Archive for May, 2018

High School Reunion 2: Dinner at Denver’s Brown Palace

May 31, 2018

Of that high school I am a grad

The education we got wasn’t bad

When I met with my mates

Standing up straight

Recalling the times that we had.

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, a friend’s funeral, and a British Columbia reprise, I am taking a break from Sioux City for my 50th High School reunion.  Any identifiable patient information has been included with permission.

I swaggered into Denver’s Brown Palace Hotel for a dinner with my high school classmates.

In 1968 I graduated from Colorado Academy, a school exceptional even in the world of private education. The brochures at the time touted it as half boarding and half day, meaning that 50% of the students lived on campus and the rest commuted.  It occupied a former military academy campus.  When I arrived in 1962 we still had stables and barracks and a few students wearing Army-style uniforms.

Imagine an all-boys school full of smart troublemakers from dysfunctional families with a startling proportion of gifted teachers.

Some of the boarding students lived close enough to ride the bus home on weekends.

The school day started with a half-hour assembly and the Lord’s Prayer, no matter what faith we had at home. After lunch a student could elect a number of activities including wood shop, band, Mountain Rescue, archery, glee club, and gun club.  After classes, policies required team sport participation 2 trimesters out of 3.

I took part in every stage production from 9th grade on.  I ate dinner with the boarders, and got a ride home from the drama teacher.  In many ways I qualified as day student and boarder and neither.

The homework ate every moment of spare time but gave us incomparable study habits. By comparison, Yale was a breeze.

While many bemoan current Political Correctness, I remember the blatant racist, sexist, homophobic climate of the Cold War years.

We got fantastic educations.

We learned critical thinking and healthy skepticism, two skills without which people fall prey to false news and propaganda.

In my clinical experience, auto-immune diseases, such as the anklylosing spondylitis that robbed me of a teenager’s swagger respond exquisitely to a person’s emotional health; the academic pressure compounded my chaotic home life’s stressors, which worsened my back pain.

Which, in turn, saved my life.

Seven years of well-documented back pain, along with a peculiar back x-ray, made me unfit for military service during the Viet Name war.

My proper diagnosis came in 1981; I started the miracle drug Enbrel (you’ve seen the commercials) in 2000. My spine straightened, and I walked with a fluidity I hadn’t felt since childhood.

The Onyx room at the Brown Palace held about 15 of my classmates, a few spouses, and one of our teachers. Some I knew immediately, for some I had to look at body language and listen to speech patterns before recognition came.

Despite my swagger, my classmates knew me.

 

 

 

 

High School Reunion 1: Siblings, sushi, and fractures

May 29, 2018

The cause might have what it takes

For the fractures that give rise to the aches

The stresses from running

Can be downright stunning

Bringing the ankles to breaks.

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, a friend’s funeral, and a British Columbia reprise, I am taking a break from Sioux City for my 50th High School reunion.  Any identifiable patient information has been included with permission.

I grew up in Denver. I went to a private school with uncompromising academic standards, and I returned here for the 50th reunion of my high school class, 1968.

My family arrived in 1956, when the city had fewer than 500,000 inhabitants. As I grew, the city grew.  I remember when the population passed a million.  I stopped growing, the city didn’t, and suburban sprawl long ago devoured wheat fields and cattle ranches.

I left Denver the first time in 1968, bound for Yale. My vow to never return lasted almost 6 weeks.  I returned in 1972 to do my pre-medical education at University of Colorado at Denver.

At that time I thought the traffic just barely tolerable, and I resented how much time I spent getting from one point to another.

I lived in my mother’s basement then, and regarded that house as my permanent address till 1979, when I finished med school, and cleared out my belongings on my way to residency.

I came in a day early because I still have family and friends in the Denver area. My parents passed away years ago.  Two of my sisters, one of my brothers and his wife, a brother-in-law, two nephews and a niece still live here.

I retain a map sense of the city’s general layout. The major arteries have changed; Interstate 25, which we used to call the Valley Highway, runs 8 lanes through the city.  Santa Fe Drive, formerly the Santa Fe Trail, has entry and exit ramps.

I marveled at how much the air quality improved in the last 50 years, despite obscene traffic, and equally at courtesy of the drivers.

In the late afternoon my sister, her husband and I went to meet my brother, his wife, another sister with her boyfriend and two children for sushi. My niece fell and injured her wrist, necessitating a trip to Urgent Care and thus a change of restaurant.

Our family likes to gather, we go out of our way to do so, and this time my arrival served as the excuse.

My brother had just finished taking the Medical College Aptitude Test (MCAT), and he asked me what it was like when I took it in 1974. I could but remember one question, and that regarded Saladin and his place in the history of the Crusades.  I hadn’t known about him when I took the exam, but I looked him up afterwards.

The MCAT’s General Knowledge section, which contained that item, has since dropped out of the exam due to massive cultural bias. Medical schools still use the MCAT score and the premed GPA as inflexible cutoffs.

My sister and her children joined us while we munched edamame. My niece broke both bones of her right forearm just about the wrist; she came in with a sugar tong splint and a sling.  Towards the end of the meal her facial expression told us all that her ibuprofen had worn off.

I showed her how to put her wrist over her head. Within a minute a smile reigned and she went back to giggling.

I told her to use gravity as an ally whenever possible, as gravity inevitably pulls downhill the swelling that amplifies pain.

Soon the adults told broken bone stories.

At age 17 x-rays showed stress fractures of my lateral malleoli: breaks in my outside ankle bones sustained from compulsive running.

Normal teenagers don’t run so far or so hard that their bones break, and, perhaps, normal people don’t come back for their 50th reunions.

 

 

Cherry blossom time in Iowa

May 13, 2018

‘Neath the tree we snacked for an hour

For the joy of the pretty white flower

Then along we did scoot

We’ll wait months for the fruit

From the tree of the cherry that’s sour

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, a friend’s funeral, and a British Columbia reprise, I am back in Sioux City.  Any identifiable patient information has been included with permission.

I have a passion for cherries. Mostly I love the fruit, the small tart dark red berries so good in pies and preserves.  I love the larger, sweet cherries as well, but Iowa lies too far north, and those trees grow too large for our yard.

Sweet cherries have neither a true dwarf cultivar, nor a dwarfing rootstock, but sour cherries do. I have had as many as 7 trees in back of my house at any one time, but this year the population has shrunk to 3.  I chose work close to home this summer, to enjoy the trees and the garden

In a good summer, Bethany and I will spend days picking, pitting, and canning the fruit. Most years we make forays to trees owned by friends who only harvest enough for a pie or two.  One year we went through 250 pounds of sugar during the canning process.

Mostly, we give away the product, and gain many friendships thereby.   We have never had anything commercial that even comes close to the brightness and clarity of flavor of what we make.

Sometime around the turn of the century, I mentioned my cherry trees in the doctor’s lounge. A podiatrist of Japanese ancestry (who grew up in Seattle) expressed an interest in coming over for celebration of the cherry blossoms.  He brought sake and snacks and his office nurse.  On a warm, sunny spring afternoon we sat under the tree and listened to the buzzing of the pollinators and inhaled the flowery perfume and chatted.

For climatic reasons I don’t understand, this year all 3 trees blossomed simultaneously. You don’t have to be Japanese to enjoy the ephemeral beauty of the cherry blossom time that lasts at most a few days.

Friday we got take-out sushi. I warmed the sake flask in the microwave.  I found the bottle of sake bought 10 years ago.  We donned medium-weight jackets against the chill and put foam stadium seats down on the wet grass.

On a cloudy day too cold for pollinators and too cold for the aroma of the blossoms, on grass green with spring and flecked with white cherry petals torn by the previous night’s wind and rain, we ate salmon and California rolls. I drank 5 warm ounces of sake and got light-headed and enjoyed the taste; Bethany tasted and grimaced.  We chatted about our plans for the weekend and the coming week and dinner plans for the evening.

And again I reflected that if you can’t have a good time in bad weather, you just need more practice.

At 2%, am I Hispanic?

May 7, 2018

I thought hard when I made application

Do I come from a Hispanic Nation?

What can I say

If my DNA

Has two percent of donation?

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, a friend’s funeral, and a British Columbia reprise, I am back in Sioux City.  Any identifiable patient information has been included with permission.

I spent the day before my birthday filling out applications.

I devoted the morning to trying to get my work permit for British Columbia, so that I can return in October for 3 months. They wanted Employment Reference Letters, Labor Market Impact Assessment, Police Certificate, Employment Records (including pay stubs if possible), Passport copy, CV, Photo, Proof of Medical Examination, Contract, Proof that I meet job requirements, Family information (including the dates that my parents died), and an Application.  The CV, the employment reference letters, the employment records, and the Application overlap each other a great deal, but not completely.  By dint of hard work and previous information gathering, I got that task done before lunch.  But I still await an employers’ Reference Letter.

I took a nap, awakened refreshed, and started work on my Texas application. They wanted a lot of information, too, but I found little redundancy.   Demanding but reasonable, an online section wanted to know all my medical licenses that I had ever had, an understandable request.  This time, though, I didn’t have to fill in the start and stop dates and the license numbers.   But I had to complete several additional forms, having to do with my criminal record (arrested as an illegal pedestrian in 1971, a crime for which my memory exceeds the records of the Geary County, Kansas court), my malpractice record (named in a suit in 2003 and dropped 2 weeks before trial), and the one summer in medical school I didn’t attend classes. I found my work record for the last 5 years the hardest:  I worked 16 different venues as a locum tenens since 2013.

I wrestled with the race questions. My DNA analysis listed 5 European groups, with 4% Western Asian.  These days I try to put down as accurate a racial picture as I can, mostly because I think the idea is useless, but the application only gave me one choice.

I find the question of Hispanic origin equally difficult. How does a person answer that question if born in France and raised in Spain?  How about those indigenous peoples brought up in Spanish-speaking countries?  At what linguistic age does one qualify as Hispanic for the rest of their lives?  How many generations in an English-speaking country does it take to disqualify a person?  What about a person with 4 each Mexican and Norwegian great-grandparents?

And what about me, with 2% of my DNA coming from the Iberian Peninsula, and fluent to the point comedy in Spanish?

 

End of a Canadian month

May 7, 2018

I have to leave by the first day of May

At least that’s what the border guards say

So my bridges don’t burn

I plan to return

And next time for a 90-day stay

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

I wrapped up April’s assignment today with a full clinic. I attended 18 patients.

I have written before about propranolol, a remarkable drug whose new uses have vastly eclipsed the original indication, high blood pressure. I prescribe it for stage fright, social anxiety, ADHD, buck fever, overactive blushing, and migraine.  Today two of my patients received prescriptions for propranolol; one has taken it for years for stuttering, and it works well (I received permission to write a good deal more than I have).

Seven patients’ medical problems come from alcoholism. Treatment depends on willingness to change, and that trait today ran the spectrum from having quit to wanting to die drunk and soon.

Two patients suffer from bipolar illness but came in for something else.

Three needed notes approving them back to work. Two asked me to write slips containing little truth, and I declined.

Two patients have puzzling clinical pictures. I don’t have to know everything, all I need to know is how to find someone who knows more than me, and I sent both patients to specialists.

The clinic manager plans to make scheduling changes, staggering start times for the docs and the Nurse Practitioner, running clinic through the lunch hour, and perhaps starting night hours. Details have to be worked out, but, as one of my colleagues observed, and gave me permission to quote, 100% of the ideas you didn’t try will fail.

I walked back to the room at lunch, ate some very tasty leftovers, and did some last-minute packing.

Back at the clinic I tried to catch up on documentation while I cared for patients, and reviewed lab, x-rays, and consults. Outside, the fine clear day clouded over, and the snow piles continued to melt.

Patients expressed dismay when I told them that Immigration decreed that to keep a relationship good enough to return I would have to leave on May 1. Actually I said that Immigration was kicking me out, but they’d probably let me come back in October.

In the long northern afternoon, Bethany and I loaded the car and headed to Prince George. Just outside of town we saw three mule deer grazing by the side of the road, and a hundred kilometers further on, far off at the edge of a flat marshland, we saw a cow moose with her calf.