Tag Archives: Beloved

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An ideal death

Death is quotidian, isn’t it?

There is a movement to make death more ideal. I agree that we should talk more about death and find out what people want, but ideal is complex. The VA did a survey and found three ideal deaths. Which is your ideal?

  1. The Hallmark Death. In hospice, surrounded by family and friends, making peace with everyone, visitors from all over. My mother died of ovarian cancer. We had a hospital bed and a baby monitor and when she was awake, she would say, “I am ready to be entertained.” It lasted for 6 weeks and my grandmothers bones rose out of her face as her weight dropped. I was so tired by the end that I couldn’t see straight. She did not want us to cry, so my sister and I did not cry. Afterwards I wished that I had cried.
  2. No warning, sudden death. Take me, in my sleep, or suddenly, with little or no warning. The heart is the number one cause of death. My father went this way, in his home. I was the one who found him, though I’d expected it for over a year. He was a bit of a hermit and had horrible emphysema, was on oxygen and steroids, but he stayed at home. That’s what he wanted and I did not fight it. It was not much fun finding him.
  3. Fight every step. There are some people who remain full code, who have end stage cancer and want dialysis, who will not give in. My sister was in this category. She was a truly amazing fighter and refused hospice until the last week. This can be about believing that one can continue to hope for a miracle or it can be about social justice or about a promise to one’s family. Some families have said, if father had been able to access care earlier, he wouldn’t be dying, so he wants everything done. I can understand all of those feelings.

So which would be your ideal? Ideally we would talk to our parents and our children and explore these different ideals. I did that with people in clinic. There are interesting openings. A patient would say, “I don’t want to die of cancer.” I would say, “How do you want to die? What is your ideal?” They would be surprised and I would explain the three different scenarios above. “Put in your order, though we do not have any control.” I would say.

We do not have control. I did prenatal care and deliveries for 19 years and didn’t have control there. I always preferred to intervene as little as possible and only if I had to for mother or baby’s health. Once our surgeon went to take out an appendix and it turned out to be something else, so took three hours. I had called a cesarean section, but had to wait. The baby had a fast heart rate and it rose in those three hours. We finally did the c-section and the baby promptly looked completely fine. I have no idea why the heart rate rose from 140 to 180. We were all hugely relieved. Sometimes the cause was obvious: a short umbilical cord or a cord wrapped four times around the neck, but sometimes the cause is a complete mystery.

I talked to a person yesterday who has a frail 90 year old in their life. They said something about keeping them from dying. I said, “Well, they are going to die eventually.” Then I thought, I wonder if they have had the discussion: what is your ideal? Do everything, which may mean being in a hospital? Hospice? At home? And I sometimes see families fight, because siblings have different ideals and may not even be aware of it.

Blessings.

For the Ragtag Daily Prompt: quotidian.

I took the photograph of the neighbor’s flowers while I was walking the cats in the dark. I like it.

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Spidergirl

Wow! My spider who has set up just outside my desk window and right by the hummingbird feeder, has such a beautiful web! It is raining today and she is hanging out in the center. She did not move when I went out to take pictures.

She is enjoying the flies and bees attracted to the feeder. I watched her wrap two up the other day. Does she stash them somewhere? The web was down the next day and I was afraid she was gone, but she is back up today.

Some people find spiders beastly but I like them. As long as they aren’t the deadly sort and don’t bite me.

For the Ragtag Daily Prompt: beast.

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Happy mum

Those aren’t mums, you say. No, I am the happy mum! My daughter has a birthday this week. I got the flowers at the Farmer’s Market and what a lovely bouquet. My car was acting up and yesterday I took it to be checked and it was the battery. Today: plumbing, sigh. But I am still a happy mum!

For Cee’s Flower of the Day.

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Storm tossed

The word tethered makes me think of the year and a half on oxygen. I had a standing concentrator for in the house. This means that I have oxygen tubing following me on three floors. I had to have connectors and I got caught on everything. I tripped over it. I wondered why it wasn’t helping and discovered the tubing was unplugged. The kittens chewed holes in it.

The sea plants are tethered too, to rocks, to grow up from the deep. I think this looks like a distressed stranded mermaid. Poor thing, her rock, her foundation has been thrown on shore by a storm. She can’t get home. I took this in May 2021, when I was still on continuous oxygen.

For the Ragtag Daily Prompt: tethered.

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Guide

The Ragtag Daily Prompt is latibule: a place where you feel safe and cosy. I was going to say my house, but I wrote this poem near the end of my stay in Italy. My latibule is my mind. The poem is named Guide.

Guide

I want to write a travel guide
To the interior
No matter where I am
nor who I am with
nor what the circumstance
Ok, in a disaster or crisis I act
I don’t withdraw
But barring that
What does your space look like inside?

My interior is a garden
And an ocean
And the universe
Monsters, angels, demons, daemons
Friends
Many dead
People remembered and loved
Even if they don’t love me
Even if there is no reconciliation
Flowers birds insects science sex philosophy
A universe of stars and math
Tiny atoms, shy electrons circle protons
Whirl happily at the atomic level
Nebulae and black holes
Other worlds and beings
Of course there are other beings
In this wide universe

I am riding on a train in Italy
And traveling my vast interior
At the same time.

Written September 10, 2023. The photograph is from a friend’s doll house.

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mom proud

In the Vatican Museum, I note that the paintings are attributed to men. I start really looking for a woman artist. Of course, some of the male artists may have stolen the work or be “passing”. I love this small sculpture, by a woman artist. I think I saw two works clearly by women. Dear Vatican: get a clue.

Around age 13, my son listened continuously to three bands or musicians. We had two years where I swear, he wouldn’t play anything else.

And this is where I feel proud as a mom.

Jimi Hendrix. Bob Marley and the Wailers.

And the third is Sweet Honey in the Rock. African American women a capella. And so he knows about Harry Moore and Joanne Little.

Prayers for all the people discriminated against, terrorized, or in the the path of disaster. And for all the motherless children, we who have had our mothers die. Dave Van Ronk: motherless child.

Go Keb’ Mo.

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Diversity

This is the Trevi Fountain. We can curate the photographs so that we can’t see the crowd. Here is the crowd.

There are lots of changes from 43 years ago, 1980, when I traveled there. More people. We were traveling in January and February 1980, so that’s not a fair comparison. But the crowd is more diverse. At that time we ran into Australian travelers, the same people in hostels as we traveled. We were mostly Caucasian. Now the crowd is much more diverse and I also do not know what language a person will speak. Race is a messy construct anyhow, very unscientific, but I really like the diversity and not knowing what language a person will be fluent in until I hear them speak.

Here is the Vatican Museum. Also crowded and diverse.

Here is a park near the train station in Rome with some “Olympics” for both kids and adults.

We were staying in hostels and only did one formal tour. I wonder if the expensive hotels have the same diversity.

Let’s end with the fountain again.

For the Ragtag Daily Prompt.

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Evil squirrels falling change

The Ragtag Daily Prompt is change. Lots of that here, since I was gone for two weeks!

  1. The evil squirrel has destroyed the third bird feeder. I was not home to chase it out of the yard yelling and it shredded the latest feeder. I am going to try one of those feeders that shuts when the squirrels weight lands on it. More expensive, but nearly equal to the three I’ve had chewed up!
  2. I left in summer and return to fall. Leaves are down, colors are turning, it is cooler in the morning and evening. We had a high of 64 F yesterday. That feels cool after northern Italy.
  3. I am stronger and slimmer. Carrying a loaded pack daily or every other day really made a difference! I was not sure my right shoulder would hold out, but it did, just. I went through PT earlier this year. I am doing my exercises again.
  4. I had some wonderful time with my daughter. Not that that’s a change, but she is stronger too!

Sol Duc tongue out.

Looking big-eyed, like a Keen painting.

For the Ragtag Daily Prompt: change.

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Work again

I have been wondering whether to try to work again. It’s risky.

I asked the pulmonologist from Swedish Hospital if there was any way to keep from getting pneumonia number five. “We don’t know.” Is it safe for me to return to work? “We don’t know.” I like the plural in the answer, is he speaking for pulmonologists or Swedish or what? Anyhow, the risk is pneumonia number five and death or ending up permanently on oxygen or needing a lung transplant or something stupid like that.

It’s not raining yet and I promised not to even attempt to return to work until it rains.

I saw my cardiologist yesterday. He thinks I should return to work. Early on he said that I am smart, “like one of those old fashioned internists who read everything.” I laughed, because yes, I am a science geek. At the next visit he said, “The family doctors aren’t always as thorough as they could be.” I replied, “I don’t know, after all, I’m a Family Practice Doctor.” “Oh.” he said, “I thought you were an internist.” Which made me laugh because it’s a sort of back handed compliment. Cardiologists do a three year internal medicine training and then more years of sub specialty to become a cardiologist. Most specialists seem to scorn Family Practice a bit, though not all. And I have definitely had specialists ask me for help. A perinatologist: “How do I help people stop smoking?” I laughed at that, too, and replied, “Do you want the five minute , the ten minute, the thirty minute or the one hour lecture?” A med-peds doc asks me to put a cast on a child’s arm because even though she is board certified in internal medicine and pediatrics, she has almost no orthopedic training. I was at that clinic to see obstetric patients that day, but was happy to do the cast too. I love the broad training and the infinite variety of rural Family Practice. It is SO INTERESTING and OFTEN FUN THOUGH NOT ALWAYS. Sometimes it’s sad.

Here is an article about a physician doing what I want to do: https://nymag.com/intelligencer/article/long-covid-treatment-lisa-sanders.html. She thrives on complexity, she thrives on diagnostic puzzles and she writes the column that the television series “House” was based on. When I watched House, what I noticed was the nearly all of the patients on the show were either leaving something out or lying. In reality, I think it’s just that sometimes we need a lot of time to pull together the complex picture and clues. I always pay attention to the pieces of the puzzle that do not fit and sometimes those are the key to finding a diagnosis that is unexpected. Dr. Sanders spends an hour with a new patient. That is what I did in my clinic for the last decade, because that hour gave me so much information and it allows people to feel heard. A ten or fifteen minute visit doesn’t let people speak. It’s slam bam here is your prescription ma’am. What I see in the multitude of notes from all the doctors I’ve seen since 2014 is that they leave most of the conversation out of the note. Things I think are important. I think most of the clinic notes about me are crap and the physician is not listening and doesn’t know what to do. I include the stuff that doesn’t fit and doesn’t seem to make sense in the notes I write. Patient appreciated, when I gave them their note at the end of the visit. “You got all that?” Oh, yes, I tried.

One of the Long Covid symptoms that Dr. Sanders mentions is people “feeling like they are trembling inside.” I’ve seen that before Covid-19. That was a symptom that I did not pin down in a particular patient, but now there is more than one person complaining of the same thing. Really, why don’t physicians include those complaints? It’s egotism to cut out anything you don’t understand and most patients want help so are motivated not to lie. Ok, they might admit that they’ve been out of their blood pressure medicine for two weeks and that’s why their blood pressure is too high, or they’ve been drinking mochas and that’s why their blood sugar is way too high, but they are really in to get help. I think it is a terrible disservice not to document what they say, even if it’s not understood and the physician thinks it’s unrelated to their specialty and they don’t know what to do.

So: I want to do a Long Covid Clinic, with an hour for the first visit, and longer than usual follow ups. Part time because of my lungs and the fatigue. We shall see, right? I am going to look for grants to help set this up.

Think of how much work went in to this statue and this church. The Basilica di San Marco took at least 400 years to build and decorate!