Shortly after I fell asleep, my phone rang. “Dr.Zha, the ER provider requested for you to come and help see some patients in the Emergency Room,” said the charge nurse. “I’m sorry, what did you say?” I replied confused.
I’ve worked in rural primary care for the past three years, and I have been on call hundreds of times. Usually, I get called to deliver a baby, admit a newborn, or accept a patient to the hospital. But being requested to work in the ER? This was my first time.
I’ve always wanted to practice full-spectrum family medicine: office visits and procedures, delivering babies, simple hospital care, and nursing home visits. So in 2019, I came to eastern Washington to work in a Federally Qualified Health Center (FQHC), serving the farmworker community.
I knew rural medicine was a “different beast” than academia. But what I didn’t anticipate was just how comprehensive this type of care could be, especially when serving a marginalized population. My patients face barriers to receiving care that go beyond money: immigration status, strenuous work schedule, lack of transportation, language, and cultural differences, to name a few.
As a result, I am frequently asked to provide care outside of my comfort zone.“I’m just a country doctor!” I would say, jokingly. “But you are ‘it’ for me,” is a common phrase I hear, which highlights that accessing specialty care is a huge challenge.
Of course, during the pandemic, when the world shut down and the already-scarce human resources in healthcare took a hit by Covid-19-related mortality and the Great Resignation, we, country doctors, had to step up. I was the urgent care provider, the family doctor, the hospitalist, the public health worker, and sometimes, the ICU doctor. But thankfully, I was never the ER provider, something that is definitely outside of my spectrum of practice.
“But I am just a country doctor,” still half-asleep, I blurted out to the charge nurse. She chuckled briefly, then went back to being serious: “I know. But we are overwhelmed with a gunshot wound, a stabbing, and a slough of non-emergent things. While our ER provider stabilizes and transfers the trauma patients, can you come and see the ‘country doctor’ patients?”
A gunshot and a stabbing on the same night, in a quiet rural town of fewer than 9,000 people? Our small rural hospital has only one ER provider at any given time, and no trauma surgeons to deal with such cases. “Ok! I will be right there!” I hung up the phone and jumped out of bed.
I joined the chaos of the “other side” of primary care for a few hours and did what I could to give my ER colleague the time and space to deal with life-and-death emergencies. After things calmed down, I got ready to leave and was desperate to go back to bed.
“Dr. Zha, you need to be escorted to your car in the parking lot, because the police have not caught the gunman who shot this patient,” the charge nurse said, as I was walking out. “What? By whom?” I exclaimed. “Well, we don’t have a security guard. So the maintenance guy will walk you to your car.”
As the maintenance worker jogged to meet me at the door, I thought about asking him “what kind of training have you had to ensure my safety?” But I didn’t say anything. I realized that, just like me, he was asked to work outside of his comfort zone. And just like me, he was willing to take on the task he wasn’t trained for because he cared.
For the first time in my career, I was scared for my physical safety. While I was glad we had each other, I also knew we needed much more than that.
Mass shootings are on the rise and they might be spilling over to rural areas like mine.
On June 1, four lives, including two physicians, were taken by a gunman who blamed a doctor for his pain in Tulsa, Oklahoma. While this incident made my heart sink, it also sounded unpleasantly familiar.
Mainland China, my home country and where I did part of my medical training, has one of the highest prevalence of healthcare workplace violence in the world (42.2 to 83.3%). Murders by unsatisfied and desperate patients were such commonplace that many hospitals advised healthcare workers to wear helmets to work.
When I came to the United States to finish my medical education, my parents were relieved that I would finally be safe at work. But judging from my mother’s panicked phone calls each time a mass shooting news breaks, I know they are less and less convinced of my safety. Usually, I soothe my mother’s concerns by telling her “I’m fine, mom, I live in the quiet countryside”. But this time, I am hesitant to pick up the phone and dial home.
Dr. Mengyi “Zed” Zha is a family medicine physician in rural Washington state and a nonfiction writer. She graduated medical school from the Geisel School of Medicine at Dartmouth in 2016, where she received the Gold Humanism Honor. She completed residency training from the Mayo Clinic – La Crosse Family Medicine Residency in 2019, where she was the recipient of the Residency Research Award. Dr. Zha is the incoming fellow of the Underserved Dermatology Fellowship in Family Medicine. She is passionate about rural medicine, teaching, academic research, and patient advocacy.
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