Tag Archives: loss

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Missing my father

Today is my father’s birthday and I miss him quite a bit, since he died in 2013. This picture was taken in clinic at the opening party. I left a message for another friend, also a singer, who has the same birthday.

Sad but I am happy thinking of him and I am still in the chorus that he helped start, Rainshadow Chorale.

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Who is driving the car?

I am at my parent’s house.

My mother and I and the baby, a toddler, go out to the car which is a huge newish SUV. I open the back door and see a drawing lying on the seat, beside the car seat. It is a drawing of my son, from a photograph. My mother has written on it, her ideas about how she wants to do the painting. I took the photograph and know it: my son has an exuberant joyous toddler expression. I climb in to the SUV. My mother gets in the front and turns the car on. She pulls forward and I start screaming, “STOP! STOP DON’T DRIVE! THE BABY IS NOT IN THE CAR!” My mother is pulling forward and backing, in confusion. She stops.

I leap out and search. Under the car by the back wheel, but not under it, is a kitten. A black kitten, lying on its side. I reach and very gently pick it up, supporting its spine. I am crying. The kitten cries as I pick it up, with pain. I say, “She’s hurt! I am going to die!”

I wake up.

I think about the dream. Even though there is a picture of my son in the car, I am a teen in the dream. The toddler is not my son. The toddler is not my daughter. The toddler is my sister. My parents had old cars, never a new SUV. The house in the dream was my parent’s house in Alexandria, Virginia. We moved there when I started ninth grade and my sister started sixth. My parents sold the house and moved in 1996.

Who is driving the SUV? Is there a responsible adult? Are they taking care of the children? Or are they driving recklessly and leaving the children to try to care for each other? Some adults are not responsible and should not be driving.

 

My son took the photograph of my daughter in 2011 for a school project, recreating a movie poster: True Grit.

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The dead are with me

I am at the lake. There are younger people with me. We go to the graveyard. The earth is soft and loose. There are no markers or stones. We do not need them.

“I can feel the people in the earth.” says one of the younger people.

“Me too!” says another.

“Of course.” I say. I name the people under the earth and introduce them. The young people are amazed. I am surprised that they have never felt the dead. I think the cities and concrete and phones and television and computers: all of these must block the signals. But we never allowed electricity here. The phones don’t work. Candles, aladdin lamps, propane stoves and heat with wood in old cabins. Thin shacks where we hear the wind and water, and tents, lying in the embrace of the earth.

We leave but when we come back, the young start to reach down into the soft earth, arms length. “Did they die young?” one asks. “We want to know more.”

“You must be patient.” I say. “Don’t push the dead.”

Later I return a third time to sit quietly alone with the dead. Dark falls, moonless, overcast, no stars. I stand to return to the cabins and my flashlight dies. I know the paths well, but not the path to the graveyard. I tie up my long skirt and kneel. I feel the ground gently. Yes, I can feel the path. I start to crawl slowly, stopping to feel the packed worn earth. I think of wolves and cougars but none have been here for years. It is not cold enough for exposure. It is just dark and slow. The dead are with me and approve.

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out of minutes

I just read your email

my phone was out of minutes

the internet was down

I was really busy working

I didn’t hear the phone

I forgot I turned it down

 

and you are out of minutes

 

The photograph is from 2007. The dunes collapse, sometimes whole sections with trees. It’s not a safe space to play.
I am choosing this for the Daily Prompt: flames.

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small child

my small child was locked under rock for years

she came out shy reluctant distrustful

you are special, the first adult in whom
she recognized another small child
locked in and called you
out to play

and we played hard

now she stomps her foot at me
“He does not play fair! He won’t come to my house!
He makes all the rules! He doesn’t listen!”

yes, bear, I know

time to go home, small child
you have had your first playmate
since you were locked away
but he is still locked in a dungeon
of monsters and zombies
you unlocked him for a little while
just a tiny bit

but he has decided not to play
he is locked down

come, small child

she is in my arms, head on my shoulder
sucking her thumb, crying
until she is too tired
and falls asleep

she will always love you, you know

anything, to have someone to play with
she let you make all the rules
for a long time

but now she wants
someone who will play fair
and share the rules
and love her back

 

12/2015

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Loved

It’s ok

I just want you to know

even if I never see you again
even if I never touch your hand
even if I never hug you again
even if you don’t answer
even if you don’t let me in
even if you are deaf to anything I say
even if you forget the moment you stop reading
even

I just want you to know

you are loved you are loved you are loved

always

even if

for my lost ones, living and dead 9/15/16

The photograph is from 2004, in the Hoh Rain Forest.

I am submitting this to the Friday Night Music Prompt #62 : Never too late for love & Keep me in your heart

 

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Fraud in Medicine: Heartwood

Here in my neck of the woods, people are continuing to quit medicine. TwoΒ  managers who have worked in the clinics eaten by the hospital are leaving on the same day, after 30 years. And another woman doctor, around my age, is retiring from medicine. She is NOT medicare age.

Meanwhile, the Mayo Clinic is publishing articles about how to turn older physicians into “heartwood”.

http://www.mayoclinicproceedings.org/article/S0025-6196(15)00469-3/fulltext

“As trees age, the older cells at the core of the trunk lose some of their ability to conduct water. The tree allows these innermost cells to retire…. This stiffened heartwood core…continues to help structurally support the tree…. Here a tree honors its elderly cells by letting them rest but still giving them something meaningful to do. We non-trees could take a lesson from that.” Spike Carlsen

Oh, wow, let’s honor the elderly. Even elderly physicians. Instead of what, killing them? Currently we dishonor them, right?

But what is the core of the issue? Skim down to “Decreased patient contact”:

“Already, many physicians are choosing to decrease their work to less than full-time, with resultant decreased patient encounters and decreased institutional revenue. Prorating compensation to match full-time equivalent worked will aid in financial balance, but the continued cost of benefits will remain. However, when that benefit expense is compared with the expense of recruiting a new physician (estimated by some to approach $250,000 per physician), the cost of supporting part-time practicing physicians becomes more attractive.”

Ok, so the core of the matter. “Decreased institutional revenue” and the employer still has to pay BENEFITS. NOTHING ABOUT THE QUALITY OF CARE FOR PATIENTS.

Again, the problem is still that you can’t really “do” a patient in twenty minutes, and that full time is really 60 or more hours a week. To be thorough, IΒ  have to absorb the clinical picture for each patient: chief complaint, history of present illness, past medical history, allergies, family history, social history (this includes tobacco, drugs and alcohol), vital signs, review of systems and physical exam. And old records, x-rays, pathology reports, surgical reports, laboratory reports. I fought with my administration about the 18 patient a day quota. I said: ok, I have a patient every twenty minutes for 4 hours in the morning, a meeting scheduled at lunch, four hours in the afternoon. When am I supposed to call a specialist, do refills, read the lab results, look at xray results, call a patient at home to be sure they are ok? The administration replied that I should only spend 8 minutes with the patient and then I would have 12 minutes between patients to do paperwork. I replied that they’d picked the Electronic Medical Record telling us that we could do the note in the room. I could, after three years of practice. But it nearly always took me twenty-five minutes. I would hit send and our referral person had so much experience that she could have the referral approved before my patient made it to the front desk. BUT I felt like I was running as fast as I possibly could all day on a treadmill. Also, the hour lunch meetings pissed me off. I get 20 minutes with a patient and they get an hour meeting? Hell, no! I set my pager for a 20 minute alarm every time I went into a meeting and I walked out when it buzzed. I needed to REST!

After a few weeks of treadmill, I dropped a half clinic day. But of course that didn’t go into effect for another month and I was tired and ran late daily. And every 9 hour clinic day generated two hours of paperwork minimum: nights, weekends, 5 am when I would not get interrupted and could THINK. Do you really want a doctor to review your lab work when they are really tired and have worked for 11 hours or 24 hours? Might they miss something? It might have been best if I had been quiet and just cancelled two people a day, since the front desk knew I was not coming out of any room until I was done, but I argued instead.

The point is, you would like to see a doctor who listens and is thorough. You do not actually want a medical system where there all these other people who read your patient history forms and enter them in to the computer and your doctor tries to find the time to read it, like drinking from a fire hose. If we want doctors and patients to be happy, then doctors need time with patients and we need to off the insurance companies who add more and more and more complicated requirements for the most minimal care. One system, one set of rules, we’ll fight over the details, medicare for all.