March 19, 2013

Rhinelander chronicles: Part 3

A few brief updates about life up in the North Woods:

Last week: I spent last week primarily with a different preceptor Dr. S, a younger doctor than Dr. C (the dog-sledding adventure-seeker) but still a solidly established physician in the community.  I feel sort of guilty about this, but I may have actually enjoyed my week with him more than the first week.  He was super nice, let me see patients independently, and doesn't talk all the time the way Dr. C does. (This is what makes me feel guilty: Dr. C has amazing stories to tell and lots of wisdom to share, but when he does, he talks about a mile a minute and I honestly feel more fatigued after a day with him than I did all week with Dr. S.)  I also just think I really like his style of listening to his patients--I think our interviewing styles click better.  Anyway, it was a good week.

Friday morning I spent in the ER and saw two patients--which was practically a rush for them.  There are only 3 rooms and a trauma/procedure room, since the ER and hospital in Tomahawk are a critical care access point rather than a trauma center.  Most of their cases get referred out to Rhinelander or to Wausau.

I also found out that I was accepted to the Activists Leaders Institute for MSFC in May!  They are paying for accommodations and travel to the conference, so all I do is show up and learn!  I love going to MSFC events: being around my future colleagues and activists is invigorating and inspiring.  (Plus, it's the first weekend of my psych rotation, so I won't even have to miss any OB-GYN and it was easy to get the afternoon off for travel!)

Weekend: This was my first weekend spending the whole time in Rhinelander.  Saturday, I was actually pretty productive and studied all day, so I rewarded myself with a trip to the old-fashioned movie theater in the center of town to see Silver Linings Playbook (It was awesome.  I still find myself thinking about it, three days later).  Despite there being snow piled everywhere, apparently the town St. Patrick's day parade had gone down the main drag at 2pm, followed by a pub crawl.  I didn't have cash for the movie so I popped into a bar and found the rest of the town inside and well along in their Irish celebrations.

Sunday, I took a nice long walk through the neighborhoods nearby because the sun was shining so brilliantly, I couldn't stand to stay inside any longer.  I made the acquaintance of an older lady who was also out for a walk.

Last night, it snowed again.  It made today pretty trying, partly because I was already tired from poor sleep habits and partly because I am SO. DAMN. TIRED. of winter at this point! I think it's supposed to be sunny and cold in the next few days, which I think at this point in the season is definitely preferable.

I can't believe the month is almost over, or that the time has gone so fast, or that OB-GYN starts in less than two weeks...can't wait!!

March 11, 2013

Rhinelander chronicles: Part 2

A lot of it.

It fell like leaded cotton and snuck into every cranny. It fell for more than twelve hours, took a break, and kept coming.  I woke up to a post-apocalyptic world: seven inches of snow was frosting-thick on cars and sidewalks and front steps.

The drive to work took much longer than it usually does.  The road was really more of a suggestion of compacted powder with tire tracks than a carefully delineated path.  The front bumper of my car plowed through the plateau of re-accumulated snow in the space between my tires.  The roads were bumpy from every nugget of compacted snow that had been flung away by prior cars, and my neck and shoulders still ache from the death-grip I used on the steering wheel.  I found my heathen self searching for divine intervention in order to reach the clinic.

By mid-morning, repeated plow passes and the ground's leftover warmth from last week revealed the blacktop roads.  The drive home was with glorious speed, my foot on the pedal relishing in the traction of tire on pavement.

March 6, 2013

Rhinelander chronicles: Part 1

Family medicine is a specialty of breadth of knowledge and depth of relationships.  This is especially true here in my rural clerkship, where my preceptor has seen multiple generations of many families and where a visit for one member of the family also usually results in tiny other check-ins on the rest of the clan.

My preceptor is amazing in many ways.  First, his patients clearly adore him, which is for the obvious and simple reason that he truly listens to them, knows them, and cares for them.  He manages to convey all of this without resorting to paternalism or self-righteousness.  Even on my first day, he mentioned "entering humbly into the exam room" and the "humility of medicine." This is definitely a stark contrast from the RPM clerkship: few specialties require hubris of the magnitude demanded by anesthesia and surgery.

Second, my preceptor is just simply a badass.  He was in the air force, lived in Alaska and worked there to establish many of the native village health clinics, ran the Iditarod several times, and now is a family physician who works in his clinic, is the medical director of the local nursing homes, and gives health presentations to the community on wellness and holistic health.

I am constantly surprised by his sincere pursuit of the lifestyle changes that can make long-term improvements in his patients' lives.  He approaches these topics with sensitivity but also honesty and humility (there it is again!), and while it may be hard to quantify whether or not his efforts are successful I find myself benefiting from the constant exposure to his exhortations to treat oneself well, to value one's relationships with others, to revive the spirit with music and poetry, and to embrace one's inner beauty as a pure expression of self.  His approach is so positive-minded that I feel pretty constantly uplifted.

That being said...

Family medicine is exhausting.  I really enjoy talking to people and hearing what's going on in their lives; when I'm in the exam room, I feel fully present and I like the experience of connecting to them.  However, something about the constant onslaught of patients makes me feel smothered.  Maybe this is just the early pains of adjusting to a new rotation, but so far I have been mentally spent by the end of the day, far more than on internal medicine or any of my other rotations (it seems.  Maybe this is just because I'm two months out from surgery and the mind suppresses what it cannot forget).

Today we did nursing home rounds.  Some of the patients are just heartbreaking: they have no other place to stay, or they're just too unsteady to live on their own anymore, or they have become debilitated by illness and need the constant cares that a nursing home can provide.  One woman was recently diagnosed with lung cancer (on top of other ailments) and today she was tearful and worried.  She wanted to know how chemo would go: would she be sick? how sick? how long would it last? would radiation hurt? what side effects would happen? was she going to die?  My preceptor tried to comfort her as best as he could.

Another woman had written down her memoirs, including all her travels from when she was younger, and had them bound in a hardcover book (complete with dozens of pictures).  My preceptor left me with her to chat and she let me flip through the pages.  I would ask her a question and it would spark her memory for a story or two.  She had been a bit crabby and frustrated when we first came in to talk to her, but a half an hour or so later when I left, her spirits seemed lifted.  So many of those patients just want someone to listen and visit with them.

I have Friday off, so I'm going back to Milwaukee for the weekend.  I like it up here but the weekend can't come fast enough!