Tuesday, August 21, 2007

Wrapping Up

Wrapping Up #1: At the end of last week, we were visited by a very distraught little boy who had fallen off a ladder at camp and broke his arm in two places. Fortunately, he recovered quickly (as little boys are apt to do) once we stabilized his arm in a temporary cast (and gave him some stickers and narcotics). Then, on Friday, he returned for the full cast, and I had the pleasure of wrapping him up:

First, we put on the "white sock" to protect his arm. Next, we started applying the super-cool wet 'n harden cast material (in super-cool green, of course)

And then, voila! The bravest cowboy in Big Sky was ready to once again roam with the deer and the buffalo, with seldom a discouraging word.

Wrapping Up #2: As some of you may know, I have a strange wire sculpturing talent that emerged out of nowhere when, as a precocious tween living in a condo in Lakewood NJ back in the early '90s, I managed to convince the guys working in the dirt behind our house to give me a 3-foot length of colorful fiber optic telephone wire that they were going to toss anyway - and discovered that I had an uncanny ability to twist and wrap individual wires into little wire people. My first piece was a 3-club juggler, and from time to time over the last, oh 15ish years (has it been that long really??) I've slowly worked away at that original wire stash, usually to make my trademark "namaste yogi(ni)" person. In anticipation of some extra free time in Big Sky, I brought a swath of the stuff out here with me, and over the last few days, made some gifts for Dr. Fritz (who loves her poodle), Brad (an avid mountain biker), and Jen (who did an Ironman triathlon!):

Rapping Up #3: Sunday dawned sunny in Big Sky, so I decided to tackle the renowned Beehive Basin hike. Same as the last hike up Mt. Washburn, I went at it alone, and same as the last hike, there was that slim but real chance of encountering a bear. So once again, I sported some bear spray, and tried to scamper up the crazy steep and crazy beautiful mountain (one of whose peaks has a series of spiral dark stripes that make it look not unlike a big rock version of a beehive) with enough volume to scare off whatever Smokey's and Yogi's happened to be in the area. So yes, at one point I resorted to some Eminem.

But mostly, the almost 3-hour hike over fault lines and through luscious wildflower fields (like this whole 3-week experience has done in general) gave me the opportunity to think and reflect, without the usual overstimulation of a cellphone, computer, wifi, or ipod. Or the noise pollution of cars. Or the visual/mental pollution of advertising. I don't know...I may be slowly turning into a country girl. Shocking for those who know how attached I am to my cell phone and computer, I know. But as much as I value constant connection to all of the people and projects in my life, I've realized here that it comes at a bit of an expense, in not giving me room for connection to myself, and more importantly, to the earth. We all talk about global warming, globalization, the global economy, etc - but how often do we really, truly remember that we neither own nor control the Earth. It's just a planet we've found ourselves on, and it's stunningly complex and beautiful, and...we're neither the first, the only, nor likely the last ones to live here. It's easy to forget about the earth of the Earth when we spend most of our lives suspended in concrete and steel above it, eating food products that bear little to no resemblance to the earth-grown/raised whole foods from which they are derived, and living largely intellectual, sedentary lives that bear little to no resemblance to those that our ancestors - who we can thank for evolving us these brains and bodies - lived. So...while I may not exactly be ready to trade in my MacBook and Corolla for a machete and canoe, I do want to make a commitment to better balance of my time between the hi-tech, new, world of information and mind - and more time in the low-tech, millenia-old, natural world of earth and body.

Friday, August 17, 2007

(Good) Food, Folks, and Fun

I'm amazed at how quickly this second week has whizzed by! I guess it's partly because things seem to go slower when everything's new and you spend every second thinking, adapting, figuring out - it makes the days seem longer, and certainly more exhausting! So by this week I pretty much settled into life in Big Sky and at the clinic. And, I also had three evenings of fun with my new colleagues/friends!

On Sunday night, Doc hosted a Perseid Meteor Shower viewing on his back porch. It was pretty cool to see the shooting stars zip across the sky; but even without the meteors, the sky was amazing! We could see the Milky Way with a clarity that I didn't think was possible outside of the planetariums I frequented in elementary school, and there were so many extra stars visible that finding the constellations was a little like a "Where's Waldo?" page! Also, we saw about half a dozen satellites (as in those manmade things we hurl up into the sky to orbit and do stuff for us) plodding along on their computer-generated path. It was uber-cool.

On Tuesday, Brad was going to take me and Jen for a guided mountain bike ride, but the smoke from the fires was so bad you couldn't even see Lone Peak, the *11,000 foot huge ginormous mountain right next to the clinic*!! It was like the mountain had disappeared into the mist! Crazy. So yeah, we didn't go out then - instead, the new orthopedic surgeon took us all (me, Jen, Doc, and Dr. Fritz) out for a *very* nice meal at the Rainbow Ranch, on behalf of his new orthopedic practice. Note: While I am against pharmaceutical gifts to doctors, I think that it's a *great* idea for all the filthy rich sub specialist practices to take family docs out to dinner (and on trips, and send chocolate, etc) to thank them for the business - since basically they will largely rely on (future) me and the other primary care docs for referrals.

After dinner, Doc invited us all back to his gorgeous house for Scotch tasting (he's a big fan and connoisseur); he vowed to make single-malt-Scotch-lovers out of all of us! I wouldn't necessarily say that I loved it, but when paired with a fine sherry (they go well together because the Scotch is aged in barrels that were recycled from those used for sherry aging, so they have faintly similar tastes), and lured by the prospect of drinking a Scotch that was born in the same year as me (1979!), I - as we say for patients undergoing procedures - "tolerated it well, with no complaints." I expected to learn a lot out here, but identifying summer constellations and drinking Scotch were not on my short list!

Finally, the smoke cleared up yesterday, and so after work Brad
and Jen and I put on our helmets and bike gloves, tanked up on water, and headed out for the Ousel Falls Trail - and the prize at the end of the trail - you guessed it! - Ousel Falls.
It was SO much fun - I crashed thrice, had to get off my bike to walk it up a steep incline twice, lost my phone once, but broke no bones! (and I found my phone again, whew) Here are my battle scar pics from afterwards. P.S. Brad's taking me out biking again tomorrow morning - woohoo! Don't worry mom, I'll be careful... :)

Tuesday, August 14, 2007

Head, Shoulders, Knees, and...

Yesterday, our patients seemed to be singing that song as they came in with their complaints:

Head - mom on guided kayaking trip with family, playing "kayak tag" when the instructor tagged/whacked her in the side of the head with the edge of the paddle!
* Note: when playing kayak tag, try to tag the *kayak*, not the person

Shoulders - guy who peels logs for a living, helped a friend move over the weekend and developed left shoulder pain
* Note: for all those who think peeling an orange can be tough...we've seen people with the most interesting occupations out here

Knees - older gentleman in his 60's was out hiking with friends in the mountains, slipped on a rock and tumbled down 3-4 feet, landing on his shoulder and knee; he got a big bump on the leg that swelled up to the size of his fist, but we weren't too concerned when he told us that he'd been fine hiking out of the mountains *18 miles* back to his house.
* Note: it's remarkable how healthy and fit everyone is out here. back in CT, it seems that 1 out of every 3-4 patients is obese and/or has diabetes. Out here, not only have I not seen a single person with diabetes, but even the octogenarians hike and bike regularly and are generally fit as fiddles. I attribute the difference partially to selection bias (i.e., healthier athletic types like living/vacationing in these parts), but partially to the environment itself (i.e. since everyone hikes and bikes and stays fit, newcomers are more likely to adapt by becoming/staying athletic and fit - kind of like the recent research suggesting that obesity is "contagious")

and Toes - young guy jumped out of his big truck wearing only flipflops and misjudged the distance to the ground.
* Note: just a quick word about footwear - everyone out here wears Keen shoes, my favorite brand of hip multi-purpose waterproof footwear! yet another reason why I heart Montana.

So...that was yesterday. We also saw a bunch of Eyes and Ears and Mouths and Nose(s), and joked that after all of that extremity stuff, today would bring stomachaches and other core complaints. And wouldn't you know....

My first case of this morning was a boy who was having pain around his bellybutton that migrated down to the lower right part of his tummy, with nausea and pain upon movement...it was as if he was reading right out of the textbook! I almost second-guessed myself because the diagnosis seemed so obvious. And indeed, when we sent him up to the surgeons in Bozeman, they confirmed...my first diagnosed case of appendicitis. But it didn't stop there; I also got a recently released convict with classic peptic ulcer disease, a vacationer with classic urinary tract infection, and a college student at the end of her week on spiritual tour with a Native American shaman who had classic viral gastroenteritis with dehydration. Stomachaches, indeed!

Brad (our uber-helpful bearded mountain man who serves as clinic manager, nurse, X-ray technician, and a million other things, and reminds me a bit - in an endearing way - of Al from Tooltime, but taller) was planning on taking me and Jen (the leggy blonde ER resident working/living with me, who's passionate about public health, has done an Ironman, and bears a passing resemblance - in all the right ways - to Jennifer Garner) out for a mountain bikeride after work today. But...the air is pretty smoky from all the forest fires, so not sure if it'll work out. Until soon!

Saturday, August 11, 2007

Wash 'n Burn

I Heart Montana. On Thursday evening Shelley (family friend, generous car lender and weekend benefactor, music teacher extraordinaire) drove up from Salt Lake City to spend the weekend with me, and we kicked it off with dinner at the Cinnamon Lodge, which had been recommended to me by both newspaper and personage as "the best Mexican food in Big Sky". Huh. I can't say that my vegetarian fajita or margarita were even in the top, oh, 70% of those I've eaten...but Shelley's lemonade, cheeseburger, waffle fries, and raspberry rhubarb pie were spectacular! (I tasted all but the cheeseburger and concurred) So...I guess what they *really* meant was that the Cinnamon Lodge has "the best non-Mexican food at a Mexican restaurant in Big Sky"...

Not sure whether it was the margarita, the too-many-times-refried beans, or just the large late dinner, but Thursday night I had restless sleep with very weird dreams. I'll spare you most of the details, but needless to say, they were of the "anxiety" variety, and featured a cameo by Barak Obama, a fudge sale, and my attempt at placating angry Israeli vendors with my decidedly non-fluent Hebrew skills. It's been many moons since I last dreamed that I was speaking Hebrew, and I mention this dream at all because Friday marked the end of my first week at the clinic, and was otherwise unremarkable and slow...until my last patient, a guy who decided for still inexplicable reasons that he was going to stop by, without an appointment, for his yearly physical...at 4pm on a Friday afternoon! It would have been annoying...except that he was Israeli! And I got to speak Hebrew with him! In Big Sky, Montana! The day after I had a dream that I was speaking Hebrew! Weird...

Ok, maybe you had to be there. But I'll tell you where else you had to be: John Bozeman's Bistro, where Shelley and I had dinner Friday night, in - you guessed it - Bozeman, MT, which was named after - right again! - John Bozeman himself! We not only had the most unbelievably delicious meal (the kind of meal one wouldn't believe was possible to obtain in Montana after our Mexican fiasco the previous night; the kind of meal one remembers in great detail months, even years after consuming; and the kind of meal one can only afford, both financially and waist-bandedly, to have on *very* special occasions)...we also found out about the history of Bozeman, and its founder, JB himself. JB was, our menu informed us, a visionary. He came out here mid-19th-century with the rest of the gold-grubbers, but unlike them, realized that nothing gold can stay...so he looked for another source of income that might actually be realistically sustainable. And he found a great little piece of land that looked agriculturally promising, and started convincing prairie-crosser after prairie-crosser to settle down with him...and within 4 years, the town of Bozeman was official. Sadly, just 3 years later, JB was mysteriously killed during a routine trip to Billings for flour, but I would argue that his untimely death is just further evidence that one person (yes, like you!) can make an enormous, lasting difference in the world in just a short time, just by developing a passion, a conviction, or any unique self-expression that they are determined to share with the world.

That night, we camped out at a cute little campground east of Bozeman, where I did some laundry (the "Wash" portion of this post's title). The sunset view was breathtaking - both in its beauty, and in the fact that all of the beautiful sunsets out here these days are in large part due to the particulate matter suspended in the sky from all of the forest fires burning throughout the area. The native Montanans staying in the next tent over told me that it's only in the last 7-8 years that there have been such bad fires and drought every single summer - probably due to global warming; it was pretty sobering to realize how much climate change is already affecting not just theoretical weather patterns, but actual people's lives, health, and experience.

Saturday morning we each had the pleasure of experiencing the campground's amazing showers, which basically had the same qualities as the ideal man: clean, hot, and strong. (just kidding - I'm actually looking for a guy who's more like an expensive new suit: smart, looks and smells good, makes me feel great, a perfect fit) Then it was off to Livingston, MT: the ORIGINAL gateway to Yellowstone! (so the sign said) Upon entering this sleepy little town (see speed limit) in the apparent middle of nowhere, we didn't have high hopes for breakfast - but we found the best diner-like establishment ("voted best in Livingston" says the sign, and you can see from the pic that we weren't the only ones to agree) that had yummy biscuits, great eggs with fresh spinach, and...you'll never believe this...soy sausage! Unfortunately, they were all out of it, but I was thrilled just knowing that it was on the menu. Here's Shelley excited about her upcoming eggs Florentine.

Well, I guess I assumed too much about Livingston - turns out it's really quite a hip hop happenin' place (filming homebase for A River Runs Through It, etc.) It's also the place where the Yellowstone River (translated from the French Roche Jaune),
the longest free-flowing/undammed river in the country, has its Big Bend, and where Lewis and Clark and Sacajawea (whose statue we found in the park after much searching - but it was worth it!) came through on their historic river trip.

I napped the rest of the way to Yellowstone - except for a brief break to snap a picture of my recently discovered midwestern fetish
(I don't know why, I just love 'em!): cylindrical hay bales - but was wide awake when we passed through the Roosevelt Arch Entrance and were greeted by our first park wildlife!

We spent the rest of the morning and early afternoon driving around the northern loop of the park, enjoying the animal magmatism (pun intended - did you know that Yellowstone is on top of the largest currently active volcano in the world? So the land is, as they say, very magmatic), waterfalls, and stunning vistas.

We took one scenic road that didn't seem to be trafficked by anyone official, so I spent those 6 miles snapping shots from my "safari viewpoint": sitting on top of the car with my legs dangling down through the open sunroof! (don't try this at home)

Finally, as we were thinking of leaving, we came upon the trailhead for the 3.0 mile, 1300 ft rise trip up to the top of Mt. Washburn, elevation 10,000 ft and change. I decided to start hiking up and promised Shelley that I'd turn around after an hour; the sign estimated that it would take 4-5 hrs roundtrip, so I assumed I'd make it about halfway up. I therefore also assumed that I wouldn't need more than my one 20 oz bottle of water, or any food, or any protection other than my hat, sweatshirt, and trusty can of bear spray. Fortunately, or unfortunately, I really hauled up the side of the mountain, and found myself nearing the peak after just an hour of determined hiking! The view was worth it -
I could see the billows of smoke emanating from the big southeastern park fire, and the swath of resulting smokey sky that seemed more than anything to have been smudged by a giant godly thumb. I could also just make out the Grant Teton peaks, 75 miles away!

After a brief stop to document my achievement, I headed back down, thinking that I'd try to jog part of the trail and get back in a total of just 2 hours. My knee started throbbing, and a fuzzy antlered deer grabbed my attention for a bit, but I made it, to my and Shelley's surprise.

The thrill and satisfaction faded, however, when we headed back on the road and my body revolted at my slightly foolish endeavor (you traveled 6 miles over 2600 ft of total elevation in August and gave me how much water? and wore how little sunscreen? and had eaten how much in the last 4 hours? you idiot!), and I thought for a moment that I might have to self-diagnose heat exhaustion and go find the nearest Urgent Clinic. Fortunately, I recovered, and Shelley's insistence that we stop in the town of West Yellowstone for a big salad and pasta dinner, with much water and lemonade rehydration, proved to be the best medicine.

In short, Shelley and I had a fantastic weekend; and I washed (my clothes), I burned (my nose and shoulders a tad, but not as bad as I'd expected), and I scaled Mt. Washburn!

Thursday, August 09, 2007

Getting Into the Groove

After a bustling first two days at the clinic, the last two days have been downright leisurely, nowhere near our 32 patient load on Tuesday. Luckily, the freezer is stocked with all sorts of yummy distractions, so yesterday we amused ourselves with "Fudgcicle 3:30" and today we had "Orange Pushup Noon". Hooray!

Yesterday the one big excitement came first thing in the morning, when a kid walked in with bloody mouth and a tooth in his hand. Teeth really are kind of like glaciers, or people - there's much more to be found under the surface if you look - the kid's whole tooth with the root was about an inch long! (If that doesn't seem like a lot to you, look at the first joint of your thumb, and imagine a tooth that big) The poor kid was freaking out, which meant that his mom and dad were freaking out, and although I was really interested to see how we were going to handle the situation, I have to confess that while standing in the room I suddenly felt myself getting lightheaded and nauseous... I almost had a vasovagal (fainted)! It brought back "fond" memories of my first forays into the operating room as a third-year med student, when I had to break scrub to make a quick escape on two occasions so as not to fall or vomit onto the patient. How embarrassing for someone who claims to love blood. Sigh. Luckily, we (and by we, I mean those who were not leaning against the bathroom sink in a cold sweat) were able to put his tooth back into its socket and send the family off for a visit to the dental surgeon (fyi - if a tooth falls out, the best way to save it is to soak it in milk or saliva until it can be reinstalled).

The other unusual case yesterday involved bear spray. As I mentioned previously, this is bear country. Hikers and other outdoor adventurists are therefore advised to carry along bear spray in the unlikely (but not impossible) event of a bear attack. Now, here's the important thing to know: bear spray is NOT like bug spray. To keep away bugs, you apply bug spray to yourself. However, bear spray is just a really really strong version of pepper spray, so you do NOT want to apply this to yourself - you want to apply it to the bear! Apparently, there are periodic cases of people coming into the clinic who did not understand this distinction... d'oh! Likewise, in these parts, bar brawls don't necessarily end in shootouts or stabbings; on Monday night, at a local Big Sky pub, there was one such brawl, and it ended when the inciting bozo sprayed a can of bear spray at his opponent. Ouch! Yesterday we saw the bartender, who had been trying to break up the fight when he walked into a cloud of the offensive stuff. Luckily, he was doing fine, much better than the time a few years ago when he was sleeping and his dog chewed off the top of the bear spray can lying next to him, unloading the whole thing right in his face...

Fortunately, I have yet to see a bear, though I did see a bighorn sheep having dinner by the side of the road on my way home yesterday. (not my picture - I couldn't get to my camera - but I promise this is what it looked like) Dr. Daniels let me borrow his bright orange mountain bike for the time being, so I tried biking the 4 mile uphill stretch to the clinic this morning. Part of the trip included a wooded trail along a creek, and even though it was close to the road, I was still a wee bit concerned that a bear might be lumbering across my path to catch a morning swim...I therefore followed the 'make noise to ward off bears' recommendation...so there I was, biking along a somewhat precarious mountain path about 25 feet from the edge of the road, singing "Louie, Louie" (the first song that came to mind) as loudly as my non-altitude-conditioned lungs would allow.

Tuesday, August 07, 2007

Bedbugs and Chainsaws and Bears...Oh My!

My first few days in Big Sky have been...well, the opposite of boring. I woke up on Sunday at the crack of...uh, 8:30am, and waited for Dr. Daniels, the head doc at the clinic and my new next door neighbor, to come by for an orientation as promised. I guess I'd imagined that he'd show up bright and early, because I thought I might have to work that day - but when he finally showed up nearing upon noon, I discovered that I not only had the day off (woohoo!) but that the clinic opens daily at the highly manageable hour of 10am, in part so that everyone working there can get in their beauty's rest and morning run. What a life!

P.S. Yesterday I mentioned the Gallatin River, which winds like a beautiful shimmering diamond belt all along the highway from Yellowstone through Big Sky and north to Bozeman (see below) - ironically, my new home, located on "Riverview Lane", appears to be the *only* spot in a 50 mile radius that *doesn't* have a view of the Gallatin River! Go figure.

On the downside, when I asked about nearby running/biking trails, I was cautioned to watch out for grizzly bears and moose, both of which live in the area and "will easily tear you to shreds". Oh yeah, and there's also been a black bear loitering on our very property over the last few weeks. Greaaaat... Some people have a bad hair day; I definitely don't want to be one of the unfortunate to have a bad bear day!

After Dr. Daniels left me trembling (with joy at my day off, and with fear at the prospect of encountering a bear up close and personal), I took advantage of the free time and headed up to Bozeman, the nearest city. If, like me, you happen to be the kind of person who rates new cities by their density of bookstores and coffeeshops, then you, like I, would agree that Bozeman rocks! It's a college town (University of Montana site) that becomes a haven for ski bums every winter, and it's got a bit of an outdoorsy, hip vibe - intermixed with an indescribable Montana vibe. I walked down Main St. and popped into any open stores to grab their free local magazines and newspapers, and then read through the entire stack while I ate lunch. It was here that I found out about all of the fun and exciting goings on in this area right now; for example, the Manhattan Potato Festival!! Manhattan *Montana*, that is.

I had a blissful time shopping at the enormous, fabulous community co-op in downtown Bozeman (the fresh feta! the organic basil! the homemade carrot-ginger soup!) and then got back on the road south to Big Sky, ready to enjoy the peaceful scenery. But...nature wasn't in a peaceful mood, and as the sky darkened to a deep, indigo blue, and long forks of lightning streaked over the mountains on the horizon, I wondered if it was a problem that I was about to enter the patch of road they call "the canyon", a strip of about 10 miles that has no cellphone reception and little place to pull over. Soon enough, the rain started pouring over my car. And I mean *pouring* - I could not see more than 2 inches in any direction, and it occurred to me that this looked more like a blizzard than a rainstorm. Sheesh. As if in response to my wintry thoughts, the sky started sending down some token pea-size hail in addition to the continued sheets of water. I couldn't really pull over, so I just put on my hazard lights, came to a full stop in the middle of the road, and prayed that some crazy truckdriver didn't think he was macho enough to barrel through this crazy storm.

A few minutes later, the rain subsided, and just as my windshield wipers started squeaking a rainless protest, I turned them off, and turned the next corner, and saw...

the most beautiful rainbow shimmering against the trees! It was complete, from ground to ground, and I was tempted to go looking for the pot of gold or to try to go over and jump into it, but I resisted. Rainbows like this just don't seem to exist in the Northeast - the last time I saw a rainbow like this was in South Dakota last year. Maybe there's something in the water around here.

Ok, so now that you've read all about my various little adventures, you're probably wondering: so how's the clinic, that whole reason you came out here in the first place? Ok ok, I'll tell you: it's so much fun! As I mentioned earlier, we don't start til 10am, but then we go nonstop til about 5-5:30. I barely have time to grab lunch! The patient population is split between locals, tourists, and the construction workers making all of the houses and hotels that the locals and tourists live in. So we get a lot of tourist issues (colds, ear infections, a case of hottub folliculitis today), as well as all sorts of interesting outdoor adventure accidents (the guy yesterday who fell off his horse and broke a rib, along with the usual sprains, strains, and scrapes). Today was a crazy busy day, full of weird rashes, a chainsaw accident, and a case of the bedbugs! Yes, they actually do bite! Fortunately, the guy whose chainsaw got the best of his knee wasn't too badly hurt, and he was nice and patient enough to let me do most of the suturing (22 sutures! he asked me to count them so he could tell his grandson how many he'd goten) to put the skin of his knee back together again. It's so rewarding to have these people come in torn up and hurting badly, only to leave a short time later all sewn up, painfree, and full of gratitude for what we were able to do to help them. It's a *very* different feel than my hospital rotations, where I felt that people would come in and languish while we sort of patched things up well enough to send them home, by which time they often developed a nosocomial infection or other problems that they didn't have when they came in.

So, that's all for now - I'm having lots of fun being back on the clinical side of medicine after my year of research - I'll admit it, I'm a sucker for immediate gratification - and this is an amazing learning opportunity. Dr. Daniels has a huge library of "interesting chest Xray cases" that he's been showing us - oh, and by "us" I mean me and the other visitor here this month, an awesome emergency medicine resident who is also a great teacher and is more than happy to let me do *all* of the suturing we encounter (she's sick of it by now). So I should be an experienced seamstress by the end of the month. More soon!

Sunday, August 05, 2007

Over the River and Through the Woods...

Thrice. Literally. This time last weekend I was driving back over the Delaware River and through the forested hills of the Water Gap area after a most relaxing and nourishing birthday weekend at Earthgate with 20 marvelous people, friends old and new. We'd swum, hottubbed (putting the optional into "clothing optional"), eaten lots of cob corn and other veggies, slept,

yoga posed, made new friends (each other), made music, had enthralling conversations , learned from each other, hiked/jogged to a lush waterfall, and in general, had a grand old time doing mostly nothing.

Then, it was off to Kansas City, over an even BIGGER river (the Mississippi, of course), for the annual family medicine conference for students and residents. This should have been my second time attending, but some of you may know of my mishap a few years ago, when, en route to the conference on my birthday, I missed my connection in DC, decided it wasn't worth the trouble to stay overnight and continue on only to catch the tail end of the conference, and instead had an impromptu birthday party in Dulles airport with some DC friends kind enough to trek out to join me, before flying right back to CT before nightfall.

Luckily, I was successful in my second attempt to attend, and had an absolutely outstanding time with my 4 other fellow Yalies passionate enough to go into family medicine despite a school environment that is not entirely excited about our choice. After four years of having to justify our career choice over and over and over again to classmates and teachers, it was SO exciting (and what a relief!) to suddenly find ourselves surrounded by hundreds of amazing, interesting, fantastic people all equally passionate about the difference we'll make in the world as family physicians! It was like living in a foreign country for years, and finally coming home to your own kind again, people who speak your language and totally 'get' you.

On the downside, there were so many cool people and programs, that I found myself nearly overwhelmed by the opportunities! Out of over 300 potential training programs, I am proud to announce that I have successfully narrowed it down to...

30 different programs in 14 different states. Oy.
So, if you're reading this and you know me, please let me know your vote for where you'd most like to visit me over the next three years: Arizona, California (northern or southern), Colorado, Connecticut, Massachusetts, Minnesota, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Virginia, Washington (state), or Wisconsin.

One of the states not on this list, Montana, was in fact my next and final destination for the rest of the month. Well, not exactly my "next" destination - on Saturday morning I left the downtown Marriott in Kansas City at 4:30am, and after 1500 miles of travel by taxi, plane, and car - with stops in Denver, Salt Lake City, Idaho Falls, and West Yellowstone - I finally arrived in Big Sky, Montana!

The backstory: After my co-conspirator Allison and I passed through here on our "White Coats to West Coast" 21-day, 7600 mile cross-country roadtrip last June, I vowed to return to what I consider to be among the most beautiful places in our entire country. Then, a few months ago, while browsing on the internet for interesting elective medical rotation opportunities, I came across the Big Sky Medical Clinic . I applied on the spot, got accepted the next day, and before you know it, I found myself driving along the Gallatin River, through Yellowstone (over the river, etc...), and up a gravel road to the "guesthouse", my new home for the next 3 weeks.

I don't get cell reception or wireless at the guesthouse itself, but we do have a wonderful shower, satellite TV, and...well, the view's not too bad...!