Why I Came, and Can I Fix the American System When I Get Back?

My reasons? I’ve got quite a few

I didn’t want to say I withdrew

My application

But my rationalization

Got me to work with the right crew.

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.

The patient (who gave me permission to write a good deal more about her than I have) asked why I came to British Columbia.

A lot of people ask me that question, and I truncate the truth, too complex for brevity. In no particular order:  I have a thick stubborn streak.  I had a tiger by the tail: see the project through or have to say that I’d withdrawn an application for licensure.  I wanted to spend more of my time taking care of patients and less time at meaningless but marginally lucrative mouse clicking.  I have a sense of adventure.  I wanted to know the truth behind what US doctors vilify and US liberals champion but neither have any experience or knowledge about.

There are more.

So I just said, “I wanted to know find out about the Canadian system.”

As I opened the door she asked, “So, when you get home, are you going to fix the American system?” I said, “No, but the first step is educating the American docs. And I’m not sure they’ll believe me.”

Actually, I don’t think the liberals will believe me, either.

+=+=+=

Last night the smoke from the forest fires drifted into town. The dramatic evening sky progressed from intriguing to eerie.  Finally, darkness fell, thick and hard, two hours early.  The smell of smoke kept me from falling asleep.  This morning we watched the news for two hours to see how close the fires are.

We don’t want the fires to come this way. Too close and the town dies from lack of wood.  Much too close and the whole city goes up in flames.  I wouldn’t want to have to evacuate, and I don’t know which way we would go.

We’re seeing an increase respiratory problems from the smoke. Some people have come in from BC’s largest city, Prince George, because of air quality.

=+=+=+=

Last time I was on call, I saw 14 patients, and 3 diagnoses accounted for 13 of them: back pain, abdominal pain, and left facial pain. The only one not covered by those three complaints came in before the others, and left, cured.

 

Contentment and birthday pizza

At the end of a beautiful day,

We caught the sun’s reddened ray

We snacked on raspberries,

Pizza and cherries

And then we went on our way.

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.

Different organizations have different ways of celebrating birthdays. During my New Mexico years, I got used to bringing food for the clinic when I marked a change in age.  I continued the habit into private practice and Community health.  Mostly, I had Bethany pick out a good selection from Panera.

One of my colleagues ticked just a little closer to 40 last week, and a selection of cupcakes appeared in the clinic. And, at the last-minute, he and his wife put together a pizza-based gathering after work.

Bethany and I drove out to his house at the outskirts of town. He has had black bear, grizzly bear, deer, moose, wolves, and caribou in his back yard.  But on this particular evening we contented ourselves with stories of close wildlife encounters.

The docs drove up, one by one. Before the noise disrupted conversation, I showed off my trick of sharpening knives on the back of a ceramic plate.  Till the pizza arrived, we snacked on chips, and sweet cherries freshly picked in southern British Columbia.

We ate the pizza at leisure. I’ve written in the past about how doctors tend to bolt their food because we never know when we’re going to get called away.  These physicians know how to work hard but more than that they know how not to overwork.  We enjoyed our food.  We chatted.  Topics included economics, politics, horticulture, wildlife, and medicine.  We recounted various places we’d been.  Perhaps because of my country of origin, we had some lively history discussions, fortunately none of them mentioned the Fenian raids, where renegade Americans tried to invade Canada shortly after the Civil War.

The day waned, and I relaxed. Forest fire smoke takes the clarity from the air but it makes spectacular sunsets.  In this case, the solar disc reddened well above the horizon, while cool evening breezes mixed in with the heat of the day.  I reclined after a good day at the clinic and in the late stages of a great summer.  I had worked but not too hard, I had eaten but not too much.  I had chatted knowledgeably but without pedantry.  I had sharpened the knives, but no one cut themselves.

I wallowed in contentment, thoroughly in the moment.

After a bit we toured the grounds. We picked raspberries and ate them immediately.  We saw the Saskatoon berry bush, trampled by the visiting bear.  I looked for the peach tree I had seen earlier.

And when the mosquitos came out, we said good night.

 

 

Patient Transfer and Push-back

The specialist just needed a chance

To vent his frustration and rants

Just as expected,

The referral’s accepted

Sorta what I thought in advance.

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 listen to the subspecialist’s voice on the phone, and I can hear the overwork through the bluster, asking me what I think he can do for the patient that I can’t.

The local term for what he is giving me is “push-back.”

I got a lot of it from Alaska Native Medical Center (ANMC) in Anchorage when I would try to transfer a patient. Even before I would pick up the phone, I knew I’d be attempting to enlist the cooperation of a physician close to burnout, with a service already bursting at the seams, analogous to pouring gallons into quarts.

In another century, in another country, I faced push-back from every rung of the hierarchic ladder at the academic hospital, when I had to ship out a patient with Reye’s syndrome. With vomiting, altered mental status and a swollen liver, I had made the diagnosis in less than a minute, and spent two hours proving it with lab, while late evening ticked into early morning. The medical student, intern, and resident all tried to block the transfer, but passed my call up the food chain.  The presentation to the chief resident, polished by the first three layers, included answers to the questions posed by the underlings in a coherent, rapid fire fashion.  In the silence of a 3 second pause I could hear something in him break, a resignation to the inevitable, and then he said, “Well, I supposed I’m going to have to accept the transfer.”

(I’ve not seen a case of Reye’s syndrome before or since; it disappeared when we stopped giving children aspirin. That particular patient recovered completely.)

I never ran into push-back in New Zealand. The physicians at the university hospital sounded fresh and cheerful every time I called.  But they have a different system; following the online flowchart weeded out the majority of unnecessary calls.

Today I catch the subspecialist in at the university hospital fresh, in the middle of the afternoon.  He fires off a list of questions, interspersed with complaints of thinly spread resources.  When he pauses, I confess I use a whiff of sarcasm when I say, “Would you like me to answer, or would you like to keep going?”

I figured out, early in my private practice years, that I spent more time and energy trying to avoid work than actually doing it, and I quit pushing back the ER docs when they called me to admit a doctorless patient. Because I built up good will, about every 7 years, when I really needed to, I could dodge an admission.

Between my sarcasm and the chance to rant uninterrupted, the subspecialist loses momentum, and in the silence over the phone, I can hear something break. Resignation replaces resentment when he accepts the admission.

I later learn he has a reputation as a good, caring, skillful physician in a badly understaffed situation.

I feel for him. I hope he doesn’t burn out.

Canadian rough fish: delicious but bony

The prep and the time that it took

For the sinker, the line, and the hook

And don’t forget bacon

For the rig that you’re makin’

When you fish the lake or the brook.

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.

A lot of people in this town do a lot of fishing.   And while I really enjoy the sport, my lack of knowledge, skill, and experience give the fish quite an advantage.  I approach the problem like I approach a clinical case with unclear references: I ask the successful.  Anglers love to talk and show off their cell phone pictures.

I got clues to several spots where the fish congregate. I bought swivels, hooks, sinkers, lures, and a net.   The panel consensus for bait, to my surprise, came down to bacon.  For a lot of reasons, I haven’t bought bacon for decades, but I ignored all those nitrites on the other side of the plastic, and bought a kilo of ends and trimmings.

The real commitment came when I paid for my license.

So on Sunday morning, Bethany and I put the bug spray, sunscreen, and bear spray into her backpack, loaded the pole and my lunch box (I don’t have a real tackle box) into the car, and set off for one of the local myriad of lakes, the most commonly recommended spot.

With a breeze strong enough to deter mosquitos, and skies fresh washed by heavy rain the night before, we pulled onto a spit of land and parked in the shade.

I can’t tell you why I can handle worms and body parts without revulsion, but bacon makes my skin crawl. Still, I got a good hunk of it on the hook, and casted it into the wind.  The idea of this rig is to put the sinkers on the bottom and have the bait floating free.  Then I sat down on a log.  Bethany, who helped assemble the equipment, sat down to read.

My mind drifted.

More serious, better equipped fisherman would have a truck and a boat. Or at least a good size cooler, a chair, and a real tackle box.  But I learned in archery that the more seriously you take something, the less fun you’re having when you do it.  And, at this stage of the game, I can’t blame the pole for angling failure.

Then the rod thumped in my hand. I tried jerking the pole to set the hook but the sinkers had wedged up against something on the bottom.  I jerked, and pulled this way and that, and started to reel in the line.  Of course by that time the fish had thrown the hook.

I kept cranking, knowing I’d have to rebait.

Then the rod thumped again, and I realized the fish hadn’t thrown the hook.

I pulled in an 18 inch fish that I couldn’t identify. With Bethany’s help, I dispatched him.  I put more bacon on the hook (not as bad the second time), and cast again.

The second fish took the bait but not the hook.

The third fish, of the same species as the first, took the hook deep and, though smaller, couldn’t survive release.

We now had enough fish for a meal for two. And as much fun as fishing is, I don’t harm animals except for food and self-defense.

I fried the two fish, both a bit big for the frying pan. We found the flesh tasty but bony.

I changed clothes in the afternoon and went over to the hospital

My patient, one of those who know more about fishing than I do, identified the fish as a pikeminnow (formerly called squaw fish), a rough or coarse fish without limit or size restrictions.

Fish snobbery fills the angling world; Iowans turn their noses up at the invasive silver carp, Alaskans won’t eat pink salmon, and fly fishermen display bumper stickers saying “To spin is to sin.”

But I was thrilled to catch a rough fish the length of my forearm. Even if I had to touch bacon.

 

A very long taxi ride back

The day sure started out slow

It went fine, but wouldn’t you know

To make the trip back

I caught a ride in a hack

And the driver made satisfactory dough.

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.

The day on call went smooth and slow to start, with fine, solid naps in the morning and afternoon, caring for 5 patients. On the brink of leaving for the day on time, I knew I had to stay when the ambulance radioed in news of two injuries from the highway.

I have to confess my ambivalence when it comes to airbags. Front airbags don’t add much safety to modern seatbelts, too often they activate when they shouldn’t.  Side airbags, on the other hand, provide another layer of protection that saves lives.

I have never before attended survivors of crashes where airbags deployed. I developed the term “bag rash” to denote an abrasion from the airbag, and the patient gave me permission to write about it (and more).

Right when most people would sit down to dinner, the ambulance brought in another patient with problems exceeding our hospital’s capacities; in fact, requiring trained escort for the trip to Prince George.

The responsibility fell to me because nursing staff could not be spared from the hospital.

The back of the ambulance amplifies a road’s imperfections. I did my best to meditate through my nausea as we sped down the highway.

We stopped at the EMS station at the halfway point. Not all stretchers (in EMS-speak, carts) can lock securely in all ambulances (EMS-speak, cars).  I can’t detail here the complications that demanded a change of ambulances and crews, but I got to stretch my legs and breathe in the cool pure air, and ride in a much more comfortable seat.

I turned the patient over to the ER doctor, we volleyed a bit of French, and then I had to confess to the staff I’m not really Canadian. I have been working on my accent, after all, and I don’t obviously sound like an American at this point.

Then I called a taxi: the ambulance that met us would only go back as far as the halfway point.

A very long time ago, my pre-med biology lab partner drove cab, I rode with her a couple of times. She clued me into the details of the business.  In the States, the cab company rents cars to drivers.  The drivers don’t start making money till they’ve made up the fee, and some shifts they don’t make any money at all.  Bidding on the best cabs goes by seniority, and the new drivers (at that time) drove uncomfortable, unsafe vehicles.

As we rode, I interviewed the driver, just like I interview patients. He speaks fluent Punjabi and Hindi and a bits of Tagalog and Mandarin, but has forgotten the French required of all students in Canadian schools.  His English carried a perfect northern British Columbia accent, but I found out he’d been born in India and at age 10 moved to the very town we were headed to.  As the daylight faded into twilight, and as the long northern twilight deepened to dark, I listened.  He worked in the pulp and paper business till age 55 and started driving cab a couple of years later.  He doesn’t rent the hack from the owner; he keeps 45% of his fares.  He makes good money in the winter, but not in the summers.

We came into town in the darkness, talking about aurora borealis. He pointed out places from his youth, but had to be directed to the new hospital.  He showed me where the movie theater used to be.  They changed the films three times a week, he said, and he went to all the movies, and that’s where he’d learned English.

When he dropped me off at the hospital, I looked at the fare on the meter, and I was glad that the trip had been worth his while.

I dropped the unused morphine and the crash bag at the nurse’s station and walked back to the hotel. I hoped for a glimpse of Northern Lights in the moonless sky, but the clouds hid the stars.

 

Picking up a loving pair of hitchhikers

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.

 

Fisherfolk and forest fires.

If you can’t take the fire, stay out of the smoke

The stuff that makes you wheeze, cough and choke

This great conflagration

Caused evacuation

And perhaps even brought on a stroke.

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 had call this last Friday, Saturday, and Sunday, and I’m on call again tonight, Wednesday. Over the weekend I saw so many people with possible or definite stroke that my neurologic exam, thorough but a bit rusty on Friday, was polished and speedy by Monday morning.

I have had to do suturing at least once a day for the last week. I do not anticipate robots taking over this part of my job in my lifetime; especially if children are involved.

Stitching people up brings the opportunity to just chat with the patient, and I got the chance to pick the brains of a couple of really expert fisherfolk. The lakes around here hold some lake trout, ling cod, bull trout, and Dolley Varden.  One person I talked to has never come back without a fish, and more than one told me about great spots to catch 28 pounders.  Of course we call fishing stories just that for a reason.  Still, after I bandage the wound, the cell phones come out and the photos of the fish have been very impressive.  The most common, and the most successful bait around here seems to be bacon.

Every morning and evening, when I enter and exit the hotel, I see the crews that stay here, too. Of course I expect the seasonal workers: the rail crews, pipeline workers, tree planters, and such.  But now I see firefighters rotating off the line, and I have attended a few in the clinic.

Today the raging forest fires brought in the first of what I anticipate will be a long series of people with respiratory problems. Those numbers might take a while to ramp up, but lungs show an acute phase inflammation, over the first few hours to days, and a longer term late phase inflammation that lasts 6 weeks.

The area doesn’t have many roads, and the fires have cut off evacuation routes south. Last week, at the town’s only thrift store (staffed by hospital auxiliary volunteers), Bethany ran into a family who had to flee the fires.

 

Surviving grizzly bear attacks, controlling drug prices, and training a Dragon.

The thought that gives me a scare

Has do to with a grizzly bear

For he’s big and he’s massive

And pretty aggressive

And, out here, not terribly rare.

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 travel and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent US 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.

Some people survive events far beyond the usual human experience.

Lightning strikes more citizens of New Mexico than any other state, and when I worked there I met several. The Natives hold such survivors in high esteem; some tribes elevate them, obligatorily, to Medicine Man status.

Alaska, with the highest percentage of licensed pilots in the country, seemed to have a disproportionately large number of people who lived to tell about plane crashes. I met survivors of gunshot wounds there and in Nebraska.

Today I spoke with a person who survived a grizzly bear encounter.

Most of the bears around here are black bears. Though they’ll eat anything, the majority of their diet comes from plants.  They climb trees, and do their best to avoid people.

Grizzlies are different. The largest land predator on the planet, they have an aggressive temperament.

The bear only bit my patient once, then retreated to keep track of her cubs (the person gave me permission to write a good deal more than I have). If you’re in bear country with the inexperienced, before you start out, make sure everyone knows to freeze if a grizzly approaches, and never to run.  Carry either bear spray or a rifle, and be prepared to use it.

I really wanted to talk to the patient about life and work in this area, but my primary job, fixing people, comes first.

-*-*-*

Price of medication exceeds the price for physician services. In the US, the prices have escalated beyond reason, making the drug company stocks some of the best.  Insurance leaves a lot of Americans without adequate medical coverage, and the cost of medication becomes an important consideration.  When I worked Community Health, all our prescriptions went through our pharmacy. The pharmacists determined the formulary (the choice of drugs), and did a good job of containing costs.  The facilities in Alaska have a similar system; in those places the people don’t pay for their prescriptions.

For most in this town, employers pay for health insurance to cover what the Province’s Medical Service Plan (MSP) doesn’t, like medications.  PharmaCare, a government program, buys the meds  for the low income segment.  Only a very few lack money for drugs, and most of those are self-employed.  The Indigenous and Metis (of mixed Native and other descent) have all their drugs paid for.

*_*_*_

Over the weekend the facility got new dictation software installed. The previous version had worked just well enough to let you think you wouldn’t have to proofread, but still made glaring errors.  Today I used the system for the first time, training my Dragon over the lunch hour.  It did pretty well, but, once, when I said Prince George it typed first gorge.

The diversion of patients because of forest fires

The forest, it seems, is on fire.

And the wait can sure make me tire

When our referral facility

Has maxed capability

And my patients have problems most dire.

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 write this, 183 wildfires rampage through the wilds of British Columbia. The smell of wood smoke permeates the air and a haze hangs over the nearby mountains.

We have been lucky during this last week of fires, with 3 days of solid, soaking rain. But with complex topography comes complex weather patterns, and nearby valleys have had no precipitation at all.

Yesterday I had call. I took care of people with problems in their skins, bones, throats, lungs, hearts, eyes, abdomens, fingers, toes, brains, ears, and genitals.  Two came in close together, with problems exceeding our facility’s capability.  I ordered blood work; I like to sound prepared when I speak to a doc in a referral center.  Then I waited.

And waited. When I got results back, I called the hospital in Prince George to speak to a couple of consultants and to formulate a plan, then I had the central ambulance dispatching service called.

Theoretically, the dispatch centralization makes sense; practically, however, it means a terrible delay in getting patients into the ambulance.

I had hoped to send both patients in the same vehicle to Prince George, but in the course of making arrangements I found out that the number of injuries coming in out of the forest fire had overwhelmed the schedule for sophisticated diagnostic tools, and couldn’t I please send the second patient to Dawson Creek?

It meant a longer delay for the second patient, but I agreed, and called the ER there with a bizarre, creepy history perfect for the opening of a horror movie.

Of course, in the hours between the arrival of those two patients and their departure, other patients came in for treatment.

At six I walked to the hotel to eat supper with Bethany. I had been continuously occupied for the previous 10 hours.  I wolfed my food, napped briefly, and walked back to the ER.

I started in on documentation, typing directly into the Electronic Medical Record. I continued between the patients who kept trickling in.  I ran into a surprising number of patients with back pain who adamantly spoke against narcotics (and I agreed with them).

I finished at ten, and returned to the hotel. I had attended 21 patients.  The emotional fatigue of waiting to transport those two critical patients far exceeded the physical tiredness.

And then I had no calls for the rest of the night.

Locks on the Clothes, Keys on the Shoelace: the dress of a millwright.

The millwrights has many a key

For the mill cuts up many a tree

On the machine go the locks

Preventing visits to docs

And keeping the workplace accident-free

 

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.

Thursday I took care of 17 patients. One pediatric patient required all my patience, skill, and accumulated experience to get the job done without alienating the kid.  The oldest patients barely qualified as septuagenarians.

I wrote a lot of prescriptions for blood pressure drugs.

I used my deep-breathing techniques on three patients to bring blood pressures into the acceptable range.

Though only 15% of Canadians smoke, the nicotine addicted comprised more than half my patients.

I wrote several back-to-work slips, all employees in the timber industry.

I cared for even more millwrights and former millwrights. Changing logs into useable products involves a lot of dangerous machinery, and the people who fix the machinery come in loaded with padlocks on their clothing.  They lock a machine before they work on it, to make sure it won’t start accidentally.  Spare keys get carried where they can’t get lost, such as tied into shoe laces.  During the work day, a “whistle” signals a need for a millwright.

One of my patients in frustration said, “Can you give us a referral to see a specialist we can actually see?’ and we laughed after I asked for and received permission to use the quote in my blog. While I know my way around the human body, and most of the things that go wrong with it, I don’t know the local medical community.  Yet the permanent doctors trained near here, and know the consultants personally.

There’s also a province-wide network providing phone-in advice for docs . The consultants get paid on a fee-for-service basis; the patient has a unique identifying number, and the doc has a bunch of unique numbers (I have 8), one of which is the right one to use.  Computer algorithms coordinate compensation.