When my phone rings in the middle of the night, it can only be one of three callers: my mother who lives in China, the charge nurse/emergency room from my rural hospital, or the after-hour on-call service for the community health clinic I work for. All three should know to only wake me up for emergencies. Because as a family physician, even if I am up all night to take care of patients, I still need to attend my full-day of clinic the next morning.

I grew up in Beijing, China, where the population is 21 million. My high school alone had over 40,000 students. Now, I am a country doctor in rural America, where the population is a few thousands. Needless to say, doctors are few and far between. I came to rural primary care because my skills are needed here: I treat chronic illnesses such as diabetes and hypertension, do wellness visits for kids and adults, see acute care cases such as broken bones and vaginal bleeding, deliver babies, assist Cesarean sections, take care of sick patients in the hospital, and provide hospice care when needed. This is called “full-scope” or “full-spectrum” family medicine, also known as “cradle to grave” healthcare delivery. And some say that physicians like me are of a dying breed.

When I graduated medical school from Dartmouth in 2016, I was awarded the John F. Radebaugh Community Service Award. This award is given to one student each year who exemplifies outstanding community service during his/her four years at the Geisel School of Medicine. Along with a plaque, I received the book House Calls with John by the late Dr. Radebaugh himself. Dr. Radebaugh spent his long and fruitful career serving the poor. He helped develop migrant farm worker health clinics, worked with the United Farm Workers' Union and Cesar Chavez. “I often had night house calls, which were especially tiring, for they affected my performance on the following day.” Dr. Radebaugh wrote. But he never refused these calls. Little did my medical school professors know, just three years later, I would be following Dr. Radebaugh’s footsteps in serving the migrant farm workers and taking calls that would dramatically impact my nights and the days to come.

As a general rule, I don’t turn my phone off even on the days when I am not on-call, if I have any patient more than 36 weeks pregnant. This means, as a woman provider who is extremely patient, my phone has not been put on silence or turned off since I started this job almost three years ago. Most people think the Emergency Room or the Operating Rooms are where the medical theatrics take place. In reality, us country doctors have the front row to the drama known as the human condition. Here are some examples of the calls I might get:

“Hello, are you the doctor? I really need to talk to someone before I hurt myself. I don’t want to give you my name, because I don’t want you to call the police, and I will not go to the hospital!” I am not equipped to provide therapy, but in this case, I buckle up and give it my best shot.

“Dr. Zha, your 33-week-pregnant patient is 7cm dilated and changing fast, and we cannot find the heartbeat of the baby, you need to come now!” In this case, I jump out of bed, put on some clothes, and run to my car. On the way to the hospital, I quickly rehearse the steps of neonatal resuscitation in my head.

Lastly, “Dr. Zha, this is Dr. Adams from the emergency room, I would like to admit a patient to you. I think this patient might be too sick for our hospital, but all the ICUs in our state are full. Can you help?” In this case, I take the patient history from the ER colleague, while panicking inside. I go to the hospital to admit the patient, and expect to be there for the rest of the night.

Of course, I also get those phone calls that could have waited until the morning. But like Dr. John Radebaugh, I never refuse to be nice on the phone even when my sweetest dream is rudely interrupted in the middle of the night. This isn’t because I haven’t been attempted to just hang up, but that regardless of my clinical judgement, I am in the very moment of someone’s vulnerability. And if I am not eager to help, no one else will.

Call the Country Doctor is a twice-weekly blog where I tell interesting stories of my life as a full-scope family doc, to give readers a glance into the world of rural primary care. Perhaps more importantly than answering literal phone calls, I am answering my calling as a physician. Here, I try to look into myself, the healthcare system, and the American society with keen curiosity and relentless interiority.

(Posts are not medical advice, and all views are strictly my own. Patient details will be significantly changed to protect privacy. )