Looking at residency, it’s Jackson where the breach between what I knew and what I felt I needed to know was widest. I’d wake up to a patient in the ICU and a few more on the wards, and expect to be a nephrologist of sorts, the critical care person, a medicine consultant for local family doctors. After one of those days, my preceptor Mike Menolascino had me make a house call on a rancher with wide-open mitral regurg and Staph endocarditis. His wife wanted to stop the IV antibiotics. Mike said I should stay until they were finished asking questions, and then stay a halfhour more. Having grown up in Idaho, I know that rural places are places of extreme weather, where you get resistance from the environment. People have to struggle a little bit to live and over their dead body they’re going to a specialist in Salt Lake City. So it’s a tribute to the vitality of ranchers that we stopped the antibiotics and he’s still alive today … People in Jackson possess a strong sense of place. After being in the Tetons, I’d talk about moose spotted on trails, wind scouring the range from the west, spring slough slides. When you come back from the mountains, everybody knows exactly what you’re talking about.