A bad bed, great Northern Lights, and a patient with “red flag” symptoms


The bed here? Let’s just call it bad
The second worst I’ve ever had
But for the sake of the night
I saw Northern Lights
‘Twas worth it. It made my heart glad

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. Right now I’m on temporary detail to Brevig Mission from the hospital in Nome, Alaska.

The bunk here came near to the worst I have slept in, second only to a very bad mattress in New Zealand. I contemplated putting the mattress on the floor, but at 3:00 AM I remade the bed head for foot. Before lying back down I watched a spectacular aurora borealis for about 5 minutes. A person, apparently a teenager with a backpack, walked through the darkness and didn’t waken the sleeping dogs.

The clinic, built to standards set by the Joint Commission on Accreditation of Hospitals and Organizations (JCAHO), has my bed thirty paces from the exam room, which in turn is 12 paces from the break room. Across the 8 feet corridor from my exam room the two-bay trauma room yawns, almost the size of the ER in Petersburg, Alaska. On my way to work I pass the 2 chair dental suite, two other exam rooms, a shower, the pharmacy/lab and two generous utility rooms.

The Community Health Aids (CHAs) staff the facility most of the time in the absence of a physician, PA, or NP. Selected on the basis of intelligence and resourcefulness rather than on degree, they handle the load most of the time, and call for help when they can’t.

Today I met a patient I’d heard about in Nome. Now doing well, one could never imagine the difficult Anchorage ICU course after Medevac complicated by a storm, an experience shared by many here.

On three occasions today I talked to patients with long-term back pain, and none of them requested narcotics. My personal experience with the problem gave me credibility when I talked about ways to approach the problem without drugs, including nicotine, caffeine, alcohol, and marijuana.

One patient near the end of the day came up with “red flag” symptoms serious enough to send to Nome but not serious enough for a Medevac. I shared the CHAs’concerns. I called the PA in Nome who will see the patient tomorrow and relayed my differential diagnosis. While doing so I could talk about the patient’s use/non-use of nicotine, alcohol, and marijuana by pantomiming to the CHA and receiving either a nose wrinkle or an eyebrow raise (Inupiaq for no and yes respectively). Before I hung up the staffers prepared paperwork, all I had to do was sign it.

With the last patient seen and the janitor finished, after another 9-hour work day, I went out into the cold. I wore my new sealskin mittens for the first time. I stood on the beach and looked north and west at the tip of the Seward Peninsula.

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