Sunday, May 10, 2015

On Mother's Day


This might be our last Mother's Day.
My mother is dying, 
and she's doing it on her terms.

You see, my mother has end-stage kidney disease because
of her many years of diabetes.
And, she is refusing dialysis.
And, I am supporting her decision.

In 2003, when I was going to graduate from medical school,
my mother was told that she would need dialysis
within the next 6 months.
She refused.

She told her nephrologist that she would take
whatever medication it would take to keep going
without dialysis.
She told him that she would follow
whatever diet, no matter how restrictive, to keep going
without dialysis.

And, she did.
For 10 years.

And, then in 2013 her nephrologist called me
to tell me to talk my mother into getting dialysis,
because it was time and her kidneys were worse.

I talked to her.
I talked to him.
I talked to her, 
and she said "no!"
So, I talked to him.

And here we are.

A few months ago she asked me how it would go.
I told her that her body would start getting weaker
and that some dangerous electrolytes in her body would build up
and that one day, her heart would probably go into a fatal arrhythmia 
because of the buildup of potassium
and that would be it.

She nodded in understanding, sighed
and said, "OK"
then changed the subject to something about 
the cruise we have planned in September.

In April, for her birthday, we traveled to all the 
National Parks in Utah and added Great Basin in Nevada
and Death Valley in California.

And, as on all road trip, we talked,
but this time it was about such things as
where she wanted to be buried
(not in the ground, in a mausoleum,
and not near the bottom but as high as she can
for the view,
and she would have liked to have been
buried at Rose Hills, but then decided she
wanted to stay at our local cemetery
because "everyone I know" is there.)

She told me where all the important papers are.
She changed her bank account so I could be on it.
She's told me what to do with everything from
her beloved Miata to the ceramic figurines my
grandmother painted and which fill our house.

She doesn't want to plan anything beyond September.
She's become more introverted.
And, I worry how much time is left.
I noticed this last trip how tired she is,
how frustrated she is in her body that is failing.

And my soul is breaking because I can't imagine a world
without her in it.
But, I've had to start facing it.

So we wait.
We slowly plan week by week.
Month by month.
With a goal of September.
So that she can see Alaska.

And, I can see it alongside her
and keep that memory forever.
Like all the little ones I've been collecting
over the last several months,
never knowing which one might be
the last.
And, hoping beyond hope,
that she makes it to September
and Alaska.







Thursday, April 30, 2015

#297 to 264 - Z is for Zombie Apocalypse


Thank you for visiting my blog throughout this month.
I hope that some of you will stay and continue to follow
my blog throughout the rest of the year.

Although this month I focused on fun things
like travel and photography,
at the heart of it all, I am a doctor...
in the Emergency Department...
working in areas with high levels of
drug abuse,
homelessness,
unemployment,
and poor education.

There's a lot of trauma and drama
some of which I write about here.


I share stories and pictures when I can,
but I do work in a rural area some of the time,
so it's hard to keep HIPPA-compliant and
still give a complete story... 
Nevertheless, I do write a lot about my own experiences
and feelings.
And my beliefs on the importance of taking responsibility
for your health and that of others.
So I write about those things as well.

As for the Zombie Apocalypse..?
Well, methamphetamine abuse is high in the areas where I work.
If I could just videotape the patients that come in high on meth,
or the medical problems that meth brings
I'd have hours of tape to share to hopefully
keep someone from going down that road.

You can Google "meth mouth," "meth skin,"
"the faces of meth" to see what I see every day.
People prostitute themselves for meth.
They steal whatever they can for meth.
They come to the ED for drugs that they can then trade for meth.

I had a patient tell me yesterday that they lost their medical insurance
so they couldn't see their doctor for their chronic pain condition
so they were "self-treating" with meth.
I know they were going to take whatever prescription 
I wrote them and sell it.
Irony is, because they were homeless with no ID, the pharmacy
called to tell me they couldn't fill the script.

And, because of the effects on the brain, there's no
reasoning with these patients.
They don't understand that methamphetamines will lead to being tired
or weak or shaky because the effects are like running a marathon, full out,
without important things like eating or keeping hydrated.
They don't understand that the "worms under the skin" that they see or feel
are because of the effects on the nervous system.
So they pick at their skin to the point of causing bleeding
which leads to scarring and, worse yet, infection.
Which can lead to sepsis, possible amputation and sometimes death.

Pain management is a huge issue with these patients
as meth has fried out all of their pain receptors so now
pain which to you and I might be handled with a Tylenol now
requires large amounts of narcotics.

Don't even get me started on the dental problems...


Whew!  I thought we needed a nice pastoral scene from
the little chunk of Earth I call home...
Chickens and geese, I write about them too....

Hope to see you again soon...!

p.s. In July I do a birthday iPod shuffle where I write the whole month
about songs on my iPod, and I participate in NaBloPoMo in November




Wednesday, April 29, 2015

#265 - Y is for Yosemite

As I said before, going to conferences where you can get CME (continuing medical education) credits are a great excuse for getting out and traveling to new places.  One of the first conferences of last year was to Yosemite National Park.

We had just bought the new Jeep and so this was its first road trip...

The conference had morning meetings and then coordinated a naturalist to take us on afternoon hikes.  It was great to learn so much about the park... and get some exercise after sitting in class all morning.




We did see some wildlife, and the waterfalls were down to a trickle because of the poor snow pack...



The views were amazing, and I couldn't shoot enough photos without thinking there was an even better shot around the next corner... 






Yosemite was the first national park that challenged and inspired me to visit all the national parks.  But, I know I will come back to this one again and again... 






Tuesday, April 28, 2015

#265 - X is for Xel-Ha


Xel-ha is a great little place south of Cancun in Mexico.



It's got its own private lagoon where you can snorkel the day away.


A pretty big lagoon...





Plenty of things to see...


Or just relax and do nothing all day...






Monday, April 27, 2015

#265 - W is for Wish List


I've been posting photos from my travels for the last month
and there are still so many places I would like to go.

The following is my Top 10 Wish list of places
I still have yet to travel to:

10.  Arctic Circle 
9.  Antarctica
8.  Great Wall of China
7.  India, and go to an Indian Wedding
6.  Denali National Park
5.  Nepal (I know an earthquake just happened, but I want to see Everest)
4.  Great Barrier Reef
3.  Seychelles Islands
2.  Kalahari Desert to see the Meerkats
1.  Tahiti to stay in one of those huts on the water

What's on your wish list...?









Saturday, April 25, 2015

#272 - V is for Vacation


What's your idea of the perfect vacation...?

Here are a few shots that show off some of my 
favorite vacation ideals...

Romantic

St. Maarten

Riviera Maya

Riviera Maya

Seattle


Refreshing

Chicago

Maui

St. Lucia

Antigua

St. Maarten

San Francisco

Big Sky, Montana

Tulum, Mexico


Refueling

Destin, FL

Cartagena, Columbia

Boston

Hood River, OR

San Francisco

Bodega Bay

New Orleans


Living the Dream

Gettysburg

Washington D.C.

Maui, HI

Everywhere we can...










Featured Post...

The Mid 40's are in the Books

For some reason I never got around to writing about traveling to National Parks numbers 44, 45 and now 46...! Back at the end of June...