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A Day in the Life: Life in the Slow Lane

April 22, 2023

May 2023

In this edition, Divis Khaira, MD, describes what it’s like to be the only hematology provider within a 200-mile radius. Dr. Khaira is a hematologist/oncologist at Aspirus Health in Laurium, Michigan.

Divis Khaira, MD
Divis Khaira, MD

Institution: Aspirus Health

Specialty: Hematology/oncology

Years Practicing: 33 years

After many years of private practice, I decided to retire, travel, and do locums. After a three-year stint in Guam, in a tropical haven, I signed up for a full-time position in the Upper Peninsula of Michigan to experience the seasons and snow. This has involved serving four hospitals and traveling about 1,200 miles a month in beautiful country. Here is a sample of a typical day for me.

4:00 a.m. I wake up and get online to trade Forex. It’s early and a good time for trading the European and U.S. markets. I set up my account and keep an eye on my trade while I do mobility exercises. The stretches feel wonderful, and the trading is better than going to Las Vegas.

7:00 a.m. I shower, grab cup of tea, and head out to meet the plumber at one of the shacks that my husband bought to rehabilitate. He’s back in San Diego, avoiding the harsh winter, but he’ll be back this summer to work on it. The pipes have burst, and the plumber has to put in a new furnace, modulate the temperature, and repair the pipes. I am learning the building business. It’s a good way to interact with the community and learn the culture and living style.

I think how lucky I am to be able to make these repairs. Many people here cannot afford to repair burst pipes and may live without basic amenities. A patient once shared with me, that in the old days, his father took the family to the town baths once a fortnight. Many folks here still continue to bathe once a week.

This shack, like many of the houses here, is more than 100 years old and has the old knob and tube electrical that has to be changed out. The houses have very steep stairs with narrow treads, which I once experienced the hard way when I fell down a flight. I now wear an Apple watch that promises to dial 911 if I fall. It is not uncommon for people here to fall down the stairs and get injured.

8:00 a.m. I set out for my destination knowing it will take me 2.5 hours to get to the outreach hospital 114 miles away. I plan my expedition like a military operation the night before. I keep a survival kit in my car, which includes a blanket, plenty of cat litter, and a shovel to get me out of a snow drift if I need to. Temperatures may go down to -6 to -25°F.

Sometimes on her trek to work, Dr. Khaira starts out before the snowplows have cleared the path.
Sometimes on her trek to work, Dr.
Khaira starts out before the snowplows
have cleared the path.

I looked up what time the sunrise would be – if I leave too early, the roads are really icy – and check the snow conditions. This area is very remote and usually gets about 300 inches of snow a year.

It is snowing today, and the ice on the roads is treacherous. The snowplows have not come out, which may be a good thing, since they obstruct the road and blow a lot of snow, making visibility very poor.

With all the snow, I can’t discern the road unless I hit the rumble strips in the middle. I am nervous about the frozen lakes next to the roads, especially if there is a bend, which increases my chance of skidding. (I am an aficionado of TV shows about missing people who are found after 20 or 30 years in cars that have skidded into the bottom of lakes.) I must also have eyes like the Hindu God Ravan to watch out for deer. If I have an accident, there is spotty phone service and certainly no AAA. The only recourse is calling 911, if there even is phone service, or I could call an 82-year-old patient of mine who gave me his number in case I ever get stuck.

I listen to hematology and oncology podcasts to pass the time while I drive. Most are very good, and I feel educated and empowered by the time I reach the clinic. On the way back I will listen to a book on Audible.

9:30 a.m. I arrive at my destination after 2.5 hours of driving – the time change on my route works in my favor – and my day at the clinic starts.

The staff at the clinics are very experienced, and the nurse practitioner is simply awesome. The prevalent insurance here is HMO, including Medicaid. The insurance is guaranteed to deny and kick the can. The hospital I’m at today is at the edge of Wisconsin, and Medicaid requires patients to travel five to 10 hours to the other side of Michigan if they need certain specialty care. Patients may forgo treatment because they don’t want to travel in dangerous conditions or they can’t afford the cost of gas, or both. Our nurse spends a lot of time getting authorizations, and she is excellent. There are many hardworking staff at all the clinics who are giving back selflessly to the communities that they are a part of.

Many of the patients are co-managed with the University of Michigan and Mayo Clinic since the more complicated surgeries and treatments are referred to them. I see a patient with melanocytic schwannoma in the pelvis and refer him on. Another patient I see is 92 years old and has had a non-healing wound of the forearm for five years after a cut from a jagged can. The biopsy shows squamous cell cancer, so I refer him to the nearest radiation center, which is 2.5 hours away.

The clinic remains busy as I wade through the day. The hospital administrators want me to write detailed after-visit summaries to help patients understand their diagnosis and treatments. The problem is, many of the patients I see are unable to read or write and, according to my staff, the after-visit summary is likely to languish on the top of the patient’s refrigerator.

5:00 p.m. This is the time to catch up on paperwork, call back physicians who are co-managing, review the advanced practitioner notes and sign off on them, and review labs. The hospitals are in different time zones, so I have to log in and out of the electronic medical records to sign various notes.

6:45 p.m. I end my day and head to a hotel to stay overnight. I join an oncology webinar and listen to debates on Twitter spaces while I eat dinner. There are no restaurants that serve healthy food here, so I pack my own. One effect of this is that I have inadvertently started eating once a day, which gives me more energy!

It is a simple life, and my husband and I have learned that we can do without shopping at the big department stores and big city living. We are grateful for no traffic and for the pristine nature. The fall colors are breathtaking. Best of all, there are no predators, cougars, or snakes and no hurricanes, earthquakes, or tornadoes. Even COVID took a long time to wend its way up here.

There is something to be grateful for: no life in the fast lane!


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