Archive for the ‘Canadian Adventure’ Category

The last week of the year

January 5, 2018

The Canadians were boxing that day

The 26th is a time that they play

But I took the call

Which was not rushed at all

But was long. What can I say?

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. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia, to which we have returned. Any identifiable patient information has been included with permission.

Much has happened in the last week.

Sunday: I don’t celebrate Christmas, I support my colleagues who do and go out of my way to take call on 12/24 and 12/25. But this year, I had to compete with two colleagues who don’t celebrate either, and for the 3rd time since the 70’s I didn’t work the holiday.  Bethany and I went cross country skiing.

Monday: We rented waxless skis from one of the hospital staff. I wore most of my clothing, including seal skin mittens and a beaver fur hat purchased in Alaska.

Bethany and I hadn’t cross-country skied together so far this century. The last time I went out on skis, waxless skis had just come out. I still ran then, compulsively, and I had some flexibility left, and my hair and beard had yet to turn the color of snow.

We went out for 3 kilometers, not far as cross-country skiing goes. I didn’t fall till the very last, and had to clip out of my skis in order to stand up.

Tuesday: I celebrated Boxing Day for the first time.  One of my Canadian patients explained the holiday:  “You stay in your pajamas all day and eat left overs and play with your toys.”  Of course I thought that kind of celebration laudable and wondered why it would only come once a year.   But I had volunteered for call that day, giving it to the Canadians who celebrate the holiday, and who couldn’t imagine that an entire country wouldn’t.  Steady patient flow, about one per hour, let me pay enough attention to each patient without rushing.  But it kept up till just shy of midnight.

Wednesday: ER patient at 3:00AM, requiring lots of ER care. In the middle, I returned to the room, showered, and changed. Back at the hospital an hour before dawn, the sky brightening in the east.  I faced the coldest temperature of the year thus far, -25 Celsius (-18Fahrenheit).  The new snow squeaked in protest as I stepped.  I worked the walk-in clinic, despite assurances I could take the morning off after a hard call.  I lunched back at the hotel, napped marvelously, and walked back to finish the afternoon.  I didn’t want to drive; scraping car windows inside and out takes more time. I did, however, drink a cup of coffee.

Thursday: after caffeine ruined a good night’s sleep I returned to clinic early to finish the inevitable odds and ends that come at assignment’s termination.   Unable to enter the dictation system for a discharge summary, I sighed, sent an email, and moved on.  I cleaned out my electronic queues of lab and x-ray reports, and consultations. I had 500 items, of which two made me exclaim out loud, not because I had been wrong, but because I had been right.

Friday: We scraped the car windows, put the heat on full blast, and packed.  At the clinic we said good byes and snapped pictures.  On the drive to Prince George any outside temp less than -19C iced our breath inside the glass.

Saturday: Getting to the airport 30 minutes before boarding gave us plenty of leisure.  I pointed out my multi-tool to the airport security personnel.  She told me Canada approves blades less than 5 cm, but I would lose it in the States.  It doesn’t have a blade but I didn’t argue.  We left in the dark and the snow, and 18 hours later landed in the dark and the snow in Sioux City (and temperatures of -26F/-33Celsius, even colder than Canada) after two long layovers separating three boring flights.  The best kind.

 

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A Tale of Two ER Patients

December 27, 2017

The blood came gush from the nose

Staining the floor and the clothes

But a Merocel pack

Slid from front to the back

Brought a stop to the flood, I suppose.

 

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. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia, to which we have returned. Any identifiable patient information has been included with permission.

A tale of 2 ER patients.

I find the process of transferring patients out daunting and frustrating. The remoteness of the community demands stewardship of the two ambulances with their crews.  Thus, when possible, I send  patients to Prince George via POV (privately owned vehicle).

Even then, the process of stabilize-and-transfer can involve an hour or two of ER time when I get to chat with a patient.

I got to talk with a chef, who gave me permission to write a good deal more than I have. His camp, with 120 workers, employs three cooks, each responsible for one meal a day.  We had a great time talking about gravy; we agreed that corn starch beats flour for thickener, and that a good broth or stock means more to the sauce than the drippings.

*-*-*-

 

I gave a different ER patient the reverse of my usual dietary advice. Eat three scoops of premium ice cream at bed time, I told her.  Don’t drink water, always make sure your beverage has calories, especially high fructose corn sweetener.  I described how the Iowa beef industry uses it to accelerate fat gain in cattle.   I told her not to eat anything without gravy, mayo, or a sauce.

At the end, I said, “I write a blog. I won’t mention name, diagnosis, or age, but I’d like to write about the eating plan I gave you, the opposite of what I usually give out, how poison for one person is life-saving for another.”

She waved her hand and said, “You can use my name if you like.”

 

*-*-*-

During my IHS time in New Mexico, I saw 2 or 3 major nose bleeds a week for 18 months.  In that time, I became skilled at packing the front part of the nose to stop the bleeding.  Most times I could get the stanch the flow, and when I couldn’t, I knew what to do to get the patient to specialist care.

But since then the nose bleeds I’ve seen were simple, easy to stop temporarily followed immediately by a touch with a silver nitrate stick for permanent resolution. .

But the problem of serious epistaxis (bleeding from the nose) relies heavily on equipment, and the equipment has changed in the last 30 years. Our hospital has specialized catheters with inflatable balloons (the Rapid Rhino), and sponges made of material that promotes clotting (Merocel).  We also have tranexemic acid, unknown in the 20th century

For the time frame involved, I’ve seen more than my share of complicated nosebleeds this trip. I discovered that the closest Ears, Nose, Throat specialist doesn’t take call, and that most of the ER docs cheerfully confer by phone.

I joined NIRD

December 20, 2017

I think that what you have heard

Could be boiled down to a word

The truth I must face,

And even embrace

Is the fact that I’m really a nerd.

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. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia, to which we have returned. Any identifiable patient information has been included with permission.

No one called me “nerd” in high school, only because the word hadn’t come into currency. I belonged in the clique of intellectuals that didn’t have a clique. I figured out pretty early that I’d rather study than party, read a dictionary than drink, and find a movie’s logical inconsistencies and anachronisms than sit back and enjoy it.   By the time I could relax and embrace my nerdiness, I knew how to find groups that valued and even revered book learning.

So I jumped at the chance to join Northern Interior Rural Division of Family Practice, or NIRD and the chance it offered for a Christmas party and an opporutnity to get together with other rural docs. I even ignored the misspelling.

True to my inner nerd, I got us to the party on time at 11:00AM, and before anyone else.

Most physicians brought their families and most of the kids were younger than 12. I probably graduated from med school before half the docs were born.

I gave a yoyo demo. Bethany and I repaired an 11-year-old’s yoyo, I gave him a new string and taught him how to wax it to improve the sleep time.

The docs from our clinic, with spouses and kids, settled at one table. To my surprise and delight, we didn’t discuss patients.

We had a great meal, centered on turkey but with plenty of vegetables. We didn’t rush dessert, and chatted on after everyone else had left.

At 3:00PM, little daylight remained. Bethany and I picked out a movie, but couldn’t find the theater in the dark despite 3 GPS units.

We stayed overnight in a rather nice hotel room. I’d never seen glass interior walls that opacified for privacy.

The next day we bought groceries at Costco and Real Canadian Super Store, which vies with Costco for great prices but offers a better selection.

Without the rampant Canadian politeness, we probably wouldn’t have escaped from the parking lot of either store before closing time.

We had a beautiful drive back, with clear skies and bright sun, and fine, gleaming white frost on the trees.

 

 

December 7, 2017

We had a short, boring flight

In Prince George we stayed over night

Though the sky turned quite black

It’s good to be back

The laughter and warmth bring delight.

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. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia, to which we have returned. Any identifiable patient information has been included with permission.

We waited in the boarding lounge in Vancouver for our next flight north, and fell to talking with fellow passengers. One has retired, and I asked what he does in his spare time.

His wife has volunteered at the hospital for 50 years, he said, and he visits her on the days she does. He also farms, raising hay in the summer. As I have farm land, and have worked with farmers, I very much wanted to know how many cuttings of hay he gets in a year.

“One,” he said. And in the exceptional year when he tries to get two, the next year’s yield suffers.

He also told me about his medical problems. While the rules of confidentiality don’t apply to airport conversations, I don’t like to write about anyone without permission.

The sun set while we chatted, and we boarded in the long twilight.

The flight was short and boring, the best kind.

We stayed over night and the next day hit the mall.  In general we don’t like shopping between Thanksgiving and Christmas because of insane crowds and impossible parking. Without a checked bag, though, we lacked critical items. I hoped to make up for my lack of a parka with a sweater, and we’ve found trekking poles almost as necessary as cleats when walking on ice.

And the grocery store in our target small town couldn’t hope to match the price or selection of Costco.

We got a great clearance price on a cooler.

Then we drove north on roads clear in the sun and snow packed in the shade, always alert for black ice and moose.

We got our old hotel room back. We unpacked and lunched at the Chinese restaurant, then I strolled to the clinic just before closing.

The laughter, warmth, and high physician morale enveloped me when I walked in. I grinned for a lot of reasons: small town friendly, Canadian polite, great nurses and support staff, and the special magic of this particular group.

 

Holiday rush

December 5, 2017

Home from the Arctic we set

At the Omaha airport we met

But, Oh! What a drag!

We can’t check a bag!

And we went to Vancouver by jet.

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. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia.  Any identifiable patient information has been included with permission.

I finished work 15 hours before our flight’s scheduled departure. We acquired little during our stay, but the task of packing took all of Bethany’s considerable skills.  We cobbled together a supper of edible odds-and-ends.  We played one more Scrabble game but couldn’t fall asleep till 5 hours before we needed to get the taxi to the airport.

The airlines advise 2 hours for security and check in, but here we couldn’t check baggage more than an hour ahead. We slipped our ice cleats into the checked suitcase, gate checked our 2 roller boards, and fell asleep before the plane took off.

We spent the long layover with Les, a friend of 35 years and Anchorage resident for 30. Without the wind we’d faced for the last month, the Anchorage temps while a few degrees colder seemed positively friendly.

Contrast, as always, the essence of meaning, the big-city realities of Anchorage jarred our senses. We faced traffic, stop lights, food prices that don’t take the breath away, and stores the size of hospitals, and did our best not to stop and gape.

We helped move a boat and shop, then after dark found ourselves in an airport decorated with full body mounts of moose, musk ox, polar bear, brown bear, and halibut. We landed in the rain in Seattle.

Because of the very long times and distances involved, the vast majority of Alaska traffic overnights in Seattle and Anchorage, thus the large number of hotels close by.   Less than 18 hours after checking in, we landed in Omaha.

Less than 48 hours of mail, laundry, and friends later, back in the Omaha airport for Thanksgiving travel, Bethany headed to Virginia, and I to upstate New York.

I thoroughly enjoyed my time with two brothers, three sisters, a brother-in-law, two nieces, two nephews, a daughter, and a son-in-law. I had to slide my internal clock back across 5 time zones, adjust to outdoor temps above freezing, and accommodate to twice the daylight hours.  I find sleeping in generally difficult but, due to a body clock both shaken and stirred, managed to sleep past 9:00AM.  Coffee in the morning, contrary to usual habit, helped.

Just like that Bethany and I met in the Omaha airport and headed back to Sioux City with 3 days to get ready for the next month in Canada.

The night before departure, Bethany looked carefully at the itinerary and announced we only had an hour layover in Chicago, where we changed airlines. We would not be able to check a bag.

Then followed a furious baggage editing. While we spent thirteen weeks in New Zealand with one roller board and one back pack each, we didn’t have to deal with serious cold.

We decided we could get trekking poles and sweaters in Prince George if needed.

In Vancouver, when asked the purpose of my trip, I replied, “Business.  Would you like to see my work permit?”  The young BC Immigrations man did, and asked me what sort of business I do.  “I’m a doctor,” I said.  “I’ll be working up north for a month.  And, boy, do I like your system.”

He looked up.  “Well thanks for coming! We’ve a shortage of doctors.”

The click of a linguistic show-off

August 29, 2017

That language didn’t come quick

And my accent is still a bit thick

It might sound like a crow cough

But I am a show off

And used my Naa Dene click.

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 spoke a lot of Spanish in my quarter-century working in Sioux City. Eventually, my accent settled into the developing Spanish accent of the area.  On taking care of a Hispanic patient for the first time, I frequently got the question, “Where are you from?”  And I’d reply that I’m American.

The query, “Yes, but what is your nationality?” invariably followed.

(Regretfully, people of Asian descent in both Canada and the US face the same question; the questioner usually implies that a person with a particular appearance must be from somewhere else.)

Sometimes I use the word Gabacho (a derogatory term for white Americans, heard mostly in the Midwest). Sometimes I’ll talk about my grandparents being from Russia and the Austro-Hungarian Empire.   And sometimes I shrug and say I’m a linguistic showoff, because I am.

If they ask me why I speak Spanish, I just say it’s good business.

Many but not all the Natives from the Bands close to here come from the Naa Dene linguistic tradition. So I greeted one of my patients today with, “Daa natch’eyaa,”  meaning, “How are you?”

“Sa’atch’ee,” came the reply, meaning, I’m fine. As I prepared the injection, he asked, “What kind of white man are you that you speak our language?”

“Aalk’iidaan,” I replied, “Shi naalnish Toohaajaalehidi. A long time ago I worked with the Canoncito Band of Navajo.”

Navajo language belongs in the same group as Naa Dene, with some important differences.

Being a linguistic showoff, though, I couldn’t stop there. I asked the Naa Dene word for goat.

It took me three weeks to learn the first consonant in that Navajo word. The linguists use the ! to represent the click, to the best of my knowledge, the only click outside of Africa.

My patient didn’t want to look surprised when I repeated it accurately, but he did.

 

 

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

August 14, 2017

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

August 13, 2017

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

August 12, 2017

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

July 31, 2017

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.