Tag Archives: life

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Soldier on

Older
bolder
golder
told yer
moulder
soldier on

What is older? Anything and anyone older than me? At one point I have 5 women who are over 100 years old as patients. Two are 104. One is local indigenous tribe and tells me about white women moving to another pew if she sat down near them in church, back when she is in her twenties. I am apologetic at that visit because it is hospital week. Our pacific northwest hospital has chosen cowboys as the theme so being a bit oppositional defiant, I have braids with one feather hanging down. I swear that EVERY ONE of my indigenous patients comes in, including the 104 year old. I apologize, but they mostly seem amused by my rebellion.

They also influence me. Now when a 72 year old complains about being OLD, I say, “You are not old in my practice.” They look confused. I say, “I’ve had five people over 100 all at once, so you don’t get to complain about being old until you are 90.” People laugh, but they also usually look pleased. Over 100 is a LOT older than 72. When someone is over 100, I don’t really doctor them much. I might say, “This is what the book says we should do.” “I’m not doing that,” says my 101 year old. “Ok, cool.” I say. It’s hard to argue with.

And the joke about the centurian? What do you like best about turning 100? “No peer pressure.” Um, yes. I want them to tell ME what they’ve done to reach 100. The one thing that they all have in common is that they are all stubborn. I don’t know if stubbornness is what gets them there or if we just get more stubborn as we get older. Both, perhaps.

By stubborn, I don’t mean that they don’t learn and do new things. I had a woman in her upper 70s who I diagnosed with diabetes. At the next visit she said cheerfully, “I found these five apps for my phone. This one tells me the carbohydrates, this keeps track of the distance I walk, this one tracks my blood sugar.” I don’t remember what the other two did. This was a decade ago. She was retired from Microsoft. I wanted her to teach a class for me and all of my other diabetic patients.

My grandmother took classes in her 80s in lip-reading. She was going quite deaf and her hearing aides were not terribly helpful. She had videotapes and a rather shy teacher who would come to the house. She would glare at him and the videotapes. She attacked learning it like a piranha and was furious that she couldn’t learn it faster. I am like that too and my son learned some patience from the violin. He couldn’t play well immediately and found that practice works.

At what age is someone old? I think that’s moving target and the older we get, the older we think it is. I do think 104 is a lot older than 72. When does your culture think that people are old? My fierce grandmother said that she would look out her window. “I see little old ladies across the street and think, oh, poor things, they are so old. But then I think, OH, I am older then they are!” She died at age 93, fierce until the end and curious about death too. Her last words to my father were, “Look, Mac, I’m dying.” He said, “I’m looking,” and she stopped breathing. She was always curious and funny and could tease quite terribly and she and my mother butted heads and loved each other. She loved my father too, and me.

The photograph is my maternal grandmother, Katherine White Burling and it’s one I took.

For the Ragtag Daily Prompt: older.

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You can have some of the things some of the time

My father’s name is Malcolm Kenyon Ottaway. He went by Mac. He died in 2013. I miss him and I still follow Mac’s Rule.

Mac’s Rule is simple: You can get one third of the things that you think you can get done in a day.

I played with this on my days off for quite a while. I would write a list of all the things I wanted or needed to get done. Once I write the full list, it looks silly. Soon it is clear that he is correct.

When I am working full time in Family Medicine and have a five year old and a new baby, I think about getting something done on the weekend. Clear my desk, organize photographs, that sort of thing. After a while I realize that the weekend was more like this: Meals. Get kids clean and dressed. Laundry for the next week. Clean the house a bit. Do some fun family things! Read to kids and put them to bed! My list changed and instead of the ambitious “organize photographs”, I would think of something very small. Perhaps take one roll of developed photographs, pick some of the duplicates, send them to the grandparents. That was it for the entire weekend.

If I apply Mac’s Rule to my life and list all the things I want to do, which third will I pick? For years I write lists for a day off and then pick the top third that I want to get done. If something is added to the list, a friend calls to go to coffee, I take something else off. I make sure that the list always has something that I need to do on it (and often don’t want to: start taxes, pay bills, clean a bathroom, whatever). And something fun.

I don’t try to do it all. It’s very satisfying to get that 1/3 done on the list. And I feel like superwoman if I get an extra thing done! I get to choose which third to do and think about it. And the stuff that I don’t want to do slowly gets done over time. It isn’t that awful to do one of those duty jobs, thank you letters, tax information, dental appointment, mammogram, every day and then it gets DONE.

I am working with someone who puts RUSH at the start of every single email subject line. I have to say that it makes me want to dig my feet in and not even read the email. What kind of rash haste are they working under and why would I pay any attention to the RUSH by the ninth email? It is annoying and ludicrous. I move those emails to the next day list and don’t read them on the day of arrival. No pressure, so there.

Blessings on my father, for Mac’s Rule.

For the Ragtag Daily Prompt: rash.

The photograph had to be taken before May 2000, because my mother died on May 15 and she is on the boat. I don’t know who took it, another group sailing. Both my kids are there, my father with the tiller, and I am tucked behind the friend facing the camera. Why haven’t we pulled the motor up? This is Sun Tui, the boat currently in my driveway on a trailer.

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Peace Plague

If I can be anything I want to be
today let me be a peace plague.

Let me be a peace plague, airborne,
spread fast in the air
just a breath of wind
two neighbors who are angry stand at a fence
one drops a rake, the other a hose
they stare at each other. “Come to tea,”
says one, and the other comes.
Someone stops writing a letter of complaint
and gathers blankets for the warming center instead.
A policeman aims at a kid with a gun
shouts “Freeze.” and then he freezes too
on an intaken breath, and the kid drops the gun
hands up, breathing my plague.
And in a war zone, one side chokes on the air
and stops firing. The other aims and stops as well.
Both fall to their knees and weep. After time,
some get up and start gathering the wounded. Others
tear sheets into bandages and yet others start moving the rubble
finding the bodies. The bodies must be found and buried
in holy ground before rebuilding. My cousin
opens her mouth to gossip again and inhales and chokes
and stops. She says something other than she had planned.
Peace spreads like a wave, like a plague, and everyone
looks for someone to help.

If I can be anything I want to be
today I want to be a plague of peace.

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Elder Care: Goals

I really enjoy elder care in Family Medicine. Mostly. Even some of the very difficult or very complicated people.

One thing I would try to figure out is what is the person’s goal? This can be quite funny at times.

“Can we talk about what you would want if you got really sick? If you were too sick to talk to us?”

“I don’t want to talk about death.” Ok, this person is in their 90s.

“That is fine, but if we don’t talk about it, your daughter and I have to guess what you want. And we tend to do more when we don’t know.”

That person glares at me. “Oh, all right.”

Sometimes a person says, “I don’t want to die of cancer.”

It turns out that this is an opening. “Ok, what DO you want to die of?”

“I don’t want to die!”

“Well, me either, but I can’t fix that. There are at least three “ideal” deaths that the Veterans Administration talks to people about. Maybe we could go over them. You could put your request in with your higher power.” I have written about the three here: https://drkottaway.com/2023/10/06/an-ideal-death/. The “Hallmark” or hospice death, sudden death and fight it all the way.

But, other than not dying, what is the goal? To stay in one’s home? To move to a retirement organization that has a nursing home and care until death? Home care insurance to stay home? I do have people imply that they will go into the woods or crash their car or something if they get very sick, but not very often. They are usually aware that I have to respond to any suicide threat. How much care do they want? People often say, “I wouldn’t want to be disabled,” but it turns out that life is often worth living even when very challenging. Most people want to be treated for cancer, for heart disease, for congestive heart failure, to go on.

Sometimes death comes from a cumulative load of chronic problems. We had a gentleman in his 80s in the hospital ICU many years ago. He had pneumonia, congestive heart failure and bad kidneys as well as a host of other problems. I sat down with him. “We are treating you, but when we give you enough medicine to help you breathe, your kidneys are getting worse. This is a small rural hospital. I could transfer you to the Seattle hospital, 2 hours away. You would have a cardiologist, a kidney doctor, a lung doctor. Here you just have me and the nurses. Either way, I do not know if you will live through this. What do you want to do?”

He chose to stay. “My family can visit me here.” His family was visiting daily. “I do not want a breathing tube. I do not want dialysis. If my kidneys go, let me go.” We discussed this with the family.

Four days later it was clear that without dialysis, he was dying. Dialysis might have slowed it, but he may still have died. He was no longer waking up. We withdrew the antibiotics and removed most of the monitoring and switched him to hospice. His family continued to visit and he died a few days later.

He did die in the hospital, and yes, we used some machines up until care was withdrawn, but this still seems like he got to make choices and his family understood. It can be much harder with memory loss when the person really can’t make choices any more.

He was complicated. To keep him breathing well without a machine, we had to give him diuretics, that were eventually too much for his kidneys. A bad heart, lungs with emphysema and pneumonia, and bad kidneys. Sometimes the liver is not working either, and then what is there left to work with? Nearly all drugs are broken down by either the liver or kidneys. Simethicone is not absorbed, so that’s the exception.

Sometimes people get along until too many things accumulate and then they end up in the hospital and on multiple new medicines. It can be very confusing. Regular maintenance is a good idea.

Sometimes the family wants something different from the patient. Or there is an elder parent and three adult children, who all disagree. My job is advocate for the patient. But this is Family Medicine, so I have a responsibility to the patient but also to the family. The person, the family, the community, how is it all fitting together? Sometimes functional, sometimes not.

I had one person who called me when he had been flown to a Seattle hospital. “I have to get home.” he says, “Can you release me? I have to take care of my wife!” I panicked for a moment. “Is your wife bedridden? Where is she? Why are you in the hospital?” She was not bedridden and she was fine. He was being more and more behaviorally squirrelly. He could no longer drive, but drove anyhow. His wife disabled the car, because he would disappear. I sent him to a neurologist for memory testing. The neurologist said, “Hmmm.” and sent him for neuropsych testing. The neuropsych report said dryly that his memory was fine, but he had certain long standing behaviors related to past heavy alcohol use. Oh. He was quite proud of not drinking and going to AA, but he also triangulated with his family and me. I sat him down and said, “Ok, I am not going to talk to a different one of your five children every time you see me in the clinic, because you’ve said, “Don’t tell mom I called you.” Pick ONE person for me to talk to and now you have to have a family member with you when you come to clinic.” He grinned and chose his wife. He had certainly fooled me about his memory, because he blamed his behavior on his memory. The neurologist was not quite fooled. The family calmed down and he did not drive any more, thank goodness. He was not an easy patient, but he was entertaining and educational too. And I felt that I had helped both him and the family.

Sometimes families fight. Sometimes a dysfunctional family will get way worse when someone is sick or dies. Sometimes families go on fighting. Other families are so kind and so good to each other and their elders. Every family is different.

For the Ragtag Daily Prompt: concentration.

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1932 Letter

My cousins sent me a packet of letters. Some are from my mother to her mother, but this one is from… well, see if you can guess.

Dear Mother and Father,

We got in the car and Grandfather and me sat in front and Grandmother sat in back. Grandmother said, “Do you want your window closed?” and I said, “No.” Then, in a few minutes after that I said, “I am getting kind of chilly.” Then in a few minutes after that I tumbled over the back of the seat into the back seat. Then I shot my pistol out the window and tried shutting it again but it wouldn’t go. Then I waited awhile and then I shot off my pistol again and it worked. Then I shot off my pistol again in a few minutes after that but somehow it didn’t work. And then after awhile it started raining.

Then we got home. After a little while Eva May came over. Then after awhile Jimmie came. Jimmie brought over his gun with him. He had a long gun.

After supper I took my sparklers over to Jimmy’s and Eva May’s house. They invited me over before supper and then I started lighting my sparklers. I lit one after another and in a few minutes I said, “I’ll go over and get my pistol,” so I did.Then I went back for awhile and then I came home and stayed and we had the rest of my sparklers in the house. And then we all went to bed pretty early.

This is postmarked July 6, 1932 Decorah, Iowa. It cost .03 cents in stamps to mail. It was sent to Mrs. Temple Burling, 3434 Arden Ave, Hollywood, Illinois. The handwriting is quite beautiful. The letter is signed “Bobby” in quite different handwriting. The letter was sent from “Bobby” — Robbins Burling, age 6, as the narrator, with one of his grandparents transcribing to his mother (my grandmother) Mrs. Temple Burling (Katherine White Burling). I think it is a charming letter and so like a kid, with the repeats: “and then in awhile”. I am going to send it to “Bobby’s” grandson, who now has a child of his own. Here is the rest:

In the morning I got up and got dressed. Before I got up I was real quiet because I thought they were asleep because they were so quiet and they thought I was asleep because I was so quiet. Then finally they came past the door and when I knew – it they were awake – and they knew it – I was awake. And then I got up and got dressed.

Then after breakfast Grandmother and me went out and weeded. In a few minutes I said, “I’ll get the hay off the lawn for you.” so I did. I told her if she thought it was worth a penny and Grandma said, “Yes.” And then I said, “Do you think it’s worth any more than a penny?” and Grandma said “Yes.” In a few minutes we came in and she gave me a cent.

I left the penny in my hand and Jimmie came over and called me and we decided that we would make giant fingers and then as we were making giant fingers we decided we would make funny masks but we didn’t. We decided to make Chinamen’s hats but we didn’t.

Jimmie wore his hat in a funny pointed way and I wore mine with a round hole in the middle and kind of crooked too. And we went out to scare the girls and at first we didn’t scare girls but we scared Jimmie’s mother and we didn’t scare the girls after all. He went out to scare a man and he told me he’d be back and I got an idea while he was gone but he didn’t appear.

And then we went out and did some errands – got some peanut butter and then went to the library to see if they had any Dr. Doolittle books and they did. At first they asked if we’d read Dr. Doolittle at the Circus and I said, “I have.” and they put that back and looked some more and found another and asked me about that and it was called Dr. Doolittle and the Movie. Then at night Grandma read me some. We read part of it while I was in bed and then I started talking to Sixen and fell asleep finally and work up next morning. Then we had breakfast and I raked some more and I got another penny.

Bobby

For the Ragtag Daily Prompt: letter.

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Difficult?

With Cee’s Flower of the Day on hiatus, I am casting around. Here, a weekly prompt: divorce.

My ex and I did a year of couples counseling and then another year of hammering out the details. I felt like a terrible failure and did simultaneous solo counseling to figure out why I was failing. It took me two years to make the decision and I was anxious the entire time. And then once I decided, the anxiety evaporated like morning mist.

One thing that I realized is that we each had a blind spot. I love working and am a hard worker and even to the point of working until I get sick. My ex did not want to work, partly because his father seemed to hate it so much. My ex was dedicated to doing something fun every day and that was a revelation to me: were we allowed to have fun? So it was all lots of fun for a decade. He was in charge of play: bicycling, swing dance, going to music, golf (golf did not take with me), tennis. I was in charge of work and practical things. This started to fall apart with kids, because I wanted to have fun with the kids and he said, “Kids aren’t fun.” As I moved into defining fun, he refused to move into work.

At some point during the prolonged divorce process, I realized that some of it was not about me at all. He knew at some level that he had to go work, because his son was reaching his teens. My ex looked at me one day and said, “I’m going to have to thank you for this, aren’t I?” “Damn straight,” I replied. I wished he could deal with the work thing in the marriage, but he couldn’t. He went off and went to nursing school and has an RN. I talked to him yesterday on the phone. He said, “I decided when I was young that I was going to do tons outdoors until I got old and then I would work. And look how it’s working out!” A little hard on me, I think. Meanwhile the kids got bored with the whole thing so they were reassured that it was not about them.

Anyhow, I think it was the right thing to do though difficult. During one argument my ex said, “I have avoided doing anything hard.” I was annoyed and said, “What’s the hardest thing you’ve ever done?” “Marry YOU.” That made me laugh: a perfect snappy comeback and probably true.

This is The Yes Yes Boys, doing Make it Easy. I bought the CD when they played live at the Upstage here. I love this song. It’s not on You tube, but you can download the music for free here: https://hobemianrecords.com/product/why-say-no/.

“If you still can’t make it easy, get you a job and go to work
Don’t be hanging round here and there, miss your meals, wear a raggedy shirt
Cause when you’re missing your meals and you’re missing your bed
That’ll give you the pneumonia that will kill you dead
If you can’t make it easy, get you a job and go to work“

Highly recommended and very funny!

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Messy

Everyone I get to know and really become friends with, has a messy life with difficulties. I think we are terribly afraid to admit it, with the curated lives on the place that is not a book but has lots of Faces. I write that all of my patients are smart and they are. I had my own rural family practice for eleven years. My goals were more time with patients and to do good medicine. I succeeded at both. With more time, I could learn a little more about my peoples’ lives. People that I would never suspect of having very messy lives still have them. Does everyone in our culture have estrangements, family that they don’t talk to, parents that they find difficult, friends that they have gotten upset at and abandoned?

In high school my daughter says, “Most of the fights are stupid. Usually someone says something without thinking, even in passing. Person B takes it personally, gets upset, talks about it to others and then person C or D says something back to person A or shuns them. Person A has no idea what is going on and is hurt and upset. It is stupid.”

Adults do this too. I had a friend where I would think about something for a week and then go back to him. “You said this. What did you mean?” Usually he didn’t mean anything or meant something very far from what I was thinking. At least I went to him and did not add person C or D or E to the mix. He said, “You think about it for a WEEK.” Well, that was his own fault, actually, because he can’t tolerate anger. Even if I was upset or hurt, it was still interpreted as anger. Raised in an alcohol household and trained by medicine, I can hide feelings. After a while he could tell when I was chewing on something.

We grow up physically by our mid twenties, but often we don’t grow up emotionally. Especially if relationships are interrupted and colored by drugs and/or alcohol. People miss developmental stages. Everyone is trying to cope as best they can, but I do wish our culture celebrated mature calmness and quiet adulthood, rather than just the wild youth. Wouldn’t that be a change?

If you were to curate your life for something like the site that is not a book and has Faces, what would your ideal be? What do you aspire to? Kindness? Emotional maturity? Peace? My feed has friends, insects, birds, rocks, fossils, funny animal videos and music. I get almost no politics in it. I have not blocked anyone or anything. I try not to friend people I do not know. It is peaceful and a celebration of nature and yes, that is what I would like to curate.

Blessings.

For the Ragtag Daily Prompt: curate.

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The next stage

It is hard to build a new life after pneumonia number four.

Running my own clinic and seeing patients and keeping track of a business for eleven years, along with two children, now adults done with college and masters and jobs, I did not have an enormous amount of time.

During covid, I started beach walking with a person. Two years into covid, they say, “I have to get back to my real life.” Oh. They say, “You need your own life.” Um, yes, and clearly they are not in it, by their choice. That was a year into pneumonia four and I was still on oxygen. The person bailed. I was a detour to get them through covid. Ugly, but I am trying to learn everything I can from them. About myself and who and what to avoid!

WordPress and the blogging community helps sustain me through this! I can write when I am ill (at least so far) and when the pandemic closed down. I am so encouraged that people contribute from all over the world. A small candle of hope.

I don’t know if I’ll be able to do a limited clinic or not. I am hoping so.

Meanwhile, I’ve been getting to know more people outside clinic and going to live music and dancing and doing open mikes. I am doing the poetry open mikes. A friend in a band says, “But you don’t come to mine!” “That’s a music open mike.” “We need poetry,” he says. So I’ve gone twice and it has been really fun and I am getting to know that community as well. Last Thursday someone said my poems are weird. “I don’t mean bad, just from a different angle.” Meaning unusual, I think. Perspective.

I have been here for 23 years. I know many people in the music community from singing in chorus all those years, I have a church community, I know many people in the dance community, my father and I were in the Wooden Boat community, I have both good and not so good connections in the medical community. The legal community knows both my children, through Mock Trial competitions. I was in the Rotary for ten years and that is another wonderful community. The exchange students going all over the world and people giving back also give me hope!

Suddenly I am busy. I will have to start choosing between things. I still have the aftereffects of Covid-19. I had mild chronic fatigue before it and still do. I think I am stuck with that, so I have to build in rest and quiet time. At least, physical quiet time. My brain doesn’t really do quiet, but that is ok.

Hooray for every day and for building the next stage.

________________

I took the photograph this week from Point Defiance, Mount Tahoma, aka Rainier.

Limited:

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A house for our lives

I wonder why we don’t design houses for our lives.

A family house could have everything on the first floor, with a bedroom, wheelchair accessible, and a full bath. The stairs could have an entryway that can be closed off. Upstairs, a sitting room, a full bath, two bedrooms or three and a pocket kitchen. Laundry facilities need to be on the main floor, but they could be in a mud room/entry that is part of the entry to the stairs.

The basement, if there is one, could be for storage or for another apartment.

A couple could buy the house, raise kids in the whole thing, then downsize to the main floor, rent the upstairs, perhaps rent the basement.

My daughter and son want less stuff. Neither has the packrat gene from me and they want to be mobile and have cleaning be very easy and moving be easy. I feel guilty that I have a big house alone, but it is full of stuff that I am slowly decreasing. It has a daylight basement, but there is no bathroom down there nor kitchen and the laundry facilities are there. Also the plumbing is 4 inch across 2 foot concrete sections from the 1930s and runs under the slab poured inside the 1930s garage foundation. The garage is built to the neighbor’s line in back and five feet onto the lot in the middle of the block at the side, so I have two lots. If I take it down, I could not rebuild there because of codes. I think that to do the basement as an apartment I’d have to redo the plumbing first, which is daunting. Also renting is tricky. That is, getting someone out if it is not working can be a challenge.

Friends are looking for a four bedroom house. They have three children so that is what they need now. But the eldest is 14, so it will not be long at all until they need less house. I picture bedroom modules that can be detached.

Our town is very short on long term rentals because now people can make more with short term rentals to the tourists for the many festivals. This in turn is messing up the traffic and increasing accidents, because there are two two-lane roads into town. And a ferry. The people who work in the shops and restaurants are having to commute. People own a fifth house that they may visit only twice a year. It looks like it will get messier, though we may have another housing crash. Right now houses are going up.

My daughter has been designing her future tiny house for a while. The second entry is to a mud room with laundry facilities and a tile floor and a shower so that she can climb out of swimming or running or mountain biking or sailing gear and have a place to hang everything before she goes into the rest of the house. She will want to be able to clean herself and her gear.

My grandparents had a house on Topsail Island in North Carolina. There was an outdoor shower under part of the house, to wash the sand off before we were allowed upstairs. Then another hose to wash our feet once we were up on the deck. Sand and the smell of the ocean, all the time.

Friends have a four apartment building. They altered the two on the top floor to make one apartment. The lower two they rent, sometimes to family. There are four bedrooms on top and two in each apartment. They have a big kitchen and a pocket kitchen in the top section.

Some of my patients need tiny houses, a place alone, even though they also need social contact. I hate the big ostentatious show houses, especially the ones with the play room on a different floor, let’s relegate the children to a different part of the house. Then the elders can also be relegated.

I wish housing were more about need and practicality and less about money and status. And still, we are spoiled….

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written 8/2/2017