Category Archives: teamwork

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Devil’s Kitchen and No Thoroughfare Canyon

Sunday a friend and I hike in the Colorado National Monument again. I have not run out of trails at all! Two trails. Up the Devil’s Kitchen shorter trail, which requires some clambering. Fabulous rocks and fabulous views!

Next the No Thoroughfare Canyon Trail. It has falls and a pool: here is the pool.

It is a bit dry at this time of year. We did not do the entire canyon: we’re both traveling this coming weekend, so we needed time to get ready. Packing and cleaning.

It’s hard to see the scale in photographs. The rocks on the ground are as tall as I am. And that is the trail, winding through those rocks. Did the rocks wash down from further up? They do not look like the surrounding hills. Those are some serious boulders for a seasonal stream to carry.

For the Ragtag Daily Prompt: clamber.

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10 rounds

Got sick in clinic yesterday, about 20 minutes after eating lunch. Abdominal cramping and lost lunch and lay down until I could drive home. Went to sleep for another four hours. I got up to hydrate slowly, some water with a little sugar, every 15 minutes. Taking it slowly is gentler on the stomach. I went back to sleep.

I got up at 11 pm and had a few crackers. This morning I am tolerating tea, but my body feels rather like it’s been beaten up. No clinic today, but I think tomorrow would be ok. We shall see.

I am not sure of the cause. I was given some gluten free donuts and wonder if one had gluten. Food poisoning is not very common in the places I have lived. We are seeing some people with Covid who have abdominal symptoms rather than upper respiratory, so I am debating whether I should home test.

It’s been a strenuous twenty four hours!

The photograph is from the Fruita Fair a few weekends ago. I really wanted to do this with the kids. Today even looking at the picture makes me slightly nauseated! Whew! They were in climbing harnesses and then attached to giant rubber bands and bouncing. Some were able to do flips, too. Not me, not today!

For the Ragtag Daily Prompt: strenuous.

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Authenticity and masks

The Ragtag Daily Prompt today is identity. Yesterday I went to work an hour early so I could attend the Friday morning Continuing Medical Education. It was about adult ADHD and the positives and negatives.

I do not have a diagnosis of ADHD. I have one friend who insists that I have it, but I don’t much care. However, the speaker started talking about masks and authenticity. She said that we are told to be authentic at work, but that people with ADHD often find that their authentic self is not welcomed and they learn to mask.

I asked, doesn’t everyone mask somewhat at work? She said, “Good point, and yes, people do.” It got me thinking about identity and masks. I pretty much clammed up in Kindergarten because I was too much of an outlier and culturally wrong. We did not have a television and television was pretty much what the other children talked about. I knew songs and poems but these did not interest my peers. I was interested in science, too, but that was also not popular. I think I was a geek before it was named and as soon as I learned to read, I became a bookworm. I am not sure if having a television would have made any difference, either.

Fast forward to after high school. I went to Denmark as an exchange student my senior year and then needed to make up credits to graduate. Another high school student was in my Community College classes. After a bit, she said, “I thought you were shy in high school.” I said, “No, I just didn’t talk.”

Currently I am more authentic in the room with patients than with the rest of the staff. Corporations are very weird hierarchical places. My authentic self always questions authority but I am trying not to do it all the time. At least, not out loud. The patients seem to be fine with it. I had a very difficult conversation with an elderly couple this week about memory and planning, now, before they can’t. I got hugs at the end of the visit even though we’d gone into frightening and difficult territory. They did very well. Yesterday was my last day at that clinic and next week I am in another one. Even after just four months in this clinic, I will miss many of the patients and hope they do well.

Yesterday I really did Urgent Care. My schedule only had a few people and then six more sick ones were added on. We had to call an ambulance for one, the first time I’ve had to do that here.

What is authenticity and what is our identity? Is the work mask less real than the self in our minds?

I took the photograph at a small hot springs resort. A friend that I’ve known since high school and I met there. I love the bookworm rabbit. I think she represents the happy bookworm part of me. I read about 7 novels a month, haunting the library here. Maybe I will get to know some more people over the next 6 months.

For the Ragtag Daily Prompt: identity.

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Bolster my courage

I am having nightmares. About clinic. Yesterday I bolstered my courage and sat down to write my dream out. What are my dreams trying to tell me? Should I extend my contract or not?

I dream that in clinic I have a male patient with his wife in the room. He is very dramatic, saying, “I am so ill, help me, help me.” He says, “I am on quercetin. You have to help me.”

He won’t tell me what his symptoms are, so I respond to what he says: “Who prescribed quercetin? What is your diagnosis?”

“Oh, you don’t want to help me,” he says. His wife just watches.

“Do you have pain somewhere? Any chest pain? Any abdominal pain? Any pain anywhere?”

“No, no, you don’t understand!” he says, “You aren’t listening!”

“I am trying to help you,” I say. “Can we reschedule you for a longer visit?” This is one of the impossible 20 minute ones. Honestly, he doesn’t look like he’s in pain. I do a quick listen to heart and lungs and feel his abdomen.

“No, I need to be in the hospital, I can’t go home!”

“I can’t put you in the hospital without a diagnosis, but we can move you to the emergency room.” Of course, the ER won’t be happy about this.

I leave the room and call the ER. The ER doctor is understandably grumpy, since I have no idea what this is about and am suspecting a psychiatric cause. “Urine drug screen,” I say. “He doesn’t smell drunk. I do not think it’s meth withdrawal.” “Make sure you do a note,” snarls the ER doctor. Good luck, since he won’t answer any questions. “How behind am I?” I ask the nurse. She just rolls her eyes. I probably have at least four or five more on the schedule. I come back to the room. Now two preteens are in the room, looking in the drawers and taking things out. Their parents do nothing to stop them.

“Please sit down now!” I say. “Put that down!”

The teens sullenly comply. The father is moaning. He has the prescriber on his cell phone. He hands it to me. I introduce myself. “What is your diagnosis?” I say. “Why is he on quercetin?” The person at the other end mumbles. “Excuse me, what did you say?” He’s gone. I say to the mother, “Please take the children to the waiting room. Sir, are you requesting that we call 911?” It would be a call saying man moaning, no idea what he’s on about. Vitals are normal, he denies chest pressure or pain, he doesn’t have an acute abdomen, his oxygen level is fine, no fast heart rate, no fever. Drama.

I wake up, thinking that I may have to call 911 to get the wife and kids out and I have to have someone monitor him while I see other patients and we just don’t have enough staff and I am ready to just cancel the rest of the afternoon. If I were in a hospital, I could call security, but we are a satellite small clinic.

So… what the heck is THIS dream about? And do we really get patients like this? Yes, but not often and I haven’t had any like this here. I think it’s funny that this dream has so much detail, down to the supplement that the man is taking as well as the clinic room. I usually work in room 1 and 2, but this was in room 5.

To be continued.

For the Ragtag Daily Prompt: bolster.



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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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All of my patients are smart 3

Human behavior doesn’t surprise me, really. Sometimes it disappoints, depresses, demeans, dispirits and demoralizes. And it’s not the patients. It is the corporate workplace and how it abuses people. And circles the wagons against a threat. Including against employees that it views as threats.

I think all of my patients are smart. “You got this,” I say. I explain what carbohydrates are and that they are in everything, practically, except meat and oil. And some meats have carbohydrates too: shrimp, for example. But my patients can figure this out! My patients rise to the occasion! I am not saying that they do smart things all the time. No one does, including me. Even the smartest ones can do things that are not a good idea or are a really bad idea. Growing up in an addiction household, I think I escaped addiction mostly because I had decided that no adults could be trusted by the time I was three. I thought they loved me but I couldn’t trust them not to give me to someone else. Ironic, that the distrust saved me from taking the same path. My sister took it and is gone. My patients are smart and all I have to do is share my education and experience! They take the ball and run with it! Not all. Sometimes it’s too late and everyone dies eventually.

Corporations, on the other hand, are infuriatingly stupid.

The photograph is me in 2015, sailing my father’s boat with my daughter, in Port Townsend Bay.

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Fit, function and frustration

The clinic that I have been in now since a week or two in July is an older clinic. It does not have wall mounted computers in each room and in fact, there is no desk at all in the exam rooms. As the temp, the other two doctors have priority over me in picking their rooms. I do not like the exam table in one room. It isn’t a regular exam table. It turns out to be a table for a DO to do adjustments. I am an MD, not a DO. The table might get switched out but it has not been yet.

Meanwhile the desk. We have laptops that plug into the desktop in the offices that we each share with a medical assistant. The desktops have a standard keyboard. The laptops are small, and my laptop that I am typing on now is in between the two. At first my fingers had trouble switching between three different keyboard sizes. Now it is pretty automatic.

So, no desk in the exam room. I do most of my note in the room and don’t dictate. I type reasonably fast. But I hate a laptop on my lap and anyhow, we are all sitting too much, so I stole one of the two Mayo trays from the procedure room. Mayo trays have adjustable height, are stainless steel so they can be cleaned after surgery, and they are a pretty good desk for a laptop. I choose to stand while typing in room one.

Next it turns out to be inconvenient to drag the Mayo tray back and forth from room one to room two. I am leaving it in room one. Room two has a standard exam table, so I pull out the “pull out leg rest” (yes, I looked up the name), push the step in and then I can sit on my stool and use the “pull out leg rest” as a desk.

The medical assistants have adjusted, mostly. The patients blink at first, but they seem fine with it. Sometimes I am attempting to find something and also attempting not to curse this particular electronic medical record. The other day I needed an ankle-brachial index test. Ok, not under ABI. Two were under ankle-brachial index. I chose the one that was not in our clinic, since we don’t do them. I got a message back that that was wrong. I chased the other doctor down. She called a third provider who remembered. The one I need is under “us ankle-brachial index”. Really? Hopefully I will remember that annoying local electronic medical record filing quirk, but I may not. If you are wondering what it is, it is a test for arterial disease in the legs, comparing blood pressure in arteries in the legs with the arms. The “us” stands for ultrasound.

The photograph is Elwha supervising on my desk at home.

For the Ragtag Daily Prompt: desk.

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Tea and talk

Tea and talk and tittle tattle
exchange of views among some boomers
solving problems as ideas rattle
or spreading nasty damaging rumors?
Talk of science and books and space
are the words mean or kind?
whispers about someone’s face?
Rumors about someone’s mind?
It’s hard to fight a rumor mill
people talking behind your back
the poison seeps and spreads and spills
a deadly dagger in your back
Time passes and people find
sometimes it’s the accuser who lost his mind

For the Ragtag Daily Prompt: tittle tattle.