Posts Tagged ‘Inuit’

Corneal numbness and a schizophrenic hitchhiker

April 24, 2018

You might think cocaine’s a prize

The truth is it’s a thing I despise

You’ll hallucinate bugs

On that class of drugs

And you might try to pry out your eyes.

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. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

Before and after clinic, and between patients, the docs in this clinic congregate in an office with 6 chairs and computer stations.   You can find quieter, more efficient places to dictate or keyboard or research under this roof, but, still, docs who have work stations elsewhere come in frequently during the day.

Earlier this week, at the beginning of the day, I brought up the subject of eye pathology. In the course of a referral to an ophthalmologist, I learned that cocaine abuse can numb the cornea, and I spoke the new knowledge to my colleagues.  The information amazed them just as it had amazed me.  And then the clinical stories started.

Cocaine and other drugs like unto its kind, such as meth, speed, or crank induce hallucinations and delusions. Paranoia, of course, runs rampant, but so does the sensation of insects or foreign bodies in various parts of the body. Most people who have known tweekers know that they pick at themselves, giving rise to “speed sores.”  They also pull out hair (trichotillomania).  But then we all listened, rapt, while one physician talked about a heavy cocaine user who had used a screwdriver to try to remove a non-existent contact lens.  We all shuddered, shook our heads, and muttered, “drugs.”

Canada stands on the verge of national legalization of marijuana, and I see no good coming from it.

+-+-+-

I got called to ER for 2 patients in the early morning hours. The second patient recognized and greeted me by name.  “Were you gone for a while?” she asked.

Within 24 hours two more patients made the same mistake: they thought I had permanent status rather than temporary. The place is starting to feel like home.

+-+-+-

I picked Bethany up at the airport in Prince George Friday evening. We stayed the night, went grocery shopping at Costco on Saturday, and got on the highway.  Just outside of town, we picked up a hitchhiker.

Last summer we picked up a couple from Europe, working their way across Canada for a year.

This time, at about the same place, I pulled over for a middle-aged man with backpacking gear.  We chatted as the kilometers slipped by.

Residing in some of the more violent, drug-ridden, lower-rent sections of East Vancouver, he’d lost several bicycles and his wallet to theft. In years past, he’d driven motor vehicles, from garbage trucks to RVs, from the Midwest US to Anchorage, Alaska.

Then he started to talk about how dizzy he got when surrounded by too much technology, especially wi-fi.

He planned to take the Dempster Highway north through the Yukon to Inuvik, the capital of Nunavut, the Canadian Territory that belonging to the Inuit.   He wanted to work along the way.

As the now familiar highway slipped past, I listened to his delusions coming with increasing frequency, without contradicting.

I strongly suspect untreated schizophrenia.  He can function in society, even if he functions marginally. He can hold a job, even if not for very long, and he has chosen a path that leads him away from high availability of drugs.

We dropped him off in an area with decent traffic flow. I looked up the Dempster Highway when we got back to town.  I hope he times his river crossings right, otherwise he’ll be waiting a month for a ferry or an ice bridge.

 

 

Advertisements

First impressions of Nome

January 4, 2015

I came from the land of the brome
To the subarctic city of Nome.
Where the story is told
Of how they dredge up the gold
But the weather is warmer than home

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.

Nome, Alaska sits 102 miles south of the Arctic Circle. The 161 mile distance prevents seeing Russia from here, even on a clear day. As I write, the Nome thermometer at 9 degrees registers 10 degrees warmer than my home town’s current temp.

Before the gold rush, Natives had temporary habitation here. But the yellow metal brought 20,000 people to Nome in 1899. The placer gold ran so rich through the beach that the extracted mineral depressed worldwide gold prices. Wyatt Earp came here to “mine the miners;” making money at gambling and alcohol, and left a rich man, in 1906.

The 100 year storm washed away most of the beach gold early last century. Dredging the Bering Sea bottom for that gold continues as a major economic activity here. The newspaper, the Nome Nugget (Alaska’s oldest newspaper) this week carries ads for 3 competing gold buyers.

At one time Alaska’s largest city, Nome now has 4500 inhabitants, about half Native. Correctly observing the pejorative nature of the term Eskimo, they prefer the word Inuit, Inupiat, or Yupik, depending on their language.

Perhaps owing to the recent passage of the Christmas holiday, the mood here contrasts with that of Barrow (see previous posts from 2010 and 2011). Nome feels more economically active and commercial. Barrow’s heart beats to the rhythm of the whaling seasons.

In town only 48 hours now, I’ve been to been to two grocery stores and two restaurants. Koreans run both eateries, but one touts its Japanese menu and the other its Chinese fare and its pizza.

I’ve also learned about the polar vortex.

Fluids of different densities, like air of different temperatures, mix poorly. As the air near the pole, in the polar vortex warms and loses its contrast to the air further south, it mixes better, and the warm air can travel north and the cold air can travel south. Thus the recent violent storms attributed to the “polar vortex” really find their cause in the weakening polar vortex. And the temp at home frequently exceeds the temp in Nome.

I declined my agency’s offer of a rental car. My apartment sits over a garage half a mile from the hospital and a mile from the furthest grocery store. I walked around Nome yesterday and the day before, getting my bearings, and breathing in the mood of the city. The commercial district, Front Street, features a lot of liquor stores, most of them closed. But I also found a theater, several restaurants, a couple of stores selling native art work, and a couple of churches. Despite the above 0 temperature, the wind made me glad of my long underwear and my Arctic grade parka with the wolverine ruff.

Medical Advice at Parties.

July 8, 2012

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 21st 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 27th 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.

Overheated, Inuit Country and Western, Inuit dancers, Qivgik, Northern Lights, and fireworks

February 13, 2011

We went out to watch, not to dance,

We went out to walk, not to prance

     To outdo Northern Lights

     We were watching last night

You would need some federal grants.

 Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

Qivgik, the Messenger Feast, started Wednesday.

A hundred years ago, one village would send a messenger to another village to invite them to a feast.  In the depths of the winter, most of the village would brave the cold and the snow to cross the tundra.  The party would last four days, with gifts from the host village at the end.  After recovery of a year or two, the invited village would return the favor.

Bethany I have had the luck to witness Barrow hosting Qivgik this year.  In the 21st century, most arrivals came by plane, few came by snow machine, and no one came by dog sled.  They flew in from Canada, Siberia, and Greenland.

Of course, most of the time I worked so late I was too tired to attend.

Yesterday the clinic’s heating system outdid itself as beastly hot; I suspect the department couldn’t have gotten hotter without installing microwave equipment.  With the extra population of Qivgik comes extra illness and injury, and my work day went late, without time to stop to drink water.  I finished sweaty, tired, overheated, on the brink of dehydration.

As hot as I was I didn’t suit up all the way, and we walked into a still night at 20 below Fahrenheit (30 below Celsius).  The fresh cold air, sharp on my cheeks and ears, came as a soothing relief. 

The snow squeaked under our boots, high-pitched as tortured Styrofoam .  Three blocks later, I was still too hot when we arrived at the Roller Rink to listen to the Bethel Fiddlers.

We brought no expectations to the listening.  Two guitarists, a bass player, and a drummer stood around the fiddler/singer who occupied center stage.  They played Country and Western, the same genre that dominated Casper, Wyoming when Bethany and I courted each other.

We hadn’t expect that music to come so far north.

The entire band, and most of the audience, were Native (they prefer the term Inuit or Native to Eskimo).  One couple two-stepped on the dance floor.  After a while, Bethany and I got up to dance, and we could see the other couple, our age and Native, were very much in love and having a great time.

We fox-trotted and waltzed and fox-trotted some more, then we went back into the night to the Barrow High School gym.  Sort of like bar-hopping without the bars.

People dressed casually for the Arctic chill, and I commented to Bethany how well we’d acclimated to the low temperatures.

In the few short weeks we’ve been here we’ve met enough people that we were greeted by name.

In the gym we watched the Natives dancing for themselves, not for the tourists.  They danced with passion, power and skill; the motions telling epic stories of adventure, danger, and triumph, and I could only understand about a third.

At one point a well-costumed young man danced while the sixteen men and women behind him drummed and sang.  Smiling, a Native man my age dressed in the blue-collar uniform of jeans, t-shirt, and baseball cap walked on, looked at the younger man, bobbed twice to get the rhythm, and started dancing.  In twenty seconds he was joined, one by one, by four others of similar age and dress, all of them grinning.  They danced well, the motions describing canoeing, hunting, and caching meat.

We left before midnight, crunching through the snow back to the apartment.  I had cooled down to the point where I buttoned up my parka, but I left the hood down.

At the apartment we sat in the darkened room, pulled the shades up, and watched the action on the frozen lagoon in front of us.  Trucks drove in circles; snowmobiles zipped back and forth, cars parked on the levee.  We talked about what we’d done that day and the dances we’d seen at the Roller Rink and the gym, we agreed contrast ruled as the essence of meaning.  People clustered more and more around the Nalukataaq grounds two hundred yards away, Bethany fell asleep, while I watched a pale green glow in the sky above the Arctic Ocean.

I woke her up when the fireworks started.  The whistlers and fountains lit up the night while the Aurora Borealis intensified and swept silently back and forth across the sky.

It was the best non-federally funded display we’d seen.

Lectures on the Sadlermuit, egg foo yung on the beach

July 25, 2010

On the ocean we watched chunks of ice

After lectures not once but twice

    We had egg foo yung

    In the blaze of the sun

And enjoyed a supper so nice.

Bethany and I walked over to the Heritage Center in the early afternoon to catch the bus out to the Naval Arctic Research Laboratory for a lecture. 

There are one or two lectures a week here in Barrow.  Some are at the Heritage Center, some at the library, and some at NARL.  The woman who runs the program declares she’s a quarter Irish, a quarter French, a quarter English, and a quarter Inuit.  She makes sure the lectures are informative and are accompanied by first class snacks.

I didn’t know about the programs till I stumbled onto one about snowy owls.  I missed a good one about how birds accommodate their circadian rhythms to the twenty-four hour daylight, and another about NOAA.  The lecture we took in was about genetics of the North Slope Inuit.

The Inuit, as we know them, spread from western Alaska across the Arctic about 1200 years ago and in the process displaced the Dorset people.  A relic population of the Sadlermuit of Hudson’s Bay were wiped out by an epidemic spread by whalers in 1902; there were fewer than 100 at the time. 

The Dorset culture hunted seals and walrus well; their parkas didn’t have hoods, they lived in scattered dwellings and were sparsely populated.  They didn’t hunt whales.

Now that we have DNA testing we can match DNA of that last group with the DNA of the people we identify at Dorset sites, and for a long time we thought that the Inuit replaced the Dorset.

But we can now say a certain amount of Dorset DNA lives on in current Inuit populations.

I would be really interested to see if there’s Inuit or Dorset DNA in Denmark.  After all, the Danes ruled Iceland and Greenland for a thousand years, and where there is cultural contact there will be gene flow.  It’s in the nature of young men and women.  Consider the woman who runs the lecture program.

On the bus out and back we talked with other lecture attendees.  One fellow has retired to Barrow after living here thirty years; he worked in Planning after he worked in construction.  One woman is a health educator and teaches at the College.  One woman is a NOAA officer, just finished a tour on a boat, is here in Barrow training other NOAA officers, and will be going to a 13 month tour of duty in Antarctica.

I talked about what I do.

The NOAA officer seemed fascinated by my job description, expressed an idea she’d toyed with of going to medical school.  Then she threw back her head and laughed and declared she didn’t like being around sick people.  I agreed, then, that med school wouldn’t be a good option for her.

In the evening, after my good, solid nap, Bethany and I walked over to the Brower Café for supper.  The building dates from 1889 and was originally a haven for stranded whalers. 

We ate excellent egg foo yung and sizzling rice soup while we watched the sun glinting on the Arctic Ocean, white ice floes gleaming in the distance.

The sea ice broke up, the eczema responded to propranolol, the young respect the elders. And don’t use possessives when you talk about whales.

June 25, 2010

I’m learning the Inuit tongue,

Enjoying respect from the young.

     It’s a terrible loss

     To get hurt blanket tossed

These are wonderful folk I’m among

I have permission to give the following information.

A teenaged patient with eczema, severe to the point of disability, came in a couple of weeks ago.  For reasons clear to me only at the time I did a thyroid test and his TSH was slightly low, indicating an overactive thyroid (the current primary thyroid test, the TSH or thyroid stimulating hormone, measures the brain’s demand for thyroid hormone; low levels indicate excessive circulating thyroid hormone).   A week or so ago I prescribed propranolol.  The eczema is markedly better today; the patient looks happier and is sleeping better. 

Next time I have a patient with poorly controlled eczema, I hope I remember the patient who had been to multiple dermatologists for years and got better with propranolol.

The patient was happy, the relative was happy; I could see things had turned out well, and I came away with job satisfaction. 

The young people treat me with great respect.  I commented on that to a knot of early twenty somethings.  They smiled at me with grandchild-like love and talked about how reverence for elders is part of the culture.

I got to talk to two people with critically low vitamin D levels, in the single digits, today.  Both have diffuse bone pain.  I explained how calcium doesn’t get absorbed or used properly without vitamin D, and in compensation the calcium in the bones gets mobilized.  Which keeps the circulating calcium up at the expense of skeletal strength.

Alas, one of the two uses narcotics recreationally; I hold confidence that I’ll make the bones better but I harbor no illusions that the narcotics seeking behavior will stop.  I hope I’m wrong.

The sea ice broke up in the early hours today.  This morning, working on the elliptical, I watched white ice flows on blue water floating slowly south, pushed by the winds. 

We’ve seen the first Nalukataaq injuries.  I’m a person with enough sense to say that blanket tossing looks like fun for the young but not for me.  Not everyone agrees with me.

My Inupiak language acquisition program is progressing.  I’m in the stage of echolalia, where I can repeat short sentences but I don’t know what they mean.  I was able to say “Good morning.  How are you?  I’m fine.  My name is Dr. Gordon.”  But my head is not in the language and the language has not taken root in my head.  I am, however, working on it.

Seeking to get a better handle on the grammar, I asked one of my informants how possessives are handled.  I got a blank stare.  I have a limited number of nouns in my vocabulary, so I started with whale, agvik.  “How would you say my whale?” I asked.  I got another blank stare.  Finally the informant said, “You wouldn’t say that.  You never say my whale or your whale or even our whale.  You just say whale, ahagvik.

Arctic walk-in clinic

June 3, 2010

A major transition’s a pain

When it comes to significant change

     If you do it too fast

    The results may not last

Too slow and you’ll suffer the pangs.

The weather cooled today, thawing stopped and everything froze.  Clouds completely cover the sky, visibility is about a half mile.  White dominates the view from my apartment window.

About one hundred yards from the hospital housing a road runs next to a six-foot berm; two hundred yards past that is the Arctic Ocean.  The berm was put up to keep the waves out-of-town when the storms get bad.

Orientation took up most of yesterday.   Employee Safety manual was pretty routine. The most common on the job accidents here are slip-and-fall on the ice.  I also have to be mindful of the polar bears that occasionally come into town.

The ethnic diversity of the hospital staff, the patient population, and the doctors startles me.  I have encountered speakers of French, English, Inupiat, Tagalog, Thai, two Malayo-Polynesian languages, Breton, and Spanish.  I was too polite to ask the first language of others from Pakistan, India, and Africa. 

Physician morale is very high.  Every weekday at 8:00 AM the doctors meet to discuss cases.  The interchange of information, the case discussion that nourishes every physician’s growth is part of the daily routine.  Of the permanent physicians, the shortest tenure is five years and the longest is 12.  

I spoke with one of the locum tenens doctors yesterday who loves Barrow.  We talked about the relief of not being an owner, or boss, and about how much more we love healing than managing medical care.

Most Natives are Inuit and do not like to be called Eskimo.  For many, Inupiak is the first language of the household.

I intend to learn at least enough Inupiak (Inuit language) to be polite.  My first word today, pahalayikpiin, is a greeting. 

The complexity of Inupiak will be beyond my grasp in the time available.  I’ll do my best and make a lot of mistakes.

I worked the walk-in clinic this afternoon.  I enjoy pediatrics, and today most of my patients were under the age of 12.

Like Sioux City, much of the adult medicine I saw today had to do with consequences of the legal addictive drugs: nicotine, caffeine, and alcohol.  Infectious disease dominates the clinical problems of the younger patients.

The hospital is making the painful transition from paper medical records to the electronic medical record.  The medical practice formerly known as mine went through the same process but we compressed it and finished in less than six months.  I have heard people express feelings that things are moving too fast and too slow.

The outpatient area moves patients through in a time-efficient fashion.  Little floorspace wastes few steps.  The amount of work that got done amazes me; there is much to be said for close quarters and against spaciousness.