Clerkship began with sirens, followed by a bang on the door. Our next-door neighbour Bill was on the doorstep. Wide-eyed, his explanation tumbled out:
"People are heading to their muster stations! There's a fire at the plant!"
There was no time for questions before he was off with his dog Ruby in tow, his van squealing out of the empty lot. Robin, my roommate and a fellow med student, and I stared at each other: Where were we living? Were we supposed to be mustering? Should we be worried about the ominous smoke cloud drifting slowly towards us?
I had never been to the Kootenays when I signed up to do my entire third year clerkship in the small town of Trail, BC, so a visit a few months before the move seemed like a good idea. Driving down the steep icy hill, I started to second-guess my choice as the enormous lead smelter came into view. I was leaving the comparative metropolis of Prince George for this? As I walked through the grey streets to the dated hospital building, I questioned the whole "I want to be a rural GP" schtick I'd been so adamant about for years...
Despite these reservations, I was committed to doing my clinical training here and thus began a long and fruitless housing search. Our moving date was imminent when at last the local midwife agreed to rent her 111-year-old AirBnB investment property to us. In a little brown
one-and-a-half storey nestled between two nearly condemned pre-war houses on the edge of the Columbia river, we found ourselves living amidst some of Trail's more colourful characters. After transient years in apartments and residences across the country, I suddenly had a neighbourhood again.
On my second week in town, I met Henry, our 91-year-old neighbour from a few houses down. He had lost his license and seized on the prospect of new drivers to help him with his errands. His voicemails provided a daily dose of humour and normalcy during the turbulence of our first weeks of clerkship:
"Robin. I would like you to take me to Walmart. They have corn on for 37 cents and normally it’s a $1.37! I think I’ll buy a dozen. Or maybe two dozen. I can freeze them, you know.”
And then he forgot to hang up, so the voicemail continued for six minutes.
In addition to providing panic-inducing warnings about smelter fires, our neighbour Bill was always up for conversation, sharing wild stories about the town he'd lived in for over sixty years. Standing in the vacant front lot while our dogs played, he never failed to make us laugh:
"I was out last night at the burned out house up the hill doing security. Y’know, the one that blew up because they were making shatter? Anyways, the neighbours tell me it’s because a turkey exploded in the oven? ‘A turkey?’ I sez, ‘that musta been some turducken!’”
My knowledge of my neighbourhood expands in the months that follow, with a house call to drop off a compression sleeve to patients from family practice. They are an elderly Italian couple with limited mobility, and I find myself marvelling at how they must manage the steep staircases I ascended to reach their house in the upper levels of Trail's terraced streets. Unlike in a larger town, their landscape is my own, and the challenges they must face day-to-day are easier to identify when I see them again in clinic a few weeks later.
The crossover between patient and neighbour continues to blur. We had called Elderly Services a few months prior with neighbourly concerns about Henry's worsening dementia, but hadn't managed to prevent his fall and subsequent hospitalization. One day, I walk into a room for a consult and discover him in the adjacent bed, now my patient's new neighbour.
In December, I am in general surgery clinic assessing a patient for a nagging elective issue that has worsened dramatically since his last consult four year ago. He looks vaguely familiar, but so do a lot of patients. As he rises at the end of the appointment with the surgeon, he turns to me and asks "You live down on Brookview, right? With the little puppy?”. Suddenly it clicks-- he's Bill's friend, who sometimes collects our recycling. He hasn't had his procedure four years after his initial consult because after extensive personal tragedy, he ended up living in poverty in a fifth wheel down the river. It's one thing to accept the effects of social determinants of health intellectually, but to see it in your neighbours renews my passion for advocacy in new ways. At the same time, there are blind spots-- it's only after months of living side by side that we learn our neighbour Bill doesn't have running water.
In our orientation to medical school in Vancouver, we spend a lot of time learning about how to define boundaries. Never tell a patient where you live. Maintain professional distance at all times.
Rural clerkship has taught me how to redefine these boundaries. It would be inhumane to ignore the patient I met on the psych ward when he approaches me downtown. And just like I can't pretend not to know Henry when I see him at the hospital, I also have to acknowledge the existing relationship when I see my preceptor's child in the ED. After respecting the clearcut ethical standards (not acknowledging a patient in public if they don't acknowledge you, not caring for patients with whom you have a personal relationship), rural practice leaves you to navigate the grey zone of neighbour and patient as best you can.
Somehow, it works. And suddenly, halfway through my first year of clinical medicine, in a quintessential Canadian moment, I am at the local hockey game with a quarter of the town in attendance. I look around and spot patients and preceptors throughout the crowd. I’ve made a home here.
By Sarah MacVicar, MSI3
