Ely. We have to write an end of the year essay about our RPAP experience and I’m stumped. What’s Ely? I’ve got no fucking idea. Ely is a picturesque town on surrounded by iron black waters and pristine wilderness. Ely is Dees Bar and The Steakhouse, sad drunk dirty fun backwards wild and untamed. Ely is normal life and an escape from normal life. Ely is pride and desperation. Ely is winter, cold, gray, and dark. Ely is winter, quiet, magical, and endless. It’s a small town where you make friends at the laundromat. In Ely you go to high school sports games and church fundraisers no matter how old you are or what you believe in. It’s a waxing and waning town where pride, boredom, resentment, dependency, and excitement all blend into each other. Ely is a jacked up coal rolling pickup with NRA bumper stickers rumbling down Sheridan Street. Ely is a silent lake pierced by the haunting cry of a Minnesota loon.
To work as a doctor in Ely means personal medicine. Ely is medicine at its finest and medicine at its dirtiest. Being a doctor in Ely means really knowing everyone in the grocery store and figuring how much brain to turn on and off. Working in Ely has meant balancing personal and professional life in a way I’ve never had to think about before. Living in a place, spending time in patient’s homes, drinking with them at the bars, coaching their children, and eating soup and cornbread next to them at church fundraisers all changes the practice of medicine. In Ely patients become people.
In Ely I watched as a 92 year old woman was allowed to die. She came into the clinic in severe respiratory failure brought on by yet another bout of pneumonia. The on call doctor knew her well. We stabilized her in the ED and talked to her family as she continued to deteriorate. She’d known her doctor for years and had made her wishes known. She wanted no lifesaving treatment. She wanted to die peacefully when her time came. It took less than an hour to find a Catholic priest, start treating her pain, and bring in the rest of her family. The intimate relationship between the physician, the patient, and her family alleviated the guilt associated with deciding not to institute lifesaving treatment.
As I brought in lozenges so that this woman’s family could keep her lips moist as she struggled through her final breaths, I thought about the first patient I ever saw die. Ten months ago I met a sharp 92 year old woman who was admitted to Abbot Northwestern in respiratory failure. We became friends and yet I stood by as she spent over a week in the ICU being poked, prodded, and breathed into. Ely is a place that can teach you how medicine is human, about humans for humans and practiced by humans.
Ely means walking out to your car after work to see a red pickup drive slowly past your bumper stickers. It means balling up your fist as the pickup swings around the parking lot to pull up next to you. I recognized the man who got out of the truck as a patient I saw in clinic two months before. He was a taciturn woodsman in his fifties with no medical history, no medications and a stomach ache that wouldn’t go away. His history didn’t add up so I moved on to the physical exam where I heard crackles in all lung fields on pulmonary ascultation and a musical holosystolic cardiac murmur that increased at the apex with no radiation to the carotids. He had open heart surgery the next week and I hadn’t seen him until just then as he pulled up his shirt to show me the scar running down his chest. I felt like a jackass.
Ely is driving to work past the “Make Ely Great Again” sign again and again and again until you can’t take it anymore so you rip it down and stuff it in the trash. Ely is white. Poor white liberal white rich white conservative white canoeing white ATV white mining white BWCA white and the lines that cross and entangle these blurry distinctions. Ely is non-white. Ely is Vermillion Community College that specializes in forest service, land management, and law enforcement jobs but recruits young black athletes from the south to come up and play sports knowing full well how hard it is to integrate into this cold white town.
Ely is drinking fresh coffee listening to the birds wake up in the woods and wondering what it is that drives some of us to fight against the welfare of others. Ely is listening to MPR as you make your morning bowl of Crappola and plain whole milk yogurt and feeling a dark wave of sadness wash over me. It only takes five minutes to hear about how GOP senators are fighting to slash Medicaid funding which provides healthcare for the poor, the disabled, and children. That’s a fucking joke right? It’s gotta be a fucking joke.
Ely is rage. There’s a rage brewing in our world right now, a rage that I’ve never before had to engage with on the level that I do in Ely. I may not have been born with a silver spoon, but no doubt I was born with a locally sourced and functionally generic spoon purchased so that my parents could spend their money taking my brother and I traveling around the world. I’m beyond privileged. I know that there are people of every skin color and gender that suffer and lack opportunities, but that’s no excuse for bigotry. We live in a time of skyrocketing wealth, massive income inequalities, and technology that encourages us to want everything. Couple that with the fact that this same technology is changing how we see and communicate about racial and gendered oppression that is cemented in hundreds of years of history and we have a powder keg of discontent on the verge of exploding.
Ely sits firmly on the center of that powder keg. Don’t get political why do you have to talk politics everything isn’t about race why can’t everyone just not see color why can’t women just be women and men be men why does everyone have to be so politically correct? That’s what usually happens when the conversation veers anywhere other than the basic. On my final drive from Ely down to the “Cities,” I savored the experience of listening to bad country music while watching the sun slowly fall between storm clouds. I needed to turn my brain off for a few hours and drain Ely from my mind.
I began the trip however with a podcast that addressed the questions of what is fact and fiction, and how after so many years of scientific and technological process, there appears to be a strong pushback against the ideal of the scientific method. I love the scientific method. Besides having the opportunity to engage with people on such an intimate level, a renewed appreciation for critical thought and science is what I’m most grateful for in medical school. So this podcast struck a cord with me because whether or not I’m discussing global warming, mining, abortion, or vaccines, I find myself increasingly frustrated by people’s pervasive desire to ignore basic truths and content themselves with the simple statements: “It’s just my opinion,” and “It’s a matter of faith.” The speaker separated opinions into “intrinsic truths” which are facts about which the holder doesn’t care about evidence, and “extrinsic truths” which are facts about which the holder is willing to discuss, debate, and defend. She didn’t offer any grand solution, just the simple strategy of recognizing these differences. I wish I had this framework for some of my discussions in Ely.
At the risk of sounding banal, Ely is what you make it. It’s beautiful and terrible, it’s inspiring and depressing, you can roll with it or try to change it and you can do neither or both. No matter what experience I finish up, I always struggle with the question of whether or not I did it right, this past year being no different. Should I have held my tongue more when race and mining came up? Was I too distracted and unfocused? Should I have carved out more time in the woods? I could answer yes to each question and a thousand more, which quickly renders them all useless. I spent my year in the north woods doing what I did and I’m grateful to have had the opportunity.