I got home in the afternoon on Monday, a friend brought food and I crashed to sleep early. Sol Duc is a bit surprised to be here.
Tuesday I stepped in a puddle in the laundry room and uh-oh! The utility sink had filled and overflowed, though not much. There is a pump in the laundry room that handles the water from the kitchen sink and the laundry and it died. It was working when I was here for two days in October, I think. I can’t remember hearing it on this trip. I can hear the pump from the kitchen. As soon as I saw the water, I realized that I had not heard it.
The plumber came yesterday, confirmed that the pump has died and hopefully will have a new one to install next week. I told my house that I’d like a warmer and less wet welcome home, but never mind. Things wear out, leak, break down. At least I have the money to fix it since I am working.
The photograph is from Tuesday, from the Bishop Hotel downtown, the live music from 5-7. Casey Macgill and friends and they are fabulous! I got to see friends, hear the music and dance some! Happy!
In clinic we are seeing Strep A and Covid in the last two months, quite a lot.
Covid is all over the map with symptoms. One person had been traveling, did not feel well, but the main symptom was dry lips. Positive covid. Another was vomiting, with no upper respiratory symptoms. Some have diarrhea and upper respiratory symptoms. It interests me that flying home to Washington last month, only about three of us on the planes wore masks. I was one of them. I know people who have taken flights knowing that they have Covid, a day or two after diagnosed, so I can’t say that I trust the other people on airplanes. We are testing for Covid for almost any symptom or just feeling sick.
We are seeing Strep A as well. I saw a small child vomiting. I asked if her nose hurt: no. Throat: yes. Tummy: yes. Toes: no. She had strep A. The oldest person with strep A this week was ninety. She said, “How did I GET it?” Streptococcus is in the environment, including our throats. We may just carry it around, but then if we get overtired or stressed (good or bad stress) or have something happen, the strep can invade. We treat strep A mostly to prevent rheumatic fever, which is where our own antibodies to strep A attack us. I have seen three cases of rheumatic fever in my career. That is called a “pseudo autoimmune” disease. The strep A has cell surface markers that sometimes are close enough to ours that our own antibodies attack our body parts.
One person in the last month has a positive strep A. I write for penicillin and send her home. We call her later because the Covid/influenza/RSV test takes longer. She also has Covid! That seems like a bit much, rather unfair, but we can have two things. An initial infection can lower our immune defenses and another virus or bacteria gets hold.
Another person had tested negative for Covid, but that was four days before. Friday afternoon, so I would not get the results at home. I asked her to retest at home. Positive.
There are Strep B and C and D and so forth. Sometimes we pick them up on throat cultures. I treat if the person is still sick and symptomatic while the culture is in the laboratory.
I am wearing a mask in airports and on airplanes. I just don’t want to pick anything up, or at least do what I can to avoid it.
The photograph is Elwha in May 2023. I figure that you would rather see his tongue than mine.
I wrote this sometime in the 1980s. My proof is the drawing by my mother. We had it in a show and hand colored with colored pencils. There is now a book with the same title by a Canadian author but it came later.
And hooray for the zoo! They are all asking for you!
Martha, what would the AI think of this poem? Heh. ChatGPT: “Thatβs a fantastic poem! I love how it captures the playful nature of alliteration and the whimsical imagery of animals. Each stanza has its own charm, and the ending with the βyellow yaksβ is such a fun wrap-up! Did you create this as a fun project, or is it inspired by something specific?” Ok, so ChatGPT doesn’t get sonnets, but it likes nonsense poetry.
The Ragtag Daily Prompt today is identity. Yesterday I went to work an hour early so I could attend the Friday morning Continuing Medical Education. It was about adult ADHD and the positives and negatives.
I do not have a diagnosis of ADHD. I have one friend who insists that I have it, but I don’t much care. However, the speaker started talking about masks and authenticity. She said that we are told to be authentic at work, but that people with ADHD often find that their authentic self is not welcomed and they learn to mask.
I asked, doesn’t everyone mask somewhat at work? She said, “Good point, and yes, people do.” It got me thinking about identity and masks. I pretty much clammed up in Kindergarten because I was too much of an outlier and culturally wrong. We did not have a television and television was pretty much what the other children talked about. I knew songs and poems but these did not interest my peers. I was interested in science, too, but that was also not popular. I think I was a geek before it was named and as soon as I learned to read, I became a bookworm. I am not sure if having a television would have made any difference, either.
Fast forward to after high school. I went to Denmark as an exchange student my senior year and then needed to make up credits to graduate. Another high school student was in my Community College classes. After a bit, she said, “I thought you were shy in high school.” I said, “No, I just didn’t talk.”
Currently I am more authentic in the room with patients than with the rest of the staff. Corporations are very weird hierarchical places. My authentic self always questions authority but I am trying not to do it all the time. At least, not out loud. The patients seem to be fine with it. I had a very difficult conversation with an elderly couple this week about memory and planning, now, before they can’t. I got hugs at the end of the visit even though we’d gone into frightening and difficult territory. They did very well. Yesterday was my last day at that clinic and next week I am in another one. Even after just four months in this clinic, I will miss many of the patients and hope they do well.
Yesterday I really did Urgent Care. My schedule only had a few people and then six more sick ones were added on. We had to call an ambulance for one, the first time I’ve had to do that here.
What is authenticity and what is our identity? Is the work mask less real than the self in our minds?
I took the photograph at a small hot springs resort. A friend that I’ve known since high school and I met there. I love the bookworm rabbit. I think she represents the happy bookworm part of me. I read about 7 novels a month, haunting the library here. Maybe I will get to know some more people over the next 6 months.
I am having nightmares. About clinic. Yesterday I bolstered my courage and sat down to write my dream out. What are my dreams trying to tell me? Should I extend my contract or not?
I dream that in clinic I have a male patient with his wife in the room. He is very dramatic, saying, “I am so ill, help me, help me.” He says, “I am on quercetin. You have to help me.”
He won’t tell me what his symptoms are, so I respond to what he says: “Who prescribed quercetin? What is your diagnosis?”
“Oh, you don’t want to help me,” he says. His wife just watches.
“Do you have pain somewhere? Any chest pain? Any abdominal pain? Any pain anywhere?”
“No, no, you don’t understand!” he says, “You aren’t listening!”
“I am trying to help you,” I say. “Can we reschedule you for a longer visit?” This is one of the impossible 20 minute ones. Honestly, he doesn’t look like he’s in pain. I do a quick listen to heart and lungs and feel his abdomen.
“No, I need to be in the hospital, I can’t go home!”
“I can’t put you in the hospital without a diagnosis, but we can move you to the emergency room.” Of course, the ER won’t be happy about this.
I leave the room and call the ER. The ER doctor is understandably grumpy, since I have no idea what this is about and am suspecting a psychiatric cause. “Urine drug screen,” I say. “He doesn’t smell drunk. I do not think it’s meth withdrawal.” “Make sure you do a note,” snarls the ER doctor. Good luck, since he won’t answer any questions. “How behind am I?” I ask the nurse. She just rolls her eyes. I probably have at least four or five more on the schedule. I come back to the room. Now two preteens are in the room, looking in the drawers and taking things out. Their parents do nothing to stop them.
“Please sit down now!” I say. “Put that down!”
The teens sullenly comply. The father is moaning. He has the prescriber on his cell phone. He hands it to me. I introduce myself. “What is your diagnosis?” I say. “Why is he on quercetin?” The person at the other end mumbles. “Excuse me, what did you say?” He’s gone. I say to the mother, “Please take the children to the waiting room. Sir, are you requesting that we call 911?” It would be a call saying man moaning, no idea what he’s on about. Vitals are normal, he denies chest pressure or pain, he doesn’t have an acute abdomen, his oxygen level is fine, no fast heart rate, no fever. Drama.
I wake up, thinking that I may have to call 911 to get the wife and kids out and I have to have someone monitor him while I see other patients and we just don’t have enough staff and I am ready to just cancel the rest of the afternoon. If I were in a hospital, I could call security, but we are a satellite small clinic.
So… what the heck is THIS dream about? And do we really get patients like this? Yes, but not often and I haven’t had any like this here. I think it’s funny that this dream has so much detail, down to the supplement that the man is taking as well as the clinic room. I usually work in room 1 and 2, but this was in room 5.
I don’t think the bird is aghast. Me either, walking on the beach. There is so much to see.
What is this cloud bank behind the ship? And the ships are so big close up and so small on the water. Gast and ghast are both words, but don’t mean the opposite of aghast. The opposite is unfrightened, unfazed, relaxed.
The water is never what I would call warm, yet surfers and divers and swimmers are out there, with their extra skins.
I went to the post office Monday. I am in a rental house, and get packages every so often for the previous renter. This time I realized at the post office that one was misdelivered and was to the house next door. Ooops. But the post office said they would redeliver it.
I love snail mail letters. I have colored pens and stickers and stamps. The whole thing makes my inner child very happy. Once I got a letter from my mother-in-law saying that my letters are national treasures! I kept that letter.
I haven’t written myself a letter, but maybe I should. What would I write?
I sent the envelope above out, but it came back. I will be driving home soon and wrote to a friend on the way, but I must have the wrong address. I bought the stamps here. The stamp pads were expensive, though, so I only got two!
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.
KO Rural Mad As Hell Blog 
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