Northern Exposure

Cordova, Alaska

October 25, 2015

Early morning walk on the ski-hill above town with clouds just lifting out of the valley.
Early morning walk on the hill above town with clouds just lifting out of the valley. See posts from December 2014 for more about Cordova the first time around.

Friends have said that my Alaskan adventures remind them of the popular TV series. I found the comment amusing at first, but it’s kind of true. Cordova feels a lot like that mythic place setting. In a town of 1500 a newcomer sticks out like a polar bear in Ohio. People of all ages strike up conversations in the grocery store, with me and each other. The one sit-down restaurant, The Reluctant Fisherman (known simply as “The Reluctant”), serves as a neighborhood gathering opportunity as much as a place to have a meal.

Cordova Harbor
Cordova Harbor
View of Cordova Harbor from my table at The Reluctant.
View of Cordova Harbor from The Reluctant.

I ponder the naming of The Reluctant as I sit down to dinner after a walk around town to stretch my jet-cramped legs. The fishing vessels moored in the harbor make their own statement, but the restaurant, sitting on a bluff overlooking the bay, evokes an entirely different perspective, one that sums up all the minuses of the fishing life in a single word, and I suddenly realize it reflects some of my own feeling this time around.

Just a bit of fall color remains.
Just a bit of fall color remains.

Scheduling a couple weeks in Alaska seemed like such a good idea at the time, but working away from home for 4 out of the last 10 months has caught up to me. Yet the feeling is not just about wanting to be home.

I was anxious the first time I came to Cordova, knowing I’d be the only doc here for a month, afraid I’d not measure up to the patients who presented themselves to my care. I didn’t have too long to worry because the worst case scenario appeared almost out of the starting gate: a patient with multiple trauma whom my team and I successfully coded for 5 (that’s no typo) hours before being airlifted out. I had no idea a patient could balance on the knife edge between life and death for that long. Most people who survive codes do so in the first few minutes, and most codes are stopped within 20 to 30 minutes if the patient does not recover vital life functions of breathing, pulse and blood pressure by then.

But a physician’s job at a critical access hospital like Cordova’s, without advanced diagnostic or therapeutic technology, is to stabilize the patient for transfer to an institution with those capabilities. We did our job and we did it well. Unfortunately, the patient died later that day. Why the angst? Heaven knows we lose people all the time. Doctors do not confer immortality. But I discovered that day that there is a difference between how you feel when you lose a patient despite all the tools of modern medicine, and how you feel when you lose one without all the tools being available. I accepted the limitations of this location when taking the assignment, yet this was a new pill for me to swallow. Despite years of experience, I’m still surprised at how my brain can’t always prepare me for what my heart will feel.

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Thank goodness I had nothing else that compared to that case. Just bread and butter medicine from pediatrics to the elderly: pneumonia, COPD, kidney failure, diabetic crises, angina, chronic pain, gastroenteritis and ear infections, end-of-life care, and the sad but universal cases of dwindling elderly patients who can no longer care for themselves, complicated by an equally dwindling number of people they might depend on for help. I was thrilled to be practicing the full range of medical skills I’d acquired over the years, with patients whom I also had time to get to know. Just like the pain of childbirth, I suppose, it was only the thrill I remembered when I was asked to come back.

I recognize in hindsight that only as the time to leave home approached did reluctance creep in, a victim of my naiveté destroyed in the effort to save my unsalvageable patient. I am reluctant to be in that position again—to confront perhaps a salvageable patient—one who might benefit from better skills than those I, or any one person in this remote place, can bring to the infinite disasters that might appear on a gurney delivered by the local ambulance. A word of advice: do not enter medicine if you cannot face the demons of self-doubt.

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Yet Cordova itself is the tonic. Amidst all that professional baggage is the unaccountable delight that I am back here. With each step on a mossy mountain track, every soaring eagle and snow capped mountain, every sea otter and salmon, even the torrential rain: I love this place, its wildness, its isolation, the splendor, the grandeur of the vistas, and the genuineness of the people. As Cordova seeps in, reluctance fades. I desire more than anything to be worthy of the privilege of being here.

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