My feelings are not that complicated now I feel sorry for your need to be quite cruel Sorry and occasionally wonder how You justify acting like a stubborn mule a distillation of your treatment is quite clear you choose to keep the people you control promises mean nothing when you feel fear Telling yourself we’re evil takes a toll You feel free and safe when you axe another friend You feel that all your problems are at bay A new need immediately builds again Who will be the next victim of the day? Your world shrinks every day you live A stone cold heart forgetting how to give.
Sonnet 14
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Isn’t it an amazing tree? Complicated and yet forming an overall beautiful shape.
On Sunday I was in Portland with a friend and went to a memorial at the Laurelthirst. It was for a musician named Turtle. Local musicians showed up like crazy. There were at least six very fine guitar players, three on stage at a time and sometimes more. They switched in and out and switched styles. It was a beautiful tribute.
My two favorites were “They threw me out of the band” and one that bemoaned everyone playing music and drinking and that he had to sing another song about another dead band member. Funny and sad.
Red Paw puts her elbows on the table and her chin in her hands. “Told you so. Been telling you for 11 years.”
The small child/angel is sitting in a chair that morphs from regular boardroom chair to youth chair as she morphs back and forth.
“Nice job with the chair.” says Red Paw.
The two split and now there is a Small Child and an angel, sitting in two chairs.
Red Paw morphs too, into a bright red angel with a black halo and black bat wings.
The White angel nods and a feather drops. The feathers are bright white. Her halo is made of gold glittery pipe cleaners and attached at the shoulders.
Red Paw’s halo floats and seems to pull at the room.
The Quiet Woman sits in the fourth chair, with a cup of tea. “Anyone else?” she asks.
The others shake their heads.
“We are discussing the diaspora. Is it time to let them go?”
“Has been for 11 years.” says Red Paw nastily.
The small child nods.
The White angel says, “They want to believe what they want to believe. Let them go.”
“T, B, S, C, S, D, A, F, N, C, T, L, K, R and then next generation as well?”
All three nod.
The small child says, “They can contact us at any time.”
“They won’t.” says Red Paw.
“People can change,” says the White angel.
“And do they always?” says Red Paw.
“No.” says the White angel.
“I agree,” says the Quiet Woman. “We are done.” She brings a gavel down on the table, which rings like a singing bowl. The other three blur and melt in to her.
“We are done.”
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The photograph was taken 2016 or earlier when Halloween was on a Sunday. I dressed up and so did the minister.
An old friend died this morning. She was a college friend of my parents and has known me since birth. I will miss her quite terribly.
She and I took a road trip in September. She had lost thirty pounds, not on purpose. I thought I had better do the road trip while we could. We went from Michigan to visit five households of old friends in Wisconsin. I lived with her and her family for a year during college in Madison, Wisconsin in the early 1980s. She is a beloved mentor.
She also introduced me to all sorts of groups. She has an amazing record collection.
I went with her to see Warren Zevon in Madison.
The painting is my photograph of one of her oil paintings. It is about 3 by 5 feet and gorgeous.
Why? The problem with templates in primary care medicine is they focus on getting a specific list of questions answered for something like ear pain or back pain. They miss the weird stuff. They miss the outliers.
I hated the templates when we got our first electronic record in the early 2000s. The doctors who liked computers spent a year picking the system. Then they trained all the clinics for one week and we all went live. One of the biggest problems was that they liked computers and talked the language. We didn’t. We quit asking questions within a week, because when we asked a question it 1. Was a user problem and 2. They treated us like we were stupid and 3. They answered in Geek, which we did not understand.
We quit asking questions. The nurses and I all filed for workman’s comp because our shoulders locked up. Our shoulders hurt. We figured out how to get the stupid thing to work. Every doctor and nurse and PAC and nurse practitioner worked to figure it out on our own.
Two years later, they set up some standards for use. We resisted again, because they gave us orders in Geek and anyhow, we had no respect for them and we didn’t care. Change what we were doing? After no support for two years? Good luck!
It took me two years and three months to get the system to write what I considered a good clinic note. I had contacted an outside specialist three months in and asked how our notes were.
“You want me to be honest?” he said.
“Yes.”
“They suck. They are useless.”
“That’s what I thought.” I went on fighting the system and hating it. I won, eventually. Parts of my note continued to suck, but I figured out how to work around the stupid templates and put in some REAL information.
Now wait, you say, is the template totally useless?
In some situations, like emergency rooms, it may be very useful. It helps keep a harried ER team with four people from a car wreck from missing something. And if you are an ENT, otolaryngologist, you do see a lot of ear and mouth and throat things, so templates may help. But I think they are terrible for primary care.
They are good for billing, though. If you have all the boxes checked, the insurance company pays, and you can move on to the next victim. The insurance companies pay more if you see more people in a day. That is why our administration said, “See people for one thing per visit.”
However, that is not ethical. Say it is a 70 year old diabetic with atrial fibrillation on coumadin with a bladder infection. You cannot just say bladder infection and slap them on sulfa. For one thing sulfa screws up the coumadin and puts them at risk for bleeding. For a second, diabetes can affect kidney function and so can age and you have to adjust antibiotic dose for lower kidney function. For a third, if their glucose levels are out of control, the infection may not be controlled by an antibiotic. It’s not one thing. And the average patient has 4 chronic disorders in a study way back in the early 2000s. That means some people have none, some people have eight or more and most people have 3-5. Hypertension, diabetes, toe fungus, chronic shoulder pain, heart disease, the list goes on and on.
In any visit, I am alert for the things the DON’T fit. One time I am doing a new patient visit for back pain and note that she is hoarse. I bug her about the hoarseness. She admits it is continuous and has been there for two months. I do two referrals, because continuous hoarseness can be laryngeal cancer.
When she returns, she thanks me. She has vocal cord polyps, not cancer, but needs laser surgery. “You didn’t have to do that but you did.” she says. And do I feel good about not ignoring it? The visit went over time, but I’d rather go over time than miss laryngeal cancer, right?
We were taught to let the patient talk. Open ended questions. They’ve done studies that doctors cut people off from telling their stories very very quickly. If you let people talk, sometimes they say something that doesn’t fit the template, and we have to pay attention. Sometimes a comment or a couple comments are the clue, the key, the thing that doesn’t fit. Don’t force it into the template. Pay attention instead.
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The very serious group of people is a county medical meeting, 2014.
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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