A telemedicine morning

This morning my work was remote

Still, I wore my white coat

So many did sneeze

On account of the trees

The cedar pollen’s like smoke. 

Synopsis: I’m a Family Practitioner from Siux 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 3 Community Health years, I took temporary gigs in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  Since the pandemic, I did telemedicine, staffed a COVID-19 clinic in southeast Iowa, worked at the Veterans Administration in South Dakota, held a part-time position close to home, worked 10 weeks in western Pennsylvania, and had a 5-month assignment in Northern Iowa.  I’m doing telemedicine at home again.

I descend the basement stairs before full day and open the shades on the window.  I take a couple of minutes to restart my work computer, pass the two-stage security sign on, check internet speed, microphone and camera. 

Then I look out my window, before the day starts and take my first sip of coffee from a cup brought home from an adventure. 

Having a window at work ranks not only as a status symbol but as a quality of life measure.  I can’t think of another medical niche that would let a doc gaze onto the outside world while attending patients. 

Pennsylvania.  Alaska.  Pennsylvania.  Texas

Male.  Female.  Male.  Male.

First 5 calls all between age 27 and 63.

Bipolar.  Tobacco.  Alcohol.  Cough.  Toothache.  Bipolar.  Rash.  Cough.  Real sinusitis.

Referral to psychiatry.  Motivational interview for smoking.  Tales of drama and irony amplified by hereditary behaviors.  Acupressure.  A problem that needs more care than I can give remotely.

I take a 5-minute break to catch up with the documentation.

Iowa.  Texas.  Iowa.  Alaska.

Two pediatric patients, two adults in their 30s. 

Cough.  Cough.  There is no better cough suppressant than honey, and I talk about beekeepers , their large social networks, real honey and the adulterated product sold in stores.

A patient who says their pharmacist knows me and a chance to show off great pronunciation of a polite word in a language I don’t speak.

Texas.

The mountain cedars of Texas have started to explosively release their pollen.  If you live with those trees for more than 8 years you will be allergic to them.  Fluticasone nasal spray (generic for Flonase).  Zyrtec.  Neti pot. 

Pennsylvania.

Try gravity drainage for your sinuses.  If it works, do it as often as you need, if it doesn’t work the first time, the second time has a 10% chance of working. 

Texas.  Texas.

Sinusitis and tobacco. 

I stretch my legs and throw a handful of peanuts-in-the-shell onto the back patio picnic table.  My coffee has cooled to perfect temperature and it warms and nourishes me. 

Unlike most doctors, I didn’t start drinking coffee till after I’d turned 70 and the pandemic was in full swing.  The coffee cup of the 21^st century holds the equivalent of 3 20^th century cups. 

A chance to use my Spanish and hope I don’t embarrass the Hispanic by speaking the language better.

A 5-minute break to watch the squirrels with the peanuts.  They’ll be back several times later in the day. 

Iowa.  Texas.

Pregnancy complicating medical decision making, opting for the lowest-impact treatment. 

Drama and irony, discovered because I keep my mouth shut and listen, revealing key elements of the patient’s illness. 

Tobacco and alcohol.  Alcohol.  Alcohol and marijuana. Marijuana with no tobacco or alcohol.  Three patients in a row with no intoxicants. 

STI.  Medication refill. 

Calls from school, calls from trucks, 3 calls from minivans, 2 calls from home.

An audio only call.  Strangely, almost all these are for burning with urination.

Calls from public places.

Pink eye.  Respiratory.  Chest pain: go to ER RIGHT NOW. 

My stomach growls. 

I linger with the last patient, and tell a joke in Spanish. 

I change back into my t-shirt and come up the stairs for lunch.  I have the rest of the day ahead of me.

Back in Alaska

To come back we both felt the push

To Alaska, this time, not the bush

We see cars, we see trucks,

But never mukluks

You could say that life’s rather cush.

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, western Nebraska and Canada.  I have now returned to southern Alaska.  Any identifiable patient information has been used with permission.

 

We have now flown so many times to the 49^th State that we managed to arrive at our destination the same day we left.  Still, we traveled for 17 hours.

We got here shortly after the “spring forward” time change, which sends the entire country one time zone east.  We dealt with that problem by going three time zones west.

Coming to Alaska till now has meant “the bush” to me: places accessible only by air or water.  High prices, consistent foot traffic, ATVs and snow machines on the streets at all hours.  Life in those places resembles life on islands, with a close sense of geographic identity and an almost  complete lack of theft.  You don’t need driver’s licenses or license plates if you have a vehicle there.  And most people don’t.

The majority of the patients I’ve cared for in the bush have been, well, Alaska Native.  Specialist care means flying into Anchorage (in one place it meant a boat ride to Ketchikan), with all the implied hazards, not to be undertaken lightly.

And now we find ourselves in a metropolitan area with a couple of movie theaters and a really great selection of grocery stores.  The main thoroughfares have traffic lights (that work).  We haven’t seen a single ATV on the streets yet.

The hospital architecture resembles that of the hospitals of western Iowa where I’ve worked, but the directory here lists dozens of doctors, including at least one surgeon.

It’s still Alaska.  Restaurant prices and portions befit the largest state in the Union.  We found a pile of moose droppings five steps from where we parked the car.  The sidewalks show the ravages of multiple, radical freeze-thaw cycles.  The Walmart parking lot pavement consists mostly of chuck holes.  Ravens dominate the skies, eagles come a close second, and the drone of small aircraft continues throughout daylight hours.  When clouds clear, you can see breath-taking mountains in more than one direction.

Knowing when to stay and when to go

You know what happened? A lot!

I missed that government spot

At least for right now

But time might allow

Me to get the position I sought.

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 adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, the fallout of certain Presidential Executive Orders has me cooling my heels at home. Any identifiable patient information has been included with permission.

At one time I asserted that if I woke up Monday morning with nothing planned I could have work by Wednesday. In fact I’ve found a 2 week lag time between decision and employment.

Last week I gave up on taking a government position in Alaska for the winter; too much uncertainty followed the Presidential hiring freeze. I talked to my agent (more accurate than the title Recruiter that she gives herself).

A lot happened in 48 hours. I found out at least 3 places where I worked and had a good time had recruited permanent docs and didn’t need my help.  My agent opened up a discussion with an installation south of here that will offer me both inpatient and outpatient work.  I talked to them, we hit it off, I said ‘yes’ to the job.  Shortly after that I got an Alaska job offer, but I’d already committed to Iowa.

I asked for and received a 4-day work week, probably close to 40 hours, and the chance to come home on the weekends. Bethany will come with me for most of the trip.

In the meantime I miss the strong cold of the northern clime. The temps here drop into the teens at night, but days have been sunny and while long underwear has become a routine part of my wardrobe I haven’t even thought about bringing my parka out.

The last couple winters I spent in Alaska, and somehow being away from home made the cold easier.

Last week I talked with an agency seeking a permanent placement in a spot 35 miles from here; MapQuest more accurately put the distance at 75 minutes, too far for me. I have thought about telling my agent the name of the facility to see if they want a locums, but I’m concerned about the ethics.

I started correspondence with a firm who wants to place me in a hospitalist job in New Mexico. The position looked reasonable, it would give me a chance to visit the places I knew and loved during my Indian Health Service days, as well as speak a lot of Spanish and maybe renew my Navajo language.

And, with all this going on, I seem to be making progress on my planned Canadian employment.

No matter where I go, I’ll have an adventure.

 

Learning curves and light days: notenoughworkosis

Some say that I’m a quick learner
I know I’m an EMR spurner
But I’m feeling much fresher
With a little time pressure
And the EMR they call Cerner

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 System (EMR) I can get along with. Right now I’m in Nome, Alaska.

Any introduction to a new system involves a learning curve, involving time necessary to acheive fluency and efficiency. The overall system here involves little difficulty outside of the electronic medical record (EMR) systme). I had a passing acquaintance with Cerner, the product they use here,back home, where I hated, loathed and despised it.

I try my best not to fight it. All EMRs are built by people who don’t talk to doctors, and are purchased by people who don’t take care of patients. The ideology that gave us the Palm Pilot could give us better systems.

But the administration here, recognizing the EMR’s steep learning curve, scheduled me very light for the first couple of weeks, about one patient an hour. I’ve preogressed enough that in the last two days I have had double-bookings once an afternoon, and even asked my nurse to start poaching patients out of ER and the Fast Track.

My first afternoon patient didn’t show, nor did my second. I said to my nurse, “When too many patients have noshowitis I get notenougworkosis.”

I looked forward to my last three patients. I taught myself how to put a lab order into the computer before the patient arrives. Sure enough, the result came back abnormal enough to justify hospitalization just as the nurse readied the other two patients (family members).

I had to learn the process for admiiting patients, even more Byzantine than the usual order process, and I had to do it while the other two patients waited. So I had time pressure for the first time since October 2.

I called the computer trainer, who walked me through the process. Even though he got hung up a couple times and, at the end, we encountereed a task, that, if I had done it today would have saved me time. But such couldn’t happen till next Wednesday, though that did not become clear until the trainer and I had run a number of microchip laps.

During the process, one of my colleagues, frustrated by the anti-ergonomics, fumed that seeing the patient took 15 minutes but putting the orders into the computer took 45. And I couldn’t quarrel with him. We talked about opening up a practice with paper records and charging $50 a call.

Eventually, I got the sick patient admitted, the order into the computer, and the other two patients seen. I put lab orders in for both the inaptient and outpatient side. At the end, 3 patients took me 90 minutes. And trying to get three people taken care of simultaneously stressed me out. But I liked it a lot more than the thumb twiddling I’d done in the beginning of the afternoon.

Decompression: not to be confused with mania

It came, this feeling sublime,

With the freeing up of my time.

Don’t get in a panic,

I haven’t turned manic

But boy, this place is just prime.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa.  In 2010 I danced back from the brink of burnout, sold my share of a private practice, and, honoring a 1-year non-compete clause, went to have adventures in Alaska, Nebraska, Iowa, and New Zealand.  I returned to take a part-time position with a Community Health Center, now down to 40 hours a week from 54.  Right now I’m in Petersburg, Alaska, on a 1 month working vacation. 

Two weeks after I left the Practice Formerly Known as Mine, I called my doctor from Alaska.

Me:  I’m so euphoric I’m afraid I’m having my first manic episode.

My doctor:  So you’re feeling good?

Me:  Yeah.  Really, really good.

My doctor:  Are you doing anything impulsive ?

Me:  Like?

My doctor:  Like spending money?

Me:  Does paying arctic prices for a pint of Ben and Jerry’s count?”

My doctor:  No.  Or gambling?

Me:  No

My doctor:  Doing anything risky?

Me:  Like going out on the sea ice?  Absolutely not.

My doctor:  How are you sleeping?

Me:  Fantastic!  Eight solid hours a night and waking up rested without an alarm.

My doctor:  You’re not manic, you’re just happy that you’re decompressing.

That same euphoria washed over me in waves while I walked around Petersburg the day I arrived, just an overall sense of happy.  Yes, the blue sky and the dramatic mountains could take the breath away from a fish, but it takes more than good weather to bring happiness.  I suspect I’d be this happy if I wandered around Pittsburgh (I won’t write off that possibility).  I think it has to do more with freeing up of time constraints than with scenery or a new place.

***

I left for work back home on a Wednesday with the thermometer firmly at 7 below zero; I got off the plane in Petersburg, Alaska at 45 degrees, and the air, compared to Sioux City, smelled like spring.  I ran around in shirt sleeves till the sun went down.

***

First thing off the plane I went to the clinic, where, since I left in August, a new electronic medical record (EMR) system has taken hold, though the reasons remain unclear to me.  Sleep deprived and jet lagged (the trip lasted 28 hours), my brain fails to consolidate the lessons.  Yet I observe that if it takes me 3 tries to learn something, I might as start that day  and have my first failures out of the way.

***

Second day of clinic I find I learned more than I thought.  As with any complex computer system, I run into some transient functionality problems.  Because I can’t talk about patients, I’ll talk about the disease states I encountered:  sore throat, cough, back pain, laceration, and neuropathy.   I saw four patients (if you do the math you’ll see at least one patient had more than one  diagnosis) at the rate of one per hour, and for Monday I have the confidence to handle one every 45 minutes.

I seem to learn quickly.

Saying no, and not getting my first choice.

I think I’ll take off for a week.

Perhaps a large elk I will seek.

Or I’ll take me a drive

For ten days or five

To the Front Range, out near Pike’s Peak.

 

SYNOPSIS:  I’m a family physician from Sioux City, Iowa.  In 2010, I danced back from the brink of burnout, and, honoring a 1-year non-compete clause, worked in out-of-the-way places from New Zealand to Barrow, Alaska.  Now I work part-time at a Community Health Center, on average 54 hours a week.  Just back from a two-week working vacation in Petersburg, Alaska, and a week Continuing Medical Education in San Diego.

 

Usually I plan ahead better than this.

About three weeks ago I decided I wanted to go elk hunting during the first week of November, I contacted an outfitter, and, at the same time, requested to be off the schedule for that time period.  Few outfitters would consider such short notice hunts, but I know one who would.  Three days into the negotiations I read his Facebook post that he’d gone lion hunting, planning a return in two weeks.  I performed a basic game theory analysis and decided I’d better make alternate plans, especially because I’ve learned the importance of time off.  I started thinking about taking some Continuing Medical Education time (I have 48 hours left in my account), and I went looking for a course in a place where I have family and friends and came up with a 5 day Board Review course in Denver.

I haven’t actually paid for the course.  Imagine my surprise when a locums recruiter contacted me at the beginning of last week to see if I wanted to work for one week in Alaska.

I thought about it for a day and a half and replied that I wanted details.

The only reason I can pronounce the name of the place is because I already speak one Athabascan language.  I went to Wikipedia and found some really interesting history; the clinic serves the Native population.  The village has air and water access but no road leads there.

I considered it enough that I asked that key business question, How much?

The figure came out so low that it shocked me.  When I do locums work, I frequently say that it’s not about the money.  Such a price could pass for an insult.  But I inhaled and asked if the situation carried profound humanitarian implications.  I would work below industry minimum if a colleague had a life cycle event or faced a crisis.

I casually went back to my email while I awaited the call.

The clinic staffs exclusively with locums, and had a one week coverage hiatus.  The recruiter gave me a counter offer below my bottom line, saying that the firm didn’t want to lose money on the deal.  I replied that I didn’t either, and asked her to keep me in mind for future assignments.

My first choice would have been the elk hunt, but experience has shown me I rarely get my first choice, and I generally finish happier when I don’t.

Not getting the offer I said yes to.

To the recruiter I didn’t say ‘no’

I’ve decided that I want to go

Life can be cush

But in Alaska’s there’s bush

And salmon, mosquitoes, and snow.

Synopsis:  I’m a family doctor in Sioux City, Iowa.  In 2010, I left my position of 22 years to dance back from the brink of burnout.  While my one-year non-compete clause ticked off, I travelled and worked from Alaska to New Zealand, and now I’m back working part-time (54 hours a week) at a Community Health Center.

I said ‘yes’ to a recruiter.

It took a good deal of thought, but I remembered what a great time I had doing locum tenens (temporary doctoring) work.  I looked at the number of hours of Paid Time Off (=vacation) and I decided I could go back to Alaska for a couple of weeks.

I had worked with that recruiter before, who has shown incredible skills as a negotiator and who made me specify 5 different parameters of how much I wanted to get paid, and has never failed to bring a position in for me.

This particular gig boasts a 40 work week with no nights and no weekends in the Alaskan bush less than 2 air hours from surgical backup.  It sounded perfect.  All things in context, all things in comparison: it looked like a vacation.

(The bush is anywhere in Alaska that can only be reached by plane, boat, or snow machine.  I like the bush but my zone of comfort stops as soon as it takes more than two air hours to get to the patient to surgery.)

I fantasized about fishing the river for salmon in August and visiting friends who moved to Alaska after residency.  I looked up the village on Googlemaps and Wikipedia.  The Natives have their language intact, but the job might have been for the non-Natives.

I thought about that part.  Native health facilities generally don’t treat non-Natives except in cases of emergency (other exceptions include active duty military and their dependents), but non-Natives play an important part in rural Alaska.  Any place with a large enough non-Native population will need a medical facility.

My mood improved while I thought about going on a new adventure.  I filled out a vacation slip, and I walked with a bounce in my step.  Bethany, accurately, said I quit whining.

The recruiter called me Friday to say that three other docs, all full timers, had put in for the job.  In all likelihood it will not go to me.

But during that entire euphoric year of walkabout I almost never got my first choice, and I still had a great time.  I’m starting to look into other opportunities, and I’ve got my time frame narrowed down, to the last part of August.

No matter what I plan, it won’t turn out the way I planned.  I look forward to the surprise.

Job offers and Sisyphus

Call brings me no compensation

I struggle with documentation

I might sound like a boor

But our EMR’s poor

And a source of great irritation.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

 I’m starting to get wanderlust again.

Most days bring 6 to 10 job offers, some permanent, most locum tenens (temporary or substitute).  I look at locations and I fantasize.

Places interest me.  A spot in Wyoming evidently has terrible problems recruiting, I’ve received very good offers for the last 10 months.  Indian Health Service has a trouble filling positions as well.  Veterans’ Administration, Armed Forces posts, and Bureau of Prisons chronically seek physicians. 

The one that piqued my interest the most this week was Nome, Alaska, partly because I just finished Michener’s Alaska and partly because I worked in Barrow.  I wouldn’t really take the job because they want Family Practice with Obstetrics, and I swore off delivering babies on May 7, 2010.  Nor do I want to work more than 2 air hours from surgical backup.  Still it looked like a really, really interesting gig.

Ireland keeps sending me information about “hot jobs.” 

I have no interest in cities, not even exotic cities like Albuquerque or San Francisco, though I might consider something in the Denver area because of family and friends there.  For some reason Wisconsin has fallen completely off my radar screen.

I don’t much look for pay rates; still I’m impressed by some of the figures I see.  Bottom lines upwards of $300K come occasionally, but what really catches my attention are the offers of extra money for taking call. 

Bethany and I had such a great time in Alaska in the winter and New Zealand in the fall. 

While I can still remember the absolute euphoria of coming home and seeing familiar faces and sleeping in our own bed, I can feel myself starting to find fault with my current job.  I have begun to dwell on the call for which I receive no compensation and the hours of documentation I do outside of work hours.  The electronic medical record system (EMR), horribly inefficient to start with, irritates me more and more every day.

And if I miss too much sleep I find judgmentalism creeping into my thoughts.  Hospitalizing the same people for the same problems (which come down to bad lifestyle choices) makes me feel like Sisyphus. 

Yet I really enjoy my coworkers, the morale of the clinical staff runs consistently high, and I like doing hospital work.  A lot of docs don’t.  Thus electronic and regular mail recruiting touts “all outpatient” in capitals with several exclamation points at the top of the page.

The clear ability to walk away from a job gives me tremendous negotiating strength.

Unlike Sisyphus, who had been condemned to eternally roll a boulder up a hill, only to have it roll down just before it reached the top.

Medical Advice at Parties.

At parties I’m asked for advice

It’s happened way more than twice

Wouldn’t you know

Sometimes I say ‘no’

But I usually try to be nice.

 

Bethany and I received a surprising number of last-minute invitations to parties today. 

People ask me for medical advice in social situations.  On one occasion, shortly after my mother’s death, I snapped and yielded to the urge to sarcasm and immediately regretted it.  Yes, the request arrived at an inappropriate time and place; no, the patient had never seen me on a formal professional basis; yes, I had every right to turn the request down.  But I did so with finesse and eloquence, a misapplication of good verbal skills.

Today I recommended the book, Love, Medicine, and Miracles in the buffet line, and a trial of over-the-counter meclizine while eating spanokopita.  I listened intently to an alcoholic’s relative, and agreed counseling would be a good idea.  I nodded while a person detailed a coworker’s headaches.

In med school and residency and even later, the docs who mentored me would say, “It comes with the territory.”  I suspect the phrase comes from traveling salesmen who would use it to describe the positive and negative things about working in a particular area.  The advantages of working in Montana differ from those of New York.

I would worry more about seeing a patient as a collection of diseases rather than as a whole human being if I didn’t talk about so many other things with the same set of people.  Today I had discussions about archery, firearms, ballistics, gardening, stone fruit, bicycles, New Zealand, and Alaska.

Yesterday I had a good talk with a friend, just back from 8 weeks of locum tenens (substitute doctoring) in Barrow.  The Inuit filled their quota of 21 bowhead whales; on one day they brought in three.   Weather socked the place in more than once, preventing critically ill patients from reaching services on a timely basis.  We agreed that Barrow ranks as a place on the fringe of the 21^st century, that theft was nonexistent, and that the North Slope people smile more than any population we’ve seen.

Bethany and I spent two weeks in June in southern Alaska.  Four days of fishing, four days with friends, and four days of Continuing Medical Education with the Alaska Academy of Family Practice’s 27^th Annual Scientific Conference in Kenai.  The sun set about 11:30 and rose a couple of hours later.  Which gave us a lot of time to fish but played havoc with our sleep.  Not nearly as bad as the 8 weeks of unremitting day without a single sunset the first time I went to Barrow. 

I might go back to work in Alaska, eventually, but Barrow remains outside my zone of comfort, like working in Sioux City and having the nearest referral hospital in Dallas.

Returning to Barrow

This trip is a bit of a lark,

Not exactly a walk in the park

     Where the polar winds blow,

     Making blizzards from snow,

Up north, where it’s cold and it’s dark.

Our friends gave us a going away party Friday night, or maybe we gave them a party; either way we had a great dinner.

It was an extension of our Friday night potlucks, which will continue in our absence.  With an original head count of nine for sure and four maybes, I made a boeuf burguignon. 

Having seen the movie, Julie and Julia, I picked up two tips for the recipe: dry the beef on paper towel before putting it in to brown, and don’t crowd the mushrooms in the pan.  From the net I learned to make a roux to thicken it. 

While constructing the main dish, I put together guacamole, using six avocados and four fresh roasted Poblano peppers.  I thawed out the fillet from Bethany’s huge ling cod, caught last August during our dream fishing trip on Alaska’s Prince William Sound.

Head counts at potlucks run notoriously inaccurate till the last-minute.  Eventually, twenty-one guests arrived, and as always, we had too much food:  fresh-baked challah, green salad, squash and asparagus salad, cut fruit, sweet potato casserole, chips, salsa, noodles, angel food cake with strawberries, bread, beef and fish.

The conversation didn’t stop with the eating; clean up continued after the meal.  Three of us sipped at Crown Royal while we washed and dried dishes and put away leftovers.  I distributed the rest of the cod to people who promised to cook and eat it within twenty-four hours.  Our last guests left about 10:30, and Bethany and I rolled into bed, congratulating ourselves on a first-class dinner.

I hadn’t finished packing, but our schedule was flexible enough to permit items be put into luggage in the morning.  At the last minute we remembered to bring exercise bands, a portable telephone for the landline, my electronic tuner, batteries, books, and CDs. 

John, our good friend, will be house sitting while we’re gone.  (He has a fifth degree black belt and he knows how to shoot.)

As I write, Bethany and I are en route to Alaska for a winter adventure, back to Barrow for the end of the sixty-three day Arctic night.  She plans to work as a substitute teacher and I’ll be back working at the hospital.

We stayed in Anchorage Saturday night and Sunday, visiting our friends Les and Beth, whom we’ve known since Wyoming.  Les and I discussed the fine points of vitamin D, calcium, and phosphorus metabolism, along with genetics, skin color, and astronomy, in relation to one of his current pediatrics cases.  We fried potato pancakes (latkes) and ate salmon we caught in August and had smoked. 

Later, the group enlarged, the erudition base broadened, and the discussion ran from the Constitution to free trade (as defined in 1775), free trade (as defined in 2011), economics, the gold and silver standard, the process of Constitutional amendments, the price of manufactured goods, the Swedish Empire, freedom of religion, and excesses of monarchs.