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.

February 24th, 2015, a day that will live in infamy

March 3, 2015

When it comes to the drug they call pot
What is it good for? It’s not.
But they were quick on the draw
To pass a new law
And speed up the memory’s rot.

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.

Marijuana use runs rampant across the US.

In the early part of the year I asked a patient, a single parent of five and a major pothead, if they would hire a babysitter who got stoned every day, and we agreed that any intoxicant impaired ability to care for children.

My first Monday back brought me to contact with patients running into problems as a direct result of their marijuana abuse.

Mostly hemp excess happens in the context of abuse of other drugs, usually tobacco and alcohol. All three contribute to poor memory, seizures, depression, loss of restful sleep, low testosterone levels (both sexes), low sex drive (both sexes), lowered resistance to infection, poor pain tolerance, social isolation, and irresponsible parenting.

Yesterday I had a heart-to-heart talk with a couple in the maelstrom of dysfunction; the medical problem that brought them in stemmed directly from marijuana abuse. I correctly guessed that both had cold, controlling, distant mothers, and exciting, generous-to-a-fault fathers who failed to follow through on promises and brought repeated disappointments. They readily admitted that each could tell me everything wrong with the other and neither had much of a handle on their own failings. I pointed out that drug abusers can’t exist without enablers, and the cycle can be hard to break because it has roots more than a generation old.

I took a step back and talked about myself. The vast majority of med students, 70%, come from chemically dependent households and most of the rest had other sources of dysfunction in their nurturing families. I skipped the details of my upbringing, but I told them about Alanon and the Adult Children of Alcoholic Parents movement, which use the same 12 steps as Alcoholics Anonymous, and how I went to meetings for 7 years. Every strength is a weakness, every weakness is a strength; it all depends on what you do with them. We agreed that their current approach didn’t work. I replaced a benzodiazapine tranqulizer with Dilantin (most common use=seizure or migraine, but a good second or third choice for almost everything), recommended 12 step meetings for both, and called in Behavioral Health Services.

I learned more about human behavior in dysfunctional families from Alanon than I had from med school.

My last patient requested a back-to-work slip, which I cheerfully supplied. But in the process I uncovered alcohol and marijuana excesses; I accepted at face value the patient’s assertions, and said, “Let me be the first to tell you that nicotine, alcohol, and marijuana will make any medical problem worse and none of them better.”

I could more easily believe that the weed wiped out memory than that all previous docs had missed the chance to educate the patient.

During my two weeks off, the state of Alaska legalized marijuana on February 24th, a date that will live in infamy for those with intact memories, but the pot heads will promptly forget.

I suspect that those in power prefer an apathetic electorate with a poor memory.

Drama and irony, looking for work, and apply for another license.

March 2, 2015

A position, too good to be true

At last, just today, it fell through

The problem, I fear,

Is I want to stay near

And enjoy the Iowa view.

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 return to Nome at the end of the week.  I have plans through to the middle of April but nothing firmed up after that.  Today I worked on finalizing my application for my Pennsylvania license.

My penchant for complete honesty has worked against me, again.  They asked about any criminal offense in the past, and of course I included my three traffic tickets, my 9 parking tickets, my wildlife ticket from Wyoming, and my illegal pedestrian conviction from Geary County, Kansas, in 1970.  So I had to call the Iowa State Police Department of Criminal Investigation and request a letter.

I also phoned my med school, my most recent Chief Medical Officer, the County Courthouse, and the Nebraska Department of Health and Human Services Licensing Division.

Every time someone asked, “How are you?”  I told them, “Annoyingly cheerful,” and smiled my way through the conversation.  The interchanges went well, I got everything I needed.

But I hold no hopes that a Pennsylvania license will come earlier than June, and arranging work will take another 6 weeks after that.

I tell recruiters my considerations; I won’t work with the EMR which drove me from my last position.  I also make very clear the limits I put on prescribing tranquilizers, nerve pills, and stimulants.  I still get a lot of offers.

In the meantime I hope to start work as a hospitalist here in Sioux City a week a month in May.

A position in Alaska that promised three days’ work per month, with transportation, turned out to be too good to be true.

I had my eye on a job about two hours from here as a hospitalist; they wanted someone to take their weekend call once per month, and to work their hospital patients 1-2 days per week , for a total of about 8 days per month.  Though a 2 hour drive, it promised a reasonable pace and an upscale patient population.   But, in a recent change of job description, they wanted me to work Outpatient as well, and to use the EMR I found incompatible.  Today I received this forward:

I did speak with the CEO about this candidate. He will not consider a candidate that does not want to work on C******** (the EMR I won’t work with). His ideal candidate is a provider that can do Outpatient and Inpatient. They had a FP that died in his sleep three weeks ago. They have a huge need.

The drama and irony left me breathless.  I’ve offered to work with them if they’ll get me a scribe.

 

A fund raising auction at the Convention Center

February 18, 2015

The city of Nome has a flag

They imprinted it all over some swag

Just for the kiddos

I made the right bid-do

On a bucket, a bottle, and bag

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.

When one says Convention Center in a town the size of Nome, one means a building with less floor space but better acoustics than the high school gym.  Adequate for the Nome Preschool annual fund-raiser, it seats about 200.

I bought tickets for the evening’s raffle last week, and, in the spirit of supporting community institutions, walked over to check out the auctions.

I bypass the home-baked desserts and chili, browsing items on the silent auction table.  With no interest in cosmetics, fragrances, and home-made garments, I note winter clothing bearing logos for telephone, construction, and fuel companies.  I discard the idea of a wrench set, or anything else difficult to transport.  I consider the knife and flashlight sets.

I find an item entitled City of Nome Swag: a plastic bucket holds a Frisbee, T-shirt, fabric shopping bag, water bottle, and ball cap.

I like to bring back small stuff from my travels, an ivory polar bear from Barrow, a ball cap from Waikiri.  And this batch would suit my purposes.  Especially the water bottle.

I sit with a PA and a CMA from work.  We swap stories about Alaska.  I learn about an island where statute prohibits locking the car or the outer door of one’s arctic entry, because bears regularly harass the population and people need to have shelter in a hurry.  We talked about Adak Island, I hear about being stuck for two weeks because of winds.

The live auction list reveals a lot about the location and the town’s values.  The Natives invented the ulu, a kind of knife very useful for dressing hides, and the program sports three of them, one for sewing.  I find a half-dozen kuspuks, an ornate, hand tailored upper garment with a hood and an elaborate kangaroo pocket.

The auctioneer pitches tryouts for the Community Theater, and emphasizes that we have gathered to raise funds.  He chants through pieces of local art, a home dog grooming kit, and a toddler’s Ski-Doo jacket.  The first item that holds an interest for me, dinner at every restaurant in town and movie tickets for two, also catches the crowd’s fancy; the bidding passes the triple digit mark and keeps going.  In the course of the evening, the other items that fetch the highest prices include 100 pounds of air freight (three different airlines), 10 pounds of crab (three lots each), a one night fishing getaway to Niukluk river, a helicopter sightseeing tour for 3, an hour of bluegrass music from Landbridge Tollbooth (a local group), Nome Discovery Tour for 4, 100 gallons of fuel, and 40000 frequent flyer miles with Alaska Air.

Every 15 items, the action stops.  A child picks a door prize ticket (cash), and the MC reads the names of successful silent auction bidders from two or three tables.

I outbid everyone for the Bucket of Nome Swag.

In the third round I buy a dog sled ride. My bid goes over the triple digit mark.  Later I find out the musher, the District Attorney, qualified for next year’s Iditarod.

I look forward to the conversation as much as the ride.


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