What I Did On My Summer Vacation

Well, I didn't go back to Africa, if that's what you're thinking. But it was an action-packed summer nonetheless. First, I graduated from residency. Then, I fretted about my career prospects. Then, I studied a little for the boards (and passed, it turns out). Then, I fretted about jobs some more. And a bit more after that. Then, Ben and I did some traveling to see family and friends (Philly, NJ, San Diego). Then, Linus ran away, and boy did I do some serious fretting about that. Thankfully he was found after about 10 hours of Linus' great adventure part deux (part 1 was last summer when he ran away and was found at the Buckaroo Tavern in Fremont. For serious). Then it was back to fretting about being a big girl doc.

Turns out that going from full speed (aka med school, residency) to dead stop (post graduation) is hard on a type A person. I would think. Not that that describes me or anything... As a result, out of fear of not having a job, I ended up getting not 1, but 3 jobs (and all the joyful paperwork, contracts, licensing that goes along with that!). Which made for a busy end of the summer.

A quick summary of my various job commitments:

Job 1 - A 3 week locums (akin to temp doctoring) stint filling in for a fabulous, hardworking, mildly manic family doc who runs an addiction medicine service at a local hospital. The inpatient service consists of about 20-25 patients who come to detox off substances (most often heroin, oxycontin, or alcohol, but also including methamphetamine, cocaine, benzodiazepines, barbiturates, and the ever-popular all of the above). These patients usually stay about 5 days, stabilize medically, then (hopefully) go on to more long term inpatient rehab and treatment facilities around the state and beyond.

I spent some time working in this unit as a resident but felt a bit unprepared for the challenges involved in taking care of this patient population. Turns out it is emotionally and physically draining to watch patients at rock bottom continue to make bad life decisions. And it is even trickier to walk the line between gaining trust of the patient and forming a therapeutic alliance, while at the same time being painfully honest, trying to get them on the right road to recovery. Sometimes it was just hard to find the right words at all (like, how do you tactfully say "well, you've been drinking a fifth of gin a day for 20 years, so no, I don't think that simply removing the alcohol from your apartment is a good recovery and treatment plan for you."). There is definitely some finesse to it that I hadn't quite mastered in my 3 weeks there.

The other complicating factor in this job is that the other half of the patients there are pregnant women suffering from addiction. Most of these women have heroin (or some opiate) addiction and end up being stabilized on methadone for at least the duration of their pregnancy (if not longer). The storeis of these women alone are riveting enough to comprise their own blog. Suffice it to say that their social situations are tragic and complex, and their medical issues are equally so and read like a high risk OB text: shortened cervix, preterm delivery, oligohydramnios, IUGR, 2 vessel cord, previous ectopics, previous c-sections... (and sometimes all in the same patient). Put into the mix that all the women are on methadone (and some at doses high enough to kill a small horse, or me, or both). I learned a lot while suffering from high blood pressure and gastric ulcer disease, no doubt.

Which brings me to job 2 - Locums stint part deux. This time in Bethel, Alaska. Which is actually why I am resurrecting this blog. I came back from Africa yearning for a rural, remote experience without the jet lag and altitude sickness. Turns out a few Swedish grads have searched for something similar and found themselves in Bethel, working for the Yukon-Kuskokwim Delta Regional Hospital. I started this ball rolling in February (turns out it takes about 6 months to get an Alaska state medical license) and... here I am. About to leave for the Alaskan bush for 3 weeks.

A little on Bethel, brought to you by Wikipedia:

Bethel (Mamterillirmuit in Central Alaskan Yup'ik) is a city located near the west coast of the U.S. state of Alaska, 340 miles (550 km) west of Anchorage. Accessible only by air and river, Bethel is the main port on the Kuskokwim River and is an administrative and transportation hub for the 56 villages in the Yukon-Kuskokwim Delta.

Bethel is the largest community in western Alaska and in the Unorganized Borough, as well as the 9th largest in the state, with a population estimated to be 6,356 in 2006.^[3] Bethel is home to the lone detention center in southwestern Alaska, the Yukon Kuskokwim Correction Center.^[4] Bethel is also one of the latest communities in Alaska to become a "wet city" (to allow the sale of alcohol within the city).^[5]

Annual events in Bethel include a noted dogsled race, the Kuskokwim 300, and Camai, a traditional dance festival held each spring.

I will try my best to keep you abreast of my next big adventure. Right now I am in the final phase of packing. Strangely, I am bringing a lot of the same things that made the African jaunt (plus more layers and rain gear, minus malaria prophylaxis and sunscreen). I'm feeling equally jittery about delving into the unknown, though I am comforted a bit by the knowledge that there is, at least, high speed internet.

So stay tuned for your next installment of where in the world is Dr. Cabou...

Oh, and what of job 3, you ask? Well, I'll be starting in a Seattle community health center in October doing full spectrum family medicine (outpatient, intpatient, OB). That is certainly also giving me some palpitations, though for now I'm trying to focus on the most immediate scary thing(s).