Archive for November, 2017

At the end of another Arctic assignment

November 27, 2017

After the lessons not learned

And the good advice has been spurned

Sometimes slow, rarely quick,

People get sick,

I do my best though the bridges are burned.

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I just finished a month in the Arctic.  Any identifiable patient information has been included with permission.

Aside from well child checks, perfect people do not come to see me. Most of my patients have made a lot of decisions they regret, and, whether they realize it or not, when the consequences add up they get ill.

In my years in Community Health I learned that schizophrenia, bipolar (formerly called manic-depression), and substance abuse overlap so much as to be indistinguishable.

Sometimes patients are difficult to talk to. Schizophrenia, for example, can rob the face of expression and make speech slow and monotonous; Parkinson’s disease can do the same thing.

Alcoholics, marijuana abusers, smokers, meth heads, and narcotics addicts get sick more often and more severely than those who lead orderly, substance-free lives. Leaving the start line with mental illness that hampers learning from experience gets compounded with substances that do the same thing.

I do my best to focus on my job: fixing what can be fixed and preventing what can be prevented. Bringing up a person’s past mistakes brings nothing good to a medical visit.

Every day I attend patients in desperate circumstances. I do my best to listen to what they say, and what they don’t say.

When I start to fall into the trap of judging people who have come to the inevitable consequences of reality avoidance, I remember the many mentally ill I’ve cared for who tried so hard to stop the voices in the heads. Because it’s easier not to judge if the person has a diagnosis.

I sit and talk to someone who has burned a lot of bridges, brain cells, and assets using recreational chemicals, and I do my best to tease out the story from a wandering narrative. I nod and look into the face of devastated youth and beauty.  I listen to speech patterns that some find annoying, and when the patient finishes talking I ask the right questions.

I do my best to get them to the correct medicine. Often the patient requests drugs that will make their problems worse, not better, and I explain the rationale for avoiding them.  Mostly they follow the logic, sometimes they don’t.

A lot of the people here have asked me if I’m staying. I don’t plan to, but I’d like to come back.

Inevitably, I don’t get along with some people.

But then, perfect people don’t come to see me.

 

 

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Winter Alaska Life: really cold and dark

November 12, 2017

Consider the price of the meat

What you get at the store can’t be beat

But up here, to be blunt,

The price of the hunt

Makes the comparison sweet

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

In the northern hemisphere, the sun sets later daily from June 21 till December 21, the Winter Solstice. At points on the Arctic Circle, the sun doesn’t rise at all that day.  The winter I worked Utkiagvik (then called Barrow) I arrived a week before dawn; if I had come early enough, I would have experienced night from November till January.  Here we have about 72 hours when the sun doesn’t show itself, and that won’t happen till after we leave.

When the sun sets, it will set in the south, not the west.

I find myself now so far west that I can watch the sunrise at lunch.

+*+*+*

For the most part ER mornings run slow, with late afternoon surges. I hit the cafeteria early, before noon and at 430PM.  Not only the aging eat so early; I did so in residency when I worked ERs in Wyoming.

I cover ER not out of passion for the genre but out of obligation as a team player. Still, the set up here has brought me no more than 9 patients per clinic day, and the ER has brought me no fewer than 10.  Thus ER here has brought me more professional satisfaction.

I would prefer shifts shorter than 12 hours.

+*+*+*

I love languages. The North Alaska Native Association (NANA) partnered with Rosetta Stone and in 2007 brought out two versions of Inupiaq, Coastal and Interior.  On previous Alaska trips I tried but failed to get the product.  This time, though, the local NANA office had the item for sale, and on a rare day off I tramped through a light snow and bought it.

But I couldn’t get the software to install. Yesterday, in another rare day off, I called RosettaStone.  It took 90 minutes to find out that the program can’t be used with my current software (Windows 7 Professional).  The phone rep cheerfully told me that I could add another language, and which language did I want to buy?  After 3 tries he still didn’t understand that, working with Inuit I wanted to speak their language.  He just thought I wanted to add to my inventory.

+*+*

The price of hunted meat, including license, travel, fuel, and ammunition, makes the end product unjustifiable from an economic perspective. Here, however, where food either comes by airplane or comes into the area of its own accord, pursuit of game animals and fish brings in the cheapest calories.  “Stew” in the lower 48 means the meat flavors the vegetables.  Here, with potatoes running $3/pound, one flavors the meat with the vegetables.

The town has 3 grocery stores, all of them expensive. One sells reindeer meat.  On my day off I bought a couple of pounds at breath-taking prices, and cooked up a stew.  Delicious, but it really needed 4 hours of simmering rather than the 2 ½ hours I gave it.

 

 

 

When is influenza Work Comp?

November 7, 2017

A recurring problem, I fear,

Is the flu I get every year

Am I a jerk

To say I got it at work?

I don’t want to be a pain in the rear.

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

Friday I worked but not very hard. I saw more people off the schedule than on due to the number of no shows.  I attended as many people with respiratory problems as with bone-and-joint problems.  As the day wore on I felt, more and more, the aching from yesterday’s 3-hour walk on the ice-covered road leading out of town.  I resolved walk more.

After work Bethany met me in the hospital cafeteria for the weekly prime rib dinner. As Iowa beef snobs we rarely leave home to eat it.  We made an exception; it turned out to be very good, and my piece of meat came large enough to overwhelm.

But my cough, gradually improving over the last 8 weeks, came back stronger than ever on the short walk back to our apartment, and I realized that my tundra-seeing expedition couldn’t account for the ache in my upper back.

I started to shiver, my nose started to run, and my cough worsened. At 9:00 PM I called the Veteran’s Administration for permission to go to the local ER.

I spent 40 of my prepaid phone’s 200 minutes on hold.

My fever and aching worsened, I took Tylenol, I broke into a sweat and I felt better. Which I told the nurse when she answered.

The nurse had no concept of Alaska’s vastness.   She asked if I could get to the VA facility in Palmer, Wasilla, or Anchorage; I told her that I was a good deal closer to the Russian border than  to any of those places.

She knew more nursing than geography.

Eventually she advised fluids, rest, and Tylenol.

Every year I get the flu shot; it’s about 50% effective at preventing flu but it’s 90% effective at preventing death from the flu. And every year, I get the flu.

I got sicker on Saturday evening and went to the ER. I anticipated and got a flu test.

During the wait for results my chills cycled with sweats twice. I took my first oseltamivir (Tamiflu) pill before I left the ER.

But as I had signed in, the slip of paper wanted to know if the problem were work-related.

So many times in the last year I asked sufferers who sought my advice if they wanted the problem put onto Work Comp (or, in Canada, onto the WCB, Workman’s Compensation Board). The vast majority refused; some feared being fired in reprisal, some didn’t want to hassle Human Resources, and some felt their regular insurance would take care of things.

I have almost no social interaction outside the hospital, and I deal with the infected on a daily basis. Until now, I understood the perspective of the self-employed: fear the Work Comp insurance rates will go up.  This time, though, I stood in the shoes of the employed.  And I understood the hesitance.

I didn’t check YES or NO. I wrote, Let’s talk.

A Halloween parade seen from the ER

November 1, 2017

The children went trick-or-treat

While Anchorage was shut down with sleet

Thus diverting the flight

With the time growing tight

But the end was alright, it was sweet.

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, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

I like to be flexible in my assignments. While I prefer to concentrate on outpatient work, I enjoy the intensity of inpatient.  And I’ll cover ER to keep things running smoothly.  So for the last two days I’ve worked the Emergency Room.

Of the three morning patients, one turned out a good deal sicker than anyone could have foreseen.

The nursing staff prepped for Halloween, scrounging odd props for impromptu costumes. We found a red rubber half ball manufactured with a valley down the flat side so that the proper pinch would keep it on the face as a clown nose; with the addition of a hood used for positive pressure in the event of severe respiratory contagion, it made for a really creepy visual.

The kids started showing up at 3:30PM in costume. The hospital distributed large sacks of candy to each department, and three distributors took their places at the end of a corridor, just outside the ER door, giving out miniature candy bars.

Inside the Emergency Room, while the costumed kids paraded past, severe illness worsened in front of our eyes and we dealt with the rippling waves of back stories of drama, irony, and dysfunction. I danced back and forth with increasing urgency as the notorious Alaska weather complicated the patient transfer, past distraction and into improvisation.

By 5:00 PM, when I went into the corridor to snag a bite of junk food, I found the nurse jauntily giving out the treats by the handful.

“I thought we were supposed to give out candy one at a time,” I said.

“I’m tired of this,” he said sotto voce, “I want to go back to work.” And he kept greeting the kids in costumes with laughter.

Just after 6:00 PM I hot-footed down to the cafeteria; the kids had finished trick-or-treating but the Halloween decorations remained on the doors and bits of black and orange crepe paper littered the floor. I got the last 4 pieces of fish and returned to the ER.

Missing food, sleep and human affection leads to burnout. Large paychecks cannot make up for the inability to eat a relaxed meal.  Bolting bites of fried cod between talking to patients did not give me a break but it kept me from impatience.

During one of my status checks I found the patient double thumbing her phone’s keyboard. “Have you put everything up on Facebook yet?” I asked.

“Oh. Yeah,” came the off-handed reply.

I finished at 8:30 PM, full of adrenaline. When I got back to the apartment, Bethany told me that the three foxes which live beneath the school hadn’t been relocated yet, thus the children missed recess. “I know,” I told her.  But I couldn’t tell her why.