The March Edition: Rolling Tundra Review

March is almost gone and the snow is melting here and turning the roads into streams of mud and potholes into ponds. It has been sunny nearly every day, even the days that begin with thick fog or progress into snow flurries in the afternoon. The days are increasing in length quickly, especially in the evenings when the sun is still relatively high in the sky at 9 PM already. The sun is still not up by 8 AM yet, but coming soon. One of the things I’m looking forward to is the sudden explosion of every green growing thing into the short, intense burst of summer we have here.

We actually had a tundra fire here about 3 weeks ago! I was listening to the dispatch on the EMS radio at home and trying not to laugh. I think every volunteer firefighter , engine, ambulance and pumper truck from both Naknek and King Salmon showed up. At one point I heard, “Dispatch this is engine two with three buckets and two flappers.” Flappers, I think, are sticks with, well, flaps of some material on the end that are used to beat out flames. I’ve seen them, but never used one. I figured that I would be called to the clinic shortly to treat twisted knees and broken ankles on people who hiked in the dark across tundra carrying buckets and flappers. But the wind blew the fire to the edge of a little lake and it went out all by itself. No one figured out how it got started, but no one got hurt and it was a great training exercise.

Speaking of tundra, if you have never tried to hike across it, let me try to describe it to you. Picture bowling balls of widely varying sizes randomly strewn across a sloping floor. The balls must have a flat side because they don’t roll down the mild slope. Then, cover the bowling balls all up with a layer of soft foam rubber that varies in thickness from ½ inch to 4 feet in no particular pattern. Get the foam rubber wet. Then cover the whole thing evenly with very low-growing ground cover plants and the occasional shrub, making sure to camouflage the sometimes-precipitous difference in height between the bowling balls and the floor. Try hiking briskly across this, while also leaning into a 30 mph wind that is blowing your hair into your eyes and mouth and two VERY large Inuit huskies slam into you from the side or behind every so often. OK, so the Inuit huskies weren’t out during the fire, but I did experience this scenario twice daily when I took care of my friend’s sled dogs and chickens while she was out of town for 10 days. You can only walk two dogs at a time otherwise they turn into a pack and are likely to chase caribou. Not that I’ve seen any caribou yet, but people assure me that they are not infrequently seen down by the grass flats and even on the beach.

My friend’s house is really an amazing thing! She built it herself, with some help from friends, from a lot of salvaged material as well as lumber and supplies that all have to come by barge in the summer. It has solar power and the water system consists of captured rain and snow melt that feeds into a 1,000 gallon tank located in the second floor of the house. She also has a back-up generator, a propane heater, a wood stove and a wood cook stove, so she’s pretty well set even without being on the grid or having a well. I have located a bigger place to rent starting in May, and if nothing goes wrong I’ll be in a 3 bedroom, 1.5 bath house on 2 acres off the highway with a sauna and a smokehouse and lots of tundra for the dogs to run in. It’s a little farther from the clinic but not much, and is just down the road from my boss. So now I’m trying to accumulate some furniture, since the place isn’t furnished. The place everybody turns to for buying and selling, as well as announcing and commenting on whatever is going on, is a Facebook page called the Bristol Bay Exchange. It’s kind of a digital newspaper, or at least fills some of the functions of one. And speaking of newspapers, one of the funniest reads I have encountered is the Dillingham police report that comes out in the weekly paper that serves Bristol Bay and the entire Aleutian chain. There are also police reports from other towns and villages, but the guy that writes the Dillingham one is obviously a frustrated journalist who is having to start at the bottom and work his way up. I will share some of the best ones in the next blog entry. Laying in your supplies for the winter when you live off the road system includes making a barge order in the spring to come from Anchorage when the ice is off the oceans and rivers. There is a catalog with just about everything you can think of in the way of foodstuffs (not fresh, but canned or boxed or jarred), household supplies, dog food, even straw bales, steer manure and fertilizer, all of which I ordered for gardening this summer. You have to buy at least 25 cases total (a bag of fertilizer counts as a case) and it costs 23 cents per pound for shipping. I went in with a friend on an order since neither of us had 25 cases by ourselves. It’s interesting how we comparison shop here—we check the barge catalog, then we check Amazon.com and see if they have the item cheaper or for the same price but free shipping on Amazon Prime. I do splurge on a weekly Full Circle Farms CSA box of fresh, organic produce flown up from Seattle. I am continuing to really enjoy the Camai clinic and all my coworkers. Katie Copps-Wilson is my PA counterpart and we are not only seeing patients but teaching sex ed and puberty at the school, painting and remodeling the provider office, and working on forming a Wellness group along with the Park Service and other community members. I think we will work well together! Here is Katie with some of her educational models:

I did a little exploring around the Red Salmon cannery the other day, which was deserted now but will be bustling 24 hours a day in June. I will close with a few of the pictures I took there.

WOW! Winterfest

Last weekend was Winterfest, a four-day extravaganza involving the entire community of Naknek, South Naknek and King Salmon (who are for the most part all one community, particularly since all the kids go to one school in Naknek). It's a big enough deal that the kids are out of school Thursday and Friday. There were so many things going on that it made my head spin trying to figure out what to go to! The official start was on Thursday night when the Winterfest queen was crowned. I really like the way they do things here--nominees for the queen position must be over 60 years old, and this year's queen was nominated by several youngsters who read their letters to the audience. The queen was too bashful to give an acceptance speech, and in fact had to be fetched from some duty she was performing somewhere to accept the honor. This was followed by a talent show, mostly consisting of kids of various ages doing musical numbers, but also featured a master hula hooper. The kindgergartners did two song and dance numbers to great roars of approval from the crowd. One of them made it to Youtube, so you might look for that performance of the Jackson Five's version of Rockin' Robin. There was an incredible amount of raffling going on (is that a verb? to raffle?)and resulted in a lot of money being raised for the school and a FOUR PAGE small type list of winners, and my name was NOT on any of those pages. There were Texas Hold Em tournaments, dart tournaments, cribbage tournaments, puzzle assembling tournaments, a Mystery Murder potluck, dances, a multi-village basketball tournament, an air drop of candy and ping pong balls redeemable for cash (I bet there will be candy and ping pong balls being excavated from the tundra a thousand years from now). Some of the events that required normal winter weather rather than the record-breaking 40 degree weather we'd been having had to be cancelled, such as the Polar Bear Plunge and the ice skating events. On Saturday I participated in the bazaar which was held in the old gym. Camai clinic had a table with various informational literature and I offered to do blood pressure checks, but no one took me up on it. Maybe because I spent most of my time (and a lot of money, I might add) circulating amongst all the other booths, meeting people, checking out the wares and taking pictures. There was Jill, the RN who works with us part time but who was selling Jillie's Jellys, made from Salmon berry, Nagoon berry, raspberries, and other exotic local berries. There was ivory and baleen carved items of jewelery. There was beading and origami and sushi, and my favorite booths, the tanned hides and skins of local trapper's efforts.

Now before you get all tree hugger and vegan on me, these mammals are in vast abundance here, and people still trap for subsistance and to make a little cash to feed and clothe their families. The workmanship on some of the things they make is incomparable! One of the native ladies had her grandmother's parka which was made entirely of wolf fur. I bought a sheared beaver skin hat which is the softest, warmest thing you have ever felt! I am completely aware that I look ridculous in it, but I don't care--winter weather is back and the temps have not been getting much above zero recently, and this hat is WARM!

I also entered the chili cook-off with my "Green Double Bean Chicken Chili" and won 3rd prize! This competition occurs twice a year, once at Winterfest and once at Fishtival and has very strict judging rules and guidelines. I won $20 cash and a $75 gift certificate to the Chinook gift shop. Guess what you're getting for your 30th birthday, Cole! Surprisingly I had no after hours calls the whole weekend. I'd only had one call so far, and that was when Leeann, the itinerant PA was still here, so it was actually hers but I went in too. This poor lady had slipped on the ice, falling forward, but had grabbed onto some alder branches to try to keep from falling, which jerked her arm right out of the socket. We didn't even need the x-ray we took to see that her shoulder was dislocated. The physician for the native clinic happened to be here for his quarterly visit, so he came over too as we tried futilely to get that arm back in. Even after some pretty healthy doses of narcotics, we couldn't get it reduced, so finally called in the big guns: Max. He is the son of the local native Health Aid, who was the one who brought the patient in, and he is a big guy. Picture that football player they used to call the refrigerator. With him providing 300+ pounds of muscle for the traction on the arm, and the doc's manipulation of the shoulder blade from the top, we finally got that arm back in the shoulder. Whew! Another lesson in doing the best you can with what you've got. Since then I've only had three call, and only two of them in the middle of the night. Neither of them involved Medivacing anyone out. I was home sick last Friday with a miserable cold and missed the Medivac that was sent out by my colleague Nattie and the PA student who is here for a month on his rural/underserved rotation. Here's a picture of Nattie, a little blurry, but that's our Nattie--always in motion!

The river and ocean are not completely frozen over, but have a lot of ice and mini icebergs on them. I was standing on the same dock where I took the Beluga whale pictures and the tide was coming in and it gave me vertigo watching the river run the wrong direction. It felt like when you're sitting in a parked car and the car next to backs out and it feels like you're moving forward. I almost fell in! The weather has been cold but sunny every day, and the last few days there has been almost no wind. I took a photo safari down past the Peter Pan cannery and to the beach and to the old historic Russian Orthodox church and cemetery. Maybe it seems morbid, but I love cemeteries; there is so much history there. This one is being slowly reclaimed by the tundra and the alders. There are so many old Russian Orthodox wooden crosses that have lost the story of who is buried there. I wonder if there are records anywhere? Some of the graves are still tended to, but the church is starting to fall apart.

I have this fascination with the fishing boats. I have never been remotely interested in boats with motors; I like kaykaks, rafts, canoes, but couldn't care less about ski boats, etc. But there is something about the commercial fishing boats that really compels me. Something about being a working boat rather than a pleasure boat I guess. I can't even begin to describe the number of boats in dry dock here! Everywhere I look they corrugate shipyards in rows, bristling with antennas and navigation devices and sometimes hoists and cranes.

The canneries all have bunkhouses for the workers who flood the area during sockeye season, June and July mostly. Virtually all of the sockeye salmon supply in the world comes from Bristol Bay. I had to take a picture of the dorm called the Italian for my Italian son Paolo! There was also a festive survival suit decoration adorning one of the bunkhouses. Those are supposed to keep you from immediately freezing to death if you fall in the water. That one must have a leak.

In the interest of relearning some of my skills that I haven't used for years, the new paramedic here gave an IV clinic yesterday and we all practiced on each other, inserting IVs, drawing blood and giving fluids. Here is a picture of Challane proudly displaying her work. I think she had a different idea of what the picture would look like! She actually did a very quick, competent job and really hardly hurt me at all. So those who know me well know that I have not had any TV reception for a number of years, and in fact have been losing money on my Netflix subscription for the last couple of years because I just haven't felt like watching TV was enough of a priority. Well now that I actually have a little free time, I bought a new DVD player, and couldn't figure out how to hook it to the ancient TV here in the cabin. Sidebar here: I did finally get to see a couple of those reality TV shows about Alaska, and I'm sorry, they are kind of ridiculous, as most reality TV is. Alaskans are universally embarrassed by them. But I digress. So I decided to splurge and get a modern TV, a skinny thing like other people have that looks like a computer monitor. It just so happened that my latest Consumer Report arrived with ratings of plasma and LCD televisions, so I did my research and looked all over online and selected what appeared to be a very good value and ordered it. Did I mention that I'm not so good with spatial analysis things? I really had no idea how TVs were measured, but I knew that 60 inches was sort of the big size and I didn't need anything like that, so I bought a 43" one. It never really occurred to me to think about how big 43 inches really is until the box was delivered to my door. OMG Becky! I had pictured something about 1/3 that size! But when I really stopped and thought about it I realized that 60" is FIVE FEET! I mean, I'm not THAT dumb! I just didn't picture that in my head because, well, I'm just not good at spatial things. So now I have this big ass TV that I could probably sell tickets to watch except that my cabin is only about 350 square feet and this thing takes up most of the living room. And now I don't get any of the TV channels that I got before. But boy is that a great picture on the BAT!

I will close this long, rambling missive and go out to put a downpayment on some groceries. I'm having some of my colleagues over for dinner and a movie on the BAT tonight.

Rolling Tundra Review, Episode 2 Life is so full I hardly know where to begin! I’ve really only seen a few patients, but have had time to work on policy and procedures, collaborating with the other full time provider, Katie, and others on learning and trying to implement the advanced features of the medical records program, and trying to get ready to begin taking call 24/7 for 3 weeks starting tomorrow. This particular electronic medical record (EMR for short, although we have other names for it too) is much simpler than the one I’ve been using for the last 2 years, but as with all of them, it has flaws and frustrations, reduces clinician’s productivity, and shifts an awful lot of administrative stuff to the providers (physicians, PAs, Nurse practitioners). But the atmosphere and management at Camai are such a breath of fresh air for me! It’s small enough, and we have the right kind of manager, that everyone participates in many of the decisions and are encouraged to take ownership and figure out the best ways to take good care of people. The clinic director, Steve, is not a medical person and he told me that if I needed managing, this probably wasn’t the right job for me! Right on—I’m more than willing to take responsibility in exchange for having some autonomy and not being micromanaged. Bush (not George) Alaska is like that anyway; stay down to earth, use what you have, and don’t stand too much on ceremony. Here's a cool old building downtown that people are trying to buy for a museum.

In rural Idaho you often see a bunch of cars and trucks parked around people's places, but here you see a bunch of boats.

Both Katie and Linda, our medical assistant, are going on vacation tomorrow leaving the clinic in my somewhat shaky hands, but I have a great bunch of people to work with. There is Nattie, who is a local and has been a PA for around 30 years. And there is Challane, who has been learning the ropes from Linda. There is a new paramedic right next door in the bunkhouse, Bart, who is more than willing to lend a hand in emergencies. Jill is an RN who works one week a month in the pediatric oncology department in Anchorage, and is helping with EMR and also will lend a hand in emergencies. And then there are the front desk, billing, and general all-around Jills of all trades, Samantha, Amanda, Kelsey, Rebecca, and office manager Sharon. Who also owns a gift shop in King Salmon that I visited last weekend and spent too much money at! Next door was the Katmai National Park Visitor’s Center, where I spent a good hour and a half looking at all the exhibits, browsing through the brochures, talking with Debbie who has been out here for around 30 years, and spending MORE money on books! I didn’t know until having dinner with Kelsey, who worked all this past season at Katmai, that this is the place that Timothy Treadwell got eaten at! You may have seen the documentary “Grizzly Man.” Kelsey knows many of the people who knew him and were part of the sad aftermath of shooting the two bears involved and recovering what they could of Timothy’s and his girlfriend’s bodies. You can fly into Brooks Camp from King Salmon and stay in a lodge there, and watch the brown bears at the falls and in the rivers catching salmon. Brown bears and grizzlies are the same species, but they are called grizzlies inland and brown bears out here on the coast. Apparently there is a subspecies on Kodiak Island. Right now the bears are all sleeping in dens, and hopefully the warm weather and lack of snow won’t wake them up too early! On the way home from King Salmon I stopped and walked around the small cemetery. Some of the wooden crosses are hand painted with people’s names and dates. It’s obviously a well-tended place. The graves were as unique and individual as the people are here. The high point of my week was today after work when Steve’s son in law, Troy Hamon, took me out flying in his small Piper something or other airplane and gave me a tour of the Naknek area!

I have never been in a plane THAT small, and it was a blast! My pictures aren’t that great, but we flew over some abandoned canneries, up the Kvichak river a ways, over Naknek and then over South Naknek.

We also flew up the Naknek river, and saw some beluga whales, which I didn’t get a picture of. But I did get a picture of one on Saturday afternoon from the Port docks, and watched them feeding in the river until it got too cold (for me—they kept on feeding.)

Those white spots in the water are genuine beluga whales coming up for air. Yes they are! I also tried to take pictures of the seals, but they kept playing hide and seek, so I got a lot of pictures of empty water. Here’s a picture of my little cabin from the front door.

Grocery shopping is heart stopping here! It’s really making me try to make wise choices—a regular size bag of chips is $10.00. Nope, don’t like chips that much! Half gallon of milk for my lattes is $6.99, which I MUST have. Broccoli, $5.99 per pound. Eggs, $7.00 a dozen, but at least those are Linda’s good homegrown eggs, because they aren’t any cheaper at the store. This week I get my first delivery of my Full Circle Farms produce box, and I can’t wait! $57 a week for fresh vegetables is pretty darn good. My boss, Steve, also generously gave me about 4 sockeye salmon steaks, a big package of smoked salmon, and some mooseburger. What a difference the freshness makes! The fish was vacuum packed and frozen about 4 hours after it was picked out of the set net. He says I can come help during the fishing season and have some of the fish. I have to double check to see if the regulations say that non-permitted people just can’t touch the NET, or can’t touch the fish at all until it’s gutted and taken care of. After I’ve been here a year and am a bonafide Alaska resident, I can get my own subsistence permit. I already have a permit from the village tribal government to camp and pick berries on their land. Next Saturday is Winterfest, which apparently consists of various activities that will be more difficult without the river being iced over, but will also have a bazaar with craft items, etc. I will be at the Camai booth part of the time, maybe taking a blood pressure or two. Later, after fishing season I think, we’ll have Fishtival. Kelsey says there’s a festival every time you turn around. I miss all my friends and family and my dogs, but I’m really enjoying being up here! Stay tuned for more.

Welcome to Naknek

Naknek Week 1 I traveled uneventfully through Spokane, Seattle, and Anchorage airports, arriving at King Salmon around 7 PM on Wednesday the 22nd of January. I was met by the gracious and thoughtful Kat, our executive assistant at the clinic, who had also cleaned my cabin, washed bedding and towels and put fresh sheets on the bed, and bought me some breakfast makings for the morning. My guitar and dulcimer and my giant suitcase all arrived unscathed, and I pretty much went right to bed by the time we got to my new home in Naknek. Now picture a solid, homey little log cabin in a remote clearing, surrounded by trees. Now wipe that out of your head, because my cabin doesn’t look anything like that. It’s in a group of rental cabins owned by the local tribal corporation, right off the Alaska Peninsula Highway that runs between King Salmon and Naknek. It is very clean and quite comfortable, and as the director of the clinic, Steve, describes it is “a little lower quality than Motel 6.” But really it’s fine, nice and warm and only 2 miles from the clinic. The walls in most of the place are painted an interesting color, somewhere between salmon, coral, orange and pumpkin, depending on the light. It has most of the things I need, and will be just fine as soon as the 6 more boxes of my stuff arrive.

The vehicle I am driving is a 1998 Nissan pickup with a canopy on the back. It’s interesting to see as many really nice rigs here as I’ve seen, since most rigs get the stuffing beat out of them on these roads in a short time. If I decide to purchase a vehicle, I’ll be looking for a beater. It costs about $2500 to barge a vehicle here in the summer from Seattle or Anchorage, so everything is worth at least $2500. I am already in love with this place! I can’t describe why or how much I already feel at home, except for maybe it has a lot to do with how welcoming and friendly everyone has been so far. I met the mayor at the high school basketball tournament this weekend and got the skinny on all kinds of things. On Saturday I drove out to the cliffs just above the Bering Sea (about 1.5 miles from town) and noticed another pickup there with a guy sitting in it who waved me over. Turns out he was the Fish and Game wildlife biologist here for about 40 years, and he invited me to use his binoculars and spotting scope to look at the Beluga whales that were feeding out in Kvichak (kwee-jack) Bay. All I could see was the occasional brief flash of back as they fed on the smelt that were being pulled by the tide out toward them. Apparently the whales actually come quite a way up the Naknek river, which is about the size of the Pend Oreille. Then he gave me a copy of Sibley’s Birds of North America, saying that he gives away 10 or 15 of them every year! The beach was littered with chunks of ice, most of which were covered with sand and pebbles and were in some pretty unusual shapes. The weather has been ridiculously warm for January—in the ‘40s, and the snow is pretty much gone. Hopefully there will be more snow so that the sled dog races can still proceed this year.

Later that day Ann Shankel picked me up to go to her house and go for a walk with 3 of her 4 sled dogs out in the tundra. Ann is the local Rolfer and apparently the only one who still has sled dogs in the area. She is also a very successful cold weather gardener and fills many other roles in the community, including swim team coach (yes, Naknek has an indoor swimming pool!). Her dogs are mostly Inuit Huskies, who are the aboriginal sled dogs, still found in Greenland as well. They are HUGE, and amazingly friendly and playful.

Today I was invited out to Linda’s house that she shares with our director’s daughter and her husband and kids for lattes. Linda is one of our two Medical Assistants, and according to the other providers I’ve talked to, makes us all look good in her quiet way. They have chickens and will be my much-appreciated source of fresh, homegrown eggs. It is so beautiful here, even in the winter with tundra brown and gold!

I will have to figure out how to make peace with the wind; I have never liked wind and it’s windy pretty much all the time, I think. At least that ought to help keep the mosquitoes off in the summer! Stay tuned for more of the Rolling Tundra Review (you probably have to be a certain age to get that)!

Just to catch up any of my readers who have been out of touch for the last 3.5 years: I graduated, passed my boards and immediately went to work for a 3-clinic non-profit community health care organization, assigned to the clinic in my home town of Priest River, Idaho. It's been a huge learning experience, and I'm happy to say that I had a great mentor in the physician there, JB Fowler, and the best nursing and front office staff around. I wish I could say the same about the corporation's management...so here I am off to work in Alaska, where I've longed to return since I left in 2010. I fly to King Salmon on January 22 and then will be driven the 15 miles to Naknek, which is just about all the road there is. Unless you fly or come by boat in the summer, you can't get here. Well, you could theoretically come by snow machine or dog sled, but most people travel by air. I was planning to take my golden retriever and my malamute with me this first trip in, but then started thinking a little more seriously about schlepping two big shipping kennels, two big dogs, a big suitcase, my skis, and a guitar and decided that I should probably get settled in and get set up before I bring in the dogs. So I'm busy deciding what I really must have up there right away, packing those things into large plastic totes, drilling holes in the edges and securing the lids with wire tires and sending them via the US Postal Service. Not cheap, but the only way. UPS and Fed Ex don't seem to deliver up there. It's kind of hard to leave my patients here, most of whom are also friends, and it's hard to leave my mom who is in assisted living up here, and it's hard to leave my niece. But it's time for me to do this! I will be there at least two years, and who knows? Maybe forever. Everyone I've talked to who has worked and lived there has only good things to say. Stay tuned!