lunar

Who is this diving? Can you tell?

Whew, at the end of Blogging from A to Z, happy things all month. I am tired. This weekend I went to see my daughter at college. We went for a walk and saw the above bird. More than one. Have you guessed?

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This is a Common Loon, in breeding plumage, here.

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I love the precise collar of black and white that stops at the back of the neck. They swim much lower in the water than our mallards, and the mallards don’t dive.

Ready to dive:

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Gone!

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Rest from the Blogging from A to Z Challenge! Right now we have 248 people who have completed it: here.

Zzzzzz

The letter Z: zzzz. Zzzzzs, blessed sleep.

My friend is not asleep here. But what a place to sleep!

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And sleep in the sun!

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Sleep on a couch!

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Sleep in a boat!

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And back to the daybed.

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Blogging from A to Zzzzzz, and the challenge is done.

Z

y for yes

Blogging from A to Z, happy things. Y for yellow, yearn and yes! w

I yearn to get more exercise. Sort of. I’m not making it enough of a priority. I did walk to work about a week ago and lots of trees were topped with birds. First a yellow shafted Northern Flicker. Am I sure it’s yellow shafted and not red shafted? Well, no. I would need a brighter day to see it’s tail that well.

Next:

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Corvus, the crow. Here. Next a robin:

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And who is this? Very upright and about the size of the crow:

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The branches made it a tricky focus shot and I zoomed all the way in. There! Yes!

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I think this is a juvenile Swainson’s hawk, here. It could be a Cooper’s hawk but doesn’t have a long tail. Correct me, birders, if I am wrong!

Yes, yearn and yellow…. yea for the letter Y.

Y

 

 

water to wash

Happy things from A to Z, the letter W. W for water, wet and wash!

We were very excited about the green turtles in Hawaii. But we photograph birds too:

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Down by the water, checking it out. Then the featured post, bathing in the sea. And a clean wet bird:

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We think this is a yellow billed cardinal, originally introduced from Brazil, here.

W

Blogging from A to Z, the letter W.

veil

Happy things from A to Z: the letter v. V for veil and vulnerable and vamp.

While we were in Hawaii, there was a rain squall that blew up. We went back to the car and as you can see, the other photographer crashed. Really really asleep, veiled by a towel.

We are vulnerable when we are asleep. Relaxed. Out. The rain was ferocious. I felt protective while he slept. I also felt protected by the car…

And then vamp! Our noon Rotary held a fundraiser to update the kitchen of the Boiler Room. We dressed up, went to dinner and contributed money. The Boiler Room is a drug and alcohol free welcoming space in Port Townsend that has given out tons of free meals and soup and employs people as well. We are from the Sunrise Rotary. All the groups help each other. The theme was something about the old west and they had teens from the Interact Club to take pictures with our cell phones:

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We were being serious for a moment. I could definitely make up a story about the picture!

And vamp it up! I was trying red lipstick for the concert on Saturday. I am in a small group called the Starlets and we sang Andrews Sisters songs. Red, red, red!

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V

Blogging from A to Z, the letter v.

Under us

I am thinking about Earth Day today, because on Earth Day I was singing in two concerts.

My theme is happy things: under, us, universe.

Under us
earth
over us
universe

One attendee at the concert said that we added to the joy in the universe.

Happy Earth Day.

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U

Blogging from A to Z.

 

 

 

 

rainshadow

Blogging from A to Z, the letter R for rainshadow, rehearsal, raise your voice! Only I did R yesterday and should be on the letter S! Sing, shout and shadow…there, whew!

My father and seven other people started Rainshadow Chorale in 1997. I joined when I moved here. He died in 2013, but we are still singing. Two concerts today and one tomorrow, and by yesterday they were nearly sold out. All three.

We had a dress rehearsal last night, with Rebecca Rottsolk, our brilliant director, doing the final touches. It’s the first time that we rehearsed in the space that we will sing in, so we pay close attention to how we sound there.

And raise your voice in song and praise! We walked this morning and traded songs with the birds: song sparrows, red wing blackbirds and quieter birds…the above photo of the bird slipping quietly through the ripples. Here is another view:

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I think that this is a Hooded Merganser, here. Hooray for happy things and the letter r. And the letter s too!

R

S

question

Blogging from A to Z, Q is for query, quest, question.

I took the afternoon from work yesterday to go for a walk with my son, who is visiting from Maryland. We went to Chetzemoka Park and down to the beach. More blue herons and more photographs! Hiking back, we saw a halo around the sun, above the ridge. I know that this is formed from a reflection of ice crystals in the atmosphere, more information here. It is magical! And there was something in the tree…. what is it? A quest with a zoom lens reveals:

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In the first picture the angle is different and the eagle is right by the trunk of the tree, difficult to see. We were watching great blue herons take off from the beach and land in  trees on the ridge but I heard an eagle’s cry and the silhouette is wrong for a great blue heron.

Queries and questions and quests: happy letter Q.

Q

P for prior authorization

The letter P and my theme is happy things. But what comes to mind are these P words: prior authorization,  pharmaceutical, payer.

Prior authorizations are NOT a happy thing. The latest twist from insurance companies, three different ones in the last week, is that they are requiring prior authorization for old inexpensive medicines. I ordered a muscle relaxant for night time only on Thursday last week for a person with a flare of back pain. Friday I was dismayed to see that the insurance company was requiring a prior authorization. I have to prioritize the order of urgency of all the work: I did not have time. I called the patient who had paid cash for it. The insurance company wins. They didn’t have to pay for a covered medicine because they made it difficult to get. They keep the patient’s money.

Prior authorizations are on the rise very rapidly. With over 800 insurance companies, each with a different website, each with multiple insurance “products”, no one can keep up with it. It is a shell game, the ball under the cup, three cups moving, but the ball is the money and it’s already palmed by the insurance companies. I predict that this will continue to get worse. We do need a single payer system for the simple reason that physicians will not be able to hire enough staff to learn and navigate 800 different websites. I do most prior authorizations on the phone in the room with the patient: the other day we spent 35 minutes on the phone only to have the insurance company say that we had called the wrong number. Call another one. Not the one on the insurance card. We could complain to the state insurance commissioner, but my patient is afraid of losing their insurance. Time’s up. The prior authorization is not obtained, and we are five minutes into the next patient’s visit. People are finding that the medicine they have taken for 20 years suddenly requires prior authorization.

And remember: prior authorization is your insurance company making rules and extra paperwork for your physician. It is advertised as a way to save money, but it costs YOU money. Back in 2009, the estimate was that physicians in the US had to spend 90,000$ per year EACH on employees to do prior authorizations by computer or phone. And YOUR insurance dollars go to the employees at the insurance company refusing medicines and dreaming up new medicines to refuse. They change the contract. Every year and during the year. The law is now that 80 cents of each dollar must go to healthcare, not profit, but those computer and phone employees are counted as healthcare. Do we really think that is healthcare?

Take CT scans. Medicare does NOT require prior authorization. But most insurance companies do. Think about that. Is age the difference? CT scans increase cancer risk over time so physicians don’t order them by reflex.

And for pharmaceuticals, insurance companies often have an on line formulary. But it is different for every insurance “product” in individual companies. A patient and I were trying to sort out a less expensive medicine on a website and we were having difficulty figuring out which insurance she had. Multiple abbreviations and color coding and we could spend the entire clinic visit just figuring it out. Is that what medicine is in the United States? You can say that someone else in the office could do it, but the more employees your physician hires, the less time the physician will spend with you, because he or she has to pay all of those people.

If there was one set of rules, one website, I would learn it. Medicare for all, single payer, when will the United States people wake up and tell congress: if you want our vote, make it so.

P

But wait, where are the happy things? I am so happy that I still am in business in my small clinic, p for patients and patience and prayer and single payer, we will have medicare for all in my lifetime. Whether I am still a practicing physician in the US at that time is uncertain. If I can’t afford my own health insurance, my clinic will close. Wouldn’t that be ironic?

 

Happy no

Name, noun, nut, gnome, know, no…

I have a nutty streak, a silly streak and love silly things. It helps me to balance clinic. Sometimes things are hard there, I hope to be able to do something for many people that I see. Half my patients are over 65, one is now 100, and no one lives forever even if I recommend the right things and they live a medically perfect life. I am always mourning for someone.

So my nutty streak comes out with listing words for the letter N and adding gnome and know. Are they N words or not? I think they are.

And my happy thing today is the word NO. How, you say, can NO be a happy thing?

This weekend I wanted to do too much. I wanted to attend a retreat about change that went from 9:30 to 3:00 but I also was already tired. It would be with a  group of people that I don’t know well, so my introvert side would be on guard. My son was coming into town and I needed to make choices and save energy and say no to myself. I went to the retreat, but only for two hours. I wanted to stay longer but did not. And that protected my energy for the next day and this busy week.

Do you argue with yourself and want to do too much or something your shouldn’t or spend too long on something that you didn’t plan to? Look, I thought this would be a very short post to catch up….

N

There were three great blue herons on the beach the other night, and then an eagle in the surf. The herons were fishing but also watching the nearby eagle, the people on the beach, loose dogs going by, and each other. Their feathers were windblown and they made me think of teens at a dance, looking at each other with interest, but pretending they were more interested in fishing.

Happy Blogging from A to Z!