Posts Tagged ‘Grand Island’

Two beepers, three phones: first night on call in Amberley

May 12, 2011

These days, the bag isn’t black,

Not one, they are four, each a pack.

      You can’t carry them far

     Unless you’ve a car

And for beepers there’s never a lack 

Synopsis: I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance from the brink of burnout, while my one-year non-compete clause ticks away I’m having adventures and working in out-of-the-way places.  Right now I’m on assignment in Waikari, a rural area in New Zealand’s North Island, an hour outside of Christchurch.

I took my first night on call. As I left the clinic in Waikari the nurse handed me four backpacks of medical equipment: one each with oxygen, resuscitation equipment, resuscitation medications, and immobilization devices like cervical collars.
My father, a physician, carried a black bag everywhere, even on vacation, and we, the children, couldn’t understand why he would do such a thing. I understand why now, and with greater understanding comes an adult’s disagreement.  A vacation needs to be a vacation, a time to rest and let go of vigilance.

An article 105 years ago in the Journal of the American Medical Association detailed what a doctor should carry so that lives could be saved outside of hospital.

The black bag has morphed into the 21st century in New Zealand.  The internal combustion engine assures the doctor that a hundred pounds of gear stays available. What would have passed for dead on the spot a hundred years ago has become salvageable.
In the US, doctors don’t get on-site trauma training. Few would go to the scene of an accident or tragedy.  Almost none make house calls, and the black bag remains a relic of the past.

Here, an on call doctor might respond to the site of a cardiac arrest or massive trauma car collision.

I made a house call in New Zealand for a post-op Maori patient.  Manicured grounds surrounded a well-maintained home down a long driveway.  (Most Kiwis take better care of their yards most Americans, and the homes, for the most part, are neater.)  I brought a stethoscope, but all I needed was good clinical judgement and compassion.

I arrived home today with two beepers clipped to my belt, one for each geographic district that I covered, and the clinic cell phone in addition to my NZ cell phone (still undependable) along with my American Droid. 

I haven’t carried a beeper for a year.  In Alaska the hospital provided a wonderfully reliable cell phone; in Keosauqua my cell phone coupled with my apartment land line served well.  With no call in Grand Island, I didn’t need any sort of after-hours communication. 

Yet I clipped the two hip-sucking parasites on my belt, and, as if they had never left, they felt right at home.  I shuddered.

With my five pieces of electronics and Bethany’s two, we went out to supper, and just as we walked up to the restaurant, my clinic cell phone rang.

I gave instruction about stopping bleeding from a cut that didn’t require stitches. 

I have discovered that the secret for sleeping well when on call consists of convincing yourself you’re not on call.  I looked at my quintuple-redundancy electronics and lied to myself, but I still had a faint niggle at the back of my mind.  Self-deception prevailed for six hours of sound sleep but not for all eight.  I received no calls.

I gave over the beepers in the morning, and as soon as I got to the clinic I gave up the extra cell phone.

You meet the nicest people around a shotgun

October 31, 2010

Found ammo is better than loot

But friends are a much bigger hoot.

     The lesson I got

     For the shotgun I brought

Improved the way that I shoot.

Men like projectile weapons.  If we didn’t have constraints like time and money, most of us would do little else besides practice.  As kids we never got our fill of shooting because our dads had limits like time and money.

Thus men of retirement age gravitate towards sporting clays courses, trap ranges, golf courses, and archery lanes. 

Today I took my shotgun to Grand Island’s Heartland Public Shooting Park. (Explanation: a shotgun cartridge contains multiple pellets.  Today, I used loads of #8 shot, about the size of poppy seeds.  Good for killing clay targets but not for much else; you can buy them in Castro’s Cuba.) 

The facility ranks as the nicest shooting park I’ve been to.  It has up-to-date equipment, well maintained paths, and great habitat.

The sporting clays shotgun course covers seventy-five acres.  A mile-long gravel path encircles it. 

I enjoy a lot of things about shooting sports, among them the camaraderie and socializing.  A stranger here, I had to set out on the course by myself. 

Still, the weather cooperated and at the first of ten stations I hit 7 of the ten electrically thrown targets.  

At the third station I found a whole box of shells.  A brand I’d never heard of, Rio, with bright blue plastic husks, the only words on the box not in Spanish were MADE IN TENNESSEE.

Ammunition constitutes the biggest cost in shooting.  Occasionally one might find a shell that another shooter has dropped; to find an entire box outranks finding five dollars. 

I resisted the temptation to shoot them all right there.  I put them in my backpack, telling myself I’d turn them in at the clubhouse when I was done, then thinking, Yeah, right.  I grinned to myself as I walked away from the station and a button buck deer crossed my path.  

I considered the irony; the deer can’t find a safer place to live than a shooting range.  People who own firearms tend to be law-abiding.  No one would risk getting kicked out of a shooting park for discharging a firearm in the wrong place at the wrong time. 

As I walked up to station #4 I saw two golf carts pulling away with five people.  Even at a walk I caught up with them at station #6.  I pulled my muffs from my ears and asked, “Who’s shooting Blue Rio’s?”

They all were.  I told them I’d picked up a box of their shells, they invited me to shoot with them.

Tim and John were teaching three adolescents.  As I got into position, we saw a rooster pheasant gliding into the thick switchgrass ahead of us.  I had just loaded my 12 gauge when one of the young adults pointed out a deer almost hidden in the tall grass, less than 50 yards in front of us, probably the same button buck I’d seen earlier.  He stared at us for a while, got bored, and browsed off into invisibility. 

I didn’t shoot very well; Tim gave me some pointers, and I smoked two flyers in a row. (When one hits a clay target with enough pellets, it breaks into a cloud of debris, like smoke.)

I had a yoyo in my backpack and I did a minute’s worth of tricks.

“You know,” Tim said, “You meet the nicest people around a shotgun.”

I’ve changed a lot more than Interstate 80

September 27, 2010

The traffic has sped up and slowed

I’ve changed my travelling mode

    This is Nebraska,

    It’s not like Alaska.

We’ve got the I-80 road.

I travelled Interstate 80 the first time at the start of the summer of 1968, going east from Denver on my first road trip.  I drove my friend’s new Chevelle directly away from my high school graduation.  Bitter about the previous seven years at home and at school, I determined to never return. 

At age 18 I had much to learn.

At that time I-80S existed only in segments, and wouldn’t be named I-76 until the Bicentennial.  I pulled off the two-lane in Julesburg, and while the attendant pumped my gas and washed my windshield I listened to the wind in the telephone wires and thought I’d heard the loneliest sound in the world.

The speed limit signs at that time changed from 70 to 80 with the daylight.

I drove to meet up with my music buddies in Illinois, sure we’d change the world with our music.

The summer didn’t go according to plan.  We came back to Denver in the middle of July when the pianist’s mother died.  The pianist and I didn’t find day jobs and we didn’t find much in the way of music jobs, either. 

I travelled west on I-80 that winter for Xmas break; I had yet to learn to travel light, yet to learn that school books brought on vacation never add to knowledge but diminish the vacation’s quality.  Again the three musicians rode in the pianist’s Chevelle, and got stuck in a snow drift outside of Cozad.

For the next four years I-80 served as my hitchhiking corridor to and from college.  When I went to medical school I traveled the same highway, catching rides or thumbing.

Bit by bit I-76 reached completion and the four-lane finished skirting Omaha.   

We moved to Iowa in 1985.  At that time the speed limit was 55 and we had three small children.  The twelve-hour drive to visit my parents thus dilated to eighteen hours until we learned to drive at night.

In May of 1989 I received a call as the sun was going down.  My stepfather had a stroke; my mother told me not to come.  Bethany brewed me a Thermos of real coffee and I left immediately.   He died four days later, and I drove back with the radio off, alone with my thoughts.

My mother got sick in 1991 and died in 1993.  During that interval I made the trip many times by air and by car.  I learned how dead-end and bitterness define each other, and sap the joy from life.

We made the pilgrimage every summer to visit my father till the kids grew up and my father died.  I travel I-80 less often now than I used to.

I have taken to making the trip in two stages; I have stopped tonight at a motel in Big Springs, now that I have a level of affluence that I didn’t have the years that I travelled all night or camped briefly in Grand Island or slept a few hours in a rest area.  Quieter, safer cars speed back and forth.   Speed limits have gone down and then up.  Gas mileage keeps improving.   Nebraska highway maintenance remains a model of functionality. 

I am on my way to an educational conference in Denver through the American Academy of Family Practice.

In the last forty years I’ve changed more than the road has.

This trip is the first time I haven’t been in a hurry going or coming.  I’m enjoying it a lot more.

From Alaska to Nebraska, contrast is the essence of meaning.

September 24, 2010

Today while planning my work

I went faxing to recruiters and clerks

    From Barrow, Alaska,

    To Grand Island, Nebraska,

This business has plenty of quirks.

I spent much of the day hustling up work. 

When I decided to make my career move in February I planned to do a palindromic geographic reiteration of the places that had brought me to Sioux City in 1985, but things didn’t work out.  Instead I made a very long first step in this next phase of being a doctor, to Barrow, Alaska, as far north as a person can go in the United States.

At about that time I put too many items on my list for a year: an armed forces installation, an Indian reservation, New Mexico, Wyoming, and a prison.

It turns out that the defense bases need a lot of doctors but want a six month commitment. 

I’m currently getting credentials for an Indian reservation clinic, and a one month placement in a prison health facility looks good.

I have confirmed an actual job for the last week of October in Grand Island, Nebraska. 

Most people in this country think of Interstate 80 when they think of Nebraska, and their conception is of a flat, boring place.

I would agree that the Platte River Corridor is boring, but Grand Island lies just south of the Sandhills.

A majority in this country, including most Iowans and a distressing number of Nebraskans, have never heard of the Sandhills, a place of quiet and peace and incredible beauty. 

At the end of the last Ice Age, sand accumulated in dunes in what is now western Nebraska, Kansas, and South Dakota.  When the Europeans wiped out the buffalo, the natural overgrazing stopped, and the dunes sprouted grass.  In the last hundred and twenty years, the Sandhills have been able to support more and more life.  Because water moves freely through the sand that comprises the district, many lakes dot the area.  The water table is very shallow, though scant rain falls.

The air is clear there, and the sand soaks up the sound.  The first time I went I was struck by the lack of noise.

I enjoy Sandhills people.  There is no pretense about them; if there are 200 people in an area the size of Rhode Island and half of them live in town, there is no room for a phony but there is space for almost everything else. 

Once, in Arthur County, I tried telling a shaggy dog story, but I did it with a straight face, and when I got to the punch line, nobody smiled.  At the point I realized that if I would impose on the sensibilities of my audience for such a tale, I would have to announce it as a joke.

Filling out forms, a disagreeable lifetime pursuit

September 18, 2010

Every day since I left the dorm

I’ve had to fill out the form

     They’re never the same

     Except they ask my name

And how well that I stick to the norm

 In my senior year of high school I got so fed up with filling out forms that I put twenty items on a questionaire, titled it FILL OUT IMMEDIATELY, and left fifty copies at the school’s front desk.  Forty-six forms were filled out.  I don’t like filling out forms, and what goes around comes around.  I think I’m being punished for my prank.  As life goes on, the forms get more frequent and trickier.

I’ve been filling out forms to find new locum tenens jobs.

Even where I am a known quantity with a good reputation, I have to supply the same information.

They all want to know where I’ve worked, where I went to school, where I have licenses, if I have physical or mental problems, if I have alcohol or drug problems, if I’ve ever been convicted of a crime, if I have ever been taken off of Medicare or Medicaid rolls, if I’ve ever been sued, if I’ve ever been refused privileges at a hospital or been disciplined there.

But are the same and the questions are all phrased differently.  “Have you ever been convicted of a misdemeanor or felony in any jurisdiction of the United States or other country?”  is not that same as “Have you ever been convicted of a misdemeanor or felony aside from minor traffic violations?”  I answer the first one with my five parking tickets, my one moving violation, and my conviction of being an illegal pedestrian (I’m not joking).  For the second I can check the No box.

Some ask for the day, month, and year when I started and stopped certain activities, some for the month and year, and some just ask for the year.

They also want copies of my licenses, medical school diploma, and Continuing Medical Education (CME) activities.

I would think that in the twenty-first century checking me electronically would be more reliable than looking at photocopies of paper documents. 

A number of countries would like to import American doctors; one such country’s eighty-seven page query document collection is written so opaquely that even though the official language is nominally English I can’t understand the forms; I’ve been working on them for months and each time I get the jitters.

Today I went down to Staples and got copies made of the certificates which are most asked for: med school diploma, residency certificate, state medical licenses, the details of my legal history, and DEA permit.  I left with five copies of the packet.  I’ll need them. 

I’ve been talking to recruiters for spots in New Zealand, Wyoming, Dubuque, an Indian Reservation and Grand Island.  I’m stoked.

Of course I have to remember that many plans fall through at the last minute.

I’m a family practitioner from Sioux City, Iowa.  While my one-year non-compete clause ticks out I’m having adventures.  To comment on a post, click on the title.