siouxland life magazine - september 2011

a guide for living in siouxland

Post-surgery recovery depends on age, motivation

Siouxland after dark

Who keeps the city running

When the sun goes doWn?

reclaimed referenceScouple salvages barn Wood for personal library

Heart conditions in youth can go undetected

How to find a primary care doctor when yours retires

Siouxland life iS on the web! Visit www.siouxcityjournal.com/siouxlandlife

september 2011

2 sePTeMBer 2011 Siouxland life

Siouxland life sePTeMBer 2011 3

contentS September 2011

16

PubliSher steve griffith editor Bruce Millereditorial Joanne fox, Tim gallagher, earl Horlyk, nick Hytrek, Marcia Poole, John Quinlan

PhotograPhy Tim Hynds, Jim lee PreSentation editor amy HyndsadvertiSing SaleS nancy gevik advertiSing deSign stacy Pajl, Jill Bisenius

©2011 The sioux City Journal. siouxland life is published monthly by The sioux City Journal. for advertising information, please call (712) 224-6275. for editorial information, please call (712) 293-4218.

8 diScover deltiologydarold sea has collected more than 100,000 postcards including some humorous ones.

10 cellular confeSSionJim Cody kicked his cellphone habit and now enjoys life face-to-face.

13 baker’S manBob Kolar loves his seven-days-a-week commitment to working as a baker.

on the coverYou may be in bed but the city keeps on moving after the sun goes down. a bartender in His-toric fourth district, above, is one occupation we explore in our issue devoted to sioux City after dark. Photograph by Jim Lee

featureS4 feature home: Cow barn library7 Collections: Postcards10 Cellphone addiction13 food: Baker17 siouxland after dark18 after dark: Bartender19 after dark: 911 operator20 after dark: emergency room doctor22 after dark: Truck driver24 after dark: Casino technician

25 after dark: Truck stop cashier26 after dark: security guard28 after dark: newspaper carrier29 after dark: night cook30 20 Questions: organ donation specialist32 Post-surgery recovery36 replacing your family doctor40 Youth heart health44 Medical answers from the doctor47 Parting shot: lust


ron and Kathy Klemme are shown in a library room ron built in a large outbuilding at his home in rural Hawarden, iowa.

ron Klemme displays an antique book in the library room he built from recycled barn wood in a large outbuilding at his home in rural Hawarden, iowa.

HAWArDeN, IoWA – From the road, drivers may mistake the brown building on County Road C12 for a machine shed. They might even notice the raised garage door hides a vehicle.

What they don’t know is the south side of the building has been remodeled into a library, which houses a couple thousand religious books.

Many people – typically avid readers – have lots of books gracing the walls of their living rooms or gathering dust in boxes around the house.

Ron Klemme and his wife, Kathy Klemme, have enjoyed pursuing their

thirst for knowledge about their Catholic faith through periodicals, magazines, prayer books, anthologies, autobiogra-phies, biographies, novels and nonfiction literature.

Those tomes were taking up precious space. But where to put them?

The answer was found in an existing cow barn on their 342-acre Sioux County home.

“When I was faced with tearing it down, my sister suggested salvaging the wood,” Ron explained. “Then I thought why not use it to remodel part of the tool shed into a library?”

“We’ve been married 42 years, so I’m used to him doing this kind of stuff,” Kathy said in an aside. “But I knew he had wanted a book room for years, so I supported the idea.”

Ron began tearing down the barn, “as much as I could without it falling down around me,” he confessed, and stacked the wood into piles by the shed.

“People would drive down the road and must have thought I had started a lumber business,” he added. “They would slow down and then must have been watching the process as the boards be-came fewer and fewer.”

text by Joanne Fox | Photographs by Tim Hynds

former cow barn uSed for perSonal

library

Home Library room


The Klemmes joined forces to power wash all of the boards for preparation to be stripped and sanded.

“I guess I’m kind of a handyman,” Ron said about his carpenter abilities. “I did work for a contractor when I was in college, so I had some sense of what I wanted.”

The pine wood worked perfectly for the remodeling project.

“In fact, I didn’t have one extra piece left when I completed it about six months later,” Ron pointed out.

While some may believe a private library would seem like something out

of an old movie, there can be merit to having a custom-built one. The Klemmes now have a unified manner to catalogue their collection, while having easy access to all of their books. Sixteen separate shelves were built from floor to ceiling on one wall to house the library offerings. Extra books are shelved right outside the room.

But it’s not only books for which the room provides a home. On the same wall as the shelves is a Last Rites set, an item found in most pre-Vatican II Catholic homes, which included all of the ne-cessities for a priest to administer the

Sacrament of Extreme Unction.“I got that on eBay,” Ron explained of

the 3D frame, which shows the Blessed Virgin Mary holding Jesus after he was taken down from the cross. “I think it was made in the late 1800s or early 1920s.”

Another wall has a large crucifix, made in Russia, that Ron purchased from a collector in Scottsdale, Ariz.

Pictures are hung on other walls. The Immaculate Heart of Mary and the Sa-cred Heart of Jesus grace the sides of a large bookcase. A black-and-white photo was taken during the 1926 Eucharistic


Congress in Chicago.Next to the door, which came from

the former St. Patrick’s Catholic Church rectory in Akron, Iowa, a rectangular stained-glass window lets in beveled light.

“That I built specifically for the space,” Ron said. “It was originally in St. Mary’s Catholic Church, Rock Valley and I bought that from Connie Maher (of Ha-warden, Iowa). Her husband, Deacon Joe Maher, had acquired it before he died.”

A library can’t function without enough space to house books, yet still needs to be cozy. The Klemmes’ room has the bare necessities: A table, a desk, two comfortable chairs and a kneeler, which Ron got from St. Peter’s Catholic Church, Jefferson, S.D. Overhead lights provide the illumination for the room.

The walls sport the look of knotty pine, but Ron preferred to go with a more neutral color for the walls, adding to the uncluttered, organized ambience.

On this hot August day, the tempera-ture was more than temperate.

“This room worked really well for us when it was inclement weather,” Ron ad-mitted, sweat forming on his brow. “I did create a space for an air conditioner, but we haven’t installed one. Yet.”

The books are meaningful, as is the decor, but the Klemmes agreed it was the comfortable and homey atmosphere that allowed them to relax, maybe decom-press, mediate and obviously read.

“I’m a big fan of St. Alphonse Liguori,” Ron said of the Italian Catholic bishop who was a prolific writer. “I’ve got most of his writings.”

“I’ve discovered there never seems to

be enough time to read,” Kathy added. “If I come out to the library, away from the phone, the television, the computer, the interruptions, I can really enjoy reading.”

ron Klemme tore down on old barn on his property and recycled the wood to create a reading room to house the Klemmes’ large collection of Catholic books and other religious items.


collector revelS in

deltiology

100,000and counting

Go AHeAD. CAll DArolD Sea a del-tiologist.

It’s a title he’s proud to embrace.You see, Sea is consumed with deltiol-

ogy, the hobby of collecting postcards.How many does he have?“I stopped counting at 100,000,” he

confessed.“They’re everywhere,” wife Alice clari-

fied in an aside.In actuality, Sea’s organization of the

volume of postcards would make the producers of TLC’s “Clean Sweep” weep. One closet has numerous shelves of three-ring binders, each marked with a category. Open a binder and you’ll find each postcard in a protective sleeve,

meticulously marked with dates and ex-planations.

Sea provided these insights so others might better understand the passion of a deltiologist.

Q. When did you start collecting postcards?

a. I attended a public auction in 1988, near Cherokee (Iowa) and saw people fighting over postcards, bidding $10, $20 and $50. I started investigating and the deeper I got into it, the more intrigued I was.

Q. how does one start collecting postcards?

a. I started looking for postcards at antique stores, auctions, estate sales, postcard shows. The Internet is another

text by Joanne Fox | Photographs by Jim Lee

collectionS Postcards

darold sea has more than 100,000 postcards in his col-lection, including, from top, santa postcards, a pop-up postcard, art drawing postcards and novelty postcards.


Above The Chicago city scene postcard lights up when illuminated from behind.Left darold sea holds a set of 10 puzzle postcards that combine to make a portrait of napoleon.Below family portrait postcards are included in the collection.

place, but typically prices are higher.Q. What was the first postcard you

purchased?a. Right after that auction, I stopped

in an antique shop on West Seventh Street and bought some postcards that caught my eye. I’m not sure if I could lo-cate the very first one.

Q. What criteria do you use for choosing a postcard for your collection?

a. I look for the unusual.Q. What about price?a. Most of mine cost under $5. I’m al-

ways looking for bargains.Q. are postcards a good investment?A. The world’s record price paid for

a postcard is more than $62,000. It was a penny postcard of Babe Ruth, auto-graphed by Babe Ruth. I don’t have any-thing at that level.

Q. What gives a postcard value?a. Age. Condition. Subject matter.

Most collectors would say anything that predates 1930.

Q. does the postcard have to be mailed to have value?

a. Some say that provides a solid date; others say the postcard is no longer in perfect condition.

Q. What are some of your unique ones?

a. I have a postcard of my mother’s

basketball team in Hartington, Neb., dated 1924; one of myself as an infant in 1931 and one of dad, Lester, in 1918. In fact, I have an entire binder of family postcards.

Q. What’s the oldest postcard you own?

a. I have a copy of a Korrespondence – with a K – Card from Austria, dated from 1873.

Q. Which one are you most proud of?a. I have 10 cards from France that

when mounted, make up a portrait of Napoleon. I think the manufacturers did that to sell more cards.

Q. how supportive is your family of your hobby?

a. Alice is my chief “sniffer” when we go out postcard shopping. Many friends

have “donated” to my collection.Q. Who provided you with a unique

postcard?a. I was given one that my dad had

sent to Miss Mabel Sundquist that ex-tended birthday greetings to her in 1920. What’s interesting? Mabel was not my mother. I got the card from Mabel’s sister.

Q. how many different kinds of post-cards are there?

a. Literally hundreds. I have a display which shows cards made out of canvas, felt, cork, steel, plastic, copper and silk. I even heard there were postcards made out of ground-up money. I have one about one-quarter the size of a tradi-tional 3 x 5 card. I have another one that fans out like an accordion to about 5-feet across. I have one that squeaks when you press it. Then, you have odd shapes, like a horseshoe or corncob or a fish.

Q. Why do you continue to collect?a. It’s a fascinating challenge to find

unusual postcards. It’s educational for me and fun.

Q. do you collect anything else?a. No.Q. any thought to ever stopping the

postcard collection?a. Maybe. I’m getting old.


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elK poINt, s.D. – Jim Cody jumped into his car one morning and reached into his front pocket, just as he’d done every day for months.

“My God,” he recalled thinking, “am I subconsciously reaching for a cigarette?”

He wasn’t. Cody reached each day for his cell phone. And it was gone. After months of fumbling for, squinting at and listening to, Cody had discarded his cell. He was going cold turkey.

“I raised eight children, got them all their first car, paid for their teeth to be straightened and made sure they all went to college,” said Cody. “I’ve also run a successful business (Cody’s Homestead Restaurant) for 39 years. But I couldn’t handle a cell phone. I could not leave mine alone. I was engrossed.

“I’m an addict.”While U.S. agencies and a select few

overseas have programs dealing with

confeSSionS of acell pHone addict

text and photographs by Tim Gallagher

HealtH Addiction


an addiction?amy Bloch, program director of outpatient services at Jackson recovery Centers in sioux City, said her staff has yet to deal with a patient who voices addiction concerns when it comes to a cell phone.Bloch has helped people work through process addictions involving internet use, gambling, spending and eating.But a cell phone? not yet.Bloch cautioned against using the term. “People can use the term ‘addiction’ loosely,” she said. “Yes, people can miss it when they don’t have it. and people may use it too much.”But those issues alone don’t qualify as a process addiction. Bloch said there are eight criteria to look for in such process addictions. Three main areas to focus upon include physical/emotional withdrawal; loss of control; and the continuance of the be-havior despite negative consequences.

this issue, none seem to be in place lo-cally. An official at the Betty Ford Center in California, for example, notes that overuse of cell phones has become a so-cial problem for thousands of users.

People even disconnect from personal contact with their significant other while responding to texts and calls. A news service in Spain reported that 15 percent of Spanish teens sleep with their cell phones in order to answer messages overnight.

Teachers across Siouxland collect cell phones if they hear them ring or buzz during class. Students across Siouxland,

on the other hand, have become adept at texting on a phone hidden in their pocket.

Cody didn’t get to that point. Still, he was frustrated with himself and his in-ability to keep from fumbling with the phone at all hours.

“I’d leave the restaurant and drive down the road when my phone would ring,” Cody said. “I would fumble with it, see who was calling and wonder what was wrong.”

The person on the other end would often have very little new information to share. Often, they simply wanted to share. Cody said the conversation – the great majority of them at least – could have waited until a face-to-face meeting

later in the day.“For those who use cell phones in

business, I understand why they must keep it,” Cody said. “I also understand the fixation people have with them.”

It irks employee Irma Holmes at Cody’s Homestead that her boss ren-dered his cell inactive. She stood behind him at Wal-Mart recently and noticed he left the store without a few of his purchased items. Holmes would have called Cody right away. Instead, she took the items and gave them to him the next day.

“What’s the difference?” he asked.Holmes laughed and shook her head.

“It does bother me,” she said. “I’m used to calling him for no reason.”

Cody has seen the phenomenon un-fold the past few years at the family busi-ness he’s owned and operated for nearly four decades. Countless children have entered his establishment with their head down, punching texts while waiting for a burger and fries.

“We have families who come in and eat and never talk to each other,” he said. “I approached one man who was sitting at our counter with his head down tex-ting. I said very sternly, ‘No texting at the dinner table.’”

The man looked up in shock and then continued his text.

Such behavior prompted Cody to commit his thoughts to writing. As in es-say form, not a text.

“I worry about the young people who will be taking care of me in the nurs-ing home,” he wrote. “I worry their art of communication will be lost because they spent more time texting than talk-ing. Small talk and speaking have to be learned and practiced like most other social skills. I worry because of their con-stant texting; they will not learn to speak with the proper emotion or, more impor-tant, recognize the emotions in someone else’s voice.”

He asked, “Are we doomed to be a people who speak in a flat, monotone voice with a blank look on our face?”

Cody’s writing is animated, lively. So is his manner. He has read his essay in the eatery. He’s gotten lively applause. He keeps the essay on the shelves in the kitchen, within reaching distance.

And he still has the cell phone. It’s a Samsung, kept in his pocket. Cody reach-es for it several times per day. It keeps the time and still has all of his contact numbers for family members, employees and friends.

The difference? It doesn’t ring. “And the charge lasts a week,” Cody said.

Jim Cody keeps a cell phone around – for the contact list and the clock, and uses a land-line phone to make calls.


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sunkist Bakery owner Bob Kolar has been working in bakeries since he was 15.

food Baker

HoW loNG HAs bob Kolar started his work day in the middle of the night?

The Sunkist Bakery owner travels back to high school to answer that question.

“I started baking when I was about 15 years old,” says the father of four and grand-father of two. “My mom worked in a little bakery in Walnut Grove, Minn., and I started helping out – first with cleaning and then with baking.”

He was hired the next year at a bakery in Tracy, Minn., where he started his shift be-tween midnight and 12:30 a.m., got off at 7:30 a.m. and went to school at 8:15 a.m.

Thanks to a mentor’s early encourage-ment, Bob began to consider baking as a

future occupation. But he wondered if the night hours would be a problem. His men-tor pointed out that “nobody bothers you” at work in the middle of the night. Much can be accomplished.

He also pointed out that the bakery busi-ness brings rich opportunities to develop last-ing associations with walk-ins and business customers who order big. “That sounded good to me,” says Bob who came to Sioux City in the early 1980s. He first worked at and then purchased Sunkist Bakery, a seven-days-a-week commitment. He can’t imagine another life.

“I love baking, I love this community and I still love coming to work in the middle of the

baker’S work day beginS in

wee HourStext by Marcia Poole | Photographs by Jim Lee


night,” says Bob as he wraps up a 12-hour day that began about 2:30 a.m.

Bob can do just fine on about five or six hours sleep a night. At wake-up time, he rises, showers and watches ESPN “for about five minutes” before heading out from his family’s acreage between Hin-ton and Merrill, Iowa. “I turn on the mu-sic and nobody bothers me. It’s the best driving time there is.”

His wife, Jodi Kolar, “laughs at my routine,” he says. Yet she’s every bit as dedicated to her position as Associate Professor and Chair of Nursing Education at St. Luke’s College. “We both love our jobs and we’ve made it all work,” says Bob who raises bighorn sheep as a hobby.

After he arrives at his Morningside Av-enue bakery, Bob starts the process that keeps some 17 employees engaged in various aspects of producing, selling and delivering dozens and dozens of different bakery items in impressive quantities.

Walk-in customers enjoy a range of goodies. Many are regulars who stay awhile to chat over pastries and coffee at the place once occupied by Roe’s Dairy.

“I really enjoy the people who come in and I appreciate their loyalty,” says Bob. “One of the best things about the day is coming out front and seeing people I know. That’s a great feeling.”

He also values the camaraderie of em-ployees engaged in the labor-intensive business that serves customers in Sioux City and the surrounding area. One of the key items in that big-volume busi-ness is ready-to-bake pizza dough for a variety of local “pizzerias.”

Like most other Sunkist Bakery prod-ucts, the pizza dough is made from scratch. Training in Manhattan, Kan., supplemented Bob’s culinary and baking training in the art of making pizza dough in 10- to 17-inch “skins.” Sunkist does a “huge amount of pizza dough. In fact we just finished up about 800 crusts for one customer.”

More traditional bakery items are on display for walk-in customers. Cakes, from German chocolate to Snickers to champagne creations, are in full view in a revolving display case. Along the front counter, customers can delight in an array of doughnuts and their cousin pastries, including Bismarks, Long Johns, flips, Danish, fritters, braids, cream puffs and éclairs.

“Do we make our own éclairs? Yes, we make them from scratch,” says Bob.

Autumn whets the appetite for fruit, pecan and cream pies. Sunkist makes

caramel apples as well as compact pic-nic cakes, carrot cake, classic brownies, lemon bars, strawberry bars, pumpkin bars and peanut butter bars.

Dozens of kinds of breads, even diet bread, are on the bakery’s list. And how about hamburger buns, hot dog buns, Kaiser rolls, Pullman loaves, assorted dinner rolls, English muffins and bagels?

Pecan rolls, muffins and mini loaves are regulars alongside varied cookies, in-cluding, crispies, thumbprints, cut-outs, cookies-on-a-stick, cowboys, chocolate chip and sugar cookies.

With independent bakeries becoming a rarity, Bob takes pride in his operation’s link to traditions that started centuries ago. Bakeries were at the heart of most communities. They were mainly one-person operations, often regulated by local governments. The exception? Large-scale operations that produced biscuits, known as “hardtack” or “ships bread,” needed for sea voyages, overland expedi-tions and the military.

These practically indestructible bis-cuits, which were more like crackers, had no home-baked counterpart. Production was limited to commercial enterprises

often connected to flour mills, according to the Oxford Encyclopedia of Food and Drink in America. The huge U.S. hardtack industry is said to have evolved into our even larger commercial cookie industry.

Affordable sugar and flour, the intro-duction of chemical rising agents, such as baking soda, and new cookie recipes helped fuel the commercial cookie in-dustry in the late 19th century. Modern ovens, mechanical mixers and other technology, as well as growth in urban population and women working outside the home meant less baking at home and more business for independent bak-eries. Sunkist Bakery has existed since the 1930s, first operating in downtown Sioux City, according to Bob.

The greatest reward for his work is likely the same as that of long-ago bak-ers who also started their work days in the wee hours of the morning.

“It’s all about customer satisfaction. To see somebody go out of here happy and satisfied; to have a customer call me and say, ‘That was great,’ is everything.”

Sunkist Bakery is located at 4607 Morn-ingside Ave., 276-9422.

Bob Kolar takes fresh baked cookies out of the oven at sunkist Bakery.

“I love baking, I love this community and I still love coming to work in the middle of the night.”

bob kolarBaker at Sunkist Bakery


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Siouxland after dark

Photograph by Jim Lee

W hen you’re fast asleep, thousands of Siouxlanders are at their peak, working jobs that need to be done after hours.

What happens during the night shift?This month, Siouxland Life talks with a handful of

“after dark” workers, only to discover they really love the hours and the freedom they provide.

“The world doesn’t stop just because you work nights,” says Tiffany Nettleton, bar manager at Buf-falo Alice. “You still have to see the kids off to school and you still need to attend their events. That’s the great thing about having a somewhat flexible sched-ule. You get to be there for your kids.”

The downside? Sleep deprivation. “When you go to work after the sun goes down and leave work be-fore the sun comes up, it takes a physical and emo-tional toll on you and your body’s biorhythms,” says Tom Benzoni, an emergency room physician.

Strange things? You bet. Truck driver Mark E. Hahn was mooned once. Nettleton has so many stories she could fill a book.

Just because there aren’t a lot of people moving about doesn’t mean there isn’t work to do after mid-night.

Ready to check out the night shift?Then, join us this month for Siouxland After Dark.


text and photograph by Earl Horlyk

Siouxland after dark Bartender

AFter more tHAN 14 years of work-ing behind the bar at Buffalo Alice, Tif-fany Nettleton has enough colorful ma-terial to write a book.

In fact, Nettleton even has the perfect title for her bartending autobiography: “As the Pizza Burns,” a play on B.A.’s pop-ular menu item.

“You see it all when you work in a bar,” Nettleton, B.A.’s bar manager, said

with a laugh. “It’s too bad that most of it can’t be printed in a newspaper.”

Yet Nettleton willingly gives a “suit-able for publication” look at what it’s like to be behind the bar most nights at Buf-falo Alice.

What’s the best thing about working at night?

“When I started at B.A.’s, my husband worked days while I worked nights. That

was perfect because our two kids (now age 13 and 16) were still young and we never had to worry about babysitters.”

the worst?“No sleep. Even though I say I work

at night, my shift actually starts much earlier. When you’re working 14-16 hours some days, you’re really working on fumes.”

if you could change anything about your job, what would it be?

“Obviously, the hours. But, if you love what you do, you adjust. I love what I do. If I didn’t, I wouldn’t be here.”

What don’t people realize about working nights?

“That the world doesn’t stop just be-cause you work nights. You still have to see the kids off to school and you still need to attend their school events. That’s the great thing about having a somewhat flexible schedule. You get to be there for your kids.”

What do you do during the day be-sides sleep?

“You end up doing what everyone else does. You do the shopping, take care of the house and try to take care of stuff be-fore your workday begins again.”

What’s the strangest thing that’s happened during a night shift?

“Well, that falls into the category of things I can’t say in the newspaper. But the best thing about B.A.’s is every night is gonna be different because every cus-tomer will be different. At one table, you will see a bunch of doctors or lawyers. And at the next table, you’ll see a bunch of skateboarders. Everyone gets along because they are treated well. That’s im-portant to me.”

What are weekends like?“I don’t think I even know what week-

ends are anymore. But I guess every night is sort of like a weekend when you work in a bar. Our customers come to B.A.’s because we create a casual atmo-sphere where they can kick back and have fun. Even though I’m working, I still get to be in on the fun.”

‘every nigHtiS gonna be different’

name: Tiffany Nettletonoccupation: Bar manager, Buffalo AliceShift hours: Varies but often in-cludes a Friday shift that often begins at 9 a.m. and concludes at 2 a.m., plus a Saturday shift that runs from 11 a.m. to 11 p.m.



“Having the afternoon to spend the time with my family. I feel like I have ev-ery day off. Because I work at night, I’m there during the day if the kids need me.”

the worst?“The sleep patterns. I’ve been doing

this for 15 years, so my family is well-adjusted to my sleep pattern.”


“I don’t know that I would change anything about my job. I love what I’m doing.”

What don’t people realize about working at night. What misconceptions are there?

“That I’m well-adjusted to (working at night). That is my normal.”


“I’m very involved with all my kids’ activities. I never miss a game, never miss a concert because of my work schedule.”


“My stories are endless, both horrible

and hilarious.”What are weekends like?“I am fortunate enough to have week-

ends off so I can spend time with my family.”

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normal SHift text by Nick HytrekPhotographs by Jim Lee

Siouxland after dark 911 Operator

name: Lori Larkinoccupation: Lead operator, Woodbury County Communications CenterShift hours: 10:30 p.m. to 6:30 a.m.


If statistics hold true, Tom Benzoni will live 10 fewer years than he would with any other job.

“It’s true for doctors as it is for air traf-fic controllers, police officers or any other occupation,” said Benzoni, an emergency department physician with Mercy Medi-cal Center – Sioux City. “When you work an overnight shift, it can take 10 years off your life.”

“No matter how long you do it,” the 18-year veteran of the emergency room explained, “your body really never ad-justs.”

Benzoni shares duties with six other doctors. He’s either working an early morning shift, a day shift or the over-night shift.

An emergency department must be staffed 24 hours a day, seven days a week, 365 days a year.

“When I started, it was the young doc-tors who would pull the overnight shift but that wasn’t fair,” Benzoni said. “Pa-tients deserve the same quality medical care, whether it’s 2 p.m. or 2 a.m.”

In fact, that’s what keeps him going no matter time of the day or night.

“Nobody chooses what time they get sick,” Benzoni said as he begins another eight-hour shift. “But if they do get sick, they’ll know they will get medical care from people who can make the differ-ence between life and death.”


“You mean besides getting to knowing cops on a first name basis? Well, it’s the satisfaction you receive from working with compassionate professionals and it comes from knowing that a patient you’ve treated will be leaving the emer-gency department in better shape than the way he came in.”

the worst?

“Sleep deprivation. We all need sun-light. When you go to work after the sun goes down and leave work before the sun comes up, it takes a physical and emotional toll on you and your body’s biorhythms.”


“I began my career in a Detroit hospi-tal’s emergency department in 1983 and I’ve been doing it ever since. I’ve seen plenty of changes in medicine and in technology but it hasn’t really changed the way I do my job. Growing up, I was always the kid who embarrassed my mom by staring at the lady in the grocery store. I was curious and always wanted to ask why the lady was in a wheelchair. Now, it’s my job to be curious and ask the questions no one else would ask.”

What don’t people realize about working at night?

“People, especially young doctors, think the overnight shift pays more than the other shifts. That’s not the case because there’s no night differential. They always say there are two types of doctors. There are the ones who are professional and then there are the ones who only wished they were. Working overnight, doctors can discover which category they belong.”


“Depending on my schedule, I e-mail people, do some shopping and drop off the kids at whatever activity they need to go to. Maintaining a normal family life is very important. I may miss the opening bell or I may have to miss the final buzz-er of a game, but my kids always knew I’d be there for them.”


“It’s all subjective since strange is

often ‘normal’ in the middle of the night. People will come in, holding their arm and I’d think, OK, here comes a broken arm. And then they’d move their hand and I’d see, OK, they’ve been shot. I’ve also had my fair share of guys coming in after a late-night scuffle. It’s always the same story. They were always mind-ing their own business when two dudes jumped him from behind. It’s never one

‘StrangebecomeS tHe norm

after midnigHt’text and photograph by Earl Horlyk

Siouxland after dark Emergency Room doctor

name: Tom Benzonioccupation: Emergency depart-ment doctor, Mercy Medical Cen-ter – Sioux CityShift hours: On rotation with six other doctors, the 4 a.m. to noon shift; the noon to 8 p.m. shift; and the 8 p.m. to 4 a.m. shift.


dude or three dudes. It has to be two dudes. See, strange becomes the norm after midnight.”

What are weekends like?“They simply no longer exist. A sick

patient doesn’t know it’s your weekend, your birthday or Christmas Day. They simply want to feel better. It’s your job to make them feel better.”

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Siouxland after dark Truck Driver

name: Mark E. Hahn (not the radio announcer)occupation: Truck driverShift hours: ap-proximately 4:15 p.m. to 1:45 a.m.


“In my line of work, there is a lot less traffic to deal with.”

the worst?“Winter driving,

especially during white-out bliz-zards. I don’t like working a differ-ent shift than my wife, Michelle. Also, before my children grew up, I missed their after-school and evening activi-ties, like concerts, competitions and such.”


“I wish I could do the exact same thing, just during the day.”


“There are a great many things happen-ing at night that enable a person’s day to run smoother.”

What do you do during the day besides sleep?

“I am unusual, because I work a second job during most weekdays. I also also have some busy hobbies, such as remodeling and me-chanic’s projects.”

What’s the strangest thing that’s hap-pened during a night shift?

“I was ‘mooned’ out the back window of a school bus one night.”

What are weekends like?“The most important is making quality

time to spend with my wife and family.”

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neigHborS need to underStand quiet wHen you work

graveyard SHifttext by John Quinlan | Photograph by Tim Hynds

Siouxland after dark Casino technician


“I can get to the machines to clean them and work on them, whatever I have to do. And when we have custom-ers, you’ve got your regulars and you get to know them pretty good. I like to work nights because in the daytime I have doctors’ and dental appointments. I don’t have to take time off work. And I get all my stuff done in the morning. I just like working graveyard. I’d never worked it before until I started working here 10 years ago.”

the worst?“I miss out on a lot of stuff ‘cause I

sleep at night. So there’s a lot of places I don’t get to go ‘cause I’ll be sleeping. Like

some concerts.”if you could change anything about

your job, what would it be?“Nothing. There’s nothing wrong with

it.”What don’t people realize about

working at night? “That your neighbors have to be quiet

during the day while I sleep. People are just amazed that I work graveyard. Ei-ther you like it or you don’t. I’ve talked to other people that worked it, and they haven’t or they did. One extreme or the other.”


“I usually go to bed about 2 in the afternoon. I do my outside work and

whatever laundry. I get my shopping done. There’s nobody in the stores in the mornings during the week.”


“Well, the electricity goes off some-times, and that’s a disaster. Lots of ma-chines get up. Not much happens on graveyard shift.”

What are weekends like?“I do a lot of sleeping, for some reason.

I work Friday night and Saturday morn-ing. It gets a little busier. There’s more people that will stay during the night. But you’ve got your regulars that are here all the time, it seems like.”

name: Ruth Lallyoccupation: Graveyard shift slot machine technician, WinnaVegas Casino, Sloan, IowaShift hours: Midnight to 6 a.m.


nigHt SHift meanS

Slower buSineSStext by Nick Hytrek | Photographs by Jim Lee

Siouxland after dark Truck Stop Cashier


“The ability to talk with people and not hold up the lines so much.”

the worst?“Just trying to stay awake when your

body wants to sleep. I usually drink a monster espresso, that’s my drink of choice.”


“For it to be busier. Of course, with new hours that (truck) drivers have to take off, most choose to sleep at night now.”


“They think you can get so much done during the day but don’t realize you don’t get as much sleep. Most people

don’t realize how little sleep you get.”What do you do during the day be-

sides sleep?“I have a second job. I just try to relax

a little bit before I go to bed, but there’s always errands to do, shopping to do. There’s always plenty to do besides sleep.”


“Last year when we had the storm in June, a piece of our sign broke off and came through the plate-glass window.”

What are weekends like?“I don’t usually work weekends any-

more. Typically, they’re slower at night on weekends than during the week because most drivers try to be home on the week-ends with their families.”

name: Carla Asheroccupation: Cashier at Truck Haven truck stop on Singing Hills BoulevardShift hours: 6 p.m.-6 a.m. Tuesday through Thursday


keeping an

eyeopen for tHingS tHat go bump in tHe nigHt

text by Joanne FoxPhotographs by Tim Hynds

Siouxland after dark Security officer

What is the best part about working nights?

“For me the best part about working nights is the people I work with. Along with other security officers, there are few other college employees working over-night. We have developed a very good working relationship with one another. Work is much more enjoyable when you actually look forward to seeing the people you work with.

“There is another benefit to working nights. Our campus sits on a hill with a very good view of a large part of Sioux City. We have nature trails, a pond and wooded areas on campus. I enjoy pa-trolling these areas as well as the other areas of the campus at night. The night sky can really be amazing and I feel like I have the natural beauty of woodlands, trails, and pond all to myself. Lastly, over the years I have been treated to incred-ible light shows when thunderstorms roll through the area.”

the worst?“Sleep! I find it very difficult to go to

bed when the rest of the world is waking up. There is something that seems very unnatural about going to bed when the sun is coming up and the noisy robins are so cheerful and loud. I often wonder why every robin in town has to sing un-der my bedroom window.”


“Believe it or not there is not much I would change. All of our needs are met and the working conditions are first-rate. However, one thing does come to mind. We get dinner breaks just like the day-time employees but, there are not many choices to make during the overnight hours as most restaurants are closed. This is my hope for change, an all-night buffet close to the school!”

What don’t most people realize about working nights?

“Working overnights really is a dif-ferent world. I have friends who would like to get together with me for lunch

or coffee from time to time. What they don’t understand is that noon to them is midnight to me! If you really want to have coffee or a snack with me, stop by my office at midnight!”


“Well, sleep is a big part of it, but if I have a doctor’s appointment, or a car repair appointment, it is pretty easy and stress free. I have seen people waiting at one place or another, looking at their watch, hoping to get back to work before their break is over. Working nights, I am in no hurry, just groggy. Otherwise my day starts at about 3 p.m.”

What’s the strangest thing that’s


happened during the night shift? “Being on a college campus there have

been some strange events on occasion, but for security reasons I will select a hu-morous event instead. When something goes ‘bump in the night,’ campus securi-ty officers are the people who investigate what goes bump. One night I received a call from a very upset caller, a resident of one of our student housing units who stated that somebody was just outside her bedroom window. We responded to the unit immediately and could actu-ally detect movement right around the corner. As we cautiously peeked around the building, we were relieved to find a doe with her fawn grazing on the grass. We called the person back and told them what we discovered. Not amused, she asked us to tell them to leave. Not speak-ing deer, I clapped my hands and the two trotted off toward the woods. What a relief!”

What are weekends like?“My weekends go very slowly. I am

unable to sleep during the night so I maintain my regular cycle of sleeping during the day and keeping awake all night. I watch television, read or go for walks. I have tried to change my sleep patterns for the weekends, but with no success. I enjoy gardening, but this hobby is impossible to pursue during the night.

“I really do enjoy working the over-night shift. It is a different lifestyle and can take some getting use to, but for me it’s worth it.”

name: Jerry Meisneroccupation: Campus security officer, Western Iowa Tech Community CollegeShift hours: 9 p.m. to 5:30 a.m.

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Find it hereDirectly delivered in your sioux city Journal, at each advertiser’s business, on the web at

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a guide for living in siouxland


Journal

carrierlikeS extra Spending

moneytext and photographs by Tim Gallagher

Siouxland after dark Paper carrier

What’s the best thing about working the night shift?

“Are you serious?” she asked, answer-ing the question with a question. “The reason I’m doing it is because it’s help-ing me put a new roof on my house. It helped me put in new windows and re-model the house.”

Lias has carried the Journal for 16 years. She took over for her son, who had a route before he headed off to college.

“I took it over for a little spending money and it’s now resulted in a patio door to windows to more,” she said.

the worst?“The worst part is the weather, and

the worst weather is ice, which we had plenty of this year. I don’t mind the snow. I can use an umbrella when it rains. It’s the ice that’s terrible.”

Another drawback are various toys and lawn items occasionally left out overnight by a homeowner. Many of those items don’t have reflective mate-rial, making it tough for carrier Lias to spot in dawn’s early light.

“If a street light is out, which does

happen, people need to keep their side-walks and driveways free,” she said.

if you could change anything about your job what would it be?

Lias returns to an old foe: Ice. “No more ice, that’s what I would change,” she said.


“Being a carrier is a tougher job than people realize,” Lias said.

That said, she’s appreciative of the money she makes and the tips she earns from thankful Journal readers through-out the year.

“I get tips throughout the year. And every single time, whether it’s $5 or $50, I make sure to write a thank you note.

That’s important,” she said.What do you do during the day be-

sides sleep?Lias doesn’t sleep during the day.

She works in the accounting division at Western Iowa Tech Community College in Sioux City. Having an early-morning part-time job gives her the freedom to spend her evenings any way she wishes.

What’s the strangest thing that’s happened during your shift?

“I have seen several accidents,” she said.

What are weekends like? “Sunday papers can be heavy, espe-

cially around the holidays,” Lias said.

name: Steph Liasoccupation: Sioux City Journal paper carrierShift hours: Early morning, be-fore dawn


nigHt cook Happy wHen cuStomerS aSk for Him

text by John Quinlan | Photographs by Tim Hynds

Siouxland after dark Cook


“The customers. The co-workers. I like working here at Horizon. It’s a good ad-mosphere and I’ve got a lot of customers who come in and ask for me to flip for them. I just love it here.”

the worst?“Nothing … Oh, yeah, the heat. It’s re-

ally hot. If it’s 97, it’s probably 110 back there. It’s real hot working in that hot heat. But other than that, nothing.”


“Nothing really. The people are real good down here. I couldn’t change any-thing … unless you put the kitchen in the cooler or the freezer. That would be a lot better.”


“At night, people don’t get out and some people have to work in the morn-ings. It’s hard when people have to get up early in the morning, they just don’t get out at night. They know it’s hard work-ing at night. Some people just don’t like working 10 to 6 because they can’t sleep in the morning. And it’s hard for them if they’re family members because you’ve got kids. It’s hard for them to work be-cause the kids get up in the morning and they can’t get no sleep.”


“Watch TV. Relax. Stay out of the heat. I go over to family members and have a cook-out. Have fun. I sleep maybe five hours, get up and then take a little nap before I come to work.”


“Strangest thing? Nothing strange. Oh, people come in here and get loud and obnoxious and we have to kick them out. Sometimes.”

What are weekends like?“The weekends are rowdy. They’re

busy. We still get real busy from 1:30 until about 3 sometimes. It’s slower during the week. It’s a faster pace. When you get in there, you have to set up so you don’t get behind, run out of stuff. But other than that, it’s fast-paced. We’ve got steady cus-tomers coming in during the week and on weekends. All the time.”

name: Paul Dicksoccupation: Cook, Horizons Family Restaurant, Sioux CityShift hours: 10 p.m. to 6 a.m.


“One organ donor can save up to eight lives and one tissue donor can save or positively impact the lives of 50 to 60 people.”

profile Q&A


20 queStionS with a donation services specialist

mary ann o’dell

1. What does your job include?I do hospital development. I cover 23

hospitals in Northwest Iowa and I pro-vide education in donation. We also do record reviews because we’re all tied in to Medicare and Medicaid.

2. you encourage people to sign up to be organ and tissue donors?

I do donor awareness, of course, but my role probably isn’t as big as our PR staff. I do presentations.

3. how well is the public aware of what they need to do to become a donor?

I don’t feel the public is very well-in-formed. Most of us go to the DMV and get our license and they ask if you’re willing to be a donor and you answer it yes or no. I don’t think they really un-derstand what they’re signing up for. I think we need to do more education.

4. What surprises people the most when you talk to them about organ donation?

I think the amount of people that can be helped through the gift of organ and tissue donation. One organ donor can save up to eight lives and one tis-sue donor can save or positively impact the lives of 50 to 60 people.

5. What are the most common myths or misconceptions people have about organ donation?

The one probably is that you can re-cover from brain death and that organs are still being sold to people who can afford them.

6. are men or women more likely to be a donor?

It seems studies indicate women are more likely to donate than men.

7. What’s the most common dona-tion people agree to?

Organ donation is usually easier for people to comprehend than tis-sue donation. You know right up front lives will be saved, whereas with tissue

donation you don’t always see results right away.

8. any guess on the percentage of people who are donors?

We know that in Iowa, approximate-ly two-thirds of residents who are eli-gible have signed up through the DMV to be donors. Right now there are 1.4 million Iowans who have signed up.

9. how many people would need to be signed up to meet the need?

Right now there are 111,000 people in the United States waiting for dona-tions. In Iowa there are 630 people waiting for organs. Every year in the United States there are 1.5 million pro-cedures done that require tissue grafts. There are millions of people who suffer from corneal blindness who could ben-efit from corneal transplants.

10. how big a need is there for or-gan donation?

Every day, 18 people die waiting for an organ transplant across the United States. Annually, around 25,000 organs are recovered for transplant.

11. What conditions would prevent someone from being a donor?

Some things right up front like if you’re being treated for active cancer, but you still may be able to donate cor-neas. Basically every case is looked at on an individual basis.

12. do you meet with families of accident victims in the hospital to talk to them about possibly donating?

I do meet with the families here.13. how difficult is it to meet with

someone in that situation?It is the toughest, saddest, most hor-

rible time in their lives. It is a privilege to meet with these people and provide them with this information.

14. how do you approach them?I go up and let them know I am here

to talk to them about donation. By the time I meet with them, they know their

loved one has died. I tell them that they have the possibility of helping save the lives of many people and that I am there to help them with the pro-cess if this is something they choose to go forward with.

15. What kinds of reactions do you get?

The reactions can be from families who will approach the hospital staff and let them know they know about organ donation to others who say that under no circumstances would they consider it.

16. have any families ever gotten hostile with you?

Yes.17. What percentage of families

you meet with in those situations agree to donate their loved one’s or-gans?

At Mercy last year, three-fourths of the families in this situation did agree to go forward with donation.

18. do you ever get to witness meetings between organ recipients and the donor’s family?

I’ve not actually see reunions, but I have had the pleasure of meeting sev-eral recipients, and the gratitude they express for their donors is unbeliev-able.

19. What’s that like for you to meet these people?

It is probably the most humbling ex-perience in your life to know their life may have been saved because of some-thing you may have done.

20. how can one become an organ donor?

You can sign up when you renew your driver’s license. You can go to the website, www.iowadonorregistry.org and you can literally sign up for every-thing there. You can also go to www.iowadonornetwork.org or you can send in a brochure.

What’s involved with an organ donor program? Nick Hytrek talked with Mary Ann O’Dell, RN, donation services specialist at Mercy Medical Center, to find out.

text and photograph by Nick Hytrek


Joseph Morris, Md


HealtH Post-surgery recovery

soUtH sIoUX CItY – Marilyn Broveak listened to her doctor when she was told it was not wise to recuperate at home following surgery on her shoulder.

“In fact,” she said, “they wouldn’t let me go home.”

Broveak fell outside her home on May 6 and landed on her right shoulder. While she was waiting for surgery, Brove-ak was a resident at Regency Square Care Center from May 10 to June 1.

“The doctors told me they didn’t have enough parts to fix my shoulder,” she

said with a poker face. “I had the surgery in Omaha on June 2 and came back to Re-gency on June 6. I left there on July 7 and came back to my house.”

Too often, individuals are so relieved to be rid of pain and

discomfort and so ready to leave the hos-pital and return home, that they don’t hear what the health care providers are saying about challenges during the recu-peration process

What to expect will depend a great deal on the surgery itself, explained Dr. Joseph Morris, a general surgeon with Tri-State Specialists, Sioux City.

“With minor surgery, such as a gall bladder, we’ll talk about side effects and pain and things to watch out for,” he said. “With major surgery, it’s a bit more overwhelming to tackle the many topics associated with going home. We do our best to prepare patients for the transition the closer it comes to going home.”

According to Sue Brenden, certified gerontology nurse and director of nurs-ing at Regency Square Care, there are a number of variables to be considered when evaluating going home after sur-gery or going to a skilled nursing facility.

“One big issue is the age of the pa-tient,” she said. “The elderly population have a tendency to have more side ef-fects from anesthetic than the younger population. The thought processes are slowed down by the anesthetic which will cause the patient to make choices that may not be in their best interest.”

Brenden cited another important aspect of recovery after a surgery is re-gaining previous level of strength and mobility.

“Sometimes a patient who goes di-rectly home after a surgery will not push themselves to exercise or do strength

an x-ray shows the repair to Marilyn Broveak’s shoulder following surgery.

poSt-Surgery recoverymore difficult tHan expected


training for the following reasons: It hurts too much; I am not sure how much I should be doing as I don’t want to strain my incision area; I am too tired; I just don’t have any energy; this surgery has hit me harder than I thought so I just need to rest so I can get stronger,” she said. “The reasons can go on and on.”

Calorie intake is another issue with an individual going home, Brenden noted.

“Who makes the meals and are they providing the nutritional needs for the individual to promote tissue or bone healing?” she asked. “Meals on Wheels can be set up for those who are at home, but that is only once a day they are get-ting an adequate meal. What about the other two meals?”

“A lot of people won’t have a normal appetite for up to three weeks after an

abdominal surgery,” Morris pointed out. “During surgery, intestines go to sleep a bit, so patients may lose their appetite and people will call me, very worried about that. It’s actually not an unusual occurrence.”

One should expect some pain, cer-tainly some discomfort, upon returning home, Morris said.

“We always try to find a balance be-tween pain control and medication. I think folks have been brainwashed into taking pain medication after surgery. We encourage them to try and accept some pain as normal,” he added. “For example, pain associated with gall bladder surgery often comes from constipation. Even if we warn patients about that, it still takes them by surprise when the pain is more after the surgery than it was before.”

Brenden reported patients are sur-prised to discover how long it takes for their bodies to get back to the previous level of function.

“It doesn’t matter how big or small the surgical procedure, it takes a toll on the body and it needs at least six weeks to recover,” she said. “Most people are impatient about the healing process.”

Broveak noticed that with her recu-peration.

“I decided the other day I was going to make the bed, even though I’ve lost the strength in my right arm,” she said. “It took me a long time. I just kept work-ing and working with it and I finally got it done.”

For patients, forewarned is forearmed, Morris said.

“With the Internet, you can get quite

“It doesn’t matter how big or small the surgical procedure, it takes a toll on the body and it needs at least six weeks to recover. Most people are im-patient about the healing process.”

Sue brendenDirector of nursing Regency Square Care Center

Marilyn Broveak sits in the living room at her south sioux City home. Broveak is recuperating at home following shoulder surgery.


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a bit of information – just make sure you get a site with good medical advice,” he said. “I’ve heard a lot of crazy things, but many people come in with a print-out and it’s helpful.”

In his 20 years of practice, Morris has seen a substantial change in the post-surgery approach.

“I’d say it’s been a dramatic change in the past 25 years and it’s really acceler-ated with laparoscopy,” he said, refer-ring to the surgical operations which are performed through small incisions. “Lengthy stays, such as a week, are rare for a patient.”

Skilled nursing facilities vary in what they can offer residents which is why Brenden stressed the importance of hav-ing a patient and family members check into them carefully.

“The discharge planner at the hospital can assist in placement for patients who are looking for a skilled nursing facility for their rehabilitation time after a sur-gery,” she suggested.

Morris cautioned that just the words “nursing home” strikes fear in many pa-tients when looking at after surgery care.

“So we used ‘assisted living’ or ‘skilled care’ or ‘intermediate care’ because patients are scared when they hear ‘nursing home’ thinking they will never leave,” he explained. “But as our popula-tion ages, we’ve run into more and more patients who need that. The decision should center around if you and/or your spouse can actually provide care.”

Marilyn Broveak talks about the injury to her right shoulder and how she has adapted to her limited movement during her recovery from surgery.


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Q: My sister-in-law had a lumbar microdiscectomy surgery...Q: My sister-in-law just had a lumbar microdiscectomy about 10 days ago. Her surgeon told her no PT (Physical Therapy) is necessary. I was always under the impression that you should have PT after surgery, at least to help break up any scar tissue that might form. Am I mistaken? Why not do PT? It can't hurt right… It seems odd that this surgeon told her PT was not necessary.A: As for your question, you are 100% correct that your sister-in-law should have some course of physical therapy. A different spine surgeon would recommend PT every time.Anyone who has had spine surgery should have at least 4-6 weeks

of physical therapy as soon as they are able to post op (operation). How quickly after spine surgery depends on the surgery they have had. There are many, many reasons that physical therapy is important. As you pointed out, aiding in breaking up any surgical scar tissue around the incision line is important and usually done with ultrasound and massage. If not, you are just left with more troublesome tissue than was once there to begin with.Also, it is important to get those muscles moving again and moving correctly. As with anyone who has had spine surgery, prior to the surgery, one is normally in a great deal of pain and less active. Because of that pain, muscles are not being used correctly, because the patient has not been moving correctly and has been over compensating by using some muscles and not using others. To balance that incorrect movement and strengthen the core muscles that have become weak from lack of proper use, PT is imperative. The mechanics of the spine have changed after surgery, therfore the patient needs to be instructed upon exercises and how to bend, stoop, move, and lift properly again. Learning to do these exercises correctly and to continuing to do them at home is vitally important. This will help prevent the second surgery by keeping the muscles strong, instead of staying weak which causes further injury to the spine.It's unfortunate that your SIL's doctor doesn't believe in physical therapy as it is highly likely that she may injure her back further and suffer the consequences of not having physical therapy. Fifty (50) percent of workers compensation injuries are from individuals who have already been injured once. This could eliminate that.Don’t be a "frequent flyer" in their spine surgeon's office. After you have ruled out any help which may be made from more conservative treatment, surgery may be necessary. But by all means, if you find yourself there, have your doctor give you orders for physical therapy the first time. To better treat you, Multicare Physicians Group offers Medical, Chiropractic, Physical Therapy, Massage Therapy, Accupuncture, and Massage in our 8000sq ft facility. Request your Therapy to be done at Multicare.

Dr. Sneller


It’s A brAve NeW world out there when it comes to the relationship be-tween doctor and patient.

Long gone are the days when the fam-ily doctor would make house calls. Less long gone but dramatically more obvious are those days when you saw a GP for everything. In the near future, often even today, you won’t be seeing your family doctor. You will be visiting Urgent Care, a hospital or some other facility to confer with a hospitalist, surgeon, physician as-sistant, nurse practitioner, physical ther-apist or maybe your health coach. Health coaches are big now on the coasts.

“And I obviously believe that you’ll

see less emphasis on the type of patient/physician relationship that you and I value and see as optimal,” said Dr. Larry Sellers, 64, chief medical officer for Mercy Medical Center-Sioux City.

Such is the changing health scene of health care in Siouxland ... and beyond.

It is one Sellers, a doctor for 37 years, hardly recognizes from the days not that long ago when physicians worked 20, 30, 40 hours in one place, on call at all hours, their social lives often non-existence. That isn’t the way of most of today’s young docs. Not when you get into the whole new issue of changes in physician productivity that are really generational,

text and photograph by John Quinlan

HealtH Doctor-Patient relationship

doctor/patient relationSHipin flux today


Sellers explained.For instance when a physician who

is 65 decides to retire and his medical group decides to replace him, he must think about recruiting two or three phy-sicians from a productivity perspective to properly cover all of the retiring doctor’s patients.

“The priorities in the profession have changed in the last 30 years dramati-cally from (days when) always before the profession came first. I’ve got to work 90 hours a week. I know that going into the profession, it’s a 24/7 profession. I’ll make arrangements for coverage if I need time off. But yeah, that’s what I do. The mar-riage relationship and so on suffers,” Sell-ers said. “But the priorities for younger physicians, generally speaking, place the profession below quality of life, below family, below concerns about lifestyle. So productivity-wise, the current estimate is that the new generation of physicians, in general, will be 50 percent as productive as the retiring generation.

“They won’t be putting in the time. So therefore they won’t be able to see all those patients that your doctor saw dur-ing his career.”

prioritieS cHangeThese changes in prioritization, along

with the gradual evolution of the pro-fession away from male domination to more gender equity and racial diversity, have impacted the system to the ex-tent that there are no longer enough

physicians who want to be in family practice or general internal medicine practice with the same commitment of time and call coverage, Sellers said. This is especially so for unassigned patients in the emergency room at the local hos-pital, he noted.

And while most physicians of Sellers’ generation put in 20 to 40 years or more of practice, the Gen X and Gen Y doctors are more anxious to retire earlier, assum-ing they can afford to do so in today’s economy, or move on to another job, he noted.

Finding a GP or an internal medicine practice replacement has been a problem since before the Graduate Medical Edu-cation National Advisory Committee was formed more than 20 years ago to help deal with the situation, Sellers said.

That report said we don’t have a shortage of physicians, but we do have an urban/rural maldistribution and a bit of a specialty problem “in that we don’t have enough docs who want to be family doctors to do general practice or general internal medicine doctors or pediatri-cians or even OBGYN docs in that cat-egory,” he said.

After Sellers joined a practice of seven internal medicine specialists in Sioux City, he gradually saw the practice depleted by retirement, departure and death, and the survivors quickly learned that they were not able to recruit internal medicine doctors willing to share equi-tably in on-call coverage for the group,

which included covering the two hos-pital emergency rooms for unassigned patients that might need their specialty. Even reducing the on-call coverage obli-gation from 90 to 60 hours a week failed to draw any new recruits.

“It’s been a real education to have come in practice through the periods of time when profession came first and trying to replace a physician who died or a physician who retired – and not being able to do that,” he said.

And this, he added, made it extremely difficult for the physicians in his practice to provide the same level of service to their patients.

“Today the recruitment of internal medicine and family practice, those are the two most difficult specialties to re-cruit nationwide,” Sellers said.

more HoSpitaliStSOne solution may be for hospitals to

do more, and it has already begun with the hiring of hospitalists, doctors work-ing directly for hospitals. Hospitalists, in fact, are being more commonplace every year

“More and more you’re seeing hos-pitals like St. Luke’s and Mercy get into the physician employment business,” he said, noting that the word “hospitalist” didn’t even exist until the mid-1990s.

He also mentioned the cost/price squeeze that hit family doctors in Iowa about 10-15 years ago, forcing many in private practice to refuse to accept any new Medicare patients because Medicare reimbursement was so low.

“Obviously, there’s been a lot of talk about health care reform, the necessity for that based on the economic reality that Medicare trust fund is going to run out or money in the very near future,” he said.

With an aging population and in-creased health care consumption, change is inevitable.

Some physicians have gotten cre-ative about this by avoiding Medicare and charging some type of “access fee,” maybe $2,000 a month or $20,000 a year for patents who want to be in their prac-tice. “It’s called concierge medicine. They creatively found a way to sustain prac-tices, making themselves available 24/7,” he noted.

While this works well on the Coasts (and in The Hamptons on TV’s “Royal Pains”), the concept hasn’t really caught on in the Midwest.

It’s just too expensive, Sellers said.The result is that more community

hospitals are getting into the employ-ment business, with some of the revenue

finding a doctorWhen your family doctor leaves or retires or you move to a new town, finding a new primary care doctor is a big priority.in the past, people could check with the county medical society to see what physicians are ac-cepting new patients, and that is still a possibility in many locations, said dr. larry sellers, chief medical officer of Mercy Medical Center - sioux City.and usually when a doctor retires or leaves a practice, that practice feels an obligation to provide medical care for the patient. so a list of available physicians is offered to departing pa-tients. and some doctors suggest matches to the patients they are leaving behind.Transferring to a new physician is not without its problems. Patients are used to one doctor’s way of doing things, sellers noted. But if you don’t like your new doctor, you can always look for another.some physicians will even consent to an interview before you sign on as their patient.But if you are moving to another town, don’t expect the physician you are leaving behind to make any recommendations. They rarely know that many physicians in other communities.Your best bet?“i recommend when you get there, ask your neighbor who their doctor is because from a per-sonal perspective as a patient, i don’t stay with a doctor if i don’t think he’s taking good care of me or treating me right,” sellers said. “But if i do, i’m going to say that dr. smith, he comes across a little bit gruff, but gosh, he’s the best. He gets me in every time i have a problem. He’s always got suggestions to help. i like him.”That is the kind of recommendation you want to get.“That’s pretty good in terms of patient experience. You’re not likely to end up with a dr. smith who’s a quack. who’s got lots of malpractice suits, etc., etc.”


they receive from patient care going into physician recruitment, compensation and benefits.

“So the dynamic as it is playing out will, of course, favor the well-to-do sys-tems. Systems that might exist in areas that have low prior reimbursement, they are at a disadvantage because they don’t have the cash reserves,” he said. “They don’t have the operating margins to shift into physician recruitment, compensa-tion and retention. So what happens? They go out of business.”

Yet while the opportunities may be declining to see a physician as often as you used to, care will be available.

tHe team approacH“We’ll make you an opportunity to see

a health care provider, but it might be a non-physician,” Sellers said. “It might be a PA, a physician assistant. It might be a nurse practitioner. It might be a hospital-ist. And here’s a new word for you: health care coach.”

Many systems are developing just such a model of managing patients with chronic illnesses like diabetes, high blood pressure, congestive heart failure, osteo-arthritis and other ailments more com-mon as we get older, Sellers said.

“You’re going to have an intermediary person who may be a nurse but may be a bachelor’s-prepared person that we’ve trained specifically to be a coach,” he said. “A coach that emphasizes personal interaction, has some knowledge about adult education and works with the pa-tient to make sure that they are compli-ant with the recommendations.”

If the patient has problems, he or she will have access to a team of people, the usual suspects along with nurses, dieticians, physical therapists and the like, who will review the chronic disease management criteria, the patients who have these illnesses and be sure they are on track to achieve the best result.

Another interesting evolution, he said, is the growth of Urgent Care, provided at physicians’ clinics and retail stores that have pharmacies. Generally staffed by mid-level health care providers, it fits in well with the health coach option.

And all of this is developing rapidly, Sellers said, noting that about one-third of physicians in practice today are over the age of 65, the oft-designated retire-ment age.

“And that’s really mind-boggling,” he said. “With that significant a percentage of our physicians in that age group, there is going to be a significant impact of physician retirement on the ability of pa-tients to have a doctor that they consider their doctor.”

The Home Builders Association of Greater Siouxland extends our thoughts and prayers to everyone affected by the flooding. This is a time for us all to be thankful for each other and help our fellow citizens and businesses. Please be very careful when you hire a company or individual to help you in this time of need. There are people out there that prey on individuals during a crisis. Call your Chamber of Commerce, ask for references, or contact us for our membership information.

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eyad najdawi

Jess HerbolD HAD No reason to suspect he had a heart problem. Why would he?

He could work all day in the heat on his parents’ farm without any problems. He was in shape, preparing for the up-coming football season. He’d never expe-rienced any heart difficulties.

“I was 17 years old. I was in pretty good shape. I was big and I was strong,” Herbold said.

None of that mattered on Aug. 5, 2008. Then a junior, Herbold was practicing with his Kingsley-Pierson teammates when he began having heartburn-like pain, similar to what he’d experienced in the prior year. Doctors treated him for an ulcer at the time.

This time wasn’t much different, but he called his mother, who told him he should come home. Herbold instead said he’d stay and watch the rest of practice. Shortly after hanging up, he collapsed, and his coaches saved his life by per-forming CPR on him at the practice field.

At the hospital, doctors found a blocked artery and installed three stents and a defibrillator/pacemaker. Doctors in Sioux City and the Mayo Clinic have been unable to figure out what caused Herbold’s condition.

“The only thing they can decide is it was a birth defect or that the artery had been partially torn and was causing the burn-ing sensation and finally blocked,” Herbold said.

His condition was defi-nitely uncommon. But the circumstances surrounding the discovery of his heart condition are common to young athletes. Many are in good physical condition when, out of the blue, a heart condition pops up.

That’s how most are discovered, said Dr. Eyad Najdawi, a pediatric cardiologist

Heart HealtH important for young people

text by Nick Hytrek | Photograph by Tim Gallagher

HealtH Post-surgery recovery


on aug. 5, 2008, Jess Herbold, then a 17-year-old junior at Kingsley-Pierson High school, suffered a heart attack on the second day of football camp. He had been treated for an ulcer in the year prior to the heart at-tach, but had never experienced any heart problems. He was presented with a football signed by teammates shortly after his heart attack.


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a

presentation

at Prairie Pediatrics in Sioux City.Most young athletes who experience

heart trouble were probably born with an abnormality, he said. But many of those conditions either don’t reveal themselves until later in life or signs and symp-toms are overlooked. It underscores the importance of regular checkups with a primary-care physician, who can gather a complete family health history and document any changes seen in a young patient’s condition.

Even then, heart conditions can go undetected.

“No matter what you do, there are circumstances in which you can miss. There are documented cases in which there were no signs, no red flags,” Na-jdawi said.

Najdawi said the incident rate of sudden death of young athletes is 1 per 100,000-300,000, a very small number. To make that number even smaller, Najdawi said young people must be aware of any difficulties they may be experiencing.

The problem is, many teens blow off symptoms for a number of reasons. They may dismiss the possibility that

someone their age could have heart trou-ble. They’re afraid they might actually have a heart condition. Or they fear that voicing concerns may lead to them los-ing playing time or a spot on the team. Parents, too, sometimes shrug off their teenager’s concerns.

“Brushing aside a complaint some-times can be a detriment,” Najdawi said.

He said young athletes should take any concern seriously. Maybe they’re short of breath during workouts because they’re not in top shape, but it doesn’t hurt to get checked out. If the doctor sees anything of concern, he or she can order further tests.

Najdawi said athletes should pay at-tention to symptoms that don’t match up to the actions they’re undertaking. For example, shortness of breath after running wind sprints is to be expected. Shortness of breath during prepractice stretching isn’t.

Najdawi said common symptoms of heart trouble include shortness of breath, chest pains, blackouts, losing conscious-ness and abnormal heartbeats. A family history of heart problems also is an indi-cator.

Chances are, a heart abnormality would be caught during an annual sports physical performed by a physician, Na-jdawi said.

Unfortunately, that won’t catch all of them. Herbold said cardiologists told him there was no way his regular doc-tors could have known he had a heart condition. Fortunately, his coaches’ quick response saved his life.

Now a University of Iowa sophomore majoring in accounting, Herbold contin-ues to take medication and watch his cholesterol, and he’s had no heart trouble since that fateful day. During regular checkups, doctors give him a clean bill of health.

“They say my heart’s healthier than before,” Herbold said.

common heart conditionSMany heart conditions discovered in young athletes were probably present at birth, said dr. eyad najdawi, pediatric cardiologist at Prairie Pediatrics.in many cases, these conditions don’t present themselves until later in life when the heart becomes stressed during intense physical workouts. in some cases, signs and symptoms were missed or overlooked.najdawi said these four conditions are the most common seen in young athletes.• Cardiomyopathy, or an abnormality in the heart muscle. It’s genetic, for the most part. it may not show up early, but a primary care physician can know to look for it by taking a complete family history of the young patient.• Coronary artery abnormalities. Under normal circumstances, this condition won’t show up, but it will during stressful conditions such as workouts.• Abnormal heart rhythm.• Long QT syndrome, in which the heart beats normal under normal circumstances, but abnormally under stress.

“I was 17 years old. I was in pretty good shape. I was big and I was strong.”

JeSS HerboldHeart attack survivor


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The short answer is that reusing wa-ter bottles is generally safe for you and is most certainly better for the environ-ment.

The long answer has two parts. First, is the question of chemicals in the plas-tic leaching out into the water and sec-ond is in regard to microbial growth in the bottles.

There are many chemicals that are components of plastics that are regu-larly used for food and drink containers. Some common ones are bisphenol A (BPA), polyethylene terephthalate (PET), or phthalate. In order to be cleared for use in food and drink containers these chemicals must all be extensively stud-ied and pass some very strict safety stan-dards. Those standards require that the chemicals alone do not cause any health problems and that those chemicals do not break down and leach into the food or beverage when they are exposed to all sorts of conditions (heat, cold, mechani-cal stress, microwaving, etc). Despite all the testing over the years that has proven plastic chemicals to be safe, there are occasional health scares circulated on the Internet and by word of mouth rumors that chemicals are hazardous. Those rumors are simply that, rumors that sound scary. Now the real concern you should have regarding the refill-ing of water bottles is microbial growth. Bacteria, molds and even algae can grow on any surface, plastics included. You wouldn’t use the same cup, bowl or plate for weeks on end without washing it would you? Why would a water bottle be any different?

The way to address this is to clean

the bottles with soap and water before you refill them, and to throw the bottles in the recycling bin when it gets a little ragged looking.

Happy hydrating …

is it good to watch tV in the dark? or will this do something to your eyesight?

Watching TV in the dark, driving a car at night, reading for a long period of time or looking at a computer monitor for ex-tended periods of time all can lead to eye strain. While not particularly dangerous or damaging to your eyes, it can cause some unpleasant effects such as head-aches, fatigue, dry or sore eyes, neck or back stiffness or blurred vision.

The focusing mechanism of your eyes requires the use of some sets of small muscles in and around the eye itself. These muscle sets contract or relax to allow you to focus at a certain distance or light condition and, just like any other muscle in your body “those” muscles get tired when used excessively. When your eyes are not quite focused right, your brain attempts to compensate by mak-ing you blink more, move your head or making you squint. All of those things eventually increase your discomfort and cause the symptoms listed above.

Some ways to reduce eye strain in-clude:

1. Taking breaks where you focus on something at a different distance. This will allow the muscles you had been us-ing to relax for a little while.

2. Adjust the color and contrast of the TV and change the light conditions in

‘doc, i’ve got a queStion …’answers to your medical questions

advice Medical Answers

meet the docdr. Bill dorwart is a second-year family Medicine resident at siouxland Medical education founda-tion. He grew up in sidney, neb., went to medical school at the university of nebraska Medical Center in omaha and has numerous family members in siouxland.

what do you think of refilling water bottles? Some say it is oK as long as the water bottle didn’t get hot – if you left it in the car, for example.


Most people love to have lots of windows in their homes. Windows make a home bright and cheery by letting the sun shine in, and they give you the feeling of openness or “space.” But when the seasons start to change from summer to fall to winter, do you notice a draft of cold air breaking in from your windows? The fall months are the perfect time to replace old windows with energy-saving ones. Here are some winter window hints for keeping the warm air in and the cold air out.

The first step for reducing cold air drafts and heat loss is to inspect your home from both the inside and outside. Be sure to check the areas where window frames meet the structure or siding of the house. Plug any cracks or openings with caulking or weatherstripping. Caulking should be used to seal all small cracks on non-moving surfaces, inside and out; and weatherstripping is used on windows (and doors) and other

movable parts of the home.Storm windows can also keep

the heat you’re paying for inside. If purchasing storm windows isn’t within your budget, consider making your own with clear plastic film and a light wooden frame. Inexpensive kits can also be purchased at most hardware and home improvement stores.

And have you considered the glass in the windows? Ordinary window glass transmits ultraviolet heat rays from the sun. While this sounds great for the winter, remember the summer effects this can have on your air conditioning bill. You can help control this effect in your favor by applying reflective film or by installing low-emissivity (low-E) glass. Low-E glass has an almost invisible metallic coating, either suspended between the two panes of glass on a film, or applied directly to one of the inner panes of glass. Basically, the coating reflects heat

while letting light in. But the same coating will also help keep your wintertime heat indoors. Be aware that windows made of low-E glass may cost 10 to 30 percent more than conventional glass double-pane windows.

And even on cold days, the sun can take part of the load off the furnace and help warm the inside of the house. After you’ve sealed any leaks where cold air can get in, open the drapes and let the sun shine in.

For more energy-saving tips or visit www.nahb.org.

Let the Sun Shine in — Keep the CoLd Air out

Doug ConradPresident

Heritage Homes of Siouxland

712-255-3852www.hbags.com

the room. Your eyes will tire out faster when there is a large difference in the light level so adding a moderate light to the background of the room or adjusting the TV settings may help decrease that difference.

3. Reduce the glare off the surface to make it easier for your eyes to focus on the images on the screen than the reflec-tion off the screen. This is not that big of a problem with newer TVs, but older ones with a glass screen or some projec-tors can have quite a bit of glare.

Happy viewing …

they say you should take aspi-rin if you think you’re having a heart attack. but what kind? how much? when? would it just be better to take aspirin every day?

First of all, if you think you are hav-ing a heart attack, you should be on your way to the emergency room not rummaging through junk drawers or

searching the super market aisles for the perfect aspirin. If you happen to have some aspirin on hand, take it on the way to the hospital. If you get to the ER and you haven’t had any yet, you will get some pretty darn quick. The reason-ing behind that is that aspirin stops the platelets in blood from clotting and when you are having a heart attack you do not want any more clots; because more clots would mean more blockage of the already blocked arteries supplying the heart muscle.

Now to actually answer your question, when aspirin is given at the hospital, 325 mg in a chewable form is what is given. The chewable is used because it is absorbed the fastest and the dose of 325 mg is used because that is the dose that will give the best anti-platelet effect without overdoing it.

Aspirin comes in many different sizes and formulations, the most common doses you will find are 81 mg and 325 mg and the most common formulations are chewable and enteric coated.

If you are taking aspirin to protect your heart, the current guidelines say that you should be taking 81 mg a day. However, those guidelines are for people at lower risk for a heart attack or stroke but who haven’t had a heart attack or stroke in the past. If you have had a heart attack or a stroke in the past or if you have multiple risk factors such as diabe-tes, high cholesterol, obesity or smoking history your doctor may ask you to take a higher dose of aspirin or they may prescribe you a different type of platelet blocker. As for the chewable vs. enteric coated formulations, in the situation where you are taking aspirin for heart protection that is a matter of personal preference. The enteric coated aspirin is a little easier on your stomach while the chewable comes in a smaller tablet that you can swallow if you want. In either case you are getting the medicine in your body where it can do its work.

Happy anti-platelet-ing …


Your heart should never stop working.So we never stop caring for it.

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Other people lust after cars, big homes or expensive jewelry.I long for organization.Ever since I was a child, I wanted the kind of order that only

comes with file folders, colored labels and alphabetically in-dexed “stuff.”

While friends passed their time in toy stores, I whiled away hours in stationery shops. Manila envelopes. Paper clips. Sta-plers. Scissors. Glue pots. Colored pens. And reams and reams of paper fascinated me.

At 12, I was so determined to follow the Dewey Decimal Sys-tem, I bought library cards, envelopes and “date due” slips to classify all of the books in my family’s home. No library could rival my system – particularly since I also put plastic sleeves over the book’s paper jackets.

The library was perfect – just right for playing school.But once I got old enough to amass more things, the best

laid plans started falling apart.Papers formed heaps. Heaps formed piles. Piles morphed

into messes.Like Andy Warhol, I just boxed the stuff up and realized I

had lost all sense of organization.When I went into a friend’s house and saw a basement full

of bins, categorized by season, item and date, I was mesmer-ized. And jealous.

I wanted a basement where I could find everything.What did I need to do it?First, I started with blue Rubbermaid bins. I bought enough

of them to hold my own Library of Congress.Unfortunately, I had no clue where to start.Would I put a letter of the alphabet on each one and just

toss in things that began with that letter? What about the very thin list of things that started with “q” or “x.” Could I combine

those? Would I need several for items that started with “b,” “s” and “t”? Would there be disparity that wouldn’t mimick my friend’s order?

The idea was stupid.Then, I thought of categorizing everything by year. But what

about that stuff that falls in some nebulous pile? Some pictures look like they were taken in 1997 or 1998. Others clearly pre-dated the ‘60s.

Seasons were good – my mom had shopping bags for each holiday. In each one, decorations were clearly organized and marked.

But what about the period that comes between New Year’s Eve and Valentine’s Day? What do you call that?

And what about tax receipts? Do they go in individual month bins or do they belong in yearly ones?

Again, another dumb idea.I did put Christmas items in red and green bins, Halloween

stuff in orange and black ones.But then, I started to wing it. Yes, all receipts went in three

big “seven-year” bins (so that I could find them).But then I started creating new categories: “Stuff to look

through,” “Good stuff,” “Stuff to throw.”And, handily, many of the items found a home.Unfortunately, it became difficult to fill the “Stuff to look

through” because I’d look through it and not get much done. So, like Andy, I just dumped things in, sealed them up and shoved them under the basement stairs.

My basement now has the appearance of organization but you can’t look too closely.

Just because it’s in a bin doesn’t mean it has gotten the Good Housekeeping seal of organization.

It just means it’s out of the way.

parting SHot By Bruce Miller

otHer people luSt after …

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siouxland life magazine - september 2011

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