Tag Archives: think

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Why mean?

Why do people do that smiling mean thing? Where they are teasing too close to the bone, meanly, with a smile. If you object, then you are labeled as someone who can’t take a joke or who has no sense of humor. How do people handle them? I put them on avoid and do not want to be around them. But really, what motivates them? Power? Humiliate others to feel better about themselves? What a very sad and pathetic way to go through one’s life.

This is related to me thinking about what people think about. I think about what motivates people a lot and why they do what they do. This, apparently, is NOT what most people think about. My curiosity about people dates back to being a very small child and being passed from household to household because my mother had tuberculosis. I decided that adults did not understand children and that they loved me but didn’t understand that babies should be kept and loved. My sister was born when I was three and I told people that she was MY baby. I was determined to take care of her. Alcohol continued to make the adults in my household unpredictable and sometimes dangerous, at least emotionally.

My mother could charm a room and all visitors, but sometimes she would talk about them after they left. My family tended to ignore me if I was reading, because I really did not listen if I was deep in a book. Books were an escape and a safe place. People would have to call me three times to get me out of one. But sometimes my brain would click me out and I would listen to the conversation. My mother would talk about people’s motivations and was often quite negative and not nice. Interesting, but not nice.

When I realized that most people don’t think about others’ motivations most of the time, I felt rather freed and enlightened. I promptly ran into not one, but two mean people, at different sites. I do not understand meanness. I worry that it will be in the White House soon, as well. And what, that meanness wants to annex part or all of two other countries? Is this fascist envy? That’s what I think. So there.

The photograph is Sol Duc in 2022.

For the Ragtag Daily Prompt: mean.

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Thinking about this and that

I am thinking about thinking. What do people think about most of the time?

This partly comes from my ex. He thinks out loud a lot, an external processor. My daughter and I wanted to know what he thinks about. My son asked. “Dad, what do you think about?”

“Golf.”

“Golf?”

“Yes.”

“Anything else?” says my son.

“No.” says my ex.

I have no idea if this is true or not. Sounds hella boring to me, honestly, but he seems entirely happy with it. De gustibus non est desputandem.

I had lovely winter holidays, celebrating EVERYTHING. I went to my son and daughter-in-law’s out east. My daughter and her significant other came out and we did presents on December 27th. Then we went to see my two aunts and uncle for a couple days. They are in their 80s and delightful! Back to my son’s and we saw my kids’ remaining grandparent, my ex-husband’s father’s significant other. Got that? And one of my kids’ paternal cousins with her significant other. I stayed with old friends for the last three days, which was also delightful. We went to the Smithsonian American History Museum and read every single thing. But only in two exhibits because that place is huge.

Now I am back to my current home and hello, cat! Back at work as well. More about that next time. The sands are shifting and I may be in another clinic. Monday a patient asked if I am their new doctor or am I a floater? I said I prefer “Temp” to “Floater”. She laughed.

For the Ragtag Daily Prompt: think.

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Student travel

I traveled around Italy for two weeks with my daughter. We had backpacks and we planned it as we went. We usually had a place to stay two days ahead or a little more and both had return tickets. Hers is changable, mine was not unless I got sick. Then the insurance should kick in.

The last time I traveled in Italy was with two cousins in 1980. We traveled from January to March, with a Eurorail pass, and tried to do $20 per day. We did not like Italy very much because we felt terribly hassled by men. They yelled things at us, invited us into their cars, felt us up on buses and in general were awful. We were dressed in jeans, hiking boots, down jackets and frame packs. This made us obviously from the US or Canada, but we certainly were NOT dressed in a “suggestive” manner. We were very relieved when we got to Greece and there was less harassment.

I did not think I would be hassled since I am 43 years older. We were not hassled and I really did not see that behavior happening. I did see some outfits that I would consider rather sexy on young women in the hostels, but mostly people were in summer clothes. Narrow tank top straps, mini skirts and short shorts were frowned on in a number of the Catholic churches, and my daughter borrowed a large scarf from me as a skirt a couple of times. I liked Italy much much more this time. Thank you!

It was interesting to travel with a backpack in Europe again. There are other grey haired people in the hostels, though the closer to the tourist areas we were, the younger the clientele. I liked my pack better than a roller bag because honestly, there were stairs everywhere. At first both my feet and my quadriceps complained about the amount of walking and walking with a backback, but I got stronger. I woke up with terribly sore quads every day the first week.

My daughter wanted an open schedule. We had the first two night’s stay set up but no more than that. We took turns finding places to stay, getting tickets for big things like the Vatican Museum, and getting bus and train tickets. Google maps is quite amazing. We could put in our destination and it would tell us which bus and which stop and trains and metros. Back in 1980 we pored over maps, so that is a big change.

When I got off my last plane, I put the pack on and thought, either it is lighter or I am stronger. Both, I think, because I had eaten all the food while on the airplanes. Food is heavy!

I want to travel again next year, though I don’t know where. I have a long list of ideas.

Here is my daughter’s neat pack:

And my messier one:

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The Extroverted Feeler’s haircut

My son was an Extroverted Feeler when he was little. Let’s call him EF.

We move in the middle of his first grade. From Colorado to the Olympic Peninsula, arriving on December 31, 1999. Y2K. The computers do not stop the next day and the world does not implode. My mother has recurrent cancer.

He starts school. He is in a three year class in public school with two teachers. It is a first, second, third grade mixed class. There are fifty kids and he is starting in January.

His mother is bananas because she is trying to learn a whole new set of patients, phone numbers, specialists and local medical slang. His father hates moving and lies on the couch. His grandmother is not doing well. He doesn’t have any friends yet. He misses his Colorado friends and his teacher. He is gloomy.

His father takes him to get his hair cut.

They return and I nearly swallow my tongue. The EF has a triple mohawk. A central spike of hair, shaved on both sides, and then another spike on each side. He and his dad thought it up. I tell myself: it’s just hair, it’s just hair, it will grow back! Horrors.

Two weeks later the EF is cheering up a bit and has a friend. Why? Apparently the haircut garnered attention. Within a week, not only does every kid in his class know his name, but most of the parents do too. “Who is that kid with the triple mohawk?” The EF is very pleased.

He gets a triple mohawk once more. By now I am ok with it.

After that he gets normal haircuts. His grandmother dies, but he has some friends now. His mother is less bananas over time and his father knows the name of every checker at the grocery store and all the coffee shops and the golf pros.

There was a cartoon where a mother is telling her son not to stare at a person with a mohawk. “But mom, don’t they get mohawks so that people will stare?” Uh, good point!

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For the Ragtag Daily Prompt: mohawk.

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Deleting spam

I still think of you occasionally
when I pay the bills, I think of you
when I clean the catbox, I think of you
when I clear the spam, I think of you
it’s the Get’a’super-sized’rod’ ones
that make me think of you and laugh
I want to send them to you every time
I still think of you occasionally
Get’a’super-sized’rod’ and poo and bills

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This too two

This too two I want to remember.
Disagreeing. Respectful nearly always.
You say, “You argue with everything.”
“I think about both sides.” I say.
“And if I am alone I discuss both with myself.”
You roll your eyes and I grin and continue.
This too two I want to remember.

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Practicing Conflict

An essay from my church talks about the writer avoiding conflict, fearing conflict and disliking conflict. This interests me, because I do not avoid conflict, I don’t fear conflict and actually, I like it. Our emeritus minister once did a sermon in which he said that when you are thinking about two conflicting things at once, that is grace. I have thought about his words many times, especially when I am not in agreement about something.

Does this interest in conflict mean I fight all the time? Well, sort of, but not in the way you think. I don’t fight with other people much. I fight myself.

What? No, really. Most topics have multiple sides. Not one, not two, but many. Like a dodecahedron or a cut gem. Hold it up to the light, twelve sides, each different. I argue the different sides with myself.

I learned this from my parents. My parents would disagree about something, they would discuss or argue about it, and then they would bet. Sometimes they bet a penny, sometimes a quarter, sometimes one million dollars. Then one of them would get up and get the Oxford English Dictionary, or the World Atlas, or some other reference and look it up. This was pre-internet, ok? 1970s and 1980s.

Sometimes my parents would even pay each other. The penny or quarter. My father spoke terrible French and my mother had lived in Paris for a year after high school, so he could get her going by insisting that his French was correct. It wasn’t. Ever.

There were other arguments in the middle of the night that were not friendly and involved yelling, but the daytime disagreements were funny and they would both laugh.

Once my sister is visiting after my mother has died. My father is present. My father, sister and I get in a three way disagreement about physics. I’m a physician, my sister was a Landscape Architect and my father was a mathematician/engineer, so we are all three talking through our hats. However, we happily argue our positions. Afterwards, my gentleman friend says, β€œThat was weird.” β€œWhat?” I ask. β€œThat was competitive and you were all arguing.” β€œIt was a discussion and we disagreed.” β€œI won’t compete.” β€œWe let my dad win, because it makes him happy.” β€œThat was weird.” β€œOk, whatever.”

My gentleman friend is also shocked when my teen son challenges me at dinner. My son says, β€œI am researching marijuana and driving for school and there isn’t much evidence that it impairs driving.”  I reply, β€œWell, there is not as easy a test as an alcohol test and it was illegal, so it has not been studied.” We were off and having a discussion.

Afterwards my gentleman friend says, β€œI am amazed by your son bringing that up. We weren’t allowed to discuss anything like that at dinner.” I say, β€œWe pretty much discuss anything at dinner and both my kids are allowed to try to change my mind. About going to a party or whatever.” He shakes his head. β€œThat is really different.” β€œOk,” I say.

This habit of challenging authority, including adults, did not go over well when my son was an exchange student to Thailand. It did not occur to me to talk to him about it. He figured it out pretty quickly.

Back to my internal arguments. If I take a position, I almost immediately challenge it. I think of it as the old cartoons, with the angel on one shoulder and the devil on the other. The devil will make fun of things and suggest revenges and generally behave really badly. The angel will rouse and say, β€œHey, you aren’t being nice.” Then they fight. The internal battle very quickly becomes comic with the two of them trading insults and bringing up past fights and fighting unfairly. When it makes me laugh inside, I can also be over the driver who cut me off, or someone who spoke nastily, or whatever. My devil is very very creative about suggested revenges. When the angel says, β€œYou are meaner than the person who cut you off!” I am over it.

When I was little and disagreeing with my family, my sister could tell. β€œYou have your stone face on!” That meant I was attempting to hide a feeling, especially fear or anger or grief. Siblings and family are the most difficult because they can read us and see through us like glass. My physician training also teaches control of feelings. I have sometimes wanted to grab a patient and scream β€œWhy are you doing this to yourself?” but that really is not part of the doctor persona. I am doing it inside, but I can put it aside until later. Then the devil goes to town! And the angel tries to calm the devil down.

Maybe we all need more of this skill. Pick a mildly controversial topic. Argue one side of it. Then switch positions and argue the other side. Go back and forth until it gets ridiculous. Let each side get unreasonable and inflammatory and annoying. This can play in your head and not on your face. Once you can do a mild topic, move on to something a bit more difficult. If you only know the arguments on your side, read. You can find the other side, the internet is huge. Start gently.

A friend says, β€œYou always argue about things.” I say, β€œI prefer to think of it as a discussion.” β€œYou always take the other side.” β€œWell, it interests me. And if there is no one to discuss something with, I discuss it with myself!” β€œWeirdo,” says the friend. I think he’s jealous, really I do. Don’t you?

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how doctors think, a dual pathway

A friend calls today and says that another person is bleeding and yet they have been set up to be seen Monday. Why isn’t this an emergency?

Based on the limited information the friend tells me, I agree with the doctors. It is NOT an emergency and I explain why. It is uncomfortable for the person because it may be cancer. Why is that not an emergency?

Let’s use chest pain in the emergency room as an example. Doctors have two brain tracks that are triggered simultaneously by every patient. The first one is “What could kill this person in the next five minutes?” The second is “What is common?” Common things are common and more likely. In medical school the really rare things are nicknamed zebras. You know there are a lot of horses but you can’t miss the zebra. I suppose that in Africa the common things are zebras and the rare ones are orcas or something like that.

Anyhow, the killers for chest pain are heart attacks, sudden death. But there could also be a dissecting aortic aneurysm, where the largest artery in the body is tearing. That person can bleed to death really really fast and that is a surgical emergency. No doctor wants to miss it. There could be a pulmonary embolism, a clot blocking the lung. Chest pain could be from a cancer. A very rare chest pain is from the valve leaflets in the heart tearing so that the person goes in to flash pulmonary edema. And there is Takayasu’s Arteritis, “broken heart syndrome”, where the heart suddenly balloons in size and again, heart failure ensues. Heart failure is actually pump failure, so fluid backs up in the lungs or the legs or both. It is usually slow but rarely very fast and dramatic. A collapsed lung can also cause a lot of pain. And my list is still not complete, I haven’t mentioned pericarditis or myocarditis or a compression fracture.

The common things do include heart attacks, but also anxiety, musculoskeletal problems, inflamed cartilage of the chest wall, fibromyalgia flares, broken ribs, trauma and other things. I was very puzzled in clinic by a woman with pain on both sides of her lower chest wall. In front but cutting through her chest. I ruled out many things. I thought that it was her diaphragm. I sent her to a rehab doctor for help. The rehab doctor sent her to radiology. She had a compression fracture of her spine and the nerves were sending pain messages on both sides. That was not even on my “differential diagnosis” list, because she had no back pain at all. My list changed that day.

Physicians and nurse practitioners and physicians assistants and registered nurses and licensed practical nurses and medical assistants are all trained to think of this differential diagnosis. We are alerted by the history and have to think down both pathways. Last year working as a temporary doctor, the medical assistant came to me saying, “This patient’s blood pressure is 80/60.” “Is he conscious?” I asked, as I went straight for the room. “Yes, he’s talking.” He WAS talking, which means that he’s gotten to 80/60 slowly or is used to it. His heart rate was fast, up near 120. I immediately had him drink water and keep drinking, as soon as he denied chest pain. The problem was dehydration: he was developmentally delayed and had only had one cup of fluid that day and it was now midafternoon. I spent time explaining that he needed 8 cups each day. Not more than that, because if he had too much fluid, it would lower his sodium and make his muscles weak. Most days he drank 3-4 cups. His chart graphed the problem: some days he had normal blood pressure and a normal heart rate. Other days his blood pressure was below normal and his heart rate was fast, his heart trying to make up for the low level of fluid. Cars don’t do so well when there is almost no oil, do they? His kidneys were affected as well. I asked him to drink the 8 cups a day, discussed the size of the cup (not 8 gallons, please) and then recheck labs in 2 weeks. If his kidneys did not improve, he would need a kidney specialist. It turned out that he had nearly fainted that morning in the waiting room. His group home person admitted that no one had noticed that he really was not drinking fluid. I thought that the patient understood and would try to drink a better amount of fluid.

So back to the person I was called about. Infection has been ruled out. This is blood in the urine. A kidney stone has been ruled out, but there is something in the kidney. This is urgent, but if the person is not bleeding hard, it is not emergent. When there is blood in the urine it does not take very much to turn it red. If there is a lot of blood, that can be an emergency, but from the story I got third person, it’s not very much. The emergency things are ruled out but there is still not a clear diagnosis. Yes, cancer is one of the possibilities but it could also be benign. Now a specialist is needed to figure out the next step and the differential diagnosis, the list of things it could be. They will order tests in the same dual order: what could kill this person quickly and what do we need to rule out as common? People often can be very anxious during this period, which is normal. The person says, “I don’t care what it ISN’T, I want to know what it IS.” But sometimes it is a zebra and it takes a while to get to that specific test.

Another example is a woman that I sent to the eye doctor. The optometrist thought it was something rare and bad. He sent her to the opthamologist, who ruled out the first thing, but thought it was something else rare and bad. He sent her to a retinal specialist. The retinal specialist ruled out the second rare and bad thing and said, “No, you have something very rare that is benign.” My patient said, “I have three diagnoses. Who do I believe?” I replied, “No, you have one. The optometrist knew it was unusual and sent you to an eye doctor. The eye doctor know it was unusual and sent you to an even more specialized eye doctor (a “sub specialist”. We keep them in basements.) Now you have a diagnosis. It was a scary process, but I think you should focus on the third opinion because hey, she said it’s benign and it won’t hurt you! That is the best outcome!” She thought about it and agreed. The process was frightening but the conclusion could not have been better.

For the Ragtag Daily Prompt: disquieting.

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Adverse Childhood Experiences 13: unsense

As a child in an alcoholic/addict household where you can not trust adults, who do you trust?

You either trust yourself or you buy in the alcohol story.

If you buy in, you have a high probability of either becoming an addict or marrying one, depending if you prefer the enabler or the enablee role.

If you trust yourself, you develop certain senses. You pay attention to people’s emotions. You pay attention to what people FEEL, what people DO and not what people SAY. You do not care what they say: what matters is what they do. My sister said she used to walk my parent’s house during high school and try to feel the mood. Did she need to hide?

The enabler role is trying to control the other person. There are amazing variations on this. I cared for a person whose sister would not take care of herself. Every time the sister is hospitalized, the person goes and cleans tons of garbage and rotted food from the apartment.

“Stop doing that,” I say, “You are enabling her. Call Adult Protective Services to go look at it instead.”

It can be very difficult to stop and can take years. People can change.

I have noticed that the enabler role is lethal. The enablers seem to die before the enablee. Certainly in my immediate family and with many patients too.

Enablee is the person controlled. Alcohol, drugs, gambling, anger, emotions. It is very very interesting to watch. I have read parts of my mother’s diaries. She was the enabler, with my father as the enablee. However, the diaries document them fighting in the middle of the night when he is drunk. And I remember high school, putting the pillow over my ears, because they were screaming at each other.

But wait. Why would she argue with her drunk husband? Why would anyone argue with a drunk person? You have to wait until they are sober.

And slowly I realize that my mother too was an alcoholic. I remember her drinking. Best cover for an alcoholic is a worse alcoholic, right? It’s fairly horrid. But it explains some stories and my food insecurity. They would not get up in the morning to feed me. My mother told stories of me trying to feed myself: cheerios and laundry soap. If my father was hung over, ok, but, why wouldn’t my mother get up? I think they were both hung over. That or else she really did not want a child. Especially a nine month old with opinions while she was trying to get over tuberculosis. She never got to hold me after birth until 9 months. And then I did not want her. I wanted her mother.

Trusting yourself, life can be a bit complicated. You sense the emotions others are hiding. Being a physician allows me to ask about the hidden things, very gently. Sometimes they come out right away. Sometimes it takes months. Sometimes years and sometimes never. My sister and I discussed going to parties and thinking, oh, that person is the child of an addict/alcoholic. This person is in pain. This person is quite happy but hiding stuff.

I told a counselor I do not know how to turn it off. She replies, “Why do you think I am a counselor?”

I don’t see auras. I feel things: like a cloud. Like a tiger, like a bear, like a whale, singing.

I think I will go with the whale.