Goodbye Big Sky, Hello Big City

It's now been one week since I said goodbye to Big Sky (that's the aptly named Lone Peak in the rear view mirror - the one that astonishingly disappeared from view during the "smoky sky days" from nearby forest fires a few weeks ago), and I miss it mightily!

Everything came full circle in the end. My last patient at the clinic was the same wiry septuagenarian who had come in "to meet the new students" nearly three weeks earlier, at which time she'd generously given each of us a free copy of her widely read (well, in Big Sky at least) guide to local hiking trails. I thanked her for her excellent suggestions - my vigorous Beehive Basin Hike the previous weekend had been entirely due to her guide, which said it was the most popular hike among locals - and I obviously wanted to do whatever the locals digged. But the visit was not only nostalgic, but also a bit ironic, because her chief complaint was a sore knee that was precluding her from being able to hike any trails! And so, in keeping with my ever-lengthening list of new procedural skills, I deposited a nice fat syringe full of steroids into her knee; and in keeping with the standard amazingly gratifying nature of urgent care outpatient medicine, my patient was able to walk normally without pain within 5 minutes! I suppose the other ironic, and gratifying, piece to this story is that she was both my patient and my hiking guide - and as some of you may know, the word "doctor" comes from the Latin verb docere, "to teach", the same root as our word for museum guides, "docents". I have always imagined my role as a physician being more of a teacher, or guide, coaching my patients towards better health. And, as a medical student, I have undoubtedly learned far more from my patients than they have learned from me - in essence, they have been *my* 'doctors', or teachers.


Speaking of teachers and doctors - one of the passions that I rekindled out in Big Sky was making wire sculptures. Here are the ones I gave to Brad - who wears a million hats at the clinic, took me on some badass mountain bike rides, and seems to know and do almost as much as the physicians short of writing prescriptions, and Doc Daniels - it's supposed to be a likeness of him, wearing his stethoscope and drinking a shot of his velvety warm single-malt Scotch out of the bottle.

So, here I am back in New Haven. Not for long though. A week from today I'll be down in the Big City, preparing for my next medical adventure, a sub-internship in family medicine at a big hospital in the Bronx. I anticipate it being like the exact photographic negative of Big Sky - humid, crowded, tons of people, all my patients will be very sick and have hypertension and diabetes, I'll have little time or opportunity for mountain hikes or bikes, and - the differences aren't all negative - I'll be staying with my best friends and have wifi and cellphone access all the time!

But. I will never forget Big Sky. My heart sang every morning when I left my cozy cabin and headed to work on a road flanked on all side by soaring mountains and incredible beauty. Working at the clinic confirmed for me beyond a doubt that I wasn't crazy when I started having this dream as a 7-year-old that "I wanted to be a doctor" - in fact, even though I don't get my official degree for another 9 months, my three weeks at the clinic felt like the fulfillment of that childhood dream. My work there, suturing and counseling and fixing - really helping and curing people (imagine that!), instead of the dreadfully unsatisfying tinkering of meds and lab values that seem to be the m.o. of most medical care, was *exactly* what I'd imagined myself doing when I first ditched all prospects of going into ballet or ice cream trucking, and latched onto medicine. I can only feel lucky to have discovered something that I'm good at and *love* doing - and will...eventually...get paid for doing.

One last comment/insight about my time in Big Sky: it reminded me of the power of context. (I highly recommend reading The Tipping Point for more on that concept.) Out there, I was continually surprised by how genuinely nice everyone was, and how happy and content everyone seemed, and most of all, how chill and non-impatient all the patients were: for once, they lived up to their moniker! Not only that...I would consider myself to be a staunch Democrat, and a pretty leftward liberal at that. I might even confess that I think Republicans are...a little bit...well...stupid. I know, it's horrible. But. Out there in Montana, and driving through Idaho, far from Boston and New Haven and the other staunchly liberal Democrat cities that have comprised the majority of the places I have ever called home, I actually began to see the other side. There are so few people bothering you out there - it seems a natural extension to not want the government to bother you either. Hiking and biking by myself in grizzly and moose country, I'll be the first to say that the thought crossed my mind several times that I'd feel a *lot* safer if I had a gun on me. A gun! Me, thinking that it would be nice if I had a gun! I know, it's ridiculous. But out there, it wasn't. And so I have concluded, and I urge you to consider this in your life, with the people you seem to disagree with: until you powerfully and deeply understand a person's context, you will *never* powerfully or deeply understand their content.