With the realization that medical
schools need to expose their students to rural medicine,
we are, on a regular basis, being exposed to medical
students. This past week we've had three from the University
of Ottawa, one from McMaster, one from Memorial and
a Nurse Practitioner student. While six students are
more than we would want on a regular basis, it all worked
out well. On Sunday night we hosted a meet and greet
with the physicians, students and staff so everyone
can get to know each other before the fun really starts.
Monday The next morning
I take the student assigned to me around the hospital.
She's from Toronto but adjusts easily to the quirks
of rural medicine. She assists with a newborn during
a Caesarian and the infant has some respiratory difficulties.
It's a good learning opportunity. The child is also
born with a hypospadias, which she has not seen before.
She then assists at a few gynecological procedures.
What the rural practice offers to these students is
the chance to participate in a wide variety of medical
disciplines without having to look over the shoulders
of interns and residents. The afternoon is taken up
with orientation, but the next day she gets into the
swing of office practice. It's always difficult for
students to get used to the pace in a busy family medicine
practice. But it's also hard for me to slow down and
spend a bit of time reviewing history, exam and medical
decisions. The exercise of having to explain your thinking
to a student forces critical appraisal of what you are
doing. Of course, this requires that you actually have
a rational approach to what you are doing...
Wednesday morning I take
my student to the hospital and handle a number of small
cases. The second involves the radical excision of the
lateral margins of a young man's great toenails. These
have been ingrown and get frequently infected. Steel-toed
work boots exacerbate the problem. He wants both feet
done at once. His wife and mother-in-law accompany him.
He's very apprehensive about needles and, in spite of
topical anesthetic, the ring blocks cause him much pain
and anxiety. Sedation helps a bit. His wife and her
mother are great followers of The Learning Channel and
are quite excited to watch the procedure. One pulls
out her digital camera and starts video-filming the
procedure. My guiding of the medical student provides
a running commentary of what is going on. The only interruptions
are the moans of the patient who cannot feel any pain
but doesn't much like the process and would prefer his
partner had more interest in him than in his toes.
That afternoon there's a hospital
meeting with the head of the Regional Cancer Clinic,
the head of the Heart Institute in Ottawa and the Chair
of Medicine at Ottawa. They review their areas of expertise,
the goals and aspirations of the organizations they
manage, new problems and new programs designed to address
them. It gives us the chance to give these people the
rural perspective. This is a rare opportunity and we
struggle as a medical staff to avoid only bringing up
our problems. In retrospect, our problems are mainly
patient-based as a result of systemic problems. Theirs
stem from their inability to really change those systemic
problems.
Thursday My wife and I both
finish work early and head off to meet with our financial
advisors, a process we usually try to do three to four
times a year. Reviewing your finances sometimes feels
about as comfortable as a rectal exam. Usually we also
have to top up our RRSPs, make a further deposit to
an RESP and talk about how our finances would be if
we retired in a few years. Any doom and gloom is usually
tempered by the line that the market equilibrates and
over the past years has shown steady growth. Somehow
the sun and moon and stars seem better aligned on this
day and we are advised that the economy in general and
our investments in particular have been performing well.
Were we to retire at age 85 we will have moved up from
Kraft dinner to Lean Cuisine! We write out a bunch of
cheques and leave poorer but enriched by the experience.
The drive home from Ottawa takes
about an hour and a half through rush hour traffic.
Once on the highway we recover from the scrutiny of
financial planning and try to realistically set some
goals for the next few years. Next year, we are likely
to become "empty nesters" and so we talk about renovating,
downsizing, traveling, reducing workloads and working
hours, pursuing hobbies and a myriad of other options.
We both like our work. We both enjoy spending time together.
We both feel we would be smart to slow down our pace
of life somewhat. It's not the first time we've had
this conversation and somehow talking about this does
not necessarily translate into change. Thankfully, we're
once again saved from concrete decisions by reaching
home.
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