Posts Tagged ‘Aurora Borealis’

Summation of a month in the Arctic

December 3, 2017

The alk phos kept coming up high

And the local docs can’t tell me why

And the TSH low?

It’s just part of the show

Like the constantly cloudy sky.

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 in Arctic Alaska the Friday before Thanksgiving. I found the pace  leisurely, sometimes to the point of frustration.  I enjoyed my most productive days, 14 in 12 ER hours and 11 in 8 clinic hours, but the day 5 patients spread over 8 hours I filled the empty minutes with Continuing Medical Education (CME), email, Wikipedia, and naps.

I found 6 mildly low TSH (thyroid stimulating hormone) assays out of 9 that I ordered. Out of the 12 alkaline phosphatase (an enzyme found in liver and blood) tests I requisitioned, 10 came up mildly high. When asked, the clinical director confirmed that, yes, those two tests came back abnormal more often than not, but had no good explanation.

I covered the twelve-hour ER shift four times, coming into contact with 2 patients with dislocated fingers. I got to follow, from afar, the progress of the sickest patient I saw, sent out on a plane to a surgeon and hospitalized for the better part of two weeks.

I never worked more than 44 hours in a week.

I bought Rosetta Stone Inupiaq, the language of the Inuit, only to find it wouldn’t work on a computer using any software newer than Windows XP.

The major plus of the assignment: great leadership. The major minus: the housing (supposedly built from recycled cargo containers) which promoted isolation.

The rainy weather that greeted us promptly froze 4 days after our arrival, when the snow started. Cloudy skies prevented a good view of the Aurora Borealis, and the wind might have shifted direction a few times but never went under 20 mph.

During the month, a baby seal strayed through a breathing hole in the ice and appeared at the foot of an apartment house stairs. A week later, a caribou showed up at the hotel, looking lost.  Three days after we left, I got a video of a herd of caribou running on the sea ice outside the same hotel.

Inspired by the high cost of food, both Bethany and I lost weight.

I bought a hat made of beaver fur and a letter opener of mastodon ivory.

We never quite made it to the gym but we took lots of walks in the cold and the wind.

Bethany substitute taught Special Education, and found herself paid a good deal more than she’d expected.

Would we return? Absolutely!  But we would have to ask, When?




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.


A bad bed, great Northern Lights, and a patient with “red flag” symptoms

March 25, 2015

The bed here? Let’s just call it bad
The second worst I’ve ever had
But for the sake of the night
I saw Northern Lights
‘Twas worth it. It made my heart glad

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 out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. Right now I’m on temporary detail to Brevig Mission from the hospital in Nome, Alaska.

The bunk here came near to the worst I have slept in, second only to a very bad mattress in New Zealand. I contemplated putting the mattress on the floor, but at 3:00 AM I remade the bed head for foot. Before lying back down I watched a spectacular aurora borealis for about 5 minutes. A person, apparently a teenager with a backpack, walked through the darkness and didn’t waken the sleeping dogs.

The clinic, built to standards set by the Joint Commission on Accreditation of Hospitals and Organizations (JCAHO), has my bed thirty paces from the exam room, which in turn is 12 paces from the break room. Across the 8 feet corridor from my exam room the two-bay trauma room yawns, almost the size of the ER in Petersburg, Alaska. On my way to work I pass the 2 chair dental suite, two other exam rooms, a shower, the pharmacy/lab and two generous utility rooms.

The Community Health Aids (CHAs) staff the facility most of the time in the absence of a physician, PA, or NP. Selected on the basis of intelligence and resourcefulness rather than on degree, they handle the load most of the time, and call for help when they can’t.

Today I met a patient I’d heard about in Nome. Now doing well, one could never imagine the difficult Anchorage ICU course after Medevac complicated by a storm, an experience shared by many here.

On three occasions today I talked to patients with long-term back pain, and none of them requested narcotics. My personal experience with the problem gave me credibility when I talked about ways to approach the problem without drugs, including nicotine, caffeine, alcohol, and marijuana.

One patient near the end of the day came up with “red flag” symptoms serious enough to send to Nome but not serious enough for a Medevac. I shared the CHAs’concerns. I called the PA in Nome who will see the patient tomorrow and relayed my differential diagnosis. While doing so I could talk about the patient’s use/non-use of nicotine, alcohol, and marijuana by pantomiming to the CHA and receiving either a nose wrinkle or an eyebrow raise (Inupiaq for no and yes respectively). Before I hung up the staffers prepared paperwork, all I had to do was sign it.

With the last patient seen and the janitor finished, after another 9-hour work day, I went out into the cold. I wore my new sealskin mittens for the first time. I stood on the beach and looked north and west at the tip of the Seward Peninsula.