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.