Country Doctor’s Payoff Is Quality of Life

Sunshine filters through the window as Dr. David Loxterkamp gently prods his first patient of the day for the second time.

“How are you feeling?” Loxterkamp asks Roland Knowlton, 63, who lies swaddled in a thin green blanket on a bed at the Waldo County Hospital.

Groaning, Knowlton blames his gallbladder for the pain that brought him to the hospital around 2 a.m. Loxterkamp arrived a few hours later and now, hours after breakfast trays have been cleared, examines his patient again.

Knowlton’s symptoms don’t point to a gallbladder problem, Loxterkamp says, but years of family practice have taught him one thing.

“When patients are worried about something, we address it even when it doesn’t appear to be the cause,” he says. “Patients have an intuition about their own bodies.”

Loxterkamp, 44, is one of eight family practitioners in Waldo County, which historically has been one of the poorest counties in the region. Educated at the University of Iowa Medical School, Loxterkamp came here with his wife 13 years ago to escape the bustle of city life.

His experiences are chronicled in his new book, “A Measure of My Days: The Journal of a Country Doctor,” which describes the challenges and pleasures of a rural medical practice. University Press of New England is the publisher.

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Loxterkamp saw Belfast as a place where he could develop close relationships with patients and practice better medicine than in a big city.

The coastal views and rolling hills were as breathtaking as he imagined, but the beauty could not disguise the area’s problems. He quickly discovered hunger and indigence had not disappeared from a county once dominated by poultry and sardine plants and shoe factories.

“Anything along the coast is refurbished and looks nice,” Loxterkamp says. “But go just three miles inland, and it’s a whole different world of trailers and ramshackle huts.”

About half of Loxterkamp’s patients rely on Medicare or Medicaid, and requests like the one he receives from a diabetic patient on this summer day are not uncommon. When the man tells Loxterkamp his power is about to be shut off, the doctor promises to write the utility about the man’s condition in hopes of keeping the lights on.

Belfast also has not escaped big-city problems.

On the same day, Loxterkamp counsels a young woman about to undergo HIV testing and coordinates psychological treatment for another young woman suffering from an eating disorder that has left her mentally and physically exhausted.

Rural medicine is not a path to riches. Loxterkamp drives a battered Volkswagen Jetta and his practice has only recently been able to afford a retirement plan for its staff.

But the payoff, he has come to believe, is a higher quality of life for his family and in the relationships he establishes with his patients.

Many of his neighbors distrust outsiders, he said, but he eventually earned their trust by becoming a part of the community.

“Unlike my counterparts in the city, I’m able to admit my patients, care for them in the intensive care unit and do home visits,” he says. “I’m also able to reinforce my relationships with my patients because they are the same people who teach my children, who I sing with in the community chorus and who pump my gas.”

He says the variety of patients he encounters keeps him busy, and he enjoys getting to know families.

On the same day that he sees Roland Knowlton for what turns out be an acute gallbladder, Loxterkamp treats Knowlton’s daughter-in-law for an irritation she’s developed on her hands.

He also treats an elderly woman hospitalized for diabetic complications. As he examines the sores on Charlotte Alexander’s foot, he asks how her family is doing.

“He’s one of the family,” the 80-year-old woman says of the doctor. “If I had any room for him, he’d be my son.”

After that, it’s a home visit to check on a multiple sclerosis patient experiencing breathing problems. Loxterkamp strides through the kitchen into a sun-soaked bedroom, where Jackie McKeen lies under a quilt, her body immobilized by the disease. In a wispy voice, she tells the doctor she has recently been short of breath, an observation her caretaker husband backs up.

Loxterkamp measures the oxygen saturation in Jackie McKeen’s blood and finds that her count is below normal. He tells her husband that Jackie needs to sit up more, prescribes new medicine and tells him to call if her condition does not improve.

Personal relationships can complicate his job. In communities where relationships extend beyond the examination room, it can be difficult to know where professional boundaries end and personal ones begin.