Fasten Your Seat Belts Please

My day was just concluded with a stroke of sheer genius. I was walking out of the hospital after sign-out and realized I never used the $12 cafeteria voucher I got during orientation. We all know my disdain for hospital cafeteria food and my obsessive compulsive use of tupperware (glass!) to bring left overs which I have maintained while in the tundra. I had no intention of actually getting food, although Ben keeps chiding me to try a moose burger. I did, however, realize I was out of milk ($6 half gallon went by quickly) meaning - horror- no oatmeal squares tomorrow for breakfast. I poked my head in the cafeteria to see if they had milk for sale and... jackpot! I proceeded to walk home the 1.4 miles with $12 of milk in my backpack. I thought you might appreciate a photo of my haul. I also want to see how many blog entries I can open with a photo of an overpriced diary product.

Day 2 was a slightly less painful version of day 1. I am getting the hang of things a little more. Though there are some things I will never get used to. Like the frequency of suicide attempts around here. Suicide is a huge problem in the YK delta region (and I suppose likely in the whole state). I have already had 3 admission for suicide attempts (in 3 days!). Someone also succeeded in killing himself last night in one of the villages. One of my RMT calls today was for an 11 year old girl with suicidal ideation. The behavioral health people at the hospital work extremely hard with extremely limited resources. The only inpatient psych unit is in Anchorage and often has a waiting list.

Another hard thing to get used to is lack of nursing homes. And good geriatric care in general. I was dreaming up an away rotation in Bethel for the Swedish Family Medicine geri fellowship (seriously, Carroll!). I have 3 octogenarians on my service currently who are all unsafe to go home. The few nursing homes that exist are in Anchorage and have very long wait lists. Home health services are barely existent. We end up settling for some very worrisome alternatives. The family units here are very strong, with elders occupying an honored place. But often the children have grandkids and great grandkids at home to care for. And home care supplies are a little limited. I am currently hoping to discharge one of my patients to his daughter's home but am in a holding pattern until we can arrange to get his hospital bed, commode, and walker to Bethel from his remote village. Funny how "remote"changes depending on your perspective.

Speaking of odd things flying on airplanes, I learned today that we can order medications to be sent on airplanes out to the villages. Today one of my RMT calls was for a 74 year old woman with extreme constipation, likely fecal impaction (imagine trying to explain how to digitally disimpact someone over the phone to a health aide. it didn't go that well). So I wrote a prescription for some enemas and a bottle of lactulose to go out on the morning flight. I can just imagine my little fleet's enema buckling up in its seat next to the bottle of lactulose, listening to the flight attendant do the safety talk.... "Should we have a sudden change in cabin pressure, oxygen masks will appear from above your seat...." Gotta keep it light sometimes. It's crazy out here!