Alaskan Picture Pages

I extended my time in Alaska to include a week of vacation. "The Phoenix" came up and joined me, and we spent a week cramming in as many activities as possible.

The first day we went on a bear-viewing tour. We chartered a small float plane and went to a nearby bay where we could safely view the bears from a boat.

Mama grizzly bear fishing for her two cubs:

I wouldn't want to be a salmon!

These two Spring cubs made all sorts of loud whiny, grunty sounds for more fish:

Smaller, adult male grizzly:

Black bears look small and cuddly by comparison:

I think this eagle was hoping for some leftover fish:

We spent a few days in Denali National Park, doing some hiking and white water rafting. We didn't have very much time for hiking, so we took the park shuttle as far as we could to the Savage River and walked around. Denali, by far, had the some of the best scenery. I had hoped to see caribou, moose, and dall sheep, but it didn't pan out. Mount McKinley is only visible a handful of days every month, so we didn't get to see it during our time there. Oh well, more incentive to return for a longer stay next time.

Fall looks entirely different on the tundra:

Me, looking carefree:

Marmot!

This is a ptarmigan, which I think must mean "tastes like chicken" in native tongue. One of our fellow tourists tried to convince us that it was a golden eagle. We just smiled and nodded.

After that, it was on to Seward Peninsula via the Alaskan Railroad (which has great views, but is a REALLY slow trip, so I was glad we took the motorcoach back!). We spent a couple of days on on Fox island at a fairly secluded hotel, where we dined on salmon, kayaked on the ocean, and took advantage of their personal chef.

The next day, we went on a wildlife-viewing day cruise. Highlights included spotting some whales and watching a glacier calve.

I think this sea lion was also on vacation:



Flirty otter:

Mama and baby whale:

It was difficult to go back to work, and I still have tons of photos to sort through, but I'm glad I went, and feel like I took pretty good advantage of the time that I had in Alaska. It's such a huge state, that there's no way to cover everything in one visit, and for some of the things that I wanted to see (Northern Lights), you really have to check it out at different times of the year. August was a great time to go though, as there was still plenty of daylight and tourist season was tapering down, so a lot of places that we went weren't as crowded.

Alaska, Part 2

More pictures from my recent Alaskan trip:

Pink salmon, about to die after spawning.

Silver salmon, hung out to dry in one of the villages.

I went fishing (for the first time EVER), while I was doing a four-day village stay to do annual check-ups and medication renewals. I didn't actually catch anything, but by the end of a couple hours, I was no longer casting into the weeds. The best part of it was that on the way out to the fishing spot, we saw a lynx swim across the river and there were a couple of bald eagles that flew by.

There was a seafood processing plant in town, where you could buy a pound of Alaskan Red King crab for pretty reasonable prices. It was even cheaper to buy the live ones, however there just wasn't a pot big enough for a full crab in the apartment and I was a little squeamish about chopping up crab guts. These suckers were spiky, but from now on, I will probably associate watching the Summer Olympics with sitting down with a pile of fresh steamed crab legs and butter.

Tundra geese:



I really wanted to get a good picture of a musk ox, but even with my larger lens, this guy turned and stared me down from about 200 yards, so I opted for a non-gored liver and a distance shot.

Ready-to-pick fresh blueberries.

As for the actual month of medicine, I delivered three babies (ok, one of them popped out before I could get my gloves on). It was actually a primary care/family practice rotation, so a lot of time was spent seeing people in the outpatient clinic while covering any emergencies. I did do several flight transports, including one harrowing one where the patient was in hypovolemic shock, and we had no blood products with us, and were down to our last 500 cc of fluid on the airplane. It was nerve-wracking to just watch someone's blood pressure fall, with nothing to do but hope to get them to the hospital (and operating room) before they arrested. Another of my patients had a heart attack, but he was transferred quickly and did well.

I worked a ton of hours for those four weeks, but it was interesting to see how patient management has to be adjusted to the resources that are available. I also learned to advocate aggressively for my patients, dealing with unknown specialists over the phone to get them what they needed. It was a good month, but I don't have any intentions of returning... at least not for work.

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.

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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.)

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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...