deadwood Archives

Goodbye and Hello!

April 12, 2021 No Comments

Leaving Rapid City, South Dakota

Svikki MD

I officially wrapped up my first assignment as a locum physician! It was a great experience and I am glad I headed out to South Dakota for 6 months. Sure, it would’ve been even nicer in a non-pandemic world but even with a raging pandemic, I had a really good time.

On my last day in front of the critical access Lead-Deadwood Hospital

Each assignment I do will teach me new things about life, medicine, travel, people, and so much more. Even though it was only my first assignment, I’ve learned a few things for future assignments.

Luggage: I arrived at the airport in Rapid City back in October with a full suitcase, a full weekender bag, a full carry-on suitcase, and my purse. I left with the same amount of luggage. However, I shipped three medium-sized boxes of stuff to my dad’s and mom’s places. I really didn’t buy much on my own (except several books) but with Christmas and my birthday occurring during my assignment, a few extra items accumulated. Lesson learned: leave some breathing room in your luggage on the way there to allow for room for items that will accumulate.
Wardrobe: I packed about two weeks’ worth of business casual clothing. Only a few items were for casual wear. I really should’ve asked what the dress code was, especially during a pandemic. I ended up wearing scrubs to work every day! At some point, I stopped wearing my fancy Fig scrubs because I didn’t want to have to run to the laundromat and do laundry constantly. So I wore hospital scrubs daily. I could’ve left all those business casual clothes at home which were most of the contents of my large suitcase. Lesson learned: inquire about dress code. If business casual is required, curate a week’s worth of wardrobe that mixes and matches to minimize items packed.
Textbooks: I packed about 6 medical textbooks with the intention of working through them during the 6 months. I at least opened each book, some more than others. It was too many options though. I also packed several reference books. As you can imagine, this led to a pretty heavy weekender bag. Lesson learned: focus on 1 or 2 books to work through so it’s more realistic it’ll be done. I found that many of my reference books come with online access, so I activated them all and can access them through an app on my phone or computer in the future instead of schlepping them with me! Also, UpToDate is usually my first stop anyways… if you know, you know.
Hobbies: similar to my textbook situation…I packed too many different art supplies: acrylic paints, watercolors, India ink pens, pastels. When faced with too many options, it felt intimidating to start anything legitimate. I did use some of the items for Christmas and Birthday cards but not enough to justify packing all those things. Lesson learned: limit art medium to 1 or 2 options and focus on improving those skills during the assignment.

Family Time

Due to the pandemic, friends and family weren’t as free to come to visit me in South Dakota as they otherwise may have been. Two friends did make it out and I am grateful for that. It was fun showing them the area. Now, I’m happy to have some time with my family before my next assignment starts.

Dairyland

I flew to Wisconsin from South Dakota to visit my father and his wife. It also happened to be Easter weekend so my father’s wife’s children plus partners came to visit. It was a great feeling being surrounded by a fully vaccinated crew of people (except the two small children… but children probably won’t have to wait too much longer to get vaccinated hopefully). The weather was gorgeous and we even went on a boat ride on the lake. I stepped into my role as Easter bunny once again (it has been a while) and hid the eggs for the kiddos. Being able to sit around a table and have conversations with people was so lovely.

After that weekend, I headed towards Ohio. I made a pitstop for the night at my friend/co-resident’s home about halfway along the route. She has an adorable golden retriever that loves to cuddle… bliss!

Buckeye State

Now, I’m spending time at my mom’s place in Ohio. We’ve had a couple of days of really nice weather. I’ve already visited my peeps at my residency. It in no way feels like I graduated 8 months ago. Talking with the other residents about their clinic schedules, I can still very viscerally feel the anxiety associated with 15-minute appointments, precepting, and trying to stay sane. It gets better, my friends!

My mother and I did a little Goodwill run yesterday. I’ve mentioned before how much I love thrift stores. The environmental benefit of reusing clothing, the wallet-friendly prices, and supporting local organizations are just a few of the perks. It’s also so fun not knowing what you’ll find! I found a viscose H&M dress that still had the original tag. The original cost of that dress was more than I spent on my whole purchase. The other purchases were a beautiful rayon jumpsuit from Lucky Brand, two super soft cotton tank tops from Old Navy, and a cotton pajama set from Victoria’s Secret. At retail prices, that would all cost at least $190 (estimated from a quick online search of comparable products on the company websites). I paid $27 for everything. Each piece fits perfectly into my existing wardrobe and fills a void.

I would rather go thrift shopping than go to a mall any day! Macklemore, hit me up!

mfg

Locum

Wrapping It Up

March 28, 2021 No Comments

As this month comes to an end, so does my assignment out here in South Dakota. It seems like 6 months flew by!

Svikki MD

The past two weeks have once again been a mix of hospital work and jumping in at the clinic several days. On the floors, we had a lower census for most of the time. That changed some with three admissions at once Friday afternoon and an admission yesterday bringing our census to eight. For my friends who work in large hospitals, a census of eight sounds like nothing. It’s 2/3 of our capacity though in our little critical access hospital with 12 beds.

Walking in halls filled with history

I was given the opportunity to have a look at the unfinished document that will become a booklet about the history of medicine in the Black Hills. Although I work in a small critical access hospital, this particular one has a pretty interesting history. Deadwood and the neighboring town Lead are at the center of what once was the Homestake gold mines. With an influx of people looking for gold followed an influx of nuns and doctors looking to take care of the people working in the mines and the towns. Multiple hospital buildings have existed over the years, each growing in size and sophistication with every new building/renovation.

At one point, everyone in the area wanted their healthcare performed in my current hospital because healthcare was free to the people working for Homestake. They would have a copay if they went somewhere else. One of the docs I work with has told me stories of how he assisted in his patient’s open-heart surgeries, orthopedic surgeries, delivered uncountable babies, and did all kinds of procedures. A real badass doctor if you ask me! I’m sure that was a super interesting time to be working as a doctor. Kinda bummed I missed out on it!

After the Homestake mine closed, more and more business left town, and it’s down to a skeleton crew in the hospital these days. Babies are only delivered if they show up in the ED. Endoscopies and vasectomies are the extents of surgery. A few specialties are located in Spearfish, a 20 min drive away. Most are located in Rapid City, however.

Reflections

Looking back at the six months of my time here, let me share some thoughts.

The Medicine

Medicine is the reason I came here. Having worked in University Hospitals and a fairly well-sized hospital during residency, it was definitely a change of scenery coming to a critical access hospital. People here are more independent than a lot of their counterparts in larger hospitals. That is because they have to be. In large hospitals, specialists get involved quickly and patient care gets divided up amongst multiple consultants. That definitely has pros and cons. Ideally, it gives you more specialized care. For the primary care provider coordinating the care during a hospital stay, it sometimes feels like coordinating multiple chefs in a kitchen, however.

Here, the providers in the ED and clinic have to make a decision early on: can we handle this here or does it need to be shipped out. That decision takes into account staffing, therapeutic possibilities, and the need for specialized consultation. I’ve had some interesting case presentations come through but we had to transport the patients to Rapid City because our facility was not appropriate for the care. As a doctor, you miss out on managing some interesting and more complex cases because of it. When they do stay, however, it’s you managing everything which is a good experience to have.

The ED is staffed by mid-level providers (Physician Assistants and Nurse Practitioners). I have respect for the work they do. It is them and a nurse on shift and one of us docs on call as back up. They assess, stabilize and transfer patients to the appropriate level of care. I respect the stabilization part of that the most. Patients can come in in cardiac arrest or as trauma patients and they have to stabilize the patient for transport. That is a lot of responsibility. There are some great providers working in that ED and I’ve enjoyed helping them out and learning from them during the past couple of months.

The People

The majority of people I have encountered here have been delightful and friendly. They are down-to-earth and easygoing. Many are interested in my thoughts of the area and they feel proud about what the area has to offer. Due to the pandemic, I did not socialize with anyone outside of work.

When I initially arrived, the Covid-19 virus was just starting to pick up in the community. I became very frustrated with “the South Dakotans” because I saw masses of mask-less people in the restaurants/bars/casinos on my drive home, mask-less people in the grocery stores, ads on the radio for parties on every holiday. I had several encounters in the clinic with people who contracted the virus and either didn’t want to believe it or didn’t want to be tested. There were even some very unpleasant encounters where it took a lot of strength to remain professional. Announcements from the state’s governor and establishments not following CDC guidelines added fuel to my fire.

Then I started noticing how many people were coming in to get their influenza shot. Once the Covid vaccine became available, I saw how high the demand was. I noticed how afraid many patients were to come to the clinic because they were isolating at home. I realized that the people I called “the South Dakotans” and was mad at, did not represent all South Dakotans. There is a large proportion of sensible people here, I just wasn’t seeing them because they were staying home, avoiding crowds, and using telemedicine for their healthcare to reduce their risk of exposure. Additionally, I realized many of the maskless people and people in crowds weren’t even from here! They came from out of state due to the relatively non-existent restrictions.

So, I apologize to South Dakotans for generalizing my frustration at first and thank you to those who have been helping combat this pandemic.

The Area

Talk about wide-open spaces! From the Badlands to the Black Hills, the landscape is beautiful out here. I would’ve explored more of it had it been the other 6 months of the year that I was here. I got a few nice hikes in at Spearfish Canyon when I first got here. On the two occasions I had visitors, we explored various national parks that supplied us with grand views and up-close encounters with wildlife. Again, if it weren’t for the pandemic, I would’ve looked into doing more things like finding some horses to ride, festivals to attend, and maybe would’ve checked out the notorious Terry Peak mountain that has supplied us with so many orthopedic injuries.

Since the weather has gotten warmer on occasion over the past few weeks, I’ve really enjoyed going on hikes at Lookout Mountain in Spearfish. I don’t overdo it or wander into the forest too deep since I’m by myself. I know I haven’t even begun to see what the area has to offer on trails. I’ll have to come back in the summer months and with some friends or family to explore some more.

Speaking of wide-open spaces. The area was featured in the movie Nomadland (streaming on Hulu and nominated for various awards). It’s worth watching. If you watch it, pay attention to the hospital scene when the characters are in South Dakota working at Wall Drug and one of them gets ill. The nursing station you see at 57:21 is the place I work at! Shout out to nurse Courtney and PCT Karin for making it into an Oscar-nominated movie (their names are seen on the board in the shot).

The Culture

Not to sound like a broken record, but the pandemic sort of ruined this one for me. I really wanted to learn so much first-hand about the indigenous people of the area. Due to the pandemic, museums, attractions, and reservations were closed. I did read a few books which helped me gain a little insight into the Lakota culture. The books helped me understand some of the things I saw at Crazy Horse Memorial and in the Adam’s Museum. I wanted to immerse myself so much more though. I had several Native American patients and some did share insights but I did not press others for information. They were there to heal, not to educate me.

I also didn’t experience much of the Cowboy culture you might expect out here. I did have some tough-as-rocks ranchers as patients though. One is a nonagenarian lady and is tougher than several 30 something year olds I saw. I’ll have to come back to get on a horse and ride out on a ranch sometime.

The Coworkers

This is truly the saddest part about my assignment being over here. The people who work in this small hospital and clinic have been amazing. They took me up in their work-family and made me feel exceptionally welcome. Over the months, I got to know the majority of the people working in the hospital and know everyone in the clinic. I was invited to Thanksgiving and Christmas family dinners. I received flowers on my birthday. They even organized a get-together tomorrow afternoon in the clinic in my honor before I head out later this week.

I’ve had some great laughs with the people here. We’ve worked through some tough cases together.

I have to move on because my wanderlust demands it and the next job is lined up to start in the next couple of weeks (more details about this once the start date and details have been solidified). Aside from that, I definitely could’ve continued working in this environment. So, thank you to everyone in Deadwood and the greater area for making my time here great despite it being during a pandemic. I look forward to coming back in the future to visit, explore, and catch up!

mfg

Locum

You look tired.

March 14, 2021 No Comments

The past two weeks were quite busy. Apparently it showed in my face since a pediatric patient told me I looked tired during our encounter. Gotta love children’s honesty.

Svikki MD

March Week 1

The first week of March, I spent most of my time in the hospital. I had a quiet call on Tuesday. We cleared house pretty well throughout the week as many of my swing bed patients were either discharged to nursing homes or were able to go home. Wednesday, I gave a virtual lecture about fatigue to the South Dakota Academy of Physicians Assistants via Zoom. Thursday, I had another STEM mentoring meeting… also via Zoom. Due to some shortages of staff in the clinic, I helped out Thursday and Friday afternoon. The other Family Medicine doc was headed off for a week-long vacation and signed out an acute care patient to me on Friday. This bought me the second weekend in a row of coming in to see patients.

March Week 2

This past week was even busier. Since we had cleared the house the week before, we were due to increase our census again. A few of those swing bed admissions didn’t arrive from Rapid City until about 4 or 5 PM, which kept me there late to see them and get all the orders placed. On Wednesday, they were short providers in the clinic and I headed over to help out with walk-ins. On Thursday, one of the clinic providers had to go home due to their child being sick. I discharged a patient and saw two of my inpatients and then headed over to the clinic at 9 AM to see walk-ins for the rest of the day.

As so many times before, there was a walk-in at 4:45 PM for a skiing accident from the nearby mountain. They reported the accident had happened within the hour….it is odd how these accidents keep happening right at the closing time of the mountain at 4 PM. This late walk-in again necessitated a nurse to stay late with me and the radiology tech to stay late for imagining. I was pretty sure the bone wasn’t broken when I saw the image but I always wait for the official radiology read to be sure. It wasn’t broken. I let the nurse leave to get to an appointment she was running late to and ace wrapped the injury myself and got the family out of the office by 6 PM.

I drove home to have dinner and spent the rest of the evening finishing up charts from that day (I hate carrying unfinished charts over to the next day).

A Holiday Weekend that didn’t need to happen IMHO

Friday is really when the madness started. This past weekend was St. Patty’s Day weekend in Deadwood. It is essentially a huge drinking festival all weekend. Although I was told it was a bit scaled back from the normal due to Covid, the radio ads for the pub crawl and party announcements made me think it still wasn’t going to be low-key. I was on call all weekend and I feared I would be called in because the ED would be overrun by drunken people. Luckily, they doubled up on ED providers for the weekend. I started the day with discharging a patient and then had two swing bed admits lined up to arrive.

After the first had arrived, the ED called regarding an intoxicated patient that needed admission. Simultaneously, I was trying to field several prescription requests that were pouring in Friday afternoon. I was the only doctor in the hospital and clinic that day and I was on call, so I got all of the patient messages and prescription requests. Many of them were for controlled substances….which aren’t quick click-of-the-button refills. I make sure the refill is appropriate, check drug monitoring programs, calling pharmacies, and having to decide the minimum amount I can prescribe them so that their primary care doctor can continue the refills if they deem them appropriate. That all takes some time.

In the midst of all of that, I received a text from the office asking if I could come to see patients because two of the three mid-level providers that were working that day had to go home. They were either sick themselves or had a sick child. That left only one mid-level in the office. I was able to find an hour to pop over and help out before the clinic closed. Afterward, I still had my second swing bed admission to take care of. The acute care admission bought me my third weekend in a row of rounding.

Saturday

Throughout Friday night, I received several calls from the ED to go over patients. Saturday morning, the calls from the hospital started regarding the intoxicated patient. The treatment plan wasn’t working properly. I was on the phone 4 or 5 times before I quickly hopped into the shower before heading to the hospital. A call came in the middle of shampooing my hair. I thought it was the hospital nurse again and it would be a quick call. However, it was the call center and a patient’s daughter wanted to speak to the on-call provider. So I hopped out of the shower, shampoo in my hair and dripping wet to go grab something to write down some information. For the next 10 minutes, I was dripping all over the floor while taking care of the call. I quickly finished my shower afterward and headed to the hospital.

For the next 5 hours, I worked on adequately managing the patient going through withdrawal. I was able to take care of a few other tasks with other patients in that time as well before finally going home. I was exhausted and took a nap. My first nap in a really long time.

Sunday

Last night was also interrupted a couple of times with calls. Needless to say, I didn’t feel particularly refreshed this morning. Luckily, I had implemented a functional plan for the withdrawal patient and didn’t receive any calls related to them. I spent a few hours this morning in the hospital and then returned home for another power nap. Since then, it’s been pretty quiet.

Indecisive weather

The weather has been sort of wild these past two weeks as well. During the first weekend, it was 68 degrees Fahrenheit! I went on a beautiful hike at Look Out Mountain in Spearfish. Over the past week, the temperatures have dropped again and as I type this, a winter storm is moving in and it’s snowing out with multiple inches expected to fall.

One thing I love: Working with great nurses. It’s been busy and I’ve worked with some great nurses to get through it. Experienced nurses are such a valuable resource for physicians, especially new grads. We also laugh a lot together which makes the work environment so pleasant here.

One thing I ate: Coconut Miso Ramen from Purple Carrot… nothing like slurping down delicious Ramen in between seeing patients to keep you going!

One thing I’m grateful for: the vaccine rollout going as well as it is and President Biden’s announcement that all adults will be eligible to receive the vaccine by May 1st,… Hallelujah!

mfg

Locum

Thank u, next.

February 28, 2021 No Comments

Unlike Ariana Grande, I’m not referring to men. The past two weeks have been rather uneventful. It all seemed rather routine… which is also why I’m starting to itch for a change of scenery.

Svikki MD

My patient census number has grown a bit over the past two weeks. There was a steady turnover of patients, nothing too stressful. There were definitely some characters in the mix but for the most part, the patient panel was nice. I was out on time most of the days. A few evenings, I stayed late helping out in the clinic.

Weight-based everything

I had my first pediatric admission this past Friday. I had gone over to the clinic around 3 PM to help the nurse practitioner with a patient. Then, there were a couple of late walk-ins so I offered to see them. That kept me busy until about 6 PM. On my way back to my hospital office, I ran into one of the nurses. She was telling me that they might have an admission. I inquired what the case was and she told me it was a child. My follow-up question was who the physician on-call was. It was one of the internists. I told her they probably wouldn’t be allowed to admit, Internal medicine takes care of patients 18+ years of age. Family medicine sees all ages.

I made a call to the regional president to ensure that I had pediatric admission privileges. Turns out, I do. So then, I had to make sure I had nurses that felt comfortable with a pediatric patient. Once that was all in place, I went and assessed the patient for myself. The orders took a while to enter because medications and IV fluids for pediatric patients are weight-based. Since I don’t admit pediatric patients often, I double-checked every order.

By the time this was all done, it was 8 PM. I drove home to eat some dinner (Girl Scout cookies are not an appropriate dinner… that’s all I had around in the hospital). The admission History and Physical note was submitted at 10 PM and I was spent.

The late evening Friday acute care admission also won me a weekend of rounding. Luckily, kiddos are usually pretty quick to turn around and the patient was ready to go home by Saturday afternoon. That spared me a trip to the hospital today.

Change of Scenery

I’ve been on this assignment in South Dakota for 5 months now, I have one more to go. A workflow is in place and I know most people at the hospital and all the people in the clinic. The work environment is lovely and my co-workers make my job enjoyable. So, now I feel like I’m ready for a change.

I don’t know how much the pandemic plays into this itch for something new. If life was like the “before times”, I would probably be visiting the local movie theater every weekend (one of my favorite activities during residency besides horseback riding). However, I’m not a bargoer and I hardly eat out, so that wouldn’t be any different. Maybe I’d visit a few more of the local museums and attractions if it weren’t for the pandemic.

The major difference in activities would be traveling. If I could take a trip once or twice a month somewhere, I probably wouldn’t be antsy. With the pandemic and (necessary) restrictions currently still in place, that’s not the most feasible option.

Moving forward, assignments that are 4-6 months will probably be ideal depending on workload and where they are. I’m really trying to go to Hawaii for locums and am willing to go there for a year. People have warned me of island fever, and maybe I’ll regret my current stance, but there are many islands to keep me occupied. I’m willing to take that risk 😉

One thing I love: Sunny days after snowfall. We hardly had any snow on the ground last week and then overnight, several inches of snow came down. However, it’s sunny and lovely out today! I’ve already been on a walk.

One thing I ate: Samoas and Tagalong Girl Scout cookies. As a former Girl Scout, I had to support the cause… and my occasional sweet tooth.

One thing I’m grateful for: Books. I feel there is such a slump in interesting shows to watch. Not that there is a lack of content, just a lack of content that interests me. I bought Bill Gate’s new book How to Avoid a Climate Disaster yesterday and look forward to having it on rotation with my medical and finance books!

mfg

Happiness, Locum

On the Search for Warmth and Financial Freedom

February 15, 2021 No Comments

For all those people who want to start singing “I’ve been looking for freedom” to me

Greetings from what feels like the arctic! With temperatures as low as -18°F/-28°C this past week, South Dakota, like much of the country, has been a bit chilly. Next week we should maintain above 0°F at least. We didn’t get nearly as much snow as other places though. The roads have been decent for the most part (thank goodness for the SUV with 4W drive). Getting into the car in the morning feels like sitting down in a freezer. The condensation from my breath was freezing on the inside of my wind shield!

Reminiscing about last week when socks were optional

Svikki MD

Maintenance was nice enough to install a heating element in my office space this week. The existing heating structures weren’t functional anymore. Unfortunately, I’m not sure the new heating element ever actually started working. Luckily, I wear multiple layers of clothing to work to keep me warm.

Patient numbers were down, across the region, this week. I did have a few new swing bed admissions but for the most part, it was rather quiet. I helped out in the clinic a bit as well.

Casual morning commute in -13°F/-25°C weather

There is a skiing/snowboarding area just 8 miles from work. Something really strange must happen around 4 PM up there. We will start seeing walk-ins to the clinic for ski/snowboarding accidents around 4:30 PM. We had 3 of them Friday evening. Of course they aren’t all tipping over and hurting themselves at 4 PM… the ski lifts close at 4 PM. So, they will fully maximize their ski pass and then head to the clinic. By the time we see them, have X-rays done, wait for the X-ray reads, consult with ortho for broken bones and splint them… it’s 7 PM.

As a locum provider with nobody waiting on me at home, I don’t mind the extra hours. I do feel bad for the rest of the crew though. They have kids to pick up, family waiting at home and have to work overtime. All because people don’t want to leave the lift at the time of injury.

Weekend To-Do List

I make myself a weekend to-do list just about every weekend. It gives me a structure of what I want to accomplish over the next 48 hours. This weekend, it included items such as Hawaii Medical License research (since I reaaaaally want to work there some day), looking over my finances, doing laundry, working on a presentation for a conference in a few weeks, and getting my taxes done.

As a locum physician, I am an independent contractor. That has led to me needing to learn some things about taxes I didn’t need to know as an employee. I’ve learned how to pay estimated quarterly income taxes on the federal, state and local level. That is because as an independent contractor, my paychecks have no taxes deducted from them. Which means, I need to pay the government income taxes quarterly. There are certain deductions I can make that an employee can’t. But I also have to pay taxes an employee doesn’t, like the self-employment tax. Having been both an employee (as a resident and part time faculty at Youngstown State University) and an independent contractor last year, I had to learn to cover both bases.

Working on my financial education

I actually really enjoy working with numbers. Every Friday, I go over my finances after receiving my paycheck. The money is allocated to savings accounts for various purposes. The largest portion is put aside for those quarterly tax payments. I only allow myself to use 12% of my paycheck. Almost everything I purchase is bought with a credit card to earn points/cash back. I pay off the standing balance every week. Whatever is left of those 12% after paying off the credit cards is mine to use. I continue to live almost as frugally as I did as a resident, so a portion of that money still ends up in savings.

I’ve been reading books lately about investing as that is something I definitely want to get into soon. Unfortunately, financial education is not something that is well integrated into our public education system,… although it totally should be! (As should more home ec classes… I mean “Family and Consumer Science” classes as they are now called apparently.) So, I am continuously trying to further my own financial education.

Lit List

Some of the books I’ve read and really enjoyed so far include:

Rich Dad, Poor Dad by Robert Kiyosaki
The Millionaire Next Door by Thomas J Stanley & William D Danko
Cash Flow Quadrant by Robert Kiyosaki
The ABCs of Real Estate Investing by Ken McElroy

I’m currently working through Robert Kiyosaki’s Rich Dad’s Guide to Investing and Ken McElroy’s The ABCs of Buying Rental Property. The goal of all of this is to be informed and someday achieve financial freedom. That financial freedom will then give me the freedom to spend time with family and friends, work when I want to and free up enough time so that I can work as a doctor in various parts of the world in underserved communities while not getting paid for that work.

Have you read any great personal finance books? Please do share! Leave a comment below with the title so I can check it out!

One thing I love: FaceTime. It just really makes long distance not feel so long at all <3

One thing I ate: vegan chocolate mug cake,… throw a few ingredients in a microwavable mug, stir it up and microwave for a minute to enjoy. Far less mess than making a whole cake and fewer tempting calories lying around.

One thing I’m grateful for: having a warm place to live. The temperatures are crazy low across the country. I hope people who don’t have a warm place to live are finding enough safe places to stay warm. Unfortunately, I know that’s not the reality for everyone.

mfg

Happiness, Locum, Travel

So ready for 2021

December 27, 2020 No Comments

With a name like 2020, this year really had the potential to be great. In some ways, it really was. A global pandemic brought people together on a scale that I have not seen in my lifetime. Scientists were able to make an extremely effective vaccine within a year! (They were able to move forward so “quickly” because many of the barriers that usually hold up vaccine development were lifted.) The social movements in the United States and around the world brought necessary awareness to society and will hopefully continue to bring on much-needed change. We’ve seen our lives completely turned upside down and people continue to persevere.

Hopefully, we all get through this experience with a greater appreciation of community, value for our health, and a sense to try to be better in this world. It’ll definitely be a year I don’t forget and will be telling my children and grandchildren about.

From last year’s Christmas and honestly my favorite video of my niece.

Svikki MD

Change is coming to my work schedule…again. If you’ve been following along over the past several weeks (thank you!), you will have noticed that I was reducing my clinic hours to make more time for the volume of patients in the hospital. This week, I finally had to make the move to focus primarily on hospital work.

It was getting to be too much trying to be in two places at once. There was plenty of work that needed to be done in the hospital. I’d have to jump over to the clinic in the afternoon to see patients. That also required time, follow up, and brainpower. I felt like I had to compromise my full commitment to either one side or the other.

Consequently, I spoke with the office manager and laid out observations I had made over the past three months. Physicians and nurses alike seemed frustrated. Doctors in the office were interrupted while with their clinic patients due to calls from the floor nurses. The floor nurses were having a hard time getting timely responses from the clinic docs. The doctors didn’t have time to take on admissions because they were busy in the clinic. However, bigger hospitals had to make room for more acute care patients. Clinic volumes were down so they didn’t really even need me in the office. The mid-levels had nearly empty schedules while they packed my 2.5 hours full.

So, moving forward, I will be solely in the hospital seeing patients and trying to keep our swing bed census around 10 patients. I’ll work in the clinic if many providers are out. However, I won’t have a clinic schedule per se.

Holidays in the Hospital

With the mid-levels out of the office for the holidays, my colleague and I were actually pretty busy in the office on Wednesday and Thursday morning. After the clinic closed Thursday at noon, I headed over to the hospital to see my 9 patients. A couple of patients were discharged home in time for the holidays.

I opened up my gifts on Christmas Eve while FaceTiming with my family. I’m pretty used to working over the Christmas holiday, but I’ve never had a Christmas where I wasn’t physically around my family. Thank goodness for FaceTime because it honestly didn’t feel lonely despite being alone.

Christmas day, I was back in the hospital seeing patients while wearing a light-up necklace my mother sent me. I’m all for bringing a little joy to patients stuck in the hospital for a holiday. My colleague invited me to have lunch with his family. The food was delicious and it was nice getting to know his wife and daughters. It was only the second time since moving here almost three months ago that I have socialized with anyone outside of the hospital setting. My colleague does wood work and made me this bowel from some local wood! I love gifts with a purpose and memory attached to them.

Hopes & Dreams

With a new year only a couple days away, I think most people become sentimental and plan for the future. I am no exception to that. Pre-pandemic, my years were filled with travel, concerts, adventures and so much fun. I’ve made a few videos over the years reflecting back on the previous year with travel videos and pictures.

Despite the global pandemic that changed so much and forced us all to slow down in our private lives, I was still able to do a few things. Pre-covid in the US, I was able to attend my Aunt’s birthday in Germany and sang a set for all her guests.

At my Aunt’s Birthday bash just before Covid hit in March.

I returned to the States to immediately start working in Flu clinics and on the COVID floor as one of the first residents to do so in our hospital. COVID changed how we celebrated our graduation from residency but we made the best of it. The late summer allowed for a brief window where I was able to visit family in Germany and take my little sister on a trip to Italy for a few days. I returned from there to move across the country to South Dakota to start my life as an attending physician.

Photoshoot with one of my best friends in Hamburg in March

Working in healthcare and at times being over-worked in healthcare, I am still very grateful for the fact that I am out here every day helping patients and have a job to go to. I have so much respect for people to go around. To the people who have been working from home for the majority of this year. The utmost respect for the (mainly) mothers that have been keeping a household running, childcare managed and continue to work through it all the best they can. I have so much respect for the teachers who are working crazy overtime to try to continue to educate our future generations. Respect is also due to all the frontline and essential workers. My gratitude goes out to all the people who have been physically distancing, wearing masks, washing their hands, making personal sacrifices, and just being respectful of other people’s wellbeing.

Italy with my younger sister in September

2021

A change on the calendar from one year to the next doesn’t automatically solve all of the problems faced in 2020. Actually, it does nothing of the sort. But it feels like a new beginning. There is so much potential for this specified timeframe of a year to be better than the previous 365 days. Many things indicate positive change: the vaccine rollout, a new administration, and continued knowledge/experience gathered about the challenges we face. On a personal level, I will hopefully be able to safely celebrate a few weddings in 2021. Our family is expanding in size in multiple ways. Although I don’t think we will get quite back to the lives we would like to fully in 2021, I do believe we will be making big strides in the right direction.

At one of my best friend’s sister’s very, very intimate wedding in May.

I hope everyone has a safe New Years and continues to be safe, conscientious and loving.

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

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