Great teacher! I remembered 40 years later

So well did he teach from his zone

I still know what I had known

And it came back to me

What I did see

And could call it complex of Ghon

Synopsis: I’m a Family Practitioner from Siux 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.  After 3 Community Health years, I took temporary gigs in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  Since the pandemic, I did telemedicine intermittently in my basement, staffed a COVID-19 clinic in southeast Iowa, visited family, attended funerals, worked at the Veterans Administration in South Dakota, held a part-time position close to home, and worked 10 weeks in western Pennsylvania.  My current gig in northwest Iowa, started in June, will draw to a close on November 9.

I arrived on the Acoma Reservation in northern New Mexico in July 1982, fresh from residency.  The Indian Health Service recruits with difficulty because of cultural conflicts, salaries, geographic isolation, and centralized leadership’s poor communication with the docs in the field.  I started with a group of 5 other physicians, all of whom came directly from training.  With one exception, we completely replaced the physician staff who preceded us.

Doctors in remote hospitals have jobs in addition to patient care, among others EMS director, infection control officer, Pharmacy and Therapeutics committee, and Lab Director.

Before the grand tides of experience could grind away the sharp-edged arrogance that comes from Passing the Boards, while we regarded the 110+ hours per week of residency as normal, I volunteered for TB Control Officer.  I got Sent for Training. 

The Indian Health Service had to maintain a training infrastructure to deal with tuberculosis because that disease had almost vanished from mainstream USA while Native American and Alaska Native groups maintained rates that hadn’t fallen much in 50 years. 

I had peripheral involvement in only one case during my training, a member of the Shoshone Nation whose doc had no experience with TB, either, and the disease advanced to tragic consequences.

The teacher who ran the training program in Denver for IHS docs knew his stuff and qualified as a teacher so gifted that 40 years later I remember his lessons.

After I left the Hochungra reservation, during my private practice years, I saw, on average, one case per decade.  An outbreak among the Inuit and Yupik punctuated my sojourn in Nome, but because of the context, the hospital had infrastructure and protocols to deal with it. 

Today I looked at a chest x-ray.  Much to my surprise, I saw a white sphere, about a half-inch in diameter, sitting towards the edge of the lung, with a cluster of similar, tiny spheres near the hilum, or center.  I recognized a Ghon complex, a rare finding diagnostic of TB.  I showed the patient (who gave me permission to write what I have).  I talked about how lucky I had been to had a teacher so good that, 40 years later, I could recognize something I hadn’t seen since 1983.

Tags: Acoma Reservation, chest x-ray, Ghon complex, Hochungra, Indian Health Service, Nome, Shoshone, TB control officer, tuberculosis