I met Jeffrey when he came to the rural emergency department where I’ve been assigned this month. Restless in one of the small unit’s three acute beds, I quickly noticed the large abscess over his left elbow that had brought him to our door. The pain was apparent, the fear only slightly less so. With no CT or ultrasound, much less the MRI he’d ultimately require, the decision was quickly made to transfer Jeffrey to the larger hospital an hour up the road, where half an hour in a whirring machine would eventually show the bacteria that had invaded his joint and bone.
We chatted for a few brief minutes — about the drug use that had led him to this point, the depression he found himself sinking more deeply into by the day — the same topics, really, that we’ve come accustomed to with the victims of addiction we see all too often. Before the night drew on much longer, Jeffrey had been whisked off by the critical access hospital’s dedicated transfer unit.
After four exciting and challenging weeks at one of the nation’s leading emergency medicine centers, my school has shipped me off to a small community in rural Pennsylvania. The experience, in the two short weeks I’ve been here, has been unlike any other rotation of medical school. I awake each morning to a low-lying mist that conceals the mountaintops on either side of this tiny town. The hospital — no more than a mile down the road — requires me to pass through the town’s only stoplight, which is unfailingly red when I pull up to the white line. I find myself in little time, however, in the parking lot of the small complex nestled into the side of the southern mountain.
I spend most of my days seeing patients in a two-room clinic across the gravel road from the ED. When an ambulance rumbles by or my pager sounds, I hurry next door to start the workup while my attending makes his way in or begins charting. Our catchment area has no more than a few thousand potential patients and a yearly ED census somewhere in the high triple digits, and I’ve quickly come to know many of the residents of this small and tight-knit town. Patients I see in morning clinic wave from their porches as I pass on my evening runs. The nurse who helped me fix a bleeding PICC on Tuesday is the one who slides me a sweating drink from behind the bar on Wednesday. Jeffrey, freshly returned from a weeklong inpatient stay two towns over, flags me down at the gas station to show me how well he’s doing.
Where I’d been initially hesitant about this mandatory month far from home, my experience so far in rural emergency medicine has been an eye-opening opportunity. I’ve taught basic skills to the borough’s fledgling rescue squad, and roared off into the night with the volunteers in their incongruously well-appointed ambulance. I bumped down abandoned dirt roads in the forgotten hours of the morning, and I’ve stabilized patients in the back of the rig and been able to then continue their care in the emergency department. With no imaging, consults, or backup, I’ve learned volumes from the emergency physicians who staff this medical outpost.
Two more weeks to go until I pack up the car and head back to Philadelphia for another month in a mecca of emergency medicine. Until then, each day here in rural America provides another chance to be a part of a hospital so thoroughly interwoven into the surrounding community. Each patient offers another opportunity to witness the special medicine practiced by an emergency physician known and trusted by his patient-neighbors.