I was thinking about retiring, and COVID-19 gave me a push [PODCAST]

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“Last March, I was working in a small primary care practice on the west side of Denver. COVID-19 came to town. On Thursday, March 12, we were told the schools would be closing. On Friday, we were told that clinic staff had to wear masks — and the clinic had to start testing patients for COVID-19.

The only problem? There were no medical-grade masks to be had. Not through the state health department, not on Google, not anywhere. Likewise, there were no COVID tests available. A patient came into the clinic late that afternoon, complaining of a high fever and a bad cough for three days. He wanted to know if he had COVID-19. So did I! But there was no way to test him.”

Janet Tamaren is a family physician and author of Yankee Doctor in the Bible Belt: A Memoir.

She shares her story and discusses her KevinMD article, “I was thinking about retiring, and COVID-19 gave me a push.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Janet Tamaren. She is a family physician, and she’s the author of the book “Yankee Doctor in the Bible Belt: A Memoir.” And she wrote the KevinMD article “I was thinking about retiring, and COVID-19 gave me a push.” Janet, welcome to the show.

Janet Tamaren: Thank you.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Janet Tamaren: OK. I went to medical school in Kentucky, so I was somewhat used to the culture there. I grew up in Cleveland and went to school in different places, but I ended up in Kentucky, and it was a little bit startling in Kentucky that there were some cultural differences. I did not know that the country could be so different. I had lived in Boston, Denver, and Cleveland, and I had traveled all sorts of places, and I didn’t realize there was a different culture going on in the South.

So I got used to that a little bit, and then I went to practice in rural Kentucky. There was a whole other culture going on, and I wrote a memoir about it because it was such a unique experience. I really enjoyed getting to know my patients. I don’t know if people out there are thinking about doing family medicine, especially in a small town. You really get to know people. That was quite an experience. I really enjoyed it.

And then I moved back to Denver to spend time with my grandson and children, and then I worked in urgent treatment centers for a while, and then at this primary care clinic on the west side of town in Denver, which translates into a poverty clinic, literally, where they all speak Spanish and I needed translators for every patient. So I had a wide variety of experiences, including the rural health part and then moving to this primary care clinic on the west side, which was again another poverty clinic, which is what I’d been dealing with in Kentucky.

And this little article I wrote was about the day COVID came to town, which I think we can all relate to. I think we can all remember where we were when they told us schools were shutting down. One day, and the next day they said, “Oh, by the way, all you medical providers, go find some masks.” And the next day they said, “Oh, and put up barriers so you’re not, and have enough space that you can get distance between you and your patients.” And they said, and by the way, they didn’t say this, but they basically did, they said, “There’s no testing available.” There was no testing available that first week.

And then we scrambled around in our little clinic and discovered there were no masks to be had anywhere. We all did a search, with the health department and online and internationally, and there were no masks to be had anywhere, nothing other than the little flimsy white mask that you wear in the clinic when someone might have the flu. So I think we could all relate to that week. That was a Thursday, when things were tightening up, and then it was a Friday when things really tightened down, and it really got scary because they said, “We’re going to close down the economy on Monday,” or something.

So that’s what incentivized me to write this, that memorable week working at a clinic. It was terrifying, that last day, that Friday: “Oh, yeah, we’re closing down the country, we’re closing down the schools. Everybody mask up who’s working, who’s seeing patients.” And there were no masks. Patients, of course, continued to come into the clinic, and then one of them that I described says, “I’ve had a cough for three days, I’ve had a high fever for three days, I might feel better today. Oh, by the way, it started with diarrhea for two, three days. Do you think it’s COVID?” And I’m going, “I have no way of knowing.” I didn’t quite say it like that, but I’m thinking, “I have no way of knowing.”

It was scary, and we had no protections whatsoever, and I’m of an age, well over 65, such that all that high-risk business really hit home. I wanted to get that out of my system. I wrote this down because it was such a memorable week, day, month. And then I called up the guy who ran the clinic, who’d been in practice for 50 years, the next morning, and I was about to offer my resignation because it was terrifying, at which point he says, “Oh, by the way, we’ve decided to close the clinic because it’s too scary.” So that was how I got to be retired.

Kevin Pho: So you wrote this story. It’s titled “I was thinking about retiring, and COVID-19 gave me a push.” That March was about 18 to 19 months ago, and of course a lot has changed since then. Tell me about that choice now, upon reflection. If you were offered that opportunity to retire because of COVID, would you have done the same thing?

Janet Tamaren: I think I had no choice. I mean, at that point in time, they were telling people my age to shelter at home. Again, I don’t know about the doctors who worked in well-staffed, well-supplied clinics, but even the good hospitals in town, even the very nice hospital, still didn’t have the protective equipment. So I don’t know how many other doctors faced this choice of, gosh, risk my life. Maybe everyone who continued working basically accepted that choice, but for those of us over a certain age, it was really scary, because they were very clear that we were at high risk. So I think I would have done it again, given that information.

The only thing that would have made it different, and I’m sort of perseverating about it right now, is if I’m fully vaccinated and if there’s not a Delta coming through, I might consider going back to work. But I am fully vaccinated, and there’s a Delta coming through, and I have grandchildren, and they’re not vaccinated. So there are risks, you know. So right now, I’m OK with being home.

Kevin Pho: Of course, you didn’t get a chance to leave clinical medicine on your own terms. It was kind of forced upon you because of the pandemic. How do you feel about that?

Janet Tamaren: Well, it was going to have to happen sometime, and I didn’t know what time it was going to have to happen, because I’ve enjoyed talking to patients in the clinic, and I enjoy talking to patients, trying to test out my Spanish, and the patients were kind of thrilled that I was trying. And it was always interesting. So that was kind of hard to leave behind, that kind of contact and the mental stimulation.

The contact I haven’t replicated, except I’ve been spending more time with the grandkids, which is a different kind of contact. The mental stimulation, though: I’ve been writing a book about my experiences in Kentucky, and I then spent some time finishing it up and researching. And I think this is true for all of us who’ve gone through medical school: There’s something about medicine we like, and even when you leave it, you’re still wanting to go research things. I find it very comforting to go look up the medical literature and, you know, read the New England Journal of Medicine and find out what’s happening and what’s new.

And in terms of the book I wrote, that was fun, because I could use that digging into things to sort of revisit diagnoses or patient situations I’d come across maybe 10 years ago and see if anything had changed in terms of treatment, in terms of diagnosis. Turns out a boatload of things have changed. So it was a nice opportunity to look at the new findings in genetics and in, like, cancer diagnosis and treatment, and it’s been an extraordinary time in that regard, the last 10, 20 years, when I was busy with clinical medicine. I wasn’t keeping track.

Kevin Pho: You’re also the author of the book “Yankee Doctor in the Bible Belt: A Memoir,” and you talk about your experiences practicing in rural Kentucky. You did mention that practicing in rural Kentucky was different from a lot of the other places that you practiced. So can you go into more detail about some of those differences and your experience practicing rural medicine in Kentucky?

Janet Tamaren: Well, the first thing I noticed, the first day I was there, was people spoke in English, which was a little bit foreign to me. You’d ask, “How are things going?” and they’d say, “Likely.” But what does that mean? And I had to get used to that. I’d already gotten used to the accent, living where I did in Lexington, Kentucky, which is not rural. I’d already acclimated to the Southern drawl, or accent, so I could understand that, which was important, because when I first got to town in Lexington, I could not understand anybody. It took me a couple weeks until I got through that barrier.

So I could understand people in the rural area, but they were rural. They were talking about tractors and stuff I didn’t know, and tobacco, and hunting. And this is one of the stories in my book: One of the first patients was a little boy who hadn’t been sleeping in school. His father brought him in because he kept falling asleep at school. The teachers were upset, and the little boy explained he’d been going out hunting every night, and I said, “What’s a?” So I had to get through those kinds of barriers.

There was also, in Kentucky, besides the rural, you know, my ignorance of farming and farm animals and stuff like that, there were also differences. They were kind, they were isolated, they were kind of proud of it, that they may have never left the boundaries of their little town. You know, this was a point of pride. And the families were real tight. They all live close to each other, or next door, or close, which was different for me, because I had spent some time in Denver, and Denver is a city where a lot of people move to find a new life. You know, young people move here, and it’s an adventure thing. They don’t do that in Kentucky. They stay put. And probably the corollary of that is that they don’t really trust outsiders. They’re kind of, well, they just don’t really trust outsiders. And they had some cool things to say about New York City, as being the playground of the devil, the devil’s playground.

And there was, oh, there was also the difference in terms of, they believed in creationism and in interpreting the Bible as quite literal. That was the Southern Baptist fundamentalism, which infiltrated every aspect of their lives, and that was a little hard for me, because I came from a background of molecular biology and genetics. And they were building a museum to honor creationism, which is, between you and me, a source of laughter for the rest of the world. When I traveled to Europe and I mentioned, or they told me about, a museum in Kentucky honoring creationism, or showing dinosaurs and people coexisting in their dioramas, overseas they were laughing at us. Anyway, so that was a bit of a divide for me.

And also, they had a belief, which I think pertains to how badly they’re dealing with COVID, which is that if God loves you and you pray, then God will protect you, and maybe you don’t need vaccines. I think that’s sort of feeding into this, that if you’re a good person and God loves you, and prayer is very important, God will protect you. Whereas my experience, my feeling, is God gives us scientists and gives us wisdom and allows us to do medicine and design vaccines.

Kevin Pho: We’re talking to Janet Tamaren. She’s a family physician. She’s the author of “Yankee Doctor in the Bible Belt: A Memoir.” She’s also the author of the KevinMD article “I was thinking about retiring, and COVID-19 gave me a push.” So Janet, talking again about the rural population, especially in Kentucky, what would you say are some of the biggest challenges that patient population faces today?

Janet Tamaren: Well, I compiled in my book, because I asked myself that question, what I called the scourges of the South, the three scourges of the South. This is before COVID came to town. I think right now they’re really having a rough time. They are famous for the rate of diabetes, type 2 diabetes. Many of my patients have diabetes. I’m not sure if Kentucky is at the top of the list of states in terms of diabetes frequency, but if not, they’re very close. They were way up there in terms of emphysema, COPD, because they are a tobacco-producing state, less so now, the economy is changing, but everyone, heavy smoker, heavy smoking everywhere.

People would tell me they started when they were six. One guy told me he started up behind the barn when he was six, working on his father’s tobacco farm, and he was, like, 45 when I knew him, and he looked around 65, 70, and he was dying of emphysema. No surprise there, because, you know, two packs a day wasn’t uncommon. Alcoholism: I had several patients with alcoholism. I considered that one of the top three just because I saw so many patients with it.

Otherwise, people only came, and I think this is part of a rural health clinic, people came when they were sick. Generally, working at an urgent treatment center later on, people would come because they had a runny nose. I mean, I’m kind of exaggerating, but they would come with a cold and think you could fix it. They were a little, this is not kind, what I’m about to say. There was one lady who came because she was going on a cruise to Mexico and she wanted medicines in case she got sick. She wanted an antibiotic, in case she got sick, ahead of time, and she wasn’t talking about Montezuma’s revenge. She wanted to have coverage for a cold, a cough, whatever. And the fact that she thought we could do that, I don’t know.

It was just coming to the doctor when you need to. The folk in Kentucky did that. Maybe they waited too long. They’d been sick for a week or two, but still, they usually showed up with a bona fide complaint, unless they were trying to get drugs out of you.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Janet Tamaren: Well, in terms of the retirement article, I found, it’s been a year and a half now, so I just wanted to share with people that if they’re nervous about life after doctoring, there is a life. And writing a memoir is always fun. It gives you a chance to revisit patients that you may not have seen for a while. It also gives you an excuse to call them up and ask them how they’re doing. So that’s not a bad venue for transitioning, if other people need to transition.

Kevin Pho: Janet, thank you so much for sharing your time and insight, and thanks again for being on the show.

Janet Tamaren: OK, well, thank you.

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