The months I spent here were 4
And I thought as I walked out the door
Of the esprit we displayed
And the tractor parade
And how I might come back later for more.
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, a British Columbia reprise, my 50th High School reunion, I just finished a 4-month assignment in northwest Iowa. Any identifiable patient information has been included with permission
I spent the last 4 months in Iowa farm country. Agriculture dominates the town’s economy. The local subculture has biases against tobacco, alcohol, drugs, and infidelity, and for hard physical work with personal integrity. Thus my patient population included a lot of very spry folk in their 70s, 80s, and 90s.
I attended several in those age groups with Workman’s Compensation injuries.
I identified Parkinson’s disease in more than a dozen patients, and over the course of the summer saw them improve as I gradually increased their doses of carbidopa/levodopa (trade name, Sinemet).
Four different patients presented with various symptoms which turned out to be hypothyroidism. Some I made better. But I left before the mandatory six week wait for hypothyroid follow up.
I suspect vitamin B12 deficiency in anyone with neurologic problems. Five such patients had low B12 levels. Several had borderline levels, and when I did the confirmatory tests of methylmalonic acid and homocysteine I found disease that needed treatment.
I approached several cases of heart failure with the relatively new combination of ACE inhibitor and beta blocker.
Nobody made an inappropriate request for a scheduled drug, a tribute to the tiny medical community and the doc who preceded me.
A number of patients came in with confusing, dramatic neurologic symptoms looking like stroke but resolving when treated for infection and dehydration.
The hospital CEO, a nurse by training, has great leadership skills and no fear of getting her hands dirty. She did a fantastic job with difficult IV starts. When a staffer fell ill unexpectedly, she cooked and served supper to the inpatients.
Such leadership quality echoes throughout the organization. The clinic manager keeps the staff pulling the wagon in the right direction. People work hard here. Lab and x-ray results came back with dizzying speed.
I used the electronic medical record to retrieve data, but I dictated my hospital, clinic, and ER notes. I entered my inpatient orders on paper. My outpatient nurses entered prescription, lab, and x-ray orders for me. All in all, I got to concentrate on patient care and not on the computer. In fact, policy keeps computers out of exam rooms.
Early in the summer, a nurse, the clinic manager and I went on a house call. As we left town on the country road, we pulled up in back of a slow-moving MRI semi. Eventually, he passed a farmer on his tractor, who turned out to be part of a tractor parade that stretched as far as the eye could see down the road.
It slowed us, but we all enjoyed the experience and talked about it for the rest of the summer.