Archive for the ‘Becoming a Doctor’ Category

Picking up a loving pair of hitchhikers

July 24, 2017

We stopped by the side of the road

The couple was loving, it showed

The don’t need the dance

That improves hitchhiking chance.

They played, they laughed, and they glowed.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I never owned a car till I was 29 and just finished with med school. And, even then, I couldn’t have afforded it if my friend hadn’t sold it to me for a dollar.  I have friends like that, and, ten years later, when I’d done a bunch of body work and replaced the engine, I sold it back to him for the same price.

In those years, I, walked, bicycled, occasionally flew, and, mostly, I hitchhiked. I got good at knowing where to stand to put out my thumb, and how to dress.  I learned practical applications for game theory even before I’d heard of the concept.  I developed a 4-second dance, hilarious in its incongruity, that would bring me rides when women with small children couldn’t get picked up.

I also learned how to be a good passenger.  More than half the people who picked me up found themselves in personal crisis, and they wanted to talk.  I learned how to listen and I honed my interviewing skills to a fine edge even before I thought about medicine.

I met Bethany at the airport in Prince George, coming back from a family visit to south Texas. Starting the long road back, we picked up a couple, hitchhiking their way north to the Yukon.

The young man spoke Spanish with me; I volleyed a bit of French with the young woman but the road noise and my failing hearing made a proper conversation impossible for me. They showed themselves  good listeners, and, when we dropped them off, I pointed out where to stand to maximize the chances for a ride.

But I forgot to give them the benefit of hitchhiking lessons I’d learned: don’t wear hat or gloves, stand in front of your luggage, not behind it. I didn’t teach them my dance.  They didn’t need it.  The movement that grabs the eye, the smile that says, “I’m safe and I’m fun,” came out naturally in the way they played, lovingly, with each other.

 

Team Building Experience, Past and Present

July 23, 2017

We played Two Truths and a Lie,

Then had sushi and beer bye and bye

From the end to the start

Team building’s an art

And none of our airplanes could fly.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

As I began my second year of residency in Wyoming, the buzz words “Team Building Experience” had just started circulation. Who knows who decided tubing the North Platte would fill that function?  But nobody objected to the idea of leaving town for a day, driving an hour or two, renting truck inner tubes, and getting into a meandering river.

Whoever made the decision hadn’t looked realistically at the time involved. What should have lasted two hours at most turned into a six-hour struggle.  All of us, at one point or another, left the water carrying the tube, swearing never to get back in.  And all of us jumped back in the river.  We all had our reasons, but the most common one turned out to be the sound of rattlesnakes.

I can honestly say no one died, though most of us finished in the gentler stages of hypothermia.

The program wisely decided against further Team Building Exercises for the duration of my tenure. At various times different subgroups held bonding experiences involving large amounts of alcohol and no official sanction.

I don’t know when and if more Team Building Exercises happened.

The office here has Team Building Exercises twice yearly. The clinic closes and a locum takes over the ER.  This time vacations had a couple of the permanent docs absent, and, despite the temporary nature of my assignment, I got invited, too.

We started off with a couple of getting acquainted exercises; one of them called Two Truths and a Lie. We all wrote three sentences on a card, two true and one false.  The group had to figure out the author and to ferret out the lie.

I wrote, “My first college major was Music Theory and Composition. I was an Olympic hopeful in Archery.  I spent 4 nights in jail.”  More people believed I’d been a top athlete (false) than I’d been a composer (true).  But everyone found the idea I’d spent time behind bars plausible, and wanted to know why.  They couldn’t understand what Illegal Pedestrian meant.  I explained it was an archaic Kansas expression meaning Male with a Ponytail.

We went on to build airplanes using nothing other than 3 boxes of aluminum foil. We broke into pairs, sat back to back, and had one person describe a picture to the other person so as to reproduce it.

The last game involved trying to grab an unfolded red napkin from the back of the belt from as many others as possible. I decided to abstain more because of my back and ankles than my age.

After sushi and beer we sat around and chatted and relaxed, something we don’t get to do often.

At the end we thanked our office manager for putting together a great day.

It beat the heck out of inner tubes, rivers, and rattlesnakes.

Admit ignorance: practice it, get good at it.

March 13, 2017

If you don’t know a yes from a no,

And if you can’t tell the fast from the slow

Listen up, please,

For I can do it with ease,

Just say out loud, “I don’t know.”

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. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

Over the weekend I observed the anniversary of my graduation from medical school. I remember the night well; I went out to the Chinese restaurant in East Lansing (at that time, there was one) with my father and my brother.  My fortune cookie said, “You will have great power over women.  Use it wisely.”

Before and after I have heard many commencement speakers, but the only one I remember was the one from March 11, 1979. “When you get up in the morning,” he said, “First thing, look in the mirror and say, ‘I don’t know.’  Practice it.  Get good at it.”  I remember a good deal more of that speech, but that particular commandment came to my mind this morning.

The patient came in for follow-up of cough. He had had all the right treatments before he got to me, but he wasn’t getting better.  I repeated the chest x-ray and didn’t see pneumonia.  Antibiotics, steroids, breathing treatments helped but not nearly enough, and he felt worn out from the cough bothering his sleep.  I said, “I don’t know what’s wrong, but, clearly, something is wrong.  And I know exactly what to do when I don’t know what to do, and that’s to send you to someone who knows more than I do.  Because I’m the world’s final authority on nothing.”  We were lucky to get him a follow-up appointment with the pulmonologist in a week.

But at the end of the visit I told him about my medical school commencement speaker, and how good I’d gotten at saying, “I don’t know.” And then I asked permission to write about him in my blog.  “I won’t say name of course, or age, or gender, but…”

“Doc,” he said, “You can tell ‘em my name is ### and I’m ## years old and I’m ### for all I care. Especially if it’ll teach other doctors to admit when they don’t know.”

I can hope.

An awful lot has changed in medicine since 1979. We don’t use penicillin for pneumonia any more, and rarely do we bring out the digitalis.  But doctors still have to admit when they don’t know.  It’s one of the rules of the game.

 

 

Live like a student now, or live like a student forever.

November 7, 2016

Here’s a puzzle for the bold and the clever

If a dollar’s a lot like a lever

You can be foolish or prudent

To live like a student

For now, or even forever.

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. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor.  After a moose hunt in Canada, I am back on the job in western Iowa.  Any identifiable patient information has been included with permission.

I didn’t get into this business for the money, and I have a strong aversion to debt. I stayed hungry in medical school till I got a National Health Service Corps scholarship: the Feds paid for my tuition and books and sent me a monthly stipend which paid rent and groceries, but not enough for a car.  In return, I promised to work at a designated Medically Underserved Area, a year for a year.  As I had all along intended to work in the Indian Health Service, I mistakenly didn’t view the contract as debt acquisition.  I savor the memory of my IHS days, but I would recommend that course now only with cautions.

Because debt is debt. Our daughter’s med school financial counselor advised her that she could “live like a student now, or live like a student forever.”

Lending institutions then and now approach medical students with loan offers. On a corporate basis, the payoff works well.  Students can borrow money against the future high earnings.  The lenders’ pitch goes something like “Hey, you’re going to make so much money in the future, why suffer through years of poverty?”

Those students who take the bait for 4 years can acquire debts that last for decades. Some get locked into suboptimal job situations.  And some keep borrowing, maintaining a high-dollar lifestyle but without building wealth.

A banker once told me a lot of doctors have a smaller net worth than their monthly Adjusted Gross Income.

Between keeping a simple lifestyle and Bethany’s wise management of our funds, I can afford now to work as much as I want, and keep visiting new places. For the next few weeks we’ll be in western Iowa.

We have a snug apartment attached to an ancillary service building, and we share kitchen and living room space with a medical and a pharmacy student. The building even carries a sign that says ”STUDENT HOUSING.” And living with students brings back memories of my early career.

I started today learning my 13th Electronic Medical Record system in 25 months.  All have major weaknesses, and this one promises a steeper learning curve than most.  I take no comfort in the fact that Corporate plans to replace it in less than a year.

The community turned out larger, more prosperous and energetic than we anticipated, and the hospital itself appears well-organized and well-run. The primary care area’s layout minimizes the time wastage inherent in larger medical operations.

And, for the time being, I don’t mind living like a student again.

 

 

 

Unattended Patients: first week in Nebraska

December 7, 2015

What will the hospital do,

To equally assign to the crew

And not hurt the workers

Who make up for the shirkers

Who dodged the call that they drew

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.

 

Sometimes, people who don’t have a physician, or who don’t have a local physician, need hospitalization.  As time has gone on, I’ve seen shifts in the way that hospitals approach the problem.  Every hospital where I’ve worked made privileges contingent on willingness to care for those patients on a rotating basis.

The move to staff hospital ERs full-time started in the 70’s, and I can remember a very good ears-nose-throat specialist putting on a set of scrubs to take the night-time duty.

In residency, the ER doctor would open up a box containing 3×5 cards with the name and phone number of every primary care doc in town, take the card at the front, call the doctor in question, and move the card to the back of the box.  We referred to those patients as “box calls,” and OB had a separate rotation.  Some docs took the system with more equanimity than others, and, as always, the workers resented the shirkers.

When I came into private practice, both hospital ERs maintained a list on the bulletin board next to the emergency doctor’s work station.  He or she would make the call, and cross the name off the list when the doc in question accepted the admission.  We called it the “hit list.”

Those patients rarely had insurance or money.   I did for free most of the care in that system, and I regarded the financial loss as part of my social obligation to do some pro bono work.  Other docs didn’t see it that way, and some invariably had a reason to dodge the hit.  I did my best to be pleasant on the phone to the other doc.  I established a good rapport and a good rep, but about every 7 years, when very tired or overloaded, I’d use my past cooperation to delay till daylight the next hit.

Those two institutions have since moved to a system where the ER doc makes the decision to admit, and the hospitalist employed by the hospital attends the patient during their stay. Fewer and fewer primary care doctors attend patients in the hospital. Alone among first-world doctors, US physicians have the option to do both inpatient and outpatient work.

Here in western Nebraska, where our critical access hospital has a staff in the single digits, I agreed to take care of the unattended admissions (here called the “no docs”).  I suppose that makes me the de facto hospitalist.  I resolved to be the best of the breed, and, if the patient has a physician out of town, to make a doctor-to-doctor call at discharge.  At the end of my first week here, I met the goal 100% of the time, in numbers barely into the plural range.

I have gotten comfortable with the inpatient EMR, I still don’t have access to the outpatient EMR.  Midweek we moved into a very nice town home outside of town with a lake view.  I face a 14-minute commute, unless I go slow enough to admire the scenery.

On Chest Tubes and ATLS

November 15, 2015

I studied up for a test

That involved a tube in the chest

For the old and the young

When collapsed is the lung

That treatment, life-saving, is best. 

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. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, and working Urgent Care in suburban Pennsylvania. Any patient information has been included with permission.

I drove south to Kansas City for the Advanced Trauma Life Support (ATLS) course.

In medical school, I saw exactly one chest tube insertion, involving the “best chest surgeon in town” (in retrospect, either bipolar or alcoholic but more likely both).  I watched the surgeon make repeated jabs with a scalpel into the chest of an unanaesthetized late adolescent man who had come to philosophical terms with his upcoming death from cancer and just wanted to die comfortably. I observed the screaming and the torture for as long as I could.  When my vision contracted down to a tunnel, I knew I would faint, and rather than do so at the patient’s bedside, I forced one foot in front of another down the hall to the dictation desk behind the nurses’ station, laid down, and fainted.

The experience put me off chest tubes, but chest tubes can make the difference between life and death when a lung collapses (pneumothorax) or blood pools inside the chest on outside the lung (hemothorax).

The first time I did the ATLS course we used live, anesthetized dogs and cats to practice endotracheal tubes, venous cut downs, and chest tubes.  It bothered me then and it bothers me now that the animals did not survive our education, but the experience of the dying 18-year-old bothers me more.

I got out of the Emergency Room.  My certification lapsed, decades passed and the century turned before I needed that credential again, when my work in remote locations brought me to ER coverage.  In December of 2010 I took the ATLS again.  We used manikins for practice, not living animals.  Venous cut downs had almost disappeared.

I do not regret never having to use those skills.

Now that I stalk the locum tenens trail again, some facilities want the credential, and I discovered, to my chagrin, that mine lapsed a year ago.

Venous cut downs, the last ditch to get IV access, have disappeared in favor of a technique that bores into a long bone, called interosseous.  Endotracheal tubes continue.  The scopes still use incandescent light bulbs, having failed to progress to halogen, they may skip directly to LED but will more likely be replaced by the video Glidescope by the time I recertify next, in 4 years.

The chest tube practice manikins continue to improve, providing a closer simulation to a live human than a cat or dog ever could.

I hope I never have to use my skills.

Denver Panhandlers, Then and Now.

September 28, 2015

On the street they reach their hand out

It’s money they’re talking about

If the world is a stage,

They’re here to beg,

They have problems, of that there’s no doubt

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 System (EMR) I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, and two weeks a month working Urgent Care in suburban Pennsylvania. I’m attending a medical conference in Denver.  Any patient information has been included with permission.

Most docs finish med school with crushing debts, I finished with great poverty skills and a 2 year obligation to the Indian Health Service (I stayed 5).

I did my pre-medical education at University of Colorado at Denver, at the time a commuter college with no dorms and no parties.  Paying for your own education brings out the student’s motivation.  My classmates had other employment and wanted better.

Lower downtown Denver at the time had just renovated its Skid Row around Larimer Street with specialty shops, but the bums, drunks, and prostitutes still frequented the neighborhood, occasionally drifting away from the pawn shops to the campus.

In those years I rode my bicycle everywhere, and I confronted panhandlers only when my bike broke down and I had to take the bus.

I returned to Denver for the American Academy of Family Practice’s  FMX, a convention for continuing medical education (CME).  We drove in from Iowa over the weekend.  We visited family.  The classes start tomorrow.

We walked from a very nice hotel to a silversmith’s on Larimer Square.  I’ve known the owner for 40 years now.  We walked down the 16th street Pedestrian Mall, past the panhandlers.

During my pre-med days a lot of young people found themselves on the streets because of lousy economic opportunities and generational alienation, they had good mental health.  They figured that the difference between no pay and minimum wage didn’t justify 40 hours of structure.

But at the time a lot of Indians came off the reservation to drink heavily in Denver (the sober ones, the vast majority, stayed on the reservation, giving the non-Indians in Denver a false impression of Indian alcoholism).  One afternoon I found myself walking down 15th Street when a Crow Indain confronted me.  “I’m just got into town,” he said, “I’m trying to get together enough for a bottle.  Can you help me out?”

He had caught me at a bad time.  I had much to learn about softening my words.  “You want me to help you out?”  I exploded.  “I’ve got a quarter in my pocket and I don’t have enough to buy a patch for my bicycle tire because I used the last one this morning and I got another flat this afternoon.  I haven’t eaten since 6 this morning and I don’t have enough for the bus.  No, I can’t help you out.”

He was taken aback and reached into his pocket, offered me half of what he had.

Humbled, I took enough to buy myself a new patch kit.

The street people look better fed but less washed than they did 40 years ago, and not an Indian among them.  My years in the Community Health Center softened my reaction to those who beg for money.  I have treated so many mentally ill that I appreciate the overlap between bipolar, schizophrenia, and substance abuse.  Most but not all the people I saw asking for money had the bizarre affect of schizophrenia and the twitchy gait of the overmedicated.

I gave some money, I didn’t give to others.

I can afford it a good deal more than the Crow who helped me buy a patch kit.

Another Road Trip 12: reminiscing in Saginaw

June 22, 2015

It was such a long time ago

O’er the bridge I would walk to and fro

But one day running late

I hopped on a freight

And survived.  But how, I don’t know.

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 System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. In the midst of combining work with a family visit, I had to make a sudden trip to Colorado for a funeral. Right now I’m starting out on a bicycle trip with an alumni association.

We arrived in Detroit with our circadian rhythms disrupted by bad sleep and grief, got onto the highway and went north.

I came to Saginaw in the summer of 1977 for my medical school clinical training.

I had no car and barely money for food.  I lived across the street from the St. Luke’s parking lot, a block away from Saginaw General Hospital.  St. May’s, directly across the river, would have taken 20 minute bicycling in good weather.  Or I could walk across the railroad bridge, a process that took 8 minutes if I walked fast, and gave me a brief respite of outdoor exercise.

One day, running late, a slow-moving train occupied the bridge.  Remembering a technical conversation with a hobo,  I ran alongside the train, matched speeds, grasped the ladder, and jumped on.  I rode across the bridge, dismounted at a jog, and arrived at the noon lunch lecture on time.

I repeated the process a dozen times, but once, after the temperature had dropped with the seasons into the teens, the train started to accelerate while on the bridge.  I had dressed for a short walk across town, and the wind chill numbed my hands in less than a minute.  I had visions of freezing to death as the train headed out of town and picked up speed.

I made a stumbling dismount from the train at a run, in front of a waiting car. (What did that driver think, seeing me in a white coat with a stethoscope around my neck?)  I made it to the lecture, alive and on time, and never rode another freight.

And now I could ride the streets in my own car.  While the day faded, I showed Bethany what I remembered of my time in Saginaw.

Covenant took over Saginaw General and St. Luke’s and merged them into one institution.  A bronze statue and a couple of nice plaques now sit outside of St. Mary’s Hospital, on grounds much better maintained than any I ever experienced during my tenure.

A vacant lot has devoured the house where I lived my senior year, the furnished room rented for $200 per month.  The letter bearing news of my National Health Service Corps scholarship came to that address.   The grocery store and the greengrocer, walking distance from my first dwelling here, have disappeared.

Medicine has changed as well.  Laparoscopic surgery, unknown then, has become the norm.  Ibuprofen, Tagamet, Prilosec, Zyrtec, and Flonase, each a game changer, no longer require even a prescription.  Total knee replacements (I saw Saginaw’s first) are routine.

When I lived here, research hadn’t even started to elucidate the inflammatory cascade of ankylosing spondylitis, and aspirin was the best drug for its close cousin, rheumatoid arthritis.  And my back hurts less now than it did 40 years ago because of Enbrel, the miracle drug, which would not be invented till 1999.

We parked at St. Mary’s and  I led Bethany to the intersection where I alit from the train.  We walked up the tracks to the railroad bridge.  I had never seen the river that high.

reminiscing

Jury Duty: Avoided. The truth sets me free

December 21, 2014

The sentence given to me

Ten days or a large fee

A minor infraction

But now, no retraction

And the truth indeed set me free

Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center, where I worked for 3 years.  I left last month because of a troubled relationship with the Electronic Medical Record (EMR) system.  Now I’m back from a road trip, working a bit with one of the rural docs, and getting ready for another job in Alaska.

I didn’t own a car till after I graduated from medical school.  In the late 60’s and through the 70’s, I answered my transportation needs on a local level with a bicycle and on a larger scale with hitchhiking.  I ran more risks than I should have, and I don’t want my children to learn what I learned.  But I had loads of fun.

In March 1970 a driver dropped me at the intersection of Kansas 177 and Interstate 80, east of Junction City, Kansas.  Another long hair stood at the same on ramp.  We shook hands.  He offered me some honey, and we shared a snack as we stood well off the pavement, next to some rocks.  I talked about the limestone and explained the flint nodules.  Then the Geary County Sheriff’s deputy showed up and arrested us both.  Before sunset, I had been convicted of being an illegal pedestrian, and sentenced to $100 or 10 days.

Since then the law has changed, the Supreme Court finding that sort of sentence discriminatory against the poor, and now the convicted can’t buy their way out of jail.

I didn’t have the $100 at the time, and, besides, I love adventures and I’d never spent time behind bars before.  I got to hang out with 4 other guys, charged with, variously, bad checks, breaking and entering, murder, and illegal pedestrian.

Terrible weather hit the evening of my incarceration, white-out blizzard conditions.  Four days later when the weather broke, the judge summoned me back to court.  He looked exhausted.  My mother had been calling him at home, day and night.  He told me to get on the Greyhound Bus and leave the county.

I don’t much like Greyhound Buses and my feelings for Geary County in general and Junction City in particular have mellowed but little since then.

Now when I fill out a credential application, such those completed for my Pennsylvania license or for my upcoming assignment to Nome, I say “I spent 4 days in jail for being an illegal pedestrian, my real crime was probably having a pony tail in 1970 in Kansas.”

More than forty years later, summoned to jury duty when I had no work scheduled till Friday, the judge promised we’d be out, at the latest, tomorrow afternoon.

The judge, smiling and professional, asked preliminary questions.  He if we’d been arrested.  Mine was the only hand that went up.

Laughter rang in the court room when I said illegal pedestrian, and came louder when I said 4 days in jail.

Then the judge cleared the courtroom, and called me back in 10 minutes later.

I admitted my biases, both for and against the defendant.  While I have a deep mistrust of law enforcement, I said, because of my work I have an even deeper trust of lab results.

Then he asked if I believed that people get stopped for Driving While Black.  Yes, I said, I did; it has happened several times to one of my daughters because she got all the kinky hair genes from my wife and me.

Three and a half hours after I entered the courthouse, I walked out into the bitter cold.

Speaking the truth might have set me free. It at least got me out of jury duty, but it took all morning.

Memories of March 11. 1979

March 14, 2014

Three decades ago I did walk
How fast move the hands of the clock!
My life rearranged
As a man I was changed
And I remember the speaker’s fine talk.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, sold my share of a private practice, and, honoring a 1-year non-compete clause, went to have adventures in Alaska, Nebraska, Iowa, and New Zealand. I returned to take a part-time position with a Community Health Center, now down to 40 hours a week from 54. Right now I’m in Petersburg, Alaska, on a 1 month working vacation.

The anniversary of my medical school graduation arrived with snow and rain in southeast Alaska.

March 11, 1979 remains a date burned into my personal calendar. I had hitchiked back from Montana, my 4th move in 5 months. I stayed with friends in Saginaw and East Lansing the few days till graduation.

My father and brother flew out from Denver.

The graduation speaker did an effective job; I still remember what he said: There aren’t very many true emergencies. Write down what you need to know for each one on 3×5 cards and carry them around till memorized. Every morning, first thing, look in the mirror and say, “I don’t know.” Get good at it. Medicine is a jealous mistress with a cruel embrace.

He spoke for about 20 minutes. His exact words probably reside somewhere in the archives, but I carry the most important parts in my memory.

Michigan State at that time and to this day keeps the med students in East Lansing for the two preclinical years; after that the College of Human Medicine sends the students off to the five clinical campuses around the state. Those clinicals years constitute the crucible that makes a doctor. We saw people born and die; we delivered babies. We received praise and verbal abuse. We listened to attending physicians expound wisdom and acclaim outright lies. And for our last year, most of us travelled.

We lost track of each other. Some slowed their program from four to five years, some longer. Some dropped out. For the next three years we focused on our post graduate training, and for the next thirty years we focused on our careers.

But most of us walked across the stage that cold and snowy night in East Lansing.

I almost didn’t.

While I stood in line I started to panic. I had been a student for 24 years at that point, and without a school and a program, I had no identity. With only two classmates ahead of me, I turned to my one time roomate, who, fortunately, came right behind me alphabetically. “I can’t do this,” I said, “I’m a student. I don’t know how to be anything else.”

He said, “Be quiet. Turn around and graduate.” Which I did.

In that short walk across the stage I underwent a metamorphosis. I walked off the stage gripping a faux parchment (not the diploma; they had handed me a note that promised my diploma would be mailed to me), a changed man. The change, of course, had built over the three years of premed and the four years of medical school, but those few steps brought me past the tipping point.

Yes, I had lost an identity and in doing so acquired another.

My classmates and I milled around in euphoria and then we prepared to leave.

My father and brother and I went out to the Chinese restaurant afterwards. My fortune cookie said, “You will have great power over women. Use it wisely.”