Archive for July, 2010

A short hiatus to go fishing.

July 30, 2010

The scoop that I’ll be dishin’

A trip for which many are wishin’

  The Place that I’m bound

  Is Prince William sound

For a week I’ll be going out fishnin’ 

 

I’ll be fishing for the next ten days with Bethany, Les and his friend Lee.  I’ve not done much fishing in the past but I enjoyed what I did. 

We’ll be in a location so remote that there is no internet access; yes, such things, like musk oxen, still exist.

Posts will restart on my return.

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Moose watching in Suburban Anchorage

July 28, 2010

After a supper of chicken a jus,

The workplace had turned us loose.

     We went for a walk

     We had a good talk,

And got close to a young spike bull moose.

Anchorage is not Barrow.  There are divided highways and McDonald’s and Starbucks and strip malls. 

But there are also green belts with pedestrian trails and signs telling you what to do if you encounter moose, black bears, or brown bears.  The newspaper sports section talks about mushing and fishing along with baseball and basketball.  Football in southern Alaska starts in the first week of August.

Les, an Anchorage doc who did the same residency I did, and I took his dog for a walk last night, down suburban streets to a green belt.  On the way we saw a twelve-year-old boy standing in his driveway, clicking away with his camera.  “What are you taking pictures of?” we asked.

He looked up, and then looked back to the place behind the hedge he’d been photographing.   “Moose,” he said.

We stepped into the driveway to see, sure enough, a spike moose chewing his cud on the well-kept suburban lawn, about three paces away.   Mute cement lawn deer looked on.   I hadn’t brought my camera.

We got to the green belt and Les pointed to where the four-lane crosses and said, “That’s where the big boar brownie was killed crossing last year.  Hit by a car.” 

We walked on a bike path, occasionally hearing “On your left!” from behind.  I hadn’t realized how quiet bicycles can be because I usually am the one riding the bicycle.

After a while I looked to the right and said, “Those spruce are looking a little scrawny here.  They just got planted?”

He said, “That’s taiga.  That’s as tall as they’ll get.  Probably a pocket of permafrost under there.  Roots can’t penetrate very far down.”

Further on the path crossed a clear, turbulent stream.  “Are there any salmon?  You see any?” he asked.  We stood on the bridge and looked, and I allowed as how I didn’t.  “A couple of days ago  I heard there were salmon running here,” he said.

I said, “Here, Les, look at the signs here.”  Posted at eye level were three signs advising the dates that fishing was not permitted, and that outside those dates non-residents weren’t allowed to fish, and residents were permitted catch-and –release using artificial lures only.

We walked through the long sub-arctic twilight.  I talked about the positive parts of the Barrow experience.

The doctors have functional communication with no back-stabbing.  If Doctor A and Doctor B have a problem, anyone who tries to enlist Doctor C will just end up looking bad.  Call means twelve hours.   Five days a week the docs meet for thirty to sixty minutes to discuss patients, which results in a lot of learning. 

I also talked about the painful transition from paper-based medical records to electronic medical records, and our discussion turned to practice management.

I told him how great it was to work at the bottom of the totem pole and not have to worry about making systemic decisions.

From Barrow to Anchorage: Alaska has a lot of room for contrast.

July 27, 2010

I came in out of the bush,

When shove had gotten to push

    The realization

    That civilization

In Anchorage can be rather cush.

We landed in Anchorage at night, in the rain, and the culture shock set in.

I spent eight weeks in Barrow, the furthest point north on Alaska’s North Slope.  There are fewer than 10,000 people in an area the size of Wyoming where permafrost prevents trees.  Access off-slope is by plane, and once a year by cargo barge.  There is limited local travel by boat, or in season by snow machine or dogsled.  With forty miles of unpaved roads and one stop light operating only during the school year, twenty minutes of walking can get you clear across town.  Most people are subsistence hunters.

Contrast is the essence of meaning.

The biggest change was the darkness, after eight weeks of unrelenting daytime.   I found it soothing, a relief to the eyes, a quieting of the senses.

Lots of cars go really fast on bumpless paved roads in Anchorage.  I saw more cars than snow machines parked outside of houses, and didn’t see four-wheelers at all.  People frown.  Most every house has a garage.  Pavement covers the ground everywhere. 

Trees grow here.  People say “vegetarian” without laughing.   You have to look up to see the sky; it doesn’t slam from horizon to horizon.  Meat comes from stores, and stores are big.  Young people view elders with impatience.  Traffic congests the streets.  The ocean lies further away.  Mountains rear up out of the landscape.   People worry about grizzly bears, not polar bears.  In Anchorage you can talk for hours without using the word whale, and the citizens recycle in seriousness.

Folks keep their useless material possession inside here and outside in Barrow.

Businesses that you won’t find in Barrow:  lawn service, bathing suit boutique, tree surgeon, tree nursery, vegan restaurant, asphalt service, basement service, septic tank service, heated garage floors, saddler, large animal veterinarian, horse boarding, climbing equipment, animal rights fundraisers, stump removal, skate board accessories, gutter cleaning, building restoration, or landscaping.

We spent the night in a nice hotel paid for by the locum company.  We came on a dark and rainy night.  While the rain poured outside we slept soundly.  In the morning we were awakened by the distinct sound of water leaking onto the ceiling.  Despite the posh surroundings, lack of hot water cancelled our shower plans.  Cheerfully delivered complaints at the front desk resulted in complimentary luxury breakfast overlooking a lake devoted to float planes. 

We took our time during breakfast; food tastes better unrushed.  I watched a beautiful but unhappy couple murder intimacy while we ate. 

Hot water service returned during breakfast.  After we showered, a nice man from building maintenance with a radio appliance growing out of his ear came just in time to note the water dripping from the ceiling. 

Gaven, the college age son of Les and Beth, met us in the lobby.

Les is a family physician, and Beth is a Family Nurse Practitioner; they own and operate a medical office here in Anchorage, and have for the last 25 years. Les and I did residency in Wyoming two years apart.  Les and I went deer hunting in the cornfield Beth owns outside of Casper; I was with him when he killed his first deer.

Tour to land’s end and flying south to the night

July 26, 2010

We’re turning our back on the light

After eight weeks of delight

     In a wide bodied plane

     To the land of the rain,

Flying south with the night

 After supper last night, exiting Brower’s café, we ran into the Aarigaa 4×4 Tours driver, and, on the strength of a cell phone number, contracted to have him pick us up at noon for a tour of the peninsula north of Barrow.

Bethany packed the night before.  I spent the morning packing. 

I’m not used to spending that much time prepping for a journey, but this has been an eight-week sojourn, and there were loose ends to tie.  I returned pens and notepads to the clinic, sent a book back to its owner, and attended a very nice brunch hosted by one of the other doctors.

A lot of medical and nursing staff departed the Barrow hospital this weekend.  One of the other docs observed that two kinds of people work here, the happy and the unhappy, and each will try to change the other’s perception. 

I picked up a grilled turkey sandwich from the cafeteria and added basil, planted a week after I arrived, and plucked fresh from the flower pot on the window sill.  The sandwich was astounding.

The driver was ten minutes early, and Bethany and I were the only ones on the tour.  The day was tooth achingly bright, the air brilliantly clear, the wind reasonable.

We took the dirt road north out of town, past the DEW line and NARL and Old Barrow, aka the Shooting Station.  The folk here dry a lot of meat and fish at Old Barrow because a dearth of traffic means cleaner air.

At the end of the road of the road we continued on gravel.

The arctic currents have been eroding the peninsula for centuries with an accelerating pace.  Heavy storms in the fall throw gravel onto what was once tundra, making difficult driving. Up the east, lagoon side, we passed a lone figure, rod and reel in hand beside a four-wheeler, at the water’s edge.  We came to the end of the land.  Fresh water, green against the deep blue of the Beaufort Sea, poured from the lagoon.  A flock of gulls two hundred yards away regarded us from a barrier island.  We watched flights of king and common eider ducks. 

We swung north to Point Barrow along the north, ocean side of the peninsula. 

The sea erosion has exposed Inuit burial sites; the archaeologists excavated the graves, and the Natives reburied the bodies properly in cemeteries in town.  Seventy years ago the point was five miles further north; the sea reclaims its own here at the rate of twelve meters a year.

We got out of the van and I walked to the water to dunk my fingers and taste the sea.  I picked up a heart-shaped rock and a few others; I will bring them south to put on gravestones.

On the west side of the point we startled a flock of gulls fighting over the carcass of a king eider duck.

We passed a mountain of whale bones left from last fall’s whaling season to keep the polar bears out of Barrow proper.  I exited the van to video the gulls; the guide warned me not to get too close because the whale fat impregnated mud would give make my boots a stink that would last years.  The warm summer sun brought out the aroma, unpleasant but not nearly as bad as the hog plant at home.

We stopped in Old Barrow and saw the remains of a sod house.  Whale bones held up pieces of tundra as late as the 20’s; the houses have since collapsed into mounds hospitable to snowy owl nesting.

I finished packing, we hauled our bags downstairs and called a cab.  We waited in the parking lot and I basked in the sun, the air temperature in the mid-fifties, reveling in the peace of the unhurried moment. 

We ran into a two-nurse, six-kid, one-nanny family at the airport, also checking bags early.  Bethany and I helped carry their totes, then we walked back to the apartment.

I kept using the word lush to describe the feeling.

A nap at the apartment, dinner in the cafeteria, and another quick cab ride to the airport.  I didn’t mind the plane’s hour tardiness.  Bethany and I entertained the six kids by teaching them yoyo tricks and sign language.  I chatted with the high school principle and her PE teacher husband.

We came into Fairbanks at dusk, street and car lights winking on along the roads.  Small float planes line the sides of the airport’s landing lake.

And now I am flying south to the night, a good clear view of the full moon between Fairbanks and Anchorage.  I haven’t seen darkness for eight weeks, it is as much a comfort to the eyes as green grass is in the spring.

Lectures on the Sadlermuit, egg foo yung on the beach

July 25, 2010

On the ocean we watched chunks of ice

After lectures not once but twice

    We had egg foo yung

    In the blaze of the sun

And enjoyed a supper so nice.

Bethany and I walked over to the Heritage Center in the early afternoon to catch the bus out to the Naval Arctic Research Laboratory for a lecture. 

There are one or two lectures a week here in Barrow.  Some are at the Heritage Center, some at the library, and some at NARL.  The woman who runs the program declares she’s a quarter Irish, a quarter French, a quarter English, and a quarter Inuit.  She makes sure the lectures are informative and are accompanied by first class snacks.

I didn’t know about the programs till I stumbled onto one about snowy owls.  I missed a good one about how birds accommodate their circadian rhythms to the twenty-four hour daylight, and another about NOAA.  The lecture we took in was about genetics of the North Slope Inuit.

The Inuit, as we know them, spread from western Alaska across the Arctic about 1200 years ago and in the process displaced the Dorset people.  A relic population of the Sadlermuit of Hudson’s Bay were wiped out by an epidemic spread by whalers in 1902; there were fewer than 100 at the time. 

The Dorset culture hunted seals and walrus well; their parkas didn’t have hoods, they lived in scattered dwellings and were sparsely populated.  They didn’t hunt whales.

Now that we have DNA testing we can match DNA of that last group with the DNA of the people we identify at Dorset sites, and for a long time we thought that the Inuit replaced the Dorset.

But we can now say a certain amount of Dorset DNA lives on in current Inuit populations.

I would be really interested to see if there’s Inuit or Dorset DNA in Denmark.  After all, the Danes ruled Iceland and Greenland for a thousand years, and where there is cultural contact there will be gene flow.  It’s in the nature of young men and women.  Consider the woman who runs the lecture program.

On the bus out and back we talked with other lecture attendees.  One fellow has retired to Barrow after living here thirty years; he worked in Planning after he worked in construction.  One woman is a health educator and teaches at the College.  One woman is a NOAA officer, just finished a tour on a boat, is here in Barrow training other NOAA officers, and will be going to a 13 month tour of duty in Antarctica.

I talked about what I do.

The NOAA officer seemed fascinated by my job description, expressed an idea she’d toyed with of going to medical school.  Then she threw back her head and laughed and declared she didn’t like being around sick people.  I agreed, then, that med school wouldn’t be a good option for her.

In the evening, after my good, solid nap, Bethany and I walked over to the Brower Café for supper.  The building dates from 1889 and was originally a haven for stranded whalers. 

We ate excellent egg foo yung and sizzling rice soup while we watched the sun glinting on the Arctic Ocean, white ice floes gleaming in the distance.

The easy, the hard, the self-made

July 23, 2010

My clinical experience was linking

 A case that set me to thinking,

     It wasn’t the lead

    But porphyria instead

And it was aggravated by drinking.

Morning conference included a discussion of a patient with psychiatric problems, severe recurrent abdominal pain, constipation, and neurologic problems including diffuse whole body pain.  We threw ideas back and forth across the table.  I really didn’t have much to add.  I’m a front line doc, I’m not a specialist and if my colleagues have looked at a patient I can offer a different point of view and not much else.  But it was fun to be in the discussion.

Half the morning patients didn’t arrive.  In the time freed up by the no-shows I called patients about abnormal lab results and made arrangements for follow-ups of other problems. 

One of the morning patients, when asked if I could write about him, said “My life is an open book, write what you want.”  He had a problem with anger, he said, and before he moved to Barrow he spent fifteen years in prison.  Twenty years ago he left Anchorage for a two-week vacation in Barrow.  He quit drinking and spent his own money for three years of counseling.  He is a hard-working family man, a solid citizen.  In many ways he has become the person he chose to be.

We talked about how many people in Barrow have quit drinking.  Some have used the church, some have used AA, and some have just quit. 

I brought lunch, shepherd’s pie, back to the apartment.  Bethany and I shared generous portions and did improvisational comedy.  We marveled at how bright and clear the air was, and made frivolous speculation about what the red and white Canadian Coast Guard cutter was doing, anchored 800 yards outside our window.

After lunch I sought out an exit interview with the acting Clinical Director.  Most of what I talked about was the healthy part of the medical subculture in Barrow and why I’d had such a great time.  I had a few constructive suggestions.

Afternoon walk-in clinic brought the parade of the human condition, drama and irony, the diamonds in the grit.  At one point, responding to yet another patient’s request to refill all of the other prescriptions, I didn’t say, “Make an appointment, this is too much for one visit.”  I said, “Sure.  It’s my last day,” and I grinned.  But I gently asked that the patient be kind to other doctors in the future.

I don’t have many publications to my credit, but one of them was entitled Looking For The Lead, and it was published in The Hudson Monitor.  A patient who should have had lead poisoning didn’t; he had porphyria.

The porphyrias are a group of rare disorders in the synthesis of heme (the red stuff in hemoglobin).  I have seen about three dozen cases; the very long story of why I would even look involves a friendship with a thoughtful surgeon and a unique sequence of patients. 

It was porphyria that drove George III of England mad, leading directly to the formation of the United States and weakening the monarchy of Great Britain.  The symptoms of the disease include psychiatric problems, severe recurrent abdominal pain, constipation, and neurologic problems including diffuse whole body pain.

Thus, when the luck of the draw brought me the last patient of the day with that symptom complex, I thought of porphyria.  I had to scurry around to the lab to get the right twenty-four hour urine test ordered.

Treatment will be more about avoiding drugs, especially alcohol, than about taking them.

I won’t be here when the lab results are back.

Separation anxiety, heat intolerance north of the Arctic circle, and conversations with a sculptor/hunter

July 22, 2010

There’s a way of emotional grieving

When the time comes close for the leaving

     Separation anxiety

     Transcends all piety

Culture, and language, and believing.

The young man I attended gave me permission to write this information.  He came in with his supervisor after an on-the- job injury.  While treating him, we talked.  He’s an apprentice hunter, he holds a steady job, and he’s a sculptor with aspirations of doing animation.  He face sparkles when he talks. 

He makes tiny statues of people that he puts in corners where people do not expect to see them.   His sculptures adorn both home and workplace.

We talked about the artist’s moment; for him it’s watching the face of someone who noticed his art for the first time, seeing the reaction and delight.  For me, as a musician, it’s watching peoples’ heads bob in time to the music, even if they’re ignoring me as a musician. 

As a writer, I would like to think that people chuckle when they read the limerick, and, having been hooked, can’t stop reading till they get to the end.

We also talked about gill net fishing and subsistence hunting.

One of the perks of Barrow hanging out with hunters all day.

At morning conference today we talked about how maternal and paternal alcohol use contributes to schizophrenia later in life.

We exchange a lot of information in morning conference.  We talk about patients by name.  We talk about clinical problems.   I get much education from my colleagues. 

I brought up a particular patient with recurrent right lower quadrant pain whose CT showed a normal appendix.  I expressed my concerns that the image might not have had adequate resolution to show a carcinoid (a low grade malignancy occasionally found in the appendix).  It turned out that everyone around the conference table had taken care of the patient at one time or another and we all agreed the appendix needed to come out.

I am coming to the end of my tenure here tomorrow, and today I developed separation anxiety.

Separation anxiety is a universal human emotion.  It’s the reason roommates fight at the end of the school year or spouses fight just before one goes on a trip.  I knew that I would have it when the time for me to leave came close.   Bethany’s presence buffered the intensity.

Today the weather turned warm (fifty-one Farenheit), the wind stopped and the sun came out.  The heat in the outpatient area became intolerable, and I went to maintenance and complained three times.  I probably wouldn’t have been emotional in my declaration of impossibility of working conditions if it hadn’t happened towards the end of my tenure. 

I think the reason people have separation anxiety is because it softens the pain of emotional loss.  It’s a way of saying, “I have plenty reason to be mad at that person/institution.  So I won’t miss him/her/it when they’re/I’m gone.”

What’s north of the northernmost town in the US?

July 21, 2010

We drove between sea and lagoon

Where the Eskimos use the harpoon

     There’s nothing new

     North of the line that is DEW

Where the sun shines from midnight to noon.

Bethany and I and another couple took an ASNA (Arctic Slope Native Association) vehicle north of town Monday  evening.  Vigorous winds and temps in the thirties kept us mostly in the truck with the heater full blast.

Barrow sits on a peninsula, south of a large lagoon which opens to the east.  Natives have been coming here to hunt for thousands of years.  The road north from Barrow forks at the near end of the lagoon; we chose the north branch over the east.

The cold dry climate preserves the signs of human activity for millennia.

The DEW (Distant Early Warning) Line that I read about fifty years ago in My Weekly Reader, the radar installations to warn the continental US of incoming Russian nuclear missiles, maintains a facility outside of Barrow to this day.  The staff has been cut, and I hope the electronics have been modernized.

The Naval Arctic Research Lab, or NARL, has been a fixture in Barrow since the Cold War; one of my friends from Yale worked here in the two years he took off.  Much of the site has been taken over by Ilisaqvik, the local college.

Further on, the grassless high school football field stretches its hundred yards plus end zones here on the permafrost. 

In the middle of utter desolation, the town’s hardware store faces the Arctic Ocean ten miles north of Barrow’s center.

The berm on the ocean side of the road keeps the waves off during the violent autumn storms, and hides polar bear activity from humans.

Past the DEW line and NARL is Old Barrow, abandoned in the ‘40’s as a year-round settlement and now a summer campground in a ghost town.

We talked to a non-Native fisherman with a twenty-foot gill net and a cooler full of really beautiful fish which I couldn’t identify.  The net is suspended from floats with a blaze orange buoy at one end and a bar driven into the permafrost at the other.  Fish swim in and can’t swim out.

We went to the end of the road.  There is a large sign frame with no sign which I took for a poetic statement in its own right.  We walked around, making comments about the shotgun shell husks and the two empty boat trailers.  There were two small craft out on the water, possibly 25 miles from shore, fishing or sealing or walrus hunting. 

On the way back a large flight of small endangered eider ducks flew across the road.

Gray whales by the gravel pit and an entire musk ox at Joe’s museum

July 19, 2010

The grey whales put on a show,

While in our faces the cold wind did blow

     Later, when dry

    We had ice cream and pie,

And toured the Barrow museum of Joe.

I spent most of Sunday morning sleeping, having had a hard night on call yesterday.  After lunch Bethany and I went for a walk on the beach.

The sea ice had retreated towards the north, a fine white line at the horizon.  The wind picked up and I was glad for my layers of polypropylene.

We walked down the street past Pepe’s and the bank and the police station, towards the Japanese restaurant, then found an easy slope to walk down to the beach.

The sand here is coarse and dark. The gentle waves belie the monstrous breakers that rush up out of the sea in the fall. 

On our left we could see where the earth has been eroded by the autumn waves. 

As we walked I looked out over the ocean and to my surprise saw the spout of a whale, followed by the black sheen of its back

I could have said “Thar she blows!” but I didn’t.  At a loss for words I sputtered a couple of times before I managed to say, “Whale!  There’s a whale!  Look, over there!”

Bethany’s head snapped up and fifteen seconds later, the white spout followed the black of the whale’s back.  She saw it, too.  While we watched we saw the phenomenon repeat every fifteen to twenty seconds for minutes.  I brought out my camera, set for motion picture.  I used the most telephoto possible, and the whales breached while the shutter was open, till the camera announced that the card was full.

Then we started walking again, no longer stunned by the wonder.

Probably grey whales, we decided and probably travelling in a pod. 

We reached a place on the beach dominated by heavy equipment, and we turned onto the road to walk back into town.  We had been at a place called The Gravel Pit.  On the road up we saw the pieces of driftwood, including a whole spruce trunk.

The architecture of many cities appeals more than that of Barrow.  A chain link fence separates the ruins of centuries old houses, where whale ribs and driftwood supported permafrost sod, from the end of the runway where the jets come and go.  The rest of the town is dramatically weather-beaten.

The number of burned-out shells of houses appalled us.   But the elation of having walked into a successful whale watch stayed with us.

 After supper we walked down to Pepe’s for dessert.  At ten we went with Joe to his museum.

Joe, the son of Fran who owns Pepe’s, has lived in Barrow for 34 years.  He made a good living delivering water for most of that time.  Now that the majority of houses have indoor plumbing, he works at the restaurant during the day and opens his museum, by appointment, after 10:00 PM. 

He has whole body mounts of a grizzly bear, a polar bear, a mountain goat, a wolverine, two wolves, and a musk ox.  He combs the beach, and when the water is calm he goes out in his kayak.  He keeps all the relics he finds, from old pop cans to firearms. 

I recognized the pop cans from the fifties.  I was able to identify the rusted hulks of three Winchester rifles, a Mossberg shotgun, and the remains of a flintlock. 

When we got back I pulled the video images from the camera onto the computer.  I couldn’t see the whales breaching.

Night call when there is no night

July 18, 2010

I went on call for the night

But it never stopped being light

     As things came around

     The sun almost went down

And I didn’t stop being polite.

I have just finished the first and only night call of my stay in Barrow

One of our docs prefers to work nights, and when in town does almost all the night shifts.  I thanked him two days ago and he just shrugged, saying that if the sun is up for 24 hours a day it’s not such a big deal.  I said it was a big deal to me, and thanked him again.

I did, however, get assigned one night shift, from 8:00 PM to 8:00 AM, and that was last night.   I called in x-ray twice and ultrasound once.  I saw two drunks, three people with abdominal pain, and two lacerations.  Half of the patients were children

Some general information without information regarding anyone specific.

A toddler, given an object, will find a way to insert that object into an orifice.   

A cut needing stitches raises suspicions of a family under stress.

 People who don’t sleep well get sick.

You can’t know what you can’t know.

Stress and alcohol make things worse which makes drinking under stress a bad idea.

A thin young drunk runs faster than an aging, overweight, well equipped cop in Kevlar, but doesn’t get far because the cop can run in a straight line.

If you’ve seen more than three doctors for the same problem, the chances that I’m going to make you better tonight are not good.

No one can count anything after two drinks, especially not the number of drinks consumed.

Every day I see patients I will see at least one thing I’ve never seen before.

Most lifelong scars are acquired under or near the influence of alcohol, before the age of 10 or between puberty and 25.

I’m still seeing whaling injuries.

Things that seem like a good idea at the time turn out to be a really bad idea when alcohol is included.

The sun won’t set here till August 2. When I walked down the hallway to ER at 2:30 this morning, there was a bright blob on the western horizon and cars had headlights on.

 

This is as close to a sunset as I’ve seen in seven weeks.