Luckey and Good: My Day with a Primary Care Doc

Earlier this year, U.S.News and World Report ranked UNMC No. 6 in primary care education. In an effort to explain the importance of “primary care” on the health care continuum, we felt it was important to “show” not “tell” what those two words mean. What is life like for a primary care provider? What are the benefits and drawbacks of practicing primary care in a rural area? I set to find out earlier this summer by spending the day shadowing family medicine doctor and UNMC alum, Gerald Luckey, M.D., in David City, Neb. His day started early and ended late. And in between, it defined primary care.

6:19 a.m.: Dr. Luckey is picking weeds in front of his two-story house with his stethoscope in hand. Earlier, over a slice of toast and coffee, Luckey dialed into the Healthland Network with his iPad to check the vital signs of hospitalized patients. “It helps me get a head start to the day,” he said.

6:29 a.m.: Luckey pops open his garage and hops on his bike for a quick ride to work. Photographer Phil Nealey and I are running to keep up with the 67-year-old. Luckey pedals by before Nealey can even get the lens cap off. He settles for taking pictures out his driver’s side window with his left hand.

6:36 a.m.: A mile and a half later, Luckey arrives at the Butler County Health Care Center, where he has served the people of rural Nebraska for more than three decades. Inside, we find Luckey with a cup of coffee, having traded his loafers for tennis shoes, his slacks for scrubs and his tie for a white coat.

6:53 a.m.: Luckey heads into the procedure room. On the docket: two colonoscopies and an upper GI endoscopy. He hangs up his white coat as the nurses sedate the patient. Using a video-game like controller to view the woman’s intestines, he notes diverticulums in the colon – a weakness in the muscle wall. “She just needs to eat more old-fashioned oatmeal,” he says.

As the camera reaches the secum of the colon, Luckey gathers the team for a look. His fascination with the human body hasn’t waned after almost 40 years in medicine.

There’s no special story as to why he chose to be a doctor. “I looked up to the family physician and knew I had younger brothers who would run the farm.” And that was that.

7:28 a.m.: Luckey scrubs out, and I scurry after him as he heads to the doctors’ lounge to dictate into a landline phone. His voice is soft, and I catch about every fourth word. Colonoscopy.Period.Diverticulum.Period. You can tell he does approximately 175 colonoscopies a year.

We take a brief tour of the staff lounge, where the lunch lady knows the husband of Luckey’s first patient. In a town of fewer than 3,000 people, it’s not surprising that Luckey’s next patient taught his nurse’s son to drive a stick shift in high school and pulled her car out of a ditch last winter. That patient is John Dehner, and today is his 81st birthday.

8:16 a.m.: The AM radio plays softly as Luckey performs an upper GI endoscopy on Dehner. A dose of “bubble buster” to clear away saliva reveals an abnormal, corkscrew-like swallow. With the help of his team, Luckey nips a piece of esophagus to test for possible Barrett’s esophagus. They’ll know the results by tomorrow. Luckey heads down the hall and informs Dehner’s wife of 50-plus years that everything went well. “Now, let’s get John some birthday cake,” he jokes.

Luckey disappears, then returns five minutes later, telling me he had to check on a patient in the hospital. I just can’t keep up with this guy.

9:09 a.m.: Teresa Pokorny of Bellwood has a family history of colon cancer. That’s why she’s here for a colonoscopy before age 50. Luckey puts her at ease, asking how the crops are growing. As he’s finishing up, Luckey discovers and removes a polyp. They’ll test it for cancer, but he’s confident it’s benign. He tells Teresa she did an excellent job on the “prep” — code for colon cleansing. “Do I get a sticker for that?” she quips.

10:07 a.m.: Luckey stops for his fourth or fifth cup of coffee (he’s not sure) after changing back into his button-down-shirt and tie. He winds his way over to the clinic side of the building and confers with a nurse. A man called worrying about blood in his urine. Another was concerned that insurance won’t cover a brand-name prescription. A pregnant woman asks if she can have dental X-rays at eight weeks along?

“Luckey, the hospital line is for you,” someone yells from around the corner.

10:27 a.m.: Luckey opens the door to one of three exam rooms and is greeted by Albin and Gladys Shultz. Luckey doesn’t mind the two-for-one appointments. “You get more accurate information,” he said.

Gladys mentions that calluses on her feet have been bothering her. A good pedicure might have been in order, but instead Luckey trims her calluses on the spot.

Hanging on the wall is a plaque in the shape of the State of Nebraska. “2003 Nebraska Family Physician of the Year.” Luckey also received the 2012 J.G. Elliott Award from his alma mater, the University of Nebraska Medical Center, for being an “outstanding physician, leader, educator and innovator in rural medicine practice.” None of his colleagues was on hand to witness the honor. “He didn’t tell us until the Monday after,” says Dr. Mark Carlson.

Luckey has served as a mentor to many UNMC medical students and health professionals. “The students are able to do more here,” he said.

Unlike many office-based family physicians, Luckey and his students do hospital rounds, perform surgeries every Wednesday, dabble in obstetrics and gynecology and rotate being on call for the emergency room every fifth day. Luckey does nursing home rounds on his day off. “It allows us to maintain our skill set,” he said. “But we could use more help in the area of mental health and psych.”

In return for sharing his knowledge with students, they help him with his iPhone and electronic health records. “We still have paper charts, but we try to order prescriptions via the computer,” he said. “Some days I feel like a data-entry person.”

11:05 a.m.: A patient with a persistent cough and a crushed vertebra is back.

Luckey sympathizes as he knows she likes to garden. After reviewing X-rays, he demonstrates flexion exercises for the pain and prescribes an inhaler for the cough.

12:02 p.m.: Luckey helps himself to oven-fried chicken and cranberry salad as he joins a confidential credentialing meeting. I’m happy to have a few minutes to sit down. I rue the moment I decided not to wear tennis shoes.

12:46 p.m.: Luckey is sipping a Diet Mountain Dew at his workstation outside the clinic exam rooms. He walks us by the mailroom, where we get a look at his overflowing inbox. He’s part of a physician’s group whose members exchange charts for review. He’s also affiliated with several physicians hoping to set up a rural Accountable Care Organization or Health Care Co-op. He spends weekend nights on these projects.

1:11 p.m.: A 94-year-old woman who had a rapid heart rhythm is in because medication is making her heart beat too slowly.

1:31 p.m.: An 82-year-old woman who recently had shoulder surgery is in for a follow-up. Her range is impressive. Her worst problem: not being able to do her hair.

2:37 p.m.: An 80-year-old woman with chronic back problems. Luckey sketches the reason for her pain onto a notepad and recommends a patch to alleviate it.

The appointments continue well into the afternoon. Knee problems. Hip problems. Heart problems. Blood pressure problems. Bed sores. Dry mouth. Dry skin. Diabetes. (No more “Mexi-fried nachos” from Amigos for that guy). Back pain. Chest pain. Plain old pain.

One woman brings in all 10 of her prescription bottles. This is why Luckey favors the medical home concept, where one physician coordinates all the care. The idea is to keep the patient’s costs down by serving as a one-stop shop. “If we send people away (for their health care), that’s bad for the local economy,” he said. “We want to keep them home, and patients appreciate having their health care delivered in their hometown.”

The town of David City is “lucky” to have Luckey, who was born on St. Patrick’s Day. A Shelby, Neb., mother once told him his last name was the reason she chose him to deliver her son. That son: Gold medal Olympic bobsledder Curt Tomasevicz. Maybe she was on to something.

3:10 p.m.: A line has formed, and Luckey is bombarded as he emerges from an exam room: “What would you call this type of ulcer?” Ischemic;   “PT or OT?” (Physical therapy or occupational therapy?) PT; “Can you read this EKG?” Yes.

While Luckey is with another patient, Physician Assistant Leah Hays says, “If I could take someone to the fountain of youth, it wouldn’t be my mom or dad, it’d be Luckey. He’s the best family medicine doctor in the state.”

Luckey — a Columbus, Neb., native — relishes small-town life. “Ninety-five percent of the things I like to do are quick and handy,” he said. He fills up his gas tank once a month.

There’s no traffic, and there are no strangers.

He tells the story of the time when his knees were younger and he was nearly finished with a long run on a gravel road on a hot day. He had maybe 100 yards to go. Just then, a farmer tore off after him. “Doc, whaddya think of these blood pressure readings?” Did he stop? “Oh yeah, I stopped and talked to him.”

3:45 p.m.: A nursing home wants to bring in a patient. Luckey doesn’t hesitate to add him to his afternoon appointments.

4:07 p.m.: A patient with a marginally low thyroid level is feeling “pepless.” Luckey also checks her feet for psoriasis, places her shoes back on and tells her he always wanted to be a shoe salesman.

4:32 p.m.: Luckey drains fluid from a patient’s swollen knee. “We can do mine while we’re at it,” Luckey jokes.

For the clinic staff, 5 o’clock signals quitting time. Luckey still has hours of work ahead of him. He needs to check on three patients he admitted to the hospital, fill a dozen or so prescriptions and finish documentation on all the day’s patient visits.

Even by the time I’ve returned to Omaha and have recounted the exhausting day to my husband, Luckey is still at the clinic. About 8 p.m., he heads home for dinner with his wife, but he’s back at the clinic by 9:30 to sign off on more than 35 messages. Luckey autographs more paper than Taylor Martinez pens pigskin.

11:45 p.m.: He’s home for the night. In less than 7 hours, he’ll pedal back to the clinic to do it all over again.

“It occurs to me that this schedule is not what many people desire,” he said. “It just happens to be what I enjoy.”

Dr. Crouse and the Mustang

When David Crouse, Ph.D., was in his last year of college, in 1965, he took the nest egg he’d been saving and bought a Ford Mustang, brand new. It was perfect, custom ordered. He still remembers it coming off the truck.

“It was burgundy, with a black vinyl top,” he said.

He clicked a roll of film’s worth of photos of it, as if it was a newborn, and all these years later, he still has the pics.

Dave Crouse and his brand new burgundy Mustang, 1965.

A few years went by, and he got married and then drafted, seemingly all in one breath.

“It was not a good time to get drafted,” Dr. Crouse said. Almost immediately, he was shipping out.

His wife couldn’t drive a stick shift. With a heavy heart, Dr. Crouse asked his dad to oversee the sale of the Mustang.

Then he headed off to Vietnam.

When he got back, Dr. Crouse decided to find his car. “Some kid went out and totaled it,” his dad said.

That was that. Well, kind of. As the years passed, Dr. Crouse found himself checking E-bay, and motor auctions, and the like, looking for ’65 Mustangs.

You never forget a first love.

Dr. Crouse is retiring this week, after having been at UNMC for 35 years in various roles, most recently associate vice chancellor for academic affairs. He’s been the go-to guy again and again, a utility man who always answered the call.

So, what’s he going to do with himself now?

Dr. Crouse was back in his hometown a couple years ago when an old pal said, “Did you see your car?”

After decades apart, Dr. Crouse was reunited with a “clone” of his old beloved Mustang — it was re-built using several of his car’s original parts.

They tracked it down. “You related to Marion Crouse?” the man said. That was his dad. “That’s who I bought it from in ’68.”

The man had loved the car, but then sold it to a kid who crashed it. The man was so mad he bought the wreck back from the junkyard, and salvaged whatever he could.

The guy took parts from Dr. Crouse’s original beauty, put them together with the parts and chassis from a 1966. Car guys call it a “clone.”

“It took him 30 years,” Dr. Crouse said. But there it was.

What will he do in his retirement?

Well, now he has a another, new set of pictures to show you: a burgundy Mustang, black vinyl top. Beautiful; but the labor of love has just begun.

Acclimating to America: International Student Orientation Fun

He’s from Tokyo. She’s from Indonesia.

He will study bio statistics. She will study emergency preparedness.

Following graduation, he plans to stay here. She plans to return home.

Masayuki Takizawa and Dewi Ningsih are both new students in the College of Public Health. They couldn’t be more different. And yet alike at the same time.

They were here on Monday and Tuesday for the International Student Orientation, an inaugural event at UNMC that brings together new students from the countries of China, India, Egypt and Tajikistan to name a few. It included presentations from ITS, the DMV and the GOYP (Greater Omaha Young Professionals). (Nothing like a few acronyms to get you used to campus.) Other topics were immigration, security, banking, housing and worship.

He found the ice breaker helpful. She got the most out of the academic integrity session on plagiarism. They both liked the UNMC scavenger hunt. The students divided into teams and were given clues to find campus landmarks like Hope Tower, the Student Life Center, and the Graduate Studies Office.

Together, Takizawa and Ningsih dubbed themselves “Team Lazy.” The garnered signatures from volunteers at 10 of the 14 campus landmarks, but were ditched early in the competition by a more ambitious teammate.

“Why is she running?” questioned Takizawa.

Team Lazy doesn’t run.

But other teams did. The Find Outers.

And the Pizza Chasers. Some of the teams also reverted to their first languages in the chaos of the contest.

That wasn’t possible for Team Lazy.

“Tell me about Tokyo,” said Ningsih

“Big. Crowded. Expensive. But convenient,” responded Takizawa.

He came here two years ago for an MBA, but after three semesters decided it was “too boring” and switched paths to public health.

“Connection is everything,” he said. “I want to use the exchange of knowledge to think globally, and act locally.”

She came here five months ago to further her emergency care education.

And maybe find a soulmate, she added.

(Cue the lump in my throat.)

As for campus, he’s been impressed with the cleanliness and safety. She’s noticed the kindness of others.

Team Lazy ran into their former teammate on their way back to Sorrell from the McGoogan Library, one of the scavenger hunt landmarks.

They tried to point her in the right direction without giving her the answer.

“Where are all the books?” they quizzed.

“The bookstore?” she responded.

Cue laughter, the language everybody speaks.

Welcome to UNMC.