Qia and the dark

This story is part of a series about a Balint group for angels. Balint groups are groups for physicians to get together and talk about cases that bother them. This often means facing their own biases and discriminatory feelings. I wrote this in January 2022. The current estimate of Long Covid is 10 to 30% of non hospitalized people. Which is huge and terrifying.

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“And really, it looks like at least half the population will get Omicron. The question,” says Qia, “is how much Long Haul it causes. If it causes 30-50%, like Delta, we are in serious trouble.”

The angels are silent.

“Do you think it will?”

“I am hoping for under 10%.” says Qia. “But of course I do not know.”

Silence again.

“Why do you go to WORST CASE?” snaps Algernon. His wings rustle.

Qia blinks at him slowly.

She thinks about it. “It is the safest place to start.”

Algernon frowns at her. Another angel slowly nods.

“If I start in the worst case scenario, I can face it. I have to think about it, work through it, plan for it. Then I can back off and hope for one of the less horrific scenarios.”

“You are WEIRD.” says Algernon.

Qia is annoyed. Her wings go bat and blood red.

“Word.” whispers a very young angel.

“WHY?” snaps Qia, “WHY NOT face the worst?”

“Most people never do,” says the moderator.

“What?” says Qia.

“Most people never face the worst. They don’t want to. They are terrified. They are scared. They do things to avoid thinking about it. They skip that step and just go straight to hope.”

Qia glares at her. The moderator smiles and her wings go black as pitch.

“We aren’t PEOPLE. We are ANGELS.” says Qia, nearly snarling.

Algernon laughs. “Yeah, well, some of us do not want to think about the worst either. That is Gawd(esses) job.”

Qia is doubly pissed off to be crying. “No, we have to think too.”

“Qia, I agree, but it is hard.” says the moderator. “That is why you have the job you have. Because you are willing to go straight to the dark.”

Qia has her face in her hands.

The angels surround her, soothing, and start to sing.

drkottaway’s werewolf theory

Papers about antibodies and immune system responses are proliferating. About Chronic Lyme disease, fibromyalgia, chronic fatigue, long haul Covid-19. We are near the tipping point of understanding vastly much more about the immune system, though understanding what is happening and being able to “fix” it are poles apart. You have to invent the germ theory before you can invent an antibiotic.

Allopathic medicine currently says that behavioral health disorders are caused by “neurotransmitter imbalances” in the brain. That’s a bunch of vague hooey, isn’t it? There is one mouse neuron that has been studied and has 300 different kinds of receptors for serotonin. Scientists blocked one and the mice acted obsessive compulsive. That was one kind of receptor. They are trying to figure out the other 299 and what they do in combination. Does this sound like we understand the brain? No, it doesn’t.

BUT there are papers about antibodies. Antibodies can mimic neurotransmitters, like dopamine, like serotonin, like adrenaline, like norepinephrine. Hmmmm. With multiple different types of receptors for each neurotransmitter, the antibodies could be specific for some receptors and not others. The antibodies could block the receptor, like the wrong key in a lock. Or the antibody could act like a key and turn the receptor on.

One barrier to understanding Long Haul Covid-19 and chronic fatigue as autoimmune diseases is that they do not cause a rise in the usual inflammatory markers. Those are the ESR (erythrocyte sedimentation rate) and CRP (um, I forget — oh, C-reactive protein). This does not mean that there is no inflammation or that these are not autoimmune disorders. This means we have not found a diagnostic marker. Rheumatoid arthritis can be “sero-positive”, with a positive rheumatoid factor marker. Or it can be “sero-negative”, with a negative rheumatoid factor lab, but it’s still rheumatoid arthritis.

What does this have to do with werewolves? Great question! I am thinking about the adaptive advantage of making antibodies to our own neurotransmitter receptors. How could that POSSIBLY be an advantage? What it means is that when someone is very very ill, or very very stressed, or both, at a certain point the immune system starts making crisis antibodies. These cause neurotransmitter and other symptoms. Brain fog, obsessive compulsive disorder, anxiety, muscle pain, fatigue and on down some very long lists. A recent study of fibromyalgia patients looked at 8 antibodies. One was an antibody to the GABA receptor. All of the patients had some of the antibodies, none of them had all of them, and they all had different patterns. So there is no marker and the neurotransmitter antibody could explain brain function changes.

Why werewolves? I am thinking of the old legends that are embedded in multiple countries and languages. Werewolves, demons, vampires, angels. My fourth pneumonia has left a problem: I can’t tolerate gluten any more. We did the antibody tests last week. I think they will be negative, because my gluten intolerance is relatively mild. I can have a tiny bit. People with bad celiac really can’t have any. I may have an antibody that is either a low level or one that has not been described yet. So with repeated infections, four pneumonias plus the exposure to my mother’s antibodies to tuberculosis in the womb, I now have what is looking like a permanent change in diet. This pneumonia started in March 2021, so it’s over a year. I had diverticulitis after that in August. I ate a piece of tempura two months later and thought, ooops, that has gluten! The next day I hurt in the same place as the diverticulitis and decided that I would stay well away from gluten for a while.

The adaptive advantage of having antibodies that change our diet or character or make us stronger or weaker would be to force us to change. To leave a community. To ask for help. To hide during a pandemic. To fight or be suspicious of everyone. Being a grumpy werewolf might save your life in a pandemic, as long as you don’t break any laws and eat someone. A friend likes the dark and hibernates and likes protein best: vampire or bear? I am not sure, maybe a vampire bear. Chronic fatigue seems to “save” or at least stop people from working 20 hours a day and driving themselves to illness. I am not saying that chronic fatigue is good or fun: but it might be adaptive. Brain fog and stiff muscles: zombies, anyone?

Can we do anything to prevent ourselves from getting these mysterious but probably autoimmune disorders? Yes. Lower stress. BUT WE ARE IN A PANDEMIC. Yes, but we can still lower stress. Here are three things to do:

  1. Do not work yourself into the ground, into illness, into the grave. Take breaks.
  2. BREATHE. A simple exercise to quiet the nervous system is to breathe in four seconds and out for seconds. You have to pay attention or count, unless you do it as part of facing a wall meditating, but it works. The veterans I worked with agreed that this works and they are not an easy crowd to please.
  3. LOLCATS or whatever makes you laugh. Sit under a tree. Throw rocks in the water at the beach. Play with a child’s toy with or without the child. (Remember to share.) Sit in a rocking chair and rock gently. Go for a walk, slowly, no ear buds. Listen to the birds. Watch the tops of trees move in the wind. This quiets the sympathetic fight or flight response and switches us to the relaxed parasympathetic. Do this every day at least once.

These all quiet the nervous system which in turn quiets the immune system.

But wait, some people are in a war zone or a disaster zone or an earthquake! Yes. Help them. Get them out. Send something locally or internationally. Give something to your local “buy nothing” group or Heifer or one of the groups in your town: Rotary, Soroptmists, Elks, your local Area Aging help group.

And that is Drkottaway’s Werewolf Theory, a work in progress, under study. I need NIH West. Contact me to start the fund drive.

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References:

Overview of fibromyalgia: https://www.verywellhealth.com/autoimmunity-neuroinflammation-in-fibromyalgia-5197944

Fibromyalgia as an autoimmune disorder: https://spondylitis.org/research-new/fibromyalgia-might-be-an-autoimmune-disorder-a-new-study-says/

They have given human antibodies from fibromyalgia patients to mice. The mice get fibromyalgia. https://www.nature.com/articles/s41584-021-00679-y

I took the photograph of Sol Duc today.

lost wings

every time a bell rings an angel gets its wings

what sound is the opposite of a bell?

a bell that has lost its tongue? its voice?

a silence when shaken?

a bell rung that doesn’t speak

an angel’s wings are lost

what have they done?

how have they failed?

and why

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the ineffable silence

remains

Practicing Conflict

An essay from my church talks about the writer avoiding conflict, fearing conflict and disliking conflict. This interests me, because I do not avoid conflict, I don’t fear conflict and actually, I like it. Our emeritus minister once did a sermon in which he said that when you are thinking about two conflicting things at once, that is grace. I have thought about his words many times, especially when I am not in agreement about something.

Does this interest in conflict mean I fight all the time? Well, sort of, but not in the way you think. I don’t fight with other people much. I fight myself.

What? No, really. Most topics have multiple sides. Not one, not two, but many. Like a dodecahedron or a cut gem. Hold it up to the light, twelve sides, each different. I argue the different sides with myself.

I learned this from my parents. My parents would disagree about something, they would discuss or argue about it, and then they would bet. Sometimes they bet a penny, sometimes a quarter, sometimes one million dollars. Then one of them would get up and get the Oxford English Dictionary, or the World Atlas, or some other reference and look it up. This was pre-internet, ok? 1970s and 1980s.

Sometimes my parents would even pay each other. The penny or quarter. My father spoke terrible French and my mother had lived in Paris for a year after high school, so he could get her going by insisting that his French was correct. It wasn’t. Ever.

There were other arguments in the middle of the night that were not friendly and involved yelling, but the daytime disagreements were funny and they would both laugh.

Once my sister is visiting after my mother has died. My father is present. My father, sister and I get in a three way disagreement about physics. I’m a physician, my sister was a Landscape Architect and my father was a mathematician/engineer, so we are all three talking through our hats. However, we happily argue our positions. Afterwards, my gentleman friend says, “That was weird.” “What?” I ask. “That was competitive and you were all arguing.” “It was a discussion and we disagreed.” “I won’t compete.” “We let my dad win, because it makes him happy.” “That was weird.” “Ok, whatever.”

My gentleman friend is also shocked when my teen son challenges me at dinner. My son says, “I am researching marijuana and driving for school and there isn’t much evidence that it impairs driving.”  I reply, “Well, there is not as easy a test as an alcohol test and it was illegal, so it has not been studied.” We were off and having a discussion.

Afterwards my gentleman friend says, “I am amazed by your son bringing that up. We weren’t allowed to discuss anything like that at dinner.” I say, “We pretty much discuss anything at dinner and both my kids are allowed to try to change my mind. About going to a party or whatever.” He shakes his head. “That is really different.” “Ok,” I say.

This habit of challenging authority, including adults, did not go over well when my son was an exchange student to Thailand. It did not occur to me to talk to him about it. He figured it out pretty quickly.

Back to my internal arguments. If I take a position, I almost immediately challenge it. I think of it as the old cartoons, with the angel on one shoulder and the devil on the other. The devil will make fun of things and suggest revenges and generally behave really badly. The angel will rouse and say, “Hey, you aren’t being nice.” Then they fight. The internal battle very quickly becomes comic with the two of them trading insults and bringing up past fights and fighting unfairly. When it makes me laugh inside, I can also be over the driver who cut me off, or someone who spoke nastily, or whatever. My devil is very very creative about suggested revenges. When the angel says, “You are meaner than the person who cut you off!” I am over it.

When I was little and disagreeing with my family, my sister could tell. “You have your stone face on!” That meant I was attempting to hide a feeling, especially fear or anger or grief. Siblings and family are the most difficult because they can read us and see through us like glass. My physician training also teaches control of feelings. I have sometimes wanted to grab a patient and scream “Why are you doing this to yourself?” but that really is not part of the doctor persona. I am doing it inside, but I can put it aside until later. Then the devil goes to town! And the angel tries to calm the devil down.

Maybe we all need more of this skill. Pick a mildly controversial topic. Argue one side of it. Then switch positions and argue the other side. Go back and forth until it gets ridiculous. Let each side get unreasonable and inflammatory and annoying. This can play in your head and not on your face. Once you can do a mild topic, move on to something a bit more difficult. If you only know the arguments on your side, read. You can find the other side, the internet is huge. Start gently.

A friend says, “You always argue about things.” I say, “I prefer to think of it as a discussion.” “You always take the other side.” “Well, it interests me. And if there is no one to discuss something with, I discuss it with myself!” “Weirdo,” says the friend. I think he’s jealous, really I do. Don’t you?

shut

I was keeping the door cracked, hoping a friend would come back
but it’s too painful to hope all the time, a constant heart attack
I slammed doors and windows this morning, took my heart out of hock
If you want to see me again, you can damn well knock!

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Four flocks of geese flew over on the beach a couple days ago, heading south. It always makes me want to travel too! And one of my trees is shedding leaves already, yellow and all over. Fall is on its way.

flight

Cormorant, I think.

About to take flight.

A good take off point.

It takes five years for bald eagles to fully mature. This one is close.

And a great blue heron in flight in the fog.

For the Ragtag Daily Prompt: flight.

Unexpected hero

When I first think about divorce, I call my sister.

I say, “I am thinking about a divorce.”

She replies, “YOU don’t want to be a single mom.”

I think, well, crap, that is true. Me: “I AM a single mom. It’s just that one of them is FIFTY.”

My sister proceeds to tell me how difficult it is to be a single mother.

I have to self examine my OWN prejudices against single mothers.

Then I wade in, to solo and couples counseling, for a year. My ex fires our couples counselor after a YEAR. He says the counselor is on my side. “We have been talking to him for a year!” I protest.

“I want a new one,” says my then husband.

I find a new one. I am filling out the paperwork. It asks, what is your goal?

That is the moment I decide: I write “Amicable divorce.”

The two years before that moment, I am not sure. I am trying very very hard to see if it can be fixed. But it takes two to tango and my then husband will not tango. Not one step.

We were each attracted to something specific in the other person. My then husband did not want to work at any sort of traditional job. His father would come home angry from work for years. I loved working, always.

I was a terribly serious child, growing up in an alcoholic family, and I have food insecurity. That is, at some deep level, I always worry about whether there will be food. When I meet my then husband he says that his goal is “To have fun every day.”

This slays me. Have fun? And he WAS fun. Biking, jitterbug dancing, he was a tennis and golf pro, he was smart, well read, divorced from a marriage of convenience to a lesbian to cover so she could be a small town librarian. Really? Yes, really. I demanded to see the divorce papers before we got married. My then husband thought I was very very funny and I thought he was too.

When we divorce, people tell me he will never pay child support. He won’t stay in contact with the kids. There are a lot of opinions.

Wrong, wrong, wrong. My ex returns to school, gets a “displaced homemaker scholarship” because he was a househusband (yeah, I said he was smart). He goes to nursing school and gets an RN. “You’ve yammered about medicine at me for fourteen years, I might as well.”

He gave me hell about us living in an “old person’s” town. Then in nursing school he calls. “Hey, I’m doing a rotation. Guess what it is.”

“Don’t know, what?”

“Nursing home.”

I laugh.

“I LOVE these OLD PEOPLE.” he says. And he DOES. He is wonderful with them. He works in a nursing home for years. He gives scholarships to the medical assistants when they leave for nursing school. He brings coffee to his medical assistants and the other staff. He drives by on his day off because one elderly woman will only take her medicine if he gives it to her. He gets pianos for the nursing homes. He does memory loss concerts, where he tries to engage memory loss folks. We store music as entire songs, or entire albums, so if someone starts a song, they can often go through the whole thing. He can sometimes get someone singing who no longer can string a sentence together. Families love it.

Early in covid he calls me. “I have covid.”

“Sh-t.” I say. “Are you ok?”

“Oh, yeah. Everyone at the facility has it. Two staff didn’t so we sent them home. We are working sick because there isn’t anyone else.”

“Holy crap.”

“Yeah, it’s a little depressing. My memory loss folks can look ok at the start of the shift and are dead by the end.”

A quarter of the patients die. This is before the vaccine. My ex sails through covid, says he doesn’t feel bad, for him it’s just a cold. He says, “I miss some of them.” Yeah, holy crap.

So another hero. And he paid the child support every single month and stayed in touch with his kids in his own odd way. “Mom, he tells me about his golf shots,” says my daughter. I laugh, “Yeah. Well, he loves you.” “I don’t care about golf.” she says. “I know, me either,” I say.

The photograph was taken with my camera by my friend Amelia in 2014, I think. It is me and my ex, seven years after the divorce was final.

I read this to my ex prior to posting. Posted with his approval.

Defiance

Ok, this is a beautiful and romantic song, and yeah, George Strait is pretty.

And then there’s the Offspring. Singing Self Esteem. Guess which I like better.

The Offspring: defiance and singing about all sorts of things that we don’t talk about: “The more we suffer the more we really care!” Some of my patients needed to listen to this song. Often the mom, with a spouse and three children, who was taking care of all of them but not herself. “Who takes care of YOU?” I would ask. “No one,” some moms would say. “Look. There are FIVE people in your family. You are one of them. You deserve the same level of care that the rest of them are getting. I want you to include yourself in the people you take care of.” “BUT” “NO BUTS. If you don’t, then you are setting expectations for your children: the boys that a wife will take care of them and the girls to be walked on. Is that what you want?” “NO.” “Change it.” They often would, slowly but surely.

And The Offspring are further my heroes because of this song: Opioid Diaries. Ok, a punk band telling opioid overuse people to get help. MY HEROES! Thank you Offspring!!! It’s not easy to watch but wait until the ending and what if offers. I treated opioid overuse for the last 12 years in my small family practice clinic along with everything else: diabetes, hypertension, whatever. I never felt threatened or frightened, but some of that is because I grew up in an alcohol family. I recognize addiction. Reminding my of my parents is not a good sign. And I had to learn boundaries at home first. This is an uncomfortable video to watch but to me it is beautiful, because it offers hope.

skulls

I took this on my trip in March 2022. So far no one has guessed where I was correctly. There is a wonderful Zoology and Science Museum. A mystery for you to consider, where was I?

For the Ragtag Daily Prompt: ancient.

of the air and water

Great blue herons never look like they are of the earth to me. They look like they are of the air and of the water. Unearthly. I keep wondering if they are angels.

Eagles do not look earthly either. They do land on the beach occasionally but I see them in the air or in the trees most of the time.

For the Ragtag Daily Prompt: unearthly.