Well, it’s 425pm and it’s dark. Actually it’s more ghostly, misty, pre-dark than can’t-see-your-hand-in-front-of-your-face dark. But it will be that dark soon. I saw that dark last night by the time I arrived at my apartment in Cordova, home for the next 31 days. The flight from Anchorage was spectacular. We rose so rapidly through a dirty dishwater sky after take off that I was completely startled to suddenly see mountains all around us poking their massive heads through the canopy. There was snow frosting the ridges, but rippling glaciers and rivers of clouds running in the valleys between peaks. The clouds gradually gave way to glimpses and then wide swaths of arctic-blue water and a multitude of islands below, but everywhere, everywhere the jagged peaks thrust high then dropped steeply to the ocean. Very easy to see why Alaska has more planes than cars! There is simply no where to put a road. In fact even a landing strip is a bit dicey. We kept coming down, and down. The mountaintops were higher than the wings on the jet, and still we were descending and I couldn’t see a bit of flat ground on which to land. Short runway and lots of G’s on touchdown, but smooth. Hate to try that in poor visibility!
Time is distorted here, starting with the 4 hour time difference, which is messing with me. I “slept in” until 5 this morning…you will all laugh to know I’ll be early for a while! The funny thing is I still set my alarm even after I got up because there is no sunrise (or Rob) to tell me it’s time to go. I’m switching on every light in the room when it’s dark to keep seasonal affective disorder at bay. So far it’s been just lovely to have quiet stretches to read, write and reflect. I’ll let you know if that changes. Or perhaps you’ll be able to make the diagnosis from afar by a creeping despondence in my posts!
It’s very apparent just how crazy being a hospitalist has made my life. I love the medicine and my patients, but the pace and the problems of our health care system are brutal. I’d love to change that– but I’m paralyzed by the sheer scope of the task. Things feel, and are, slower here. Fewer patients to see, fewer (almost no) specialists, or procedures, no electronic records, though they are coming. The expectations are different too. Of course excellent care remains the paradigm, but within the scope of what can be done at a critical access hospital 40 medevac minutes away from more advanced technology. It’s not just the scale of the scenery, but time is bigger here too. There seems to be more of it. More time not just to talk to patients, but to listen.
I have met nothing but extraordinarily pleasant people so far. (Perhaps they deep-freeze the nasty ones on some of those islands we passed in the jet.) Spent much of today getting physical and verbal tours of my new work place, a finely equipped facility with lots of people who are devoted to their work, just as I’ve discovered most everywhere I’ve ever worked. If we could simply get our systems to support us…ahhh, but there’s the operative word…simply. I hear I may go for days without seeing a patient in the ER, and I haven’t seen one yet today, 9 hours into my first of three 24-hour shifts. But then I may have 7 people in a night. I do manage the patients we admit as well, and the nursing home residents (10 beds) in the facility. So I did see a few people today, for pretty much the same things as usual. They were very welcoming, completely putting to rest my concerns they might be put off by an outsider coming to their town.
Day 1, continued: midnight
Called in for rush hour in the ER. You’ll have to use your imagination and previous televised episodes of ER for the range of clinical issues I’m likely to see here…In other words, I’d like to tell ya what I saw, but then I’d have to kill ya!