Nebraska: Second week

Is it real, a drill or a fake?
An exit we always must make.
The alarm would require
In event of a fire
In any case, it gives me a break.

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 (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Right now I’m in western Nebraska. Any patient information has been included with permission.

The hospital here has a marvelously functional system, but I’m not sure it would scale up to a larger institution.

If a patient comes through the ER in the middle of the night and needs admission, the ER doctor does the history and physical and writes the admitting orders. In the morning, either I or the patient’s usual attending physician assumes care. I get to turn off my cell phone at night; if I have an admission, I’ll find a message on my voicemail in the morning. I don’t carry a beeper.

As in most winters, the respiratory disease season has started. I diagnose a lot of viral illness, and I do a lot of explaining why antibiotics in these situations cause more problems than they solve.

Most rashes that I see come from viruses, most will go away with no treatment. Pityriasis rosea (PR) stands as an exception.

The typical history of PR runs something like this: a large red patch cropped up from a few days to a few weeks before the rest of the rash broke out with elliptical lesions whose long axis follows lines of skin cleavage, giving rise to a “Christmas tree” distribution on the back. Light cases don’t itch. If the patient receives no treatment the problem will go away. In six weeks. Until a year ago I had thought no treatment would shorten the duration of PR, but an exceptionally good Continuing Medical Education (CME) session in Pittsburgh brought the news that acyclovir can stop the problem in less than 2 weeks.

But I didn’t see a case from then until I came here. I’ve made the diagnosis more than once, and it pleased me to no end to start the new medication.


I arrived Wednesday at 7:20AM and started my morning routine. I had just hung up my coat and started the sign-in process when the fire alarm went off. I grabbed my jacket, closed my office door, and closed exam room doors all the way down the hall till I could step out into a brilliant glorious morning.

I looked south over the town, through the crisp, clean air, at a few pure white clouds against the bright blue of the Sandhills sky.

Two workman, dressed in blaze orange vests, were starting their day. After a few moments savoring the outdoors I asked, “Do you know if it’s a fire drill or the real thing?”

Their heads jerked up and they stared at me. They asked, “Did the fire alarm go off?”

I nodded.

They looked at each other and then sprinted past the temporary CT trailer to the back door.

I made my way around to the employee crowd at the main hospital entrance. “All clear, Code Red,” sounded before I could ask about a real fire.

Two hours later, the fire alarm sounded again. My Medical Assistant wanted to go about her duties, but I insisted that we leave immediately, donning my coat as we went. She closed exam room doors on one side and I on the other. Just as we got out of the building the alarm stopped.

I thought back 11 months ago, when the fire alarm sounded in Nome and everybody in the hospital went into the parking lot at -15F. Most of us grabbed our parkas. The air there, too, was clean. The frozen Bering sea gleamed white, and the mid-day sun hung low in a pure blue sky.

No matter how much I love my work, I welcome a break to go outside.


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2 Responses to “Nebraska: Second week”

  1. Charlie Says:

    Ok Doc, you’ve got me on Alaska but I am sure it is beautiful but now – Nebraska. I can comment on Nebraska. It is a area of rare beauty. During the night if clear the stars are as clear and bright. It sometimes bothers me to hear people make desparing remarks about how boreing it is. Can they not see the shadows and dips in the landscape, the outline that tree or the eyes blazing in the night. During the day, away from the traffic and towns it is amazing what querks of nature that are there. I have seen bob cats and coyotes, quail and pheasent, geese and rodant. It is a wonderland. If the weather is bad – it can make life interesting and Lord help us if a person has a mechanical problem. But Nebraska is a wonderful place to be if you like nature and you have an imagination. Enjoy

    • walkaboutdoc Says:

      The most boring part of Nebraska, the I-80 corridor down the Platte River Valley, is the part that most people think of when they think of Nebraska. Because that’s the part that most Americans see. Perhaps the designers planned it that way, so that the thinly settled, pristine parts don’t get settle and built up. Now if you tell most Americans how beautiful Nebraska is they give you a blank stare or shake their heads.

      Works for me.

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