A very long taxi ride back

July 26, 2017

The day sure started out slow

It went fine, but wouldn’t you know

To make the trip back

I caught a ride in a hack

And the driver made satisfactory dough.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

The day on call went smooth and slow to start, with fine, solid naps in the morning and afternoon, caring for 5 patients. On the brink of leaving for the day on time, I knew I had to stay when the ambulance radioed in news of two injuries from the highway.

I have to confess my ambivalence when it comes to airbags. Front airbags don’t add much safety to modern seatbelts, too often they activate when they shouldn’t.  Side airbags, on the other hand, provide another layer of protection that saves lives.

I have never before attended survivors of crashes where airbags deployed. I developed the term “bag rash” to denote an abrasion from the airbag, and the patient gave me permission to write about it (and more).

Right when most people would sit down to dinner, the ambulance brought in another patient with problems exceeding our hospital’s capacities; in fact, requiring trained escort for the trip to Prince George.

The responsibility fell to me because nursing staff could not be spared from the hospital.

The back of the ambulance amplifies a road’s imperfections. I did my best to meditate through my nausea as we sped down the highway.

We stopped at the EMS station at the halfway point. Not all stretchers (in EMS-speak, carts) can lock securely in all ambulances (EMS-speak, cars).  I can’t detail here the complications that demanded a change of ambulances and crews, but I got to stretch my legs and breathe in the cool pure air, and ride in a much more comfortable seat.

I turned the patient over to the ER doctor, we volleyed a bit of French, and then I had to confess to the staff I’m not really Canadian. I have been working on my accent, after all, and I don’t obviously sound like an American at this point.

Then I called a taxi: the ambulance that met us would only go back as far as the halfway point.

A very long time ago, my pre-med biology lab partner drove cab, I rode with her a couple of times. She clued me into the details of the business.  In the States, the cab company rents cars to drivers.  The drivers don’t start making money till they’ve made up the fee, and some shifts they don’t make any money at all.  Bidding on the best cabs goes by seniority, and the new drivers (at that time) drove uncomfortable, unsafe vehicles.

As we rode, I interviewed the driver, just like I interview patients. He speaks fluent Punjabi and Hindi and a bits of Tagalog and Mandarin, but has forgotten the French required of all students in Canadian schools.  His English carried a perfect northern British Columbia accent, but I found out he’d been born in India and at age 10 moved to the very town we were headed to.  As the daylight faded into twilight, and as the long northern twilight deepened to dark, I listened.  He worked in the pulp and paper business till age 55 and started driving cab a couple of years later.  He doesn’t rent the hack from the owner; he keeps 45% of his fares.  He makes good money in the winter, but not in the summers.

We came into town in the darkness, talking about aurora borealis. He pointed out places from his youth, but had to be directed to the new hospital.  He showed me where the movie theater used to be.  They changed the films three times a week, he said, and he went to all the movies, and that’s where he’d learned English.

When he dropped me off at the hospital, I looked at the fare on the meter, and I was glad that the trip had been worth his while.

I dropped the unused morphine and the crash bag at the nurse’s station and walked back to the hotel. I hoped for a glimpse of Northern Lights in the moonless sky, but the clouds hid the stars.

 

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Picking up a loving pair of hitchhikers

July 24, 2017

We stopped by the side of the road

The couple was loving, it showed

The don’t need the dance

That improves hitchhiking chance.

They played, they laughed, and they glowed.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I never owned a car till I was 29 and just finished with med school. And, even then, I couldn’t have afforded it if my friend hadn’t sold it to me for a dollar.  I have friends like that, and, ten years later, when I’d done a bunch of body work and replaced the engine, I sold it back to him for the same price.

In those years, I, walked, bicycled, occasionally flew, and, mostly, I hitchhiked. I got good at knowing where to stand to put out my thumb, and how to dress.  I learned practical applications for game theory even before I’d heard of the concept.  I developed a 4-second dance, hilarious in its incongruity, that would bring me rides when women with small children couldn’t get picked up.

I also learned how to be a good passenger.  More than half the people who picked me up found themselves in personal crisis, and they wanted to talk.  I learned how to listen and I honed my interviewing skills to a fine edge even before I thought about medicine.

I met Bethany at the airport in Prince George, coming back from a family visit to south Texas. Starting the long road back, we picked up a couple, hitchhiking their way north to the Yukon.

The young man spoke Spanish with me; I volleyed a bit of French with the young woman but the road noise and my failing hearing made a proper conversation impossible for me. They showed themselves  good listeners, and, when we dropped them off, I pointed out where to stand to maximize the chances for a ride.

But I forgot to give them the benefit of hitchhiking lessons I’d learned: don’t wear hat or gloves, stand in front of your luggage, not behind it. I didn’t teach them my dance.  They didn’t need it.  The movement that grabs the eye, the smile that says, “I’m safe and I’m fun,” came out naturally in the way they played, lovingly, with each other.

 

Team Building Experience, Past and Present

July 23, 2017

We played Two Truths and a Lie,

Then had sushi and beer bye and bye

From the end to the start

Team building’s an art

And none of our airplanes could fly.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

As I began my second year of residency in Wyoming, the buzz words “Team Building Experience” had just started circulation. Who knows who decided tubing the North Platte would fill that function?  But nobody objected to the idea of leaving town for a day, driving an hour or two, renting truck inner tubes, and getting into a meandering river.

Whoever made the decision hadn’t looked realistically at the time involved. What should have lasted two hours at most turned into a six-hour struggle.  All of us, at one point or another, left the water carrying the tube, swearing never to get back in.  And all of us jumped back in the river.  We all had our reasons, but the most common one turned out to be the sound of rattlesnakes.

I can honestly say no one died, though most of us finished in the gentler stages of hypothermia.

The program wisely decided against further Team Building Exercises for the duration of my tenure. At various times different subgroups held bonding experiences involving large amounts of alcohol and no official sanction.

I don’t know when and if more Team Building Exercises happened.

The office here has Team Building Exercises twice yearly. The clinic closes and a locum takes over the ER.  This time vacations had a couple of the permanent docs absent, and, despite the temporary nature of my assignment, I got invited, too.

We started off with a couple of getting acquainted exercises; one of them called Two Truths and a Lie. We all wrote three sentences on a card, two true and one false.  The group had to figure out the author and to ferret out the lie.

I wrote, “My first college major was Music Theory and Composition. I was an Olympic hopeful in Archery.  I spent 4 nights in jail.”  More people believed I’d been a top athlete (false) than I’d been a composer (true).  But everyone found the idea I’d spent time behind bars plausible, and wanted to know why.  They couldn’t understand what Illegal Pedestrian meant.  I explained it was an archaic Kansas expression meaning Male with a Ponytail.

We went on to build airplanes using nothing other than 3 boxes of aluminum foil. We broke into pairs, sat back to back, and had one person describe a picture to the other person so as to reproduce it.

The last game involved trying to grab an unfolded red napkin from the back of the belt from as many others as possible. I decided to abstain more because of my back and ankles than my age.

After sushi and beer we sat around and chatted and relaxed, something we don’t get to do often.

At the end we thanked our office manager for putting together a great day.

It beat the heck out of inner tubes, rivers, and rattlesnakes.

Fisherfolk and forest fires.

July 20, 2017

If you can’t take the fire, stay out of the smoke

The stuff that makes you wheeze, cough and choke

This great conflagration

Caused evacuation

And perhaps even brought on a stroke.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I had call this last Friday, Saturday, and Sunday, and I’m on call again tonight, Wednesday. Over the weekend I saw so many people with possible or definite stroke that my neurologic exam, thorough but a bit rusty on Friday, was polished and speedy by Monday morning.

I have had to do suturing at least once a day for the last week. I do not anticipate robots taking over this part of my job in my lifetime; especially if children are involved.

Stitching people up brings the opportunity to just chat with the patient, and I got the chance to pick the brains of a couple of really expert fisherfolk. The lakes around here hold some lake trout, ling cod, bull trout, and Dolley Varden.  One person I talked to has never come back without a fish, and more than one told me about great spots to catch 28 pounders.  Of course we call fishing stories just that for a reason.  Still, after I bandage the wound, the cell phones come out and the photos of the fish have been very impressive.  The most common, and the most successful bait around here seems to be bacon.

Every morning and evening, when I enter and exit the hotel, I see the crews that stay here, too. Of course I expect the seasonal workers: the rail crews, pipeline workers, tree planters, and such.  But now I see firefighters rotating off the line, and I have attended a few in the clinic.

Today the raging forest fires brought in the first of what I anticipate will be a long series of people with respiratory problems. Those numbers might take a while to ramp up, but lungs show an acute phase inflammation, over the first few hours to days, and a longer term late phase inflammation that lasts 6 weeks.

The area doesn’t have many roads, and the fires have cut off evacuation routes south. Last week, at the town’s only thrift store (staffed by hospital auxiliary volunteers), Bethany ran into a family who had to flee the fires.

 

Surviving grizzly bear attacks, controlling drug prices, and training a Dragon.

July 13, 2017

The thought that gives me a scare

Has do to with a grizzly bear

For he’s big and he’s massive

And pretty aggressive

And, out here, not terribly rare.

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. After three years working with a Community Health Center, I went back to travel and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent US assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Some people survive events far beyond the usual human experience.

Lightning strikes more citizens of New Mexico than any other state, and when I worked there I met several. The Natives hold such survivors in high esteem; some tribes elevate them, obligatorily, to Medicine Man status.

Alaska, with the highest percentage of licensed pilots in the country, seemed to have a disproportionately large number of people who lived to tell about plane crashes. I met survivors of gunshot wounds there and in Nebraska.

Today I spoke with a person who survived a grizzly bear encounter.

Most of the bears around here are black bears. Though they’ll eat anything, the majority of their diet comes from plants.  They climb trees, and do their best to avoid people.

Grizzlies are different. The largest land predator on the planet, they have an aggressive temperament.

The bear only bit my patient once, then retreated to keep track of her cubs (the person gave me permission to write a good deal more than I have). If you’re in bear country with the inexperienced, before you start out, make sure everyone knows to freeze if a grizzly approaches, and never to run.  Carry either bear spray or a rifle, and be prepared to use it.

I really wanted to talk to the patient about life and work in this area, but my primary job, fixing people, comes first.

-*-*-*

Price of medication exceeds the price for physician services. In the US, the prices have escalated beyond reason, making the drug company stocks some of the best.  Insurance leaves a lot of Americans without adequate medical coverage, and the cost of medication becomes an important consideration.  When I worked Community Health, all our prescriptions went through our pharmacy. The pharmacists determined the formulary (the choice of drugs), and did a good job of containing costs.  The facilities in Alaska have a similar system; in those places the people don’t pay for their prescriptions.

For most in this town, employers pay for health insurance to cover what the Province’s Medical Service Plan (MSP) doesn’t, like medications.  PharmaCare, a government program, buys the meds  for the low income segment.  Only a very few lack money for drugs, and most of those are self-employed.  The Indigenous and Metis (of mixed Native and other descent) have all their drugs paid for.

*_*_*_

Over the weekend the facility got new dictation software installed. The previous version had worked just well enough to let you think you wouldn’t have to proofread, but still made glaring errors.  Today I used the system for the first time, training my Dragon over the lunch hour.  It did pretty well, but, once, when I said Prince George it typed first gorge.

The diversion of patients because of forest fires

July 12, 2017

The forest, it seems, is on fire.

And the wait can sure make me tire

When our referral facility

Has maxed capability

And my patients have problems most dire.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

As I write this, 183 wildfires rampage through the wilds of British Columbia. The smell of wood smoke permeates the air and a haze hangs over the nearby mountains.

We have been lucky during this last week of fires, with 3 days of solid, soaking rain. But with complex topography comes complex weather patterns, and nearby valleys have had no precipitation at all.

Yesterday I had call. I took care of people with problems in their skins, bones, throats, lungs, hearts, eyes, abdomens, fingers, toes, brains, ears, and genitals.  Two came in close together, with problems exceeding our facility’s capability.  I ordered blood work; I like to sound prepared when I speak to a doc in a referral center.  Then I waited.

And waited. When I got results back, I called the hospital in Prince George to speak to a couple of consultants and to formulate a plan, then I had the central ambulance dispatching service called.

Theoretically, the dispatch centralization makes sense; practically, however, it means a terrible delay in getting patients into the ambulance.

I had hoped to send both patients in the same vehicle to Prince George, but in the course of making arrangements I found out that the number of injuries coming in out of the forest fire had overwhelmed the schedule for sophisticated diagnostic tools, and couldn’t I please send the second patient to Dawson Creek?

It meant a longer delay for the second patient, but I agreed, and called the ER there with a bizarre, creepy history perfect for the opening of a horror movie.

Of course, in the hours between the arrival of those two patients and their departure, other patients came in for treatment.

At six I walked to the hotel to eat supper with Bethany. I had been continuously occupied for the previous 10 hours.  I wolfed my food, napped briefly, and walked back to the ER.

I started in on documentation, typing directly into the Electronic Medical Record. I continued between the patients who kept trickling in.  I ran into a surprising number of patients with back pain who adamantly spoke against narcotics (and I agreed with them).

I finished at ten, and returned to the hotel. I had attended 21 patients.  The emotional fatigue of waiting to transport those two critical patients far exceeded the physical tiredness.

And then I had no calls for the rest of the night.

Locks on the Clothes, Keys on the Shoelace: the dress of a millwright.

July 9, 2017

The millwrights has many a key

For the mill cuts up many a tree

On the machine go the locks

Preventing visits to docs

And keeping the workplace accident-free

 

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Thursday I took care of 17 patients. One pediatric patient required all my patience, skill, and accumulated experience to get the job done without alienating the kid.  The oldest patients barely qualified as septuagenarians.

I wrote a lot of prescriptions for blood pressure drugs.

I used my deep-breathing techniques on three patients to bring blood pressures into the acceptable range.

Though only 15% of Canadians smoke, the nicotine addicted comprised more than half my patients.

I wrote several back-to-work slips, all employees in the timber industry.

I cared for even more millwrights and former millwrights. Changing logs into useable products involves a lot of dangerous machinery, and the people who fix the machinery come in loaded with padlocks on their clothing.  They lock a machine before they work on it, to make sure it won’t start accidentally.  Spare keys get carried where they can’t get lost, such as tied into shoe laces.  During the work day, a “whistle” signals a need for a millwright.

One of my patients in frustration said, “Can you give us a referral to see a specialist we can actually see?’ and we laughed after I asked for and received permission to use the quote in my blog. While I know my way around the human body, and most of the things that go wrong with it, I don’t know the local medical community.  Yet the permanent doctors trained near here, and know the consultants personally.

There’s also a province-wide network providing phone-in advice for docs . The consultants get paid on a fee-for-service basis; the patient has a unique identifying number, and the doc has a bunch of unique numbers (I have 8), one of which is the right one to use.  Computer algorithms coordinate compensation.

Time off from clinic for Canada Day

July 6, 2017

They celebrate the First of July

Canada’s birthday, that’s why.

On the way back from there

We saw two black bear

And gave Tim Horton’s a try

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Canada Day, this year representing the 150th anniversary of the Confederation of  colonies Nova Scotia, New Brunswick, and Canada, passed largely unnoticed in the US, but well celebrated here in Canada.

Bethany and I slept in and strolled over to the Rec Center for the free barbecue, the third so far this summer. But the demographics of the gathering, not the free food, impressed me the most.

Canada can boast the world’s most ethnically diverse population. We saw a lot of Native faces, and a good mix of Chinese and South Asians.  Everyone got along with the famous Canadian politeness.

This part of British Columbia sports a younger-than-provincial-average population. We saw easily a hundred children with almost as many strollers as baby bumps.

Consider how this mix contrasts with southwest Iowa.

Iowa, the grayest State in the Union, has the highest percentages of septuagenarians, octogenarians, nonagenarians, and centenarians. Within the last year, during my two assignments in the southwest quadrant of my home state I had the daily privilege of taking care of a lot of very old, very spry people.  They had wonderful stories to tell.  A few had survived the Great Influenza of 1918.

We eyed the line for the burgers and brats, then strolled over to the skate park to watch youngsters ride bikes and skateboards around obstacles including ramps, stairs, railings, and benches. One young cyclist took a spill.  He got up and tried to ride the bicycle but couldn’t.  He walked it over to his parents , whom we recognized.

Bethany looked over at me and asked if I wanted to fix the bike. I smiled, and we walked over to the trio and explained I had fixed bicycles professionally through premed.  Sure enough, the brakes wouldn’t let go.  I quickly realized the front wheel had done a complete 360, twisting the brake cables, easy enough to rotate the other direction.

The day after Canada Day we took a drive to mile marker 0 of the Alaska Highway in Dawson Creek.   Highway 97 winds through pine-and-poplar forests, over rivers large and small.  I hadn’t seen any agricultural development for a hundred kilometers.  But we crossed a mountain pass, with tortured rocks exposed in the road cuts, and came into a valley on with lush meadows, herds of cattle and horses, an occasional flock of sheep and the odd goat here and there.  From time to time we saw fenced enclosures with hundreds of round hay bales stacked two deep.

Chetwynd hosts the annual World’s Championship Chainsaw Carving contest; competitors leave behind piles of sawdust and exquisite carving. We stopped into the visitors’ centre.

Of course they asked us where we’re from. We explained that most Americans don’t know where Iowa is, having flown over it but unable to name any of the 7 states that share a border.  Surprisingly, the staffers have a friend who goes to University of South Dakota in Vermillion.

In Dawson Creek we took the requisite selfies at the marker for the beginning of the Alaska Highway, 75 years old this year, and lunched on sushi.

On the way back through Chetwynd, we stopped at a Tim Horton’s, a Canadian restaurant chain a notch or two better than McDonald’s, for dessert. We couldn’t stand the thought of visiting Canada without at least trying such a national institution.

We took our time on the way back, curious about the various human installations that appeared out of the wilderness on either side of the highway, mostly to do with the energy industry.

Just 15 kilometers shy of our hotel, two black bears crossed the road, taking their time, but not quite slow enough to get out the camera.

 

Lower blood pressure with deep breathing

July 5, 2017

It’s a technique, and I don’t mean to brag

But when the smoker lights the first fag

And breathes deep and slow

Though the smoke is the foe

They’re champs at that very first drag.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I see a good number of people with high blood pressure, some better controlled than others. If the pressure is too high, I repeat the reading.  A second round of measurement less than 5 minutes after the first will give a falsely elevated reading.

Most of those with hypertension (a blood pressure greater than 140/90) smoke tobacco and drink more than healthy amounts of alcohol. I point out to the smokers that they have a valuable tool, that they didn’t realize they had.

I was still working for the Indian Health Service when I had a conversation with the worst nicotine addict I ever met. She had quit 4 packs per day about 10 years prior.  Half the relaxation of the cigarette, she said, is the deep breathing technique that goes to taking the first drag.  Every meditation system in the world stresses the deep breathing that all smokers have taught themselves.

Breathing can change blood pressure a lot. The FDA approved a device to teach people to slow their breathing down; the studies showed it safe and effective for blood pressure control.

So I tell the patient to pretend they’re taking the first puff of the day, to breathe slow and deep, and I breathe with them.

I repeat the blood pressure measurement after 6 deep, slow breaths, and almost always the top number drops by 30 points and the bottom by 15, good enough for most people. Whether the improvement is adequate or inadequate, I tell the patient to breathe slow and deep for 20 minutes a day, whether in one chunk or twenty.  For those current smokers, I point out that they could get half the calming effect of tobacco just by doing the breathing exercise that they already know how to do.

+=+=+=

I had call last night. With light traffic in the ER I managed to get back to the hotel early, but I got called back at 10.

As far north as we are, I walked to the hospital with the setting sun in my eyes. Forty-five minutes later, I walked back in the twilight, thinking that I should have brought the bear spray with me.  I crossed the highway with literally not a single vehicle moving.

Learning about the timber industry

June 28, 2017

The market for trees comes and goes,

A boom and a bust, I suppose

At the end of the caper

Logs get turned into paper

And you can watch as the baby tree grows.

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. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

My education in the tree industry proceeds.

When the US economy tanked in 2008, this town felt the impact. The housing bubble burst, the demand for new houses dropped and with it the demand for lumber.  At the same time, electronic publishing cut into newspapers and other print media, so that the demand for wood pulp went down, and the local jobs evaporated.  Some people stayed, but more than half left.

The market for tree products has gradually improved since. Logs get chipped, the chips get bleached and cleaned and cooked to make pulp, which gets spread into sheets, dried, and sent to China.  Rumor has it that China turns it into toilet paper and sends it back, but undoubtedly it has more uses.

The trees around here suffered from the mountain pine beetle a few years ago. Normally that insect just takes out trees about 80 years old, but fire suppression and lack of logging shifted the ratio of old trees to total trees.  Then the area had a succession of warm winters with a resultant improvement in larva survival.  The warm winters went with dry summers which weakened all the trees, which then succumbed to the beetles.

Some trees stay green for a few years after they’ve effectively died, and get used for lumber. Dead trees retain lumber value for several years, and after that they become fodder for the pulp mills.  But those who log must, by law, replant.

The only tree planter I’ve met so far has been doing other work this century, but replanting involves a shovel and remains unmechanized.

Once cut and trimmed, logs may be trucked directly to the mill, or otherwise moved to a body of water. Secured with cables into rafts or contained with booms, they might move more than 200 miles before meeting the saw or the chipper.

Lake Williston, the largest reservoir in British Columbia and the 7th largest in the world, transports a lot of floating timber, even in the winter, when an icebreaker moves the logs.

And everywhere that logs move, people move with them. I see the consequences when humans face the tyranny of Newtonian physics:  a body in motion tends to remain in motion, a body at rest tends to remain at rest, and two bodies cannot occupy the same place at the same time.