It never ends

Today's post title comes from my medical director who saw me immersed in paperwork late today and decided to stage an intervention of sorts. He brought me to his office and showed me some of his "to-be-done" pile. Which wasn't large by any means. In fact, last week he encouraged me to complete refills, review results, and address other things between seeing patients. Really? I've tried, but I'm working hard at just trying to stay on schedule, let alone do my busy work between patients. Nice thought though. But I think the point he was trying to make was that you have to develop a system of being efficient and of not letting things fall through the cracks without letting the work take over too much of your life. Which is good advice. It's taken so much work and determination to get up here and it would be a shame if I never got a chance to enjoy the place now that I am here.

Great Expectations

Orientation week is over and I now have a slightly more clear idea of what I'll be doing here. 

About one week a month I'll be the "OD" or officer of the day. Being the OD is like wearing a lot of hats. You attend to anyone who comes to the ER--then you decide whether they can be discharged, admitted, or "shipped out". Shipped out would mean someone is very sick and arrangements need to be made to medevac the patient to a bigger hospital with specialists. The closest would be Anchorage (about 600 miles) or Seattle (about 900 miles). It's an insanely expensive ambulance ride, I think in the tens of thousands. OD is also the hospital doctor so you would round on patients who are admitted. We have a 26-bed hospital with about 4-ICU beds, so it's very small compared to the 623-bed, 8 floor hospital where I trained in Lancaster, Pennsylvania. I've been checking out the number of people on the service and it seems to average about 12 which isn't too bad. Another responsibility the OD has is answering pages coming in from the health aides in the various villages surrounding Sitka. Finally, sometimes the OD attends to the obstetrics floor. 

Most of my time as a new family doctor, of course, will be spent caring for people in the office--trying to keep people out of the ER and hospital. I really like this part of my job because over time you get to really know people and learn about what motivates them, their backgrounds, etc. There are a number of Native Alaskan groups in this area with rich histories, traditions, and customs that I really hope to learn more about while I'm here.

Luckily for me, my job includes delivering babies. I'm on call for obstetrics every couple of weeks. Right now I don't have a good sense of how many women in my panel are of child-bearing potential, but hopefully over time that number will increase and I'll be able to participate in a lot of happy deliveries with good outcomes.

Last, but not least, I have a little village of 600 subsistence living people that I am responsible for. You can only get to this village by ferry or by plane and I'll be doing that about 3 times a year for a week at a time. The rest of the year I work in collaboration (by phone) with health aides and 2 physician assistants who live there year round and will call me with questions and prescription requests. This part promises to be very interesting so keep tuned!

Tomorrow morning I start my very first clinic.

4 Years In The Making

(This post explains how I became obsessed with the idea of practicing medicine in Alaska.)

A few years ago I spent a month working as a medical student at an small Indian Health Service clinic in Northwest New Mexico. If you have never been to the Southwest you have probably by now seen some of it on the TV series Breaking Bad. The views are devastatingly beautiful. The remoteness and open spaces are awesome and kind of scary. Now imagine being the only doctor working in a 7-bed emergency room for a catch area of 20,000 people in the middle of the desert. You have an x-ray machine but no CT or MRI or echo. If someone decides to deliver you will be the one to do that. You manage alcohol intoxication all the time. If someone comes in with a heart attack or a similar emergency your job is to find out what is wrong really fast with minimal technology and request for a medical jet to transport them to a tertiary center. As a medical student I was working shoulder to shoulder with doctors making calls like that. I even worked with the doctor who found the index case of Hantavirus Pulmonary Syndrome in 1993 in a young and otherwise healthy Navajo marathon runner. These doctors might as well have been the gods of medicine to me. So when I found out some had practiced in this even more remote and crazy place called Alaska they had my attention. One of the physicians told me about what it was like to work in Barrow (the northernmost US city where temperatures remain below freezing from October to late May) and another one told me about the really long Alaskan winter nights and close knit communities. It was like they were telling stories from a different world but it was all real! I think that was the moment I realized I was going to be a rural medicine family doctor. 

After that I started looking into this place called Alaska and somehow, miraculously, convinced my wife that moving there after residency would be a good idea. We spent a month in Anchorage and a month in Juneau during my residency and I accepted an offer to practice full-spectrum family medicine (that means working in the clinic, hospital, and delivering babies) in Southeast Alaska. We arrived here on September 30, 2013 and today was my first day of orientation. If all goes well I will be blogging about my first few months as a newly minted family doctor in Southeast Alaska. Maybe my wife will lend me some of her photos to add some color to this otherwise drab blog.