I'm taking some time away from my practice. I'm going to spend some sabbatical time doing full-time locums starting in January. This isn't really a new development. I've been doing part-time locums since this past August when I had my first shift away from my current practice in 19 years at the tiny, charming Clarendon Memorial Hospital in Manning, SC. I'm just taking it to a new level now.
People (especially doctors) are a little taken aback when I talk or write about it. I've been in the same stable group, after all, for two decades. Why would I want to change that? Why mess with a good thing in a world of shifting contracts and uncertain futures?
Well, it isn't that I have any particular problem, and it isn't that I have run afoul of the group or the hospital. It certainly isn't that I can't make a living here, and it's not some sort of nervous disorder.
What is it? I think it's mostly wanderlust. I really want a change of pace and a change of scenery. No, let me rephrase: I need them. Sometimes our hallways and rooms feel like a Habitrail, and I feel very gerbilly. Maybe I also want a change of patients. We see 40,000 per year in a county of 60,000. The faces (and other parts) are starting to look the same.
Maybe I'm a little ADD. That's a reasonable answer to everything these days, isn't it? Or maybe I'm a little PTSD; I've seen too many people I know and love get very ill and die, or almost die, in the hallowed rooms of our little 20-bed department.
Of course, some of it may be control. The older I get, the more I like to be in control of my life, my schedule; everything, and for better or worse, the more I rail against authority. So if I'm the only employee or partner I have to worry about, then I can go when, where, and as often (or seldom) as I can reasonably afford while still supporting my family. That is, don't want to work a holiday? I don't have to work the holiday. Want to work two weeks in a row and have two weeks, or a month, off? Easy as pie. That's appealing, I can tell you.
It could be, on the other hand, that I'm old and lazy. As I write this, I'm getting ready to go out west to a small hospital for three shifts, 24 hours each. I may not make as much per hour as I would here, but I'll be paid for every hour (asleep or awake), and I'll be seeing about 15 patients each day. I saw 15 patients in my ED yesterday morning in the first three hours. I'm planning to use my spare time to write, read, and regroup.
I'm going off to see what it's like to work smarter, not harder. It's really the kind of thing doctors do when they slide from clinical care to administration, a different way of making money that fits their life, their health, and their emotions a little better than the endless beat-down of the modern department.
The downside? Being away from my lovely wife and amazing children. The upside? When I'm home, I'll be home. Jan tells me that when I come back from locums trips, I'm in a better mood than when I come home from my current practice, that I'm enthusiastic and cheery. If the boss says it, I believe it.
And, because we are those strange creatures called homeschoolers, the family may travel with me sometimes. What a delight that will be! Other times I'll go and then come home, realizing even more keenly how much I love them, appreciation being the reward for absence.
But the other upside is also, ironically, travel. There is a remarkable sense of wonder associated with flying and driving. I watch people when I sit in the airport. I read; I write. I see the vast sweep of America beneath me when I fly, whether it is over green fields of summer corn or the stark white of winter mountains. I read and I write on the airplane, too. And on those rare occasions when I am trapped somewhere by weather or the mechanical failure of an aircraft, I sit back with a cup of tea and enjoy studying humanity.
When I land and get my rental car, I learn new roads, new cities, new restaurants. (And the absolute consistency of every WalMart.) I listen to the radio (especially the country music my kids dislike), and I let my mind wander over the place, back to my family and then down the road again. Last winter, driving in the Midwest, I left the airport in bitter cold and pointed my car west into an ever-increasing snowfall, the gray, endless sky a kind of blanket to me. It was a bit of scenery I knew from my childhood in rainy, snowy, cold West Virginia that I still miss at times. I drove until at last the roads were covered and in the morning, my car iced over so that I had to scrape it clear and stomp my boots in the doorway of the ED.
There are other wonders that come with locums work. There is the way emergency departments and their assorted staff members are part of the same tribe, people with the same genotype. And their patients likewise. At first, I was afraid I couldn't work anywhere else, that I wasn't “good” enough. I was beset with some strange, irrational anxiety over new places. But it turns out that the job is largely the same everywhere we go. And so are the doctors and nurses and medics. In a world of division, what a joy to know that in the ED we are united in so many ways! We fuss at the same rules; we love the same food (chocolate and processed fast food mostly). We are moved by the same tragedies and hardened to the same foolishness.
Locums, whether in the low country of South Carolina with its rivers and beautiful accents, in the heart of the Midwest with its open spaces and practicality, or in the vastness and independence of the Rocky Mountains, is an opportunity to learn once more why I love America, and why I love my job.
It's also more. It's a chance for me to take my years of practice and skill and knowledge to new places. I especially like small, rural hospitals, and this work is a way for me to share my profession with patients in places that have difficulty finding doctors and to be a help to the doctors already doing hard work in remote areas. What an adventure that will be! Who better to do the most with the least resources than an emergency medicine junkie?
What will I do later? Maybe I'll miss consistency and run home to my little hospital, happy to have returned safely. Or maybe, I'll simply keep it up, at least part-time. Something tells me that I won't want to stop. Travel and new experiences sharpen my mind. The best ideas and insights I have for writing frequently emerge in the meditation and reflection of the road. I see better columns and books in my future, thanks to the stimulus of travel.
The uncertainty, in a way, is the wonderful part. After a career so far built on certainties and guarantees, on expectations and rules, the future is a little hazy. I just don't know what will be next. But that's all right. Tennyson said it so well in his poem, “Ulysses:” “I am a part of all that I have met; / Yet all experience is an arch wherethrough / Gleams that untravelled world, whose margin fades / For ever and for ever when I move. / How dull it is to pause, to make an end, / To rust unburnished, not to shine in use! / As though to breathe were life.” I've always loved that poem. Now I get to live it a little.
But what I want you to know is this: it's all right to do something new and different. It's OK if nobody understands why, if nobody else would do it. Sometimes we all need a change and an adventure. Go with it. And you're under no obligation to explain it to anyone other than your loved ones.
If you see me on the road somewhere, at a nurse's station, or stuck in a boarding area, let's talk over a cup of tea because, America, I'm coming to an ED near you!
And while I'll always be anchored with chains of love to my wife, my sons and my daughter, my home, I'm ready to see what else the world holds for this physician, finally willing to make a change instead of simply dreaming about it.
© 2013 by Lippincott Williams & Wilkins
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