Wednesday, May 16, 2007

Wilderness Medicine

Big Boss Bedell behind the captain's wheel

In rural Cascade, Idaho, you really get to see it all in a day, from the bedside to the riverside. This morning, Dr. Bedell and I were called in emergently before dawn to evaluate a patient for acute coronary syndrome-like chest pain. While this would not be something that unusual for a Cardiologist or Emergency medicine physician to see on the daily, any emergency room visit in Cascade brings excitment to an otherwise slow-moving country hospital. The beauty of family medicine lies in the breadth and diversity of patient encounters, leaving you to guess what you will see next. In a rural community hospital, where a "mass casualty" alert can potentially go into effect spontaneously given the dearth of local health care providers, we are always kept on alert, and forced to think quickly and act efficiently. Fortunately for the patient, normal EKG rhythm strips and non-elevated cardiac enzymes proved to be reassuring, allowing us to send her swiftly on her way, with a scheduled followup at the clinic in one week.

By sunrise, I was making post-partum rounds on recently laboring mothers, doing the typical stuff Ob/Gyns do, like assessing fundal heights and asking mothers if their bleeding has subsided, and if they've passed gas or had a BM yet. Switching gears between the different disciplines can be daunting, forcing me to focus hard on what I am actually assessing so as not to forget any pertinent questions to ask, or god forbid, to appear confused and stupid. After completing my postpartum check-ups, I transitioned from evaluating mothers to their products of conception, spending the rest of my mid-morning performing newborn exams on one day old infants. Transitioning into the role of a Pediatrician, I again, had to take on an entirely different approach, forced to abandon my practiced questioning skills for purely observational ones. While the little ones do not speak yet, they sure know how to kick, squirm, and cry, all signs of rebellion directed against the precipitous change from the warmly bouyant and nurturing environment of mother's womb to the cool and dry, mountainous environment of central Idaho. All of this change made more intense and less bearable by the cold steel rim of the sthethescope I have placed directly on their bare little chests.

By noontime, I was already at home, not just for a quick lunch, but to help Dr. Bedell inflate, load up, and strap down a 14 feet long raft to the platform of a trailer for shuttling down to the riverside. By 1 pm, we were thundering down the Cabarton stretch North fork of the Payette River, navigating through sets of rapids known to the locals as "Cocaine," and "Howard's plunge." I sat in the front of the raft, sipping on beers, soaking in all the warm sunny rays and the ice cold river water, reaping everything I could from life, not one bit envious of where my peers may be on an early Wednesday afternoon in the middle of May.