Madison County, NC

I literally could not understand the first patient I saw in clinic. His accent was so thick I had to use every ounce of active listening power to comprehend his statements and questions. At one point, I just laughed and nodded because he did. I have been hanging out in the city way too long. A year in Boston will do that to you. Even Chapel Hill (pretty close to the dead center of the map, pictured above) is too far away.

I began my final rotation in primary care last week. After this month, I will spend four months in class and on the interview trail, then finish my MD with four straight rotations: Radiology, Nephrology, Palliative Care, and Neuro Trauma ICU. It's a busy last few months of fourth year, but the goal is to not be an idiot when I start as an intern. This month, though, I want to firm up some of my primary care skills, taking care of patients with the usual array of chronic medical problems: high blood pressure, diabetes, congestive heart failure, depression, anxiety, etc.

While I have done some chronic disease management, I have actually spent most of my time as an urgent care / emergency medicine medical student. Many of my preceptor's patients use his clinic much like I would use urgent cares and EDs. On the average day, one or two patients will roll in with a deep laceration to the leg, hand, or face, and we will just sew them up right in the office. In fact, I've done more sewing in my first two weeks here in Mars Hill than I did during my entire Pediatric Surgery clerkship. I am also sharing time with a third year Family Medicine resident, so we will sew and do procedures while our preceptor works up patients. It's a good gig and super efficient.

Originally, I thought that doing two rural rotations as part of the Asheville Longitudinal Curriculum might be a burden. But these clerkships are turning out to be some of the best hands-on experience I'm getting as a medical student. I spent my first surgical acting internship in Linville, NC, where I truly felt like an intern. I had all the responsibilities that the interns at UNC had on Pediatric Surgery (except for the fact that I could not sign my own orders, which was probably a good thing). And here in Madison County, I'm in a similar boat. See one, do one, teach one.

After finishing up clinic on Wednesday, I flew to New York City for the weekend. My friends were appalled with my "southern accent." Apparently after two weeks here (and another two months in North Carolina), I was speaking reeeeeeaaal slooooow. And yes, I say "y'all" - something I promised my sister I would never do after she came back from Furman University in South Carolina saying it. In New York City, I'm just a country boy.

Funny. Because all my friends at Carolina call me a Yankee.