AHEC 425: Acting Internship in Surgery, Rural Western NC

Welcome to Linville, North Carolina! In my first clerkship as a fourth year medical student (damn it feels good to say "MS4" at the end of my dictations), I decided to grab a one month rotation in Western NC before heading north. What better place to go than the area where I spent my five community weeks my first two years (Linville is very close to Boone)? In fact, I am actually working at the hospital where my community week preceptor has a satellite office. Here, I will spend four weeks working with two general surgeons, learning how medicine is practiced away from THE BIG HOUSE (i.e., Chapel Hill or Mission). One of the surgeons is the third in his family to serve this area as a general surgeon in a practice established before the turn of the century. And by turn of the century, I don't mean the year 2000...

The best way to describe my experience so far is through a short vignette. The only place in Linville where I can get good cell phone service is in the Cannon Memorial Hospital parking lot (burn in hell, AT&T!). I don't have service at home or in the coffee shop I now frequent. So, after we finish rounding in the evenings, I may often be found sitting in my car catching up on phone calls. One night this week I left the door open, welcoming the cool mountain breeze. Mid-conversation, a police officer walks up to the car and starts messing with me a bit...

Dispatch, we have a 10-87-12 going on in the Cannon parking lot. Send 2 units back-up.

I put the caller on hold and start chatting pleasantly. Suddenly he realizes I'm on the phone and says, "Son, I just came by to see if you were going to take that lady back for a C-section." I was a little taken aback (one, because I don't take anyone back for sections; two, how did he know?; and three, HIPAA?). The doctors had only been discussing whether or not this patient would need to go to the OR less than 30 minutes ago. He says, "She's my cousin; I was just curious. Heard you might be in there."

News travels fast.

That gives you an idea of how small and tight-knit the community is where I have the privilege of working. It seems that the lines of HIPAA are a little blurred. Before leaving Asheville, one of the surgeons asked me what my plans were for the year. I told him that I was on my way to Boston, via Linville. He said, "Well, Linville is just sliiightly different than Boston, so good luck." I can imagine. To which our great and wise ethicist replied (in her usual, sage manner),

In the words of psychologist/philosopher Harry Stack Sullivan, "We're all more alike than we are different."

Agreed. It is a different ball game here, though. Because there are only two surgeons for the whole area, we are always on call. If something happens in the middle of the night, I am expected to be there. Morning, noon, night, and weekends. Now, given that it is a small town, emergencies occur less frequently. But the responsibilities are greater. We pre-round on our patients in the morning, see patients and take cases all day, and then round again at night. I have been the first-assist on cases that first year residents don't even get to take (I don't think it happens like that in THE BIG HOUSE). There is less "see one, do one, teach one," and more "go do one." It's fantastic. Mind you I don't "do one" if I'm not comfortable or don't know what I'm doing. I feel a responsibility for my patients here. I also feel a bit like a real practitioner.

I think I'm going to miss the medicine in my year off. I will leave you with my quote of the week:

"My dad used to say, 'If you take a son-of-a-bitch and educate him, what do you get? You get an educated son-of-a-bitch."