Archive for the ‘Road Trip’ Category

Road Trip 8: Fantasy bare-bones formulary

November 18, 2014

For our tools, the meds are the core
I used to use way less than a score
Is a need demanded
Drugs that were branded?
Saying “no” is really a chore.

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. I just returned from a road trip, to visit family and friends and attend a Continuing Medical Education conference.

After the Continuing Medical Education ended, two daughters and one son-in-law accompanied me to sushi lunch, followed, naturally, by dessert.

The ice cream parlor sat in a building that had previously housed a drug store. Closed in 1979, the interior stayed intact until the building sold to new owners who rehabilitated it and decorated it with stuff that had remained from the pharmacy years.

We observed the lack of variety in the drugs that graced the shelves, and soon the two physicians (my daughter and I) dominated the conversation with the question: If you were Minister of Health for an impoverished, small island nation, what drugs would you have on your formulary if you could only have twelve?

We started with pain relief, my younger colleague wanted ibuprofen and acetaminophen (Motrin and Tylenol); and for high blood pressure lisinopril and metoprolol. I agreed with acetaminophen and lisinopril, allowed as how I could live with metoprolol but would prefer carvedilol (in the same class of high blood pressure meds, but also useful in heart failure), and didn’t want ibuprofen at all. “Too many side effects,” I said, “Ulcers and kidney damage and such.”

Diabetes, I declared, should be met with metformin; she would prefer a long-acting insulin. And I could see her point. A long-acting insulin would at least keep the Type I diabetics alive.

I kept looking over her shoulder at the few shelves lined with medication bottles. I remembered, during residency, checking out the 1979 Physician’s Desk Reference and comparing it to the 1980 edition and thinking how small the earlier version looked. With more than 4,000 pages verging on folio size, the current edition dwarfs both put together.

What about antidepressants? We agreed on citalopram. Antipsychotics? Haloperidol (brand name Haldol). Sleeping pills? I voted for trazodone as a triple function drug, useful for depression, chronic pain and sleep.

For antibiotics, we agreed that if we only used amoxicillin sparingly, resistance to it would fade. I wanted another one in addition, such as doxycycline or azithromycin. And I shook my head; doxycycline has gone from $.04 per pill to $3.50 per pill. I asked, What about mupirocin (a topical antibiotic) but the question went unanswered.

If we hadn’t forgotten about thyroid disease, I would have suggested levothyroxine. But we finished our ice cream and went out into the afternoon sunshine. “You know,” I said to my daughter, “In the last three years, working at a Community Health Center, I know there are a lot of really neat new drugs out there, but I don’t prescribe many. Do you write for much in the way of branded meds?”

“No,” she replied, “About the only drug that’s on patent that I prescribe is Plavix (which helps prevent blood clots).” She recounted a conversation with a salesman representing Oxycontin; neither of us prescribe it at all. The rep had asserted the new reformulation made it less addictive. We laughed. A drug like that doesn’t need a rep.

During residency, I clearly remember the program director teaching us that most doctors use fewer than 20 drugs. Pick one from each class, he said, and get familiar with their side effects and their interactions. But he taught us those things before the Information Age and the Internet.

We got in the car. “What about asthma?” I asked.

“We’d have to have albuterol,” she said.

“And prednisone?”

“Yeah, I guess we’d have to have prednisone,” she said.

I suggested single 20 mg tablets scored with three lines on one side and four on the other.

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Road Trip 7: three days of Continuing Medical Education in Pittsburg

November 9, 2014

For pills the pain to abate,
Please limit the number to 8
Is there to be an excuse
For narcotics abuse?
And tobacco opens the gate

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. Right now I’m on a road trip, visiting family and friends and attending some Continuing Medical Education.

Every Family Practitioner, in order to claim the title Board Certified, has to take 50 hours of Continuing Medical Education (CME) yearly. Today I finished up a three day conference in Pittsburgh, Pennsylvania. I picked this venue so as to attend with my daughter Jesse, and her husband, Winfred.

The thrill of having my daughter and son-in-law as colleagues in this experience permeated the weekend.

The first day, Friday, I spent improving my well child checks. I found little new information, but that doesn’t mean I’ll pass the online test the first time. One of the presenters deserved the designation gifted teacher, a dynamic speaker who convinced me at every turn that I could master the material.

Yesterday a former DEA agent brought in the bad news about America’s epidemic of narcotic abuse, but more importantly told us what we could do about it. I found most interesting the fact that for new, severe pain, such as burn or broken bone, the average number of pain pills taken comes to 8; the others in the prescription hang around the medicine cabinet till some teenager pops them to see what happens. The presenter made the very good point that the doctor needs to make sure the drug prescribed goes into the right patient, whether it’s an opiate or an antibiotic.

Immediately after that I learned about the complicated new process to keep my board certification current. I still need 50 hours of CME a year, but I also need to complete three other projects every three years. An unnecessarily complicated process, the lecture took 45 minutes. I’ll be calling the helpline later this week.

And new information kept rolling in.

Human Herpes Virus 6 (you’ve heard of 1 and 2) causes pityriasis rosea, also known as the Christmas Tree rash. Acyclovir shortens duration of symptoms by 3 weeks. Three of us turned to each other in amazement; none of us had known that. Never assume that nothing changes, the lecturer said; the smartphone in this case saved the patient.

Sometimes a growing adolescent’s hip loses the growth plate, we call the condition slipped capital femoral epiphysis. To diagnose on physical exam, lay the patient supine, and passively flex the hip; if it has to rotate outwards, the patient will probably need surgery.

Road Trip 5: vegan lunch and free advice

November 5, 2014

Sometimes over coffee or tea
People want my advice, just for free
If they ignore what I say
I ask them to pay
But I’ve never collected a fee.

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. I used vacation time to do two short assignments in Petersburg, Alaska. Currently on a road trip, I left the Community Health Center last month because of a troubled Electronic Medical Record (EMR) system.
Wherever I go, people, on finding out my occupation, will ask me for free medical advice. I tell them if they take the advice, it’s free, but if they ignore it, they’ll have to send me payment.
Lunch today was no exception. I won’t go into the details of the case, even though the patient gave the information in public in front of an audience. The gastrointestinal symptoms had persisted for decades.
I always start with a good history, so as we dug into our gluten-free and vegan fare, I asked the basics: when did it start? Where do you feel it? How bad is it? What happens? What is the character of the pain/smell/discharge/problem? If it comes and goes, how long does it last and how often does it happen? What makes it better? What makes it worse? What have you tried that helped? What have you tried that didn’t help?
The luncheon café setting precluded doing any sort of physical exam beyond that inherent in conversation.
I never prescribe medication in such situations, though sometimes I advise the patient check with their doc to discuss lab or drugs.
Mostly I do non-pharmacologic therapy.
I usually start with ABCD: always blame the cotton-pickin’ drug, thus stop nicotine, caffeine, alcohol and any recreational pharmaceuticals. Then I start into the med list.
Most diseases fall into a spectrum of severity, and proper attention to sleep, diet and exercise can shift almost any medical problem into the less severe range. So sections of advice overlap, because nicotine, caffeine, alcohol and recreational chemicals murder sleep. Some fun pharmaceuticals (such as alcohol and marijuana) bring on sleep but suppress the most restful phases, delta and REM. Thus leading to chronic fatigue and loss of emotional resilience, and thus they make any disease state worse. In particular, I said, if the mind stays out of balance, so will the intestine, as all neurotransmitters (chemicals that carry messages in the brain) have receptors in the gut.
I also recommended a week’s trial of the Prune Water Protocol: put a prune in a glass of water and leave it by the side of the sink till you go to bed, then drink the water, eat the prune, and brush your teeth. Repeat twice daily. A lot of chronic digestive problems come down to chronic constipation (usually from incomplete emptying), and I haven’t met a case of non-malignant constipation that resisted the Prune Water Protocol.
The patient may or may not follow my advice, but certainly won’t pay me.

Road trip 4: with my brother in Woodstock

November 3, 2014

If addiction is the sum of all fears,
Do we wait till it all comes to tears?
Or is our prediction
Of a bad prediliction
Towards the whiskeys, the wines, and the beers?

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. I used vacation time to do two short assignments in Petersburg, Alaska. Currently on a road trip, I left the Community Health Center last month because of a troubled Electronic Medical Record (EMR) system.
I dropped my sister, niece, wife, and stepmother at the Long Island Railroad station, put my brother’s address into Samantha, my GPS, and set off for upstate New York.
My brother, an artist, recently moved into a very nice house near Woodstock. As the wind picked up and the temperature dropped, we walked around his acres. I gave him my amateur pomologist’s opinion of his aging apple trees. I looked at the standing but dead timber around the property and did some onsite surface archaeology. His girlfriend joined in the discussion of planting fruit trees.
We talked about our careers over sushi in town. Freelancing for an artist bears similarities to locum tenens for a doctor, especially in terms of contract negotiation. We agreed that inability to at least appear to be willing to walk away from a deal ruins a negotiating position. I detailed my recent untoward experience with a recruiter low on professionalism.
My brother recently studied hand anatomy. I brought to his attention how much all seven siblings’ hands resemble each other.
Later, at his house, we sipped at small quantities of very expensive bourbon, and brought up the subject of addictive disorders in our own lives and in our family.
The key to recognition of an addiction is continuance of a behavior despite adverse consequences, especially missing social commitments.
I put forth my analysis of taking call as an addiction for doctors. He pointed out, correctly, that insight rarely creeps into addicts’ lives. Then we tried to figure out which behaviors qualify as addictions.
I talked about a friend who works as an alcoholic; his business relies on selling wine and spirits. He starts drinking when he gets to work and stops when he gets home; it doesn’t interfere with his work, but, still, that doesn’t keep him from the diagnosis. And it might make bring new depth to the term workaholic.
Our conversation turned to sociopaths and the problems society has from those who enjoy other people’s pain. Probably those people tend to certain professions, including police, corrections, military, and, regretfully, medicine.
Then I started telling jokes. All seven siblings share a quirky, off-the-wall sense of humor; we bring quick, easy laughs to all conversations. My ability to remember and effectively tell jokes remains as rare in our family as it does in general.

Road Trip 3: Thick New York traffic while listening to the collapse of societies

November 2, 2014

The traffic makes New York a mess
Despite a new GPS
But I got quite annoyed
The tolls to avoid
Added 10 hours, more or less.

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. I used vacation time to do two short assignments in Petersburg, Alaska. Currently on a road trip, I left the Community Health Center last month because of a troubled Electronic Medical Record (EMR) system.
Just before leaving Sioux City, I bought a new GPS unit for the trip. I named her Samantha.
Sweet heart, the GPS who guided us through my year of walkabout, had psychotic tendencies. From time to time, her screen would turn purple and she would demand a left turn in inappropriate places, such as boreal wilderness or the middle of a bridge. The simple universal Microsoft fix, turning off and turning on, worked well, but she took to losing contact with reality so frequently that we retired her and gifted her to a friend who rarely leaves town.
We bought her successor while in route to St. Louis, but I ruined her by attempting an update.
With the passage of two years, all car GPS systems have improved. Samantha gets traffic updates (I don’t know how) on a regular basis. I advised her in the beginning I didn’t want her telling me to make U turns, and when I left Pittsburgh, to get her semiconductors to avoid the Pennsylvania Turnpike, I told her to avoid tolls. Thus I got onto I-80 but didn’t realize I’d added 600 miles to a 300 mile trip till the middle of northern Pennsylvania.
With leaden skies over spectacular fall colors I proceeded east, and traffic thickened. Road kill possums, raccoons, and deer by the dozen lay in mute testimony to Newtonian physics.
Still, I maintained good average speed till the George Washington Bridge. Appropriately, I listened to an audio book on the collapse of societies while idling in coagulated traffic. I thought about Adak Island, where, less than three weeks ago, we marveled at seeing four vehicles moving at the same time. I decided that between the approaches and the span proper, the GWB held more pavement than the entire island where I’d hunted caribou, and possibly more than all of the Aleutians put together.
With jangled nerves, I picked Bethany up at the airport. Exiting proved beyond Samantha’s capabilities. With the experience of three laps through the maze, we figured it out.
I hope to drive in New York City as little as possible.

New Zealand Roadtrip 4: to Dunedin and the yellow-eyed penguin

June 11, 2011

To penguins, every and each
Here is a lesson to learn and to teach
After a day fishin’
The mating fruition
Starts off down at the beach

 
Synopsis: I’m a family practitioner from Sioux City, Iowa. On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places. We’re touring after a month-long assignment an hour outside of quake-stricken Christchurch, in New Zealand’s South Island. We’ll be back home, Good Lord willing and Missouri River behaves, in a day and a half.

 
The ferry brought us from Oban on Stewart Island to Bluff as the sun set; we stayed the night at the outskirts of town.
We drove the next morning from to Dunedin, coming in from the south, and plotted our departure day moves. The airport sits thirty kilometers from the city center; we checked with the rental car office about dropping the Hyundai off early.
In the city center we enquired at the I-Site for penguin viewing, and booked a guided tour on the Otago Peninsula.
With plenty of time, we set out using the low-detail map from the tourist center, but having no directions to Penguin Place. In Portobello, faced with a Y intersection, we made the mistake and took the literal high road. The name Highcliff Road should have tipped me off.
I think the world of Kiwis but hold low opinions of their roads. Highcliff Road, winding sharply high above steep drop-offs, would have been bad enough. Younger men with no trauma experience might find the drive exhilarating; I found it terrifying. With loose gravel, grossly inadequate lane width, and no barriers, I soon found myself straddling the white line, until it gave out and, without the option of turning around, I continued on asphalt narrower than the infamous Oil Strip of the Nebraska Sandhills. At one point I faced an oncoming Mercedes, with a driver either overconfident from untreated mania or just careless because he had the inside lane. With my outside wheels on the ten-centimeter shoulder, I cleared his rearview mirror by millimeters.
We finally descended to sea level. At Penguin World we met eleven other tourists from New Zealand and Asia. We got a look in the penguin hospital, and we went out to the viewing area to see the wild yellow-eyed penguins.
At this time of year, when the short days limit the amount of time the aquatic birds can spend fishing, they leave land early in the morning, eat all day, and return in the evening. We walked the trail through the replanted native bush, and saw a little blue penguin (the smallest species) in its burrow and not looking well. Without moving, we saw two fur seals lounging on the dune grass, and the yellow-eyed penguins coming onto the beach with the waves.
Our guide discussed the seasonal mate selection process of penguins, and called the gathering in the surf a “beach party.” First three, then six stood on the beach just at the high edge of the waves, representing one percent of the earth’s total of yellow-eyed penguins.
Penguins mate monogamously but divorce; the rate runs much higher in the emperor penguins in Antartica, which maintain closer contact because of the cold. The yellow-eyed penguins spend less time together and have a lower divorce rate. They sometimes form same-sex unions.
I suppose there’s a lesson about human behavior, but I’m not sure what it is.

New Zealand Road Trip 3: Haast, Bluff, and Stewart Island

June 11, 2011

To Stewart we took the ferry

We arrived and longed for the prairie

     From New Zealand to Nome

     There’s no place like home

We’ll fly with no help from a fairy.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places.  We’re touring after a month-long assignment an hour outside of quake-stricken Christchurch, in New Zealand’s South Island.

We drove south from Paparoa and Bruce Bay, along New Zealand’s southwest coast, down the loneliest stretch of highway either of us could remember.  So little traffic passed we saw no other cars for thirty minutes at a stretch.  Two sheep wandered outside their paddocks in evident safety.

Despite Southern Hemisphere’s  fast-pproaching  wnter, though we drove further south than Minneapolis lays north, the temperature stayed above freezing.  We filled the tank in Haast at the slowest pump I can remember, requiring a quarter-hour for six gallons (twenty-four liters) while I swatted at biting black flies.

Rains forests require rain which biting insects love; no surprise that flying blood suckers abound in the environment.  They’re just doing their job.

Further south we lunched in Queenstown, a mountain resort that reminded Bethany us of the tourist glitz in Keystone, Colorado, complete with a huge lake.

On south we went, further south than either of us had ever been before, and stopped in Kingston, the only guests at a motel that would have charmed if we hadn’t had to wrap ourselves in blankets to play Scrabble.  New Zealanders don’t think much of central heating; during the few cold months many heat with wood, a few with coal, but hostelry relies on space heaters. 

Further south yet, through Invercargill to Bluff, the southern tip of the South Island and famous for its oysters.  We walked from the Drunken Sailor car park further south, to the point, and looked across the water to Stewart Island.

The author inspects a sign post in the parking lot of the Drunken Sailor

We took the afternoon ferry there, landing at sunset.  The usually laid-back Kiwi attitude slows to the speed of the tides on Stewart Island and outside the tourist season they really relax.  One shop turned on its lights during the posted store hours of 1:00 to 3:00 but didn’t unlock its doors till 1:30.

Oban remains as the sole town on the island, with a year-round population of 600.  The rest of the island hosts the southernmost wild whitetail deer population in the world.  I briefly contemplated the irony and absurdity of leaving Iowa to hunt the same species that browses in my back yard.

Two hours before sunrise we awoke at the South Seas Hotel and walked out to Ackers Point in hopes of seeing little blue penguins, the smallest species.  Having made a mistaken detour into a sheep paddock in the darkness despite the use of the clip-on headlight I bought in Barrow, we arrived too late to see the raft depart.

We walked around town after breakfast, then went back to the hotel to sit in the midday sun, never more than halfway from the horizon.

“I’m ready to go back,” Bethany said.

“So am I,” I said, standing, closing my eyes and clicking my heels three times.  “There’s no place like home”.  I opened my eyes.  “We’re not in Kansas!”

“Nor in Iowa,” Bethany said.  “We still have to drive to Dunedin, fly to Christchurch to Wellington to Auckland to LA to Phoenix to Omaha and drive to Sioux City.”

Unprecedented rains and a road trip: if you can’t have a good time in bad weather, you need more pratice.

May 1, 2011

We got us some chocolate and such,

And the drive it seemed a bit much

     For the rain to endure

     On a short weekend tour

To visit a doc who is Dutch.   

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  I’m on assignment now  in Matakana, on the North Island of New Zealand, north of Auckland.

State Highway 1 crosses lush green plains and negotiates hills and escarpments with alarming curves.  I would have loved the drive at age twenty-two with a Porsche and assurance of immortality.  Some wisdom and game theory application  induced us to stop in Kerikeri, at a quality motel at a reasonable price and surprise free drink. 

Next morning we checked the local grower’s market.  We found familiar vegetables with unfamiliar names; courgettes, aubergines, and capsicums correspond to zucchini, eggplants, and bell peppers. 

An avocado grower offered small Hass for $.50, large for $1.00 and seconds for $2.00 a bag.  We looked at each other and remembered a road trip thirty years ago.  Newlyweds with our first child on the way, we bought a bag of defective avocados with tiny pits at a farm stand in south California.  One or two ripened a day as we toured Indian Health Service sites on our way back to Wyoming.  Remembering how we relished each one, I handed over a $2.00 coin.

 We talked to a Japanese orchardist with a passion for persimmons.  We had never tasted one, and had no idea how to eat them.  The Pakeha bloke selling cold-pressed olive oil at the next booth joined in the conversation; he recommended eating the skin, but the persimmon vendor disagreed.  In the end, we got two gratis, one soft and one firm.

Over breakfast in a café we read New Zealand newspapers.  I skipped international news and read about a fatally battered child, a lawyer caught driving drunk, an internationally recognized Kiwi woman caught with five kilograms of cocaine in her suitcase in Argentina, political maneuverings, and a woman who uses Facebook to lure fifteen-year-old boys.

Before we left town, we stopped in (another) chocolate factory and couldn’t find a meeting of Chocoholics Anonymous, so we bought chocolates.  It’s not like we have a problem or anything…

The shop next door sells items made out of kauri, the huge trees that dominated New Zealand till a hundred years ago.  The world prized the fine-grained, knot-free, honey-colored wood.  Most of the kauri trees, like most of America’s redwoods, have been logged.  Until the stands reach sustainable numbers, fossil kauri (some 30,000 years old) provide wood for small items.

As we left Kerikeri, the drizzle strengthened, and the gentle breeze freshened to a strong wind.

We arrived in Mangonui in a heavy rain to meet with a Dutch doctor who had been through orientation with me.  We met his wife, his father-in-law, and the couple’s two young children.

The northernmost district of New Zealand, Northland, got pounded this week by unprecedented rains, up to half a meter (about twenty inches) in an hour, damaging infrastructure and closing the road to the north tip of the island.  Power shut town for eight hours today.

An unprecendented storm pounded northernmost district of New Zealand, Northland, with 50 cm(twenty inches) of rain in an hour, damaging infrastructure and closing roads.  Power shut town for eight hours today.

Most houses rely on electric pumps and tanks of rainwater.  Few outlying towns have sewage or water treatment systems.  When power goes out, houses lose water.

Our hosts made tea and coffee, brewed with water heated on a barbecue.  We drank while we looked out over Doubtless Bay, talking about children, scabies, Netherlands, dolphins, impetigo, family, vacations, appendicitis, Maori, pig hunting, tobacco, and alcoholism.

We talked about how great it is to work in the laid-back Kiwi culture, with a reasonable pace and a well-integrated cross-cultural experience.

We had a late lunch in Whangarei, a town large enough to host a teaching hospital.  The steady rain strengthened to a storm as we left town.   For the next three hours, rain fell in sheets when we could see it and winds buffeted the car and threatened to push us across the road, already damaged by record rainfall.

A seven-week road trip in review

January 2, 2011

As I welcome in the New Year

Let me make this perfectly clear,

     For this I can vouch:

     I sleep well on a couch.

Watch out for eagles and deer.

I am back in Sioux City after a six-thousand mile, seven-week road trip.  I stopped to visit family in Chicago, New York, Long Island, West Virginia and Virginia.  I saw friends in Iowa City, Pittsburgh, and Columbus, Indiana.  I worked for a month in Keosauqua, in southeast Iowa.  I took the Advanced Trauma Life Support course in South Bend, Indiana.  I relived memories in Illinois and Indiana.  I feasted Thanksgiving in Virginia with Bethany’s family.

Even outside of work, I gave advice about rashes, ears, coughs, nutrition, exercise, bipolar disease, depression, sleep, smoking cessation, alcoholism, sex, and plantar fasciitis.  I helped assemble Ikea furniture and I took stitches out of a dog’s leg.

I hunted deer in Iowa and I didn’t hunt deer in Virginia.

I discovered I like sleeping on a friend’s couch more than I like sleeping in a nice hotel, and that some sofas are more comfortable than some beds.

I ate out a lot.  Portion size nowadays suffices one person for two meals.  Chinese food varies a lot from restaurant to restaurant, which adds to its charm. 

I found out I drive long distances better at night than during the day, and that I never, ever want to drive in New York City again. 

I learned to recognize signs of psychosis in Sweetheart, my GPS.

I saw lots of deer and foxes (living and dead), llamas (all alive), migrating ducks and geese, a few grazing buffalo, dozens of soaring vultures, a piliated woodpecker, and a surprising number of eagles.

I worked in Keosauqua, Iowa, for a month and had a wonderful time; few things bring me as much pleasure as curing a person before they leave.  I like living close enough to work that I can walk; I love working with good colleagues.

Revisiting the routes I travelled when I hitchhiked in the sixties and seventies showed me that the road changes slower than society.   I found more prosperity now than I did then; I saw no hitchhikers anywhere.

Some people figure out things out with time, some people don’t.  A lot of people from my past turned out to be bipolar.  Drama and irony dance with the human condition; even orderly communities wrestle with grief.

Money doesn’t buy happiness but a good night’s sleep comes close.

The number of wind turbines I saw from the highway indicates our country’s energy policy shift towards the renewable.

I get better gas mileage and I see more things to write about when I drive 55 than when I drive 75.

I had a great time everywhere I went, but I like home the best.  I missed my friends, my wife, my house, my kitchen, and my bed. 

I make friends easily but I missed the friends I’ve had the longest.

I missed my social network.

I like geology.  I enjoyed looking at the exposed history of the earth in road cuts.

I missed cooking so much that when Bethany took a weekend and visited me in Keosauqua I cooked beef bourguignon. 

I missed speaking Spanish.

They say you can’t discover new lands if you never lose sight of the shore; I don’t think you can learn how much you love home if you never leave.

Road trip again: Keosauqua to Sioux City and back

December 11, 2010

Sit myself down?  Well, I might

With the short days I’m driving at night

     And when I arrive

    With a mileage dive,

This traveling thing is a fright.

The same week I drove back from the Advanced Trauma Life Support (ATLS) class in South Bend, Indiana, I drove from Keosauqua to Sioux City.

I left the quiet and peace of Van Buren County in the afternoon.  While the sun faded I navigated the county roads, and I hit the four-lanes in the dark. 

I’m getting better and better at night driving because I’m doing so much of it.  I’ve been road tripping for a month now, and while I saw my family at Thanksgiving I didn’t see them at home.  I grinned most of the way up Interstate 29, staying alert for deer and thinking of home.  I indulged in my favorite caffeine dosage form, dark chocolate.

I rolled into bed six hours after I left Keosauqua, revved up from the drive and the caffeine.  Still, I slept well because of the home court advantage: in my bed with my wife.

After Bethany left for work in the morning I attacked two weeks’ worth of mail. I prioritized the top five percent and threw the rest away.  I didn’t have a single personal letter to open.   The Post Office subsidizes junk mail by charging more for first class, thus the junk mail clogs our postal system.  The vast majority of my mail goes directly into the landfill.  The US Postal Service needs a competitor.

I went to a couple of banks with a month’s backlog of miscellaneous checks

At the blood bank they told me I’d have to wait till January 6 to donate blood.

When I stopped for gas I found my right front tire low at fourteen pounds, explaining the drop in gas mileage from 31 to 25.  I concluded I need to check my tires more frequently.

At Care Initiatives Hospice I signed paperwork, and learned that a third Hospice program will soon open in Sioux City.  I told the head Hospice nurse to send the competition a cake or something, to welcome them.  They won’t be taking market share from us, I said, the pie will just get larger. 

To explain why I would go to Storm Lake to meet the fellow from Sioux City who will make a brace for my right ankle would impose on the reader’s patience; the punch line comes down to timing.

On the way back to Keosauqua, Sweetheart, my GPS, had, well, problems.  I followed her instructions past a sign reading, PAVEMENT ENDS.  I turned her off, turned around, got out the pocket road atlas with a palm-sized map of Iowa, and reverted to celestial navigation, longing for a really good sextant.  Fortunately I had a clear night and bright stars. 

In the last week I’ve driven 1400 miles.  I arrived back in Keosauqua looking forward to not travelling till the end of the month.