Tag Archives: photography

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Conserving energy

I was out of clinic for two years and then very part time for a year and now not quite full time as a temp. I bargained to not quite be full time.

The electronic medical record is having a consequence, along with the pressure to see more people faster. The primary care doctors, at least the younger ones, do not seem to call their peer specialists any more. (Family Medicine is a specialty, just as Internal Medicine and Obstetrics/Gynecology are.) I called a gastroenterologist and left a message last week about a difficult and complex patient. The patient had cried three times during our visit. The gastroenterologist was very pleased I had called, was helpful, agreed with my plan of using the side effects of an antidepressant to try to help our patient, and thanked me three times for calling her. Wow. I am used to calling because during my first decade in Washington State, our rural hospital had Family Practice, General Surgery, a Urologist, Orthopedics and a Neurologist. For anything else, we called. I knew specialists on the phone for a one hundred mile radius and some knew me well enough that they’d say a cheery hi.

Now communication is by electronic medical record and email on the medical record and by (HORRORS) TEXT. Ugh. I think that there is quite a lot of handing the patient off by referring them to the Rheumatologist or Cardiologist or whatever, but the local Rheumatologist is booked out until February for new patients. That leaves the patient in a sort of despair if we don’t keep checking in on the problem. If I am worried, I call the Rheumatologist and say, “What can I do now?” I’ve had two people dropping into kidney failure and both times a call to the Nephrologist was very very helpful. I ordered the next tests that they wanted and got things rolling. One patient just got the renal ultrasound about three months after it was ordered. Sigh.

I have one patient who is booked in February for a specialist. I called that specialist too, they did not want any further tests. I told the patient, “You aren’t that sick so you won’t be seen for a while. It isn’t first come first serve: it is sickest first. We all have to save room for the emergencies and sometimes those are overwhelming.” The specialist agreed and the patient is fine with that and I think pleased to know that we do not think she’s that sick. She feels better. If things get worse, she is to come see me and might get moved up. Neither I nor the specialist think that will happen.

Is this conservation of energy, to communicate by email and text? I don’t think so. I think sometimes a phone call is much more helpful, because the other physician knows exactly what I am worrying about and they can tell me their thoughts swiftly. Sometimes they want me to start or change a medicine. Things can get lost in the overwhelming piles of data and the emails and labs and xrays and specialist notes all flowing in.

My Uncle Jim (known as AHU for Ancient Honorable Uncle Jim) used to sing part of this:

Yeah, that’s just how I call my fellow specialists.

For the Ragtag Daily Prompt: conservation. Don’t cats win at conservation of energy?

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Tool

I don’t wear livery at work
and anyhow that’s a uniform for men
or a place to board horses
though the horses can be male or female.
Once I go to my daughter’s second grade
for a bring your parent day
and bring part of my uniform,
or perhaps it is a tool or instrument,
my stethoscope. The children all want
to listen to my heart
or at least touch this magical tool.
Afterwards I receive thank you notes.
I think that every one, except my daughter’s
thanks me for bringing the stethoscope
to their classroom. I did not know how
special and magical a tool can be.

__________________

For the Ragtag Daily Prompt: livery.

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More dance

Now, here is some tricky twirling. The photograph was taken by Terry, in April 2023 at the Bishop Hotel. Tom had an injured ankle but we danced anyhow! I was very careful twirling because his balance was tricky, his foot was sticking out and I did not want to knock him over! I didn’t, and we both had a good time anyhow.

This is from March 31, 2023, right before the Swinging on the Sound dance weekend. Live band and lots of dancers warming up for the dance weekend.

My daughter called home from college at one point and said, “Mom! I love to TWIRL!” She was contra dancing and soon started swing dance and shag and other styles. I bought her dance shoes for her next back to school supplies. We bring shoes that we don’t wear outside, to protect the floors of old 1930s dance halls. We need leather or suede soles often so that we can twirl and slide!

Here is the band that Tom and I were dancing with: Jonathan Doyle and friend.

For the Ragtag Daily Prompt: twirl.

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Maps

I really like maps. I have a small hiking book for the area and a book of hikes. When I am riding in my daughter’s care, I admire a map of Colorado, a geologic highway map and shaded elevation map. My daughter says, “You gave that to me when I moved to Denver. Take it!” She doesn’t like extra stuff. Use it or lose it.

The geologic side fascinates me. It shows color coded zones of different rock formations and has some history. Rocks and mountains, delightful!

Some of the hikes here are also mountain bike trails and loop in all sorts of ways. I try to remember to photograph the map at the start of the hike, so that I can refer to it on my phone. Lots of hikes are out of the range of phone towers, so I won’t depend on GPS!

Grand Junction lies in the Grand Valley and runs mostly east/west along the Colorado River and Interstate 70. They have named the streets on a grid with letters and numbers. This has some odd charm: I live off of 21 and 1/2 road, which is 21 and 1/2 miles from the Utah border. There are some 1/4 and 3/4 roads too. The lettered roads start with A at Orchard Mesa. There is an F and 1/2 road. How fun! There is also a downtown switch, where suddenly the numbered roads go from 1 to 7 and drop out of the numbers set from the Utah border. There is an article explaining here.

The photograph is part of the Colorado Geologic Map. The altitude map is on the other side. Isn’t it pretty?

For the Ragtag Daily Prompt: guide.

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Pick one, delete two

I went through my blog this morning, picked a month two years ago, and deleted a bunch of photographs and the accompanying posts. More room! It is not a very fast process.

I am thinking about the Ragtag Daily Prompt today, hamfatter. It makes me think of Miss Piggy first. Don’t we all have a little bit of ham in us if we are in the right situation? Even if it’s just a dream or a daydream. Hamfatter also brings up ham and my inlaws. My son and daughter-in-law and daughter were all home for my birthday earlier this year. We also stopped at my daughter-in-law’s house, to pick my son up. Her parents heard it was my birthday and gave me a ham. How surprising and kind!

Yesterday I ordered prints of photographs to send to them, almost all with their daughter. She told me not to print any of the climbing gym or of the pets that her mother dislikes. Got it! I tried to pick ones that they will enjoy. It is a start of holiday gifts.

I am still having disaster nightmares, last night about my house. My house is far away right now and apparently my brain is worrying. I dreamed that there were clean baby clothes folded and piled all over the place in the upstairs bathroom, even on the commode. I took them off it and discovered that it was backed up. Then the walls dissolved and I realized with horror that there was water flooding through them! Then I woke up. Not a fun dream and no, there are not clean baby clothes in the upstairs bathroom. I think it is a combination of being far away and the coming administrative change. In some states it is illegal for a physician to discuss abortion. Will vaccines be next? And the most abortions are the spontaneous ones, where the pregnancy ends and passes. We call that a miscarriage but it is also called a spontaneous abortion. I wonder if those are illegal too.

I dress a bit more formally for work then at home. Maybe there is a bit of hamfatter there, too, entering the role of doctor.

I took the photograph in 2007.

For the Ragtag Daily Prompt: hamfatter.

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Who is there?

This is not a brilliant photograph, but it is interesting. This is taken from North Beach in 2022 with my cell phone. It was a very grey day and wet and we heard roaring. I imitate both animals and birds, so I roared back and tried to match the call. This is the response. These are sea lions and they can be enormous. The elders and biggest ones stopped and stuck their heads out, wanting to know who is there? Thankfully they did not come ashore, because the males can be 2.4 meters long (7.8 feet) and 390 kg (859 pounds). We did stop roaring, a bit intimidated. We had roared back at them other times. The sea lions are moving north, more information here.

I am trying to find time and energy to keep removing lots of old blogs and photographs to make room for the new. I could pay for more space, but then I have to keep paying for it, so I don’t want to. I have gone back and read my 2009 posts, no pictures, from the Mad As Hell Doctors trip and from writing elsewhere. I write more often with the Ragtag Daily Prompt, but the longer medical posts are intermittent.

Work has been interesting and I feel a bit off balance, because the plan is in flux and morphing. Right now I am in the same clinic Monday through Thursday, but at two different desks. I won’t be in this clinic for the rest of the assignment unless something changes. I don’t know where I will go next. Primary care has lost two providers in the six months I’ve been here, but I don’t know if that is an ongoing rate nor how many there are total.

My first job out of residency had a terrible turnover. I was fifth senior doctor out of fifteen in two years. That is a really really bad sign. By the end of the second year I was fairly sure that I would not be staying and that I could not change the culture. The three women doctors that I had joined had been trying for two years and one had already left! I was gone by the end of the third year.

And back to roaring with the sea lions. Here is Walt Kelly’s take on roaring, his poem Northern Lights.

Oh, roar a roar for Nora, for Nora in the night,
For she has seen aurora borealis burning bright.

A furore for our Nora! And applaud Aurora seen!
Where, throughout the Summer, has our borealis been?

_____________________

For the Ragtag Daily Prompt: grey.

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Low fog

I took this on New Year’s Eve on a walk with my kids and old friends in Maryland. We fooled around in a park. I like the low fog hanging in the trees, always further away when we walked to it.

Seesaw, Margery Daw, Jackie shall have a new master
He shall have but a penny a day, because he can’t work any faster.

That is the version of an old nursery rhyme that I learned from my mother. There is more about it here.

I am going through and starting to delete old blog posts and photographs to make room for the new ones. Not one of my stronger talents!

For the Ragtag Daily Prompt: seesaw.

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Wait

I came close but no cigar
I want a mind that I can love
hand holding mine in the car
I send a quiet prayer above
Love of nature, kind to friends
not afraid of their own dark
Lust to learn until their end
willing to risk to build an ark
Curious but not controlling
Not addicted to booze or drugs
Intense at times and others strolling
Opinions, laughter and lots of hugs
My heart open yet I don’t faint
I think I am waiting for a saint

_____________________________

I wrote the poem yesterday, but I have used up my memory in wordpress and now I need to go through and delete things. Any advice, Martha? I know you did it. It seems that I have to delete the post and the photograph, or is that not true? Advice welcomed.

I search my photographs for gloves and it comes up with two: foxgloves! Well, strictly speaking, that is a form of glove, right?

For the Ragtag Daily Prompt: glove.

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Made it!

Sol Duc and I made it home on Thursday, 325 more miles, arriving happily to the house in Grand Junction. I got ready to take her for a walk later and stepped outside: snow! We went over 7 passes driving from Port Townsend to Grand Junction and some smaller peaks that did not have the altitude marked, but didn’t get snow. On the last night a big storm was rolling in from the south east in Colorado and from the west in Utah. I thought, whew, I may just make it.

We did and I took the photograph yesterday morning before driving to work. Just a sprinkling, more as I got to Palisade, but not on the roads. It warmed up and melted through the day.

People have told me that Grand Junction does not get that much snow. That may be relative, that it might not be much compared to Denver, but a lot more than Port Townsend. I have no clue! We will see.

For the Ragtag Daily Prompt: unexpected and no clue!