Posts Tagged ‘rabies’

Another road trip 14: a fist fight on the road, and a fox out at mid day

June 25, 2015

If you happen to come on a fox

Check the time on you clocks

For that bad rabies virus

Might sometimes require us

To bury the thing in a box.

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. I spent the winter in Nome, Alaska, and I just finished assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, my wife and I are doing a bicycle tour of northern Michigan.

After a substantial breakfast at the hotel restaurant, we again gathered in the parking lot to review the day’s route.

We exited from Traverse City on the TART (Traverse Area Recreational Trail), a really nice, smooth, well-paved bike path with really lousy signage.

Tandem riding resembles flying in that the hard parts are the take offs and landings, and we faced one of each with every intersection.

At the Mawby vineyard and winery, the only US facility dedicated exclusively to sparkling wines, we learned more about viticulture.  At the end I asked about the deer and the marc (the leftover grape skins and seeds).  Deer eat the new growth in the spring and are dealt with summarily; the marc is composted.

At lunch in Sutton’s Bay we studied the map , and our tour guide gave us a choice of taking secondary roads with very light traffic but a slightly longer total mileage, or facing the gradual grades and heavy traffic of a main route.  We took the back road, leaving ahead of the group.

Sutton’s Bay High School’s Driver’s Education car passed us.   We settled into a rhythm.  The sun shone and the breeze blew and the only sounds were the birds and the hum of the tires on the asphalt.

We came up a gradual incline to find a real fight had spilled from driveway to road.

Two shirtless young men punched at each other with vicious intent and little training   A young woman watched, distressed.  As we passed, I announced, loudly, that I would call 911.  The young woman yelled at me to mind my own business, using more words than she had to.  The Driver’s Education car had pulled over, and the young woman in the driver’s seat bore a facial expression between smirk and embarrassment watching the action in the rear view mirror.  We started up the hill and I shifted down.

I commented to Bethany that neither young man had a weapon, the fight appeared fair, and thus I had no interest in seeing the fight stopped.  The two combatants had something to settle, and knowing the dynamics of the age, would probably become fast friends afterwards.

From the other side of the ridge we heard sirens.  As we toiled up steeper and steeper grades in lower and lower gears, a police car came rocketing down the road, followed by another, and then another.  I observed that law enforcement was having a slow day.

We bottomed out on the gears, and, breathing hard, toiled to the summit without having to get off and walk.  Then we rocketed downhill, the speedometer climbed to a thrilling 32 MPH.

Bad signage prevented us spotting the turnoff in Lake Leelanau, asking directions got us back on the right path, and we started up a gentle but persistent slope.

We made good time going uphill, sheltered by pines, and overlooking a lake.  Then I saw the fox running ahead of us.

I enjoy seeing foxes; it should mean I’ve been clever or stealthy.  But a fox is a nocturnal animal, and seeing one at midday means something has gone very wrong.

We knew the fox could be rabid.  Turning around, marginally possible because of the conflict between turning radius and road width, risked putting us over.  Continuing at speed to pass the fox would bring us closer; I slowed.

The fox glanced back at us, ran on another 10 yards, and disappeared into the roadside cover.

Had I a firearm, I would have shot the fox presumptively.

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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.

A walk to the grocery store at thirty-five below

January 20, 2011

We walked in the snow and the ice,

The moonlight was ever so nice,

     Ignore all the clocks,

     Watch out for the fox

Who goes out eating lemmings and mice.

The intense arctic cold doesn’t stop Bethany and me from going outside.  Under a full moon, with clear skies, we walked out to the airport last night; the wind chill dropped the effective temperature to -35 degrees Fahrenheit.   My breath condensed on the faux fur ruff of my parka as well as my beard, which led to our evening discussion of hoods trimmed in fur.

Hunters eagerly seek the wolverine here, but I also see wolf, beaver, lynx, otter, arctic fox, grey fox, and red fox on outer wear.  Tanning skins taken locally falls to the women and the women get the best of the furs; men, for the most part, get the trimmings. 

Most arctic fox in this area carry rabies.

Snow crunches at high frequency in this weather.  Barrow receives little precipitation, less than five inches per year on average, so when snow falls the wind blows the ground bare between snow drifts.  Nonetheless moonlight here on a clear night comes in with a “very bright” rating.

The afternoon clinic ran busy and ran late; I worked through the dinner hour and finished fatigued.  Both yesterday and today I took care of four people in one family in one room.

The outpatient area of Samuel Simmonds Memorial Hospital has six exam rooms and an ER with two bays.  The first patient of the afternoon was quite ill and needed a good deal of medical care, staying in the department for three hours.  Patients who signed in at 4:30 didn’t get seen till after seven.

Most patients today had cough with or without fever; the circulating syndrome apparently started on Friday, and the virus has gone ripping through town.  As usual, those sickest before the epidemic  suffer more during the epidemic.

I find great pleasure in the side conversations I have with the hunters here.  I can pick out whalers most of the time by the glow on their faces.

Two days ago Bethany and I walked to the store.  It wouldn’t rate as an adventure if it hadn’t happened with -45 degree wind chills, and a full moon that didn’t set.  Our glasses grew layers of ice, as the wind whipped wisps of snow along the ground.  We found good traction on the hard dirt roads that have been snow-packed by vehicles but textured by machine.

The grocery store ranks as a medium-sized supermarket.  The ammunition section comes well stocked with common calibers like .223, .45 ACP and 7.62×39.  The presence of a good selection of .22 Hornet surprised me.

The fact of nectarines from Chile in the produce section at $4.50 a pound astounded me.  I can remember saying my mother saying that a hundred years ago kings couldn’t get what can be commonly found in a grocery store; stone fruit in the middle of winter ranks as a triumph of modern man.  I said, “Bethany, I’m buying some.  Contrast is the essence of meaning.”

Rabid arctic foxes and northernmost rotarians

June 10, 2010

I don’t want a lengthy deferral

When I ask for a timely referral

    There should be a prize

    For the abnormalest eyes

In a place that’s remoter than rural

Tonight a young man gave me his permission to write this much about his case.

I saw him last week some vague and improbable visual and neurologic symptoms.  Of course I examined him, and almost as an afterthought I checked his eyes.

His eye movements were alarming.

I’ve seen abnormal extra ocular movements before, always I’d known they’d be abnormal before I started the exam.

I presented the case at morning conference the next day; the thrust of my presentation was that he needed to be referred out, but I didn’t how to make that happen.  Later that day, per group suggestion, I called a neurologist at Alaska Native Medical Center in Anchorage, who agreed that referral needed to be made within a week.

Since then I’ve taken a personal interest in trying to get the appointment expedited.

The patient came back today, subjectively and objectively worse.  It took time and running around, but I made sure the patient got down to Anchorage in an accelerated time frame. 

I’ll be presenting the problems involved at morning conference, again tomorrow. 

After clinic this afternoon I was invited to the meeting of the Rotary Club, which lies north of all world’s Rotary Clubs, including those in Greenland.  Two of our docs are longstanding Rotarians. 

The meeting was at the Mexican restaurant, Pepe’s North of the Border, tonight serving Yankee pot roast.  I did however get to speak Spanish with one of the waiters.  About ten of us gathered for the installation of a new Rotarian, and a short speech. 

Just before the speech, my phone rang.  ER is swamped, and walk-in patients are stacking up. Could I please come?

No problem.  It’s a four block walk in gorgeous weather.

I can’t talk about the patients I saw.  I can talk about the current problem here with rabies, being carried by arctic foxes, and how it complicates the treatment of all bite wounds in a town where animals, wild and tame, live close to humans.

People seeking narcotics are a common problem in medical practice throughout the US, and Barrow is no exception.  In Sioux City I established a reputation early as never giving narcotics for migraines and very rarely using narcotics except when the diagnosis was well established.  My reputation has yet to be made in Barrow.

My Inupiak vocabulary grows; I learned to say “I’m fine,” which if said too fast becomes “I’m crosseyed.”  I also acquired the words for gallbladder, dirty, whale, and I don’t know.

Tomorrow will be 21 days since my career change, the three-week rule applies.  I will have to be extra careful.  I’ll shorten my work outs, watch my words, and take no chances.