The road to the town where I did my rural clerkship travels east from Portland until you reach a sharp turn off Highway 84 that heads south. Soon after leaving the highway, you lose cellphone service and have to brave the rest of the route on your own. The hills are vast, beautiful, and seemingly endless, covered in green and yellow-shaded grass with scattered trees and occasional ponds sparkling in the sunlight. Compared to Portland, it feels like another planet, with wide-open space in every direction and far more cows than people. The town’s welcome sign sits in front of two large historic tractors, signaling arrival to a town that prides itself on working in the fields – growing wheat and raising cattle.
On the first morning of my rural clerkship, I felt like I had traveled back in time. The hospital was a single-hallway building consisting of an Emergency Department, ten hospital beds, and a nursing home facility all under one roof. The clinic was just up the road, allowing the doctors and staff to cover the ED, inpatient service, and clinic all at the same time. Immediately, I was struck by the friendliness of the nurses and the rest of the staff – the visiting medical student (me) was a familiar tradition, transitioning every 5 weeks from one of us to another, but they didn’t seem to mind the consistently rotating wheel of new faces.
That first morning, I rounded on an elderly gentleman who had suffered a devastating stroke two days prior, but had been started on steroid medication and his mental status was beginning to improve. We talked for a while that morning, and I learned that he was on hospice care, likely destined to spend the rest of his life in this small rural hospital. We parted ways that morning, and at that point he was simply a patient, similar to the patients I had met and treated at OHSU.
After clinic that same day, I drove 20 miles out of town searching for a swimming hole my preceptor had recommended. I had been given verbal directions, but after reaching a fork in the road I didn’t remember hearing about, I realized that I had likely gone too far. I doubled back, driving slower this time, feeling lost without Google maps. I eventually found a campground and I turned in, hoping to find either the lake or someone who could help me. As I drove along a narrow road, I saw a pick-up truck heading toward me. I rolled down my window and a man who was driving did the same. I asked him if he knew of a popular place to swim nearby. He smiled and explained to me where the lake was – he was clearly local and knew his way around. He asked me where I was from, and I told him I was visiting from Portland. At that moment, we were just two men who happened to cross paths out in the wilderness.
The following morning, I returned to the hospital to check on my patient. When I walked into the room, he was not alone – he had family with him. As I reached out to shake their hands, I looked more closely and realized it was the same man who had given me the directions the day prior. We laughed about it, as he recognized me as well, and he asked me if I had found the swimming hole, which I had. I remarked that the path to the lake was much steeper than I expected. He responded that he hadn’t realized I was a medical student.
From that day forward, I saw this man daily, knowing these individuals not only as a patient and his family but as people of the community, as the same people who helped me find that trail my first day in town. That, to me, was the great difference between working in this small town and working where I was more accustomed. In an urban environment with large hospitals and countless patients, we often know our patients more by their lab values than their stories. In small towns, patients are not simply patients – they are members of the same community. We know what they do for a living. We know their kids. We know their drinking habits, not because they tell us but because we see them in town at the bar and grill. It brings a new meaning to medicine when you’re taking care of your neighbors, when your patient is also your car mechanic or your child’s 4th grade teacher.
In the beginning of the fourth year of medical school, people talk a lot about specialty choices. Everything is about surgery versus internal medicine, anesthesia versus emergency medicine, and the list goes on. There is much less talk about experiences with patients, about what it feels like to be gaining proficiency in taking care of people, or about the unique bond you feel when helping someone heal. Our rural clerkship is a unique opportunity to get back to the basics of what it means to be a physician. It reminds us of how doctors practiced for so many years of our history, as small-town physicians who were counted on by their neighbors when they were stricken with disease. Today, the web of medicine has changed remarkably, but for me, the draw of the profession still remains in the ability to touch a patient on the shoulder, even for just a moment, and relate as two people trying our best to take care of one another.
This post has been selectively edited to protect the privacy of those involved. Locations, names, genders, ages, times, conditions, details and more have been modified or excluded.