Northern spring

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Patterns in the spring ice

There’s a day every spring when you become a runner again. The muscles that atrophied/hypertrophied from a winter of skiing suddenly find their balance. On Saturday I spent too much time watching my footwork over the icy trail around Bass Lake to know what kind of shape I was in. It felt great to be back in the woods, but it was hard to get going when I was spending most of the time trying not to slide off the trail over a cliff or into a sharply cut tree limb. My speed was tempered by the thought of a false step followed by a sharp branch sinking into my side. Sunday however, I ran an old logging road deep into the woods and kept stretching out my stride as the trees flowed past me. I think that all runners share the same yearning for the pounding peace that we get when we’re alone with our thoughts. On Sunday I knew I was a runner again.

I recognized the patient and her husband immediately when I walked in the room but I couldn’t remember where from. I think they were both in their sixties but they looked like they’d lived a rough seventy-plus years. She presented for a COPD exacerbation likely brought on by a viral URI. I spent over half of the visit trying to figure out what and how much medication she was taking. Between the coughing and two of them griping at each other I was having a hard time concentrating on creating a differential beyond the obvious, when suddenly I realized that I’d seen her in October for a similar complaint. At the time, her husband was wearing a “Make America Great” biker t-shirt with a picture of Trump and Clinton on the front and a back that read “If you’re reading this, the bitch fell off.” Swallowing the wave of judgement that washed over me, I finished up the visit and left the room.

My preceptor agreed that the patient was likely suffering from a COPD exacerbation probably brought on by the combination of a viral URI and medication non-adherence. We stepped back into the room to create an action plan and get the patient on a tapered dose of oral prednisone. As I sat on the step of the exam table, my eyelids got heavy and my eyes began to glaze over as the doctor went over patient education. Hey Collin, you need to get more sleep honey. I jerked my head up and looked right into the patient’s eyes. There was something uniquely kind in her voice, and it was evident that she’d paid close attention to my name when I introduced myself. I have to constantly resist the urge to narrate my life as a personal “This American Life” episode. I don’t want to minimize real experiences as teachable moments that lead to understanding between individuals who are good but flawed in different ways. However, I couldn’t help but feel that this moment was another reminder of how most people have a goodness in them and how important it is for me to take the time to find it.

I eased myself back down on the seat of the rowing machine feeling weak and vaguely nauseated. It was my last of 3 sets of 500 meters rowing, 10 pull-ups, and 30 dips. I hadn’t been on a rowing machine for over a year, but I felt obligated to change things up for Jill my workout partner and ER nurse. Five hundred meters is nothing, it takes about a minute and a half if you’re pushing it and no more than a minute and forty five seconds if you’re dogging. At one minute I felt like I was going to barf and twenty seconds later my vision started to tunnel. At 500 meters I dropped the handle and toppled sideways off the erg. Pushing myself to my feet I stumbled towards the mats but had to take a knee in front of the squat rack. Nothing in my body seemed to be working. A couple seconds later I struggled up and over to the mats. I used my last bit of energy to catch myself before hitting my face and twisting over to my back. I didn’t move for 20 minutes or so as Jill castigated me for being a terrible patient with a worried look on her face. All I could think about was my stomach rising and falling with my breath and my heart buzzing in my chest.

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A red pine grove reminiscent of truffula trees

There are some clinic visits that I wish I could film. In the same way that watching Louis CK talk about shitty emotions in his brilliant “of course but maybe” sketch, there’s something cathartic about hearing the truths of others. I’m fortunate enough to receive daily doses of unfiltered honesty, and I can’t imagine a better way to learn about life. It’s exhausting and means that usually when I come home all I want to do is cook, eat, and be alone. I wouldn’t trade it for anything. One of my favorite parts of this job is when patients uproot the narrative I’ve created for them. There’s been a lot of talk lately about blue collar workers and mining, and I’ve developed more than a few of my own prejudices. This past week I met two people who work the Iron Range mines and who blew these prejudices to shit. The first was a 72 year old man with 48 years in the mine. Our conversation was meandering per the usual retired old man visit until he started tearing into Donald Trump’s five draft deferments. You’re probably a Republican he grinned while looking at me, but I’m a Democrat because they work for the common man. They’re not perfect either, he continued as I wondered why he thought I looked like a Republican, but at least the Democrats try to make this world a better place for common people. I couldn’t have said it better myself.

I met my next miner last Wednesday afternoon. Her exhaustion was palpable when I walked into the room. She was a woman in her late 60s who was presenting for a complete physical. When screening for constitutional symptoms, she noted that she had gained a lot of weight over the past year. After a hint of further questioning, she looked up at me from blue eyes heavy with bags and her story came pouring out. She’s worked her entire life driving truck in the mines. Her shifts were recently increased from 8 to 12 hours. She has only one 45 minute break per day and the mine provides a dank mouse infested shack to spend it in. She’s looking forward to summer so she can eat her lunch outside instead of inside her truck. She hates spending time in the shack where the sexism can get overwhelming. Here she paused, I’m sorry I shouldn’t have said that. At first I didn’t understand what she was apologizing for, and then I took her hand and inarticulately muttered that she had nothing to be sorry for. She kept talking.

This is the fourth mine she’s worked for and it’s taken her four mines to realize that they don’t give a shit about the people who work for them. She’s had to take pay cut after pay cut in order to do her part to keep the mine afloat. She knows that her loss of salary is of no real consequence to the inevitable outcome of the mine shutting down. Her face looked drawn and tired. I used to hate the tree huggers who came up from the cities and now I sign every anti-mining petition that I see. I’ve struggled to put food on the table as a single mom working the mines and the first three mines I worked for took every dollar that I put towards retirement. They’re all liars and they don’t care at all about the community or the people who work for them.

Sometimes I meet patients who leave me at a loss for words. They’ve simply lived so much more life than I have, that any advice or consolation I could give seems ridiculous. Maybe someday I’ll have the right words, but last week all I could do was listen.

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Northern sunset

That being said, I won’t shut up if given the right opportunity. A little over a month ago I got a call from a professor at Vermillion Community College asking if I’d give a lecture on STIs to her human sexuality class. As we were hammering out the details, she said that she’d also appreciate if I included a little information about consent while I was at it. She mentioned a few times during our phone conversation that her class had 35 students and was “fun but wild, so I jumped at the offer. What better opportunity to put my money where my mouth was regarding gender and health? I have never worked harder putting together a lecture in my life. I have also never been less satisfied with the lecture that I’d prepared. Knowing what a problem sexual violence and health is, I felt pressure to get it right. The class was multi-racial, mixed gender, and had varying perspectives. They were more engaged than I could have hoped for and they peppered me with difficult but legitimate questions.

It was quickly evident that there’s a huge need for young people to have facilitated conversations about sex where they get facts and aren’t being judged or moralized to. They seemed starved for the conversation, and it was great to hear 18 and 19 year old guys from the south talking openly about consent and asking questions about when things can get murky. The STI talk got a little derailed with a conversation about rabies (one student asked whether viruses kill hosts), but the conversation about consent was open and forthright and it made me realize how ready people are to having that conversation. It was difficult to strike the balance between being humorous, honest, and serious. There was a running joke about about how the goal of my talk was for them to have better sex, but they easily grasped the concept that communication not only leads to a better experience for both parties but decreases the risk of someone experiencing trauma. They then impressively pivoted to talking about trauma when we briefly talked about the letter that Emily Doe read to Brock Turner. I left with frustration and hope. If a group of socially/racially/economically diverse men and women at a local college were this open and receptive to such a hard conversation, we need to be stepping up our engagement in schools across the country.

You guys are working out like girls today, I’m impressed you’re keeping up! I grunted out my thanks to the 60-some year old Amazonian doing burpees to my right. Greg and I had finally made it to Jill’s workout class and we were struggling. Seeing Jill’s no excuses attitude in the gym, I’d spent the past two months avoiding the workout class she teaches. However, when Greg’s wife finished class one night and commented that it was probably too hard for us, we were put on notice. He’s a nurse at the hospital and firefighter with two kids and five years on me, so there was nothing fair about our beer challenge for who could get through the workout easiest. Okay, now down into super-woman! Jill screamed at us. Or super man, said one of the other other women in the class. Today we’re super-women, Greg choked out next to me. Agreed, I groaned the goal is to be super-women today. The older ladies laughed and kept on kicking our asses. It took a few beers and a lot of sauna to begin to feel normal again. Drinking more beer and cooling off on the dock, we were both able to put our aerobic class humiliation behind us.

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