small town country doc vicissitudes

It's a weird adjustment doing the small town doc thing. Every day I hear secondhand about someone I took care of, like, "My daughter was drunk and smashed her finger in a car door Saturday night and you fixed it." People know about me before I meet them. I called one of the docs to admit a patient and he started telling me his patients, my in-laws, told him I had started working there.
The nurses at the small town ER call me "the Shit Magnet" because someone hardcore crazy sick usually comes in whenever I'm on. I've always had a white cloud so I haven't accepted the shit magnet label yet.
I'm used to a complete disconnect between my work life and social life. Not here.
The weirdest of all happened Monday. There was a lady who fell hiking and hurt her ribs. She had come in Sunday and was told she bruised her ribs and prescribed pain medication. She had returned because the pain was worse and she was short of breath. I walked in the room and it was someone I know well from the ski hill. Up to that point she had no idea what my day job was.
She was in extremis and I couldn't hear breath sounds on the right. This meant she had dropped a lung. I ordered a chest X-ray and ran over to radiology to review her X-ray from the day before. It had been read as negative by the ER doc on duty, but still unread on the radiologists desk. We looked at it together and a small pneumothorax was present. It was small enough that it probably would have been watched as an outpatient, so not the most egregious miss, but still a miss. I always take it personally when I'm the one who missed it.
The new X-ray was much worse. The lung was so deflated that she was starting to get tension pneumothorax, a life-threatening emergency. I heard that the surgeon on call had left the hospital. We tried his office, the OR, his house and his beeper and nobody could find him.
I had to pull the trigger. Dilly-dallying any longer would have killed her. Ideally a pigtail catheter should be used but I've never done one, so I opted for the old school chest tube, which I've done hundreds of times in the ghettos of Philly and Providence. I've been living in a pay-for-performance world for the past few years, so I've been farming out the chest tubes to PAs and surgeons lately in the interest of time management. I do them maybe once every couple years now.
I will never get over putting in chest tubes. You're really stabbing someone in the chest in slow motion, and you have their life in your hands.
The last one I did the patient and his brother were counting the rosary. It was surreal.
There's a point in chest tube insertion where you use blunt forceps to push through the rib muscles and into the plueral space. No matter how much sedation and local anaesthetic you use, it still hurts the patient like a bastard. In tension pneumothroax there is a dramatic woosh of air as the tension is released when you get into the pleural space.
So I'm stabbing this lady I know, and she's talking to me about my kids inbetween groans. She trusts me completely, and I'm scared to death.
Woosh. I'm in.
I got the chest tube in and she immediately looked and felt better. The lung was back up on the chest X-ray.
The surgeon had been on an afternoon bike ride and couldn't hear his beeper.
This was one of those moments I longed for when I applied to medical school, the opportunity to intervene in badness and fix it. To do this for someone I know socially is an unbelievable honor.
I think I'm going to hear all about this at the ski hill.