Pullin’ Bear

Ever wonder how big game – shot in the vast American wilderness – gets brought all the way back to civilization?

I recently visited a Cabela’s that just opened in our town. For the uninitiated, Cabela’s is easily the most expansive and comprehensive hunting, fishing, outdoor-gear store on Planet Earth.  They’re basically a small city with a roof.  Along with every gear component you can imagine, they have an eye-popping display of stuffed animals in the center of their store.

By “stuffed” I mean taxidermied.  So we’re talking, real, wild, once-alive animals now stuffed and posed to look alive.  I have stuffed animals all over my house, but none of them ever had teeth or laid claim to primordial carbon.

Personally, I’m not much attracted to killing animals of the natural world, and stuffing them and putting them on a wall isn’t very interesting to me, either.  In general, this city boy thinks of taxidermy as nothing more than bald carnivorism on guiltless parade.  Who ever thought the severed head of a deer, garrishly hung from a wall, would serve as decoration?  Isn’t some version of humility or mourning in order for this kind of thing?  If I were a taxidermist, I would recreate the entire scene, complete with twisted, exposed entrails, horrid death-grimace, contorted body and spattered blood in wide, fan-shaped arrays.  And every display would always include the GUN that did the dirty work.

Anyway, these guys have HUGE bears stuffed and in fierce poses with claws bared.  This includes a real polar bear, over 8 feet tall.  Somebody killed a freaking polar bear! I thought we just studied those things.  Staring up at that ginormous carcass, I wondered first where the hapless thing had been shot (heart?  head? gi tract, perhaps?), then ruminated on the ethics of such an action, then wondered how the freaking hell they carried an object that huge out of the woods and into my Cabela’s.

Today I saw a patient with back strain who encountered a similar problem.

“Hurt my back.”

“Oh?”  I replied, trying very hard to be interested in yet another low-back pain problem.

“Pulling a bear out of Porter Crick.”

I looked up, interested without trying now.  “Like, a bear? You mean with claws and fur and omnivorous urgings and the hibernation thing?  That kind of bear?”

“Yep.  Reared up while we were deer-hunting.  Stood about 6 feet.  Took him down with one clean shot.”

“Holy crap!”  Oops.  Professional, professional.  Be PROFESSIONAL, stuipd!  “Jeez, how’d you get him out of there?  And, on a non-medical note…were you a little worried about getting your face swiped off?”

“Yeagh.  Poor bastard was coming right for me.  About 50 feet off.  He had a bee up his arse for some reason.”

“So, once he was down, what did you do.”

“Me and Jake field dressed ‘im,”  I nodded approvingly at this…I can only imagine what the heck it really is…maybe try wikipedia later.  “Then we dug some motorcycle straps outta our packs and pulled the critter by his paws.”

“You pulled him by straps from his paws,” I repeated, acting normal but thinking of No Country For Old Men. “How far?”

“‘Bout 8 miles.  Through brush and trees.  Plus our guns and packs and all.  Bear was about 400 lbs.”

“Good GOD, man.”

“Yep.  Well, whadda ya gonna do for my back, doc?”

“Pretty much nothing, dude!  Anybody carrying a 400 lb. bear out of the backcountry is going to have back pain.  And I doubt you’ll listen to me telling you to rest it, right?”

“Wahl I was only comin’ in today because we leave for some elk hunting in Idaho in 2 days and I wondered if you could give me something to help with the pain before I go.”

“If you want to stand across the room, I’ll shoot you with one of those tranquilizers they shoot into elephants on the nature channel.  That might make you woozy, though.  It might affect your ability to shoot safely.”

“Nevermind, then.  I’ll be fine.  Just checkin’ in, doc.”

100 Years Old

I suppose the title of this entry could just as easily refer to a patient who reached a century of life, but I’m actually musing on the centenarian building where I’m working this month.

I’m sentimental.  I love history – loved it more than biology in undergrad.  So a building like this place carries whispers of the past into my psyche every day I arrive.  I bask in a steady breeze of stories – known and unknown – each day when I walk through the back door.  New Yorkers often explain the love of their city by describing the enormous number of engaging cultural things available to do…even if they never do them.  This building offers the same thing, but in the currency of stories.

You could spend months here just learning about all the things this building has seen.  You can ponder the tree stump near the front door where a guy blew himself up with dynamite while his wife was inside for an appointment.  Or think about the years when the building served as the town’s hospital, complete with an ER, lab, mortuary and second floor (since removed).  Also drifting through the single hall and 4 exam rooms are the ghosts of the doctors who pioneered the practice, and the dogged support staff that kept this place running through years of desolation, poverty, isolation and depression.  This building survived storms, heat, wind, rain and over a hundred hunting seasons.

Consider the relative youth of even the oldest parts of our culture:  We’re tykes on the world stage.  The oldest American culture – Native American – has been essentially glossed and veneered over by our exuberant European ancestors so that our main cultural heritage in America references the late 1700’s.  I suppose if you’re really trying to push the date back, you could reference 1492 and Columbus, but really, the American Experiment started in 1776.  This makes us babies among world cultures.  Embryos, practically.

So a building like this is one of the few material references to times and people long dead or moved away.  We are a transient culture, and our history is still too new to be truly memorable.  We need a good couple thousand more years to really figure out who we are, what we’re about.  Until then, some of us hold on to places like this: a lonely building filled to the weakening rafters with wisdom, loss and joy.

(At left: the earstwhile “pharmacy”, also a kitchen and occasional birthing room – now where pharm samples are kept)

Things You Learn in the Sticks

Well, I’m not really in ‘the sticks’.  But I am spending the next month in a rural town – population approx 2210 including cats and cows – at a small family medicine practice.  The people I’ve met this week are kind, interesting and usually more polite than I’m used to in “The City” (population 98,000).

Here are a couple eye-opening things I’ve learned so far:

1.) Remedy for croup –

Slather “grease” of some kind (I imagined Crisco…but I’m sure it’s often something closer to the barnyard for people who actually do this) onto a bandanna  Then pour turpentine onto the grease and fold the bandanna on itself until it is approximately the width of the child’s throat.  Put the folded bandanna into the oven  and heat that baby up until the grease melts into the bandanna.  Then put it on the child’s throat (once it’s cooled down a bit, of course).

“That bark’ll be gone by mornin’.”

2.)  Goats with 3 testicles are not uncommon –

The addition of another male sex organ increases, you might guess, the goat’s virility.  He sorta rules the barnyard.  These particular specimen of masculinity are constantly looking for mating opportunities.  One thing you might NOT have suspected is that they often urinate on their own heads.  Nobody really knows why, and I’m sure less-endowed sheep do this on occasion, too.  But you see it often with the tri-testicle guys the most.  They have a remarkable way of contorting their bodies so that they can position their head just under the “stream”, and give themselves a golden shower, as it were. 

I should add that they also have the uncanny ability to, uh, service themselves.  Nice.  I knew some kids when I was a teenager that would have gladly given at least one of their limbs for this particular talent.  Honestly, upon hearing this, I felt a little jealous on behalf of my buddy Mike, who once promised me that if he could achieve what apparently these goats do with ease, he’d never leave his house again.  Mike, wherever you are, don’t give up!  It can be done! 

How all this came up in the middle of a family medicine visit, I’m not quite sure.  Especially such intimate details of the life of an anatomically-gifted (cursed?) barnyard goat.  But this is the kind of thing that comes up when you’re a family doc in rural America.  Today, I’m much more prepared.  I hope.

Why No Doctors in Them Thar Hills?

‘Cause there ain’t no money for ’em…that’s why.

By ‘hills’ I’m implying rural America, and unfortunately, most people living there pay for doctors through medicare.  As I’m sure you’ve heard, this lovely Guv program pays less than cost in many circumstances, which is a great primer for how to go bankrupt, but isn’t a good way to keep doctors around.

In general, there are many doctors who would gladly forgo the demand for actual dollars as compensation for their years of training and constant hard work.  American history is full of examples of small-town country docs accepting cremed marmelade and a basket of Emu eggs as payment for little Dirk’s delivery and circumcision.  Those days are disappearing, of course.  The reason for it is actually quite simple:  Medical training today costs close to 8 yearly incomes of an average middle-class American family.  In rural areas, where most families are hovering at the poverty line, training a doctor would cost roughly (emphasis on rough) the entire yearly salary of 3 low-income rural families for 8 solid years.

Few can afford this, of course.  Especially altruistic types, who tend to be broke in the first place.  So would-be doctors these days go into debt for the money.

And then the banks come callin’…and they aren’t happy with 3 chickens and a haircut every month for the next 40 years.  They want cash.  Bear in mind that Uncle Ebeneezer will at no time recognize concepts like “quaint Americana” or the notion of “civic duty”.  Civic duty to your average banker consists of leaving only one desk light on at night…the one illuminating the stunning windfall of interest payments soon to be arriving from the hapless big-hearted doc in Flish, SD.

“But!”  Our wise Guv exclaims, “Let’s institute loan repayment program! We’ll make it available to doctors who are willing to work in areas we will designate as ‘under-served’.  We’ll offer HUGE sums of loan-repayment money.  Something like $20,000!  Who can resist that?”

Great idea.  Except that every great idea from government has to be governmented, which then quickly turns it into a really stupid idea.  Governmenting.  It’s my new invention.  I’ve transmorgified a noun into a verb.  Since it’s my invention, I get to define it: 

Governmenting, v. – The act of taking a perfectly reasonable idea that could benefit vast swaths of Americans, endorsing it, and then subjecting it to a kaleidescopic array of regulations, bizarre armchair ethics, vague definitions and hyper-polysyllabic word definitions such that the initial idea is not only forgotten but dwindles into laughable obsolescence.

Yes, the Guv offers an average of $20,000 per year of loan repayment.  Sounds fantastic, right?  Except that the average doc owes $250,000.  “Quit complaining, you brat!”  You might exclaim, “It’s pretty good money even if it’ll take you awhile to pay off the loans.”

Actually, that’s true.  Some people work an entire year just to pull in around $20,000.  In fact, docs are still occasionally heading for the hills with just this argument ringing in their ears.  As he drives down dusty I-90 toward the incomprehensibly-named “Crow Agency” Montana (leave it to the Guv to name a town an agency), young Dr. SW thinks to himself, “Hmmm.  250k divided by 20k equals 12.5 years.  Working out here brings me substantially less in yearly salary, so that 20k will be all I can contribute to my loans.  But 12 years.  That ain’t bad.  I can take it.  Nice view, after all.

But here’s the problem…the REAL problem with Governmental loan repayment programs.  It’s very simple.

The repayment is taxed.

The English language is too limited to describe the stupidity of this.  The same entity that gives the money takes it right back before the hapless doc – standing in his new Wrangler jeans at the bean-mash and Chevy show – actually gets to pay those loans.  And the entitiy who paid the loan doesn’t think of themselves as the same as the entity who is doing the re-taking so they often don’t even mention this taxation concept to docs before they sign their contracts.

To someone’s credit (no idea who), they’re coming clean recently about the taxation issue, inserting a disclaimer into their recruiting material.  Jammed forgettably into the back of the glossy packet I received extolling the virtue and adventure of working on the frontier, was this:

Participants in the LRP (loan repayment) will be paid up to $20,000 per year for signing a 2-year LRP contract and agreeing to serve full-time clinical practice at a designated Indian health program priority site in the United States.

It should be noted that LRP benefits have been ruled to be subject to FICA (social security) taxes.  This means that 7.65% of the loan repayment amount will be withheld and sent to the SS Administration.  Additionally, 20% of the LRP contract amount will be sent directly to the Internal Revenue Service to assist in paying the additional income taxes incurred as a result of participating in LRP.

This means nearly 30% of a doctor’s loan repayment grant is re-taken before it can be applied to the actual loan.  And remember, the base salary of rural docs is significantly lower than that of city counterparts, so the grant repayment is important.

The system needs repairs on many levels.  Universities need to charge less (maybe landscape less or something).  Banks need to make funds available at less profit.  Training needs to be shorter – everywhere else in the world, doctor training is 6 years after high school and then residency.  In the U.S. the training takes 8.  And a big part of the solution needs to be Government programs that are genuinely viable, moral and rational.  The current system tricks doctors into taking low-paying jobs in distant lands and traps them there by helping them with much less of their loans than they expected.

There’s lots of things that need fixing, but one of the first should be to stop all the governmenting.