Posts Tagged ‘Saginaw’

On marijuana, wages, and education

November 4, 2018

Here’s what to learn from the sages

Education is not just about wages

Your life it makes richer

For the depth of the picture

And it keeps your mind out of cages.

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, western Nebraska and northern British Columbia. I have returned to Canada now for the 4th time.  Any identifiable patient information has been included with permission.

Medical school starts with 2 years of classroom study, with little actual patient care except classes in interviewing and physical exam. Third year brings the cataclysmic change to clinical work: one month you sit in lectures and try to absorb as much as you can, and the next month you deal with people who bleed, vomit, cry, and sometimes die.

My medical school, based in East Lansing, sends 80% of the medical students to smaller communities for those crucial two clinical years. I went to Saginaw.

At the time, the automobile industry dominated the town. Up till then I had always lived either in big cities (not my favorite) or college towns.  Saginaw changed my context radically; I ran into a lot of blue-collar workers on a daily basis.  I had left my bubble.

One of my classmates, having grown up in Michigan, remarked that one of his high school classmates started working in an automotive plant at age 18, and a doctor would have to work till age 45 or 50 to match lifetime earnings.

I recall a millwright on the internal medicine service who made as much money as the attending physician, and worked much better hours.

Fast forward 42 years, and Bethany and I have landed in a different mill town.

Bethany substitute teaches. She found the elementary students polite to the extreme.

But she has concerns about many of the middle and high school students, concerns she shares with the administration. A lot of students don’t engage in class because as soon as they turn 18 they can start high-paying mill jobs.

My grandfather had a talk with me before I went off to college for the first time. A man so wise that even as a truculent 18-year-old I recognized his wisdom, he said, “You don’t get an education to earn more money.  You get an education because an educated man leads a richer life because he understands what he sees.”

Few people have a grandfather like that, and fewer still come from a cultural background that values learning for the sake of learning.

Of the 18 patients I attended on Friday, while the season’s first heavy, wet snow hushed the town, 14 abuse marijuana, using it multiple times daily. Of those, 12 have high-paying factory jobs, and of those, 10 have chaotic homes.

I don’t know where to look for causality, to the weed, the wages, or elsewhere.

But I do not think making marijuana legal will do anything positive to engage the students in school.



Another Road Trip 12: reminiscing in Saginaw

June 22, 2015

It was such a long time ago

O’er the bridge I would walk to and fro

But one day running late

I hopped on a freight

And survived.  But how, I don’t know.

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 am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. I spent the winter in Nome, Alaska, and I just finished an assignment in rural Iowa. In the midst of combining work with a family visit, I had to make a sudden trip to Colorado for a funeral. Right now I’m starting out on a bicycle trip with an alumni association.

We arrived in Detroit with our circadian rhythms disrupted by bad sleep and grief, got onto the highway and went north.

I came to Saginaw in the summer of 1977 for my medical school clinical training.

I had no car and barely money for food.  I lived across the street from the St. Luke’s parking lot, a block away from Saginaw General Hospital.  St. May’s, directly across the river, would have taken 20 minute bicycling in good weather.  Or I could walk across the railroad bridge, a process that took 8 minutes if I walked fast, and gave me a brief respite of outdoor exercise.

One day, running late, a slow-moving train occupied the bridge.  Remembering a technical conversation with a hobo,  I ran alongside the train, matched speeds, grasped the ladder, and jumped on.  I rode across the bridge, dismounted at a jog, and arrived at the noon lunch lecture on time.

I repeated the process a dozen times, but once, after the temperature had dropped with the seasons into the teens, the train started to accelerate while on the bridge.  I had dressed for a short walk across town, and the wind chill numbed my hands in less than a minute.  I had visions of freezing to death as the train headed out of town and picked up speed.

I made a stumbling dismount from the train at a run, in front of a waiting car. (What did that driver think, seeing me in a white coat with a stethoscope around my neck?)  I made it to the lecture, alive and on time, and never rode another freight.

And now I could ride the streets in my own car.  While the day faded, I showed Bethany what I remembered of my time in Saginaw.

Covenant took over Saginaw General and St. Luke’s and merged them into one institution.  A bronze statue and a couple of nice plaques now sit outside of St. Mary’s Hospital, on grounds much better maintained than any I ever experienced during my tenure.

A vacant lot has devoured the house where I lived my senior year, the furnished room rented for $200 per month.  The letter bearing news of my National Health Service Corps scholarship came to that address.   The grocery store and the greengrocer, walking distance from my first dwelling here, have disappeared.

Medicine has changed as well.  Laparoscopic surgery, unknown then, has become the norm.  Ibuprofen, Tagamet, Prilosec, Zyrtec, and Flonase, each a game changer, no longer require even a prescription.  Total knee replacements (I saw Saginaw’s first) are routine.

When I lived here, research hadn’t even started to elucidate the inflammatory cascade of ankylosing spondylitis, and aspirin was the best drug for its close cousin, rheumatoid arthritis.  And my back hurts less now than it did 40 years ago because of Enbrel, the miracle drug, which would not be invented till 1999.

We parked at St. Mary’s and  I led Bethany to the intersection where I alit from the train.  We walked up the tracks to the railroad bridge.  I had never seen the river that high.


Give bad news sitting down

May 15, 2015

Pathology stalks the people I run into; in a restaurant, airport, sports shop, or grocery store

October 7, 2010

I suppose I could do it for free,

Diagnose whatever I see.

    Unsolicited, intrusive

    And sometimes elusive

Advice I’d give without fee. 

Thirty-two years ago, in the winter of 1978, I walked into the Chinese restaurant in Saginaw, Michigan with another medical student.  As we sat down, my classmate observed, “It’s funny, you know, as soon as you start doing clinical work, people start talking to you about their medical problems.  Whether they know you’re in med school or not.”

“Maybe,” I said, “We just got more attuned to listening for it.”

 As we munched our mini-egg roll and spooned our egg drop soup, we overheard the couple in the next booth talking about a parent’s recent surgery.  We looked at each other and we ate, two not-quite doctors, listening to public conversations about very confidential matters.  After a while I said, “Coincidence?”

My classmate shook her head.  “Karma,” she said.

I expressed my doubts, but while we stood in line at the cash register a man was talking to his friend about a recent doctor’s visit.  We could tell there was a great deal he hadn’t understood, and we two students made eye contact and, without saying anything, decided to let the moment pass.  When we layered our clothes up and stepped out into the shocking cold of a Michigan winter evening, I said, “Maybe it is Karma.”

Such events riddled my days and nights ever since.  Whether I admit I’m a doctor or not, the drama and irony of medicine’s interface with the human condition accompanies me wherever I go.

“My husband’s doing better,” I heard the woman say this afternoon, “With that new drug, I don’t know what you call it, it grows new veins and such, well his stumps have healed up real good and he’s started to grow hair there ‘n’ the doctor says that’s a sign of healing, like he’s getting his circulation back.  And it’s hard on me.  Beer ‘n’ cigarettes, beer ‘n’ cigarettes I tell him, that’s my therapy.”  I didn’t point out the irony.

“So I went to the dentist,” the man said in a public venue, “And he did x-rays and everything, well, come to find out there’s nothing wrong with my teeth, no abscess or nothin’.  And he put me on penicillin like I asked and I’ve been taking it for a week, a week, and I’m better, the pain is gone but there’s still swelling.”  I nodded.

In an airport on the slidewalk I diagnosed the person ahead of me with scoliosis, osteoporosis, and neuropathy; I wondered about deficiencies of B12, folate, vitamin D, and thyroid.

On the airplane I saw the lion-like facial features of acromegaly, the consequence of a pituitary tumor in adulthood.  I wondered how it affected the person and the family.  Again, I didn’t say anything.

I don’t give unsolicited advice to people who aren’t my patients.

It’s none of my business