On Grim Rural Self-Sufficiency

Recently I met an internist who may be relocating to a rural community to work as a hospitalist.  When I told her our hospital has no dialysis services, she asked, in horror, "What happens if someone comes in with hyperkalemia?"  Uhhhh....I rattled off a few intern's pearls on the subject before I realized I probably sounded condescending and hastily changed the subject.

Truth is, when you're a rural family doctor or a rural hospitalist, you often have to implement first-line interventions for a sick patient because you can't just pass off an urgent situation to a throng of waiting specialists.  First of all, there is no throng of specialists, and second, even if there were, they'd probably have so much work to do you'd never catch them waiting around for you to call.  So working in a rural community produces grimly self-sufficient doctors.  Don't get me wrong:  I'm glad I have consultants in our community and call them whenever I'm in over my head, but I never call them instead of starting my own work-up and plan.   

The main danger of this rural self-sufficiency is not to my patients, but to Noo.  I can handle critical hyperkalemia without too much kerpuffle, but perhaps I get a bit too full of myself and take on more than I can handle at home.  For example:

1.  Two years ago I took up organic gardening and canning and put up several gallons of tomatoes, with which I am still cooking to this day.  There were several critical canning sessions which went on into the wee small hours of the morning, when most normal doctors would be sleeping.

2.  By the way, the organic raised-bed garden is now completely overgrown with native grasses.

3.  I installed all the curtain rods in our house, without a perfect grasp of how to choose drill bit size to match up with wall plugs, with a result that most of these rods are ever so slightly off-kilter and at least one of them is being held in place by masking tape.

4.  Flush from my success with the curtain rods, I proceeded to install floating shelves--again, with imperfect understanding of how to choose drill bits.  Needless to say, these shelves are slightly off-kilter and several have keeled forward under the burden of the decorative objects placed upon them.

Oh well, at least I learn from my mistakes.  At least I think I do.  So far this week I have:

1.  Repaired the large holes in the wall left behind after removing the shelves in #4 of the above list.

2.  Taped off the edges around all the closets in the master bedroom, in preparation for painting.

3.  Primed the walls in the master bedroom for painting.

4.  Gone around with a special edging attachment to get the edges of the walls painted, which--with #2 of this list--is a bit like wearing a suspender and a belt.

5.  Repaired a shelf in the laundry room, an easy fix, not even worthy of an item on a list, but hey--I'm going to grab the glory when I can.

The master bedroom's color is going to be spinach green.  I hope my painting job is up to par, because this wall color will probably last longer than all those gallons of tomatoes. 

Comments

[Felix Kasza]

MomTFH --

at a guess, calcium or magnesium if the hyperkalaemia is causing arrythmia. Insulin will move K+ from extracellular fluid into cells, _temporarily_ parking it where it is not in the way. The insulin is usually given with glucose to prevent hypoglycaemia, at 5 or 6 grams of glucose per unit of insulin (a ratio with which I strongly disagree, unless the patient has insulin-resistant T2DM or is on steroids).

Cheers,
Felix.

[MomTFH]

I want to hear the pearls!

I am pretty impressed with your do-it-yerselfer work around the house, even if it has had some results that needed a little fine tuning. And I think I have expressed this opinion before, but I firmly believe that all bedrooms should be some shade of green.