Posts Tagged ‘GPS’

Spanish at the dairy

November 17, 2016

The cows they are many, the workers are few

Spanish is spoken by all of the crew

I just love a caper

With records on paper

The time in the morning just flew.


Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, I am back on the job in western Iowa. Any identifiable patient information has been included with permission.

Yesterday morning my first email asked me if I would mind going to do dairy workplace physicals. I would get two nurses, records would be on paper, and business would be conducted in Spanish. I asked how much I’d have to pay; the clinic manager laughed.

I saw a win-win-win situation.

This morning I checked Googlemaps and put the address into my GPS. I didn’t think anything amiss until she had me turn right at the edge of town.  Which didn’t quite look like what the map had shown.  I followed the electronically feminine voice until she told me I’d arrived at my destination.

I looked around at a plum thicket, some pasture land, and a grain bin. Definitely not a workplace.

The first person I passed, a trapper throwing a muskrat into his truck, shook his head, and gave me some convoluted directions. As I made the first indicated turn, I hailed another driver approaching.  He got out of his pick up when I asked directions.  He shook his head, too, and then he laughed, and asked me if I’d used a GPS.  I had to admit I had.  Such electronics, he said, don’t work on country roads, and he’d seen plenty of others, including semi drivers delivering goods, make the same mistake.  From his economy of delivery, I could tell the directions he gave had been given dozens of times before.

Three miles later, I got onto pavement, then back onto a dirt road, and arrived at the dairy.

The two nurses preceded me. Halfway through set up, we discovered we didn’t have disposable paper to cover the conference table to turn it into an exam table and we had to phone for a roll.  But I ran through the questions with the first patient, and started the exam.

The learning curve lasted 3 patients, then we fell into a rhythm.

Eighty percent of the physical abnormalities occurred in the head and neck, several serious enough to require follow-up. Not surprisingly, like most American patient populations, I dispensed a lot of advice on binge drinking, tobacco cessation, and dietary restraint.  But every dairy worker gets an enormous amount of exercise, and I didn’t tell anyone to get more.

About half the people came from Guatemala, half from Mexico. We had a good time talking about Mexican cooking.

I learned that the dairy milks more than 3,000 cows twice daily and that the milk gets hauled less than two hours.

When I asked what work they’d done before coming to Iowa, I got surprises. At least two (who gave me permission to write this) finished veterinary school in Mexico.  I didn’t understand what they told me about licensing (after all, I’m 20 months into trying to get a Canada license and I couldn’t explain what I’d learned in less than an hour), but I found out that the three most common diseases they see are pneumonia, mastitis, and laminitis, a problem with the hooves.  Others had university degrees in other areas of expertise, and all wanted to learn English.

I recommended Rosetta Stone.

We finished 15 complete physicals by noon. I lunched at the restaurant the workers recommended.

I make better enchiladas.


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.

Terrible traffic and courteous drivers, narrow lanes with gorgeous vistas, impossible situations with competent bureaucrats. Caution: contains 1100 words.

March 26, 2011

I started orientation

On the verge of final frustration

    Without enough slumber

    I awaited my number

And at last I got registration

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.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Leigh, New Zealand, hoping to start work next week. 

I slept poorly last night because of anticipation of my weekly Care Initiatives Hospice meeting, my orientation to the new clinic, my interview with the Medical Council of New Zealand, my appointment with Immigration, and the need to move at the end of the day.

We have no net access in the beautiful town where we’re staying; running out of megabytes and the noise of passing trucks marred my Skype session and jangled my nerves as I sat outside the only wireless hot-spot available, a half-hour away from our apartment.

At orientation, in Wellsford, I filled out more paperwork, came up short on the professional liability issue, the work visa, and the medical registration number.

I have been struggling with those three issues since I arrived.  Before I can have a license, the Medical Council of New Zealand wants to see me, with my original medical school diploma and my passport in the same place at the same time.  Most days dawn with the expectation that Today Will Be The Day and end with hope for tomorrow.  Four days ago frustration replaced anticipation. 

My license hung up a week ago on the fact that the hard copy Certificate of Good Standing from one of my State Medical Boards hadn’t arrived. (When I made my overseas call to investigate, the person who sent it out muttered he always had problems with overseas mail.) 

The process involves a three-way Catch-22: to have a job, one needs a license and a visa; to have a visa, one needs a job, which also requires a license; to have a license, one needs a job.  Because 40% of the doctors in New Zealand come from other countries, physicians rate enough flexibility to render the task possible.

The manager of the twelve doctor operation, Sara, glows with professionalism; calls flew back and forth, and by 11:15 I had my invitation to meet with the Medical Council in Auckland.  I could visit Immigration first as long as I had the invitation in hand.  We headed out at 11:30.

The drive took an hour and a half, through spectacular vistas. 

Auckland , New Zealand’s biggest city and four times larger than the capitol, Wellington, boasts 1.4 million people.  As with any other city that size, the traffic problem drives many to insanity.  The hyper vigilance engendered by accommodating to driving on the left didn’t help me, though the courtesy of the other drivers did.

Our GPS guided us to the proper spot but couldn’t find us a parking place.

Twenty traffic-crawling minutes later, Bethany guided me into a parking spot in a facility designed for very small cars being driven by really good parkers.

Downtown Auckland appears to be vigorous, energetic, young, and Asian, with a few Maori and Pakeha thrown in.  Sushi, tandoori, curry, and kebab restaurants crowd against banks, electronics shops, and fashion stores. 

Immigration rules from the fourth floor of a high-rise office building.  I heard languages from Korea, China, Japan, India, Germany, America, and Australia.  Dress ranged from business suit to blue jeans, footwear from flip-flops to oxfords to hiking boots.

After a fifteen minute wait in line I approached the counter with my green plastic folder full of paperwork.  Three people handled the stack, assured me that all was not in order, I would need to leave my passport, and they would send me my visa in a couple of days.

I called my agency in a panic from the counter.  “This is anything but a walk in the park with a couple of rubber stamps that you promised,” I said.  “I can’t leave my passport, I need it when I meet with the Medical Council.  They tell me you need to call Carl.”

I was told to sit down and calm down and wait.

We waited.  In the early afternoon, I knew from long experience, sleep deprivation hits after the morning hormonal surge has left.  Worst case scenarios ran through my mind, and I started to figure.

There is much to be said both for never giving up and for knowing when to quit throwing good money after bad; such is the basis of game theory.

“If I’m not working in a week,” I told Bethany, “we’re going home.”

“You sure you want to give them that long?” She asked.

“I’m figuring time investment as a percentage of time spent working,” I said.

We waited another hour.  I called my agency.  “Nothing is happening.  I’m getting upset,” I said.  Just before I said I’m giving this up as a bad bit of work and I’m going home and the heck with you, a grizzled office veteran called me.

Smiling, courteous, and professional, I relaxed in his presence.  He explained the hang-up and the work-around, and called me back to desk 6.

Two more people handled my packet, and ten minutes later, with the hologram-decorated visa pasted into my passport, we left.

Polite drivers let me edge into the crush of Auckland’s rush hour.

I faced reminders of home: lanes as narrow as the Pennsylvania Turnpike and Jersey barriers.

We arrived ninety minutes early in suburbia marked by young trees.

I power napped and brought out my computer while Bethany slept beside me.  At 5:15 I met with a Justice of the Peace who looked over my papers, handed me a 250 page tome “Medical Practice in New Zealand,” and assured me that five working days was optimistic for a license number.

Waiting for traffic to abate, we ate in a food court and I bought work shirts.  We drove out of the city, back out into the verdant countryside as darkness closed around us and a drizzle fell.

By the time we got back to Leigh the clouds had opened and rain fell in sheets.  Traveling light brings the advantage of quick packing, and before nine we had unloaded and unpacked into an incredibly gorgeous beach house with a view.

Eighteen hours later I had my license number.

This post was written on Thursday, not posted till now because of internet access problems.

Of leisure skills, Hospice, coq au vin, Barrett, Ellington, and drug reps

January 7, 2011

I sent patients from Hospice alive,

I visited my old clinic hive.

     So that I’m not alone

     I got a new phone,

And served dinner at fifty past five.

I started my day by getting a new phone.

I had to replace the old one with a smart phone that would let me use a drug database.  It can also function as a camcorder, take excellent pictures, act as a GPS, remember more music than I’ve had time to listen to in my life, and browse the net.  I rate it Pretty Miraculous, but I realize I’m starting at the bottom of the learning curve and that it can do a lot more.  I’ve missed every call I’ve gotten so far today because I changed my ringtone.

I did well at my saxophone lesson.  My teacher, Diane, and I played some pretty great music; we did a duet by Barrett and it came out well.  Then we jammed some Ellington.  I allowed my analytic hemisphere rest and I let the horn find the notes.

My teacher continues to be a beacon of life lessons.

I stopped by the Clinic Formerly Known As Mine, I got lots of hugs and told my tales.  I also ate the lunch the pharmaceutical manufacturers’ representative brought, but I didn’t talk to the rep, and as I walked away from the clinic I realized that in the last eight weeks, the amount of time I hadn’t spent talking to drug reps totaled forty hours.   On the other hand I know of four new drugs on the market that I need to learn about, possibly more.

I’m still the Medical Director at Care Initiatives Hospice; while on my epic road trip I attended meetings by Skype.  Today I enjoyed having a real meeting.  I feel we do a good job; we let another patient out of Hospice alive.  We cut dosage or eliminated a medication six times.  A Hospice meeting brings lessons in the human condition, eternal verities about drama and irony, and, as always, great stories.  I won’t write those stories because demented people cannot give their permission.

Back at home I cut up chicken hindquarters.  I poured tablespoons of garlic salt and black pepper into half a cup of flour.  After dredging the chicken in the flour, the pieces browned nicely in canola oil at the bottom of a Dutch over.  I took the pieces out and dumped in a pound of sliced Portobello mushrooms  and two chopped white onions.  After sautéing those till the onions were translucent I put the chicken back in, dumped in a bottle of white wine, and pressed in a dozen cloves of garlic. The covered pot went into a 350 degree oven.  Two hours later the house smelled lovely; by then I had two loaves of take-and-bake baguette bread ready, and the rice cooker had done its job.

Our friends, Dolf and Mercedes and their children came over for dinner.  They talked about the Florida adventure they’d just been on and I told about my 6000 mile, 7 week road trip.

Dolf has a strong work ethic but he also possesses an enviable set of leisure skills.  About a year ago I went to him for advice in that realm.  He said, “I got one word for you:  practice.”

I’m taking his advice.

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.

Of chest pain and delusional GPS units

October 30, 2010

The chest pain is the worst part

Though a work-up was done at the start

     I’m out here in rural

     So I got a referral.

The problem, I think, is the heart.

I call my GPS unit Sweetheart.  Most of the time she (she speaks with a feminine voice) reliably gets me from place to place. 

Once in a while she loses contact with reality; while Bethany and I were driving from Anchorage to Fairbanks, north of Denali she became quite confused and wanted us to turn left when all we could see was roadless moose, bear, and wolf habitat.

I drive 1.3 miles from my hotel to the clinic where I work, and most of the time Sweetheart guides me correctly.  About one-third of the time, in one particular segment of the drive coming or going, she gets confused and tries to have me do maneuvers ranging from U-turn to cloverleaf.   I’ll usually say something like, “Are you sure, Sweetheart?  Did you take your medicine today?”  I’ve now learned the route, and the places where she becomes delusional, and I’ve taken to not turning her on to get to work.

Friday afternoon I took care of a third grader, whose mother gave me permission to include the information below.  With a main complaint of cough, he has a long history of chest pain and pallor with exertion.  Sometimes if he plays too hard he has to stop and rest.  His cough started with one of those episodes.

The mother read the alarm on my face, assured me the patient had been to a pediatric cardiologist, and described a thorough work-up.

The mother and I agreed in our lack of comfort with the situation and the desirability of a second opinion.   I called one of my colleagues and friends, a pediatric cardiologist in Sioux City.  I gave him the story and he accepted the referral.  Then I told him why he hadn’t heard from me since May, what I’d been doing and where I’d been going.  I explained that my non-compete clause doesn’t apply thirty miles away from Sioux City.

After we hung up I gave the mother the doctor’s name and phone number so that she can call and schedule an appointment.

Then I did yoyo tricks for the patient.

No doctor practices in a vacuum, all of us depend on a referral network; I’m most comfortable sending patients to doctors I know and trust.  In this case, I didn’t know the pediatric cardiologist the patient had seen, but I knew the history sounded like a heart problem.

There is no substitute for thinking things through.  No matter how good your GPS unit, you still need to watch where you’re going.

Linguistic encounters over breakfast

August 13, 2010

What language did they really speak?

It wasn’t Hebrew or Greek

     I wouldn’t leave them alone-a

    They were from Barcelona

My Spanish unpracticed was weak.

This morning we heard a couple at a gas station not speaking English.  Both were dark in complexion; the woman had curly hair and a Mediterranean nose; the man was tall and slim, clean-shaven with very short hair. 

I tried not to be obvious.  While I was under the hood, checking the oil, I leaned over to Bethany and said quietly, “Are they speaking Hebrew?” 

She listened and shook her head and said, “Slavic, I think.”

We saw them again at breakfast.  We kept trying to catch enough of their conversation to get a fix on the language.  I didn’t hear the gutturals of a Semitic language or the nasalized vowels of a Slavic language.  It certainly wasn’t Italian or Greek.

They spoke quietly, clearly having a good time and cracking jokes. 

Every time one of them spoke loudly enough and clearly enough, background noise spoiled the reception. 

After the meal I leaned over and said, “Going to Fairbanks?”

Now Alaska Highway 3 only has two destinations for rental cars: Anchorage or Fairbanks; my question was a fairly obvious bet.  Yes, they were going to Fairbanks.

I’ve just been in Barrow for eight weeks, I said.  They asked, Barrow?

I pointed out the village at the top of their map.  They were impressed.  I explained that the only way to get there is airplane or barge.  Then I got to ask the critical question: Where are you from?

A lot of visibly ethnic people in this country object to that question, as many Americans will assume that Asians aren’t really from (for example) South Dakota.  Tourists aren’t so sensitive.

They were from Spain.  I immediately opened up with my Spanish.

The story of my acquisition of Spanish fluency runs long; the short version is that I learned in ninth grade and the only time I quit practicing was the time I spent in Navajoland.  For the better part of twenty years, half my working day was in Spanish.  When I left Sioux City I spoke much better Spanish than when I was just fluent.

This morning, after ten weeks in Alaska, my tongue felt clumsy, and I didn’t change my accent to match theirs.

Then the couple revealed that they’d been speaking not Spanish but Catalan, a Romance language as closely related to Spanish as Portuguese; Spanish was their second language. 

She works in a non-governmental, nonprofit organization; he does information tech for a hospital.  They flew from Frankfort nonstop to Anchorage.

We drove on to Fairbanks, and our GPS unit, evidently confused by something, kept telling us to take a sharp left into the boreal forest.  We turned her off.

En route to Fairbanks we stopped at an overlook and saw fires burning along the Tanana river. In Fairbanks proper, Bill, a Native we met, guided us to the visitors’ center, a well-built facility near downtown.  We got city maps, directions to our bed and breakfast, and toured the exhibits.  I bought a zipper pull made of walrus ivory from a Native artisan.

At the moose antler arch, Fairbanks Visitors Center


The prosaic part of the journey came at the Laundromat, followed by a movie.

We haven’t been to the movies in three months.  We enjoyed the comedy and being together.