This is hard stuff

I work in a clinic with low income, medically and socially complex people. On average, the patient load is between twelve and twenty two per day. The pace is fast for primary care. Its not the ER, but its no cake walk either. I've adjusted, so far, pretty well to the pace and level of complexity. I think that this is because my life has been pretty stressful up til now. Now, I have to do two things really; work and take care of myself. Cake walk.

For those of you who don't really know what a Cake Walk is, here's your explanation. During a street fair in small town mid-west, the Ladies Aid Auxiliary or whoever makes a bunch of baked goods. A circle is marked out with numbers on the street. A flock of cake-loving contestants stand at each number and, while music plays, the contestants walk around the circle. Suddenly the music stops with each person on a number. A member of the LAA calls out a number and the one lucky person standing on that number wins a cake. Yay, cake!

But I digress.

So, the other thing I'm working on these days is forgiveness. It's a long story. But for the three of you who read my blog, you know what I'm talking about. I don't know if a person can really move forward and live without forgiveness. I stumbled upon this exercise on Pema Chodron's website (http://www.shambhala.org/teachers/pema/tonglen1.php.) Yeah, I didn't know that Buddhist monasteries had websites but here ya go. It is powerful.

Wanda and I took a walk by the river this morning. It's 54 degrees, sunny, and get this: windless! Gotta love New Mexico. Five days ago we had 6 inches of snow, howling winds, and freezing temperatures. If ya don't like the weather, wait a few minutes.

Its the same way with teenage girls. We've had a high pressure front building for a few days that finally became a full-fledged storm last night. Ten minutes later it passed and there were blue skies again. The conclusion is that I need to nag less and she needs to show more responsibility.

There is something exhausting about constantly needing to re-set boundaries. That's relationships for you, though. Its always a new bone to chew on, or maybe its the same old tooth marked bone that's been buried and dug up again for the 100th time.

What goes up must come down

Merry Christmas! I've been out of the bloggers loop for most of December, not due to lack of inspiration but more to lack of sleep and other complications. So much for my goal of continuing three posts per week.

Katie has been here since last Saturday and we've really been having a great time. It makes me miss her even more when she's gone. Her freind Crystal stayed with us on Monday and Tuesday. We had intended to drop her off on Tuesday but the interstate was closed because of snow and ice. She ended up taking the train back down to Albuquerque on Christmas eve.

We went to the Sipapu ski lodge for Christmas eve and Christmas day. We had a white Christmas, with snow falling most of yesterday along with that ridiculous mountain wind that never seems to stop. The big highlight of Christmas was snowboarding lessons and an attempt on the mountain.

Katie and I got our lift tickets and were fitted for boots and boards by some very patient employees and waited for our lesson outside in the snow. Our instructor, a twenty-something guy with cheekbones that could cut paper took us through the basics. Katie, of course, picked it up right away while I spent a good portion of the lesson on my ass. This theme repeated itself through the day.

We took a break for lunch and naps and went back to it. The beginners slope was set to one side of the mountain, obscured by a line of trees. The lift that served that slope was an old-fashioned platter lift. Basically, it's a disk about 8 inches across attached to a single post that drags its victims about 200 meters up the mountain. The platter is spring loaded and is not meant to be sat on. The skier/snowboarder places the platter between their legs and holds onto the post for dear life while heading up the slope.

So, up I went. Katie didn't want to snowboard after lunch so her job was to stand at the bottom of the lift, take pictures and taunt me. I attempted the lift a half dozen times with no success. The farthest I traveled was about 20 yards. Did I mention that one needs to be strapped into their skis or snowboard and be well balanced when riding the lift? After the 6th attempt at the lift and landing square on my tailbone I decided to give it a rest. When I returned to the base of the lift in humiliation I was informed that Katie, either out a well develope sense of competitiveness or out of the shame of watching her "old" mom try to go up the hill while she stayed safely at the bottom, had gone to retrieve her board. She did some practice runs down the lesson hill and came to join me on the lift of doom

I was completely determined that I was not going to be defeated. I attached the safety leash and binding of my rented snowboard and hopped up to the lift. I clung to it with the ferocity of a person clinging to the side of a cliff. For three quarters of the ride I stayed more or less up right but lost my balance about 20 meters from the top. I decided I'd be damned before I'd let go and made the rest of the trip on my backside. Katie joined me about three minutes later. That's when we both realized that Sir Edmond Hillary was right; "Its the getting down part that is the trick".

We had a moment of panic. In front of us stretched the intermediate practice slope and to the right was the beginners slope. Katie opted for the intermediate slope and used her snowboard as a sled. I opted for the beginners slope. Now when I think of "beginner" it is a nice gentle slope with no real turns. Something easy. This was not the case here. The beginners' slope was just as steep as the intermediate side and had the added bonus of a cliff on the right side that dropped through the trees into the river below. It must have taken me a good 15-20 minutes to reach the bottom, most of that time on my rear. The same people passed me three times, included an 8 year old boy shushing along who asked if I was ok. Damn kid.

That was the end of our snowboarding adventure. Neither of us were willing to fight the lift and risk life and limb getting back down again. We packed up our things and came home. We'll probably try it again after our aching muscles have recovered but it won't be anytime soon.

The Happy Birthday Edition

Yesterday I turned 38. If this is what pushing middle age is like- WOW, bring it on!

I had been feeling really lonely lately and was being a little whiney. I was trying to envision my life with 50 cats and it just wasn't making me very happy. Yesterday, though, my wonderful family and friends reminded me of what a wonderful life I have. Starting at 6am I received emails, phone calls and text messages. Even my brother Aaron, who generally maintains radio silence, sent a birthday text. I got flowers from a new beau, had dinner with Vince (a classmate who has come up to work at El Centro) and Katie called and said she'd be staying for the entire Christmas break. All in all a fabulous day.

We try so hard to be independent and emotionally sturdy but its wonderful to be reminded that one is cared for in this world. Here's my favorite of the Thanksgiving pics: Those are my brothers Aaron and Josh and Aaron's baby EJ. I have edited out the wine glass...

Can't Trust the Weather man

Today was just plain ole cold. The temperature stayed in the low twenties all day. It didn't warm up, the sun didn't come out, the wind didn't stop blowing. Just frigid temperatures all day and into the dark night. Flurries were forecast for the late afternoon and evening. That would have been nice. A little picturesque coating of white over the trees, a little winter wonderland to complement the twinkling Christmas lights on the plaza.

Did we get snow? NO, we did not. The sky isn't clear but the bright reflective light of a snowy night is absent. So all we have is cold. Great.

Anyway, on the bright side I've no longer got the funk. My energy level is up and I'm upsetting as many applecarts as I can manage while keeping my job and not getting arrested. I'm blowing off my family at Christmas to take Katie to Sipapu ski resort and learn to snowboard. What the hell, I've got health insurance. Its a little more complicated than that of course but I'm not sure I want to get into the whole thing. In a nutshell, it's about getting out of the box I've squeezed myself into trying to please other people. Nutshells are for composting, not for living in.

Over-analyzing My Navel

So I've still been feeling fairly cranky the last few days. Since it's more interesting to poke at the dead snake with a stick and watch it squirm rather than to say "look, a dead snake. I think I'll just let it lie", I'm obsessing over my poor outlook.

After talking to my daughter's stepmom last night, I realized that the anniversary of leaving my 2nd hubby was imminent. It's been nearly two years and both Katie and I have had major improvements in our lives. We don't have to deal with the daily stress of living with a person who's unpredictable behaviour wreaked havoc with our sense of safety, well-being, and self-esteem.

Every day I work to let go of the anger and sadness of that time. For some reason, its not getting any easier. This morning, my father told me that I should throw a party and celebrate my liberation. Maybe that would be a good idea; have some food and a bonfire, invite some friends. It sounds pretty cathartic.

What color is blue

I've fallen pretty squarely into a funk. Thanksgiving was wonderful. Wanda and I went on a couple of great hikes over the weekend. There was a bright spot over the weekend and the house got tidied up and I had some wonderful couch-surfing guests. We soaked at the Montezuma hot springs while the snow fell. Work today was fine, had a great lunch with my colleagues. Wanda and I had a nice walk at sunset. I talked to Katie about Christmas and we did not have an argument (though she's being a little evasive about this boy she likes at school). My favorite cousin, Shad, is coming in from Alabama and we're going to meet in Santa Fe for dinner this week. I have an appointment at Ten Thousand Waves (www.tenthousandwaves.com) for my birthday. Really, there's no reason for it at all.

Its cold and dark. I'm in this weird cycle of hot and cold romance (which has not been blogged about) with a man which is making me a little crazy. My bike still has a flat tire and I haven't ridden in a few weeks. I've been feeling under the weather and have cramps. Blah Blah Blah.

So I'm resisting the urge to go immediately to bed. I practiced my flute and will do a little yoga and take some more ibuprofen. I'm going to start going to the gym with one of the girls from work and not answer my phone for the rest of the week.

Bed sounds pretty nice right now though.

I'm grateful for coffee

I'm also grateful for the rain we're finally getting this morning. Its been a while and we really need the moisture. I actually have quite a lot for which to be grateful. All the usual stuff; health, nice solid roof, happy healthy child, good friends, my dog and my family. I'm grateful, as always to be in the time and place that I'm living. Every day is a gift and I try very hard not to forget.

This is Wanda, expressing her gratitude by rolling in the sand at McAllister lake.

Thanksgiving, Families, and all that jazz

El Centro Family Health, my employer, has a dental clinic here in Las Vegas. Unfortunately we have a hard time keeping a dentist and our clinic is temporarily closed until a new torture specialist... I mean dentist can be lured to the banks of the Chicken River. Kudos to our management, though. Instead of laying off the staff until further notice, they are spreading the dental assistants and receptionist around to fill in at other clinics. Today, Theresa went with me to the La Loma clinic.


On our long ride to La Loma (which isn't in the middle of nowhere, but you can see it from the front steps) we spent some time getting to know each other. She asked me where I was from, if I traveled a lot, where my family lived. She has always lived in New Mexico, has only been to California, and her entire, enormous, extended family lives in Las Vegas.

My family is small, we gypsied around till we landed in New Mexico, and I've traveled a fair amount though not as much as I'd like and not as much as many of my friends. I'm considered a bit of an oddity up here, at least among my hispanic friends. I'm a single woman who left her family behind to live in a place where I knew not a soul. Of course, they expect white folks to be a little wierd like that.

I asked Theresa about her holiday plans. She said she has seventeen cousins who all live in town and the family gets together for each of their birthdays. Thats about 1.4 birthday parties a month, not counting the folks that married into the family and their kids. So Thanksgiving dinner is not such a big deal for them as it is for those of us who don't see our nuclear families regularly and may only see our cousins at biennial reunions, if we go.

Theresa is curious about the big wide world but has reservations about wandering out in it for too long. She thinks its because the extended family is a blessing and a curse. They love and support you so well that you don't really know if you can make it without them. And so sometimes you don't try.

I'm headed down to Albuquerque for Thanksgiving. Both my brothers will be there with their families. My sister-in-law's family will probably be there too. In my family, at least my father's branch of it, we're independent to the point that my brothers and I often don't see each other for months at a time (though my brother Josh lives 90 minutes away) and I'm not sure of the last time I spoke to my youngest brother Aaron. My father is staying in town for Thanksgiving for the first time since 2003 and that's just because their dog is dying and my father's health isn't stable. Otherwise they'd probably be in Mexico again, eating fish tacos instead of turkey.

We love each other very much but support is rather loose. There's definitely no pressure to stay put. In fact, my father and stepmother strongly suggested that I leave New Mexico after graduating from PA school. Maybe I will, later. For now, my debts are getting paid and I'm recovering from a lifetime of tough lessons.

Anyway, I was hoping for a strong ending to this post, but I'm sort of wandering and am not sure if I'm getting anywhere. So, au revoir... I've got to cut up the bread for the stuffing.

A Girl's Best Freind

I've just finished watching Gentlemen Prefer Blondes. Its the movie with the iconic Marilyn Monroe number "Diamonds are a Girls Best Friend". Norma Jean did her best booty shake and breathy man-flattering but the real star was Jane Russel. Now that was a woman who could turn heads. While Marilyn turned her attention to any man who could give her a little hard currency, the equally curvy Jane made 'em work for it. A fella had to have more than half a brain to keep up with her and enough nerve to prove it. This was a woman who had the entire men's Olympic team doing a special workout for her benefit. You go, Jane!

Jane Russell as Dorothy Shaw in Gentlemen Prefer Blondes (1953).

Where the hell are these women now? Jane had brains and a body. Not some stick figure figure, either. She had hips and breasts and a teeny waist (helped, I'm sure, by a good foundation garment). Quick wits and a hot bod, she's my new heroine. These days we're all supposed to be thin as rails with big boobs and a flat tummy without the aid of a girdle. Thank god for Jennifer Lopez's ass. Of course we can't all have a personal trainer to work out with 2+ hours a day. We have things like jobs and budgets the preclude that sort of thing.

There's been talk about the affect Michelle Obama will have on feminism. Michelle is fabulous: brilliant, gorgeous, and utterly devoted to her family. An article on slate says that she embodies the ideas of feminism so well that she surpasses them. She's another heroine of mine. Jane should have had an effect on feminism too. She showed that a woman could be beautiful and smarter than everyone else in the room.

Update on random stuff

There are a bunch of loose ends on the blog so lets tie them all up (or in knitting parlance, weave in the ends). I'm still not finished with the "snowdrift sweater" I'm stuck on the cabled section of the sleeves. But I have finished a pair of mittens and a hat for myself from the purple alpaca I bought at the Taos Sheep and Wool festival. I've nearly finished spinning the shetland fleece and I've started a pair of christmas mittens for one of my nephews/niece from some green and blue bulky yarn from my stash. Stash busting, so satisfying.

I've got 9 gallons of fruit wine fermenting in the guest bedroom. It has gotten to the point that in order to make more I'd either have to buy more 1 gallon glass fermenting jars or wait till I bottled what I've got going. Since a) I'm going to run out of room if I keep going like this and b) the holidays are coming and a gallon of wine is not really an appropriate gift for Katie (maybe when she's older) I decided to wait. Midwest Supplies sells some really great winemaking kits that I'm considering including a bordeaux and a malbec, but they require a 5 gallon bucket to start out and they make about 30 bottles of wine. I'd seriously have to reconfigure my storage space but how cool would that be!

This morning I'm heading out to help with the Thanksgiving Gallinas Cleanup in which folks go out and pick up the trash that's accumulated on the Riverwalk. Since I really enjoy that area and have seen some nice wildlife right in the middle of downtown I'm happy to help out. Also, I've been here almost six months and haven't taken many opportunities to get involved in much of anything besides work and really am feeling the need to be more sociable. In fact, I'd better get my breakfast together so I can get there on time.

Belated weekend update

Somtimes it takes a few days to digest one really great day. Saturday morning Jon From The Office invited me to go to his brothers farm. "Dress dirty" he said. After I retrieved my mind from the gutter, I threw on a pair of old jeans and my fifty cent flea market sweater.

The drive east of Las Vegas never fails to amaze me. Jon, his two super-cute little girls, and I piled into the range rover and cruised out along the flat, empty mesa-top for fifteen or so minutes, turned onto a paved county road for a while longer. Red tail and Harris hawks wheeled overhead and perched in the pinon trees. Suddenly the terrain dropped in front of us. We wove along the side of a deep canyon. Amara, Jon's five year old, told me all about the dinosaurs that lived down there, and pointed out a boat on the canyon floor. All those years of racing up and down the I-25 corridor, trying to get to Denver before lunchtime and I had no idea this lay on the other side of the road.

Two or three ranch gates down the road and we were at Mark and Amy's place. It's a sixty acre island in a gigantic ranch. The Gallinas river (the little river that flows past my place) cuts through the middle of their land. When Mark bought the property, the house was four stone walls, more or less intact, and half a roof. He and his wife, family and freinds rebuilt the roof, stuccoed the outside, plastered the inside walls a cool sherbert green, installed plumbing and gas. Their electricity is solar with a back up generator. They have a few horses, a pack of silly dogs, and the clear blue sky overhead. That perfect, tourquois, endless, New Mexican sky.

Amy and Alisha (hope I spelled that right), Jon and Mark's mom, made bisquits and gravy. Jon gave me a tour of the greenhouse and showed me the edge of the mesa over the Gallinas edged with cottonwood trees and. We found a few arrowheads to add to my collection. It always surprises me to find these bits of work. So many pieces of someone's time, laying around for us to pick up as we will.

After stuffing ourselves on a good, old fashioned breakfast, we laid assault to the walls of the new section of the house. This was the reason I needed to "dress dirty"; we would be laying adobe bricks. Jon and Mark's parents mixed the mud morter, Amara and I were in charge of plopping the morter on the last course of bricks, and the boys laid and leveled the next course of bricks. Amy is in her first trimester with their first child. She sat under the portal and peeled the skins off the garlic bulbs they were preparing to plant. Amara and I had a system. I scooped up the mud and placed it on the bricks and Amara did a belly flop onto the mud to squash it into place. When we started, her coat was off-white. By the time she finally said "Uncle" she was stained the same red as the cliffs.

It was a wonderful lesson in staying present. Normally, I would have been all business. We have a goal and that goal must be reached, no matter what. No monkey business. Its some hold over from my german anscestors, most likely. Amara showed me that it wasn't an urgent situation. Her family had a nice snug stone house and this was an expansion of their love. I took a deep breath and we fell into a rhythm of scoop and squish, scoop and squish. A while later, Mark and Jon got out their guitars and played while the little ones napped.

I wanted to stay there, in that gorgeous afternoon, for as long as possible.

Lessons from too much time spent sitting

I'm going to get disciplined about this thing and start writing at least three times a week. It worked last week and possibly the week before. I can do routines and discipline... it just takes routines and discipline.

Today was desperately boring. Everyone from the main clinic had to sit in on a mandatory mediation. Apparently there are some pretty be troubles right here in River City. Fasten your seat belts, its going to be a bumpy ride. Actually not that bad. We at El Centro like to think of ourselves as a family. A big, squabbling, funny, dysfunctional family with messianic tendencies. And yes, I think we will save the world. At least our little bit of it. Today was all about getting to know your neighbor and talking about their strengths, the beauty of their character and the value of their experience. All of the times that you wished to grasp your neighbor firmly by the throat, rather like a rat terrier, and shake the life out of them- these instances were definately off the agenda.

On the whole, I think it was a great exercise. How often do we tell the people in our lives how much we value them? The most interesting person, I thought, was the janitor. He's a grizzled biker dude with a wisp of a goatee, multiple black and grey tattoos, and for riding his Harley he wears a headscarf that covers his face with a leering skull. He vibrates with energy and you can tell by looking at him that he's been in some unsavory situations. The clinic is also the cleanest its been since I got there. He has a smile and a good thing to say every afternoon. Today he had some really beautiful things to say about the importance of trust, respect, and open communication.

Damn, I did it again. I made assumptions about our biker dude before I knew a thing about him. Every time I do that I get a jolt and I'm ashamed of myself and my firmly middle-class assumptions about appearances and what they mean. You'd think I'd learn this little lesson by now. Thats why we're here I guess, to learn and relearn to love our fellow travelers.

Waxing Philosophical... Again

Its been a very intense few weeks with some very sick people coming through the office. Hopefully, I've done all the right things for them. Most of what we do in medicine is listen, at least it should be our main job. Sometimes all that can be done for a patient or for anyone is to listen. Close the chart and pay attention to what they are saying. There's time for writing notes later. That brief appointment may be the most important part of someone's day. It could change the course of their life.

People are not an accumulation of their symptoms, they are the best written novel you've ever had in your hands. Even more interesting: when they come to my exam room I become part of their story. All the elements are there; birth, love, disappointment, joy, struggle, fear, courage and death. What more could you want. Of course, you have to be willing to get your hands dirty.

But I like that kind of thing.

Friday Night at the Cinema

Wanda and I are watching movies tonight. Katharine Hepburn film "Long Day's Journey into Night" is playing on American Movie Classics. It's Ms Hepburn at her most vulnerable, most fragile but its a wonderful ensemble film. Her morphine addicted matriarch of a dysfunctional family was a risky role. I love her for that. Of course, at that point in her career she could afford the risk both financially and emotionally. Usually Hepburn played strong, smart women next to equally powerful leading men: Cary Grant, Spencer Tracy, Peter O'Toole, and even John Wayne. Under her characters' thick layer of confidence and brilliance was a deep desire to be loved.

We're waiting for the snow that's supposed to come tonight. Its awfully cold again but the sky doesn't have the right look. I think its bluffing again. Soon, I hope, we'll get something besides cold.

Snake Oil and Hair Tonic

I'm all about prevention, personally and professionally. Prevention keeps bad things from happening. It's the fence that keeps the wolf from the door. It's the observant freind that picks the banana peel up off the floor before disaster strikes. It's seatbelts, vitamin C, and condoms. An ounce of it equals a pound of cure. But that depends on who pays for the study proving that the cure works.

Its all over the news today that giving Crestor, a statin drug that decreases low density lipids (bad cholesterol), to patients with no cardiovascular risk factors (in other words, no discernible reason why they should have a heart attack or stroke) in order to prevent heart attack or stroke. At first glance, this looks like great news. Think of all the lives we can save with just one little pill taken daily. Another great discovery brought to us by the pharmaceutical industry. Better living through chemistry.

What they don't tell you is that the study was funded by AstraZeneca pharmaceuticals. These are the kind folks that make Crestor, as well as drugs to treat high blood pressure, cancer, gastric reflux, pain, schizophrenia, asthma, and allergies. I prescribe their products every day to keep the wolf from my patients' doors. For the most part I think these are good and useful chemicals that help people function at a higher level than they would without these medications.

The NPR piece on Crestor today interviewed residents of Framingham, MA, the site of the longest running study on cardiovascular health ever. The good citizens of Framingham have been giving up their corpuscles to scientists for over 30 years for to help us all prevent early demise from heart disease. Through this epic bit of science we've learned that eating right and exercise can help us tremendously. We've learned that an aspirin a day keeps the cardio-thoracic surgeon away. And today we learned that Crestor will keep us from the monsters lurking under the stairs, waiting to snatch us in the light of day when we aren't looking.

Another missing detail in the NPR story was that the study was funded by AstraZeneca. They didn't let us know that the retail price of Crestor is $320.00 (costco pharmacy online) for 100 tabs (a three month supply). For a mere $32 dollars a day, lives are saved. Of course, crestor is approved by most insurance plan formularies, lists of drugs that insurance companies will cover.

I'm not saying that this isn't valuable information. We should be doing everything we can to prevent disease and disability. I want my family members, my freinds, and my patients to be vital and healthy for as long as possible. If this medication could really do the trick, I'd be handing it like a snoopy pez dispencer.

I'm a little tired of health care being run by Gordon Gecko. Maybe I'm a little bitter that the pharmaceutical industry no longer allows the sales staff to bring us free pens or take us out to lunch. I don't have a problem with the free market, but I have a problem with the free market practicing medicine.

Primun non nocere.

It's Monday morning, lets do a swan dive into controversy to get the blood moving. One of my clinic duties is to take care of patients at the local university student health. Most of the time this includes a lot of colds, sports physicals, pap smears and STD checks. Its generally pretty light duty. The patients are young and healthy and just don't involve the level of complexity that I see at the other clinics.

Since its been a couple of months since classes have started, the girls have started to come in for pregnancy tests. The last one (fortunately not pregnant) had only a vague idea how pregnancy happens. Most of our time together was spent discussing how the process actually works. She understood that sex=pregnancy/STD (good) but that's as far as her knowledge went. She didn't know what ovulation was, didn't know the timing of the menstrual cycle (she wasn't even late), and was not really sure how fertilization happens. This led to a great deal of fear and panic.

Eighteen year olds are allowed to vote on our elected officials and this year came out in massive numbers to elect the first multi-racial president. They are able to drive a car and most are expected to take drivers education classes in high school so that they are safe behind the wheel. They are able to join the military and/or be drafted, learn to carry a gun and kill someone before their frontal lobes are even finished developing. But we don't teach them about their bodies because, as a society, we think its "too dangerous" and leads them to increased sexual behaviour. That makes about as much sense as giving the keys to a sports car to a person who doesn't know the brake pedal from the gas and the turn signal lever is just there to make that rhythmic clicking sound.

According to the Journal of the American Medical socity (no citation, sorry), kids today are actually engaging in less risky behaviour than we did in the wicked 1980's when I was a teenager. They are waiting to have sex, using condoms more frequently and smoking and drinking less. The rate of teen pregnancy has actually gone down in the last ten years. However HIV and syphilis infections are actually going up. The places that are still having problems with teenage pregnancy and sexually transmitted diseases are where sexual education doesn't happen at all or where abstinence only (same thing) is taught.

Teaching kids about sex doesn't necessarily make them want to go out and fornicate like rabbits. If done correctly, it will make their hormone soaked brains think twice now that they know the potential consequences of unprotected sex. It leads to an understanding of how their bodies work which decreases fear. We're curious primates, fear only works as a short-term motivator. We are designed to have sex. Telling kids to wait has never worked all that well. Sure, in the past it kept the majority from bonking before they were married, or at least getting caught. But there were always a few daring souls who had their hands in the cookie jar.

Sexual education is like drivers ed. We don't really want these kids in a car. They are inexperienced, have short attention spans, and have more auto accidents than any other demographic. But if we can say "this is the seat belt, this is a stop sign, this is how you keep from getting hurt on this crazy road" its better for all of us.

Its 18 degrees this morning. That's pretty darn cold. I've got the woodstove cranked up but I'm not sure how fast its going to get warm in here. My house is a bit deceptive. I have giant floor to cathedral-ceiling windows with south-western exposure which are great for collecting sunshine but the house is primarily heated by a little woodstove on the first floor. So its been warm and snug when I get home from work even if it's getting dark way too early. I think I'm going to have to make a fire before bed and bank it up nicely so that I don't get frostbite in the morning. Its hard enough to get up when its dark without forcing myself from a nice warm bed into the cold air.

The weather has snuck up on us. Just four days ago, it was a balmy 40 degrees in the morning. Snow is forecast for this coming weekend. Snow. Yes, I know I've moved to a town in the foothills of the mountains. Yes, I live in the river valley. But I wasn't prepared for 18 degrees in New Mexico during the first week of November. This makes me a bit concerned about the temperatures in February, when its really winter. I'd better get some more sweaters.

Let me just say, one more time

WOOHOO!!!!!!

Today there will be celebrating, maybe a little gloating, and a whole lotta joy. Its Christmas and Easter and New Years Eve all rolled into one. But its not just about Obama and his brilliance, it about us and our awakening as a nation.

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has. Margaret Mead

Chop Wood, Carry Water

Well, my freinds. We've finished an election year. We have done the thing that was declared impossible. As a nation, we aimed for something greater than ourselves. Something greater than Barack Obama. We moved beyond our fear into the unknown. That is called faith. Faith is greater than an affiliation with any group. Faith is the belief that beyond the trials of now, we can do better, we can create a world that transcends color, that transcends religion, that transcends our daily bread.

So will we wake up tomorrow and find that the sky is a different shade of blue, that our coffee is better, our lover more beautiful, our finances magically fixed? Most likely not. The hard work has just begun. We, as a nation, have signed up for a tough job. But the important thing is that we've signed up.

I don't know if President Obama will fix everything. I firmly doubt that he is the messiah. But I do think he is a leader. I do think his mind is one of the finest of our time and I think he has the stamina and the gifts to pull us through this time. As he said in his acceptance speech, its time for all of us to lay aside our cynicism, put our shoulders to the plow, and take responsibility for ourselves individually and as a whole. We are our brother's keeper.

One of the labors of Hercules was to clean the stable of King Augeus. The king kept a herd of gigantic horses there. Gigantic horses make... well, you know. Apparently the king had a difficult time keeping farm hands. The horses were ill tempered, had huge iron-clad hoves, and made a huge pile of manure on a daily basis. The mortality rate among the farm hands was more than the king's liability insurance could handle. Ergo, piles of shit higher than the towers of the palace. The king required that the cleanout occur in one day, and if completed, Hercules would receive 1/10 of the kingdom.

Rather than pick up a shovel, Hercules was able (by virtue of his divinity) to divert the flow of two swift rivers through the barn. Of course, this was a completely unexpected approach to problem solving. King Augeus did not want to pay for the unorthodox approach to barn maintenance and things did not end well for him.

The point is that a) we have a big pile of feces in front of us that needs cleaning and b) a shovel and wheelbarrow aren't going to do the trick. Barack Obama may not be Hercules, though. Maybe we are, collectively, Hercules. And by applying creativity and elbow grease, we can meet the labors before us.

A Monday by any other name is still a monday

Today I had two separate cases of the opposite of sibling rivalry. It was love and unselfishness and forgiveness of any childhood injury inflicted. I'm a fortunate soul to be witness. Let me preface the rest of this entry by saying that today was by far the worst Monday I have had in quite some time. It lived up to its reputation of being complicated, awful, and exasperating. It was a three martini sort of day, if I drank martini's. Which I don't because they are even more bitter than Mondays.

In the midst of the complicated patients who seemed to be on the verge of death or as I like to say "One foot in the grave, the other on a banana peel" and others who were fogged over by their psych meds, and even a couple of angry folks (because they were scheduled behind the lady with acute heart failure and they weren't at the front of the line), were a pair of sisters. I'd seen the "healthy" sister (let's call her Maria) for a heavy case of ear wax a few months ago. Today she was wheeling her older sister (let's call her Bernadette), age 74, in for follow up after being released from the hospital in Albuquerque. The Bernadette started out with a heart problem and come out with half her colon removed. Both were diabetic, but Bernadette had upped the ante by developing a tricky heart, scar tissue in her belly from previous surgeries which blocked her colon, and a host of other medical issues. Neither of them really understood the reason for the emergency surgery or why the Bernadette had diarrhea and I didn't either because I couldn't get ahold of her physician in Albuquerque until they were long gone.

What was really beautiful about this whole mess was that Maria was managing Bernadette's diabetes beautifully. Maria was changing Bernadette's diaper's, bathing her, making sure she got all the right medications, all the right food, and all the other things she needed. She took Berna to all her appointments, to the pharmacy, cooked and cleaned for her. It didn't matter any more what had happened in the hot days when their parents were alive, when they were young and pretty. The unconditional love was laid out like a table, full of food carefully prepared and presented. A gift that they may not have known was in them to give.

Another pair was a brother and sister. The sister was mentally disabled, probably from the seizure disorder and the polio and who knows why really. She was in the clinic for a pre-operative physical exam. She needed a new hip because the old one had rotted in it's socket. Don't really know why that happened either. Her brother brought her in to see me. I think he also took care of their elderly mother. He looked tired, washed out. But he answered all the questions and asked all the questions. He was gentle with his sister's inability to pay attention to the exam, reminded her to to stay in the present. It was his time and effort that would get her to the cardiology appointment I had to schedule and him who would take her for her surgery and interpretted my explanations about abnormal EKG's and abnormal kidney function. He was the one who steered her down the hall carefully as she veered from one thought to another. I felt like I was cutting down the last tree in their forest. Bad heart, bad kidney's; can't wait to see what the orthopedic surgeon says when he see's her labs.

But there he was, probably a role he's played all his life. Don't leave your sister alone, she's fragile. How long had he been taking her by the elbow, making sure she didn't careen into the walls? What had he given up to the altar of unconditional love and protection? How long will he last once his mother and his sister have slipped this earthly coil?

In this middle of all this mess of monday: the frustration, the diplomacy, the irascible nursing staff is this shining light of love and sacrifice. I hope I can find something like that in all my days here.

Contemplation on the Human Animal and Solitude

Since I've moved to Las Vegas, my social and romantic situation has changed. Being the new kid means that I'm still working on creating a social millieu. I'm also not currently in a relationship. Having gone through marriage (rather like having gone through "the war"), long term relationships, graduate school with a cohort, raising my daughter, and living with my family of origin, this is the first time I've really been alone. Its a strange feeling.

On the one hand: I don't need to check in with a partner or a parent or get a babysitter if I decide I'd like to do something. I can play torch songs as loud and and frequently as I please. My wine making projects can hijack the spare bedroom and my wool can sit anywhere it wants. If I don't want to clean the kitchen/livingroom/bedroom, no one complains. I can make decisions on money, vacations, and everything else without consulting anyone. That's nice. It's an enviable amount of freedom.

On the other hand: It's sometimes lonely.

So, why does loneliness bother us, meaning me? I think it's because humans are mammals, specifically primates. All animals have social constructs. This is for the protection of the individual as well as the health of the herd or troupe or flock. The worst thing that can happen to an animal is to be separated from the group. It leaves them in a vulnerable position, open to starvation, illness and predation. In primate groups and horse herds, if a member misbehaves they are pushed to the fringes of the circle until they show that they are sorry for their behavior.

In Celtic society, there was no corporal punishment. Instead, offenders were exiled, usually to Scotland. Solo travel was greatly discouraged in most countries until the 19th century because of the dangers lurking behind every tree. These were very real dangers that included banditry, animal attack and sexual assault. Women who had been widowed and lived alone were targeted by their neighbors as witches. Individuals in abusive relationships will stay even to the point of death in order not to be alone. It has always been safer to live in the herd or to be coupled than to be alone.

The benefits of the herd are numerous. Sharing the food, the labor, the childrearing. We need laughter, music and storytelling. We help each other with building shelter, protect each other in times of danger and share our individual gifts to make life better and richer.

So, aside from the reproductive imperatives of coupling up with a mate to make more of ourselves we are also hardwired to need to be part of a group of some kind. The medical evidence shows that people with active social lives are healthier and live longer. Married men are healthier and live longer (married women not as much). If we could all find ways to keep these social needs met in a supportive way that doesn't lead to destructive behavior, it would lead to healthier, happier members and a happier, healthier world.

Are we there yet: a tale of election year fatigue

Four days to go and I'm ready for President Obama to be inaugurated so we can get on with the work of fixing the big hole in our national roof. There was an article in Newsweek about "election addicts", people who spend 20 hours a week and more following new reports, polls and Obamamercials. These folks are apparently worried that they will have a difficult time adjusting to a campaign-free lifestyle. Instead of getting their nightly fix of Fox's fair and balanced reporting, they are contemplating ways to fill the post electoral emptiness.

I have to admit, I'm watching the Daily Show more regularly than usual. But secretly I'm in love with Jon Stewart. Funny, smart, handsome: what's not to love. However, I'm skimming over the election coverage every where else and change the radio station when campaign ads come on. I missed Michelle Obama when she came into town, which was disappointing. She garnered a pretty big crowd, the size of which is somewhat disputed, and gave a great speech (though it was pretty similar to the DNC speech given in Denver).

But really, I'm ready for it to be over. I've been hosting a campaign volunteer since early October. He's the perfect houseguest, he's never around, doesn't make a mess and, when I see him, is very pleasant. I'm ready to have the house to myself again, though. Tip toe-ing around in the morning isn't fun. However it's forced me to use the automatic feature on my coffee maker so that the bean grinding does not disturb. That, my freinds, is the most wonderful invention of the modern world. Its like the coffee fairy came in the middle of the night and made my morning cuppa. Its absolute bliss to smell that coffee in the early dark hours before I'm even out of bed and just stumble down the stairs to fill my mug. The only thing that could possibly top that is to have an attractive man prepare the beverage exactly the way I like it and bring it up the stairs so that I could drink it in bed. Then the attractive man would make breakfast, clean up and leave until the next morning.

But I digress.

It'll all be over soon and then we can watch to post election analysis until inauguration, then the post inaugural analysis and then...

Its a Lovely Holiday with Wanda

I've just gotten back from three days at the Black Range Lodge (www.blackrangelodge.com) in Kingston, NM. Kingston is about thirty miles wast of Truth or Consequences which is 300 miles south of Las Vegas. Look at a map.

The Lodge is one of the few original buildings left of the silver-mine boom town that went teats-up after the US went from a silver-backed currency to a gold-backed currency. All that remains of a bustling town with 20 saloons, one church, and a semi-famous Madam named Sadie Orchard is the Percha bank (now an Art Gallery, thank you Bonita, resident artist extraordinaire), the Assay office (a private residence) and the Black Range Lodge. The Lodge is 120 years old and is run by a very lovely couple, Katherine and Pete. It's property lines are adjacent to the Gila (hee-la) National Forest, full of pinon, juniper, and mountain mahogany.

Thursday night after check in, I'm snuggled up in my sheep pajamas under the down comforter reading "Henry and June", relating a little too well with Anais Nin, when I hear something similar to a jet taking off outside my window. I keep reading, cuz I'm dumb that way sometimes. A few moments later I hear someone calling my name outside. The handyman, Dan, is banging frantically on my door "Angela! Fire!" I throw something that won't be laughed at in the morning, grab the dog, my suitcase and the CD's and run out the door. Dan lit the path down to my car with a flashlight but he needn't have bothered. The back of the Lodge was completely engulfed in orange light and sparks where whirling into the dry juniper trees around us. We got Wanda into the car and the three of us moved across the street just as the emergency vehicles where coming into the drive. Fortunately the volunteer firehouse is just a few doors down and neighbors were quick to act. I watched from the car as flames shot up over the roof of the three story building. When I looked away from the fire, I saw a falling star. This is it, I thought, this is the end of 120 years and the end of Katherine and Pete's dream.

When the smoke cleared, the Lodge had been just slightly damaged, but the workshops in the back as well as an old fig tree had been completely immolated. The hillside hadn't gone up in flames and no one had been seriously hurt. The old hot water heater had exploded. It could have been a tragedy. Twenty feet from the flames sat two propane tanks. All around the Lodge lay construction materials; wood, straw bales, and miscellaneous scavenged items. It all could have burned to the ground and taken the national forest and all the neighbors with it. Good neighbors, good angels.

Katherine offered to give me my stay for free, which I declined. I stayed the entire weekend, as planned. Wanda and I walked for miles in the forest, picked pinon nuts, saw javelinas in the broad daylight, and deer on the hillside. None the worse for wear and I have a dramatic story to tell on Monday morning.

Vote Early, Vote Often

Ok, all four of you who follow my blog, hopefully you've all sent in your "vote by mail" applications and have received your mail-in ballots. Its time to break out the black ball point pen, fill out that bad boy and send it off. One of you has warned me of the possibility of vote theft by the bad guys (no name dropping, George). I'm not sure whether to succumb to the paranoia and hand deliver my ballot to the county clerk's office or drop it into the Anton Chico mail box.

Don't blow this off, voters. If you don't make your opinions known now, you can't bitch about not getting what you want! And, for crying out loud, if you receive any kind of social services, have family in the military, have to choose between your utility bills and your medical treatment, are concerned about the economy, care about your neighbors, drive a car, or heat your house you need to think very long and very hard about whether the status quo has worked for you.

Consider-Your-Mortality-Monday

I had to take some time yesterday afternoon to sit by the river with the dog. We watched a kingfisher fly, screeching, along the water. We watched the fading light change on the yellow leaves as the sun went down.

It was a draining day. One of my morning patients had recently been diagnosed with breast cancer. She was still reeling from the recent suicide of her son. Her grandchildren had been taken out of state by their mother. My patient sat in the exam room in tears, apologizing for making a scene. She lives alone in her little house in the mountains, only coming into Las Vegas for food and doctor's appointments.

I told her to make a scene. A big one.

At lunch, I recieved a text message from my father "atrial fibrillation. Pres ER". I panicked. I was calculating how long it would take me to get home on my bike and drive the two hours to Albuquerque. I was trying to sort out who could feed the dog. When I was finally able to get ahold of my dad, he was stable and in the process of being discharged, and had an appointment with a cardiologist. This morning he sent a text message that said he felt great.

I made a big scene.

Atrial fibrillation is serious, but not fatal if corrected. Its a fairly easy to manage cardiac condition in which the electrical system is disrupted and the normal, regular heart beat is short-circuited. The rate increases and the rhythm is jerky. That's how I was feeling, short-circuited and jerky. But, though this is a condition that should cause concern, its certainly not panic-worthy. Unless its your father and you are two hours away.

If this was a patient, I would very calmly give some oxygen, call the ambulance, and take the other appropriate actions. If this was a patient, I would explain what was happening in a rational, calm matter, being certain to reassure them and their family. It wasn't, though, and I lost my cool.

So, Wanda and I spent some quiet time on a ledge above a bend in the Gallinas river, feeling the wind, and watching the storm blow in.

Its Official!

Fall is here. It was cold enough today that I had to light the wood stove. Holy Cow, that thing heats the house fast. It was rainy and cold and dark this morning and if it weren't for work, I'd have stayed home all day in my pajamas.

I've nearly finished Katie's arm-socks (fingerless gloves), all done but the cast off. And let me just say "Its about freakin' time". The next time you get a hankerin' for making custom-knit arm-socks from custom spun silk yarn, think hard. I started these things in June. It is now mid-October. I'd do the happy dance with Wanda, but...

Yawn

I have come to the realization that, in spite of the great content, my blog is BOOOORRRIIING. No pictures, no links, no fancy stuff. This needs to be remedied. Therefore, my goal for the weekend is to fancy up the blog-space. That is, if my computer comes back from Best Buy before then in working order. I'm driving down to Santa Fe tonight to get the bike tuned up and the rack attached by people who know what they are doing (the nice folks at the new SF REI), then to drop off the computer with the geek squad boys. Then maybe dinner at Dhara Thai. When I have a restaurant craving these days, its for Indian or Thai food. Neither type of cuisine can be found in Las Vegas currently. I'll miss my bike for the rest of the week, but I can feel the gears slipping and it just needs doing.

Wonderful weekend and doggie update

First the doggie update: The dogs that have been harrasing me for the last three months have finally been tied up after the very prompt and courteous attention of the San Miguel County Animal Control department. While I'm not thrilled about dogs being tied up, it's better than being allowed to run in the streets being a danger to themselves and others. On my way home from work today, I saw someone's little dog lying dead in the ditch. This is the sort of thing that happens when dogs are allowed to run on the road. Hopefully the owner of the little guy will pay attention and take care of the rest of his animals.

My weekend was a whirlwind and absolutely wonderful. My dear and old freind Paul (whose birthday is today) brought Indian food up from Albuquerque. Miraculously, it was still warm after a two hour journey in the car. Aaaahhh. Is there a patron saint of Indian food, or a goddess of the kitchen or some such thing. Next day we went to Taos with Arthur, one of my co-workers. It was the weekend of the long anticipated Taos Sheep and Wool festival. The drive through the Sangre de Cristo Mountains to Taos was breathtaking. The aspens are turning brilliant shades of gold and red in the midst of the deep green ponderosa pines. It was like driving through an impressionist painting of fall.

The guys, naturally, ditched me the minute we got to the wool festival. Never mind then. Today Arthur asked me to knit him a sweater and then realized he could have chosen a fabulous one of a kind yarn. Ha, said I, you should have stuck around! Anyhoo, I picked up a lovely shetland lamb's fleece: white with brown tips and little bits of grey. Also, after much deliberation, I found a wonderful yarn called "wicked". It's a bright purple alpaca plied with white alpaca. There were bits of acid green wool accents. Perfect for some outrageous mittens, say I. It was a perfect fall day in Taos. It was a bit overcast with just enough chill in the air to remind you of the date.

Sunday we went out to Lillian's ranch. That deserves its own post. Hasta manana.

wait a minute while I find my soap-box

I love dogs. My current domestic partner is a canine. If there is such a thing as reincarnation, I'd like to come back as my dog. She has a soft bed, high quality kibble, lots of lovin', and all the rabbits she can chase. It's my job to take care of her. This means I feed her, make sure that her water dish is clean and full, and take her to the vet when she needs it. It also means I keep her away from the street. This is not only for her safety, but for the safety and security of other dogs and people.

Not everyone will agree with the dog:child analogy, but here goes. Children have the same sort of requirements. Food, safety, good health and love. Parents should also be obligated to ensure that their children (or pets) know how to behave in society. This also ensures their safety and success.

Let me now make a big ol' caveat. I love living in Las Vegas, NM. The people are freindly, I have amazing view of the mountains, my job is great. Basically, I'm a pig in poo. There is, however, a giant black mark on the town report card. Irresponsible dog owners. These are the folks who let their dogs run out into the road, terrorizing their neighbors, getting hurt. Generally not taking care of their obligations as dog owners.

It doesn't matter if you go for the "dog as surrogate child" approach or the "dog as owned object". Either way, the person who owns a dog (or has a doggie family member) is responsible for its actions just as they would be responsible for the actions of their human offspring. If around the clock care and responsibility is not your cup of tea, don't have kids and don't get that puppy. Neither one stays cute forever.

Most days we have "theme days" in the clinic. We'll have a whole run of chest pain or a couple of guys with erectile dysfunction, or a bunch of kids with colds or a slew of nervous moms. Its a funny phenomenon seen in almost every clinic setting. Even when I was a massage therapist there would be weeks that 10 out of 30 clients would have similar problems.

Cold's and flu's in the fall don't count as part of a theme day. Regular procedures, like PAP smears don't count either. Common maladies have to be out of season. Generally the problem needs to be a little bit of a head scratcher. And there has to be more than one, but more than two is better.

Today, so far, is not a theme day. But it is Friday and it is half over.

mail order blues

The winemaking kit from Midwest Supplies came in on Tuesday. I did the appropriate happy dance on the porch. In my head, I've already made several batches of yummy wines, they all taste wonderful and my freinds and family are duly impressed. Then I did something very unusual. I read all of the instructions straight through. This is what's known as a buzzkill.



In the basic kit, you get a bucket and a big bottle, known as a carboy, tubing, a stopper and airlock for the carboy, and enough yeast and stuff to make 15 gallons of wine (wait, did you hear music?). However, it did not come with a little device called a hydrometer. The hydrometer is used to measure alcohol content and helps the vintner to know when fermentation is finished. This is important. I also realized that I would need more than one carboy, some corks for my finished bottles and something to put the corks into the bottles. Bottles I've got. An embarrasing number of empty wine bottles. Sigh.

Also on my online shopping spree was a rack and a set of folding baskets for the back of my bike. Since my bike is my primary week-day transportation, this is imminently practical. The amazon.com listing stated that the bicycle accessories were easily installed and were universal in fit. That should have been the first warning. The rack must be installed first and the baskets hung from the rack. The rack comes with a set of three screws and a bracket in case the universal fit isn't.

After 15 minutes of searching for a hole in which to put the screw (insert double entendre here), I managed to align the screws and the openings. Let me tell you something. Size Matters. The screws were too short to pass through the rack and the hole on my bike and grab the washer and nut on the other side. Off to the hardware store during my lunch hour.

Another Amazon order gone awry. I place an order for a couple of books and a CD a few weeks ago and recieved double copies of everything.

I think I'll stay off the surfboard for a while...

Domestic Goddess

Lately, I have been spending a good portion of my weekends cooking and preserving food. My spinning wheel has been whirring along and I've got the back of the "Snowdrift" sweater finished. If I added actual house cleaning to that list, I'd say my nesting instinct was in full bloom. But lets not get carried away.

Saturday I hit the farmers market and bought some gorgeous yellow squash, leeks, and apples. There was also a woman selling the sweetest, most beautiful peaches in the world and I bought two big baskets. Half of the peaches got canned yesterday. They have the most beautiful golden orange color and look stunning in their little pint jars. I saved a few for eating and the rest for the wine making kit that should be here in the next few days. The squash got sliced up and frozen and I haven't even touched the apples, let alone the pears from last week.

My neighbor, Lillian, brought me a quart of goats milk when she came to dinner on Saturday. Since I'm not a big milk drinker I think I'll make some goat cheese. I found the directions on the internet. You can find anything on the internet. Lillian is the soul of independance. She runs a 1200 acre ranch by herself, the house has no electricity, no running water and an outhouse. During the week she lives in town so that her 15 year old daughter can attend the high school here in town. She has a little herd of dairy goats and 3 1/2 chickens.

All this domestic activity leaves me very little time to engage in my favorite pity-party fantasy: I will end up being the crazy old lady who lives with 50 cats. I understand that this is completely irrational. I've started seeing a lovely man who makes me laugh my butt off. And I don't like cats (other people's cats are fine). My single german shepherd makes enough hair for all of those fantasy cats and I don't need more animal hair in my life.

pure as the driven slush

I've been working on the Snowdrift cardi from "Inspired to Knit". However, while the sweater in the pattern book is white, mine is being knitted in a charcoal grey handspun corriedale with little silvery bits. Its working up very fast and easy. Since my brain seems to be still somewhat addled from graduate school, fast and easy is something I appreciate.

My ambition of finishing all the unspun fibers in my stash before the Taos Sheep and Wool festival (first weekend in October) may have been a bit, well, ambitious. I still have a pound or two of the corriedale and a little over an ounce of silk to finish out Katie's gloves. In the world of fiber-stash, this is practically microscopic, but I'm trying very hard not to accumulate stuff. On the other hand TSW comes but once a year. Here are some yarn/fiber buying justif... I mean reasons:

1. I can use the TSW purchases to make and/or give away as gifts

2. Improving one's skills (in this case, spinning, knitting and weaving) are helpful for maintaining good mental health

3. I'm supporting small, local businesses

4. Supporting these small local businesses helps to keep traditional skills allive

5. It will be a lovely fall day in Taos and I will have driven all the way up there

6. Sheep and Llamas and Goats, oh my

7. I really really like string

8. soooo sooooffft

Excuse me, I think I drooled on myself...

new knitting book!

My new knitting book came in! Yay! Its called "Inspired to Knit". Katie and I found it when we were at the Alpaca show in Estes Park, Colorado two weeks ago, but it was a bit pricey and I'd already spent a bundle on that little short trip. I think we spent less money in Mexico eating in restaurants and staying in a nice ocean front hotel than I did for tha jaunt up to Estes Park. Anyway, its one of the few pattern books that I've found that I would actually make every single item in the book. Even better: I got it on sale on Amazon. Gotta love Amazon.

There was a wonderful, soft fall rain tonight and I watched "Love in the Time of Cholera". I wept at all the appropriate times. I wasnt' sure about how the movie made me feel. Was I crushed that there was no one who loved me enough to wait around 53 years and change? Should I be heartened by the thought of love in my last days? Should I sleep around till my true love becomes available? Wait, I don't have a true love, should I sleep around anyway? Too many messages...

Anyhoo, it was a wonderful film. Marquez is a poet. Javier Bardem is spectacular. He has supplanted all others except Jon Stewart for my affections.

Mondays are for...

So Mondays are the day that everyone that had a sniffle or a drinking binge or just a bad weekend comes into the clinic with all their saved up ills. Monday is also the day when we need that little bit of extra caffeine or a cocktail or something to keep us going till five o'clock. the morning seemed manageable, but the afternoon swirled around me. I spent most of the time not knowing who was where. I hate mondays.

Good news this afternoon though. A patient who was diagnosed and treated for pancreatic cancer last year came in for a blood pressure check. Pancreatic cancer is often a death sentence. She'd been sliced, diced and irradiated and is so far in the clear. A month ago, she came in for pain in her abdomen. I adjusted her blood pressure medication and sent her off to the CT scan already scheduled with her oncologist. I felt like I was arranging deck chairs on the Titanic. She brought in her results and her CT scan was as normal as we could have hoped with no sign of cancer. I exhaled.

She had told me what a difficult time her adult children had experienced with her diagnosis, how they worried and and fretted over her and grieving the possibility of losing their mother. She told them (and me) "we're born to die, I'm not afraid to die but I'm not dead yet. We have to live until we can't".

Little bits of immortality and light to be found among the ashes of the day.

Yay! I'm off to see Katie

Tomorrow I travel to the far north to pick up my girl. I haven't seen my daughter Katie since I put her on a plane July 5. She's living with her father and step mother and their other children in Parker, Colorado which is on of the many suburbs of Denver. I'm starting to get used to her absence, not comfortable but more like an amputee. Yes, I can get around and I'm learning to compensate for my missing limb but what wouldn't I give to have that piece of myself back. I've talked to other women whose daughters moved away from them as teenagers. They all say their relationships changed for the better, their girls all came back to them. I don't necessarily expect this but it doesn't change the quality of the longing.



I'm reading the biography of Dame Freya Stark who started traveling in the middle east in the 1920's at the age of 36 and wrote about the religions and cultures she found there. There's a wonderful quote from one of her letters about the nature of relationships



One is apt to think of people's affection as a fixed quantity, instead of a sort of moving sea with the tide always going out or coming in but still fundamentally there: and I believe this difficulty in making allowance for the tide is the reason for half the broken freindsips.



So perhaps this is the key to the cultivation of love. Keeping the bonds loose enough to allow for movement.

the $700billion question

Yes, we know, Michelle Obama was brilliant, moving, elegant; basically everything you'd want in a first lady. Barak's video entrance was charming, the kids were cute. If they'd had the family dog in denver (or better yet live via teleconference from Alaska) it would have been perfect. Beyond perfect.

But here's the real deal.

The war in Iraq/Afghanistan has cost the American taxpayer $70 billion dollars and some experts are now saying we should look at $1 trillion to cover George and Dicky's little kegger on the beach. That doesn't count the amount of euro's and pound's sterling thrown into the kitty. It also doesn't take into account the amount of money spent to blow things up over the ocean just to see how well they spread mercury into our tuna steaks.

Well, here in New Mexico I had to tell an uninsured woman that to definitively diagnose her with Multiple Sclerosis, she needed to have a $6000 MRI. This was so that I could see whether she just had a cold or a chronic degenerative disease which would slowly incapacitate her, burden her family (if she had one) and eventually lead to her early death. Thirty minutes later I had to search the Wal-mart $4 drug list to see if there was something that I could give a single mom, who was going to school full time and working, with bronchitis and what is likely untreated asthma. The woman who was in tears because even with the sliding scale co-pay at our non-profit clinic was not sure she could afford to be treated and still cover the groceries for her and her two year old.

So folks, where are we going to go this year? More of the same? Putting up 8 foot fences around Mexico? Blowing up our freinds and neighbors? Or will we wait till those freinds and neighbors are us.

wait, wasn't June just 10 minutes ago?

From my porch I have a view of the Bosque del Rio Gallinas. For the rest of you gringos that's the woods along the Gallinas river (Gallinas means chicken... funny name for a river, I'd love to have been hanging around the day they named that one). Its filled with cottonwood trees that are older than the United States and perhaps where saplings when Coronado was busy getting lost on his way to Kansas. There's an old apple tree, some wild plums and roses, red willows and fragrant red clover. The little Gallinas river that flows behind my house is full of fingerling trout, big bull frogs and mosquito eating spiders that spin their webs over the swift flowing water.

Today I looked out at the trees and the cottonwoods were starting to yellow. I smelled roasting green chile on my ride home from work. This means fall is creeping in. Soon, the aroma of pinon wood smoke will be coming up from the sleepy chimneys in the morning. The birds at my feeders will head south, to Mexico and other warmer places without hard mountain freezes.

Fall is my favorite season in New Mexico. The oppressive summer heat has passed, the hardness of the unremmitting sunlight and perfect turquoise sky slips into something more comfortable. The smells change from the sweetness of clover and sage to the spice of chile, woodsmoke. Every year I go through the same shock. As if I didn't know that the chamisa and astors wouldn't fill the mesas with gold and purple and the pueblos wouldn't start their feasts and I wouldn't start bringing out the mittens and sweaters. My porch sitting days are numbered.

oh, by the way...

So everything was going along swimmingly yesterday at the La Loma clinic. Not too busy, plenty of time to finish charts, do a few Continuing Ed on-line courses, read a little fluff at lunch. At quarter to four a mom and son come in to see me. Son, a precocious 8 year old, has a cold. Piece of cake. Mom says she has same symptoms but is a bit worse. Also has a recurring gyno issue. No problem. I whip out my winning combo of western medicine and nutrition/supplements. Ta-da! Score one for the home team. I can still get out of the clinic by 4 o'clock.

As I'm getting ready to send her out the door, she says to me,

"I've been having this chest pain"

"Excuse me?"

I go through all the standard chest pain questions: sweating, nausea, pain in other locations, stress level, digestive problems, cough, weight loss... No clear picture was emerging. Great. I can't really let her leave without checking out an EKG. She doesn't have insurance, of course.

4:15

I send my nurse, the fabulous Antonia, in to do the EKG. Five minutes... NOT! Our EKG runs the single lead strips instead of the nice, neat 12 lead page.

30 minutes later: I come into the exam room to see poor Antonia tangled up in about 12 feet of EKG paper. If we both hadn't been so frustrated, it would have been hilarious. Fortunately, there wasn't anything scary looking on the rhythm strip. I gave her the appropriate precautions and sent her on her way.

So, if you have chest pain, make sure that's the first thing you tell your health care provider...

And we begin

So here is the blog I've been threatening to do for the last year! I'm a single, long distance parent, a brand new Physician Assistant, and a dabbler. Since graduating from PA school and starting my job, my real primary occupation has been porch-sitting with Wanda the Wonder-Shepherd, bird watching, and wine drinking on said porch.

Where did the title come from? I've recently move to Las Vegas, NM, a city of 14,000 souls 2 hours north of Albuquerque. It still retains the aroma of the wild west, and no thats not just the cows you smell. There are hundreds of dogs running loose around here (note to self: talk to the humane society/animal control about spay-neuter programs), a few who chase me down the street while I ride my bike. I've made friends with some of these fur-balls but some require a shot across the bow with a little pepper spray. While I've never made actually pepper-spray contact, its nice to know I've got it if I need it.

The live grenade part... During my second week at work I stopped off at Dick's Liquor's (I'm not making that up) to buy a nice red that would go well with porch-sitting. There were several police cars blocking traffic a block or so down the street. Hmm, interesting. As I was standing in line with my selection I overheard a conversation between some other customers. Apparently the owner of the pawnshop down the street had bought a box of junk from someone but hadn't gone through it at the time of purchase. When he finally decided to sort through the box, he found a pair of live, vietnam era hand grenades. Needless to say, downtown Las Vegas was (mostly) evacuated, the bomb squad brought in, probably from Santa Fe and the ordinance disposed of properly.

That's when I knew I wouldn't be bored...