Posts Tagged ‘Thanksgiving’

Malignant materialism: Black vs. Plaid Friday

November 26, 2018

Thanksgiving? Not all that you’ve heard

And the turkey’s a much larger bird

A gift for your grad?

For Friday’s now plaid.

For the local business assured.

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.

Canada celebrates Thanksgiving the second Monday of October. Feasts commonly include turkey, squash, vegetables, and apple pie; regional variations include salmon, wild game, Brussels sprouts, wild rice, unique local foods, and what Americans know as New England boiled dinner.

The narrative of the Canadian First Thanksgiving has to do with Martin Frobisher’s successful landing with more than a dozen ships on Baffin Island.

The US Thanksgiving holiday comes the third Thursday of November. The common story of the first Thanksgiving includes the Pilgrims inviting the Wampanoag to a meal celebrating the first corn harvest.

Not surprisingly, the Wampanoag tell a different story that sounds more likely, having to do with irresponsible celebratory gunfire, checking the wellbeing of the vulnerable English, and fishing and hunting in the process. Particularly ducks, geese, turkeys, and deer.

Deer haven’t changed but turkeys have. Since 1950, average slaughter weight has more than doubled, from 13 to 29 lb.

The holiday itself has morphed with the times; religion, hunting and gunfire for the most part have dropped away, replaced by a prolonged, sedentary feast followed by a commercial feeding frenzy. All with a prolonged football binge.

Canadians, like their southern neighbors, kick off their big retail season with the day after American Thanksgiving, calling it Black Friday.

I went to work this year when my friends and relatives in America went out of their way for arguably the biggest meal of the year.

I found it a day to be thankful, without overeating. A hospital patient went home.  I got along with my wife, my colleagues, my patients, and my co-workers.  I walked from a decent dwelling to a decent work place without fear for my physical safety.   I got to see patients improving, and I witnessed the miracle of more addicts coming to insight.

The next day my arrival in clinic started with an accusatory, “Where’s your plaid?”

“P-plaid?” I asked, noting the surrounding tonsorial color scheme indeed dominated by plaid.

Plaid Friday, they told me, celebrates buying locally.

I shrugged. I don’t own anything plaid in Canada.  My general abhorrence of malignant materialism, combined with hundreds of snow-packed kilometers between me and the nearest Wal-Mart made supporting Plaid Friday easy.

Finding myself on call till 6:00PM qualified as the biggest surprise.

 

 

 

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Holiday rush

December 5, 2017

Home from the Arctic we set

At the Omaha airport we met

But, Oh! What a drag!

We can’t check a bag!

And we went to Vancouver by jet.

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 and western Nebraska. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia.  Any identifiable patient information has been included with permission.

I finished work 15 hours before our flight’s scheduled departure. We acquired little during our stay, but the task of packing took all of Bethany’s considerable skills.  We cobbled together a supper of edible odds-and-ends.  We played one more Scrabble game but couldn’t fall asleep till 5 hours before we needed to get the taxi to the airport.

The airlines advise 2 hours for security and check in, but here we couldn’t check baggage more than an hour ahead. We slipped our ice cleats into the checked suitcase, gate checked our 2 roller boards, and fell asleep before the plane took off.

We spent the long layover with Les, a friend of 35 years and Anchorage resident for 30. Without the wind we’d faced for the last month, the Anchorage temps while a few degrees colder seemed positively friendly.

Contrast, as always, the essence of meaning, the big-city realities of Anchorage jarred our senses. We faced traffic, stop lights, food prices that don’t take the breath away, and stores the size of hospitals, and did our best not to stop and gape.

We helped move a boat and shop, then after dark found ourselves in an airport decorated with full body mounts of moose, musk ox, polar bear, brown bear, and halibut. We landed in the rain in Seattle.

Because of the very long times and distances involved, the vast majority of Alaska traffic overnights in Seattle and Anchorage, thus the large number of hotels close by.   Less than 18 hours after checking in, we landed in Omaha.

Less than 48 hours of mail, laundry, and friends later, back in the Omaha airport for Thanksgiving travel, Bethany headed to Virginia, and I to upstate New York.

I thoroughly enjoyed my time with two brothers, three sisters, a brother-in-law, two nieces, two nephews, a daughter, and a son-in-law. I had to slide my internal clock back across 5 time zones, adjust to outdoor temps above freezing, and accommodate to twice the daylight hours.  I find sleeping in generally difficult but, due to a body clock both shaken and stirred, managed to sleep past 9:00AM.  Coffee in the morning, contrary to usual habit, helped.

Just like that Bethany and I met in the Omaha airport and headed back to Sioux City with 3 days to get ready for the next month in Canada.

The night before departure, Bethany looked carefully at the itinerary and announced we only had an hour layover in Chicago, where we changed airlines. We would not be able to check a bag.

Then followed a furious baggage editing. While we spent thirteen weeks in New Zealand with one roller board and one back pack each, we didn’t have to deal with serious cold.

We decided we could get trekking poles and sweaters in Prince George if needed.

In Vancouver, when asked the purpose of my trip, I replied, “Business.  Would you like to see my work permit?”  The young BC Immigrations man did, and asked me what sort of business I do.  “I’m a doctor,” I said.  “I’ll be working up north for a month.  And, boy, do I like your system.”

He looked up.  “Well thanks for coming! We’ve a shortage of doctors.”

Work hunger

November 30, 2014

With the questions they’re asking of me
You could say that I’m working for free.
I really don’t mind.
I think that it’s fine
I darn sure don’t want the fee.

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, where I worked for 3 years. I left last month because of a troubled relationship with the Electronic Medical Record (EMR) system. Now back from a road trip to visit, and take in Continuing Medical Education, I’m helping to fill in at a clinic not far from home.

In a social gathering, a physician can be sure that people will approach with personal medical questions, unless doctors comprise the gathering, and even then sometimes the doctors will reality test with other doctors.

One doc I know got fed up and said to the person at hand, “Just go back to the bedroom and take off all your clothes, and I’ll be there in a minute to examine you. After all, a medical visit includes an examination.”

Another, while in med school, told her less-than-sober relative who had harassed her with sexual innuendo thinly disguised with a medical question to take down his pants, and let’s have a look at the part involved. Which effectively shut him up.

And on one occasion, I confess that I snapped, “I’ve just worked 14 hours, my mother died 8 days ago, and if you want advice, make an appointment and expect to pay just like anyone else. You’re not giving away your refrigerators for free.” (I didn’t refer to refrigerators; but even in public I’ll protect confidentiality. That only happened once. And while I’m not proud of my response, I can see that the comment found me in the midst of the grieving process.

Mostly, we get used to it.

Over the holiday, people with skin, weight, headache, chest, emotional, and sleep problems came to me in the context of prolonged sedentary feasting.

And I didn’t object, in fact, I welcomed it.

I miss my work. My current situation finds me with an unsatisfying number of patient contact hours. I got to give sound advice, especially what the person should say to their doctor, in an unhurried fashion. I didn’t have to worry about the tyranny of documentation or billing. Nor did I write a prescription.

And I got the chance to delve into the patient’s situation: what did the illness mean to him/her? Friends and family contributed to the history, and I got a much better picture of the whole situation. So I could say, for example, make sure you tell your doc your whole family history. Or, metoprolol is a better, cheaper beta blocker than atenolol or labetalol.

And later on, I could go on the internet and access Sermo.com, a website exclusively for licensed physicians. A doctor can post details of a puzzling case, and other physicians can comment. They brought me a new perspective: testing might show you the patient’s allergies, but the allergies may or may not cause the problem.

Dr. Germaphobe at Thanksgiving

November 26, 2014

‘Tis the season to bring on the mood,
Our calorie count to delude
What makes us so sick
Not sleeping’s the trick
And the crowding, the booze, and the food.

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, where I worked for 3 years. I left last month because of a troubled relationship with the Electronic Medical Record (EMR) system. Now back from a road trip to visit, and take in Continuing Medical Education, I’m helping to fill in at a clinic not far from home.

At this time in November, most Americans start their annual feasting season, though a few started 3 weeks ago on Halloween.

The average American gains 5 pounds between Thanksgiving and New Years Day.

We also travel to new locations with new microbes. We crowd, making microbe transmission easier. We disrupt our sleep patterns by our travel plans and our socializing. Lots of us consume much more alcohol than we’re used to. While we weaken our immune systems and confront them with strange germs, we gorge. And then we wonder why we get sick.
I get great welcome at Thanksgiving for my knife sharpening abilities and for my turkey carving skills. My ability to bring a shaving edge to most any non-serrated cutting instrument comes from years of hunting. My medical training has nothing to do with slicing white meat.
But my bacteriological knowledge, tuned to a fine paranoia by the CDC’s applied Epidemiology Course’s Food Borne Illness section, has not met with the same enthusiasm. I have even earned the nickname Dr. Germaphobe for my recommendations: keep the hot food hot, the cold food cold, and only reheat once.
People will cheerfully ask me about rashes. They express sincere gratitude when I put a razor edge on their knifes using nothing more sophisticated than the bottom of a coffee mug. But I can tell they politely suppress the eye-roll when I talk about food poisoning and room temperature.
I have stopped telling the story about how the Mars Lander program used chicken soup as a medium to detect extra-terrestrial life. I’ve inflicted it upon my family too many times.
They still invite me to make the gravy.

Roadtrip 8: Thanksgiving in Virginia, waking hypnosis and suggestibility of drunks

November 25, 2010

I tried for cooperation

In a man with inebriation

    Not out of the question

   With waking suggestion

He thought he was out on vacation.

More than thirty years ago, as a medical student I did a month rotation at a remote location in a western state.  I got help and supervision when I asked for it, but I took my share of call.  One evening an inebriated man came in after a knife fight with a number of cuts on his face.  For the sake of the story, I’ll call him Paul, because he didn’t go by that name. 

At the time, instantaneous breath alcohol level testing remained in the realm of science fiction, so I can’t quantify his level of drunkenness.  But the amount of alcohol he’d ingested prevented him from remembering three things for five minutes.  He didn’t want to cooperate, and even if he’d wanted to, he forgot instructions in half that time.

Pharmacology taught us that alcohol makes a person more suggestible.  The third time I asked him not to pull the surgical drape off, I pushed back and I said, “Paul, you look pretty tired to me.  Are you feeling tired?  You look like you might need to take a nap.  Would you like to take a nap?  It’s OK, if you want to just lay back.  We have a really comfortable bed right here.  Go ahead, take a nap.”  His eyes shut as he lay back abruptly and started to snore.  Two or three minutes later he tried to sit up and fight, and I repeated myself.  Sometimes I told him he’d forgotten his head was glued to the pillow.  (I can still remember the lacerations: two on the forehead, one on the left cheek, one on the upper lip, and two on the scalp.)  It took me an hour and a half; I compared the process to trying to tattoo the Mona Lisa on the back of a running buffalo.

I had never tried waking suggestion or hypnosis before, my first try succeeded beyond my expectations.  I’ve told the tale many times since.  It’s a good story, appropriate for medical and non-medical audiences; I use body language to show myself a callow medical student, and I use the tonal nuance of my voice to demonstrate how I felt when I believed in a principle but lacked experience.

The family gathering for Thanksgiving in Virginia included (among others) my daughter Jesse, currently in her second year of family practice residency.  As we finished turkey, gravy (see yesterday’s post), mashed potatoes and stuffing, she told about using waking hypnosis on an intoxicated, combative patient to render him cooperative so she could sew up facial cuts.  Three minutes after she finished, the patient started fighting and busting the joint up. 

We slapped high fives for the joys of waking hypnosis.

In the age of the internet, connectivity, and information retrieval, the story remains the quantum unit of teaching.

Road trip 7: Making gravy in Manassas, Virginia

November 24, 2010

I don’t care what you have heard

On this I can give you my word

     Gravy I made

     With flavor first grade

From the broth of the Thanksgiving bird 

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  While my one-year non-compete clause ticks off I’m having adventures.  I’ve worked in Barrow, Alaska and Grand Island, Nebraska.  Currently I’m on a road trip from western Iowa to eastern Iowa by way of New York and Virginia.   

During my residency my friend, Les, now an FP in Anchorage, (see my posts from August) told me that a good broth would make a good sauce better than good drippings.  In one sentence, he brought my cooking a quantum leap forward.

To make turkey gravy, start simmering the giblets in 3 cups water in a covered sauce pan at the same time you start roasting the turkey.  Check the giblets from time to time, adding water as necessary.  You should finish with 2 cups of broth.  When the turkey is done, so are the giblets.  Add the drippings from the bottom of the pan to the giblets broth, and skim the fat if you want to.  Thicken with cornstarch:  add ½ cup cold water, wine or apple cider to ½ cup cornstarch (don’t try to add cornstarch to liquid, you’ll get frustrated), stir that mixture into the broth/drippings, and gradually bring it to a boil while stirring constantly.  The mixture will thicken suddenly.  You get lumps by adding cornstarch when to liquid too close to boiling, trying to warm it too quickly, or adding extra cornstarch after it has thickened.

I add a teaspoon or two of soy sauce.  Variations can include garlic, curry powder, ginger, lemon, basil, cilantro, you get the picture.  If you add an herb, don’t over do it.

But here in Manassas I made gravy without drippings.

No problem.

Once, decades ago I set out to make broth and got distracted.  I didn’t add water, and when I came back the broth had boiled away to glue and then the glue had started to brown.  Such accidents had happened before, but this time I stopped the process before the product burned.  I added water and tasted the accidentally delicious result.  I had succeeded in synthesizing drippings.

I put half the broth from the turkey giblets into a fry pan and reduced it over high heat till glue-like bubbles started to form, then turned down the heat and watched the color slowly turn to brown.  I added the rest of the broth, deglazing the pan, and thickened it with cornstarch.

The resulting gravy has almost no fat. 

During my poverty days I learned to make broth from whatever bones remained from whatever animal or bird had graced my table, a rare occurrence at the time.  Chicken or turkey giblets serve the function as well.  Put the bones in the slow cooker when you leave in the morning and when you return the broth will be ready. 

Or, after the Thanksgiving feast, separate turkey meat from bones, put the carcass into the slow cooker, and when you get up in the morning you’ll have broth ready to be frozen or turned into gravy, perfect for topping hot turkey sandwiches.

If you need calcium supplementation, add a cup of white vinegar to the pot where the bones boil.  The finished broth will contain the calcium but the vinegar flavor will have boiled off.