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...