Soroca, Moldova, built on the hills overlooking the Dniester River. Note the Communist style housing on the hillside. Soroca is built on several hills along the Dniester River.
Thursday, November 11, 2010
Wednesday, November 10, 2010
What prompted me to delve into this path of thought was the discovery of an obituary of a former patient of mine. Now I am not an obituary reader, though I am told many people my age are. But I just happened to find this one and low and behold it was for a patient whom I remembered well. M. P. had been in my practice for many years. She really didn't have too many of the chronic diseases that plague most older women. I recall a little bit of diabetes which really didn't require any meds and some high blood pressure that was controlled on 1 med. I know she developed an underactive thyroid while in my care and I had started her on daily thyroid hormone replacement. She had a lot of difficulty whenever she received any kind of diagnosis, and she was very concerned about having to take any kind of medication. Since the thyroid condition would require her to take meds every day for the rest of her life and to occasionally to have blood tests to check on the correct dosage, she was very down about this. She would whine in the office about, "how was she going to do this? How could this have happened to her?" etc. etc. She was also often going on about various family problems that seemed too much for her. Sometimes she would go into the family issues a little and they were usually stories about inter personal relations of some sort. She really didn't have family members who were abusive, or in trouble with the law or anything like that. But the interpersonal problems often were a burden for her. So I recall looking at my schedule and seeing her on the schedule and knowing that I would have to gear up my cheerfulness to get her through the visit and also to get me through the visit.
So I was quite surprised to see this sentence in the obit that I found: First her many friends and relatives were listed. Then, "M and her husband of 60 years had many close friends before and during their mariage that they maintained over 60+ years. Described by many as a "true lady", M was known for her friendliness, charitable spirit and insistence on putting the needs of others before her own. Her kindness and generosity will never be forgotten." This did not seem to be the woman who I saw in some ways whining to me during every visit in the medical office. Which is the correct picture? Or are both views true?
I began to review my own recent medical visits to my own doctors from my view and then how they might seem from the doctor's side of the visit. The doctor sees the patient for a very short time, especially now adays. He/she doesn't know anything about the patient from anywhere else in the outside community. The patient feels the pressure of time of that office visit and has to quickly and emphatically get across to the doctor what is bothering them. There often is not enough time to put these complaints into perspective. I know the difficulty I was having with arm pain after my melanoma surgery and I had to convince my doctors of the degree of this discomfort if I wanted to achieve any success in the treatment of these problems. I particularly felt this need when I returned to my plastic surgeon with these complaints. I felt he was not giving credence to the problems. I guess I did whine a little more than I am used to, but he felt I was under the care of a physical therapist and the therapist reported I was improving so the surgeon felt he didn't need to do anything further. Yet he was the one who had started the pain, obviously, so I felt a strong need to get my suffering across to him against the time pressure that I also felt as the patient.
So if there is such a vast difference between who people are in everyday life and who they have to be when they go to the doctor, how can the relationship between patient and doctor resolve itself? An excellent question! I think that the oness is on the doctor. He/she must realize that this paradox exists. And the doctor must create sensitivity and listening and observation skills that can detect the patient's needs and make the patient's communication more efficient. And patients must ask questions and not be shy with the doctor. It turns out that the visit to the doctor's office is one of the most important interpersonal communications that take place in our later life. Each participant needs to understand this and realize how easy it is for this communication to go wrong. I just know that I don't want to be misinterpreted in my visits like I misinterpreted poor M. P. Lets hope that all of you feel comfortable enough with your physician to bring up your concerns and let's hope you have a skillful physician who appreciates the complexities of these interactions.
Note: At the beginning of this post, I used the caduceus, a universal symbol for the field of medicine. I plan to use this symbol in the future also when the topic is medical. It is familiar to most everyone as an apparent snake, or sometimes two snakes entwined around a pole. The origin of this symbol is quite interesting. Check upcoming posts and I will explain its origin. You may be surprised.
Sunday, November 7, 2010
This is Ann that is posting these photos, but they are the work of my photographer husband. I received one request for some more of these photos to be posted. I only require one request. So here are more.
Cape turtle dove
White browed robin-chat
Yellow billed stork
Pair of Pied kingfishers
Great grey heron
Wire tailed swallow
long toed lapwing
open billed stork
Red billed oxpecker on Cape buffalo
Cape White eye
Grey headed gull
That's it. A good mix, I think. Most are fairly large birds that sit still in order to be photographed. But here and there my husband caught a good picture of a small bird. And it was those photos that helped me identify the bird to get them on my life list.
Thursday, November 4, 2010
Glossy starlingI promised you some photos of Botswana birds (also throughout Southern Africa). Here are some of my husbands expert photos.
But first let me tell you a little how I got into birdwatching and how my husband got in to photographing them. As an adult I have always enjoyed keeping birdfeeders full all year around for the birds. During migration season and during invasions in the winter I enjoyed identifying the various birds that visited the feeders. We then lived in suburbs with housing closer together so we didn't see a lot of these migrants during the year. They did not nest locally. But we lived fairly close to the Milwaukee River, though not on it. I think this location was responsible for some of the attraction. Birds tend to use the River and its surrounds as flyways. I think my first birding trip occurred when we went to Israel for a visit in the 1980s. My husband needed to stay to visit his family there, but I had signed up for a Spring Migration Festival in Eilat, on the Red Sea. That was an interesting time. I will tell that whole story in another posting. Over the years I have attended a few other birding festivals. But mostly during our many travels, I have tried to birdwatch while my husband tears on ahead in the trip. He is not one to stop along the road to identify a special bird I spot through the window, or even to slow down our siteseeing strolls to identify a bird. But then we found some cooperative great blue herons and great egrets which were content to stand still for him to get quite close with his camara. He got some good shots and that is how the bird photography bug bit him. Now he doesn't have the really heavy and long lenses so small birds are not good subjects. But there are a lot of fairly large birds around the world. Africa is certainly no exception. In fact I think there are many more large birds there than in North America and even some of the smaller birds seem to be unafraid of people and pose quite naturally for photography. I think he got some beautiful photos while in AFrica. I have loaded some of them here on this post.
black backed vulture
lilac breasted roller
red billed hornbill
Spotted dikkop or thick knee
helmeted guinea fowl
African fish eagle
This is the limit of these high resolution photos that I can fit on this website. There were many more birds seen, but will have to post them another time. Let me know by email, or in comments if you would like to see more.