My Last Day

Today was the last day of my externship.  I’m going to miss Dr. Stewart, his family and the office.  Over the past two weeks, I’ve spent the majority of my time shadowing in the clinic, although I did spend a few days in the ER with Dr. Smith and Dr. Joy.  What I loved most about rural medicine was the relationships that physicians build with their patients.  That may sound super cliché, but compared to prior shadowing experiences, I have not a single physician who knows as much about his patients as Dr. Stewart does. Usually when I shadow, I hear about the patient’s medical history, strictly medical, before seeing a patient.  Not only does he know everything, medical and non-medical about his patients, but he also knows about his patients’ relationships with their husbands/wives/boyfriends/girlfriends/siblings/children/parents.  Literally.  He’s also delivered two generations of people here in Charlevoix.  So, it is not such a far-fetched question to ask if he has delivered the 40-year-old patient in room 2.

What else did I love?  The variety.  If you see my addendum to my first post, you’ll see how diverse this practice is.  This is the kind of practice and knowledge I hope to have after practicing for many years.  I never really considered specializing in anything, but after this experience, I really doubt that I will specialize.  How cool would it be, to have the knowledge that allows me to take care of a person from birth to death?  That requires an enormous amount of practice and skill.  A physician would need to keep updated on all kinds of information involving every aspect of the body.  He or she would also have to read a variety of journals and cannot settle for reading a few and focus solely on one organ.  I apologize if it sounds like I am attacking specialists; I am not.  I just think that family practice is undervalued and that family practice physicians deserve a lot more credit than we give them.

I am immensely grateful that I was able to shadow Dr. Stewart and his partners for these two weeks.  Dr. Stewart, especially, is an amazing teacher- he really involved me in every with every single patient and taught me many different techniques and tests that gave me more confidence in myself and that will prove useful in med school, I’m sure.

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After one last day of seeing patients in the clinic, we sat down in his office and he showed me some prescriptions, written in the time of dinosaurs, i.e. the pre-1960s.  In this time, medications were not made using standardized methods- the doctor would tell the pharmacist how to make a medication and then, the pharmacist would prepare the medication, from scratch, in the lab.  Take a look at the prescription, dated September 21, 1936, below:

 

The doctor and patient’s names have been covered up in accordance with HIPPA regulations.  On the first line, the doctor has ordered 40 grains of Acid Acetylsalicylic acid.  This should sound familiar to you if you took Orgo 1 lab- this is just Tylenol.  On the third line, notice that the doctor prescribed Phenobarbital, which used to be used as a sleep medication.  The fourth line reads 2.5 grains of Essence of Belladonna- to make this, the pharmacist would physically extract the essence from the Belladonna leaves in his lab.

Before the 1960s, medical students had to take a course where they would learn the components of drugs and how to make medications.  After the government required medicine to be manufactured in a uniform matter however, this course was dropped from the curriculum.

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One last thing, Dr. Tinney, the pediatrician that shares the building with Pine River Medical took me up on his plane.  And I did indeed fly it for a little while!  Flying is a lot more difficult than Dr. Tinney made it seem; I kept overturning or underturning.  Here are some pictures:

The plane- seats 6.

Dr. Tinney sat on the left, and I on the right

click to see a better view.  If you look REALLY closely, you can see the Mackinac Bridge.  Its the little white pillars sticking out of the water towards the middle of the picture and slightly to the left.

That little red dot on the smaller peninsula is the lighthouse that Charlevoix is famous for.

Dr. Tinney and I

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Thank you again everyone: Dr. Stewart, Kate, Dr. Joy, Dr. Mann, Christina, Wendy, Sue, Dr. Tinney, Amy, Regina, Connie, Dr. Brown, Dr. and Mrs. Newcombe, Dr. Smith, Dr. Ivey, Michelle, Donna, Sue, Chris, Jean, Betty.  This was an amazing experience :)

The ER

The ER in Charlevoix is definitely different from the one at Detroit Receiving.  For one, there are only 9 beds, compared to the 25 in DRH.  For another, there are not many cases of trauma that pass through this unit.  The majority of rural ER, as Dr. Brown told me, is an extension of family practice.  While I was there, I saw firsthand, how people use the ER as a walk-in clinic, something that is strongly discouraged, since a trip to the ER is much more expensive than a visit to the doctor.  I saw a few kids with sore throats, another girl with cramps and a few patients with stomachaches- in short, nothing life threatening.  There were some cases that required immediate attention, but not many.

While in the ER, I met Bryan, a resident from Munson Hospital in Traverse Ctiy.  He is a DO, and I spent some time asking him about the differences between MD and DO.  According the Brian, an important difference between the two schools is their approach to treating people.  DOs, in addition to prescribing medicine as treatment, use Osteopathic Manipulative Treatment to treat people physically, at the source of pain.  He told me how can sometimes treat pain without medication, either by pulling or pushing a muscle back into place.  That method sounded so interesting to me, and I heard that Wayne med students can even take this as an elective?  I think.  I’m not entirely, sure, but I am going to double check this, because this is definitely a skill I want to have as a physician.

with Lake Michigan in the back

<--Charlevoix Hospital

 

               Pine River Medical building -->

Skin is surprisingly elastic, as I learned when I saw sutures put in and taken out.  I was actually surprised at how squeamish I got when Dr. Joy was stitching a patient up with a head cut.  I am usually completely comfortable during dissections and watching gross stuff on TV, but for some reason I felt so much pain when watching the needle go in and out of the skin.  Luckily the patient’s face was covered so he/she couldn’t see the pain on my face.  Hopefully this squeamish thing goes away after some practice in med school.

Row, row, row your boat

So I promised that I would write about the boat races.  Basically, Dr. Stewart enjoys a fantastic lifestyle.  He worked hard during medical school, residency and when his kids were growing up, but now he gets to relax, work nice hours and take his sailboat out whenever he wants to.  (He still makes house calls though, and is very willing to be accessed by patients at home- his phone number is not unlisted.)

Honestly, I did not understand the majority of the boat related conversation and still can’t tell starboard from port, but I did understand that maneuvering a sailboat require great skill and manpower.  We had 5 people, not including me, who worked together to make sure our boat didn’t end up like this unfortunate one:

poor dismasted boat

After checking to see if the above boat was ok, we resumed course and ended up in second!  (no thanks to me of course;)  I tried to take some good pictures, so hopefully they can give you a sense of the calm on the boat.  This was a great experience and I'm really glad that Dr. Stewart took me out.  His crew were also very welcoming and great fun to be with- thanks again!

looking up into the sail and spinnaker

ahoy

Beaver Island

One of the reasons why I requested to go to Charlevoix was because of its location on Lake Michigan.  Another motivation was to revisit Beaver Island, the place where my senior class and I spent a weekend conducting “science” experiments in the Island’s diverse ecosystems.  This time, I was able to go over on the plane, a short 20-minute ride that I made with Dr. Mann.  Here is the plane:

seats 6 plus dog comfortably

 The skies decided to send down rain that day, but our very able pilot flew through this just fine.  The Charlevoix airport, as expected, consisted of a small building and a few landing strips.  The Beaver Island airport, however, did not match my expectations- it was even smaller than I had imagined.  We actually landed in a field, slowed down a bit, and then the pilot drove us over to park on the airstrip.  Here’s the airport:

 At the airport, Chris, the PA at the Beaver Island Health Clinic picked us up.  Due to the downpour, I was unable to get a good picture of the clinic, so I will substitute with one from the Clinic’s website:

As Donna, the Clinic’s coordinator, showed me around, I was amazed at the variety of services the clinic offered.  A PA, Chris, and a Nurse Practitioner, Sue, staff the clinic on a daily basis.  In addition, a physician, psychiatrist, a physical therapist all visit weekly/biweekly.  A dentist also works full time on the island.  There is also an X-Ray machine on site and a delivery room- though it usually not used, except in emergencies when a woman cannot be flown mainland to deliver a baby.

I was surprised to learn that only about 600 people live on the Island year round.  Many of them, like Donna have a deep history here, and many are elderly or retired.  Thus, the school here is very small- there are only 75 children in the entire school kindergarten through high school.  Since there is not much to do on the island, the main problems that afflict the people are alcoholism and depression.  And because this is such a small community, word spread if anything, good or bad, happens.  I was reminded forcefully of this lesson when one patient came in, telling us about the mistreatment she suffered after she was involved in an incident that made her unpopular with the islanders.  I cannot say more though on this matter because of HIPPA regulations.

Before I left, Dr. Stewart recounted the history of Beaver Island:

It starts with Brigham Young deciding to take his congregation west.  When he reached Illinois, John Strang, another Mormon leader, claimed to have spoken to God, Who commanded that the Mormons move north, not west.  Strang and Young split up.  Strang’s group traveled along the western coast of Michigan until they found Beaver Island, which was completely uninhabited.  Strang and his followers settled there, and Strang crowned himself king (the only king to ever exist in America); he also made himself unpopular the mainlanders.

  

One day, a man left his congregation and escaped to the mainland; in response, Strang issued a warrant for his arrest and ordered troops to capture him.  When his troops reached shore, battle ensued and the mainlanders forced the troops to turn around.

  

A few days later, the man sailed back to Beaver Island, demanded to see Strang.  When he met Strang, he shot him in the head and made a quick escape aboard a US Navy ship that happened to be docked on the Island.  Although the Islanders were furious, the ship granted him asylum; later, a mock trial was conducted and the man was pronounced innocent- a mark of how much the mainlanders hated Strang.  When Strang finally died a few weeks later from the gun wound, the word spread to the mainland.  These people came and forcefully removed the Mormons from the Island; the buildings and infrastructure were left intact.

  

A few years later, the Irish, fleeing the potato famine settled on the now empty Beaver Island since it was of a similar climate to Ireland.  This is why Beaver Island is called the Emerald Isle.

Although I was not able to explore the island fully, from my last trip here, you should visit the public beach here.  There are tons of fossils that you can find, which is cool since its rare to find these kinds of things outside of museums.  Also, if you can spend a night here- do it!  This is one of the rare places that you will be able to see the stars and galaxies at night, a truly breathtaking view.  I must do this when I go back to visit.

Then...and Now

This is by far going to be my favorite post.  One of the reasons why I loved shadowing Dr. Stewart was because he went to Wayne State for undergrad, graduate school and med school and lived in Detroit.  It was so much fun to ask him all sorts of questions about how Wayne/Detroit today differ from the Wayne/Detroit of yesteryear (“back in the 1800s,” as he likes to say).  Like Dr. Stewart’s son, I was born in Hutzel Hospital.  Like Dr. Stewart, I lived in the same apartment building as he did during his undergrad (Sheridan Court) and on the same floor (the fourth floor).  The only difference was the time.

All of the responsibilities Dr. Stewart juggled during med school deeply impressed me.  Not only did he have a wife and child, but as Wayne’s policy restricted him from receiving grants from the school, he had to work 20+ hours a week at a bacteriology lab, called Second Hope on Cass, to finance his education and his son’s diaper bill.  Can you imagine doing that?  I think not.  And this was before lectures were prerecorded and med students could watch them at 1.5 speed.  All the groaning and moaning we as undergrads do (especially about the MCAT) seemed childish.  And speaking of the MCAT, In Dr. Stewart’s time, the MCAT was scored on a scale of 1600; it tested the sciences and had a verbal reasoning-like section.  Just a fun fact.

And look- this hallway is still the same!  Well, I think it was, until about two years ago, when they moved the med students’ mailboxes. (picture taken from Dr. Stewart's yearbook- a fun read)

A story from Dr. Stewart about how Hutzel Hospital got its name:

The heroine of this story is Ms. Hutzel, a lady devoted to charitable causes.  She served on the boards of many philanthropic organizations across Detroit and played an instrumental role in raising money for a variety of foundations because of the many connections she forged.  She was especially involved with Woman’s Hospital, which handled the majority of the OB/GYN cases in Detroit.  When Women’s Hospital looked to expand, the C.S. Mott family of Flint offered $40 million towards this project; in return, they wanted the hospital renamed Mott Hospital.  Ms. Hutzel worked hard to coordinate all of the finances involved but on the very last day, when the contracts were to be signed and the deal finalized, she was sick and could not attend.  During the meeting, which the Mott family attended, some person threw out a suggestion: “Let’s name the hospital after Ms. Hutzel.”  Everyone sat stone still, including the Mott family.  Nobody challenged that idea; it was a mark of how much respect everyone had in the room for this great lady.  Another person seconded the motion, then another and another.  Even with the Mott family present, the board unanimously agreed to name the hospital after Ms. Hutzel.  You won’t find that story on the Hutzel Hospital website.

Let's end with some more pictures from the yearbook:

 Then:

click to see bigger version

                                                                                    

                                                                                         Now:

Then:

aka Edgar Allen Poe/Mark Twain (don't worry, I've already told him this)

                                                                                       Now:

Exploring Charlevoix

During my lunch break and after shadowing every day, I explored the downtown, which centers mainly on Bridge Street and its two stoplights- one before the bridge and one after the bridge.  Since Charlevoix is situated between two big lakes- Lake Michigan to the west and Lake Charlevoix to the east, there needs to be some way for boats to sail from one to the other.  Hence, the drawbridge, which goes up every half hour:

One thing that I loved about Charlevoix (especially after living in Detroit): the cheap and endless parking!  There are so many lots just one block away from Bridge Street and for so little- a dream come true.

Ok- now for the more important stuff:

Charlevoix had a pretty decent variety of vegetarian options.  I really need to learn to like seafood, because that would have opened up a few more venues for me.  One day I’ll learn to get over the smell of it, but for the two weeks I was there I ate mostly vegetarian.  While I was here, I also tried my best to stay away from the chain store restaurants in order to get a better feel of what food was available locally.  Some of the better places with vegetarian options:

       Scovies

       Sadie and Jake’s (though you should avoid the hummous- no one can do that better than Dearborn)

      Argonne (in Petoskey)

       Whitney’s of Charlevoix (not as overpriced as its namesake in Detroit)

 Overall, there was not as much variety in terms of food, which was a little disappointing; most restaurants featured American cuisine, or at most a few ‘exotic’ dishes.  But, what Charlevoix lacks in what I call ‘food food,’ it more than makes up for in desserts and fruit.  There is a weekly farmer’s market here on Thursdays and I can guarantee from experience that the fruit here is fresh and full of flavor.  In addition, even though I missed it both weeks, you should also try Lodie’s bagels- all of the office staff raves about these bagels and they sell out fast, so get there early.  There are also a ton of farmer’s markets in the surrounding area.  My favorite place to visit, by far, was Friske Orchards.  Here, they bake all kinds of pies fresh daily and they also offer breakfast at very reasonable prices (a big plus since I am a hug breakfast fan).  They have pancakes, omelets, oatmeal, scones and omg it’s really good.  Another thing, they have a big selection of knick knacks that would make great gifts, much better than the boring postcard or an average shotglass.  I have discovered that expanding my sights and exploring areas a little bit outside of town is a great way to really appreciate the diversity of talent located here.  To find Friske Orchards, drive about 10 miles south of Charlevoix on M-31 (this doesn’t take long at all since the major roads here have a 55 mph speed limit).  In town, you can sample fudge and ice cream at either Murdick’s or Kilwins.  Kilwin’s is a bit more expensive though, but both are are good options.  Oh yea, don’t go eating your fudge openly in public, that’s touristy behavior and the locals will label you a fudgy (plural: fudgies).  And one more place- American Spoon.  They have an amazing selection of jams.  You might be thinking: what a dork- jams?  But trust me, these are not your ordinary jams.  They have flavors like Apple Salsa, Mango Habanera, Pumpkin Chipotle and Maple Cream.  Plus, you can sample most of them in the shop before you buy.  Eat these with crackers, its a great snack food (or a great way to get lunch on the cheap, just saying).

Also- there are a few different parks that you can go to here that have access to either Lake Charlevoix or Lake Michigan. Michigan park is, logically, located on L Michigan and Ferry Park is on L Charlevoix.  A bigger park that's about 4 miles south of town is Fisherman's Island State Park.  All good choices and nice places to relax.

 

The Beginning

The drive up here was pleasant.  One bit of advice- when driving by yourself, bring something to sing along to, or play some kind of game with your head, because driving alone can get really boring.  I found my hotel in Petoskey, settled down a little and went over to the downtown to find some food.  To those of you that visit this area, check out Thai Orchid, it’s a good Thai place.  Don’t ask me how authentic it is though, because I am not sophisticated enough to know that, sorry :).  Whoever designed Petoskey’s downtown did a good job.  There are lots of stores and restaurants to wander through. 

The next day, my first official day, I took off from Petoskey to meet Dr. Stewart in Charlevoix.  The sun had not fully risen yet, and a light breeze came from the Lake.  Windows down, the drive was beautiful especially when I turned a corner and saw Lake Michigan below me.  What a nice alternative to the construction barrels I usually see at home.

When you enter Charlevoix, you will see gorgeous petunia beds lining the street and huge planters overflowing with flowers hanging from streetlamps.  This is an adorable city I thought, No wonder they call it ‘Charlevoix the Beautiful’.  Dr. Stewart later told me that the whole city gathers to plant these flowers in one day of early spring.  That is the nicest community activity that I have heard of.  I crossed the drawbridge and headed west on Park Avenue.  The houses were small-ish but, unlike the garish mammoth-size houses people like to buy at home, all of these houses had character and were definitely not cookie cutter.  Here’s an example:

An Earl Young home.  This architect designed other homes in the area, called Mushroom Houses

I met Dr. Stewart at the hospital and found that he was every bit as warm and caring as I had imagined him to be when I talked to him on the phone.  We took a tour of Charlevoix Hospital, which sits on Lake Michigan; thus, all hospital rooms have a view of this- If got sick I would like to recover here.  Then, we saw the clinic where he spent most of his days working.  He works with a group of five other physicians in a private practice: Pine River Medical Associates.

Addendum (8/9/10): After experiencing life as a physician here for the past two weeks, I find that Dr. Stewart’s practice is not only unique, but it is also the ideal set up, at least for me.  Not only do the physicians in Dr. Stewart’s practice see patients in the clinic (and occasionally make home visits), but they also have a contract with Charlevoix Hospital to provide ER services.  Until a few years ago, they also handled a large share of the OB/GYN cases in the area.  The physicians, thus, have a little of everything and truly take on the role of the ‘old country doctor’- They see patients in the clinic, run the ER and deliver babies; basically, they can see a patient from birth, through any major and minor crises in the hospital and into adulthood.  Awesome right?

After that, Dr. Stewart headed home and I stayed to shadow Dr. Mann.  Basically, Dr. Stewart takes Wednesdays off during the summer because he races his sailboat on that day- the physicians here have a really nice lifestyle.  I can't wait for the next two weeks.  More on the boat racing in a future entry.