I took the strange route to primary care, and an even stranger route to rural family medicine. In an 11th hour decision made after weeks of residency interviews, I realized that while I was passionate about internal medicine, the specialty I’d always considered mine, there was a different sincerity in my voice when I told rural family programs that I wanted to spend my career living and working in small communities.
The vernex is still on my skin, so to speak, two years out of family medicine training, one year out of a family-practice anesthesia year, and yet I feel honoured to be part of such a challenging, multifaceted profession that has taken me north of the arctic circle and around the globe.
Three months ago, I was working in a small northern community when I received a surprising phone call from medical transport. Tragically, a family vehicle had collided with a semi, with one fatality. The survivors were in critical condition, but due to weather conditions, all air transport was grounded. What resources did we have to deal with unknown traumas in 4 patients ranging in age from 6 months to 40 years old, two unconscious, with extraction still underway?
And so we started making phone calls. Shortly after, our improvised trama team received the survivors and assessed and stabilized them until transportation was available 7 hours later. All survived, thanks to our team of family physicians, one LPN, one RN, two paramedics, one radiology tech, one lab tech, and the local EMTs that were gracious enough to triage the other patients in the waiting room (including 2 chest pains and 3 abdominal pains with abnormal vitals).
One month ago, I intubated a patient in respiratory distress 5 minutes after meeting her as her sats dropped below 40% on BiPAP, rode along in the ambulance as she was transported to a tertiary care center, returned to cast a Colles’ fracture, assess a delirious patient with end stage cirrhosis, and see my thankfully understanding patients in my afternoon clinic.
Although those particular days have cost me the most sleep so far, I suspect my generalist roots are clearest on the normal days. These are the days when I round on my palliative care patient, a 70yo woman with metastatic lung cancer, and adjust her nausea medication. I discharge home a jaundiced baby and arrange to see him and his mother in clinic in a week. I head to the OR and anesthetize patients for laparoscopic gynecological procedures, performed by my family physician colleague. I head back to clinic and counsel a pregnant patient with abnormal genetic screening results, reassess a patient who is waiting for an echocardiogram to diagnosis likely diastolic heart failure, place two IUDs with bedside ultrasound confirmation, before I return to the hospital to perform a spinal for a stat C-section for fetal distress, and assist with the resuscitation of the child. I return to clinic and finish seeing a 70 year old patient with weight loss and rectal bleeding and a recent immigrant with shortness of breath on exertion.
My work comes with the support of amazing specialists who understand the role of family medicine on the front-lines of Canada’s healthcare system, especially in rural and remote areas. These specialists have trained and mentored me, and now they still keep me abreast of the ever-changing research that impacts my patients’ lives. I am young in my career but excited for the decades ahead. I expect them to be challenging, rewarding, and never boring.