Guest Post Monday – Ode to a Black Cooking Pot

My parents accumulate people.  There were always extras around our home, for Thanksgiving, for Christmas, for Sunday afternoon generic communing.  Mom and Dad downsized about ten years ago.  Fortunately, they didn’t downsize their desire to informally adopt a lovely variety of strays.

We met Siya Ndwandwe when he was a freshperson at Macalester College, my mom’s alma mater.  My mother heard from the International Student Host Coordinator that Siya, native to Swaziland, had nowhere to go for the winter break!  He lived with my parents for a couple weeks and they took over as his official Host Grandparents.

Siya is a lovely man.  He visited his family last summer and photographed his (biological) grandma’s cooking pot.  Today he wrote an ode to the cooking pot.  Here it is:

“You round-bellied son of a god,
Black as the night,
Unapologetically black.
The hush songs you sing
Bring neighbours, near and far
As the big brown logs burn bellow your belly.
You were there at my uncle’s funeral,
You were there at the family reunion,
Just there, doing your thing, without care!
You three legged, son of a god.
You cool, centered, and care-free son of a god.”

Thanks, Siya, for letting me post!

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Thanksgiving – Off the Beaten Path

So.  Family and Friends.  Let’s just get that one out of the way right off the bat.  Great.  Here’s a list of other stuff I’m thankful for in no particular order:

1) curiosity

2) pain sensation

3) music

4) butter

5) dreams

6) indoor plumbing

7) color

8) safe drinking water

9) neuronal plasticity

10) creativity

11) the reticuloendothelial system (apparently the preferred term is now the mononuclear phagocytic system – I’m officially old)

12) the Bill of Rights

13) Iris the now deceased yellow labrador retriever who ate my grandmother’s antique settee during a windstorm

14) Henry the late irascible terrier chihuahua mutt who selected Ace as my future mate

15) dead Teddy, the furless geriatric pomeranian who bit everyone but me

16) community

17) empathy

18) books that keep me up till 1 am against my will

19) the sewer system

20) sexuality

21) emotion

22) the mucociliary escalator

23) and YOU

What would you add to the list?

 

Musical Moment

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My Tiny Revolution

This past week has been – uh – interesting.  I’m not sleeping particularly well and am nearing the point where I’ll need to withdraw completely from all sources of media.

I decided to take some Tiny Steps in a Tiny Revolution, pretty much to keep my sanity.  (The Tiny House thing never really worked for me, but a Tiny Revolution?  That’s a cause I can get behind.)

Here are the Tiny Steps in my Tiny Revolution thus far:

1) I greeted strangers at Target with eye contact, a smile, and a “Good Morning.”  It went well.  A few folks didn’t hear me or pretended not to hear me but the vast majority smiled and greeted me right back!

2) Tiny Step One was exhausting and I recovered by doing Tiny Step Two: eating more locally-sourced cookies.  The particular cookies that revived me after Step One were conjured at the Positively Third Street Bakery of Duluth, MN.

3) I refreshed my memory on the Electoral College Situation and vowed to ask Someone Smart how it could be overhauled.

4) I read a nice predictable romance novel that used all the reassuring romance novel words, tidbits like “frisson” and “moue.”  The presence of semi-realistic sex was a refreshing surprise.

5) I didn’t ask anyone to unfriend me on FaceBook.  If you voted for Trump, I would welcome an opportunity to engage in civil discourse around your personal beliefs, preferably accompanied by something hard-core – chocolate flourless cake with fudge sauce would be a good start since I’m not really one for the drink.

6) I wrote a riff on Margaret Wise Brown’s Goodnight Moon.  You can catch it here if you missed it on Wednesday.

7) I distributed many hugs and will continue to be free with my love.

8) Ace moved out of our marital bed into the guest room recently when I caught a cold.  During his absence, I replaced him with a pile of nice fluffy clean unfolded laundry.  Yesterday, I folded all the laundry, put it away, and ordered Ace back into our bed.  He whined a bit about my snoring but I know that he knows that we know that it’s best to keep those you love close at hand in uncertain times.

9) We used to do “Rose & Thorn” at night, naming one good thing and one less good thing.  Now we do “Three Roses.”  We end each day with three positives apiece = nine positives overall.  A veritable rose bouquet.

10) I reconnected with a family that I met eight years ago.  They arrived in the United States as refugees and are now US citizens, working Americans, homeowners, residents of a thriving racially and culturally diverse suburban neighborhood, and parents/grandparents of a new generation.  This is America at its best.

What Tiny Steps are you taking in your Tiny Revolution?

Musical Moment

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Goodnight Doom

In the great oval room

There is a telephone

With the nuclear neumes

And a dead dream of -

She-POTUS slaying the Agent of Doom

The BA from Wellesley and Yale JD

Just couldn’t win over misogyny

 

And a red Senate

And carmine House

Are dropping their gloves

“Get ready to oust!”

And a Combover keen to grope gals in the tush

Says “I’ll soon be POTUS!” to pal Billy Bush

 

Goodnight goon

Goodnight buffoon

Goodnight Agent Orange, Demon of Doom

Goodnight phoney

And goodnight Comey

Goodnight emails

And goodnight “Me!” males

Goodnight “Make America…”

And goodnight fake America

 

Goodnight Birthers

Goodnight Party of Tea

Goodnight POA daughters

And goodnight Melani-

Goodnight pussy

And goodnight piece of ass

You messed with The Pantsuit, you Creature of Crass

 

Goodnight Benghazi

And goodnight Neo-Nazis

Goodnight Johnson

And goodnight Weiner

(Can’t we get leadership with a vageener?)

Goodnight Combover

And goodnight MiGs

Goodnight nobody

Goodnight fascist pigs

And goodnight to Narcissus, whose hands are not big

 

Goodnight to the sane ones

Sleep well the night through

Because in the morning

We’ve got work to do

 

Musical Moment

 

Thank you to Margaret Wise Brown.

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Stuff You Say If You’re Lynne Rossetto Kasper

Dear Ms. Kasper:

Rick Nelson, our local food writer for the Star Tribune, wrote a lovely article about YOU in the Taste section, October 27, 2016.  An article titled “The Soup You’ll Make All Winter” certainly captures attention.

Let me share with you my personal version of Dante’s Inferno:

First Circle of Hell: Prepare appetizers for a crowd of 150, focussing, naturally, on locally sourced ingredients.  It’s Minnesota.  In February.  Think squash.

Second Circle of Hell: Dip 9000 strawberries in four types of chocolate.  Artfully angle the chocolate lines to best effect.  Strizzle complementary colors across the dipped berries.

Third Circle of Hell: Revamp the school lunch program for the Saint Paul Schools, accommodating nut allergies, gluten intolerance, picky eaters, the full gamut of dairy options, and -

You get the picture.  I don’t love cooking.

Rick Nelson does, or at least he loves eating.  He recorded a meet-n-greet session with you at Cooks of Crocus Hill where you prepared harira, a traditional Moroccan soup, live, in-studio.

(Fourth Circle of Hell: Host a live cooking event.  Be perky and approachable.  And produce a delicious end-product.)

I decided to bite the baguette and make the soup.  I thought you should know that I experienced a bit of a language barrier in attempting to interpret your comments and the recipe itself.

1) You use a number of interesting adjectives such as “good-quality-tasting” extra-virgin olive oil, “freshly grated” orange zest, and “freshly ground” black pepper.  I’m guessing my standards are slightly different from yours.

2) The verbs are also intriguing.  Regarding the aforementioned black pepper, you claim “that pepper just sings.”  I heard no singing, though “O Mio Babbino Caro” would’ve been a lovely choice.  You say “bring to a gentle bubble.”  With reference to cooking verbs, I understand “boil” and “simmer” and that is all.  I cranked up the knob on our central burner, the one that sets off the smoke alarms due to heat, and hoped for the best.

3)  You do not recommend attempting this soup in a slow cooker, claiming that the “sauté, that sizzle, is activating those flavors.”  Another incomprehensible cooking verb – sizzle?  Next time around, I will be attempting this soup in a slow cooker.  I thought you should know.

4) I ROFL’d (my sources inform me that this involves a fit of hilarity and a horizontal surface) over the paragraph about buying whole spices and grinding them in a coffee grinder that I could purchase at a garage sale.

(Fifth Circle of Hell: Grind spices on-demand for Wolfgang Puck, Emeril Lagasse, Anthony Bourdain, and Gordon Ramsay.)

5) To continue the spice theme, I was completely baffled by your admonition: “don’t put raw spices into things, because they’re dead.  You always want to warm up your spices, open them up, get them alive.”  In my mind, “open them up” is something you do when laparoscopic surgery runs amok, as in, “Crap.  I nicked the aorta.  Looks like we’re gonna hafta open her up.”

6) In the ingredient list, you say “1 (28-oz.) can whole tomatoes and their liquid, puréed (do not use tomato purée).”  Part Two of the ROFLing.

7) On the accompaniments list (again – language issues – to me accompaniment involves a piano), you suggest “3 tbsp. ground hot chile (Aleppo if possible).”  I, like Libertarian candidate Gary Johnson, ask “What is Aleppo?”

8) “Season to taste with salt and pepper.”  This is singularly unhelpful.  I grew up with a mother who jumped on the Jane Brody Bandwagon in the early days.  Carbs=good.  Fat=bad.  Salt was the S-word in our house, little white grains of evil.  Hence, I was introduced to the allure of salt rather late in life.  A general ballpark, like “start with one tablespoon,” would be much appreciated.

9) I found the ROI (return on investment) somewhat lacking.  I spent an hour chopping, an hour procuring ingredients, and another hour cooking.  With that time commitment, the result needed to rock my world.  I thought it was pretty good, so I’ll be making it in a slow cooker next time.  Sorry.

10) The Big E tasted it and proclaimed, “This isn’t really my kind of meal.  My kind of meal is a big steak and deep-fried french fries,” not to be confused with regular, non-redundant french fries.

11) I’ll pick my last bone with Rick Nelson, who claims in the online version of the article that the recipe is both “easy” and “a total keeper.”  Rick, in our house, “keeper” refers to fish.  And for me a recipe is, by definition, never easy.

So, thanks for the recipe.  I’ll be sure to let you know how things work out with my Crock-Pot.

Anne Lippin

Musical Moment

 

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I Fought the Mall and the Mall Won

Let me make my position on the Mall of America patently clear:

I Hate It.

Yesterday, the Big E and his friend, who coincidentally shares the same name, dragged me to the Mall.  Their deep research into the topic had revealed that the MOA is a happening spot for Pokemon Go.

I kicked.  I screamed.  I whined.  I protested.  And eventually I said fine.  I’ll go with you for One Hour.  Seriously, it was like I’d suddenly produced a real live unicorn.  > Poof <

We parked in Georgia and walked into the Sears entrance.  Surely, the Mall can’t, in fact, be a hellmouth if it’s anchored in the northeast corner by Sears.

The Big Es were happy as Pikas in a Pokeball.  They wandered hither and yon, among the kiosks, through the massive indoor Nickelodeon Universe amusement park, around the potted palms.  They ran into a particularly wonderful situation outside of three consecutive cosmetics stores.  ”Mama!  We both caught a Blastoise!”  I’m not exactly sure what that means, but it’s good.

While they searched out mythical beings, I played my own game of Guess the Diagnosis.  Here’s what I saw:

1) many probable pre-diabetics and some actual diabetics

2) the diabetics/pre-diabetics were also likely hypertensive and dyslipidemic

3) polycystic ovarian syndrome in a couple young women

4) pregnancy – lots of it, like a whole epidemic

5) anorexia in one young man : (

6) sex trafficking – I didn’t see it, or didn’t realize I was seeing it, but there’s good reason I chaperoned The Big Es.

7) one definite hardcore smoker plus a handful of casual smokers

8) one definite methamphetamine addict

9) likely many prescription drug addicts – they’re harder to spot

10) a couple cases of osteoporosis

11) MANY broken ankles waiting to happen – what’s up with the Illogical Footwear Choices, ladies?

12) lots of nice, loving, normal human interaction – very refreshing indeed!  People were happy yesterday, and were treating their partners, kids, friends like we should all the time…

On the drive home, I reminisced about the Days of Yore when I’d go dancing at the MOA and my hair would reek of cigarettes for forty days.  Thank you to the authors of the Minnesota Clean Indoor Air Act.

My bottom line is if I have to be stuck in the Mall of America for an hour on one of the most glorious fall days ever, I’m glad I’m stuck with two boys who are only in it for the Pokemon.

Musical Moment

 

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Unapologetically Smart

I am a woman.  I am smart.

I’m using “smart” in the standard academic sense of the word, not to minimize other forms of intelligence (artistic, emotional, spatial-relational, etc.), but to limit the scope of this discussion.

Perhaps I made a few people uncomfortable by opening with those two lines.  Heck, I made myself uncomfortable.  Do I sound too braggadocious?  Should I back up my assertions with cold hard facts?  Is this the right way to make my point?

My parents expected that I would do my best work to the best of my ability.  Early on, I learned not to talk about doing well in school; my academic success was inversely correlated with Positive Reaction of Classmates.  ”You got an A?  I hate you!”  How many times did I hear that?  Being average is just that, being average, one of the majority.  Being above-average means drawing attention to yourself and attention, in the hierarchical pack mentality of 1970s public schoolchildren, was rarely good.

In elementary school I proved to be a good speller.  As my “reward,” the teacher removed me from class and sent me to the librarian to dissect word roots, his own personal linguistic passion, one that I did not share.  A good girl does as she is told.

The Junior High yearbook pictured a boy and a girl for each of several categories: Cutest Smile, Most Likely to Be a Moviestar, whatever.  Did we vote?  I think we voted.  Anyhow, I took it as a personal affront that “Most Likely To Succeed” seemed completely independent of academic performance.

In high school, I was insulated from teasing by surrounding myself with like minds.  Three of the five valedictorians came from my core group of HS friends.  Yes, I was one of them.  The valedictorians.  And I was mortified that people, like the entire student body, knew my GPA.

My high school dating experience was quite limited, fortunately.  I knew that boys didn’t like it when girls were too smart and I’m sure that I would’ve played dumber if I deemed it necessary for relational harmony.  So I’m glad I didn’t date much.  My end-of-HS boyfriend, another of the valedictorians, liked his girls smart, and immersed himself in friendships with girls who wanted to study and learn.

By the time college rolled around, I expected the competitive nasty teasing to be over and done with.  Not so much.  I continued to keep my academic situation to myself, even developing a script for when people asked, “What’d you get?”  Never trumpet your cerebral assets from the mountaintops.

I met my college boyfriend when he TA’d my computer programming class.  He seemed to enjoy that I presented him with a question/problem that he couldn’t answer, and I knew there might be some hope of a relationship working.  He married a super smart woman, whose line of work I can barely begin to comprehend, much less explain – something to do with genetics and the various factors that impact cell development, gene expression, and cellular death.

In my junior year at Oberlin, I received a letter from an organization about which I knew exactly nothing: Phi Beta Kappa.  They said I could mail them something like $50 and become a member.  I mentioned the letter to my parents as well as my hesitance to pay the fee and join their little club.  Mom and Dad said, Anne, this is ΦΒΚ.  You have to join.

Enter medical school.  Dating was, uh, interesting.  ”I’m in medical school” is completely different from saying “I’m in college.”  People have their own biases about medical school, medical students, doctors, and women doctors.  Even now, many folks who find out I’m a doctor are intimidated.  I found myself trying to reassure the last person to admit intimidation, saying, “Oh, I haven’t been in clinic in a long time,” as if the temporal remoteness of doctorly duties would somehow normalize me.

But back to dating.  Most of the men I dated felt threatened by me and my brain.  I say this because they engaged in frequent micro aggressions, to use a newer word for an ancient concept.  I was familiar with the little jabs, often masked as statements of fact or even compliments.  I’d heard similar sentiments on the playground years prior.  ”Of course you would know that because you’re going to be a doctor.”  Or “I only went to business school, not medical school.”

The most glaring example occurred when I was a third-year medical student.  I started dating a first-year resident.  I can’t remember what led up to it, but I basically said Isn’t it cool how the second half of the menstrual cycle is constant, like you can count backwards fourteen days from a woman’s period and, bam, that’s where she would ovulate.  So all the variability in the length of the menstrual cycle comes from the first half.  Awesome.

My boyfriend freaked out because he didn’t know this basic menstrual fact.  He didn’t know it and I did, a third-year med student and more importantly, his girlfriend.  My knowledge made him feel bad about himself.  I backpedalled – I just studied it, you know, so it’s fresh in my mind.  It’s okay.  I’m sure there’s a lot that you know (that I don’t know).

We didn’t last – thank goodness.  Maybe he needed to be with a woman who knew less than he did.  Lora Park (NY Univ at Buffalo) researches this phenomenon, that men want to be smarter than the women they date.

The field of medicine as a whole continues to be rife with sexism and misogyny, as evidenced in a recent Washington Post article.  How many times did people assume I was a nurse?  How many times did patients choose to call me by my first name, while referring to their male physicians as “Doctor”?  And there was that blatant proposition from the professional athlete after I had just finished his rectal exam in the ER.

Where am I going with this?  For many men, it’s deeply unsettling when a woman is smarter, faster, or better at something.  Insecure men often fall back into comforting patterns of objectification, sexism, and misogyny, instead of celebrating women’s strengths.  Regression to Mean.  As men contemplate a long-term committed monogamous relationship, let’s say a relationship lasting at least four years, they are freaked out by the idea that this woman might be smarter than they are.

The 2005 Access Hollywood video and Howard Stern tapes show Donald Trump being himself.  Anyone who is surprised hasn’t been paying attention.  Anyone deciding to disavow only now didn’t do their research.  In Trump’s mind, women are conquests, reduced to a compilation of body parts, either sexually desirable or disdained.  He believes he can take whatever and whoever he wants, without regard to pesky things like consent, legality, or morality.  And men who feel threatened by smart women love the camaraderie of “locker-room talk.”  A good old-fashioned session of misogyny will clear that insecurity right up.

In case you were wondering, #ImNotWithHim.

Here’s the deal: I want my president to be smarter than I am.  I want her (and I’m using “her” as the generic pronoun just for kicks, not as some commentary on Clinton’s candidential viability – I can make up words, right, ’cause I went to medical school), I want her to know more than I do about history, law, politics, Black Lives Matter, economics, conflict resolution, the Labor Movement, public education, communication, government, group dynamics, and activism to name just a few.  I want my president to be able to acknowledge when she is ignorant and continue her journey of lifelong learning.

There you have it.  I’ll see you at the polls and I’ll be voting for a candidate who is #SmarterThanIAm.

I’m all about action.  What can we do?  How can we do better?

1) Raise girls to be unapologetically smart.  This is different from being arrogantly smart or ungenerously smart.  Here’s a script we can teach our girls: “If you feel bad about yourself because of my accomplishments, that’s your problem, not mine.  Don’t attack who I am to feel better about yourself.”

2) Raise boys (and girls) to value smart girls.

3) Teach boys how to bond with each other intimately in ways that don’t denigrate girls and women.

4) Teach boys how to genuinely demonstrate affection, not by pulling hair, physical aggression, or teasing.  At the library, I recently witnessed a teenage boy throwing a girl around.  And he didn’t think he was being mean.  He probably thought he was telling her he liked her.

5) Speak up.  Speak up when you see that teenage boy throwing a girl around.  Speak up in the locker room when teammates start down the well-trod path of sexism and misogyny.  (Ace assures me that he hears reductive sexist banter in the hockey locker room all the time.)  Folks who do psychological work with children, teenagers, and adults, please chime in on suggested approaches.  I must confess, at the library I didn’t know what to do or say.

6) Give kids the vocabulary to admire each other.  ”I liked it when you read that poem in class.”  ”Wasn’t it awesome when Shanika went off on String Theory and Mr. X was like, dang.”

7) Vote for candidates who are smarter than you are.

8) Add to my list.

Musical Moment #1 evolves to

Musical Moment #2

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Minnesota Reportable Communicable Disease – the stuff we got in 2015

I did not watch the presidential debate last week.  Wild horses couldn’t drag me away from my most favorite publication from the Minnesota Department of Health:

The Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2015.

Folks, this is pleasure reading at its best, full of pestilence, suspense, and SEX.

I’ve culled this riveting report into a tiny list of takeaway messages.  For you.  From me. xoxo.

1) The numbers reflect reported cases, not the actual incidence of disease.  21,238 cases of Chlamydia were reported in 2015.  That’s like all of Golden Valley.  Or half of Edina.  As you may know, chlamydia can lurk around, relatively asymptomatic until it wreaks havoc.  So 21k is certainly a lowball number.  Plan accordingly.

2) Health disparities continue.  People of Color are disproportionately affected by HIV and AIDS, malaria, measles, chlamydia, carbapenem-resistant Enterobacteriaceae, gonorrhea, tuberculosis, and Hepatitis A, B, & C.  This is an opportunity for meaningful improvement!  Let’s get to work!

3) Many of the reported communicable diseases are vaccine preventable.  I will list them for you:

  • Haemophilus influenza (104 cases, 18 deaths)
  • Influenza, “The Flu” (1501 cases, 3 pediatric deaths)
  • Measles (2 cases)
  • Meningococcal Disease (7 cases)
  • Mumps (6 cases)
  • Pertussis, “Whooping Cough” (594 cases)
  • Rabies (No human cases!  Keep vaccinating your pets!)
  • Streptococcus pneumoniae Invasive Disease (534 cases, 56 deaths)
  • Varicella, “Chicken Pox” & “Shingles” (361 cases)
  • Viral Hepatitis A (21 cases)
  • Viral Hepatitis B (19 acute cases, 165 newly identified chronic cases)

4) Food prep is no joke.  Wash your hands.  Check internal temps.  Don’t eat raw meat.  Travel carefully and choose restaurants wisely.  (bloody diarrhea, bloody diarrhea, bloody diarrhea)

5) Tiny mosquitoes make big trouble.  West Nile Virus (9 cases), LaCrosse encephalitis (1 case), Western equine encephalitis, and Jamestown Canyon virus can all be transmitted by Minnesota mosquitoes.  My friend’s mother contracted West Nile Virus and is now wheelchair bound due to neurologic and cognitive impairment.  Chikungunya, dengue, malaria, and Zika are also transmitted by mosquitoes, but all Minnesota cases of these diseases were acquired internationally in warmer climes.

Here is some helpful information about DEET from the Environmental Protection Agency.

6) There is no need to travel internationally to acquire tick-borne illness.  Our very own Minnesota ticks can give you anaplasmosis (613 cases), Lyme disease (1176 cases), babesiosis (45 cases), Powassan virus, and ehrlichiosis.  There have also been rare Minnesota cases of tick-borne Tularemia and Rocky Mountain Spotted Fever.  Chester, our yellow labrador retriever, kindly collected 16 deer ticks in a 24-hour period in Otter Tail County.

Once again, here is some helpful information about DEET from the Environmental Protection Agency.

7) Let’s talk about sex.  The rates of chlamydia and gonorrhea in Minnesota are increasing, disproportionately impacting adolescents, young adults, and People of Color.  Syphilis is also on the rise, particularly among men who have sex with men.  Meanwhile, antibiotic resistance is (no shock) increasing.

The number of new Minnesota HIV diagnoses per year (228 cases in 2015) has remained relatively stable over the past ten years and continues to be associated with poverty and high population density (the Twin Cities).  Females and adolescents make up an increasing percentage of new HIV diagnoses.  According to the MDH, in 2014 Minnesota ranked 16th lowest HIV diagnosed infection rate at 7 cases per 100,000 people.  Louisiana had 36.6 cases per 100,000 people.  Coincidentally, Minnesota ranks 7th lowest for poverty, while Louisiana ranks 49th.

Start talking.  Silence = death.

8) I love public health.  Thank you to all the people who spend their lives trying to protect the rest of us.

 

You can read the full The Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 2015 HERE.  I strongly recommend reading it with a bowl of popcorn and beverage of your choice.

Musical Moment

 

 

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Jacob Have We Loved

Dear Jacob:

They found your remains last week, buried just off a country road, scarcely thirty miles from your home.  That tiny remnant of hope, a single flickering candle, is now and forever extinguished.

You are dead.

The man who kidnapped you, raped you, killed you – can we even call him a man?  He is beyond evil, past the language that I understand.  I want him there, far away from what I know, far away from the comfortable familiarity of small-town Minnesota.

In his confession, he said that you asked, “What did I do wrong?”  Nothing.

You did nothing wrong.

You are light.  You are innocence.  You are truth.  You are beauty.  You are possibility.

I can’t read the rest of the confession or I will be haunted.  Your face stays with me, your smiling face.  I can conjure your image in my mind more easily than the faces of my cousins.  They are changing.  You are constant.

Forever young.

Please know that I hold your family in my heart.  Let me take a fraction of their pain, some small broken piece of the suffering they carry every day.  Help me teach my child strength and compassion, justice and peace, that he may be a gentle, healing presence while he walks this earth.

We love you, Jacob.  Rest easy now, rest in the arms of your community, and let us sing you to sleep.  You are one of us.  We will never forget you.

Love,

A Minnesota Mother

 Musical Moment

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The Beauty of a Handwritten Note

“I’m kind of old-school,” Dr. Seshat admits.  She’s a millennial doc, finishing her Internal Medicine residency around the year 2000.  Her practice straddles the old and the new.  During her training, Seshat documented with a pen in a paper chart.  She joined an independent group of primary care physicians in Florida.  “It’s kind of funny when you’re in it, you just don’t know.  I think we’re behind in a lot of ways.”

Several years ago, Dr. Seshat experienced two major changes with her practice.  1) A hospital gobbled up her group and suddenly she was one of 500 physicians.  2) Her clinic transitioned to an Electronic Health Record – not the one in use at the associated hospital.  Dr. Seshat’s clinic administrator said, “Scan the last three [chart] notes into the EHR,” as if any patient’s medical history could be summarized and transferred in three notes.  “I was never really a good dictater and I never dictated clinic notes.  Ever.  So even though we have Dragon [voice recognition software], which I’m trying to get better using, it wasn’t an easy transition.”

Seshat found the EHR to be completely inaccessible.  It’s not the way her brain works.  The group used one EHR for a couple years before switching to another.  EHR’s are like trying to make your way around a country where you don’t know the language and have limited resources (tech support).  At first, you’re lost.  As you wander around, you begin to recognize a few landmarks, maybe a restroom (the medication list), maybe a gas station (the past medical history).  If you’re lucky, you bump into someone who speaks your native tongue and can give you a few pointers (sharing dot phrases and exam templates).  Some docs have greater facility in the new territory.  Others are just trying to survive.

Now imagine being transported suddenly to a new country.  You have to start all over.

Dr. Seshat was drowning in documentation.  “I had to go part-time because I couldn’t do it with the documentation.”  She approached her clinic leader, armed with resources from the internet on how to present her request.  “I made this proposal for me to work part-time.  (No, no, it’s not done down here.)  I think the only reason they let me was I’d been there [in her particular clinic] so long.”  Seshat cut back to three work days per week.  “And at first it’s super great, but it turns out I just do a lot of work on the days I’m not there.”

The new EHR is less than optimal.  “There’s still a lot of box-checking,” Seshat says.  “I don’t even understand all the different score cards.  We have different quality goals because we merged with another group.  And there’s a Healthy Registries thing.  I don’t even really know how important it is that I’m trying to do these certain things.  With Counselling for BMI [Body Mass Index – a measure of obesity] I figured out it was fourteen clicks and two scrolls to enter in that I did the counselling, and that’s not even in my note!  And then it wasn’t even being counted [accurately] by Healthy Registries.”  She quit the rigamarole and decided to take a break from the fourteen clicks and two scrolls.

A prime example of the inefficient use of physician resources.

“I feel like I need to work at a frenzy, but I don’t.  And if I keep up with my notes I’m horribly behind with my patients.”  She completes her documentation at night, on vacation, on weekends.  “Like literally, we went to California and I spent the entire plane ride doing my notes.  I had to work the second day that we got there.”

Seshat’s greatest joy is “treating the same patients for such a long time.  Even though I’m not Family Medicine so I don’t see kids, I definitely have seen generations of the same family.  I really don’t see any new patients because I’ve been in practice so long.  The ones [patients] that don’t like me, they’re gone.  The relationship is the best part.”  Ironically, these long-standing relationships make it hard to stay on time.  “I can be much faster with someone else’s patients.”  No need to check in about the granddaughter headed off to college or the beloved geriatric pet parrot.

I ask Dr. Seshat what she would do for a micro change, at the level of her clinic practice.  “I really need a scribe.  I just feel like we’re always behind the times.  So I just assume sometime down the road there will be a scribe.”  We discuss a remote scribe service that charges $10/patient.  The physician wears a pair of special glasses so the scribe can “see” what’s going on.  “I just don’t see enough people to make it worth hiring someone.”

Dr. Seshat chose to preserve the doctor-patient relationship and her own sanity at the expense of her salary.  Her current compensation model is based on work RVUs [relative value units], a model that rewards quantity and not necessarily quality.  “So I just pretty much try to see as few people as possible so that I can have a normal life.”  Documenting for two days on vacation may not qualify as a “normal life.”  “I have really great patients,” she continues.  “My office set-up is good.  I feel like I shouldn’t complain.  It’s mostly the electronic piece, I guess.  It’s the worst.”

What change would Seshat like at a macro level?  “I guess better access at lower cost.”  I ask her to elaborate.  “If I want to send someone for a colonoscopy, I have to have them see GI [gastroenterology].”  Even to request a routine colonoscopy?  Yes!  “It’s a complete waste of time and money for the patient.”  When Seshat wants a patient to receive Zometa infusions for osteoporosis, she has to send them to rheumatology or oncology first.  I’m shocked by these revelations.  An unnecessary New Patient Consult costs money (for the patient and the insurance company) and generates money (for the specialist).  To demand that patients needing screening colonoscopy see a gastroenterologist first almost seems offensive, like a primary care doc can’t be trusted to make the call.  “I don’t know why.  I don’t know if it’s a culture of distrust or a culture of old-fashioned-ness.”

Access is a huge issue in Florida.  Seshat informs me that 44 counties in her state only have one insurer that accepts Obamacare patients.  ”And they didn’t expand Medicaid in Florida.”  Dr. Seshat echoes a familiar mental health refrain: “I feel like there are no psychiatrists.”  Disparities in access are further stretched by concierge medicine, where patients with financial means pay fees above and beyond insurance in order to join a concierge physician’s panel.  In essence, they pay for more immediate access to the doc of their choice.

We discuss the growing trend in the Northeast where physicians simply decline to accept insurance.  “They’ll give you something that you can try to get reimbursed on your own,” Seshat says.  Anyone who has ever disputed a denied insurance claim knows which patients are likely to wind up with a No-Insurance-Accepted physician.

Dr. Seshat’s longstanding relationships with patients are keeping her in the game.  For now.  “I want to quit my job but then part of me has that pride/guilt thing.  How could I not do this?  But I gotta do something.  I feel lucky that I can work three [long] days a week, I mean that’s huge.”

She’s spending Labor Day completing the documentation for 34 patient visits.  For the sake of accessible primary care in Florida, get that doctor a scribe!

 

Musical Moment

Seshat is the Egyptian goddess of writing and measurement.

 

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