A modern view of country doctors

When Dr. Therese Zink started collecting real-life stories for a book about country doctors, she had one rule:

No Norman Rockwell-like tales from a bygone era.

Zink, a family physician in Zumbrota, Minn., was determined to put a 21st-century spin on the subject of rural medicine in her 2010 anthology, "The Country Doctor Revisited."

And yet, she couldn't help including the story of a doctor who drove to an Amish farmhouse to perform a circumcision. There, he discovered -- to his horror -- that he had forgotten his scalpel.

At that point, the baby's father slipped into the kitchen and returned with an 8-inch steak knife.

"Will this do?" he asked.

And sure enough, it did.

"Things have changed, but some things haven't," she said. "That's the beauty of being rural."

Zink, who has dabbled in writing throughout her medical career, decided to gather stories from people on the front lines -- doctors, nurses, medical students -- to show how rural medicine has transformed in recent years.

The days of the solo country physician, trudging through wheat fields with his trusty black bag, are long gone, she says, especially in Minnesota. In some ways, technology and economics are making rural medicine almost indistinguishable from its urban counterparts.

And yet. ...

"There is an intimacy with your patients," she said, "that makes it a very special way to be a doctor."

As country doctors go, Zink is a relative newcomer. Raised in Ohio, she spent most of her medical career in the Twin Cities and other urban settings before buying a small farm in southern Minnesota in 2004. Today, she practices at a Fairview clinic in Zumbrota, and teaches at the University of Minnesota Medical School.

The idea for the book, she says, came out of her work at the university's Rural Physician Associate Program, where she oversees medical students who spend part of their training in small-town clinics or hospitals.

When they return from their nine-month stints, she said, the medical students are overflowing with stories, often about poignant or haunting encounters with patients. As a writer herself, Zink would encourage them to write about their experiences -- altering enough details to protect patient privacy -- and share them in class or online discussion boards.

"Some of them, as I read them, just begged for a bigger audience," she said.

For the book, she selected some of the best, then rounded them out with the voices of experience, collecting stories, poems and essays from doctors and others who have practiced for years. The result is a behind-the-scenes portrait of small-town medicine, as seen by those wearing the white coats.

One recurring theme is the often blurry line between their professional and personal lives. "In medical school, you're taught that you can't be friends with your patients," Zink said. "That's not possible in rural areas. The expectation is, you are [friends]. So how do you negotiate that?"

In one story, an American Indian medical student at a hospital in Bemidji, Minn., struggles with the aftermath of the 2005 Red Lake shootings. "In the ER I found myself staring at young, Native men, all victims of the tragedy in Red Lake," wrote Dr. Erik Brodt in a chapter called "Learning to Walk the Healer's Path."

"My mind raced and my stomach curdled sour. Do I know this kid? Oh, no. Does he remember me?" Later, he writes, "Once the last patient was discharged and the camera lights dimmed, the community remained ... in need of healing. So did I."

In another story, a Nigerian-born doctor describes a nagging sense of hostility from the adult children of an elderly white patient. After several tense days, he discovers that -- far from resenting him -- they want him to become their father's permanent doctor.

Another physician, in rural Wisconsin, writes a poem about praying for a patient's peaceful death.

Several of the stories are by Zink herself. One, first published in a major medical journal, is laughingly titled: "Thank God for My Ass." She writes about Jimmy, her miniature donkey, and the unexpected role it played in smoothing her way with a stressed-out family.

"It's one of the few things I've written that practically wrote itself," she said. It turns out that the patient's family had borrowed her donkey for a Christmas play, months before they met during a medical crisis. "I realized the gift of having made that connection with that particular family," she said, "and it was all because of this donkey."

The book, which came out last fall, is the 18th in a series on "Literature and Medicine" published by Kent State University Press.

Zink proudly notes that it's now in its second printing, and she's already at work on several other books, including a novel and another collection on becoming a doctor.

Dr. Jon Hallberg, a colleague at the University of Minnesota, calls Zink a gifted writer who can capture the dual sides of medicine. "It's science on the one hand, but it's stories and people on the other," he said.