Thinking like a bush doctor and transports to Anchorage

It is my first Sunday on call

The problems are large and they’re small

      No candy, no flowers,

     But it’s only twelve hours

And the ER is just down the hall.

First Sunday on call in Barrow; I’m going to write this as it happens.

People can use the same words and mean different things.  When you say ‘on call’ in Sioux City, for example, you mean something 24 to 164 hours long.  ‘Weekend call’ in Sioux City means  48 to 72 hours long.  In all cases, you mean providing medical services for 10,000 to 100,000, depending on your specialty.

In Barrow, ‘on call’ means something that’s 12 hours long, and for no more than 6,000 people.  I think the high physician morale here rests firmly on that short time period.  If you never have to face a harrowing clinic day after a hard weekend on call, if the worst you will face is 20 bad hours without rest, you have a much better outlook than if you have the possibility of 96 continuous bad hours (which would be a four-day holiday weekend). 

I start Sunday with a workout on the elliptical.  Then continental breakfast: boiled eggs, coffee cake, oatmeal, yogurt, juice, toast, peanut butter, cold cereals, coffee, milk, fresh bananas.  Promptly at 8:00 I walk the 80 yards from the cafeteria to the ER.  Three smiling nurses (two female, one male) do clinical things on computers.  Don’t jinx us, they tell me, right after I say that it’s quiet. I’m now free to go do something else.

I’m called to Inpatient and in short order it’s apparent that the patient has to be transported to Anchorage.  I call the Medevac team.  I have to call the supervisor.  Who wants me to call Anchorage.  Anchorage wants me to try a particular intervention and see how it goes.  Feeling overwhelmed by a circular runaround, I call one of the more experienced hands.

The other doc knows bush medicine really well and goes over treatment algorithms with me.  We get to game theory and conclude that one should never gamble more than one can afford to lose.  Firmly taking the situation in hand, the more experienced physician gets things arranged.  In the middle of stabilizing the patient for transport, I get called to Outpatient.

I pull off a linguistic coup for the first patient.  Not my best language, still I do it better than anyone in the hospital.  The relief of the patient when I greet and introduce myself in the patient’s first language is palpable. 

I am able to talk to the pharmacist on call and get the patient a single dose of a non-formulary drug.

Then I am back to Inpatient.  The Medevac crew has assembled.  My colleague looks very calm facing the prospect of a transport.  There are two thick volumes on the desk for me to read. 

The crew, my colleague and the patient wheel down the hallway and I watch them go with relief.

I round on half of the other doc’s patients (the least I could do) and write discharge orders.  I fall into a conversation about writing with one of the nurses before I finish rounds, and before I know it, I need to break for lunch.  When I come back from lunch I find one of the patients eating.  I hate interrupting a patient’s meal, and because discharge will not be possible today, I assure the patient I’ll be back.  I write a little and I take a snooze.

More patients in the afternoon but the pace is still reasonable.  Most but not all of those who seek care are Inuit.  I see problems related to the unique geopolitical landscape.  I do math for the patients who smoke; at $100 per carton, one carton every five days comes to $7300 per year.  Problems run in families.  Chest pain needs to be investigated.  Puzzling pain that has been checked out by three layers of good (to judge from the work-ups) physicians in the last four years gives me a chance to draw a long bow and shoot in the dark.  Some patients seek care, not cure, and will keep coming back for problems, real and imagined, no matter what I do.

In the middle, I make it back to Inpatient and finish rounds.

In one of the outlying villages a series of events transpires so bizarre as to sound like the preamble to a shaggy dog story.  I make a series of calls and at the end I am thinking more like a bush doctor and have more rationally estimated the limits of our capabilities.  The doctors in Anchorage  help clarify the need to transport from the village to Alaska Native Medical Center rather than to Barrow.  We don’t have CT here.

Supper is an ordinary piece of fish with an absolutely astounding citrus/cilantro sauce.

I finish calls about the patient in the outlying village.  Two more local patients, and I am on my way back to my apartment before 8:00PM. 

It has been a productive day on call. 

I call Bethany and we talk about our day.  I call my friend Bob who lived two summers in Barrow in the late ‘60’s; he warns me against caribou meat and we talk about the success of the whaling season.  I practice my saxophone for a little over a half hour, and I post this.

I have been recruited by the local music community and I have rehearsal tomorrow.  I have weak chops, I’m not sure I’ll make it through the whole gig.


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