"This is radio nowhere..."

My second day on the wards turned out to be equally eventful as the first. I came in at 7:45 am and started rounding on the patients. Turns out medicine is still medicine out here. Meaning, lots of the same issues I've dealt with many times before (delirious geriatric patients, placement issues, alcohol withdrawl, trying to minimize pain meds, etc). At noon I was called away for a delivery. It was the same 18 year old woman I sent home in early labor (or back to prematernal housing since she is from a remote village) the day before. It was her second baby, though she progressed slightly slower than most native alaskan women do, meaning she didn't literally explode the baby out in no time flat. It was a lovely delivery of the most adorable pink and screaming baby boy. The nurses told me later that it also wasn't a typical delivery because the woman actually expressed some discomfort. Apparently women up here are beyond stoic. My patient seemed pretty darned stoic in that she was mainly sleeping or silently awake until she was completely dilated, when she started crying silently into the pillow. At crowning she did show some pain by writhing a bit in the bed. The nurse said, "I know those women in the lower 48 scream and yell at 2 cm, but it's just not like that here." These are some tough womenfolk.

After the delivery my pager was all a buzz with ER and RMT calls. We got four new admits: a 40 year old male with alcohol induced cardiomyopathy (big, ineffectively functioning heart), a 48 year old male with a small bowel obstruction, an 85 year old woman with gastroenteritis (there is a campylobacter outbreak in one of the villages), and a 26 year old woman with epiglottitis (swelling of the epiglottis, deep in the throat, usually caused by a bacteria, rare in adults, and potentially deadly). I'm learning that what we in the lower 48 consider rare is fair game out here in the tundra (for example, I just heard that botulism is occasionally seen here). The woman luckily was stabilized in the ER before coming to me. I am having a few panicky thoughts regarding my last week here (to be spent in the ER). But back to the present.

I'm also learning other challenges of taking care of people from small towns, namely the fact that everyone knows each other. Cases in point: The woman that we took on the medevac happens to be the grandmother of the L and D charge nurse (update on her: I found out that she ended up having rare antibodies in her blood (Kell + for the medical peeps) and had to be flown to Anchorage from Bethel to get the blood she needed). Also, the 85 year old woman with gastroenteritis had the misfortune of being in the ER the same time her grandson came in with a spinal cord injury (drunken fall, apparently). Four generations of her family were in the ER, bouncing between two rooms. It was amazing and sad.

The familiarity of all folks around here is very apparent on the radio traffic as well. The health aides know all the docs, so I'm a dead give away as a newby when I return the pages. I'm getting a lot of, "Dr. WHO? k-a-b-o-o? You must be new!" One of the health aides called me about a patient with a tooth abscess and I noticed the aide and patient shared the same last name. "Do you happen to know this patient," I asked? (which is actually a very silly question because even if she was not related to the patient, the aides certainly know all of their fellow villagers) "Oh, she's my daughter" was the reply.

Many of the health aides have been blowing me away with their knowledge of medicine and the intricate functioning of the medical system up here. Of course, there are the new health aides that frighten me with their lack of urgency about scary things, or who give me every detail of a physical exam from head to toe when all I want to know about is one body part (usually the last one described). But for the most part I've been so impressed by and grateful for their knowledge that I feel like chartering a plane to each village and bestowing honorary medical degrees upon all of them. More than once I've thought to myself "Wow. I'm glad she had a plan for this. I wasn't too sure myself."

The pages from the health aides flowed in rapid fire yesterday. I was very thankful to have another FP helping me out with my service. But tomorrow I start an 8 day stint all by my lonesome. Time to take away the crutches.

Today was my day off. I hate to admit this to everyone who is expecting the tundra to be continually bleak, but the weather has been gorgeous. And (Seattleites look away) the forecast for the next week is warmer and sunnier than Seattle. Doesn't look like I'm going to get much use out of my down sweater and long johns. Which is just fine with me.

I went for a run into town this morning and took in the sights. On my way in I passed an electronic marquee at the library advertising classes on creating a Facebook page. Perhaps I should attend?

After my run I took it easy in my cottage and rejoiced in the fact that, ironically enough, the Eagles' game was on here and not in Seattle. It was a tough loss for the Eagles, though they were beaten by the Packers, and I do admit to having (only very slightly) divided loyalties.

Tonight I plan to watch an episode of Northern Exposure and to try not to fret about the coming week. I've had the theme song to that show in my head all week. I have an inner soundtrack that is alternating between that and, thanks to the radio medical traffic, the Springsteen song "Radio Nowhere." Tuning out for the night...