Category Archives: teamwork

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Bananafish

As I say in the Ragtag Daily Prompt yesterday, I go for a float on the New River near Floyd, Virginia, with my cousin Steve and his wife Dyane. Steve says, “Let’s go for a float on Saturday.” I am picturing myself in an inner tube with a beer, very very relaxed.

On the day of the float, Steve says, “Do you want to fish?”

“Sure”,” I say. He is a pro fishing guide and I was not trying to angle a guided fishing trip. Also, I have not fished for years and have only attempted a fly rod once. And I was informed that I was terrible at it.

On the way to the New River, with Steve driving like a banshee and the boat trailer howling behind us, Steve says, “You have to get a fishing license. Go on line.”

Why do I need a fishing license? I won’t catch anything. I don’t know what I am doing. I struggle with my phone as the truck whips down the two lane roads and I get a three day fishing license for the State of Virginia.

We go to the New River and unload the boat. “This is the second oldest river in the world. The oldest is the Nile. They both flow North.” I am wondering how you “age” a river, but we are unloading the boat and fly fishing gear. No beer, sigh. I can’t drink it anyhow unless it is gluten free.

Steve’s son ferries the truck and trailer to the take out, and we are off in the boat. It’s a beautiful little boat, with a fishing seat in the front and a seat in the back and Steve is in the middle, rowing just enough to keep us 30 feet from the bank. Exactly.

“You remember how to cast, right.” says Steve, handing me a fishing pole. A fly fishing pole. The fly is about three inches long, has deadly looking hooks, and bubbles when you reel it in. “It drives the fish insane, so they hit it,” says Steve.

“Well, um. I pull on the line, right, and there is something you flip to let it loose?”

“Didn’t grandpa teach you to cast?”

“No, never.” My father and paternal grandfather did not get along and we didn’t visit much. I thought that Grandpa just was not interested in teaching girls to fish, but my aunt says, no, he was afraid of my father. They never made up.

Steve gives me a minute of instruction and I start casting. I am in the back of the boat, thank goodness. I am more worried about catching myself or my cousins or the boat or a tree, and can’t imagine catching a fish. The lure is a Whopper Plopper which bubbles pleasantly as I reel it in. I am quite terrible but don’t hook myself. Steve and Dyane take turns rowing and they are really really good. Steve is using a cork bug, a handmade and painted “popper”. He lands it on the water as light as a bit of dandelion fluff.

I am instructed to pull if I get a hit. Much to my surprise I get a hit and I pull, mostly because it startles and scares me. That fish gets off. The second fish hits Dyane’s line and she reels it in. I want a picture of a fish. Steve holds up the little smallmouth bass. Might not want that photograph for advertising, cuz. Back into the water it goes. Dyane catches another. I catch a fairly good sized one and here is the picture. I am just as surprised as I look, surprised that I caught a fish.

Now Dyane rows for a while. Steve fishes off the front, waving his pole and dropping the fly one foot from the bank. He is telling Dyane, “Watch the current and the wind, you want to anticipate so the boat is neither too close nor too far from shore.” I had asked if there were any rapids. No, says Steve. I have my big camera, because we are not going to tip over.

Storm clouds are building up. There is some thunder. It isn’t raining yet.

No fish for a bit. We come to a small side stream. Steve is rowing. He says, “Hey, this is where someone caught a Muskie last time we were out. I’m just going to drop a line in.” I have stopped fishing for the moment because I am tired and getting clumsy and I want to snack and take photographs. Steve picks up the pole with the Whopper Plopper and drops the lure in to the mouth of the stream and WHAM, a fish hits immediately. It is BIG.

“Row into the stream where it’s cooler, Dyane!” yells Steve. I grab the net. “No,” says Steve, “That net is too small.” I put it down and plop back on my seat, Steve is fighting the fish and Dyane climbs into the rowing seat and moves us towards the stream.

The fish is calmer in the cold, I guess. Or tired. Steve climbs out of the boat, picks up the Muskie and gently takes the hooks out. It looks like an alligator without legs. The head is all mouth and teeth and the whole fish is a yard long. (There is more lightning and thunder and closer. I am thinking the F word.) Steve puts it back in the water as soon as I snap pictures. “Gotta make sure it’s ok,” says Steve, watching the legless alligator sit on the stream bed. It looks grumpy. There are two more in the water by the boat.

BLAM! LIGHTNING HITS THE FIELD BEHIND STEVE SIMULTANEOUS WITH THUNDER AND HE JUMPS. “OH!” he says, “I FELT that. I just got hit by lightning!”

“Are you ok?” then I look in the water. “Are the fish floating belly up?” No, they are not. Steve is not burned, just a shock traveling through the earth and the water. “CAN WE GO NOW?” I say, “ROW!” There is now a shit ton of lightning all around us with thunder at the same time and the rain starts. I’ve got my camera in plastic right away, but I am eyeing the metal in the boat. “Is that conductive?” I say, as Steve starts rowing with the current.

“Hell, yeah,” says Steve. I am trying not to touch any of the metal in the boat, holy crap, ROW, get me OUT of here. Shore is no safer and now it’s pouring. Warm, but the LIGHTNING.

Steve is still pretty amazed, “I was hit by lightning!” Dyane and I just mutter “row”. The lightning moves further away with the edge of the storm and now it’s just raining a soaker rain.

The rain starts to let up a little. “Anyone wanna fish again?” says Steve.

“NO! There might be lightning at the back edge of the storm. ROW, please.”

Steve gets a phone call about the guiding the next day. I reach forward and try to keep rowing with one oar (I am DONE with this float) and he gets off the phone reasonably soon and rows again.

We arrive at the take out, with the tail edge of the storm passing over us (the back?) and one of his partner guides is loading their boat back onto the trailer. “Hey!” says Steve, “I got hit by lightning!” He tells them about it and then gets the truck and trailer. We pull the gear out of the boat. BAM! There is another big lightning strike right across the river, but none of us are in the water. Phew. I get in the truck. I’m not cold but very wet. I do have a change of clothes and a towel. We had planned to swim, but the lightning dissuaded Dyane and me.

We drove the truck back to the house and both Dyane and I had a small glass of wine. A friend has been motorcycling around the country and he told me about five different people killed by lightening in a thunderstorm up around Chicago. He had gotten off the bike and gone for shelter. Good decision!

Next morning we are all up making coffee and discussing breakfast, when Steve looks at Dyane. “It was the BANANAS!” he says.

“What?” I say.

“BANANAS!” says Steve.

“Oh!” says Dyane. “I forgot1”

“What?” I say again.

Steve explains. “Bananas are bad luck on boats. It’s a really old superstition. Dyane packed two bananas and you ate one and she ate one. You can’t take bananas on fishing boats.” I look it up. Here: https://www.aquamarinepower.com/bananas-on-a-boat/ . It dates to the 1700s. No bananas on fishing boats.

And that is my bananafish story.

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The photograph is my cousin Steve as he casts right before the Muskie hits, with Dyane and with the storm clouds piling up down river.

Here is his fly fishing site: https://newriverflyfish.com/

A day late, but for the Ragtag Daily Prompt: fishing. You will see the Muskie on the RDP site from yesterday. But today’s post also fits today’s prompt: cloudy!

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Done and undone

I am done with my third Grand Junction travel doctor assignment and packing to go home. I don’t think much of my temp company at the moment. I had to nag them for two weeks regarding the travel plans. I had to call both airlines (one hour 18 minutes and one hour 38 minutes) to be sure that taking Sol Duc on board the plane is arranged (it wasn’t). I called the hotel for the day between planes and they do not take pets. I called the company that takes me from the airport the last two hours home and they DID know about the cat. One out of four. They finally switched the hotel on Friday, the last day of work.

Then at 5:18 pm I am sent an email saying I have to vacate on the 19th. The first plane is on the 21st. It was sent by the rep who is covering me and knew the travel arrangements are for the 21st. I am glad that I pay way more attention to detail as a physician than they do to my travel and housing. They frankly suck. And I am not vacating until Monday. They may charge me at which point I will say they need to pay me for spending more than 5 hours fixing their travel screw ups.

I did say to the rep on Friday, “Well, if it’s not arranged today, I will just call the emergency travel line at 5:01 pm. They will help me.” The emergency travel folks cost them more money. That apparently caused them to do the last arrangements. I am doing the travel in two days because otherwise my cat would be in the carrier for 12 or more hours. That is not reasonable.

I am done except for travel home. Today I finish packing and cleaning.

The photograph is Sol Duc in front of our rental house yesterday. I think she will miss the heat here. She seems to quite enjoy 90+ degrees.

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For the Ragtag Daily Prompt: done.

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Taste

I am back in Colorado for another work stint.

I am in a different house.

I am in a neighborhood, of cul de sacs that don’t connect. My house is quiet in front but backs on a very busy road, an artery. The speed limit is 40 mph but people often go faster.

The house seems odd to me. There are curtains and shades on every window, all closed when I arrived. I open them, because I like light. There is a 3 by 4 foot television in the living room, another in the master bedroom and a third in a guest bedroom. There is a large kitchen with tons of shelves and cupboards, but a table only seats two, and there are two more chairs at the counter. This feels very odd to me. It seems as if the whole house is arranged to watch television.

I go for a walk in the neighborhood. There are many houses. There are beautifully trimmed lawns and there are flowers and some roses. What is missing? There are no people. Walking a mile and a half, finding the mostly hidden corridors from one cul de sac to the next, I see one man working on his lawn. Even though it is Saturday afternoon, I seen no children, no dogs, no toys. I see two garages that are open, one with a man and in the second I hear a child. Why are there beautiful lawns and no people? And many of the lawns have little flags saying, poison sprayed.

I do turn on one of the televisions after my first day of work. The living room one says that the antenna is not hooked up. The guest bedroom one works. I look on the service. Nearly every movie is about violence and conflict.

I do a little research on the internet. I go to the library and take out 8 books. One is Nonviolent Communication, by Marshall Rosenberg, PhD. Most of the others are fiction. Yet so much fiction is about conflict too. Good triumphing over evil. I am pretty good at nonviolent communication in clinic after 30 years: I want to meet each patient somewhere that is helpful. Sometimes they don’t like what I find, or don’t want to do what I recommend, but I have a deep and abiding faith that everyone can change, that they are smart, that I can make a difference and that they are capable. I think that belief helps daily in clinic.

I choose this book because I want to be better. Some of my family is estranged. I thought that was rare and horrifying at first, years ago. Now I think that it is horrifyingly common, much more common than I realized. How do we heal this? What can we change? I don’t want to be in a dark house with the shades down watching “good” triumph violently over “evil”.

There is a pond, man made, with a fence around it, half a block from my house. There are two male mallards, a female, and eight ducklings. They are fuzzy and delightful. I stop my car and watch the first time I see them, and I walk over too.

I haven’t seen anyone else there. I think we can change. I have hope. I have a deep and abiding faith that we can change.

For the Ragtag Daily Prompt: garlic.

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Honey

Work is being a bit of a difficult place. I think that if a clinic is has two new providers with one new medical assistant, there should be some formal support in place. Not the manager of multiple offices sticking their head in the room with the three of us at computers and saying, “Everyone happy?” Um, no. This came to a head two days ago. Then yesterday I am asked to write up what I said to the manager.

No. I don’t think that is appropriate. If they have formal evaluation forms, fine. If they want a biweekly formal meeting, fine. If I ran the zoo, I would be sitting down biweekly with the job description to say, “This area is going well, this part needs some more attention. What is going well from your perspective and how can we communicate better to help each other and the patients?”

In fact, in my very first practice in 1996, I asked for a meeting with my receptionist. They had one for each pod of 2-3 providers. She was so freaked out by it that she brought the office manager, much to my surprise. I didn’t care and just said, “What is going well, what isn’t, where are the communication gaps, how do we fix them?” The receptionist looked at the office manager, said she had been scared that I was going to yell at her, but since I wasn’t, she let the office manager leave. We were fine after that. I just want a well functioning team and I am happy to help build it.

So, after thought, I am going to refuse this write up and ask what their HR process is and say that I am not satisfied with the office support and that it is quite unreasonable to leave two providers new to the clinic to guide and train a new medical assistant.

The Ragtag Daily Prompt is honey pot. That bring up this delicious and quite naughty Taj Mahal song, ooooooo. As my mother would say, you catch more flies with honey than vinegar.

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Busy clinic

Clinic has been hopping. I have been at the present site now for six weeks, so I am starting to know a few of the patients. That is, the ones that are sick and I am worrying about. It is best if your doctor’s pupils don’t dilate when they hear your name.

I have been getting helpful calls back from specialists. I have a person who has high liver tests where hepatitis and overweight and alcohol don’t seem to be the cause, so I needed an updated list of what labs to send for some of the less common liver problems. Thyroid disease, hemochromatosis, alpha one antitrypsin deficiency, smooth muscle antibodies, various other antibody disorders. The list is quite a bit longer than in the past. I warn my patient that some will come back right away and some may take a week or two. The patient is anxious and wanted to go right to the emergency room, but I ask them to wait: I get a call back from gastroenterology within 24 hours to set up the current laboratory order list.

For liver tests, we ask about alcohol intake first. Then look at weight: a high body mass index can cause fatty liver disease. Unfortunately, that can lead to cirrhosis and liver failure, so it is not trivial. We check for hepatitis A, B and C. Then we start looking for the less common causes. My person is relatively young, but that is with me taking care of age 18 and up. I tell my person not to take any supplements, I look at any prescribed medicines. No alcohol for now.

The list of tests changes quickly. If I have not worked this up recently, it’s good to check in with the specialist. The gastroenterologist may not be up to date on ankle sprains, but they are tracking the changes in their specialty. My specialty is everything, so sometimes I need a current update. Most of the specialists are just fine with this phone call.

Occasionally I do this by message. I have a new diabetic who has a cardiologist already. Diabetics are usually put on either an ace inhibitor or an angiotensin receptor blocker to protect kidney function. I message the cardiologist and get a fast answer. Start an angiotensin receptor blocker and the suggested dose. Also very helpful.

A patient tells me on the phone that I get an “A” for the day. I called them to check on them two days after changing a medicine dose and to say that the other specialist wants even MORE laboratory tests. The patient says she has not gotten a call from a doctor before. The “A” made me laugh, but it did feel good.

I am learning the local medical pathways and how to get things done in this particular medical system. The functional bits, the dysfunctional bits, and how to work around them.

For the Ragtag Daily Prompt: functional.

Sol Duc really likes staying in her pillow fort. Sometimes I want to hide in a pillow fort too. So much for being “grown up”.

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Print or cursive?

My father’s father was a pressman and the head pressman when he was in Knoxville, Tennessee. This is back in the lead type times, when the type had to be set before printing the newspapers. Before they moved to Knoxville, they lived in Connecticut. My father said that my grandfather helped develop the four color process for the comics. My father would get the new comic books, Superman, straight off of my grandfather’s press. Too bad those were thrown out!

I started cursive in school in about fourth grade and I did not like it. I learned, but I thought it was ugly. My father knew how to write in italics. I liked italics much more and asked him to teach me. I adapted the capital letters to make them easier and then I wrote my papers in italics when we were not allowed to print. The teachers objected but I pointed out that we weren’t allowed to print in the papers, but it did not say, “No italics.” I imagine that some teachers found me difficult.

My cursive is still stuck in about fifth grade and I almost never use it.

Meanwhile fast forward. A law is passed in Washington State that prescriptions cannot be written in cursive. However, it does not say that we have to print. The same loophole. I usually printed prescriptions anyhow, so that the pharmacist could read it. I got compliments occasionally for printing in a legible way. I didn’t spell certain medicines correctly, but the pharmacists never seemed to care about that. Now it is all by fax and since Covid started, even the controlled substances go by fax.

For the Ragtag Daily Prompt: print.

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Snew

“Knock knock.”

“Who’s there?”

“Snew.”

“Snew?”

“I don’t know, what’s snew with you?”

I will have to pull out my patience cards today because, yes, it’s snowing. And I have family supposed to come from east and apparently that atmospheric river is dumping in the mountains. It’s supposed to snow in the mountains until midday Thanksgiving. I’m not sure I can have the whole meal all ready for them to arrive.

Ok, but patience, and let’s get creative. We could always do the cooking and have the meal on Friday instead of Thursday.

It is supposed to turn to rain here and the snow will be gone by noon. I jumped out of bed like a little kid, though, shouting “SNOW!” Sol Duc is unthrilled. The roads don’t look too awful and I wonder if anyone will cancel in clinic or it will be as usual.

Yesterday was a bit of a zoo, mostly because over 100 people realized that they are nearly out of some prescription and called for a refill. I knocked my message box down from 48 to 31 in the first 25 minutes and then it kept piling back up over 50. I also wish that if an 87 year old has a serious emergency room visit, they’d give me a longer follow up, because it can’t be done WELL in 20 minutes.

I expect that today will continue a bit nuts. Getting ready for Thursday and Friday off, to lie around pooped!

It’s all good.

For the Ragtag Daily Prompt: patience.

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Conserving energy

I was out of clinic for two years and then very part time for a year and now not quite full time as a temp. I bargained to not quite be full time.

The electronic medical record is having a consequence, along with the pressure to see more people faster. The primary care doctors, at least the younger ones, do not seem to call their peer specialists any more. (Family Medicine is a specialty, just as Internal Medicine and Obstetrics/Gynecology are.) I called a gastroenterologist and left a message last week about a difficult and complex patient. The patient had cried three times during our visit. The gastroenterologist was very pleased I had called, was helpful, agreed with my plan of using the side effects of an antidepressant to try to help our patient, and thanked me three times for calling her. Wow. I am used to calling because during my first decade in Washington State, our rural hospital had Family Practice, General Surgery, a Urologist, Orthopedics and a Neurologist. For anything else, we called. I knew specialists on the phone for a one hundred mile radius and some knew me well enough that they’d say a cheery hi.

Now communication is by electronic medical record and email on the medical record and by (HORRORS) TEXT. Ugh. I think that there is quite a lot of handing the patient off by referring them to the Rheumatologist or Cardiologist or whatever, but the local Rheumatologist is booked out until February for new patients. That leaves the patient in a sort of despair if we don’t keep checking in on the problem. If I am worried, I call the Rheumatologist and say, “What can I do now?” I’ve had two people dropping into kidney failure and both times a call to the Nephrologist was very very helpful. I ordered the next tests that they wanted and got things rolling. One patient just got the renal ultrasound about three months after it was ordered. Sigh.

I have one patient who is booked in February for a specialist. I called that specialist too, they did not want any further tests. I told the patient, “You aren’t that sick so you won’t be seen for a while. It isn’t first come first serve: it is sickest first. We all have to save room for the emergencies and sometimes those are overwhelming.” The specialist agreed and the patient is fine with that and I think pleased to know that we do not think she’s that sick. She feels better. If things get worse, she is to come see me and might get moved up. Neither I nor the specialist think that will happen.

Is this conservation of energy, to communicate by email and text? I don’t think so. I think sometimes a phone call is much more helpful, because the other physician knows exactly what I am worrying about and they can tell me their thoughts swiftly. Sometimes they want me to start or change a medicine. Things can get lost in the overwhelming piles of data and the emails and labs and xrays and specialist notes all flowing in.

My Uncle Jim (known as AHU for Ancient Honorable Uncle Jim) used to sing part of this:

Yeah, that’s just how I call my fellow specialists.

For the Ragtag Daily Prompt: conservation. Don’t cats win at conservation of energy?

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Tool

I don’t wear livery at work
and anyhow that’s a uniform for men
or a place to board horses
though the horses can be male or female.
Once I go to my daughter’s second grade
for a bring your parent day
and bring part of my uniform,
or perhaps it is a tool or instrument,
my stethoscope. The children all want
to listen to my heart
or at least touch this magical tool.
Afterwards I receive thank you notes.
I think that every one, except my daughter’s
thanks me for bringing the stethoscope
to their classroom. I did not know how
special and magical a tool can be.

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For the Ragtag Daily Prompt: livery.

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Pick one, delete two

I went through my blog this morning, picked a month two years ago, and deleted a bunch of photographs and the accompanying posts. More room! It is not a very fast process.

I am thinking about the Ragtag Daily Prompt today, hamfatter. It makes me think of Miss Piggy first. Don’t we all have a little bit of ham in us if we are in the right situation? Even if it’s just a dream or a daydream. Hamfatter also brings up ham and my inlaws. My son and daughter-in-law and daughter were all home for my birthday earlier this year. We also stopped at my daughter-in-law’s house, to pick my son up. Her parents heard it was my birthday and gave me a ham. How surprising and kind!

Yesterday I ordered prints of photographs to send to them, almost all with their daughter. She told me not to print any of the climbing gym or of the pets that her mother dislikes. Got it! I tried to pick ones that they will enjoy. It is a start of holiday gifts.

I am still having disaster nightmares, last night about my house. My house is far away right now and apparently my brain is worrying. I dreamed that there were clean baby clothes folded and piled all over the place in the upstairs bathroom, even on the commode. I took them off it and discovered that it was backed up. Then the walls dissolved and I realized with horror that there was water flooding through them! Then I woke up. Not a fun dream and no, there are not clean baby clothes in the upstairs bathroom. I think it is a combination of being far away and the coming administrative change. In some states it is illegal for a physician to discuss abortion. Will vaccines be next? And the most abortions are the spontaneous ones, where the pregnancy ends and passes. We call that a miscarriage but it is also called a spontaneous abortion. I wonder if those are illegal too.

I dress a bit more formally for work then at home. Maybe there is a bit of hamfatter there, too, entering the role of doctor.

I took the photograph in 2007.

For the Ragtag Daily Prompt: hamfatter.