And 8 weeks draw to a close

This gig has come to an end

I noted a gallbladder trend

The blues seem to vanish

While I’m speaking Spanish

Or mixing in Tex-Mex, a blend

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 3 Community Health years, I took temporary gigs in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  Since the pandemic, I did telemedicine, staffed a COVID-19 clinic in Iowa, worked at the Veterans Administration in South Dakota, held part-time positions close to home, worked 10 weeks in western Pennsylvania, had a 5-month assignment in Northern Iowa, then several months of telemedicine.  I am now in Texas, a big place with a lot of Spanish speakers. 

I rarely sleep well the night before an assignment’s last day, and last night was no exception.

I bicycled in a heavy mist that bordered on a fine rain, not quite enough to dampen either my shirt or the road surface.  I arrived about 10 minutes early.

Three of my 7 morning patients didn’t show, and I had already met 3 of the four who did.  I sent one to ER.  I signed off a form for another, and while I agreed with the patient about a choice of medication, I knew that the dosage required titration that really needed continuity of care.

For one patient I summoned Google Images as an instructional tool, but not from my most common requests: piriformis syndrome, trochanteric bursitis, and DeQuervain’s tenosynovitis.    

My electronic in-box had a refill request, and 6 patients worth of lab work containing no surprises.

After a noon snack in the break room with Bethany, I sold my bicycle to one of the staff.  I demonstrated the pump, helped fit the helmet, adjusted the seat height, and gave a lesson in using the gears. 

Then we went to a popular local destination for art. 

I gave away the archery target and 6 arrows I have been using to another staffer, and returned the borrowed bow to its owner. 

I enjoyed the gig.  I found four cases of B12 deficiency, and 5 cases of thyroid disease, one of them serious.  I went through the stepwise process of identifying gallbladder disease more than a dozen times, and on two occasions had to push for emergency surgery. 

Most my ER referrals went because of chest pain, some others because of serious infection. 

As with every other venue, alcohol and tobacco brought a lot of patients.  Increasing acceptance of marijuana brings an increasing pathology load.

About 20% of my patients preferred Spanish, another 20% came in as English only.  Many work in agriculture. 

The town owes much of its unique mood to the social structure.  The vast majority of people have more than 10 relatives less than 5 miles away. 

Bethany and I talked it over.  Would we want to come back?  We definitely would.  But not during the summer.  As I write this, the mercury is inching to 95 despite cloudy skies. 

Code shifting

If it’s most, can we call it a clique?

For there’s more than one language they speak

When I’m using my Spanish

My blues they will vanish

When I go on a code-shifting streak

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 3 Community Health years, I took temporary gigs in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  Since the pandemic, I did telemedicine, staffed a COVID-19 clinic in Iowa, worked at the Veterans Administration in South Dakota, held part-time positions close to home, worked 10 weeks in western Pennsylvania, had a 5-month assignment in Northern Iowa, then several months of telemedicine.  I am now in Texas, a big place with a lot of Spanish speakers. 

Most people who take high school Spanish forget almost all of it within 6 months of graduation. I can point to one 6-week episode in 9^th grade when the teacher declared, “These are the last words of English you will hear in my class.”  I reached fluency quickly though it took me years to build vocabulary.

The majority of the people in this area have Spanish surnames, but only about 10% lack mastery of English.  But Spanish fluency seems to be proportional to age.

Texas started as a province of Mexico.  The history since, loaded with nuance and subtlety, deserves volumes.  The Hispanics here have US lineages that go back much further than the paltry 100 years or so that my family has lived in this country.  And if you want to go further back, many have Indigenous roots. 

I took 4 years of high school Spanish and one year of college literature, but, aside from those critical 6 weeks in 1965, those years have little to do with the language I speak. 

I went into private practice in Iowa just before the meat packing industry, always reliant on laborers with little English, attracted workers from Mexico, Guatemala, Honduras, El Salvador, Dominican Republic, and Colombia.  Over the next decades, I heard Sioux City generate its own Spanish accent and listened the accent morph. 

So when I got here I asked some vocabulary questions:  Do we call the people who take off and put on shingles techeros or ruferos?  When we give directions do we talk about blocas or qudrados?  Is a Ford 150 a troque or a camioneta?

The bilinguals here say they speak Tex-Mex rather than Spanish.  But that would be like saying I speak Iowish because I don’t call a truck a lorry. 

Recently, the shift in languages has started to impact English.  Perfectly acceptable constructions here now include Get down from the car and I drink that pill in the morning.

The people in the UK who listen to American English say we dwell too long on our syllables.  And to a limited extent I can hear parallel differences when comparing Mexican Spanish to Tex-Mex. 

Linguists call dancing between two or more languages ‘code shifting.’  Some words or phrases are easier in one language than another, and I use those shortcuts when I can. 

Every time I switch languages I get a little jolt of endorphins. I suspect that most bilinguals experience the same enjoyment.