Finding work and meeting ex-patients

April 17, 2015

The hardware she helped me select

Then noted a pain in her neck

I derived such enjoyment

At her place of employment

No charge for a three-minute check

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. I just got back from a 3 month stint in Nome, Alaska.

I returned from Nome to Sioux City ten days ago; Testing my immediate employability theory, I woke up Monday morning with nothing on my schedule, and tried to have work by Wednesday. My time frame incorrect, in less than a week I had work lined up from the 3rd week in April until the last of September.

I don’t write in detail about these jobs until I sign contracts, sometimes not until I see plane tickets. Five out of 6 jobs fall through. This summer I’ll work Urgent Care in 12 hour shifts, from 3 to 5 days per week. And, if things go according to plan, much of my summer I’ll spend working in Pittsburgh.

I’m also talking with a Canadian recruiter. Most American docs reflexively vilify the Canadian single-payer system but few understand it. I want first-hand experience despite the fact that with one exception, every Canadian physician I’ve met hated their system.

But every day I see former patients.

At the gym, a fit-looking, slim, middle-aged woman came up to me while I sweated on the elliptical. “You saved my life,” she said, “It was eleven years ago I stopped smoking. I fist-bumped with her, genuinely glad she changed her life. Yet I believe that if my patient gets better, 80% of the credit goes to my patient, and 20% to me.

Last week at Sam’s Club, a young man approached me with the good news that he’d stopped drinking soda pop and had started drinking more water. He looked healthy.

Yesterday a former patient reminded me that 25 years ago to the day I ushered her into the world. I had the great good fortune to diagnose pregnancy, do the prenatal care, attend the delivery, and perform the well child exams. She has grown into a strong, competent, attractive young woman with an impressive array of skill sets. An asset to the city, her family, and the health care industry, I feel privileged to have watched the process.

Today at the hardware store, a staffer complained to her co-worker about knots in her neck. (She gave me permission to write this.) “I’m a doctor,” I announced, “and I can make those knots go away.” I sat her on a stool at the back of the store and put my hands onto her shoulders, finding the usual set of painful lumps, starting with the upper inside corner of the left shoulder blade, the cluster of four between the shoulder blades, along with the characteristic tightness along the back of the neck. I used a routine that I developed over the years, progressively massaging the head’s support muscles, finishing with a standing upper back crunch. She thanked me profusely.

At the end, I said, “Making your neck knots go away, that took three minutes and it’s free, but it doesn’t address the whole question of why you’re not sleeping well, which is the root cause of the problem and would take 20 minutes.” She wanted to know where I work, and I had to tell her I’m between jobs.

I didn’t tell her I so enjoy making people feel better that I quit charging for spinal manipulation. But I left my business card, and encouraged her to read my blog.

Foxes, itches, triumph, and hunter: on the cusp of leaving Nome

April 1, 2015

On the med list I’m pulling a switch
‘Cause my patient came down with an itch
Now they’re getting the sleep
That’s restful and deep
And for trazodone I found the right niche

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. Right now I’m back to Nome from temporary detail to Brevig Mission.

I took care of a patient with a very bad diagnosis and a very bad itch. I will leave it up to the specialists to try to change the course of the disease, here in Nome I will try to relieve suffering. Because itch in the context of unrelenting pain constitutes torture. We looked over the med list.

Me: Aren’t you allergic to codeine?

Patient: Yes, it makes me itch, real bad. Same with the hydrocodone.

Me: Stop picking at yourself. Why do you take the oxycodone?

Patient: Beats me. Doesn’t work. That’s why I finished ’em early.

Me: If they don’t work, why do you take it?

Patient:

Me: Maybe oxycodone is making you itch. Let’s try stopping it.

Patient: But how am I going to sleep?

Me: How are you sleeping now?

Patient: I’m not. Those pills don’t work.

Me: Maybe we should stop them.

Patient:

Me: How about if I give you a sleeping pill to help you sleep and you come back next week. How about trazodone?

It took some explaining, but the patient came in, looking fresh and happy and focusing a lot better, having slept well 4 nights in a row, and now having much less pain. Because (everyone knows) that good sleep helps a person deal with pain.

And another demonstration of the principle of ABCD (Always Blame the Cottonpickin’ Drug).

***

I can post this about the young man because I got permission from him and his mother and because everything is on Facebook. Well on the way to being a hunting legend at age 14, he got his first polar bear at age 11, same year he got his first bowhead whale. He has lost track of the number of walruses he’s gotten so far this year. I still won’t publish his name or what he came in for.

***

I stepped into my cubicle about 10 in the morning and saw a red fox run past.

Foxes hunt at night, any abroad by day raises suspicions of rabies. At home, if I see raccoon, skunk, or fox outside of dusk, dawn, and night, I will seek a weapon to dispatch the animal. In Barrow, we assumed rabies in all arctic foxes.

The furry red animal ran along the north side of the building, around to the west. I said, loudly, “There goes the fox!” and strode briskly to the other end of the clinic to try to get another look; I worried it might head to town. I didn’t see it again, and decided it dens either under the hospital or in the maze of construction dross nearby.

****

The first patient of the day felt really, really good after the vitamin B12 shot yesterday. Best in years; better sober after that shot than drunk.

Which made my day.

***

I leave tomorrow after an abbreviated afternoon clinic. Staffers have come in to wish me well. I got a great going-away card, a very trendy tote bag, and a pair of hand knit socks. Along with the story of the wool (starting with the sheep) and the WWI-era sock knitting machine.

Brevig back to Nome

March 31, 2015


I flew out and back Bering Air
My clothes in layers I’d wear
I come and I go
In the ice and the snow
And a bag of dry fish I did share

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. Right now I’m on temporary detail to Brevig Mission from the hospital in Nome, Alaska.

I don’t sleep well the day before I travel, without regard to mode of transport. I rose early and showered and packed and ate.

Then I napped, for the best sleep I got all night. By 8:00AM I logged on to the computer.

I worked a steady pace through the morning. At noon the staff left for lunch. I stayed by myself and ate trek mix while I read a Jonathan Kellerman novel (I write better than he does, but he has the genre formula nailed down).

With but one afternoon patient scheduled, I had time to finish documentation. The Bering Air agent, who had showed up during a house call to check me yesterday, came in. The plane would be a little late, he said, flying from Nome to Wales first. He needed my weight. I offered to get on the scale (declined), and gave my best honest estimate. But he also needed weights on pharmacy and lab air freight.

Things had finished when the staff asked me to add in another patient. I looked at the clock. Plenty of time before the 4:00 departure. Sure, I said.

And I said that for the next three patients as well. I luxuriated in unhurried patient care. And each time I entered the data into the computer in a timely fashion.

I told the staff what a great time I’d had. They told me to come back in summer for prettier scenery. I looked out at the snow-covered hills and the frozen Bering Sea, and wondered how things could ever get prettier. They assured me they would. And they talked about how Brevig never sleeps in the summer, how the place bustles with activity. And about the fishing.

I said that I would have like to have tried dry fish.

The staffers looked at me in dismay. I should have spoken before, they said. And I saw how my shyness, from not wanting to impose on my hosts, appeared as standoffish. And all that announced at 3:50PM.

A Community Health Aid (CHA) bundled up faster than I could imagine, and jumped on her ATV.

It takes me a good deal longer to get on my arctic-grade bib overalls than the CHA’s near instantaneous preparation. As I mounted the ATV behind a diminutive staffer, we saw the plane coming in from the northwest.

The CHA on the ATV passed us on the hard-pack snow of the village street, and the staffer in front of me took the bag of dry fish from her without slowing, as casually as if it happened every day and as smooth as the railroad used to pick up sacks of mail. Approaching the airport, we saw the only truck in town, a 4WD club cab pickup.

I needn’t have worried about keeping the plane waiting. We pulled up before the pilot, working on his documentation, killed the engines.

Wearing my arctic layers let me confine my baggage to 1 day pack. I sat as instructed just behind the passenger in the co-pilot’s seat.

After a 5-minute flight to Teller we deplaned one passenger who had flown from Nome through Wales and Brevig to get home.

Ice melting into puddles astounded me when we arrived in Nome with a temp 20 degrees higher than Brevig when we left.

Contrast remains the essence of meaning, even when just barely above the melting point.

Still making housecalls

March 26, 2015


The sun on the snow gets so bright
Reflecting the light off the white
The stuff new to me
Is wonderful, see,
And Aurora brightens the night.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. Right now I’m on temporary detail to Brevig Mission from the hospital in Nome, Alaska.

I make house calls. I enjoy them. I don’t do them very often.

When I worked in Navajoland, the war between the bureaucracies resulted in the demolition of a perfectly good clinic with the empty promise of a quick replacement; I got mean after two weeks of pay with no work and talked the Public Health Nurse into driving to hogans. I treasure those memories of the community I got that way.

Sometimes at home “housecall” means the patient comes to my house.

Here in Brevig I made three house calls on foot today. The Community Health Aide (CHA) and I walked together, through the blinding bright sun-on-snow, in bitter cold and wind.

Confidentiality precludes discussion of patients and problems in any but the most general terms. All three patients would have had difficulty getting to the clinic.

But I can talk about the context.

All the houses had portico closed on three sides, protecting the outside door and a space between the inner and outer doors. Two had firearms casually stacked in that space; I noted .22s, .223s, 12 gauges shotguns, all with outer finishes roughened by prolonged use in hard conditions. Each home had a first-class wood stove in the living area; no trees grow here but lots of wood drifts on the beach.

I saw frozen pizza boxes and traditionally dried salmon. Tabasco sauce bottles sat next to peanut butter jars. A single gleaming spark plug sat on a washing machine next to a rusty box/open end wrench. People sewed furs from sheep, beaver, seal, and wolf with waxed dental floss.

I commented to the CHA how the smallest, most mundane details of someone’s daily life fascinate people from other places; for me a flock of wild turkeys or a doe and her fawns in my backyard rate a yawn but would bring her wonder, while Northern Lights every night and a nearby island good for hunting seal knock my sox off.

During the visits people talked about bingo. I don’t gamble, but bingo on the Bering shore promised a unique experience, and at 7:00PM, my clinic documentation done, I suited up and walked out into the brightness.

I did not find the bingo game.

In a village this small and this isolated, the children play as freely as I played in the 50’s. Two, who recognized me from clinic, came up to show me their puppy while I wandered.

Back inside, my glasses frosted over, rendering me sightless till the ice sublimated and the temporary darkening relaxed.

I napped and read until a patient came in with a CHA at 9:00PM.

Not sick enough to warrant a Medevac, but definitely in need of an IV and a few 21st century pills, they left in the dark an hour and half later.

A bad bed, great Northern Lights, and a patient with “red flag” symptoms

March 25, 2015

The bed here? Let’s just call it bad
The second worst I’ve ever had
But for the sake of the night
I saw Northern Lights
‘Twas worth it. It made my heart glad

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. Right now I’m on temporary detail to Brevig Mission from the hospital in Nome, Alaska.

The bunk here came near to the worst I have slept in, second only to a very bad mattress in New Zealand. I contemplated putting the mattress on the floor, but at 3:00 AM I remade the bed head for foot. Before lying back down I watched a spectacular aurora borealis for about 5 minutes. A person, apparently a teenager with a backpack, walked through the darkness and didn’t waken the sleeping dogs.

The clinic, built to standards set by the Joint Commission on Accreditation of Hospitals and Organizations (JCAHO), has my bed thirty paces from the exam room, which in turn is 12 paces from the break room. Across the 8 feet corridor from my exam room the two-bay trauma room yawns, almost the size of the ER in Petersburg, Alaska. On my way to work I pass the 2 chair dental suite, two other exam rooms, a shower, the pharmacy/lab and two generous utility rooms.

The Community Health Aids (CHAs) staff the facility most of the time in the absence of a physician, PA, or NP. Selected on the basis of intelligence and resourcefulness rather than on degree, they handle the load most of the time, and call for help when they can’t.

Today I met a patient I’d heard about in Nome. Now doing well, one could never imagine the difficult Anchorage ICU course after Medevac complicated by a storm.

On three occasions today I talked to patients with long-term back pain, and none of them requested narcotics. My personal experience with the problem gave me credibility when I talked about ways to approach the problem without drugs, including nicotine, caffeine, alcohol, and marijuana.

One patient near the end of the day came up with “red flag” symptoms serious enough to send to Nome but not serious enough for a Medevac. I shared the CHAs’concerns. I called the PA in Nome who will see the patient tomorrow and relayed my differential diagnosis. While doing so I could talk about the patient’s use/non-use of nicotine, alcohol, and marijuana by pantomiming to the CHA and receiving either a nose wrinkle or an eyebrow raise (Inupiaq for no and yes respectively). Before I hung up the staffers prepared paperwork, all I had to do was sign it.

With the last patient seen and the janitor finished, after another 9-hour work day, I went out into the cold. I wore my new sealskin mittens for the first time. I stood on the beach and looked north and west at the tip of the Seward Peninsula.

And after the Iditarod, Brevig Mission

March 23, 2015

Taking off after the race
Away from the Nome City base
I flew Bering Air
To Brevig, that’s where
You use hondas the reindeer to chase.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. Right now I’m on temporary detail to Brevig Mission.

Yesterday I remembered my years in high school distance running; I ran dead last in 6 out of 8 meets my junior year. I wanted to be at the finish line for the last (“red-light”) finishing musher of the Iditarod, the daunting thousand mile journey from Fairbanks. Forty-three years ago, the winner came in close to the time that the “red light” racer did this year.

I didn’t know I’d napped through the siren announcing the incoming dog team till I got downtown. The festive atmosphere had deflated in the week since the first musher came in. The thinning crowd wandered the streets, carrying free posters in plastic bags.

I avoided the mushers banquet as too noisy, and, with 1/3 of the city’s population, too crowded.

One last load of laundry before bedtime, then up very early.

With one daypack for clothes and a postal box with food, I called for a taxi.

The driver’s breath spoke last night’s alcohol excess. On the ride to the airport he talked with delight about the possibility of starting to drive to Teller (80 miles from Nome) if his company gets new vehicles.

I recongized a third of Natives and non-Natives in the Bering Air terminal. The business still runs on paper, no one compained about computers. But they needed to know the weight of my baggage and my person.

In the absence of a PA, the pilot announced the destination and the crowd thinned by the dozen out the door; TSA doesn’t screen if the plane can carry fewer than 49 passengers.

I wore most of my clothing; I finished putting on my insulated bib overalls (suitable for snowmobiling) just when the pilot called “Brevig Mission.”

The village sits on the south side of the Seward Penninsula, supported by subsistence hunting, fishing, and gathering. The clinic, the store and the school provide a few jobs.

The sun shone clear and bright on the snow over the hills as we winged north out of Nome; I marvelled at the bare pavement of the runway. The Caravan (also the name of a minivan) held seven humans including the pilot and a lot of freight.

Glad I heeded the friendly warnings about a marginally heated passenger cabin, I snuggled into my parka (here called a parky)

We landed in Teller, close enough to Nome that a 3 season road connects the two communities. The airstrip has no terminal; offloaded freight went onto ATVs and sleds behind snow machines.

We stayed on the ground less time than it took to fly to Brevig Mission (locally, just Brevig).

We could see Teller from the airstrip. Again, no terminal. I rode on the back of an ATV (locally, all called hondas regardless of manufacturer) into town, ten very cold minutes.

I set my gear in the bunk room at the back of the clinic, next to the door marked MORGUE. At the urging of the clinic staff, I accepted a ride to the store. Despite the small population (400, up from 276 in 2000) I could easily have lost my way. I tried to take in landmarks but in the end accepted the same ride back to the clinic.

I went to the bunk room and stripped off layers of long underwear.

I started right in at 1145, and saw 9 patients, more than I’ve seen in a single afternoon in the last six months.

The equipment in the clinic is dated but serviceable; last century’s doppler found the baby’s heartbeat just fine but I had to count the beats for 15 seconds and multiply by four.

I spoke with a reindeer herder, a plane crash survivor, an expectant mother, more than one carrying permanent injuries from snow machine collisions, and one who couldn’t tell the difference between lipoma (a benign lump of fat) and lymphoma (a cancer of the lymphatic system).

As always and as in all my past clinical settings, the ravages of tobacco, alcohol, and marijuana on physical and emotional resilience accounted for most of the pathology.

But here, for the first time, when I brought out my calculator to total up the financial cost of substance abuse, I met with looks of true dismay.

I put it into concrete terms: “Between $11 a pack for Marlboros, $15 a joint for weed, and $1.21 a can for pop, you’re wasting a new honda every two or three years.”

I didn’t say, And I’ll bet you’re underestimating the expense.

Iditarod finish and a possibly rabid fox.

March 19, 2015

With training, genetics and pluck
And a dash of plain old good luck
With ice on his face
At the end of the race
He won thousands and a new truck

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. Right now I’m in Nome, Alaska.
We walk through the cold and dark at 345AM to downtown Nome.

The festive atmosphere has reached its fever pitch with hundreds of people clustered around the finish line at the intersection of Bering Avenue and Front Street. Snow has been trucked in to cover the glare ice of Front Street, east of the Subway shop/Gold Coast Cinema, where a fresh snow ramp leads up from the Bering Sea beach. Camera booms, manned and unmanned, raise and lower; halogen lights turn a small circle under the burl arch into a gaudy imitation of day.

Two dozen inebriates stand outside the Board of Trade Saloon.

The sign outside the bank reads 15 degrees when we walk past in a light snow. I learn from the PA that every musher, as an unpaid employee of the US Postal Service, carries 2 pounds of mail that must be delivered before the musher officially completes the race. Mail mishaps over the years included packages left at checkpoints when lightening a load and mail burnt when a sled caught fire.

Loud teenagers cluster on my right, one climbs the temporary iron fence and yells that he can see the headlight. The Google helicopter hovers over the snow ramp, flying sideways to give the camera the best angle.

Then the dog team pulls into view, down the street, moving at a trot, the musher’s head lamp a white beacon. The dogs pull the sled as they have for the last 8 days/18 hours and 986 miles, joyously, their tails held high. One dog rides in the sled.

The musher will come away with $70,000, a new truck, a lot of smaller prizes, and the chance to make lots on endorsements.

We meander back to the apartment, hoping in vain for Northern Lights, and roll back into bed at 500AM.

I sleep till 715AM, when I pull myself out from under the covers. With a long experience of sleep deprivation, this morning I slept well in the absence of the vigilance of taking call, but I didn’t sleep long enough, and I jolt myself with the caffeine of hot chocolate.

The talk in the clinic centers around the race, and who did and didn’t get to see the first musher come in. With a very light schedule, I settle in to read my intranet email.

Brevig Mission Clinic closed because of heat failure. Power out on Little Diomede. Eye care and CAMP (the healthy lifestyle program) shortstaffed today. Iditarod Open Mic Night tomorrow at Bering Sea Bar and Grill. Watch out for the fox on the north side of the hospital who doesn’t seem to be afraid of people (no one mentioned he might be rabid).

March 18, 2015

We wait at the end of the race

The dogs maintain quite a pace

The great atmosphere

With wet t-shirts and beer

And workshops on qiviut lace.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. Right now I’m in Nome, Alaska.

A carnival atmosphere has descended on Nome. Yesterday after work, Les (a long time friend, and colleague who graduated from my residency program shortly after I did) and I walked downtown to meet up with Bethany, who has been working at Pingo’s, a café on Bering Avenue that seats, at most, 14.

The Iditarod race commemorates the relay that brought life-saving diphtheria serum to Nome in 1925. Winter mail at the time moved, if not by rail, by dog sleds driven by contract mushers. Public health officials pressed the teams into service.

Hollywood fiction could not possibly hold a candle to the drama and pitfalls of the real story. A surgeon stumbled onto a batch of serum in a closet in the railroad hospital in Anchorage. The wind destroyed the telegraph, mushers got their signals mixed up and almost missed each other on the trail. A howling gust blew a sled over, spilling the precious package into the snow, and retrieved only at the cost of frostbitten fingers. The last leg took a dangerous shortcut across sea ice.

Three years later, air service started in Alaska, snow machines came in the ’60s and the dog team ceased to function as a commercial mode of transportation when the US Mail stopped the last contract in the 70’s, about the same time the Iditarod started. Now, about a hundred teams set out on a 1000 mile race each year in March.

The route changes year to year depending on weather but the distance stays remarkably constant The first competition came through in three weeks, the top mushers are now finishing in 9 days.

Nome sees its most intense tourist business during Iditarod week. The schools close and the locals don’t even try to eat in restaurants. People have to look both ways before crossing the street. We suspect the airlines bring in extra flights.

We walked from Pingo’s to the Lutheran Church for their fundraising soup supper. Where else would a menu include soups such as reindeer sausage gumbo, moose, caribou, musk ox, and chicken curry, served with roll and butter and dessert?

As eclectic as the church menu, the week’s events include, among others, a qiviut lace knitting workshop, Native Olympics, the screening of The Spirit of the Wind (a musher’s movie), the music groups Acoustic Oosic and Bering Strait Jacket, a seal/walrus lecture, a fur hat making demo, the I-did-a-beer-run race, meet and greet the mushers, a musk-ox slide show, a reindeer grill out, a qiviut processing and spinning workshop, a seal skin sewing demo, a lecture on the original serum run, a reindeer herding talk, a sled dog pulls its weight and twice its weight competition, and wet t-shirt/wet buns contests.

We chowed down on moose soup and reindeer gumbo, and a brilliant 9-year-old, with whom I had had a writer-to-writer talk in clinic, came over to say hi.

Outside, we walked under clear skies with temperatures hovering around zero, and relished the warmth.

Duff, dog sled, and death

March 9, 2015

I wouldn’t mind being the Duff
Had my leader charisma enough
Mine did, for sure,
Though there was no cure,
He was courageous, kind, brilliant and tough.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. Right now I’m in Nome, Alaska.

I find the Gold Coast Cinema here in Nome so unique that I saw The Duff, a teen angst genre film.  The title refers to the Designated Ugly Fat Friend; while not necessarily fat or ugly, to qualify as a Duff one can’t be as attractive as one’s friends.  Find a clique, you will find a Duff. Not a surprise  though  we don’t like to think that human groups have pecking orders.  If you have an alpha, you must have someone lower on the hierarchy, and the one at the bottom, the omega, becomes the Duff.  In my experience, and in the movie, the Duff has more IQ points than the hot friends. 
The script pointed out that for every measure of social desirability (looks, strength, money, power), someone always occupies a higher position.  Thus the omega depends on the alpha as much as the alpha depends on the omega.
Taking the sled dog ride I bought at the Nome Preschool annual fundraising auction, today I learned more about sled dogs than just their hierarchies..
Tom, the musher who donated the item, picked me up on a very clear, very cold day, and brought me to his home 15 miles north of town.  Of course I quizzed him on the sport.
Working dogs are happy dogs.  Most come from the Alaska Husky breed, which lacks AKC credentials.  A team usually starts with 12.  As the years have gone on, the race has ended more quickly and the dogs do better physically.  While mushing, these animal ultra-athletes will eat the equivalent of 22 Big Macs a day.  Deciding to run the Iditarod requires a 3 month commitment and a huge monetary investment.  A good long-distance dog trots rather than gallops, in a smooth, level-back gait.
The lead dogs, furthest from the musher, have standing in the hierarchy, but must make a lot of decisions.  The next pair back, in the swing position, have the responsibility for making sure the turns aren’t made too sharply.  The pair closest to the sled, the wheel dogs, take a lot of jarring from pulling, and females have more resilience than males.  Most dogs prefer the other, team positions between the front and the back.
Tom kindly surveyed my gear, gave me toe warmers for my socks, and lent me a seal skin hat and a balaclava.  He let me mush on the return trip.
The immense work in dog sledding comes from maintenance of the team; just yelling HIKE was pretty easy compared to harnessing the canines.  Learning to keep the tug line (that nylon rope that connects to the sled) came easily.  I found my short ride in a dog sled exhilarating, in a primal way difficult to describe, and very cold.  At the end, despite my arctic grade layers, the cold had sapped most of my energy.
When I returned I learned a friend had died.  An excellent physician, a good husband, and a devoted father, he taught me a great deal about leaving judgment out of my day, and, in the process, having more energy and getting better clinical results.  My tears lasted a short time, we had watched this event approaching for years.
He led the team by example, he kept us focused on the clinic’s mission, and, in the process, kept us believing in it.  His charisma bound the group together and prevented us from breaking under terrible strain.  HIs guidance, hard work, and good, sound personal advice brought light to my three years at the Community Health Center. I admired his intense personal courage, maintaining a strong work ethic and a sunny countenance in the face of terrible disease.
With a leader like that, I never objected to not having the lead dog or alpha position.  I wouldn’t have minded being his Duff.
 

March 6, 2015

One winter Sunday I strolled
Towards the Bering Sea in the cold
For a G-rated flick
Not my first pick
But at the theater they call Coast of Gold

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. Right now I’m in Nome, Alaska.

The first time I went to college, I went as a music major. Even though I understood it, I intensely disliked opera; I found the score weak musically and the libretto (the story) frivolous at best, and always poorly written. The comic opera lacked funniness.

My dislike of such a genre extends to musical comedy. It doesn’t make me laugh, the music doesn’t make me want to dance, and the lyrics don’t inspire me to memorize them and sing them in the shower.

I make it a point to avoid G-rated movies; I find scripts aimed at children, well, juvenile.

Nonetheless I walked over to Nome’s Gold Coast Cinema and Subway Shop to see Annie.

I went for the experience and to have an excuse to walk in 5 degree weather to the edge of the Bering Sea.

I found modern, stadium seating and a ticket priced at $9. The Subway sandwich shop in the lobby added previously unknown variety to the concession menu. And probably few Subways offer popcorn and movie candy.

Perhaps because the weather just turned cold, or perhaps because school goes back into session tomorrow, the crowd numbered under 50. Children in heavy show boots clomped up and down the stairs most of the performance, going to and from the bathroom and the concession stand.

At the end of the show I leaned my back against the wall of the outsized foyer (in Alaska architecture called the Artic Entry, in Inupiaq the cunichuq, which allows for donning and removing layers) and slipped on my Yak Trax, a device of coiled steel spring and rubber, which, applied to the soles of one’s boots, gives traction on ice.

Outside, though 5 degrees colder than yesterday, I found I adapted quickly to the winter and I stood on the seawall overlooking the Bering Sea. I gazed off to the west, towards Russia, a country I have no urge to visit.

I looked over Norton Sound, and thought of the 1950’s John Horton song, “North to Alaska” and the classic line, Just a little southeast of Nome.

Southeast of Nome will put you into some very frigid water; this town is located on the southern shore of the Seward Peninsula.

Alas, popular music failed in historical accuracy. Sort of like comic opera failing at comedy.


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