Archive for January, 2011

An arctic evening walk, to the store and the restaurant

January 31, 2011

We went out at fifteen below

In the sunset, and we walked through the snow

     I said, oh so bold,

     It’s not all that cold

As long as the wind doesn’t blow.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

Bethany and I went out in the evening yesterday.  We suited up; me with my Carhartt Arctic Extreme coveralls and Alaska parka, Bethany with her snow pants and long down parka.  We both wore hats and mittens.  With calm winds and temperatures in the negative teens, ice quickly formed in my beard and on the faux fur ruff of my hood.

Brower café resides in a hundred-and-twenty-year-old structure originally constructed as a haven for stranded whalers.  It looks west onto the Arctic Ocean.  As we walked the mile under azure skies in the long northern twilight, up the shallow incline to Browerville, we realized the restaurant was closed when we ran into the owner leaving.  With two-stroke snowmobile engines whining in the background, she told us about the alternate Sunday opening schedule.

We trudged through the gloom, angling north, following the road by the sea.  Bethany asked about polar bears; I told her I hadn’t seen any tracks.  We turned right, towards the grocery store, called commonly Aycee’s in English and Stuapak in Inuit.

In the parking lot we witnessed the incongruity of a man in Bermuda shorts and a down parka getting out of an SUV while snow machines made bootlegger turns so they could slide into parking places between cars and four-wheelers.

Inside, my glasses fogged and we filled our cart with our parkas.  Peaches at $3.68 a pound seem very dear by Iowa standards but a positive bargain in comparison to North Slope prices; the very fact that I could even consider the purchase amazed me.

Outside, the skies had darkened and the temperature had risen when we started back to the hospital housing.  We dodged snow machines zipping from lagoon to lagoon.  My breath didn’t condense on my facial hair.  A breeze freshened at our backs and my glasses fogged, then frosted with the moisture. 

I waited outside by the steps while Bethany put the fruit in the apartment; I pushed my hood back and took off my hat and mittens.  The mercury had soared to zero. 

Our boots still squeaked in the snow, but at a lower pitch than tortured Styrofoam.  We walked down the hill to the Japanese restaurant.

Though it sits a few yards from the water’s edge, it has no windows to look out over the frozen sea. 

Six of Barrow’s seven restaurants serve American breakfast.  Contrast being the essence of meaning, I enjoyed looking at a menu which offered side orders of (among others) grits, English muffins, and kim chi. 

Going against our third gastronomic tourist’s principle, don’t leave Iowa to order beef, I asked for the ox tail soup.  The manager expressed surprise at my choice, and we had a good conversation.  The last time I’d had ox tails had been 1959.

I enjoyed the dish, as much for the difference as for the similarity to what I’d had before.

On the way home, the temperature had risen to 11 degrees.  I left my parka open, I unzipped the legs and front of my coveralls, and pulled back my hood.

I do not know why the air cools when the sun rises, drops during the daylight hour or two, then warms after sunset.

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Cocaine, nosebleeds, and snakebites: lessons learned in a hurry and not forgotten.

January 30, 2011

Is cocaine the thing that you need,

When it comes to a nose that would bleed?

     Would some other med

    Do the same job instead?

It depends on the books that you read.

I did my residency in Wyoming.  Thirty years ago, I had a license and when I had a free weekend I could work where doctors needed help.  Most places paid fifteen dollars an hour; a seventy-two hour weekend could generate a lot of cash for a young man who had just finished twenty-one years of student poverty.  I soon found that the value of the learning experience exceeded the importance of the money.

In a large state with very few people, before the Internet, I found the pressure of dealing with medical problems outside my experience stimulated me to read, learn, and retain. 

Once, the ER where I was moonlighting got a call about a person who’d been bitten by a snake and would arrive within five minutes.  I had never seen a case of snakebite, but I went to the bookshelf, pulled down Rosen’s two volume Emergency Medicine, and read as fast as I could.  I looked up; no patient, but I had another minute before arrival.  I pulled down Harrison’s Principles of Internal Medicine and read what it had to say about snakebite.  The patient now three minutes late, I took a breath and started plowing through the books at hand.  Twenty minutes later, amazed at how much I’d learned in so short a time, I went to lunch.  The patient never arrived.

When confronted with a frightening nosebleed, Emergency Medicine provided me with a chapter that shines as a paragon of what medical writing should be: a review of the anatomy and physiology, elements of history and physical, proven techniques, and pitfalls, in a concise ten pages.

I faced an epidemic of nosebleeds at the Indian Health Service hospital where I worked fresh out of residency.  I could never determine if my hospital alone or if the area IHS hospitals in general had had their supplies of cocaine removed, nor for what reason.  I knew, for sure, that when I was confronted with the only legitimate use of the medication, nosebleeds, or epistaxis, I couldn’t get my hands on the drug of choice. 

We made do with 2% Lidocaine with epinephrine.  For a year and a half I saw a minimum of two major nosebleeds a week.  Most were the common variety, where the bleeding comes from the front part of the nose, but we also saw the terrifying bleeding from the back part of the nose.  I remember calling up the consultant in the big city at the other end of the highway and saying, “The patient has my best anterior (front) and posterior (back) nose packing job and he’s still bleeding, I’m afraid you’re going to end up ligating (tying off) his external carotid artery.”

“Nah,” he replied, “I haven’t had to do that for ten years.”

He called me the next day and said, “I had to tie off the external carotid.”

My experience with nose bleeds has stood me in good stead ever since, and yesterday I took care of two patients with that problem.  For one, I simply pinched the soft part of the nose shut for five minutes, and the bleeding stopped.  When I looked at the middle part of the nose, I found diffuse redness. 

The dry air in Barrow gets worse in the winter, and noses desiccate and bleed; most of those patients don’t need anything more than a little bit of Vaseline a couple of times a day.

When I looked at the other patient I found a snake-like varicose vein, the origin of the bleeding, about the length of an eyelash.  Numbing the area the way I’d learned in New Mexico, I touched bleeder with a silver nitrate stick for three seconds.  The nitric acid from the stick created a burn, and the vein stopped functioning as a blood vessel. It won’t bleed again.

It hurt like the dickens.  The Lidocaine hadn’t done its job as anesthetic, not like cocaine.

Fever, cough, aches, and plunging temperatures when the sun comes out

January 27, 2011

 

Epidemics of this are not new

But what is a doctor to do?

    With coughing and aches

    Till the high fever breaks,

The typical symptoms of flu.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  I’m taking a sabbatical to come back from the brink of burnout.  While my one-year non-compete clause ticks off, I’m having adventures, working in out-of-the-way places, and visiting family and friends.  Currently I’m on assignment in Barrow, Alaska, the northernmost point in the US.

Three symptoms distinguish real influenza: fever, cough, and aching.  Each year the particular circulating strain will show some unique characteristics; last year, for the first time, vomiting and diarrhea accompanied most cases.  Some years headache happens to most of the patients, other years people complain of profusely runny nose.

Chaos mathematicians and complex systems analysts can explain why the flu in a community will reach a tipping point and go, well, viral.  We’re all familiar with the scenario; a few people get the flu, the first cases aren’t too bad; later cases get much worse.  At the peak of the epidemic, our co-workers stay out sick, the schools close, and we can’t get anything done.  Ninety percent of the cases occur within three weeks; the epidemic starts in the north and spreads south.

The scenario repeats itself yearly.  Except for last year, when the pandemic H1N1 “swine flu” turned out to be more of a sardine than a shark, most people got their flu shots and flu season went well.

Many years the tsunami of the flu season overwhelms the medical infrastructure; in 1993, at the end of the season, neither love nor money could have bought an influenza test kit, amantidine nor rimantidine and the chronically ill died by the score.

The virus has Barrow in its grip this week; more than half the patients I’ve seen in the last week were suffering with the same symptoms.  Today we received confirmation of influenza.

With housing in short supply in Barrow, people crowd.  Contagious diseases, especially those spread via the respiratory route, run rampant in these conditions. 

I’ve been working late every day; today I hit forty hours and went into overtime.  Yesterday I finished before supper for the first time since I got here.

I labor with some very good doctors, all hard-working team players.  We have a well-equipped hospital and a well-stocked pharmacy, and exactly six exam rooms.  Emergency medical transports, dramatic life and death cases, leave by air daily.

I wish I had more time to listen to each patient’s story.  I want to ask questions like, what did you find when you got there?  How many geese did you get and how did you get that many?  How can you load eight caribou to be pulled by one snow machine?  How do you find a wolverine?   What is the best way to use fur as a ruff on a parka?

Outside the temperature runs twenty-five degrees below zero till the sun comes up, and in the clear skies of the afternoon the mercury plunges and the radio warns people not to go out.

A man, a harpoon, and a whale

January 26, 2011

A man once stood on the ice,

And a whale came up, very nice

    His crewmates did hike,

    But he made a good strike

And the tale’s been told, more than twice.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  I’m taking a sabbatical to come back from the brink of burnout.  While my one-year non-compete clause ticks off, I’m having adventures, working in out-of-the-way places, and visiting family and friends.  Currently I’m on assignment in Barrow, Alaska, the northernmost point in the US.

Talking with whalers has become the highlight of my day.

Barrow depends on whaling for subsistence.  In the spring, April and May, the whaling crews go out in umiaqs, or skin boats, with harpoons and shoulder guns, for bowhead whales.  They make the boats on wood frames with skins harvested from walrus (other places use bearded seal).  With components of 19th century technology, percussion caps, black powder, and locally worked wood, they make sophisticated harpoons. 

Barrow has about fifty whaling crews, each has a captain.  Intelligent, forceful, and decisive, every captain has strong leadership skills.  The crews will get together in a few weeks and start clearing trails out to the ice, when the first breaks appear and leads of open water show through.

Bowhead whales got their name from using their heads as battering rams.  If they want to come up to breathe, they can smash through six feet of ice when necessary with their bow-shaped heads.  They migrate north into the Arctic Ocean before any other sea mammal.

I have heard the following story from several sources, and I have no reason to doubt its veracity.

Last spring whaling season the captain of a crew decided to move the tent to a place closer to the water; all but one member left to bring equipment further out on the sea ice.  One member, left alone, spotted a whale, who offered himself to be killed, and came to the edge of the ice.

The man, alone, standing at the water’s edge, threw the harpoon, and made a good strike and didn’t know it.  The whale ran, as struck whales do, directly away from where he stood, and the man watched the three hundred feet of line attached to the harpoon play out.  Just before the end of the rope, just before the blaze orange float went into the water, the whale turned around, and swam directly back towards the man.

Then, giving his soul to eternity and his body to the people, the whale died.

And started to drift with the current.

The man grabbed the line attached to the harpoon.  With no way to call for help, it took all his strength to keep the whale from drifting away.

He maneuvered the rope around, looped it on a snow machine, and before the whale could drag it into the sea, he grabbed the radio and signaled for assistance.

He held onto the whale for another 45 minutes before his crew members arrived.

They say he collapsed when he arrived at the hospital, but he lived.

When I’ve heard the story, I’ve inferred that it happened because the man was hunting right, his heart was pure. 

The whalers have agreed with me.

Sunrise comes with sunset; the day really is too short when it’s 75 minutes long

January 25, 2011

We watched the darkness go away

At the side of a lagoon or a bay.

     Forget solar power,

    It’s only up for an hour

The twilight is longer than day

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I’m taking a sabbatical to bring myself back from the brink of burnout, while my one-year non-compete clause ticks away, having adventures, working in out-of-the-way places, and visiting family and friends.  Currently I’m in Barrow, Alaska.

Barrow’s annual sixty-three days of darkness ended Sunday with sun-up a little past one in the afternoon, followed shortly by sun-down.  Another doctor, a guitarist, Bethany and I went out to watch, with a temperature of sixty-five degrees below zero.

The Arctic Circle runs slightly north of Fairbanks, dividing the land of the Midnight Sun from the rest of the world.  At the Equator, the sun shines twelve hours daily, and days last as long as nights.  As one travels north or south, day length during the summer grows, and during the winter shrinks, until at the Poles day and night each last six months.  In Barrow, halfway between the Anchorage and the North Pole, the summer sun stays up 82 days and the winter sun goes away for sixty-three days.  If light did not bend in the atmosphere, the darkness and light would be more symmetric.

Thus, the local joke about the detective questioning the suspect, starting with, “Where were you on the night of November to January?”

We dressed for the cold and set out from the hospital after lunch.   

Humans exude water, and in extremely cold weather groups of humans and their activities create what the meteorologists call “habitation haze.”  We left Barrow shrouded in fog, but three miles from home, clear of the ground cloud, we could see the tip of the disc peeking out from the horizon, and we turned east.

Punchy with the thrill of seeing the sun for the first time, we got out of the SUV, leaving the engine running and the heater going full blast. 

I underestimated the cold.  After forty-five seconds trying to use the camera bare-handed, I realized how close to frostbite I’d gotten, and I went back into the vehicle.  After I warmed up, I buttoned my parka, put on my aviator’s mittens, and went back out.

Such cold becomes a sharp presence, and the slightest breath of wind hones its edge and it cuts like a razor.

But the angle of view, towards the south, meant that the habitation haze of Barrow interfered with the best view.  We got back into the SUV and headed north towards the point, laughing and joking and giddy with daylight.

We stopped in the parking lot where the road ends, and angled the windshield south.  Out in the bitter cold, with a full view now of the sun, we watched it climb to its zenith, not quite clearing the horizon, taking pictures, while our breath condensed into white crystals on our outer layers.

We observed the sun’s descent from inside the vehicle, the robust SUV heater struggling against the cold. 

The colder the air, the more it refracts, and the horizon appeared further away than expected; rather than dropping away in the distance, it rose.

At quarter past two in the afternoon, the day ended, and we headed back to town. 

We’d been out all day and we still got back in time for football.

When fur is a necessity

January 25, 2011

In a place where life’s on the brink,

The cold makes cheeks rosy and pink.

     The fur of a fox

     Can protect from the frost

But nobody’s wearing a mink.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Transitioning my career away from the brink of burnout, I’m on a sabbatical my one-year non-compete clause expires.  I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m in Barrow, Alaska, the northernmost point the in the United States.

Forty degrees below zero Fahrenheit equals forty degrees below zero Centigrade.  At those temperatures, the cold has a hard cruel edge.  Wind, given such a weapon, cuts like a saw.  Exposed flesh freezes to death in moments.   I catch my breath when I step outside, and if I walk too fast or if the wind comes from the wrong direction, I put my hand up to my face to protect my nose from frostbite.

This cold demands a central place in the everyday life of the North Slope.  It is a fact that will kill you if you give it the chance.

Such frostbite as I’ve seen here has been confined to the face and neck, when the cold has found a soft spot in the armor of the last layer a person puts on before going outside.  People here don’t venture out unprotected more than once.

This kind of dangerous cold makes wearing fur a necessity, not a luxury.  Wolverine fur, the most visible, predominates as a ruff on the hood of a parka, but a lot of the shearling lamb, fox, wolf, and beaver stays hidden as the best parkas keep the fur side inside.

I haven’t seen mink, even once.

The people here, Native and non-Native, live with the cold.    

Some people, whether connected with the hospital or not, just don’t go outside for longer than it takes to get in and out of a taxi.

A few of the young, dressed for the experience, go out for fun on snow machines; the distinctive whine of the engines sounds throughout the long Arctic night.

Most people riding on snow machines go out of necessity, not recreation.  Hunting happens year-round; most of the calories consumed in Barrow come from creatures who breathed their last less than fifty miles from here.  Firearms qualify as tools.  The people hunt, not recreationally, but for subsistence.  They whale, not for wages, but to eat; if they didn’t, they would starve.

The women sew to survive and manufacture most of the outerwear.

Thus living in Barrow means wresting the necessities of life from the most unforgiving environment in the world.

Yet, when I find myself in a group of people here, I count nine smiles for every frown, a ratio eight times better than any other place I’ve been.  Except, perhaps, a comedy club.

Changing the diagnosis in the face of change: against complacency

January 23, 2011

I took a good look at the hand

I kept an expression so bland

     without honest guide,

     You can run but not hide

Just keep your head out of the sand

Synopsis: I’m a family practitioner from Sioux City, Iowa.  Transitioning my career away from the brink o f burnout, I’m taking a sabbatical while my one-year non-compete clause expires.  I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m in Barrow, Alaska, the northernmost point in the United States.

I took care of a patient who has given me permission to write the following information.

Hand pain, concentrated at the joints where the fingers meet the hands and the knuckles closest to those, and pain in the wrists, brought her in to see the docs here in the fall.  Concerned about some abnormal blood work, they requested a rheumatology consultation.  The rheumatologist diagnosed osteoarthritis and prescribed non-steroidal anti-inflammatory drugs (NSAIDs).  Osteoarthritis comes from wear and tear on the joints.  In the hands, it characteristically affects the knuckles closest to the nails.  It has nothing to do with rheumatoid arthritis, a disease which scourges the entire body.  Treatments for the two diseases differ vastly.  NSAIDs comprise the mainstay of osteoarthritis therapy, the powerful drugs which modulate the immune system in rheumatoid arthritis have no place in osteoarthritis.

The patient got steadily worse.  She now has severe morning stiffness, pain that wakes her up at night, and worse pain than ever in more joints than before, now including her shoulders and knees.

As soon as I walked in the room, I saw that the fingers of her right hand were swollen in a fashion that gives rise to the term “sausage fingers.”

While I’m checking for other diagnoses, I’m fairly confident she has rheumatoid arthritis.  Her x-rays, normal in December, confirm the joint erosion and bone thinning near the joint, typical of the disease.

Like every patient, she lives in a social, family, and community context.  Whatever her diagnosis, the course of her illness will touch everyone she knows in an unpredictable fashion.

My sensitivity to the rheumatologic diseases stems from my own ankylosing spondylitis, and my experience with the medical profession misdiagnosing me for seventeen years (which was the best thing they could have done for me at the time; the rudimentary treatments back then weren’t much better than the disease).

I know when I don’t know and when I don’t know I know what to do: call someone who knows more than I do.

Humans tend to complacency.  I had the urge to accept the diagnosis of osteoarthritis, because I regard the rheumatologist as having expertise in the area.  But in the end, I just couldn’t make the patient’s history and the physical findings fit.  Even if the patient had osteoarthritis in December, she doesn’t have it now.

  Patient conditions change, world conditions change, and without the ability to adapt, survival becomes problematic.

A walk to the grocery store at thirty-five below

January 20, 2011

We walked in the snow and the ice,

The moonlight was ever so nice,

     Ignore all the clocks,

     Watch out for the fox

Who goes out eating lemmings and mice.

The intense arctic cold doesn’t stop Bethany and me from going outside.  Under a full moon, with clear skies, we walked out to the airport last night; the wind chill dropped the effective temperature to -35 degrees Fahrenheit.   My breath condensed on the faux fur ruff of my parka as well as my beard, which led to our evening discussion of hoods trimmed in fur.

Hunters eagerly seek the wolverine here, but I also see wolf, beaver, lynx, otter, arctic fox, grey fox, and red fox on outer wear.  Tanning skins taken locally falls to the women and the women get the best of the furs; men, for the most part, get the trimmings. 

Most arctic fox in this area carry rabies.

Snow crunches at high frequency in this weather.  Barrow receives little precipitation, less than five inches per year on average, so when snow falls the wind blows the ground bare between snow drifts.  Nonetheless moonlight here on a clear night comes in with a “very bright” rating.

The afternoon clinic ran busy and ran late; I worked through the dinner hour and finished fatigued.  Both yesterday and today I took care of four people in one family in one room.

The outpatient area of Samuel Simmonds Memorial Hospital has six exam rooms and an ER with two bays.  The first patient of the afternoon was quite ill and needed a good deal of medical care, staying in the department for three hours.  Patients who signed in at 4:30 didn’t get seen till after seven.

Most patients today had cough with or without fever; the circulating syndrome apparently started on Friday, and the virus has gone ripping through town.  As usual, those sickest before the epidemic  suffer more during the epidemic.

I find great pleasure in the side conversations I have with the hunters here.  I can pick out whalers most of the time by the glow on their faces.

Two days ago Bethany and I walked to the store.  It wouldn’t rate as an adventure if it hadn’t happened with -45 degree wind chills, and a full moon that didn’t set.  Our glasses grew layers of ice, as the wind whipped wisps of snow along the ground.  We found good traction on the hard dirt roads that have been snow-packed by vehicles but textured by machine.

The grocery store ranks as a medium-sized supermarket.  The ammunition section comes well stocked with common calibers like .223, .45 ACP and 7.62×39.  The presence of a good selection of .22 Hornet surprised me.

The fact of nectarines from Chile in the produce section at $4.50 a pound astounded me.  I can remember saying my mother saying that a hundred years ago kings couldn’t get what can be commonly found in a grocery store; stone fruit in the middle of winter ranks as a triumph of modern man.  I said, “Bethany, I’m buying some.  Contrast is the essence of meaning.”

Snow machine excess, cold injury, and wolverines

January 19, 2011

Some people, they smoke and they drink,

Some trap the otter and mink

     But the story’s been told

     That Barrow’s so cold

You can’t open your eye if you wink.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  To avoid burnout, I’m transitioning my career, and while my one-year non-compete clause expires, I’m working in exotic locations, traveling, having adventures, and visiting family and friends.  Currently I’m in Barrow, Alaska, the northernmost point in the United States.

I’ve been back on the job for less than twenty-four hours, here in Barrow.  I’ve seen several cases related to snow-machine use.

In Barrow, one avoids the terms sled or snowmobile in favor of snow machine.   The people here use them, not for recreation, but to do necessary work.  People hunt from snow machines, so that hunting injuries are almost synonymous with snow machine injuries.

Most, not all, caribou migrated south past the Brooks Range when the days grew too short.  Herds of up to five hundred remain, grazing on the tundra.  In temperatures so cold that alcohol freezes, in the Arctic night when the sun doesn’t rise and the moon doesn’t set, subsistence hunters go after them with firearms ranging from .22 magnum handguns to 7mm Remington Magnum rifles.

A lot of parkas here sport wolverine fur on the ruff. Unique in that breath frost won’t stick to its fur, hunters eagerly seek the “skunk bear.”  The creature has such a nasty disposition that it acts like a serial killer, slaughtering everything in its path for fun and eating for necessity. 

The government issued a wolverine fur-trimmed parka to a person I know (not a patient) during the cold war, for work done in the Arctic.  To this day, the nature of the work and the circumstances of issuance remain clouded in mystery.

Hunters also go after wolves; polar bears occur as targets of opportunity.

Most of my clinic load, whether in Iowa or Alaska, has to do with damage from alcohol and tobacco.  Respiratory infections, cough, asthma, depression, fatigue and malaise, hypertension, high cholesterol follow from those two substances.  Counseling people to quit, though a good idea, rarely works.

When the patients come in with fetal alcohol syndrome and fetal alcohol effect, it’s too late.  With irreparable damage I just make the best of the situation.

I won’t say where, but I attended a set of fraternal twins, one of whom had fetal alcohol syndrome and one of whom had much milder fetal alcohol effect.  Some people are more resistant to alcohol than others, and such resistance starts before birth.

If most of what I see in any clinic has to do with drinking and smoking, the majority of the remainder has to do with the unique factors of where the clinic stands.  Barrow’s air is so dry that eczema here runs an order of magnitude worse than any I’ve ever seen.  Yet most people know the cold so well that frostbite comes rarely.

The first case of frostbite here in Barrow came my way today, very shallow damage, but not to fingers or toes.

Arrival back in Barrow: spilled milk in the Arctic night

January 18, 2011

Down the dark runway we rolled

Through the night, the snow, and the cold

    You know I might sigh

    Over spilled milk, but not cry.

I didn’t come here for the gold.

Synopsis:  I’m a family practitioner from Sioux City, Iowa, in a career change to avoid burnout.  While my one year  non compete clause ticks out, I’m having adventures, working in a lot of places, and visiting family and friends.  Currently I’ve returned to Barrow, Alaska, where I had my first locum tenens assignment this summer.

We left Anchorage at sunset.  We walked out onto the tarmac, entering the plane near the tail.  We peered around the end of the aircraft and saw the sun going down.  We will not be able to see the sun again for at least a week.  Gentle cold filled the clear air.

In the plane, a thick bulkhead with a locked door separated our area from the front of the plane, and Bethany and I thought that first class passengers took their privileges seriously.  As we hadn’t heard them called, and as none entered the plane at the front, we realized that the plane carried none.  Cargo occupied the fore part of the jet. 

Most of Alaska is “the bush,” meaning that goods and people come and go by water or air.  In state, Alaska Airlines allows three pieces of checked baggage at no extra cost.  In Barrow’s airport, you can see the flow of goods in the duct taped Rubbermaid bins.  Big screen flat-panel TV’s come in with every flight, though the baggage handlers in Barrow use as much force as baggage handlers everywhere.

Yet, on the plane we sat next to a young man who had driven a truck last May from Anchorage to Prudhoe Bay up the Dalton “highway”, then from Prudhoe Bay to Nuiqsit via the Ice Road.  He’d driven from there to Barrow along the shore, crossing bays on the ice.  Thus, a trickle of vehicles comes to the North Slope by road, and, at great risk, arrives in Barrow. 

The plane landed, hard, in the dark and snow, on the only pavement in Barrow; Bethany and I pulled on our heavy parkas before we deplaned.  Barrow’s airport has no jetway; we crunched across packed snow and ice to the terminal.  Between Barrow and Anchorage the cold had hardened to 15 degrees below zero, small snowflakes fell. 

The community pitches in for baggage handling at the airport.  Natives, who prefer the term Inuit to Eskimo, comprise more than half the population of Barrow.    

A container of milk ruptured in the baggage during the flight and spilled over the baggage infrastructure; I grabbed paper towels from the restroom, mopped as best I could, and tried to direct the luggage away from the drying residue.

I noted less airport chaos on my arrival this time than on my first trip; only half the plane had people. 

Outside, the full moon lit the snow-covered scene.  Despite the dangerous cold that greeted us, a few young men in their late teens wore baggy shorts and flip-flops.