Rabid arctic foxes and northernmost rotarians

I don’t want a lengthy deferral

When I ask for a timely referral

    There should be a prize

    For the abnormalest eyes

In a place that’s remoter than rural

Tonight a young man gave me his permission to write this much about his case.

I saw him last week some vague and improbable visual and neurologic symptoms.  Of course I examined him, and almost as an afterthought I checked his eyes.

His eye movements were alarming.

I’ve seen abnormal extra ocular movements before, always I’d known they’d be abnormal before I started the exam.

I presented the case at morning conference the next day; the thrust of my presentation was that he needed to be referred out, but I didn’t how to make that happen.  Later that day, per group suggestion, I called a neurologist at Alaska Native Medical Center in Anchorage, who agreed that referral needed to be made within a week.

Since then I’ve taken a personal interest in trying to get the appointment expedited.

The patient came back today, subjectively and objectively worse.  It took time and running around, but I made sure the patient got down to Anchorage in an accelerated time frame. 

I’ll be presenting the problems involved at morning conference, again tomorrow. 

After clinic this afternoon I was invited to the meeting of the Rotary Club, which lies north of all world’s Rotary Clubs, including those in Greenland.  Two of our docs are longstanding Rotarians. 

The meeting was at the Mexican restaurant, Pepe’s North of the Border, tonight serving Yankee pot roast.  I did however get to speak Spanish with one of the waiters.  About ten of us gathered for the installation of a new Rotarian, and a short speech. 

Just before the speech, my phone rang.  ER is swamped, and walk-in patients are stacking up. Could I please come?

No problem.  It’s a four block walk in gorgeous weather.

I can’t talk about the patients I saw.  I can talk about the current problem here with rabies, being carried by arctic foxes, and how it complicates the treatment of all bite wounds in a town where animals, wild and tame, live close to humans.

People seeking narcotics are a common problem in medical practice throughout the US, and Barrow is no exception.  In Sioux City I established a reputation early as never giving narcotics for migraines and very rarely using narcotics except when the diagnosis was well established.  My reputation has yet to be made in Barrow.

My Inupiak vocabulary grows; I learned to say “I’m fine,” which if said too fast becomes “I’m crosseyed.”  I also acquired the words for gallbladder, dirty, whale, and I don’t know.

Tomorrow will be 21 days since my career change, the three-week rule applies.  I will have to be extra careful.  I’ll shorten my work outs, watch my words, and take no chances.


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