I have been feeling the peculiarities of living in a small town recently, so this week's Wrap focuses on rural-themed posts:
- The Country Doctor fulfills another rural role: transportation home for his prenatal patient. Upon arrival, he sees a slice of poverty none of us should forget exists.
- Secretwave is doing a rural rotation, and learning about small-town home remedies for the ills of humankind. You won't find these in the Merck Manual.
- Bongi, who reminds me of Scheherezahde, because he never runs out of stories, reminisces about surgery in the dark at a rural hospital. I have a few power-outage stories I plan to share in the future. Here's a tip: recharge your batteries and keep a flashlight in every room.
- The obesity epidemic is not a rural phenomenon, but here in Rural, CA. I see many more 350+ lb. patients than I do in, say, Palo Alto. The causes of morbid obesity are complex and the motivation of an obese individual to make healthy life choices is important; however, the rural poor often have access only to high-carb processed food which makes extreme dietary change difficult. In my community, we have only one surgeon who performs malabsorptive procedures and no one who does lap bands. However, I get a lot of queries from patients and I try to be realistic about the psychological, medical, and metabolic counseling I give to people who are curious about weight-loss surgery. Once again, Ramona Bates of Suture for a Living fills an essential gap in my knowledge base: how to assess psychological fitness for bariatric surgery?
Thanks for another great crop of posts. I hope to catch up with some more reading soon.