ST. JOHN – You might assume the best place to suffer a heart attack is near a major urban hospital specializing in coronary care.
Another good place is on a racquetball court with Tony Lundberg.
Three months ago, Lundberg’s 50-year-old opponent collapsed midgame, 90 miles from Sacred Heart Medical Center in Spokane.
“He looked like he was seizing. Then he turned blue,” recalled Lundberg, a rural family physician. “So I immediately went into ER action mode and started CPR.
“He’s a really big, big guy. Fortunate, I was able to get some other players to help me open his airway.
“The EMTs arrived and shocked him back into rhythm. We got him to Pullman Regional Hospital, and from there he was flown to Spokane.”
The patient had four plugged vessels, and required a coronary artery bypass graft, Lundberg said. “But he didn’t lose any heart muscle, which is extremely rare.”
Had the incident occurred almost anywhere else that day, the man likely would have died, Lundberg said. “Instead, we’re playing racquetball together again, and he’s even better than he was before.”
When not playing racquetball – or pingpong, Lundberg’s other recreational passion – his career keeps him constantly in motion. Two days a week, weather permitting, he skateboards to a small medical clinic down the street from his ornate Victorian home in St. John, population 600. Two other days, he drives 37 miles to a clinic in Tekoa. He also performs surgery at Whitman Hospital in Colfax, where he pulls emergency room duty every sixth day, and monitors in-patients every sixth weekend.
Based on 18 years of experience, Lundberg believes rural physicians “do better medicine than most places.”
He explained why during a recent interview, and prescribed a cure for one of health care’s biggest headaches.
S-R: Where did you grow up?
Lundberg: Las Vegas.
S-R: What were your interests as a teen?
Lundberg: I was a computer geek. I hacked into sites and copied things I wasn’t supposed to.
S-R: Did you have a career in mind?
Lundberg: I considered medicine early on. When I was 12, I had a horrible ear infection. Our next-door neighbor was a doctor, so he came over, checked me out, and gave me some sample meds. Within a day I was feeling better, and thought, “That looks like a cool profession.”
S-R: What was your first job?
Lundberg: I installed insulation in attics with my brother when I was 15. The next year, I got a job stocking shelves at a drugstore.
S-R: How about after high school?
Lundberg: With the money I’d saved, I went to Medellin, Colombia, on a two-year mission for my church. We still go down to Mexico as a family to build houses. My wife, Kelly, learned Spanish and teaches it here in St. John.
S-R: Where did you attend college?
Lundberg: I went to Brigham Young University and got a degree in humanities, with an emphasis on Spanish literature.
S-R: Then what?
Lundberg: After Kelly and I graduated from BYU, we looked for a place where I could attend medical school and she could get her master’s in speech therapy. The first place I interviewed was Kirksville College of Osteopathic Medicine in Missouri, and it felt like home. Luckily, Truman State University nearby had a great program for speech therapy.
S-R: What’s the distinction between an MD and an osteopathic physician?
Lundberg: They’re pretty equivalent. I feel I have an extra tool, because we’re taught manual manipulation for pain. If someone’s hurting, sometimes we can treat them without medicine.
S-R: What path did you choose upon graduation?
Lundberg: I’d planned to go through an osteopathic residency, but we discovered Kelly had ovarian cancer. So I applied to the University of Washington’s rural residency program in Spokane, where Kelly’s family lived. From there, I went up to Colville to train and was able to moonlight in an emergency room for two years.
S-R: What brought you to St. John?
Lundberg: Kelly’s dad was familiar with small towns, having built assisted-living facilities to give farmers a convenient option when the time came. Based on his recommendation, Kelly started calling around. The first doctor she talked to – here in St. John – said he hadn’t told anyone, but he was quitting to move closer to his family. I immediately set up an interview with the Whitman Medical Group in Colfax, then bought that doctor’s house in St. John, and here we are, 18 years later.
S-R: What is Whitman Medical Group?
Lundberg: We’re a private corporation that employs a team of about 40, including six doctors. We staff three clinics – St. John, Tekoa and a bigger clinic next to the hospital in Colfax. I’m the satellite guy.
S-R: Is it unusual for towns the size of St. John and Tekoa to have a physician, even two days a week?
Lundberg: Yes. Until five years ago, Tekoa had a physician’s assistant. When he retired, the town invited us to use the clinic.
S-R: What’s your caseload?
Lundberg: I see 25 to 30 patients a day.
S-R: How many hours a week do you work?
Lundberg: Including paperwork, about 70.
S-R: Is there a busiest time of year?
Lundberg: January, February – flu season.
S-R: If you practiced in a larger community, such as Spokane, would you earn more, less, or about the same?
Lundberg: Less, because we’re our own corporation. But if I were a rural doc trying to make it on my own, I couldn’t do it.
S-R: Does the second medical school in Spokane bode well for rural health care?
Lundberg: Definitely. We work with both UW and WSU, as well as other universities. Last year, I mentored three students.
S-R: What sort of person is best suited to be a rural physician?
Lundberg: Someone with broad-based training and the ability to work independently.
S-R: What advantages does rural health care offer?
Lundberg: The biggest advantage is knowing our patients. When you see a physician in a bigger city, it’s usually quick. And they’re not your neighbor – they don’t see you in other situations. Knowing someone’s family dynamics is so important, especially in end-of-life situations.
S-R: Anything else?
Lundberg: Besides seeing patients in the clinics, I also admit them to Whitman Hospital, so there’s continuity of care. Our rural patients are treated as well as they would be anywhere in the country. I think we actually do better medicine than most places, because we respond immediately. For instance, a lady came in with a tumor on her leg, so I took a picture and texted it to one of the top oncologists in Spokane. He agreed it looked suspicious, had me take a wedge biopsy, and we got her in to see him two days later.
S-R: Is the fact that you have to drive back and forth to Tekoa and Colfax a disadvantage?
Lundberg: Maybe. But two days a week I skateboard to the clinic in St. John and walk back home for lunch with my wife. It evens out.
S-R: Nationally, rural patients tend to be sicker and poorer than the general population. Is that the case in Whitman County?
Lundberg: We’re fortunate in that a lot of our patients are farmers, and generally they do pretty well.
S-R: Do you accept new patients, or are you at capacity?
Lundberg: I’ll see anyone. If you’re a rural family doc, closing a practice seems counterintuitive. I want to help people, whether they have insurance or not. But we do have rules to make sure someone doesn’t have a problem with opioids.
S-R: What do you like most about your job?
S-R: What do you like least?
Lundberg: Paperwork. If someone asked me how to fix medicine, I’d say pay doctors less per visit and require less foolish documentation.
S-R: Do you have a motto or mantra?
Lundberg: Physicians sometimes lose the ability to listen. They just try to hear the facts, diagnose the problem and get patients out the door. My mantra is “Keep caring, despite being tired,” because most diagnoses come when you’re listening to someone’s HPI (history of present illness). The exam is secondary. Most issues are figured out when you listen well.
S-R: Any changes on your horizon?
Lundberg: Not immediately. But my goal is to get full palliative-care certification, so when I do eventually go somewhere else, I can do hospice.
S-R: Where might you go?
Lundberg: We’ve thought very seriously about Colombia, Guatemala or Mexico. I’ve done medical missions in Belize, and that was wonderful. They don’t have the onerous, unnecessary documentation we have here.
S-R: As a small-town physician, do you have neighbors stopping you in the hardware store seeking on-the-spot medical advice?
Lundberg: No, they’re respectful – sometimes too respectful. An elderly friend next door was very sick one night – chest pains, shortness of breath – but waited until the clinic opened the next day to see me. I said, “Why didn’t you call me?” “Well,” he said, “you were with your family and I didn’t want to bother you.”
S-R: Tell me about your family.
Lundberg: We adopted our first child 21 years ago, after Kelly finished her chemotherapy, and we convinced her oncologist that she’d live long enough to raise a child. All together, we’ve adopted four babies in the U.S., and one from Guatemala. Family is very important to me.
S-R: Any more adoptions in your future?
Lundberg: No. (laugh) Five is sufficient.
Writer Michael Guilfoil can be contacted at firstname.lastname@example.org.
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