Posts Tagged ‘Sweetheart’

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.

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.

Dropping acid, shattering dreams, marital fidelity, memories of the summer of 1968

December 2, 2010

A pianist and I, for a summer,

Lived in a house with a drummer

    The dream came to a stop

    When the acid got dropped,

And his trip turned into a bummer.


Synopsis:  I’m a family practitioner from Sioux City, Iowa.  While my one-year, thirty-mile non-compete clause ticks off, I’m working locum tenens in different places and taking some time to breathe.  After working two weeks in Grand Island, Nebraska, I drove east, visiting friends and family and having Thanksgiving with my wife’s family in Virginia.  I’ve just started work in Keosauqua, in southeast Iowa.

On the way to Keosauqua from Columbus, Indiana I chose to detour through Crawfordsville, Indiana and Galesburg, Illinois.

I drove to Galesburg the first time in 1968, directly from my high school graduation, sure I would never return to Denver.  Our jazz trio planned to work at Gale Products for the summer, play jazz in the non-work hours, and be world-famous musicians.  Positive we would change the world for the better, we knew nothing about business.

Only the drummer found work as planned.  We played a lot, I developed a good set of chops, we wrote some decent tunes, but we found few gigs. 

That summer the piano player courted Bonnie, the woman who would become his wife, whom he met his freshman year at Wabash College in Crawfordsville.  The weekends we didn’t have playing jobs we would drive from Galesburg to Crawfordsville.  We slept on cots in Bonnie’s basement, her mother cooked for us.  In the evenings we danced to Simon and Garfunkel. 

The untimely death of the piano player’s mother torpedoed my plan to never go home again. 

Later that summer we got an agent, who told us a music group’s failure usually comes down to personality conflicts.  We assured him that wouldn’t apply to us.

Early second semester 1969, the drummer took LSD and dropped out of his sophomore year at Cornell College.  In retrospect, it precipitated his first manic episode.  The piano player and I never trusted him again.  At the end of that term I knew, for a lot of reasons, I would never become a Great Composer.

Tuesday I pulled off the Interstate and drove into Crawfordsville.  I gave Sweetheart, my GPS, the address of Bonnie’s house.  I drove past the courthouse with its Civil War Memorial, past the college campus.  I didn’t remember the town being so prosperous, though the people keep their lawns as neat as they always did.  Passing the humble house at the top of the hill, memories of the summer flooded my brain.

I thought a lot from there to Galesburg.  I found my way from the Interstate right to the house we’d lived in on South Seminary Street.  It sported new paint, a rejuvenated porch, and white siding.  Galesburg pulses with a vitality we hadn’t seen forty years ago. 

Much has happened since then.

The drummer went on a downward social spiral and currently resides behind bars.

The piano player still plays piano.  Always the best musician of the three of us, he stuck with it.  He plays gigs here and there but he has a day job teaching.  He’s still married to the same woman.

I’m not as naïve as I was then.  I’m a much better doctor than I was ever going to be a saxophonist.

Arrival in Keosauqua

December 1, 2010

The condo is sure a nice perk

I told the hospital clerk.

    Although I might roam

    And I’m far from my home,

It’s good to be back to work.

I drove into Keosauqua, Iowa as the sun set.  For unknown reasons, Sweetheart, my GPS, guided me right to the hospital parking lot.  She had a psychotic break on the interstate near Champagne, but responded to the standard Microsoft fix: turn off, then turn back on.  After that she did fine.

Van Buren County in southeast Iowa, population six thousand, has no fast food and no stop lights.  Keosauqua, the largest town, sits in a bend of the Des Moines River.  The business district still uses diagonal parking. 

The hospital, built at the top of the hill in 1951, has grown and kept pace with the times.  The only original parts of the institution still in use may be the longest continuously used hospital cafeteria and kitchen in the country.

The assistant administrator guided me down the hill to the duplex that will house me for the next month.  A very livable place, well furnished, it has a living room big enough for martial arts forms and a kitchen adequate for Real Cooking.

I’ll try to keep the TV off.

I went out to dinner the first night in town with another doc and his wife.  The primary care cadre has fallen from six to three (including me).  Over world-class beef we talked about the realities of medical practice, and the thrill that comes when you can fix the patient before they leave.

Orientation lasted the morning.  I’ve been introduced to three dozen people,  all of them friendly and smiling, of whose names I remember four (including my own).  The first-rate facilities represent all the necessary services. 

I talked with a surgical specialist who snow birds two weeks out of four; by his estimate he works an average of forty hours a week.  We agree that docs in private practice don’t know how to count the number of hours they put into their jobs, that in reality full-time for a doctor means an eighty hours a week, and that sustainability means forty hours.  We discussed the perennial Medicare pay cut that threatens and what would happen if it came through.

I shared observations with another surgical specialist who moved here after decades in a big city.  We shared consensus on the tradeoff between money and management on the one hand, and decreased stress on the other.

In the afternoon I saw patients ranging in age from a few weeks to almost a century.  One I educated about posterior tibial tendon dysfunction, drawing on my experience; we also discussed retirement.  With another I talked about corneal abrasions and deer hunting.  With a third we conversed about B12 deficiency, anemia, and the Great Influenza.  I took care of thumb pain, ankle pain, constipation, and confusion.  I got to refer the patient with a sebaceous cyst to the surgeon; I didn’t have to wedge the procedure into a crowded schedule. 

Throughout the afternoon I felt the profound relief of being back to work, the joy of the profession that I love.

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.