Most Influential Books

The following are just the books that have influenced me more so than any other. Not necessarily my favorite books, most of them are.

1.) Call of The Wild- Jack London

2.) It's Not About The Bike - Lance Armstrong

3.) Mountains Beyond Mountains - Tracy Kidder

4.) Complications - Atul Gwande

5.) Travels - Michael Crichton

6.) A Walk In The Woods - Bill Bryson

7.) The Millionare Next Door - Stanley & Danko

8.) The Earth & Man - Rand McNalley

9.) The Dragons of Eden - Carl Sagan

10.) A View Of The Mountains - Morris Gibson, MD

11.) Spontaneous Healing - Andrew Weil, MD

“Upon buying your ticket, you gave up a lot of your rights.”

Read more here.

Trip To Seattle-NAPCRG

What an outstanding trip to Seattle.

I flew out of Wichita on a late flight because of cost- and arrived to Seattle 1 hr before my presentation. God bless the iPhone as it allowed me to quickly pull up maps, train vs bus vs shuttle fares and schedules, contact our research director who was already at the conference, and listen to Screeching Weasel on the train ride in as a snapped a few pictures and texted them to Maryclaire to let her know I was here safe.

I checked in to the beautiful Westin and ran to my room with barely enough time to jump into my new suit and run down to the poster session. I was immediately grilled with questions regarding our research on the MedEncentive software that had been implemented by a large medical clinic in town. I was barely familiar with the latest version of our poster when the chair of our department, former president of the AAFP, and coauthor on the study came to check in on me.

We went out for some good Thai, and after getting a few postcards, went to the hotel gym to get a quick workout and hottub soak in.

I enjoyed Born to Run on my Kindle, and watched a little terrible television before passing out from sheer exhaustion.

It wasn't until the next day that I didn't feel discombobulated anymore. I think I've been fighting a low-grade virus for the past few weeks.

The morning plenary lecture by Jane Gunn from the University of Melbourne was excellent and inspiring. Equally inspiring were the number of international researchers in primary care who offered briliant insights of their own, as well as pressing questions. I walked away moved to continue with research as an important part of my career.

As there was no programming other than another poster session immediately after the lecture, I took to the streets. People make fun of me for my Mont Bell down jacket, but I love that thing. It was perfect for the wet cold drizzle of Seattle. I was very shocked that it really is that wet and grey- but it is! I wandered around town for about 3 miles then used Yelp! to find the best breakfast in town. The place with 609 5 stars was Piroshky Piroshky- a Russian pastry bakery. This led me to walk to Pike's Place- the market near the waterfront. A group of people at a Starbuck's 2 doors down let me know that that must be the first Starbuck's-and it was. A performer was busking out front and she was so amazing I figured she was somebody famous coming back to her roots, but I really think she's just someone who will be famous- some of the best guitar and singing I've ever heard. Across from the shops is the covered market of Pike's Place with organic produce, hand carved art, flower markets and more.

I met the others at the hotel and conference for lunch, and we set out to do it all again.

After, I put on my shorts and shoes and headed out for a running tour of other areas of the city. I simply ran until I saw something interesting- then would pop inside to look, talk, or eat. I went to the Seattle Art Museum, the Central Library (the highlight of my trip I think), the Space Needle, and many places in between. I loved moving quickly from place to place. It was my first significant run with the New Balance MT-101's, and I have to say I was very pleased with their performance. Soaked and cold, I arrived to the hotel in time to change and meet the others for dinner. We ate at a mall Mexican restaurant and I had the best (and first) vegan sweet potato and black bean tacos ever! Two of my companions had musculoskeletal complaints and I did some OMT before bed. Also before bed a quick hop into the hot tub with the latest issue of Outside Magazine, some TV (the new series Boardwalk Empire on MTV- wow is it good), and a few more chapters of Born to Run. It was a nice read not only because of the story, but because I was putting in 6-10 miles of walking and running in each day!

In the morning Paul Grundy spoke on the Patient Centered Medical Home. As it was my last day in Seattle, I chose to wander a bit more through the city immediately after. I hit the South Downtown area this time, eating, walking, and people watching. I also managed to get a haircut in with an hour to go! I mailed off my postcards, took the light rail back to the station, and sadly flew home with a very, very late (as usual) arrival in Wichita.

It was a wonderful trip. The conference was inspiring, the research was well received, and I loved Seattle. It is, besides Asheville, the only other city I've been able to see myself living. The outdoors, the food, the energy, and everything it had to offer (what limited amount I could see in my two days there), the strong sense of public health, primary care, and the established scope of practice (there is an OB fellowship at the Swedish Family Medicine Residencies) make it a very desirable alternative if for whatever reason I wasn't able to live in North Carolina.

Now it's back to work!

Unscheduled Stops

It's dark outside early, it's November, and the wind is howling outside my window while I sit in bed with two siamese and a Macbook Pro under wool blankets, sitting on a heating pad.

This afternoon it was just warm enough to wear a t-shirt for a run but I pulled on a long-sleeved Capilene and I'm glad I did because there were more than a few cold blasts of air every time I stopped to adjust my shoelaces or wait for a traffic light.

Today my short jog turned into a remarkable run. I wasn't looking forward to running downtown today because sometimes in Wichita the downtown can seem barren and that's depressing. Economic downturns tend to be depressing. But I ran through the cityscape toward the riverfront and had to stop in my tracks when a massive formation of birds chasing bugs caught my eye- then another grouping- then another. Not more than 100 feet off of the ground swirling between the buildings. Thousands of them, looking like magic.

I kept churning along, listening to Hot Water Music, running past the public library, past Century II and the fountains, and along to the riverfront. I stopped at the bottom of the steps of the fountains. To smell the roses figuratively, but literally to appreciate 30 Canadian geese standing on the sidewalk along the river and on the dried banks below. They looked up at me curiously- this man running along a draining river at sunset on a blustery day. 10 of them in unison forgot about me and dipped down and drank some water. The others mingled amongst themselves. I decided to walk through the group as the fastest way to get on with my run and delighted in their antics- their squat movements, their choreographed drinking and pecking, and their disinterest in me. I laughed out loud.

I continued running but stopped shortly to appreciate a statue I've passed plenty of times and never bothered to appreciate. I was stopping so much to appreciate so much today i may as well give it my attention now.

"Dedicated to the Pioneers,"

the plate read. The statue is of a mother and her son- she clutching her Bible to her chest and her son's hand, and he clinging to a crude carved boat to take to the river. It made me appreciate the history Kansas has to offer, the pioneering spirit, the past and future Family Doctors of tending to those few who lived and live in the remote regions of Kansas. Later this evening I would tell an interviewee visiting from the Pacific Northwest stories about Wyatt Earp calling out a posse only 300 meters from where I was standing looking at that statue, or Carrie A. Nation taking a hatchet to a bar near my downtown loft. There is so much history here.

I completed my run with no more interruptions. I came home refreshed, happy to move my body again and with a better appreciation of Kansas and the good fortune I have to be able to take times to pause- for a moment or for a weekend- and appreciate the nature and culture of the place I get to live and train in.

Snow Already?

Flurries on the way to work today.

Out of one hospital now, and into the other- I'm covering labor and delivery as well as the pediatric service in Waterville. I'm essentially practicing Maternal Child Health, which was my intention in the first place.

Inpatient medicine really took a lot out of me. The days just blended together and there was hardly ever any down time. I felt like I was working harder to keep my patients from dying unintentionally than improving their conditions- a sentiment echoed by several of my colleagues. The most unbelievable day I have had in my medical career took place when- covering the hospital service alone with my medical student- I was in the ED to evaluate an elderly woman with high blood pressure and dizziness who probably wouldn't need to be admitted. I received a page from the ED, which I was already in. Curious, I took a step out of the room to the middle of the department and asked if someone had paged me. They had- to let me know the patient who was next door to the room I was, who was diagnosed with a pulmonary embolism (a highly lethal blood clot in the lung) and was being transferred South had left AMA after cursing out the nurses. Right after I received this information, I had another stat page- a difficult patient upstairs whom we had expected to leave AMA- was leaving AMA, but had also attacked the nurses, and just before leaving the floor announced to everyone in sight that she was going to kill herself. Instead of allowing her to leave, we then had to retain her with security to evaluate her for absolute suicide risk. I spent a long time working through most of her bizarre rationalizations and demand to read her own chart. After calming her down we were able to formerly discharge her- however the printers were down in the hospital, and I would have to hand write her 5 page list of medications, as well as all of her discharge instructions.

The patient with the PE was never found, the suicidal woman calmed down and went home, and the little old lady with high blood pressure was given the lowest dose anti-hypertensive medication I have ever prescribed and sent back to her home. After all of this I had to do a full history and physical and dictate on a patient on psych who had- a sore throat. And they knew she had a sore throat but didn't know what to do with it. I'm talking about licensed physicians. I signed out, and was extremely relieved to be leaving for vacation.

Vacation was far too short, but I was extremely grateful to spend any time at all home with my godchildren and my family. Sleep is nice too. With a somewhat heavy heart I flew back to New England- back to work.

Maternal Child Health has been relieving. It is a service with long hours- 24 hours on then off, but I get to work with babies- my real passion. It has been nice to work on a discrete team with the nurses, midwives, and obstetricians, and pediatricians, and to get to spend some time in the OR doing sections. The service has been busy but very manageable. There have been some surprises (a precipitous delivery while I was extremely disoriented from having fallen asleep for 5 minutes), but mostly happy experiences. The beauty of being actually, completely off after a call has been extraordinarily refreshing- even if I sleep for most of that day. I've started enjoying work once again (after a very brief hiatus secondary to burn out), and am reading and working every chance I get. I hope it stays fun...

On a side note, someone please buy me an Amazon Kindle. Oprah has worked her magic and now it has bored it's way into my brain. THANKS

Leaves Are Changing

It's Fall in New England, and the year is going by rapidly.

I'm well into my fourth month of my residency in rural family medicine, and I'm amazed by how fast it is all going. I love the work I am doing, the people I'm doing it with, and the place I live. It's a miracle how much things have changed from my very recent life as a frustrated medical student.

I am currently covering the inpatient hospitalist service for our residency, and the hours are long and the cases sometimes frustrating. I can't complain though, as the patient interactions are almost always rewarding, and the work is interesting and diverse. From negotiating with a starved and depressed old man to eat, to sitting with another man while he died- only to watch him rise from the dead and be sent back home, to nursing a neglected baby back to health, to delivering babies and managing obstetric emergencies- just like the family practice clinic- I never know who will be waiting for me at work each day. It has been a bit difficult balancing work schedule, sleep, personal finances, and relationships, all while practicing good medicine- but I think I'm somehow doing it. Housework has basically been triaged to the basement for the next month or so, and I do sometimes open my eyes to find I've already gone to bed and am awakening for my work day without remembering having gone to sleep the day before.

Call has not been nearly as miserable an experience as anticipated, and overall the workload is basically manageable. I do seem to be running up against a wall however when it comes to managing both my outpatient duties and the busy hospitalist service. I get behind on prescription renewals, call backs to patients with lab results, and social service follow-ups, because I'm busy doing discharge summaries or managing sliding scale insulin regimens for inpatients. On other days I'm on top of my clinic, but I lose track of my patient list in the hospital and tasks get neglected.

Last month I covered the Emergency Department here in Augusta, and I enjoyed the luxury of shift-work with no call, the interesting cases coming through the door, as well as the large amount of procedures I was able to perform in such a short period of time each day. Work days beginning at 10 am were nothing to complain about either. I am grateful for the doctors I was able to learn from in the ER- both seasoned Emergency Medicine physicians from Boston, as well as Family docs who have transitioned their practices to full-time ER work. I gained a good deal of confidence in managing codes and emergent situations, that has translated well into managing emergencies on the floor of the wards. Yesterday I ran a successful code with no backup from any attendings, felt comfortable during the entire process, had a good outcome for the patient, and received great feedback in the end on how things had gone. If I hadn't had such good exposure in the ED, or such talented physicians training me throughout my time here, I don't think I could have managed as well.

All in all I'm still loving being a rural family doctor in training. I wouldn't change any of it for anything, except to be closer to the people I love- my friends and my godchildren. But a brief vacation is in the works for the near future, and home is only a call away.

Now for some sleep!

Things That I Believe In...

An ongoing list:

Swiss Army Knives (Basic: Tinker, etc.)

PBS

Apple Computers

Anthropology

Toyota Pickups

Moleskine notebooks

The American Medicical Student Association (AMSA)

Manual Medicine

The US Constitution

Neighborhoods & Community

Education

The Bicycle

Patagonia Stand-Up Shorts

Wikipedia

Osteopathic Medicine (the practice, not the institution)

Primary Care

Family Medicine

Bill Bryson

The National Geographic Society