Tag Archives: work

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Eating sunlight

Beloved
I don’t think I can bear this
It’s a good plan
To work five more years
And retire in better financial shape
House paid off
But it hurts so

My tattered bruised and battered heart
Already patched so many times
And to see so many people each day
Hurting

Why, Beloved?
Why don’t we mature?

Maybe I’ll be a tree again
Living wood
That bends and moves with the wind
That eats the sunlight
Drinks the rain
Endures the snow and drinks it as it melts
Until spring comes
And I stir and start to bud
Deciding when it’s time
To uncurl leaves in warm sun

_______________________

For the Ragtag Daily Prompt illusion. Or should it be delusion? Or survival? Or beyond that to peace?

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Balancing act

I am working at a site in the greater Seattle area, but I am not going to say where. Why? Two reasons. One is that the patient diversity is huge: the organization is organized to take care of low income, uninsured and immigrant patients. The second is that I am still trying to decide if the balance of the organization is working. It may be working but it might not be working for me.

I am at a large clinic, with primary care, dental, behavioral health, a nutritionist, a pharmacy and three in person translators. In any one day I will probably use translators for at least six languages. English, Spanish, Dari, Hindi, Punjabi, Arabic, French, Somali and sometimes languages that I have to look up the country because I don’t know where that language is spoken. The work is fast and furious.

The overall no show rate is 20%. This makes the day very unpredictable. It can be very very fast and busy with everyone showing up and then later there are three no shows in a row. I think that the no show rate has been less than 20% but on Tuesday it was more. However, everyone showed up in the morning and there was a hospital follow up that should have had 40 minutes and only had 20 and of course then we ran later. My lunch theoretically starts at 12 but I went to lunch at 12:50 and came back 6 minutes late, at 1:06. Then people no showed while I worked to finish off everything from the morning. It did feel a bit nuts.

We are using the electronic medical record EPIC. I find EPIC epically frustrating. It is “feature rich” which means it has too many ways to do things. If I ask someone how to record a phone call to a patient, it takes eight steps. A week later I have to do it again, I ask again, and the next person shows me a DIFFERENT set of eight steps. And there have to be at least eight ways to do anything, so it is very confusing. Also, the “home” page can be personalized to the extent that people look at my version (I have not personalized it much) and say, “Mine looks different. I don’t know how to do that on yours.”

Whew. So, how to cope with the fast furious unpredictable schedule? I am “precharting”. For this Tuesday, I spent 70 minutes going through the patient charts on Saturday. Then I may know why they are coming in, if they had a heart attack two weeks ago and are following up, if it is a well child check and the last one was two years ago, if there are outstanding issues like a elevated liver tests or they have not been in for their out of control diabetes for a year. Then, of course, some of them do not show up. It is so busy that all I feel when someone no shows is some relief, like a ray of sunlight in a dark forest. Ok, the person who was horribly sick and in the hospital for a week and had surgery, they really do need to follow up. But I cannot make them, no one can.

We have live translators, outside translators who come with the patient, family sometimes translates and two phone translation systems. Our live translators cover the following. One Spanish only, one Dari, Arabic and ?maybe Russian. A third language. The third does Hindi, Punjabi and something else. I can’t tell by language who is a recent immigrant or refugee or who is a citizen of the United States for thirty years.

The clinic system has high standards for care of an often vulnerable population. However, I have not decided if it falls into a statement by my grandfather: “The higher the ideals of an organization, the worse its’ human relations.” My job in Alamosa had very high ideals, but I was fifth senior doctor out of 15 in a mere two years. A burnout job. This one has three new doctors coming in soon. My training and assistance to learn EPIC has been sparse and not up to my standards. If the new doctors are treated the same way then this is a burnout job as well. This is a place that I could work in intermittently alternating with other places in the country, but only if it is balanced for both the patients and the physicians. The jury is still out, but there are many red flags. It is a six month job and I am two months in, so we shall see.

Hugs to everyone.

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For the Ragtag Daily Prompt: nuts.

The photograph is from Larrabee State Park this weekend. My daughter came out and saw many of her friends, stayed with me, and we camped for one night at Larrabee.

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Taste

I am back in Colorado for another work stint.

I am in a different house.

I am in a neighborhood, of cul de sacs that don’t connect. My house is quiet in front but backs on a very busy road, an artery. The speed limit is 40 mph but people often go faster.

The house seems odd to me. There are curtains and shades on every window, all closed when I arrived. I open them, because I like light. There is a 3 by 4 foot television in the living room, another in the master bedroom and a third in a guest bedroom. There is a large kitchen with tons of shelves and cupboards, but a table only seats two, and there are two more chairs at the counter. This feels very odd to me. It seems as if the whole house is arranged to watch television.

I go for a walk in the neighborhood. There are many houses. There are beautifully trimmed lawns and there are flowers and some roses. What is missing? There are no people. Walking a mile and a half, finding the mostly hidden corridors from one cul de sac to the next, I see one man working on his lawn. Even though it is Saturday afternoon, I seen no children, no dogs, no toys. I see two garages that are open, one with a man and in the second I hear a child. Why are there beautiful lawns and no people? And many of the lawns have little flags saying, poison sprayed.

I do turn on one of the televisions after my first day of work. The living room one says that the antenna is not hooked up. The guest bedroom one works. I look on the service. Nearly every movie is about violence and conflict.

I do a little research on the internet. I go to the library and take out 8 books. One is Nonviolent Communication, by Marshall Rosenberg, PhD. Most of the others are fiction. Yet so much fiction is about conflict too. Good triumphing over evil. I am pretty good at nonviolent communication in clinic after 30 years: I want to meet each patient somewhere that is helpful. Sometimes they don’t like what I find, or don’t want to do what I recommend, but I have a deep and abiding faith that everyone can change, that they are smart, that I can make a difference and that they are capable. I think that belief helps daily in clinic.

I choose this book because I want to be better. Some of my family is estranged. I thought that was rare and horrifying at first, years ago. Now I think that it is horrifyingly common, much more common than I realized. How do we heal this? What can we change? I don’t want to be in a dark house with the shades down watching “good” triumph violently over “evil”.

There is a pond, man made, with a fence around it, half a block from my house. There are two male mallards, a female, and eight ducklings. They are fuzzy and delightful. I stop my car and watch the first time I see them, and I walk over too.

I haven’t seen anyone else there. I think we can change. I have hope. I have a deep and abiding faith that we can change.

For the Ragtag Daily Prompt: garlic.

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New scar and whale songs

My receptionist of 6 years at Quimper Family Medicine, Pat McKinney, died on February 6th. The photograph is from October, when I was in Port Townsend again for two weeks. She and I went for a walk. Well, I was walking and she was in a wheelchair. She was in hospice for over a year.

We had fun working together. Pat played music at her desk because the patient rooms were not quite sound proof enough. One day she was playing whale songs. I hear her on the phone with a patient. “The noise? Those are whale songs.” Pause. “Oh, Dr. Ottaway insists on whale songs.” I started laughing, because she was the one that picked them. So much for MY reputation.

When the covid vaccine came out, I got mine as a first responder. A few days later we had a lull between patients. I was standing in the hall near Pat’s desk. I said, “I don’t know why people are fussing about the vaccine, it seems fine to me,” and I gave a big twitch. Pat started laughing. I could set her off all day by twitching at her.

Patricia McKinney, 2/17/1943 – 2/5/2025.

For the Ragtag Daily Prompt scars.

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Honey

Work is being a bit of a difficult place. I think that if a clinic is has two new providers with one new medical assistant, there should be some formal support in place. Not the manager of multiple offices sticking their head in the room with the three of us at computers and saying, “Everyone happy?” Um, no. This came to a head two days ago. Then yesterday I am asked to write up what I said to the manager.

No. I don’t think that is appropriate. If they have formal evaluation forms, fine. If they want a biweekly formal meeting, fine. If I ran the zoo, I would be sitting down biweekly with the job description to say, “This area is going well, this part needs some more attention. What is going well from your perspective and how can we communicate better to help each other and the patients?”

In fact, in my very first practice in 1996, I asked for a meeting with my receptionist. They had one for each pod of 2-3 providers. She was so freaked out by it that she brought the office manager, much to my surprise. I didn’t care and just said, “What is going well, what isn’t, where are the communication gaps, how do we fix them?” The receptionist looked at the office manager, said she had been scared that I was going to yell at her, but since I wasn’t, she let the office manager leave. We were fine after that. I just want a well functioning team and I am happy to help build it.

So, after thought, I am going to refuse this write up and ask what their HR process is and say that I am not satisfied with the office support and that it is quite unreasonable to leave two providers new to the clinic to guide and train a new medical assistant.

The Ragtag Daily Prompt is honey pot. That bring up this delicious and quite naughty Taj Mahal song, ooooooo. As my mother would say, you catch more flies with honey than vinegar.

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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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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?

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For the Ragtag Daily Prompt: grey.

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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

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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!

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So far

I made it to Brigham City last night. That was a long driving day, 503 miles. I tried to stop in Snowville, but the motel would not take cats.

The only weather resembling a deluge so far was from Seattle until I crossed Snoqualmie Pass. It rained and rained, sometimes heavily. Once over the pass, the rain disappeared and we lost the ocean smell again. Dry and more trees and desert and wheat. I counted mountain passes, six so far that listed the top altitude. Some had smaller passes between, three more. The first one yesterday had ice patches so I stayed in the right lane with the trucks. Less ice.

One more day, I hope.

For the Ragtag Daily Prompt: deluge.