On the plains I worked for a week
The enjoyment was close to my peak
A lot of folks I befriended
But then the need ended
And new work I’ll now have to seek.
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 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. Last winter I worked western Nebraska and coastal Alaska. Getting my wife’s (benign) brain tumor treated took a large part of the summer, then a week each in urban Alaska, Pittsburgh with family, and western Nebraska. Any identifiable patient information has been included with permission.
A week passed quickly on the plains of Western Nebraska.
A respiratory virus, looking for all the world like influenza, with fever, cough, and ache, but also with runny nose, and lasting the better part of a week, provided 1/6th of my clinical material. I really didn’t do anything for those patients except recommend Tylenol, fluids and rest.
Seasonal respiratory allergies accounted for an equal number. My two favorite drugs in that regard, Zyrtec and Flonase, now available without a prescription, have high quality evidence to support their use. Still I gave instruction on how to use Flonase based on personal experience.
I took care of a patient with an agricultural injury, and, in the process, learned about Stewart’s Wilt, an important corn disease, which originated not far from where I worked.
I sent two patients to the new MRI, and, surprisingly, both scans picked up significant pathology.
I didn’t get a chance to take care of any hospitalized patients, but I did get the chance to talk to a couple of new doctors with a passion for rural medicine.
I had a wonderful conversation with an Army linguist, and found Arabic has 3 Hs. I got to talk about how Navajo has the only click outside of Africa (the initial consonant in string and goat, the middle consonant in blue). We had a marvelous time tossing jargon back and forth and singing praises of Rosetta Stone.
I used my massage skills to make one of my patients better before leaving the clinic.
I started a complicated endocrine investigation, and will probably not know the results.
I kept at least one patient out of the hospital with Gatorade.
One twelfth of the patients came in with dermatologic problems. I recounted the remarkable experience my son-in-law, my daughter and I had at a Continuing Medical Education event in Pittsburgh, where the lecturer announced that we can now treat pityriasis rosea (with the same antivirals we use on herpes viruses). He went over his daughter’s experience with a red rash in a “Christmas tree” distribution just before her wedding, with no time to change her backless, strapless wedding gown. He told her nothing could be done; twenty smart phone minutes later she showed him his error.
All in all, I took care of 36 patients, the same number I used to consider optimal for a day’s work in private practice. In those days clinic hours went 9 to noon and 1:00 to 4:30, with two hours dictation after supper.
I had a great time. I bonded well with staff and patients, but, towards the end, though the installation might invite me back when one of their docs takes a vacation, I realized they don’t need my full-time services now. My experience exemplified the success of the locum tenens concept.
I even got out a couple of hours early. On a Friday afternoon.