Welcome IAFP readers!

I don't know that I've ever had an audience of strangers before, so I'd like to welcome any new readers and apologize in advance for the experience some of you are about to have. This blog started as the slipshod, slapdash result of my attempt to keep in touch with friends and family (a handful of whom frown upon activities like "not living in a major metropolitan area" or "primary care" or both) while I was living far from a major metropolitan area and exploring an interest in rural primary care this past summer. I've been meaning to add a few more posts about my experience in Quincy to this blog and will try to do so as time permits.

Undoubtedly, many of you will be first-year students looking for info about whether or not you should apply to the IAFP Summer Externship program. The answer you are seeking is: yes. I'd actually argue that the answer is "definitely yes," especially if you are just curious about family med and are not certain about what kind of medicine you'd like to practice. Who knows - you might actually end up becoming an orthopedic surgeon who sub-specializes in treating rare anomalies of the left hamate, but the IAFP externship will give you a robust clinical experience on which to make a better-informed decision. At the very least, even if you don't end up going into family practice, you'll probably collaborate with a family practitioner in the care of a patient at some point, and it would behoove you to have some familiarity and appreciation for their neck of the medical woods. If you have any questions, I'm happy to share more of my thoughts about the program.

Finally, I feel like I need to include a disclaimer that I am in no way speaking on behalf of the IAFP or any organization whose name is a combination or permutation of the words Quincy, family, medicine, or practice. Also, if you don't have a sense of humor, I suggest you immediately direct your web browser to an un-funny website like CNN or UK Parliament.

"Quincy: Life is Good." [MCAT Writing Sample Edition]

"Quincy: Life is Good." Discuss.

There are many ways in which life is good in Quincy. First, downtown Quincy has a variety of businesses, ranging from a tattoo parlor and pleather goods shop to an authentic German bakery and the town's only sushi restaurant (owned and operated, naturally, by Chinese immigrants). Second, Quincy has a history remarkable for hosting a Lincoln-Douglas debate, maintaining a deep channel for Mississippi River trade, being a documented stop for folks utilizing the Underground Railroad, and winning the Illinois Dept of Transportation Aeronautics Division "Best Heliport" award (Blessing Hospital Heliport) in 2000. Finally, Quincy has many family-friendly events scheduled in the summertime, such as a hot air balloon rally, music festivals, town barbecues, and Quincy Gems baseball games, where the team mascot - the Gem Bird - happily stands for photos with adoring fans.

But life can also be not so good in Quincy. First, if one does not own a car in Quincy, getting one's basic needs covered can be very difficult. For example, the only places to get food within immediate walking distance of my neighborhood are the hospital cafeteria and a Dairy Queen. And sometimes the Dairy Queen's soft serve machine breaks down. Second, while Quincy itself is on a bluff, the immediate surroundings are prone to flooding, as was seen in 1993 and earlier this summer, when waters reached the 500-year flood stage. Third, no one seems to know why Quincy is called the "Gem City," and when asked if there's anything here in town that an out-of-towner should not miss, most people recommend going to a different town: Hannibal, MO (Mark Twain's hometown). Finally, when an adoring fan stands next to the Gem Bird to get her photo taken, she quickly realizes that the Gem Bird looks really bored and smells like wet dog.

Some parts of Quincy support the idea that "Life is Good," while other aspects suggest that life may not be so good. Determining whether or not life is good in Quincy depends upon how you define a good life. A car owner who values pleather goods, an award-winning heliport, and fun events for the entire family would probably say that life in Quincy is pretty good. On the other hand, a lactose-intolerant non-driving hydrophobe critical of Mark Twain's work may not enjoy living in Quincy.

Circumcision!

First, a few disclaimers: No, I do not currently have an opinion in the pro- vs. anti- circumcision debate. No, I do not know if I will have my boys circumcised if/when I have kids. No, I do not plan on including any photos with this post.

There are three accepted techniques of performing a circumcision: the Gomco (Pamchenko?), the Plastibell, and the Thing That I Haven't Yet Learned. The Gomco involves a steel device that looks like an old-timey pocket stapler to hold the baby boy's foreskin while you make a clean cut around it with a scalpel. The Plastibell uses a plastic contraption and string that also guides the doctor in cutting the foreskin, but a plastic collar remains around the penis for a few days to a week. One of the benefits of the Plastibell is that the baby doesn't need to have any bandages; the ring, along with some dried skin, falls off in a few days to a week on its own. One of the benefits of the Gomco is that parents don't need to worry about something falling off of their baby's penis in a few days to a week: an event that may be disconcerting, especially to squeamish fathers.

I first encountered these procedures in a conference room, where a line of play-dough model penises were wrapped in nitrile foreskins cut from the fingers of blue exam gloves. The order of operations seemed simple enough: clean and locally anesthetize, clamp the foreskin and break any adhesions, place the device of choice, and snip. No problem!

When I observed a doctor perform the procedure for real, the baby getting circumcised seemed to think there was a problem. In fact, he decided this would be a great venue to attempt a new record for the longest string of rude comments ever screamed out in baby language. Eventually, the upper-register receptor cells in my ears degenerated from overuse so this wasn't a persistent issue. By the end of the procedure, when the baby was safely back in Mom's arms, we were all friends once again.

Farm Safety Day!

"Farm Safety/Ag Awareness Day is to familiarize new residents with the agricultural 'culture' of Quincy and surrounding areas as well as to introduce residents to the inherent safety issues faced by many farm families...You will learn from experienced FFA members of the dangers of working on farms, dangers associated with farm chemicals and handling livestock."

A lot of really bad things can happen to you on a farm. Grain can drown you in a matter of seconds. Hydraulic lines on farming equipment can perforate your skin, injecting your flesh with highly pressurized oil. You could get Silo Filler's Disease, Farmer's Lung, or Organic Dust Toxic Syndrome from assorted gases and dust coming off of farm products in enclosed spaces. And of course you could get caught and crushed up in many ways by combines, power takeoffs, augers, and other assorted mechanical equipment accidents.

Because so many of the patients seen at the clinic live a farming lifestyle and are exposed to these risks on a regular basis, the new interns (and sometimes a visiting medical student) go on a farm safety tour at a nearby family farm. In addition to learning the basics of tractor safety, we learned about other aspects of farming life that can lead to chronic conditions. For example, when 80 year-old Farmer Bob comes waddling in to your office complaining of back issues, you might consider that his vertebrae are all messed up from decades of being jostled from bumpy riding on an old John Deere and lifting 50-lb bags of seed two at a time.

Other aspects of farming life also contribute to health issues. After a tough morning of watching what farmers do, we stopped for lunch at a local eatery: The Paloma Diner. This where Farmer Bob meets up with his friends (probably named Hank and Jim) to chow down after burning several hundred calories on the job. The food, while delicious, is definitely rib-sticking and loaded with things that enable cardiologists to send their kids to private schools, especially once Bob gets older and no longer has as active a role in running his farm.

Urban Quincy and My First Time in MO.

[From a couple of days ago, but got misplaced on my blog page]

I probably should address something sooner rather than later. Quincy really isn't rural. It has a population of about 40,000 people, a university, the local NBC affiliate (WGEM), a pro-am baseball team (Go Gems!) and a regional airport (GEM...just kidding, actually UIN) with commercial puddlejumper connections to St Louis (STL) and Kansas City (MCI). There are strip malls with most major fast food joints, as well as a Starbuck's, Panera, TGIFriday's, etc. The description of suburb-sans-urb is a reasonable approximation for people whose frame of reference is Chicago or any other major metropolitan center; but Quincy is legitimately its own urban-suburban center rolled into one.

Having said all that, I spent the afternoon today at a prenatal care clinic on the other side of the Mississippi River, in the town of Monticello, MO (pop 200). The county seat of Lewis County (county population less than 10,000), Monticello has three buildings: a gas station, a house, and the Lewis County Public Health Department. Every two weeks, two medical residents and an attending physician set up shop with one of the public health nurses at the Health Department building (pictured above) to provide prenatal care to the expectant mothers of Lewis County. This is a gem of a program. Many of these mothers - a few of whom come in from area Horse-and-Buggy Mennonite and Amish communities - would not otherwise be able to get regular prenatal care; but through this clinic, they can get checkups, lab work, and referrals for ultrasounds back in Quincy when needed. Apparently there is only one other prenatal clinic like this in the entire state of Missouri, and one of the nurses estimates that 60% of the expectant mothers in the county who wouldn't otherwise get prenatal care do get care because of the Monticello clinic.

And the care that the women get is great. An undeniable spirit of teamwork exists between the patients and the care providers. The doctor I was working with knew exactly how to explain things to patients in a manner that was informative, yet friendly and conversational. In one visit, the doctor used stories about her own first pregnancy to illustrate what to expect in the second trimester while the young first-time expectant mother asked questions as if talking to a good friend rather than a professional stranger. I hardly think the doctor and that patient will meet up later to do their nails and gossip about what happened today on Living Lohan; but I have confidence that not only did the patient come away from the appointment knowing what to do until her next checkup, but also that she will actually show up for her next checkup. With any population anywhere, this is no small feat.

Off to a good start.

Twenty patients seen in seven hours. No one yelled at me. One patient went out of her way to tell me she thinks I'm going to make a great doctor. All patients received excellent care tailored to their biology, situation, and personal preferences. I declare today a victory.

Before my non-med school friends convert to Christian Science for fear of having an underling first-year medical student managing their care the next time they need open heart surgery, let me clarify what I mean when I "see" a patient. I am not pretending to be a doctor in any way. I am not dispensing medical advice that someone might have once said could possibly be true in PBL (psmall bgroup learning) because they once read it on Wikipedia. I am either taking a pre-history (a preliminary history, not one where I record events in cave drawings) or observing as the MD or DO to whom I am assigned does something actually useful, like dispensing medical wisdom about tummy aches or making visual and cytologic confirmation of a vaginal yeast infection. I often nod in sage agreement with the doctor as he or she says something insightful, like "I can write you all the prescriptions in the world for your heart problems, but they're not going to do anything unless you take the meds regularly." So true, doc; so true. I feel it.

The pace will undoubtedly get a little more grueling. I undoubtedly will get more mercilessly pimped. But for today, I think I put a good foot forward and appeared convincingly competent given my level of formal training. I should enjoy this feeling while it lasts.

First day is tomorrow.

"This program has been designed to provide 1st year medical students with an understanding of the scope of family medicine as a primary care specialty. Students experience clinical medicine, not just observing, but participating in the healthcare delivery to citizens of rural, urban and suburban communities. Since inception in 1990, the program has grown rapidly. It is our desire to expose as many students as possible to family medicine, emphasizing ambulatory care in a community setting."

This is what brings me to Quincy, and my first day "on the job" is tomorrow. Exactly how I will be able to participate in the healthcare delivery to citizens of this community is unclear. I can take someone's blood pressure and pulse pretty well, and I can appear pretty purposeful while placing my stethoscope on someone's torso; but, if asked if I hear anything abnormal, I would have to report with confidence and gusto: "I haven't really learned that yet." My white coat is clean. My stethoscope is at the ready. At least I will look the part. And so it begins tomorrow morning at a very civilized 8:45 AM.

All aboard the Carl Sandburg! and My First View of Quincy.

It’s about 10:30 AM and Amtrak Train 381, The Carl Sandberg, hurls me steadily onward toward my destination. We left Chicago promptly at 7:35 and by 8:30 we’ve reached cornfields. The transition from city to agriculture happens in a pixilated progression. Modular units of city give way to suburbs, which eventually alternate with patches of fields until stalks of corn and rows of soybeans consume the vast majority of the horizon. Breaking up the landscape are farmhouses, silos, roads, and an occasional water tower advertising that places like PLANO have adequate water pressure.

By 11:55, I am sitting outside of the Quincy train station, waiting for my ride into the center of town. Calling the Quincy train station a “train station” is a generous description. The 18’ x 18’ cinderblock single-room construction is little more than a warming hut for winter passengers. There are no bathrooms. There is no ticket counter. The only retail opportunity is a newspaper box for the latest issue of the Quincy Herald-Whig. I take out two quarters and buy the last copy. Officer Travis Wiemelt gets the above-the-fold photo, below a large headline reading “Chief: Gang Activity on Upswing.” This is difficult to imagine from my vantage point. Does Quincy, like Chicago, have a rough-and-tumble South Side? Looking around, I try to imagine where this gang activity might exist. Certainly not at the quiet train station. Or the animal hospital across the street. A touring polka band wearing matching “IRELAND” t-shirts and Bavarian caps has disembarked from my train and is having it’s picture taken. The breeze smells faintly of cows.

Rural med, here I come!

It's 2:14 AM, and my train leaves Chicago Union Station in about 5 1/4 hours. I am headed to the town of Quincy, IL, which apparently is "like a Chicago suburb, but on it's own with no big city nearby. Just cornfields. And soybeans. No, can't forget the soybeans." Indeed.

I will be in Quincy for four weeks to do a rural medicine externship, sponsored by the Illinois Academy of Family Practitioners, but more about that later. For now, I just wanted to get this blog started. And take a break from packing.

Items packed thus far:
1 White Coat
1 Stethoscope
1 hardcover copy of Bate's Physical Exam Skills
4 boxes of delicious Frango mints to bribe my way into people's hearts

I hope to update this frequently while I am in Quincy -- please comment! Or e-mail me. I'd love to know which friends are actually bored enough at work to read this and am happy to tailor my posts to what you people want to hear about.