Tag Archives: outdoors

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Busy clinic

Clinic has been hopping. I have been at the present site now for six weeks, so I am starting to know a few of the patients. That is, the ones that are sick and I am worrying about. It is best if your doctor’s pupils don’t dilate when they hear your name.

I have been getting helpful calls back from specialists. I have a person who has high liver tests where hepatitis and overweight and alcohol don’t seem to be the cause, so I needed an updated list of what labs to send for some of the less common liver problems. Thyroid disease, hemochromatosis, alpha one antitrypsin deficiency, smooth muscle antibodies, various other antibody disorders. The list is quite a bit longer than in the past. I warn my patient that some will come back right away and some may take a week or two. The patient is anxious and wanted to go right to the emergency room, but I ask them to wait: I get a call back from gastroenterology within 24 hours to set up the current laboratory order list.

For liver tests, we ask about alcohol intake first. Then look at weight: a high body mass index can cause fatty liver disease. Unfortunately, that can lead to cirrhosis and liver failure, so it is not trivial. We check for hepatitis A, B and C. Then we start looking for the less common causes. My person is relatively young, but that is with me taking care of age 18 and up. I tell my person not to take any supplements, I look at any prescribed medicines. No alcohol for now.

The list of tests changes quickly. If I have not worked this up recently, it’s good to check in with the specialist. The gastroenterologist may not be up to date on ankle sprains, but they are tracking the changes in their specialty. My specialty is everything, so sometimes I need a current update. Most of the specialists are just fine with this phone call.

Occasionally I do this by message. I have a new diabetic who has a cardiologist already. Diabetics are usually put on either an ace inhibitor or an angiotensin receptor blocker to protect kidney function. I message the cardiologist and get a fast answer. Start an angiotensin receptor blocker and the suggested dose. Also very helpful.

A patient tells me on the phone that I get an “A” for the day. I called them to check on them two days after changing a medicine dose and to say that the other specialist wants even MORE laboratory tests. The patient says she has not gotten a call from a doctor before. The “A” made me laugh, but it did feel good.

I am learning the local medical pathways and how to get things done in this particular medical system. The functional bits, the dysfunctional bits, and how to work around them.

For the Ragtag Daily Prompt: functional.

Sol Duc really likes staying in her pillow fort. Sometimes I want to hide in a pillow fort too. So much for being “grown up”.

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Cliff collapse

This is taken on Marrowstone Island, going south from East Beach. The king tides take down sections of cliff and whole trees every years.

The island surfaces in the low tides and the seals rest and sun and ignore the ships.

For the Ragtag Daily Prompt: collapse.

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Austere choice

What could be more austere than rock?

Taken in Echo Canyon in the Colorado National Monument, Thanksgiving, 2024.

Austere choice

Why do I still feel sad when I think
that I am best off with my cat
and that I should eschew dating.
Why do I feel like I am rejecting love?
I don’t have that sort of love.
It’s not like I am rejecting anything.
I am rejecting looking for it.
I am rejecting active interest in a partner
other than my cat.
What is wrong with that?

I do not ever want to reject hope.
I am not trying to reject wanting.
Hope and want are the deep and terrible ache
for the Beloved. I do not reject that.
I am still open, Beloved, to what you send,
though getting more particular in middle age.
A writer says that he uses a pencil and a pad,
because no better tool has been invented.
I take the same approach to wanting love.
If the relationship is more work than my cat,
for less love, why bother? It seems silly
and until I go home to the Beloved,
so far, I am best off with my cat.

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The first thing Sol Duc does when we go out for a walk, is roll on the sun warmed dusty sidewalk. The house faces south.

For the Ragtag Daily Prompt: austere.

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Vision

What will peace look like? People
will still disagree often
but like my parents they will appreciate
evidence and science. They will listen
to each other with interest, with respect.
They will bet a penny or a quarter or a million
imaginary dollars and one will go to look up
the correct capital of Azerbaijan, while
the other argues that they MEANT back in 1478,
really, so they do not owe one million imaginary
dollars and they both start laughing again.

_______________________________

The photograph is of the ice in Echo Canyon, two days ago. Or maybe it is angels, waiting.

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Surreal failure

I am still thinking about Friday’s Ragtag Daily Prompt: failure. Now that I am middle aged (by my clinic definition, which put over 90 as older), I think the biggest failure of my generation is a peaceful world. For me, a peaceful extended family. I am good friends with my father’s family and my ex-husband’s family. But the maternal family, well. I have thought about that for the last two days: could I have changed that?

Yes, but at what cost? My sister followed the “family rules” on that side. She is dead from cancer. My mother also followed the rules and died younger than me from cancer. I can’t say that the rules cause cancer. But doesn’t our culture say over and over, be yourself? To fit in the family diaspora, I would have to play the triangulation game and gossip about others as they have gossiped about me. No, thank you, no. I don’t want to. They seem to need a family member to hate and have chosen me and labelled me and call me angry. I think they are silly and emotionally immature. At the very least, I would have had to keep my mouth shut and accept them gossiping about me.

The family failure and untrue gossip, with no one ever asking for my viewpoint, mirrors the US culture. Split and needing someone to hate. At this rate, we’ll need the hippies back, with flowers and joy and counter culture and dropping out. Someone fun, at least until the drugs wear off. Someone to say, we need joy back, we need friends, we need love.

It’s not just my failure though. The family failed. They make cruel choices and target people. It happened in my generation, my mother’s, my grandparents. I wonder if it is happening in my adult children’s generation. Who is the next target? Who will refuse to counter-gossip and fight with each source? My adult children are not part of it at all, because I had less and less interest in spending time with mean gossips and I did not want to expose my children.

Lies and drama and meanness and gossip. I hope my adult children’s generation does better. We went to Wicked on Thursday. I did not like it much. Too much drama. Why do we want drama? The world seems more and more surreal. Give me the lovely hike we did on Friday instead, Echo Canyon.

For the Ragtag Daily Prompts: failure and surreal.

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Chew on this

No, hummingbirds don’t chew as far as I know, but they sure are tough. I had an Anna’s hummingbird that would overwinter in Port Townsend, surviving even when it was snowing and got down to 17 degrees. The food would freeze and I would have this small fierce creature swooping over my head making a ticking sound to remind me to thaw the food out.

My daughter and friend started over the mountains last night but holed up in a motel partway. They said that the roads weren’t that awful but the lack of visibility was exhausting. It is hard to see where the road is in the teeth of the storm! I am glad they are safe and we will see what happens today!

I learned to take the food in at night, so it would be all ready in the morning.

For the Ragtag Daily Prompt: chew. (Choo choo! I wonder if the train is getting through!)

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Snew

“Knock knock.”

“Who’s there?”

“Snew.”

“Snew?”

“I don’t know, what’s snew with you?”

I will have to pull out my patience cards today because, yes, it’s snowing. And I have family supposed to come from east and apparently that atmospheric river is dumping in the mountains. It’s supposed to snow in the mountains until midday Thanksgiving. I’m not sure I can have the whole meal all ready for them to arrive.

Ok, but patience, and let’s get creative. We could always do the cooking and have the meal on Friday instead of Thursday.

It is supposed to turn to rain here and the snow will be gone by noon. I jumped out of bed like a little kid, though, shouting “SNOW!” Sol Duc is unthrilled. The roads don’t look too awful and I wonder if anyone will cancel in clinic or it will be as usual.

Yesterday was a bit of a zoo, mostly because over 100 people realized that they are nearly out of some prescription and called for a refill. I knocked my message box down from 48 to 31 in the first 25 minutes and then it kept piling back up over 50. I also wish that if an 87 year old has a serious emergency room visit, they’d give me a longer follow up, because it can’t be done WELL in 20 minutes.

I expect that today will continue a bit nuts. Getting ready for Thursday and Friday off, to lie around pooped!

It’s all good.

For the Ragtag Daily Prompt: patience.

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Sad about the cows

The first photograph is Sol Duc. She is lying on my jacket to object to and obstruct me going to work. She has learned the new schedule, but things are a little different. In the three weeks we were gone, the night time temperatures have dropped into the 20s, so it is frozen outside. Yesterday it warmed to a high of 53 but not for long. It is dark in the morning and dark at night when I get home and we have not been walking with the harness and leash as much. Brrr, cold. We had a long walk yesterday at 10 am because it was my administrative day and I was caught up.

Sol Duc can’t find her pet toad any more. I think the toads have dug in for the winter and there are fewer and fewer insects. I think she is a bit bored. I’ve been building cardboard box puzzles for her, with the cat food ball inside. She has to roll the ball around to get the dry food to fall out. Maybe now she misses Elwha a bit, too. My work days are a bit long, leaving at 7:00 am and sometimes not home until 6:00 pm. Right now I have to drive to the other end of the valley.

The second picture is this morning’s sunrise. Gorgeous, yes? But that is the field across the street from us and that changed while we were gone too. They are building roads, all of the wild plants are gone, and it is staked all over and has large machines. And kitty corner, to the southwest, no more cows! The cows are gone! Are they inside for the winter or really gone? I think that they are really gone, because I see cows in other fields. The hay barn is still in use, but the cows have been moved. The city of Grand Junction is building and encroaching on the farms. We are right on the western edge of Grand Junction. No more early morning roosters, either.

I am not sure how to tie this to the Ragtag Daily Prompt, circular. Sol Duc is pretty circular when she curls up. The earth and the sky are circular. Emotions circle, happy to sad to surprised to worried and back. I am a little sad about the loss of the field and the cows, sigh, but happy Saturday to you.