Patients from Away

Every year I get at least half a dozen new patients who are “from away”, as we say in Maine. Obviously, I’m “from away” myself. I chose to come here after once driving up from Massachusetts, where I had been an exchange student, and seeing the untouched vastness and the slower pace of life in rural Maine.

Until a few years ago, these new patients were all people who had fallen in love with Maine by vacationing here, or they had come here because of job opportunities.

Lately, I have puzzled over why some of my new patients have chosen to move here; many of them have serious health problems and disabilities, they have never visited Maine before (or seen a Maine winter) and they don’t know a soul here.

A few have hinted about the lower cost of living, and I didn’t really think very hard about that until I saw an article in the Wall Street Journal about a baby boomer in California who moved to an Iowa town of 700 just to be able to survive on the resources she had left to live out her life on.

Here, you can buy a modest house for a tenth of what a similar one costs in California or a third of the cost in Brockton, Massachusetts.

But Maine, as much as I love my adopted home state, offers some serious challenges for dislocated older patients with serious health problems. We have a shortage of physicians in most of the state, in both primary and specialty care. Dialysis centers and radiation oncology clinics are few and far apart. We have few options for public transportation, and small towns rarely have taxi services.

Winters can indeed be hard, heating costs are high, and the town I live in regularly loses power during snowstorms, sometimes longer than 24 hours at a time.

I have many patients who are “snowbirds”, and as they get older, they often decide to give up their second homes in Florida and stay year round in Maine. But they know what it’s like here, and most of them have most of their family right here.

I wonder if those of my patients who have moved here alone in their sixties or early seventies have thought of how their journey will end – not where they wanted to be, but where they ended up.

I worry about them.


2 Responses to “Patients from Away”

  1. 1 Peter Manns September 25, 2017 at 11:13 am

    I did a locum in a small, remote rural town in Australia.

    I was amazed by the number of people with serious, chronic illnesses that needed the services of a tertiary hospital at least five hours away. Many were at risk of sudden deteroration requiring urgent transport to the city.

    I asked one such person why he had moved to this town. His reply “Doc, the houses are cheap. I bought one for just seventy thousand!”

    “Yes, that’s well and good but want if you get really crook and need urgent attention?”

    “That’s easy Doc. You’ll just call in the helicopter and everything will be right.”

    And indeed I did. At twenty thousand dollars (tax payer funded) for each trip.

  2. 2 Susan Neely September 26, 2017 at 1:06 am

    I am touched by your concern. I am old and plan to relocate to N.Carolina where the cost of living is lower where the Cherokee roamed. Make sure these patients have their living wills in place with Healthcare and General POA. Personally, I have chosen no intervention when my health begins to fail. Cataract removal is the only surgery I agree to..
    If I break my hip…euthanasia. I know where I am going after this mortal body fails and have no fear of meeting my Lord.

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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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