Life As A Rental

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I work as a locum tenens physician, or, as I call it, a “rent-a-doc.” I work for companies that supply temporary physician help to hospitals and clinics. I don’t have my own office practice or patients. I go where I’m needed and leave when the job is done.

I’ve done this exclusively for the past 16 years because I got tired of the people signing my paychecks lying to me.

Anyone still in traditional practice understands my feelings. For the most part, health care administrators are as inbred as St. Bernard dogs and just as crazy. The only thing that matters to them is the bottom line. Patients, physicians and staff are necessary evils they could just as well do without. I’m no different from the janitor and more than one has made that quite clear.
“You don’t like it, fine. Quit and I’ll hire three more just like you.”

Working this way comes with distinct advantages. The companies help me get and pay for state medical licenses. They provide transportation to the work site, hotel accommodations and, most important, liability insurance, which can run $150,000 a year.

I don’t get involved in hospital politics or pissing contests with other physicians. I do my job, get paid and go home. I earn about a quarter of what I could make in private practice, but I don’t have the stress and the headaches. If a job becomes untenable, I can give 30-days notice and say “adios, muchachos!”

I can work as much as I want depending on available jobs. Occasionally nothing will come up for a few months, but sometimes there are more jobs than I can do. (I’ve had to turn down jobs in Hawaii because of other commitments.) I’ve had the opportunity to visit places on someone else’s nickel, from Alaska to New Hampshire, from Michigan to New Mexico.

Most of my jobs have been covering solo physicians who want to get away, groups looking to replace physicians who have left or retired, or indigent clinics that are chronically overworked and understaffed. I filled in for an Army Reservist who went to Kuwait for three months of solo call. I subbed for a physician who needed surgery. One woman took off six weeks to have a baby. I worked at a clinic in New Mexico with eight midwives and two other physicians doing 140 deliveries a month.

Sometimes the situations are a bit more delicate. A hospital needed help after firing two physicians who’d gotten into a fist fight at a department meeting, sending one of them to the emergency room. The only two OB/GYN physicians in a remote area, each in solo practice, despised each other and wouldn’t cross cover. Another physician drew a one-week suspension for substance abuse. I’ve learned to not ask too many questions.

The only downside is being away from home and living out of a suitcase. Most of the time I stay in a hotel owned by one of many well-known chains. Occasionally, the accommodations are more upscale. And one hospital had the most luxurious call rooms I’ve ever seen: Sleep Number beds; Bose Sound Docks for iPods; desks with computers and All-Steel Acuity mesh-back chairs; mini-refrigerators; a wall-mounted LCD TV and private bathrooms with showers and motion-activated light switches. The work was grueling, but I could retreat to this relative paradise during lulls.

But some clients are cheap and I end up in a dive.

Two different hospitals put me up in mold-infested housing they owned. One client wanted me to stay at her place with her cat and asked me if that was a problem only after I’d arrived (I’m deathly allergic to the little beasts.) I shared a house with another physician, which worked out reasonably well until he decided to broil a steak at 2 am, setting off the smoke alarm.

I stayed in the last vacant room in a newly-built assisted living facility next to a hospital in south central Illinois. Not bad, but very cramped. I sent the residents a big box of old VHS movies for the enormous TV in their lounge, long before plasma and LCD TVs. I still have the thank you card they all signed.

Locum tenens isn’t for everyone. I’ve gotten used to going to work immediately with little or no orientation. Maybe that’s because no matter where I go, things are usually pretty similar. The names and faces change, but the routines, the challenges and the rewards remain the same.

Image: CBS

Good Bye, Old Paint

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He was the medical director of an Ob/Gyn clinic for the indigent in a southwestern town near the Mexican border. In its heyday, eight midwives and three physicians—including a near-deaf Catholic nun whose car sported an “Ordain Women!” bumper sticker—handled thousands of patient visits a year and delivered more than 130 babies each month.

Poor folk are never a priority for the health care system, even less so if they are black, Hispanic or worse a border-jumper. Many of the patients gave the same rural mailbox number for an address, having paid the “coyotes” thousands of dollars to be smuggled into the US. I can’t say I blame them, because I’d had to deal with the consequences of poor obstetrical care some of them had gotten across the border.

I first met him in 2000 when I worked as a locum tenens physician at the clinic for seven months. At that time he was in his late 50’s, a slight man with thick brown hair and glasses whose quiet demeanor sometimes produced a wry joke that both surprised and amused. I thought he was a kind and decent man, even after I found out he was a staunch Republican and had his picture taken with George W. Bush at an inaugural ball. I’m not sure he ever acknowledged the irony of devoting his life’s work to people the Republican Party despised.

But a sadness always surrounded him as if he recognized the futility of the task while refusing to give in. The hospital expected the clinic to be profitable but funding was always a problem. Private physicians in other specialties never wanted to see the patients in consultation. Some of the hospital staff treated them as vermin. He did his best but most of the time, unlike Sisyphus, the stone never got anywhere near the top of the mountain before falling back.

As often happens, he was pushed out in favor of younger (and less expensive) physicians. He retired a little farther north where he lived before taking his own life the day after Christmas, 2012. His ashes were buried on a ranch in the western state where he’d first practiced—a fitting repose for an old hand.

“Why?” will forever remain unanswered. Was it being discarded like an old pair of shoes? Was being a physician his entire identity and, lacking that, his raison d’être had evaporated? Or had he just reached the end of his trail, tired and dispirited?

He may never have realized to how many people’s lives he brought comfort and healing, but those of us who bore witness will never forget.

Photo credit: CanStock Photo

Talking to the Wall

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Physicians don’t listen for shit, even when the patient is another physician.

I spent two hours in my own ER after doing a Cesarean section in a hot operating room. I was sweating like a pig and starting to get shaky, even though I’d had breakfast a few hours earlier. Thinking my blood sugar was plummeting, I wandered out to the nurse’s station and asked for a sugared pop (which tastes like pure syrup when one is used to diet).

Joy, a nurse with a very kind soul, thought I looked like crap and took my blood pressure. She got a panicked look in her eyes because my diastolic was 108. I’ve been on medication for about 12 years and my pressures are usually fairly normal at home. She took it again suggested I go down to the Emergency Room.

I said, “I feel fine. How about I go lay down for a few minutes?”

“So we can find you dead in the call room? How about the ER?”

I objected again so she grabbed the guy who’d done anesthesia for my Cesarean. He listened to my heart, looked at my blood pressure readings and said, “You really should go to the ER. I know the doc down there and I’ll give him a call.”

I relented. “OK, I’ll just mosey on down there.”

The nurses all said, “NO! We’ll get you a wheelchair and take you down. And if you don’t behave, we’ll call Denise to do a one-on-one with you.” Denise is another nurse and doesn’t take crap from anyone! I thought I’d be safer in the ER.

They wheeled me out of the unit, into the elevator and down a very long hallway to an ER bed. The ER nurse had me change into one of those idiotic gowns, then hooked me up to a monitor and a blood pressure cuff. She asked me the usual questions: Did I have any chest pain? Was I taking any medicine? Did I have a history of hypertension? Heart disease?

The ER doctor came and I repeated the same information, adding I was taking medication for my blood pressure; that I couldn’t take it at night with the drug that helped me pee because my blood pressure would plummet and I’d fall on my face; that I wasn’t diabetic but that I’d had a can of sugared pop shortly before coming down.

He listened to my heart and lungs, ordered an EKG, a chest X-ray, and blood work and told me he’d return when all the results were back. Standard ER protocol. I figured all the results would be normal.

The nurse started an IV and drew a few tubes of blood. Then someone from Imaging (the X-ray Department to anyone my age) snapped a chest x-ray. She apologized for the cassette being cold, but it felt really good on my back. I thought about the good old days when x-ray departments had 55 gallon drums of discarded films. Now everything is digital and viewed on a computer screen.

A Cardiopulmonary tech did an EKG, which read normal sinus rhythm—big surprise. Yes, the EKG machine reads the strip and makes comments. After that Dave from Respiratory Therapy came by with an albuterol solution because my lungs were a little tight.

“Have you ever done a nebulizer treatment,” he asked.

“Yeah. I have Symbicort—“

“That’s not a nebulizer med.”

Dammit, let me finish my sentence. “—albuterol inhaler and albuterol solution for my nebulizer.”

“So, you know how to use it?”

Yeah, it’s like taking hits off a bong but I’m not about to tell YOU that.

I laid on the gurney, pondering what my wife would say when I told her I’d been in the ER as a patient. I’d left my personal cell phone upstairs in my locker so I couldn’t call her, which was probably just as well.

The ER physician came in about 90 minutes later. All the results were normal, except for my non-fasting blood sugar of 174, which was not a big surprise after ingesting 39 grams of pure sugar. My blood pressure had returned to more normal levels. He told me to take it easy the rest of the day.

All was fine until I got the discharge paperwork which the following diagnoses:

  • Acute generalized weakness
  • Near syncope (fainting)
  • Chronic diabetes
  • Uncontrolled hypertension

WTF??? I didn’t have “generalized weakness” and I didn’t come anywhere near fainting. I’m not a chronic diabetic. I’ve checked my glucose levels frequently at home and if anything I’m prone to hypoglycemia if I don’t eat for several hours. (My record low was 54). My blood pressure came down to normal after lounging on the gurney for two hours. One makes a diagnosis of hypertension with several blood pressure readings over several days, not a couple of hours. If I had to guess, I think he assumed “fat Hispanic guy; must be diabetic, hypertensive, non-compliant and a walking heart attack waiting to happen.”

The next day I had the nurses at the office check my blood pressures, which were normal every day. I bought a glucometer and poked my fingers five to eight times a day, dutifully recording what I’d eaten and when along with my blood sugars, all in a nice Excel spreadsheet. My fasting blood sugars were just a bit high (101-103), but they normalized when I had a protein snack before bedtime.

Patients have complained to me that their doctors didn’t listen to them. Well, they are probably right more often than not, and for that I am truly sorry.  And now I understand.

Photo Credit: Canstock Photo

Slow Dancing

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Nothing in my life – even my oral Board exam – was as terrifying as the first time I slow danced with her.

I was not one of the cool and popular kids in high school (even though one of my best friends recently admitted she thought I was a “player”). I rarely got asked to a gathering at someone’s house. I was more likely to get a “Happy New Year” phone call at home while I drank hot Dr. Pepper and watched Johnny Carson. So, when the Eckstein brothers invited me over one summer evening, I gratefully accepted. And I knew she would be there; she usually was.

Parties were fairly simple affairs back then. We gathered on their lawn and played Frisbee or Jarts—lawn darts with heavy steel points that were banned after several accidental trephinations and deaths. A portable phonograph, relocated outside and plugged into a couple of extension cords, was loaded with 45s or an occasional LP. The parents supplied munchies and drinks and then disappeared into the house but ever mindful of our presence.

When the sun went down and the bowl of chips was down to crumbs, the music shifted from Top 40 rock to stuff meant for slow dancing. Songs like The Turtles’ You Showed Me, The Cryan’ Shames’ Up On the Roof/It Could Be We’re in Love, Tommy James and the Shondells’ Crimson and Clover, and, of course, Bread’s I Want To Make It With You, the fantasy of every horny teenaged boy.

But there was one song that will always remind me of her. Three ascending guitar notes then a drop to two chords:

You ask me if there’ll come a time
When I grow tired of you
Never my love

Suddenly, it was now or never. I screwed up every ounce of courage, walked over to her and, with a look that was both asking and pleading, held out my hand which, to my surprise, she took. No words passed between us.

She was a beauty. Shoulder length chestnut brown hair; deep brown eyes I could never hope to read, and skin as soft as…well, any comparison would be superfluous at that point. She wore a sleeveless white blouse, turquoise shorts and white tennis shoes. I wasn’t sure what I’d done to be rewarded this way, but I wasn’t about to argue.

Now, I didn’t know how to dance. My attempts to teach myself ended abruptly when my mother walked into my room while I was practicing the Twist—a dance that was already a decade out of date. I knew that my job was to slowly spin in a circle while not stepping on her feet until the music stopped. So I just put my arm gently around her back and prayed for the best.

I wasn’t sure how to hold her hand: up and out like our parents danced, or close in, by our shoulders. I wanted to pull her close enough to me to feel her breasts against my chest, but I was afraid of impaling her on the embarrassing erection that popped up the minute we touched. We gently swayed back and forth, around and around. I would never forget the warmth of her breath on my neck and the scent of her skin.

And then it was over.

I thought about kissing her softly, gently before we parted but I wasn’t about to press my luck. We went back to where we had been sitting, like boxers to their respective corners at the bell. I had no idea why she danced with me. I was too shy and insecure to even talk with her, let alone carry on an extended conversation about something other than “my life sucks.” But it didn’t really matter. I’d had a glimpse of heaven and that was enough.

Sometimes I’d have dreams at night, the two of us slowly dancing alone, feeling loved, hoping it would never end.

Never, my love.

Where the Heart Lives

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I went to the wake for the mother of a high school friend on a butt-ugly, stinking hot September in 2011, back in a town I’d learned to hate decades earlier. I left with something more.

Susan and I weren’t close enough to be confidants, but she was close enough to be more than just a face I used to know, staring out at me from a yearbook page. We lived about a block from each other, rode the same bus to school and a group of us would hang out at her house on occasions. Sue’s mom, like the mothers of my other friends—Margee and Betsy—were kind, lovely women whose houses provided sanctuaries from my tumultuous existence. I went to honor her memory, not to fulfill any obligation.

Rosemary or “Rosie”, as we all knew her, died a few weeks after she’d began having difficulty breathing which progressed to gasping for every breath. The doctors diagnosed primary peritoneal cancer and started chemotherapy, but one morning she woke up unsteady on her feet. She fell into a coma a short time later; a CAT scan showed a massive stroke from which she’d never return. She was 81.

Rosie’s life had been well-lived. She married her husband in 1949 and they were together for 55 years, until he passed away in 2004. They raised five children who have all done their parents proud. Sue became a veterinarian, something she’d wanted to do since high school.

Rosie was a friendly woman with a smart sense of humor. A few of us had gathered at Sue’s house one evening during our high school years and the talk inevitably turned to sex and Vaseline. Without missing a beat, Rosie said, “After five kids, who needs Vaseline?” We were astounded someone’s mother would say something like that because it sure embarrassed us. (Years later I would discover the joys of annoying my own kids with “TMI.”)

There was already a line of people when I arrived at the funeral home. By the time I left it was out the door and down to the sidewalk. Rosie had many people in her life who loved her and would miss her dearly.

A collage of pictures from Rosie’s life stood on an easel in the corner, summarizing eight decades in a brief moment. The most poignant picture was one I’ll never forget: Rosie standing behind her oldest daughter, preparing for her wedding.

I talked briefly with Sue’s sister-in-law, Mary Jean, and Mary Jean’s mother; then I sat next to Margee. We chatted for a while and tried to identify people we knew from high school as they joined the line, but some of their names eluded us. They had all stayed in town and, as far as I could tell, they were happy with their lives.

I reflected on Rosie’s life and then on my own. I drove around town and took pictures of my past: the bowling alley and the hospital where I had worked; the school where I attended eighth grade and had my first girlfriend; the empty lot where our house once stood. I rode along the rural roads where I used to bike, remembering the relative peace of being alone and the chaos that waited at home.

Forty years have healed the wounds of adolescence. The ugly scars from then have faded into those of fine leather. I hated the place when I left and couldn’t get away fast enough. Years of living in the suburbs, however, has made me yearn for a small town in which to retire, the ultimate irony.   One person’s godforsaken acre is another’s paradise and, while I wouldn’t move back—there are far too many painful memories of my past life—I’m no longer inclined to disparage the places others call home.

We spend our lives looking for the place where we belong. Some find it early; some have to search for years or decades. Others never find it because home is more of a feeling within than a physical location.

I found my home when I stopped looking so hard.