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Monday Sep 19, 2016

Community Response to Disaster Shows Beauty of Rural Practice

This blog post has nothing to do with evidence-based medicine, health policy or treating disease. It is purely a reflection on the good will I've seen among my patients this summer.  

We have all been in situations where we have struggled to maintain our composure when practicing medicine. We don't always succeed. We lose people we love, we see family members mourn the loss of our patients, we deliver terrible prognoses. But recently, I've found myself holding back tears kindled by respect and awe rather than misfortune.  

This past week, I saw a patient who lost both of her vehicles in the flood that struck West Virginia in June. So many of my patients were affected by the flood I couldn't possibly call to check on each of them. This particular patient struggles with depression and poorly controlled diabetes, but during her visit, she didn't shed any tears about her losses or her skyrocketing sugar. Instead, she told me about a total stranger from another county who gave her a car. A person she had never met and with whom she shared no mutual acquaintances had asked around town looking for an older person who had lost a vehicle, and someone connected them. There were no strings attached. This kind man simply delivered her a working car.

An elderly couple I care for lost everything they owned in the flood. Every single board of their home was swept away. Last week, I saw the wife for a follow-up about a fall she had suffered. Amazingly, she was smiling more than she had in a long while. She said they finally got a new place to live when a trailer was delivered two days earlier. Nearly everything she needed just showed up. Word made its way around the community that the trailer had arrived without a washer and dryer, and she had faith those items would show up, too. Until then, she had no problem doing without. 

This woman had spent almost three months living in a camper, and not once during our frequent meetings had she complained to me. She smiled a lot, but eventually she started to cry as she listed all the wonderful things that people she had never met had done for her family.

I've had multiple patients tell me they were offered assistance, but they redirected that help to someone who needed it more. I stared at these people -- with a dropped jaw, I'm sure -- as they told me their stories. I've seen their losses -- trailers stripped down to the metal chassis with a burned pile of belongings nearby. Yet they somehow feel there are others who lost more and are more deserving of help.

One of the things that drew me to rural medicine was the idealized concept of community, where supposedly everyone knows everyone and things just work out. Recently, I had a patient who needed to be transported to an ER, but like many of my patients, he refused to get in an ambulance. He was afraid he wouldn't have a ride home, so he wouldn't go unless a friend could pick him up from my office and drive him to the hospital. I thought he was stable enough that I could have someone else sit with him while I continued seeing other patients, but I had staff frequently updating me on his status. They would interrupt other visits to tell me his blood pressure, heart rate and the whereabouts of his friend.

Not just one, but two of my other patients stopped talking about themselves during exams and said that it sounded as though someone was really sick and needed to go to the hospital. Both said they would gladly take the patient if needed, even though neither knew who it was. This is not a $5, 15-minute drive. It's an hour one way.

This scenario put me about an hour and a half behind schedule. As I apologized to patients for running late, they all said that they knew I had an emergency and thanked me for seeing them.

I do a lot of home visits, and recently I walked into one patient's home to find six other patients -- none related to that permanent resident -- living there because their homes had been damaged in the flood.

My patients' compassion and willingness to help others doesn't just stop with each other. One day, my cell phone rang while I was in a room with a patient. I apologized, saying I needed to take the call because my husband's car had died on the interstate and I was trying to help him find a towing service. My patient (who was being seen acutely for chest pain) offered to go pick him up. And she meant it. 

Rural family medicine is wonderful because the patients make it that way. 

Kimberly Becher, M.D., practices at a rural federally qualified health center in Clay County, W.Va.

Posted at 10:13PM Sep 19, 2016 by Kimberly Becher, M.D.

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