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'Cowboy Medicine' Shapes the Frontier in Rural Nevada : Health care: Dr. Brian Callister is called upon to do just about everything, even sew on a dog's ear. But 90-hour workweeks take a toll on family life; he plans to move to Reno.

July 09, 1995|TOM GARDNER | ASSOCIATED PRESS

TONOPAH, Nev. — The patient's ear was sliced off--word had it by devil worshipers. It was a Sunday night and the nearest specialist for this type of patient was 150 miles away. So the call went to Dr. Brian Callister.

After initial reluctance to take the case, Callister responded and reattached the ear. He performed surgery on a kitchen table in a mobile home.

The patient, a nurse's cocker spaniel, healed fine.

Sewing on a dog's ear was a fluke, but it was not that far out of the ordinary for a doctor in what can still be called the frontier. As chief of staff and chief of medicine at Nye Regional Medical Center, Callister is called upon to do just about everything.

"When I was training at UCLA, I never thought I would be in a position where I would be sewing a dog's ear on, let alone taking care of a pediatric case or things other than straight internal medicine," he said.

Callister, 34, a Phi Beta Kappa graduate in economics from Stanford University, a top scholar at the University of Utah School of Medicine and the 1991 physician of the year in his residency at UCLA, chose this barren former mining town to avoid rearing his young family in the city.

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But the 90-hour weeks, telephone calls at all hours and people interrupting day-off barbecues at his home for instant diagnoses have prompted his plan to move his practice to Reno later this year.

"You literally have to be able to take care of everyone and everything at any time, whether you are on duty or off duty, whether you're home or on the road," he said.

"If a problem comes up, you're there and you have to deal with it. Why? Because there is nobody else."

Reno and Las Vegas are home to nearly 85% of Nevada's population. Areas designated as rural have 7% of the population.

The rest of Nevada's residents, barely 125,000 of them, are scattered across a huge expanse the Census Bureau describes as frontier.

Nye County sprawls over 18,064 square miles, making it bigger than Massachusetts, Connecticut, Delaware and Rhode Island combined.

When people are hurting, they travel up to 200 miles to Callister or one of two other doctors at the center midway between Reno and Las Vegas.

Once there, they receive what Callister calls "cowboy medicine."

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"It's a 'grab what you have and use what you have' style," he said. "Cowboy medicine is the ability to diagnose and treat medical problems with whatever you have. We don't always have the highest technology of equipment we would like to have, but it's amazing what you can do with small amounts of resources."

One recent Sunday, a truck flipped over and left two men seriously injured.

Callister drove to the emergency room and waited for the ambulance to reach radio range from the remote accident site nearly 100 miles away.

He evaluated the patients' vital signs as reported by paramedics, then recommended emergency treatment until the ambulance arrived more than one hour later.

And he called in the help he thought he might need: an X-ray technician, the anesthetist, another doctor, nurses--most on their day off.

All were cross-trained to switch places if needed.

Even the Episcopalian priest who responded to provide spiritual support, had it been needed, is a respiratory therapist. Callister once routed him out of the pulpit, mid-sermon, for an emergency.

A passenger in the truck was admitted here for treatment after a CAT scan showed no brain injuries. But Callister didn't like what he saw on the driver's X-rays. Another picture revealed a broken neck, and the man was flown to Reno.

It's not just accident victims or ailing patients who challenge Callister and his staff.

Last year, Nevada's first known case of rodent-borne hantavirus walked into the hospital. The little-known disease had largely been confined to Indian reservations in the Southwest, but Callister and fellow emergency room doctor Chris Ward spotted the symptoms.

"I didn't even remember its name, but I was sure it was that mouse-poop thing," he said. "We sent the results to the Centers for Disease Control. They confirmed it and said they had a crew on the way."

When Callister arrived here four years ago, emergency medical technicians generally were qualified only for what he calls "load and go"--getting patients into the ambulance and hoping they survived the trip to the hospital.

Since then, he estimates he has trained 300 technicians who now follow instructions to perform life-saving techniques on the patient they're transporting.

He sees it as part of a legacy that will remain when he reluctantly leaves a town where he knows people rely on him.

"I didn't want to raise my family in an urban area. I wanted to raise them in a rural area," he said. "I went somewhere people honestly need me . . . in numbers that are far greater than most people would ever realize."

But those needs and those numbers became too demanding as his family grew.

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