Tag Archives: teamwork

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group

For the Daily Prompt: popular.

I was on Herron Island for two nights. We were the second responders to a house fire and called 911.

Are the gulls grouped for social reasons? For survival too. If there is a predator, those sleeping will be awakened by the others.

The hurricanes and the house fire: I am thinking about emergencies and emergency response and emergency preparedness. How are you prepared? The fire trucks had to come to the island by ferry and it took twenty minutes.

I am donating to Shelterbox, that sends disaster boxes all over the world, shelter, water filters, cooking equipment and food supplies. And crayons and a coloring book for the children. I hope they are arriving in all the places, wars, hurricanes and other disasters.

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joy

This photograph is from 2011. The Synchronized Swimming competitions took an enormous amount of time and work for the girls and work for the parents. And the coaches and the people who held the meets and judges. I am looking through photos and the girls had such fun together, older and younger, beautiful teamwork and joy.

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diligence

I am a day behind on the A to Z Challenge but that’s ok! I started a day late anyhow….D for diligence. One of the 7 virtues. This is from the 7 Heavenly Virtues, a different list from the cardinal and theological virtues. Bravery is not on the Heavenly list. Diligence is the match for the sin “sloth“. This virtue does not double as an emotion, just as chastity does not double as an emotion. I can feel diligent but it’s not like saying, “I am a sloth today! I feel totally lazy!”

The photograph is from 2011, my daughter and another member of the synchronized swimming team. My daughter started at age 7 and could barely swim one length of the pool, much less two. She fell in love with it and continued until the team disbanded, and then moved on to swim team. It is a spectacularly difficult sport, to dance upside down in the water. They score on the Olympic scale right from the start, earning scores of 1 or 2 out of 10.

Here they are leading a land drill, with younger team members in the water. This is at a meet, so they are ready with their suits and hair pieces for the team performance.

There are so many things that can be approached with diligence that lead to the joy of doing something well and with one’s entire heart…..

 Musicians work with great diligence too….here.

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Resilient

We went for a walk last night down town. On the way back, the bell in the fire tower was illuminated and looks magical. The tower was built in 1890 for the town fire bell and has been preserved. Read about it at the Jefferson County Historical Society : http://www.jchsmuseum.org/Resources/Resources-HistoricPreservationBellTower.html

I hope we can come together as a country for health care as this community has for the bell tower….

This is for the Photo Prompt: resilient.

 

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Diagnosis is only half the job

In clinic I have two jobs.

The first job is to diagnose. Chief complaint, history of present illness, past medical history, allergies, review of systems, medications (and vitamins and supplements and herbs and any pills or concentrated substances), social history including addictive substance use, family history, physical exam. What is my diagnosis? A clinical portrait of the patient.

The second job is to communicate and negotiate. I have to get a snapshot of the person’s medical belief system, their past experience with MDs, their trust or lack of trust, whether they are willing to take a prescription medicine. I have to try to understand their world view at this visit, at this moment in time. And it’s not static and may change before I see them again. If I can understand the person well enough to communicate with respect, with concern, with understanding, then we may be able to negotiate a treatment.

In clinic the other day I had a new patient who said, “I am not going to be pushed to take prescription medicine.” I responded, “That’s fine. I am not going to be pushed to do medical testing that I think is inappropriate, either.” She actually laughed and said, “Ok. That’s fair.” This is a patient who is coming from alternative treatment but wants medicare to cover her tests. After the visit she called and said that her provider wants a certain test before they feel comfortable proceeding with a therapy. I responded that I need a note and an explanation of the planned therapy before I will order the test. (Honestly, it’s an increasing trend that I get calls from patients with messages like “My orthopedist wants you to get my back MRI prior authorized.” and “My physical therapist wants my hand xrayed.” Our new office policy is: the provider has to communicate themselves, not via the patient. Also, it ain’t always so….)

I had patient once in the emergency room who said, “I have an antennae in my tooth. Get it out.” Her roommate nodded, looking terrified. This was after a fairly confusing complaint of tooth pain. I needed to think about an approach. I said, “I need to check on another patient. I will return.” I left the room in the emergency room and considered approaches. I went back in and said, “I am not a dentist. I can’t take out the tooth. BUT I can call a doctor to help with the sounds that you are hearing until we can deal with the tooth. The doctor is a psychiatrist.”

“Ok. Call them.” said the patient. The roommate practically collapsed with relief. Psychiatry said, yes, looks like psychosis and we have a safety contract and she will come in Monday. People HAVE actually had metal in their mouth that picked up radio sounds, but psychosis is much more common. Also, if you can say the station call sign that is a lot different than voices that are telling you to harm yourself.

I thought about my approach carefully. I did not want to argue about the tooth. I wanted her to agree to talk to psychiatry. So I told the truth: I can’t fix the tooth. It’s Saturday night. Here is what I can do. I never said, hey, I don’t think it’s the tooth, I think it may be a psychotic break. She may have known that it was not the tooth but been too terrified or too disorganized to tell me. And there was a small chance that in fact, it WAS the tooth.

It is not worth trying to “fix” or change someone’s world view. If they trust their naturopath more than me, that is ok. But it’s a negotiation: I am a MD and I will do treatments that I think are appropriate and safe and I may or may not agree with the naturopath or chiropractor or physical therapist or accupuncturist or shaman. But the goal in the end is NOT for me to be correct: it is to help the patient. Half the therapy is respect and trust and hope. And kindness.

The biggest problem with ten minute visits and the hamster wheel of present day medicine in the US is that the second job is often not possible. Complex diagnoses are missed or patients leave feeling unheard, not respected and frustrated. Time to make the connection and to understand is very important and is half the job. Physicians and patients are frustrated and it is only getting worse.

 

The photograph is my daughter and her wonderful violin/viola teacher, right before my daughter played for a music competition.

 

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Water

W for water in the Blogging from A to Z.

Water, water, water. After my mother died of ovarian cancer in 2000, I went to therapy in 2002. I dreamed of water, over and over again.

The photograph is from the 2009 National Junior Synchronized Swimming Competition, in Federal Way, Washington. Cameras with removable zoom lenses were not allowed. There was a professional photographer. I had an electronic camera given to me by my father, with a formidable built in zoom. Synchro is difficult to photograph because they are in the middle of the pool and they are under water at least half the time. I had been practicing taking pictures of my daughter’s intermediate level team and would time the electronic delay to try to catch lifts.

We were at the Junior Nationals volunteering to help. This earned our team points for the northwest district and it takes many volunteers to run the contests.

This is an eight person Junior team at Nationals and six of them are under water. They are not allowed to push off from the bottom. They all have to be in position to do the lift and the person lifted has to be strong and balanced and ready. Two people are being lifted here: the woman below supporting the woman above and in turn, being supported and lifted by the rest of the team. I chose this photo because of the strength, athleticism, balance and teamwork. The team members swim so closely together that they kick and scratch each other. Or fall on each other in a lift. I want all humanity to have this kind of teamwork and lift each other.

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Teamwork

The photo is of a synchronized swim trio.

Only one swimmer is really visible. She is being lifted by the other two. They are not allowed to touch to bottom at all. It is all done lifting their own or each other’s bodies out of the water by swimming.

Sychronized swimming is a shrinking sport in the United States, because it is such hard work. My daughter started at age seven and had to swim three laps. She made it one length and then had to hold on to the lane divider to rest during the rest of the laps. She went under three separate times during that first practice. I nearly jumped the divider all three times, but she came up each time.

“How was it?” I asked when she got out.

“I nearly drowned three times.” she said, stomping past me in a rage.

She says that she hated it for the first year and that I made her keep going. If I did, I would feel guilty, except that she loved it so much after that. Seven years of synchronized swimming, until our very small town team folded, and then swim team. She is now a junior. What she wants most in college is to continue to swim on a team.

Back to the photo. To be lifted straight out of the water that far, you must be in the right position, you must have very good core strength, and your two partners must be in the right position underwater and lift correctly. You must practice and practice and practice and practice.

And you do this in time to music.

We need to work as a team in the world to deal with infection, to deal with ebola, to work together. My daughter loved synchronized swimming because it is so challenging and because it is above all, teamwork.