Is this a tree?

Is this a tree?

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:

https://en.wikipedia.org/wiki/Human_embryonic_development#/media/File:HumanEmbryogenesis.svg

It’s a bit difficult to call the embryo a baby.

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:

The hardest loss of breast cancer.

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.

For the Ragtag Daily Prompt: explain.

sand pattern

I took this photograph yesterday on East Beach in glorious sun.

I left the house to hike at 5:30 am. I didn’t hear about Roe v Wade being overturned until later in the day. I am grieving and will fight for women’s right to determine their own health. Each sperm is alive and each egg too. Don’t tell me they should all be saved, because then we would all starve. Life doesn’t start at conception. I think that some men wanting to control women starts with conception. They certainly don’t want their sperm controlled.

In the photograph are great blue heron tracks. I saw at least three great blue herons. At least four eagles, sitting in the tops of trees along the cliffs enjoying the sun.

The beach changes daily. We go to North Beach and one day it is long stretches of sand and the next it is covered with rocks of all sizes. We have been hiking so regularly that it is really clear that the beach changes as much as human moods! Every tide is different.

Here are chalcedony nodules found yesterday. We still call them agates, but since we are getting fussier and want the clear ones, they are more correctly called chalcedony nodules.

The beach changes like US politics. The water rushes in like a new administration, removes small and large boulders and rushes out again. A new Supreme Court Judge, a new person in this appointed position or that, change, change, change, a new pattern. I am grieving about Roe v Wade, but contributing to the fight for women’s rights and for women’s health. I wish that as a country we were less dramatic and nicer and did not need to have an enemy to shout at all the time.

Maybe that change is coming, but slowly. We might learn from social media and from all sorts of lessons. I have some hope.

Meanwhile I’d rather be with the great blue herons and the eagles.

For the Ragtag Daily Prompt: patterns.

Juneteenth and Father’s Day

Juneteenth and Father’s Day, I am celebrating and thinking of both, and missing my father and my grandfathers. Yesterday was a delayed memorial for my ex mother-in-law. I loved her and we stayed in touch and I continued to visit her and also loved her second husband. He was another grandfather to my children. We had six grandparents, with my ex’s parents divorcing a year after he and I married. Now we have one living. My paternal aunts and uncle have stepped in as the parents and grandparents that are missing for me and my children.

The pressman is my paternal grandfather Kenyon Charles Ottaway. Or Charles Kenyon? Now I need to ask my Aunts. I do not know what year that was taken. He was head pressman in Knoxville Tennessee in the early 1960s. He went by Ken. My Aunt Pat adds that he was nicknamed “Inky” and that the above photograph was taken in Bridgeport, CT. On the back it says ’45, so our guess is 1945.

My father, me, and my sister Chris.

The second photograph is my father, Malcolm Kenyon Ottaway, and me and my sister. My father went by Mac.

Jubilee for freedom and for both father’s day and Juneteenth. I miss my parents and my grandparents, love to all of them. Hooray for Sweet Honey in the Rock, too.

Sending love and peace.

For the Ragtag Daily Prompt: jubilee.

Covid-19 and walking pneumonia

I wrote this essay in July 2017. Before Covid-19. It is clear that Covid-19 is also causing a walking pneumonia. People are exhausted when they get out of bed. No fever, they may not cough much, but if they get up, they can feel exhausted. The key to this is the heart rate, the pulse. If the pulse jumps 30 points faster or more, this implies lung swelling and reduced lung capacity. Right now, the only treatment we have is rest and time to heal. I should know, I’ve had really bad walking pneumonia four times: the first two times I was out for two months. The third time 6 months with 6 more months half days and chronic fatigue. The fourth time put me on oxygen.

I want to offer hope to the people with Long Covid-19. Having been through four bad pneumonias, with increasingly long recovery times, and now disabled for doing Family Medicine, I have experience to share. I will write more about that in the next essay.

From 2017: Walking pneumonia is changing.

The classic bugs are four “atypical bacteria”:

mycoplasma pneumonia
chlamydia pneumonia (this is not the STD chlamydia. Different one.)
legionella
pertussis (whooping cough)

However, streptococcus pneumonia can also be a walking pneumonia OR a lobar pneumonia. In a lobar pneumonia the person usually is short of breath, running a fever of 102-104, and they point to where it is: hurts in the right upper chest. On chest x-ray there will be consolidation: whited out from fluid or swelling instead of nice ribs and dark air. They are often tachycardic and hypoxic.

In walking pneumonia the person often has no or minimal fever, they just feel tired or short of breath when they do things, and the chest xray can be “clear”. It isn’t really “normal”, it’s just that the bacteria or virus affects the entire lungs and causes some swelling throughout and doesn’t white it out.

“Double” pneumonia is when the chest film is whiting out on both sides. We also see the lungs whiting out with ARDS — acute respiratory distress syndrome. So after trauma in a car wreck and lots of broken ribs, the lungs can be bruised too and white out. Ow. Influenza virus can cause lung swelling and in the 1917-1918 flu infected military recruits lungs were swelling shut. They would turn blue and die.

“My” strep that I’ve had pneumonia with twice is streptococcus A, not strep pneumonia. It causes strep throat mostly though it can invade and cause sepsis or pneumonia or cellulitis. There are currently 4000+ known strains of strep A, and some are resistant to antibiotics or can cause kidney damage or do all sorts of nasty things. I think that “my” strep is resistant to azithromycin.

The current guidelines say to treat walking pneumonia with azithromycin. However, a paper came out this year saying that resistance to azithromycin is rising among streptococcus pneumonia and that nearly 50% of strains tested were resistant. Uh-oh. That means that azithomycin doesn’t work and the person can get sicker and may die. I talked to a pulmonologist in Seattle when I needed help with someone. He said that he would have said there weren’t any resistant strep pneumo strains here in Washington except that he had one intubated and in the ICU right then. “I’m convinced now, ” he said.

A lobar pneumonia is easier to diagnose. Abnormal chest x-ray, reasonably healthy people run a high white blood cell count (so my frail folks, immunosupressed folks and 90 year olds don’t raise their white blood cell count), and a fever (ditto) and look sick. The walking pneumonia people come in saying they have been coughing for 3 weeks or 4 weeks or two months. I am doing more lab testing because of the resistance.

This winter I have seen 6 different causes of walking pneumonia here: influenza A, respiratory syncytial virus (In more than one person over 60. That is NOT who the books say it should affect. It’s supposed to mostly cause bronchiolitis in babies and preemies), pertussis, strep pneumococcus, strep A and none of the above. All looking pretty much the same, but with different treatment.

https://wwwnc.cdc.gov/eid/article/15/8/08-1187_article
https://www.cdc.gov/pneumonia/atypical/mycoplasma/index.html
http://www.medscape.com/viewarticle/820736
https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=79
RSV: http://kidshealth.org/en/parents/rsv.html
Mycoplasma resistance to azithromycin has been reported too: http://erj.ersjournals.com/content/36/4/969

mother

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.

Love whole

I loved my liar sister
I love her still

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.

Playful Packrat

My sister freaks out once. “Oh, my gosh. Our parents still have boxes from their last move a decade later. What will we do when they die?”

Me: “Get a storage unit and open a box a year at Christmas for the rest of our lives.”

Her: “That could work.”

I tell my sister that we could start a magazine in response to Real Simple. “We will title it Playful Packrat.” We come from an impressive line of Packr– I mean, Collectors. Collector is honorable and respected. Packrat is, well, unfashionable. Perhaps I should title it Circumspect Collector instead. I know someone who seems to be collecting heavy equipment, which is an interesting choice. One needs more property than I have for parking.

My house would make Marie Kondo shudder. The photograph is the basement: the stack is my mother’s larger artworks. I am moving stuff around now that I am home-on-oxygen instead of running around clinic like a crazy rabbit. And like this writer, https://www.architecturaldigest.com/story/maximalist-response-marie-kondo-minimalist-mandate, it ALL gives me joy. Well, ok, not the tiny ants. We are at war. My kitchen may be cluttered but by gosh it’s clean clutter because the tiny ants let me know immediately if I screw up.

Anyhow, my mother died in 2000, my sister in 2012, and my father in 2013. My parents left me their stuff and grandparent stuff, some of which I had never seen, and I still get dead people mail. The colleges and universities are the most persistent. They don’t care if someone is dead, they still mail out the Alumni Magazine. I get U of WI, Cornell, Princeton, U of Oregon, Medical College of VA, OHSU and Williston. Holy moly. U of TN and SUNY Binghamptom have lost track of us, thankfully. I wish I had kept my father’s notes on Beowulf and mailed them to Williston for their library. It would be a sort of just revenge. I still have boxes (my excuse is busy physician) so I will bet that I can find something to mail to each one of those places. Something that they want just as much as I want their Alumni Magazine. With a cover letter that says that my contribution is hidden in the documents. One dollar each.

I have too much stuff but I have now turned middle aged, that is, I am over sixty. So I now am on the downward side and decide, there needs to be outflow rather than inflow. I like my stuff but it’s time to start moving it. My mother was a prolific artist and all of the silent auctions in town will now be blessed by her art. And don’t worry, it is not awful! She has art in the Smithsonian, the National Museum of Women Artists, and a bunch of other places. See my April A to Z for details.

For my father it was books and musical instruments. I still have the guitars. I think there were twelve trumpets? A lute, a harp, a cello — the lute is in very bad shape and the others have gone to someone else and the school, respectively. Recorders, gone. I have flutes, my regular flute and then ones made out of clay, cherry, pvc pipe and bamboo, as well as a Native American flute. I am mostly playing the regular flute, Native American flute and guitar.

I am guilty of books, too. I DO want to read them all, but even if I did nothing but read for the next sixty years, I might not finish. The excuse that some are reference does not fly. Some are pure unsullied entertainment and by gosh, I am keeping those! I am not allowed to go to the book sale next week. I do have a library box but the books are not leaving at the rate they have been arriving in the last year. And it’s my fault.

Anyhow, I am enjoying my clutter. After all, we invented tables to put things on. Sometimes we do have to clear the table for the NEXT project, but no worries! There is always the floor!

Cheering up music:

what would YOU choose?

Here is a story of a choice about an abortion, a theraputic abortion, where a mother has to make a difficult choice. I have seen Family Medicine patients since 1991, so this will not identify a particular person. No HIPAA problem.

I see a new patient in clinic, a woman, who already has children. She has back pain. All is routine until she says, “Sometimes my leg goes numb from the knee down.” I stop. This is NOT normal. “Completely numb?” I say. “Not patchy?” “Yes.” “How often?” I ask. She shrugs. “Not very.” “If it happens again, call me and I want to see you right away.”

Why? This is unusual because most numbness follows dermatomes if it is from back pain. The dermatomes on the skin wrap from the back down the leg all the way to the toes. When someone describes numbness or the pain of shingles in that distribution, we know which nerve is affected. Numbness from the knee down can come from diabetes and other causes, but it is not on one side and it doesn’t come and go. So the unusual stands out for me.

“Anything else weird?”

“I had vision problems in my last pregnancy. They sent me to specialists, even a neuro opthamologist. He couldn’t find anything.”

“Ok.” I shrug. We move on.

She calls two days later. “Both legs are numb from the knee down.”

“Come in today,” I say.

Both legs ARE numb from the knee down. She also can’t lift her feet. The muscles from the knees down are weak. I get neurology on the phone. “MRI her from the top of her head to the base of her spine.” I call the hospital and set it up. That day.

She has seven brain lesions suspicious for multiple sclerosis. She did have an MRI in the previous pregnancy, which was negative. I do not remember how old the child was, 2-4 years or more when I saw mother.

I call her back in for results, we talk about specialists, and I call a neurologist in the nearest big city, three hours by car from where she lives. We start medications and my patient is scheduled.

She has multiple sclerosis. The flare improves. The visual symptoms were MS in the previous pregnancy, but it was not yet visible on brain MRI.

Then she gets pregnant again. Her symptoms immediately flare. She comes to me and I call the neurologist.

The symptoms are not a little worse. Much worse. “I suggest she terminate the pregnancy.”

My patient is horrified. Until the neurologist’s next words. “She needs to terminate if she wants to be able to walk for the children she has.”

My patient chooses an abortion, to terminate the pregnancy. Because she has a bad version of MS*, she remembers the symptoms in the last pregnancy, she is young, she is clearly progressing and she wants to take care of the children she already has.

What would YOU choose? For yourself, for your sister, for your wife. If you are male, do you have any right to make that choice? Now picture yourself pregnant with that choice. And thank you for reading this.

*Addendum: present evidence says that multiple sclerosis does NOT worsen with pregnancy. However, another illness, NMO (neuromyelitis optica) instead tends to become more active in pregnancy. It previously was lumped in with MS until the antibodies (anti-NMO) were identified and it was realized it’s a different subtype of demyelination disease, with its own treatment options. Medicine changes over time and the woman, the neurologist and I were working with the information available at that time.

R is for Resume

I am blogging A to Z about artists, particularly women artists and mostly about my mother, Helen Burling Ottaway.

I find two copies of her resume. One is from 1991 and one from 1993. I will add the 1993 information, but it’s a LOT. My mother was prolific! She complained about getting ready for shows and I did not realize how very many she did! I am so proud of her. She died of ovarian cancer in 2000 and I do miss her still.

Helen Burling Ottaway

  Del Ray Atelier

105 E. Monroe Ave

Alexandria, VA 22301

SELECTED SOLO SHOWS

1991 Nov     Will have solo show at Bird-in-Hand Gallery, Washington, DC

1989 Sept     “Cascades: Watercolors of Washington State”, Bird-in-Hand Gallery, Washington, DC

1988 Nov     “Fantasy Etchings”, National Orthopedic Hospital, Arlington, VA

1987 Oct      “Spirits to Enforce, Art to Enchant”, Fantasy Art, River Road Uniterian Church, Bethesda, MD

1986 Mar     “Prints and Poems”, Poetry by Katy Ottaway, Martin Luther King Library, Washington, DC

1984 Nov     “Forests, Flower, and Fantasies”, Sola Gallery, Ithaca, NY

          Apr     “Birdland and other Lullabies”, Pastels, Gallery West, Alexandria, VA

1981 May    “Fantastical Bestiary”, Etchings and Drawings, Gallery West, Alexandria, VA

          Mar     “The Way of the Brush”, Watercolors, Gallery One, Alexandria, VA

TWO PERSON SHOWS

1986 Nov     Two Person Show, “An Occasional Pair of Claws”, Fantasy Art with Omar Dasent, Gallery West, Alexandria, VA

1985 Apr     Two person Show, “Figures and Foliage”, Pastels, Capital Centre Gallery, Landover, MD

1982 Nov     Two Person Show, “The Four Seasons”, Gallery West, Alexandria, VA

SELECTED GROUP SHOWS

1990 Feb     “Visions 1990” Westbeth Gallery, New York, NY

1989 Feb     “Year in—Year out”, Studio Gallery, Washington, DC

1988 Mar     “independent Visions III”, Metro Gallery, Arlington, VA

          May     Juried Show, Sculpture, The Art League, Alexandria, VA, Juror: Bertold Schmutzart

1987 Dec     Juried Show: “The Best of 1987”, Martin Luther King Library, Washington, DC, Jurors: Dr.

                     Jacqueline Serwer, Sandra Wested, Robert Stewart

1987 Apr     “Independent Visions, Fifteen Women Artists”, Metro Gallery, Arlington, VA

          Feb     “Portraits 1987”, The Art Barn, Washington, DC

1986 Oct     “Juried Show, “Printmakers VIII”, The New Art Center, Washington, DC

          Jan     “Independent Visions”, Metro Gallery, Arlington, VA

1985 Dec    Invitational, “Highlights of the Year”, Martin Luther King Library, Washington, DC. Jurors:

                     Linda Hartigan and Monroe Fabian

          Nov    Invitational, “The Macadam Nueve-Splintergreen Conspiracy Show”, Gallerie Inti,

                     Washington, DC. Curated by Omar Dasent and Ann Stein

          Oct      Juried show, “Printmakers VII”, WWAC, Washington, DC. Juror: Jane Farmer

          Mar     Invitational, “Mama, Don’t Let Your Babies Grow up to be Artists”, The Splintergreen

                      Conspiracy, Martin Luther King Library, Washington, DC. Curated by Omar Dasent

          Mar    “Shakespearean Images”, Hofstra University, Hempstead, NY

1984 Nov     Juried Show, “Printmakers VI”, WWAC, Washington, DC. Juror: Carol Pulin

           July     Juried Show, “Printmakers VI”, WWAC, Washington, DC. Juror: Jo Anna Olshonsky

           Oct      Four Person Show, “Just Four”, Galerie Triangle, Washington, DC

                        “The First Great American Camel Show”, Gallery West, Alexandria, VA

1983 Mar      Juried Show, “Printmakers V”, WWAC, Washington, DC. Juror: Barbara Fiedler

          Feb       Juried Show, “Artists – Art Historians: A Retrospective 1972-1982”, National Conference, The Women’s Caucus for Art,m Bryce Gallery, Moore College, Philadelphia, PA

1982 May      Juried Show, “Woman as Myth and Archetype”, WWAC, Wshington, DC. Juror: Mary Beth Edelson

          Feb       Invitational, “Art is where the Heart is”, Gallery 805, Fredricksberg, VA

          Feb       “The Printmakers of the WWAC, The Torpedo Factory, Alexandria, VA

          Jan        Juried Show, “The Eye of Eleanor Monroe”, WWAC, Washington, DC Juror: Eleanor Monroe

1981 Oct.      Juried Show, “Collage and Drawing”, WWAC, Washington, DC Juror: Jan Root  

Numerous juried shows, the Art League, Alexandria, VA

Numerous group shows, Gallery West, Alexandria, VA

EDUCATION

1967 B.F.A Cornell University, Ithaca, NW

WORK EXPERIENCE

1992-currently   Teach Drawing and Watercolor, Capital Hill Arts Workshop, Washington, DC

                              Teach Art Class for Seniors, Recreation Department, Alexandria, VA

                              Teach etching workshops and watercolors at the Delray Atelier, Alexandria, VA

1987-1990           Graphic Artist, Al Porter Graphics, Washington, DC

1985 Fall               Co-Director of Gallery West, Alexandria, VA

1982                       Director of Exhibitions, WWAC, Washington, DC

1982                       Director of Gallery West, Alexandria, VA

1981                       Chair of Exhibitions Committee of Gallery West, Alexandia, VA

                                Taught watercolor classes at Washington Women’s Art Center, Washington, DC

                                Taught children’s art classes for the Arlington Recreation Department

1967-1970             Assistant Curator at the Ithaca College Museum of Art, Ithaca, NY

ATOZBLOGGINGCHALLENGE2022 #art #Women artists #Helen Burling Ottaway #ATOZCHALLENGE #Christine Robbins Ottaway #APRILATOZ

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