Tuesday As many of
us in practice know, the day after a long weekend is usually
chaotic. This week our hospital also takes a number of
first year medical students as part of their educational
exposure to rural medicine. We're getting more involved
in teaching as medical schools scramble to train their
increasing numbers of students. We rural physicians hope
that, over time, it will eventually help alleviate doctor
shortages in our neck of the woods. This is all very grand
and altruistic, but today I have a morning clinic that's
bursting at the seams.
When things are a bit calmer later
on, I take one of the students to the nursing home where
we visit a number of patients and see a variety of medical
problems. He has visited a home only once before. He's
both interested and enthusiastic and has a naturally
kind demeanour that my patients take to even
the demented ones! I have a number of patients with
basal cell cancers and actinic keratoses and I quickly
get him involved in treating them with cryotherapy.
The old adage of "See one, do one, teach one" kicks
in and before long he's an expert. Later that day he
helps me pick out a guitar for my son's birthday.
Wednesday I get to the hospital
early to remove a lesion from a patient's forehead that
has all the hallmarks of a basal cell cancer and the
same student scrubs in to help. If this keeps up I'm
sure he'll soon think rural life is bad for the skin.
After seeing my inpatients I attend rounds. This includes
a session with a medical ethicist, something I was not
looking forward to. Most of these people seem to relish
'muddying the waters,' but this person was bright, dynamic
and, for an ethicist, decisive. He brought with him
several scenarios that acted as a springboard for discussion.
When things ended I felt a bit more comfortable dealing
with some of the more controversial issues we face regularly
That afternoon a different student
joins my colleague and me for our clinic. His interests
are more internal medicine focused. When I was in first
year I had no idea what some specialities did, let alone
which I wanted to pursue.
We find a few patients with an
IM-sized list of diagnoses. However in mid clinic a
patient comes in with an inflamed cyst that needs draining.
We freeze it, do a cruciate incision over the most fluctuant
area, and drain a large amount of rancid material. I
get the student in there probing and pushing out the
contents. The patient is cooperative and pleased at
the relief he gets. The student appears to enjoy it
too. The enthusiasm of first years is good for the soul.
That night we attend a medical talk on lipids and small
dense LDL particles. Even this fails to dampen their
Thursday A new student this
morning in clinic, this time interested in hearing chests
that have different clinical findings. As luck would
have it, the chest sounds are monotonously normal and
we're stuck seeing crying kids and the demented elderly.
At last a diabetic smoker with heart disease comes in
with a six-day history of productive cough and malaise.
Alas her chest is also clear.
That afternoon I and a colleague
convince two of the students to join us in a round of
golf, something we try to do every Thursday in golfing
season. These two feel they're playing hookey but we
rationalize that they need to get a taste of life in
the country. The golf is predictably unpredictable and
a winner is not decided until the last putt.
Friday Clinic goes fairly
smoothly through the morning. I get our student to see
an 18-year-old squeezed in for a rash after a desperate
phone call from his mother. After his history and exam
I come in to critically appraise the student's history,
exam, diagnosis and treatment. Our derm emergency turns
out to be a two-year case of acne affecting the upper
trunk, face and neck. His mother, it turns out, is a
That afternoon our students head
back to the city and their summer work. While their
presence slows the pace, it keeps life interesting and
more than makes up for any loss of time or income.