Rural Doctoring

The Least Sexy Holiday Invite, Ever

The cat is adorable, but the offer--not so much:

Never Mind the CT Scanner

Here's the most important piece of equipment in the hospital:

You got it, the ice machine. Just ask all those parched patients on Med-Surg which device they'd take with them to a deserted island.

Bigger & Crazier Than I Am

I mean the Pacific Ocean, and I mean in a good way:

This is why I need to make a greater effort to crawl out of the hospital more often, and remember why I moved all the way to Rural.

When a Lump is Just a Lump

A commenter kindly asked for a Noo update, so here it is:

After her critical illness this summer, the oncologist did not recommend resuming interferon therapy for melanoma. He had an antibody titer panel done which showed a weak immunologic response to the four months of interferon she'd already completed, and even though this isn't proof positive that the treatment "took," it is better than nothing and we were all quite relieved to shelve the idea of resuming thrice-weekly therapy, with its attendant exhaustion, diarrhea, and general unwell-ness. Since recovering from her hospitalization, Noo has been having regular skin exams, all uneventful until the last appointment when the dermatologist noticed an enlargement of one of her anterior cervical lymph nodes and sent her back to the general surgeon to have it looked at.

Now, the problem with these two events is that they were separated by a couple weeks of anxiety while the referral went through the usual channels and Noo had to wait for the next available appointment with the surgeon. Being in the medical field, I know better than to expect immediate reassurance, but I have to admit--it would have been nice if she had been sent from the derm office directly to a waiting surgeon who could excise the damn node the same day. And it would have been terrific if the pathologist agreed to cancel her dinner plans that day in order to get the sections prepped and stained, and then spent a leisurely hour looking at them under the microscope before dictating her findings. But this is not how things work, and I know this well, and now I also know a bit more about the gnawing worry the patient and her family experience while they are waiting for results, whether good or bad.

In this case, the news is good:  the excised node is a simple reactive node, no recurrent melanoma, no cause for alarm. So Noo has been restored to the category of Practically Normal People and we are carrying on with our post-melanoma lives, more dazed and confused--but also more grateful--than we were before the diagnosis became a personal journey.

Me, Abandoned by Martians

It's been several months since the space-time continuum was indelibly altered by Noo's critical illness and my decision to leave Gimbels. Whereas previously I was a bit of a chatterbox on this blog, I have to acknowledge a certain surly silence which has take the damn thing over ever since. I've never been good at change, and there's been nothing BUT change since July, and all I could do was surrender myself to it and see where it would take me. Most of the time I feel like one of those ordinary citizens in the movies who, through no fault of their own, wake up at the center of a David Lynch movie, apparently plunked there by Martians. A video montage of this movie might include scenes such as:

My State of Mind, In a Nutshell

The holidays are around the corner, and yesterday I read the word "Hope" on a holiday display as "Hep C."

Hoo boy.

Silence. Listen.

Noo and I had to put our cat to sleep ten days ago, a very bad day indeed. I was starting a week at Nordstrom and had to drive back and forth from work to home three times that day, and it's hard to drive on rural highways when you're crying.

I've been quiet on the blog because I've been listening to myself. I realized that I've been putting solutions together for years which look good on paper but truly suck in practice. Flashing my middle finger at Gimbels and working at Nordstrom (a good job, btw, but...) seemed so reasonable at the time, but I hate being away from my home for a week at a time, and I hated missing my cat's final moments because I was on my way from 60 miles north. Not that working at Gimbels that day would have been a walk in the park, but I would have been there and I would have been able to hold her one last time. Thank goodness Noo was there. We raised this cat from a 4-week old kitten and she was like the warm pulse of our household. I don't expect everyone to understand this sentiment, but cat people will, and I honestly don't give a shit about any opposing opinions.

"Being there" is an emerging theme in my current reflections about doctoring, early middle age, the creative life, and What Comes Next. I'm going to try to get some of these reflections onto the blog but only episodically. I need to be quiet. I need to listen.

Everyone Has Her Limit

No, I haven't disappeared off the face of the earth. Since my last post, I've been holding down the jobs at Macy's and Nordstrom and one of my cats got sick. She was diagnosed with diabetes and kidney failure, and now--in addition to being an effective nocturnalist and itinerant rural hospitalist--I am also learning how to give her subcutaneous fluids (twice a day), insulin (twice a day), and vitamin B12 supplements. She's got diabetic polyneuropathy so she can't really walk around, which means I'm changing a lot of linen and investing in waterproof crib liners to keep the house habitable.

I've coped effectively with the upheaval in my professional life, Noo's melanoma diagnosis and subsequent critical illness--but my cat getting sick sent me over the edge. So I've been crying a lot and succumbing to retail therapy and generally being fairly insane, but things are getting better because my cat is getting better, so I'm hoping to resume thoughtful blogging about the life of a rural doctor soon.

Comparison Shopping for Rural Hospitalists

Recently a reader asked me why I left rural practice, and I took this as a sign that my recent job-hopping has made me seem like one of them fancy-pants, highfalutin' cityfolk doctors who make such a stir on TV. At one time, I too believed a country doc stayed in one town for thirty years, delivering babies and burying octogenarians, until you finally drop dead in the office one day after seeing a clinic full of patients. Modern doctors seem to move from job to job, role to role, throughout their careers, as mobile as information technology supervisors, customer service representatives and hedge-fund managers, regardless of the demographic they serve.

Crawling Into The Hole

OK, I'm starting my second run of night shifts at Macy's, this time SEVEN in a row so I'm hoping my day-to-night transition method is going to hold up: