I'm home now during a rare and unexpected break in patients in the midst of my Saturday "off-site" call and thought I'd write you a note. You should feel honoured: this is the first non-work-related letter I've completed in over a year.

This morning started with me doing rounds at 9 am on all the in-patients — kind of easy as they were almost all mine anyway. Then I had a cast to repair, a few people with sore throats to sort out (that would be pretty hard to say fast 10 times in a row, wouldn't it?), and a few other bits and pieces. No real huge emergencies, which is nice after that really strange arrhythmia 2 nights ago (atrial fib going in and out of v. tach). Mike Furey, one of the cardiologists in St. John's, really helped me out with that one.

I find it pretty cool working in a place where one of the major referral centres is the place I trained. The voices on the other end of the line are familiar to me and I get a sense that we all have a clear understanding of our own roles and that we're all on the same team. I find it eliminates a whole lot of second guessing when the consultant is someone I've trained under (and hopefully was able to impress with my charm, lightning fast and sharp diagnostic skills, and all-around good looks!).

I've been here in Placentia for over 3 years, with the last 2 working out of my own clinic (Fort Frederick Medical Clinic) but also doing tons of stuff at the hospital. Every day sees me rising at 6:30, leisurely getting ready for the day and heading out the door an hour later. In-patient rounds take only about an hour, depending on how many beds in our 10-bed hospital are filled with my patients, and then I sometimes have chemotherapy or small procedures to do before I head to the clinic. One day a week I do my night call, and I do my turn on the weekends, lately about 1-in-3.

I will admit that I'm pretty proud of "The Fort." I've put a lot of time (and money) into making it stand among the best medical clinics around. It's great fun when I stroll (or if I'm late, sneak) in through the back door and get down to the work of seeing my patients. Coming as a surprise to me is the utter joy I experience when taking care of patients with class 3 and 4 congestive heart failure. For some reason, the close monitoring, the careful medication titration, the aggressive use of ACE inhibitors, is a delight. As Placentia has an older population, quite a number of my patients fit this bill. But it is also neat to never know whether it's a kid with "a turn in his foot, Doctor" or a person with chest pains waiting to be seen next. I haven't lost my love of the unexpected and the variety, and I hope I never lose it.

I'll admit, though, it is kind of disheartening when you're working flat-out but still struggling with things like cash flow and a debt that is virtually as large as it was when I left medical school. I find it a little strange that my colleagues in different parts of the country are taking job action over fee schedules I would gladly welcome. And then I wonder, "What am I doing here?" But then again, I don't know if I could ever leave Newfoundland.

My patients are always asking me if I'll be heading out sometime, and my answer is that things would have to be pretty bad for me to go. Lately, with increased call, less personal time and with still the worst fee schedule in the country, it has seemed like it's getting kind of close to "pretty bad." Like most docs in the province, I guess I keep hoping that things will improve and that I won't be forced into any drastic decisions that nobody really wants.

Something else my patients keep asking me is about my prospects for marriage. For some reason, most of my 80-plus women patients say, "Don't ruin your life yet and get married. You've got plenty of time in life for that down the road." Oddly, the younger women want to see me married off. In any event, right now I'm utterly single, though there's always prospects....

Anyhow, I can't believe I've squeezed this much onto a sheet of paper. I'd better finish off now, anyway, as I want to get a good workout in before being called back to emerg. I recently set up a concept of priorities to help me frame my life: body, soul, family, friends, being a good doctor. Anything that doesn't fit in there somewhere just doesn't get much of my time anymore, leading to me reading more books in the last 2 months than in the last 3 years and also leading me to get my cable hauled out.