• Med Student's Rotation Ignites Passion for Rural Care

    For as long as I can remember, I have collected Christmas earrings. My tradition is to wear a different pair every day during December. Some of my gaudy pairs, like Christmas trees made from neon green pipe cleaners, I inherited from my grandmother. Subtler pairs, like dainty snowflakes, have been gifted to me. I also have flashing red bulb earrings that I purchased myself. As a third-year medical student, I continued this tradition while finishing a 12-week rural family medicine rotation in Mountain City, Tenn.

    As a member of the Rural Primary Care Track at East Tennessee State University Quillen College of Medicine, I have spent significant time in this community during my medical school career. This tiny town of 2,500, nestled in the mountains where Virginia, Tennessee and North Carolina collide, is breathtakingly beautiful, especially in the winter. Rolling hills surround the small downtown on all sides. While on rotations, students live right behind the elementary school in a house built in 1901. We feed ourselves by visiting the few restaurants in town or with groceries from the lone grocery store, Food Country.

    Our fearless leader is James Shine, M.D., who has practiced in this small community for more than 20 years. He's one of only a few physicians left in town, along with his partner in practice and wife, Susanne Shine, M.D. There are no obstetricians and no pediatricians. Patients travel 30 minutes to Boone, N.C., to see specialists, and are often airlifted an hour to Johnson City, Tenn., in emergencies.

    My experience in Mountain City solidified my desire to practice rural medicine, and one story in particular highlights the impact of this rotation on my career.

    It is the beginning of December 2017, and on this particular day I am wearing Santa earrings. Santa's face is made of tiny acrylic beads, with many loops of white hanging down for a bushy beard. I am about to meet a patient I will call Brian. He is a 31-year-old man with an intellectual disability whose primary caregiver is his mother, who I will call Gail. Both Brian and Gail have been patients of Dr. Shine's for many years.

    Because of our longitudinal mentorship, Dr. Shine lets me go in the exam room alone and I enter confidently. I've been doing this every day for a while now and I'm beginning to feel like I am actually learning how to think like a doctor. Brian is sitting on the exam table, jovial and excited. He points to my ears and smiles. He likes my earrings. He is here today for a checkup and refills, but Gail also wants to show Dr. Shine an irregular mole on Brian's arm that she's been worried about for the past few months. I take a look, ask questions, perform my physical exam and we chat about the holidays. I know Dr. Shine is with the patient in the next room and is not waiting on me. He is methodical and patient in each visit. He takes his time.

    Back in his office, we chat about Brian -- the updates from his specialists, his preventive health needs and the worrisome skin lesion. Upon looking at it, Dr. Shine decides he'd like to do a punch biopsy of the lesion for further evaluation. It's my lucky day, because Dr. Shine is just going to numb the area and then let me do the biopsy. Then I get to put in some simple sutures to close up the site. In the exam room, Dr. Shine explains the procedure to Brian and his mother. Brian nods his understanding, but he asks if it will hurt. I am nervous, too, as opportunities to truly participate can be few and far between as a medical student. But the procedure passes quicker than I could have anticipated. Brian is calm with Dr. Shine's soothing reassurance throughout. He'll need to return in a week for the removal of the stitches.

    The beauty of a long, community-based rotation means that I am still here to take the sutures out a week later. It's further into to December and my earrings are getting bolder, red stockings with miniature strung lights. Gail tells me that Brian talked about my earrings all the way home last week. I let them know the biopsy was benign, remove the stitches and Brian stands up to hug me.

    It is the first time I feel like I've been a part of someone's care team. The first time I feel like I am participating, rather than trying to stay out of everyone's way. It is a moment I cling to through the rest of my clinical rotations.

    Since that December, I've seen many of my Mountain City patients in the offices of specialists in Johnson City at the hospital where I do the rest of my rotations. To see them again and have them recognize me as a part of the team that that cared for them back in Mountain City has been one of the most special experiences of my time in medical school and a major reason I am searching for rural opportunities in residency.

    The passion I feel now for rural medicine is evidence of the ability of rural clinical experiences to ignite passions and transform careers. I am so grateful to Dr. Shine, who just retired from teaching, but not from practice, this past year. At a celebration of his teaching career, I found myself thinking about not only his impact on the patients of Mountain City, but his impact on patients across the country whose physicians learned under his kind and compassionate eye. I am lucky I will soon be one of them.

    Margaret Miller is the student member of the AAFP Board of Directors.


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