Posts Tagged ‘NOAA’

Meeting the VA’s New Rheumatologist

January 11, 2017

I drove through the snow to Sioux Falls

The place with the old red brick walls

Where it seems it’s the norm

For the staff to be warm

To the vets who walk down those halls.

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 assignments in western Iowa and southeast Alaska, I’m back home. Any identifiable patient information has been included with permission.

I heard this joke in 1982: You walk into the patient’s room in the VA and there are three glasses of orange juice on the bedside table.  What’s the diagnosis?

The punch line goes, “Patient died 3 days ago.”

Fast forward 20 years.  Having suffered for more than 30 years with chronic back pain from ankylosing spondylitis (much like rheumatoid arthritis but affecting the spine) I had started the miracle drug Enbrel a year prior, and finally got an appointment with the Veteran’s Administration rheumatologist in Sioux Falls, South Dakota.

Please do not judge the VA on the delay of care. I separated from the Public Health Service (along with National Oceanographic and Atmospheric Administration, the two uniformed services that no one knows) with such anger that I divested myself of certain papers. After the critical regeneration, booking a first-time rheumatology appointment took the same 6 months that it would in the private sector.

I came unprepared for the warmth and caring that flowed from everyone in the institution. I certainly did not expect two secretaries on their lunch break to help a clearly disoriented vet wandering the hallway, nor to do so with such kindness.

Since then I’ve driven once or twice a year back to Sioux Falls to meet with the rheumatologist. Every month or so I get a refrigerated container in the mail worth about $2,500.

The routine includes a lab appointment; if scheduled for 9:00 I can count on being done with the blood draw by 9:02. I have watched the system acquire bits and pieces of efficiency, until it happens as fast as possible without rushing the patient.

I’ve not had a morning doctor’s appointment previously. The blood test itself takes an hour to run, and I can only imagine the clockwork precision behind the scenes.

I sat down to wait. I napped.  I read a medical journal I’d brought from home.

I chatted with another vet, one of the moral giants who regularly walk the corridors there. I saw a lot of modified heroes.  In the last 15 years I’ve seen the number of women vets steadily increase.

A nurse came out to tell me of the doctor running behind schedule. I told her I understood patient flow, especially in a raging blizzard.

The doctor apologized to me for the delay, too, before anything else. I’d not met her before.  Young, energetic, and kind, she has a quiet competence about her along with the extraordinary intelligence that  permeates the subspecialty.

We both spoke well of the rheumatologist who preceded her during his semi-retirement, and I thanked her for coming to the VA. We agreed that telemedicine might be the future in a few specialties, but not in rheumatology.

Not until I explained my ankle problem in medicalese did she ask, and I told, of my status as a physician.  After that things went much faster.

I spoke briefly of how much I liked locum tenens. But I didn’t give details, so as not to make the next patient wait longer.

Where I’d walked into the building in low visibility, I walked out in bright sunshine. A fierce north wind which ruined gas mileage on the trip up sped me on my way home.

 

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No such thing as a free breakfast

November 15, 2015

Uncle Sam sure lied to me
And paid me a much smaller fee
I didn’t know what I’d get
Because I’m a vet.
Still, free breakfast just wasn’t free.

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 (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, two weeks a month working Urgent Care in suburban Pennsylvania. Any patient information has been included with permission.
On Veteran’s Day, Bethany and I went out to a chain restaurant that offered a free breakfast to veterans. I brought my VA card.
Ankylosing spondylitis kept me out of the war in Viet Nam. Later on, when I sought to enter the Indian Health Service, I believed them when they said that I could only get in if I went as a Commissioned Officer (they lied); ankylosing spondylitis would have disqualified me, but a report from a shaky radiologist sealed the deal, saying “no evidence of sacroiliitis.”
The Department of Defense (DoD) controls 5 of our Uniformed Services (Army, Navy, Air Force, Coast Guard, Marines), but not the Public Health Service (PHS) or National Oceanographic and Atmospheric Administration. My service in the PHS qualifies me for Veterans’ benefits at the VA, and the VA has been very good to me.
In fact my IHS service units had Civil Service employees working the same job as Commissioned Officers. They got overtime past 40 hours a week and started with more than twice the base salary. All in all, my naivete cost me more than a quarter million dollars early in my career, but the value of my VA benefit is catching up. And I count my time as a Commissioned Officer as priceless.
There is no such thing as a free breakfast.

Conversations with a Marine and a pessimist; eights shots to the zero

November 11, 2010

Today I went down to the range

Thinking my sights I would change

     In eight shots I was zero’d,

     I’m a vet, not a hero.

With benefits, well, rather strange.

I showed up at the gym an hour later this morning than I usually do and struck up a conversation with the fellow on the stationary bicycle next to mine.

We graduated high school the same year.  He loves watching his career-long project, thirty-two years of work, coming together. He’s looking forward to retiring.  He has a National Guard pension, his wife has a pension as well.  When they get to retirement age they’re planning to work because they love it.

I mentioned that I get VA benefits.  He’d served with the Marines in Viet Nam, and he wanted to know what branch of the service I’d been with.

Most people can name the five uniformed services in the Department of Defense: Army, Navy, Air Force, Marines, and Coast Guard.  Our nation has two other uniformed services: National Oceanographic and Atmospheric Administration (NOAA) and the Public Health Service (PHS).  A uniformed service runs on a military model and has a uniform; I finished my time with a rank of O-6 and I never wore the uniform though it still hangs in my closet.

Contrast as the essence of meaning: though the government calls us both veterans, clearly the word means two different things when applied to us; I never carried a weapon in my five years of service.

I started owning firearms as soon as I could afford them.

Late in the afternoon I took my muzzleloader down to the range to sight it in.   Shot by shot, I poured powder down the barrel, rammed the projectile home, placed a primer under the hammer, and took careful aim.  I adjusted the sights and after eight shots I hit an inch above the bull’s eye at a hundred yards.  When I retrieved the target, all eight shots were in a four inch group, though I’d moved the point of impact two inches left and two inches high.

Projectile weapons enthusiasts in our country tend to be conservative and anti-government.  I showed off my target to another range member.  He asked me if I hunted, and I said I did.  “Yeah, you know, I don’t hunt, but the way this election went, boy, I don’t know, it’s a bunch of crooks in Washington.  You know, you get rid of one bunch of thieves and put another in.  I don’t care what you call ‘em, Democrats or Republicans or Independents, they’re all the same.”

I couldn’t disagree with him.  But I pointed out that survivalists need a botany book more than they need a gun; in the absence of government, hunters will take the animals quickly, but plants will offer a longer-lasting food supply. 

Then I said that even if the government consists of crooks and thieves, we’re better off now than we ever have been; quality and availability of goods, services and information continues to improve yearly.  A depression in 2010 beats the best of times in the ‘50’s.

He couldn’t disagree with me.  As I walked away he thanked me for putting a positive spin on his day.

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.