Border Doc

IMG_0018Driving to work, I sometimes tune in the Canadian morning news on my car radio. It feels so comfortable to this old Swede to hear the weather forecast with temperatures measured in degrees Celsius – Anders Celsius was a professor of astronomy almost 300 years ago at Sweden’s Uppsala University, my Alma Mater.

Everyone’s memories are smattered with numbers that carry great significance; I once had a 40.2 degree fever (104 F), my bedroom temperature was 13 degrees (55 F) one January morning, and so on. Numbers you grow up with carry more emotional weight than ones you learned as an adult.

The Swedes and the French-Canadians have many similarities, not just the metric system. I feel very much at home with the way my older patients here on the border view health care. Just like the Swedes, they often question medical interventions, and they believe in their bodies’ ability to heal without the help of medicines and procedures. This is the classic view, dating back to Hippocrates’ writings, far from today’s notion that most processes in the human body are diseases that should be treated or regulated with blockbuster drugs. Many French-Canadian patients are relieved to hear that their infections can be managed without antibiotics, while more mainstream Americans often question why they can’t have a prescription “just in case”.

When I first moved to this country, I needed to polish my English. Finding the right balance between medical terminology and common words, sometimes learning the colloquialisms, took some work. In Maine, we use words like “spleeny” for being squeamish or less than heroic in medical situations, and “bunch” for any unknown tumors, lumps and bumps on the human body.

Here, on the Canadian border, my one year of High School French was nowhere near enough to understand conversations in the grocery store or the local diner. Even a more proficient French speaker would have had trouble understanding the local dialect. Some of the purely local “Valley French” words are also used in English here. People often come in, saying things in English like “every time I eat broccoli I get the flu”, which means broccoli gives them diarrhea. Many English words have made their way into Valley French, like “une appointment avec le docteur”; neither “appointment” nor “docteur” are proper Parisian word choices for saying that you have a doctor’s appointment.

On a typical day at my border clinic, which actually overlooks the river that separates our two countries, more than half my patients have French surnames. Many slip French words into our conversation. And often, when family members speak together in French, they throw English words in here and there. Some of my older patients feel more comfortable receiving all their instructions in French rather than in English.

I also feel the French-Canadian presence when I move around within the clinic or sometimes just lean too far back in my office chair, and my cell phone vibrates with a text message that announces that I am now connected to a Canadian cell phone tower, and roaming fees may apply.

This connectivity issue gets in the way of using my EMR on my little tablet computer during housecalls. We have to maintain parallel paper and computer records for our home bound patients, who live where there is no cellular internet connection.

In our little store, Canadian money is always welcome, but there are strict limits on how many eggs, how much meat and how many bottles of wine our neighbors can bring back across the river.

The Credit Union gladly exchanges Canadian money also, and the stores in much of Maine accept Canadian dollars.

Some of my patients cross over to Canada to shop for their medications. Prices are government regulated there and sometimes much lower than here. I and many other doctors in our state have a “border license”, which makes our prescriptions valid across the border. Prescribing for Canadian pharmacies requires some knowledge of the differences between what is available here and across the river. Some brand names are different, and some drugs are available only here while some only exist there.

Driving through town, I stop at a bilingual Stop/Arrêt sign before pulling out into the modest traffic. Minutes later, as I drive down the stretch of Route One we call “Moose Alley”, I slow down for a hesitant four legged jaywalker and then set the cruise control to 56 miles per hour. With the push of a button on my steering wheel, the dashboard display reads 90 km/h. That feels very familiar and comfortable.

My commute takes me through the dense pine forest and over the hills with their long vistas across to the mountain ranges of Canada and towards the south. There, almost two hundred miles away, are the specialists I have referred my patients to for thirty years, colleagues I know by first name and often speak with over the phone, but rarely see in person. That’s how far my patients have to travel to see a gastroenterologist or a vascular surgeon, or to have a PET scan, stress echo or a balloon angioplasty.

After the last stretch, on a snow covered back road, my little red 1936 farmhouse gradually appears in view. Seeing it, with its Swedish flag by the front door, you could think you were three thousand miles away in Sweden, in the village where my father was born, and his father and grandfather before him.

I sometimes ponder that this area looks a lot more like the Sweden I grew up in than the modern day Sweden I have visited in recent years. It also doesn’t look like the increasingly congested suburban America I first visited forty years ago, near where the Pilgrims landed south of Boston. Time somehow passed faster elsewhere than it did in these remote northern towns and villages where I live and work, on the very outskirts of America. My office is in the only town in this country where McDonald’s opened and later closed a restaurant due to a lack of customers. It is an environment with fewer distractions than most places, closer to nature and to the timeless essentials of life. It is a place where doctors shoulder big responsibilities but also get to feel a unique closeness to and appreciation of the patients who depend on them.


1 Response to “Border Doc”

  1. 1 Brita February 16, 2015 at 3:58 pm

    This brought me back to a clerkship I had up there as a student last winter. I found myself fascinated by this beautiful and foreign slice of our country. It seemed there were many more similarities between folks living across the river from one another than between my experience and the Mainers I met. I hope I can visit again someday soon!

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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