About a year ago when I was sitting in Med Ed 200 listening to the clerkship directors sell the different clinical sites, I decided that I wanted to go to Caribou, Maine, for Family Medicine. I wanted to see during the rotation what it was like to be an old-school country doctor—someone connected to the community who is ready for whatever walks in the door (and ready to walk out the door, if need be). I figured the more rural, the better.
Caribou is located along the northern-most bend of the Aroostook River, about 100 miles northeast of Mt. Katahdin, the northern terminus of the Appalachian Trail. One night I could just make out the aurora borealis from the hill across the river. My preceptor there was Dr. Carl Flynn, who takes care of a large percentage of Aroostook County (an area greater than Connecticut and Rhode Island combined), and coaches high school hockey. He attended medical school in Newfoundland, and has a dog named Scotia. Francophone staff work in his office, which often comes in handy.
With the simplicity of a small town, you get a stark view of the ways illness and disease affect whole groups of people, and the resulting social and financial consequences. You also get to feel like you know a place. I went over to Canada once while I was up there, mostly to see the St. John River and have some poutine. The border patrol asked where I was coming from. “Oh yeah, Flynn’s my doctor. Tell him George with the mustache in Fort Kent says hi. He’ll know who it is.” I was 50 miles from Caribou.
“Continuity of care” gets mentioned a lot in weighing advantages and disadvantages of different specialties. One day, before going into a room Dr. Flynn said: “There are two ways you can give bad news. You can ask them what they know and draw it out delicately, or you can hit them right between the eyes… This one is a right between the eyes.” An older woman was waiting anxiously. She had been a patient for many years and was coming in to learn the results of an abdominal CT scan, which had shown her cancer had spread to the liver. When Dr. Flynn told her, she grimaced, stood up and walked out of the room and down the hallway. When she came back in she thanked Dr. Flynn for “just coming out and telling me. That’s the way I deal with people, and the way I like people to deal with me.” We saw a lot of patients, from newborns to 93 year-olds, and probably fewer ‘worried-well’ than in the Burlington area, but that illustration of what a difference knowing your patients can make will stick with me forever.
*Some details have been changed to protect patient confidentiality.