Archive for August, 2010

Smoked salmon potluck for Tuesday

August 31, 2010

Tonight I served up some fishes

Which tasted absolutely deliciouz

     The guests were not fleeting

     When they were done eating,

They stayed and helped with the dishes

Several years ago, Bethany hosted a supper on a Friday night for twelve.  The evening went well, and she put on another about a month later.  We relished the good conversation, good food, good company, and relaxation.  Prep and clean-up were a huge amount of work; still she hosted events with increasing frequency, and then with regularity.

Then her mother got sick and she was gone for six weeks.  By then the dinners had become so enjoyable for our social group and for me that I didn’t want them to stop.  I phoned the participants and told them that while Bethany was gone I would be hosting not a supper but a potluck, and I would be providing the main dish.

I enjoy cooking, many do not.  Those on the list who preferred not to prepare food didn’t mind helping with dishes afterwards. 

That first Friday potluck went well.  The work load of cooking and clean-up was well-distributed.  When making the calls earlier in the week I would ask people, “Do you want to bring or clean?”  Overall, the labor intensiveness of the event decreased.

Our Friday night potlucks have taken on a life of their own.  While we were in Alaska the usual crowd met in our house without us.

We brought back sixty kilos of fish from Alaska, and I intend to use it before freezer burn sets in.  This week we’ll have two potlucks, one on Tuesday and one on Friday.

I smoked two salmon fillets over charcoal.  We boiled chunks of halibut briefly in light sugar syrup (a cup in a quart) and got an approximation of lobster. 

Before the meal was done I was already planning for Friday.

How I learned to speak Spanish, and why I never stopped.

August 30, 2010

Spanish I learned in Grade Nine,

And now that language is mine

     If you want to know why

     My emotions were high,

And my patients think it is fine

When people ask me why I speak Spanish, I give the short, simple answer:  I picked it up in middle school and I’ve never put it down.  Like all simple answers to complex questions, it is neither wholly true nor wholly untrue.

I remember the April morning in ninth grade Mr. Esbenshade walked into Spanish class and said, “These are the last words of English you will hear in my class.”  He dumped a bag of Cuisenaire rods (small wooden blocks, color coded by length) on the table, held one up and said, “Regleta.”  He motioned for us to repeat the word, made sure every one of us could say it, and moved right on to the verb tener, meaning to have.  At the end of the class I was thinking in Spanish, but I was not thinking very much or very deep.

High emotions make for high learning; for example, everyone remembers where they were and what they were doing when they heard about 9/11.  Adolescence is a time of high emotions; my emotions at that time were even higher because very bad things were happening in my family of origin.  The language took root in my brain and has not left since. 

At my high-school reunion two years ago I talked about Mr. Esbenshade, and one of my classmates said, “I remember that day.  I didn’t learn a thing.”

I think Mr. Esbenshade changed teaching strategies out of frustration.  My group had failed to learn first year Spanish in seventh and eighth grades.

Seventh grade Spanish was El Espanol al Dia.  We didn’t get past Chapter Nine and we retained none of it over the summer.

In eighth grade they tried putting us in the brand-new Language Lab and giving us ALM (Audio-Lingual Method) Spanish. Evidently some thought the theory good at the time, but I doubt that constant repetition in the absence of visual reinforcement will induce anything but boredom in most normal middle-schoolers.  Nonetheless my children and wife will sometimes blurt ‘Albondigas!  No te dije?’ (Meatballs! Didn’t I tell you?) because I retained that phrase–it sounded like cursing.

After high-school I took a year of Spanish literature in college, but I haven’t studied Spanish on a formal basis since 1969. 

I worked in the minimum wage sector for a long time.  Language barriers being what they are, if I wanted an intelligent conversation with my co-workers during those years I had to speak Spanish.  I learned from mistakes and imitation.  There really is no substitute for practice.

The three years I worked with the Navajo I mostly worked on my Navajo language (Dine bizaad); I still spoke Spanish with some of the older men who had learned the language to carry on commerce with the local Hispanics. 

I came to private practice just before the tsunami of Hispanic immigration to Sioux City’s meat packing plants.  In a few years, half my practice was conducted in Spanish.  My office nurse learned basic Spanish.  We hired a series of Spanish-speaking receptionists who were very good workers.

Two decades ago, on a regular basis I could see relief on a patient’s face when I walked in speaking Spanish.

I attained fluency many years ago; now I’m articulate in Spanish to the point of doing comedy.

A fractured ankle at a Sunday School picnic

August 29, 2010

If it’s a fracture, it might need a cast
In an ankle that swells up so fast.
     The problem might be
     Vitamin D,
It’s come up low in the past

After eight weeks work and four weeks vacation in Alaska, I’m back in Sioux City. Prior to this absence I’ve not been gone from home more than eighteen days running, and never more than six weeks in a year.

My body doesn’t handle the late August heat like it has in years past, and I still reach for a coat before I go outside, even if the weather is hot.

In the late afternoon Bethany and I went to a (literal) Sunday School picnic. People greeted me warmly; I talked about living in Barrow, seeing the sea ice, working with subsistence hunters, being in a place where the roads do not connect with the outside. But I also talked about the vacation and the fishing.
I felt a hand on my elbow while recounting my experiences. A close friend and good neighbor asked that I have a look at his child’s ankle, following a fall.

I’m conscientious about honoring my non-compete clause, but I saw the situation as a clear-cut Good Samaritan action.

We walked over to the car, where I found the child well buckled up and clearly in pain.

I saw obvious swelling at the front of the upper ankle; the kid was exquisitely tender there.

I said that the ankle was almost certainly fractured, and I advised elevation, ice and avoidance of weight-bearing until x-rayed.
A good amount of research has been done trying to determine when to and when not to x-ray a traumatized ankle. Sudden, rather than delayed swelling frequently indicates a broken bone. The severe swelling made me reasonably sure of a fracture.

One of the child’s relatives called me three hours later; I’d diagnosed well, I heard, the tibia (shin bone) was broken near the ankle.

I called the parent, who gave me permission to write about the incident. Make sure that the kid gets a 25-OH vitamin D level, I said; a fracture like this isn’t normal.

I didn’t mention the high prevalence of vitamin D deficiency.

Ten cubic feet of mail.

August 28, 2010

I faced a huge pile of mail,

I moaned, I groaned, and turned pale

     Some was quite crass

     Most was third class,

And none was fit for resale.

I arrived back in Iowa and when I stepped off the plane I could smell the growing corn in the warm, heavy summer evening.

It was quite a change from Alaska.

The same plane carrying me carried another doc I’m proud to have as a friend, colleague, and inspiration.  I also ran into a pharmaceutical manufacturer’s representative who is just coming back to work after four months maternity leave.

Bethany and our youngest daughter, Aliya, picked me up at the airport.  My body was still running on Alaska time, of course I slept poorly.  But I awoke early and faced a mountain of mail.

The pile was literally two feet wide, two feet deep, and two-and-a-half feet tall.  Daunting to say the least, I hauled in the recycling bin, and tossed most of it.  Bethany tried to winnow the wheat from the chaff, and the pile would have been two times the size if she hadn’t.  Maybe three.

I kept out Journal of the American Medical Association, the Family Practice News, American Medical News, Yale Alumni Magazine, and American Hunter.  There were five checks and six pieces of important mail.  The reject pile came to forty-two pounds.

Every doctor faces information overload; we had a lecture about it shortly after I started medical school.  The speaker told us if we didn’t prioritize we’d be swamped.  The situation has worsened steadily since.

Friday morning I tried decimating the mail, and when I was overwhelmed I drove out to the medical office formerly known as mine.

I got a lot of hugs.  They were happy to see me, they’d missed me, and were excited to hear I would probably start working in Urgent Care during the next month.  I pulled up pictures of Bethany and me fishing in Alaska (see my posts from early August). 

I went over to Care Initiatives Hospice to sign some paperwork; we talked about how the new program is growing.

I stopped in at the bow shop to say hi to the archery community.  They were happy to see me, too.  I found out that the weather had ruined the entire bowfishing season.

I went to my favorite Mexican grocery and picked up avocadoes.

Everywhere I go here I see patients and friends.

When I got home in the later afternoon Aliya and I went out to the garden to pick chiles and tomatoes. We looked at the deer damage in the garden that happened when the electric fence failed.   I started a chicken to smoking over charcoal and cherry wood (great to cook with but a tragedy for the trees even if they did die of old age).

For the last couple of years Bethany and I have hosted pot luck dinners on Friday nights.  The largest crowd has been eighteen, the smallest seven.  This Friday we had twelve.  An outstanding night for food, conversation, and company.

I’m a family practitioner from Sioux City, Iowa.  While my non-compete clause expires I’m having adventures.  I just came back from two months of work and a month of vacation in Alaska.

Contrast is still the essence of meaning: coming home after a summer away.

August 27, 2010


I can write and compute on a plane

I regard ennui with disdain

     I’m loving the list

     Of the things that I missed

As I fly away from the rain

As I write this I am airborne and homeward bound.

Yesterday, Les, his wife Beth, their son Gavin and I discussed the Alaska primaries in the very long Anchorage afternoon.

Much passionate discussion follows any election.  Of the last twelve weeks, I spent ten in the bush.  I’m not an Alaska resident.  I had no emotional investment in the recent vote.

But I have a great appreciation for our current marvelous epoch.  An hour’s worth of minimum wage work buys more goods and services than it ever has, and the quality of those goods and services just keeps getting better every year.  During my long years of student poverty and minimum wages an hour’s work before taxes bought me a pound and a half of chuck, now an hour’s minimum pay fetches two pounds of rib eye, and the meat is a safer product.

 In 1979 when postage was eight cents I bought a used Zeiss Ikon Contaflex camera for $65.  My $150 digital camera can shoot 100000 pictures without buying film. The same shirt pocket-sized machine takes high-definition movies with sound. 

To my regret I cannot name the poet who wrote about forever awaiting the rebirth of wonder.  I still marvel at the fact of flying and computing at the same time.

Last night Les and I picked up dry ice at an Anchorage supermarket.  We stayed up late talking and looking at the photos and videos we’d generated during my Alaska adventure.

I didn’t sleep much, I was too excited about coming home.

We got up very early and loaded frozen fish and dry ice into the coolers.  We relished the last minutes of our company and made plans to get together again in January or February or March or April or May. 

He dropped me at the airport and I stood in line with people carrying fishing rods in rigid cases.  I talked about the good fishing and good company and times I’d enjoyed. 

In the Seattle airport I sat next to a Japanese woman on her way to a town close to Sioux City.  She did a year as an exchange student there, returned to Japan to become a nurse midwife.  She does not share call with anyone, and we talked about the difficulty of constant vigilance.  She doesn’t have time to practice piano but we talked about music.

On the Seattle airport tram I spoke with a man who had been fishing in Alaska, and had one good day with the silver salmon.  HIs joy grows as his work morphs from auditor to financial officer.  Auditors are necessary, he said, but he feels he’s doing more good and adding more value in his current position.

Contrast is the essence of meaning, whether in the natural cycle of things or in the progression of one stage of life to another.  In eight weeks of continuous daytime in Barrow, I missed the relief of night and I didn’t see the sunrise or sunset.  The beautiful, clear Anchorage afternoon sunlight yesterday took on more beauty for having followed thirty continuous days of rain.

The wonderful parts about day-to-day life lose their wonder;  when they come every day they are taken for granted, but when we go and come back we can relish and savor the ordinary. 

We lose track of the really neat people and things around us when there are no spaces in our togetherness.

I’m a family practitioner from Sioux City, Iowa.  I’m taking a year off for adventure while my non-compete clause ticks.  I spent eight weeks working in Barrow in far northern Alaska, and a month vacationing in southern Alaska.

Vacation ending, going back to work and friends.

August 25, 2010

I’m not doing things in a hurry.
Around the backyard I don’t scurry.
     My leisure’s not lacking
     I’ve started in packing,
And we had a fine dinner of curry.

I’m getting ready to leave Alaska and go back to Iowa.
Packing comes with a special set of problems involving frozen fish logistics; I’ll be mailing home a box of clothes, leaving a rolling duffle, and bringing a hundred pounds of frozen, tasty Alaska fish. Doing so in the high temps of August requires planning, strategy, and a good knowledge of the basic laws of thermodynamics.

I miss the people at home who miss me, and as my departure date nears I exchange more and more emails to that effect. For the first time since 1979, coming back from vacation doesn’t mean coming back to work; it means coming back to friends.

OK, it means I’m coming back to work, but the line between work and friends has blurred as the years went on. I sent an email yesterday and made a phone call, and I’ve got two jobs lined up already. Neither will violate my 30-mile, one-year non-compete clause. Both will involve much longer commutes than my Barrow assignment (see my posts from June and July). But I’ll be living at home, tending my garden, sleeping in my own bed, taking saxophone lessons, and hanging out with my friends and family. And I’ll have more time to enjoy them; one offers thirty-two hours a week and the other a maximum of eighteen.

One job will involve ninety minutes of driving a day. I’m not looking forward to the commute so much as I’m looking forward to seeing Siouxland from a different perspective.

Les and I spent most of yesterday dealing with camping gear. Tents, rain flies, boots, and tarps had to be hung up to dry; clothing and camping dishes needed to be washed. His rifle (a beautiful Sako .375 H&H Magnum) needed to be cleaned. Sleeping pads had to be deflated, dried, and rolled. Coolers needed to be washed. Propane bottles needed to be disposed of.

We didn’t rush the process. Sometimes we talked, and sometimes we just enjoyed each other’s company. We took a break to walk the dog. We took another to inspect two Civil War rifles his wife inherited (both of which appear to be fully functioning and quite capable of self-defense from the moose and brown bear that live in the neighborhood).

I took thirty minutes to make calls and change my airline tickets.

In the early afternoon he went to work; I blogged and napped and checked the predicted weather for my homecoming journey.

We worked in the clear summer Alaska sunshine, the best weather Anchorage has seen all summer. I conscientiously used sunscreen but my color visibly improved by the end of the day.

When the equipment was all taken care of and I’d posted blogs, I split a bottle of hard cider with Les’s son, Gavin. Overwhelmed by neither the alcohol content nor the sweetness, I enjoyed them both. And at the end of the day, Gavin, Les, and I sat down to a very good meal of Indian food.

I’m a family practitioner from Sioiux City, Iowa.  While my noncompete clause ticks away, I’m having adventures.  If you want to post a comment, click on the title of the blog.

Don’t buy a lottery ticket, you might win.

August 24, 2010


This isn’t meant to be funny,

Yes, you can have too much money.

     If you win the lottery,

     You’ll just buy more pottery.

And get fat on high-quality honey.

Yesterday I received an email from a person in a computer company in response to a customer experience survey I filled out.

My experience was very negative, and I filled out the survey accordingly.

I won’t dwell on details, they were too upsetting at the time. To rehash them, or to name the company, would only let a bad experience ruin more moments than it already has.  

Suffice it to say that when I multiplied the number of hours I had spent trying to fix a problem times my hourly rate I got a number higher than the value of the computer.

I considered not calling back on the principle of not throwing good time/money after bad, but I’m earning less these days.

At this point, nothing that the company could do would change my mind.  I wouldn’t even take a free computer from them.  The last I spoke with them I said that what I really wanted was to never, ever be involved with the company again.

But I did call the number.

The fellow approaches each call with no expectations.  All in all, the conversation went very well.   Certainly if his colleagues had been of his caliber there wouldn’t have been a problem at all.

It didn’t hurt that he came from Alaska.

We talked about the more important things in life, how life is full of trade-offs. 

Economists have shown that people get happier in proportion to their money only until they’re slightly over the poverty line, then they get more unhappy with every extra dollar. 

We discussed how lottery winners end up ruining their lives.  I recalled a Wall Street Journal article about a man who won the lottery.  Even though he could manage money well (he started with a net worth of $7 million), a year after he bought the winning ticket every dollar was gone, he was divorced, and his daughter was dead.

I don’t buy lottery tickets because I’m afraid I would win.

I told him I was thoroughly enjoying my vacation because I didn’t have any overhead and I wasn’t worried about lost income while I was gone moose hunting.  We also talked about family.

I allowed how the reason that I decided to talk to him had to do with me working a more relaxed schedule.

Twenty-five years ago the average American child at age nine had spent more time with the TV than they would spend with their fathers during their entire lives.  We agreed that things have gotten much worse with video games, internet, and cable.  I told him about how I had brought up three daughters without TV (which is a different post altogether). 

In the end I asked him not to go after the specific people at the company (about six in number) who had wronged me.  Approach the problem from a systems point of view, I said, don’t go head hunting. 

At the end of the conversation, I observed that rapid corporate change results in turnover large enough that three years from now his company wouldn’t be the same place.

So that never (as in ”I’ll never buy from your company again”) will be reconsidered in three years.

An evening colloquium about how great things are

August 24, 2010

You don’t get both money and time

Somewhere you must draw the line

    It’s all about tradeoffs

    I’ll not be a Madoff,

Which is good.  I won’t even whine.

I’m starting my 4th week working here; so far I’ve found a thiamine deficiency, three overactive thyroids, a dozen vitamin D deficiencies, three whale-related injuries, a testosterone deficiency, a folic acid deficiency, and a thyroid deficiency.  Each one happened to a unique human being in a family context.

I have written six prescriptions for narcotics (something I don’t do much in Sioux City); each one has an absolutely horrendous reason to be on long-term addictive drugs.

I told a patient that, in his particular situation, marijuana is less destructive than alcohol.  I can do that because here alcohol is as illegal as marijuana, and, besides, I could smell the marijuana smoke on his clothes.

I’ve seen more treatable ear infections (otitis media) in the last three weeks than I have in the last two years put together. 

My Inupiak vocabulary grows; today I learned the proper pronunciation for grizzly bear, which uses a consonant common in Navajo but absent in English.  I can ask where something hurts, and I know the words for bodily waste products.

Rheumatoid arthritis, TB, and Hepatitis C run rampant on the North Slope. Constipation is more common than healthy bowels.  Many seek narcotics, multiple sclerosis is rare.  Marijuana abuse is as frequent as alcoholism; I see twice as many recovering alcoholics as I see active drunks.

 People who have survived unspeakable trauma against all odds come to me with the terrible problems related to the aftermath.

Most people here don’t believe in global warming.  They uniformly grumble that by this time last year the grass was green and the sea ice was gone.

I do not understand why people from tropical countries would come to Barrow and stay, but they do.  People started coming to Barrow at the beginning of the pipeline construction, and they remain here to this day.  No one complains about the cold, no one complains about the twenty-four hour sunshine.

People here are very well-travelled and they talk freely about where they’ve been.

The morning was very easy; one of my five scheduled patients showed up.  The afternoon got serious and went long, finishing after 6:30.  The cafeteria had set aside my meal and stayed open an hour late.

The hospital food exceeds my expectations; the dietary staff cooks with love and imagination. 

This evening in the commons room we got together and talked about what a great place this is to work.  It doesn’t pay as well as another venue we discussed, but the pace of work is reasonable, the food is good, the commute is short, and the esprit de corps is strong.

I”m a family practitioner from Sioux City, Iowa.  While my one-year, thirty-mile non-compete clause ticks, I’m having adventures.  This post was written while on assignment in Barrow, Alaska but not posted till now.

Moose hunting on Kalgin Island

August 24, 2010

 I offer up not an excuse,

My joy it would hardly reduce

     I was in the wrong spot

     I had not a shot

And I didn’t bag me a moose

If you look at a map of Alaska, you’ll find a body of water leading up to Anchorage called Cook Inlet.  South of Anchorage by a couple of hours you’ll find the cities of Kenai and Soldotna; if your map is good enough you’ll see Kalgin Island just west of those towns.

No electric lines tie down the landscape on Kalgin.  No electricity aside from batteries and generators, no running water; cell phones and internet connections don’t work.  A few cabins on private land house commercial fishermen, homesteaders, and out-and-out recluses. 

Four of us, my friend from residency Les, two of his friends (Tristan and William), and I chartered a float plane to fly us there for a week.

There is no commercial air or boat service to the island. 

Small aircraft infuse Alaska skies.  People refer to that majority of the state accessible only by air, water, snow machine, or dog sled as the bush.

If you want to know, we flew in a 1954 De Havilland Otter.  It has floats for landing on water and carries five passengers.

No bears on Kalgin Island, moose were introduced during the twentieth century and have done well but not spectacularly.  Spruce bark beetles killed a lot of trees and the beetle kill continues; rotting logs crisscross much of the land. 

We came in two days early to set up camp and scout.  We saw moose that day, before the season opened and too far to shoot.

I borrowed Les’s Sako .375 Holland and Holland Magnum for the occasion.

I didn’t bring my computer, but a notebook.  I found that more happens in a boring day of sitting around camp than I care to write or than my audience would care to read.

We did some fishing and caught rainbow trout and a kind of trout called a Dolly Varden (which was delicious).  The salmon came swimming upstream and I watched them swim into the lake, looking for all the world like freshmen at a mixer.

I watched trumpeter swans in their family group at the edge of a beaver pond.  When the beaver saw me they decided to defend their territory and came swimming up in formation.  They didn’t leave the water but I watch them tail-slap the surface of the pond and dive.

I have a process I call Hunting Right.  It works for me but there are a lot of hunters it doesn’t work for, they hunt in a very different fashion, and they do well.  For me, Hunting Right means four steps at a time, stop, look, listen, wait until the forest forgets my presence, then move again.  The object is to not disturb the consciousness of the animals.  It becomes an end in itself, a state of meditation, but it is not easy to sustain.  It got me five steps away from a large, glossy red fox who never knew I was there.  A marten passed within two feet of me and didn’t care. 

But I didn’t get within shooting range of a moose.

There’s a reason we say, “We’re going hunting,” instead of “We’re going killing.”

I’m a family practitioner from Sioux City, Iowa.  I’m having adventures while my non-compete clause ticks away.

A pension is good only if you’re alive to receive it

August 22, 2010

Of the folks who work on the rail,

I could tell you many a long tale

     But working too long

     And things go just wrong

I’m picking the right time to bail. 

After I had taken care of a patient and told her of my coming change of career plans, she talked about her deceased husband.  He had worked very hard for the railroad for almost forty years and died of a massive heart attack four months before he retired.  A friend of his had died three months before retirement.  She told me she would miss me as her doctor, but she understood my decision.  “You’ve worked hard,” she said, “it’s time for you to enjoy yourself.  Have a good time.”  I asked for, and received, permission to write about what she’d said in my blog.

We’ve known for a long time, observationally, that all work and no play makes Jack a dead boy, but today the AMA daily email news confirmed that working overtime leads to heart attacks and shortens life expectancy.

The patient and I hypothesized that the railroad pays so much overtime because they know that if they work you hard enough you die before you can collect your pension.

I remembered the beginning of my Junior year in high school talking with a Senior, Jimmy Hopkins, who had worked much of the summer for the railroad.  He got straight time for eight hours, time and a half for the second eight hours of the day and double time for the next eight hours. It sounded great at the time.  Now it doesn’t sound so good.

I have a number of railroad employees in my practice and most of them suffer from sleep deprivation.  They are well paid and badly overworked.

I’m a family practitioner from Sioux City, Iowa.  While my one-year, thirty-mile non-compete clause ticks I’m having adventure.  I wrote this post on May 15th, but saved it for publication while I’m out hunting moose.