I can­not do jus­tice in my descrip­tion of the majesty of the view of the canyon from its base.
As we trav­elled down­river, the canyon walls pro­gres­sively rose to either side of us, layer by layer.
At night, we slept on the sandy river­bank, a nar­row swath of stars vis­i­ble in the slen­der night sky above, brack­eted by the mas­sive rock canyon walls.
As will hap­pen in adven­ture travel, ladies got injuries from scram­bling down side canyons on hikes.
A twisted ankle here, a scraped knee there.
As I had been outed as the sole physi­cian on the trip ("Hey, I just do butts" didn't keep the limbs away), I got to make hmm­mmm noises as a prod­ded swollen ankles look­ing for crepi­tance, and then sent the injured to soak their ankles in the frigid river.
Thank good­ness for the three nurses tak­ing the trip.
After one askance look at my attempts to use an ace wrap, they gra­ciously took on the prac­ti­cal aspects of the man­age­ment of our patients, so the patients no longer resem­bled extras from "The Mummy Walks".
I was glad for my med­ical fam­ily and for their skillset.
Around sup­per­time mid­way through the jour­ney, the swamper (the all-purpose cook/cleaner on the trip) called me over to see a new patient, Joan.
Joan's trav­el­ling com­pan­ion had noti­fied the raft crew that she wasn't feel­ing well at all.
When I spoke to Joan, it was clear that she wasn't well.
Dis­ori­ented, weak, and con­fused, her breath wafted over my face.
Fruity.
A quick search of her belong­ings by my (med­ical) fam­ily revealed that Joan had the gear for dia­betes.
A friend on the trip revealed that Joan had at times referred to her­self as 'brit­tle', and had been dis­turbed by the irreg­u­lar­i­ties of the meal times and con­tents dur­ing our raft­ing.
I was aghast.
What was a brit­tle dia­betic doing on a trip of this sort? How­ever, no time for aghast.
Our patient was in DKA, mid canyon.
No help avail­able.
My med­ical team unearthed Joan's glu­come­ter, and we started admin­is­ter­ing the reg­u­lar insulin we had found, using read­ings of blood glu­cose to assist in our guessti­mates.
Although she was con­fused, my col­leagues encour­aged Joan to drink an elec­trolyte solu­tion we had con­cocted from fruit juice and salt.
Her pulse was rapid and a bit weak.
We felt des­per­ate and a bit alone, with those tow­er­ing walls, night falling, and no advanced med­ical assistance.
As dark­ness fell, I noticed the swamper fid­dling with some equip­ment from the raft-a short wave radio.
But once set up, he didn't use it to call out; he sim­ply sat, gaz­ing at the sky.
Sud­denly he picked up the hand­held and called out.
"May­day may­day, may­day.
May­day may­day, may­day from the canyon.
May­day may­day, mayday.
" A response came.
"Canyon, this is United 2657 enroute toLas Vegas.
What is your situation?" Not so alone after all.
It turns out that planes mon­i­tor the air­waves directly over the canyon as they pass.
We lost United in just a few moments, but each plane that left our air­space (we could see their lights travel through the thin patch of stars over­head while in radio con­tact) would tell us with the Vegas air­port tow­ers help when the next plane would make con­tact.
The tower relayed our calls to the local ED, who helped us to man­age Joan through the night.
Joan sur­vived to be heli­coptered out of the down­river Bright Angel Camp the next day, com­plain­ing all the while that she felt fine.
She did in fact do fine, due to the var­ied skillset of my med­ical fam­ily.
My colleagues.
Fam­ily mat­ters.
But just as the Amer­i­can fam­ily struc­ture has changed, so too has the medial fam­ily.
Allow me to explain.
Davies, in a 1999 British Med­ical Jour­nal arti­cle, described the Med­ical Fam­ily as it was in ages past.
The doc­tor, a father fig­ure, wise firm and kindly, and in com­mand of the fam­ily.
The nurse, the mother fig­ure, duti­ful and watch­ful, car­ing for both the father and child.
The patient, our child, respect­ful and obe­di­ent, and in awe of the father.
Yeah right.
You can stop your snig­ger­ing now.
The med­ical fam­ily in the past, and per­haps still in the minds of your older physi­cian and nurse col­leagues, was a clear ver­ti­cal hier­ar­chy.
But what of the med­ical fam­ily today? Today's med­ical fam­ily is no longer ver­ti­cally arrayed, but hor­i­zon­tal.
The physi­cian is a part­ner in health care, pro­vid­ing advice and infor­ma­tion which may not be heeded; the nurse, also a part­ner in care, seeks to calm the waters between the doc­tor who per­ceives a loss of con­trol and the non­com­pli­ant patient; the patient, now part­nered with us, seeks med­ical guid­ance but is autonomous in actions.
It's a whole new ball game to those of us raised on Mar­cus Welby.
Cen­tral to improv­ing your dys­func­tional med­ical fam­ily is hav­ing all mem­bers under­stand this new hor­i­zon­tal array of fam­ily posi­tions, that doc­tor, nurse, and patients in today's health­care are part­ners, no longer sub­servient.
You must help your col­leagues to under­stand.
Think of it as an adventure.