Archive for June, 2018

Hardware, software, and chairware

June 24, 2018

A problem is found, tell me where?

Is a problem that’s not the software

I said to IT

Perhaps it is me.

Is the answer to be found in the chair?

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, and my 50th High School reunion, I’m back in Northwest Iowa.  Any identifiable patient information has been included with permission.

Eight years ago I took a course for doctors who want to be writers. Don’t use the word suddenly, they said, and never write, “All hell broke loose.”

I suppose all writing has rules, yet I haven’t figured out all the rules for effective blogging.

But I find myself enjoying this gig. A small hospital is an efficient hospital; one doesn’t waste a lot of steps.  Consider the context:  a functional Iowa town just big enough to have a hospital.  In two weeks I’ve dealt two marijuana users, and no drug seekers.  Every urine drug screen has come back clean.  Fewer than 10% of the patients smoke.

And I have time to spend with the patients. I listen attentively, I don’t interrupt.  I get to dictate my progress notes, and I can enter my hospital inpatient orders on paper.

I haven’t figured out how to use the Emergency Room EMR, not quite the same system as the inpatient program. I just couldn’t get it to turn on.

Today the Information Technology person asked me to show her the problem; I signed on and got a nice border on an otherwise blank screen.

“Is it the hardware?” I asked

She shook her head.

“The software?”

Headshake.

“The chairware?”

She looked at me, left eyebrow crowding the right.

“You know, the person in the chair?”

She burst out laughing, and told me she’d get back to me.

Despite cool, rainy weather, the clinic overheated. We got out the fans.  I sweated.  For the first time I realized that my large flat screen monitor produces a huge amount of heat.

The morning went at a reasonable pace. Online research, signing my dictations, reviewing labs.  Then at 11:00, suddenly, all hell broke loose.  The surgeon and the nephrologist each asked me for consultations.  The radiologist called from Orange City.  The neurologist called from Sioux City.  Two non-English speakers turned out to have a much more complicated clinical picture than we could have imagined.

I worked through lunch; the nurses and I did not get a chance to eat.

In the course of 4 hours I read 4 electrocardiograms, ordered 4 sets of labs and admitted 2 patients. I accommodated a walk-in.

I worked hard to replace my fluids lost to sweat.

And just as suddenly, things went quiet at 4:15PM. I finished with the two hospitalized patients at 5:00PM on the dot.  Food became my next priority.

 

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Weekend call: lunch at the gas station or the country club?

June 20, 2018

You won’t believe what the ER nurse said

The patient came in on a wagon that’s red

Then later, for grub

We went down to the club

And on burgers and fries we were fed.

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, and my 50th High School reunion, I’m back in Northwest Iowa.  Any identifiable patient information has been included with permission.

I took call last Wednesday, worked the clinic 8 hours on Thursday, then took call again Friday, Saturday, and Sunday. Bethany came up for company on the weekend, by coincidence the town’s annual summer festival.

I had two patients in the hospital on Sunday, and after leisurely rounds we wondered about lunch. Neither the bar nor the Pizza Ranch would open before supper.  Which left two choices.

I asked Bethany, “Where would you rather go, the gas station or the country club?” We laughed, and decided on the country club.  I got out Google Maps, and checked the route.

Not wanting to be more than 20 minutes in case I got called back, we drove, but we could have walked the 5 blocks. The only customers in the middle of the afternoon, we ordered burgers and fries.  I ate with the relish and tension that lunch on Sunday call brings: savoring every bite knowing that I could be called away at any time.

Not a fancy lunch, but very tasty.

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In Emergency Department linguistic convention, the nurse will present the patient’s name, age, and gender, brief condition, and how that person arrived. Mostly I hear that the person “presented ambulatory via privately owned vehicle” or “presented on stretcher via ambulance.”  But people have also come in by boat, snow machine, bicycle, and ATV.  This weekend, for the first time, I cared for an adult patient who arrived on a Radio Flyer red wagon.

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In the last week I have had to do a lot of research. I can’t talk about the cases that inspired the research, nor whether related directly to a patient or not, but I learned a lot. Borrelia burdorferi causes Lyme disease, but the cork-screw shaped bacterium has a couple of cousins that can cause problems as well, and they can slip right past the standard Lyme disease test.  Provoked small rodent bites carry so little risk of rabies that the Iowa Hygienic Lab recommends neither treatment nor testing.  Twenty percent of the 20,0000 Americans bitten by rats last year developed rat bite fever, a disease easy to cure with penicillin.  To diagnose Legionnaire’s disease, run a test on the urine.

 

High School Reunion 3: the Beatles Suite, no Scotch or cigars

June 19, 2018

The supper we passed bite by bite

As the party went into the night

The smoke was too risky

To go out for some whiskey

And some of us still have to write.

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 some part-time work 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.

One of my classmates had the terrific generosity to buy a crowd of 25 a very nice meal at a landmark Denver restaurant, the Brown Palace. The talk ran to careers and retirements.

Most of my classmates remembered my days with the Navajo and the Indian Health Service. More than half find themselves in some phase of retirement.

I announced my intention to keep going till 2035 as much from sincerity as for the shock value.

After dinner our host showed us his room, the hotel’s Beatles Suite, where the Fab 4 stayed during their Red Rocks performance in 1964. We talked about music.

Jimi Hendricks, Vanilla Fudge and Soft Machine played at the venue in 1969 with an opening band called Eire Apparent. The number of my classmates attending astounded me, equally that I had seen none of them there.

I would assert, and many would agree, that popular music reached a zenith between 1964 and 1975. Well trained musicians broke with musical conventions, tweaking formulae, and writing poetry that may yet stand the test of time.

I can’t overstate the importance of music to my generation. In the days before digital recording devices, when music came pressed onto vinyl or magnetized onto tape, a person’s record collection and how they cared for it served as a personality thumbprint as well as a financial barometer.

Two of us had been in the Preps, the school’s instrumental group who played Big Band numbers. One had his own rock band, playing significant gigs in Denver and Boulder even before he was 18.  I still play sax, and I mentioned my time playing professionally in Barrow, Alaska in 2010.

Another classmate, a former Glee Club member, still composes and sings.

Our host suggested Scotch and cigars; I declined as my distaste for smoke far outweighs my appreciation of fine distilled spirits.

I caught a ride back to my sister’s house with a chum I’d first met in September 1963 when we started into 7th grade; I collided with him again during my pre-med years at University of Colorado at Denver.

We both write. I mentioned my 9 novels.  I have nothing published and haven’t had an agent since the first one.

I told him I blog, and he asked, “How often do you feed the dragon?”

I like a turn of phrase so good it gets a lot of play without being trite, and even better for application outside of its usual ball park.

While I work, I said, 4 or 5 posts a week. His face showed both shock and amazement.

Not everyone writes. Those of us who write do so because we have to, not because we think we’ll get paid.

Call, Storm, Flood, and Nursing Home Rounds

June 19, 2018

Bad sleep when on call is the norm

Made all the worse by the storm

Far from a dud

It gave us a flood

But incidentally watered the corn.

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, and my 50th High School reunion, I’m back in Northwest Iowa.  Any identifiable patient information has been included with permission.

The call from the ER at 5:00AM didn’t exactly wake me. The thunder did that hours before, and I tried dozing after.  But I never sleep well on call, and the lightning flashes came through my eyelids, strobe lights through a red curtain.

I should have slept well. My clinic day segued directly into ER call at 5:00PM.  One patient, of my generation, came in with a dramatic history, full of the ironic pains that only the power of human love mixed with inevitable human fallibility can bestow.  Stressed people get sick, sick people get stressed, and I needed 21st century technology, from CT scans to telemedicine. In the end, we finished with a mystery, a neurologic conundrum we do not understand but Hollywood loves and misrepresents.

I still have a lingering feeling that I shouldn’t complain when I have a 12-hour day; earlier this decade I had harder 38-hour days in much more hostile environments, and I kept going.

Still I could have used another couple of hours between the sheets. At the guest house door I looked across the parking lot to the hospital.  With no hat, my white lab coat, more sponge than tarp, offered no protection from the wet.

Damp but not soaked after 50 paces in the rain, I arrived in the ER seconds before the patient.

The presenting problem required much lab and x-ray. I called a fellow ER doc in another city for reality testing.  A subtle but definite physical finding that many would not have noticed complicated the diagnostic picture; a solid, sharp patient with a strong sense of reality clarified it with declarations of no heroics and no surgery. Later, a medically literate relative helped to enforce the decisions.

With the patient tucked into a hospital bed at 7:00 AM, I found the cafeteria had run out of eggs, and I returned through a light rain to the guest house, to make breakfast, and take a too-short nap.

At 9:00AM the clinic manager and I drove 15 miles out to a neighboring town with a nursing home. The cornfields, run emerald riot with perfect temperature and generous rains, had low spots turned to streams and rapids by 6 inches of precipitation in 3 hours.

In the course of the morning I cared for 10 patients. I stopped 4 medications, and started 2 but left orders to stop 3 more.  I had the honor of attending 3 people who had survived the 1918 influenza epidemic. I ordered lots of lab, with little hope of more than a 10% pick-up rate.

I look forward to my next visit, when I’ll be able to see the effects of adjusting some neurologic meds, and I’ll get to talk some more to alert, sharp people born before the Depression.

I hope I get to their age with their faculties.

New Job, First Week

June 13, 2018

I laughed, and said with a snort

In the square of the town there’s a court

You could call the town small

There isn’t a mall

And friendly comes by the quart

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, and my 50th High School reunion, I’m back in Northwest Iowa.  Any identifiable patient information has been included with permission.

I saw a distressing number of serious pneumonia cases during my first week on the new job. Each patient presented differently, each brought in a life story from a family context.  And each challenged me in a different way.

We have exceptional pneumonia vaccines that don’t prevent pneumonia nearly as well as they prevent death from pneumonia.

In the last 40 years the disease has changed a good deal, and we’ve reduced the death rate, but not nearly enough.

The history and physical make the diagnosis more than anything. We listen for a crackling sound as the patient breathes in, but mostly we listen to the patient’s narrative.  Still we get blood counts, blood cultures, chest x-rays, and occasionally CAT scans.  A new blood test, pro-calcitonin, helps a lot but hasn’t made an appearance in any facility where I’ve worked.

I disappointed several patients by not finding ear wax.

I have acquired a minimalist approach to medication at this stage in my career, an approach that many of my patient appreciate. I especially enjoy stopping statins, a class of cholesterol-lowering drugs that can stop heart attacks and strokes, but will not prevent a first one after the age of 65.

The facility has a small staff and a small footprint. I counted 36 steps from my office to the ER, and 6 steps from ER to radiology.

I get a steep discount on meals, reasonable cooking served in reasonable portions.

Various licensing details have insulated me from the worst of the Electronic Medical Record (EMR) headaches, and I get to dictate my notes.

A small parking lot separates my accommodations from the ER; a landline assures good communications in the unlikely event of a sound night’s sleep.

I haven’t run into marijuana problems yet. Smokers constituted a surprisingly small proportion of the patients.  Not surprisingly, binge drinkers here, as everywhere, have difficulty with insight.

The facility has a gym, a CAT scanner, anesthesia, and a surgery program. I worked with two of the nurses here during my days in private practice, and I established a relationship with the radiologist during one of my other assignments.

Most of the referral traffic will go to Sioux City, where I still know many consultants.

And there’s an absolutely first class pizzeria about 20 minutes away.

 

Paper Order Joys and Outpatient Dictation

June 7, 2018

If it helps to make a decision

We like a CAT scan’s precision

It sure made my day

When in truth I could say

It looks like you’ve dodged an incision.

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, and my 50th High School reunion, I’m back in Northwest Iowa.  Any identifiable patient information has been included with permission.

I arrived 15 minutes early for a brand-new gig. I started the usual orientation: meeting a lot of people whose names I forget and shuffling around a confusing geographic set-up.

No one expects me to remember everything the first day, but much like any other human learning endeavor, one has to find a starting point,

The facility has three EMRs, one each for the hospital, the clinic and the ER. The ER and hospital systems communicate with and resemble each other, but do not qualify as twins.  And I’ve used the hospital system before, in Nome and in western Nebraska.

The outpatient system, however, looks like nothing I’ve ever seen.

For reasons I don’t completely understand, my schedule keeps changing, and I covered an outlying clinic in the afternoon.

I cared for 5 patients, including 2 children, both of whom I mesmerized with my yoyo. I managed to not increase anybody’s prescription burden, recommending only agents available over-the-counter.

Not a single patient came to the ER that night, yet the vigilance of call kept me up.

I only attended 8 outpatients and an inpatient the next day, yet high-stakes clinical material dominated the landscape. I sent two patients to the CT scanner down the hall.  Surprisingly, the results swayed the decision-making process in both cases.  Neither went to surgery nor to inpatient.

A different patient became my first admission to the hospital. The wonderful nurses gave me the choice of writing my orders or entering them into the computer system.  Grinning, I took the hand-written option, and later watched a new-hire nurse struggling through an unintuitive system.

The glitch that prevents me from using the outpatient system for entering lab and x-ray orders or for electronic prescribing continues to defy resolution. The management here lets me write my orders on plain paper and have the nurse enter them into the computer. I dictate my notes.

And I finished on time. For whatever reasons, for the time being I can enjoy slow patient flows.

The patients have already started asking if I’ll move here. Forever.  I thank them, but I decline; Bethany and I still have more adventures to look forward to.

 

 

High School Reunion 7: Epilogue

June 6, 2018

I wouldn’t go back if I could

To practice the way that I should

Would the music I write

Bring the world light?

As a doc, I’m doing more good.

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 took a break from Sioux City for my 50th High School reunion.  Any identifiable patient information has been included with permission.

 

I left Denver for Boston on a red-eye flight, with a layover about lunchtime in Indianapolis.

I struck up a conversation with a waiter who served me in an airport restaurant. He saw my noise-cancelling headphones and called them “really nice.”

They were an anniversary gift from my wife, I said. To the delight of the children present, I showed off my really nice, spiffy yoyo, also an anniversary gift from my wife.  I didn’t mention the really nice bicycle repair stand she’d bought me for our 10th anniversary.

He asked how Iowa differs from Indiana, and farming popped into my mind first, so I talked about how Iowa might have good ground, but Indiana has better. Then I had to explain that I work as a doctor, not as a farmer.

Because he found himself working on a holiday (Memorial Day), I asked if he were a student.

Working two jobs to save money to further his schooling he found himself in an educational hiatus.

He composes music, and he wants to change the world for the better thereby.

I told him I started my first undergraduate career as a Theory and Composition major. I told the truth, that I hadn’t wanted to do the disciplined work to develop my meager talent, and that I didn’t fit into the dominantly gay subculture of the college music scene.  But I didn’t tell the whole truth, that I had gone to Yale, with one of the best music programs in the world.

I have a high school friend who still qualifies as a musician, I said, and when we play our tunes from the ‘60s I express amazement that I wrote stuff that good.

But I again made the observation that I have done a lot more good as a doctor than I ever would have done as a composer.

I want to tell him that the chances of him actually making enough to pay for housing and food and transportation by playing and composing with artistic integrity come close to the odds of winning the lottery; he faces fierce competition from hoards of those determined to follow their passion, and competition drives down the price.

But I don’t. If he succeeds he can revel in it, and if he doesn’t, his dreams will die a hard death soon enough.  .

 

High School Reunion 6: into the Denver Country Club for the very first time.

June 5, 2018

Of our class we missed 28

There were three who had met their fate

And as for the rest

I just think it’s best

To say they’ve got too much on their plate.

 

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 took a break from Sioux City for my 50th High School reunion.  Any identifiable patient information has been included with permission.

Our reunion Class Dinner took place at the Denver Country Club.

I called Denver home from 1956 to 1979. I have returned at least once a year since, and I had never set foot in the Denver Country Club. I don’t know when the facility dropped its ethnic exclusions for financial reasons, but I make a habit of avoiding places where I’m not welcomed.

Out of a class of 43, 15 of us showed for at least part of the activities. Which leaves 28 who didn’t come.

One of my classmates, 25 years ago, while soliciting funds and participation on behalf of the school, made the observation that we were a very alienated class. I could not disagree.

Some suffered more than others.

Statistically, the class would have had between 2 and 4 gays, who would not dare have come out in such a virulently, violently homophobic environment.

A Native American, from the Arikara nation, attended a couple of years. We all remembered him as extremely smart and very quiet.  He and I ran half-mile and mile together.  In retrospect, I shudder at the quantity of racism showered on him.

We had a Hispanic, also extremely quiet and smart, who arranged with a teacher to do a self-paced calculus unit while the rest of us worked on pre-calculus. While we valued him as a friend, we showed no cultural sensitivity.

One came from the Thai Royal Family, and we understood his absence.

I had to consider that half the class didn’t pass the senior English final, and weren’t allowed to graduate with the class. I could understand them carrying a grudge though I hope that they don’t suffer from doing so.

The class list marked 3 as deceased.

All in all, not a bad turnout.

Three classmates and a significant other shut down the party at the prematurely septuagenarian hour of 9:30. As we exited, we noted that the DCC would have excluded us in 1968.

We never felt discrimination from our classmates.

I never thought of myself as one of the cool kids, though.  And then I thought better.  I had no enemies in my class.  I must have been one of the cool kids.

High School Reunion 5: The Colorado Academy Gun Club and the “Bill Jones” incident

June 3, 2018

A math instructor named Bill.

The headmaster noticed his skill.

He didn’t stay

Past the very first day

For he went about armed, for the thrill

 

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 took a break from Sioux City for my 50th High School reunion.  Any identifiable patient information has been included with permission.

I graduated from Colorado Academy in 1968, having started 6th grade there in 1962.  In my high school years, we had a number of student organizations I wanted to explore but never did, among them the Gun Club and the Archery Club.

The Gun Club emphasized shotguns. They met after lunch to shoot clay pigeons, and reloaded shells in the Biology Lab.  The biology teacher overseeing the operation we fondly referred to as Bwana because he loved to hunt.

The Archery Club also met after lunch; in the days before compound bows and bow sights they made their own cedar shaft arrows.

Boarding students, during season, could check out their shotguns first thing in the morning, and go down to the pond to hunt ducks and geese. The dining hall staff would prepare any birds harvested.

We never had problems with violence or misuse of firearms. Nor did we have a single accidental shooting, though we suffered through a disturbing number of other accidental deaths.

The school required we take Hunter’s Safety in 9th grade as part of the biology curriculum.  The textbook, BSCS Green Edition, emphasized ecology.  Rachel Carson’s Silent Spring was required reading.

From the beginning we learned to respect firearms as tools, with proper rules of use.

I do not know when the Colorado Academy Gun Club ceased to exist.

When we returned for reunion, we carried awareness of the Columbine and Parkland tragedies, and we asked the Alumni liaison about plans for an active shooter. The school added a “welcome center” (really, a guard hut) shortly after Columbine, and two non-faculty staffers carry firearms.

Many years after I graduated, when Because the Rivets Will Scratch the Seats, a school history by John Sullivan, came out, I read with alarm about the “Bill Jones” incident.  The Headmaster had hired a new math teacher about 1962. On the first day of school, the instructor greeted the students normally at the bus.  In the classroom, he took out his .45 and laid it on the desk. Within hours the headmaster had the armed teacher in his office.  He separated the instructor from the firearm and eventually succeeded in getting him back to his psychiatric hospital.

The incident puts a different spin on the move to arm teachers.

I never heard anything about “Bill Jones” during my primary and secondary education, nor had any of my classmates. They hadn’t read the book.

 

High School Reunion 4: oral history video

June 1, 2018

We made up a book, just a spoof

And the card was inserted, as proof

A system so swinal

Failed half on the final

And, fifty years later, there’s proof.

 

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 arrived half an hour late for the oral history session video recording, ready to tell the truth, and as always, the truth contains some ugliness. I sat and listened, and after a moment glanced at a sheet of suggested questions.

The discussion, as I entered, ran to the subject of the hardest teachers; two names came up repeatedly.

One brilliant math teacher held the patent for the circular slide rule. (Few remember the slide rule, a computing device limited to 3 significant digits; making it circular rates as an act of pure genius.)

The other taught Senior English. He didn’t stop at the difference between metaphor and simile; he distinguished good from bad literature and taught how to read in depth.  Every week we read a book and reviewed it in addition to the class reading assignments (for example, Moby Dick).  To teach us to work under pressure, he would surprise us with a 3 page paper due the next day.

He had a fully subjective grading system and never gave A’s. A single misspelling, grammatical mistake, punctuation error or use of the verb “to be” would bring a decrement of a letter grade.

None of us could remember the single ambiguous question that failed so many on the final, so that half the students walked with the class but they didn’t graduate. A quarter attended summer school.  Even then, some didn’t pass.

Yet, for all that, many of us still write, and all of us read critically.

No one but me remembered an easy teacher, a man who taught music theory and composition with clear expectations and lots of praise.

I described the day Mr. Esbenshade announced he would speak no more English in Spanish class, and how I thereby learned to speak Spanish.

Another question asked about pranks. The Class of ’67 outdid us.  They sodded the English teacher’s room and wrote “Good literature can make you smell the grass” on the board.  They carried the Headmaster’s Bentley to the front steps and left it where it couldn’t roll.

But a group of my classmates, fed up with the weekly English assignment (read a book and review it), reviewed a non-existent book and had the audacity to make up and insert a card for the library’s card catalogue. They got away with it.

Discussions wandered from the original question. Most memories and vivid stories took place outside.  People rappelled off the dormitory roof; they hiked and biked and skied.

Once, the Mountain Rescue leader (who also taught shop and played viola) sent some of the students on a deer drive. Jumping from a tree onto the deer, dispatching it with nothing but a knife, he showed the students how to dress out the carcass and he fed them the meat.

The second to the last question asked if, knowing what we do now, would we choose to go to Colorado Academy for our education.

Nothing comes without a price, you can never get more out of something more than you put in. We all agreed we got an incomparable education.  So we talked about that question, but not one of us would answer it.