PA vs. NP.....#10

When I began looking into the PA profession 5 or 6 years ago, one of the questions I almost always ran onto was, what is the difference between a Nurse Practioner, and a Physician Assistant? In fact it seemed that any school you would interview with was going to ask that question. There have been master’s theses written about it, and it seems this is very important to know…which ever school you go to.

Outside of school, there seems to be quite a bit of competition between the two professions, each claiming to be better suited to the job. NPs claiming they have a greater right to the job by way of their experience, and PAs because of the extended clinical training and education under the “medical model”. At times this debate almost comes to blows. I think one of the biggest differences is that we are governed by different bodies, and one seeks greater independence than the other.

When all the smoke clears, it would appear to me that though there are different paths, NPs (I am using this because the mid-level nurse’s name does seem to change quite frequently) and PAs end up in about the same place, with similar skills and legal rights. Both are mid-level healthcare professionals with the goal of providing the best medical care to their patients as possible, and both have the obligation to extend their education outside of school, which is a never ending process. Though it would seem that PAs are more procedure oriented, I think this comes down more to personal preference, as I have seen NPs who love to do procedures, and PAs who would just as soon not.

On this last rotation, I was precepted (new word?) by a FNP-C which is a certified Family Nurse Practioner, Jeremy Basse. At first I was a little leery because of all that I have just wrote about at the beginning of this article. I was pretty sure that he would be looking down his nose at me, thought that I probably wouldn’t get to do any procedures, etc. I could not have been more wrong.

Mr. Basse is quite frankly one of the finest health care providers I have worked with on my year long sent of rotations. I dare say that he may have outdone some of the ER doctors I have worked with. His knowledge is extensive; his skill set broad, and his concern for his patients’ number one. He kept the pressure on the whole rotation, ever inspiring me to stretch out and learn more, but never in a condescending manner. He not only pushed me to learn new things, but also shared his “library” from his school and personal gathering which is really impressive. Great teacher.

It has almost gotten to be a joke, because whenever I am asked which rotation I liked the best, I almost always say “The last one”. But truly, this may be the one I like the best. I don’t mean that this is the one I’m dying to spend the rest of my life doing, because at this point I feel under skilled for the task. It takes great dedication to do this job, it involves so much more than just medicine.

Now here is the kicker. Jeremy has not been out of school that long himself. I don’t think he even has a years experience since his certification.

I cannot tell you how impressed I am with this guy. While there, some very difficult situations arose that would have shaken an experienced doctor, and Jeremy kept his head down, kept cool and worked each case with every skill he had, and did an exemplary job.

While in Unalakleet we came across the most difficult case I could possibly imagine, and he worked it professionally, compassionately, and could not imagine anyone doing it better. I am so very proud to have worked with him. Not to mention his wife, Wendy and daughter, Ilsa who are both beautiful, and were so kind to have made me feel at home. Believe me in Unalakleet you can’t imagine how important that is.

So when it comes to the NP vs. PA controversy, I pray that as a PA I am able to live up to the standards set by the NP I worked with, he has certainly set the bar very high for his fellow NPs, and for me.

By the way, I’m not saying all this to get a good grade on my rotation. My evaluation has already been turned in, and I did not get a perfect score.

But I am very proud of the score I got…

rto

Even in Alaska....#9

Spring fever hits pretty hard. The snow is starting to melt and emotions around here are pretty different. Most people have this wide eyed staring sort of crazed look. One you would imagine you would see on the faces of people buried in winter snow for months beginning to see the breaking of Spring. This of course is contrasted by the teenagers who are running out of snow to run their snow machines on. They have the look of grounded teenagers who have just had the keys to the car taken away. As contrasted to the younger kids who are completely thrilled to be ridding their bicycles again.

The adults, both men and women are so excited for spring. The men are getting geared up for seal hunting (Oogrut) and have their eyes on the Bering Sea waiting for an easterly breeze that makes the ice shift, and allows them to get their sixteen foot boats out into that freezing water so they can drive between the chunks of ice looking for Bearded Seals sunbathing. These things are pretty big, and in these sixteen foot boats with two or three men, two or three seals…freaks me out to think about it, but they love it, and every day are looking for the right opportunity to go.

Everyone is excited about the prospect of fishing. I was at the elders last week and they were both talking about going fishing. He is around 87 and she is not far behind, but they both look like starry eyed kids when it comes to fishing. Young or old, male or female, everyone is crazy about fishing. Catching, cleaning, drying, smoking…they are in to it. And you better know how to use an Ulu. Know what I mean?

The women all talk about berry picking. This is one of the main ingredients in a dish they call Akutaq,or Eskimo Ice cream. It is made with what they call blue berries (but they are much smaller than the version I am used to, and not as sweet) fish, salmon or whitefish, sugar, and Crisco. That’s right, the same kind grandma used to fry chicken in. It seems that Crisco is quite the delicacy here. I had a patient who I was talking to about her lipid profile the other day tell me “I guess I’m going to have to give up Crisco on Pilot crackers, that’s always been my downfall!” Ya think??? Wonder why you cholesterol is through the roof? A pilot cracker is this cracker they sell here that is round and hearty. It is about 4 inches in diameter, and almost a meal in itself. The people here keep a supply of them around like Rooster Cogburn used to carry corn doggers. "You’ll never starve if ya got a sac full o corn doggers". I don’t think Chin Lee is making these crackers though.

The people here come by this habit honestly, because in the old days (and still quite a bit now) they would eat seal oil, or blubber like that. When the white man came along with a tub of white grease that was easier to get than driving your sixteen foot boat out into the cold water to harpoon a seal, seemed like the natural alternative. The difference is that the people that eat a lot of fat that comes from seals, have great lipid profiles. So it may not be your cup of tea, but it’s definitely the good fat. There is a group here now who is doing a study on it, and they say it’s a good idea to eat plenty of seal oil. After seeing the lipid profiles of these people for over a month, I’m all over town trying to buy a couple of jars! I’ve tasted it, and found it to be quite good. If I can get a supply of seal oil, all I'll need is the pilot crackers.

Every day there is less and less snow, and more and more daylight. Right now it is 10:00 PM and there is still a couple of hours before sunset. In the evenings I have made a habit of going up this big hill just behind the village to look out over the Bering Sea to the west, and the village and the Unalakleet river to the south. It is an incredible view, and changes nightly. The wind has a huge effect on the ice flow on the sea. If the wind is from the east, it blows the ice out, and you can see more water. If it is from the west on the north it blows it in towards land so on some days you can't see water. Right behind the village is what they call the slough, and it is breaking up now with big cracks in the ice, but it is still about 4-5 feet thick. There are sea gulls all over town now, Unalakleets version of robins which come signaling spring. There is a bridge over the slough where people throw carcases from seals, geese, or what ever they have been hunting to feed the sea gulls. When I drive over the bridge on the 4 wheeler they swam me as if I'm the guy bringing it. Jeremy's wife Wendy says the noise they make sounds like they are all saying, "Mine! Mine!" She's right.

Everyone is out. Walking and talking about how busy they will be this summer.

Life goes on....

rto

I guess there is always a balance...#8

Just because I haven't posted anything lately doesn't mean nothing is happening here in the wilderness, or that I haven't been writing about it. I will probably spit out a few over the next week. I have had some mixed emotions the last week and a half and have had sort of a hard time getting them sorted before I could express them.

As the saying goes, no matter where you go...there you are. That certainly remains true to life here. Though I write about how beautiful it is here, and what a wonderful time I'm having, over the past week there has also been some tragedy, and sadness. As with everywhere I guess, alcoholism is a part of this culture as well. Maybe more so. Unalakleet is what they call a "damp" village which means that you can't buy liquor here, but you can have it shipped in. It is alright to possess alcohol, you just can't sell it here. At any rate there is plenty to be found.

When you take a history and physical on patients, there are always questions that have to do with habits. Do you smoke, if so how much, and how long? Do you use alcohol, if so how much and how often...etc. Here the answer to alcohol is frequently yes, and frequently the how much and how often is two drinks, a couple of times a week. These are what I consider routine answers anywhere I have been, till one day my preceptor said to ask what two drinks means. Here, a drink is a bottle of whiskey. Apparently they do not mix cocktails here, they open a bottle, and consume it. Two drinks...WOW. The purpose of drinking here is not social, it is to get drunk. I have seen only a few people who will have just a beer, or a cocktail. The vast majority of people here do not drink.

I am not judging this behavior, I have seen it everywhere I have been, but here I have witnessed the devastating consequences of this behavior, where everywhere else I guess I have been more insulated. Here it is not auto accidents that you see everyday on TV where DUI is involved and become almost immune to, it is neglect and domestic violence that is right in your face. With the adults it is a choice, and they have the right to make it, but for the children it is not, and they suffer the most. It is sad to think that this is what they see and will learn, and probably grow up to copy. You can't give what you don't have.

I really don't want to go into the details in something this public, but I can't express how sad I am to see how so many of the kids are affected by this here. I have seen kids who need close care, that simply are not getting it because their parents are drunk. I have on a couple of occasions literally wanted to kidnap children just to take care of them during their illness. Here, the kids having kids thing is pretty common. A lot of high schoolers have children in multiples. Family groups are tight here, but alcoholism is also a family disease, and often the support is not enough. Today I am attending the funeral of a baby girl, who passed away last week, and alcohol was involved. So very sad. It really took the wind out of my sails, and it has been hard to get going again. I still feel a bit of panic when a child comes to the clinic, but I realize this is the job I have chosen, and I am doing my best to process, but it breaks my heart.

I wanted to be honest about what I see here, so that is why this appears instead of the stuff I normally write. I don't want to give you the impression that this is the predominant lifestyle here, because that is certainly not the case. Unalakleet is strong in family history, and tradition and most of the people here have incredibly good values, probably better than what I see at home. When people here fish, hunt, or gather, they share with the elders who can't. Not only do they share, but it is the tradition to prepare the food before it is given. If it is Caribou, it is skinned and butchered, if it is fish it has been cleaned, or dried, berries are washed and presented ready to go. They have a wonder view of taking care of their elders, who are respected. Though they exist, there is no old folks home here in Unalakleet, and believe me, it's not because they don't have old folks. It is a very close knit community, and they share everything.

Including happiness, and grief...

rto

Easter, like no other...#7

Ok, I'll just start with the moment my eyes opened.
It wasn't to see the Easter bunny, or eggs scattered or a big basket. It was Jeremy (NP) telling me it was time to get up and go for a snow machine ride. I mean when he knocked on the door, I was dead asleep, and ten minutes later we are whipping through the back country on his machine. I'm thinking we are probably going to die out here because the only tracks we are seeing is from the snow machine, moose, and what looks to be a couple of foxes...not like the kind in the bar. One of the things Jeremy is telling me is that you can go farther on a snow machine in an hour than you can walk in a couple of days. At forty five minutes, I'm thinking I'm too old and fat to get stuck in a snow drift out here. It wasn't too bad, because I have a lot of faith in Jeremy, and he is still alive after quite a bit of doing this.(Of course he is young and in shape and looks at me as if I could feed the whole Donner party on well marbled meat)

I don't think I could describe in words what this experience was like. Beautiful for sure, endless views of snow covered mountain tops, cool crisp air, and nature in it's greatest glory. At one point Jeremy stopped on top of a hill top, and all around us was postcards. River valleys, mountain tops, white white snow, and quite. If the sky would have been clear I don't think I could have taken it. The contrast of the blue against all this would have been to much for me to handle my first time out. Without question, it was breathtaking!

On occasion when we would hit a place that was flat enough, and the drifts weren't too high, and skill was not such a factor, Jeremy would let me drive the snow machine. What a blast. It's an odd combination of motorcycle, and jet ski. His is very nice with warmers in the handles, which is great to have on a 5 degree day and 35-40 mph wind. We tooled around the back country for about an hour, and then went up this little road, and Jeremy had me stop at a bridge that seemed out of place at the time. We were on the North River, and when we stopped he showed me a log cabin that man lived in during WWII when the Americans were afraid of being attacked either by the Japanese, or Russians. He told me that people sort of took turns as look outs here. Kinda like the island watchers in the Pacific. Just watching our back door as it were. From this location I think you could see 'em commin for quite a distance.

This time of year, the river is starting to melt a little and under the bridge you could see running water which was quite beautiful against the fluffy snow on the banks. In all this white, it is amazing how striking the slightest contrast is. At one point we were riding down the Unalakleet River, which is like a highway here, and at points you could see water running, and in others you could see where giant chunks of ice were pushed up, square edges protruding through the snow that were at times blue, and at others kind of a light green, as if in some kind of crystal palace. At this point part of me is fascinated by the beauty of it all, and panicked to think I am riding on a river with cracks in it!!! Kind of an Oooooo, Ahhhhh, mixture of feelings that you get at a Forth of July fireworks show. Stimulating to say the least.
This ride went on for about three hours and is an experience I will treasure forever.
one of the things I find amazing about the adventure is that I never got cold. My face or my nose at times when exposed to the wind, but not my core. Not that I noticed anyway, maybe the excitement of it all. I will admit that I can't quite remember enjoying a hot shower as much after I got home.

Jeremy and his wife Wendy invited me to their house for Easter activities, and dinner. It was my job to bring the ice cream.(can you believe it?) I asked around, and everyone said that pizza shop had the best ice cream, so I thought I would run up and get some. When I got there I met a couple of guys that were shooting the breeze at the counter while the kids were celebrating a little girls birthday a la chucky cheese. I got the ice cream and put it on the counter. As usual the question of your not from around here are you got started and as you might imagine I was soon shooting the breeze too. After the usual questions of where, when and why were covered, they started asking me what I had experienced and I told them about the same things I have been telling you all, and I added "I've sure heard a lot about seal oil, but I haven't gotten to try any yet." That was enough. Within a couple of minutes Bret the owner had brought out a tray of seal oil, oogrut which is dried bearded seal meat, dried "Humpy" which is fish, and beach greens...before you ask, I don't know, but it looks like cilantro. All of these things are dipped in the seal oil before you eat them, and they are all very good. The seal oil is used here pretty much the same way we would use olive oil, and it is supposed to be very good for you. The whole time I'm eating all this, I am getting stories about Eskimo life, and local history from a guy named Bill. I think I'm gonna like these guys. I had to leave to meet Jeremy and Wendy or I would have stayed for the fried fish head. I was offered the eyes... gotta go, maybe next time. Great fun, great guys.

Got to J&W's where their daughter had had a slumber party the night before. Their daughters name is Isa, and seems very inteligent for her age. Very pretty young lady about 7 years old accompanied by her friends Tatiana, and Judy, also very cute. They were having a grand time, and we all loaded into Jeremy's Jeep and took off for the Dog Sled Races. No kidding. As part of the Easter celebration they had dog sled races that lasted for hours. Started with the kindergarten kids with one dog, around a short course, and ended with the men with teams of 5-6 dogs on the long course. Kids everywhere, dogs everywhere, Eskimos everywhere. I definitely know how it feels to be a minority now,and am glad to report that I could not have been treated better. It was a blast. Just watching was interesting. Moms have these big warm coats with the huge fur edges, and tucked inside like a papoose are the babies in this sling kinda thing. Warm and toasty! I always thought that the Eskimo women looked kinda fat in those coats, but it's because there are two people in them! Don't know why they kept asking about my kid...

Last race of the day...men. Sleds lined up everywhere, the big course plotted out around the ship and back. Jeremy had made arrangements to borrow a team, and I was waiting for the race to start, and was excited about watching him race for the first time when I heard, "Richard, get on this sled and race with them!" Didn't even have time to ask any questions, next thing I know I'm standing with my feet on the runners of a dog sled yelling "Hike!....Hike!" like I know what that means or that I have any idea of what I'm doing. The dogs take off and I'm along for the ride. Soon after we take off we are supposed to go to the right to go around the ship, so I start yelling, "Gee!...Gee!" which is supposed to be the command for turn right, but I guess my accent through the dogs off a little, cause they all headed left. So with all my mushing experience I did what came natural...went were the dogs went. A little later I tried the command for left, "Haw!...Haw!" but it more matched the sound of the dogs and the Eskimos laughing at me. I am proud to say that for all the mess ups, I still came in second....
to the last.
Thank God for the drunk guy. I'd take him to a meeting, but all's fair in love and dog racing.

After, we had a wonderful Easter dinner at the Basse family's home.

A perfect end to just another day in the wilderness...

rto

No matter where you go… #6

It’s amazing to me how even way out here on the arctic tundra, life is still pretty much the same as in Tulsa, Ok., or Austin, Tx., or LA or New York City… Of course the backdrop is radically different, but the people aren’t. Mamas are taken care of their babies, teachers are teaching, drunks are drinking, and kids act exactly the same here as most any place back home. I finally found a place that serves cheeseburgers and fries, so I decided to walk up there and get one tonight. Heck, they are only $12.95, why not? This place is called the Igloo (go figure) and is quite the local hangout. I ordered my burger, got a Coke out of the fridge, $3.95 and sat down at a table to relax after a long day in the clinic. In the Igloo are a couple of pool tables, which incidentally still only cost a quarter to play, some old slot games like Pac-Man, and a shuffleboard table.

There are only two tables dedicated to eating, and one had a whole family taking up all the space, so I sat at the other. Pretty soon a little girl, I’d say about 12 or 13 came up slid out a chair and sat down. Next she whipped out her cell phone and started texting.(I still haven't figured this out cause my phone has no bars.) Soon she was joined by another who had her cell phone out texting someone else, and in between the two were comparing text and laughing like a coupe of girls.(again, go figure) Up walks a teenage boy wearing a stocking cap, and a pair of headphones (very M&M) who only casually gives a notice to the girls, and then struts off to the beat of whatever rap he was listening to, on to the pool table where he is soon joined by a couple of other “cool” guys with their stocking caps and headphones. The guys are checking out the girls, the girls are checking out the guys, both making comments and snickering… and I mean if you were to pick the whole crew up, swap out their cloths for jeans and T-shirts, role back the clock…it was a scene from Grease!!! We are at least an hour and a half plane ride to the nearest “city” and you couldn’t tell these kids from any other…any where. Kids will be kids. (go figure)

I know I probably sound cheap, but everything here is very expensive. Except for a game of pool of course. The rational is that everything has to be brought in by barge, or by air freight and that is why everything costs so much. They figure the price of just about everything based on its weight. Coke is over $3.00 because it weighs more, milk is $7.00 because it weighs more. The other day I went to the store to buy a candy bar, which cost $2.00. In the lower 48 you could have gotten this candy bar anywhere for under a dollar. So I put one dollar and three quarters down on the counter and started to walk out. The guy at the register said, “Hey buddy, this candy bar is $2.00!” I said, “No sweat, the quarters weigh more!!!!”

Anybody got bail money????

rto

Home Visits With The Elders #5

I've been on two home visits so far. Both have been to tribal elders who were too sick to come to the clinic. Actually I think both could have made it, but hey, they are tribal elders....

I really enjoyed both trips. The first was to a lady who was having some specific health problems but other than that couldn't seem to find what was wrong with her. She has had all the diagnostic studies, and all have come up negative. Some time ago she was very sick, and had to be flown to Anchorage to be evaluated. She had lost a lot of weight, down to about 85lbs, and was suffering from what we call "failure to thrive" which is not a good call for old folks. Pretty much indicates they are on their way out most often. They did put her on an anti-depressant, and she started to bounce back. When we went to visit her, she was in good spirits, was able to walk around a little, was regaining strength, and had gotten her weight up to 112. She had been on a lot of medications, and while in Anchorage they stopped most of them. I think she was just over medicated. This is not uncommon in elderly people. Too often they don't have their medications reviewed. They start on a medication, doctors add more as they go and forget to tell the old folks to stop taking the others so they take everything given to them. They don't know what the medications are they just know they take this one for their liver, this one for their heart, etc. I think this was the case with this elder, and when the medicines got stopped she started coming back. She is married to an old French trapper, and they both have quite a story to tell. On the wall was a picture of her holding a moose's head up that she had shot with a 22. Her husband spends his time making Ulu's which is a kind of Alaskan knife that all the natives use. He makes them out of old saw blades and antlers.

The next visit was to an old elder, who has heart problems, and he just needed a check-up, and his meds refilled. We go by once a week to check his weight, heart and lungs, and to fill his med-pac which is one of those daily pill reminder things that has the days of the week on it and also different times so that they take their medicine on schedule. We find that if we go by and do this they do real well at taking their meds and consequently do much better than left on their own. He and his wife, Ted and Alice were a delight. Alice is about 3 feet 8 inches tall, and loves to laugh. Most of the people I have met here are pretty stoic, and though they like to have a good time don't kid around a lot. Not Alice, she likes to play and so does her husband. They were a lot of fun and we kind of hit it off. Most around here are not sure just how to take me yet, but it takes time for fungus to grow on you. Anyway Ted and Alice were talking about their Eskimo names, and the NP (nurse practitioner) I worked with said that if I was around long enough I would probably get one too. At that point Alice looked at me and said "Domon". Sounded like Dough-mon, with the accent on mon. When she said this both she and Ted broke out laughing. I thought OK, let's make fun of the newbie. The NP asked them what it meant. They said it didn't mean anything, it was just a name. I asked why it was so funny, and they told me it was the name of a friend of theirs who was kinda fat, liked to laugh and was funny, and I reminded them of him. They said they could not think of him without laughing and that they thought I was pretty funny too...and fat. I don't get it...
They are so cute, and I will get to see them every Friday while I'm here and look forward to how that relationship develops.

I borrowed Jeremy's (the NP) four wheeler this evening and got to drive around some. It is very pretty here. I guess you have to have a taste for it. It's like Santa Fe, if you don't like adobe, the town can be pretty monotonous. Here everything is snow covered, but to me it's beautiful. I've always had a thing for snow covered mountains, and we have those, and a lot more. They say there is more snow here than they have seen in over twenty years...I guess that would be more evidence of global warming. Unalakleet is on a peninsula, which is bordered on one side by the Bering Sea, and on the other side by a big river. I haven't found the name for it yet. The side that has the river is backed by mountains in the distance, and the other direction is the frozen sea and on a clear day you can see forever. It must be to the west because that is where the sun sets, and today it was spectacular. Because of the deep snow and ice, everything has a kind of blue tint like you would see in the cracks of a glassier, and as the sun sets it casts a pink shadow on the clouds. All the colors are very soft and pleasant.

The people in this village are for the most part very kind and hospitable. They have been very nice to share their heritage, and tell stories about the way they live now, and in the past. During the coldest part of the year, they don't do much but try to stay warm. If you didn't know about the rest of the year you would think they are lazy. They do love basketball, snow machines, and 4-wheelers. When you look a little closer, you realize they are incredibly hard working people. They are always hunting, and today I saw a guy cutting up a Caribou on a band saw in his front yard. The limit on Caribou for the natives is 4 a day!!! Not many of them try to get anywhere near that amount, but they do make sure the freezer is full of meat all the time, and I mean lots of it. They also do a lot of drying to make like a jerky. When it warms up and the water starts to thaw they will start fishing, and this is the time that they really bust it. They fish almost every day, and clean and dry the fish not only for themselves to eat, but this is what they feed their dogs. Guess that is where the term "lucky dog" comes from. I tried some of the dried salmon tonight, and it was a treat. What I had was brined, smoked, and dried. They also have some that is like teriaki, and a couple of other flavors. They also bake, grill and poach it like you would have in the lower states. Not only do they do all this, but they also have other jobs too. The fact is that they are hard working honest people, and very tolerant of my silly ways.

Last thought for the evening...the satellite dishes. In the lower states, you always see the dishes pointing up into the sky, out into heaven and it would seem right. Here the satellites seem to aim parallel to the ground. Like they are aiming into their neighbors house!

Ya know? Maybe they are....

rto

Can Ya Hear Me Now??? #4

Bet not!!! Ain't no "more bars" here. My $500.00 phone is now a travel alarm! I'm so happy to have Internet access I can't begin to tell you. It's pretty slow, but at least I have some way to stay in contact.

I had a little trouble getting here. Besides the difficulty getting the rotation set up, the damn volcano near Anchorage started acting up, and I had my flights delayed two times before I finally got to Nome. The first time was alright cause I was stuck in Seattle where I had stopped to spend a couple of nights with my cousin Craig and his family so the extra night didn't bother me.

The next day I got up at 4:00 to fly to Nome, and made it without a hitch. When I got off the plane however, my flight to Nome had been canceled till the next day. I was about to leave the airport and get a room in Anchorage when I got a call on my cell from a med student who was also stuck. The people at Norton Sound Health Corporation had given her my number, and figured that we could at least support each other. She is a fourth year med student from Long Island, and looks a lot like a friend of mine from New Mexico that is from New York, only her accent wasn’t quite as strong. We talked for a while in the airport while I was finding my luggage she had found a flight that got us out of Anchorage that night at 5:30, so we were in Nome by 9:00. The NSHC put her up in her apartment that she will live in through her rotation, and then told me I was going to have to sleep on the floor of a PA's apartment that was doing a rotation in Nome...so that's what I did for 2 nights. I did get a blanket and a pillow.

The next day we had orientation, which was a crack up. The instructors seemed so happy to have someone to lecture to. The lectures were infantile and over subjects that we have covered every time we step into a hospital. The really should have a universal card for this stuff so you could just flash it and they would know you've heard this all. One of the instructors even did magic tricks during his lecture "to keep our interest up". I think he could use a few more lessons. So that nap took about 3 hours. Then we filled out our obligatory paperwork and they through us in the Pit.

We were sent to the walk-in patient clinic, showed where the charts were and told that it was bad form to patient shop (which is where you look at the charts and only pick out the patients you think it would be cool to see) and we were told to pick up the next chart in line and see the patient, write up a diagnosis and plan, and get it approved by one of the Docs in the clinic. There were about 4. The idea was to get us broken in to how the system worked, and get used to how they keep records, order tests, get x-rays, etc.

It reminded me of MASH. What a bunch of characters. The guy in X-ray was kind of the "Radar". He wore bright purple scrubs, and a surgical cap that was pulled down so low that you could hardly see his eyes. He had that attitude like the weasel on the old cartoons that is constantly wringing his hands and smacking his lips...you know the one I mean?? He could not have been more wired if you popped him in the ass with a shot of speed! There was a PA there who was one of our supervisors who was the "Charles Emerson Winchester", too smart, too cool, and an arrogant ass. We didn't have a "Clinger" but we did have a gay Eskimo who took up the slack. Fortunately he was a patient, and shortly after arrival had a pseudo seizure (fake) and was hauled off to the ER for them to deal with. Of course there was a "Hot Lips". I hit on her, but to no avail. Damn this belly!

So I grabbed my first chart. Under chief complaint (the reason they are there) was written:

Penile discharge.

Yep, my first Alaskan case was the clap. I'm so glad I came to the wilderness to help the poor under served population of natives. So I went into the room had him show me his problem, and took a swab for culture and sensitivity to confirm what he had, and what to treat him with. Basically you run a q-tip up the guy’s urethra to get a sample of the offending matter to send to the lab. When I came out I found a nurse and asked her how I labeled it, and where the lab requisition forms were. She looked at it and said, "Ah… that's not the way we do that here. We take a dirty catch urine specimen." A dirty catch is just a urine specimen with the exudate in it. Ooops. It was painless. I didn't feel a thing. To bad the patient didn't have the same view. Maybe he will remember this and think about a condom next time he finds new love. At any rate, I gave him his dose and sent him on his way.

The staff had great fun at our expense for the rest of the evening. They weren't very helpful because it was just too funny watching us screw up everything we touched. When I say we, I mean me, Coralynn the med student from NY, and Chad the PA student from the University of Washington, who's floor I was sleeping on. At least I wasn't alone, and we formed a pretty tight bond that evening. The Three Musketeers. Did get to see a lot of different types of cases, and it was a lot of fun and good experience. I saw a guy who had been in a snow machine wreck, a new pregnancy, examined and helped a couple of sick kids, an abdominal complaint. All in all a good variety of patients. By the time it was over we did know where everything was, how to order (and take) tests, and learned the procedures for NSHC. A very good experience. Afterward the three of us went downtown and had a big dinner, and a great laugh.

I guess everything went OK, cause the next day they shipped me out to the village. Pretty scary flight. Single engine plane over about 100 miles of semi-frozen Bering Straight. Did a little praying on that one. If you go down, life expectancy is in the neighborhood of 35 seconds...if you survive the crash. Happy to say I didn't get that experience. Landed in two other villages before I got to Unalakleet. I'm happy to report that this is the nicest one. I'm living in the clinic, which at first sounded a little funky, but this clinic is the jewel of the system, and the clinic is state of the art, and in a brand new building. It's like I have the nicest house in town. The building I would say is probably over 5000 sq ft. Lots of windows. Great view of the town. Nice and warm, and I have a comfortable bed and good hot shower. And it's just me.

And the guy in the morgue...

Just kidding. He moved yesterday...

Still kidding.

rto