COMMENTARY

Rediscovering the Joy of Practice via a Rocky Mountain Reboot

Melissa Walton-Shirley, MD

Disclosures

August 14, 2019

Last year, I took an 8-day job as a hospital-based locums cardiologist in the Great Northwest because unlike many of my colleagues, I could not skip gleefully into retirement. I had hit the "force quit" button on my career instead of optimally logging out and slowly shutting down. Besides, the pay was great and it was an opportunity to travel—but my greatest motivation was self-preservation. I'd never felt so lost.

My husband Tony and I deplaned in Montana in December 2018. We squinted beneath the blazing sun—a stark contrast to the gray damp Kentucky winter we'd left behind. Billings is a sprawling, sunken city that rests atop an ancient sea bed, bordered by huge copper rim rocks that run on for miles. The "Rims" are an amazing natural platform for viewing the soaring snow-capped peaks of the Rocky Mountains.

We dropped our bags at the hotel and I rushed to the hospital for a short meet-and-greet. It took only 4 minutes to reach the parking lot of the hospital, a fact that would come in handy during the long call nights ahead.

Team Support and the Dreaded EHR

A veritable football team of medical resources awaited me. For the first time in my career, electrophysiology support would be a constant. There were also a coronary artery bypass surgery program, an interventional team, a fantastic imaging specialist, and a host of welcoming nurse practitioners and physician assistants. I would be the consulting general cardiologist, which meant I interpreted mostly echocardiograms but also the occasional stress exam. I would also see critical care patients. 

The cardiology team support was a sharp contrast to my 30-year history in a two-member physician group that frequently transferred patients for higher-level care. This more academic approach included conference rounds each morning at 8 am and again at 4:30 pm. Every single patient case is presented and re-presented daily, with ample time for discussion.  Despite these positives, I dreaded the need to learn a different electronic health record system.  

After 2 confusing hours dabbling in EPIC for the first time, I was  handed the pager for the weekend. I immediately wished that I had started my job at the beginning of a work week when there is more technical support.  Fortunately, a very patient nurse practitioner attached himself to my hip until 5 pm on Saturday (3 hours beyond his customary weekend rounding time). As he turned the corner to leave, I resisted the urge to run after him like an abandoned child.  

Lost and On Call

The hospital is large, and since I'm geographically challenged, I was forced to ask for directions often. Late one evening, someone answered, "I don't know either. I'm new here," so the physician-stranger and I meandered together for a while, commiserating. Finally, I memorized the location of a statue of the Virgin Mary to use as a landmark, but still, like Alice in Wonderland, I seemingly wound up at the bottom of the same stairwell in a different place. The stress of acclimation caused my blood pressure to soar, and I was grateful that I'd had the presence of mind to bring both my blood pressure cuff and extra pills.

The nights were tough, with incessant calls. At most I counted 1 hour and 47 minutes of uninterrupted sleep. Since I had no established rapport with the patients or other providers, I was constantly getting up to see nearly every patient within the hour. On my first trip, I was on call several nights running and soon decided that this schedule wouldn't work for this hypertensive refugee of a retiree who had chosen locums work over antidepressants. The team agreed, and for the next trip out, they added more breaks and support.

Relaxing With Dinosaurs

On our second trip out West, Tony and I toured the Museum of the Rockies in neighboring Bozeman (the best dinosaur and fossil exhibit I've ever seen). We sat by a crackling fire at the Element Hotel and perused a coffee table book by famed western artist Charles Marion Russell. We visited the studio of the gifted sculptor Rod Zullo, whose work is in several permanent collections and includes bronze wolves and dinosaurs. We felt like kids again.

Sculptor Rod Zullo. Courtesy of Melissa Walton-Shirley

I enjoyed being immersed in a busy emergency department; at one point I was awaiting three different aircraft carrying patients with acute coronary syndrome. I came to appreciate how the hospital serves local Native American reservations as well as many remote areas of Montana and Wyoming. Then, as suddenly as it started, the work week was over. Relief was tinged with a heavy dose of disappointment as I felt I were leaving the Disney World of cardiology.

Exterior Museum of the Rockies. Courtesy of Melissa Walton-Shirley

I couldn't face the thought of returning to cleaning closets and manning Swiffers, so I quickly accepted another assignment. I am now approaching my seventh trip to Montana.

This time, I hope to find an opportunity to follow the Yellowstone River and to walk on the tops of the Rims. I want to get lost again in the beauty of the majestic Rocky Mountains and breathe the crisp cool air. But mostly, I can't wait to be part of a care team again. I am anxious to return to the great state of Montana where I refound joy in the practice of medicine. It is also where I vowed that no matter where life takes me, I will never lose that joy again.

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