Category Archives: rural medicine

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Open

O for open: open water and open heart, for the Blogging from A to Z Challenge.

I kept thinking O for ocean, but the photos that I want to use are not of the ocean but of a lake. My daughter and I were there in 2012. She was a synchronized swimmer for seven years and then joined swim team in eighth grade. We went to the lake and she practiced distance swimming. She is used to a 1950s 20 yard pool. She started at the lake by swimming to a little island we call Kidnap Island. I canoed while she swam, and my cousin’s daughter came along on the first trip. They left the lake soon after that. My daughter swam farther and farther every day, with me in a canoe to ensure that no power boat would run her over.

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We were on our way to the parking lot one day, when a power boat slowed. “Long way out, aren’t you? All alone?” said one of the men. I was in a small one person canoe that only weighs 18 pounds and is really tippy. I wouldn’t take it out in any sort of nasty weather.

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“No, I am with my daughter.” I pointed to the water.

“She’s swimming? Where did you start?” he said.

I pointed back to our cabin. Far enough that he couldn’t see it.

“Really? She swam that far?” He and his friend watched my daughter power along.

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“Yes. Swim team.”

“Is she swimming to the parking lot?” The cars were still really distant.

“Yes and probably back, too.”

“Wow. I thought it was a long way for a canoe!”Β  They drove on, shaking their heads.

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Open water and open heart. It takes practice to swim that far. I swim about two days a week, about a mile in the pool. My daughter shakes her head: the swim team swims three to five miles at each practice, and she swims six days a week in the season. She considers me a wuss. I consider her a calorie burning machine.

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It takes practice to keep an open heart. That is what I need in my rural family medicine clinic. An open heart allows space and expansion and time for people to open up. To say things that are bothering them or frightening them or grieving them. I am back at work now for two weeks, but by the end of the day yesterday, I was tired, tired, tired, as if I had swum across that lake. I need to rest sometimes…..

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Not quite acculturated

N for Not quite, in the Blogging from A to Z Challenge.

Not quite acculturated

And she was unsympathetic
That doctor
That immigrant doctor
I heard she told a patient
“You’re too fat.”
This was whispered
In accents of pleased shocked horror

She came to dinner
That unsympathetic doctor
Southeast asian
Told a little of her story
To my wide eyed children

When she was 10
They were boat people
Escapees
Refugees
Pirates caught them
Real pirates
“They weren’t so bad,” she said
“We were about to die from lack
of food and water.
Though we heard other stories
that were very bad.”

My daughter could imagine the boat.
She moved to my lap.
The pirates were too real.

Perhaps plenty is not always taken
for granted
And sympathy is a matter of degree.

previously published on everything2.com

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Move

M is for Move in the Blogging from A to Z Challenge

Move

Blessings on you

Take care of my heart

I know I’ve left it with someone kind

You don’t have to do anything with it

No giri

No obligation

You can set it anywhere

In a corner where it gets dusty

And covered with sawdust

Under the couch

In the woods

The kids can play catch with it

I don’t care

I am armored up

I am ready

I am ready to move

In the direction that I have chosen

Stand aside, please

I don’t want anyone to be hurt

Power up, armour, sheilds

I pick my sword back up

Obeisance to the Beloved

I move

38314-m

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Just, Justice, Juxtaposition

J in the Blogging from A to Z.

Just, Justice, Juxtaposition

It is funny

R says that I should not
associate with J
leave the wrong
impression
everyone watches
judges in a small town

I am committed
to J

J wants more
pushes

I can’t tell
if J thinks
I’m joking
or just
is pushing me
past my limits

I don’t know

but it is funny

because J and R
are alike
passionate
idealistic
madmen

ethical
committed

R does money
J does improv

yet alike

and R is the joker
and J is the taskmaster

and everyone
is not
what they seem

and my reputation
is shards
anyhow
in the surf
my X
told all
that I wasn’t
putting out

before
we were X

one
in the surf
was my office manager’s
daughter
and my office manager
asked me
next day
couldn’t
I control
the X

I laughed

someday
I want to bring
J to R
or
R to J
and watch

them
circle
like cats
antipathy
or recognize
the heart
that stands open

which is why
I love them both

previously published on everything2.com

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Little Blue Pill

Little blue pill
Little blue pill
Help me help me
I’m over the hill

Don’t wanna have sex
Nope nope nope
Little blue pill
Gives my husband hope

Can’t make a pill
Til we define the disease
Doctors would you
Hurry up please

Little blue pill
Little blue pill
Help me help me
I’m over the hill

Thought them hormones
Would make me hot
Doc was right
They did not

Hot flashes make me
Sweat and moan
No help from that
Testosterone

Little blue pill
Little blue pill
Help me help me
I’m over the hill

Doctor this
Is really no joke
My husband says
He’ll slit his throat

Can’t make a pill
Til we define a disease
They’re trying hard
Those drug companies

I think we’ll know
If they define a disease
Drug companies will plaster it
On tv

Doctor I found
Just the thing
A brand new stimulating
Clitoral ring

Don’t wanna have sex
Nope nope nope
Little blue pill
Gives my husband hope

previously published on everything2.com

the mushroom is from the olympic peninsula. we didn’t know what it was and did not eat it.

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Foul sweets

This is for the Ronovan writes weekly haiku prompt. The words are foul and sweet. I am at a medical conference where we are really delving into diet and how the high sugar/ high corn syrup and high carbohydrate typical american diet increases our risk of inflammation. Eat more vegetables! And here is the poem….

Foul sweets, treats greet us

Meet us, daily folly. We

growl at sweets, eat meat.

 

The picture is a mushroom growing out of a tree on the Olympic Peninsula.

 

 

 

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Convalesce in style

This post is for my cousin, who is convalescing. She is showing the classic convalescent improvement sign beloved by all physicians in that she is already impatient with the pace of healing.

I took the photo last week when I was downtown and The Palace Hotel had a sign inviting everyone to walk around. It is a fabulous 1889 building and is full of amazing rooms and furniture. I have stayed there once, in the Captain Tibbels room.

This fainting couch is on the second floor common area. I picture my cousin lying on the couch in a period glamorous dress, with a handkerchief and smelling salts. Or if that is too romantic, she could wear steampunk style, as she convalesces…..

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Recovering from influenza exhaustion

Influenza can cause swelling in the lung tissue. This is different from pneumonia, in that it is not fluid in the lung air spaces and different from bronchitis, where there is swelling and inflammation along the tissues lining the lungs.

In really severe influenzal lung swelling, the air spaces swell shut, the lungs are bleeding and bruised, and the person dies. Young healthy recruits in the 1917-1918 influenza would literally turn blue as they were no longer able to breathe and they would die.

If a person is still feeling exhausted after the initial week of influenza, they need testing to find out if they have lung swelling. This can be done at home or in your doctor’s office.

To test at home, the patient should sit relaxed for 10-15 minutes. Take a one minute pulse count: normal is 60-100 beats in one minute. Then the patient should get up and walk until short of breath. Sit back down and repeat the pulse. If the pulse is jumping up 30 points or if it is over 100 after walking, there is still lung swelling. The treatment is rest.

To test in my office, I add a pulse oximeter. I get a resting oxygen and pulse level, walk the person and then watch the recovery. The oxygen level will often drop and then rise to the sitting baseline as the heart rate recovers. Most people do not need oxygen if they have a healthy heart and healthy lungs to start with.

You can see why influenza would be so dangerous to someone with an unhealthy heart or lungs, because the heart can’t make up the difference.

I had influenza in 2003 and had lung swelling to where I could not walk across the room without my heart rate going to 132. Sitting, my heart rate was 100. My normal heart rate is 65-75. It took two months for the swelling to subside and mostly I lay on the couch. Be reassured that if you rest when you need to, you will recover.

The photograph has my father sitting and Andy Makie standing with the harmonica, at a music party at my house in 2009. Both my father and Andy are gone in their 70s, primarily from lung damage from cigarettes. Miss them both. Thanks to Jack Reid too.

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The future of medicine

we recognize the true embodied mind
we stop the stigma of the many beaten down
the damage done in childhood caught in time
hearts open and lift the broken off the ground

we learn that diagnoses are a crutch
drugs plaster over deep and seeping wounds
mental labels hurt the patients oh so much
we learn to listen: broken hearts sing grieving tunes

cruel medicines and thoughts are shelved for good
gentle boundaries surround hearts to keep them safe
we rise as friends and families and doctors really should
the angry monster revealed as longing waif

damage done in childhood to the brain
lays survival pathways that we no longer call insane

The photo is me and my sister Chris. I do not know who took it, but I think it was at my maternal grandparents. They are deceased, my parents are deceased, my sister is deceased. I don’t know who to credit.