Posts Tagged ‘polar bear’

Foxes, itches, triumph, and hunter: on the cusp of leaving Nome

April 1, 2015

On the med list I’m pulling a switch
‘Cause my patient came down with an itch
Now they’re getting the sleep
That’s restful and deep
And for trazodone I found the right niche

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 back to Nome from temporary detail to Brevig Mission.

I took care of a patient with a very bad diagnosis and a very bad itch. I will leave it up to the specialists to try to change the course of the disease, here in Nome I will try to relieve suffering. Because itch in the context of unrelenting pain constitutes torture. We looked over the med list.

Me: Aren’t you allergic to codeine?

Patient: Yes, it makes me itch, real bad. Same with the hydrocodone.

Me: Stop picking at yourself. Why do you take the oxycodone?

Patient: Beats me. Doesn’t work. That’s why I finished ’em early.

Me: If they don’t work, why do you take it?

Patient:

Me: Maybe oxycodone is making you itch. Let’s try stopping it.

Patient: But how am I going to sleep?

Me: How are you sleeping now?

Patient: I’m not. Those pills don’t work.

Me: Maybe we should stop them.

Patient:

Me: How about if I give you a sleeping pill to help you sleep and you come back next week. How about trazodone?

It took some explaining, but the patient came in, looking fresh and happy and focusing a lot better, having slept well 4 nights in a row, and now having much less pain. Because (everyone knows) that good sleep helps a person deal with pain.

And another demonstration of the principle of ABCD (Always Blame the Cottonpickin’ Drug).

***

I can post this about the young man because I got permission from him and his mother and because everything is on Facebook. Well on the way to being a hunting legend at age 14, he got his first polar bear at age 11, same year he got his first bowhead whale. He has lost track of the number of walruses he’s gotten so far this year. I still won’t publish his name or what he came in for.

***

I stepped into my cubicle about 10 in the morning and saw a red fox run past.

Foxes hunt at night, any abroad by day raises suspicions of rabies. At home, if I see raccoon, skunk, or fox outside of dusk, dawn, and night, I will seek a weapon to dispatch the animal. In Barrow, we assumed rabies in all arctic foxes.

The furry red animal ran along the north side of the building, around to the west. I said, loudly, “There goes the fox!” and strode briskly to the other end of the clinic to try to get another look; I worried it might head to town. I didn’t see it again, and decided it dens either under the hospital or in the maze of construction dross nearby.

****

The first patient of the day felt really, really good after the vitamin B12 shot yesterday. Best in years; better sober after that shot than drunk.

Which made my day.

***

I leave tomorrow after an abbreviated afternoon clinic. Staffers have come in to wish me well. I got a great going-away card, a very trendy tote bag, and a pair of hand knit socks. Along with the story of the wool (starting with the sheep) and the WWI-era sock knitting machine.

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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.

Polar bears and rumors of polar bears

February 24, 2011

We had a bit of a scare

When the rumors all said “polar bear”

   Such a big predator

   Right outside of our door

You can go out unarmed if you dare.

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.

During the blizzard our patient flow fell yesterday.  This morning at our daily morning conference, we had few patients to discuss.

Not many made it in yesterday, among them a disproportionate number of drug seekers.  We talked about that problem at length.  Despite our frustration we kept good senses of humor.  Two topics generated most of the rest of the conversation, one was the weather with blizzard conditions again forecast starting at noon.

We also talked about the polar bears.

Barrow sits on a peninsula that juts into the Arctic Ocean.  With 7500 souls in towns, the bears have an area the size of Wyoming to roam and never see a human.  Natives legally hunt and eat bears, and the bears sometimes hunt and eat people.  The Barrow Inuit have drawn most of the bears away from town with a designated whale carcass dump site, six miles from any human activity.  Still, bears go where they will, and last night three of the white bruins came into town.

Bears are a fact of life in Alaska, an undeniable reality.  There are many places where getting out of a vehicle unarmed is just plain stupid.

Thus, less than twenty-four hours after our arrival, we had a pamphlet slipped under our door.

Polar bear pamphlet found under our door

 

Last night, while Bethany and I sat in the Commons, a nurse called to us from the hallway to come see the polar bear that had been sighted on the lagoon.  We jogged through the corridors to our apartments, and watched the tail lights of eight snowmobiles and trucks running patterns on the ice outside the hospital housing.

The large white carnivores had prowled around the elementary school, we heard, and had last been seen where we were looking.

Bethany, who had walked to the elementary school in the dark that morning, and had almost walked back but for the blizzard in the afternoon, said that she was even happier she’d accepted a ride. 

I learned that the bear police had been called out.

“Bear police?” I asked.  “There is such a thing or are you pulling my leg?”

The bear police get called out any time a bear is sighted in town.  The first one to kill the bear gets to keep it.

Snow machines motored, eerily quiet, on the ice in front of the windows we were looking through.   I didn’t see a long gun on the sleds or riders.

This morning, we heard three bears had been seen, one by the school, and two on the lagoon.

We found this sign posted at the exits:

Just read the sign and ignore the spelling.

Probably something I’ll never see in Sioux City.

When Bethany and I walked to the grocery store this evening, we debated borrowing a firearm for the walk.

Hospital staff changes, strep and Herpes epidemics, and polar bears shot with light rifles

February 7, 2011

I’ve hunted pheasants and quail

But the hunters here are way off my scale

     They don’t find a scare

     If faced with a bear

When they’re out on the sea hunting whale.

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.

Today the temperature bottomed out at twenty below Fahrenheit (negative twenty-five Celsius).  The morning went reasonably well, I never fell too far behind, and the patients came in an orderly fashion.  The schedule allotted plenty of time for each one.

At 11:30, the entire medical staff was called to the Commons for a meeting with the President of the Hospital’s governing body.

She told us about personnel changes, and didn’t give reasons. 

I don’t know, and I don’t want to know, why one person left or was asked to leave.  The transition will take place after my departure.  My day will run much better if I concentrate on the things I can change and influence.

No institution has attained perfection, but the hospital here made marked steps towards the better between the time I left and now.  Most notably we have developed a compassionate, effective algorithm to deal with narcotics seekers.

The afternoon brought patients in the aftermath of the influenza.  Of course several people came in with their asthma kicked into high gear.  But I also saw three cases of Herpes Simplex Virus I (HSV I, or cold sores), one of which was just in time for treatment.  Back pain and headaches worsened after the virus had gone; flu hammers the body so badly that we’ll be seeing aftershocks in the form of other diseases for six weeks.

We also have a strep throat epidemic circulating, and I prescribed a lot of penicillin.

And while those two plagues rage, there’s a subtler infectious problem at the same time: babies with aphthous stomatitis (blister-like sores inside the mouth).

Anticipation of the Qiviuk, or Messenger Feast, runs through the town like electricity.  Knowing that a patient expects fifteen or twenty patients to stay for a week colors therapeutic decisions. 

More than half my patients today are whalers.

A man I spoke with gave me permission to recount the following information.  A co-captain of a whaling crew, he killed a polar bear last year during the spring whaling season.  He used a 7.62×39 rifle, a cartridge considered by many as marginal for deer.  They had scared this particular polar bear away three times, but the fourth time the bruin approached he was not to be deterred.  At a distance of twelve paces, the man shot the bear just behind the corner of the jawbone.  The bullet did not exit, but the bear died instantaneously.  In the six hours it took to skin the first bear, three other, smaller bears approached and were easily shooed away.  He explained how he’ll use the sea to clean the hide for tanning.

Guarding the camp against bears, he said, is a very important job.  I couldn’t imagine doing it with a rifle that light.

The flu epidemic continues but other illness doesn’t stop, freight barges across the Aleutian, and a bullet-free approach to polar bears

February 5, 2011

With an ether can wrapped up with bacon,

A bear can be sadly mistaken,

     For with just one bite

     That punctures it, right?

He’ll be dead before three steps are taken.

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.

Morning rounds on Friday dwelt on the flu.   The yearly influenza epidemic is raging in Barrow, though the peak hasn’t hit, we expect it next week.  Barrow’s three retail stores have run out of Tylenol. 

Most people do OK with the infection, but a few, especially the infants, have gotten very ill.  Some have been flown out on a Medevac plane.

Though the flu predominates, we see a wide variety of other problems.

When people suddenly decelerate from going too fast on a snow machine, car, motorcycle, airplane, or boat, flesh and bone try to occupy the same space as steel or glass, snow or ice.  The person always loses.  While limbs shatter quickly, lives shatter more slowly, then families shatter later.  A permanent injury taxes resilience of the person and his or her social context, and the effect ripples through generations.

Over the yearsm (before I came here) I attended two different male patients who had no social context.  Neither had any friends or family, both worked alone.  They died in their fifties of malignancies.

Most of my patients who had scheduled Friday morning appointments didn’t show.  In the afternoon, I took care of patients with, successively, influenza, diabetes, hypertension, car accident, back pain, more influenza, ankle injury, seizures, an eye problem, viral vomiting with dehydration, a productive cough, more influenza, and another ankle injury.

Through the day, on the job and outside my work, I talk to people.

I got information on the barge system.  This last year the Native government, Uqpiagvik Inuit Corporation (UIC) sent four barges up from Seattle.  One tug boat can handle one or two barges.  Most years the freight needs can be handled by three barges, but the new hospital construction demanded supplies.  Hazardous materials come by barge, including diesel fuel, gasoline, industrial chemicals, and the black powder used by the whaling crews.  UIC owns three barges and two tugs, and contracted with a private company to bring the other barge up.  Outside the short summer barge season, necessary supplies come up the Dalton Highway from Fairbanks to Prudhoe Bay, then fly air freight to Barrow.  The barges transport goods to the outlying villages, where they stop on the way to Barrow, but they also haul freight to Prudhoe Bay.

I was told that if one wraps a can of ether-based car starting fluid in bacon and throws it to a polar bear, the bear will bite the can, puncturing it, and will die in a matter of seconds.  I can’t swear to the veracity of the statement, and I’m not going to find out.  I’m darned sure not going to carry bacon around in bear country.

Hanging with real hunters, egg fu young, playing saxophone, and Northern Lights

February 4, 2011

Long are the dark arctic nights,

If you’ve come out just to see sights.

     Be cautious, I swear,

     Of the great polar bear,

And look up to see Northern Lights.

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.

When I tell people in the lower 48 about Barrow, they frequently ask, “Why would anyone want to live there?  In this day and age?  Are you kidding me?”

I read the Unabomber Manifesto when it appeared in the Washington Post in 1995 .  The distillation of his treatise comes down to this:  modern society’s problems result from people having their basic needs of food and shelter met without working for them; most people are bored and without psychological fulfillment because they haven’t had to overcome obstacles to avoid death from starvation or exposure.

To my dismay, I agreed with his sentiments till Ted Kaczynski tried to justify killing and bombing other people.

Twenty-first century American ennui doesn’t happen in Barrow because most Natives are subsistence hunters.  

One of the reasons that I love Barrow is that the folks here really are happier than most places.  If I go to the store, I see smiles on most of the faces; I don’t see that many grins anyplace outside the North Slope except at a comedy club.

I also get to hang out with real hunters all day.  Their lives and the lives of their families depend on the success of their hunt.  The people here exist because of a combination of modern firearms and the ancient accumulated wisdom of centuries of hunting and fishing in the planet’s most hostile environment.

I talked with a man who shot more than five hundred geese during the whaling season; he told me about getting three with one shot.  Another person, who has harpooned seven whales over the course of his life, recounted killing two of those whales in one day.  A fisherman I spoke with caught eight hundred smelt on a day when his friend caught three thousand and expounded on how great they are to eat frozen.

Even though I hunt, next to the subsistence hunters here I feel like a tourist with a muzzleloader.

Tonight, the mercury sits at 11 degrees below zero Fahrenheit.  Bethany and I walked a kilometer to Brower’s café and ordered egg fu young with hot and sour soup.  The prices of restaurant food run high here but the portion size stacks up with the largest; we brought home leftovers, though polar bears have been sighted in that part of Barrow during the last two weeks.

After I dropped Bethany off at the apartment, I took my saxophone to the house of the guitar player who anchored the band when I worked here last summer (see my posts from June and July).  We miss our trumpet player and leader, but we still like making the music.  Halfway through, Bethany called to tell me to go outside.

We came here with the intention of seeing the Northern Lights.  This evening’s Aurora Borealis streaked green across the sky from horizon to horizon.

Snow machine excess, cold injury, and wolverines

January 19, 2011

Some people, they smoke and they drink,

Some trap the otter and mink

     But the story’s been told

     That Barrow’s so cold

You can’t open your eye if you wink.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  To avoid burnout, I’m transitioning my career, and while my one-year non-compete clause expires, I’m working in exotic locations, traveling, having adventures, and visiting family and friends.  Currently I’m in Barrow, Alaska, the northernmost point in the United States.

I’ve been back on the job for less than twenty-four hours, here in Barrow.  I’ve seen several cases related to snow-machine use.

In Barrow, one avoids the terms sled or snowmobile in favor of snow machine.   The people here use them, not for recreation, but to do necessary work.  People hunt from snow machines, so that hunting injuries are almost synonymous with snow machine injuries.

Most, not all, caribou migrated south past the Brooks Range when the days grew too short.  Herds of up to five hundred remain, grazing on the tundra.  In temperatures so cold that alcohol freezes, in the Arctic night when the sun doesn’t rise and the moon doesn’t set, subsistence hunters go after them with firearms ranging from .22 magnum handguns to 7mm Remington Magnum rifles.

A lot of parkas here sport wolverine fur on the ruff. Unique in that breath frost won’t stick to its fur, hunters eagerly seek the “skunk bear.”  The creature has such a nasty disposition that it acts like a serial killer, slaughtering everything in its path for fun and eating for necessity. 

The government issued a wolverine fur-trimmed parka to a person I know (not a patient) during the cold war, for work done in the Arctic.  To this day, the nature of the work and the circumstances of issuance remain clouded in mystery.

Hunters also go after wolves; polar bears occur as targets of opportunity.

Most of my clinic load, whether in Iowa or Alaska, has to do with damage from alcohol and tobacco.  Respiratory infections, cough, asthma, depression, fatigue and malaise, hypertension, high cholesterol follow from those two substances.  Counseling people to quit, though a good idea, rarely works.

When the patients come in with fetal alcohol syndrome and fetal alcohol effect, it’s too late.  With irreparable damage I just make the best of the situation.

I won’t say where, but I attended a set of fraternal twins, one of whom had fetal alcohol syndrome and one of whom had much milder fetal alcohol effect.  Some people are more resistant to alcohol than others, and such resistance starts before birth.

If most of what I see in any clinic has to do with drinking and smoking, the majority of the remainder has to do with the unique factors of where the clinic stands.  Barrow’s air is so dry that eczema here runs an order of magnitude worse than any I’ve ever seen.  Yet most people know the cold so well that frostbite comes rarely.

The first case of frostbite here in Barrow came my way today, very shallow damage, but not to fingers or toes.