May 18, 2024 by drkottaway

HOPE!

Elwha has been spotted, I am pretty sure, three times out back in the bushes where he disappeared. Now, if I can get him to come out. A very nice person sent photos. It looks like he’s dropped serious weight since he ran off. I am going to sit out there this evening and see if he will come to me.

April 14, 2024 by drkottaway

Tenacity

Two skills needed in primary care are tenacity and listening. That is a combination that can make a diagnosis. Here is an example.

In residency, many years ago, I have a patient with developmental delay. He lives in a group home. He can’t talk though makes some noises. The group home staff bring him to me. His head is misshapen because his mother had measles in her pregnancy.

The staff says, “We think his head hurts. He just isn’t behaving right.”

“Did he fall?”

“We don’t think so.”

“Fever? Nasal congestion? Cough?”

“No.”

“How long?”

“Over the last week.”

I do an exam. I really can’t see his tympanic membranes because of his skull shape.

“Maybe he has an ear infection. I can’t see. We’ll try antibiotics, but if he is not improving, bring him back. In five days.”

They bring him back. “He’s no better.”

I get on the phone. I need a CT scan of his head and the group home say he won’t stay still. I need anesthesia to sedate him for the CT scan. It takes two tries and quite a bit of phone explaining with both the anesthesia department and the radiology department. Persistence. I am looking for a subdural bleed in his head from a fall, or a sinus infection, or something.

It is done and I get a call. Not from radiology or anesthesia but from the ear, nose and throat surgical resident. He is very excited. “Your patient!”

“Yes,” I say.

“He has a pseudocyst! In his sinuses! He has abnormally large sinuses and this is the biggest pseudocyst anyone here has ever seen!”

“Um, ok.” Honestly, I’ve never heard of a pseudocyst. It turns out to be packed nasal drainage in the sinus. Bad ones can erode through bone into the brain. Certainly that seems like the cause of the headache!

“We are taking him to surgery!”

Residency can be pretty weird, when someone gets really excited about a rare disease or interesting trauma case or whatever. I found that I was entirely happy just doing health maintenance exams and encouraging people to quit smoking and exercise and drink less. However, I was also good at finding weird things.

The ear, nose and throat surgeons in training were very happy about the surgery. The group home staff were happy too. “He’s back to his old self. Thank you!”

It took tenacity to set up the head CT. It’s important to listen to the families and caregivers too, because they know the person better than I do. They were right: his head hurt. And we found out why and were able to treat it.

For the Ragtag Daily Prompt: tenacity.

Water is tenacious too, wearing down stone and wood and glass.

July 3, 2023 by drkottaway

Reveal

The photograph in the Ragtag Daily Prompt guess yesterday is of a beach object. I was sure that it was a fossil, but a fossil WHAT? I picked it up about a year ago.

Last week a friend comes by and says, “Oh, I know. It’s a mammoth tooth.”

REALLY?! I am thrilled. And go search the internet.

https://www.burkemuseum.org/news/mammoth-find-sequim

Mammoths turn out to be Washington State’s state fossil. Mammoths are also the state fossil of a bunch of other states. Texas doesn’t have a state fossil, it has a state dinosaur.

https://en.wikipedia.org/wiki/List_of_U.S._state_fossils

Other people have found mammoth fossils on the beaches here.

A big find: Mammoth molar discovered on Sequim beach

And they have found mammoth remains, including teeth. Mine is just part of a tooth. The chewing edge is shown in today’s photograph.

Did you guess?

December 30, 2022 by drkottaway

Small miracle

Notice the coat. What is missing? Here is a cropped earlier photograph:

We go for a lovely walk in Rockcreek Park in Maryland. It is very cold and the creek is half frozen. My son goes down to the creek and throws rocks on the ice.

The ice makes wonderful sounds and the rocks mostly do not go through the ice. It is in beautiful patterns.

We get cold and are ready to head back. My son realizes that he has lost the button. We spend some time looking for a brown button in brown leaves. No button. We are colder.

When I look at the photographs later, they confirm that the button was lost on that walk!

The next day my ex-husband’s father’s second spouse comes to brunch. She is the last of the six grandparents. We have a lovely brunch. She is a potter and a landscape architect and is helping my son and daughter in law with their garden and yard. After brunch we walk back to the creek, keeping our eyes peeled for the button. She has a button collection but not that button. He might find one on the internet. Or he could contact Pendleton, since it is a Pendleton coat. Very handsome.

At the creek we search in the leaves and along the water, all of us. No button. I cross the little bridge, seeing a lump on the ice the right size and color. I clamber down the bank. “No,” I say, “Oh! Yes! Found it!” The brown button is sitting on the ice. It must have shot across the ice when he bent down to pick up a rock! “Hooray!” we all say. A small miracle for the season. Happy winter holidays and prayers for those lost.

December 3, 2022 by drkottaway

Lit

That moment after the tree is taken down
not from greed but because the trunk has split
dangerous operation; all survive
Even the tree. A split 20 foot trunk may survive.
We won’t know until spring.
You are hunting in the sections that are down.
“Yes!” you say and hold them up.
“Invaders. They’re not native.
I shoot them when they steal the birdseed.
They crawl into the trunk to die.”
You hold a shriveled carcass up with each leather glove.
They too look like leather or shrunken heads.
Your smile lit up
at this evidence of your successful aim:
killing squirrels.

I think this is my first ekphrastic poem. Inspiring photograph, right? So that makes me laugh, it’s so gruesome. I was looking for a photograph for the Flower of the Day and came across this. Taken in January 2022.