A Simple Country Doctor

“Why Burns?” friends will ask. They don’t want to come out and say it, but what they mean is, “What in the hell is out there for you?” They see empty buildings and sagebrush, the realities of an abysmal economy that has plagued this part of Oregon for more than thirty years, since the mill went silent. I don’t have a pat answer. For ten years I have lived here because I choose to. “Why Burns?” is not just a question of why I would move to this remote and unique frontier community, but also, “Why are you you?”

I came to medicine later in life than some. For my first twenty-three years, I moved gradually away from my rural upbringing, from a farm boy who sheared sheep for gas money to a social worker with a UO degree living in suburban Portland, with a wife and a monthly rent payment that was a struggle to meet on a nonprofit salary.

Then life changed dramatically, as it often does, through the least dramatic of events. A summer weekend brought another counselor and me to the golf course, to decompress and discuss our joint frustrations. Two pleasant young men celebrating their graduation from medical school completed our foursome. Later, as we loaded our clubs back into my Civic, I said to my colleague, “You know what? I don’t think those guys are any smarter than we are.” That night I informed my wife and visiting father, “I think I am going to go to medical school.” My wife, in her unshakable fortitude, replied, “Oh, and how long would that take?” “As far as I can tell,” I said, “I should be making a paycheck in about ten years.” My father’s reply carried his simple and always poignant wisdom: “Well, in ten years you will be ten years older either way; pumping gas or as a doctor.”

So I went back to school, working the nightshift as a mental health counselor. I loved everything I did, from obstetrics to surgery, emergency care to primary care. Initially I was determined to pursue neurosurgery. One afternoon I informed a friend in the lab (a Hungarian neurosurgeon) that I intended to apply to a neurosurgical residency. He shook his bearded face slowly and said in a heavy accent, “No, no, no, you not be a neurosurgeon.” Offended, I made my case defensively: I had excellent grades, great board scores, research. . . . “No, no, no, you like your patients too much,” he explained. “A neurosurgeon has to love the surgery. He like the patient, but the surgery he love.”

He was right. I did love the people I cared for. I decided I would not be a neurosurgeon, but trauma surgery seemed to be a profession with enough testosterone and adrenaline to keep anyone intoxicated for a lifetime. Before I could apply for the training that I was convinced was my future, however, I was assigned a six-week rural rotation in Burns.

On this rotation I put in my first sutures, ran traumas in the ER, delivered my first baby. Taking care of people was not just about seeing someone in the office; you saw them everywhere they needed you (even the frozen food aisle of Safeway). The doctors here really knew their patients; not by meticulous review of their medical records, but because they went to church with them, hunted with them, sat next to them at high school basketball games.

One day my attending physician and I saw a young woman, halfway through her pregnancy, with complications that needed a specialist evaluation urgently. She and her husband had driven nearly 100 miles to get to us, and when the doctor informed them they would need to drive another 130 miles to the specialist, her husband said, “I don’t know, Doc, I drove in the ranch truck and I don’t think it will make it that far.”

Without pause the doctor reached in his pocket, took out his keys, and said, “My Suburban is in the parking lot, it is full of gas, just leave it there when you get back into town.” My view of what it means to be someone’s doctor changed in that moment.

I returned to the university and told the chair of the surgery department that I would not be pursuing a surgical residency. Instead, I would obtain training to be a rural physician. As she tried to talk me out of this—“It is a waste of your skill to be a family doctor . . . we could get you a fellowship at Duke . . . you will never make a decent income in a practice like that”—I could only think, “She really doesn’t know.” I was fairly certain she had never delivered a baby before dawn, smiling at the cherubic fussiness of a newborn; then held back tears as she consoled a family about the loss of a grandmother; then taken a deep breath and moved on to reassure a middle-aged man that he was not having a heart attack. She had never pulled the keys out of her pocket.

I was in Wisconsin training to prepare for a rural practice when a relative attending a wedding in Burns somehow passed on the information that I was going to be a family doctor. I was asked to consider setting up my practice there, and I knew it was a done deal before I ever got on the plane from Wisconsin.

Practice in Burns was everything I expected and more. I loved the variety, I loved being the last and only line against misery and illness in this community, and I loved caring for people that I cared about. I became a professor for the university, teaching medical students in the same rotation that had changed my life. I had no desire to convince students to be rural doctors, only to teach them to be good and caring doctors, and to that end I hope I have been successful.

So, why Burns? Why live where I look out of my window at a smokestack that stands silent over the remains of a city 100 years past its heyday, where cattle outnumber people, where my phone number is in the book because I know someone would just knock on my door if it were not? Because Burns is beautiful. Sure, I could point out the joy of being on Steens Mountain, looking over the Alvord Desert. The humbling enormity of wide-open space and the majesty of the Malheur National Forest. But these features, however stunning, are not the most inspirational attributes of this small, dry piece of Oregon. Burns is beautiful because it is full of beautiful people—generous people who look you straight in the eye, smile, shake your hand, and actually care when they ask you how your day is going.

Recently, two nice young women from Portland came to our Emergency Department. They were on a long-distance bike ride but one had developed an infection in her leg, easily treated, but making further travel by bike impossible. Their car was in Prairie City, about ninety miles away, and we have no car rentals in our community. They were in a pickle. Without pause I found myself saying, “My van is in the parking lot, it is full of gas. . . . ” I reached in my pocket and handed them my keys.

By Kevin Johnston

Kevin Johnston '91 earned a BS in sociology from the UO and an MD from OHSU. He practices medicine in Burns, Oregon, where he lives with his wife, Tammy, and their four daughters.