I have been watching Gabe Brown's polyculture farming. Never leaving the earth bare. And Geoff Lawton's urban permaculture. Managing water flows on sloping land.

Our garden is a bit wild. It celebrates my indecision about what to pull and what to keep. Foot tracks flow downhill(not the right thing) and gardens are sort of on contour(sort of the right thing).

I like plants that are perennial or reseed like spinach, kale, parsnip, parsley, potatoes. So we do have those running free. Jerusalem artichoke is hard to get rid of so we have some of those..

We have a good few fruit trees, but they are small. I need to wait to see how they will look and what needs to happen underneath them. What else I can fit in between.

We have a nice big flowered clover that I think is a good ground cover, but trying to plant into it seems like the new plant will have a lot of competition. But perhaps the nitrogen payoff and the cooler soil will balance it out.

I have to find some alt gender maqui and kiwi berry plants to help pollinate the ones I have.

Do other e2 folk experiment with their gardens?

Delete the previously inserted entry in order to continue. We watch the laundry spin and get spun out in turn. To parse these sparse requitals and spit to the tune of the new funny.

An errant text, a misfire, a preejaculate foreplanned by no one ever.

How we came to be. An original script, you're sure now, right? 

Untellingly, the simulacrum showed no sign of disturbance upon observation.

Maybe this was all there was going to be after all. Checking off each individual closing with the beginning of confidence.

 

Eventually the source dissolves into the vagaries of memory and chance, smoke and metonymy. As tense gains traction, the format of these thoughts, an angular thrust of the tongue in the eye of the mind. A phrase begat by a phrase for the price of one prince's ransom.

Two tomatos, if you please. The urgency embarrassed us all.

I said no to a patient yesterday.

The patient came for a fifteen minute get to know you visit. I don't charge for this.

The patient came all the way from Whatcom County. I am in Jefferson County, Washington. That is about 99 miles but involves a ferry ride from Whidby Island to Port Townsend. So it must take at least three hours each way.

The person is on suboxone. Their provider is going to cash only January 1, 2017 and won't take insurance. I had no notes from the provider, only from the primary care doctor. I don't know if the suboxone is being given for opiate overuse, or for chronic pain. The person only admits to chronic pain and denies opiate overuse. The use for chronic pain is off label and I don't do that: it's too confusing and we are all afraid of the DEA and authorities.

I already have patients from Jefferson, Clallam, Island and Kitsap Counties.

I called the person's primary care doctor and I forwarded the information to the University of Washington Pain Clinic. They are swamped as well, after the Seattle Pain Clinics closed: http://www.seattletimes.com/seattle-news/health/the-whitecoats-dont-care-one-mans-desperation-and-death-when-pain-clinics-close/. They are giving priority to the people with implanted pain pumps, because the rest of us aren't trained in those dosage adjustments.

And I need to sit down and read the CDC guidelines for chronic pain. The short version: https://www.cdc.gov/drugoverdose/pdf/guidelines_factsheet-a.pdf and the long version: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. It is a fifty page PDF. Try doing the two page one in a fifteen minute clinic visit. Ha, ha, good luck. And then make sure you can tell the difference between an opiate overuse person and someone who only has chronic pain: easy, peasy, right? I find that they ALL say they have chronic pain and no opiate overuse. ALL OF THEM. Well, except the heroin folks. The heroin folks are easier because they never say they don't have a problem. It's still emotionally difficult because about 1/3 quit treatment with me and then some die. In their 30s. In their 40s. In their 20s. I mind.

It's such a mess. If a person gets started on suboxone, yeah, it will work for chronic pain too, but what if I get hit by a truck? There aren't anywhere near enough prescribers, docs are quitting, and it's labor intensive. The doctor is going to cash payments in Whatcom most probably because they are just sick of the huge mass of paperwork and restrictions and worrying about medicare or medicaid coming after them.....

....but I have limits as well....only four counties.

I need some cheering up, dang it. Wine, wine, wine... nope. Ok, one person said last week that he feels better then he has in YEARS and brought me a Christmas card.....'taint all bad.

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