A Midwestern Family Physician
A blog by Daniel Marley, MD
Somewhat random notes/thoughts/philosophies of a Family Physician who has been at it since 1986.
Why am I writing this blog? I think because I wanted to tell the story of an average middle American primary care doctor and some of the difficulties we face in these times.
I view myself as a fairly average family physician in a fairly average American city. Monday, Tuesday, Thursday and Friday, from 7 am until 6 pm, I see patients in a group medical practice in Bloomington, Illinois. I work through my lunch hour every day, and spend another hour after seeing patients finishing up phone calls and finishing my charting of office notes. I spend typically 2-3 hours every weekend going over lab results and other computer-based charting. So a 50 hour work week is pretty standard for myself and my partners. Not too bad for a 55 year old physician. However, I don't consider myself unusually special in any way.
I practice in a "typical" middle American town (Bloomington/Normal) in the center of Illinois with general area population of about 200,000 people. My patients are from all walks of life, of many different cultures, and of all ages. I have many nuclear families as well as extended families of several generations as my patients. Asians, Indians, African-Americans, Mexican-Americans, and of course Caucasians make up my practice. My practice is probably of a somewhat younger average age that some of my partners, since I have only been in practice in this location since 2005.
After medical school, I spent three years in a Family Practice residency in Oklahoma City, then worked another year "moonlighting" and working on a fellowship in what is now known as "Evidence-Based Medicine." In 1990, I moved into my first official practice as a full-fledged Family Practice physician in McFarland, Wisconsin--just a few miles from Madison.
What is Family Practice?
It still surprises me that many people don't really understand what Family Practice is. I can't tell you how often I am referred to as a "general practitioner" and it makes me cringe. A general practitioner is an antiquated term referring to a physician who finished medical school, did a one year "rotating" internship, and then went into practice. GPs often did most everything back in their heyday.
A Family Practice physician serves a 3 year Family Medicine residency, spending time with various specialists: surgeons, internal medicine physicians, rheumatologists, endocrinologists, geriatrics specialists, sports medicine specialists, pediatricians, cardiologists, neurologists, pulmonologists, and others. We spend three years rotating in the hospital on our inpatient services as well as the inpatient services of Ob/GYN, Internal Medicine, Psychiatry, and Pediatrics.
We spend increasing amounts of time with each passing year in our own clinic with our own "panel" of patients, honing our outpatient clinic management skills. So by the time we are ready to pass our American Board of Family Medicine exams ("Board Exams"), we are pretty well trained, especially in the outpatient management of families--babies, kids, teens, young adults, adults, women's health, and geriatrics. Personally, I was trained to deliver babies and to do routine Obstetrics and did so for about 7 years before giving it up due to time commitments.
How are we different than other specialists?
The specialty which probably is the closest to Family Practice is Internal Medicine. However, of course, Internists are not trained to work with infants or children. I had considered pursuing a residency in what is called MedPeds, or Internal Medicine/Pediatrics, but just found that a Family Practice residency met my needs and kept me in one "home group" with my own program and peers.
Because of the fact that we can work comfortably with infants through patients at the end of their lives in their 90s or beyond, we enjoy working with entire families as intact units. Nothing brings me greater satisfaction than providing care for an entire family including babies and grandparents.
I have now had a license to practice medicine for 27 1/2 years. I have been a board-certified Family Practice physician for 25 years. I was in practice 15 years in McFarland/Madison, and now 9 years in Bloomington.
Formative Years:
I think the first inklings that I was developing an interest in the biological sciences and human physiology specifically was around age 7 or so. My parents had bought me several "All About" books, mostly related to the sciences. "All About Rockets and Space Flight," "All About Air Transportation," and "All About the Human Body," (by Bernard Glemser). I would read and re-read these books until I could quote whole passages by memory. Then a mail-order series of books that would come every month, on the sciences in general, but many of them about medical technology and "breakthroughs" in medical science in the late 1960s.
I was a child of science. Voraciously reading about dinosaurs (of course, as all boys my age did and still do), I then became fascinated with the Ice Ages and all the incredible changes that had occurred to life on Earth just in the past 30,000 years. Then the next natural step--I learned about primitive humans and evolution and how animals (and plants) adapt to changes in their environment.
Another set of books had a profound effect on my 7 year old mind: the Time/Life series on "The Earth" and "The Desert" and "The Sea" and "The Universe" and "The Forest." I still run across these books at estate sales now and then. They were phenomenal. The photography was amazing. The pictures piqued my interest, so then I'd read about the pictures, and never got tired of re-reading these. My brain was now primed for the natural sciences, and forever after that nothing else felt more comfortable--that is, thinking in terms of the natural sciences felt like "home."
In fourth grade I got a gorgeous huge chemistry set, one of the best ones made by this specific company. I got straight away at work, going through the book of experiments that came with the set. Often I deviated significantly from the "book" by just "mixing things up to see what would happen." Of course, back in the '60s, there were no safety glasses, and open flames and alcohol burners were acceptable, and who-knows-what toxic fumes might be emanating from the open end of that test tube. (Sometimes I'd just sit back and admire my set up: racks of chemical bottles, iron rods and clamps holding flasks and glass tubing--it was just sooo cool!) The smell of burning sulfur and glycerine and stains of potassium iodide on the table, playing with raw liquid mercury I had extracted out of old thermometers--it is a wonder I am still living, I suppose.
The bigger lesson I learned was the whole concept of SCIENCE: You make observations of what is happening in the world, put together a hypothesis as to why you think these things might be happening, and then test your hypothesis through experiments to see if your hypothesis CAN explain what happens. If the experiments don't work, then your hypothesis is wrong and you move along and think of some other hypothesis, design more experiments, and KEEP TRYING.
Science became my religion: If I didn't know how something worked in the natural world, I wanted to know what the best explanation was, and if we didn't know, WHY didn't we know? I checked out books on geology, weather, bacteria, DNA, ocean exploration, glacier science, more human physiology. If it could not be explained by science, it meant we just hadn't looked long or hard enough. Science is evolutionary, science is self-correcting. You never accept anything at face value. If someone told me, "The sky is blue because of particles in the air that reflect sunlight." Then my next question was, "Why BLUE?" and I'd go to see if I could find a book that would explain the fact that the particles reflect the shorter, bluer wavelengths rather than the longer, redder wavelengths.
I remember coming home from a trip to a museum, where there was a 3-D model of the steps of an appendectomy. I promptly got some modeling clay and made my own layered model, with appendix at the bottom (attached to a colon), covered by fat, peritoneum, more fat, muscle, and skin. Using my makeshift scalpel (a butter knife), tweezers, and other "instruments," I'd make my incisions, dissect away the intervening layers, and get to the appendix, tie it off with my mom's sewing thread, and then sew up the layers in reverse order.
I remember saving hard for a few weeks to gather $2.00 worth of change to buy a toy doctor kit at the local pharmacy.
I remember saving hard for a few weeks to gather $2.00 worth of change to buy a toy doctor kit at the local pharmacy.
About this same time, perhaps in 4th grade, I started bringing home preserved specimens to dissect. The drug store that stocked my chemistry set chemicals and lab glassware also stocked jars of preserved clams, fish, and other small non-mammals for dissection. I also got a microscope and was searching for butterfly wings and pond water specimens to look at under magnification.
I got completely freaked out one day in my basement: I was all alone in the basement. I had gently knocked a house fly out of commission with a kitchen towel. I placed the whole fly's body under the lowest power objective lens of my microscope. With direct lighting from above, using my microscope as a dissecting scope, I trained in on it's head and neck. I figured I'd be able to get a better view of the head if it weren't attached, so I took my dissecting knife and attempted to cut its head off. All I remember is this sickening light brownish pasty-looking goo coming from its neck region as the head rolled off and I became thoroughly grossed out, flicked the fly parts off onto the floor, and ran back upstairs in a fearful hurry. I was afraid to go back into that basement for a couple of weeks as I was sure the ghost of that headless fly was looking to exact revenge on me.
In fifth grade an incredible occurrance took place. Due to overcrowding of my fifth-grade classroom, the principal decided to place 6 or 7 of us fifth graders in a somewhat less-than-full sixth grade class. My teacher was Mrs. Andreason--beautiful, young, vivacious, and very progressive in her teaching style. She was one of those rare teachers that made you look forward to coming to school every day.
We had a very significant curriculum in the life sciences that year. I signed up for project after project. Through my parents I established a relationship with a butcher who supplied me with all kinds of interesting items: I brought cow eyes into the class to dissect, as well as cow lungs, hearts, kidneys, and brains. (One mistake with the brains--we worked on them on Friday, and left them out over the weekend without refrigerating them. Monday morning the classroom stank to high heaven of rotting cow brains, so we made a mad dash to dump them out the classroom windows and quickly closed them up.)
I put together a model of the human alimentary tract, using home-made salt dough clay for the small and large intestine, a length of brown surgical tubing for the esophagus, a pink plastic bowl for the stomach. I tried to get some hydrochloric acid to demonstrate digestion of some crackers in the stomach, but the adults felt the acid was too dangerous (good call!), so I used acetic acid (vinegar) instead.
I built those plastic, see-through models of the "Visible Woman" (and also a "Visible Horse")--you know, where you build up the organ systems one by one, then the bones, then encase them in a clear plastic "skin."
I made a working model of muscle contraction physiology demonstrating how the biceps muscle works to flex the elbow and the triceps works to extend the elbow. I don't know if I drove my teacher crazy with my requests to make models or bring in stuff--if I did, she never let me know. The kids in the classroom seemed to get a kick out of the stuff. I was never teased for being a science nerd.
Moving on to sixth grade was a relative let-down. I had a dour, humorless male teacher, and most of the biology studies I became interested at that time were regarding the opposite sex. First crush, first girlfriend, first kiss, etc.
This meant continuing reading in the natural sciences, but often in a more applied context: I studied the science of light and color as it pertained to photography, but then that led to a fascination with the way the human eye and vision works. My interest in mountaineering led me to read more about what happens to the human body when pressed to the extremes of altitude and stress and fatigue and cold. I started reading about how to survive in the wilderness--how to use wild plants for food and medicine.
As I made new friends in Bloomington, we became very adventurous. We camped and hiked every chance we could. I was now in High School. Three medically memorable events occurred:
At the end of my freshman year, in 1973, I had to get my tonsils out. I was wracked with recurrent epidodes of tonsillitis. In the course of dealing with these episodes, my mom would take me to our "family doctor," whose office was on the square in downtown Bloomington. From my experiences with this MD I developed a strong sense of "if I was ever a doctor, these are the things I'd never do." He had no prearranged appointments, so people just showed up and sat in a huge waiting room waiting for their name to be called, first come/first served. So we'd wait for upwards of an hour. Finally I'd be called in with my mom. We'd sit in the exam room. The nurse would get a sketch of a history. The doctor would bluster in in a huge hurry. He would say two or three words, shine a light down my throat and feel my neck and then would disappear. He'd soon return with a steel tray and a big syringe. He'd shoot my arm with the big syringe and then say goodbye. He would rarely say 2 full sentences to me or my mom. Within the next 30 minutes I'd get a somewhat pleasurable "buzz" and sort of lightheaded, and within 24 hours my sore throat was fading fast. I think, in retrospect, he was probably giving me a combination of a corticosteroid and an antibiotic, but he never told me as much.
I went in to St. Joseph's Hospital right after school got out in 1973. The same doctor performed my tonsillectomy. I went home the next day. I thought I was going to die. The pain was severe. All this talk about "You'll be able to eat all the ice cream you want!" was a SCAM. Ice cream hurt as much as anything. I could barely talk. I laid in bed for a week sipping on Kool-Aid and soda and ice water and gulping down Empirin Compound and eventually started feeling more normal. It took me two weeks to recover back to basically normal.
At the end of my freshman year, in 1973, I had to get my tonsils out. I was wracked with recurrent epidodes of tonsillitis. In the course of dealing with these episodes, my mom would take me to our "family doctor," whose office was on the square in downtown Bloomington. From my experiences with this MD I developed a strong sense of "if I was ever a doctor, these are the things I'd never do." He had no prearranged appointments, so people just showed up and sat in a huge waiting room waiting for their name to be called, first come/first served. So we'd wait for upwards of an hour. Finally I'd be called in with my mom. We'd sit in the exam room. The nurse would get a sketch of a history. The doctor would bluster in in a huge hurry. He would say two or three words, shine a light down my throat and feel my neck and then would disappear. He'd soon return with a steel tray and a big syringe. He'd shoot my arm with the big syringe and then say goodbye. He would rarely say 2 full sentences to me or my mom. Within the next 30 minutes I'd get a somewhat pleasurable "buzz" and sort of lightheaded, and within 24 hours my sore throat was fading fast. I think, in retrospect, he was probably giving me a combination of a corticosteroid and an antibiotic, but he never told me as much.
I went in to St. Joseph's Hospital right after school got out in 1973. The same doctor performed my tonsillectomy. I went home the next day. I thought I was going to die. The pain was severe. All this talk about "You'll be able to eat all the ice cream you want!" was a SCAM. Ice cream hurt as much as anything. I could barely talk. I laid in bed for a week sipping on Kool-Aid and soda and ice water and gulping down Empirin Compound and eventually started feeling more normal. It took me two weeks to recover back to basically normal.
Later that summer, I was riding my 10-speed bike home along a city street, along with several other friends on their bikes. Somehow I misjudged a construction sawhorse marking a 7 foot hole in the pavement, and rode my bike into the pit. My bike plummeted down the hole, but I got thrown onto the road on the other side, head first. (No one wore helmets in 1973.) Knocked completely unconscious, I had no recollection of the event until waking up in a daze on the street with a police officer leaning over me telling me I'd be ok. They loaded me on a stretcher and packed me up in an ambulance and shipped me to St. Joseph Hospital, to the same wing and floor I'd spent recovering from my tonsillectomy a couple of months previously. Fortunately, there was no real pain except in the attempt to clean the road gravel out of the wounds on my face. The next morning I was pretty stiff, but otherwise felt fine. There was even a tiny article in the local paper about my accident: "Boy Hurts Face."
The third and final event was the most shocking for me. In the mid-autumn, several friends and I were backpacking along a railroad right of way in central Illinois. Starting out on Friday afternoon after school, we set up camp in the dense woods in the right of way. Around noon the next day we took a hike down the railroad to a bridge over a local river. I watched from the railroad track, through the ties, down to my friend who was walking along the metal girders making up the supports of the bridge. He was balanced about 15 feet above the shore of the river, and decided to drop to the ground. As I watched from directly above, he dropped down and promptly sprang back up and then keeled over on his side, writhing in agony. He kept saying he was hurt, over and over. I figured he had broken his leg.
I scrambled down as quickly as I could, and found out that actually what happened was that he had landed forcefully on a sharp, hard, woody, dried weed stem that penetrated through his anal region and perforated his colon. We didn't realize the severity of his injury, and slowly walked him back to our camp, where he took a brief nap. He awoke dilirious and vomiting, in early stages of peritonitis. We hustled him up to a local store, called our parents, who drove him the 25 miles back to Bloomington to the ER. It wasn't until the next day that we found out that he had to undergo emergency surgery and now had a temporary diverting colostomy.
These three events drove home to me the relative fragility of the human body, and the dramatic effects of what seemed like relative inoccuous injuries or trauma. These events reinforced in my mind the need for the body to remain in careful balance to stay fully functional and healthy. They also fascinated me with the technology and art of repairing the damage to the human body.
I also, as a result of these events, became pretty cautious and risk-aversive. I realized how quickly something could go wrong. So when my friends would start talking about an activity that might involve some risk, I felt it was my responsibility to try to analyze that risk and the potential for injury. I wasn't always successful, but I at least felt I got everyone to at least think twice.
I started packing along a pretty complete first aid kit and survival kit for our outings. I wouldn't say I was obsessed with safety issues, but I did have a healthy respect for the possibilities.
Entering my senior year of high school, I took advanced biology, which included dissections of fetal pigs and adult cats. We also got to design and carry out our own experiments. My partner and I designed and carried out fruit fly genetic experiments, psychology experiments on grade school kids, and experiments on the effects of antibiotics on different bacteria. One of my classmates (now an Internal Medicine physician) had the wonderful idea of boiling a dead dog for a couple of days to get all the bones clean to put together an actual clean skeleton of the dog. The piquant aroma of boiling dog permeated the Bio II classroom area for a week.
Also at this time, I was supposed to be deciding on my future with regard to college and career. I truly wanted to aim in the direction of medicine, but I had heard horror stories of the stresses and expense of medical school. I was still enamored with nature, and with the life sciences, but I was now an avowed lover of wilderness. I decided to move in the direction of forestry or environmental engineering.
I completed two years at Illinois State University, close to home. I had several reasons to stay close: I had a scholarship from my father's employer that covered the costs of tuition at ISU, and with me living at home I saved a TON of money (for my parents, anyway). I was able to remain close to my girlfriend with whom I had fallen completely head-over-heels in love. I was hoping to remain in the rock and roll band for which I played bass. I figured I was just getting my "gen-eds" in, and after two years would take off for Colorado State University to major in Forest Management Science.
Colorado Years:
In 1977, it came time to move out to Fort Collins. I fell crazy in love with the mountains and the sun of Colorado. I spent my three years there and got my degree in Forestry. I worked as a forester during the summers. The absolute favorite part of my job was talking to vacationers in the camps and the parks. My Forest Service partner and I often got invited to have dinner with camping families and we'd sit around their campfire talking with them. I was fascinated by these peoples' stories of how they developed their love for camping and the mountains, and the tales of their lives and families, of their marriages and grandkids, of their travels and tribulations.
A moment of enlightenment: One rainy early evening in the summer of 1979, my partner and I sat in a small cozy restaurant in a little tiny mountain town in central Colorado. We were finishing our reports and writing letters home. All around us were families of the local townspeople. All ages. Little kids still wet from their evening baths, running around in PJs, older folks swapping yarns, and EVERYONE KNEW EVERYONE. Kids would jump in someone's lap and then run away to someone completely unrelated and snuggle up with them for awhile. It seemed a little like a "commune," but these truly were all separate families who simply had no problems accepting the other families and helping out whom they could.
I clearly remember thinking: I want to live in a town like this someday. Walking out of there that evening with the alpenglow on the nearby peaks, the delicious smell of pine wood smoke in the air, the unbridled laughter of the kids echoing from inside, I knew this was what heaven would be like for me. I felt I could live in a place like this as a forester, but something was missing. I wanted that more direct connection with the people--the kids, the parents, and the older generation.
I applied for all kinds of permanent forestry jobs, but got nowhere. It was 1980, and a major recession was place. Then, I actually landed a job as an intern with Weyerhauser in Tacoma, Washington. I went up there and toured the place. I was pretty excited. Then in early May of my graduation year, I received a letter from Weyerhauser that due to budget cuts, they were doing away with the internship program and I would not be joining them. I was crushed! I had no job.
I was offered a position as a research fellow in a Master's Program at Virginia Polytechnic Institute and State University (Virginia Tech) in Blacksburg, VA. I decided to take it. It was a mostly-paid gig for two years. And, I now had a plan:
The Plan:
I had decided that, with the loss of the job at Weyerhauser, I was not meant for forestry work. I had had a re-awakening in my heart and soul and mind to go back and pursue a career in medicine. I got my hands on a couple of medical textbooks and found them fascinating and it felt to me like a return to comfortable old bed. It felt so natural. I knew I had to make medicine my life.
My specific plan, as outlined in my journal of the time: Go to Grad School. Study for MCAT exam (Medical College entrance exams). Take MCAT. Apply to medical schools. In the meantime, work on Master's Degree in Forestry. Hopefully get accepted to Medical School. If not accepted, my options would then be to take a job in the eastern US in forestry (a thought I abhored, since I could barely stomach the eastern US after my love-affair with the mountains of the west), or go back to Colorado or Utah or Oregon to pursue a Ph.D. in Forestry.
I did fine on my MCAT exam. Then I started applying to medical school. I applied on the early decision plan to Southern Illinois University School of Medicine (in Springfield, IL). I got called for an interview. I did NOT get accepted, but in my subsequent phone conversations with the Assistant Dean, I learned the ONLY reason I was rejected was my lack of exposure to medicine in a job or volunteer activity.
Therefore I promptly went to the local hospital, Montgomery County Hospital in Blacksburg, and volunteered. They put me to work in the Emergency Department. I worked evenings and weekends as an ER volunteer, helping with whatever the ER nurses and doctors needed. In a matter of a few months, a job opened up as an "ER Technician," which was actually just a glorified orderly who was stationed in the ER. But I applied for the job and got it. Now I was actually working a second job (my first was as a graduate research assistant for Virginia Tech).
So my days were filled with forestry machinery, running skidders and hydraulic loaders and welding and drilling steel, and building forest harvesting machinery for my research. My nights were filled with helping out in the ER with doctors and nurses and patients. I didn't tell my forestry professors that I was working at the hospital; I didn't think they'd understand. I was worried then that I'd have to explain that I did NOT want to go on in forestry and that I wanted to pursue my future in medicine.
On nights I wasn't working in the ER, I'd hole up in the Virginia Tech library, reading medical journals. The Journal of Trauma was one of my favorites.
So again, late in 1981, I applied Early Decision to SIU School of Medicine and went for my interview. I now had a whole bunch of experience working in the ER. Back in Blacksburg, I waited. Then the letter. I was accepted! I would be joining 71 other first year medical students at SIU School of Medicine in the fall of 1982, for the Class of '86.
I finished up my Master's Degree in Forestry, moved back home to Bloomington, and prepared to move down to Carbondale, IL where the first year of med school took place. Since the first year was "basic sciences" like anatomy, physiology, embryology, genetics, biochemistry, and histology, the curriculum mandated us staying at SIU's Carbondale campus for one year, then we'd all move to Springfield, IL for the next three years of more "medically" oriented learning.
Prior to moving down to Carbondale, I took a 2 week road trip by myself back out to Colorado, to camp, hike and see old friends. It was very bittersweet to be back there in the mountains I loved, knowing that for the next four years I'd be buried under mountains of learning in Illinois.
My new plan: My ultimate life dream had morphed: As I was driving alone down a lonely back valley dirt road in Colorado, I saw myself 10 years in the future--living in a little mountain town, as the town's only local doc, taking care of local families and charging $25 a visit, no matter what. If people couldn't pay, I'd accept pies or meals or bartered services. I'd hop in my Jeep and make housecalls out to a patient's ranch. That was it!
The third and final event was the most shocking for me. In the mid-autumn, several friends and I were backpacking along a railroad right of way in central Illinois. Starting out on Friday afternoon after school, we set up camp in the dense woods in the right of way. Around noon the next day we took a hike down the railroad to a bridge over a local river. I watched from the railroad track, through the ties, down to my friend who was walking along the metal girders making up the supports of the bridge. He was balanced about 15 feet above the shore of the river, and decided to drop to the ground. As I watched from directly above, he dropped down and promptly sprang back up and then keeled over on his side, writhing in agony. He kept saying he was hurt, over and over. I figured he had broken his leg.
I scrambled down as quickly as I could, and found out that actually what happened was that he had landed forcefully on a sharp, hard, woody, dried weed stem that penetrated through his anal region and perforated his colon. We didn't realize the severity of his injury, and slowly walked him back to our camp, where he took a brief nap. He awoke dilirious and vomiting, in early stages of peritonitis. We hustled him up to a local store, called our parents, who drove him the 25 miles back to Bloomington to the ER. It wasn't until the next day that we found out that he had to undergo emergency surgery and now had a temporary diverting colostomy.
These three events drove home to me the relative fragility of the human body, and the dramatic effects of what seemed like relative inoccuous injuries or trauma. These events reinforced in my mind the need for the body to remain in careful balance to stay fully functional and healthy. They also fascinated me with the technology and art of repairing the damage to the human body.
I also, as a result of these events, became pretty cautious and risk-aversive. I realized how quickly something could go wrong. So when my friends would start talking about an activity that might involve some risk, I felt it was my responsibility to try to analyze that risk and the potential for injury. I wasn't always successful, but I at least felt I got everyone to at least think twice.
I started packing along a pretty complete first aid kit and survival kit for our outings. I wouldn't say I was obsessed with safety issues, but I did have a healthy respect for the possibilities.
Entering my senior year of high school, I took advanced biology, which included dissections of fetal pigs and adult cats. We also got to design and carry out our own experiments. My partner and I designed and carried out fruit fly genetic experiments, psychology experiments on grade school kids, and experiments on the effects of antibiotics on different bacteria. One of my classmates (now an Internal Medicine physician) had the wonderful idea of boiling a dead dog for a couple of days to get all the bones clean to put together an actual clean skeleton of the dog. The piquant aroma of boiling dog permeated the Bio II classroom area for a week.
Also at this time, I was supposed to be deciding on my future with regard to college and career. I truly wanted to aim in the direction of medicine, but I had heard horror stories of the stresses and expense of medical school. I was still enamored with nature, and with the life sciences, but I was now an avowed lover of wilderness. I decided to move in the direction of forestry or environmental engineering.
I completed two years at Illinois State University, close to home. I had several reasons to stay close: I had a scholarship from my father's employer that covered the costs of tuition at ISU, and with me living at home I saved a TON of money (for my parents, anyway). I was able to remain close to my girlfriend with whom I had fallen completely head-over-heels in love. I was hoping to remain in the rock and roll band for which I played bass. I figured I was just getting my "gen-eds" in, and after two years would take off for Colorado State University to major in Forest Management Science.
Colorado Years:
In 1977, it came time to move out to Fort Collins. I fell crazy in love with the mountains and the sun of Colorado. I spent my three years there and got my degree in Forestry. I worked as a forester during the summers. The absolute favorite part of my job was talking to vacationers in the camps and the parks. My Forest Service partner and I often got invited to have dinner with camping families and we'd sit around their campfire talking with them. I was fascinated by these peoples' stories of how they developed their love for camping and the mountains, and the tales of their lives and families, of their marriages and grandkids, of their travels and tribulations. A moment of enlightenment: One rainy early evening in the summer of 1979, my partner and I sat in a small cozy restaurant in a little tiny mountain town in central Colorado. We were finishing our reports and writing letters home. All around us were families of the local townspeople. All ages. Little kids still wet from their evening baths, running around in PJs, older folks swapping yarns, and EVERYONE KNEW EVERYONE. Kids would jump in someone's lap and then run away to someone completely unrelated and snuggle up with them for awhile. It seemed a little like a "commune," but these truly were all separate families who simply had no problems accepting the other families and helping out whom they could.
I clearly remember thinking: I want to live in a town like this someday. Walking out of there that evening with the alpenglow on the nearby peaks, the delicious smell of pine wood smoke in the air, the unbridled laughter of the kids echoing from inside, I knew this was what heaven would be like for me. I felt I could live in a place like this as a forester, but something was missing. I wanted that more direct connection with the people--the kids, the parents, and the older generation.
I applied for all kinds of permanent forestry jobs, but got nowhere. It was 1980, and a major recession was place. Then, I actually landed a job as an intern with Weyerhauser in Tacoma, Washington. I went up there and toured the place. I was pretty excited. Then in early May of my graduation year, I received a letter from Weyerhauser that due to budget cuts, they were doing away with the internship program and I would not be joining them. I was crushed! I had no job.
I was offered a position as a research fellow in a Master's Program at Virginia Polytechnic Institute and State University (Virginia Tech) in Blacksburg, VA. I decided to take it. It was a mostly-paid gig for two years. And, I now had a plan:
The Plan:
I had decided that, with the loss of the job at Weyerhauser, I was not meant for forestry work. I had had a re-awakening in my heart and soul and mind to go back and pursue a career in medicine. I got my hands on a couple of medical textbooks and found them fascinating and it felt to me like a return to comfortable old bed. It felt so natural. I knew I had to make medicine my life.
My specific plan, as outlined in my journal of the time: Go to Grad School. Study for MCAT exam (Medical College entrance exams). Take MCAT. Apply to medical schools. In the meantime, work on Master's Degree in Forestry. Hopefully get accepted to Medical School. If not accepted, my options would then be to take a job in the eastern US in forestry (a thought I abhored, since I could barely stomach the eastern US after my love-affair with the mountains of the west), or go back to Colorado or Utah or Oregon to pursue a Ph.D. in Forestry.
I did fine on my MCAT exam. Then I started applying to medical school. I applied on the early decision plan to Southern Illinois University School of Medicine (in Springfield, IL). I got called for an interview. I did NOT get accepted, but in my subsequent phone conversations with the Assistant Dean, I learned the ONLY reason I was rejected was my lack of exposure to medicine in a job or volunteer activity.
Therefore I promptly went to the local hospital, Montgomery County Hospital in Blacksburg, and volunteered. They put me to work in the Emergency Department. I worked evenings and weekends as an ER volunteer, helping with whatever the ER nurses and doctors needed. In a matter of a few months, a job opened up as an "ER Technician," which was actually just a glorified orderly who was stationed in the ER. But I applied for the job and got it. Now I was actually working a second job (my first was as a graduate research assistant for Virginia Tech).
So my days were filled with forestry machinery, running skidders and hydraulic loaders and welding and drilling steel, and building forest harvesting machinery for my research. My nights were filled with helping out in the ER with doctors and nurses and patients. I didn't tell my forestry professors that I was working at the hospital; I didn't think they'd understand. I was worried then that I'd have to explain that I did NOT want to go on in forestry and that I wanted to pursue my future in medicine.
On nights I wasn't working in the ER, I'd hole up in the Virginia Tech library, reading medical journals. The Journal of Trauma was one of my favorites.
So again, late in 1981, I applied Early Decision to SIU School of Medicine and went for my interview. I now had a whole bunch of experience working in the ER. Back in Blacksburg, I waited. Then the letter. I was accepted! I would be joining 71 other first year medical students at SIU School of Medicine in the fall of 1982, for the Class of '86.
I finished up my Master's Degree in Forestry, moved back home to Bloomington, and prepared to move down to Carbondale, IL where the first year of med school took place. Since the first year was "basic sciences" like anatomy, physiology, embryology, genetics, biochemistry, and histology, the curriculum mandated us staying at SIU's Carbondale campus for one year, then we'd all move to Springfield, IL for the next three years of more "medically" oriented learning.
Prior to moving down to Carbondale, I took a 2 week road trip by myself back out to Colorado, to camp, hike and see old friends. It was very bittersweet to be back there in the mountains I loved, knowing that for the next four years I'd be buried under mountains of learning in Illinois.
My new plan: My ultimate life dream had morphed: As I was driving alone down a lonely back valley dirt road in Colorado, I saw myself 10 years in the future--living in a little mountain town, as the town's only local doc, taking care of local families and charging $25 a visit, no matter what. If people couldn't pay, I'd accept pies or meals or bartered services. I'd hop in my Jeep and make housecalls out to a patient's ranch. That was it! 