Friday, September 19, 2008

Alaska, Part 1

I am not sure I can summarize the whole 4-week rotation and vacation in just a few entries, but I am going to try. My rotation was through the Indian Health Service, and it took several months of filling out paperwork and waiting for a temporary resident permit to get the thing set up. I chose to go to Alaska, partly because some residents the year before me had gone there and had a great time, and partly because I had been hearing about locum tenems options for a while and had wanted to check it out.

I went to a small city made famous during the Gold Rush of the 1800s (I'm avoiding mentioning the name directly to avoid Google hits.), and getting there from here was somewhat awkward. In particular, it involved a 6-hour layover in Anchorage and sleeping on a bench outside the bathroom with my luggage since apparently there's a law against checking luggage more than 4 hours in advance!
The next morning, I was met by a hospital employee at the airport, who thankfully took me to my apartment, which turned out to be well-furnished and very conveniently located down the street from the hospital. Walking around town that first day, I was shocked to see that gas was priced at $5.39/gallon (apparently it gets delivered once a year, so the price doesn't fluctuate daily like back home) and a gallon of milk was over $7.

The first day at the hospital was spent giving a urine sample for drug testing (which seemed kind of silly because why run the risk of having to eliminate free labor?) followed by a maddeningly-long 1.5 hour session (not exaggerating) of fingerprinting. After that, I was free to roam around town.

The next day, I was pretty much thrown right into the mix of things. The majority of my work involved seeing patients in the outpatient clinic. Sometimes they would schedule me for patients, but typically I just saw walk-in's. The hospital did have an ER, but it literally was a room, not a department, with two beds. I was given a pager, and had my first 24-hour call the second day of work and pretty much every 4th night after that.

On-call duties included village phone calls. The hospital doctors are responsible for overseeing the treatment plans of health aides in fifteen different villages. Typically, all day long, health aides are faxing in notes of what patients they have been seeing throughout the day. Then, whomever is on call, spends the whole afternoon returning phone calls and guiding treatment for patients that you just hear about on the phone. Most of it is pretty standard stuff-- earaches, sore throats, etc. Health aides have a few months of training, and then they follow instructions from a systems-based state-approved book to diagnose and treat patients. The ones that have been doing it for years are pretty good.

When the health aides get stumped, they sometimes take a picture of the problem and send it online through a special program where the physician can then view it and discuss it with them. Luckily, mail/delivery planes go to most of the villages once or twice daily, so really sick people can be sent in to the outpatient clinic to be evaluated in person. If someone is urgently sick, then a MedEvac flight team is sent directly out to the village. Depending on the person's severity of illness, they either are brought in to the local hospital, or directly to Anchorage.

Shifts on-call could be interesting. Typically, the x-ray tech, pharmacist, and the lab tech would go home around 7pm, so you had to decide if whatever you wanted to work up was really worth waking someone up at home to get the x-ray shot or blood drawn. Most of the time, unless someone had something acute like chest pain, you would splint the sprained ankle and have them come back in the morning. The hospital did not have a CT scanner, and during my orientation, I was told that we only had 4 units of blood to work with in the whole hospital. Pretty much, unless you wanted to admit someone for something like a basic vaginal delivery or pneumonia, most people got stabilized and shipped to Anchorage. It was an interesting way to practice for four weeks.

That first week, it was about 40 and cloudy on most days, but I still spent as much time as I could walking around. Prospectors on the beach hand-pan for gold, and the more ambitious souls have smaller dredging operations.

I met a prospector named Jessie, who showed me the gold he had spent all day hand-panning on the beach. It didn't look all that impressive-- almost like a large lump of pigeon droppings. Carefully, he folded the foil containing his gold as a lit cigarette balanced between his fingertips and he turned on a small propane stove.

As the gold dried, it became more shiny, and was more coarse-grained than the sand. He talked about how many colors per pan made for a good day's work and said that he had learned his skills from Tattooed Don, who had learned from Blueberry John, who had been "panning theses beaches since before any of these dredges were ever here."

Jessie poured the gold flakes into a small glass vial. He said it was 12-hours worth of work and 3/4 of an ounce, for which he should b e able to make about $700. (I briefly wondered why I went to med school, when apparently you can just sift gold off the beach.)

That first weekend, I also went on a park ranger guided hike on the tundra where she pointed out a lot of the wildflowers. We had to cross a stream barefoot, and it was cold enough to make me nauseous. The size of the town and the way everyone knew each other's business was pretty comparable to my hometown back in Arizona, but the environment was a big change in environment for this Desert Rat...

Tuesday, September 09, 2008


Missed a couple of numbers:

32. Calculators so that I don't have to rely on my math/counting abilities

48. Three-Paycheck months (happens twice a year if you get paid every 2 wks)

Monday, September 08, 2008

100 Things

I have been home for about a week now, and it's taken me a little time to get back into old routines. I spent five weeks in Alaska (four of it working, and 1 of it playing). A few days since I have been back were spent catching up on sleep and mail, and then diving back into busy night shifts.

There are a ton of pictures to sort through, and stories to tell, but I am glad to be home. I'm going to follow a lead from Chris, and list 100 things I'm grateful for (in no particular order).

1. Family

2. Army Guy

3. Friends who will let you drag them around at crazy hours for a week and still speak to you.

4. Friends who will wake up their new spouse before the sun is up to meet you for coffee at the airport during a layover.

5. That it gets dark here before 1 am

6. Alarm clock-free mornings

7. Surprise dinners waiting for me in the fridge when I get home from work

8. Anchorage bus drivers that will mail a forgotten cell phone back to you across the country

9. Antibiotic eye drops (don't ask)

10. Microwaves that don't explode when you nuke a fork... uh, twice

11. Air conditioning

12. Summer breezes when the A/C stops working

13. High-speed Internet

14. A stable job

15. Online banking accessible anywhere

16. Coffee!!!

17. DVR

18. ... and cable

19. Worn-in sneakers

20. Scrubs so I don't have to bother with getting dressed

21. Supportive co-workers

22. Knowledgeable and efficient nurses

23. Shady trees

24. Having a roof over my head

25. Alarm system

26. Perennial flowers

27. Smooth intubations

28. Unexpected happy outcomes

29. Cruise control

30. Non-exorbitant dairy/produce prices ($7/gallon of milk, $5/avocado!)

31. iTunes/iPod

33. No cavities at the dentist!

34. Quiet time to read a book

35. Picking fresh blueberries from the Alaskan tundra

36. Digital cameras

37. Nights on-call when the pager didn't go off for a few hours

38. Lightning bugs

39. Reliable transportation

40. Deadlines to push myself harder

41. Finished races

42. Friendly faces at work

43. Vacation time

44. Mint-chocolate chip ice cream

45. Female predecessors who paved the way for me in the workplace

46. Soldiers

47. Freedom of speech

49. Hand-written letters

50. Laughter

51. A finished book chapter revision

52. Freedom of religion

53. A warm hand to hold

54. Afternoon naps

55. That I live in a society that wants to take care of its elderly, disabled, and women with children

56. Opportunity

57. Rediscovering old friends

58. Free time

59. Benefiting from the creativity of others... art, music, theater, movies, comedy shows

60. Ability to travel

61. Good health

62. Optimism

63. Ability to vote and participate in government

64. Ability to have input in my work schedule

65. Ability to work overtime

66. Room to improve in my cooking skills

67. Rainy days

68. Parents that valued education

69. Tree-lined neighborhood

70. Long walks around the lake

71. Tiny details in snowflakes

72. Teachers that challenged me

73. Patients that trust me

74. Mexican hot chocolate (it's cinnamon-y!)

75. Long soaks in bubble baths

76. Foot massages

77. Post-shift bar trips

78. Long highway drives with the radio blaring

79. Running into someone I've helped in the community

80. The comics section in the newspaper

81. Learning more about other people's life experiences through blogs/comments

82. Covered parking

83. Waterproof hiking boots

84. Hours-long phone calls to de-stress with my buddy

85. That first "welcome-back" hug with a loved one

86. First-time "I Love You" and I guess the ones since then, too!

87. Starry nights and trying to find constellations

88. Campfires and s'mores

89. The way time seems to help me forget bad memories

90. My work ethic

91. My stall tactics

92. The way sumac turns impossibly-red in Fall

93. Twinkly Christmas lights

94. Memories of my grandparents

95. Daydreams

96. A future to look forward to

97. The smell of fresh-cut grass

98. My sense of humor

99. There are significantly less mosquitoes here than in Alaska

100. TO BE HOME!!!