Getting back to the bacon grease. Almost everything in the hospital cafeteria was cooked in bacon grease, even the vegetables, arguably the healthiest food there.

People would eat biscuits and gravy — the gravy having been made with bacon grease — plus a large side of bacon, wash it down with Mountain Dew or some other beverage high in sugar and caffeine, and top it off with a cigarette or two.

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No wonder the incidence of coronary artery disease was so high in this part of Kentucky.

Many patients were admitted with severe chest pain, some with four or five cardiac stents already in place. Presenting to the ER with another MI had become so routine for them that it was almost like just “another day at the office.”

There was also a very high incidence of tobacco dependence, drug and alcohol abuse and, not unexpectedly, obesity, diabetes, and liver disease.

The contrast with where I grew up, attended college, and went to medical school — Los Angeles, Denver, and Phoenix, respectively — was striking. People in these parts of the Western US seemed to care much more about preventive health measures — eating healthfully, getting enough exercise, trying to stay slim, and visiting a dentist at least occasionally, if not every six months like clockwork.

Far too many of my Kentucky H&Ps contained the words “edentulous” or “very poor dentition.”

Yet, despite the cultural and dental contrasts, it was a wonderful learning experience for me. I saw and treated the sickest of the sick. I learned about Appalachian culture. I took photographs of the unspoiled Kentucky wilderness. And I came to love the engaging openness of the Appalachian people.

Over the course of my residency, challenging though it was at times, I was gradually transformed into a real doctor. By “real doctor,” I mean someone who does what is right for the patient.

But the bacon grease I never got into.

And to this day, the smell of bacon or anything even slightly reminiscent of it brings back memories — some good and some bad — of my long nights and early mornings in rural Kentucky.