Posts Tagged ‘fishing’

6 afternoon patients and an evening power failure.

October 22, 2017

With a light do you send out a scout

To see what the problem’s about?

For it gets pretty dark

And the prospects are stark

Up here when the power goes out.

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. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

On my first Friday back in the Arctic, I got to talk with a Native about village life.  After getting through the medical agenda, I asked about fishing.

The village in question right now does it a lot.  And, with freeze up coming, the Natives are working the set nets.  Soon the caribou migration will start.

But the whaling grabbed my attention.  We talked about a village that brought in their entire quota of 10 bowheads last spring; in times past the villagers sometimes had to make do with as few as 4.  In the process, we talked about making the bombs necessary for the complicated harpoon that the Natives use.

***

I had the thrill of making two people better before they left.  One I helped with massage and spinal manipulation, one with an exercise I saw on YouTube.  “YouTube?”  the patient exclaimed, “You mean I could be a doctor from YouTube?”

I said, “You want to learn to put in a chest tube or do a cricothyrotomy?  Go to YouTube.”  And, in fact, you can find instructions on almost any procedure.

***

Still learning, or relearning, the Electronic Medical Record system here, I only had 6 patients scheduled for the day, 2 in the morning and 4 in the afternoon.  I’m just getting the hang of sending the prescription to the pharmacy before the patient leaves, and finishing the remaining documentation later.

The docs here meet with staffers for morning report, much like we did during my time in Barrow (now called Utqiavik).  Shortly before the meeting started, I realized I’d brought the wrong cell phone, the one with no local signal.  Yet, wonder of wonders, I had two bars of service and updated email.  I texted Bethany to not text me on either phone, attributing the miracle to sun spot activity.  She didn’t get the message; I have no idea if solar flares were responsible.

***

We had settled in for the night when the power failed, and moonless Arctic nights have a deep, Stygian darkness.  We have had power failures everywhere we’ve gone, and for the most part we can laugh it off as part of the adventure.  But our all-electric housing has no alternative to combat the cold, and while I searched out flashlights and head lamps (a total of five) I started to worry about making it through the night.  While the hospital has emergency power and we have long underwear, here we lack the cold weather sleeping bags and tents residing comfortably in our basement in Iowa.

The words power outage take on new meaning in an unforgiving climate.

Advertisements

Canadian rough fish: delicious but bony

July 31, 2017

The prep and the time that it took

For the sinker, the line, and the hook

And don’t forget bacon

For the rig that you’re makin’

When you fish the lake or the brook.

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.

A lot of people in this town do a lot of fishing.   And while I really enjoy the sport, my lack of knowledge, skill, and experience give the fish quite an advantage.  I approach the problem like I approach a clinical case with unclear references: I ask the successful.  Anglers love to talk and show off their cell phone pictures.

I got clues to several spots where the fish congregate. I bought swivels, hooks, sinkers, lures, and a net.   The panel consensus for bait, to my surprise, came down to bacon.  For a lot of reasons, I haven’t bought bacon for decades, but I ignored all those nitrites on the other side of the plastic, and bought a kilo of ends and trimmings.

The real commitment came when I paid for my license.

So on Sunday morning, Bethany and I put the bug spray, sunscreen, and bear spray into her backpack, loaded the pole and my lunch box (I don’t have a real tackle box) into the car, and set off for one of the local myriad of lakes, the most commonly recommended spot.

With a breeze strong enough to deter mosquitos, and skies fresh washed by heavy rain the night before, we pulled onto a spit of land and parked in the shade.

I can’t tell you why I can handle worms and body parts without revulsion, but bacon makes my skin crawl. Still, I got a good hunk of it on the hook, and casted it into the wind.  The idea of this rig is to put the sinkers on the bottom and have the bait floating free.  Then I sat down on a log.  Bethany, who helped assemble the equipment, sat down to read.

My mind drifted.

More serious, better equipped fisherman would have a truck and a boat. Or at least a good size cooler, a chair, and a real tackle box.  But I learned in archery that the more seriously you take something, the less fun you’re having when you do it.  And, at this stage of the game, I can’t blame the pole for angling failure.

Then the rod thumped in my hand. I tried jerking the pole to set the hook but the sinkers had wedged up against something on the bottom.  I jerked, and pulled this way and that, and started to reel in the line.  Of course by that time the fish had thrown the hook.

I kept cranking, knowing I’d have to rebait.

Then the rod thumped again, and I realized the fish hadn’t thrown the hook.

I pulled in an 18 inch fish that I couldn’t identify. With Bethany’s help, I dispatched him.  I put more bacon on the hook (not as bad the second time), and cast again.

The second fish took the bait but not the hook.

The third fish, of the same species as the first, took the hook deep and, though smaller, couldn’t survive release.

We now had enough fish for a meal for two. And as much fun as fishing is, I don’t harm animals except for food and self-defense.

I fried the two fish, both a bit big for the frying pan. We found the flesh tasty but bony.

I changed clothes in the afternoon and went over to the hospital

My patient, one of those who know more about fishing than I do, identified the fish as a pikeminnow (formerly called squaw fish), a rough or coarse fish without limit or size restrictions.

Fish snobbery fills the angling world; Iowans turn their noses up at the invasive silver carp, Alaskans won’t eat pink salmon, and fly fishermen display bumper stickers saying “To spin is to sin.”

But I was thrilled to catch a rough fish the length of my forearm. Even if I had to touch bacon.

 

Taking lessons at a block party

June 23, 2013

I’ll tell you how full is my dish.

A job sounds oh, so delish,

I will not go sour

To be paid by the hour

If after my work I can fish.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In 2010, I danced back from the brink of burnout and traveled for a year doing temporary medical assignments from Barrow, Alaska to New Zealand’s South Island.  I’m now working at a Community Health Center part-time, which has come to mean 54 hours a week.

I talked to a colleague with cancer today.  He faces a good month of surgery and chemo, and uncertainty of eventual return to work. We discussed the price that call exacts from a doctor.

A couple weeks ago I ran into another doc who retired completely 5 years ago at age 55.  He looked energetic and rested.  He talked with relish of how he’d taken a hammer to his laptop as his last act as a doctor.

A lawyer at a social gathering recently asked me what I thought about the Affordable Care Act, and before I could get a complete sentence out had fallen to pontificating about how the problems with American medicine were the fault of the AMA.  I listened for a quarter of an hour, and asked if he wanted to hear my opinion, or just go on about his.  He responded, frankly, that he didn’t want to hear what I had to say.

I would have told him that the ACA, good for the doctors and bad for the country, just makes me more marketable.

A couple of neighbors got together and threw a block party yesterday.  Over burgers and potluck I talked with some retirees, to try to get a sense of what they did with their time.  The most senior of the group, a WWII vet, now in his 90’s, still drives and still works.  Those of his employers I’ve spoken to love him; he shows up and he does his work and carries a reputation for complete trustworthiness.  His job bring him fulfillment, and I suspect adds to his life expectancy.

After the block party I went home and did some more work on my application for a locum tenens assignment.  I put together documentation for the easiest 225 hours of Continuing Medical Education (CME) from the last two years.  I copied the recertification wallet cards for the life-saving courses of ACLS, ATLS, BLS, and NRP.  I updated my legal history to reflect my (wrongful) speeding ticket in New Zealand and my four new but deserved parking tickets here.

I said yes to this assignment even though I have plenty of work at home.   I love my work but I want it to stop at 40 hours, and if it doesn’t stop at 40 hours I want recompense for the extras.  And I can walk to great fishing from the clinic.

Even with a contract signed the job could fall through.  If it does, I’m still going to go on vacation.

And I’m scanning my documents in case I want to go back to the locums life.  I’m trying to take lessons from the veteran I talked to.

 

Prepping for a new assignment with the certainty of uncertainty

March 8, 2011

Here’s something to keep you from hurtin’,

Set emotional pain to avertin’

     Whatever’s arranged

    Is bound to get changed

The future is always uncertain

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  I just got back from a six-week assignment in Barrow, Alaska, the northernmost point in the country.

I’ve been prepping for an assignment in another country but I’ve not written any details about the trip because so many times in the past deals have fallen through at the last minute.

My plans have changed a a lot since I decided to make a career change.  I rejected my first scheme, to stay in Sioux City but work in an allied clinic closer to home, after less than a week of consideration.  Thinking it through I realized I wouldn’t be slowing down at all.

Another plan, involving a local Indian reservation, turned out to be inside the thirty-mile limit of my contract.  Negotiations with another reservation fell through, I suspect because I asked for too much money (and they didn’t even make me a counter-offer). 

Then I had the idea that I should retrace my steps coming here, and work in Michigan, Wyoming, New Mexico, and Nebraska.  The timing turned out to be too complicated. 

I started talking with recruiters from Locum Tenens agencies.  When I finally figured out where to post my bona fides I started getting lots of calls.  Hint for any doctors or recruiters who might be reading this post:  doccafe.com and the New England Journal of Medicine have excellent bulletin boards.  I’m shocked that more agencies and doctors don’t use them.

I keep modifying my agenda, and I’ve stayed flexible.  I’ve assented to 19 jobs so far, of which four didn’t fall through and one is pending.

And I had a great time at all four jobs.

This upcoming placement, if it works, has changed and morphed.  Clinics in towns with exotic names requested a locum tenens (substitute) doctor, then changed their minds.  Other facilities, where I’d like to work, want me but bureaucratic rules could not be circumvented.  In the meantime, I corresponded with the recruiter over and over.  I searched Wikipedia and Googlemaps and Weather.com.  One recruiter left for a different position and another recruiter took her place. 

When we thought things were set, and that I’d for sure have work, I sent off to my licensing boards to send Certificates of Good Standing to the country’s licensing body and we booked tickets. 

Today I got an email titled Change of Plans.

I called the recruiter and turned on the phone’s speaker.

The proposed first placement wasn’t going to work out.  How about something else?

I grinned, but I watched Bethany’s smile fall from her face as we listened to details.  A different climate, and instead of pastoral farm country, we’d be on the beach.  One central hub facility and six outlying clinics.  Temperatures slightly warmer.  Excellent fishing, but marginal hunting.  I remained enthusiastic.

 In the last year I’ve learned to keep myself flexible when it comes to future plans, though I can’t deny the emotional rollercoaster ride from making plans and having them change.

When we hung up I was still smiling.  “It’s all good,” I said.  “Worst comes to worst, we’ll end up having a vacation till we’re tired of vacation, then we’ll come home and I’ll find something else.”

“I want some of what you’re taking,” Bethany said.

I handed her some chocolate chips.  “Take two of these,” I said, “You’ll feel better.”

ABCD: Always Blame the Cottonpickin’ drug

December 4, 2010

I relieved a lot of the fears

Of some folk with pain in the ears

     There was no detection

     Of otic infection

And I avoided the toddler’s tears.   

Friday’s schedule brought several patients with ears, nose, and throat problems.

Four, of varying ages, had earaches.  Not one had an ear infection. 

The ear sits so close to the jaw joint that less than the width of a dime separates the two at their closest approach.  The more sensitive structure, the ear, perceives pain before the jaw joint; people feel their jaw joint or temporal-mandibular joint pain in their ear, not their jaw. 

I removed ear wax, I prescribed antibiotics for dental infections, and I advised acetaminophen (Tylenol).

I examined four children under the age of three.  I played with them until their ears, nose, throat, heart, lungs, and neck had been examined.  Despite expectations of the caretakers to the contrary, I didn’t require the restraint of the child.  I use a number of tricks to reassure children, which vary by age; I enjoy exercising my expertise with this problem.

One of the patients, aged 76, of whom I write with his permission, has been married for more than fifty years and retired from carpentry for six.  He intended to do a lot of fishing when he retired, but now he’s as busy with carpentry as he was before he started drawing his pension.  We talked about what goes into a good retirement, and we agreed a person has to retire to, not from, and if a person stops they die. 

I received word about another patient I’d previously attended for confusion; I’d recommended cessation of Aleve.  Prompt resolution of symptoms followed.

I use the acronym ABCD as one of my guiding principles:  Always Blame the Cottonpickin’ Drug.  Naproxen, the key ingredient in Aleve, has few mental side effects.  Many people, like this patient, have taken it for years with no problem.

Twenty-seven years ago, Bethany and I went on a tandem bicycle trip, where she developed knee pain.  At the time I took indomethacin for the chronic back pain caused by ankylosing spondylitis (a disease much like rheumatoid arthritis of the spine), and I offered her one of my pills.  Half an hour later, she said, “I think I’m getting high from the indomethacin.”  I assured her she’d imagined it.  Three minutes later she started to giggle.  The road conditions abruptly went from great to perilous, and she continued to giggle, asserting that indomethacin caused her sudden good mood.  During the subsequent six hours when she didn’t giggle she laughed.   The drug wore off about the time we found a motel for the night.  She enjoyed indomethacin so much she never took it again.  Later I found the Physician’s Drug Reference (PDR) listed euphoria as the least common side effect. 

I learned from that and other experiences that any person can have any side effect from any medication. 

I have never seen a patient confused from Aleve before, and I probably won’t again.

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.

Capsized in Prince William Sound

August 10, 2010

We caught our limit of fish

It was everything that we could wish

     But we lost a rod

     After a fine black rock cod

And we ate a halibut dish

Four things went into Prince William Sound today, two objects and two people.

Lee is a remarkable man who has mastered the Zen of fishing; he is the skipper of the thirty-four foot boat we’ve taken out after halibut, ling cod, rock fish, cod, salmon, and shrimp.  He knows the places to go, he knows what the fish eat and how deep they are.  He had a beautiful fillet knife, custom-made by a prominent Alaska knife maker, serial number 1 of 250.  It was last seen sinking into seventy fathoms of water.

We started with a minimum of poles.  We had plenty of other tackle.  Two of the rods were good for salmon, rock fish, and ling cod; the other two rods were very heavy-duty and were for halibut.  In essence, because the location and strategy for halibut is so different from the others, we could only have two people fishing at once.  Which was OK till one of the rods went over the side and straight into 70 fathoms of water. 

It didn’t keep our party of four from limiting out on silver salmon, catching four black rock fish, throwing back two ling cod that didn’t quite meet the 35 inch limit, and bringing in a halibut weighing about twenty-five pounds.

There was also an immature silver salmon I caught, not much bigger than the bait fish, about 9 inches long.  I made the comment that it was bigger than the vast majority of fish I’d caught up till now.

Six years ago Les left a plastic container with ten gallons of gasoline on a charming, small island in Prince William Sound.  After we lost the rod we decided to come in early to process fish and to take showers and get more poles, and because we were in the neighborhood, Les decided to retrieve the gas can.  He rowed the dinghy up to the island, with me on board.

I’m not nautical at all.  I still say things like “downstairs” instead of “below decks.”  Les, however, is very nautical and maintains a keen sense of what should happen on the water or in small craft.  He is patient with me, instructed me where to sit in the row-boat, and how to keep my center of gravity low.  He rowed up out to the island, telling of seeing an orca pass right between two islands while he was eating lunch. 

Getting out of the dinghy was easy, I found the island charming as advertised, and I picked up trash/flotsam while he retrieved the gas can.  He loaded it with care into the dinghy and I sat up forward for the row back. 

But we didn’t quite clear the beach before Les and I dumped into about a foot of water.  By then the sun was out and we were warm enough.  We came up sputtering and laughing, and launched back to the Nanny Kay.

Firsts for this trip:  rod and reel on salt water, getting sea legs, bringing in a halibut the size of my dinner table, tasting fresh salmon roe, limiting out on salmon, catching a black rock cod, falling out of a boat.

Yes, I had my life jacket on.

The big fish that didn’t get away.

August 9, 2010

I really don’t know what to say

At the end of a great fishing day

     I learned how to feel

     With my line, rod, and reel,

So the big ones don’t get away.

We’re back in Anchorage after five days fishing on Prince William Sound, made famous during Exxon Valdez oil spill.

One day of fishing will generate more stories than can be recounted in 1000 words; we had adventures enough for a volume.  But blogging demands brevity.

Prince William Sound was formed when the sea flooded a river valley cut by glaciers.  With frequent weather changes, shifting dense overcasts, sudden fogs and squalls, its beauty is intense but brooding and sullen.

Our skipper, Lee, grew up during the same turbulent times I did.  He started as a fishing guide with his own boat at age fifteen.  He had a long, successful career as a marine diesel mechanic, and graduated to paralegal seventeen years ago.  He describes himself as a farm boy, but when he talks about the law his erudition shines through. 

Lee knows the location of the fish and their dietary preferences, their psychology, size, and habits.  He can tell if bait remains after a nibble on three hundred feet of line.  He knows by looking at the end of the rod if the fish on the line is halibut, ling cod, salmon or rock fish, and can tell you the size.

He has a mystic connection to the fish; one morning he caught three black rock fish in the time it took me to put on my boots.  He was very patient with Bethany and me.  The first day I couldn’t tell a nibble from a bite, and I didn’t know how to set the hook properly; I lost more fish than I landed.

On day one, the silver salmon came, bit leisurely and followed the line to the boat docilely, after that they jumped and spun and ran and fought.

Bethany caught a forty-two inch ling cod the second day.

The 37 foot cabin cruiser was manufactured in 1978, and was not well maintained by the owner who sold it to Lee’s friend, who now wants to sell it.  Lee can fix anything on the boat.

Inside, the comfortable craft sleeps six, has a 3 burner stove, a serviceable head, but no working shower.

Bethany has had problems with motion sickness.  She used the patch behind her ear, and it worked well for her.  I didn’t have a problem with seasickness; to my surprise I found the rocking motion of the boat soothing and promoting of a good night’s sleep.

Fishing on Prince William Sound

We’ve been talking for years about going on a cruise, but Bethany was hesitant because of the seasickness issue.  We can now start making actual plans.

After five days I was baiting my own hook and I could identify the fish before it surfaced.  Very early on I more than doubled my lifetime biomass catch of fish when I pulled up halibut the size of my dinner table (fifty inches, no exaggeration). 

I threw back more fish on this trip than I’d caught in my entire life previously.  Kelp greenling turn to mush when cooked, as do saber-toothed flounder.  The flounder that I caught, microscopic in comparison to the halibut, wasn’t worth cleaning.  Pink, or chum salmon, don’t taste nearly as good as the silver salmon.

Golden eye rock fish look like a kabuki nightmare.  They flare their gills and poisonous spines when brought to surface; their disproportionately large eyes bug out of their blaze orange heads.

While jigging just off the bottom for rock fish one day I hooked something of enormous weight and reeled in a ling cod a few inches shy of the 35 inch minimum, and threw him back.

The big ones didn’t get away this trip.

A short hiatus to go fishing.

July 30, 2010

The scoop that I’ll be dishin’

A trip for which many are wishin’

  The Place that I’m bound

  Is Prince William sound

For a week I’ll be going out fishnin’ 

 

I’ll be fishing for the next ten days with Bethany, Les and his friend Lee.  I’ve not done much fishing in the past but I enjoyed what I did. 

We’ll be in a location so remote that there is no internet access; yes, such things, like musk oxen, still exist.

Posts will restart on my return.