Category Archives: work

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Something

Something is happening all around me
Something unpleasant is creeping around
I trust that feeling, that core that is free
I go quiet and listen, I will stand my ground
I am told no problem, this is routine
Nothing to worry about, averting their eyes
Lay down and be walked on, take it for the team
Blind-sided, I walk through a jungle of lies.
I walk very slowly then take to the trees.
I swing on a vine past the river of tears.
Wave to the gators with teeth to eat me,
Routine bad treatment not surprising nor feared.
In the treetops I sing to the stars quite alone
I am happy and making my quiet way home.

Suddenly I am thinking about home. Travel does that sometimes.

For the Ragtag Daily Prompt: travel.

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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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Food, food, food

When I get pneumonia, I drop ten pounds the first week. Since I had influenza viral pneumonia in 2003, I don’t run a fever. I just have a fast heart rate resting and get short of breath walking across the room. With Covid, I needed oxygen.

Each time, it takes longer to gain the weight back. Then I go over my normal weight and eventually have to rebuild muscle. This time I did not gain any weight back for over a year. But now it’s been three years and I am in the muscle rebuilding and weight loss section.

It does get harder as I get more mature. Older and wiser, right? Well, maybe. At any rate, I am trying to lose weight without any drugs or injectables or herbs. I am trying to eat the way the diabetic educators tell us to: half the meal should be vegetables. Every meal. A small grain and a small protein and not too much fat and vegetables. Corn really falls into the grains.

In clinic I often do a diet history of the day before. What did the person eat? I think about half of the histories come back with almost no vegetables. Pizza is NOT a vegetable, it’s mostly in the grain department. Grains are plants, I agree, but they send blood sugar up a lot more than celery and kale and collards.

Meanwhile, where is CHOCOLATE on that plate half covered with vegetables? Darn. My dessert could be a small piece of chocolate with a carrot on the side? Chocolate dipped carrots? I honestly do not like celery. Celeriac yes, celery no, though I have it in the curried chicken salad I made yesterday. That chicken salad is not half vegetables. It has some celery for crunch but it also has grapes. So, I ate it last night with an equal amount of mixed lettuce and sugar snap peas from the Farmer’s Market.

I do not have diabetes, but if I am recommending a dietary change, I think I should be able to do it too. We shall see. I think right now my diet is about 1/3 vegetables. Fruit does not count as a vegetable for this.

The other thing about vegetables is you have to cut them up. Ok, wash them too. And it’s not like one doesn’t have to cook beans or rice or meat, but vegetables do take time. If I have a person with low blood sugar or who is feeling awful, saying make half the meal vegetables may not be realistic. When someone is really frail or ill, it may be that getting out of bed, washed and dressed and to the table is overwhelming. Cut up vegetables? Cook from scratch? Maybe not.

For the Ragtag Daily Prompt: lunch.

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Coping or manipulation?

I see someone in clinic with a difficult boss.

This brought up work stories. Now, are these coping skills or manipulation or a bit of both? You decide.

Long ago I work in a lab at the National Institutes of Health. We are super busy and doing a lot of overtime and have some media pressure as well. Our boss gets us together and gives us hell, about making mistakes. I am annoyed, because I’ve been really careful. I stew. I write a letter, what I think he should have said, which is telling us all great job, you’ve worked super hard, we are under pressure and also we need to not make mistakes. I circulate it to the four other lab techs, who enjoy it. The lab cheers up a bit. Eventually I get brave and give it to the boss. He likes it and reads it to everyone, who try not to laugh. A year after I leave the lab, I visit, and he has that letter up on his bulletin board.

Long ago I am made chief of staff at a hospital. My goal is to finish the monthly meeting in an hour. I have two senior doctors who always blow up about something in the meeting. I decide to be proactive and go to each one before the meeting and prime them. I pick a topic, say I am worrying about it, and what do they think? They each then blow up in the meeting, but now they have no opposition so there is no brawl. I prime them about something that is not really controversial. I do get the meetings done in an hour.

One year I go to the lake with my family. My children are small. My father has been drinking heavily. I call ahead and say, “Will you treat our tent site like my house and not come there if you are drinking?” “You don’t own the lake land,” says my father. “We don’t have to come.” I reply. He agrees not to drink at our tent site.

He is angry, though, and pretty much won’t speak to me. I ask if he would come to a family sing at my site. He says no. I think about it for a while and ask my cousin to hold a sing at her cabin. My father agrees to that, not knowing that I am the instigator. He is happy at it because he’s said no to me and yes to her, and I am happy too, because I love to sing and sing with him.

My father was one of eight people to start Rainshadow Chorale in 1997. I sang with him in the chorale from 2000 until the year he died.

Where is the line between manipulation and coping with a difficult person?

I think this is a time travelogue, so let it be my Ragtag Daily Prompt for today.

The photograph is of my father in 2012. He died in 2013.

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Covid Morph

So far I have gotten positive Covid tests on one patient a week, all with really different symptoms.

One older person who was short of breath walking, tired, coughing and loose at the other end.

One young one whose only symptom was profuse throwing up.

One with a sore throat, nasal congestion, cough and feeling fairly awful and about to go on a trip, darn it.

There isn’t a nice pattern to tell me what the local strain is doing. It can do any darn old thing. I have also seen someone with strep throat and another couple who had similar symptoms to the others but did not have Covid. It’s morphing like an AI, I swear. I am masking in clinic but so far so good.

The Ragtag Daily Prompt is essential. I think it’s pretty essential for me to wear a mask in clinic, in crowds and on airplanes, since I am quite tired of pneumonias.

I have been the only “provider”, that is, doctor, in the clinic for the last two days. The medical assistants and front desk and I are starting to work as a team. I ask the front desk person how to communicate with her from the clinic room most efficiently. Something was weird about the refill system and it kept refusing refills. On Tuesday I had over 100 “documents” in the computer “box”. Lab work, specialist reports, refill requests, x-ray reports, nursing home things, surgery reports, wound clinic, emergency room, and so forth. I am trying to skim them, but I can’t say that I will remember person A’s dermatology report after skimming 60 others. If you go to your primary care provider and have had some major medical thing recently, remind them. They may have gotten and read the note, but gosh, it’s hard to remember at 100+ per day. Right now I have not met most of the people, so it is even harder.

The photograph is just for fun, taken a few weeks ago on the trail that runs by the Colorado River. Lovely!

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Tinker, tailor

Tinker brought up this rhyme for me:

Rich Man, Poor Man, Beggar Man, Thief,
Doctor, Lawyer, Indian Chief.

It turns out that another version is

Tinker, Tailor, Soldier, Sailor,
Rich Man, Poor Man, Beggar Man, Thief

And I had forgotten AA Milne’s version called Cherry stones:

Tinker, tailor, soldier, sailor, rich man, poor man, beggar man, thief,
Or what about a cowboy, policeman, jailer, engine driver, or a pirate chief?
Or what about a ploughman or a keeper at the zoo,
Or what about a circus man who lets the people through?
Or the man who takes the pennies on the roundabouts and swings,
Or the man who plays the organ or the other man who sings?
Or what about the rabbit man with rabbits in his pockets
And what about a rocket man who’s always making rockets?
Oh it’s such a lot of things there are and such a lot to be
That there’s always lots of cherries on my little cherry tree.

Now I’m going to have to play with a version with some current jobs:

What about a tweeter, a twerker, a medical AI?
Influencer, programmer, cooker of meth highs?

Oops, that might not be the children’s version.

For the Ragtag Daily Prompt: tinker.

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Seeing rain

I like it when you can see the rain coming, the cloud in the distance with the rain coming down in lines and strands. I can smell the ozone and everything waking up in the rain, as if all the plants are talking to each other. “Oh, here it comes and I am so thirsty!”

“Wait, that’s a bit too much!” “Eeeee, hail!”

For the Ragtag Daily Prompt: rain.

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Hi ho, hi ho

This is zoomed in to the Colorado National Monument in the early morning. The light and shadows are wonderfully dramatic and change by the minute.

I won’t trudge to work today. I was mildly sick the last two days and am better today, so I am happy to go. Hoorah for feeling better.

For the Ragtag Daily Prompt: trudge.

And two songs from The Yes Yes Boys, 2004, here.

I do just what I please:

Make it easy:

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Tough cat

Sol Duc is quite a cat. The other morning I let her into the fenced back yard. I went back in to get my tea.

There is a knock at the front door. I open it and there is Sol Duc. “Meow!” which I hear as “Mom, I’m not supposed to be in front of the house without you.”

She comes in and I take my tea to the back. Oh.

Yes, I see the problem. She went into the neighbor’s yard and then around to the front. But she didn’t run off, she knocked. Apparently the storm was pretty hard on the fence.

This morning, after two days of rain, there were lots of small frogs singing to the sunrise in the man made run off space across the street. There is about a foot of water in it and the small frogs were all singing to their true loves. They continued to sing as the sun rose. Guess they better make hay while the pond is present, or something like that.

Sol Duc is a tough cat and smart. I think she still misses Elwha too, especially when I am at work, but she is careful not to run off.

For the Ragtag Daily Prompt: tough.