Tag Archives: damage

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Intimacy

What IS intimacy? And what is love? And are they the same thing? Do you have to be intimate to love someone? Not meaning sex, but what level of intimacy is “normal” and “appropriate”?

I am thinking of my mother. When I was just starting college, she started talking to me about my father and about his drinking. I became more and more uncomfortable and finally asked her to find a counselor or someone other than me. The thing is, she refused to DO anything about his drinking and in fact, covered it up. The two of them would scream at each other at 2 am and fight when I was in high school. It would wake me up and I would think, I wish they wouldn’t, because I have school tomorrow. But I certainly didn’t go say anything because then they would have screamed at me. And as I got older, I wondered if my mother was drinking heavily too. Because why would she argue with someone drunk at 2 am, that makes no sense. Unless she either was drunk or loved to argue or both.

It is clear that she was drinking heavily at that time from her journals. Over and over she writes, I drank too much last night. Hard to blame her for not intervening with my father if she is drunk too. But she was using him as her cover up. Her family blamed him. My grandmother, her mother, didn’t blame him. She loved them both.

When we had guests, my mother would turn on the charm. She could mesmerize a room and entertain people with stories. My sister and I and others would be the butt of the stories. My father too. After the guest left, she would often talk about them. Analyze them. Talk about their faults and weaknesses. I was fascinated but a bit horrified too. She seemed to like these people so much and to charm them and invite them back, but was talking about them behind their backs. Ick.

So intimacy interests me. I wonder how to do it “right”. Maybe right is not the best word. How to do it “functionally”. I really don’t know what normal is, my maternal family certainly did not model healthy intimacy. My generation still gossips about each other. I quit that at age 19 and refused to be part of it. I don’t think anyone saw my rebellion except my maternal grandmother. She did not say a word but I knew that I had her respect. She did not play the family game with me.

I don’t think that gossip and triangulation are a good form of intimacy or love. Person A talks to person C about person B. Word gets around and sometimes it is person D that says something to person B and person B gets upset when they realize where this came from. And how twisted and one sided the story is. And aren’t we seeing this play out on a national level? All these people saying that THEY KNOW the status of the President’s memory. I don’t. I can’t judge it from a debate. And frankly, if we are going to do a psychiatric evaluation of one, I think we have to do BOTH. Stop following stupid rumors. Why not require a neuropsychiatric evaluation on every candidate for President and Senate and House of Representatives and the Supreme Court. And make them public. That would cause some chaos, wouldn’t it? And how do you decide who is “sane” enough to govern?

I think that gossip and triangulation is a dysfunctional form of intimacy. People feel closer when someone is whispering a secret to them. I don’t think it’s healthy. It might be normal for our culture, though. Normal does not mean healthy, after all. What do you think?

This election is like a bad hallucination. Why do we accept candidates that behave badly? Are we so addicted to television and movie drama that we want it to happen in our government? I don’t. How about you?

For the Ragtag Daily Prompt: hallucination.

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Tea and talk

Tea and talk and tittle tattle
exchange of views among some boomers
solving problems as ideas rattle
or spreading nasty damaging rumors?
Talk of science and books and space
are the words mean or kind?
whispers about someone’s face?
Rumors about someone’s mind?
It’s hard to fight a rumor mill
people talking behind your back
the poison seeps and spreads and spills
a deadly dagger in your back
Time passes and people find
sometimes it’s the accuser who lost his mind

For the Ragtag Daily Prompt: tittle tattle.

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Frail

I wrote this poem about my father at least a year before he died. He was on oxygen, on steroids, terrible emphysema from 55 years of unfiltered Camel cigarettes. He would not accept much help and became more and more of a hermit. He did continue with the Rainshadow Chorale and because of it he quit smoking three years before he died.

Frail

We are going sailing
My partner says to me
“Invite him if you want.”

Then I am busy for a while

I think of calling, then forget

He was not at chorus on Monday

At last I say,
“I haven’t called. We’ll just sail.
Just us today.”

I haven’t called
because he was not at chorus on Monday

He is frail
55 years of camels
two packs a day
as if each cigarette
destroyed one alveolus
in his lungs
one tiny air/blood interface
built to exchange oxygen
and carbon dioxide
the loss is cumulative


He is frail
he is proud that the choral director
says, “I need you.”
He can’t sustain
but his entrances and time
are the best
among the basses.
They need him.

Chorus
is our winter link
two introverts
we hug at the start of chorus
sing for two hours
and talk for a few minutes at the end

Occasionally we go for a beer
I invite him for dinner
but he comes less and less
he often does not feel well at night

He looks smaller at chorus
this season
this is normal in emphysema
the body sheds weight
too much tissue to oxygenate
too hard for the lungs
and the heart, working overtime
to make up the difference
he is blessed with low blood pressure
genetic, from his father,
tough English stock,
otherwise I think he’d be dead

I didn’t call
before we went sailing
because I am afraid

I’ve driven out before
when he has not answered the phone
for a day or two
wondering if I would find him dead

I didn’t call
before we went sailing
because he was not at chorus on Monday
because if he didn’t answer today
I would not go

______________________

For the Ragtag Daily Prompt: frail.

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Adverse Childhood Experiences 15: Guidelines

I wrote Adverse Childhood Experiences 14: Hope quite a while ago.

The American Academy of Pediatrics has a guideline that physicians should introduce and screen for Adverse Childhood Experiences. The American Academy of Family Practice is skeptical, here: https://www.aafp.org/pubs/afp/issues/2014/1215/p822.html. Here are two more writeups: https://www.aafp.org/pubs/afp/issues/2020/0701/p55.html and https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/screen_for_aces.html.

It is difficult to screen for ACE scores for the same reason that it is difficult to screen for domestic violence and to talk about end of life plans. These are difficult topics and everyone may be uncomfortable. Besides, what can we DO about it? If growing up in trauma wires someone’s brain differently, what do we do?

I don’t frame it as the person being “damaged”. Instead, I bring up the ACE score study and say that first I congratulate people for surviving their childhood. Good job! Congratulations! You have reached adulthood! Now what?

With a high ACE score comes increased risk of addictions (all of them), mental health diagnoses (same) and chronic disease. Is this a death sentence? Should we give up? No, I think there is a lot we can do. I frame this as having “survival” brain wiring instead of “Leave it to Beaver” brain wiring. The need to survive difficulties and untrustworthy adults during childhood can set up behavior patterns that extend into adulthood. Are there patterns that we want to change and that are not serving us as adults?

This week a person said that they blow up too easily. Ah, that is one that I had to work on for years. Medical training helps but also learning that anger often covers other feelings: grief, fear, shame. I had to work to uncover those feelings and learn to feel them instead of anger. Anger can function as a boundary in childhood homes where there are not adult role models, or where the adults behave one way when sober and an entirely different way when impaired and under the influence. There may be lip service to behave a certain way but if the adult doesn’t behave, it is pretty confusing. And then the adult may not remember or be in denial or try to blame someone else, including the child, for “causing” them to be impaired.

What if someone had a “normal” childhood but the trauma all hit as a young adult? I think adults can have trauma that changes the brain too. PTSD in non-military is most often caused by motor vehicle accidents. At least, that is what I was told in the last PTSD talk I went to. Now that overdose deaths have overtaken motor vehicle accidents as the top death by accident yearly in the US, I wonder if having a fentenyl death in the family causes PTSD. Certainly it causes trauma and grief and anger and shame.

I agree with the American Academy of Pediatrics that we should screen for Adverse Childhood Experiences. We need training in how to talk about it and how to respond. I have had people tell me that their childhood was fine and then later tell me that one or both parents were alcoholics. The “fine” childhood might not have been quite as fine as reported initially. One of the hallmarks of addiction families is denial: not happening, we don’t talk about it, everything is fine. Maybe it is not fine after all. If we can learn to talk to adults about the effects on children and help people to change even in small ways, I have hope that we will help children. We can’t prevent all trauma to children, but we can mitigate it. All the ACE scores rose during the Covid pandemic and we are still working on how to help each other and ourselves.

Here is another article: https://www.aafp.org/pubs/fpm/issues/2019/0300/p5.html.

Blessings.

For the Ragtag Daily Prompt: open wound.

The photograph is one of Elwha’s cat art installations. He would pile toys on his bowl. Two bowels because I need to keep out the little ants. Sol Duc would do it too but not as often. I fed them in separate rooms. They would pile things on the bowl whether there was food left or not.

Elwha is still missing, sigh. That is a wound. The photographs are from March 2023.

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Picking apples

I have two trees: a Wolf River and a Gravenstein. I picked the Gravensteins over a month ago, but the Wolfe Rivers like to stay on the tree longer. I will pick a bunch today. They are lovely and wonderful pie apples. Picking is not quite overdue!

Meanwhile, my magnolia has damage this morning.

Human? No, I don’t think so.

That spike or the 3 prong in the neighborhood, sharpening their antlers. I have watched them other places in town. It feels safer from a car. I think I need some protection for the magnolia.

For the Ragtag Daily Prompt: overdue.

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Negotiating peace

I spend a long day wrestling with love
arguing with myself back and forth
I am no angel descended from above
Those undeserving of my love make me wroth
yet my core argues that it still loves them
and agrees their cruelty’s beyond the pale
I snarl and cough and choke on bitter phlegm
Defend my self staying far away and hale
My core agrees I shall not tolerate abuse
Forgive yet we despair we’ll ever reconcile
They show no guilt nor shame for their misuse
My core says let them be: she is so mild
Negotiation done: Agreed. I may love those who I love
But I leave contact with them to the angels and Beloved.

_____________________

Sonnet 10

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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.

___________________________

“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.

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Navigating disability

I am having an interesting week regarding disability. Maybe it will make me a curmudgeon.

A woman says, “It must be difficult to be disabled, with your lungs.” I wear my oxygen to sing in chorus. I did the concert without the oxygen but had to drop some held notes at the end. I get goofy when I am hypoxic. I also write really strange rhyming songs when hypoxic, which I recorded.

I reply, “Well, my mother and father and sister are all dead, so by comparison I am doing well.”

She looked horrified. “ALL DEAD?”

“Yes.” I said.

Mother at 61, father 75 and sister at 49. Cancer, emphysema, cancer. I am so lucky that I don’t smoke and have always disliked sodas and thought that addictive things were very dangerous for me before I started college.

I also attended a Roam Echo Telemedicine yesterday, about Long Covid. WOW. It was EXCELLENT.

https://hsc.unm.edu/echo/partner-portal/echos-initiatives/long-covid-fatiguing-illness-recovery/

Yesterday’s program was given by an attorney, discussing disability. She was describing how the chart notes can damage a patient’s chances of obtaining disability and she gave us forms to help us document disability successfully.

She put the number of people with Long Haul Covid at 30% of the not hospitalized people.

Thirty percent. That is HUGE and damaging. I have heard numbers from 10-30%.

There were also physicians attending the Roam-Echo program who have Long Covid and are realizing that they can’t work to the level they did before. Some can’t work at all.

The panel recommended neuropsychiatric testing if the patient is having any trouble with memory or executive function or brain fog. Document, document, document.

Not only that, the previously taped programs are linked to the site above. So I can watch the rest of them. It is FREE and I get Continuing Medical Education from it.

I trained in Family Medicine from 1989-93 in medical school and residency 1993-96. When I was in school I got virtually no training on how to do disability paperwork. Or even how to tell if someone is disabled. The truth is that people do not want to be disabled. In our culture it is shameful and anyhow, social security disability is often $1000 per month. Try living on that. Unenviable.

It turns out that I am lucky or smart or some weird combination. I bought disability insurance way back in medical school and paid $1000 per year for 29 years. I used it twice before 2021. I was on bed rest for 3 months of preterm labor. My insurance doesn’t kick in until I have been off work for 3 months. I wrote them a letter and said I expected to return to work six weeks after having my child, unless there were complications. The company paid me for an extra week. I called them and basically they said, we are so happy to have you return to work that we do not care.

The second time was after my third pneumonia. Strep A and my lungs and muscles were trashed. Both burned like strep throat. It hurts. I was out for six months and then worked half of my usual for another six months. Really I was working about 1/4 of a regular Family Practice Physician. I was seeing 4-5 patients a day and then sleeping for 12 hours, exhausted. A “normal” load is 22 or more. Which is not really sustainable with today’s complex patients, but that is another essay. I had chronic fatigue, MECFS, as it’s now called, but I was in denial. I never got past 8-10 patients a day for the next seven years. I was also running my own small business and had continual hostility from the only hospital in the county. I was one of three independent practitioners. I really do not understand why they thought my tiny clinic was a threat, but whatever. They could grow up.

From 2014 to 2021, I asked any patient with upper respiratory symptoms or a cough to wear a mask for the visit and I masked too. I explained that if I got a fourth pneumonia, I would be disabled for Family Practice medicine. I hoped it wouldn’t happen. I masked the people with allergies too, because after all, you can have allergies AND a cold. When Covid-19 hit, my patients just rolled their eyes and wore the masks. I only ever had one man, a new patient, object. “I won’t wear a mask,” he said.

I said, “Sir, you don’t have to. But I won’t see you without a mask, so please leave and go to Urgent Care.” This was in my waiting room.

“You mean that!” he said.

“Yes I do. I get pneumonia, so that is a firm policy.”

He put on the mask.

I closed the clinic in early 2021. Covid-19 hit us too hard and we were a shoestring clinic anyhow, with 8-10 patients a day. I went to work in the next county. I kept walking into patient rooms where people had their masks off. I had pneumonia in five weeks.

So it goes.

My disability insurance is paying. I did have to hire an attorney to get the company to explain the policy rules clearly. I don’t speak legalese, I hate it, and I think that insurance companies will use any loophole they can find to get out of paying. So far I am lucky to have navigated this. Now I have to look over my policy again, because some policies change after two years of paying and they don’t have to pay if you can do ANY paid employment. It’s pretty clear that I can’t. I went for a beach walk yesterday and then crashed for a two hour nap and then slept 8 hours last night. Any labor, walking OR brain, will crash me. ME-CFS sucks. I think we will have a handle on it in another decade and it’s clear that it is an immune system response. Too late for my employment, though. Ah, well. I got 30 years in. I was annoyed because I was NOT planning to retire yet. I keep running in to people who say, “How do you like retirement?” “I didn’t retire. I am disabled by my fourth pneumonia and grumpy about it.” “Oh,” they say. I should do the social thing, “Love it!” but I’ve never been good at that anyhow. I joke that I tell the truth because I am often not believed, so why bother to lie?

At any rate, 10 or 30% of the people who have had unhospitalized Covid-19 is a huge number of people, and we do not know how long Long Covid will last or how to resolve it. Stay tuned. I hope it is less than a decade, but it will be a little while yet.

Prayers and blessings for all.

The photograph is the really beautiful agate I found yesterday. For the Ragtag Daily Prompt: curmudgeon.

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Chronic pain #I forget

The CDC has a new set of recommendations for chronic pain.

I will write about them. I have to read them first. Hurts too much, right now, the election, and all the pandemic fighting. Stress people and you see what they are really like.

My church has melted down into a huge fight. I was in a chorus singing instead of being in a meeting. Apparently there is a group that says brown people have “taken over” the national organization of the church. Um. Hello. That is discrimination. Does the color of the skin matter if it is a good leader? Why are people insane? I filled out a county survey on drug use today. I know we have methamphetamines and heroin in our high schools because patients have told me. But then I get to the race question. What race am I? I checked OTHER and wrote HUMAN. The race bullcrap is NOT SCIENCE. I haven’t done any genetics testing. I DO NOT KNOW WHAT RACE I AM THOUGH I LOOK WHITE.

It is important for medicine in that there is proven discrimination with less screen health services offered to “brown” people, whatever the heck “brown” people means. I wish the heavens would turn us all the same color over night. Or perhaps blind us. That is not nice of me and I do not care.

I am glad that this horror came out in my church. Because now the discrimination is out in the open. And the committee has sent out a message saying NO. We WILL stay part of the national organization. We WILL not give in to this discrimination. AND I SAY HOORAY AND BLESSINGS ON THEM.

Here is the new CDC set of recommendations for chronic pain: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm . You can read them yourself.

I read to this sentence so far: “Approximately one in five U.S. adults had chronic pain in 2019 and approximately one in 14 adults experienced “high-impact” chronic pain, defined as having pain on most days or every day during the past 3 months that limited life or work activities (5).”

Part of me is horrified and part of me is calm. Because pain is a part of life. Pain, love, joy, fear, it’s all part of our emotional evolved systems to survive, right? If God is love, God is also pain and fear. It is not a split. It is both.

This song is a love song. But to me, it’s a love song from heroin to a woman. One lovely day, a place where there is no pain. There will be pain on the return, the withdrawal. I have patients say, “You need to get me pain free.” My reply was “I will not get you pain free. Pain free is dead. Or at least, they can no longer tell me if the next form hurts.” In this song, “she won’t let on, that the feelings have got so strong.” Addiction, opioid overuse.

I took the photograph of Elwha yesterday. He is my relaxation mentor.

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Arty’s warning

Trigger warning: non graphic mention of child abuse.

_____________________________

I don’t notice that things are frozen at first, because the cats aren’t frozen. I do notice the light. Also I notice the change in sounds. The car outside in the street is not moving nor making sound. Uh-oh.

I go to the front door. Might as well if everything is frozen. I just finished putting on make up, which always means a dangerous mood.

She lands first, on a white flying horse. Who smiles at me, showing fangs. Smoke is coming out of the Pegavamp’s nostrils. Eeeee.

Arty herself is in silver and black today. Silver cloth with black embroidery that seems to be writing a little.

“Good morning, Goddess.” I say, bowing. The other horses and dragons and flying motorcycles and pterodactyls are landing as well. Sol Duc is in the window. Elwha has gone to hide, quite sensibly, I think.

Arty stomps her staff on the ground. “I am really pissed.” she says.

“They named a rocket after you.”

“That penis toy? That is supposed to please me while they are killing virgins who refuse to tent their heads?”

“Sorry.” I hang my head.

“And do you know how much the smoke is going to shorten the lives of my birds and stags?”

“A lot, I think.”

“Do you all want to starve in the dark?’

I look up at her then. “No. I want grandchildren and a healthy earth.”

“Work harder.” she snarls. The rest of the dangerous crowd is muttering and snarling and the local cats have come out. They are sitting very respectfully at a distance. Rooftops. The ridge above my house three blocks up. The tree tops are frozen too.

“Do you need prescriptions again?” I ask. “I see that there have been a lot more rapists jailed. Thank you, Goddess.”

She looks tired for a moment. “We are hunting them everywhere: cities, countryside, hovels, palaces, movie sets, where ever.”

“You don’t turn them into stags any more?”

“Yes, sometimes. My hounds love to tear them apart. But sometimes prison is slower and crueler and a better punishment.”

I kneel. “What service can I do, Goddess?”

She touches me with the staff. I feel a hard bright shock, pain that roars through me and is gone.

“Write this. Write my warning. If this continues, it is death in the cold dark of nuclear winter and we will begin again.”

“Is that the only choice?”

“Oh, no, we are all being very creative. One suggestion has been the sperm banks. There is nothing that says they can’t be used to make one gender only. The one that rapes less and doesn’t kill young girls for what they wear.”

“Thank you for your warning.”

“Stand up.” she says. “You and every abused child, male or female, are under my protection. Yet the cycle must be broken and the abused must not become abusers. Write this.”

The Pegavamp drops one knee and she steps up easily. The other riders start to roar and shout and howl. Her winged creature jumps in the air and the whole group follows. There is a snap and they are gone.

The car in the street is moving and the treetops as well. The cats stand and move away.

I keep writing.

___________________

October 22, 2022