In the transition from an urban medical practice to a rural one, I have found that some of my personal habits mark me as a city slicker. Like an ocean fish that does not notice that it breathes salt water until it is taken out of it, I find that I am now conscious of some things that were invisible to me in the city. My sleeping patterns, for example.
I have always been a late riser, and don’t need to be reminded that medicine is a poor fit for a nocturnal personality. I wish I had thought of that going in. When a person weighs career choices, the time the alarm clock goes off in the morning seems a most trivial factor. Ah, but I was fooled! Rolling out of bed at 4 am for a patient in the ER is a punishing task for someone who considers an 8 o’clock waking a burden. For me, nothing that happens before 11 am is free of the fog of sleep. When I shower in the morning I have to pay attention when I wash my hair, or I may in my morning stupor forget what I have done and wash it again. I have reason to believe that I may have washed it as many as 3 times on especially hazy mornings.
Late rising always struck me as a personal weakness, but it was not until I ensconced in McComb that I recognized it as a city habit. The electric light. The 24-hour grocery. The crowded street at midnight. Cities are always going, going, going. The surrounding bustle ensures that a doctor doesn’t feel so strange working at night.
In New Orleans I always did hospital rounds after clinic. This meant sometimes starting in the hospital as late as 7 at night, and rounding until 10 or beyond. My latest time home: 2:30 am. Some argue that morning rounds are advantageous – they allow doctors to check on patients after the long night, and to write orders and plan tests for the coming day. If a patient is admitted to the hospital late at night, the morning rounders catch them first thing in the morning. Any poor sucker assigned to me and admitted at midnight might not see my face until the next evening. (Although, in my defense, if a patient was really sick I would trot over during my lunch break to lend them an eyeball.)
On the other hand, an early rounder misses afternoon admits, which wait until the next morning. My afternooners waited only hours. And I swept the ER before going home at night, meaning only the really late admissions were waiting long. But more importantly, there is simply no doubt that I am faster and better at night. My morning-to-night mistake ratio is probably 3 to 1. Believe me, if I am your doctor, you want to see me at night.
In New Orleans I was not the only late rounder. When I finished rounds and went to my car at 10 o’clock, there were usually several other cars left in the doctor’s parking lot. Not always the same ones, but other ones, nonetheless.
Not in rural Mississippi. Here I get finished at 7 pm and nurses are saying, “Working late, huh?” In my previous life if I got home before 8 my wife would ask me if I had been fired. When I leave the hospital these days, I see one lonely car in the parking lot.
Such is the rural life. We are pretty well modernized here, with plumbing and all I mean, but there is still a culture left over from the days when the milk in the breakfast cereal came from Bessie in the barn. In farm culture everything has to be done in the daylight. When the sun goes down, the thresher is in the barn and the cows have been milked. Even though most people around here are no longer farmers, they have inherited the ethic of the early riser. Almost everything in town is closed after dark, except for the grocery store, a pharmacy, and thank heaven, my exercise club. But I have been up and down my street at midnight and seen lights off at every single house except my own. I feel like an eccentric. Even my wife has taken to turning in at 10:30.
In the city, night and day are just two phases of a continuum, and this is especially true in our fluorescent medical world. I would check on my patients in the ICU at Methodist at 11 pm and the nurses would talk to me as if it were the 10 am coffee break. To them, it was. And this made me feel almost normal, as if I were supposed in a bright room checking the setting on a ventilator while a window few feet away sealed me from a lightless world where crack and money moved in opposite directions, occasionally interrupted by the peal of a 9 millimeter. That was my world. Maybe I shouldn't have been comfortable with it, but I was.
I know the error of my ways. Why should people insist on scurrying about in artificially lighted rooms when there is 12 hours of perfectly good daylight? All the beasts in nature respond to the rhythms of day and night. A doctor is supposed to know the limits of the human machine. What can be accomplished by night that cannot be accomplished as well or better by day?
Well, a lot. On the occasion when I rounded in the AM, I competed with other doctors for charts. Patients were up, going to therapy, going to surgery, going to Xray, going, going, gone – no, not gone THAT way – just hard to find. I would waste precious time wandering around the hospital looking for them. At night, everyone was in bed. Everyone had just completed a day of tests, of therapy, of surgery, and they had stories to tell. Or they were too tired to tell stories, which was just as good for me, since that meant I got home 10 minutes earlier. All peace and quiet, and I had the computers, the staff, the patients, everything to myself.
The night is a little lonely, but when your job involves talking to 50 people a day, this can be a blessing.
As we get older, we tend to get up earlier. Perhaps this is hormones, or our biological clock, or fear that we have forgotten to take out the garbage, or the realization that our time in this world is running out and we are afraid we will miss something. Though instead of looking for something important not to miss, most of us turn on the TV.
For all of my adult life, I have resisted getting up early, but the tug of the old farmer's life may be unmooring me at long last. There is a reason to get back in sync with the world as I know it. As my children get older, they develop regular day-night cycles. If I want to see them awake, I have to be home. In the morning they will be busy getting ready for school, by mid-evening already asleep dreaming of their next day of fun and lessons. If I get home late I only get to see them asleep.
I have a patient here in Mississippi who, every night for the week that I attended him in the hospital, would look at his watch as I came in and say kiddingly, “You have a wife? Not for long if you are still working at 7 o’clock.”
I want to tell him that 7 is nothing compared to my past days. I don’t. I just finish up and hurry home.
A small town is about friends and family. It has to be, because rural life lacks the endless options of the big city. There is nothing to do after dark but be with each other. This is why every small town I have ever been to describes itself as “family-oriented.” It had better be, because “boring-oriented” is the only alternative, and it just doesn’t have that same ring.
The options may be limited, but then again, whether you live in the city or the country, any alternative to friends and family isn’t much comfort anyway. Country folk aren’t fools; they get their work done early so they can go home and cultivate their most important crop -- family life. I can stand to do a little cultivating myself.