As someone who was uncertain in what field of medicine to enter, I decided to take advantage of the WWAMI experience. The reason I picked Dillon was based on a chance conversation that I had with my clinic preceptor who had went out to Dillon and still reminiscing Mrs. Loge’s cherry pie and the beautiful Montana landscape. Being in a small town for the first time, I didn’t know what to expect. Everyone whom I met were warm, helpful and extremely friendly. The patients were real “salt of the earth” especially the ranchers. The experience is unique in that we follow patients in all aspects of their care–from the clinic to the ER to the inpatient side and to the procedure room. Because of the limited access to specialists, Drs. Loge and McIntyre perform most of the procedures that we routinely fill out a requisition or refer to specialists. They perform bone marrow biopsy, thyroid biopsy, EGD, colonoscopy, treadmills and all routine primary care procedures. Both Drs. Loge and McIntyre were amazing preceptors and clinicians. On the weekend off, Dr. Loge invited me to his beautiful cabin and spend time cross country skiing and finding then chopping down a Christmas tree. It was the first time for me to do both. Lastly, Mrs. Loge’s cherry pie was as good as it was rumored to be and certainly worth the drive to Dillon.
Category Archives: Montana
Livingston, MT
I never saw a grizzly bear during my month in Livingston, even though I spent the entire time reading about them and keeping an eye out for them on hikes. This was probably a good thing. There were 9 grizzly attacks in Montana this year; two of the victims came to Livingston Hospital while i was there and I got to help care for a Hunter who had been severely mauled (had his face torn off). I heard about the attack on NPR the next morning.
The mountains surrounding Livingston are amazing (the Absorokas, the Bridgers, the Crazies). I spent my free time hiking among these mountain ranges and exploring Yellowstone. The Paradise Valley is literally a two minute drive from the house and is breathtaking. Be careful not to drive off the road while you ogle at the Absoroka Mountains.
The clinical experience is priceless, no matter what you go into, ranging from clinic, to inpatient, to ER. The main preceptor (Dr. Wadle) was a great teacher and host. The hospital staff treated me like one of the family. Pop me an email if you have questions about this experience; I can’t say enough about it.
August in Park County
In August I saw grizzly bears, wolves, bighorn sheep, and more bison and elk than I can count. I also got to see a model of medicine very different from anything in Seattle: rounding on inpatients (including the small ICU) in the morning, then off to clinic for the bulk of the day. It’s a great combination and much more balanced than a Seattle ward/clinic day. With daily clinic you can establish continuity even over a single rotation. In my month, there was a lady with COPD who I saw in clinic, admitted to the hopital, transferred briefly to the ICU, and had follow up with me in back clinic a few days later.
The few ER shifts and visits to SNFs add some variety. The scheduling was very flexible, allowing for plenty of time to explore. Plus, Wadle, a former Boise chief, is an all-star doctor and preceptor.
November in Missoula, MT
I am so glad that I chose to do a WWAMI rotation in Missoula. It was an eye-opening experience in so many ways. I spent the month with Dr. John Trauscht, an oncologist with the Montana Cancer Specialists. I felt spoiled to have so much one-on-one time for teaching. I spent time doing a mix of inpatient and outpatient work, and had much more autonomy than I thought would be possible. Every day after clinic we would sit down to review cases from the day, and sometimes review peripheral smears and bone marrow biopsies with his 2-headed microscope. We were able to generate learning points as well as new questions for me to look up in the literature. I felt like the learning was so high yield. The most amazing thing was the patients, who were so nice and down-to-earth. Dr Trauscht led by example in not over-medicalizing the conversations with patients, and he challenged me to do the same. Also, there was ample opportunity for exploring the area in my free time. There is a really neat ghost-town nearby, and futher out is Glacier Ntl Park. The town of Missoula itself is also super-fun. There are lots of cute cafes, boutiques, and local music venues. Overall, it was a fantastic experience. I highly recommend this site.
WWAMI Magic
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.
Dillon, Montana
This picture was taken on a Sunday afternoon, Dr Loge and I cross-country skied out to a spring by his cabin. Once there we made a fire and roasted hot dogs :)
just got back from my WWAMI rotation in Dillon, MT a few months ago but it feels like it was so long ago – being back in the Seattle residency chaos does that…
My experience in Dillon was excellent. I plan on going into primary care and this was really the first opportunity I had to be in a primary care clinic on a regular, daily basis. The experience is completely different than the constantly rotating schedule we have in Seattle. Working in a small town was also different – by week two I was recognizing people in the grocery store and running into patients downtown, an experience I’m yet to have in Seattle. But I think the highlight of the rotation is the mentors. I was lucky enough to work with both Dr Loge and McIntyre. They are both very welcoming and involve you in both the care of the patients and the small town Montana experience. We went cross-country and downhill skiing, I was invited over for Sunday dinner, and went out to Dr Loge’s beautiful cabin with his family.
I recommend a WWAMI rotation to everyone, even if you’re not interested in primary care, the continuity of being in the same clinic on a daily basis is something we never experience of in Seattle. In addition, Dr Loge does many procedures — EGDs, bone marrow biopsies, treadmills, joint injections — regularly, and manages patient who would be managed by specialists here in Seattle, so there’s something for people with all interests.
Oncology in Missoula
I was putting in a lot of hours, by my choice, because I was learning so much. The community doctors constantly impressed me with how good they were at everything. They were amazing diagnosticians. The oncologist I worked with, John Trauscht, was an outstanding teacher, and I loved his curiosity. John had a great way of communicating with his patients, bringing everything to their level, and always gave patients the choice of doing nothing. I saw all of his new patients and performed bone marrow aspirates and biopsies, so I was first to see and diagnose patients rather than the fifth or sixth person down the chart. One memorable patient was a middle-aged man with Burkitt’s who continued to decline despite aggressive chemo. He developed PCP in the hospital and then an HIV test came back positive. The diagnosis was incredibly devastating and it was interesting to see everybody’s reactions. He died three days before I left. Taking care of him made a huge impact on me … I loved Montana. Everyone in Missoula loves living there, and I felt very much a part of the land.
Medicine in a small, small town
It was so hard to come back from Livingston. The place is so small that I got to know people from all walks of life, and I made incredible friends. Everybody has personal as well as professional connections with patients. The hospital is a tiny little place, with four ICU beds. Everyone at the hospital supported and respected me, and I felt looked out for. There were so many memorable patients and several that I saw over and over. I saw them get sick, I saw them get better. I was totally integrated into every aspect of their care. Four times a month I did a 24-hour ER shift where I was the only physician in the hospital. I really became comfortable doing everything, clearing c-spines, taking care of heart failure and infants and reading my own x-rays. What’s unique about a WWAMI town is a sense of balance. The doctors love medicine, they’ve chosen Livingston for the diversity of patients and the intimacy they get with people. But the emphasis is on time away from the hospital, which we’re not so good at.
Taking care of the same patients for years
In my Seattle clinic, I usually feel I have one chance to fix a patient and all I’m doing is trying to get in the ballpark, so Dillon was so educational. It’s the only rotation where you’re in the same clinic every day, eight hours per day. The patients were ranchers and cowboys, tough guys with terrible problems that you could do something about, like a guy with diabetes who brought me his home glucose numbers and actually followed up the next week. My clinical skills improved so much from seeing patients back and seeing if what I’d tried had worked. My preceptor, Dr. Loge, has been in Dillon twenty-five years. He’s one of the most important mentors I’ve met. He has that clinical intuition you only develop after years and years, and he really knows the medical literature. The rotation with him really changed my outlook, even though I’m not doing primary care. I’m going into cardiology and I’ve thought about being a small town cardiologist with a small primary care practice, now that I’ve experienced what it’s like to know patients for twenty years.