Pathos

Beloved, what is my path?

I remember. You are gone and dead
I lie on my side, close my eyes
I feel your body behind mine
your arm tucked under me
your breath on my hair
your body warmth against me
your arm lying across my side
thighs and knees relaxed against mine
you are not gone and dead
as long as I can remember

Beloved, what is my path?

I remember. A path alone
so that I can see
so that I can hear
so that I can feel
so that I can write
Beloved, you set the path before me
a brief elaboration of a tube
Beloved, sometimes I want
Beloved, sometimes I say why
Beloved, sometimes I forget

And then I remember

_______________________________

For the Ragtag Daily Prompt: March.

Purity’s post

The root word for Katherine is pure, so Purity will write today’s post. Purity read about illeism in this BBC article: https://www.bbc.com/worklife/article/20230411-illeism-the-ancient-trick-to-help-you-think-more-wisely. Purity admits that it feels a bit embarrassing to write in the third person here on the blog, very egotistical, but that is not what the article is about. It is about writing that way in one’s journal. Purity has been trying it and it is interesting. It sets events at a distance and quiets and muffles the emotions related to events. How very curious.

Purity does not plan to keep writing this way on the blog nor does she plan to start speaking with a royal we. However, the United States appears to be in a state of chaotic stupidity and it is affecting everyone. Not just in the United States, but the rest of the world as well. Purity thinks of the United States as a teenage country, struggling with hormones, while the old countries stand back, watch and sigh. “At some point he will mature,” they say to each other. “Or destroy himself.” And yes, a male teenage country, stupid and boastful with testosterone. Purity thinks it will take the United States another 200 years to live down President #47 and his minions, if we survive.

At any rate, Purity hopes that the prompt of illeism might be more light hearted and be a new word to some people and tickle their fancies. Apparently our fancies mostly lie in our cats. Cats certainly seem to be experts in illeism. May you each feel as wonderful today as a cat when they own the world.

For the Ragtag Daily Prompt: illiesm.

If eggs aren’t available, why can we still buy chicken?

I note this article this week: https://apnews.com/article/usda-firings-doge-bird-flu-trump-fdd6495cbe44c96d471ae8c6cf4dd0a8. That version says that the Trump Administration is trying to rehire bird flu experts that got fired. Most of the news outlets frame it differently: https://www.nbcnews.com/politics/doge/usda-accidentally-fired-officials-bird-flu-rehire-rcna192716. Suddenly it is the USDA at fault not the Trump administration’s chainsaw fool.

Should we worry about bird flu? Oh, yes, I think so. I have been wondering why we still have chicken to eat and chicken in the stores, if millions of chickens are being wiped out to try to prevent H5N1 bird influenza from moving into humans. This article explains in unreassuring detail how factory farms, packing chickens together, and killing them at 6 weeks old for meat, puts pressure on the virus to become more deadly and kill the host. In wild birds the influenza virus wants to spread, so it’s better not to kill the host fast. That is not true on our national and international big factory farms.

Firing the people working the track the H5N1 bird influenza and trying to stop it if it starts going human to human, well. Is that injustice or arrogance or stupidity? Or all three? And who wants to work for the government now? It is being treated as a corporation, but it isn’t a corporation. Public service often pays less. Good luck hiring the best and brightest who want to serve our country and humanity.

This is the worst year in the US for influenza since 2017-2018 so far. That is without the H5N1 bird influenza really getting in to people. Here is the graph for the week ending February 15th from the CDC. I keep an eye on it all through influenza season.

The article on H5N1 bird influenza is the best argument I’ve ever read for choosing not to eat meat. I like meat, but the factory farming is going to more countries. It may produce more eggs and more chickens, but if it is also the perfect breeding ground for lethal influenza, that changes my viewpoint. We cannot go on. We will have another pandemic.

Why are humans such fools?

For the Ragtag Daily Prompt: injustice.

Unweighted

Words behind my back
damaging
hurtful
gossip and lies
I forgive
I wait

I wait

I wait, wait, weight

Weighted 13 years
For them to speak to me
Instead of about me
At last waiting makes me angry
I have forgiven
tried to connect
some of them say they love me
this is not love
waiting
weight of hurt and anger

And I let go
of the wait
of the weight

I forgive myself
I am free
I rise
I let them go
they are forgiven
but they may not enter my life
again
not ever

I forgive myself
I am free
I rise

unweighted

________________________

For the Ragtag Daily Prompts: weight and chopper. My heart is what is chopped, and the abandoning friends and family wielded the choppers.

New scar and whale songs

My receptionist of 6 years at Quimper Family Medicine, Pat McKinney, died on February 6th. The photograph is from October, when I was in Port Townsend again for two weeks. She and I went for a walk. Well, I was walking and she was in a wheelchair. She was in hospice for over a year.

We had fun working together. Pat played music at her desk because the patient rooms were not quite sound proof enough. One day she was playing whale songs. I hear her on the phone with a patient. “The noise? Those are whale songs.” Pause. “Oh, Dr. Ottaway insists on whale songs.” I started laughing, because she was the one that picked them. So much for MY reputation.

When the covid vaccine came out, I got mine as a first responder. A few days later we had a lull between patients. I was standing in the hall near Pat’s desk. I said, “I don’t know why people are fussing about the vaccine, it seems fine to me,” and I gave a big twitch. Pat started laughing. I could set her off all day by twitching at her.

Patricia McKinney, 2/17/1943 – 2/5/2025.

For the Ragtag Daily Prompt scars.

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.

Travel risks

The President is withdrawing the United States from the World Health Organization. https://www.whitehouse.gov/presidential-actions/2025/01/withdrawing-the-united-states-from-the-worldhealth-organization/

Here is the link to write to the President: https://www.45office.com/contact/

I am writing daily, just not for the Ragtag Daily Prompt. Here is my short note today:

Dear President Trump: I strongly disagree with withdrawing the United States from the World Health Organization. One function of that organization is travel clinics. If a person is traveling to another country, they can find out what illnesses are present there and get immunizations and advice to avoid getting ill. This also helps physicians treat people who have returned from another country. The physician can contact a state health department which is in turn connected to the World Health Organization. This is a foolish, dramatic and unscientific decision on your part. I suggest that you reverse it immediately or resign as President.

________________

The question I have, is he closing the borders to United States citizens too? Without the travel clinics, who get information about each country from the World Health Organization, aren’t even our own state department employees at higher risk for illness? My son was an exchange student to southern Thailand. At the time he went, there was Japanese encephalitis. He was there two years after the tsunami. He got vaccinated for Japanese encephalitis before he went and he also took medicine to avoid malaria. So, are we not going to send or accept any more exchange students?

I strongly disagree with the decision to leave the World Health Organization and our country is on the verge of crazy.

For the Ragtag Daily Prompt: verge.

What to check before bringing your elder home from the hospital

I get a call from the hospital (this is over a year ago). They say, “Your friend is ready for discharge. What time can you pick her up?”

I reply, “Can she walk?”

“What?”

“She has three steps up into her house. Can she walk, because otherwise I can’t get her into her home.”

“Oh, uh, we will check.”

They call me back. “She can’t walk. She’ll have to stay another day.”

I knew that she couldn’t walk before they called. She could barely walk before the surgery and after anesthesia, surgery and a night in the hospital, her walking was worse. She had been falling 1-5 times at home and the surgeon knew that. He did not take it into account. The staff would have delivered her to my car in a wheelchair and then it would have been my problem.

She was confused by that afternoon, which is not uncommon in older people after anesthesia. She stayed in the hospital for six days and then went to rehab, because she still couldn’t walk safely.

Recently I have a patient, an elder, that I send to the emergency room for possible admission. He is admitted and discharged after two and a half days. Unfortunately he can barely walk and his wife is sick as well. The medicare rules say that he needs 72 hours in the hospital before he qualifies for rehab. We scramble in clinic to get them Home Health services, with a nurse check and physical therapy and occupational therapy, and I ask for Meals on Wheels. It turns out that Meals on Wheels will be able to deliver in two months.

The wife refuses to go to the emergency room. I tell her that if she does get sicker, that they both need to check in. The husband can barely walk and is not safe home alone. If one gets hospitalized, they both need it.

If you have a frail elder, be careful when you are called about discharge. Go look at them yourself, make sure that you see that they can get out of bed, get to the bathroom, walk up and down the hall. Can they eat? Do you have steps into your house or theirs and can they go up the steps? I got away with saying please check that my friend could walk because I am a physician, because I knew she couldn’t and because there was no one else to pick her up. Do NOT ask your elder. They may want nothing more than to go home and they may well exaggerate what they can do or be firmly in denial. You want them to be safe at home, to not fall, to not break a hip and to not be bedridden.

For an already frail elder, even two and a half days in bed contributes to weakness. And being sick makes them weaker. If they are barely walking when they are admitted, it may be worse even after just 2-3 days. I used to write for physical therapy evaluation and exercise when elder patients were admitted, to help them for discharge. Once I got a polite query from physical therapy saying, “This patient is on a ventilator. Do you still want a consult?” I reply, “Yes, please do passive range of motion, thank you!”

Your elder does not have to be doing rumbustious dancing before they go home, but they need to be able to manage stairs, manage the bathroom, manage walking so that they can get stronger. Otherwise a stay in a nursing home or rehabilitation facility may be much safer for everyone.

For the Ragtag Daily Prompt: rumbustious.


Love and grief

I got a letter from a family member, talking about happy memories of my father, mother and sister, who are all dead. How much fun they were and my mother’s influence taking them to museums, art museums and the Smithsonian.

It’s a bit difficult to answer, since my memories are much more complicated and tangled.

I wrote a poem called Butterfly Girl Comes to Visit a long time ago. It is about my sister. My mother could charm a room full of people and enthrall them with stories. Sometimes the stories were about me and my sister and actually making fun of our feelings: fear or grief. However, my mother was so good with an audience that I didn’t break the stories down until after she died. She was 61. That involved exploring a lot of really dark feelings. My sister and I even asked my father what our mother was really like: his reply was “Morose”.

I inherited my mother’s journals. My sister told me not to read them because they were “too depressing”. I don’t agree. They explain some things. My parents often fought, screaming at each other at 2 am while I was in high school. The family story was that my father was an alcoholic. As an adult, I wondered why she would fight with someone who was drunk. Her journal says “I drank too much last night,” over and over. Well, that would explain it, right? It takes two to tango. Or fight.

My sister could also charm a room. That is the sparkle in the Butterfly Girl poem. There was a period where she would tell me that I couldn’t talk about certain things, that she was fragile, that I was hurting her. This is after I gained control my feelings and had actual boundaries: I could refuse to fight with her. Before that, she could set me off like dry tinder. Her first husband called me once, saying, “I can’t not fight with her when she wants to fight. What do I do?” I replied, “I can’t either. I don’t know. I am so sorry!” I think it took until I was in my early 30s to refuse to fight with her and took a lot of conscious work. A fiance that broke up with me right after college told me I was an ogre when I was angry. I took that seriously and worked on it. My parents were not good role models for dealing with anger or grief or fear.

I am not much in contact with my maternal family. One person said that we could be in contact if we only said nice things about my mother, father and sister. I suggested we never mention them at all. We did not reach an agreement. I realize that our society wants to speak well of the dead, but to really be someone’s true friend, I think we have to accept that people may be angry at the dead as well. I gave this handout, Mourner’s Rights, to a patient on Friday. He is in the midst of grief and we talked about it. He thanked me and said, “I am grateful to talk to someone who knows about grief.”

My parents moved to Washington State in 1996. My mother was diagnosed with stage III ovarian cancer in 1997. I moved to be near them when her cancer recurred, arriving on Y2K. My mother died on May 15, 2000, four and a half months after we arrived.

My mother was only in that area of Washington for four years. She made such a charming impression that I had people tell me how wonderful and charming she was for a full decade. I was working though the complex feelings about her and tried very hard to thank people, even though I did not feel thankful.

I have not answered the letter yet. I want to return a gentle replay but I will not play the “only happy memories game”. I don’t mind my dark feelings. The family member would mind my dark feelings, I think. It is nice to be a physician and to be allowed to let patients talk about their dark feelings. Our culture wants to deny them, remove them, be positive. That is a disservice to love and to grief.

People are astoundingly complicated.

For the Ragtag Daily Prompt: astound.

The photograph is of my friend Maline, me, and two of her husband’s family members. Maline was one of my alternate mothers, a friend of my parents. She died within the last few years.

Clinic comedy

Yesterday was my second day in the third clinic in this system and the day went a bit sideways. I am in seeing a person with their spouse. We are all masked because this is a sick visit. I try to wear a mask for all the visits but occasionally take it off if someone really can’t hear me. I go to wash my hands. The sink is small and turns on by a motion sensor. It is supposed to turn itself off. It goes on but then will not turn off and is loud. I send a quick message to the clinic director after flailing at it a bit. Why a message? The cabinet under the sink is locked, so I can’t turn the water off. With my patient slightly deaf and masks and loud water, I finish the visit trying to yell things. Ridiculous and embarrassing but funny. The patient and spouse are older and know that things break. They are not upset. The clinic director arrives, has her try at flailing at the sensor, unlocks the cabinet and turns the water off.

I shake hands with my patient and they and their spouse leave. We are in room three. I go in room 4 to wash my hands, since my patient was blowing their nose, and guess what? Yes, the water turns on and won’t turn off. I get the clinic manager. “I broke the second sink. How about I go home now?”

She laughs. “I will put in a ticket for maintenance.” She unlocks the room 4 sink and turns it off. Now we have two rooms out of commission!

I am covering for Dr. X. “See, this just shows that I wash my hands and Dr. X didn’t.” Not really. Dr. X has been out for a month already.

“Maybe it’s because they haven’t been used in a month,” says the medical assistant. We shut down those two rooms and I go into room 2 with some trepidation. The sink does not break.

Maintenance show up early afternoon and replaces the sink sensor batteries in room 3 and 4. They work just fine after that. It turns out that there are two other sinks not working, but there are patient visits going on, so maintenance will come back. The alcohol hand sanitizer makes my hands itch, so I prefer soap and water.

Isn’t technology great? Except when it breaks. I felt silly and helpless, since I was in a brand new place and the cabinets were locked!

I admonish all the doctors, do wash your hands! Even if the sink batteries need to be replaced more often.

For the Ragtag Daily Prompt: admonish.