones.Β  They pull on those bones and then a disc might be thinned or crushed and might protrude and then press on a nerve. And then for surgery, what do they do to get to the disc? Cut through the six layers of muscle….

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Does pain mean danger?

Does pain mean danger?

From a physician standpoint, sometimes the answer is “No.”

One example, sent by an alert friend, is a lump on the back of the neck, with pain radiating downwards.

This could be an abscess or an infected cyst, but since they didn’t mention infection, it is most likely an enlarged lymph node. This is one example where the doctor or nurse practitioner or psychic healer will look at it, say “Does it hurt?”, poke it and then be all cheerful while you wonder WHY they have to poke it* after you say, “Yes, it hurts.”

A newly enlarged tender painful lymph node is usually a reactive lymph node. It is swollen with cells from the immune system and is trying to heal something in the vicinity. A cut, irritated acne, a cold virus, that shaving accident, a low grade infection, an ear infection. Usually I talk about it and recheck it in two weeks.

The lymph node that will make your healthcare person worry is the one that DOESN’T hurt. A slowly or quickly enlarging lymph node that is not tender is worrisome for lymphoma or for metastatic cancer. Once it gets to 1 centimenter, I am calling the surgeon to consider doing a biopsy. We have lymph nodes throughout our body, but the ones that we can feel on the surface are only in the neck, the supraclavicular nodes, the axillas (aka underarms) and groin. The rest are under bone or muscle, though they can show up on CT scan or xray: enlarged mediastinal nodes along the great vessels and trachea in the middle of the chest.

So pain does not always correlate with the level of danger of an illness. The reactive nodes hurt because they swell quickly, and they usually go down quickly as well.

*They poked it to be sure that it is not fluid filled, that it is firm but not hard and fixed, so not an abscess or cyst, and doesn’t feel like a cancer.

I took the photograph last night with my cell phone, during a rare thunder and lightning storm here… beautiful.

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Art at Quimper Family Medicine

I change the art at clinic, these for the summer. We had four reproductions up before, of alchemy paintings from the 1400-1600s. I thought they were creepy but also interesting and beautiful.

The painting on the left is by my mother, Helen Burling Ottaway, of my sister, Christine Robbins Ottaway. On the right is an oil by an artist that I don’t know. It looks like my father. I inherited art, but I keep finding beautiful pieces. At least I can display a little and rotate them with the seasons…