I had one of those magical days that can happen in a place like Livingston. It was a blustery Wednesday morning in March with gray clouds hovering heavily overhead and a few scattered snowflakes falling to remind us that spring was not here, yet. I was finishing a 24 hour shift covering the ER and admitting patients to the hospital. I had started at 6AM the morning before. The day had been busy with a wide variety of patients including minor trauma (table saw vs. finger) and children (mostly ear infections). At midnight an 80 year old woman was wheeled in by her daughter. She had been getting progressively short of breath over the last few hours at home. By the time we got her settled on a stretcher her oxygen saturation was dipping into the mid 80s. The x-ray technician, lab technician, and respiratory therapist had to come in from home, which they all graciously did. She was septic from pneumonia. Over the next three hours we put in a central line, started broad spectrum antibiotics, placed her on BiPap and admitted her to the ICU, where I followed her care until 8AM. Leaving the hospital, exhausted, I contemplated going home for a well-deserved sleep. But the mountains, hidden by clouds, beckoned. The snow report at Bridger Bowl, the local ski area, boasted 4 inches of fresh powder. By the time I arrived 45 minutes later there were six inches of light as air “cold smoke” powder and a parking lot that was largely empty. Delirious from lack of sleep, I took the chair lift to the steepest part of the mountain for a warm up run. After the first turn I found myself face down in a mound of snow as soft as a feather bed. Using better judgement on my next run I began to get a rhythm and soon was floating on powder. Over the next four hours I skiied 14 runs and quit skiing when I was either going to fall asleep on the chair ride up or break a leg coming down. I drove back to Livingston through majestic ranching country with stunning snow-capped mountains in front of me and in my rear-view mirror and big blue sky above me. The next morning I hobbled into the hospital, legs sore from over-use the day before, to find my patient had pulled through and was ready to be transferred to the floor.


I spent a beautiful October in Jackson last year. The internists spend most of their time seeing patients in clinic, but there is a little hospital medicine mixed in. I gained experience in everything from palliative care to acute cardiac care, but it’s the primary care medicine that makes this rotation special. The docs in Jackson are committed to providing top-notch care accross the board.  Their patients view them as trusted members of the community. You’ll see everyone from ski bums to cowboys who ride into town on their horses (practically).

There was plenty of free time, as well, and I spent most of it running and hiking the long trails in the National Elk Refuge in the shadow of the Grand Tetons. It’s an easy drive to Teton National Park and just a little further to Yellowstone.  I saw tons of wildlife, and this place is a photographer’s dream. If you like to ski — I personally don’t like going downhill fast, except that I love roller coasters… go figure — anyway, if you like to ski, I’m sure you’ll love Jackson in the winter.