Life-changing events. Some teeter-totters don’t balance.


The trials that people have had
Happy? More often they’re sad.
Sometimes it’s cancer
And the patient will answer
When I break the news that is bad

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.

I cared for people today who had survived life-changing events.   I dealt with medical problems ranging from the mundane to the dramatic, but, as a writer, I wondered about the details of those moments.  Each of those events rippled through family and social structures, and had ironic and desperate consequences.  If I would write that sequence, whether as fiction or in exposition, I would want to know the details: weather, sounds, colors, smells, lighting, furniture, and clothing.  What part did surprise play?  How far did the consequences go? I don’t ask those questions; the patients have come for medical problems which may or may not relate to the original injury.  But sometimes they want to tell their story, and when they do, I listen.

I don’t interrupt. I nod my head.  I make eye contact.  Occasionally I raise an eyebrow.  Some of the narratives carry more interest than others, and some narrators give a more coherent and cogent narrative than others.  And I get a lot, but I only pump for details on the illness: quality, intensity, location, duration, modification, and context.

In ranching country, I see the consequences of livestock-related accidents. And most of those involve the hands. Rodeo cowboys in particular tend to lose fingers and pieces of fingers, trapped between saddle horns and ropes.  And a surprising number of people have survived gunshot wounds, again, most maim digits.  But the culture here pushes people to “cowboy up” and keep going, and  mostly, they do.

One of my patients today came in with such a complicated history I spoke not only with the primary care doctor but two specialists. I ordered a bunch of blood work and some imaging, and concluded that some teeter-totters can’t be balanced.

Along with listening techniques, I have ways to give bad news, something that every doctor has to do.  A malignancy rarely comes as a complete surprise; I can remember exactly one cancer patient who didn’t suspect.  I can direct the conversation so that the patient says the C word first.  When I break bad news, I listen intently to the words pouring from a breaking heart.

They ramble, full of stories, full of the drama and irony of the human condition.

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