By Dr. David Keegan
It is almost unbelievable that ten years have gone by since I left Placentia. Ten years since I last staffed our truly excellent three bed emergency department, did my inpatient rounds in our ten-bed inpatient wing, saw my patients on the secure dementia long-term care ward, and closed up my cherished Fort Frederick Medical Clinic, saying goodbye to my great staff and patients.
In another way, I look back and think what has happened in those ten years and it’s been “a lot”. I did a year of emergency training, worked in tertiary adult and paediatric emergency departments in London, Ontario, and engineered my return to family medicine. (I began missing long-term patient contact just a few short months into full-time emergency work). I got married to the love of my life, and we’ve had three great kids come into our life. We decided on a new adventure and moved to Calgary. I started playing hockey and learned to ski. So in some sense, it seems that it was, instead, long, long ago that I practiced in Placentia.
I remember back in medical school one of my professors, Dr. Roger Butler, teaching us interviewing skills almost 20 years ago and talking about his initial practice in Botwood and how it was a foundation for his whole career. I didn’t quite get what he meant then. But now, I know what he was talking about.
Those four years in Placentia were something truly special. It was in those years that I learned how to work in an interprofessional climate long before it was called that. The things I learned from Pat Careen, our “Outpatient Nurse” were incredible – from wound care to how to discretely reflect back what I’ve heard a patient say. The unit we formed for our chemotherapy patients, our palliative patients, and a whole bunch of others was based upon respect for and the maximization of each other’s scope of practice.
It was in Placentia that I got my 10,000 hours of reflective practice in. Though I didn’t keep perfect track, I worked a range of 60 – 100 hours each week. It was in Placentia that I was faced with a wide variety of clinical challenges (typically in the ER) with only the cottage-hospital level of support, and then found myself building customized networks with specialist colleagues in St. John’s and Carbonear, who were not only supportive and helpful, but helped drive the expansion of my clinical skills and evidence-based practice in numerous ways.
It was in Placentia that the patient-centred clinical method came to vibrant life in which each patient’s context had a massive impact on my assessments and in the negotiated development of an investigation and management plan. It was in Placentia that I experienced helping people with deeply hidden problems about which they finally felt comfortable to speak after being my patient for a few years, and when the immense privilege and therapeutic power of the doctor-patient relationship was made so real to me.
It was in Placentia that I learned a lot from my colleagues who were trained at Memorial and abroad. I learned tricks of the trade, as well as some crucial real world wisdom. It was in Placentia that I had the opportunity to work in so many different ways, including my own solo practice in which I got to work with great staff, particularly Laura Lannon and Sharon Regular.
It was also in Placentia that I think I became a true Newfoundlander/Labradorian and not just a townie. I have always loved St. John’s, but it was great to live outside it and smell (even more) the salt in the air and talk to people who had been resettled, and it was crucial to see firsthand the ugly impact of the collapse of the cod fishery. I felt so privileged to see the determination and spirit of the people in and around Placentia and the Cape Shore to make something happen.
When I think back, those four years packed a punch and whatever doctor I am today, it is because of them. When I get in front of medical students, as I often do in my role as undergraduate director here at the University of Calgary, my best clinical stories are from Placentia. Students are on the edge of their seats whenever I teach about the wiry 70-year old retired fisherman who got swept off the Cape Shore into the ocean during a gale and got swept back up with seawater, spiders and twigs in his lungs. Not a pin drops when I talk about the patient with pneumonia for whom the best care was to just keep her comfortable until her death. And they are amazed at how I could continue to provide care to my patients whether they were in my clinic, in the emergency, or as an inpatient.
So while I am thrilled with the things I get to do as an academic family doctor here in Calgary, and we are delighted with how our kids have thrived (who knew I would have kids who started ski racing at the ages of 4 and 6?), I am nevertheless grateful for my time in Placentia – it is where my clinical journey started and is the foundation upon which I continue to grow as a doctor.
Dr. David Keegan now lives in Calgary, Alberta, with his wife and three children.
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