Circling Back to Naknek

 

Finally, an update!  I’m 6 weeks into my 8 week stint back at my old clinic in Naknek, and it’s been good.  It has really been heartwarming to keep running into people who are so glad to see me and tell me that they’ve missed me!  I’m so much more comfortable here than I was in McGrath because it’s familiar.  There have been a few changes at the clinic, but nothing major.  And the great part of it all is that the (few) times something has come up that makes me say, “Now I remember why I quit!” it’s followed by, “But it’s not my problem anymore!”  And I can truly say now that although this was my home for 8 years, and it’s still a second home, Idaho is my real home and I’m looking forward to going back in 2 weeks.

It’s been good to see my dog, too, but I’m not allowed to have her in my vehicle or at my cabin so I have spent a couple of nights at my friend Ann’s dry cabin at her house where Kvichak lives  now so that I could spend some time with her. 

She clearly thinks that Ann is now her person, which is good because it’s less stressful for her.  But it’s hard for me!  In May I’m coming up here to help some friends pack their stuff in preparation for them retiring and moving to Fairbanks, and then I will get everything all set to cargo ship Kvichak to Anchorage where I can retrieve her, get her health certificate, and hopefully a BATH before we head down the Alcan to Idaho.  And somehow, sometime, I have to buy a suitable vehicle in Anchorage for the trip.  I’m thinking cargo van, since Kvichak’s crate is so large and we will also have all our camping gear and luggage, so I don’t think it would all fit very well in a pickup, even with a canopy.  My son Cole and my daughter in law Sam are going to be able to drive with me, although Cole will have to fly home from somewhere in Canada after a week.  We plan to take at least 10 days to make the trip and we will see a lot of places I’ve always wanted to go.  Including Banff and Lake Louise.  We plan to camp most of the time but every few days will get a motel if we can find motels that take dogs.

I’m living in the same cabin I started out in in 2014!  It’s 300 square feet, which is fine for just me at least for a couple of months.  

 It will make my new 600 square foot apartment in my Idaho shop seem like a palace, and if I ever get my 1300 square foot “Big House” built, it will feel like a whole Queendom!  My contractor says that the plumbing, electrical and gas lines are all roughed in, and they are starting on the drywall tomorrow.  I don’t know (I’ve been afraid to ask) what the ETMI (estimated time of move in) might be.  I’m hopeful that by the time I go off to Ireland on April 29 that I might be in there, or surely by the time I get back in mid-May.  But there are still a lot of puzzle pieces to put in place, like getting the well working right, getting the septic in, water lines run, etc.

I seem to be the winner of the medevac jackpot this trip (if only there was such a thing!).  It’s not very busy this time of year, but we have had 3 medevacs and I have been the provider on all of them.  We are having a population explosion out here; there WERE about 8 or 10 pregnant women when I got here.  Which is lovely, and they all are wanted babies, and I enjoy prenatal care.  But I don’t EVER want to deliver a baby out here, and especially not a premature one.  So a few weeks ago I had a first pregnancy mom who was at 32 weeks of gestation (40 is a full term) who started bleeding one night.  It was probably around 8:30 PM, so I had her come in and it wasn’t really a whole lot of blood, and she wasn’t in labor, just had kind of an irritable feeling low in her pelvis.  So I called the on-call OB doc at the Alaska Native Medical Center where she planned to give birth (most women go out and stay in Anchorage at about 36 weeks, earlier if it’s a high-risk pregnancy) who listened closely to everything I told her I had observed, and concluded that it was probably OK for her to go home and just see how she did.  The bleeding seemed to have pretty much stopped and the fetal heart tones were strong, the baby had good movement, and mom wasn’t really having contractions.  

 So we all went home for about an hour and a half when she called and said the bleeding had started up again and was heavier.  This time we quickly decided she needed to be medevacked out—but the weather was holding up the flight and predicted to continue to be no-fly weather for another 8-9 hours!  The pilot promised to keep a close watch on the weather and said he would let us know if anything changed.  I had mom and dad sleeping on the two gurneys in our ER room, and was just getting ready to try to call the Coast Guard in Kodiak to see if their big rescue helicopter might be able to get in and out when Guardian Flight called and said, “We have a window and we’re heading your way!”  It takes about an hour and a half to get here from Anchorage, and so by the time we got the patient and her husband to the airport to meet the plane in King Salmon it was about 4:30 AM.  We found out later that she had an almost immediate C-section upon arrival and ended up needing two units of blood.  Miraculously the 32 week old baby only had to spend less than a week in the Neonatal Intensive Care Unit, and weighed almost 5 pounds.  I have to wonder if they really had the dates right—even 36 weekers sometimes spend up to a month in the NICU.  I was so glad to have a happy outcome!

Then a couple of weeks later I had a call around 8:30 PM (seems to be the witching hour for preterm labor) from a mom who was 35 weeks along whose water had just broken.  This was her second baby, the first one having been born at 34 weeks almost exactly three years before, and we had medevacked her out that time too.  Fortunately the weather was great, a plane and crew were available, and we got her out by 11:30 PM.  She too had the baby first thing after arrival, and both mom and baby are doing fine.  This one is still in the NICU but doing well.

Another local baby was just born following the proper procedures, having gone out around 36 weeks and having a problem-free birth at 40 weeks, so that’s one less to worry about!  I still have two weeks left here, so I’m keeping my fingers crossed but also getting a pre-term birth box together with several drugs and concise directions about when to use and not use them, and what doses to give.  I figure if I get it all ready it will ward off anymore preterm labor, but I’m not at all superstitious.

My friend's boot inside a fresh polar bear track in Utgiagvik (formerly known as Barrow)

 

The third medevac was a good friend of mine’s husband who had a snowmachine (snowmobile for all the lower-48 ers) accident on the ice of a small lake by our airport.  It was hard to tell what was really going on because of the way the dispatcher toned it out, but to give you an idea of what a small town this is, I got a phone call from my friend as I was driving to the clinic, and I said, “Sorry I can’t talk right now, I’m on my way to the clinic for an emergency” and she said (tearfully), “I know, it’s my husband, he crashed his snow machine!.”  And she was in Sitka for the weekend! (that's her boot inside the polar bear track). No one saw the accident, and no one really knows for sure how long he lay out there on the ice, but one of our local pilots had flown over the lake and didn’t see anyone around, and when he flew back about a half hour later saw the guy laying on the ice and not moving, about 12 feet away from the snow machine on its side.  No helmet…thick fur hats are better than nothing if you’re going to hit and skid on your face across thick ice, but no substitute for a helmet.  We got him out pretty quickly, thank goodness, and he did have a brain bleed but no other injuries.  Unclear whether he will have permanent brain damage, but he’s talking and seems to be recovering well (still hospitalized).

                                                   My new slippers--leopard seal and beaver

No landscape pictures; the weather has been generally lousy, ranging from 12 below zero to 41 above.  Right now the rain has burnished the snow to a fine, zamboni-groomed finish on all the roads, parking lots, etc.  With water on top.  It's treacherous!  I can't wait to get home.
                                                   

 

McGrath at the midway point

 Greetings from sunny McGrath!  Below is the forecast for most of the rest of my time here.

Some of you asked for more photos of my little village, so yesterday I went on a major expedition, starting with the dump.  I waited until the weather app said it was going to reach maximum heat for the day, around 3 PM when it was forecast to be around minus 9 degrees F.  Compared to the minus 26 that I had when I woke up, it seemed like a heatwave.  Sadly, I didn't get any pictures because there was a very nice man there who helped me unload my trash from my vehicle and I didn't want him to think I was a complete cheechako taking pictures of an enlarged, rectangular, roofed burn barrel currently smoldering.  I haven't seen a dump quite like this before.  There are some containers for batteries and aerosol cans, so it's not completely primitive.  Turns out the dump is only about 1/4 mile beyond my cabin so it wasn't much of an adventure, so I decided to tour more of McGrath and take some pictures.  At that temperature my phone quickly lost it's battery, so in spite of cuddling it inside my coat, I didn't get a lot of pictures, so I'm including a few that I got last week.  First stop the tidy little cemetery.

By the time I took this picture my phone was refusing to focus and then just quit altogether, so the beautiful carved wooden prop and pilot's picture was actually the last one I took.  There is something very moving about these small village cemeteries; so many of the headstones or markers are so personal and almost intimate.  Many of them are quite old, and many of the names on the wooden Russian Orthodox crosses can't be read anymore.  I didn't take a picture of it, but there is a nice little roofed kiosk at the front of the cemetery that has a map of graves and names .  The marker below is an ordinary heavy iron plate stood on end.  I think the small marker with the name and dates was probably added later.

 

 

Apparently some of the interior tribes still do the customary burial house for the dead.  I'm not sure if that's what this is, but it looks a lot like the ones we saw last summer in a cemetery in a small village on the way to Talkeetna.  The Russian Orthodox man who takes care of the little church and the cemetery was an incredible wealth of history, especially of the Russian Othodox religion and it's history there.  He is the one who told us about the custom of making a house for the deceased, and there were quite a few in his cemetery, although most of them were smaller.

 

 

Right across the road is the McGrath school.  Right now they have about 40 kids.  There is a very nice full fenced playground behind the school.  The museum is just in front of the school.  I have been there a couple of times, and I will go back.  It's an amazing museum; it's only open Wednesdays and Fridays from noon to 3, so I have to go on my lunch hour so it may take me every Wednesday and Friday that I'm here to see it all.  Stand by for those pictures.

Across the road from the museum is a wonderful display of lawn art.  So much more interesting and creative than gnomes or flamingos!  I wish I could get a better picture because all the caribou and moose antlers all up that leaning pole just don't show up very well.  The fence in front is also adorned all the way across with racks.

This is the side of the shed adjacent to the lovely fence. 

Here's the post office--in case you want to send me a care package--PO Box 10.

 

Here's the view from my cozy one room cabin:

 

Here's something that tells you that you are in interior Alaska:

It's a stanchion to plug in vehicles out in front of the clinic.  I think we may see more of this kind of thing in other places for electric vehicles, but up here it's pretty hard to get a vehicle to start without plugging them in.  I'm pretty sure that my co-workers looked askance at me taking pictures of these.

 

In northern Idaho you see old pictures of draft horses pulling huge loads of huge logs; in Alaska it's dog teams.

 

Here's our local radio station, KSKO, which has been in business for a lot of years and is a public radio station.

 

I took a walk along the Kuskokwim river and came across this lonely bench with this sign just across the road:

 

I don't know the story behind this or even if the two are connected, but I think it likely.

 

Here's the frozen Kuskokwim with a creek coming into it.

It was kind of strange to happen upon these two Blackhawk helicopters parked at the small air strip next to the river where the small Alaska Air Transport planes come and go.  Apparently the military does maneuvers around here.  I flew in on Reeve Air, which uses 9-seater King aircraft and has a small terminal at the larger airport on the other side of town (not far away, believe me).

This assignment has shown me a couple of things about myself.  I need my solitude like I need the air I breathe and the water I drink, but even I have had more solitude than I really want.  There is satellite TV here and all I can say about that is that I have never seen SO MANY channels before; and very little to nothing that I care to watch.  Public TV is the best, not in small part because it doesn't have so many commercials, but for the first time in my life I have turned the TV on just for the sound of a human voice.  I have discovered that I just can't watch TV anymore.  Not having had TV reception most of my adult life, I just can't get used to having to sit through 10 minutes of commercials for every 5 minutes of a show.  I also can't relate to much I see on there.  I don't feel in any way a part of the culture anymore.  I never really did feel at home in the mainstream but now I don't see anything that I recognize.  Alaska has changed me, and there is no going back.  It's not just about TV, it's so many things.  I should have been born here because Alaska feels more like home to me than anywhere else, but my heart is even more with my family, so there I will be based from here on out.  But a large part of my heart will always be here in the villages of Alaska, and I hope I can continue to work up here at least a few months a year.  That being said I am looking forward to Christmas with the whole family this year for the first time in several years!

Just call me Lazarus...

 

Greetings from Interior Alaska, not too far east of Denali, the Great One!

Last time I posted on this blog appears to be 2015—the year a lot of things changed.  Chief among those things was my niece Samantha coming to live with me.  Puppies were acquired, old dogs died, my mom died, my grandchildren were born, and last May Sam graduated from Bristol Bay High School.  I sold most of my belongings, shipped 700 pounds of things I apparently couldn’t live without down to Idaho, and reestablished my home base back in Priest River this past July.  I sold my house on Hoop Loop and bought 20 acres of land between Priest River and Priest Lake with meadows, timber, creeks and bordered along the whole backside by Forest Service.  I’m working on getting a house built next summer, and in the meantime living at my old friend Betsy Stansell’s place. 

I resigned my job as lead provider at the Camai Community Health Center in Naknek the end of June, and will now work for them several months a year as a locum (traveling provider).  I am also now working for the South Central Foundation, which is the biggest tribal organization for health care in Alaska.  I am an intermittent employee who will work several months a year at various small villages that are served by SCF, and I can work when I want to, for as long or short as I want to, at whatever clinic needs someone.  There are 52 villages that the Rural Anchorage Service Unit (fondly known as RASU) provides health care providers for.

I am on my first assignment with RASU, in a village of about 300 people that is the hub of aircraft for the Upper Kuskokwim river area.  We are almost due west of Denali, which is about 120 air miles away.  We are off the road system, as are most villages in Alaska.  I will be here for all of November.  The McGrath clinic has two satellite clinics in two even smaller villages, Takotna and Nikolai, that usually are staffed with community health aids who are overseen by the physician assistant or nurse practitioner at McGrath.  There are usually 10 or 11 people that work at the clinic in McGrath, but it’s been very difficult to get providers all over Alaska these days, so we are short one right now.  Which means I am going to be on call all month.  At least sometimes I’m on second call, but the stressful thing about being on call is not the times you get called in, it’s all the time that you spend not being able to go anywhere or start anything that can’t be stopped quickly, waiting for that phone to ring.

It’s beautiful here!  Pretty different from Bristol Bay, with a lot of trees, mostly birch and white spruce but there are actually some alpine larch here too (the gold ones in the picture below)! 

 

Here is where I’m staying in McGrath:

Just kidding!  This is actually my cozy little cabin, which is quite nice inside:

Since nothing in McGrath is more than a mile away (except the dump), I only get a vehicle if I’m on first or second call; which is every day so I’m set with wheels.

 

McGrath has been a going concern since long before goldrush days, but may be better known now for being a stop on the Iditarod race (this is actually in the Iditarod School District).  I guess this place is booming during the Iditarod, and I will be back here during the race in early March!  I am really excited about that, being a wannabee musher myself; someday I will volunteer, but there may be things I can do while I’m here next year.

 

The village of Takotna lies somewhere over by those mountains.

 

There is a wonderful museum here that is going to take me many trips to see all of.  It is only open Wednesdays and Fridays from noon to three, so I have to go on my lunch hours.  There is a significant archeaological site here that I will include the link to.  It’s a pretty recent find, and was stumbled on by accident.  It’s a really interesting story!

https://fm.kuac.org/science/2012-11-09/rare-human-remains-may-hold-secret-to-alaskas-ancient-past

And here is a link to some area history if you’re interested:

https://ukpreservation.net/background/

If you look closely at this poster you can see the “you are here” arrow in the middle of the map.

 

 

I will be flying back to Anchorage (weather permitting, which is always the case) December 1 on one of the little 9-seater King airplanes that serves McGrath, and then on to Spokane the next day unless there is yet more of the seemingly endless training I have to take to work for SCF.  It’s pretty interesting to see the differences between the tribal system and the stand-alone Federally Qualified Health Clinic in Naknek!   On the one hand, it’s a nice break for me to not have any responsibility except for seeing patients and documenting my visits.  On the other hand, it’s part of a very large bureaucracy over which I have absolutely no influence!  SCF is giving me some good training though, as now I will be having to do a lot of things that in Naknek were done by our stellar medical assistants, such as taking xrays, doing blood draws, and running labs.

I was unable to get to the grocery store in Anchorage prior to my flight out here, but I had packed a few items in my suitcase like backpacking entrees and oatmeal and some walnuts, and I knew there was a grocery store here, so I wasn’t too worried about food.  However, the afternoon I got here I had no vehicle and no one volunteered to take me to the grocery store, in fact told me that “they don’t have much there.”  It was suggested that I use one of the expediting companies in Anchorage that will shop for you and send it out on the flights that come Monday, Wednesday, and Friday.  I was taken aback at what a visceral reaction I had to being without much food, possibly for a week until I could get a shipment in!  I really felt like I was in danger of starving!  Our case manager took pity on me and gave me some moose meat, and the PA here gave me a package of spaghetti and a jar of sauce.  When I was taken after work the next day to the grocery store I found that, much to my relief, it really does have plenty of food, even some decent fresh produce.  I however found myself going into famine mindset and spending a lot of money on very expensive food, and then still ordering groceries from Anchorage.  I also found out that Full Circle, the organic CSA I used in Naknek, delivers here too, so I also ordered from them.  Now I have spent probably way more than my per diem will add up to, and I probably have more food than I will be able to eat while I’m here, and I KNOW that I have already gained weight, but I sure won’t starve!

Please forgive the clunkiness of the layout--I haven't used this program since 2015 so I have lost some facility with it.  Stand by for more, on a completely irregular basis!