Posts Tagged ‘Northern Lights’

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.

 

Overnight in Ketchikan

April 10, 2016

Up here, it’s one of the sights

When present it cheers up the nights

I regretted quite loudly

That the sky was too cloudy

To see the great Northern Lights.

 

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 last winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. After 2 months in western Nebraska, then two months in coastal Alaska, I’m now in the Alaska Panhandle.  Any specific patient information has been included with permission.

 

After an overnight in Anchorage, we arrived in Ketchikan, Alaska’s first city and never Alaska’s capitol.

Contrast is the essence of meaning, and Alaska’s hugeness makes for a lot of contrasts. After overlooking an arm of the Bering Sea from a coastal plain with mountains 30 miles distant, mountains here rise abruptly from the salt water, with not a single swath of tundra to be seen.

Technically in the same time zone, we crossed 24 degrees of longitude to get here, as many as you cross getting from New York to Chicago.

Ketchikan built its airport on an island, and, I suspect, built the island for the airport. One takes a ferry to town.  Anticipating problems with luggage, transitions, and inadequate support for the profession of skycap, the airport offers free luggage carts.

We found Ketchikan’s mood much like other tourist towns in the off season. The gold rush over and the timber prices low, tourists won’t start arriving by the literal boatload till May.  The other industry, salmon canning, stays small to stay sustainable.

The town features large on cruises of Alaska’s Inside Passage, and last year more than a million tourists filtered through.

We stashed our cooler full of salmon in the Best Western’s freezer space. The hotel’s service amenities include a van that drives people around town.

We went grocery shopping, knowing the high prices found on any island, especially an Alaskan island. We walked back to the hotel because we needed the exercise, exploring the Marina and the parking lots off Tongass Avenue, the main drag.

On the advice of a ferry passenger, we went out to the Lodge at Cape Fox, a first class restaurant run by a Native Corporation.  We enjoyed a spectacular view of the harbor and Halibut Olympia, while we discussed a weight loss strategy for our upcoming stay.

The news predicted great Northern Lights. After dark, I went outside to look up and find dense cloud cover.

Still making housecalls

March 26, 2015


The sun on the snow gets so bright
Reflecting the light off the white
The stuff new to me
Is wonderful, see,
And Aurora brightens the night.

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.

I make house calls. I enjoy them. I don’t do them very often.

When I worked in Navajoland, the war between the bureaucracies resulted in the demolition of a perfectly good clinic with the empty promise of a quick replacement; I got mean after two weeks of pay with no work and talked the Public Health Nurse into driving to hogans. I treasure those memories of the community I got that way.

Sometimes at home “housecall” means the patient comes to my house.

Here in Brevig I made three house calls on foot today. The Community Health Aide (CHA) and I walked together, through the blinding bright sun-on-snow, in bitter cold and wind.

Confidentiality precludes discussion of patients and problems in any but the most general terms. All three patients would have had difficulty getting to the clinic.

But I can talk about the context.

All the houses had portico closed on three sides, protecting the outside door and a space between the inner and outer doors. Two had firearms casually stacked in that space; I noted .22s, .223s, 12 gauges shotguns, all with outer finishes roughened by prolonged use in hard conditions. Each home had a first-class wood stove in the living area; no trees grow here but lots of wood drifts on the beach.

I saw frozen pizza boxes and traditionally dried salmon. Tabasco sauce bottles sat next to peanut butter jars. A single gleaming spark plug sat on a washing machine next to a rusty box/open end wrench. People sewed furs from sheep, beaver, seal, and wolf with waxed dental floss.

I commented to the CHA how the smallest, most mundane details of someone’s daily life fascinate people from other places; for me a flock of wild turkeys or a doe and her fawns in my backyard rate a yawn but would bring her wonder, while Northern Lights every night and a nearby island good for hunting seal knock my sox off.

During the visits people talked about bingo. I don’t gamble, but bingo on the Bering shore promised a unique experience, and at 7:00PM, my clinic documentation done, I suited up and walked out into the brightness.

I did not find the bingo game.

In a village this small and this isolated, the children play as freely as I played in the 50’s. Two, who recognized me from clinic, came up to show me their puppy while I wandered.

Back inside, my glasses frosted over, rendering me sightless till the ice sublimated and the temporary darkening relaxed.

I napped and read until a patient came in with a CHA at 9:00PM.

Not sick enough to warrant a Medevac, but definitely in need of an IV and a few 21st century pills, they left in the dark an hour and half later.

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.

Highlights of six weeks in Barrow

March 1, 2011

You might say it flew far like a sparrow

Or fast and straight like an arrow.

     But either way time

     Like a vacation sublime

Went fast while we were in Barrow

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 just finished an assignment at the hospital in Barrow, Alaska, the northernmost point in the United States, and I’m in Anchorage for two days.

Six weeks in Barrow, Alaska, has flown by.  We arrived at the end of the two-month Arctic night.  We went out in -75 degree F temperatures, and we stayed inside while the worst blizzard in four years raged outside.

Gone!

Blizzard in Barrow

I worked 360 hours while here, but the other doctors worked more hours than I did.  I received the lightest load on the call schedule.  I didn’t work any nights.

I saw a lot of broken ankles, from snow machine accidents and falls on the ice.  I picked up two cases of vitamin B12 deficiency, nine cases of vitamin D deficiency, two cases of hypothyroidism, and not one case of frostbite. 

I took care of people from all over Alaska, including Barrow.  I also saw those from Tonga, the Philippines, Hawaii, Korea, California, Tennessee, Kentucky, Mexico, Canada, Puerto Rico, Florida, England, South Africa, Colombia, and Ireland.

I met people who had survived plane crashes and gunshot wounds.  I made personal acquaintance with more than a dozen whaling captains, and more than two dozen who had personally killed whales.

A lot of the men had taken polar bears, most at close range with low-powered rifles, many in self-defense.  One had killed a polar bear without a firearm at all.  

I talked to women who sew the seal skins onto umiak frames, and the men who hunted the seals.

When a white-out shut the town down for four days, I suited up and went outside.  Twenty paces from the building I thought better of the venture and turned back.

I didn't have to go out in a blizzard to ice up.

We watched the first dawn after sixty-three days of darkness on the afternoon of January 24, and watched it set less than two hours later.

First sunset and first sunrise in 63 days, at the point. January 23 2011

The medical community viewed the Superbowl in the Commons room, farther north than any other medical staff activity in the country.

I talked to other hunters who shot caribou, wolf, goose, duck, wolverine, seal, and walrus.  Several people had been hunted by polar bears, but lived.

We saw the Northern Lights, I for the first time and Bethany for the second.

We attended Kiviuk, the Messenger Feast that happens every two years.  I saw dancers passionately portray heroic stories with their dances.

Afterwards, while the Northern Lights swept mutely across the sky, we watched the best fireworks display I’ve seen.

While we were here we saw pressure ridges form in the ice on the Arctic Ocean.

For every active drunk I took care of I met two in recovery.

Bethany taught sign, Inupiak, Special Ed, third grade and fifth grade.  She made a lot of new friends, one of whom she started into knitting.  She got a lot of exercise.

I drove twice, a total of less than fifteen miles.

We had the best Kung Pao chicken and Mongolian beef we’ve ever had.

Both of us lost a few pounds.

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.