My column in the latest issue of the Daily Yonder.
Creative Solutions to the Rural Doctor Shortage
1
Doctor Outspoken (A poem about doctors and free speech)
Doctor Outspoken
Dedicated to all the docs who pay for their opinions with harassment and sometimes with firing.
Oh doctor dear, we need you here!
We need you day and night!
We need your skills
At treating ills
So sick folks are alright.
Oh doctor wise, we need your eyes!
We need your healing touch!
We need your knowledge
From med school and college,
Your training all matters so much!
But doctor loud, doctor proud
we need not hear your thoughts.
You tend to complain
And you’re always a pain,
Remember that you have been bought!
Doctor mad and doctor sad,
Please silence your dissident views.
You’re here for the money
And trust me there honey,
We’ll find other doctors like you.
Oh doctor broken, doctor outspoken
We know that you have a full cup.
But don’t speak your mind
Just smile and be kind.
And oh, one more thing…just shut up.
Oh doctor mister, doctor miss,
Do keep in mind who is in charge!
You heal patients’ woes
But you’re really the foes
Of the suits and the clip-boards at large.
Doctor tired, you could be fired,
For sharing the things that you see.
You just have been ravaged
By business-folks savage;
Who think speech should never be free.
Doctor wise who tells no lies,
Thank you for fighting the fight!
If we all surrender
Then none will remember
When speaking for truth was still right.
Sleeping Around in Odd Places
I used to practice locums medicine; which for the lay-person means traveling to different jobs, sometimes several states at a time. During that time I stayed in a lot of hotels. But, occasionally, I had more unique accomodations. Obviously, if you travel enough you’ll sleep in an airport here and there. No big deal. I actually like sleeping in airports occasionally. When you’re stuck, you’re stuck. Weather or mechanical issues, it’s fun to watch everyone freak out. I’ve put my carry-on under my head and passed out cold in the waiting area. Probably snored like a freight-train.
I have also been put up in apartments owned by the hospital. Not necessarily bad, although one of them felt as if it really weren’t in the safest part of town. I wouldn’t leave my things there, and I insisted on a hotel. Such is the power of locums. I had a nice room the next night.
Once I had to spend my first night in a sleeping room, after hours, in the back of a local mental health clinic. That was a little creepy. Again, I said, ‘no mas.’ I had no interest in being accidentally committed.
I’ve also slept over in hospital call-rooms, even on days off. That can be good or bad, but generally the beds are wretched. Which always makes me wonder why patients are so anxious to get into them. I guess any bed beats an ER gurney.
In one small, critical acces facility, I worked 24 or 36 hour shifts and stayed in a converted patient room. I felt a little like a very old man, raising and lowering the head of the bed, and listening in the hallway to hear nurses walking up and down, taking care of the elderly who were there for rehab. I ate off of hospital trays, sometimes reclining on my hospital bed. I may have gotten a little too ‘into character.’
Today, however, was unique. I’m not doing locums per se, but I’m working a full-time gig out of town; three or four on, seven off. The hospital has an apartment that it keeps for us to use. However, after I worked overnight last night, I was given a key and an address and sent off to find my sleeping hole. However, at 6:00 am, the lights were dim, the signs were poor and I had almost no idea where to go. In the dark, I was driving down abandoned streets, looking at windows and doorways, skulking up stairs in a retirement center, trying to figure out just where to go. Confident I would eventually be arrested, Tased or shot, I went back to the hospital and a few phone calls later I was told where to go. Indeed, my apartment was on the premises of a retirement community/nursing home. At 6:30 I was admitted to said nursing home where the lights were bright, the news on, and on old man propelled himself in his wheelchair, whilst holding coffee and looking at me suspiciously. It had that feel of a place where the day is about to start, but the changing days mean nothing.
I had a momentary terror, that I had it all wrong. Was I really leaving my shift, my 53-year-old self sleeping off the busy night? Was I still in my vigor? My children still unmarried and my wife a couple hours away, looking forward to my return?
Or was one of the kids going to come to me and say, ‘Papa remember, you retired. This is your home now! We’ll visit you later, now go back to bed.’ Shudder. Anyway…
A kind nurse took me to my apartment, and out of the off timelessness of the nursing home proper. I slept a while, and left to go home. However, due to some schedule issues decided to stay in town.
Rather than return to the apartment, which would be in use by the next doc and would consign me to the couch, I got a hotel room. ‘Ah, rapture! Cool sheets, dark shades, television before the bed!’
But as I checked in, I was cautioned, ‘we’ll be testing the alarms, don’t worry!’ I didn’t. And then, for about two hours the fire-alarm intermittently sounded, all but deafening me. My ears still ring from the thing.
Finally it stopped, and I slept off some of the night shift and its exhausting chaos. And I was not shot, stabbed, Tased, arrested, committed or restrained due to dementia.
It was, therefore, another pretty good day.
College kids should know you love them…no matter what.
My column in today’s Greenville News. Love on your kids when they’re in college!
Two of our sons began university classes last week; one a freshman, one a junior. After spending a wonderful Summer with them, Jan and I always find this a difficult time. It requires that we adjust to walking past empty rooms and accept the fact that they aren’t coming back home at the end of each day to scavenge food and tell us stories. Even their high-school junior sister misses them, although she is under the delusion that the house will be neater with brothers away. (Guess what, papa still lives here!)
Of course, we’re hardly alone. All over the state, nation and world, families send their daughters and sons off to be educated. And what a great thing! Broken parents everywhere have lost children to disease, accident, starvation or war and would love to simply have them alive, much less getting an education. I try to keep that in perspective when I feel sorry for myself.
However, as grand as college is, it’s a time of significant stress for our young people. Many are leaving home for the first time. This means great fun and adventure. But it also means a separation from those who have, for at least 18 years, been their constant supports and care-takers. It means leaving the comfort of the known for new places and new people. It exposes the kids, appropriately, to opinions that challenge their own. It introduces them to other kids from different backgrounds, cultures and lifestyles.
In addition, their sudden unsupervised state opens them up to all sorts of opportunities for bad habits and bad decisions. All of this added together can be very difficult. This is especially true in a time when, for a variety of reasons, some young people seem to be maturing later than in previous generations.
Perhaps this is why colleges are reporting more and more students struggling with depression, anxiety and substance abuse. University mental health clinics are always busy. And many kids end up dropping out or transferring to schools closer to home.
However, there’s one stressor we forget. When we send our kids to college we have high hopes and expectations for them. For years we’ve encouraged them, talked about college and even talked to our friends and family members about our kids’ academics. ‘Oh yeah, Joan here is going to Clemson and then med school; she’s going to be a surgeon! Aren’t you baby?’ (She nods her head nervously…) ‘Rick is planning to be an architect, right dear?’ Or a lawyer or an artist. We think that at 16, 17 (or even in their 20’s) they can plan their entire lives and it will all play out as scripted. That they’ll go to university, get that planned degree, go to professional school or grad school, get that awesome job and then we can tell everyone how great they did.
And yet, what if they don’t? What if they’re frightened? What if they’re tempted? What if they feel outcast? What if they get addicted? What if they get pregnant? Perhaps harder for parents (and kids) to accept, what if they aren’t ready, or just don’t enjoy the academic environment and find that they really just want a job and a family? What if, like all humans, they simply miss home and the places and people they love?
The thing is, we parents (and grands) must never let our children’s identities be completely tied to education or career. Because if is, and if it goes wrong, then the whole structure of their precious lives is shaken. I think this may be one of the biggest stressors of all. That is, their desperate fear of disappointing the ones who worked for them and encouraged them to move forward. It must be absolutely paralyzing.
Our children are valuable because they’re our children. That’s the most important and foundational truth they need to hear. Not because of their grades, scholarships, IQ’s, career goals, awards or anything else. And it needs to be followed by this truth: ‘My precious child, if you are unhappy, if school doesn’t work for you, if you change majors or change life-goals, it’s OK. You are not defined by any of it. I love you no matter what; you can always tell me the truth. And home is always here for you.’
So send them off to school with tears and joy! But always anchor their worth to the love of family, not the success or failure of their educational adventures.
Mid-sized ER Madness; Thoughts?
I know, I know, I spend way too much time ranting about work in the emergency department. But after some recent shifts, my box of rants is full once more. And what I want to point out is the enormous struggle of the mid-sized emergency departments in America today.
I know this is a problem; I work in them, and I know and talk with people who work in them. It’s getting harder all the time. So what is that ‘mid-sized’ ED? For purposes of my discussion, I’d say (depending on coverage) somewhere from 16,000 to 40,000 visits per year. Now that’s not scientific, that’s just for the sake of discussion, and based on personal experience.
I’d love to hear commentary from readers, because I’m trying to figure it all out. But let me start with a story. When I was fresh out of residency, I worked at dear old Oconee Memorial Hospital in Seneca, SC. Our volume as I recall was around 23-25K per year. We had pretty good coverage at first, with three 12 hour physician shifts a day. Patients were sick but we moved them through. And when I worked nights, I remember that it wasn’t unusual for me to lie down about 3 am and sleep till 7 am.
Fast forward. Even at my current job where I see 19K per year, there’s barely a night when patients don’t come in all night long. So is volume spread out more? Maybe. Are patients sicker? Possibly. I think some of this may be that patients have no primary care, and so they don’t even have an option to ‘wait till morning.’ In addition, a large number of patient (in all ED’s) are jobless. So in their defense, 3 am is as good as 3 pm when you don’t have to go to a job in the morning. (I’m not disparaging; but I do think this is true. Think about your teenagers who sit up all night in the summer if they don’t have jobs!)
I also wonder if our patients are sicker. I mean, medicine is pretty amazing nowadays, and people who would certainly have died when I was in medical school now repeatedly survive significant heart failure, MI, stroke, pulmonary embolism, respiratory failure, various infections and all sorts of problems. And when they do, they have to come back to the ED frequently.
For those with docs in the community, I’m sure the offices are crazy busy all the time. Even those docs have patients they just can’t squeeze into appointments. They use the ED. And maybe, just maybe, our patients are much more ‘medicalized’ than before. So much of what the emergency departments see is really psycho-social. Anxiety, depression, suicidality, substance abuse. The numbers of these conditions seem to be exploding, and they can seldom afford primary care, much less mental health care. The all-night ED is the place they go.
And there is a subset of patients who use the emergency department for entertainment or convenience; rides, snacks, a way to avoid arrest. ‘Officer, I…have…chest pain!’ These also take time and space.
So what happens is all of this descends on departments with limited resources and staff. And all day, and all night, one physician or two, maybe a PA or NP, struggle to sift through five or six chest pains alongside two stroke alerts, a suicidal overdose, two septic senior citizens, a dialysis patient who missed two appointments and has a potassium of 10 and a femur fracture. Add to that the family of five with head colds. Sure, this is what we do. We are emergency physicians and nurses and mid-levels. But into this mix, in the mid-sized department, recall that there is: no cardiologist, no neurologist, no psychiatrist or counselor, sometimes no available ICU beds, possibly no pediatrician and definitely no dialysis in the hospital.
The day is spent sorting, stabilizing, making phone calls, transferring and waiting for ambulance or helicopter to become available. All the while? Sifting through very cumbersome and inefficient computer documentation systems designed for billing not flow. And being scrutinized for through-put, time stamps, protocols, national standards, Medicare rules, re-admissions and all that mess.
I really don’t want to sound like a complainer. What I’m concerned about is 1) the safety of the patients and 2) the physical and emotional health of the caregivers. At the end of the day, we’re all exhausted. And so much is going on that we can barely find the obvious stuff, much less the subtle things that can also kill.
It sometimes seems as if departments are intentionally understaffed to save money. I understand that it’s expensive to have doctors, nurses, etc. But administrators get mad at folks ‘standing around,’ without realizing that in the chaos and suffering of the ED, sometimes it’s really important to ‘stand around.’ To breathe, to think, to rest, to gather oneself, to look up a condition or problem, to debrief. To eat. To pee.
I think that the world of medicine has decended on the emergency department. I know that we handle it valiently. But I don’t think it’s safe; and it’s nowhere as unsafe as in the relatively under-staffed and under-equipped mid-sized community hospitals of the world.
I’m proud of what we do. But some days, most days, I wonder how we do it.
Any thoughts?
Edwin
Pushing the President off a Virtual Cliff Isn’t an Answer
This is my Greenville News column from August 1. I forgot to post it to the blog until today.
Have you seen the charming computer game that allows you to push President Trump off of a cliff, into a volcano or to some other unpleasant location? It allows tolerant, caring individuals to vent their spleens against the man who they typically say is ‘not my president.’ Of course, it’s only the faintest tip of the iceberg, beneath which is a large mass of angry, violent, eliminationist rhetoric.
Not to be outdone (and certainly not new), I recently saw a similar game that allows players to do terrible things to a virtual former President Obama. In fact (in a search that I hope won’t draw the attention of the fine folks at the Secret Service) I found an entire page of terrible ‘kill Obama’ games.
Of course, there are always fringes; I hope it’s the fringes. But I fear this is becoming an increasingly mainstream behavior. I would like to say I’m surprised, but I’m not. Politics is the new religion, and every religion has its heretics. And what do we do with heretics? We kill them! Everyone used to know that was a bad thing, when it actually involved belief in the supernatural. And we’re still shocked when we see horrific tales from groups like ISIS and the Taliban, where you can still be physically (not virtually) tortured and killed for believing or saying the wrong things.
Now, even in the good old US of A, there’s an underlying rage and disdain that leads some people to harm those who disagree with them. (See the shooting of Rep. Scalise or assorted violent protests on campuses). At the least, that anger allows Americans to publicly fantasize about harm against people whom they consider, thanks to their political position or ideology, sub-human.
Of course, the venom often starts with a Tweet, Facebook or blog post, online comment or speaking engagement. Someone demonstrates that they don’t agree with the latest political or cultural trend. They are called out for their thought-crime, and instantly attacked, threatened, and shunned by a community that points righteous fingers and shouts ‘Shame! Shame!’
Discussion is further shut-down by describing the ‘enemy,’ the ‘other,’ in casually launched terms like racist, sexist, homophobic, transphobic, hateful, intolerant or any number of pejorative adjectives that help put the cross-hairs in more stark relief. (In the old days it was Catholic, Protestant or Pagan!)
The righteous can then proceed to acceptably wish harm on the heretic, as several have recently done (for example) towards Sen. McCain in light of his position on ACA repeal. ‘Should have died in Vietnam,’ one said. Others hoped his tumor would kill him more quickly.
In a post-Christian, rationalist, and scientific world, where we are told we needn’t rely on some deity to hold us to ridiculous and uniform standards of behavior we have come round again to acceptable, post-modern fantasies about killing people who make us uncomfortable.
Admittedly (and as I alluded) people of faith have often led the charge of violence towards the heretic. But for a while, we seemed to be rising above it. At least until the church of politics became the equivalent of the Church of America. (Separation clause aside!)
What strikes me, though, is that the Jesus of the Bible (not the Jesus of modern politics) said in Matthew’s Gospel, ‘’But I say to you, love your enemies and pray for those who persecute you.’
He also said all sorts of other pesky, kind things about greed, caring for the sick, the poor and the prisoners. He even said, as he was being crucified, ‘Father forgive them for they don’t know what they’re doing!’
Christianity teaches us that we’re all ‘works in progress.’ That God will, if we desire, remake us bit by bit, sin by sin, into something far better than what we are, both in this life and in the next. That however bad we are, and He means that, He will forgive if we admit we need it; admit we need Him.
We need to try and see everyone as potential saints, not contemptible demons. Wishing, or doing ill to our opponents is not rational, scientific, libertarian, constitutional, progressive or modern. It’s pre-Christian and un-American. And it harms the hater most.
So stop pushing people off of virtual cliffs. And start praying for all the heretics, however you define them. Turns out, we’re all heretics to someone. That realization alone should open our eyes and thaw our hearts.
Kicking North Koreans Down the Bloody Road of History
I don’t think that anyone really wants a war with North Korea. The potential use of nuclear weapons on either side is the stuff of nightmares; but even without nuclear weapons, the death tolls from conventional munitions such as artillery, small arms, non-nuclear missiles and air-strikes would be extraordinary.
Thus, many have been shocked that President Trump has seemed openly hostile to N. Korean Supreme Leader, Kim Jong-un. They have blamed him with escalating the conflict, with prodding the rogue nation to the brink of nuclear conflict.
In the end, it sounds as if North Korea were a gentle, quiet land of rural majesty that just wanted to be left alone, when along came Donald Trump, who started being mean to the cuddly Teddy Bear president of exotic, far-off North Korea.
And yet, we forget. We forget that the Korean war of 1950-53 began when North invaded South and that it ended in an armistice, not a peace treaty. That war cost an estimated 1.6 million civilian casualties and some 1.2 million combat casualties. I’ve met veterans of that nightmare. It was a horrible war, and would be again.
(http://www.cnn.com/2013/06/28/world/asia/korean-war-fast-facts/index.html).
However, we also forget that since that truce, North Korea has constantly provoked South Korea with infiltrations by special operations soldiers, with naval and border clashes, assassinations, terrorist events and artillery fire. We forget that North Korean operatives have kidnapped citizens of South Korea, Japan and other nations. (Many of whom never saw their families again.) Go through the list in the link below. It’s not stuff we hear much about, but it’s truly shocking. And the list only goes to 2007.
https://fas.org/sgp/crs/row/RL30004.pdf
Beyond that, we in the West (and particularly college educated Americans) have a stunning ignorance about the singular delights of the land above the 38th parallel. We forget that North Korea, that undying zombie of Communism, is a land of terrible cruelty, torture, imprisonment, starvation and sorrow. As we in the West decry oppression in all its real and imaginary forms, the people of North Korea understand it in full. Over the decades of North Korean tyranny, since 1948, hundreds of thousands have died at the hands of their own government in prison camps and reeducation centers. Attempted defection to China usually results in either more abuses, or return to North Korea with further torment. Starvation, beatings, rape, forced abortions and executions are tools of state, and entire families are punished for the transgressions of one. (I suspect no small number of those crushed souls would say today, ’bomb it, bomb it all; it really can’t get a whole lot worse for us here, eating bugs and rats, and hoping our children aren’t murdered.’)
If you think I’m confabulating, follow the links below.
https://www.hrw.org/world-report/2017/country-chapters/north-korea
http://victimsofcommunism.org/north-korea-under-communism-1948-2014/
So it’s all well and good for us to oppose nuclear war, and to oppose war in in general. But the sudden discovery that North Korea was a super friendly place until Donald Trump? That’s not historically accurate or intellectually honest.
If it all cools off and calmer heads prevail, North Korea will still have hundreds of thousands of citizens living in conditions that rival those of the Soviet Gulags, or the Nazi concentration camps. They will survive day to day, eating starvation rations, being beaten or raped, tortured and murdered; the lucky ones exported abroad as wage slaves.
Those not in the camps, even the true believers, will continue to live in the constant fear that they’ll be arrested. And in the knowledge that their success, their survival, depends on showing unwavering devotion to Kim Jong-un and his family’s dynastic brand of tyrannical thuggery. Political opponents, religious believers, families of those suspected of dissent, all will fear the government or be punished by it. Because that’s how it goes down in the Democratic People’s Republic of Korea.
Assuming, again, that the war clouds pass, free people can wipe the sweat from their furrowed brows and allow the horrors of North Korea to go on, safe in the knowledge that diplomats will continue to talk as nuclear weapons and delivery systems continue to be developed in North Korea. All funded by the slave labor of untold, unknown citizens. And as men, women and children continue to suffer and starve.
What a relief that will be! And those who say ‘not my president’ can meet in safe cafes and discuss how ‘that crazy Trump’ nearly caused a war with a country that has been provoking free nations, and torturing its own citizens, for over 70 years. Safe out of the view of sensitive American citizens who oppose oppression.
I also hope we’re all prepared for what we see when, and if, the DPRK ever falls and the West has access. Because when we go in at last (hopefully through diplomacy or some miracle), when we see the camps and hear the stories, and witness the broken lives and weeping, gaunt faces; when we at last grasp the misery and sorrow that generations of people endured under that regime, we’ll be ashamed. And it will take decades for those people to escape the toxic cloud of imposed fear that enveloped them for so long.
But then, the world let it happen in exchange for the comfort of empty discussions and endless sanctions as we (the West and China) kicked North Korea and her people down the bloody road of history.
God forgive us when we see what that ‘peace’ cost.
Vacations early and vacations late
I write from the large, quiet beach house where 21 family members have been enjoying one another, and the various delights of vacation. I write from the solitude of the large dining room table which, this morning, was full of adults and children, from six to eighty, basking in the joy of breakfast, the smell of bacon and eggs, the delight of one another, the impending pleasures of a new day’s adventures.
Vacations come in two flavors, I see today. Early vacations in Spring are full of ‘what if,’ and ‘what shall we do,’ as well as ‘how wonderful to be together!’ They are powered by the kids’ freedom from the confines of schedules; they are super-charged by the joy parents have in being liberated from the homework and activities of their young. Early vacations are made more delightful because not everyone is free yet, the traffic isn’t gridlocked and because (even on Southern coasts), the evenings are breezy and cool and the bed is chilly not from air-conditioning but from nature.
Late vacations are also wonderful. All time together, laughing, floating in the pool, kickign the soccer ball on the beach, all of it is a sacrament of love. But this morning, lying in bed, I watched through the window as heavy rain rolled over the side of our rental house; it was a gray dawn, with high dark clouds, and reminded me that Summer is not half over, but sometimes still hints at Autumn. That Summer is a roller-coaster that runs faster and faster, and its cars are driven ever faster by the return of school, the heat of the season and by the advancing ages of the children we try so hard to keep young and nearby.
This is a late vacation; and an odd one. Several of two of our children and one of their cousins cannot be here. One is working, one is looking for an apartment, one is traveling in Ireland. One will leave for college in a few weeks. They are doing what they should; in the Spring of their lives, in their twenties, life is busy. But their absence punctuates the reality that all vacations, like every single year, change. In a sunny homage to Heraclitus, ‘you cannot step onto the same beach twice,’ as it were. Kids grow up, adults grow old and things move on to jobs and school; as they have and as they should. The alternatives are for our children to be stunted forever like pets, or to die. Better they should miss vacation.
The house is quiet, except for the dryer and the occasional young person scrounging for food and saying, ‘good night Papa!’ Or, ‘good night Uncle Ed!’ They make me smile, They inspire me. And every year, we return to do so many of the same old things, to hold the form and shape of vacation even as the substance (mostly the children) move in and out. And thus there is miniature golf, and bike rides; pizza night and games; throwing football and Frisbee on the beach. Even having overpriced ice-cream too late and after too much food.
These are scaffolds that remind us of the past, and on which the young will perhaps build their own future times, or (when the times are right) bring their own loves back into our rickety traditions to enliven them.
This late vacation is drawing to a close, and I will miss it. But we have a deep trove of memories, all of us, and we have build not only the frame but the solid foundation of love upon which families, this family, can stand for generations to come.
Tomorrow it will be hot and muggy. But we will run on the beach with reckless, joyous abandon.
Nothing can take that from us as we drain the last drop of joy from this pitcher full of love and tradition.
Electronic Devices Shouldn’t be Used as Comforters (for Frightened Children)
The Dangers of Summer
This was my most recent column in the Daily Yonder. Unfortunately, the Yonder website is down or I’d give you a hot link.
It’s Spring now and all across the land things are bursting with life. Flowers are in bloom, yards are bright with new grass and the sun is high in the sky. My car was, for a while, covered in a thick, green coat of pollen. Carpenter bees are still turning my log-house into Swiss Cheese. It’s pretty out, the sky is blue and the days are warm. Blah, blah, blah. I for one don’t really like this time of year. And it’s mainly because warm weather brings me patients with all kinds of injuries; some of them pretty nasty.
In rural America, there are dangers that seldom occur to people in more populous, metropolitan areas. Ironically, though, rural folks often assume that life in the city is more dangerous. And indeed, murder rates are higher.
However, according to the CDC, deaths from unintentional injuries are 50% higher in rural than urban areas; https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html. These differences in death are due to several causes; rural citizens are further from necessary health care and are closer to large lakes and rivers, use dangerous equipment and firearms. Doubtless there are many factors involved in the difference.
Of course, some of the perils of rural life are just the result of living in close proximity to nature and all her deadly charms. In Spring and Summer, we encounter creatures that bite and sting. Just last year, while mowing our lawn, we must have run over yellow-jacket nests at least half a dozen times. By the end of the summer I just let the grass grow. ‘You win!’ I screamed to the little jerks, hiding in their holes. Whether it’s scorpions, hornets, wasps, centipedes, spiders or some other tiny monster, we simply encounter such creatures more in the warm months. And their various stings and bites, while rarely fatal, can cause dangerous allergic reactions. And make your spouse want to leave the area and move to a condo.
Fortunately, deaths from allergic reactions of all sorts are rare, and around 99 deaths per year in the US. https://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/death-anaphylaxis. Still, If you or your loved-ones are afflicted with such allergies, please talk to your physician about what to keep on hand; hopefully epinephrine injectors will get cheaper. And there are some other brands besides the ‘Epi-Pen’ that should be less costly. They just hurt a lot (the Black Widow) or make ugly wounds (the Brown Recluse).
Poisonous reptiles (Copperhead, Rattlesnake, Cottonmouth and Coral snakes) are also a feature of rural life in many areas. Those who ‘ooh and aww’ in city zoo reptile houses rarely have the singular delight of encountering these wonders in their own yards or whilst walking through the woods. But these creatures, while important to the eco-system, can deliver nasty wounds and in rare cases can be lethal. They’re certainly dangerous to your finances given the cost of anti-venin to treat the bites. So be aware as you go about working and playing in places where snakes are also enjoying the summer sun, or cool evenings.
Remember also that at least in the US, many snake bites occur because people are 1) intoxicated and 2) trying to mess with the snakes. And yes, ladies, this is a peculiar affliction of men that starts with ‘hey, betcha’ I can catch him!’ Actually, I have it on good authority that snakes don’t even like the taste of drunk people and would like to be left alone, thank you very much.
Now, other dangers of rural life have to do with the necessity of power-tools. In my own life, the chain-saw, weed-trimmer and lawn-mower are absolutely essential to keeping nature from simply over-running our house. But as the dear reader knows, these are things to be treated with great respect. Please use appropriate protective gear, like safety glasses, gloves, appropriate clothes and heavy shoes. Of course, those who work on highways or farms use much bigger types of tools and heavy equipment and have to be ever watchful. This is probably more true in Spring and Summer because that’s when farms are busy, roads need to be fixed, bridges repaired, pipes laid, power-lines connected, houses constructed and all the rest. God bless all those folks who make our lives better by doing hard, dangerous work on the hottest of days.
And of course, warm weather brings assorted recreational dangers. Hiking and camping are delights, but someone always manages to fall off of a waterfall or cliff-edge, break an ankle, sustain a laceration or encounter said biting and stinging creatures.
Bicyclists and motorcyclists look forward to warm months so that they can enjoy the open, dry road. But helmets really are important as is appropriate protective clothing, reflective material and good education. I’ve seen patients who left their tanned skin on 50 yards of asphalt. Nobody enjoys that.
Lakes and rivers are warm, and filled with persons who typically want to be dragged at high speed behind a power-boat while skiing, clinging to a large inflatable item for dear life, or kneeling on a wake-board. Likewise, fishermen head to their favorite spots (either in tournaments or alone for peace and quiet) and other aquatic persons kayak, canoe and raft the rivers that draw so many to rural America for vacations. All of which is fantastic! But remember to learn to swim, always wear life-jackets and follow local laws when doing all of the above.
Obviously there’s always the danger of heat exhaustion, heat stroke, dehydration and sunburn. We all have to remember to be careful to stay hydrated and remember that beer and caffeinated sodas don’t help. Also be reasonable about sun exposure and wear sunscreen to hep protect against skin cancers.
And if the gentle reader wishes to avoid painful foreign bodies and sutures, here’s another bit of advice. Wear shoes all; all the time. Simple and to the point.
Spring and Summer are glorious in rural America. But the dangers are many; I’ve only skimmed the surface here. Please remember to be safe, think before doing, follow the laws, don’t drink and boat, drive, ride, ski, pick up snakes, work with power-tools or do just about anything else. If you’re going to drink, find a chair and sit in it. That bit of advice would keep many an ER quiet all night long. Also remember that everything I said you shouldn’t do when drinking is something you shouldn’t do while taking narcotic pain medications.
I hope everyone has a great summer, free of emergencies. And that you can still be around when that first breath of cool air dips down from Canada and a proper season comes back once more.
Just please, please, be careful out there, OK?
(If you’re interested, here’s another link to a nice discussion of the unique injuries common in rural America. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448517/)