I am still thinking about Friday’s Ragtag Daily Prompt: failure. Now that I am middle aged (by my clinic definition, which put over 90 as older), I think the biggest failure of my generation is a peaceful world. For me, a peaceful extended family. I am good friends with my father’s family and my ex-husband’s family. But the maternal family, well. I have thought about that for the last two days: could I have changed that?
Yes, but at what cost? My sister followed the “family rules” on that side. She is dead from cancer. My mother also followed the rules and died younger than me from cancer. I can’t say that the rules cause cancer. But doesn’t our culture say over and over, be yourself? To fit in the family diaspora, I would have to play the triangulation game and gossip about others as they have gossiped about me. No, thank you, no. I don’t want to. They seem to need a family member to hate and have chosen me and labelled me and call me angry. I think they are silly and emotionally immature. At the very least, I would have had to keep my mouth shut and accept them gossiping about me.
The family failure and untrue gossip, with no one ever asking for my viewpoint, mirrors the US culture. Split and needing someone to hate. At this rate, we’ll need the hippies back, with flowers and joy and counter culture and dropping out. Someone fun, at least until the drugs wear off. Someone to say, we need joy back, we need friends, we need love.
It’s not just my failure though. The family failed. They make cruel choices and target people. It happened in my generation, my mother’s, my grandparents. I wonder if it is happening in my adult children’s generation. Who is the next target? Who will refuse to counter-gossip and fight with each source? My adult children are not part of it at all, because I had less and less interest in spending time with mean gossips and I did not want to expose my children.
Lies and drama and meanness and gossip. I hope my adult children’s generation does better. We went to Wicked on Thursday. I did not like it much. Too much drama. Why do we want drama? The world seems more and more surreal. Give me the lovely hike we did on Friday instead, Echo Canyon.
She gave me this necklace one of the last three times I saw her. She was at home with breast cancer and referred to hospice. I flew down to visit three times in the last three months. I was expecting it before then but she was very very strong and fought it all the way to the end.
We were both born in March, so this has amethysts. She liked silver more than gold and we both liked the irregularly shaped pearls. I am not sure what the dark round beads are. They could be bloodstones, which were the March birthstone before amethyst took over. I like the clasp in the front and that it is not symmetric. My sister died in 2012 and of course I still miss her.
For XingfuMamaโs Pull up a Seat Photo Challenge 2024: Week 16.
Yesterday was gorgeous. I took a friend to her second round of radiation therapy. It takes about two and a half hours, since we have to drive to another town. She was very tired and wanted to sleep when she got back. I went to lunch, seating overlooking Port Townsend Bay, in the sun. It was one of those days that makes people want to move here, not realizing that low clouds are more frequent than this glorious warm sun.
My friend M is twenty years older than me. A friend of my parents since college. When I went to college in Madison, WI, I got to know her and her husband and their two sons. I lived with them my third year of college and it was a ball! I loved the family.
I visited over the years and more often when her husband had lung cancer and died. She wanted me to come out for her younger son’s fiftieth birthday. Her daughter-in-law said, “It’s nice to meet the daughter.” Apparently M considered me a daughter. I was delighted, since both of my parents had died by then.
A year ago M was feeling less well. She started losing weight. A work up was done, finding no cause. She had a rare cancer that had been treated two years prior. But by July, she had lost thirty pounds.
Thirty pounds! As a primary care doctor, RED FLAG! Very high likelihood of dying, if that went on. She was eighty years old.
I flew out in September. We took a road trip, just the two of us, from Michigan back to Wisconsin. We visited multiple old friends of hers. She thanked me afterwards, because one friend had Parkinson’s and died ten days after our visit. We saw her sisters-in-law and we did a circuit around Madison.
Afterwards, she said that was her last time driving on highways.
By December, she had dropped another ten pounds. Then she had difficulty walking. The daughter-in-law called me. She was having trouble getting any medical attention. They had had trouble for a year! Over a week, M went from walking to not being able to support her weight or stand up. I flew up right after New Years.
Something was wrong, clearly. She’d carried her own bags in September. I was the out of state doctor. The daughter-in-law, B, was moving her from bed to chair alone. I couldn’t. I am 5’4″ and M was 5’10” and now my weight. B found a private practitioner.
On my third day there, M had chest pain. We took her to the Emergency Room. The Emergency Room did the usual things. Then the ER doctor came in. “She is not having a heart attack and she doesn’t have pulmonary emboli. So you can take her home.”
“No, something is wrong! She can’t walk! She could walk two weeks ago! We did a road trip in September!”
The ER doctor shrugged. “What do you expect me to do?”
“Figure out what is going on!”
“She is eighty.” he said. As if eighty meant we stop caring.
“No, we won’t take her home. It isn’t safe. We can’t move her. M, do you want to stay?”
“Yes,” said M.
The ER doctor looked annoyed. “All right. I’ll admit her for placement in a nursing home.”
The inpatient doctor was scarcely more interested.
“What do you expect me to do?” he said, knowing he was dealing with an annoying out of town doctor.
“Steroids.” I said, “Maybe it’s a weird form of polymyalgia rheumatica. She deserves a trial of steroids.”
He too shrugged, and started steroids.
The next day she was stronger, and the third day she could stand. It was SOMETHING, but not clearly polymyalgia rheumatica. The hospital was small and did not have a cancer doctor and did not have a neurologist. They were sending her out on steroids. Follow up outpatient.
We looked at a nursing home, but went to a private assisted living instead. The staff were minimally helpful. We took turns sleeping there. Physical therapy and occupational therapy were started. M was a bit better but not the miraculous return to normal that steroids cause in polymyalgia.
I flew home. The private physician saw her. M was set up to see the U of Michigan. B kept asking if it was lymphoma, because that can be a side effect of the treatment for M’s cancer. M’s cancer doctor said no. M got covid and the appointments were delayed two weeks.
In February she went to the U of Michigan. The neurologists came through and said, nope, not polymyalgia rheumatica, and not neurological. The cancer doctor came through. The GI doctors did an upper endoscopy and biopsied. Cancer. Lymphoma.
M said no to treatment. She was discharged to hospice. She died within 24 hours of reaching the hospice.
The cancer doctor sent an apology to B, who was right all along. This was a particular lymphoma that responds to steroids for a while. M had said that if it was another cancer, she would refuse treatment.
“These people who live a vigorous life to 70, 80, 90 years of ageโwhen I look at what those people โdo,โ almost all of it is what I classify as play. Itโs not meaningful work. Theyโre riding motorcycles; theyโre hiking. Which can all have valueโdonโt get me wrong. But if itโs the main thing in your life? Ummm, thatโs not probably a meaningful life.”
Ok, so now some doctors don’t care once you reach 75. That’s it. They define everything as “useful and productive” and if you are not doing meaningful work, well, you’d might as well die. I hope that doctor does die. Slowly. And that everyone around him refuses to do any tests to see what is happening. And who the hell defines what is meaningful work? That can be helping raise grandchildren, like, hello!
I have another friend who is going through the same thing. She is failing and the medical community in my town is shrugging their shoulders. She should have a head MRI, says the cancer doctor. So that was a month ago and it still isn’t scheduled.
Some of this is pandemic fatigue and backlash. People refusing to get vaccinated, people refusing to believe that Covid-19 exists, doctors and nurses dying of Covid-19, people refusing masks. If everyone is exhausted, what do you let go?
Apparently people over 75. But NOT everyone over 75. If you are wealthy, you will get care. Our Senators and House of Representatives certainly get care after 75. It is the isolated, the rural, the poor, the ones who don’t have an advocate, who will be sent home to die.
I took my friend here to her primary. “What do you want me to do?” he says.
“Here is the Home Health paperwork and she needs disability tags.” My friend is falling, five times that week.
“Ok,” says the primary. “I will set those up.”
When Home Health arrived, she had fallen. She had been down for 15 minutes and unable to get up. Home Health called the fire department. The fire department helped and also came back to put no slip pads on the steps. If she can buy the wood, they will build a ramp for her.
And I will go with her to the cancer doctor and I will rattle cages. She lives alone, she has no children, she has a brother in Alaska. But she also has an advocate. One who knows the medical system and who is not in an ethical stupor.
I think that is a complex question. But one example comes to mind.
An older woman, in her early eighties, is seeing me. She wants to go back on hormone replacement.
“But you have a history of breast cancer.” I say.
“That was six years ago. And I took that horrible tamoxifen for 5 years and I still am having hot flushes after a year off it and I am sick of it. Give me hormones.”
“Hmmm.” I say. “Let me do some research.”
I call the oncology group south of us. This is over ten years ago when we had no oncologists in our county.
“How old is she?” Her oncologist is digging up her records. “Ok, got her. Hmmm. Well, she had a stage one cancer and a lumpectomy and five years of tamoxifen. THAT cancer is gone, for sure. If she wants hormone replacement, it puts her at a bit more risk for a new breast cancer, but the old one is gone. As long as she understands the risk.”
My patient is back and we negotiate. “Ok, the oncologist says your previous cancer is truly gone, but hormones put you at risk for a new breast cancer. At least, raise your risk a little.” Age is the biggest risk in women, if they do not have the abnormal BRCA I or II genes. “Also, if we have you on hormones, you have to do your mammogram, because I’d want to catch any cancer early. That’s the deal.”
“Fine, I want the hormones.” She signs a consent that I’ve prepared and we put her back on her hormone replacement.
“I want to hear from you, ok? Whether it works?”
She calls in a week, delighted. “No more hot flushes! I feel great!”
__________
I took the photograph at Mats Mats Bay last week. There is a sign about osprey nests. I look up and think, oh, yes! Pretty obvious if you look up!
__________
I don’t remember her exact age and I don’t remember if the five years was tamoxifen or one of the other hormone blockers. She could have been in her seventies.At first I thought, no way back on hormones! Then I thought, quality of life is important.Maybe I choose this photograph because the nest is out on a limb.
Some cancers ARE currently forever, especially those that are stage III or IV and metastatic. Maybe they won’t always be forever.
For the Ragtag Daily Prompt stable, because maybe love is the only stable thing in an unstable world.
The bones of the great blue heron are so light, that I think it is standing on the floating kelp beds. I’d wish my bones were that light, but that would be osteoporosis. Maybe I could come back as a heron.
I struggled after my mother died of ovarian cancer in 2000. She was 61 and our love was complicated. Two years after she died I hit an emotional wall and had to go find help. My marriage was showing cracks too. I have written about Adverse Childhood Experiences, but there can be love too, even in a difficult household. I wrote this poem during that time.
My mom loved me
It’s herself she didn’t love
She didn’t love her anger
She didn’t love her fear
She didn’t love her sorrow
She didn’t love her shadows
She packed all her troubles in her saddlebags
and rode forth singing
When I was angry
she felt her anger
When I was scared
she felt her fear
When I was sad
she felt her sorrow
When I felt my shadows
she felt hers
I hid my shadows
I hid my shadows for many years
and then my saddlebags were full
They called me
I dove in the sea
I rescued my anger
I rescued my fear
I rescued my sorrows
I rescued my shadows
At first I couldn’t love them
My mom didn’t; how could I?
But I loved my mom
I loved all of her
Her anger
Her fear
Her sorrow
Her shadows
Her singing and courage
I thought if I could love her shadows
I could love my own
It was hard
It took months
I looked in the mirror at my own face
And slowly I was able to have
Compassion for myself
I am sad that my mom is not
where I can touch her warmth
and tell her I love all of her
I tell her anyway
I’m finding many things as I surface from my dive
Sometimes I feel the presence of angels
I was looking for something else
I found a valentine
that she made me
No date
Many hearts cut out and glued
to red paper
I am so surprised
My mom loves me shadows and all now and forever.
__________________________
My mother used to quote “Pack all your troubles in your saddlebags and ride forth singing.” Does anyone know where this if from? I have not found the source. It could be her mother or her mother’s parents.
The photograph is my father, the year my sister died of cancer, 2012.He died in 2013.
I would not call this a tree. I would call it a cone. It contains seeds. It is not a tree.
A pregnancy is called an embryo until 8 weeks after conception and then a fetus until birth. It is not a baby, any more than a seed is a tree. Here is a link to a picture of the embryo developing:
After 8 weeks (10 weeks from the last menstrual period) the developing pregnancy is called a fetus. It cannot survive outside the womb. A term pregnancy is 37 weeks, and the due date is at 40 weeks. The earliest survival, certainly not natural, is around 24 weeks. This takes heavy intervention and technology, a premature infant on a ventilator for months. There is risk of damage to the eyes from high oxygen and risk of spontaneous brain bleed and cerebral palsy, because the newborn can weigh half a pound. Once born, the fetus is termed a baby.
This is important from a medical standpoint and pounded into us as physicians. WHY? Because in a trauma situation, the life of the mother comes first. In Obstetrics and Family Medicine, the life of the mother comes first. In Oncology, the life of the mother comes first. My sister was diagnosed with stage IIIB ductal breast cancer at age 41. She was engaged and it turned out that she was pregnant. She wrote this essay on her blog, Butterfly Soup:
She had an abortion and chose chemotherapy, because it was her or the fetus. If she had chemotherapy pregnant, at that time she was told that it would probably kill the fetus or cause terrible birth defects. If she held off on chemotherapy for seven months, her oncologist thought she would die. She had a very very aggressive cancer and she already had a daughter who needed her.
She lived until age 49, with multiple rounds of chemotherapy, radiation, gamma knife radiation, whole brain radiation. And she lived until her daughter was 13. Without the abortion, her physicians thought she would have died when her daughter was 7.
My ethics in medicine are that patients have autonomy. I would NOT have wanted my sister to choose to refuse chemo and try to bring a baby to term while dying of breast cancer. However, it was HER CHOICE, not mine. It was private and no one else’s business and how dare people make moral judgements about another person’s medical choices. I give my patients CHOICES. They can choose not to treat cancer and go into hospice. They can choose surgery or refuse it. They can choose to treat opioid addiction or refuse. They may die of a heroin overdose and I grieve. I try to convince them to go to treatment and I give them nalaxone to try to reverse overdoses. I refuse a medication or treatment that I think will harm my patients, but my patients have autonomy and choices. That extends to women and pregnancy as well.
It is NOT a baby in the womb, however emotionally attached people are to this image. It is an embryo first and then a fetus. And in a car wreck, the woman comes first and the fetus second.
It is my mother’s birthday today, May 31. She died in May 2000. Helen Burling Ottaway and I miss her daily. Hugs to all the mothers and the fathers and everyone who has lost their mother one way or another.
I took this photograph in the mid 1980s, borrowing a camera from a friend.
That’s what makes them angry that I love my liar sister even though she lied even though she hurt me even though she lied to them
That’s what makes them angry that I love my liar sister they want to love her lies they don’t want to know the truth they want to hide from lies
That’s what makes them angry
they are hella jealous
they want to be loved like that
they want to be loved whole
they want to be loved entire
they want to be loved even when they lie
That’s what makes them angry
they are so afraid to be themselves
they are so afraid to tell the truth
they are so afraid to be honest with each other
they are so tired of hiding
That’s what makes them angry one says she will be friends if we only talk about the positive about my mother, father, sister I counter: let’s not mention them at all nor your husband. Not a word. She doesn’t answer. Silence.
That’s what makes them sad
they don’t want to feel the anger
they deny the heartache
they avoid the longing
they bargain with their souls
they refuse to feel the grief
let us feel the anger let us feel the heartache let us feel the longing let us feel our grief let us feel our souls
Beloved, we long for you so
Please, Beloved, love us whole
_____________________
My sister sent me a t-shirt from Wicked. She died of cancer in 2012. The deaths from Covid-19 and every death brings her back to me. And this song sums up our relationship.
Discover and re-discover Mexicoโs cuisine, culture and history through the recipes, backyard stories and other interesting findings of an expatriate in Canada
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
Refugees welcome - Flรผchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflรผchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
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