Dec. 1 : Flying north from San Diego to Reno, Nev., along the spine of the Sierra Nevada Mountains, the plane crossed over Lake Tahoe, just before landing in Reno. The mountains surrounding the lake were white. The trees were grey-green; and the lake itself, black, in shadow from the mountains, just before sundown. I looked down upon a California-Nevada chiaroscuro. I was on my way to a locum tenens psychiatric outpatient assignment northwest of Reno, in the eastern foothills of the Sierras, in Timberton, Calif.

Locum tenens is Latin for “holding a place.” Because of staff departures from hospitals, clinics, or private practice, temporary replacement doctors (or nurses or dentists) are needed until permanent staff members can be hired. In essence, a locum tenens is a “rent-a-doc.”

Landing in Reno, I left the main terminal lobby with its silver sculpture of a downhill skier and picked up my rental car. (For a locum tenens, the plane, the car, lodging, malpractice insurance, and the contracted hourly fee-for-service are included in the locum tenens agency’s monetary province. Not food and not gas.)

Driving north on the interstate, the car skidded a bit on a patch of black ice. Even though the car skidded only “a bit,” still, that was enough to focus my attention. (Oh! That’s what black ice is all about. Slow down, Hopalong!)

My destination was close now, and I pulled off the highway onto Main Street, Timberton.

Two blocks off Main Street was my bed and breakfast: a pale green Victorian house decorated for Christmas with white mini-lights hung as icicles from the porch roof’s eaves. The home was storybook-immaculate; the innkeepers, extraordinarily gracious. Neatness and kindliness count.

Outside, 2 or 3 inches of snow accumulated, and a snow plow “chingled” up the street, pushing the snow aside. For the rest of the evening, no sounds disturbed the winter’s silent night.

The next morning, on route to my worksite, I passed the once-upon-a time Timberton railroad station. Nearby, California Bigleaf Maple trees – their autumn hues so strikingly similar to the color palette of Eastern sugar maples in the fall – were nearly bare. A few leaves – vivid reds and yellows – were hanging on for dear life, trying to maintain the glory of the Crayola-colored fall, just passed. Eventually, however, for the leaves – and all else – time and seasons move on, waiting for no one and no thing.

In days gone by, this railroad depot bustled with passenger traffic. And lines of timber-laden freight cars with both cut logs and milled boards rolled through, supplying lumber for a growing nation. History matters.

At the clinic, my first patient asked, “Will you be my new doctor?” “Will you be here for a short time or a long time?” “ I’ve already had four doctors since I’ve been coming here.”

My night times were filled with reading:

“Of Human Bondage,” by W. Somerset Maugham, the story of a crippled atheistic English lad, attending a London medical school, seeking the meaning of life … and a square meal. [Or is that redundant?]

“Main Street,” by Sinclair Lewis. [Forget about it! My Main Street is way better than Lewis’s! Women here have the right to vote!]

“Moby-Dick,” by Herman Melville, I read cover-to-cover, for drill, to show Melville I could outlast him, no matter how long he went on.

With spring’s arrival, green leaf-buds burst forth on skeletal oak trees, enveloping the branches in a yellow-green glow that became progressively brighter and brighter as the days grew longer and longer still. Lilacs flooded the scene. Little League tryouts were in progress. Baseballs in gloves snapped. Snow clung to the hilltops, while in the valley, short sleeves prevailed. The clinic hummed.

May 1: The end of my locum tenens contract loomed. I told my patients, “This will probably be our last visit before my time at the clinic comes to an end.” Thirty days and counting.

The patients reacted with shock or indifference: shock, with the fear of changing doctors; indifference, as many had been down this road before.

“Who will be my new doctor?” “Will the new doctor be nice?” “I hope the new doctor won’t change my medicines.”

Others accepted a “waiting list” but worriedly so.

Some had me transfer their medications to their primary care physician (PCP), if the PCP would temporarily “watch over” these medications until the new clinic doctor arrived.

And in a just-before-we-stop flourish, one patient and I explored issues of “standing out and fitting in,” emphasizing the “and.” Indeed, three sessions can be a ton of time.

One person summed it up, “Doctors come, and doctors go.”

June 1: Departure day. Farewell, Main Street. Farewell, Timberton.

At the airport, the plane – No. 1 in line for departure, Reno to San Diego – began its take-off roll down the runway. The roll seemed to go on forever, and I apprehensively considered: “Might we run out of runway? Now Giddyup!”

In San Diego for 3 months, the “locum tenens itch” struck me again. A recruiter called at the right time. Four weeks later, I was in the air to Sacramento.

I drove north past fruit orchards, and nut trees, and rice paddies – wet, and filled to the brim. I wondered what the locum tenens fates might have in store for me this time around – the Lady or the Tiger?

Up ahead, train tracks crossed the road. A train horn howled. I braked to a stop …

Freight train through Marysville/Slicing through town

Sounding its horn /Gates dropping down …

Once: small town freight train/piercing the hush

Of snowy nights’ studies/High school demands

Up in the attic/Goose-neck for light

Then college, then trade school/Then M.D. achieved…

Freight train through Marysville/Hear the horse call

Rolling on rail/Heavy the haul

Boxcars and flatcars/Huge spools of wire

Supplies at a distance/What people require

Clicking and clacking/Gathering speed

HAVE HOPE – WILL TRAVEL/Wherever the need

Dr. Kline worked for more than 30 years as a staff psychiatrist for San Diego County Mental Health. He also worked for several years as a locum tenens psychiatric physician.