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

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:

1. Reach out to locum companies to get in touch with one of their recruiters.
2. Recruiter sends you job assignments that are currently open while you work on getting credentialed with the company.
3. Sort through the job offers and see what interests you, your level of competency, and the number of hours you want to work.
4. The company writes up a presentation of you and sends it to the healthcare client.
5. Clients look through the applicants and choose who they want to interview.
6. Interview with the client and hopefully both parties like what they hear.
7. Get the job offer and subsequent confirmation.
8. 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.
9. 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.
10. 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.

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.

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