Locum Archives - Page 3 of 3

Exploring Pahá Sápa

November 29, 2020 No Comments

I know I am not alone in having spent the last week much differently than I thought I would. Here’s to hoping everyone stayed safe over the Thanksgiving Holiday. I know it was hard not doing the big family gathering. My family did not get together from various states to celebrate together and that sucked. But it was the right thing to do. As I try to make the best out of every situation, instead of a party of 10+ people, I spent the holiday with one very good friend of mine.

But first, I had to work Monday and Tuesday. I was on call both days… my 4th and 5th days in a row.

Svikki MD

As my hospital census keeps growing, I needed to restructure my schedule. It was no longer feasible for me to have an open clinic schedule from 8:30AM-5:00PM and manage a hospital census of 6+ patients… at least not without spending every waking minute in the hospital. A reason I chose locum work was to avoid that very scenario.

Going forward, my mornings will be spent working as a hospitalist and my afternoons will be spent in the clinic. This will allow me to completely focus on the hospitalized patients and I’ll be able to round with the nurses and ancillary services. I look forward to seeing how this works. Depending on needs in either the in- or outpatient worlds, I’ll adjust accordingly.

Pahá Sápa

Pahá Sápa is Lakota for “Hills that are Black” aka the Black Hills.

The Black Hills National Forest is located in the western part of South Dakota and extends into Wyoming. The area is considered sacred land by many Native Americans.

For a bit of orientation, here is a closer view of the Black Hills with some key locations marked:

Deadwood

My friend and I set out on our adventure Wednesday. The first stop was naturally Deadwood! As I still don’t trust most people to follow hygiene recommendations, we didn’t go into any restaurants or casinos in Deadwood. We did walk the historic main street. We also found a fun wood carved chair to sit in and be the biggest tourists.

Custer

I rented us a remote cabin near Custer for 4 days. We arrived in the dark but we could feel we were in the beautiful middle of nowhere. The cabin was GORGEOUS! My favorite part was definitely the fire place in the living room. Our hosts had a pecan pie waiting for us. It was much bigger than it needed to be for two people but I wanted a cabin that actually looked like a cabin (lots of wood), was remote enough to escape artificial lights to view the stars, and had a fire place. This place checked off all the boxes.

Crazy Horse Memorial

Our Thanksgiving day was jam-packed. Our first stop was Crazy Horse Memorial. I had stopped by many years ago while on a two day trip to the area with a friend, but we didn’t really experience all there is to see at the location.

The story of the memorial is fascinating. Once it’s finished (not likely in my lifetime), it will depict Crazy Horse, an Oglala Lakota warrior, on his horse pointing to his tribal lands. A Lakota elder named Henry Standing Bear commissioned Korczak Ziolkowski to sculpt the memorial. He wanted his people to have a memorial of one of their heroes.

Korczak devoted the rest of his life to the memorial. His wife Ruth joined him and their 10 children all pitched in too. Korczak turned government funding down twice because he did not trust the government and feared they would overturn the memorial’s plans. After Korczak died at the age of 74, his wife Ruth took over as CEO. She made the decision that Crazy Horse’s face should be completed first instead of the horse’s face as Korczak had planned. She felt this would increase tourists visiting and thus increased income to fund the project. Ruth died in 2014 and her daughter Monique became CEO. She works with three of her siblings and three of the Ziolkowski grandsons.

The Memorial and so much more!

The grounds also house the Indian Museum of North America, the sculptor’s studio, a restaurant, a gift shop, the Native American Educational & Cultural Center, and The Indian University of North America.

It is a great place to learn more about some of our Native American brothers and sisters and appreciate all the beautiful art they create.

Mt. Rushmore

Four white males carved into the face of a mountain in one of the most sacred places for some Native Americans,… surely not without controversy. My friend and I stopped by the monument to take a picture and were then invited to hear a 30-min lecture about the controversies surrounding the monument.

The concept of a memorial at Mt. Rushmore originated from Doane Robinson, a South Dakota historian, who thought carving figures into a mountain would attract tourists to South Dakota. Originally, South Dakota figures like Buffalo Bill Cody, Meriwether Lewis, William Clark and Red Cloud, a legendary Lakota leader were considered. Robinson commissioned Gutzon Borglum to sculpt the memorial. Borglum wanted to memorialize “the founding, expansion, preservation and unification of the United States.” Thus, he picked Washington, Jefferson, Lincoln and Roosevelt.

Rose Arnold Powell and First Lady Eleanor Roosevelt wrote to Borglum and advocated that Susan B. Anthony is included in the memorial. Borglum cited lack of rock and lack of funds as the reasons why this was not possible. His main rationale, however, was that it didn’t fit his artistic vision… (eye roll).

Besides the obvious lack of representation in the figures carved, the mere fact that it was carved into the mountain in Native American sacred land makes it plenty controversial in my mind. Nonetheless, we visited and were able to learn about these various aspects and have a discussion about a monument that clearly isn’t going anywhere and does have a story to tell. It also fulfilled its intended purpose of increasing tourism to South Dakota.

Custer State Park

After viewing monuments, we wanted to view some wildlife. We drove the Wildlife Loop through the park and the name did not mislead. I even had a friendly stand off with a Bison. Since I didn’t intend to have my rental car damaged, I backed up slowly and we eventually parted ways peacefully.

The friendliest creatures were definitely the formerly domesticated but now wild donkeys. They enjoy a good ear rub and are not shy to pop their heads in and say hi!

Thanksgiving Dinner for Two

After all of that, we managed to cook for three hours to prepare a delicious vegan Thanksgiving dinner with a little (a lot) of help from Purple Carrot.

Friday – a day of rest

Since Thursday was so jam-packed, we decided to enjoy the cabin and surrounding land and just stay there for the day. We explored the quartz and mica on the hills and wandered through the forest. I collected pine cones and cut-down pine tree branches. Hopefully, I’ll be able to make wreaths out of both of those things.

Badlands National Park

Before having to leave me, my friend and I set out to see the Badlands. The landscape is pretty wild and seems like the perfect filming location for a Star Wars movie. We drove Badlands Loop Road (Highway 240) and stopped at various viewing points to see bison, big-horned sheep, and the silly prairie dogs.

I was sad to see my friend leave. Since I’ve been in South Dakota, I have had no physical contact with people beyond professional contact at work. I also haven’t spent time outside of work with anyone because of the pandemic. My friend got tested before coming to see me. We are both really cautious about the virus so I waged the risks and benefits and came to the conclusion that it would be relatively safe for us to spend several days together. Facetime gets close but it definitely doesn’t replace the feeling of a hug.

One thing I love: Looking at the stars on a clear night in a remote place.

One thing I ate: the delicious vegan Thanksgiving dinner pictured above. I’ll talk about purple carrot in more depth sometime. For those who don’t know about it, its a vegan meal kit delivery service and a life saver for me!

One thing I’m grateful for: my friend for coming to see me and my family for having made the decision to cancel this year’s gathering. Everyone’s safety and health will always come first. That didn’t make it any easier that it didn’t take place, but sacrifices must be made. I’m grateful for all the people who worked this holiday. I’ve missed many holidays myself due to work and will likely miss many in the future. I hope people who aren’t accustomed to missing holidays but did the right thing and missed out this year, can find some comfort in knowing they were not alone in doing so.

mfg

Locum, Mother Nature

Speared Fish & Sweet Deals

November 22, 2020 No Comments

I’m on call all weekend and it’s actually been a bit busy. But I definitely wanted to keep up with the weekly post. So let’s dive in!

Svikki MD

Outpatient

We were very unstaffed from a nursing standpoint this week. The nurses that were there rocked it though and got us through. I probably saw the most patients this week since starting work. It was a mix of interesting cases and a lot of COVID.

Inpatient

I spent Thursday in Rapid City working with a hospitalist who has been taking care of COVID patients for the past 5 months. We reviewed treatment protocols, his experience with patients, the patterns of decline/improvement he has been seeing with them and discussed safe patient scenarios to keep at my hospital in Deadwood (and when to transfer). I’m very grateful they were willing to let me come and discuss with their doctors. There is also more awareness for them now that we will be admitting COVID patients.

Call

I’ve been on call for 4 of the last 7 days. That lead to a few more admissions to my inpatient panel. Between seeing them on the floors and seeing patients in the clinic, this week has once again flown by.

I’m getting used to constantly being on call for my own patients. Late night and early morning phone calls don’t surprise me anymore.

Spearfish

I live in a town called Spearfish. The town symbol is exactly what you might think it is…a speared fish. Exhibit A:

Spearfish is a quaint community with the main street filled with restaurants, bars, and shops. The public library is a block off of the main street, just next to the police station and fire department. There is a community bank up the road. It reminds me a bit of a larger version of the town I grew up in. However, unlike Muscoda Wisconsin, you don’t have to drive a mile before you hit your grocery store, fast food restaurants, and the local hospital.

The surrounding land is pretty flat and sits adjacent to the Black Hills. Someone recently mentioned to me that there is a recreational path that runs through Spearfish. This seemed like a safer option for me to explore than finding trails in Spearfish canyon without cellular reception. You never know, something could happen and no one would be able to find me.

Spearfish Recreational Path

I’ve spent the last two weekends exploring the rec path. It’s a concrete path that works it’s way through meadows and woods. The people are friendly and almost everyone you cross paths with smiles and says hello. I’ve been doing a power walk/jog combo for the 3.5-miles back and forth. The trail itself is much longer than that. It feels great to be outdoors and amongst nature. I’m interested to see how well maintained the path will be when we start having snowfall again.

Along the trail, there is the D.C. Booth Historic National Fish Hatchery. It’s free to enter. According to their pamphlet:

Created in 1896 to propagate, stock, and establish trout populations in the Black Hills of SD and WY, D.C. Booth Historic National Fish Hatchery is dedicated to fish culture and resource management. After a very successful fish production history, the hatchery’s current mission is to help preserve the U.S. Fish and Wildlife Service’s historic and cultural heritage.

I took a walk around the grounds for a bit and checked out the fishies from below in the Underwater Viewing Windows area.

Although there are many, many trails in the broader area, the rec path seems like a safer alternative for the time being. The weather has been fairly sunny recently and the temperatures tolerable with a fleece while working out. I don’t think it’ll be long though before I switch out the sports shoes for the snow boots again.

Hey Macklemore, can we go thrift shopping?

I love thrift shopping. It’s something I learned to love from my mother. In big metropolitan cities, I shop for clothes and shoes and in smaller cities, I check out the thrift store before buying items new if I can. The environmental impact our consumer society has on the planet has not gone unnoticed. Also, I will save money any day I can! Most (if not all) of my Ralph Lauren sweaters, J. Crew jeans shirts, and Gap turtle necks are thrifted. I usually can’t find pants for my long legs but I have issues with that in regular stores too.

When I first arrived in Spearfish, I noticed the kitchen was missing a few essentials I needed for meal prep. I found most of them in good condition at the St. Vincent de Paul store a few blocks away. When I needed winter gloves and some shopping totes for groceries, St. VdP had me covered. My greatest deal I’ve made so far was yesterday.

I won’t be home for Christmas

I’ve decided that if I am going to spend Christmas far away from family and friends, I’m going to decorate my apartment this year and have a Christmas tree. I stopped by St. VdP to look for decorations. They currently have a deal going where you can fill as many Christmas decorations into a box as you can for just $10! I filled up on ornaments, beads, lights, stockings, a snowman mug for hot cocoa, two decorative small trees, and a Christmas tree stand. All for just $10. I felt like a rock star. Now I just need to find a tree. When the Christmas season is over, I’ll repack everything and donate it back to St. VdP. So, it’s really more like a $10 rental fee.

I’ll show you the tree once I have one and it’s decorated

If the other items I purchase during my time here are in good condition when I am ready to leave, I will donate them back. It’s an earth-friendly, wallet-friendly alternative to Amazon Prime.

It’s almost the most wonderful time of the year!

One thing I love: Pre-Christmas season….it’s so close, I can taste it. Literally, see the next section.

One thing I ate: Lindt Lindor White Peppermint Truffles. That melting white chocolate with the refreshing taste of peppermint…I’m in trouble.

One thing I’m grateful for: the invitation I received to have Thanksgiving at my colleague’s house with his family. Although I declined because I already have plans for myself that day, I truly appreciated the thought of inviting me to their family time since I’m out here in South Dakota alone. That being said, please remember, a Zoom Thanksgiving is better than an ICU Christmas. Please only celebrate with your household or core group of people. Our healthcare system can’t handle much more and I want everyone to be as healthy as possible.

mfg

Locum, Travel

Covid numbers skyrocketing? Namaste away from people.

November 16, 2020 No Comments

Namaste and Happy Diwali to all my friends who celebrated the holiday yesterday! Diwali is the festival of lights and one of the biggest holidays of the year in India. India and its culture have become a big part of my life over the last several years. I want to share my connection and admiration of the culture. But first, let’s talk about what’s happening in South Dakota.

Svikki MD

The first half of the week was filled with plenty of patients with COVID symptoms. Here are some not so great stats… {in a pandemic, you don’t want to be the one with the highest numbers. You try to be more like scoring in golf.}

Forbes listed South Dakota as one of the ten riskiest states to visit right now.
South Dakota is reporting 154.5 new cases per 100,000 people on a weekly basis. {any state with more than 25 new cases per 100,000 is considered at a tipping point….we are way past that}
The 58.8% positivity rate is the highest in the country.

Needless to say, I was happy to receive a call Wednesday morning asking if I’d be interested in attending a 2.5 day course in Rapid City.

Stabilize and transport,…stat!

The course was Comprehensive Advanced Life Support (CALS). As a healthcare worker, you have to take a lot of life support classes depending on what department you work in: Basic Life Support, Advanced Cardiac Life Support, Advanced Trauma Life Support, Advanced Life Support in Obstetrics, Neonatal Resuscitation Program… to name a few. CALS is a program designed for health care providers in rural emergency care settings. It covers the relevant portions of the above-listed courses to review with doctors, mid-levels, nurses, and EMS workers that work in rural places that don’t have all the fancy stuff the bigger places have. Your objective is to stabilize, treat life-threatening issues, and transport them out to a higher level of care.

Although I technically had the highest degree in my group (2 nurse practitioners, 2 registered nurses, and 1 EMS worker), I was definitely the least experienced and trained when it came to rural emergency care. While they ran down the list of medications needed for rapid intubation of a patient or knew how to place a pelvic binder like it was no big deal, I had a lot of catching up to do. Since I received the call Wednesday morning and the first portion of class was that evening, I didn’t exactly have time to prepare.

I learned A LOT in those 2.5 days. My favorite part was definitely learning how to place a chest tube and perform a cricothyrotomy. Although the hours were very long and the travel back and forth to Rapid City was a bit much, it was so totally worth my time. I wasn’t able to just get a hotel in Rapid because I still had to stop by the hospital daily to see my acute care patients. The whole experience was a nice break from Covid clinic. We followed very strict physical distancing guidelines and wore mask and face shield at all times. With a 58.8% positivity rate,… I trust no one.

Namaste India

Let’s take a COVID break.

India has always intrigued me with its culture, its food, its clothing, and its language. I always wanted to visit but it always seemed so foreign, I wasn’t sure I’d be able to navigate it. Lucky for me, while living in Miami, a friend of mine asked me to dinner one night. One of the attendees of this dinner was a business guy in town for a few days.

We got to chatting about all sorts of things. He is from India and I told him about my fascination with the country and my desire to visit one day. I was given the gracious offer to reach out to him when I decided to go visit and he would help me organize it. He is extremely busy with businesses all over the world, so I figured it was just a friendly gesture but that he wouldn’t possibly find the time to help me when it came time. I was very wrong in my assumption.

India, here I come!

Before starting residency, I took all the money I earned in Miami and traveled the world. I reached out to my new friend with my plans of visiting India. He asked me for a time frame, a budget, and an approximate area of the country I would like to visit. This information was forwarded to his travel agency of choice and they created an entire 3-week itinerary for me! I didn’t have to plan a thing. From the moment I landed until the moment I left, I was in great hands and was showed so much. It was some of the best weeks of my life.

My travels took me mainly through Rajasthan, the land of the kings. I started in Mumbai. One of the first things I insisted on doing was going shopping for Indian clothing. I wanted to show the people of India how much I appreciated being there and wanted to be a part of the local life.

Unsuccessfully trying to blend in

Shopping in India is quite fun. You get served chai, get to look through an abundance of fabric, and try on the most beautiful garments. After having chosen a few, my tour guide and I were off to explore the city. We were often stopped by locals to take pictures with me. A tall blonde sort of sticks out in the crowd.

I was fortunate to have a tour guide in every city I went to. This gave me such a great opportunity to learn so much about every place we visited. My guide in Udaipur invited me to his house for a meal. I met his sister who ended up doing Mehndi on my hands. Her daughter was a firecracker and kept us all entertained. The mother and I still text each other sometimes with updates. I met so many great people along the way.

Crafts & Food

We stopped at so many absolutely beautiful temples. Many of which fed me delicious meals. The craftsmanship of these temples is mind-blowing and straight-up incomprehensible. I also witness craftmanship firsthand watching artisans make miniature art, block print fabric, and cutting jewels. And I didn’t just witness,… I bought a lot of things.

Being a vegetarian at the time (I try to be mostly vegan now), I can say that India has been the easiest place for me to travel in when it comes to food. Easier even than the USA. And the food is so fresh and so delicious!

I could talk about my India trip for days but I still have a really important connection to India to share. For more pics and info, check out my Instagram page. You’ll find plenty about India, you just have to scroll down the feed a bit.

My friend Lakshmi at the elephant sanctuary in Jaipur

Residency Girl Gang

One of my best friends is Indian. During our first year of residency, we were a trio with one of our other close friends, also from India. These ladies took me in and immersed me even more into the Indian culture. I finally learned how to understand dishes on an Indian restaurant menu. They introduced me to flavors I hadn’t previously known. I learned how to cook some basic dishes. We frequently grabbed Indian food from the local Indian restaurant, watched Bollywood movies, and escaped from residency life.

Dressing up was a favorite pastime of ours

Indian weddings may be the best parties ever

One of my friends got married in India during residency. Unfortunately for me, it was during a month I was unable to take off of work. Otherwise, I would’ve flown out to be there. Lucky for me, she decided to have the reception many months later in Philadelphia. My best friend and I rehearsed for a month to be able to perform at the reception. We cleared the lecture room after hours, projected YouTube videos over the beamer and worked on creating our routine.

Prior to the reception, I went home with the bride to Toronto. Her family was welcoming and loving. We shopped for jewelry for my reception outfit. Needless to say, they also fed me really delicious food.

The reception was so fun! My feet hurt so bad and I don’t think I’ve ever danced so much. Our performance was well received.

Diwali

My first year of residency, one of the seniors had a Diwali celebration at her house. We all put on our finest outfits, ate delicious food and danced.

In my second year of residency, I attended the Diwali celebration at a nearby temple. I tried my best to keep up with the prayer by following along in the pamphlet. The only time I could catch up was when I recognized the word yoga. Again, I was fed really yummy food.

I’m not sure I did anything for Diwali my last year of residency. I have a feeling my roommate went home to celebrate during that time and I was on call.

This year, I lived vicariously through my friends and their posts and stories of celebrating. I’m hoping the world is a safer place next year and I can join the celebrations again.

An Indian wedding in a pandemic

My dream is still to attend a full-on Indian wedding. I’m talking about all five days of celebration! I thought I would have the chance when I was invited to my best friend’s sister’s wedding this year. But then, you know, Corona. Lucky for me, I made the cut as one of the 13 people who attended. I even embroidered a mask to match my new saree my best friend had brought me back from India.

The wedding festivities were condensed into a weekend with everyone present for everything (not usually the case). I left immediately after work and made it to the home 7.5 hours later for the Sangeet. We danced and sang with relatives via video conference from India. The weekend was lovely and the wedding beautifully intimate. I felt so honored to be a part of it. The mother of the bride gifted me with a gorgeous Indian dress before my departure. I can’t wait for the next occasion to wear it!

Excited for what the future holds

So like with so many things during the age of Covid, it’ll be a while before I attend another Indian celebration. I can’t wait for it to be possible again though. I look forward to the dancing, the singing, the outfits, the food, the family and friends. Most of my Indian friends are married, so currently I only have a few more opportunities to attend an Indian wedding (until their children get married that is). However, I look forward to participating in the many other celebrations this beautiful country celebrates with its many different religions, cultures, and languages. In the meantime, I’ll keep working on my Duolingo Hindi nightly.

mfg

Herstory, Locum

Déjà vu & you do you, boo

November 9, 2020 No Comments

This past week flew by. I was nervous it might not due to the election but work definitely kept me busy. But first, can I just say how relieved I am that Joe Biden and Kamala Harris won? I’m only a permanent resident and thus can’t vote. I don’t want politics to be a big part of this blog (although it is important everyone is informed and engaged in politics), but I do want humanity, respect, love, and trust to be the bedrock of everything I do. To see two people with similar values win this election gives me hope for the next 4 years. It feels good.

Svikki MD

Clinic

My patient numbers continue to increase in the office. Unfortunately, the number of patients with COVID symptoms continues to climb as well. It’s no surprise, one look at the numbers in South Dakota explains the trend. This week felt as though more severely sick people were coming in though. The day I had call, I was presented with two clinic and two ED patients for possible admission. I sent two home, I admitted one, and one needed to be transferred to a facility with ICU capabilities. It feels like March 2020 all over again….but only for me. I seem to be the only person in my hospital who has experience with the virus.

Flash Back to March 2020

For those who don’t know, when COVID started showing up in Youngstown, Ohio, I volunteered to be one of the first providers to work in the designated Flu clinics. Anyone with respiratory complaints was no longer able to see their PCP and needed to be seen in the Flu Clinic. We didn’t have testing supplies for the first several days. Things were changing on an hourly basis. We didn’t have tests, then we did, but only a limited amount. At first, we had enough PPE to change between each patient. Then we needed to start wearing the same PPE for multiple visits. It was hectic but I liked working in that environment.

Two weeks later, I started taking care of COVID patients in the hospital. The hospitalists were overwhelmed with the number of patients. Two other residents and an attending headed to the floor every day to take care of the patients as best we could. We knew a lot less back then and we were using different medications than are used now. So much was unknown (and still is) but we showed up and did what we could. Who got better and who died hardly seemed to have a rhyme or reason.

By the time May rolled around, we were back to our residency rotations. The only major difference was telemedicine visits in the clinic and having to wear a mask and shield when seeing patients in person.

Back to the future

So here I am now in South Dakota. I can see the number of cases presenting to the clinic and hospital on the rise. The big difference to Ohio however, is that I don’t have the same capabilities here like I did there. I have no ICU located two floors down, no second ICU close by, and no Cleveland or Pittsburgh nearby.

The closest hospital is only a 20-minute drive away and does have an ICU but they are hardly taking patients. Rapid City is on diversion. We are sometimes looking to different states for help. This will be an interesting winter, and not in a good way. But I am not surprised we will go through this. What do you expect if the majority of people walk around without masks, the Sturgis motorcycle rally took place and people were partying at Halloween parties last week? I do not sugar-coat it when patients ask me if this virus really is as dangerous as people say it is.

Hospital

About half of the census in the hospital this past week was mine. Mostly swing beds, since they stay for weeks. I did have the first COVID admission of this hospital. They did really well and were able to go home yesterday. Today was my first day in 20 days that I didn’t have to drive to the hospital to see patients.

Svikki Hobbies

I have so many different hobbies and interests it is sometimes hard to adequately devote time to one of them. As much of a nerd as I am, I like to give my analytical brain a rest from time to time and jump into more creative activities. At times I’ll combine the two. I often drew throughout medical school, especially anatomy class, to solidify the knowledge.

When I was packing my suitcase for South Dakota, I ended up packing a duffel bag full of artsy things; paper, water colors, brushes, pens, charcoal, and pastels.

Childish innocence

I often feel that as people get older, they get more and more hung up about doing something really well or not doing it at all. I’m definitely guilty of this. The innocence of a child not caring about how perfect the end result will be but enjoying the process of creating is something I actively try to return to. When people started telling me I have talent, it became harder to just create for fun because I felt a pressure that the end result needed to be good. It needed to validate their former praise. This feeling often stopped me from starting something because I knew I didn’t have the free time to devote to perfecting it. Once I started realizing that, I actively started just drawing at random times and random things, just for the sake of doing it.

The opposite of praise can be debilitating too. As a child, I was often told, “you can do so many things…but somehow no one in your family can sing, including you.” I didn’t formally try. I didn’t join the choir. But I LOVED to sing. I know a ridiculous amount of lyrics and my favorite part about driving a car is the fact that I can sing as loud as I want and no one hears me. From time to time, in different parts of the world, I would partake in karaoke. It’s almost frowned upon to be too good at karaoke. It “ruins” it for everyone else so it’s a safe environment. But that’s the wrong way of looking at it!! Do you like singing? Then sing! Who cares if it’s not always on key? You aren’t trying to win Idol, you are just enjoying singing.

How things have changed

Last year, while sitting around with some people and a ukulele, I started singing some songs. The guy with the ukulele has a band. His band played at my aunt’s birthday earlier this year and I was invited to be a surprise singer for a couple of songs. This was the first time I was going to be singing in front of a crowd with the expectation that it was going to be good. It was so much fun! I’m still not looking to perfect my singing but I more confidently singing out loud now having overcome the comments of my childhood.

Click here to see a video of me at my aunt’s birthday!

My point here is that I want everyone to find joy again in enjoying things you like without the pressure of it having to be good! So many people are in quarantine or partial lockdowns. If you feel like doing something or trying something new, just do it! Don’t let the need for perfection ruin the process.

Here is a sample of some of the things I’ve made over the years. My dream is to one day have a studio room where I can have all of my supplies and just go and create.

One thing I love: group chats! Although my family is spread across the globe, my little sister in Austria kept us all on top of the latest updates regarding the election.

One thing I ate: a pecan caramel cinnamon roll from a bakery down the street from the hospital owned by the mother of one of the nurses. The proximity is dangerous.

One thing I’m grateful for: Biden Harris 2020. Thank goodness.

mfg

Herstory, Locum

Scenic views, Svikki’s origin, & the scariest Halloween

November 2, 2020 No Comments

I just got back from a 3.5-mile hike in the Black Hills. The weather did an about-face over the past week and there was a high of 60 degrees Fahrenheit today with a beautiful sunny sky. I wasn’t going to let that opportunity pass by. I didn’t see another human being the whole time I was out there. It was just me, the forest and the wind. At one point, I caught myself singing “Colors of the Wind”.

Svikki MD

The other Family doc was out of the office this week. They have been in the area for decades and have a well-established panel of patients. I was on call four times last week. Between covering the other doc’s messages and prescription refills while on call and having quite a few of their patients stop by for same-day appointments, I was pretty busy last week.

Clinic

I am currently still seeing mainly same-day appointments as patients are establishing care with one of the other providers when able. It’s only fair to the patient, I’m only around for 5 more months. The same day appointments have led to some pretty interesting cases. I’ve called up other specialists more than once last week. Although our clinic only has Family Medicine and Internal Medicine physicians, I can find most other specialists either in Spearfish (20 min drive) or in Rapid City (50 min drive).

My instinct to call the specialists turned out to be right every time. Sometimes, I feel doctors are afraid to ask for help because they think they should know how to manage it themselves. I see no shame in consulting a colleague who has more expertise on a subject… at the end of the day, it’s best for my patient’s care and my ego can take it.

Hospital

I took over several of the other doc’s admitted patients while they were on vacation. Consequently, I had a different swing bed patient to check in on every day. My second to last clinic patient on Friday ended up needing admission. That bought me my second weekend in a row going in on the weekend days as well for acute care visits.

On call

There were a lot of call shifts last week. Two docs were out of the office which left me and one of the internists to cover the call schedule. Luckily, the nights were quiet. During the day, however, I was covering calls, prescription refills, and patient messages which kept me busy between clinic visits.

So why Svikki?

I wanted to use this week’s post to explain why my site is called Svikki. Most people know me as Viktoria or Viky or Vik. Only a few people call me Svikki…well, really, it is only my aunt and uncle that do. I have used the name for my social media handles ever since it’s creation though. My aunt is the one who came up with it many, many years ago.

My aunt is a master of fabric crafts. Her quilts are prized possessions in our family. Her basement has a room filled with fabrics, a fancy sewing machine, and colorful creations on the walls. One of my favorite things to do when visiting is hanging out in that room with her. She had fabric tags made for me that say “Svikki” on them so that I can sew them into the things I make. If only I wasn’t hundreds of miles away from my stored things, I’d be able to show you what they look like.

I’ve also used “Svikki” in art work I’ve made for my aunt. For example, this painting I made based on a 1950’s Zwicky Ad. I replaced the cat in the Ad with one of my aunt’s favorite cats she’s had, Pauli. He was a pretty cool cat.

Happy Halloween

Halloween is one of my favorite holidays. I’ve always been in awe of the annual parties Heidi Klum would throw. When I moved to Germany for medical school, I started hosting Halloween parties of my own. Halloween really wasn’t that big in Germany. It came as no surprise to me that for the first year, I saw a lot of your classics: witches, mummies, ghosts. The people kept on raising the bar year after year though and there were some really impressive costumes over the years.

I would start grocery shopping a week in advance of the party because I would bake so many Halloween themed treats. I’d decorate the apartment for days. Every year was unique and so much fun. Each year the party grew in size and popularity. I love hosting parties and seeing others get invested in the holiday brought me so much joy.

Working in Miami for a year, Halloween was a particularly fun time to be there. I had partied in Miami during Halloween before. However, working there with a crew of super fun people and dressing up for themed nights took it to another level!

The scariest Halloween yet… 2020

Sadly, I spent this year’s Halloween on the couch watching a movie. I’m sure I’m not alone in this. Unfortunately, I also am aware that many people were out celebrating this year. Trick or treating can be done in a safe, pandemic aware fashion, but what truly scared me, more than any scary movie could, is how many people I know went out to clubs or house parties to celebrate.

I TOTALLY understand wanting to dress up and head to the club for a night of fun, but people, we are in the middle of a raging pandemic. Many sacrifices have been made, many get-togethers canceled,… I understand. But last night probably should’ve been another one of those sacrifices. We aren’t ready for that yet,…not safely anyways. It scares me to think about how many more cases will be fueled by this. It scares me to think about my fellow health care workers and myself who have put their own lives at risk to take care of Covid patients.

The ICUs around the country are filling up. The USA does not have the capacity like some other countries do in terms of ICU beds per capita. Even less so in rural areas like Deadwood, South Dakota. Yet, the people were out last night. I don’t want to be mad at people because I know people have sacrificed a lot and want to go back to how life used to be. However, today’s decisions carry much heavier consequences with them currently. I can only hope you are spared but I can in no way guarantee that. So please, stay healthy, stay kind, stay strong, and be considerate of your fellow human beings.

One thing I love: scrolling through old pictures on my hard drive. I’ve had so many fun times in my life and time-traveling back to those times brings me a lot of joy.

One thing I drank: Hot apple cider. It’s that time of the year and I can’t get enough!

One thing I’m grateful for: my friends and family sending me packages. I LOVE getting (and sending) mail. From winter care packages to edible arrangements. Thank you! <3

mfg

Locum

Winter Wonderland

October 25, 2020 No Comments

Happy Sunday! I’m sitting at my kitchen table and looking out over the snow-covered rooftops while almost being blinded by the sunshine reflecting off of them. It’s not even Halloween yet and I already feel myself wanting to drink mulled wine and eat Weihnachtsstollen. Vorweihnachtszeit (pre-Christmas time) is one of my favorite times of the year. But let me not get ahead of the time here, I’ll share more on that once (if?) the world makes it to December. That SUV with 4W drive makes a heck of a lot of sense now.

Svikki MD

Clinic

I’m starting to get into the groove of being an attending and working in this new setting. My clinic has still been quite light in terms of volume as I am still seeing mainly same-day appointments. I’ve hardly done any of the family medicine bread and butter appointments (chronic management of diabetes, hypertension, COPD, asthma, heart failure). However, the same day appointments have led me to see a wide variety of complaints that keep me on my toes. A good chunk of the appointments deal with patients showing signs and symptoms of Covid.

South Dakota’s numbers have been rising like much of the country. Honestly, I’m not surprised though. I stopped by the grocery store yesterday and although there was a big “Mask required to cover nose and mouth” sign at the entrance, about 75% of the people were not wearing a mask. I’ve also heard about retreats happening in the area. It’s honestly frightening. This winter will likely be a very busy one for my fellow healthcare workers and me.

Hospital

I’ve also started seeing patients in the hospital. We are a critical access hospital with 18 beds. Our ED is staffed by midlevel providers and the docs are there for backup, consultations, and to do the admissions. The floor often has several swing bed admissions. This was a new concept to me since we didn’t have swing beds in residency. Essentially, they are nursing home beds in the hospital. As a physician, I have to see them at least once a week. The nursing staff has been very helpful and patient with me as I learn the ropes of their system.

A big difference to my residency that I noticed this week was the availability of things. On the plus side, I get basic labs back within a couple of hours because they are done in house. In residency, they were collected twice a day from the office and sent to the lab, so I often didn’t have results until the next day. Now, I can usually call my patients the same day with results. We use rapid covid tests, so I have been able to tell people if they are positive or negative within 20 minutes at times.

One such encounter led to a positive result. Although we do admit Covid patients, we prefer to send them east to Rapid City as they have respiratory therapists, an ICU, and a higher level of care. At the time of this particular encounter, Rapid City was full. My next option was Sioux Falls… a 6-hour drive east. The patient has a complex history and sees specialists out of state. I spoke with their doctor out-of-state and decided it would be best to send them there… also a 6-hour drive away.

The transfer center did an amazing job and we had the patient transported to Rapid City by ambulance and then flown out to their destination that night. In residency, we would occasionally transfer from our suburban/rural hospital in Boardman 20 miles down the road to the Youngstown downtown hospital and rarely to Cleveland or Pittsburgh. Sort of different dimensions out here in the west.

On Call

I had my first call this week and was woken up 4 times throughout the night. The ED provider wanted to run patients by me and the floor nurse had questions regarding one of my patients. Needless to say, I looked a bit tired the next morning. But compared to residency, it’s still so much better because the likelihood of me having to leave my bed in the middle of the night is slim now. Our residency by no means had as bad of a call schedule as some other residency programs do. However, it’s a special kind of torture to be woken up at 2 AM and have to get up, get changed, and drive to the hospital to do an admission.

Although we have specific days or nights of call, we are essentially always on call for our admitted patients. I have the option to sign my patients over to another physician if I have something planned for the weekend. Otherwise, I still head into the hospital on Saturday and Sunday to see my admitted patients. The nursing staff can also call me at any time if they need something for my patients.

This is a pretty big difference from residency. During that time, we were only on call when we had a call shift. Except myself when I had a cohort of pregnant women I was responsible for. During those few months, I was constantly on call for them as well. We also had assigned nursing home patients and the nurses could call us at any time. They had the nursing home medical director as back up though. Apart from that, you could turn off your phone if you wanted to. In a rural setting like where I am now, the doctors are a bit more old school and we follow our patients ourselves.

Freetime Shenanigans

I visited the Adams Museum and learned about the legends of Deadwood. See the post here.

The public library is kitty-corner from my block. I signed up for a membership and checked out two books. One of my goals with being a Locum around the States is to get to know its people better. A big population of people I want to learn about and get to know more are the Natives of this country. My education as a child failed me in this regard. I hope to work for the Indian Health Services with some of my assignments so that I can get up close and personal with these cultures. I travel the world to meet people from different backgrounds, who speak different languages and have different traditions but I don’t have to get on an international flight for that.

Lakota, Dakota, Nakota

My current knowledge of the Natives of this area (or any area) is very limited. I hope to change that over the next couple of months. The closest reservation is a couple of hours away, however. What I have learned so far is that portions of the Lakota, Dakota, and Nakota live in South Dakota. You may know them as Sioux, although that is sort of an umbrella term that encompasses many different and distinct cultures. I checked out two books from the library.

Winter Count by D. Chief Eagle: according to the inside cover of the book, D. Chief Eagle was born in 1925 in an Indian tent on the Rosebud Sioux Reservation in SD. Orphaned, he was raised by the elders of the tribe. It is a historical novel set during the 15 years leading up to the infamous Wounded Knee Massacre of 1890.

Quiet Until the Thaw by Alexandra Fuller: although a non-Native, actually a Brit, Fuller’s book did receive good reviews on Native American websites. It’s fictional but I hope it gives me some insight into the culture.

One thing I love: fresh flowers! They are one of the few unnecessary things I like to buy myself when I travel and then walk around the city with. My mother bought me a bouquet for my first day of being an attending and I trim, sort out and rearrange them to keep them beautiful looking for as long as possible!

One thing I ate: oatmeal pancakes with fresh fruit and maple syrup. I switched up my regular oatmeal bowl with fruit breakfast a bit on this snowy Sunday. Delicious!

One thing I’m thankful for: two of my best friends sending me pictures and videos or posting them on Instagram from the past. Beautiful pictures and ridiculous videos make me laugh and remind me of the fun times I’ve had with them. <3

mfg

Locum

Assignment #1: Deadwood, SD

October 17, 2020 No Comments

People’s first reaction to my informing them that I will be moving to Deadwood, South Dakota for 6 months is pretty similar:

“Why?”

My response, “Why not?!”

Becoming a Locum Physician

But first, let us back up a bit and review how I got here. It was probably at some point in my intern year of residency [that’s the 1st year of residency] that I heard about Locum physicians. I was immediately intrigued, “You mean to tell me there is a job as a physician out there where I can travel all over for a couple of months at a time?!”. Where do I sign the contract!? This was my attitude towards it even before I learned about all the great perks that come with the job. Here is a quick rundown of how Locums work:

Reach out to locum companies to get in touch with one of their recruiters.
Recruiter sends you job assignments that are currently open while you work on getting credentialed with the company.
Sort through the job offers and see what interests you, your level of competency, and the number of hours you want to work.
The company writes up a presentation of you and sends it to the healthcare client.
Clients look through the applicants and choose who they want to interview.
Interview with the client and hopefully both parties like what they hear.
Get the job offer and subsequent confirmation.
The travel and housing department find you your flight and a hotel/house/apartment to put you up in for the length of the assignment.
Fly to the assignment, pick up your company paid rental car, drive to your company paid housing, and show up at your assignment for orientation.
Get paid hourly!

I was sold once I found out how it worked and was not even in the slightest bit interested in looking around for a 3-year contract job like most of my co-residents. The concept reminded me a bit of how modeling agencies work (a chapter from my past).

Where do I want to go?

I knew from the start that I wanted to use this opportunity as a locum physician to see the United States and meet and care for its people from all different regions. As an avid traveler that usually would leave the country if she had some time and money, this was a great way to work and travel. Also, during a global pandemic, traveling the world really isn’t an option right now.

The map below is a good visual of the different regions of the U.S. I’d like to work in and experience.

I grew up in Wisconsin and did my residency in Ohio. It was time to venture out of the Midwest.

Time to secure the contract

So, during the last couple of months of my residency, my recruiters were sending me options and I would be looking through emails and fielding calls throughout the day looking for the job I wanted. Things moved fast. There would be a job in Wyoming that sounded amazing but would be filled the next day. A job in Hawaii but they didn’t want a fresh grad. I was looking at options in Kansas, Arizona, South Dakota, Wisconsin, and Maine. My recruiters sent my info to multiple ones.

At some point in July 2020, I was ready to lock something down considering I was graduating in a month. The options at that point in time were South Dakota, Wisconsin, and Maine. Wisconsin was out fairly quickly because I was trying to leave the midwest, not stay in it during the -40 degree winters. Both Maine and SD had fairly equal chances in my book. South Dakota moved quicker.

I had the phone interview which went well. The client wanted me and I was ready to confirm the job. However, the start date was then largely dependent on how quickly I would be able to obtain my South Dakota medical license. Consequently, I had about 1.5 months off after graduating before arriving in South Dakota on October 6th, 2020.

Flying over South Dakota toward Rapid City

Howdy South Dakota!

I’ve been here almost two weeks now. My apartment is cozy and located in Spearfish, a 20-minute drive from the clinic in Deadwood. I’m driving an SUV which at first seemed superfluous considering it was t-shirt weather outside when I arrived at the airport and I try to be as mindful of the environment as I can. My request for an SUV was validated today however by the fact that within a matter of hours, we had several inches of snow on the streets. The trip to the post office this morning definitely wouldn’t have gone as smoothly without the 4W drive on my SUV.

Please excuse the bug guts on the windshield.

The SUV is really a bit of a moral dilemma for me. At the end of the day, safety first and the weather/terrain here require it. There is a reason why almost every car I see here is some form of SUV. We were not able to find an adequate apartment closer to the clinic. I avoid unnecessary drives and walk to the grocery store, library, Walgreens, etc. to get my steps in and leave the SUV parked on the lot. It’ll be a bit of a love-hate relationship but it will prove very useful over the winter.

Reconnecting with Mother Nature

Before the downpour of snow, it was beautiful and sunny weather here. I used last weekend to go on a few hikes in Spearfish Canyon. It feels so good to be surrounded by nature again. There are so many trails to chose from in the area.

I’ll stop at this point and leave you with some pictures from my hike last weekend. As I get to know the clinic/hospital some more and get oriented, I will share what the actual locum physician experience is like here.

mfg

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