The Health Ferry (Fairy?)

10 PM rainbow



My lovely apartment at 10:30 PM



It's not hard to sleep with this much light, it's hard to GO TO BED!

I said in a brief Facebook entry on my birthday that my best present was a handsome Canadian fisherman with a big laceration on his wrist. I got a few witty responses to that—like “if you can’t take your present home with you maybe you can enjoy it while you’re here” and similar quips. Sadly, I didn’t get to do the suturing on his laceration because we also have an Australian Community Health Aid that needs to be recertified to work here after being in Australia for over 6 months, so she needed to do it. So I had to just hold his hand, so to speak, and do ancillary things. I was offered the chance to fill in every other suture after she got it basically closed, but I didn’t think it was fair to him to draw out the process any longer than necessary. Maybe that’s one of the differences between nurse training and physician training—first, last, and always we are supposed to take care of the needs of the patient before our own. And after all, he was supposed to be watching game 6 of the Stanley Cup hockey playoffs! So I have some outdated suture material and am practicing at home on placemats and such, biding my time until I get my chance.

You’d think with all the ambulance calls for drunks in distress that I’d get ONE that had fallen down and cut themselves, but so far not so. The ambulance here almost seems like Triple A for alcohoholics…AA would be a great way to prevent the need for AAA, but unfortunately the person who was the center of meetings here on the island died a year ago and I guess the meetings just fell apart.

I really am not being facetious about it…it’s a heartbreaking tragedy to see the waste of good people and the destruction that goes along with alcohol and drug addiction, and although it sure isn’t unique to Alaska, it is a problem in native communities that has decimated untold families. One of the many terrible gifts of the white man, the legacy of which still repeats itself in so many ways…Sand Point is a little different in some ways because its population has so much mixed blood and cultural influence, unlike so many of the more isolated communities in the Pribilofs, the Interior and the far north. But alcohol and drugs are a problem here, just like at home. Last night I was at the clinic attending an EMT refresher training so I could get familiar with some of the toys like the splints, inflatable pants, etc. (I don’t have any EMT training yet), and since it was being taught by the head of the EMS, when the dispatcher called for the ambulance class ended abruptly and I went along on the call.

Fortunately it was not way out in the tundra where you can only get there by 4 wheeler, so it was a short trip. Because of the public nature of this blog, I can’t say much about the call, but it was alcohol related. So I helped as best as I could in the ambulance and then worked on him in the clinic with the on-call PA and the Australian CHP until we got him stabilized. It’s all good learning for me, but heartbreaking nonetheless.

I left at 9:30 PM to hitch a ride with Laura down to the harbor, where the twice-monthy ferry, the Tustamena, was coming in at 10:30 with health care people from the main EATs office. We set up a health fair in the net shed at the city dock, staffed by traveling health fair folks who brought lots of goodies and handouts. The community was invited, and a few turned out to learn about nutrition, diabetes, safe sex, etc. It stays light so long in the summer that when there’s no school the kids routinely stay up until midnight, so I have pictures of even some little guys at that hour.

Laura photographing the ferry coming in


Here comes the ferry!


Alaska Marine Highway's The Tustamena--now running twice a month down the Aleutian Chain



Some of Sandpoint's Finest--Shane in the middle (remember the gasoline on the bonfire incident?) and our receptionist extraordinaire Melissa at the health fair

One little cutie spotted me and stopped dead, stared at me and decided that he couldn’t quite place me, but he didn’t have good memories of wherever it was we’d met last. I’d been one of the people in the exam room that held him down to look in his ears the week before. He did let me take his picture with his mardi gras beads, though.

Laura and our fabulous case manager, Cathy with her new berry bucket



Laura, Shane and my little friend

So the handsome blue-eyed Canadian skipper of the big long-line boat came back to the clinic the next day so we could take a look at his wrist and pronounce him fit to go off and fish. He’s supposed to come back and let us take out the sutures in about 10 days or so. So I don’t get to keep him, but I do get to see him again!

Sometimes I really have to take myself in hand and try to remember that I have successfully mastered other large bodies of information and been successful in using that information to accomplish complex projects. This really isn’t any different except that the body of information is not only pretty big, but people’s lives literally depend on being able to not only learn the information but think clearly in using it. I get discouraged sometimes, and think that I really should have learned more by this time…aside from trying to be a good mother, this is the hardest thing I’ve ever done. Not as important as being a good mom, but close. I try to remind myself that I have other skills and qualities that I bring to bear on this profession that are also critical to being successful, and that it just takes time and practice to put it all together. It can get tiring to work in an environment where everyone knows way more than you do! They are all really good about helping me learn—I don’t feel a bit like anyone looks down on me or is patronizing. I just feel like I’m not meeting my OWN expectations very well, and champing at the bit to get in there and do more than I’ve been able to do. My adviser, Lorna, is here this weekend and for two days next week to evaluate me and I’m a little nervous about that. But she is always very supportive and I need to remember it’s all about the learning and feedback and not so much about the grade.

I got a phone call Friday night from my son Blake, who has been fighting fire with his hot shot crew up above the Arctic Circle. He’s back in Fairbanks with his crew, now with a 2^nd degree chemical burn on his back from a leaking dolmar. He’s a sawyer, so has to pack a saw and gas when they hike in, and it saturated his shirt and burned him pretty good by the time they got where they were going. He’ll have more scar stories to tell his grandchildren. He loved his time up there as much as I did when I went out on fire, and we shared some good laughs and stories. I can’t wait to see his pictures and hear more about his time up there. He flies back to Missoula in a chartered NIC jet on Monday, so sounds like they might have Sunday in Fairbanks to see the town a bit. They are camped on Ft. Wainwright where the jumper base and all the fire offices and dispatch are located, and are supposed to do some kind of project work tomorrow.

On Sunday I have to move out of this nice apartment and will be in the local motel until I fly out on the 28^th. But EAT is very generous and will be paying for it. They have been very good to me—just goes to show how difficult it is to get people to come here and stay that they are spending a fair amount on recruiting. So I won’t have the same phone number and will have to find out what the number is at the motel. If it's urgent, you can still get me at the clinic at 907-383-5131.

More anon...

Happy FIshing Season

The harbor mid day June 7, first day of the fishing season



Tender just outside the harbor

June 7—first day of salmon season!

They tell me that the small boats started fishing at 0600 today, but the reason you still see a bunch of boats in the harbor is because the big purse seiners are standing down for awhile voluntarily to keep from catching a bunch of “dog salmon”.

Apparently the dogs are running strong out in the deeper open waters where the seiners fish, and so they’re waiting to let them get through before going out to try to catch the sockeye that are also supposed to be running now. The smaller boats, which are gill netters—both set nets and I forget what the other type is—fish closer to shore, so they aren’t as likely to catch the dog salmon. The dog salmon are actually chum salmon, but they are at the bottom of the barrel for Alaskans, so they traditionally are dried and fed to the sled dogs—thus the somewhat pejorative term “dog salmon”. Most of the women working in the clinic have husbands, sons, brothers, uncles, grandparents involved in fishing, most for quite a few generations, so I’m getting fishing lessons.

The gill nets have larger openings than the seiner nets, so the fishermen spread them out in the water, either anchoring one end to the beach or to an anchor buoy, and then pull the net out as far as it goes. Then every so often they pull up the net and “pick” the fish out of the net by hand because they get caught by the gills when they try to swim through (the fish, not the men). That’s why they call it gill netting! But the purse seiners spread out an enormous small-opening net in a circle, then draw it up at the bottom like a purse and raise up the whole thing with a giant crane, and swing it onto the boat.

Then when the boats get full, they go over to one of the REALLY giant tenders that cruise around and unload onto the tender, which then unloads at the cannery when it gets full. My picture really doesn’t do justice to just how big the tenders are! That’s a medium size fishing boat unloading or doing something alongside the tender.

I guess this part of the season will only be open for 3 ½ days, then close for 36 hours. Then it will open again, but apparently how long it stays open each time depends on how many fish are reaching their spawning streams and going up (I think). It’s really fascinating, and I so wish I could go out on a boat and watch, but I would be in the way, and when they go out and the fish are there, they work until they have to stop because time runs out or something breaks and they have to come in to fix it.

Laura had arranged for us to go out this last weekend on the boat of the husband of one of the women that works at the clinic, but apparently when she boarded the boat for the first time in a few months, it was (in her opinion, anyway) FILTHY! So there was no way that she was letting anyone see it like that, and we didn’t go. Let that be a lesson to all you crappy housekeepers as to just how far a dirty place can affect people downstream, so to speak.

When I was in Alaska on fire duty, the long, long hours of daylight didn’t seem to bother me, and I slept just fine. But I have to admit that I haven’t slept well since I’ve been here. I think it’s only partly the light; it’s also the unfamiliar noises of the young men next door who get off shift about 2 AM, the apartment building itself that makes odd noises, and the adrenalin rush of having ambulance calls in the middle of the night to have to come home from and try to go back to sleep. So I moved into a different bedroom farther from the cops next door, covered the window with aluminum foil, and started using my earplugs with the faith that the ambulance tones on the radio would wake me up when we had a call. So far on the two nights that we haven’t had any calls I have slept much better, but the hot flashes are still waking me up about every 1 ½ to 2 hours. But at least I’m falling asleep much easier and going back to sleep after any variety of wake up call more easily too.

We have two new mid-levels here now, both PAs, and I miss Thai dreadfully! Not that I don’t like the two new ones, but Thai is really someone special—very patient, very dedicated to teaching, very quietly calm and good natured, and just a great person to have around. It doesn’t hurt that he’s almost preternaturally good looking in a unique and very striking way. I wish I had a daughter so I could have Thai as a son-in-law!

I hesitate to say this, because I know Laura reads my blog and I don’t want her to think I’m kissing ass, but she is the best preceptor I’ve had! She really knows her stuff, is very well-respected by the community and her co-workers, and a wonderful, patient teacher. She is great with all ages of patient—direct when the situation calls for it, tactful and calm when that’s what’s needed, and the little kids love her! I have learned so much from her.

I would like to be able to see more patients—our goal at the end of our Nurse Practitioner program is to be seeing 16 patients a day including charting and paperwork—but that just isn’t the way things work here. This is a very different environment from a private clinic or a community clinic in a city. Not only is the population smaller, but with each provider having to do most, if not all, of their own lab work, x-rays, pulling medication, doing referrals, staffing the ER—you just can’t schedule very many patients a day. Add to that all the bureaucracy inherent in any governmental organization (and the Eastern Aleutian Tribes is a governmental agency), and the pace and rhythm and even the overall goals of the clinic are different from most of what we have in the lower 48, especially when it comes to making money. Staying afloat is important, but making money is not even on the radar screen—it’s not the purpose of the clinic at all. EAT’s vision is that “the Eastern Aleutian Tribe’s people are the healthiest in the nation.” That overarching goal is a noble one that really contrasts with for-profit health care in so many ways. I don’t think anyone could begin to be prepared for what they will encounter practicing in most places in Alaska without getting the experience I’m getting right now, and I am so glad that I’m able to do this! It has strengthened my desire to work in Alaska when I get finished with my degree.

Speaking of which, I will probably go another semester and not finish until May of 2011, for several reasons. One, I don’t know if I can get my master’s project finished by the deadline in December, especially because I really need to work more hours and make a little more money. Two, I can see now that I REALLY need some ER experience, and I don’t think I can get enough just with a one credit internship next fall. And it will be easier to deal with moving, etc., next summer than it would be next winter. I have been picking everyone’s brain about different tribal organizations and places in Alaska, and have gotten a couple of new people to contact about places on the south central mainland and in the interior. I think I could live here in Sand Point, and would love the opportunity to continue to learn from Laura. But just in terms of weather and geography I think I’d prefer to be in the interior. Most important though is being able to be somewhere, at least for the first year, where I can work with another mid-level that is willing to mentor me and help me get up to speed before I get put in a situation where I’m the lone ranger somewhere. So we will see where I end up, but I definitely plan for that to be in Alaska.

Bob Elliott, this is for you: so far no one I’ve talked to on the island has ever heard of the hot springs across the bay from Port Moller. But I talked to a fisherman from Nelson Lagoon, which is kind of NW of there, who knows exactly what I was talking about. He says that he’s never actually been there, though. He made it sound like there is a working resort around there now. He also said it was a 38 hour boat trip from Nelson Lagoon to Sand Point, so I don’t think I’ll be going there by boat anytime soon!

I still don’t know exactly where in Alaska my baby boy, I mean my manly hot shot son, is except that he’s somewhere in the very wide vicinity of Fairbanks, reportedly manning a heliport or helitack base or something. I hope he has as many good tales to tell as I did when I was there—I sure do miss the fire world! Maybe in Alaska I can figure out how to do both health care and fire…

This week I’ll be sitting in on a little bit of EMT training, the parts where they put on the C-collars (C for cervical) and the compression pants, since I don’t have any experience with that. I’m still keeping up, more or less, with my homework, but it doesn’t leave me much time to do much else. I haven’t even been playing my dulcimer, which I so carefully hand carried up here. Hopefully I’ll get a chance on my three-day ferry trip. OK, off to bed—it’s rainy here, so I can’t actually see that the sun is still close to the noon position at almost 8 PM.

June 6th ALREADY!

Fish and crab traps near the airport, waiting for the season to start

Since we had late night calls both Thursday and Friday nights (pretty much no sleep at all on Saturday--both calls were drunks--one we sent home and one went to jail), and I JUST finished my homework, I will just post these pictures for now and write up the happenings another night....thanks to all who have sent care packages and called me--it means a lot to me!



Me and a dockside friend at the Strand--waiting for the boys to show up and put their kayaks in the water after work (Laura's picture--she is a much better photographer and has a much nicer camera, so I'm putting some of her pictures up!)


Some of the sidewalks on the island

Admiral Thai, preparing to launch from the airport beach (the Strand)





Thai and Kells (the local radio station mgr) preparing for a cross-bay assault on Unga Island (Laura's picture I think)



Laura's picture--toward Pavlov--the volcano on the mainland of the peninsula to the S.W. (mostly west) of the island; it erupted just a couple of years ago



Laura's picture--the entrance to the harbor, taken from the gravel pit on the way to the airport on the S. end of the island




Laura's picture--the harbor from the gravel pit on the way to the airport on the S. end of the island



Laura's picture--looking sort of west and north from the Strand

End of the first week

Here's a picture of Laura at the "gas station", which involves driving out a narrow dock with no railings, turning around, and then backing up precisely over a metal plate in the dock. But it's open from 12 to 4 on some days. There are a surprising number of vehicles on the island considering that there are only a few miles of roads, total.
One of the biggest boats getting ready for the season; it pulled up to the gas dock as we were gassing up the neighbor's rig.

This is one of my dog friends, Puddin', on our walk today. Another dog took her place when she decided that she was needed elsewhere, a handsome and personable mutt of indeterminate pedigree, but I didn't get a picture of him. My preceptor, Laura, who going to be 50 this year, has inspired me to start running again, but this time I'm going to take it very slowly and use arch supports so that I don't get plantar fasciitis.

It has been in the 40s and maybe up to the low 50s, and drizzly, for days now. But today is reasonably dry and the wind isn't HOWLING like it seems to do most of the rest of the time. Planes didn't get in here for several days, because they fly on visibility only and there wasn't any of that to be had. But the ferry came in I hear--everyone is excited that they'll be running twice a month now instead of just once. I didn't get to see it.

Last night the local church had the annual fisherman's potluck to kind of bless and honor the fisher people before the start of the season. There was quite a spread, and many fisher folk and non-fisher folk were well fed. The fish was amazing! Salmon cakes, broiled salmon, fish pie--which is a traditional Russian dish that is pretty much just like chicken pot pie but not as soupy and made with--fish!
I know I keep putting up pictures of the same views, but the photos just don't do justice to the immense beauty of this place! I took this along the way with my walk with Puddin' today, and then on in to the clinic to do homework and post this missive.
This is the xray room. What you can't really see is the digital equipment, which is state of the art. The xrays are immediately available for viewing, and because they are digital, you can manipulate to some degree--lighten or darken for better contrast, zoom in, etc. These also get automatically transmitted to the hospital in Anchorage to be read by a radiologist. We have no xray tech here--techs R us.
This is a picture of the ER. I was here just last night--oh wait, it was actually early this morning. We had an emergency call for a Type 1.5 diabetic (remember your endocrinology, all you health care people! hint: AKA LADA; for all you lay people, it doesn't matter) whose blood sugar had dropped so low that he was unconscious. When we got him in here it was 64, but he was really out of it and testing within the next few minutes showed it to be 31! That's very low; that's like SEIZURE AHEAD if not treated immediately. We stuck some glucose gel in his mouth under his tongue, got an IV started and got some glucose going in. It's pretty amazing to watch how quickly hypoglycemia can be reversed. In less than half an hour he was alert, oriented and very apologetic about the whole thing. He scared the peewaden out of his wife and two grown sons. It's nice when things can resolve so well, so quickly.
Teleheath cart; this is an interesting (and very expensive) piece of technology! Right now it doesn't have the capability to go live, but may in the future. What it does is capture data like heart sounds, pictures of the inside of ears, pictures and recordings of a patient, etc., and save them in a "case" that can then be emailed to Anchorage to the Alaska Native Medical Center for review by specialists or ER docs or the like.
Tribe's flag hanging in conference room. It's been a good week! Thai will only be here until Thursday and then another PA comes in--quite a different sort from Thai, I hear. Blake (my younger son who is on a Hotshot (elite) wildland fire crew) is in Fairbanks, AK as of last night. He called me after his AK orientation, and was going to be headed out to somewhere in the surrounding area. I'm pretty excited for him--that is exactly how and where I first came to Alaska! I miss my friends and family and dogs and cat, but I'm still glad to be here. Emails, comments, phone calls and care packages will be rapturously received!
Teresa

pictures to go with the May 27 post

Above: Thai, Casanova and Evan on their way to a hike; below, from top: me in front of Le Manguier (left), the road to the harbor (right)
EAT Clinic from my apartment (L), the view toward the harbor from my apartment (R);
fish traps (L), the view from Salmon Ranch (R), the path between Sand Dollar beach and Salmon Ranch beach through the slot
If any veteran bloggers can tell me how to insert pictures WHERE I WANT THEM in the body of the text, let me know! This is driving me crazy!

Thursday May 27

After the DU dinner (10 PM!) and Unga Island from the airport (right)

Thursday May 27, 2010

Wow, so much to tell! I have been busy, and right now am in HEAVEN after receiving my Full Circle Farm CSA box (fresh, organic produce and groceries shipped from Seattle) and making a wonderful dinner of FRESH VEGETABLES (did I mention how expensive and not-fresh the vegetables in the local store are??) and left over prime rib (from the DU dinner on Sat.) stir fry!

To continue the tale of the DU dinner…it was a lot of fun and I met a bunch of local people and the not-local doctor who was in from Anchorage’s Alaska Native Medical Center for his bi-annual visit to the island. I also saw my seat mate from the Penn Air flight in, the one with the bird. He also, I forgot to say, boarded the plane with a big honking knife on his belt, but hey, no problem. Terrorists don’t come to Sand Point, AK; there is plenty of home grown terror right here just starting bonfires. More on that later…Much money was spent on raffle tickets and the auction to support waterfowl habitat conservation, and many people went home well armed, since much of what was up for bid was fire arms.

After dinner we went to the beach just next to the airport—my preceptor, Laura, the diabetic educator Louise, the traveling PA Thai Verzone, the doc, and my next door neighbors Evan (21 and going fishing for the first time—I mean working on a commercial boat) and his roommate, the one local cop, Shane, 22. The weather was incredibly lovely, probably in the low 50s, very calm and of course light for a long time. The pictures were taken around 10 PM, and some of our group was out until after midnight with a bonfire in the twilight of 12 AM. The doc, Louise, and I (whose body was saying it was really 1130 PM) decided we just couldn’t stay up for the bonfire, so we were given a ride home in the back of the patrol car. We didn’t get handcuffed, but we did have to put on our seatbelts. The doc sensibly decided at the outset of the bonfire planning that bad decisions were about to be made, and that he should probably go back and wait at the clinic for the inevitable burn injuries, given that the entire rest of the health care providers were now at the bonfire except for one of the Community Health Aids. Apparently when Shane returned to the beach, he felt that the fire was not progressing sufficiently so he added several cups of gasoline and used a flare on it. He was on duty in full uniform, mind you. But Laura saved the day when she told Shane that if he didn’t put down the gasoline and back away she was going to walk home. And never take his dog for a walk again. She lives above me in the upstairs apartment and Shane and Evan and Casanova live next to me. So we had no emergency calls that night.

The next day I went on a long, gorgeous hike with Laura. See pictures below:

Monday morning started the clinic day and I shadowed Laura with a few patients, got to know where everything was and got to know some of the other staff there. I thought Laura was the only health care provider there, but actually there is usually one other midlevel (Nurse Practitioner or Physician Assistant) there. They have an NP who works on contract with 5 months on, then 1 month off, so while she and her family are in Montana, I’m staying in her apartment, and Thai is taking her place for a couple of weeks. Thai works throughout the Aleutians, Pribilofs and in Anchorage and even in Antarctica. He is really great and has been very patient with me and good at teaching. He is one good looking guy, too! Half Italian and half Vietnamese, 36 and single. I’m trying to match make him with one of my younger friends because he’s just too good to be going to waste and I want to be able to stay in touch with him. My preceptor is stellar, and I feel so lucky to be with someone who is so proficient, so good at teaching and so much fun to hang out with! We have a lot in common, and I am learning a lot from her. She’s made me feel very welcome. I don’t think they have had a lot of students here, so I hope that I can make a good impression and pave the way for more students.

The clinic also has two Community Health Aids, which is a program that I think is still unique to AK but probably will be exported to other Tribal health entities in the lower 48. They are community members who go through a very rigorous training program and function as health care providers under the supervision of a physician or mid level. But often the “supervision” is via phone, and they have a very detailed book that leads them step by step through physical exam, history taking, what to do next, etc. There are two of them here, and they see patients just like the mid levels, but have to consult with us if they need to prescribe medications or have a condition that needs higher level evaluation. They are amazing! All the providers here have to do their own lab draws and tests, own x-rays, own EKGs, plus we are the staff for the ER in the clinic. There is also a local Ambulance service and EMTs.

About half the island’s year round population has some native blood, but there are almost no full blooded Aleuts left anywhere. Many people here I would not have guessed had native blood and consider themselves native, but they have a distinctive style of speech that clues you in even if they don’t appear particularly native.

We had a tundra fire on Tuesday, when someone decided it would be fun to set off some flares down on the beach near one of the areas where there are a lot of houses just above. It really took off for a few hours, and we ended up with an ER patient with smoke inhalation, dehydration and exhaustion. The tide was too far out for the fireboat to be effective, and digging line through tundra is a losing battle. They put some hose lays out and finally got a couple of coast guard planes with retardant and did some drops. The next day it started raining and hasn’t quit, so it probably won’t hold over. We all walked down and watched the fire. One of our elderly patients lives down there, and her pug (Mr. Beefy—with a pink collar) tagged along and apparently felt it was his duty to supervise the hose lays. According to Mary, he returned quite late, very dirty, and smelling of smoke.

Tomorrow we’re having a luau at lunchtime, and I still have studying to do, so I will close for now. I have internet at the apartment but it’s pretty slow, so I probably won’t do much from there. The connection is faster at the clinic, so I have to go over there to do all my homework. I miss home but I’m still feeling the high adventure here! Send good coffee, whole grain granola bars and dark chocolate!

More pictures

NOT a typical house (left); Trident Cannery (below)

More pictures: