week one in T-pah

Well, my first week “by myself” went pretty well.  I was the only provider in the clinic on Tuesday and Thursday, and Dr. S was at the clinic one hour north of here, and was available by phone.  I was forced to try to think through situations by myself, and did not allow myself to get rushed by staff (too much).  The mornings seem to start out pretty nice and steady and then as five-o’clock gets nearer, the pace starts to pick up.  This is contrary to what my body wants to do, as at 3:30pm I am longing for a cup of coffee and a little siesta.

It’s also a challenging situation on Thursday afternoons, because the only pharmacy for 100 miles closes at six-o’clock and doesn’t reopen until 10am on Monday.  So, if you’ve got a patient that needs something (like, say, antibiotics…) you’ve got to make a decision sometimes without the help of technology (like, say, a CT scan).

And so I found myself, at 5-o’clock Thursday afternoon, with a male patient with acute left-lower quadrant abdominal pain, a previous appendectomy, and a clean urinalysis…  hmmm…

So I had to do some quick thinking.  Worst case scenario—diverticulitis.  Best case scenario—constipation.  But with the pharmacy closing in less than an hour, I didn’t have time to get the CT scan of his abdomen to make a definitive decision.  So, I called in antibiotics to the pharmacy anyway (along with pain medications) and waited for the 2 hour window for my patient to drink his contrast (at home—it’s nice when the hospital is only 10 minutes away from anywhere in this town) and then proceed to get his scan done.

While waiting, I sat down for a chat with Dr. S in his office and we looked at photos and talked about his last medical mission trip to Mali, Africa (I’m invited on the next trip in October!).  Then the phone call came…  Dx:  Diverticulitis!  Woohoo!  My gut feeling was right (pardon the pun), and I did it!  Go ahead and take those antibiotics, Mr. Patient! 

There’s a lot of down-time out here too, and on Wednesday, my day off, I decided to go up to the BLM Field Office and get some maps.  I love small towns, when you can just walk into a place and instantly be friends with someone.  Steve sold me a couple of maps, and gave me another because it had not been updated in the last 10 years, and also gave me a bunch of “things to do around Tonopah” recreation maps and brochures.

So after eating lunch on Wednesday, I decided to drive 90 miles out to the Wild Burro Refuge west of town.  Lovely drive, but I wouldn’t want to break down out there.  There is nothing but mountains and sagebrush.

So I got to the Wild Burro Refuge, and realized that it is really difficult to find 85 wild burrows in 68,000 square acres of sagebrush and mountains.  The dogs had a nice time romping around in the desert and eating wild burro poop, though.  On the drive back to town I spotted some wild horses off the side of the highway, so the trip was not all for naught.  You might ask, how did Nevada end up with wild burros?  Well, it turns out they are remnants from the age of gold and silver mining, abandoned creatures when the miners abandoned their mines… a little sad, really.  But I’m sure they are much better off roaming free in the desert rather than lugging around mining implements as their ancestors did.   It was really quite a pretty spot out there in the West Desert of Nevada, with views of the Sierras and large salt marshes between the peaks. 

Apparently, (as Dr. S informed me last night) the alluvial soils of Nevada are very favorable to agriculture, if one can just tap into the large underground aquifer hundreds of feet below the surface of the Earth.  It is theorized that a large river may even run the length of the continent, stretching from Canada down to Mexico.  If a well is drilled in the correct spot, it can supply upwards of 300 gallons per minute of water to the surface (don’t close the tap…  always leave a little bit dripping… or you might have “thar’ she blows!” on your hands).  Indeed, alfalfa and potatoes are grown in abundance in Nevada:  two crops that are known for their need for adequate irrigation.

 

Another thing I learned from traveling out here in the West Desert is that upon my return to Utah, the Wasatch Mountains look even more magnificent when viewed from the west.  As I drive through the brilliant sunshine of the desert the Wasatch Mountains creep into view out on the eastern horizon:  blanketed in snow and clouds.  Each time I make the trip home those mountains tug at my heartstrings, making my return to and departure from Utah even a little more bittersweet.  Until next time…