Category Archives: travel

by

Scree dream

In September, I hike with the three friends in the Ragtag Daily Prompt photograph. I have not really backpacked into back country in years. The last time I carried the pack was in Italy with my daughter, a few years ago. She wanted to plan the trip as we went and stay in hostels. We did.

We hike in the first day, up switchbacks from the parking lot at about 3200 feet, to a pass at 5400 feet, over and down to a campsite. The sites for cooking are separate from the sleeping sites and there are serious big metal bear boxes. We are to put everything in them, including the deet and toothpaste and anything that could possibly interest a bear.

We pack day packs the second day and climb back up to the pass. We peel off there to the trail to Sahalie Glacier. After being on oxygen at sea level for a year and a half, I am beyond delighted that I can actually do this. We go up and up and the trail gets worse and worse, until it is rather nasty scree. Two other people coming down say it is even worse, slippery, unstable, if we go on.

So, like sensible people, we stop for lunch. The slope is very steep and we each find a place to perch. Lunch tastes good. Then the other three want to go on. I don’t. I want a nap. They go on, I find a slab and the view from it is the photograph: down, down, down to the lake far below.

They will get me on the way back down.

And I do go to sleep. It’s all that night time call I’ve taken over years and years. I can sleep practically anywhere, including in a noisy casino in the past. I tuck up against the rock and the sun is almost warm.

I wake up. Two other people have come by. My inner clock thinks my people should have come by. Do I wait? Do I stay? There are more ominous clouds building up and this will be much more slick and dangerous if it starts raining. And we are exposed, for lightening.

Then I see a hat, on a curve of trail below me, moving. I swear it’s one of my party. But how did they go by without seeing me or waking me. THEY ARE DITCHING ME ON THE MOUNTAIN. No, that is ridiculous. Hmm. She is not with either of the guys. I debate for a minute, shout and then grab my things and head down.

I catch her. Once they left me, there really was not a clear trail. There were multiple sort of trails. And it was tricky. They separated a bit. She lost track of the other two and then picked the least difficult way down, which seemed to be a trail. It was NOT the trail that went by me, but she didn’t know that.

We found one of the guys below us, waiting. The last came down a bit later. None of them had come on the “right” trail by me. We headed down and stopped to put on rain gear. It rained lots! We were also above the tree line, but also I would say that we were above the marmot line. We saw eight hoary marmots marmoting around on our way down. They did not seem deterred by rain at all.

So that is how I was left in the scree to dream. I would have returned by the time it started raining anyhow, and the trail was good once we got past the scree. Not all the way to the lake in the photograph, the trail ran along a ridge that is not in the picture and wound down near the lake.

For the Ragtag Daily Prompt: scree.

by

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.

________________________

For the Ragtag Daily Prompt: done.

by

Experience

Friday I left for the Fourth of July, but not for fireworks. I went to help pack for a move. My family moved every 1-5 years through my childhood, and then I moved too. College, work, work, medical school, residency, first doctor job. Second job and I stuck: I have not moved for 25 years. Travel yes, move no. But like Martha, I am thinking about all those books! I am working on cutting them down to size and many fewer favorites.

Anyhow, I have quite a bit of experience packing and moving. When my family moved from upstate New York to Alexandria, Virginia, the movers stacked the plates with newsprint between. Every single plate in the pile broke. My mother was furious. She said the packers should have nested them on their sides, so they don’t break the one below. We shall see if my experience is useful or not.

I bubble wrapped this lamp and then packed it in a big box with more bubble wrap and a lot of t-shirts. Yes, I should take the shade of but it would have required a special tool that we didn’t have. Or a trip to a lamp store. There was not enough time. The moving truck comes Wednesday or Thursday. We were nearly done when I left to drive back to Grand Junction. Newsprint, bubble wrap, a pack for glasses and quite a few boxes. I hope it all makes it!

For the Ragtag Daily Prompt: pack.

by

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.

by

Arrive and engage

Home again! I came home from Grand Junction, Colorado via Denver. Wrong direction and an additional 440 miles, more or less. I spent two nights at my daughter’s home and she and her boyfriend took me to the Botanic Gardens and to a birthday high tea at the fabulous Brown Palace Hotel. I guessed it was built in 1880. Close: 1892. We had tea in the atrium with ten or more stories above us, balconies all around and stained glass at the top. Quite gorgeous.

From Denver, I drove north and then northwest, Colorado, Wyoming, Idaho, Oregon and Washington. The pass in Wyoming had sleet and slush, terrible visibility and ice on the road. The speed limit was 35 and everyone ignored it. That was my second day and over 400 miles and both the cat and I were very glad to arrive at the hotel. Sol Duc complained quite a lot the first day and then settled down.

Driving into Oregon over another pass, suddenly it is green. Shades of brown before that but once over the pass, bright startling green. In Washington, Snoqualmie Pass brings the smell of the Salish Sea and we are close to home! We left Denver on Monday and arrive in Port Townsend on Thursday afternoon, delighted to get out of the car.

And hooray for being home! It was a little disorienting after being gone for most of eleven months. I miss Elwha cat and I think Sol Duc wondered if he was in the house too. A friend came over and brought some staples and another friend dropped off my first CSA farm box, from Wednesday! How wonderful!

On Friday I went to walk with another friend downtown, while her husband and daughter went scuba diving. The alpacas were downtown, being socialized and wading in the sound. They have very expressive ears and clearly the sound tasted peculiar. They were all well behaved and so were we.

Home, arrived and engaged already, alpacas, friends and demonstrations against P47’s insanity.

For the Ragtag Daily Prompt: arrive and engage.

by

Ice climb

Friday afternoon I drive to Ouray, Colorado, to meet a friend from high school. She has been ice climbing for years! I plan to watch, because ice climbing sounds terrifying. But I do take my harness, just in case. My friend talks me into trying it. The picture is NOT me. That is a competitor and she is amazing!

My climb was at the beginner ice wall. There are volunteers with loaner gear from gear companies. Boots, crampons, two ice axes and a helmet. My friend and a friend of hers give me instructions and I watch my friend climb first. She will be climbing all week!

I am wearing 1980s snow pants. Puffy and unstylish, but very very warm! I got all the way up and acquitted myself decently! Kicking each foot into the ice and then trusting that it will hold me, that is the interesting bit. Heel down, so that the crampon, boot and foot become a lever. And all the time in the climbing gym helped me to trust the harness, trust the ice axes, trust my feet.

For the Ragtag Daily Prompt: lever.

by

A weight loss drug complication

People are ordering versions related to semaglutide (ozempic) and dulaglutide (trulicity) from compounding pharmacies for various reasons. Their insurance may not cover the prescription or they may actually not qualify by their weight and complications. Here are the guidelines from the American Gastroenterological Association: https://www.aafp.org/pubs/afp/issues/2023/1000/practice-guidelines-medications-weight-loss.html. Those criteria: a body mass index (BMI) greater than 30 kg per m2 or BMI of 27 kg per m2 or greater with associated complications (e.g., hypertension, diabetes mellitus, and hyperlipidemia).

I have already had requests in clinic for a prescription sent to compounding pharmacy. I am refusing to send prescriptions out of state or to compounding pharmacies, because of the FDA warning. Here: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss. There are a bunch of issues: some compounding pharmacies are not using the FDA approved medicines, they are using something similar, but not the same. Also, the medicine does not come in the pen that injects a controlled amount. People have to draw the drug up and inject it. Some have injected ten times the amount that they should and have been hospitalized. It’s also worrisome that the compounding pharmacies, unlike state-licensed pharmacies, do not have to report complications.

A recent patient has deteriorating kidney function, with his creatinine jumping from 1.10 to 1.58. Creatinine is produced as a waste product by our cells and the kidneys need to clear it. His 1.10 was normal but the 1.58 is high, indicating the his kidneys aren’t clearing well, and that was only a six month interval. He is taking compounded semaglutide and compounded testosterone, with some online approval. That is, he did not get a prescription from our clinic. He started the semaglutide five months ago. The testosterone has been for years. “Stop the semaglutide and we will recheck your kidney function in a month.” His creatinine drops back to 1.10. Acute renal failure is listed as an uncommon side effect of the FDA approved semaglutide, but we don’t know if that is what he’s getting. I tell him the good news about his kidney function and say, “I think you should stay off the compounded drug.” I have not seen the same thing with the FDA approved semaglutide.

It’s complicated, isn’t it? We picked up the problem because he is on other medications and I do yearly labs on people who are on prescription medicines, to check whether their kidney or liver function is deteriorating. Almost all drugs, prescription or over the counter or supplements, are metabolized by either the liver or the kidneys. I only know of two that are not absorbed and not metabolized.

For the Ragtag Daily Prompt: pristine. I would like a pristine pill free body for as long as possible. Ok, I took one tylenol last week and I’d be dead three times over it wasn’t for penicillin.

by

Thinking about this and that

I am thinking about thinking. What do people think about most of the time?

This partly comes from my ex. He thinks out loud a lot, an external processor. My daughter and I wanted to know what he thinks about. My son asked. “Dad, what do you think about?”

“Golf.”

“Golf?”

“Yes.”

“Anything else?” says my son.

“No.” says my ex.

I have no idea if this is true or not. Sounds hella boring to me, honestly, but he seems entirely happy with it. De gustibus non est desputandem.

I had lovely winter holidays, celebrating EVERYTHING. I went to my son and daughter-in-law’s out east. My daughter and her significant other came out and we did presents on December 27th. Then we went to see my two aunts and uncle for a couple days. They are in their 80s and delightful! Back to my son’s and we saw my kids’ remaining grandparent, my ex-husband’s father’s significant other. Got that? And one of my kids’ paternal cousins with her significant other. I stayed with old friends for the last three days, which was also delightful. We went to the Smithsonian American History Museum and read every single thing. But only in two exhibits because that place is huge.

Now I am back to my current home and hello, cat! Back at work as well. More about that next time. The sands are shifting and I may be in another clinic. Monday a patient asked if I am their new doctor or am I a floater? I said I prefer “Temp” to “Floater”. She laughed.

For the Ragtag Daily Prompt: think.

by

All home

My daughter and her significant other arrive two nights ago and we open packages and stockings yesterday morning. Lots of laughter and chocolate and much contentment. Now I have a climbing harness in pale green! We did not climb yesterday, I was too tired. We did go for a park walk on an old golf course and had a delicious dinner. It is lovely to all be gathered here and trading stories and jokes and family silliness.

Today I am up early. We will drive down to see my two aunts and my uncle. The great aunts and uncle to the kids. A very delight!

For the Ragtag Daily Prompt: contentment.