Archive for June, 2015

Another road trip 17: bad navigation, a steep hill and a low speed fall

June 30, 2015

My mistake sure cost us a hill

Though coming back down was a thrill

We’ve come back from the bend

To the bike tour’s end

And when stopped, we took a small spill.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, my wife and I are doing a bicycle tour of northern Michigan.

I hadn’t pumped the tires in three days; when almost finished, Tim, the ride-along bike mechanic, gently let me know that harder inflation brings increased efficiency only on smooth surfaces.  Every other surface has a sweet spot.  The research has been done, and he gave me a reference.  Which I intend to read.

I suppose I could blame poor signage for missing the turnoff from M616 to M614.  We started uphill, I dropped the gears till we bottomed out and the grade continued to steepen.  Bethany got off to walk.  I would have walked, too but my ankles do poorly in cycling shoes, except when I cycle.

If you want to get to anyplace called Inspiration Point, you’ll have to use a lot of your own power.  We had a fleeting glimpse of that place as we rocketed away from the summit.  But we didn’t realize my bad navigation till the bottom, when Bethany spotted Sleeping Bear Dune on the other side of Glenn Lake.

I don’t mind asking for directions, and I don’t mind finding out my mistakes.  I do mind finding out that I have to pilot the tandem back up a horrid hill.

It added 9 miles onto our day, 4 of them painful.

We did OK for the rest of the day’s ride, till fatigue set in about the time we joined the TART (Traverse Area Recreational Trail).  At an intersection I called for right foot down, but still had my left foot clipped to the pedal.  The front wheel drifted off the pavement, and we tipped over onto the left side.  Between the two of us we probably lost more blood to the mosquitos the day before than to the scrapes.

At the hotel I dropped Bethany at the car and started the complicated business of returning the rented bike; at the shop I reclaimed our seats and my pedals.

At the end we indulged in the simple pleasures of showers, clean clothes, and a meal at a pie company.

We lunched with Tim (who gave me permission to write this).  A first-rate bicycle mechanic, he runs the campus bicycle shop for Michigan State University: www.bikes.msu.edu .  We share an enjoyment of vintage bicycles and a wonder for the creative evolution of multispeed cycles in the last 50 years.  Michigan State faces 1600 abandoned bicycles per year, and the shop refurbishes the best ones, about 10% of the total. They have to deal with machines dating back to the ‘50’s.  You can check his blog: https://msubikes.wordpress.com/

I talked about my days in the business, which took place during the transition from 3-piece cottered cranks to cotterless cranks, and how much I disliked dealing with cotter pins.

Tim and I both have Suntour shifters at the end of our handlebars and we prefer them to the index shifters which currently inhabit the same space as the brake levers.

Lunch over, we passed an adolescent street saxophonist playing Scott Joplin.  I fought the temptation to return with my soprano sax and my book of Barrett duets.  But I told Tim about wanting to play the streets with a sign that says, “Give your money to someone hungry or poor.”

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Another road trip 16 spilled into the Crystal and doing the Mosquito Macarena

June 28, 2015

Off we did go to canoe,

The folk in the boat numbered two.

We did tip, we did right,

The mosquitos did bite

And we slapped them to death by the slew.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, my wife and I are doing a bicycle tour of northern Michigan.

Our tour guide told us we could do anything we wanted on a day off.

I considered fishing, but without the possibility of cooking and eating the catch, decided not to.

On a group basis, the of us dozen cycled from Empire down the bike trail past Sleeping Bear Dune to Glenn Arbor for breakfast and half a day of paddling on the Crystal River.

On the strength of Bethany’s years of experience, we rented a canoe.  Everyone else got kayaks.

I kept to myself the memories of the team-bulding trip that started my second year of residency.  We tubed down a meandering Wyoming river.

Three planned hours turned into seven.  We all got out of the water at least once, vowing never to get back in, but rattlesnakes and cacti broke our resolve.    We all finished hypothermic, dehydrated, and sunburned.  We all survived.

But the canoe rental concern showed a great deal of experience.  Bethany demonstrated how to pick out the right length canoe paddle.  The young van driver narrated the three portages en route to the drop off point.  If we fell out, he said, just stand up, the water isn’t more than three feet deep.

The water’s clarity struck me first thing, beautiful and transparent. flowing over a white sandy bottom.

The second thing that struck me was a mosquito on the back of my neck, which I promptly swatted.  Remembering my late brother-in-law, I put on the life jacket.  Bethany sat me in the bow, and, with confidence borne of long experience, shoved us off.

After three days on the front of a tandem, I relaxed out of decision-making mode, and gave control to Bethany.  She said I could paddle or coast.  I sat back in the canoe seat, and killed another mosquito that landed on my knee.

About ten minutes and three mosquito bites into the trip, as we passed under a tree fallen over the water, her voice gained a dozen decibels, and she yelled, “Duck!  Duck!  Duck!”

I slouched back, and looked up calmly at the barkless pine as we passed under.

Bethany can’t exactly recall what happened next but we leisurely tipped over to the right, into the water.

Bethany talked me through the process of emptying out the canoe.  The mosquitos found us, and we continued to swat.  We got back in and started down river.

Bethany can now tell you that lake canoeing, her forte, overlaps with river canoeing, but not by much.  Over the next three hours we refined our communication system, my stroke got better and I learned to back paddle.

And I killed hundreds of mosquitos, slapping myself in a macabre Macarena.  I never got more than 4 at one blow.  While my life vest protected my front and back, they continued to feed on me, sometimes even through my hat.   Every time we portaged I would find a small black pile of their corpses on the floor of the canoe.

We hadn’t remembered the bug spray because as cyclists we hadn’t had mosquito problems.  We just sort of forgot about the world-class mosquito breeding facilities offered by the backwaters of the Crystal River.

We came up out of the water at the canoe rental.  Bethany had acquired 64 bites on her back alone.

But the waterproof compartment of my fanny pack had done its job and kept my cell phone dry.

Another road trip 15: a passion for cherries in the heart of cherry country

June 27, 2015

From cherries there comes a great juice

I can think of many a use

If you sugar the pits

It’s as good as it gets

Too good even for Zeus.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, my wife and I are doing a bicycle tour of northern Michigan.

My passion for cherry trees dates back to the mid ‘80’s when my neighbor, a farmer, announced he’d found a cherry tree on his land, it had never been sprayed and we could eat the fruit without washing it.  At that point I had never had a sour (also called pie) cherry, and one Sunday he walked me, my wife and three small daughters up an abandoned lane, past disused and collapsing farm buildings and rusting agricultural equipment, to the ruins of a house, outside of which stood a cherry tree, in retrospect, probably a Montmorency.  Bethany made a pie and a batch of jam.  I was hooked.

The next spring I planted two North Star dwarf cherry trees.  One succumbed to a hard frost while in full bloom, the other bore well for twenty years.  Later I planted Oka Giant, Nanking, Hansen’s, and even a Lapin’s Dwarf sweet cherry (in 12 years I got 13 pieces of fruit).  As time went on I acquired friends with cherry trees who didn’t want to pick the fruit.  I dedicated large portions of my summer recreational time to processing cherries.  Eventually we named the storage portion of the basement Jamistan.

One year the children, by then old enough to go to flea markets on their own, located an antique hand crank cherry pitter, capable of multiplying my work by a factor of 5.

We would continue the frenetic rhythm of pick, pit, jam, and clean up until we reached exhaustion too many times.  A few years we would only put up four or five batches, but more than once we staggered away from a tree saying, “This year the tree won.”

One summer Sunday, after the kids had left for college, I looked at quarts of pits dripping juice into the bottom of a bowl.  Noting that juice would follow sugar just like water follows salt, I filled a sauce pan with pits, dumped in sugar by the cup, put it on the back burner to simmer while I cleaned up.

Thirty minutes later I poured a surprising amount of beautiful deep red liquid into a glass, and tasted, for the first time, real cherry syrup.  It had the flavor I’d been chasing since early childhood.

While my trees ripen at home and my neighbors, at my invitation, pick, pit and pie, the cherries here, so much further north, show not a blush of red.  I would love to be here when the crop comes in.

We bicycled past miles of cherry orchards and vineyards, and took a bike trail into Glenn Arbor.

After a large lunch at Art’s we wandered down the street to Cherry Republic, a firm that highlights local cherries into ice cream, jam, salsa, candy, chicken salad and pie, among others.

As we ate our cherry pie a la mode al fresco, I quizzed Emily (who gave me permission to use her name and recount the conversation) about growing cherries.

Most of the cherries come from Montmorency trees.  Most of the harvest is done mechanically.

I asked what they do with the marc (the leftover pits and skins).  She told me the company puts together a pitarena, with a literal ton of pits, and they let the kids play in them.

She had no idea that cherry syrup could be generated from simmering pits with sugar, and thought it a capital idea.

I didn’t mention that I don’t grow Montmorency because I don’t have room in my yard.

Another road trip 14: a fist fight on the road, and a fox out at mid day

June 25, 2015

If you happen to come on a fox

Check the time on you clocks

For that bad rabies virus

Might sometimes require us

To bury the thing in a box.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, my wife and I are doing a bicycle tour of northern Michigan.

After a substantial breakfast at the hotel restaurant, we again gathered in the parking lot to review the day’s route.

We exited from Traverse City on the TART (Traverse Area Recreational Trail), a really nice, smooth, well-paved bike path with really lousy signage.

Tandem riding resembles flying in that the hard parts are the take offs and landings, and we faced one of each with every intersection.

At the Mawby vineyard and winery, the only US facility dedicated exclusively to sparkling wines, we learned more about viticulture.  At the end I asked about the deer and the marc (the leftover grape skins and seeds).  Deer eat the new growth in the spring and are dealt with summarily; the marc is composted.

At lunch in Sutton’s Bay we studied the map , and our tour guide gave us a choice of taking secondary roads with very light traffic but a slightly longer total mileage, or facing the gradual grades and heavy traffic of a main route.  We took the back road, leaving ahead of the group.

Sutton’s Bay High School’s Driver’s Education car passed us.   We settled into a rhythm.  The sun shone and the breeze blew and the only sounds were the birds and the hum of the tires on the asphalt.

We came up a gradual incline to find a real fight had spilled from driveway to road.

Two shirtless young men punched at each other with vicious intent and little training   A young woman watched, distressed.  As we passed, I announced, loudly, that I would call 911.  The young woman yelled at me to mind my own business, using more words than she had to.  The Driver’s Education car had pulled over, and the young woman in the driver’s seat bore a facial expression between smirk and embarrassment watching the action in the rear view mirror.  We started up the hill and I shifted down.

I commented to Bethany that neither young man had a weapon, the fight appeared fair, and thus I had no interest in seeing the fight stopped.  The two combatants had something to settle, and knowing the dynamics of the age, would probably become fast friends afterwards.

From the other side of the ridge we heard sirens.  As we toiled up steeper and steeper grades in lower and lower gears, a police car came rocketing down the road, followed by another, and then another.  I observed that law enforcement was having a slow day.

We bottomed out on the gears, and, breathing hard, toiled to the summit without having to get off and walk.  Then we rocketed downhill, the speedometer climbed to a thrilling 32 MPH.

Bad signage prevented us spotting the turnoff in Lake Leelanau, asking directions got us back on the right path, and we started up a gentle but persistent slope.

We made good time going uphill, sheltered by pines, and overlooking a lake.  Then I saw the fox running ahead of us.

I enjoy seeing foxes; it should mean I’ve been clever or stealthy.  But a fox is a nocturnal animal, and seeing one at midday means something has gone very wrong.

We knew the fox could be rabid.  Turning around, marginally possible because of the conflict between turning radius and road width, risked putting us over.  Continuing at speed to pass the fox would bring us closer; I slowed.

The fox glanced back at us, ran on another 10 yards, and disappeared into the roadside cover.

Had I a firearm, I would have shot the fox presumptively.

Another Road Trip 13: riding in the rain

June 24, 2015

On these you surely can bet

You’ll change the course that you set

From grapes come the wine

After 8 will come 9

If you ride in the rain you get wet.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, my wife and I are doing a bicycle tour of northern Michigan.

Travel opportunities cross my electronic desktop by the dozen, and most get deleted without opening.  But several months ago, while I was in Nome, I noticed a bicycle trip for Michigan State Alumni.  I emailed a copy to Bethany, asking, “Is this something we should get more details on?”  Ignoring my bad grammar she answered in the affirmative.

Thus yesterday we rented a tandem in Traverse City, Michigan and gathered for breakfast with other Spartans to discuss the ride up and down the Old Mission Peninsula.

I started my association with bicycles as an undergraduate.  The summer after my first degree I rode my Armstrong 10-speed from Connecticut to Colorado.  I knew little about cycle repair when I started and a great deal when I finished, and in my pre-med years I helped make ends meet by fixing bikes in my mother’s basement.  The summer before med school I built up a decent machine on a Schwinn Paramount frame with the best components I scavenged in the previous 2 years.  In the days before the Internet, I taught myself how to build, dish, and true wheels, rebuild hubs, and fix and adjust derailleurs and brakes.

At that time, I found riding 100 miles a day (“cranking a century”), even through the Rockies, difficult but possible and I did it 11 days in a row.  Camping and cooking, I would have said, constitute the hard part.

Bethany toured England, Wales, and Ireland in 1978.  When we got together, we bought a tandem bicycle instead of engagement rings, and have continued riding together, off and on, since.  Tandem riding, like many other aspects of human relationships, requires good communications, clear expectations, and well-defined roles.  But it also demands good equipment.

A dozen of us milled about the parking lot at 9:00 in blazing bright sunlight, pumping tires and reviewing the map, getting corrections to the web-generated directions.

We left town in a mob, and strung out after starting on the road that parallels the coast.  Clear sunshine came through the trees that shaded the road.

In my 4 Michigan State years and Bethany’s 2 University of Michigan years  we had never seen weather this nice: perfect temperatures, sunshine, and clear air.

We turned inland, passing vineyards, cherry orchards, and hops vines.  We stopped at a winery for a tasting.  While we lunched at a general store deli the sky clouded over and the other riders looked at a massive approaching storm on their cell phones.

Going south on the peninsula’s west side, the wind picked up.  The road traced the shore, with beautiful houses on the left, and boats and docks on the right.  The rain set in gradually.  By the time we got back to Traverse City limits it fell in sheets.

I didn’t like riding through hurricane Agnes in 1972. The brakes didn’t work, the water on my glasses stole my vision, and I feared for the water damage to the machine.  Now, even with disc brakes, a helmet visor keeping the rain off my face, and a rental bike I have no emotional attachment for, I still don’t like it.

We pulled into a park and stood in the shelter of tall pines to rest, then rode through the city streets back to the hotel, among the last to arrive.

We shared the manic morale of those who have overcome adversity, talking about where the route directions had failed, counting the thunderclaps, and detailing hills and winds.

After the bonding, we indulged in hot showers and naps and a large restaurant supper.

No camp stoves nor tents nor sleeping bag nor dishes to wash.

Same activity, different context.

Contrast is the essence of meaning.

Another Road Trip 12: reminiscing in Saginaw

June 22, 2015

It was such a long time ago

O’er the bridge I would walk to and fro

But one day running late

I hopped on a freight

And survived.  But how, I don’t know.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. In the midst of combining work with a family visit, I had to make a sudden trip to Colorado for a funeral. Right now I’m starting out on a bicycle trip with an alumni association.

We arrived in Detroit with our circadian rhythms disrupted by bad sleep and grief, got onto the highway and went north.

I came to Saginaw in the summer of 1977 for my medical school clinical training.

I had no car and barely money for food.  I lived across the street from the St. Luke’s parking lot, a block away from Saginaw General Hospital.  St. May’s, directly across the river, would have taken 20 minute bicycling in good weather.  Or I could walk across the railroad bridge, a process that took 8 minutes if I walked fast, and gave me a brief respite of outdoor exercise.

One day, running late, a slow-moving train occupied the bridge.  Remembering a technical conversation with a hobo,  I ran alongside the train, matched speeds, grasped the ladder, and jumped on.  I rode across the bridge, dismounted at a jog, and arrived at the noon lunch lecture on time.

I repeated the process a dozen times, but once, after the temperature had dropped with the seasons into the teens, the train started to accelerate while on the bridge.  I had dressed for a short walk across town, and the wind chill numbed my hands in less than a minute.  I had visions of freezing to death as the train headed out of town and picked up speed.

I made a stumbling dismount from the train at a run, in front of a waiting car. (What did that driver think, seeing me in a white coat with a stethoscope around my neck?)  I made it to the lecture, alive and on time, and never rode another freight.

And now I could ride the streets in my own car.  While the day faded, I showed Bethany what I remembered of my time in Saginaw.

Covenant took over Saginaw General and St. Luke’s and merged them into one institution.  A bronze statue and a couple of nice plaques now sit outside of St. Mary’s Hospital, on grounds much better maintained than any I ever experienced during my tenure.

A vacant lot has devoured the house where I lived my senior year, the furnished room rented for $200 per month.  The letter bearing news of my National Health Service Corps scholarship came to that address.   The grocery store and the greengrocer, walking distance from my first dwelling here, have disappeared.

Medicine has changed as well.  Laparoscopic surgery, unknown then, has become the norm.  Ibuprofen, Tagamet, Prilosec, Zyrtec, and Flonase, each a game changer, no longer require even a prescription.  Total knee replacements (I saw Saginaw’s first) are routine.

When I lived here, research hadn’t even started to elucidate the inflammatory cascade of ankylosing spondylitis, and aspirin was the best drug for its close cousin, rheumatoid arthritis.  And my back hurts less now than it did 40 years ago because of Enbrel, the miracle drug, which would not be invented till 1999.

We parked at St. Mary’s and  I led Bethany to the intersection where I alit from the train.  We walked up the tracks to the railroad bridge.  I had never seen the river that high.

reminiscing

Another road trip 11: rain, construction delays, and a flight to a funeral

June 21, 2015

After work we set out for the west

In the parking lot we got dressed

From a night full of rain

And energy wane

We ended up seriously stressed.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. While combining work with a family visit, I’m attending the funeral of my brother-in-law.

I finished a good day’s work on time at 8:00PM, on schedule for the second occasion since I started this assignment. Bethany picked me up in the parking lot as I was playing with my yoyo, just getting the hand of Gyroscopic Flop after about a year.

I napped in the room, showered, and then ate the last of the rotisserie chicken, while Bethany finished packing.

By the time we got into the car at 10:00PM we faced serious rain and not having an address to put into the GPS for the Detroit Airport.

Across the rest of western Pennsylvania rain fell in sheets, making the speed limit dangerous.

The Ohio Turnpike, chronically under construction, sported signs warning of possible flash floods.

By Toledo, the rain stopped. Misled by a detour, I faithfully followed the signs until they stopped making sense. We got out the atlas when construction rendered the GPS useless. I realized our location with shock, and turned around. We had finished a lecture about learning, detailing an Australian aboriginal language where positions markers go by cardinal directions and all the native speakers maintain an excellent sense of direction.

Night travel helps bypass traffic problems, and I would rather face rain delays than traffic delays. Surrounded by darkness, we changed in the airport parking lot. I left my scrubs and put on a blue button down shirt and khaki pants.

I slept in those clothes for a couple of hours on the floor of the Detroit airport. I slept more hours on the plane to Denver.

That city has changed a lot since I moved there with my parents in 1956, and even more since I moved away twenty years later. With time pressure, we bypassed car rental and took a taxi.

The Ethiopian driver relies on a GPS.

His English vocabulary did not include the word cemetery. He expressed disbelief when we indicated that, yes, we wanted to pull in here.

We arrived about 10 minutes after everyone else, and found the grave by the very large crowd. .

My niece and nephew, at an age where they cannot realize that death is permanent, had no grasp of the finality of this, their first funereal experience, and behaved just like well-behaved, cheerful six-year-olds. But most of the crowd, of the same age as my brother-in-law find themselves at the stage of life where they are just coming to grips with the fact of their own mortality. They had to consider death, tinged with extra drama and irony because of the youth of the decedent.

The rabbi spoke, then a bereaved brother, then one of my brothers.

At the house of mourning dozens gathered to eat and to talk. I got the chance to catch up with my brothers and sisters. One, contemplating a career in medicine, may postpone course work to help with our youngest sister. I gave the best words of wisdom I could find.

One writes, and we talked briefly about writing. Another frequently comes to work in an ER, and we discussed the insanity of that environment.

The 7 of us siblings agreed that we need to find a reason to get together without sadness. We’re looking for the occasion, possibly next summer.

Another road trip 10: starting with drama and finishing with a friend.

June 17, 2015

I started the day off with drama

For me, psychological trauma

But then at the end

I made a toddler a friend

And impressed the papa or mama.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. Right now I’m working in suburban Pennsylvania, combining work with a family visit.

Bethany and I boarded the elevator this morning, and another passenger came on.  I looked at his name tag lanyard and recognized the monogram logo.  I looked closer and saw the words “Health Care.”

“You rep for GE?” I asked him.

“Yes,” he answered, grinning.

“Centricity?”

“Yep.”  He still smiled.

I will confess to evil thoughts that I trace to my involvement with that EMR system.

I fantasized picking my laptop up, throwing it as hard as I could through the glass window and into the street, timed just right so that a speeding semi going 70 mph on a city street would smash it on the grill.

I have imagined walking up to the promotional booth at the American Academy of Family Practice, and starting a strident, offensive series of questions, accusing the rep of complicity with the Forces of Darkness, and I would be joined in a matter of minutes with hundreds of sweating, frazzle-haired doctors carrying signs and chanting louder and louder until, screaming, we dismantled the booth.

Or, better yet, getting a humbled software engineer into the clinic and showing him how badly the system worked and kicking him in the shins and saying, “Why would you bury landmines in a sandbox?”

In the time it took for a hundred things to run through my mind, I decided to say, “I left a job because of that system.”

His grin didn’t dim.  “We don’t sell it anymore.”

I had to stop my runaway emotions in their tracks.  My grim imitation of a smile broadened to genuine and I laughed.  “You absolutely can’t imagine how validated I feel.”  I shook his hand and thanked him profusely.

***

I can’t write anything specific about the first patient of the day, but I can say things started unexpectedly early with unexpected drama.

After that, the pace slowed till 11:00AM.  While I ended up caring for 39, the majority came in after 5:00 PM.  Poison ivy accounted for half the business, earache for another quarter, and eyes for 10%.

Removing ear wax, making the patient better before they leave, brings me great satisfaction across a wide age range of patients.

But the clinical highlight came with a frightened 20 month old.  I played my way through the exam, I finished with more energy than when I had started, and left the patient more trusting of doctors.  The parent, impressed with my gentleness and patience, gave me permission to write that, and a good deal more.

Another road trip 9: bad news and no limerick

June 16, 2015

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. Right now I’m working in suburban Pennsylvania, combining work with a family visit.

Monday traffic, like the clinic load, came unusually light in the morning.  At the rate of one or two patients an hour, things went well.  I had help from a PA for the first six hours of the session, and I finished my documentation as soon as I finished caring for the patient.

Most of the patients had respiratory, skin, or ear problems.  The day fell into an easy rhythm, and lunch time came and went.

I got a call from an old friend in the Pittsburgh area, a woman I’ve known since our mutual toddlerhoods.  We talked about our families.  I’ll won’t get the chance to see her this round but later in the summer I’ll be able to introduce her to my wife and local daughters.

I was listening to a patient’s chest when my phone vibrated insistently.  I ignored it; recruiters call me more than I’d like, usually during patient care hours, although I’ve asked them to email instead.

I can’t discuss the patient’s demographics nor diagnosis, but at the end of the visit I said, “It looks like I’ve given you more support group than medical care.  But I’m still not prescribing penicillin.”  We laughed, because people tend to laugh at times of drama and irony, and I got permission to write what I’d said.

I turned to documentation again, and when finished, I glanced at my phone’s display.

Pieces of really bad news come to us when we don’t expect them, they ambush us during our routines and they jar our lives.  They ruin our expectations.

The text message from my brother said that our brother-in-law, the husband of our youngest sister, had gone missing while fly fishing.

I made calls.  My stepmother didn’t have more information than my brother did.  No body had been found.

Long ago I learned to embrace uncertainty.  Every moment that I have before I know the bad thing for sure is a moment with hope.

In the later afternoon I talked with my other brother; Boulder Creek had yielded the body.

At such times words fail, and in the silence that followed much was said.

We grieve, feel, and worry for our sister and the twins.

I found comfort in the rush of patients at the end, being busy kept me from thinking about things I can’t change.

Based on information I noted while washing my hands, I made a series of guesses about the last patient’s problem (most of them correct).  Two minutes later, I said, “You wouldn’t know it based on this visit, but I’m a really good listener.  And I’d be happy to listen to your story (response: head shake).  Or we can get you out in a time-efficient fashion (response: vigorous head nod).”

I thanked the staff for their warmth, understanding, and support.  After finishing the last of the data entry, I stepped outside.  I embraced the thick, warm evening air embracing me.

Another road trip 8: diagnosing in public

June 15, 2015

I can write about things that I see

In public, where the viewing is free

The many, the few,

With no interview

It’s observation, that is the key.

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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. Right now I’m working in suburban Pennsylvania, combining work with a family visit.

Confidentiality applies to my patient population; it doesn’t have anything to do with what I can observe in public.

In 1977, when I was junior medical student, I went out for a walk with my first-year family practice resident roommate in Saginaw, Michigan.  We walked past a man with coarse features, a very broad nose and heavy jaw, and outlandishly heavy bones over his eyes.  “Acromegaly?” I asked after we’d past him, referring to a pituitary tumor that starts in adulthood, after the growth plates have fused.  He concurred.

I never stop being a doctor; Even before I had a license, I diagnosed based on observation.

A couple of months ago I sat next to a friend, waiting to get dismissed from jury duty.  I looked down at his right hand, and saw the muscles between the thumb and the forefinger twitching; the medical term, fasciculations, don’t care the evocative quality of “bag of worms.”  I asked if he had Parkinson’s.

Today, my skills kicked in full force at a social gathering.

The bug eyes of Grave’s disease are easy to spot.  The thyroid lump that some people have in the lower part of the front of the neck, goiter, sometimes goes with it.

I saw two cases of scoliosis.  In the crowd I spotted the moon face and “buffalo hump” (enlargement of the fat pad between the top of the back and the bottom of the neck) that signals Cushing’s, from too much steroids (whether made by the body or taken for other problems.)  I could diagnose autism in the young man who rocked and didn’t make any eye contact at all.  From one woman’s rolling gait I could tell she’d had a failed hip replacement.  Several of the elderly showed early osteoporosis.  Several men showed testosterone deficiency by their prematurely narrowed shoulders.

When a person looks at the floor, moves slowly, and dresses in muted colors, I don’t have to do an interview to diagnose depression.

An extraordinarily tall young woman with very long, thin fingers showed all the signs of Marfan’s syndrome; her male relative at 6’8” probably had the same problem, but I didn’t get a chance to see his hands.

I heard the whistle at the end of the cough that tells me that person has asthma.

When another person sneezed three times in a row, I didn’t even have to turn around to diagnose allergic rhinitis.