Posts Tagged ‘Petersburg’

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.

Decompression: not to be confused with mania

March 9, 2014

It came, this feeling sublime,

With the freeing up of my time.

Don’t get in a panic,

I haven’t turned manic

But boy, this place is just prime.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa.  In 2010 I danced back from the brink of burnout, sold my share of a private practice, and, honoring a 1-year non-compete clause, went to have adventures in Alaska, Nebraska, Iowa, and New Zealand.  I returned to take a part-time position with a Community Health Center, now down to 40 hours a week from 54.  Right now I’m in Petersburg, Alaska, on a 1 month working vacation. 

Two weeks after I left the Practice Formerly Known as Mine, I called my doctor from Alaska.

Me:  I’m so euphoric I’m afraid I’m having my first manic episode.

My doctor:  So you’re feeling good?

Me:  Yeah.  Really, really good.

My doctor:  Are you doing anything impulsive ?

Me:  Like?

My doctor:  Like spending money?

Me:  Does paying arctic prices for a pint of Ben and Jerry’s count?”

My doctor:  No.  Or gambling?

Me:  No

My doctor:  Doing anything risky?

Me:  Like going out on the sea ice?  Absolutely not.

My doctor:  How are you sleeping?

Me:  Fantastic!  Eight solid hours a night and waking up rested without an alarm.

My doctor:  You’re not manic, you’re just happy that you’re decompressing.

That same euphoria washed over me in waves while I walked around Petersburg the day I arrived, just an overall sense of happy.  Yes, the blue sky and the dramatic mountains could take the breath away from a fish, but it takes more than good weather to bring happiness.  I suspect I’d be this happy if I wandered around Pittsburgh (I won’t write off that possibility).  I think it has to do more with freeing up of time constraints than with scenery or a new place.

***

I left for work back home on a Wednesday with the thermometer firmly at 7 below zero; I got off the plane in Petersburg, Alaska at 45 degrees, and the air, compared to Sioux City, smelled like spring.  I ran around in shirt sleeves till the sun went down.

***

First thing off the plane I went to the clinic, where, since I left in August, a new electronic medical record (EMR) system has taken hold, though the reasons remain unclear to me.  Sleep deprived and jet lagged (the trip lasted 28 hours), my brain fails to consolidate the lessons.  Yet I observe that if it takes me 3 tries to learn something, I might as start that day  and have my first failures out of the way.

***

Second day of clinic I find I learned more than I thought.  As with any complex computer system, I run into some transient functionality problems.  Because I can’t talk about patients, I’ll talk about the disease states I encountered:  sore throat, cough, back pain, laceration, and neuropathy.   I saw four patients (if you do the math you’ll see at least one patient had more than one  diagnosis) at the rate of one per hour, and for Monday I have the confidence to handle one every 45 minutes.

I seem to learn quickly.

End of the Salmon Season

August 26, 2013

The cannery workers get tired,

In the cold and the wet they perspired.

Your attitude sours

With unreasonable hours

I watched a fellow get fired.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations.  After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center.  I’m taking a working vacation now in Petersburg, Alaska.

A cannery worker in Petersburg signs up for 10 weeks of 16 hour shifts, and no days off.  One hundred twelve hours in a week fetches 72 hours of overtime, to make the equivalent of 148 hours of pay.  An unskilled worked could conceivably gross $11,000 in a summer, but faces the difficulty of paying for a round trip ticket.  The cannery offers a bonus of $400 to those who finish the summer.

People with functional, stable home lives don’t sign on for that kind of job; each person on the cannery work force brought drama with them.  And each bit of drama showed irony when it arrived on this island.

One plant has 600 workers but loses 2% per week.  This season, 120 workers quit or got fired.

Undoubtedly a few get news from home that whatever they fled from has resolved.  Substance abuse sabotages others.  But a good number just break under the strain of sleep deprivation.

One patient came right out and asked for a day off to sleep in front of the plant safety manager, who  said, “Please, doc, give it to him.  He’s been working 16 hours a day for the last 10 weeks.”

I rarely find that kind of sympathy coming from management; I wrote the note from my heart.

No one should work doctors’ hours except doctors.  I understand why management set things up this way.  Housing comes at a premium, workers want to maximize the return on their travel investment.

I see the human cost.

On my last day here, a Sunday on call, I walked back from the Medical Center.  With patients tucked in, and no work expected for a couple of hours, I stepped into the rain, under the sky completely overcast.  I walked two blocks downhill to the main drag, Nordic Drive, and a block up to the hardware store, past cannery workers looking lost and exhausted, speaking English, Spanish, French, Patois, and Amharic.  I bought a 3 day fishing permit to start Monday.

I turned up Nordic Drive, walking uphill, south, between the canneries and the cannery housing.  A block ahead, I saw a tall, thin young man with an enormous duffel on his back, and a blue backpack hanging in front.  He spoke to an older, shorter man, who, judging from body language, gave directions to either the ferry terminal or the airport.  The younger man appeared confused.

As I passed the pair, I heard the young man say, “I don’t understand why.”

The older man said, “Because you’re terminated.”

The young man had spent close to a thousand dollars to get here, had worked horrible hours, and faced an unscheduled departure.

I kept walking up the hill.  Within a hundred paces I left behind the cannery noise, industry and commerce, the large Victorian homes built a hundred years ago at the edge of town, past the top of the hill, to where Nordic Drive runs along Wrangell Narrows and the residential area with its pocket parks comes almost to the water.  A murder of crows gathered on the phone lines.  A bald eagle glided across the water.  Gulls gathered on the intertidal by the thousand.

I thought about drama, irony, contrast, and meaning, and how context makes all the difference.

Tomorrow we’ll start winding this trip up.

 

Whales, eagles, and salmon

August 18, 2013

The fish will never ask why

Their biology demands that they try

The end couldn’t be sadder

For at the end of the ladder

The salmon spawn and inevitably die

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations.  After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center.  I’m taking a working vacation now in Petersburg, Alaska.

Life in Barrow, Alaska finds the rhythm of its heartbeat with the whale, Keosauqua with the deer.  Our home town of Sioux City, Iowa breathes with the corn cycle.  Petersburg, Alaska has its pulse with the fish, in particular, the salmon.

A Norwegian fisherman opened a cannery and founded the town about a century ago, and Petersburg has depended on salmon since.  They also catch cod, crab, shrimp, and halibut, but without salmon, the town wouldn’t exist.

Nine hundred seasonal workers came this summer to work 16 hour days in the canneries, and you can find no more than two degrees of separation between anyone in town and the fishing industry.  By the time someone finishes high school here, they have worked in that industry at some level, whether on a fishing boat or in the cannery.

Today we drove out to Hungry Point and watched the same humpback whales we’d seen in Maui.  We had brilliant conversation with two tourists from Australia.  We went a bit further down the coast to Sandy Beach and watched pink salmon desperately trying to swim upstream to spawn and eagles leisurely waiting to feed on them.

We enjoyed the spectacle, and talked to some people from Petersburg.  The rainfall ran short this summer, and the beautiful clear days have come at a price; one can’t have a rain forest without rain.  Streams have to have adequate flow for the salmon to swim.

People who live here will readily say that king, or Chinook salmon taste best, followed by red (sockeye) or silver (coho).  They speak with disdain of the pink (humpies), saying they’re good for cat food.  And no one even mentions the chum or dog salmon in terms of human food.  Yet the canneries this year will mostly process the pink salmon.

We drove out south on Mitkof Highway along the Wrangell Narrows.  We found the fish hatchery closed, and by then the good hard rain made viewing salmon swimming impossible.  On the way back to town we stopped at the Falls Creek fish ladder, which we found despite the abysmal signage.  While the rain came harder and harder we stood and looked over the concrete, manmade steps that parallel the roaring rapids.

It took a while till we knew what to look for, then the drama of the eternal struggle of life’s longing for itself played out in front of us, salmon desperately swimming against an overwhelming current to find a place to lay and fertilize eggs before they die.

No Pacific salmon survives the reproductive process.

The Valiant Curiosity passed close by

August 14, 2013

 

On this island is it peace that they sought?

Or perhaps it’s the fish that they caught.

Up the Narrows, please note,

There came a large boat,

The world’s 60th largest yacht

 

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations.  After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center.  I’m taking a working vacation now in Petersburg, Alaska.

Bethany and I walked back the half-mile from the Petersburg Medical Center on a beautiful late summer evening.  As we ascended our stairs, we looked up Wrangell Narrows at the incoming boat traffic.

A lot of commercial fishing ships call this part of southeast Alaska home.  A series of fjords makes a previous mountain range a cluster of islands, and Wrangell Narrows doesn’t permit the entry of the big Alaska cruise ships.  In the process of learning the difference between, for example, a seiner and a long liner, we look at the structure, and guess out loud.

“It’s a couple of seiners,” we say, “See the skiff being towed and the pile of net on the afterdeck.”

Then we wondered what we saw approaching.  “I think it’s a pleasure craft,” I said.

“Something that big?” Bethany asked.

The vessel stood three stories above the water, but lacked the worn look of a working boat.  In fact, it gleamed white.  No one stood on the foredeck, as for a cruise ship, and the afterdeck sported tables with umbrellas and chairs but no tourists drinking cocktails or eating al fresco.

As she passed by 70 yards away I read the name, Valiant Curiosity.  In the Information Age, we could gawk while she passed out of sight, and, five steps later, put the name in the search engine.

The world’s 60th largest yacht, built at a cost of $100 million for a billionaire German screw tycoon, had purred in front of us at a pace of 18 knots.  It left Seattle on June 18 for an Alaska cruise.

Pretty, but not as beautiful as the tree-covered mountains rising abruptly out of the water 400 yards across the Narrows.  Not breath-taking like the snow-covered peaks looming to the south.  Graceful, but not like the eagles, geese, or even the ducks.  Impressive, but not as impressive as the 900 seasonal cannery workers at their 16-hour-a-day, 7-days-a-week jobs.

We wondered why such a craft would come to Petersburg, a fishing village of 3,000 permanent residents, no gourmet dining and nightlife limited to two blue-collar bars.

I do not plan on finding an answer to that question.  And the best questions don’t have answers.