When it came to the blackened entrée

I hardly knew what to say

The salmon’s the surf

But the moose is the turf

And the wind blew the high heat away


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 in 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) system I can get along with. I spent last winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Just finished with 2 months in western Nebraska at the most reasonable job I’ve ever had, I am back in coastal Alaska.  Any specific patient information has been included with permission.

Friday we drove out to a potluck at the house of one of the other docs. I brought an Asian salad, Bethany made bread.  Other treats included sweet potato casserole, Spam fried rice, Philippine corn nuts and peanuts and pork rinds, bean salad, potato salad.

While the temperatures this winter have hovered around freezing, the mercury started to plunge last week, into the single digits. The Bay froze over, and the wind picked up.

The host faced a culinary challenge: cooking outdoors when the wind chill sucked so much heat that he had to construct a windscreen.

The entrée consisted of the unique surf and turf of this area of Alaska: blackened moose and salmon. At the end of the party I asked for and received tips on the process of blackening.

Monday the snow fell and fell hard, and I had something I very rarely have, a slow day. I perused my email.  I did some online CME, but mostly I sat.  My tally for the entire day stayed in the single digits.

Today during rounds I heard a doctor referred to a patient as a “high liner.” Too much of an outlander to have heard the term, I waited till I cared for a commercial fisherman later in the day to ask, and I learned the term refers to the best commercial fishermen, the ones who consistently bring in large catches.

One of the first patients of the day came in with a neck lump. In short order I diagnosed a sebaceous cyst, a collection of cheesy, smelly material that happens when one of the skin oil glands gets plugged.  With an apparently open schedule, I agreed to cut it out right then.  We gathered the gear, I wiped the area with alcohol, prepped it with Betadine, and draped it with a sterile towel.  Then I couldn’t find it, nor could the patient, nor the resident.  David Copperfield could duplicate the trick, but I had to repeatedly plead that I had no idea what I’d done.

In the afternoon, a young patient arrived to follow up on a shoulder injury, and I very quickly found range of motion loss. In a culture such as this, where everyone hunts and fishes,  incapacity of a shoulder can have terrible consequences.  After the x-ray, while I awaited contact with the specialist, I used an osteopathic technique called muscle energy.  I brought the arm to the barrier, and using my own muscle power had the patient perform an isometric contraction away from the barrier for 5 seconds.  I instructed in a relaxing breath, got 10 degrees more of motion, and repeated the process.  Then I showed the patient how to do it without me.  That person left with better range of motion, and I finished the day euphoric from making two people better before they left.

They both gave permission to publish more information than I have.



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