Frost heaves and bear maulings

The docs tell the stories of bears,

Of the pilot who shouldn’t, but dares

     Of the planes that turned round

     Or crashed into the ground,

And the problem of bootleggers’ wares.  

 Morning rounds start at 8:00 AM here; the doctors meet and we discuss problems and cases. 

Alaska medicine is not like medicine in the lower 48.  The doctors and the patients deal with immutable physical realities.

 Permafrost is very real and it governs the architecture and the roads.  No matter how warm the summer gets it never thaws more than a few meters deep.   When springs warms past the melting point the permafrost starts to heave.   Pavement becomes problematic, and, in cases, impossible.  During the spring, the dirt runways in the four outlying villages are not safe to land planes.  If the wind blows too hard, the helicopter can’t go either.

I think the only pavement in an area the size of the state of Washington is the Barrow runway.

I listened this morning to the stories of patients mauled by bears; the conversation moved on to stories of extreme weather, when planes could take off but not land, or land but then couldn’t take off again.  Sometimes the airplanes got diverted or returned to base.  There were harrowing stories told matter-of-factly, when you couldn’t leave the village for weeks at a time, and how sometimes the ability to get an aircraft was a matter of life and death.

I had a luxurious morning clinic, spending as much time as I needed with each patient.  I got to tell the story of my back pain, and the story of Bethany’s untoward reaction to the statin drugs (things like Lipitor or Crestor, which reduce cholesterol).

A lot of people still smoke, or perhaps I should say that a lot of our patients still smoke.   The local word for cigarette is “roll,” as in, “I’m cutting down, I only smoke 4 or 5 rolls a day.”  Just like in Sioux City, I ask the patient if they want to quit.  If they do, I ask if they want help, if so I prescribe Chantix.  If they don’t want to stop smoking, I tell them about the risk of death and disability, and, when they’re ready to quit to go cold turkey and if they can’t do it by sudden withdrawal to make an appointment for medication which will not help if they don’t want to quit. 

Then I get out my calculator.  A pack of cigarettes is almost $10.00 here.  Two people each smoking a pack a day comes to a lot of money.

I talked to someone today whose consumption of soft drinks, moderate by Iowa standards, costs almost $5,000 yearly. 

Alcohol sales are technically illegal here, though possession is not, making the criminal status of marijuana and alcohol, properly, equivalent.

It’s Friday afternoon.  I have had an absolutely glorious week.  I can’t give the details of the clinical triumphs out of respect for patient privacy, but there were several.  I have learned to say yes, no, good morning, thank you, and hello in Inupiak; I also properly pronounced the name of the village Atkusuk (there’s a click in the middle).  I am not on call till Sunday, and then it’s only 12 hours and not during sleep time.  While I was writing this, the sun came out for the first time all week and cast a shadow stark enough to frighten a groundhog, and for a moment the world was dazzling in the brightness of sun on snow.


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