Tag Archives: communication

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Taste

I am back in Colorado for another work stint.

I am in a different house.

I am in a neighborhood, of cul de sacs that don’t connect. My house is quiet in front but backs on a very busy road, an artery. The speed limit is 40 mph but people often go faster.

The house seems odd to me. There are curtains and shades on every window, all closed when I arrived. I open them, because I like light. There is a 3 by 4 foot television in the living room, another in the master bedroom and a third in a guest bedroom. There is a large kitchen with tons of shelves and cupboards, but a table only seats two, and there are two more chairs at the counter. This feels very odd to me. It seems as if the whole house is arranged to watch television.

I go for a walk in the neighborhood. There are many houses. There are beautifully trimmed lawns and there are flowers and some roses. What is missing? There are no people. Walking a mile and a half, finding the mostly hidden corridors from one cul de sac to the next, I see one man working on his lawn. Even though it is Saturday afternoon, I seen no children, no dogs, no toys. I see two garages that are open, one with a man and in the second I hear a child. Why are there beautiful lawns and no people? And many of the lawns have little flags saying, poison sprayed.

I do turn on one of the televisions after my first day of work. The living room one says that the antenna is not hooked up. The guest bedroom one works. I look on the service. Nearly every movie is about violence and conflict.

I do a little research on the internet. I go to the library and take out 8 books. One is Nonviolent Communication, by Marshall Rosenberg, PhD. Most of the others are fiction. Yet so much fiction is about conflict too. Good triumphing over evil. I am pretty good at nonviolent communication in clinic after 30 years: I want to meet each patient somewhere that is helpful. Sometimes they don’t like what I find, or don’t want to do what I recommend, but I have a deep and abiding faith that everyone can change, that they are smart, that I can make a difference and that they are capable. I think that belief helps daily in clinic.

I choose this book because I want to be better. Some of my family is estranged. I thought that was rare and horrifying at first, years ago. Now I think that it is horrifyingly common, much more common than I realized. How do we heal this? What can we change? I don’t want to be in a dark house with the shades down watching “good” triumph violently over “evil”.

There is a pond, man made, with a fence around it, half a block from my house. There are two male mallards, a female, and eight ducklings. They are fuzzy and delightful. I stop my car and watch the first time I see them, and I walk over too.

I haven’t seen anyone else there. I think we can change. I have hope. I have a deep and abiding faith that we can change.

For the Ragtag Daily Prompt: garlic.

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Busy clinic

Clinic has been hopping. I have been at the present site now for six weeks, so I am starting to know a few of the patients. That is, the ones that are sick and I am worrying about. It is best if your doctor’s pupils don’t dilate when they hear your name.

I have been getting helpful calls back from specialists. I have a person who has high liver tests where hepatitis and overweight and alcohol don’t seem to be the cause, so I needed an updated list of what labs to send for some of the less common liver problems. Thyroid disease, hemochromatosis, alpha one antitrypsin deficiency, smooth muscle antibodies, various other antibody disorders. The list is quite a bit longer than in the past. I warn my patient that some will come back right away and some may take a week or two. The patient is anxious and wanted to go right to the emergency room, but I ask them to wait: I get a call back from gastroenterology within 24 hours to set up the current laboratory order list.

For liver tests, we ask about alcohol intake first. Then look at weight: a high body mass index can cause fatty liver disease. Unfortunately, that can lead to cirrhosis and liver failure, so it is not trivial. We check for hepatitis A, B and C. Then we start looking for the less common causes. My person is relatively young, but that is with me taking care of age 18 and up. I tell my person not to take any supplements, I look at any prescribed medicines. No alcohol for now.

The list of tests changes quickly. If I have not worked this up recently, it’s good to check in with the specialist. The gastroenterologist may not be up to date on ankle sprains, but they are tracking the changes in their specialty. My specialty is everything, so sometimes I need a current update. Most of the specialists are just fine with this phone call.

Occasionally I do this by message. I have a new diabetic who has a cardiologist already. Diabetics are usually put on either an ace inhibitor or an angiotensin receptor blocker to protect kidney function. I message the cardiologist and get a fast answer. Start an angiotensin receptor blocker and the suggested dose. Also very helpful.

A patient tells me on the phone that I get an “A” for the day. I called them to check on them two days after changing a medicine dose and to say that the other specialist wants even MORE laboratory tests. The patient says she has not gotten a call from a doctor before. The “A” made me laugh, but it did feel good.

I am learning the local medical pathways and how to get things done in this particular medical system. The functional bits, the dysfunctional bits, and how to work around them.

For the Ragtag Daily Prompt: functional.

Sol Duc really likes staying in her pillow fort. Sometimes I want to hide in a pillow fort too. So much for being “grown up”.

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Conserving energy

I was out of clinic for two years and then very part time for a year and now not quite full time as a temp. I bargained to not quite be full time.

The electronic medical record is having a consequence, along with the pressure to see more people faster. The primary care doctors, at least the younger ones, do not seem to call their peer specialists any more. (Family Medicine is a specialty, just as Internal Medicine and Obstetrics/Gynecology are.) I called a gastroenterologist and left a message last week about a difficult and complex patient. The patient had cried three times during our visit. The gastroenterologist was very pleased I had called, was helpful, agreed with my plan of using the side effects of an antidepressant to try to help our patient, and thanked me three times for calling her. Wow. I am used to calling because during my first decade in Washington State, our rural hospital had Family Practice, General Surgery, a Urologist, Orthopedics and a Neurologist. For anything else, we called. I knew specialists on the phone for a one hundred mile radius and some knew me well enough that they’d say a cheery hi.

Now communication is by electronic medical record and email on the medical record and by (HORRORS) TEXT. Ugh. I think that there is quite a lot of handing the patient off by referring them to the Rheumatologist or Cardiologist or whatever, but the local Rheumatologist is booked out until February for new patients. That leaves the patient in a sort of despair if we don’t keep checking in on the problem. If I am worried, I call the Rheumatologist and say, “What can I do now?” I’ve had two people dropping into kidney failure and both times a call to the Nephrologist was very very helpful. I ordered the next tests that they wanted and got things rolling. One patient just got the renal ultrasound about three months after it was ordered. Sigh.

I have one patient who is booked in February for a specialist. I called that specialist too, they did not want any further tests. I told the patient, “You aren’t that sick so you won’t be seen for a while. It isn’t first come first serve: it is sickest first. We all have to save room for the emergencies and sometimes those are overwhelming.” The specialist agreed and the patient is fine with that and I think pleased to know that we do not think she’s that sick. She feels better. If things get worse, she is to come see me and might get moved up. Neither I nor the specialist think that will happen.

Is this conservation of energy, to communicate by email and text? I don’t think so. I think sometimes a phone call is much more helpful, because the other physician knows exactly what I am worrying about and they can tell me their thoughts swiftly. Sometimes they want me to start or change a medicine. Things can get lost in the overwhelming piles of data and the emails and labs and xrays and specialist notes all flowing in.

My Uncle Jim (known as AHU for Ancient Honorable Uncle Jim) used to sing part of this:

Yeah, that’s just how I call my fellow specialists.

For the Ragtag Daily Prompt: conservation. Don’t cats win at conservation of energy?

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If I were your child

Living in a town of 9000, now 10,000, I did not feel that my children needed cell phones. They could walk home from school. It is reasonably safe, though I knew too much about local use of heroin and methamphetamines to believe that anywhere is completely safe.

I spoke to a friend from high school in the early 2000s. He asked me to text him my address.

“I’ve never texted.” I said.

“NEVER?” he said.

“Nope.”

“Haven’t your kids taught you how?”

“My kids don’t have cell phones.”

Long silence. Then: “If I were your child, I would run away.”

I laughed. My son got a cell phone when he headed for college and my daughter got a track phone, ten dollars a month, in high school. Calls and no texting. My son ran away the same way I did, as an exchange student. He went to Thailand at age 16 and was on the Maylay Peninsula, two years after the tsunami hit. His first comment calling home was, “Mom, the world is a really scary place.” Going off to be an exchange student is a fabulous way to run away, because you learn tons and come home.

My daughter had one friend who she would go to sleep over in her teens.

“I don’t want to sleep over any more.” she said after one night.

“Why?” I asked.

“She is up texting and by midnight she and friends are having arguments by phone and she cries. I want to sleep.”

Don’t leave the phone in the kids’ rooms, parents. And don’t have the phone in your bedroom either!!!

For the Ragtag Daily Prompt: texting. With music: https://youtu.be/hkmZGh9DQZ4.

The photograph is Studt’s Pumpkin Patch and Corn Maze again.

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Valedictionary

The Ragtag Daily Prompt is valediction. Perpetua is starting the first (to my knowledge) Valedictionary, of letter sign offs. Cool beans.

Valedictionary is a new word. Mine, all mine, but you may use it! I will generously allow everyone to use it! It is valedictionariable! Another new word. I will accept suggestions as to the meaning. For now it will mean whatever I want it to mean when I use it. Words being malleable.

Now, Perpetua, you sign your post “Yours Robotically”. What does that valediction mean? You are an AI? You would like to be an AI? You are a robot? Your post was written with ChatGPT? I am curious.

How do I sign letters off?

Yours sincerely
Yours truly,
Love,
SWAK,*
Respectfully submitted,
Your corporate policies grieve me,
My father has been dead for 13 years, stop mailing him your catalogs,
Holy cats,
Holy catwoman, batman,
Aaaaarghhhhh,
Love.

_________________________

*SWAK stands for Sealed With A Kiss, and we used that when we were kids. Not recommended for professional mail or during outbreaks of covid, influenza, RSV and other plagues.

Isn’t a real piece of snail mail a treasure now? I have quite a lot of blank cards that I’ve collected over the years. Good thing, because cards are now $4-8.00 each! OUCH! I mailed letters to all my children yesterday with recipe cards, from Maline’s memorial. A friend put her photograph on one side and copies of her recipes in her handwriting on the other. Maline was a fabulous cook, fine artist, record collector, made earrings and jewelry from antique buttons, I could go on and on. It was lovely to send the recipes to my children.

I took the photograph in Marshall, Michigan in March. I would LOVE to work in a ridiculous department. Hooray for Dark Horse Brewing Company. Next time I go there, maybe I can have a tour.

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DIY FUD: more

I am Elwha, cat.

Day three of offerings. My Mother did not even take a picture of day two. I do not understand why she scorns my offerings. This is a precious mouse that I extracted from the Tower.

This was a difficult operation. I stood on the sheep that warms and carefully tried to remove the tangled mouse. Mother interfered a little, but at last I could jump down with it. And I have offered it in exchange for more food! This precious toy!

Many thanks to all who made suggestions the other day. I still do not understand how a sub would help, but I will watch for one. Perhaps if I continue to make offerings and observe, I will be able to communicate with Mother. She seems loving, even though she is also obtuse. I am still hungry and lose weight. I fear starvation. My sister laughs when I approach her, but she is smaller and does not have the same needs. Mother feeds us in separate rooms. It is frustrating.

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pigs and fishes

is it ok

if I don’t make sense for a little while?

this is hard

it’s really hard
sometimes
to communicate

I never did
join the mainstream
of medicine

I went to class
to medical school
and wondered
and noticed
that the classes resembled
descriptions of cults
how they train people

and I thought
I am not joining any cult

and I kept my mouth shut

in the elevator
when another student says
“The other day
I threw out all of my husband’s plaid shirts.
I hate them.
They are too low class.”
If he loves them, you’ve hurt him, right?
and I think
I could say
“Yes, I hate it
when my husband
wears my plaid skirt
he stretches them all out
and ruins them.”
I would be outed
even more than I already am
as weird.

I don’t say a word
I just think
words

Medical school is four years
Residency is three
I am quiet there too
impression that I am shy
which is a lie
even so, the faculty fear me

I hear, 25 years later

and I am surprised

5 foot four
130 pounds

what the hell is there to fear?

though a boyfriend says
“You turn into an ogre
when you are angry.”

but I am quiet
in medical school
in residency
except when a patient
needs me
to speak

morph to ogre
morph to werewolf
if needed

as I get older
slowly
slowly
I learn
more subtelty

mostly from my children
who are subtle
and very very smart

at any rate

I never bought in to
the give opioids to everyone

and eventually
it turns out
that my intuition
or instinct
or whatever the hell you want to call it
study of addiction from the experience
and reading in college
matches
the studies
that come out

now I have another one
an intuition

the data is catching up with me

it’s funny
in my small community

I feel so lonely
after 21 years
mother’s death, sister’s death, father’s death
divorce
single mother 2 children
niece don’t go there
I am labeled by the medical community
I hear that the senior doctor
in the community
tells a woman midlevel
at a party
that I am crazy

maybe so

but I was right about opioids

pigs and fishes

is it ok

if I don’t make sense for a little while?

maybe
just maybe

they could listen to me this time

but I don’t think

they
will

that would be ok
but it is hurting people
and I can’t bear that

so I put myself
back in the traces

once in a massage
I thought
I can’t bear this
I am not strong enough
and suddenly I was in a dream world
where my back was enormous
huge
unending
and I thought, oh, I can bear this
thank you
I think

I put myself back in the traces
I am an ox
I plant my hooves

I begin
to pull
hard

pigs and fishes

even as I cry

The photograph is from 2014. Two pairs of glasses frames ago….

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Mundane Monday 179: without words

For Mundane Monday #179, my prompt is without words.

Let’s see a photograph where the communication is wordless.

Ms. Boa turns 15 as my daughter turned 21. For a cat, that’s approximately in her 70s. She is smaller, has lost muscle mass. She can still catch mice. And she communicates: ok, mom, enough computer for today. Do something else. This was yesterday and I decided she was RIGHT!

Link your blog or send a message and I will list them next week.

From last week Mundane Monday #178 light and dark:

KL Allendorfer: a gorgeous landscape.