Posts Tagged ‘Anchorage’

Holiday rush

December 5, 2017

Home from the Arctic we set

At the Omaha airport we met

But, Oh! What a drag!

We can’t check a bag!

And we went to Vancouver by jet.

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. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia.  Any identifiable patient information has been included with permission.

I finished work 15 hours before our flight’s scheduled departure. We acquired little during our stay, but the task of packing took all of Bethany’s considerable skills.  We cobbled together a supper of edible odds-and-ends.  We played one more Scrabble game but couldn’t fall asleep till 5 hours before we needed to get the taxi to the airport.

The airlines advise 2 hours for security and check in, but here we couldn’t check baggage more than an hour ahead. We slipped our ice cleats into the checked suitcase, gate checked our 2 roller boards, and fell asleep before the plane took off.

We spent the long layover with Les, a friend of 35 years and Anchorage resident for 30. Without the wind we’d faced for the last month, the Anchorage temps while a few degrees colder seemed positively friendly.

Contrast, as always, the essence of meaning, the big-city realities of Anchorage jarred our senses. We faced traffic, stop lights, food prices that don’t take the breath away, and stores the size of hospitals, and did our best not to stop and gape.

We helped move a boat and shop, then after dark found ourselves in an airport decorated with full body mounts of moose, musk ox, polar bear, brown bear, and halibut. We landed in the rain in Seattle.

Because of the very long times and distances involved, the vast majority of Alaska traffic overnights in Seattle and Anchorage, thus the large number of hotels close by.   Less than 18 hours after checking in, we landed in Omaha.

Less than 48 hours of mail, laundry, and friends later, back in the Omaha airport for Thanksgiving travel, Bethany headed to Virginia, and I to upstate New York.

I thoroughly enjoyed my time with two brothers, three sisters, a brother-in-law, two nieces, two nephews, a daughter, and a son-in-law. I had to slide my internal clock back across 5 time zones, adjust to outdoor temps above freezing, and accommodate to twice the daylight hours.  I find sleeping in generally difficult but, due to a body clock both shaken and stirred, managed to sleep past 9:00AM.  Coffee in the morning, contrary to usual habit, helped.

Just like that Bethany and I met in the Omaha airport and headed back to Sioux City with 3 days to get ready for the next month in Canada.

The night before departure, Bethany looked carefully at the itinerary and announced we only had an hour layover in Chicago, where we changed airlines. We would not be able to check a bag.

Then followed a furious baggage editing. While we spent thirteen weeks in New Zealand with one roller board and one back pack each, we didn’t have to deal with serious cold.

We decided we could get trekking poles and sweaters in Prince George if needed.

In Vancouver, when asked the purpose of my trip, I replied, “Business.  Would you like to see my work permit?”  The young BC Immigrations man did, and asked me what sort of business I do.  “I’m a doctor,” I said.  “I’ll be working up north for a month.  And, boy, do I like your system.”

He looked up.  “Well thanks for coming! We’ve a shortage of doctors.”

Advertisements

Arrival back in Barrow: spilled milk in the Arctic night

January 18, 2011

Down the dark runway we rolled

Through the night, the snow, and the cold

    You know I might sigh

    Over spilled milk, but not cry.

I didn’t come here for the gold.

Synopsis:  I’m a family practitioner from Sioux City, Iowa, in a career change to avoid burnout.  While my one year  non compete clause ticks out, I’m having adventures, working in a lot of places, and visiting family and friends.  Currently I’ve returned to Barrow, Alaska, where I had my first locum tenens assignment this summer.

We left Anchorage at sunset.  We walked out onto the tarmac, entering the plane near the tail.  We peered around the end of the aircraft and saw the sun going down.  We will not be able to see the sun again for at least a week.  Gentle cold filled the clear air.

In the plane, a thick bulkhead with a locked door separated our area from the front of the plane, and Bethany and I thought that first class passengers took their privileges seriously.  As we hadn’t heard them called, and as none entered the plane at the front, we realized that the plane carried none.  Cargo occupied the fore part of the jet. 

Most of Alaska is “the bush,” meaning that goods and people come and go by water or air.  In state, Alaska Airlines allows three pieces of checked baggage at no extra cost.  In Barrow’s airport, you can see the flow of goods in the duct taped Rubbermaid bins.  Big screen flat-panel TV’s come in with every flight, though the baggage handlers in Barrow use as much force as baggage handlers everywhere.

Yet, on the plane we sat next to a young man who had driven a truck last May from Anchorage to Prudhoe Bay up the Dalton “highway”, then from Prudhoe Bay to Nuiqsit via the Ice Road.  He’d driven from there to Barrow along the shore, crossing bays on the ice.  Thus, a trickle of vehicles comes to the North Slope by road, and, at great risk, arrives in Barrow. 

The plane landed, hard, in the dark and snow, on the only pavement in Barrow; Bethany and I pulled on our heavy parkas before we deplaned.  Barrow’s airport has no jetway; we crunched across packed snow and ice to the terminal.  Between Barrow and Anchorage the cold had hardened to 15 degrees below zero, small snowflakes fell. 

The community pitches in for baggage handling at the airport.  Natives, who prefer the term Inuit to Eskimo, comprise more than half the population of Barrow.    

A container of milk ruptured in the baggage during the flight and spilled over the baggage infrastructure; I grabbed paper towels from the restroom, mopped as best I could, and tried to direct the luggage away from the drying residue.

I noted less airport chaos on my arrival this time than on my first trip; only half the plane had people. 

Outside, the full moon lit the snow-covered scene.  Despite the dangerous cold that greeted us, a few young men in their late teens wore baggy shorts and flip-flops.

Returning to Barrow

January 17, 2011

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.

Contrast is still the essence of meaning: coming home after a summer away.

August 27, 2010

 

I can write and compute on a plane

I regard ennui with disdain

     I’m loving the list

     Of the things that I missed

As I fly away from the rain

As I write this I am airborne and homeward bound.

Yesterday, Les, his wife Beth, their son Gavin and I discussed the Alaska primaries in the very long Anchorage afternoon.

Much passionate discussion follows any election.  Of the last twelve weeks, I spent ten in the bush.  I’m not an Alaska resident.  I had no emotional investment in the recent vote.

But I have a great appreciation for our current marvelous epoch.  An hour’s worth of minimum wage work buys more goods and services than it ever has, and the quality of those goods and services just keeps getting better every year.  During my long years of student poverty and minimum wages an hour’s work before taxes bought me a pound and a half of chuck, now an hour’s minimum pay fetches two pounds of rib eye, and the meat is a safer product.

 In 1979 when postage was eight cents I bought a used Zeiss Ikon Contaflex camera for $65.  My $150 digital camera can shoot 100000 pictures without buying film. The same shirt pocket-sized machine takes high-definition movies with sound. 

To my regret I cannot name the poet who wrote about forever awaiting the rebirth of wonder.  I still marvel at the fact of flying and computing at the same time.

Last night Les and I picked up dry ice at an Anchorage supermarket.  We stayed up late talking and looking at the photos and videos we’d generated during my Alaska adventure.

I didn’t sleep much, I was too excited about coming home.

We got up very early and loaded frozen fish and dry ice into the coolers.  We relished the last minutes of our company and made plans to get together again in January or February or March or April or May. 

He dropped me at the airport and I stood in line with people carrying fishing rods in rigid cases.  I talked about the good fishing and good company and times I’d enjoyed. 

In the Seattle airport I sat next to a Japanese woman on her way to a town close to Sioux City.  She did a year as an exchange student there, returned to Japan to become a nurse midwife.  She does not share call with anyone, and we talked about the difficulty of constant vigilance.  She doesn’t have time to practice piano but we talked about music.

On the Seattle airport tram I spoke with a man who had been fishing in Alaska, and had one good day with the silver salmon.  HIs joy grows as his work morphs from auditor to financial officer.  Auditors are necessary, he said, but he feels he’s doing more good and adding more value in his current position.

Contrast is the essence of meaning, whether in the natural cycle of things or in the progression of one stage of life to another.  In eight weeks of continuous daytime in Barrow, I missed the relief of night and I didn’t see the sunrise or sunset.  The beautiful, clear Anchorage afternoon sunlight yesterday took on more beauty for having followed thirty continuous days of rain.

The wonderful parts about day-to-day life lose their wonder;  when they come every day they are taken for granted, but when we go and come back we can relish and savor the ordinary. 

We lose track of the really neat people and things around us when there are no spaces in our togetherness.

I’m a family practitioner from Sioux City, Iowa.  I’m taking a year off for adventure while my non-compete clause ticks.  I spent eight weeks working in Barrow in far northern Alaska, and a month vacationing in southern Alaska.

Moose watching in Suburban Anchorage

July 28, 2010

After a supper of chicken a jus,

The workplace had turned us loose.

     We went for a walk

     We had a good talk,

And got close to a young spike bull moose.

Anchorage is not Barrow.  There are divided highways and McDonald’s and Starbucks and strip malls. 

But there are also green belts with pedestrian trails and signs telling you what to do if you encounter moose, black bears, or brown bears.  The newspaper sports section talks about mushing and fishing along with baseball and basketball.  Football in southern Alaska starts in the first week of August.

Les, an Anchorage doc who did the same residency I did, and I took his dog for a walk last night, down suburban streets to a green belt.  On the way we saw a twelve-year-old boy standing in his driveway, clicking away with his camera.  “What are you taking pictures of?” we asked.

He looked up, and then looked back to the place behind the hedge he’d been photographing.   “Moose,” he said.

We stepped into the driveway to see, sure enough, a spike moose chewing his cud on the well-kept suburban lawn, about three paces away.   Mute cement lawn deer looked on.   I hadn’t brought my camera.

We got to the green belt and Les pointed to where the four-lane crosses and said, “That’s where the big boar brownie was killed crossing last year.  Hit by a car.” 

We walked on a bike path, occasionally hearing “On your left!” from behind.  I hadn’t realized how quiet bicycles can be because I usually am the one riding the bicycle.

After a while I looked to the right and said, “Those spruce are looking a little scrawny here.  They just got planted?”

He said, “That’s taiga.  That’s as tall as they’ll get.  Probably a pocket of permafrost under there.  Roots can’t penetrate very far down.”

Further on the path crossed a clear, turbulent stream.  “Are there any salmon?  You see any?” he asked.  We stood on the bridge and looked, and I allowed as how I didn’t.  “A couple of days ago  I heard there were salmon running here,” he said.

I said, “Here, Les, look at the signs here.”  Posted at eye level were three signs advising the dates that fishing was not permitted, and that outside those dates non-residents weren’t allowed to fish, and residents were permitted catch-and –release using artificial lures only.

We walked through the long sub-arctic twilight.  I talked about the positive parts of the Barrow experience.

The doctors have functional communication with no back-stabbing.  If Doctor A and Doctor B have a problem, anyone who tries to enlist Doctor C will just end up looking bad.  Call means twelve hours.   Five days a week the docs meet for thirty to sixty minutes to discuss patients, which results in a lot of learning. 

I also talked about the painful transition from paper-based medical records to electronic medical records, and our discussion turned to practice management.

I told him how great it was to work at the bottom of the totem pole and not have to worry about making systemic decisions.

From Barrow to Anchorage: Alaska has a lot of room for contrast.

July 27, 2010

I came in out of the bush,

When shove had gotten to push

    The realization

    That civilization

In Anchorage can be rather cush.

We landed in Anchorage at night, in the rain, and the culture shock set in.

I spent eight weeks in Barrow, the furthest point north on Alaska’s North Slope.  There are fewer than 10,000 people in an area the size of Wyoming where permafrost prevents trees.  Access off-slope is by plane, and once a year by cargo barge.  There is limited local travel by boat, or in season by snow machine or dogsled.  With forty miles of unpaved roads and one stop light operating only during the school year, twenty minutes of walking can get you clear across town.  Most people are subsistence hunters.

Contrast is the essence of meaning.

The biggest change was the darkness, after eight weeks of unrelenting daytime.   I found it soothing, a relief to the eyes, a quieting of the senses.

Lots of cars go really fast on bumpless paved roads in Anchorage.  I saw more cars than snow machines parked outside of houses, and didn’t see four-wheelers at all.  People frown.  Most every house has a garage.  Pavement covers the ground everywhere. 

Trees grow here.  People say “vegetarian” without laughing.   You have to look up to see the sky; it doesn’t slam from horizon to horizon.  Meat comes from stores, and stores are big.  Young people view elders with impatience.  Traffic congests the streets.  The ocean lies further away.  Mountains rear up out of the landscape.   People worry about grizzly bears, not polar bears.  In Anchorage you can talk for hours without using the word whale, and the citizens recycle in seriousness.

Folks keep their useless material possession inside here and outside in Barrow.

Businesses that you won’t find in Barrow:  lawn service, bathing suit boutique, tree surgeon, tree nursery, vegan restaurant, asphalt service, basement service, septic tank service, heated garage floors, saddler, large animal veterinarian, horse boarding, climbing equipment, animal rights fundraisers, stump removal, skate board accessories, gutter cleaning, building restoration, or landscaping.

We spent the night in a nice hotel paid for by the locum company.  We came on a dark and rainy night.  While the rain poured outside we slept soundly.  In the morning we were awakened by the distinct sound of water leaking onto the ceiling.  Despite the posh surroundings, lack of hot water cancelled our shower plans.  Cheerfully delivered complaints at the front desk resulted in complimentary luxury breakfast overlooking a lake devoted to float planes. 

We took our time during breakfast; food tastes better unrushed.  I watched a beautiful but unhappy couple murder intimacy while we ate. 

Hot water service returned during breakfast.  After we showered, a nice man from building maintenance with a radio appliance growing out of his ear came just in time to note the water dripping from the ceiling. 

Gaven, the college age son of Les and Beth, met us in the lobby.

Les is a family physician, and Beth is a Family Nurse Practitioner; they own and operate a medical office here in Anchorage, and have for the last 25 years. Les and I did residency in Wyoming two years apart.  Les and I went deer hunting in the cornfield Beth owns outside of Casper; I was with him when he killed his first deer.

You can either be right or you can be happy. You can’t be both.

June 25, 2010

There are times to be strong

There are also times to sing songs

     Those who are bright

     Don’t like to be right,

In fact we enjoy being wrong.

You can either be right or you can be happy.

My Iowa next door neighbor, Kent, gave me that piece of wisdom.  It’s only true 99.4% of the time.

If you know someone well enough to have conversation, being right usually entails someone else being wrong.  That which diminishes someone close to you diminishes you as well. 

Pessimists are right more often than optimists, but optimists are happier.

A crucial part of my job is to think of the worst thing possible. 

Yesterday I referred five patients to the Alaska Native Medical Center in Anchorage; three were sent out by medical transfer plane because I thought of worst case scenarios.

Alas, I was right.  One of them is in surgery as I write.  My heart goes out to the entire family.  And because I cannot reveal data about the patient without consent, I cannot say why I feel such personal sympathy.

I would have preferred being wrong.

Morning clinic went well.   

I am not a surgeon; my medical forte is more cognitive that procedural.  I am willing to do surgery on the skin, and today I started off by removing a sebaceous cyst from a patient’s face.  I was able to take out the glistening sac and its cheesy, smelly contents intact. 

At noon the North Slope Borough Risk Management team came in to talk to us about Workman’s Compensation.  (Alaska has boroughs, not counties.  The North Slope Borough, roughly the size of Wyoming with one fiftieth the population, has between 7500 and 10000 residents, 900 of whom are employed by the Borough government.)  We talked about Work Comp law and procedures while we munched mediocre pizza (two pizzerias in the whole Borough) and fresh fruit.

We talked about the problem of lack of physical therapists, and the fact that the preferred referral center is Fairbanks.  Some of the fine points of Alaska Work Comp law got brought up (example: the employer has to report all on-the-job injuries within 8 hours of occurrence) 

Clinic was slow in the afternoon because most people are at the Nalaqutaak (whale festival and blanket toss). Business picked up shortly after I said, “Gee, it’s slow.” 

Respiratory problems and pain in the bones, joints, and muscles predominated.

At the time of this writing one of the patients is en route to Alaska Native Medical Center for surgery. 

I hope I’m wrong.

At the end of the day I walked over to the guitar player’s house.  Mac, our trumpeter and band leader is in Wainwright and won’t be back till tomorrow.  We played for an hour and a half, and had a good time.  At this stage of our musical maturation our egos have mellowed and we don’t mind giving artistic control over to our leader, who in turn works on bringing out our best musicianship.  Then we can just play and we don’t have to worry about who’s right and who’s wrong.   The guitarist and I agreed that as long as Mac mushes, we don’t mind being the dog team.

Rabid arctic foxes and northernmost rotarians

June 10, 2010

I don’t want a lengthy deferral

When I ask for a timely referral

    There should be a prize

    For the abnormalest eyes

In a place that’s remoter than rural

Tonight a young man gave me his permission to write this much about his case.

I saw him last week some vague and improbable visual and neurologic symptoms.  Of course I examined him, and almost as an afterthought I checked his eyes.

His eye movements were alarming.

I’ve seen abnormal extra ocular movements before, always I’d known they’d be abnormal before I started the exam.

I presented the case at morning conference the next day; the thrust of my presentation was that he needed to be referred out, but I didn’t how to make that happen.  Later that day, per group suggestion, I called a neurologist at Alaska Native Medical Center in Anchorage, who agreed that referral needed to be made within a week.

Since then I’ve taken a personal interest in trying to get the appointment expedited.

The patient came back today, subjectively and objectively worse.  It took time and running around, but I made sure the patient got down to Anchorage in an accelerated time frame. 

I’ll be presenting the problems involved at morning conference, again tomorrow. 

After clinic this afternoon I was invited to the meeting of the Rotary Club, which lies north of all world’s Rotary Clubs, including those in Greenland.  Two of our docs are longstanding Rotarians. 

The meeting was at the Mexican restaurant, Pepe’s North of the Border, tonight serving Yankee pot roast.  I did however get to speak Spanish with one of the waiters.  About ten of us gathered for the installation of a new Rotarian, and a short speech. 

Just before the speech, my phone rang.  ER is swamped, and walk-in patients are stacking up. Could I please come?

No problem.  It’s a four block walk in gorgeous weather.

I can’t talk about the patients I saw.  I can talk about the current problem here with rabies, being carried by arctic foxes, and how it complicates the treatment of all bite wounds in a town where animals, wild and tame, live close to humans.

People seeking narcotics are a common problem in medical practice throughout the US, and Barrow is no exception.  In Sioux City I established a reputation early as never giving narcotics for migraines and very rarely using narcotics except when the diagnosis was well established.  My reputation has yet to be made in Barrow.

My Inupiak vocabulary grows; I learned to say “I’m fine,” which if said too fast becomes “I’m crosseyed.”  I also acquired the words for gallbladder, dirty, whale, and I don’t know.

Tomorrow will be 21 days since my career change, the three-week rule applies.  I will have to be extra careful.  I’ll shorten my work outs, watch my words, and take no chances.

Thinking like a bush doctor and transports to Anchorage

June 7, 2010

It is my first Sunday on call

The problems are large and they’re small

      No candy, no flowers,

     But it’s only twelve hours

And the ER is just down the hall.

First Sunday on call in Barrow; I’m going to write this as it happens.

People can use the same words and mean different things.  When you say ‘on call’ in Sioux City, for example, you mean something 24 to 164 hours long.  ‘Weekend call’ in Sioux City means  48 to 72 hours long.  In all cases, you mean providing medical services for 10,000 to 100,000, depending on your specialty.

In Barrow, ‘on call’ means something that’s 12 hours long, and for no more than 6,000 people.  I think the high physician morale here rests firmly on that short time period.  If you never have to face a harrowing clinic day after a hard weekend on call, if the worst you will face is 20 bad hours without rest, you have a much better outlook than if you have the possibility of 96 continuous bad hours (which would be a four-day holiday weekend). 

I start Sunday with a workout on the elliptical.  Then continental breakfast: boiled eggs, coffee cake, oatmeal, yogurt, juice, toast, peanut butter, cold cereals, coffee, milk, fresh bananas.  Promptly at 8:00 I walk the 80 yards from the cafeteria to the ER.  Three smiling nurses (two female, one male) do clinical things on computers.  Don’t jinx us, they tell me, right after I say that it’s quiet. I’m now free to go do something else.

I’m called to Inpatient and in short order it’s apparent that the patient has to be transported to Anchorage.  I call the Medevac team.  I have to call the supervisor.  Who wants me to call Anchorage.  Anchorage wants me to try a particular intervention and see how it goes.  Feeling overwhelmed by a circular runaround, I call one of the more experienced hands.

The other doc knows bush medicine really well and goes over treatment algorithms with me.  We get to game theory and conclude that one should never gamble more than one can afford to lose.  Firmly taking the situation in hand, the more experienced physician gets things arranged.  In the middle of stabilizing the patient for transport, I get called to Outpatient.

I pull off a linguistic coup for the first patient.  Not my best language, still I do it better than anyone in the hospital.  The relief of the patient when I greet and introduce myself in the patient’s first language is palpable. 

I am able to talk to the pharmacist on call and get the patient a single dose of a non-formulary drug.

Then I am back to Inpatient.  The Medevac crew has assembled.  My colleague looks very calm facing the prospect of a transport.  There are two thick volumes on the desk for me to read. 

The crew, my colleague and the patient wheel down the hallway and I watch them go with relief.

I round on half of the other doc’s patients (the least I could do) and write discharge orders.  I fall into a conversation about writing with one of the nurses before I finish rounds, and before I know it, I need to break for lunch.  When I come back from lunch I find one of the patients eating.  I hate interrupting a patient’s meal, and because discharge will not be possible today, I assure the patient I’ll be back.  I write a little and I take a snooze.

More patients in the afternoon but the pace is still reasonable.  Most but not all of those who seek care are Inuit.  I see problems related to the unique geopolitical landscape.  I do math for the patients who smoke; at $100 per carton, one carton every five days comes to $7300 per year.  Problems run in families.  Chest pain needs to be investigated.  Puzzling pain that has been checked out by three layers of good (to judge from the work-ups) physicians in the last four years gives me a chance to draw a long bow and shoot in the dark.  Some patients seek care, not cure, and will keep coming back for problems, real and imagined, no matter what I do.

In the middle, I make it back to Inpatient and finish rounds.

In one of the outlying villages a series of events transpires so bizarre as to sound like the preamble to a shaggy dog story.  I make a series of calls and at the end I am thinking more like a bush doctor and have more rationally estimated the limits of our capabilities.  The doctors in Anchorage  help clarify the need to transport from the village to Alaska Native Medical Center rather than to Barrow.  We don’t have CT here.

Supper is an ordinary piece of fish with an absolutely astounding citrus/cilantro sauce.

I finish calls about the patient in the outlying village.  Two more local patients, and I am on my way back to my apartment before 8:00PM. 

It has been a productive day on call. 

I call Bethany and we talk about our day.  I call my friend Bob who lived two summers in Barrow in the late ‘60’s; he warns me against caribou meat and we talk about the success of the whaling season.  I practice my saxophone for a little over a half hour, and I post this.

I have been recruited by the local music community and I have rehearsal tomorrow.  I have weak chops, I’m not sure I’ll make it through the whole gig.