Posts Tagged ‘ER coverage’

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?




What does “call” mean? Don’t look in the dictionary

March 26, 2017

Consider the places I’ve been

Then tell me, what does “call” mean?

For sometimes the word “call”

Means nothing at all

And sometimes it can make me turn green

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, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

People can use the same word to mean different things, and the same person can use a word at different times to mean different things.

For example, when I worked in the Indian Health Service, “call” started at 4:30PM and lasted until 8:00AM. Weekend call started on Friday afternoon and lasted till Monday morning.

In my years of private practice, it started at 5:00PM and went till 7:00AM. The doc who took Friday evening call worked the clinic on Saturday from 9:00AM till 2:00PM.  The physician with weekend call started Saturday as early as he or she wanted, rounded on the patients in the hospital, and took care of admissions till 7:00 Monday morning.  For a long time we saw the patients who came to the ER, but that faded over the years.  The on call doctor did the obstetrics over the weekend.

Call in Barrow (now called Utqiavik) never meant anything other than 12 hours, weekend, weekday, or holiday.

In Petersburg, the physician on call also covered the emergency room.

In western Nebraska, being on weekend call meant doing a Saturday clinic till noon, rounding on patients Saturday and Sunday, and admitting patients from the ER.

In Metlakatla, where we had no hospital beds, the two main ER nurses had excellent clinical skills. I could rely on them to know when I needed to come in and when I could safely wait to see the patient in the morning.

I have call this weekend, starting at 8:00AM on Thursday and going to 8:00AM on Monday. During that time, I’ll round on the hospitalized patients.  But someone else will work the Emergency Room.  If a patient needs admission, the Emergency doc does an admit note and writes admitting orders.  If a patient needs me to come in and see them before morning, they generally need to be at a larger facility.

I have had two nights of call so far. The first one passed without my phone going off, not even once.  The second time I worked steadily till 9:00PM stabilizing a very ill patient for transport.

But what does call really mean, here, this weekend?

I can tell you on Monday.

And I can guarantee it won’t mean the same thing a month from now.