The sperm form all through a man's life and die after what, ten weeks? if they do not fertilize the egg
The egg
now that is a different story the egg contains nutrition to tide the new being over until the placenta is implanted
and it has the mitochondria "the power house of the cell"
the sperm have no mitochondria
the mitochondria are maternal only
when do the eggs form?
the eggs form in the fetal girl eight to twenty weeks after fertilization by the time she is born she has all the eggs that she will have
some will mature some will not most will die
the most common abortions are "spontaneous" abortions performed by God
we grieve anyway
except when we don't and when we are relieved
So when did I form?
not when the sperm met the egg sometime in June 1960
my mother is born in May 1938
she is forming me as she develops in my grandmother's womb
I am started sometime in 1937
do not tell me that life starts in humans when the sperm meets the egg
because that is wrong rong again
that is the male view isn't it? years ago they think that the man contributs the entire homunculus to the womb of the woman and she is merely the vessel
also rong
and if each baby girl holds eggs and lives that are already started
you would think
that we would treat women better
it isn't penis envy that kills women
rong again
I think that it is envy of the women and the mitochondria
maybe if we understand the eggs the mitochondria that women carry from before birth
maybe
we will treat women and girls better
___________________
I can't credit the photographer because I am the little girl in the canoe. The photographer is family, no doubt, and dead. Except for their genes, and some of them live on.
Once again here I go out on a limb. Here is my prediction for the next Really Big Thing in medicine, which is already happening. It is slowly rising from the murky swampy depths of our unconscious.
Autoimmune encephalitis? Or encephalopathy? What a mouthful. And what the hell?
Well, we have always said that we do not know the causes of depression, mania, schizophrenia, psychosis and all the other psychiatric diagnoses.
And now I think we know, though we don’t have them all sorted yet.
The cause is the immune system. And what’s more, it’s adaptive.
“NO!” (you run screaming from the room). “Not MY immune system! NO!”
Yes, I say, your immune system, my immune system, everybody’s immune system.
WHY? Well, my version shuts me down. I get tachycardia (a fast heart rate), short of breath, accusations that I am manic, my fast twitch muscles don’t work and I get pneumonia. And it lasts longer each time. Two months. Two months. Six months. A year and a half on oxygen and then off but really it took four years before my muscles started working right again. It shuts down my fast twitch muscles but not my slow twitch muscles.
So how is shutting me down adaptive?
Think. If there is a pandemic, or huge danger, or someone is trying to harm me, it isolates me. People think I am very very weird when it is happening. So I isolate, to protect myself. Isolate and voila — protection from pandemic. If I have resources, and luckily I do have resources, I can hole up. Food, drink and a broadband connection.
The book Brain on Fire and movie are about an encephalopathy: antibodies to NMDR that made the author psychotic until it was recognized and treated. I went to a virtual continuing medical education on encephalopathy in 2022, I think. In the US alone, there were already 555 patients identified with NMDR antibodies.
Now there is a whole list of antibody encephalopathies, many associated with cancers. Not all.
A physician friend calls me a few years ago. “Have you heard of NMDR antibody disorder?”
“Yes,” I say
“I have a patient with it,” she says. We are a county of 32,000 people. Rural. She is looking it up. I tell her what I know.
In January I see a patient who turns out to have Anti-Caspr2. I have to look it up. Now I see the list of encephalopathies that is rapidly becoming longer and longer.
I think that chronic fatigue, fibromyalgia and long Covid fall into immune system disorders too. Just because we haven’t figured out the mechanism: well, we may. If we don’t destroy the planet first.
I also have reservations about treatment. We are using more and more immune suppressants. I read about one that stops B cells from working. Specifically, the B cells that produce antibodies. Well, that would work for my disorder, except, I already get pneumonia really easily. And destroying the B cells lowers immunity and increases the risk of infection.
I see a patient in clinic who has a skin infection and a fever and an autoimmune disease. They are on an immunosurpressant that I don’t know much about. “Have you called your rheumatologist?”
“No, why?”
“I think you are supposed to stop the immunosupressant. Please call them today. And let me know what they say. Please!” I start antibiotics.
The patient sends a MyChart message. Yes, stop the immunosupressant while on antibiotics. In the future they will call the rheumatology office as well as seeing the clinic for any infection.
I am not saying we shouldn’t use immunosupressants. Sometimes we have to. Rheumatoid arthritis. Hypothyroidism, the most common autoimmune disease, yes, we should and do give outside thyroid hormone. But there is something else we need to do.
The clues for this lie with chronic fatigue and fibromyalgia. What triggers them? One in ten severe infections, severe stress, or a combination.
So we need to learn as a culture, as a world, as humanity, to lower stress. We can’t be high sympathetic nervous system fight or flight high achieving high spending higher faster crazier all the time.
Here is to the parasympathetic state. That is where we need to go. Go down, slow down, be kind to each other and ourselves, be gentle, laugh, fail, lie in a hammock, watch silly cat videos and fat bear week. Then the immune system might calm down and not attack us to save us. I think the immune system is pretty smart, really. Even as it pisses me off and limits me.
I know before she does but maybe not maybe she knew that last year
brave front while soliciting money on the internet as the cancer progresses
she describes new treatments I forget how many rounds of chemo she endured
eight years from diagnosis to death
I stop visiting for a year after she bullies 30K more from our father
and he calls me crying
I give myself permission to change to be a physician more than a sister
because as a sister my sister is cruel
she destroys my reputation with my mother's family
or maybe they already don't like me because I think the family rules are ludicrous and stupid
and I won't follow them
I suppose each generation has someone who says wait these rules make no sense
why are we following these?
I think she will die by February 2011 but there is another death unexpected
the death of my hope for a sister who loves me for a sister who treats me well
for a sister who loves me
and I let that hope die and I rise from the ashes and I choose not to visit
and she uses this tells people I won't visit though I don't say I won't
people sent me checks
I sent them back with thanks saying
it is too soon to leave my nascent business
my sister stays in touch this year
at last in February 2012 she calls me
my oncologist referred me to hospice but I am not going
yes, I know you are refusing to go
I don't saybut the cancer is progressing and like it or not
you will go
my sister applies for a clinical trial miles away
and at last her enthralled circle refuses
they say we are so tired we cannot drive you there
daily
I fly down for a long weekend and the hospice interview
I am excluded but ask to step in at the end
I ask the nurse is this like where I live that if there is a stroke
or a blood clot or bleeding or whatever horror
hospice will keep her comfortable
but will not treat it?
yes
says the nurse
my sister stands pushing away from the table NO she says
I AM NOT READY
yes, I knew that
you are not going
I don't say but you will go willing or no
I fly down a second time and as I leave she cries
I am surprised
we have not talked really
there are so many people in and out and I've been portrayed as a villian
there is still time
I fly down a third time
she is angry, angry now in hospice angry that she is dying
I start to sing a lullaby and she says NO
I study her I sing Samuel Hall
To the gallows I must go I must go I must go
To the gallows I must go with my friends all down below saying Sam I told you so
damn their eyes damn their eyes
saying Sam I told you so damn their eyes
she smiles a vicious secret smile
she is in renal failure strange says
I have to take a trip
I say yes you do
I don't know how
You will figure it out
How will I find you?
I am surprised again the connection is still there buried deep
You said I can take the dragon home the one I made in college and gave you
You are born in the year of the dragon you will have wings find the dragon
and you will find me
oh, good she says relieved
she speaks of a bad pig
I say maybe it isn't bad maybe it's done some bad things
she shakes her head
I say shall I take the bad pig away?
she still is not satisfied
I guess: do you want me to keep the bad pig from hurting anyone else
yes she smiles yes
again we are alone
I am Bad she says
You are not bad I say You have done some bad things
Very bad
She is crying
I say I love you anyway
and she blooms like a rose soft in a dark orange blanket with matching lip gloss
forgiven and reconciled
flying home I name the dragon Bad Pig
and gird myself for death
three days later she dies
and then the fallout and the aftermath begins
_____________________
I will attach this to the Ragtag Daily Prompt "escapade", though I think of escapades as fun. The escapade is the photograph. She and I were dancing before my wedding, in 2007. I am the short one and clearly I was teasing her about something.
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?
I am done with my third Grand Junction travel doctor assignment and packing to go home. I don’t think much of my temp company at the moment. I had to nag them for two weeks regarding the travel plans. I had to call both airlines (one hour 18 minutes and one hour 38 minutes) to be sure that taking Sol Duc on board the plane is arranged (it wasn’t). I called the hotel for the day between planes and they do not take pets. I called the company that takes me from the airport the last two hours home and they DID know about the cat. One out of four. They finally switched the hotel on Friday, the last day of work.
Then at 5:18 pm I am sent an email saying I have to vacate on the 19th. The first plane is on the 21st. It was sent by the rep who is covering me and knew the travel arrangements are for the 21st. I am glad that I pay way more attention to detail as a physician than they do to my travel and housing. They frankly suck. And I am not vacating until Monday. They may charge me at which point I will say they need to pay me for spending more than 5 hours fixing their travel screw ups.
I did say to the rep on Friday, “Well, if it’s not arranged today, I will just call the emergency travel line at 5:01 pm. They will help me.” The emergency travel folks cost them more money. That apparently caused them to do the last arrangements. I am doing the travel in two days because otherwise my cat would be in the carrier for 12 or more hours. That is not reasonable.
I am done except for travel home. Today I finish packing and cleaning.
The photograph is Sol Duc in front of our rental house yesterday. I think she will miss the heat here. She seems to quite enjoy 90+ degrees.
I am in a neighborhood, of cul de sacs that don’t connect. My house is quiet in front but backs on a very busy road, an artery. The speed limit is 40 mph but people often go faster.
The house seems odd to me. There are curtains and shades on every window, all closed when I arrived. I open them, because I like light. There is a 3 by 4 foot television in the living room, another in the master bedroom and a third in a guest bedroom. There is a large kitchen with tons of shelves and cupboards, but a table only seats two, and there are two more chairs at the counter. This feels very odd to me. It seems as if the whole house is arranged to watch television.
I go for a walk in the neighborhood. There are many houses. There are beautifully trimmed lawns and there are flowers and some roses. What is missing? There are no people. Walking a mile and a half, finding the mostly hidden corridors from one cul de sac to the next, I see one man working on his lawn. Even though it is Saturday afternoon, I seen no children, no dogs, no toys. I see two garages that are open, one with a man and in the second I hear a child. Why are there beautiful lawns and no people? And many of the lawns have little flags saying, poison sprayed.
I do turn on one of the televisions after my first day of work. The living room one says that the antenna is not hooked up. The guest bedroom one works. I look on the service. Nearly every movie is about violence and conflict.
I do a little research on the internet. I go to the library and take out 8 books. One is Nonviolent Communication, by Marshall Rosenberg, PhD. Most of the others are fiction. Yet so much fiction is about conflict too. Good triumphing over evil. I am pretty good at nonviolent communication in clinic after 30 years: I want to meet each patient somewhere that is helpful. Sometimes they don’t like what I find, or don’t want to do what I recommend, but I have a deep and abiding faith that everyone can change, that they are smart, that I can make a difference and that they are capable. I think that belief helps daily in clinic.
I choose this book because I want to be better. Some of my family is estranged. I thought that was rare and horrifying at first, years ago. Now I think that it is horrifyingly common, much more common than I realized. How do we heal this? What can we change? I don’t want to be in a dark house with the shades down watching “good” triumph violently over “evil”.
There is a pond, man made, with a fence around it, half a block from my house. There are two male mallards, a female, and eight ducklings. They are fuzzy and delightful. I stop my car and watch the first time I see them, and I walk over too.
I haven’t seen anyone else there. I think we can change. I have hope. I have a deep and abiding faith that we can change.
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.
This is not a brilliant photograph, but it is interesting. This is taken from North Beach in 2022 with my cell phone. It was a very grey day and wet and we heard roaring. I imitate both animals and birds, so I roared back and tried to match the call. This is the response. These are sea lions and they can be enormous. The elders and biggest ones stopped and stuck their heads out, wanting to know who is there? Thankfully they did not come ashore, because the males can be 2.4 meters long (7.8 feet) and 390 kg (859 pounds). We did stop roaring, a bit intimidated. We had roared back at them other times. The sea lions are moving north, more information here.
I am trying to find time and energy to keep removing lots of old blogs and photographs to make room for the new. I could pay for more space, but then I have to keep paying for it, so I don’t want to. I have gone back and read my 2009 posts, no pictures, from the Mad As Hell Doctors trip and from writing elsewhere. I write more often with the Ragtag Daily Prompt, but the longer medical posts are intermittent.
Work has been interesting and I feel a bit off balance, because the plan is in flux and morphing. Right now I am in the same clinic Monday through Thursday, but at two different desks. I won’t be in this clinic for the rest of the assignment unless something changes. I don’t know where I will go next. Primary care has lost two providers in the six months I’ve been here, but I don’t know if that is an ongoing rate nor how many there are total.
My first job out of residency had a terrible turnover. I was fifth senior doctor out of fifteen in two years. That is a really really bad sign. By the end of the second year I was fairly sure that I would not be staying and that I could not change the culture. The three women doctors that I had joined had been trying for two years and one had already left! I was gone by the end of the third year.
And back to roaring with the sea lions. Here is Walt Kelly’s take on roaring, his poem Northern Lights.
Oh, roar a roar for Nora, for Nora in the night,
For she has seen aurora borealis burning bright.
A furore for our Nora! And applaud Aurora seen!
Where, throughout the Summer, has our borealis been?
People don’t know she is a bear. She carries a bear, a teddy bear. It is named S Bear, after her husband. He died of cancer a while ago. So she carries a bear named after him. The first time I met the bear, I asked if it needed a teacup too. Because people make clothes for it and I don’t know how far it all goes. No, the teddy bear did not need a teacup.
My friend C. is a bear. She writes horror stories under the name lostcauser. The writer is from Tennessee and so is C. The stories are horrid. Lostcauser is an anagram. Rearrange the letters and you get closet ursa. Closet bear. Hidden bear.
She is not my only friend who is a bear. She is aware of her bearness, her ferocity, the beast inside. Bears like honey and blueberries, too, they aren’t just monsters. My other friend dreams of a one room shack in the woods. His dead brother is at the door shouting for help. His brother is being attacked by a bear. A huge terrifying bear.
“Did you invite it in?” I ask.
“It’s a BEAR.” says my friend.
“It’s a Dream Bear.” I say, “I would ask what it wants.”
“You don’t understand bears,” says my friend.
“I understand a lot about dreams. Some think that everyone you see in a dream is a part of yourself. It can be a part that you don’t accept.”
“Bears attack. You can’t invite them in.”
“I would ask the bear in. I would ask the bear if it would like some tea.”
I tell another friend about one of my dreams. There are monsters screaming. I go towards them.
“TOWARDS them?” says my friend. “Why would you go TOWARDS them?”
I have to think about it. “Well, they are screaming. They might be hurt. They might need medical care. I have to go help them.”
My friend shakes his head. “Only you,” he says, “would go towards the screaming.”
One time in my neighborhood, I hear horrible screaming. I get up. It is 1 am. I go out and try to find the screamer. I don’t find anyone. A few days later, I read that someone nearly severed their arm somehow, in my neighborhood. A policeman saves his life with a tourniquet. It was three blocks from my house, at the grade school. The grade school is where I went. I think the person was knifed, but I don’t know. My neighborhood does not get a lot of that sort of thing, at least, not a lot of screaming that wakes me up.
I wonder about my friend that is attacked by a dream bear. A bear that is much bigger than his dream self and his dream brother self. There must be a lot of darkness in that bear. It is angry about being ignored.
My friend C. is a bear. She knows she is a bear. Reading her stories, I do not think she likes being a bear.
I don’t mind if she is a bear. I wonder if we will have tea again some day.
____________________
For the Ragtag Daily Prompt: fan. Why? Maybe I am a fan of bears. Or maybe fans make me think of hats and gloves and tea parties. And bears.
This is based on speculation and some true events.
Discover and re-discover Mexicoβs cuisine, culture and history through the recipes, backyard stories and other interesting findings of an expatriate in Canada
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
Refugees welcome - FlΓΌchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflΓΌchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
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