Everyone is fighting

Everyone is fighting all the time
We the United States are number one
in fighting and being assholes
We fight with our allies,
with our enemies,
with countries that never imagined
we would want to annex them

This is a symptom
this is the dark underside of individualism
of the very very strong male
who leads with testosterone
dick first

This is a symptom
of fear. Under all the posturing
the bravado, the yelling and accusations
lies fear. Deep deep fear
down to to the deepest trench
in the ocean

This is a symptom
of fear. Fear that stretches out
into the universe,
as big as the universe,
fear of what?

Fear of Covid-19
of infection, of death.

Aren't we over that?
No. We are still very very frightened,
our adrenaline is up,
our cortisol is up,
our thyroid is down,
and our sex hormones are down.

We are still very very frightened,
wired all the time
get infections more often
tired from low thyroid
and we don't or can't do sex.

We barely remember
the influenza that swept the world
1918 to 1921
bodies stacked 5 deep under sheets
in the hallways of hospitals
in San Francisco

A Pacific Island
lost 80% of the adults
to death

We are fighting fear
fighting each other
fighting ourselves
rattling our sabres
shouting insults

all to hide

our deep
deep
fear.

Longing

When I am little
I long to be old

I adore my grandmother
she is wise

when I come to her
at four months

I am angry
and turn my head from the spoon

my mother tells the story
I do not remember

my grandmother studies me
and says, "Yes,

you may feed yourself."
My mother laughs and tells

"You lived on cheerios
and chunks of banana

and would not let anyone
put anything in your mouth."

There might be a darkness there
that I don't want to think about.

And the finger thumb skill
does not appear

until nine months.
Before that it is a sweep of the hand

to pick things up.
Difficult with cheerios.

I held the bottle too.
I am returned to my parents

at nine months
the grandmother gone

1000 miles away.
I do not like my mother

or my father
nor do I trust them

at first. But one must live
and I do

At two I play falldown
tackling my father

like the people on the television
and he falls down

and I laugh
It is only later that I realize

that only men play falldown.
I think to myself

nothing will stop me
if I want to do something

being a girl
will not stop me

if I want to play falldown
or anything anything else.

My grandmother gives me
the gift of anger

the gift of independence
permission to refuse

the spoon. Permission
to feed myself

and feel my feelings.
And I never ever stop.

I learn to hide some feelings
from my parents

because they cannot allow them.
Sorrow, fear and humiliation

three monsters that I must hide
or refuse to feel.

On a boat my father says
to my young daughter

"Don't be scared
or go below."

I say, "No.
What are you scared of?"

"I am scared that we are stuck
aground

we can't get to shore."
I say, "Look.

We are very close to shore.
I can swim there.

We could wait for the tide
to come back in

and float us free.
But we have two strong mothers

who are trying to winch
us off to float free."

My daughter is satisfied.
Soon another sailor sends a rowboat

taking the four children
to play on shore

while my friend and I
continue to use all our muscle

to winch the boat off
the stubborn earth.

I think it is the tide
coming in

that finally frees us
and we are too tired to sail

by then
and return to the slip.

We have entertained
every live aboard

and they tease us
mercilessly

and we do not care.
But my father's words

"Don't be scared
or go below."

resonate. I chose
to go below

as a child
to hold my feelings sacred

and refuse to entirely
stuff them.

As an adult
a friend says

"You feel things too strongly."
I clam up

immediately.
I feel things too strongly

for HER
but not for me.

My feelings are
MINE and sacred.

My feelings are
prayers to the Beloved.

Your feelings are
prayers to the Beloved.

My best work
as a physician

is when I open the door
to someone's feelings

and they let them out
terrifying

to them.
But not to me.

And when they are done
I say

"It seems to me
your feelings

are perfectly reasonable.
I would feel that way too."

Sometimes I ask
would they still want

the antidepressant?
A counselor?

A follow up visit?
They look surprised.

A weight lifted
for now.

"No.
I will see how I am doing.

I will call if I need
to come in."

"That's fine."
I say.

Somehow I don't
think the AI

can really do this
as I do.

I may be wrong.

When I am very small
I want to be old

and wise
as my grandmother

who saves my heart
and lets me feel.

Now I am middle aged.
I don't want to be old

and wise
for a while yet

but it isn't my choice now,
is it?

Bring it on
Beloved.

Bring it on.

For the Ragtag Daily Prompt: partner.

I think the Beloved is my partner in joy, in sorrow, in wicked humor. Thank you, Beloved.

Predicting medicine again: autoimmune disease

Once again here I go out on a limb. Here is my prediction for the next Really Big Thing in medicine, which is already happening. It is slowly rising from the murky swampy depths of our unconscious.

Here are clues: https://my.clevelandclinic.org/health/diseases/autoimmune-encephalitis

https://www.mayoclinic.org/diseases-conditions/autoimmune-encephalitis/symptoms-causes/syc-20576380

Autoimmune encephalitis? Or encephalopathy? What a mouthful. And what the hell?

Well, we have always said that we do not know the causes of depression, mania, schizophrenia, psychosis and all the other psychiatric diagnoses.

And now I think we know, though we don’t have them all sorted yet.

The cause is the immune system. And what’s more, it’s adaptive.

“NO!” (you run screaming from the room). “Not MY immune system! NO!”

Yes, I say, your immune system, my immune system, everybody’s immune system.

WHY? Well, my version shuts me down. I get tachycardia (a fast heart rate), short of breath, accusations that I am manic, my fast twitch muscles don’t work and I get pneumonia. And it lasts longer each time. Two months. Two months. Six months. A year and a half on oxygen and then off but really it took four years before my muscles started working right again. It shuts down my fast twitch muscles but not my slow twitch muscles.

So how is shutting me down adaptive?

Think. If there is a pandemic, or huge danger, or someone is trying to harm me, it isolates me. People think I am very very weird when it is happening. So I isolate, to protect myself. Isolate and voila — protection from pandemic. If I have resources, and luckily I do have resources, I can hole up. Food, drink and a broadband connection.

The book Brain on Fire and movie are about an encephalopathy: antibodies to NMDR that made the author psychotic until it was recognized and treated. I went to a virtual continuing medical education on encephalopathy in 2022, I think. In the US alone, there were already 555 patients identified with NMDR antibodies.

Now there is a whole list of antibody encephalopathies, many associated with cancers. Not all.

Here: https://autoimmune-encephalitis.org/wp-content/uploads/2022/10/PNK-The-Known-types-and-categories-of-AE-as-of-2022.pdf

I like the addendum “as of 2022”.

and here: https://www.nature.com/articles/s41572-025-00650-1

A physician friend calls me a few years ago. “Have you heard of NMDR antibody disorder?”

“Yes,” I say

“I have a patient with it,” she says. We are a county of 32,000 people. Rural. She is looking it up. I tell her what I know.

In January I see a patient who turns out to have Anti-Caspr2. I have to look it up. Now I see the list of encephalopathies that is rapidly becoming longer and longer.

I think that chronic fatigue, fibromyalgia and long Covid fall into immune system disorders too. Just because we haven’t figured out the mechanism: well, we may. If we don’t destroy the planet first.

I also have reservations about treatment. We are using more and more immune suppressants. I read about one that stops B cells from working. Specifically, the B cells that produce antibodies. Well, that would work for my disorder, except, I already get pneumonia really easily. And destroying the B cells lowers immunity and increases the risk of infection.

I see a patient in clinic who has a skin infection and a fever and an autoimmune disease. They are on an immunosurpressant that I don’t know much about. “Have you called your rheumatologist?”

“No, why?”

“I think you are supposed to stop the immunosupressant. Please call them today. And let me know what they say. Please!” I start antibiotics.

The patient sends a MyChart message. Yes, stop the immunosupressant while on antibiotics. In the future they will call the rheumatology office as well as seeing the clinic for any infection.

I am not saying we shouldn’t use immunosupressants. Sometimes we have to. Rheumatoid arthritis. Hypothyroidism, the most common autoimmune disease, yes, we should and do give outside thyroid hormone. But there is something else we need to do.

The clues for this lie with chronic fatigue and fibromyalgia. What triggers them? One in ten severe infections, severe stress, or a combination.

So we need to learn as a culture, as a world, as humanity, to lower stress. We can’t be high sympathetic nervous system fight or flight high achieving high spending higher faster crazier all the time.

Here is to the parasympathetic state. That is where we need to go. Go down, slow down, be kind to each other and ourselves, be gentle, laugh, fail, lie in a hammock, watch silly cat videos and fat bear week. Then the immune system might calm down and not attack us to save us. I think the immune system is pretty smart, really. Even as it pisses me off and limits me.

Go down, slow down.

Blessings and peace you.

Old woman

In middle age
I acquire a new skill
along with invisibility
middle age women
are ignored
by almost everyone

and I am gifted with power
to be invisible
and to curse

I could already curse
aloud
but this is something more

a hand gesture
and a rhyme

fingle fangle
what a tangle
dingle dangle
it won't work

for all the Epstein players
and other men
who use
mistreat
rape
abuse
imprison
women

Viagra
has nothing
on me

and all the other
invisible

middle aged

women

_____________________

The photograph is my grandmother, Katherine White Burling. I took this in 1979.

For the Ragtag Daily Prompt: cone. Just add an r in the word.

Eating sunlight

Beloved
I don’t think I can bear this
It’s a good plan
To work five more years
And retire in better financial shape
House paid off
But it hurts so

My tattered bruised and battered heart
Already patched so many times
And to see so many people each day
Hurting

Why, Beloved?
Why don’t we mature?

Maybe I’ll be a tree again
Living wood
That bends and moves with the wind
That eats the sunlight
Drinks the rain
Endures the snow and drinks it as it melts
Until spring comes
And I stir and start to bud
Deciding when it’s time
To uncurl leaves in warm sun

_______________________

For the Ragtag Daily Prompt illusion. Or should it be delusion? Or survival? Or beyond that to peace?

Perspective: beneath the clouds

Beloved why?
I am glad for your love
and warmth
and connection
and my cat’s
and my adult children
friends
family
patients
work
and why? Beloved

A high Adverse Childhood Experience Score
Two alcoholic parents
One sick with tuberculosis through pregnancy
Letters from the hospital to her mother
After birth
Never mention me
As if I do not exist

She told a story that she dreamed
she gave birth to kittens
played with them
and gave them away

Not a dream of joyously welcoming her new baby
Me.
Yet I didn’t hate her or my father
My damaged parents
My damaged sister
Who followed their path, not mine
There was nothing I could do
Only three years old when she was born
Try to shield and mother her
As best I could

Why Beloved
I have tried so hard to grow
to love
to forgive
and yet I have no human lover

My cat jumps on my notebook
And interrupts this writing
She is happier to welcome me home
Than any man I’ve ever dated

My daughter’s boyfriend picks her up
at the airport and has made her dinner

If I am a failure at love with a partner
Or too smart or damaged or difficult
To love
For humans
At least my children have both found love
And if I were to choose me or them
Yes, I’d choose them

Is that why, Beloved?
Sacrifice to heal the next generation?
It is worth it.

And yet, that small child part of me
That even as a toddler thought the adults were unpredictable, dangerous, mean when drunk as they laughed.
She is angry at them, Beloved
She is angry at you, Beloved
Or at people
Or at the universe
She still believes in every cell, in her bone marrow, in the vast universe in her mind

that she too could be, should be

loved.

Dissolution

I am sorting, Beloved.

I dream that my sister has drowned
in the ocean. A sailboat went down.
There were others on board.
Two friends ready me to dive and find her.
I don’t want to scuba dive, I am not trained.
I don’t know how to use the equipment.
I am afraid I will drown too.
I see her daughter, who is four.
Her daughter knows from my face that her mother is lost.
My friends say, “You will be able to find her.
You can find your sister.”
“But she is dead,” I say.
“I don’t want to find her.”
I know that they are right, I could find her.
But I might be separated and lost, in the depths.
I don’t want to die too.

I wake up.
The dream sticks.
My friends wanting me to wear a borrowed wetsuit
and scuba gear and go down untrained.
My sister floating in the depths, dead eyes open.
But she has been dead for years, I think.
And this is the sea of dreams
my unconscious
the greater unconscious
everything.
So why isn’t my sister’s body dissolving?
Changing to a skeleton.
A skeleton coming apart over the years.

I don’t need a wetsuit
or scuba gear
to dive in the sea of dreams
I can breathe in the unconscious
I have been to the bottom of the sea
many times before.

My niece is four in the dream.
She was thirteen when her mother died.
I think she was lost to me long before that.
The dream knows.
Her mother was lost to me
when my niece was four.
Drowned.

When the dream returns
I will say yes to the dive
I love the sea and the ocean and going deep
I don’t need a wetsuit
I don’t need scuba gear
I don’t need to find my sister’s body
She is gone
Dissolved
I let my past go.

I have not dreamed of the ocean

since.

__________________________________

I really don’t know where my sister is, because of the family schism after she died. Are her ashes somewhere?

This poem wanted to be born. For the Ragtag Daily Prompt: Who knew?

Concord

my heart is broken
love doesn’t conquer all
unselfish love
unreturned
unrequited
opens me to wound after wound
some turn from love no matter what
cling to the lies they tell themselves
cling to the poison they embrace
turn from love into the uncaring bottle
turn from love into the insensate smoke
turn from love even to the grave

I wish my heart would let them go
and heal

__________________

My friend Liz took the photograph, half way through the Rainshadow Chorale concert last Sunday.

When I get older

Is it ok for me to be a bit lazy?
A bit unkempt?
Not care about dandelions?
Weigh more?
Want to lie around after lunch?
Maybe there is something I should be doing

Maybe there isn’t something I should be doing
Maybe I should be gazing at the navel of the universe
Maybe I should be gazing at the navel of the Beloved
Maybe I should not be doing all the time
Maybe I should wait
Maybe I should watch
Maybe I should appreciate
Being here

_________________________

I am posting this without a photograph.

For the Ragtag Daily Prompt: curtain.

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.