Monday, March 29, 2010

Running Mercies, Traveling Plans, Poems

I awoke at 0645 and freaked out briefly thinking it was Tuesday (0600 is my rising time Tuesday, because that is my first day of the work week, and I face about two and a half to three feet of charts that want something from me before the pressure-cooker really starts rattling).

But it wasn't. I rejoiced that for the first time in a week I had fallen asleep and stayed all night in the same bed without the help of anything but God and Advil. Then I was spared having to face the dreaded treadmill by the unexpected appearance of the sun after an all-night rain. Well, it was probably an all-night rain; as I said, I slept uncharacteristically soundly. Here's what I observed on my run:

1. The longer the rain, the more earthworms on the sidewalk. I hate stepping on earthworms, simply because I don't know if they suffer or not. I sometimes rescue them if the rain is over and I think it is safe for them to climb back into the earth. But today I didn't, because it is supposed to keep raining and they might just have to find the sidewalk again, and there were far too many anyway. I wish them well; they are an honored part of the great chain of life.

2. Sun and rain can coexist for considerable stretches in this part of the world. I don't know that it ever stopped raining the whole time I ran. Lots of blue, lots of gray, and at the end, I was able to stop and find the rainbow that pretty much always has to be there in that kind of weather. I love sun and blue-black clouds in the same sky. I always have to stop and stare.

3. The creek is fast, deep and brown now. The creek is to Dallas what the Willamette is to Portland: Runs through the heart and gives it some of the best of its personality. I dreamed about the creek and the ways to get down to it that don't actually exist last night. I think I will miss it if we do move to the Portland area. I'm unlikely to live so close to natural water at play ever again.

4. I have a favorite song I like to listen to as I sit on the porch and cool down after a run: James Taylor and Yo-Yo Ma's rendition of "Here Comes The Sun". It was especially appropriate today. It's from YYM and friends' album "Songs of Joy and Peace" which I recommend with all my heart to all. It is a song I hope someone can find and play at my funeral. I wish I could be at my funeral with James and Yo-Yo and sing along; I love it that much.

So, speaking of sun and rain, we spent much of the rest of the morning working on vacation plans online. We need to warm up, and so decided on a trip to south Florida. Everglades, Keys, beach. It helped that the fare is $218 round-trip, and will add a LOT of air miles. I have called my brother to borrow a couple of his Jimmy Buffet novels and we are taking suggestions from friends who have been there. It will be the off-season there (we try to pick off-seasons, but not too off). We are taking suggestions from those who've been there, so feel free.

Here are two poems from the past couple of years, one sparked by a run near the creek, the other by loopy weather.


Rickreall, I married on your bank
A boy who grew up wading in your water,
Catching your crawdads,
Moving pipe on a farm that drank you.

I became a nurse so that boy
would not one day work both that farm
And a full-time job.
But we never made that move.

I don’t regret nursing or not farming.
Nowadays I sign little pieces of paper
So people can swallow little pills
That they hope will make them feel

The way they might naturally feel
If they had grown up beside you,
Raised by the people who raised him,
Or if they’d married that boy.


Moment in Yellowstone

The fountain at our feet was nothing special
by Yellowstone standards—
a butterscotch hole bubbling
with hot, noxious water.
Not surprising if people once thought
this was where the vapors of hell
condensed and boiled to the surface.
But the pools just beyond it were liquid
opal and peridot, iridescing in the
sun pouring over our shoulders.
And the pines beyond them radiated back
that same sun’s green-gold rays.
But between us and all of that heat and light—
Not on the ground, no, but
falling, driving,
straight across the whole sunny scene.
Ridiculous, stunning.


Monday, March 15, 2010

El Salvador Anniversary

The ides of March means different things to different people. Maybe it makes some of you think of junior-year English class, back when they used to make us read Julius Caesar because it was just about the only Shakespeare play with no sex in it. Maybe it is just another day in your countdown to St. Patrick's Day (I know I am always thinking ahead to be sure I have something clean and green ready to wear on my mom's birthday) or to the first day of a longed-for spring. For me, it's always going to be the anniversary of the day I spent patrolling the courtyards of a large school in Izalco, Sonsonate, El Salvador, as an election observer.
That'd be one year ago today. I had been sitting in church a few months earlier when our pastor mentioned that a local organization was recruiting people to be official election observers to help keep honest the first Salvadoran national election that had a good chance of changing the nation's ruling party. With persistent trepidation I just kept saying I'd think about it until I had drifted into saying "Yes". So glad I did. The whole thing was like a crash course in grass-roots democracy in action.

I didn't catch anyone stealing a vote, stuffing a ballot box, stopping a legitimate voter from voting (although there a lot more things that can keep you from voting in El Salvador than in the U.S.--for one thing, you have to register six months in advance), or exchanging money or weapons for votes. I didn't see anyone that seemed to have been brought in from across the Nicaraguan border to impersonate a Salvadoran voter. I just saw an enthusiastic body politic doing its job, and then getting its thumbs dyed purple to prove it had done it.
And then, just before we left, we were thanked, over and over, for doing nothing but being there to bear witness. Here is the poem I wrote a few days later:
March 15, 2009, Izalco, El Salvador

We rose in the dark and raced through the streets
to see the set-up: rivals settling into their chairs
side by side, hip to hip, cheek by jowl
to do the country’s business,
showing their loyalties gently if at all
(unlike their neighbors who would come from church
to vote with their children beautiful in party colors).
At those tables, I couldn’t tell
who was ARENA, who was FMLN
until I saw who brought them food and drink.

The word “VIGILANTE” rode the backs of
watchers who stood all day, two at each table,
dressed in red, or
dressed in blue, white, and red.
Smiling at me all day,
the middle-aged foreigner
in the white vest with the black letters,
they answered my questions,
and asked me theirs.
That word will never again sound like
The evil that it sounds like here.
They were vigilant, steadfast
on their feet all the long day, until

The doors were closed,
the boxes opened,
the ballots unfolded,
the votes read aloud,
counted by the rivals
before the vigilantes
so no one could question
that this was a real election,
a real election.
At last, a real election.

Saturday, March 6, 2010

Training my Dragon

We were offered a $2000 bonus to switch from dictating our office visit notes onto a cassette tape which another human then transcribes, to dictating to voice-recognition software. The software is called Dragon Naturally Speaking 10. The advantage to the office is probably cost (and yes, I am worried about the ladies who've been doing our transcription, but also a little mad at them for deciding to eliminate all apostrophes a few months back; I dont like things that make ME look poorly schooled). The advantage to all of us is an instant record; no waiting days to weeks--usually weeks--for the chart note to come back, be checked (apostrophes added) and signed off by us, and then to be pasted into the paper chart. It's all part of our move to electronic medical records, hereafter referred to as EMR. I think EMR will eventually be good for all of us, but the switchover is a bit like a 50-week pregnancy followed by a difficult labor.

So, for those of you who don't use voice-recognition software, I will describe some of the adventures of "training" the Dragon to hear what I am really saying. For some reason, the version the office bought is not the medical version, and, this will not surprise you, I use a lot of medical terms in my dictation. Setting aside the fact that the world might be better off if we used normal English to describe the patients' symptoms and the findings in their exams (I once said I would never use the term "erythematous" when the term "red" was available, but I have reneged for purely cultural reasons), sometimes you just need to say "paralumbar" to denote those back muscles alongside the lower spine, which often hurt. Dragon insisted it heard "parallel bars". My job is to convince it that when I say "paralumbar" I mean "paralumbar". This was a hard sell. What you do is say "select paralumbar", then it highlights the words "parallel bars" and you say "spell that" and you spell the term out for it. Then you hope it recognizes it the next time. I think it didn't. Maybe you have to do it a couple of times for it to take you seriously. I picture it thinking, "No, honey, you didn't mean that; that makes no sense. Go with me, I know what I'm doing, and you clearly don't."

A sentence I dictated something like, "The patient couldn't get his Geodon" (Geodon is a common antipsychotic drug) comes out "The patient couldn't get his jihad on." Poor guy. Dragon just lost it on "otorhinolaryngology", which I admit I spoke just to mess with it. It did recognize "ENT", so I'm going with that in the future. It has drugs it knows and drugs it doesn't. I wonder if there are prescribers who've just decided to limit their personal formularies to drugs that Dragon recognizes to save themselves misery. There is actually some medical rationale for that approach if you subscribe to the theory that old drugs are often better and safer than newer "me-too" drugs.

After I got it installed and a little bit trained, I logged off the computer, and when I logged back on, I found it wouldn't even let me in as I'd installed it with an administrator's password. My Dragon refused to recognize me as someone it had to obey, or even deal with. So I got it put on again, by a real administrator, and now I have to start training it all over again. I just keep saying to myself, "$2000...$2000....$2000...."