Category Archives: resources

Cattleman

–Michael R. Rosmann

Kent raised the manure-splattered tailgate of the livestock trailer to let his cows enter the chute into the Farmers Livestock Auction stockyards. This was the last truckload of his 130 cows that were scheduled to be sold at today’s auction. Most of the red and white cows hurriedly tramped down the sloped chute to reach the more solid footing of the concrete alleyway leading to their pens. There they would wait for prospective buyers to inspect them. Kent was familiar with each animal as she passed and knew all their ear tag numbers and names.

He remembered how he helped Sally give birth to twins in April 2003. Sally’s first calf was coming with one front leg turned backward. Despite Sally’s contractions, Kent pushed the calf ’s head and chest back into her uterus and reached inside to pull up the errant leg. After grasping both front feet, he quickly pulled the wet calf into the outside world. The second calf was less fortunate, for Kent discovered that its umbilical cord had become twisted earlier during its detained emergence.

Wincing from the hollow feeling in his stomach, Kent watched as Belle scrambled down the chute, and he remembered that she had produced the high-selling bull in his annual production sale twice in the past five years. “I’ll miss you.” Then Molly came to the trailer doorway and briefly locked onto his gaze as she gingerly placed one hoof ahead of the other into the chute. They had an eleven-year relationship. “Sorry, old girl.”

When all the cattle were unloaded and chased into their holding pens by the sale hands, Kent visited the auction office to tell the clerks that he had delivered all his cows. With a Styrofoam cup of steaming coffee quivering in his thick hand, Kent headed to the holding pens in the adjoining shed to take a last look at his pets.

. . .

A heavyset neighboring farmer in coveralls lumbered to catch up with Kent
and protested, “Kent, why is that cow bellerin’?”

Kent stopped in his tracks, turned, and responded, “She’s wondering what
she did wrong that she should have to be sold.”
The hefty man momentarily paused and put a hand on Kent’s shoulder. “Yeah,
it’s too bad,” he murmured.

Shivering, Kent struggled to maintain his composure. He remembered the
words of his psychologist whom he had consulted last week for his depression.
“Why don’t you keep a few cows for yourself; they’ll help you maintain your
self-respect.”

(Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

Part of loving rural is the relationship with animals and nature. I have my own relationships with a miniature donkey who has inspired many stories due to his onwry personality, a horse Indy who is a terrific riding partner. An experienced rider told me the relationship with a horse is 60-40. I am the sixty. Sometimes he’s right about the way home or recognizes the hole in the trail I miss. Then there are the cats, precious for the mousing abilities and their willingness to hang out in the garden with me when I weed.

In this selection Kent has to sell his cows due to financial hardship. Dr. Rosmann explores the challenges of depression and access to mental health services in rural areas. Ask questions about the mental health services in your area. Where do patients go for psychiatric help and how long is the wait? Where can patients go for counseling services, for substance abuse assessment and treatment? Often rural providers manage more complex mental health issues because consultants are few and the wait is long.

National Rural Mental Health Association has a journal and other resources.

Advertisements

Responding to the need for high quality emergency care in rural America

–Darrell Carter

Another cold blustery January night in northwestern Minnesota, and you hope everyone stays home and your hospital’s emergency department remains quiet. As the night charge nurse on duty, you are responsible for overseeing the care your night staff (one other RN and an LPN) gives to the twelve inpatients in your twenty-two bed Critical Access Hospital (CAH). These twelve patients include a mother and her hours-old newborn and an eighty-two-year-old female who is two days post-op after a hip pinning and who is exhibiting increased confusion and agitation. You hope to let your on-call doctor get some sleep since she was up much of last night delivering the baby in your nursery. The only other practicing physician in your community is gone for a much-deserved five-day break to Cancun.

 All has remained routine until 1:00 a.m. when the squawk from your ambulance paging radio disturbs your charting. The Basic Life Support ambulance is dispatched to a motor-vehicle-crash involving two vehicles and an unknown number of victims. At least two of the patients sound seriously injured. Reluctantly, you shift your role from more mundane tasks to organizing the team for the soon-to-be-busy emergency department.

 In the twenty-first century, seriously ill or injured patients benefit from a growing amount of advanced technology for diagnosis and treatment of their ailments or injuries. Highly trained specialists are now available to help manage a wide variety of complex conditions, and well-trained and highly skilled teams staff emergency departments. Unfortunately, this is true only in the larger population centers of the United States. Rural health care facilities do not have immediate access to this wide variety of specialists and frequently lack the more advanced equipment needed to diagnose or treat the seriously ill or injured patient. Rural providers frequently lack the organized team, knowledge, and skills to rapidly perform the life-saving procedures and treatments needed by the more seriously ill or injured patients. Extensive distances lengthen the time required to transport patients to specialized urban medical centers for life- or organ-saving procedures. It is little wonder that rural trauma victims have a higher mortality rate than their urban counterparts. In 2004 the Minnesota Statewide Trauma System reported that fewer than 30 percent of all motor vehicle crashes occurred in rural areas, but 70 percent of the fatal crashes are rural.

 There are many obstacles to our delivering the highest and most modern emergency and critical care to rural patients. However, the medical legal standards of care and the general public expect similar care to be delivered in both urban and rural communities. Disparity in the availability of advanced emergency care has adverse consequences. In rural areas, these include: higher rates of trauma deaths, increased burnout among providers, difficulty recruiting staff for existing health care facilities, and an increase in medical-legal risks for practitioners due to the inability to rapidly deliver emergency care or obtain easy consultation for some critically ill or injured patients.

 So what is the solution to this developing crisis in rural medicine? Some recommend more helicopters to rapidly transport the rural patients to urban centers. Others promote equipping rural communities with all the latest equipment, as well as hiring skilled specialists to respond to the infrequent events.  But is society willing to finance the cost of such solutions? Others claim living (and vacationing and driving) in the rural parts of our country is simply more dangerous, so if you elect to live in, or even venture into rural areas, then you need to accept the inherent risks.

(Excerpted from A Night in the Life of a Rural Emergency Care Team and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

Dr. Darrell Carter and his colleagues responded to this need by starting CALS—comprehensive advanced life support.  http://www.calsprogram.org/

This innovative program combines ACLS, PALS, ALSO and ATLS with a rural focus and a team response approach. In the 21st century, many rural areas are filled with innovative ways to respond to the desire of health care providers and patients to provide and receive high quality care.  What is happening in the community where you are rotating?   Please share some innovations on this blog.