Dissolution

I am sorting, Beloved.

I dream that my sister has drowned
in the ocean. A sailboat went down.
There were others on board.
Two friends ready me to dive and find her.
I don’t want to scuba dive, I am not trained.
I don’t know how to use the equipment.
I am afraid I will drown too.
I see her daughter, who is four.
Her daughter knows from my face that her mother is lost.
My friends say, “You will be able to find her.
You can find your sister.”
“But she is dead,” I say.
“I don’t want to find her.”
I know that they are right, I could find her.
But I might be separated and lost, in the depths.
I don’t want to die too.

I wake up.
The dream sticks.
My friends wanting me to wear a borrowed wetsuit
and scuba gear and go down untrained.
My sister floating in the depths, dead eyes open.
But she has been dead for years, I think.
And this is the sea of dreams
my unconscious
the greater unconscious
everything.
So why isn’t my sister’s body dissolving?
Changing to a skeleton.
A skeleton coming apart over the years.

I don’t need a wetsuit
or scuba gear
to dive in the sea of dreams
I can breathe in the unconscious
I have been to the bottom of the sea
many times before.

My niece is four in the dream.
She was thirteen when her mother died.
I think she was lost to me long before that.
The dream knows.
Her mother was lost to me
when my niece was four.
Drowned.

When the dream returns
I will say yes to the dive
I love the sea and the ocean and going deep
I don’t need a wetsuit
I don’t need scuba gear
I don’t need to find my sister’s body
She is gone
Dissolved
I let my past go.

I have not dreamed of the ocean

since.

__________________________________

I really don’t know where my sister is, because of the family schism after she died. Are her ashes somewhere?

This poem wanted to be born. For the Ragtag Daily Prompt: Who knew?

What to check before bringing your elder home from the hospital

I get a call from the hospital (this is over a year ago). They say, “Your friend is ready for discharge. What time can you pick her up?”

I reply, “Can she walk?”

“What?”

“She has three steps up into her house. Can she walk, because otherwise I can’t get her into her home.”

“Oh, uh, we will check.”

They call me back. “She can’t walk. She’ll have to stay another day.”

I knew that she couldn’t walk before they called. She could barely walk before the surgery and after anesthesia, surgery and a night in the hospital, her walking was worse. She had been falling 1-5 times at home and the surgeon knew that. He did not take it into account. The staff would have delivered her to my car in a wheelchair and then it would have been my problem.

She was confused by that afternoon, which is not uncommon in older people after anesthesia. She stayed in the hospital for six days and then went to rehab, because she still couldn’t walk safely.

Recently I have a patient, an elder, that I send to the emergency room for possible admission. He is admitted and discharged after two and a half days. Unfortunately he can barely walk and his wife is sick as well. The medicare rules say that he needs 72 hours in the hospital before he qualifies for rehab. We scramble in clinic to get them Home Health services, with a nurse check and physical therapy and occupational therapy, and I ask for Meals on Wheels. It turns out that Meals on Wheels will be able to deliver in two months.

The wife refuses to go to the emergency room. I tell her that if she does get sicker, that they both need to check in. The husband can barely walk and is not safe home alone. If one gets hospitalized, they both need it.

If you have a frail elder, be careful when you are called about discharge. Go look at them yourself, make sure that you see that they can get out of bed, get to the bathroom, walk up and down the hall. Can they eat? Do you have steps into your house or theirs and can they go up the steps? I got away with saying please check that my friend could walk because I am a physician, because I knew she couldn’t and because there was no one else to pick her up. Do NOT ask your elder. They may want nothing more than to go home and they may well exaggerate what they can do or be firmly in denial. You want them to be safe at home, to not fall, to not break a hip and to not be bedridden.

For an already frail elder, even two and a half days in bed contributes to weakness. And being sick makes them weaker. If they are barely walking when they are admitted, it may be worse even after just 2-3 days. I used to write for physical therapy evaluation and exercise when elder patients were admitted, to help them for discharge. Once I got a polite query from physical therapy saying, “This patient is on a ventilator. Do you still want a consult?” I reply, “Yes, please do passive range of motion, thank you!”

Your elder does not have to be doing rumbustious dancing before they go home, but they need to be able to manage stairs, manage the bathroom, manage walking so that they can get stronger. Otherwise a stay in a nursing home or rehabilitation facility may be much safer for everyone.

For the Ragtag Daily Prompt: rumbustious.


Love and grief

I got a letter from a family member, talking about happy memories of my father, mother and sister, who are all dead. How much fun they were and my mother’s influence taking them to museums, art museums and the Smithsonian.

It’s a bit difficult to answer, since my memories are much more complicated and tangled.

I wrote a poem called Butterfly Girl Comes to Visit a long time ago. It is about my sister. My mother could charm a room full of people and enthrall them with stories. Sometimes the stories were about me and my sister and actually making fun of our feelings: fear or grief. However, my mother was so good with an audience that I didn’t break the stories down until after she died. She was 61. That involved exploring a lot of really dark feelings. My sister and I even asked my father what our mother was really like: his reply was “Morose”.

I inherited my mother’s journals. My sister told me not to read them because they were “too depressing”. I don’t agree. They explain some things. My parents often fought, screaming at each other at 2 am while I was in high school. The family story was that my father was an alcoholic. As an adult, I wondered why she would fight with someone who was drunk. Her journal says “I drank too much last night,” over and over. Well, that would explain it, right? It takes two to tango. Or fight.

My sister could also charm a room. That is the sparkle in the Butterfly Girl poem. There was a period where she would tell me that I couldn’t talk about certain things, that she was fragile, that I was hurting her. This is after I gained control my feelings and had actual boundaries: I could refuse to fight with her. Before that, she could set me off like dry tinder. Her first husband called me once, saying, “I can’t not fight with her when she wants to fight. What do I do?” I replied, “I can’t either. I don’t know. I am so sorry!” I think it took until I was in my early 30s to refuse to fight with her and took a lot of conscious work. A fiance that broke up with me right after college told me I was an ogre when I was angry. I took that seriously and worked on it. My parents were not good role models for dealing with anger or grief or fear.

I am not much in contact with my maternal family. One person said that we could be in contact if we only said nice things about my mother, father and sister. I suggested we never mention them at all. We did not reach an agreement. I realize that our society wants to speak well of the dead, but to really be someone’s true friend, I think we have to accept that people may be angry at the dead as well. I gave this handout, Mourner’s Rights, to a patient on Friday. He is in the midst of grief and we talked about it. He thanked me and said, “I am grateful to talk to someone who knows about grief.”

My parents moved to Washington State in 1996. My mother was diagnosed with stage III ovarian cancer in 1997. I moved to be near them when her cancer recurred, arriving on Y2K. My mother died on May 15, 2000, four and a half months after we arrived.

My mother was only in that area of Washington for four years. She made such a charming impression that I had people tell me how wonderful and charming she was for a full decade. I was working though the complex feelings about her and tried very hard to thank people, even though I did not feel thankful.

I have not answered the letter yet. I want to return a gentle replay but I will not play the “only happy memories game”. I don’t mind my dark feelings. The family member would mind my dark feelings, I think. It is nice to be a physician and to be allowed to let patients talk about their dark feelings. Our culture wants to deny them, remove them, be positive. That is a disservice to love and to grief.

People are astoundingly complicated.

For the Ragtag Daily Prompt: astound.

The photograph is of my friend Maline, me, and two of her husband’s family members. Maline was one of my alternate mothers, a friend of my parents. She died within the last few years.

Thinking about this and that

I am thinking about thinking. What do people think about most of the time?

This partly comes from my ex. He thinks out loud a lot, an external processor. My daughter and I wanted to know what he thinks about. My son asked. “Dad, what do you think about?”

“Golf.”

“Golf?”

“Yes.”

“Anything else?” says my son.

“No.” says my ex.

I have no idea if this is true or not. Sounds hella boring to me, honestly, but he seems entirely happy with it. De gustibus non est desputandem.

I had lovely winter holidays, celebrating EVERYTHING. I went to my son and daughter-in-law’s out east. My daughter and her significant other came out and we did presents on December 27th. Then we went to see my two aunts and uncle for a couple days. They are in their 80s and delightful! Back to my son’s and we saw my kids’ remaining grandparent, my ex-husband’s father’s significant other. Got that? And one of my kids’ paternal cousins with her significant other. I stayed with old friends for the last three days, which was also delightful. We went to the Smithsonian American History Museum and read every single thing. But only in two exhibits because that place is huge.

Now I am back to my current home and hello, cat! Back at work as well. More about that next time. The sands are shifting and I may be in another clinic. Monday a patient asked if I am their new doctor or am I a floater? I said I prefer “Temp” to “Floater”. She laughed.

For the Ragtag Daily Prompt: think.

All home

My daughter and her significant other arrive two nights ago and we open packages and stockings yesterday morning. Lots of laughter and chocolate and much contentment. Now I have a climbing harness in pale green! We did not climb yesterday, I was too tired. We did go for a park walk on an old golf course and had a delicious dinner. It is lovely to all be gathered here and trading stories and jokes and family silliness.

Today I am up early. We will drive down to see my two aunts and my uncle. The great aunts and uncle to the kids. A very delight!

For the Ragtag Daily Prompt: contentment.

Vision

What will peace look like? People
will still disagree often
but like my parents they will appreciate
evidence and science. They will listen
to each other with interest, with respect.
They will bet a penny or a quarter or a million
imaginary dollars and one will go to look up
the correct capital of Azerbaijan, while
the other argues that they MEANT back in 1478,
really, so they do not owe one million imaginary
dollars and they both start laughing again.

_______________________________

The photograph is of the ice in Echo Canyon, two days ago. Or maybe it is angels, waiting.

Surreal failure

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.

For the Ragtag Daily Prompts: failure and surreal.

From Washington to Colorado

Whew! My daughter and her friend leave Denver to drive here Tuesday night. They hope to beat the storm. I am anxious. After 4 hours they are past the second pass, but the bottleneck is the visibility. It is exhausting to try to peer through the blowing snow and the lines on the road are covered. They stop at a motel. Whew! I can sleep!

They got here yesterday and made pies while I was at work. No bottleneck Wednesday, clear road and clear skies.

Half-Fast at halffastcyclingclub asks how I ended up working in Colorado.

I work in Colorado fresh out of residency. I did residency at OHSU in Portland. My now ex says, “Let’s go somewhere sunny, I am sick of the rain.” I reply, “Fine, find me an interview.” He does. One of his co-op housemates from Madison, Wisconsin is working as an emergency room doctor in Alamosa and directs us to a group there. We go.

In 2000 we move to Port Townsend because the Alamosa job is making me miserable, my mother has ovarian cancer, I have a job offer, and my parents are in Chimacum, Washington. Our clinic folds, as do nearly all the primary care clinics, into hospital employed clinics in 2002. I work for the hospital until 2009 and then start my own small solo clinic. This makes the hospital very grumpy. I close in 2021 because Covid and I am not comfortable signing another lease. I go to work in a town north of Port Townsend, in the next county. However, I can’t enforce the mask rule there. I get Covid in 5 weeks and am on oxygen for a year and half, and out for two years. I start some part time work.

I did not think I would get better enough to work but I do. I contact a couple locum tenens companies and start looking for another position in Washington. A less abusive one. The town north of me had only twenty minute visits, no administrative time to read laboratory results, xray results, specialist notes, notes from the previous doctors and honestly, the patient charts were a mess and looked like hoarder houses. So now I knew what to look for and avoid.

At some point, the locums representative says, “What about Colorado?” “Where?” is my reply. I do not want to go too high in altitude after having to recover for three years. Alamosa is at 7500 feet. “Grand Junction.” I look it up and it is at 4600 feet. I have already visited my daughter in Denver and was fine, so I think it will fly. “Yes, let’s try it.” In the interview I am much better at scoping out the schedule and how they handle controlled substances and whether there will be time to do the work. I bargain for slightly shortened days. Being close to my daughter is one attraction and I have read about Grand Junction and the fabulous hiking and mesas and mountain biking.

And that is how I came to Colorado.

For the Ragtag Daily Prompt: bottleneck.

Snew

“Knock knock.”

“Who’s there?”

“Snew.”

“Snew?”

“I don’t know, what’s snew with you?”

I will have to pull out my patience cards today because, yes, it’s snowing. And I have family supposed to come from east and apparently that atmospheric river is dumping in the mountains. It’s supposed to snow in the mountains until midday Thanksgiving. I’m not sure I can have the whole meal all ready for them to arrive.

Ok, but patience, and let’s get creative. We could always do the cooking and have the meal on Friday instead of Thursday.

It is supposed to turn to rain here and the snow will be gone by noon. I jumped out of bed like a little kid, though, shouting “SNOW!” Sol Duc is unthrilled. The roads don’t look too awful and I wonder if anyone will cancel in clinic or it will be as usual.

Yesterday was a bit of a zoo, mostly because over 100 people realized that they are nearly out of some prescription and called for a refill. I knocked my message box down from 48 to 31 in the first 25 minutes and then it kept piling back up over 50. I also wish that if an 87 year old has a serious emergency room visit, they’d give me a longer follow up, because it can’t be done WELL in 20 minutes.

I expect that today will continue a bit nuts. Getting ready for Thursday and Friday off, to lie around pooped!

It’s all good.

For the Ragtag Daily Prompt: patience.

Low fog

I took this on New Year’s Eve on a walk with my kids and old friends in Maryland. We fooled around in a park. I like the low fog hanging in the trees, always further away when we walked to it.

Seesaw, Margery Daw, Jackie shall have a new master
He shall have but a penny a day, because he can’t work any faster.

That is the version of an old nursery rhyme that I learned from my mother. There is more about it here.

I am going through and starting to delete old blog posts and photographs to make room for the new ones. Not one of my stronger talents!

For the Ragtag Daily Prompt: seesaw.