Category Archives: Stages of grief

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The isolated working

I ran my own small clinic from 2010 to 2022, working somewhere else, got Covid, was on oxygen for a year and a half, did some healing and then came back to work.

There has been a culture change in medicine that feels very strange to me. I did not notice it because I was in a solo clinic and not “part of the system”.

All the doctors, providers, are more isolated. I got a compliment yesterday when I was doing a “warm hand off” of the most sick or complicated patients, three new diabetics, a person with cancer, a person with a genetic heart problem. The doctor who I was handing off to is in the same clinic but we have barely talked since May. I don’t know her at all. She complimented me on excellent care “and calling specialists”.

I thought, huh. But I think that is a dinosaur doctor thing. I think mostly people communicate through the electronic medical record email, send messages about patients. For the decade that I was solo, I had to call other specialists because I was on a different electronic medical record. The email didn’t connect. The hospital reluctantly gave me a “link” to their system, but it was only a link to look. I could not write or send anything.

About two months ago I got an echocardiogram result. I read it and thought, ok, it’s not normal but what does it mean? Outflow obstruction by the thickened heart wall. Hmm. I called cardiology and spoke to the cardiologist who read it. He sounded surprised and said, “Idiopathic hypertrophic cardiomyopathy, most likely. It’s a classic echo.” “So, what do I do?” “Send him to me.” “Anything that I should change meanwhile?” “Yes,” says the cardiologist. He had me stop one medicine and start another. “No vasodilators and the beta blocker slowing the heart rate should help decrease the outflow obstruction.” “Got it.” I said. He also gave me two more tests to order.

I referred the patient to cardiology but it was a month before he got in. The two tests were done and they ordered more. If the diagnosis is correct, he’ll be sent to a special clinic in Denver. I called my patient while we were waiting for the cardiology visit. The medicine change had not made much difference as far as he could tell.

I was also told when I got here that I would never get a local nephrologist to see a patient, they were two busy. However, I have called two nephrologists about two patients and both took the patient and again, gave me instructions.

Two specialties have been very difficult to contact: orthopedics and gastroenterology. I have no idea why they are so difficult.

I can see that email feels faster. But there is no human contact, asking follow up questions is difficult, I don’t get that bit of further helpful education: this is what you do next. I have learned so much over the years by touching base with specialists. Once I fussed at a patient to go to hematology oncology about their high platelet count. The patient didn’t want to. He came back and said, “Apparently I have this newly found genetic problem. They put me on two medicines, not expensive. And I feel better than I have in 20 years.” I asked the oncologist about it the next time I called. He lit up, excited, and told me about the JAK-2 mutation. It is so exciting to learn about new areas in medicine and my patient says, “I have to thank you for pushing me to see the oncologist. I feel so much better.” Wow and cool.

Clinic feels like I am mostly isolated, a silo, an island, rarely talk to the other physicians unless I go to find them. I think hospital administrations like this, keeping the physicians in line by having their schedule be so packed that they almost never talk to each other. What a good way to keep physicians from interfering in the money making production! Ugh, I think it is quite horrible and unhealthy for the providers and for our countries medical system in the long run. I was seriously less lonely in a solo clinic.

The prognosis for our current medical system is very poor. The patients say to me, “Why do my doctors keep leaving?” They aren’t attached, they are isolated, I don’t think the physicians know what they are missing. Colleagues. Not silos.

For the Ragtag Daily Prompt: prognosis.

The photograph is from the Fruita Fall Festival.

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Love gently

Honey is older, nearly thirty years since that first feeling of being bitten by ants. She is back in corporate medicine, as a temp. Temporary, short term, maybe that will work better.

It is a joy to go in a room and be alone with a person and their monsters. Theirs and hers. Sometimes the younger ones haven’t experienced it, they are terrified if one of their monsters becomes a little bit visible, they hate seeing them. Honey tries to be gentle. If they only want to talk about the sore shoulder and not the stress and violence, well, she leaves the door open a crack. Sometimes the monsters cry.

Older people may be stiff to start with, but when they realize their monsters are seen, acknowledged, this isn’t another robot doctor in to say increase your diabetes medicine, lower your diabetes medicine, tell them a plan without ever connecting, the older ones lean back, sigh, and relax. The monsters play on the floor, Honey’s monsters playing with theirs, happy, engaged.

The hard part is the clinic staff. Honey is with them daily. The medical assistants are young. They kick their monsters aside as they walk down the hall. It is terribly hard and heartbreaking to work at her desk, with the medical assistants’ monsters cowering under their desks, kicked, abused, silent tears and holding bruises. Honey’s monsters mind. They climb into her lap and hide their faces in her shirt, under her jacket, peer over her shoulder. They don’t understand! Why can’t she be nice to THESE monsters?

Honey whispers to her monsters when the medical assistants are rooming patients. “I am so sorry, loves. If I acknowledge these, the monsters of the women working, I become a demon. It is very hard to share an office, no wonder I worked in a clinic alone for eleven years.” Honey has been through that. It is still inconceivable that some people don’t see the monsters at all. Is it learned blindness? Or just not developed unless someone had to learn it? Unless someone grows up in terror and seeing the monsters is the only way to survive.

Honey thinks some people learn to see them as adults, at least their own monsters. Hard enough to do that, without seeing the monsters clinging to other people.

Honey is tired of her monsters crying in sympathy with the staff’s monsters. She thinks maybe there are small crumbs that she can leave for these demons. Little gifts. Her monsters can creep under the desk when she is the only one in the room and leave something. A flower. A dust bunny. A crumb of a crisp. A small rock. A little gift to let them know they are seen and loved. A poem. A prayer. Just a tiny bit of love.

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For the Ragtag Daily Prompt: crisp.

The photograph is me all dressed up for the 1940s ball.

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Incomparable courage

I’ve chosen incomparable for today’s Ragtag Daily Prompt. Yesterday I posted one version of the song Waterbound. Rhiannon Giddens does the traditional version, but then I come across this song. Wow. And yes, such courage in people enslaved and there is still slavery in the world.

For the Ragtag Daily Prompt: incomparable.

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Tea bear

My friend C. is a bear.

People don’t know she is a bear. She carries a bear, a teddy bear. It is named S Bear, after her husband. He died of cancer a while ago. So she carries a bear named after him. The first time I met the bear, I asked if it needed a teacup too. Because people make clothes for it and I don’t know how far it all goes. No, the teddy bear did not need a teacup.

My friend C. is a bear. She writes horror stories under the name lostcauser. The writer is from Tennessee and so is C. The stories are horrid. Lostcauser is an anagram. Rearrange the letters and you get closet ursa. Closet bear. Hidden bear.

She is not my only friend who is a bear. She is aware of her bearness, her ferocity, the beast inside. Bears like honey and blueberries, too, they aren’t just monsters. My other friend dreams of a one room shack in the woods. His dead brother is at the door shouting for help. His brother is being attacked by a bear. A huge terrifying bear.

“Did you invite it in?” I ask.

“It’s a BEAR.” says my friend.

“It’s a Dream Bear.” I say, “I would ask what it wants.”

“You don’t understand bears,” says my friend.

“I understand a lot about dreams. Some think that everyone you see in a dream is a part of yourself. It can be a part that you don’t accept.”

“Bears attack. You can’t invite them in.”

“I would ask the bear in. I would ask the bear if it would like some tea.”

I tell another friend about one of my dreams. There are monsters screaming. I go towards them.

“TOWARDS them?” says my friend. “Why would you go TOWARDS them?”

I have to think about it. “Well, they are screaming. They might be hurt. They might need medical care. I have to go help them.”

My friend shakes his head. “Only you,” he says, “would go towards the screaming.”

One time in my neighborhood, I hear horrible screaming. I get up. It is 1 am. I go out and try to find the screamer. I don’t find anyone. A few days later, I read that someone nearly severed their arm somehow, in my neighborhood. A policeman saves his life with a tourniquet. It was three blocks from my house, at the grade school. The grade school is where I went. I think the person was knifed, but I don’t know. My neighborhood does not get a lot of that sort of thing, at least, not a lot of screaming that wakes me up.

I wonder about my friend that is attacked by a dream bear. A bear that is much bigger than his dream self and his dream brother self. There must be a lot of darkness in that bear. It is angry about being ignored.

My friend C. is a bear. She knows she is a bear. Reading her stories, I do not think she likes being a bear.

I don’t mind if she is a bear. I wonder if we will have tea again some day.

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For the Ragtag Daily Prompt: fan. Why? Maybe I am a fan of bears. Or maybe fans make me think of hats and gloves and tea parties. And bears.

This is based on speculation and some true events.

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leaves

I am working in Grand Junction, Colorado. There are not as many leaves here as at home, but the leaves are still hiding my cat! I am mad at the leaves and sad. Elwha is still missing and it’s been a week. I have had food and the carrier out for him, put up posters on Facebook, contacted the shelters and vets, and searched and searched.

The carrier failed and the door popped off when I put it down. Elwha ran. Sol Duc was still in it, so I put the door back on as fast as I could! Then I left the carrier and went after Elwha, but could not find him. I kept going out and searching, including at 2 am.

Maybe he will show up at home. It’s only 1215 miles by car.

We had another cat who disappeared and we thought was gone. The hardware store called us a month later and said, “We have your cat.” She was thinner and scared to go outside. Elwha only goes out in carrier or with leash and harness. There are prairie dogs and a canal with low trees and bushes behind the building here. I don’t think he’s there, but I am still putting food out. There is another stray tiger who now comes out to study me from a distance.

Anyhow, I wish the leaves would send him back.

For the Ragtag Daily Prompt: leaves.

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Long way

I am a long way from my ocean and from home.

I looked for a job close to home and then the temp company mentions a job in another state. “Where?” I said. They told me and I said, “I’m interested!” We started the process. I always forget what the process is like. It is hella annoying. There is miles of paperwork. We had a delay from the state, because I need a license for each state and they weren’t meeting until after the start date and then they said, “We’ll let you know in two days.” and THEN they said, “We’ll let you know in two days to two weeks.” So I had three weeks of being half packed and trying to just flow with it. I finally got word, yes, ready, two weeks ago Monday. By Friday morning the cats and I are in the car and headed out.

Now I have worked for a week here. The US currently has 500 different electronic medical records and I supposedly learned my 8th (or 9th) on Tuesday. About six hours of training on the computer and my brain shut down after four. However, the support on Wednesday was good and I started seeing patients. I was careful to say, “If I look grumpy, it’s at the computer, not you.”

So far mostly good. Except, one cat got out two days after we got to our destination. He is chipped and I am still walking miles and calling. The local lost pet group is trying to help. I miss him quite terribly. The door popped out of the carrier when I put it down. I feel like a cat mom failure, but things happen. Elwha is big and strong and I may yet get him back. Sol Duc was sensible enough not to run, but I had to secure her before going after him.

For the Ragtag Daily Prompt: flow.

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Spirit take flight

Death from memory loss is a mixed bag for families.

In the past, the average time to death from Alzheimer’s was 8 years. I don’t find a number on the CDC website, CDC Alzheimer’s. I find these statistics:

  • Alzheimer’s disease is one of the top 10 leading causes of death in the United States.2
  • The 6th leading cause of death among US adults.
  • The 5th leading cause of death among adults aged 65 years or older.3

The site also says that the number of people with Alzheimer’s doubles every five years after age 65. Sigh. Those numbers are the same ones that they taught me years ago, in a different format. 6% at age 60, then 2% more every year. By 70, 26%, by 80, 46%, by 90 66%. Like hypertension, if you live long enough, you may well get it. And yet, I have had patients over 100 years old with intact memories.

The death of a family member with memory loss can have complicated grief. On the one hand, loss and grief. On the other, a burden is lifted. If the person is in memory care, the cost may be very heavy. In our town, the memory care facility costs $7000 per month. That is a heavy burden to carry when the person no longer recognizes the family or speaks. The family may feel hugely relieved when their person passes and at the same time, feel guilty. This is someone that they love and loved. And yet, they are relieved by death. I think of it as a patient of mine described it: “The grief group at the hospital said that my husband isn’t gone. I said, yes he is, he just left his body.” It is very very hard for a family to watch their loved one deteriorate, lose skills, become confused and/or frightened and/or paranoid and the process can happen for years. With an average death at 8 years, some people live beyond 8. Maybe 12 years. It is very hard.

Blessings on those who care for the memory loss people and the families who do their best for them. Alzheimer’s is one sort of dementia, but we now have many. Pick’s disease, frontotemporal dementia, Parkinson’s dementia, multi stroke dementia, alcohol induced dementia, illegal drug dementia, primary progressive supranuclear palsy, and others.

The spirit has already taken wing and let the body follow.

For the Ragtag Daily Prompt: wing.

My son took the photograph while he was visiting.

Here is the top ten causes of death in 2022: https://www.cdc.gov/nchs/data/databriefs/db492.pdf.

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Matter

If something doesn’t matter, is it anti-matter?

Lily’s person moved two days ago, much closer. Supposedly to a place where Lily the cat can go, but instead of a private room, there is a roommate. It took me a month to get Lily cat to let me pat her, so the roommate won’t work. We are all very very frustrated. And next week daily treatments for Lily’s person start, thirty minutes away, without enough warning to get volunteer drivers. So it will be me. I am tired. But I suppose it’s anti-matter, right? We were given 24 hours notice by the nursing home and by the physicians about both the move and the treatment and they wanted to start the treatment the same day that she was moving. Whether we can provide all the transport seems to be irrelevant.

The stealthie is from Whidby Island. Right, I’m just an irrelevant shadow as far as the medical dysfunctional machine is concerned.

For the Ragtag Daily Prompt: irrelevant.

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Rumor

Oh, kindness. I think one huge kindness is not to listen to rumors and not to assume that they are correct. Whew. Though if you are ever the victim of a rumor, it will tell you who your real friends are. They will stay present, stay in touch, stay with you. Some will ask about it, others won’t, but they will stay. And you may be amazed by how many people disappear into the woodwork. They are staying “neutral”, they’ll say, but they don’t call, answer calls, or include you any more. Then they may show back up in the future. You will not trust them again. Ok, if they were going through some trauma of their own, but otherwise, no.

Sol Duc is keeping an eye on the neighborhood. She never tells me rumors, ever.

Here are three versions of Nobody Knows You When You’re Down and Out. I like the Bessie Smith one best. The John Lennon tune is different.

For the Ragtag Daily Prompt: kindness.

And another:

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Threat

I am practicing the soprano part of the Brahms Requiem to sing in early May.

The second movement is amazing. It is in 3/4 time, waltz time, but slowed to a dirge, a march, a crawl. And by adding movement on the last 16th note in a three beat sequence, so the 11/12 beat, it sounds threatening and frightening. It builds and builds and then quiets, only to build again. It is terrifying. What an amazing piece of music!

And the words, too. “For all flesh is as grass, and all the glory of man as the flower of grass. The grass withereth, and the flower thereof falleth away.”

At last it opens into a fugue and glory, but still with intensity. “But the word of the Lord endureth forever. And the ransomed of the Lord shall return, and come to Zion with songs and everlasting joy upon their heads: they shall obtain joy and gladness, and sorrow and sighing shall flee away.” There is still the undertow of grief and confusion and fear.

The building is at Fort Worden and is certainly falling away.