Category Archives: water color

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Tenacity

Two skills needed in primary care are tenacity and listening. That is a combination that can make a diagnosis. Here is an example.

In residency, many years ago, I have a patient with developmental delay. He lives in a group home. He can’t talk though makes some noises. The group home staff bring him to me. His head is misshapen because his mother had measles in her pregnancy.

The staff says, “We think his head hurts. He just isn’t behaving right.”

“Did he fall?”

“We don’t think so.”

“Fever? Nasal congestion? Cough?”

“No.”

“How long?”

“Over the last week.”

I do an exam. I really can’t see his tympanic membranes because of his skull shape.

“Maybe he has an ear infection. I can’t see. We’ll try antibiotics, but if he is not improving, bring him back. In five days.”

They bring him back. “He’s no better.”

I get on the phone. I need a CT scan of his head and the group home say he won’t stay still. I need anesthesia to sedate him for the CT scan. It takes two tries and quite a bit of phone explaining with both the anesthesia department and the radiology department. Persistence. I am looking for a subdural bleed in his head from a fall, or a sinus infection, or something.

It is done and I get a call. Not from radiology or anesthesia but from the ear, nose and throat surgical resident. He is very excited. “Your patient!”

“Yes,” I say.

“He has a pseudocyst! In his sinuses! He has abnormally large sinuses and this is the biggest pseudocyst anyone here has ever seen!”

“Um, ok.” Honestly, I’ve never heard of a pseudocyst. It turns out to be packed nasal drainage in the sinus. Bad ones can erode through bone into the brain. Certainly that seems like the cause of the headache!

“We are taking him to surgery!”

Residency can be pretty weird, when someone gets really excited about a rare disease or interesting trauma case or whatever. I found that I was entirely happy just doing health maintenance exams and encouraging people to quit smoking and exercise and drink less. However, I was also good at finding weird things.

The ear, nose and throat surgeons in training were very happy about the surgery. The group home staff were happy too. “He’s back to his old self. Thank you!”

It took tenacity to set up the head CT. It’s important to listen to the families and caregivers too, because they know the person better than I do. They were right: his head hurt. And we found out why and were able to treat it.

For the Ragtag Daily Prompt: tenacity.

Water is tenacious too, wearing down stone and wood and glass.

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Dock and gangplank

As the tide comes in, the dock and the boat rise with the tide. The rings rise up the pipes of the pipe dock.

The gangplank is hinged so it can swivel. Stairs would not make sense, because the angle would change as the tide changes.

No hinges or swivels on the bridge!

I took these yesterday in La Conner, Washington. This is the Rainbow Bridge over Swinomish Channel.

For the Ragtag Daily Prompt: swivel.

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Painted sky

I think the sky and water here are more sophisticated than I anything I can imagine.

After my mother died, I wrote a poem about her and my kids. Her part:

I keep wondering
what the art supplies are like
and if you work on sunsets
or mountains
or lakes

The rest of the poem is here https://drkottaway.com/2021/09/23/painting-angels-2/.

For the Ragtag Daily Prompt: sophisticated.

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Air and water

I took a wonderful limnology class at the University of Wisconsin, Madison in college. The study of inland aquatic ecosystems, lakes, reservoirs, ponds, rivers, springs, wetlands and so forth. I loved this course because it is such a generalist course. We talked about the chemistry of water, the physics, the ecology, the geography. The plants and animals, microscopic to bigger than us. And lakes that freeze, the ice floats on top, because it is most dense at 4 degrees C and less so at 0 degrees C. This oxygenates the entire lake as the water turns over until the entire lake is 4 degrees. Tropical lakes do not do this.

The photograph is of the Salish Sea, so not an inland space. The liminal space for me is the surface, the border between water and air. Sometimes swimming, if air and water are both warm, it’s hard to feel the exact liminal space, wet skin in the air and then the water.

For the Ragtag Daily Prompt: liminal.

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Early morning

A friend and I go down to coffee and walk out on the dock, on a fabulous sunny morning. The Northwest Maritime Center and the water are photogenic and lovely! All of the colors in the polarized light are just beautiful and it is almost warm.

For the Ragtag Daily Prompt: photogenic.

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Shattered

Is the wave, the water being shattered?

Or is it really the rock that is shattered, bit by bit, over time?

Stone shaped heart

your heart is an agate
clear stone

you have won
sort of
you think

but I am water
I am waves
I will smash you against the other rocks
and wear you down

I am water
I carve you like a laser
you wear my name
carved in your stone shaped heart

it is already written there
on your stone shaped heart
faint, because water wears slowly

water wearing stone
over time

________________________

written in April 2022

For the Ragtag Daily Prompt: shattered.

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Colored ink

I write every day, both in my journal and here and other places. Ok, the other places are not every day.

I love colored ink. My mother did too. My sister and I were raised “devout atheist”. We did not go to church and my parents claimed to be atheist, but my mother loved holidays and decorated. Christmas, Easter, and we did the elaborate eggs with layers of color then wax then a second color then more wax. My parents also held music parties for folk songs. They sang in big choruses too, so my bible education was all masses and the Messiah. My mother set up a creche at Christmas and hung gilded pears in her avocado tree along with a partridge. She scorned “modern” Christmas carols so we just learned the old traditional ones.

My mother was an artist. She did art every single day. She kept a much more erratic journal than me, but kept it for years. My sister and I had art supplies of all sorts and art lessons whether we wanted or not. I love color. I use my InkJoy pens and write every day. I switch colors each day. Sometimes I have stickers or stamps or drawings or doodles. Each journal is a different form. I have lots of fun with them.

For the Ragtag Daily Prompt: ink.