Arrival in Keosauqua


The condo is sure a nice perk

I told the hospital clerk.

    Although I might roam

    And I’m far from my home,

It’s good to be back to work.

I drove into Keosauqua, Iowa as the sun set.  For unknown reasons, Sweetheart, my GPS, guided me right to the hospital parking lot.  She had a psychotic break on the interstate near Champagne, but responded to the standard Microsoft fix: turn off, then turn back on.  After that she did fine.

Van Buren County in southeast Iowa, population six thousand, has no fast food and no stop lights.  Keosauqua, the largest town, sits in a bend of the Des Moines River.  The business district still uses diagonal parking. 

The hospital, built at the top of the hill in 1951, has grown and kept pace with the times.  The only original parts of the institution still in use may be the longest continuously used hospital cafeteria and kitchen in the country.

The assistant administrator guided me down the hill to the duplex that will house me for the next month.  A very livable place, well furnished, it has a living room big enough for martial arts forms and a kitchen adequate for Real Cooking.

I’ll try to keep the TV off.

I went out to dinner the first night in town with another doc and his wife.  The primary care cadre has fallen from six to three (including me).  Over world-class beef we talked about the realities of medical practice, and the thrill that comes when you can fix the patient before they leave.

Orientation lasted the morning.  I’ve been introduced to three dozen people,  all of them friendly and smiling, of whose names I remember four (including my own).  The first-rate facilities represent all the necessary services. 

I talked with a surgical specialist who snow birds two weeks out of four; by his estimate he works an average of forty hours a week.  We agree that docs in private practice don’t know how to count the number of hours they put into their jobs, that in reality full-time for a doctor means an eighty hours a week, and that sustainability means forty hours.  We discussed the perennial Medicare pay cut that threatens and what would happen if it came through.

I shared observations with another surgical specialist who moved here after decades in a big city.  We shared consensus on the tradeoff between money and management on the one hand, and decreased stress on the other.

In the afternoon I saw patients ranging in age from a few weeks to almost a century.  One I educated about posterior tibial tendon dysfunction, drawing on my experience; we also discussed retirement.  With another I talked about corneal abrasions and deer hunting.  With a third we conversed about B12 deficiency, anemia, and the Great Influenza.  I took care of thumb pain, ankle pain, constipation, and confusion.  I got to refer the patient with a sebaceous cyst to the surgeon; I didn’t have to wedge the procedure into a crowded schedule. 

Throughout the afternoon I felt the profound relief of being back to work, the joy of the profession that I love.

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