The laying on of hands

I had my physical this week. It was interesting being a patient after having been an attending physician for the past 2 months. A few things surprised me:

(1) My doctor asking me about my family history caught me off guard—so much so that I forgot to tell him some important details. I ask my patients this question all the time.

(2) My doctor wore a tie, which I appreciated. Interesting, as I know about the studies showing that they carry lots of germs.

(3)  It meant a lot to me that my doctor did a thorough physical examination.

I don’t examine my patients during every visit. Sometimes its because it doesn’t seem necessary. Usually it’s because of time: medication refills, referrals, multiple medical complaints, status of chronic medical conditions, they take up a large portion of the visit. But I know the exam matters to patients because they have told me so. Patients here have complained to me about other doctors who skipped this part of the encounter. When I was training on the East Coast no one seemed to care about whether you did a good physical exam. The complaint was why didn't the doctor send me for an x-ray, CT, or MRI. I'm still not sure why the expectations in this area seem so different. I can tell you another reason why we doctors don't examine patients more often. When we're staring at labs that tell us that the patient’s diabetes is uncontrolled, or we see that their blood pressure is dangerously high, it feels like what the patient needs is education/reinforcement/motivational interviewing, not an exam. But having been a patient recently, I’m starting to believe that thoughtful examination of a patient can add a lot to the encounter: clues, information, trust. So maybe its time we started making it more of a priority.

Sitka from a floatplane
Mountains to the East, Pacific to the West. The airport is at 3 o'clock.
The bridge that connects it to Sitka is the John O'Connell Bridge.

At the center?

One of the few photos I've taken on manual setting...after my wife set it up for me.

7 weeks into my new job and I am really struggling to find balance. The scale is tipping way to the side of work. It’s a good job; I’m glad to have it, but I wish I could turn my thoughts about work “off” during weekends and when I get home. It would also be nice to work out every once in a while. I have never had this problem before and it makes me feel tense.  It’s as if my internal compass isn’t pointing true north. As a Christian I know I’m supposed to have Christ “at the center” but if I’m honest, He hasn’t been. I guess that’s why it was nice to go to a local church today and hear a message about worship. Worshipping God involves stepping outside of yourself and focusing on Him.  

Russian orthodox cross

Village Life

Angoon. This village of 450 (80 % Tlingit) people is located on Admiralty Island, aka "fortress of brown bears". It's roughly 40 miles from Sitka and a 30 minute flight by float plane (because the village has no landing strip). The island is 1600 square miles. There are an estimated 1600 brown bears. This is not a joke. It has the highest density of brown bears in the US. In case you are wondering, I am the family doctor for the village and yes, I carry bear spray. Most of the time I am consulted by the nurse-practitioner who lives there year-round. But 4 times a year I spend a week there seeing the most medically complex patients I have ever seen anywhere.

Smoothest landing ever

Angoon has had it rough and brown bears seem to be the least of its problems. In 1882 it was bombed and destroyed by the US Navy. Today there are very few jobs so most people here live off the land--eating what they catch, hunt, or harvest. But they can't just eat fish, deer, and berries, so a lot of what they eat is highly processed, long shelf-life, nutrient poor, calorie rich food. I haven't been there myself but I hear the grocery store is quite expensive and as you'd expect the produce isn't very fresh.

Angoon AK from the plane

If I'm honest I'm having a hard time wrapping my head around something. Much of Southeast Alaska is as beautiful and pristine as it is resource-rich. So I cannot comprehend why there is so much pathology in Angoon. It's not hard to understand the high rates of type 2 diabetes, obesity, tobacco, and alcohol. Much of the US is like that. But the autoimmune diseases just baffle me. High rates of rheumatoid arthritis (even in young people), lupus, and a very rare one: primary biliary cirrhosis. If you're reading this and are a board-certified rheumatologist or gastroenterologist I want to be your friend.

Welcome Dr. Vega! You ready for this?

Those of you in primary care--family medicine, pediatrics, geriatrics, internal medicine--know the importance of continuity in caring for chronically ill patients. Angoon has not had much of that recently. It's no one's fault, it just has not happened. So as always happens in situations like this, the patients get the short end of the stick. It's just messed up. I'm going to summarize my week in Angoon by saying I enjoyed every patient interaction without exception and I was heart broken and inspired by the stories I encountered. After seeing and caring for all these precious people one of my elderly Tlingit patients said "don't give up on us". I literally had to leave the room so I could get it together.

The way I see it

I recently inherited Mari's old camera. I think she got tired of hearing me tell her what to take pictures of. Here are my first pictures. Disclaimer: I have no formal or informal training in using a DSLR camera, however, I anticipate the photos will get better. Click on the pics for a full-screen view.

This batch of photos is from a whale watching cruise we went on today. Humpbacks live and feed off the Northwest coast, including Alaska and British Columbia. Come November and December, some of these whales migrate 3,000 miles to to the warm waters of Hawaii. Some of them do so to breed and others to give birth. Then they migrate back to the cold and food-rich waters where they came from. Researchers estimate that the voyage takes them around 30 days.

This is a view of Mt. Edgecumbe. It's a dormant volcano on Kruzof island, 9 miles west of Sitka.

I don't own a zoom lens. Sorry about that.