Cordova Day 11

9 am

Skies clearing over Lake Eyak
Skies clearing over Lake Eyak later in the day. Those are swans paddling around the ice-floes.

There’s an old-testament sky roiling over the lake this morning, and I’m on my 3rd cup of coffee after my third night in a row of sleep disrupted by trips back to the hospital for emergencies. As with all ER’s, the problems range from the mundane to the horrendous and I’ve encountered all of it already. They tell me it hasn’t been this busy in the ER for years; I guess that’s the good news and the bad news.

I have discovered over a lifetime of work that there is no predictability to the needs of patients, and Cordova proves no different. I might go for over 24 hours without an ER visit, and then have four people show up at once, for our two designated beds. Triage then becomes more critical—eyeballing the patient for the level of “toxicity” and presenting symptoms so that I can order what’s appropriate and prioritize staff efforts. Truth is, the supporting personnel here are pretty good at knowing what to do before I tell them: I suspect, like all excellent ancillary workers, they’re just humoring me—my orders are often anticipated.

Mostly the phone just startles me awake. One memorable night it was the police pounding at 5 a.m. after the phone failed—OMG—that was a heart-thumping event. First order of business in an emergency (according to the classic, cynical but accurate, accounting of medical internship, The House of God)–take your own pulse. Early in our marriage, when I was on 24/7/365 for the Clark County Jail, Rob commented on how he’d never seen anyone so instantaneously alert when the phone rang in the night. He’d be sitting up, thrashing, trying to orient himself to the ringing in the darkness, gradually aware that I was giving orders as though I’d been lying there awake, calmly, expectantly, for the call. After years of training, this has not changed. What is noticeable though is that I require longer to reset. No longer can I go for days, or weeksof sleep deprivation from parenting duties + patient demands without accommodating. I had no idea my skills at napping would be as critical here as those of doctoring. I can come home and rest anytime, and I do. Like now. See ya later…

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Clear day view from my window, as promised. More swans. 

 

 

Day 9 Cordova

12/9/2014

Wow. They tolerate me being very close.
Wow. American beauty in Sitka pine. They tolerate me being very close. Wish I’d brought the Nikon.

In my last post I talked about how travel inevitably results in new perspectives. Today’s kernel of enlightenment: Springfield, OH is the sunshine capital of the USA! Yes! No complaining down there! I am in no danger of needing that spf 15 in my Oil of Olay while in Cordova. Day 10 in AK without so much as a glimpse of sun. I did see a hazy moon one night, but that doesn’t count. I can name > 50 shades of gray here, and none of them are the least bit titillating. Now I know you’re probably thinking I must have known there isn’t much daylight in Alaska this time of year—but you’d be mistaken. I researched all (actually, and evidently, only most of) the daylight and weather details before I took this position, which indicated a good 6-7 hours of daylight even on the shortest day of the year. Mid Ohio has about 8 hrs; not much difference. However,150 inches of precip a year in Cordova compares to our measly 39. In my imagination I envisioned piles of snow, heaps of it, Dr Suessian in magnitude and delight. I saw myself wakening to wondrous, wintry snow globes of floating, frosted flakes. It’s part of what drew me to Alaska.

Ha.

The problem is not the amount of daylight, but its obscurity in the face of all this precip. I clearly glossed over —la, la, la, la ,la, hands-over-my-ears—the part of my research that mentioned Cordova is a temperate rain forest. Also, my agent mentioned getting me a pair of “grippers” so I could walk to work as I planned. What the H is a gripper?

Crampons, it turns out. As in, all that rain turning to ice when the temp happens to drop below 32. Which is does, frequently. So I spent my first day off last week indoors waiting for the rain to stop so I could explore. And waited. Day two off work, still waiting, I set out in my jeep to at least drive around. Tried to go to the end of the Copper River Hwy – but only made it to mile 15 (out of 36). When I slammed on the brakes at the first pair of bald eagles I spotted at mile 10, IMG_4198I skidded to an uneasy stop on black ice. The eagles were unfazed by the flying gravel, and I snapped away from the car after backing up on the deserted main road. There was a bobcat in front of me digging grooves in the ice, and depositing more cinders as I passed the airport at mile 12. Having been educated into a more cautious pace, I passed the bobcat and continued…onto ice worthy of a freshly Zambonied rink. Being of the rather adventurous, slow-learner type, I continued at an even more cautious pace to skate ahead, so to speak. By now I had spotted at least a dozen eagles, some perched, some on the wing, all within 10 to 50 yards of the road and I was drunk with the possibility of more wildlife sightings. I even got out of the car (parked right in the middle of the road) to take more pics. Mistake—Clem Caddiddlehopper skidding my way to the edge of the road and back to the car in my crampon-less boots. Twenty steps never seemed such a perilous distance.

Ice, ice, and more ice
Ice, ice, and more ice

Foolishly I continued to drive, but became more aware with each passing eagle and scenic vista, of the road’s natural and miniscule slant for water run-off becoming a slick force to be reckoned with. Unable to keep the jeep from sliding sideways, and seeing the bobcat gaining on me, I decided it was time to abandon my quest, and did an 8 point turn in extreme slow-mo to head back to town. The end of the road will have to wait for another day off, which I can only hope is a bit dryer.

The town Christmas tree. What a backdrop!

Day 6 Cordova

IMG_0388Shocking though it is, this photo  is actually one of the main reasons I travel. I relish the opportunity to explore other cultures. At its most wondrous, immersing myself in another community enhances my view of the world. At its worst, this experience can be upsetting or offensive. I find the rewards of the former vastly outweigh the risks of the latter.

I heard the grinding whirr of the hoist bringing up a heavy cargo from the deck of a boat below. Curious, I walked onto the pier for a closer look. I couldn’t tell what I was seeing at first. When the reality of the gutted deer hit me, my first reaction was horror, and then, to snap it. After I took the photo I thought, Who’s going to want to look at that? For me the pic dramatically captures a fragment of culture I’m not ordinarily exposed to. It has forced me since the moment I saw it to consider what it is that upsets me. As I worked through my own feelings, I decided it was an opportunity for discussion and asked for comments on fb. Aside from the expected yucks and dislikes, I got thoughtful responses from Deb Garrity who said “I had a similar visual experience in college, and have never eaten venison. Learned about calves and also quit veal.” I too have been through my own pick-and-choose way of dealing with being a meat-eater. But John Groves hit closer to my current mark when he said, “I think many of us would rethink eating meat if we had to go to the slaughter houses to buy it. The distribution network for meat is such that we are “protected” from seeing this on a daily basis. I am sure these animals were “harvested” for the meat, but not a pretty site.”

Several years ago I made a concerted attempt to become a vegetarian. Medical literature is replete with the risks of meat, and I had a nagging, though still uninformed at the time, view of animal slaughter, though it did not come from the up-close-and-personal aspects of killing and cleaning game. My dad was a hunter and we were pretty poor early on, so we most definitely consumed everything he carried home. I have eaten lots of critters including rabbit, pheasant, and squirrel, yes squirrel, and I absolutely love venison. Actually, I love all of it. In fact the vegetarian thing lasted for about a month, and was almost a total failure for me. I am a carnivore through and through. I just do not feel good without meat. In fact there is evidence there may be a genetic basis for ancient diets affecting our current health—in other words for what I physically felt. Just this week the Anchorage newspaper described a gene in northern native people—a gene that does not break down body fat, and that is presumed to have developed as a protective thing for populations that needed to carry and preserve fat through cold weather, but which threatens newborns by making them unable to use body stores appropriately if they get sick. As a result all newborns in Alaska are going to be tested for this gene. My physical relationship with meat tells me my ancestors were surely hunters more than gatherers. But I digress.

I read everything I could find in my vegetarian days to gin up the strength to persevere. (I’d recommend Jonathan Saffron Foer’s, Eating Animals –excellent read.) I learned much about factory farming, hormone and antibiotic abuse, and the sentience of cows, pigs, and even chickens. Over time I have come to believe that how we treat animals from birth to death in our mission to bring cheap food to market is an abomination, and a sad reflection of our inhumanity. While I still cannot claim to be a vegetarian, I can report that we eat much less meat in our family, we waste almost none of it anymore, and we try to buy happy animals when possible (which is more possible in the Midwest, than in many other places). This meat is much more expensive that what can be had at Kroger, but that helps us to conserve and value it. I don’t see myself ever being able to do without a Thanksgiving turkey, or a great burger or steak, not to mention the world’s biggest obstacle to veganism—bacon. But I can say that each time I look at those deer hanging, eviscerated, from a hook, I am grateful that they lived free in the wild since birth, were taken mercifully and quickly in their native habitats, and will be consumed down to their hooves by people who will appreciate every bite.

Home Away from Home, Alaska

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The inside of home, sweet home. It’s so nice. And warm!

It’s 0839 am in Cordova, not a shred of light in the sky yet. Sunrise officially predicted at 0926, but I hope to see a bit of a glow by nine-ish. I can hear sleet pelting my picture window, but the only picture there is the drizzle of drops melting from top to bottom, like a cake that’s been iced while it’s still hot. I’m sitting under a lamp I’ve removed the shade from and situated next to my cheek to capture as much light as I can since sunset will be at 1537 and I’ve not left the hospital until after 1430 yet. My face is warm from getting too close to bulb; I feel like a sunflower, or a moth.

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Sticker shock at the grocery

I am loving my stint here so far. Duties include 24 hour ER /hospital call, daily rounding on our inpatients—we have 2 official beds (full), but flex up to more if needed (currently have 3), weekly to monthly assessments of our swing and long term care patients (? 10 or 12 beds – all full), new admissions—already did 3 of those, discharges- couple of those, outpatient clinic (I’m only assigned 2 days of that all month) and follow up of any and all new concerns with any patients. I relish the smallness of it—staff is right there, responsive to whatever I order, available to quiz on patient status, needs, protocols. One case manager devoted to pursuing solutions to social issues confronting our patients. The native american community here also runs an OP clinic which communicates very well with us at the hospital since we accept and manage their inpatients. Staff can be called in, and arrive within minutes, to support operations like Xray, lab and additional nursing. I had lab results back within 15 minutes of when I ordered them. I had already told the patient it would be a couple hours!

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That’s a bit of the hospital at right. New, well-aquipped, except they need a CT scanner.

In Cordova it’s hard to be more than 10 minutes from the hospital—the town, like many in Alaska, is accessible only by air or ferry, and the road only goes for 36 miles before it’s washed out. Most people live right in town, within about 4 square miles. Practically, when you’re on call you’re required to be at the hospital within 20 minutes –so mostly that means no hiking or boating, so I won’t check out the end of that 36 mile road, from which I might be able to see Child’s glacier and the million dollar bridge, until my day off.

Flexing services up and down as needed is much more nimble in a small community like Cordova, than in even a large town like Springfield where so many of our staff live much farther away. But this is exactly what is needed in all our health care institutions, no matter their size, to make health care as responsive and safe as possible, without costing us even more. No nurse or physician can be saddled with more patients than they can handle without increasing the risk of error. I believe it is possible if we restructure our system to focus on quality, and not insurance and medical device/ pharm profit. There are minute movements in that direction: not nearly enough. More on that later.

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Plane taking off next to road along Lake Eyak. I have a front row seat for the landing strip.

For now, it’s 915 and a milky daylight has infused the lake view outside my picture window. The sleet is replaced with a light snow so perhaps I’ll be able to walk to work—who new I needed to bring a raincoat and umbrella instead of my skis? I’ll post a photo of the scene out my window if it ever gets light enough to take a decent picture!