Fatal? Sometimes. Never recover? Frequent.

April 7, 2021

To humans, I say, one and all

The risks, I tell you, are small

Please get the vaccine

For COVID-19

To avoid the dreaded “long haul.”

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  2019 included hospitalist work in my home town and rural medicine in northern British Columbia.  Since the pandemic started I did telemedicine, got COVID-19 and then the vaccinations, and did a week of in-person medicine close to home.  I just started an assignment in Iowa.  Identifiable patient information, including that of my wife, has been used with permission.

I walked to work today, in the cool, clear spring air, with the temperature hovering just at freezing, a few patches of frost on the grass in the low spots.

I like a short commute.  The best ones don’t require a car, which builds exercise into the work day. 

My fluency with this particular electronic medical record (EMR) continues to grow but today I still needed a lot of help.  Certain design flaws and redundancies bear a strong resemblance to a system I worked with 5 years ago, but not so strongly that I could call it identical.  All EMRs evolve; every update makes each one harder to use (I’ve not heard of an exception but will accept an assertion to the contrary). 

COVID-19 and its fallout dominate our clinical thinking.  Today we had a bunch of corona-positive patients, along with a series of patients with new onset atrial fibrillation. 

I have an advanced, digital electronic stethoscope to help make up for my hearing loss, that I didn’t use once in my 10 months of telemedicine.  During that time I examined exactly two eardrums using an otoscope (the patient had the digital version).  Today those two instruments proved key to properly diagnosing more than half my patients, leaving me to wonder how much I missed without them.

COVID-19 hits a lot of body systems.  By now we all now about the cough, fever, muscle aches, and loss of sense of smell.  But a small number of people have symptoms mostly referable to the skin or the gut. 

The virus also can hit the heart.  An increased tendency to clot can lead to heart attacks and blood clots in the lungs; the virus can irritate the sac that surrounds the heart (pericarditis) and it can settle directly in the heart muscle (myocarditis).  And days to months after the infection, the heart can have problems keeping its rhythm.   

Between 10% and 30% of people who get COVID-19 will have symptoms that last for more than 3 months and earn the unofficial designation “long haulers.”  Some will never fully recover. 

But I still meet COVID-19 vaccine hesitancy.

I found out today 1) I can test patients for mycoplasma and 2) we have an inordinate amount of mycoplasma illness. For the last 40 years, anytime I diagnosed mycoplasma, I did so based on my “clinical impression,” a fancy way of saying “best guess,” not nearly as good as the serology we have here and now.

Why so much mycoplasma?  Probably because we have so much livestock so close to people. 

A return to Pennsylvania Dutch country

March 31, 2021

I’m seeing my patients face-to-face

And the spot’s a really nice place

Living up to the promise

Of horse drawn Amish

And a reasonable, small-town pace.  

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  2019 included hospitalist work in my home town and rural medicine in northern British Columbia.  Since the pandemic started I did telemedicine, got COVID-19 and then the vaccinations, and did a week of in-person medicine close to home.  I just started an assignment in Iowa.  Identifiable patient information, including that of my wife, has been used with permission.

On a beautiful windy afternoon we drove through Iowa farm country, south and east, to my new assignment, and arrived just as the sun set.  We circumnavigated the hospital and closed in on a snug little house not far from work. 

The town has remarkable prosperity.  Clean streets run between well-kept houses, not much traffic, and a few Amish horse-drawn conveyances. 

This week I have orientation.  The facility is up-to-date, clean, efficient, well-staffed, well-organized, and well-equipped.

Staffers at the front door greeted me with a temperature probe and a list of COVID-19 questions, but they did so with a combination of crisp professionalism and genuine caring.

I met a lot of people the first day and got thoroughly lost in the hospital.  A map sense of the facility will probably come before I get to know the people behind their masks. 

This will be my first assignment where I can a procalcitonin, a lab measurement that helps to distinguish between bacterial and viral infections and thus helps limit the inappropriate prescription of antibiotics.

My second day on my new job started on the inpatient area.  The hospitalist and I have a mutual friend and colleague. 

The hardest part of orientation will be the electronic medical record (EMR) system.  Depending on how one counts, this will be my 19th in less than 6 years.  My fear of computers, crushed by idiocy disguised as “features,” got turned to information superhighway roadkill years ago.  I’ve used a similar EMR in the past; this version has slightly improved speed, slightly less click-and-wait, and single click access to the Prescription Drug Monitoring Program (PDMP) that covers 5 states. 

The institution responded well to the pandemic, setting up a separate entrance and patient-care area for those people with respiratory illness.  Air pressure management keeps germ flow inwards.  I will care for the segment of the patient population that comes in with a fever or a respiratory illness.  My day will look a lot like Urgent Care, but I can follow the patients when needed. 

The locum tenens (temporary) doc who held this position for the last several months stayed long enough to help me with the EMR.  I shadowed him for a patient.  Then I observed his next patient and entered the data.  Then, while he watched, I took the history and did the physical and did the documentation.  Finally, I took care of a patient on my own, and entered the data.

That first solo patient speaks little English.  Originally from Guatemala, he works at a factory in a nearby town.  The pandemic necessitated the visit.  I had the joy of relieving suffering using nothing more than fluent Spanish and a sense of humor. 

Thus I entered data for 2 patients but it took me close to an hour.  I ordered labs and medicines, got to use my listening and rapport-building skills, arrived in the sunshine, left in the sunshine, and got to have lunch with my wife.  All in all, a very good day.

March 11, a day to remember

March 11, 2021

March 11 is a heck of a day,

A time to reflect, and maybe to play.

Perhaps I should ask

If I still need to mask

After the second vaccine delay.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  2019 included hospitalist work in my home town and rural medicine in northern British Columbia.  Since the pandemic, I did telemedicine, got COVID-19, and worked 1 week of hands-on medicine.  I took time off to help my wife while she recovers from total knee replacement.  Identifiable patient information, including that of my wife, has been used with permission.

March 11, 1979 sticks in my memory as the date I graduated from med school.  High emotions make for high learning, and I remember details of that day.  My father, himself a physician, and brother flew in from Denver for the graduation; I had hitchhiked back from Montana after a month with the Northern Cheyenne.

I don’t recall the name of the commencement speaker but I remember an address so articulate and relevant the main points stick with me to this day.  Practice saying, “I don’t know;” get good at it.  Make a 4×5 card for every true medical emergency: signs, symptoms, diagnostic measures, and treatment; go over the cards until you’ve memorized them.  Be prepared for a career that will dominate your time, emotions, and energy. 

We went to a Chinese restaurant afterwards. My fortune cookie said, “You will have great power over women. Use it wisely.”

March 11, 2020, sticks in my memory as well.  I went to Florida for a mini-reunion of my undergraduate class, and afterwards flew across the state to spend some time with the widow and daughter of my friend, Bob (see https://walkaboutdoc.wordpress.com/2018/03/14/a-friends-death-3-the-service/) .

The world still had a sense of normality then.  We didn’t mask in public.  I still said of COVID-19 that it was good training for the next real pandemic, but that it would probably turn out to be just a bad cold.  We’d be over it, I said, optimistically by July, realistically by September, and pessimistically by January.

That weekend was the last normal weekend.

 This March 11 finds me relaxing at home.  Bethany’s left knee got replaced February 16 and her gait improves daily.  She goes to Physical Therapy 3 times weekly.  I continue to bicycle on a stand trainer most mornings, and outside in good weather occasionally.  We both had COVID-19; she had both jabs and my second one comes due next week.

Today Bethany came with me to the archery lanes.  I missed my turn-off, so we decided to keep going and have a look at our farm. 

We knew the field by the standing corn in the corners. 

Bethany knitted while I sent arrow after arrow into the target. 

Afterwards we had a light lunch, I took a very short nap, and prepped my bicycle for the summer with a new chain and a new rear tire. 

All in all, it felt like my birthday.

Mirth from critical reading

February 28, 2021

For 3 months post bamlanivimab

I waited for my Corona jab

I had a laugh with the clerk

About the sign at her work

And the ice cream went onto my tab. 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  2019 included hospitalist work in my home town and rural medicine in northern British Columbia.  For most of the pandemic I’ve done telemedicine, but, having recovered from COVID-19, I just finished a week of hands-on medicine, and I’m caring for my wife while she recovers from getting a new knee.  Identifiable patient information, including that of my wife, has been used with permission. 

I arrived for my COVID-19 vaccination early enough to buy ice cream.  At the Express check out, I read the sign out loud to the clerk.

We had a good laugh, when I asserted I would not let her sanitize between me. 

She noted my sense of humor and asked if I got into trouble in school. 

I didn’t, I said, the teachers appreciated my wit in elementary school, and in middle and high school I kept my head down while those around me learned, the hard way, that the nail that sticks up gets hammered down.

I didn’t give the whole story.

Earlier in the day I got an email requesting my services as a boarding school doctor: easy hours, great pay, and close to New York City.  I delete most job offers promptly, but this one gave me pause.

Adolescent comes from a Greek word meaning pain.  Thus, we have a whole genre of films called Teen Angst movies.  I got a fabulous education in high school; my Spanish fluency remains the jewel in the crown.  But it came at an enormous cost.  I wrote a short, articulate, perfectly punctuated paragraph to the agency offering me the position.

Because of that education, to this day I read critically, starting with grammar, spelling and usage, and progressing through parallel construction and clarity.  Most Americans write atrociously, doctors not excepted.  I usually keep my criticism to myself.

But the literal reading of a sign that should have been proofread brought much mirth to me and the clerk.  Who gave permission to write about and photograph her. 

I got the ice cream into the cooler, and returned to the pharmacy exactly on time.

Finding a spot to get a vaccine did not come easily.  I had to wait the requisite 90 days post bamlanivimab (monoclonal antibody treatment for COVID-19; see https://walkaboutdoc.wordpress.com/2020/12/09/they-named-the-med-bamlanivimab-really/). 

This opportunity became known to me because the pharmacy called the synagogue, who called me.   

A week of in-person medicine

February 27, 2021

The fine points of arrow and bow

I can discuss with those in the know

Came up the CTs

Abnormal, 2 out of 3.

And I knew where the patient would go.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Alaska, Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  2019 included hospitalist work in my home town and rural medicine in northern British Columbia.  After the pandemic hit, I started into telemedicine, but I caught COVID19 anyway. I am currently working a short assignment in Iowa. Identifiable patient information, including that of my wife, has been used with permission. 

In the course of a week of hands-on medicine, I saw fewer than 2 dozen patients, half of them quite ill.  Two of the 3 CT scans I ordered came back abnormal, demanding a higher level of care.  I suspect the problem that prompted the 3rd CT resolved in the time it took to get the scan.

I find it easy to build rapport with patients.  In a town surrounded by cornfields, my ownership of land and the ability to discuss the fine points of soil management and grain markets bring credibility. 

From a series of tattoos on a patient’s arms I easily recognized a devoted hunter.  I brought out my phone and showed off one of my best 5-arrow targets (if it means anything to you, all X-ring).  We talked about game animals which led to a discussion of Alaska and the patient’s declaration that if he goes there, he won’t return to Iowa.

Twice I showed off the picture of Bethany and me with our 92-lb halibut.

I met another vigorous, employed nonagenarian.  The town has so many that I can write those words without identifying anyone in particular.  Such acquaintances lend hope to my goal of retiring at 85 and at the top of my game.  In a town this small, several hospital staffers live close enough to the patient to qualify as neighbors.  One gave me valuable information that helped guide the direction of the work up. 

The week passed leisurely for the most part, but I had one frantic 3-hour segment with 5 simultaneous patients.

All people have ups and downs, but bipolar people have extreme highs and extreme lows.  Formerly known as manic depression, it occurs at the same frequency in all populations of the world.  Most bipolar people intersect with the medical system when depressed, when neither the patient nor their white blood cells move quickly or effectively.  In fact, I can safely say that I’ve never seen a manic patient for an infectious process. During this assignment, I cared for more than one manic patient; neither had a problem to do with a contagious disease.  Still, I was able to help them. 

With such a short gig I never got full computer access.  Using a digital recorder for my records let me work efficiently.  But I didn’t see more than 6 patients a day.

A return to hands-on medicine

February 15, 2021

The urine’s backed up by a stone,

The patient, so stoic, won’t moan.

Diagnostic doubt lingers

Despite exam with my fingers

And the CT report’s on the phone.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Alaska, Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  2019 included hospitalist work in my home town and rural medicine in northern British Columbia.  After the pandemic hit, I started into telemedicine, but I caught COVID19 anyway. I am currently working a short assignment in Iowa. Identifiable patient information, including that of my wife, has been used with permission. 

I came back to face-to-face medicine after a 13-month hiatus today, to a place where I worked a couple of years ago.  Like many small Iowa towns, it has a polite population that treasures family, hard work, and sobriety.  Thus, we have a lot of people living into functional old age. 

My first patient today gave me lessons in diagnosing kidney stones, and gave me permission to write about it.  I concentrated on the basics of the history: location, duration, character, and modifying factors.  Classically, kidney stone pain has an abrupt onset, comes in waves, has a specific location without local tenderness, and hurts so badly as to generate sweating.  Those parts of the history pointed towards a hunk of calcium lodged in the tube between the kidney and the bladder. 

The rest of the history, for example recent trauma or recent surgery, did not.

I just listened to the patient, who told me almost everything that I needed to know.  I guessed at the rest and startled the patient with my accuracy.

I confirmed the diagnosis with a CT scan.

I covered the ER today, and had a total of 4 patients, 3 of them quite ill.  I ordered CT scans (both abnormal) on 2 and an ultrasound (still pending) on 1.  The 4th patient demonstrated the importance of confirming elements of history with family members. 

From May till today my work and my patient contacts have been virtual.  I enjoy remote medicine for its efficiency, but I found the inability to touch the patient or order imaging frustrating. 

I love the work that I do in Canada, despite (or perhaps because of) the under-resourced system.  In January of 2020, the last time I was there, I could have gotten CT scans on the 2 patients who required that test today.  But it would have involved 20 minutes on the phone, a good deal of paperwork, and a 2 ½ hour drive down moose- and bear-infested roads.  Today, I had the results for both patients in the time it would have taken to fill out the forms, talk to the radiologist, and call for the ambulance.

All electronic medical record (EMR) systems have problems but so far I can’t tell what’s worse: having or not having access to the system.

I enjoyed talking to the patients and touching them where they hurt, after 13 months of inability to do so. 

Contrast is still the essence of meaning.   

A return to in-person medicine

February 9, 2021

I said while crossing a creek,

Past my defenses the virus can’t sneak

I’m bound to return

To help and to learn

But the job is just for a week.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Alaska, Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  I split the summer of 2019 between hospitalist work in my home town and rural medicine in northern British Columbia.  After the pandemic hit, I started into telemedicine, but I caught COVID19 anyway.  I accepted a short assignment in Iowa. identifiable patient information, including that of my wife, has been used with permission. 

Bethany and I drove into town in the late afternoon, sun slanting onto the familiar wind turbines on the skyline.

Tomorrow I start back into real face-to-face clinical medicine.  I’ve not attended a patient except remotely for almost 13 months. 

I have gotten used to wearing comfortable pants.  Shorts in the summer, camo fleece in the winter.  Sure, I wear a white coat and button-down shirt when I do telehealth, but I switch those out for a t-shirt as soon as I finish my shift.

I could have garlic and onions with my breakfast omelet. I didn’t have to worry about my patients’ senses of smell, not even the ones who hadn’t lost that faculty to the corona virus. 

It was very comfortable.  I didn’t have to trim my mustache all that often.

I could look out my window and see wildlife.  The deer in rut showed off their confusion and drama.  A trio of squirrels napped together in the late morning on a favorite maple branch.  The turkeys stopped coming round, I suspect that the foxes got them.  Tiny downy woodpeckers, smaller than the squirrels, came and went a couple of times a day. 

And I worked short days; done at 1:00PM almost every day.

But when I start back to a full-time position, with patients whom I can touch and smell.  I’ll have a full clinic day, and I’ll have to wear presentable clothes the whole time. 

It would be more of a shock if I hadn’t worked here before.  In 2018 I did outpatient, inpatient, and ER through the summer and into the fall.  This small Iowa farming community values hard work, sobriety, personal integrity, and monogamy.  I ran into lots of nonagenarians working their way to the end of their third careers.  I followed a beloved internist who had decided to spend more time with his grandchildren.  Of course I thought highly of him because his notes and his work-ups showed a thought process much like mine.

Thus, in many ways this assignment marks a geographic return along with a return to hands-on medicine.  I have kept up with the progress in medicine, but not the progress of the town. 

Alas, this job is only a week.

A Freudian Slip in the Dark

January 27, 2021

I signed for a shift in the night

It finished way before light

But a single request

Came from points west

The slip it was Freudian.  Quite.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer of 2019 between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations. Till the pandemic resolves telemedicine occupies my professional time.  Any identifiable patient information, including that of my wife, has been used with permission. 

I went to work at 9:00PM, the first time I’d done night work in over a year.  In the next 5 hours, I cared for a record 28 patients, with not even a single technical problem. 

More than half the patients came from Texas; Florida came in a respectable second, with only one patient from my home state. 

COVID-19 accounted for less than half the clinic load, but donated more clinical work than any other source.

Unable to diagnose 3 patients with chest pain and one with abdominal pain, I sent them all to their respective nearest emergency rooms with the instructions to get there as soon as possible; all turned down the offer of an ambulance.

I understand people’s preference in bringing a genital problem to a remote physician rather than making an in-person visit.  To my surprise, the vast majority of those problems can be handled without direct visualization or physically touching the patient.  Further to my surprise came a request, a bit past midnight, to work on such a problem going back months.  Experience tells me that in such situations I should dig into the person’s social history, and indeed I asked some open-ended questions which the patient demonstrated an unwillingness to answer.  I didn’t pry.

In the last few telemedicine sessions, I saw an astounding number of people with real sinusitis: asymmetric facial pain radiating to the teeth, lasting more than 10 days, accompanied by fever.  More often I spend lots of time explaining to the patient why antibiotics would more likely hurt than help. 

When I started work, the clock had just truck 6:00PM in Alaska, and when I finished, New York had just seen 3:00AM come round.  Yet not a single patient from anywhere west of Omaha requested care.  I kept asking if patients had access to 24-hour pharmacy services (most but not all did).

Of all the physiologic aspects of aging, I miss my resilience to sleep deprivation the most.  I just don’t bounce back from a night of call the way I used to.  I had to explain to Bethany that I had made a mistake in accepting the shift, that I had thought I would start at 9:00AM rather than 3 hours shy of midnight. 

But if complete honesty governs my thoughts, I would have to admit that a lot of mistakes have a Freudian tinge.

I just have to figure out why I would do such a thing to myself. 

Our grandfathers were cousins

January 16, 2021

I took off my mask and my hat

For a nice long meal we sat

We knew each other

Our grampas were brothers.

And our dads both saw combat.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer of 2019 between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations. Till the pandemic resolves telemedicine occupies my professional time.  Any identifiable patient information, including that of my wife, has been used with permission. 

During my early years my father’s parents lived in St. Joseph, Missouri.  Every summer we visited.  I have early, dim memories of taking the train, and getting picked up by my grandfather in Kansas City.  Later, we sometimes drove.  At least once we flew from Stapleton in Denver.  I remember the food on the plane and the package of 8 cigarettes that came with the meal. 

My mother loved her in-laws, and she loved the time she spent with them and the extended family in the small neighborhood.

Later I would realize that restrictive covenants prevented Jews from moving into the wealthier area; at the time I had no idea. 

We had lots of cousins to play with. 

When I was 10, after my grandmother died, my grandfather moved to Arizona, and we never went back to St. Joe. 

I reconnected with my second cousin, Paula, after I got my DNA tested.  Close to my age, as a child she played mostly with her sisters and mine and the other girls.  She has lived in Denver most of her life.  For decades, we had no idea we resided in the same city. 

We met at a restaurant, opened to ¼ capacity as the pandemic seems to be weakening in Denver.  (I think the measure a bad idea, but Bethany and I have recovered from COVID-19, so right now we’re making use of our 90-day protective bubble.)

As soon as Paula took off her mask I recognized her, despite the passage of 60 years.

We talked a lot.  Actually, mostly I talked and she listened. 

Both our fathers, first cousins, returned from WWII damaged by combat.  Both had PTSD; I suspect worse in my father, but I can’t make the evaluation now. 

I talked a lot about the anti-Semitism I faced, just as my father and mother did.  I had a very good education, but it came at a cost.

I don’t know why, but I spent more time talking about anti-Semitism and Adult Children of Alcoholic Parents than I did talking about Judaism.  I hope my conversation showed I’ve gotten over the bad things, that with the fullness of time I have come to recognize that the painful times in fact pushed me to growth in the right direction. 

That’s what I hope. 

A road trip to Denver

January 12, 2021

We are just not seeing la grippe,

That season is barely a blip,

A trip down the road

To where the party just glowed

In Denver, another road trip. 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer of 2019 between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations. Till the pandemic resolves telemedicine occupies my professional time.  Any identifiable patient information, including that of my wife, has been used with permission. 

The fall off in demand for telehealth slots coincided with the flu season’s failure, along with the decrease in number of respiratory infections we usually see this time of year. 

Before the pandemic, the cold and flu season bumped to a start at Thanksgiving when people traveled, crowded, gathered, drank to excess, and neglected their sleep; Christmas really kicked it into high gear.  The flu season followed a predictable 3- week pattern, culminating about the time that the system ran out of anti-flu treatment and flu test kits.

But the pandemic broke the cycle this year.  Travel fell off.  With notable exceptions, people gathered less and in smaller numbers.  Despite the nationwide stats for increased alcohol use, most of my patients report greatly decreased drinking. 

With good circulating antibodies, Bethany and I took a quick road trip to Denver to visit family and celebrate my sister’s 60th birthday.

No surprise that on the road we found social interactions more subdued than normal.  Strangers nod to each other but speak little with such conversations less than 10% of pre-pandemic levels.  Masks get worn with varying degrees of efficacy. 

In Denver we gathered outside in the winter night and radically surprised the celebrant.  We distanced.  We masked. We talked, as best we could, in the cold.  The notable feature of the party was the “Glow” theme.  People had costumes lighted to various degrees. 

My sister, having interpreted for the deaf for years at Denver’s many ERs, twice through Human Anatomy and Dissection, and all the way through veterinary school, has acquired considerable medical sophistication.  After the other guests left we sat and chatted and the next day had a long, leisurely, talk-filled lunch of take-out Thai. 

Over the next couple of days we went to restaurants with a brother and a cousin, Denver having just re-opened restaurants to ¼ capacity. 

We braved the horrors of traffic to visit Bethany’s sister in Colorado Springs.

I called Denver my home from age 6 to age 32; though I went elsewhere for my education for 11 of those years I kept returning. It doesn’t feel like home any more.  The city has grown and morphed geographically and socially.  Landmarks have vanished or changed to unrecognizability. 

And when we drove back to Iowa, it felt like coming home.

I truly never though I’d be a Midwesterner.