Rural Medicine

What do being featured on a Canada Day Parade float, surviving a grizzly encounter, catching my first 35 lbs salmon, getting picked up by teenagers at a run down bar, pulling all nighters in the health clinic, and making the front page of the local news have in common?  Not much.  Except after these 4 weeks in my 1st clerkship rotation, I can say "been there, done that".

As I plunge deeper into my clerkship years, I'm thinking more and more about what I want to be when I grow up.  Rural family practice is definitely one of a kind and has kept me on my toes.  It wasn't uncommon for me to drive 2 hours to even more remote villages for the weekly clinics there.  There were days where I'd poke babies for their vaccines, K.O. an aggressive alcoholic, and several motor vehicle traumas all before being called back in for someone with heart failure that was being choppered in.  I was able to do the ER bit, but still have complete follow-up with the patients.  Pretty neat stuff that ain't served in the city. 

I can definitely see myself doing this for a living but rural is...well  rural.  I freaken love the idea of being a jack of all trades physician and have the ability to go fishing nearby while "on call".  But I'm not sure the trade-off of friends, family, and urban conveniences is worth it.  I looked forward to work everyday, but I couldn't figure out whether it was 'cause I enjoyed suturing legs up at 2am or because the alternative of watching the clock tick until my next shift nearly made me slash my wrists. There were days where I'd get off work, hike, come home and it was still only 6pm.  From there, it was TV and youtube.  Not a soul in the street to chat with.

Verdict?  Rural medicine is great.  It takes a certain maturity for a city boy to trade off friends, family, and glitzy social scene of urban life though.  I'm certainly not there yet.  If I pursue family medicine in the future, I hope said maturity will be there.  After all, rural medicine is definitely the way to do family medicine.

"coconut blood transfusion! It actually worked!"

It's been advertised like crazy. Off the Map (OTM), from the overly imaginative producers of Grey's Anatomy, fires onto cable television tonight. I'm not a follower of medical dramas whatsoever, but there was something that made me excited about this one. I've been a long time avid traveler (one continent left!) and have been been spearheading my faculty's global health department as well as gaining hands-on field experience myself. I guess it was this travel medicine bit that made me set the premiere on my iPhone calendar.

Well - my review is premature since I'm watching it as I type this (multitasking!). But let's look at the salient features of the show as well as some of the best lines I've heard on it.

Synopsis:
Young, good looking docs travel thousands of miles to re-discover why they entered medicine. Each has a different personal story, but they are bonded by their common need to run away from their life in the states. Within the first days of working, they are learn deep life lessons from the local seasoned doc and encounter riveting moments as the locals express profound gratitude for the American's altruism.

Hmmmmm...I can't even comment on this right now. I need to get a sweater to cover up my goosebumps.

Best lines:

"coconut blood transfusion! It actually worked!"
WTF?! Coconut transfusion? I can't wait to bring this up in the wards when I'm in the hospital during to an ER surgeon if we are ever low on the human donations. Just think how impressed he'll be. Sign me up for Gilligan's Island!

"I'm not a surgeon" - blond female doc
"Here, you're a surgeon........you're anything I need you to be." - the surgeon dude
I'm mentoring several groups going abroad this summer and if they pulled that on me, I'd sit them by the cow patties for a serious time out. Doctors who work outside of their skill set completely violate both basic global health ethics and medical ethics. You can't pretend to hone skills that you don't have just because you patients stem from lower resourced community. Can you imagine if a family doctor performed a triple bypass surgery on you? Yes - they WILL kill you.

"My grandma is 80 years old, but today because of you, she took her first real breath." *Tear*
Grandma reaches into bag and presents the sexy blond doc with a thank you chicken. *Insert chicken sounds*
This was actually probably the most realistic part of the show (minus the teary eyed patient). I remember a friend being presented a goat once when he was in Uganda. Back it went to the community.


Verdict?
To the 10th graders vying to be doctors, please take nothing away from this aside from the fact that doctors are obviously all gorgeous people. Apparently we are also all white (you can also be black, but only if you play a minor role in the show).

But let's take a serious look at global health and the show. My university has become a leader in filling in health gaps of lower-resourced communities. In fact, I just came back from workshop on it and am meeting the Dean of Medicine tomorrow about the future of it in our faculty.

I've been fortunate enough to learn first hand about the pillars that support the field: the ethics in working with developing nations, project development, acute disaster relief, cultural competency, needs assessment etc. OTM, like many other sugar-coated medical shows, glamorizes what medicine actually is. While doing so, it also completely distorts what it means to go abroad to practice medicine. Basic medical morals are thrown out the window and anything goes.

The show does have its merits though. For one, it fuels my fantasy that one day, medicine will actually be like that - I can save people with coconuts, fight my inner battles by saving a South American granny, and, along the way, hook up with a ton of hot young doctors who are also soul-searching.

Conclusions about OTM? I will probably stop watching the show here. It makes me angry that global health is presented in such a childish manner. But I will sleep soundly at night knowing that the public now has another reason to believe that docs working abroad are the modern sexy version of Mother Teresa.

2nd year changes

Been a while since I've posted up here. Seems like the past summer has finally reinforced my decision to stay in medicine.

"Stay"? Yeah - I had serious doubts about medicine when this last June rolled around. It seemed like I figured my days were better spent googling "pros and cons of quitting medical school" than memorizing the pathophysiology of CHD, ASD, DVT, VSD, UTI, HIV, EBV, CMD......

This past summer was amazing though. I rocked it out traveling through India - part backpacking and part global health work. The latter bit was phenomenal. I was based in the Himalayas working with a Tibetan community. Was it the lack of iPhones, cable, internet, or electricity most evenings (and let's not forget the comfort of bathing water without worms) that opened up my eyes about medicine? Nah - let's be real, I've given up numerous comforts while sleeping in the back alleys of numerous developing nations. The serenity of having very little with me was a good way to clear my mind up though. Was it the insanely genuine locals? Possibly, but I don't think it was that either.

This may come across as borderline arrogant, but it was the realization that my skills can REALLY move and shake the lives of others. I really had to feel for myself the thrill of having the skills to figure out a kid's health problems like a detective and mustering up the little knowledge I have to help her out. Sure, diagnosing scabies and giardia ain't the most glamorous thing, but knowing that I'll eventually be able to tackle far crazier med situations is pretty damn epic.














It was in this photo here that the realization smacked me in the face. I was driving with my Canadian team while driving through the crazy zig-zagged mountain roads after delivering meds to nearby villages - amazing. Guess medicine wasn't such a bad choice after all. Corny post ends here. SCENE!