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