I started out making rounds
As my current assignment winds down
Right now it’s Nebraska
Next week, it’s Alaska
On Friday I’ll be homeward bound
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.
At the end of Monday inpatient rounds I found one patient on my afternoon schedule, and when I finished I had seen 11. The age range falls heavily on the extremes: most patients either of preschool or Social Security age. Despite the fact that the US has the lowest rate of smokers in the industrialized world, tobacco related illness accounted for more than half of those patients.
I discharged one of my two hospitalized patients. I try my best to be a good hospitalist, and I tried to call the attending physician at an office a half-hour away, instead I reached the nurse. The patient would follow-up there for monitoring lab values. I passed on a consultant’s recommendations.
Here, as everywhere, the geographic imperative impacts my approach to patient care. Back home I don’t even consider risk when asking a consultant to stop by a patient’s room, but here I have to think about the hazards of putting the patient on an ambulance for an hour, or going three hours for testing to a major medical center.
Sometimes the people who live here talk about “Radio Free Nebraska,” where the search function on the car radio may fail to find anything for the rest of the trip. Still, each village or town has its unique specialty; a tree nursery and sawmill here, a bridal boutique there.
Before I tell a patient to make a follow up appointment, I ask how far away they live, and I have to take time, winter highway danger, and the cost of travel into account. For anyone who lives outside of town, I say, “Don’t come if it’s snowing, call.”
In the afternoon on Tuesday I picked up another hospital patient. The Emergency doc had done the admission and put in the original orders.
At the end of the day I faced a room full of patients, some of whom had appointments and some of whom didn’t. As I went through each person’s history, the family’s background emerged, shards of tragedy, accident, desertion and betrayal against a backdrop of economic trends, population shifts and changing social expectations. People’s bodies can be impacted by germs, as well as laws of physics, or history.
I have limited ability in such cases to fix the basic problem. But I can only do four things: medicate, operate, manipulate, or educate. Sometimes the human capacity to love leaves me thrilled, and sometimes people’s capacities for perfidy astounds.
Today, Wednesday, I discharged both of my hospital patients. I called the attending physicians. I dealt with an EMR system that sometimes turns orders into vapor. Getting a patient out of the hospital generates a flurry of activity, proof that all change generates chaos.
My first and last outpatients of the day required surgical consultation. I walked three steps across the hall, presented the case, and got things ready for both.
I had plenty of time to clear up my documentation and to clean my desk. The staff held a potluck in honor of my next-to-last day.