A Day in the Life of a Carson Country Doctor

by Jon Christensen - Photos by Kit Miller

Dr. Susan Pintar began her day with a newborn in the intensive care nursery at Carson-Tahoe Hospital.

Rachel Marie Soukup had been delivered the day before by caesarean section. It was supposed to be Dr. Pintar's day off. But she was on call for emergencies.

And Rachel didn't come into the world with greatest of ease. She had fluid in her lungs.

"You don't get that last squash out," said Dr. Pintar. So she needed a little extra oxygen for a day.

Dr. Pintar stopped by to check on Rachel on her way to work the next day. Rachel's black hair was sticking to her head. She needed a bath. But she was feeding happily from her mother's breast.

When the baby was done, Dr. Pintar picked her up. Rachel wailed as the doctor pried her mouth open with her thumb and pressed a cold stethoscope to her chest. "She is strong, isn't she?" asked the mother, Jaydene Soukup. The doctor nodded. The baby was doing fine now.

"You have a neat job," said Jaydene.

"One of the nice things about pediatrics is the patients get better faster, not like those old folks," said Dr. Pintar with a smile.

Pintar is one of four Carson Country pediatricians on call at the hospital.

Yesterday was supposed to be her day off. She had planned to spend the afternoon in her son's class at Fritsch Elementary School.

But she was on call and ended up spending the day at the hospital. She was working too hard. Her family was suffering. But babies don't come in to this world or become ill at our convenience.

In addition to attending Rachel's birth, Dr. Pintar had to send a 2-week-old baby to Washoe Medical Center in Reno by helicopter. The baby was ailing with RSV, a respiratory virus that causes a bad cold in adults but can be fatal for infants.

Today Dr. Pintar was still on call at the hospital and she was scheduled for a full day at her private practice. After calling Washoe Med to check on the baby she sent there yesterday, Dr. Pintar walked over to her clinic on Washington Street. She zigzagged through parking lots, threaded a gap in a wooden fence, and let herself in the back door.

The Capital Medical Associates clinic officially opens at 10 a.m. When Dr. Pintar walked through the door at 9 a.m. the phone was ringing. It was her sister Mary calling from Kansas to ask about antibiotics for her child.

"You have to knock back the bacteria." Dr. Pintar advised her sister. "The goal is to get him through the winter so he doesn't have tubes."

Dr. Pintar, 43, is the oldest of five children who grew up in Carson City. Her father was a school principal and her mother was a second-grade teacher. Mary is the only one who moved away.

We ideally imagine the doctor as an older brother or sister. In Dr. Pintar's case this is both true for her sister, and symbolically true for the rest of her patients.

Now it was time to prepare for them. For the rest of the hour before the clinic opened, Dr. Pintar would give her undivided attention to her nurse, June Corbit.

Together they went through a stack of manila folders a foot high. Each folder contained the medical records of a patient. They took them up one by one.

Most went into a stack for Dr. Pintar. Her day began to take shape in her mind. There were 25 folders, 25 children, 25 families whose future was in her hands this day.

There was one folder that gave her pause, concerning a boy who had been discovered alone in his room with a razor at his wrist. He was the third teenager in the last week who, she had heard, was contemplating or had attempted suicide. She would need a half-hour of undisturbed privacy to talk to the boy and his father, to refer them to mental health counseling and give them advice on possible medication.

Another dozen files went into June's stack. These were calls the nurse could take care of in between weighing in babies and dispensing immunization shots: insurance companies demanding arcane diagnostic codes before they would pay for treatments, troubled parents to help through the confusing maze of medical care, referrals to specialists, and problem patients to track down.

"Did her pregnancy test come in positive?" Dr. Pintar asked, picking up a folder from the nurse's pile.

"No," said June.

"Thank God!" said Dr. Pintar. But this promiscuous teenager was bound to get pregnant one of these days. The doctor wanted to recommend Depo-Provera, a contraceptive injection that lasts three months. "See if she'll come in," she told the nurse. "If not, tell her I'll take a syringe down there myself and say, 'Come here and let me see your butt.'"

Dr. Pintar has three children of her own and thousands of patients from all around Carson Country. The area could use twice as many pediatricians. Dr. Pintar sees her patients frequently when they are infants and toddlers for well-baby checkups and immunizations. After they start school, she usually sees them only when they're sick.

A lot of teenage girls would like to stay with her when they become grown women. But she has one hard and fast rule: "You can't be my patient if you're over 21 or have a baby," she said. "When you have a kid you can't be a baby anymore."

The emergency phone line rang. Dr. Pintar picked it up. She listened for a moment and then quickly said, "How about 10:30?" It was a doctor whose child was sick with a cold. "They know how to call on the back line," she said. "And we have to pick it up. It might be ER."

Regular checkups are scheduled on the hour so that sick kids can be slipped in on the half-hour. As 10 a.m. approached, Dr. Pintar prepared herself. "Got my stethoscope," she said, swinging the pink tubes around her neck. "Got my favorite pen. I'm ready to roll."

Behind the scenes, the doctor's office is a staging area for efficiently taking care of patients. There are four rooms for patients arranged around the nurse's central counter. From the patient's perspective it looks like any other doctor's office. There are a few simple toys in each of the rooms. But it's formal and sterile and like any medical setting a little scary when a family is waiting to see the doctor.

When Dr. Pintar enters the room that changes. There may be frightening sounds of near chaos outside, with a baby crying on a clanging scale, and urgent murmurs of parents trying to comfort a distraught child.

But when Dr. Pintar is inside each little room it feels like a house call. She gets down on the floor with the kids or examines them in mommy's lap. If a little brother is along, she'll tease him with one hand while probing the patient with the other.

"The baby sitter got freaked out about this gunk in his eye," said Rene Knorzer, who was first up this morning with 7-month-old Jesse and 3-and-a-half-year-old Sydney. Together, mother and doctor held Jesse down while Sydney played on the floor.

"This ear is red," said Dr. Pintar. "It goes along with that gooey eye."

Medical translation: "pink eye and an ear infection."

She handed the diagnosis to the older child and pointed the way to the front desk. "There's Ms. Eileen," she said. "She's got the treats."

"That's our only attraction around here," she said with a rueful laugh as she headed to the next room and the next patient.

This was a typical winter morning, a parade of snotty noses and inflamed eardrums, the first caused by common cold and flu viruses, Dr. Pintar patiently explained to each parent, the second by the opportunistic bacteria that normally live in our throats but love to invade warm gooey sinuses.

The blur of snot on the half-hour was broken only by the well-baby checkups on the hour. Dr. Pintar calmed worried parents and joked with the kids. She asked about "poop and pee." She reassured parents that their kids were fine and that they needed to relax and take care of themselves too.

"A cup of coffee, a glass of wine, is fine," she told one worried nursing mother. "This is real life." The routine was broken by an interesting case: a young boy with alarming red blotches on his legs. The doctor's diagnosis was quick and calm: Henoch Schonlein purpura, an unusual allergic reaction to a virus. The mother, Sue Joyner, watched the doctor with an apparent sense of awe.

It wasn't just because of the diagnosis. Like Dr. Pintar, Sue Joyner and her children were born with cleft palates and had to endure years of surgery to repair their upper mouths.

Dr. Pintar doesn't even think about her cleft palate anymore. Although she acknowledges the painful but ultimately healing experience may be why she went into medicine, she cannot remember ever thinking she would be anything but a doctor.

In a very real and touching way, the Joyners recognize themselves in Dr. Pintar. And she sets an example for them.

But this is also true for her other patients. Dr. Pintar reassures parents about the future. She puts their faith in themselves and their kids.

Next...What is a life Worth?