Bearing Tea Co. = bearing happiness

It’s always nice to find a good coffee house where you live, and in Nome, we have a gem! There is the best little coffee shop next to the gift and music shop called Bearing Song and Gifts Shop. You can get a warm drink and home-baked goods~like warm fresh muffins, and sit and enjoy the creative, home-made decorations of this cozy, welcoming place.Bering Tea Co

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Mason jar lights

Mason jar lights

Mason jar chandelier

Mason jar chandelier

Cozy corner where I had  a warm, fresh-out-of-the-oven muffin

Cozy corner where I had a warm, fresh-out-of-the-oven muffin

Reading nook

Reading nook

reading nook 2

Bookshelf driftwood

Bookshelf driftwood

weathered coffee table in the sunlight, olive sofa

weathered coffee table in the sunlight, olive sofa

white piano

white piano

window seat

window seat

This is a Russian ukelele:

look a little closer. the details are the best part! :)

look a little closer. the details are the best part! :)

 

Sunday Call

Another on-call day! I came in early to round on my patients, before starting the day.

stretched leather art

Giant stretched leather canvas in the waiting room to the ED.

The morning was fairly quiet, but then it started getting busy by the afternoon. A village health aide called and staffed patients with abdominal pain, jaundice, psych patient—two of them ended up getting flown in.

Another village (Little Diomede), the island right on the International Date Line, and is just across the border from Russia–called in to report a death. I have never done a death certificate long distance before, or when I had no idea about the patient. It took a while to learn what to do, and it took a while because most of the time I could not get a hold of people in Little Diomede to get the pertinent information. It’s tricky because an island like LD is supposed to comply with “national standards” of reporting to a medical examiner and the organ donation people, when in reality, they are an island of rock in the middle of the Bering Sea. They “bury” their dead by placing the bodies up on the ridge. Actually many villages around here do the same thing–because the ground is either too hard/rocky or too frozen throughout the year. Even here in Nome, during the winter when the ground is too hard, they put all the bodies in a house outside of town, then take them out to the burial grounds!

And another village called in a pediatric patient with Von Willebrands (a disorder that causes him to bleed profusely) who had hit his head and had a mild concussion and a concern for bleeding into his brain. I had him transferred here to Nome, and I talked with Pediatrics and Hematology/Oncology in Anchorage.

I admitted the most adorable pediatric patient for fever of unknown origin, nausea/vomiting, constipation, who we needed to put a feeding tube in to get him medication for constipation. He has had many various past medical problems, and it makes me wonder if something is going on. I also discussed his case with the Pediatrician, as well. Hopefully in time, the issue will declare itself and can be easily treated, because right now, neither I, nor any of the doctors are sure what exactly he has.

I had more calls and a circumcision to do (which the mom later decided not to do), but the end of the day came quickly, and the night on-call doctor helped me out to get some of the smaller things done, since I was leaving late. I feel tired, and I am still on the steepest part of the learning curve!

And I had a great ending to my day—there is a Nurse Practitioner student staying with me for a few days, and we had a really refreshing conversation about serving in underserved areas and being passionate about this kind of work, and how lucky we are to have been so blessed. because we don’t choose what we are born into, and it’s the least we can do to love and care about those around us.

Today’s cases
Rounding inpatient (4):
1 OB
1 Newborn
2 EtOH

ED 5 (3 admissions):
3 Peds (all admitted)
1 Bleeding disorder
1 fever of unknown origin
1 Psych
1 Abdominal pain
1 Asthma/bronchitis

Deaths (where I signed the death certificate, did not provide care for pt): 1

Exchanging Teller for a Special Delivery

I was going to go to a cultural festival in the village of Teller today (which I was super excited about!), but while rounding on my patients at the hospital, a pregnant patient that I saw in clinic yesterday came in active labor. Since I really love delivering babies, I elected to stay and help her rather than go to Teller…and I thought just maybe I could do both, if she delivered quickly! But that’s not the nature of labor and delivery. :) So early in the morning she progressed to near complete, then stalled. She stalled long enough that we were preparing to MedEvac her in case she needed a cesarean section, but then she very courageously (and gracefully!!!) got up and walked around with super strong contractions, and the baby moved down and before we knew it, she was back in bed, pushing out a happy, healthy baby!

Her mom was helping her get through it like a very skilled Doula, speaking to her in Siberian Inupiaq, comforting her, breathing with her, massaging her back.

It was a great learning case from beginning to end, because she may have been preterm (as her due date was not certain), and that would have meant that I should have sent her to Anchorage yesterday. While I was suturing up the lacerations on my own, it re-dawned on me: “This is it. I am the doctor now.” It felt empowering and rewarding and heavily weighted with responsibility. Of course, I still have back up, but when I feel confident with something, I no longer report to anyone! Which feels a bit weird, and makes me feel less confident all of a sudden, because I just want to check and be sure. But then I remind myself of what I’ve done before and the cases I have had, and the literature I have read. And sometimes I double check with another doc, just to be sure. And then when I know I have made the right decision, I feel a little bit stronger and more sure of my legs under me. Like a baby learning how to walk on their own, I’m sure I will have times where I fall or sit back down, or catch myself, but the way to learn how to walk is to start walking on your own.

While in residency I worked with an amazing, humble, super intelligent Nephrologist who had this Jewish Physician’s Prayer hanging over his desk, and I had to hang it by mine:

Dear Lord, Thou Great Physician, I kneel before Thee. Since every good and perfect gift must come from Thee, I Pray that You give Skill to my hand, clear vision to my mind, Kindness and Sympathy to my heart and Strength to my body. Give me singleness of purpose, and the ability to lift at least a part of the burden of my suffering fellow man, and a true realization of the rare privilege that is mine. Take from my heart all guile and worldliness, so that with the simple faith of a child I may rely on Thee.
Amen
Author Unknown

I love how humble and thoughtful it is, and how it refocuses me to the purpose of medicine.

This is the Fireweed wall on the East end of the hospital.  Many walls of the hospital are painted with the colors of the tundra. This is from the tundra flower, fireweed (I have yet to see the flower!). In Alaska, they say when the flowers turn to cotton, it means there are 6 weeks till winter. I saw the cotton tufts when I arrived three weeks ago…I’m not sure when they first turned to cotton, but I guess that leaves less than three weeks till Winter.fireweed wallfireweed-alaska-1 I think by all standards that I’ve ever lived in (ie freezing temperatures, snow, scraping cars), it’s already Winter. I wonder what Winter really means here?!

I ended up leaving rather late after discharging one patient, and having a long conversation with another, and finishing up more paperwork. I am on call tomorrow, and I am preparing myself for whatever may come! I’m sad to have missed out on the cultural events in Teller, but I am sure there will be more. I got to walk home on a beautiful evening, with the wandering sunset travelling lower and lower across the sky.

I also go to see my awesome neighbors and they had more of our friends over for a nice visit and a relaxing glass of wine! Here’s to Now! OLYMPUS DIGITAL CAMERA

Beach therapy

This lovely friday, I got to round on my patients earlier in the morning, and then I had clinic. I saw lots of well women exams and pregnant patients (yay!)–I hope I get to deliver some babies! then I got to do radio traffic again, which was busy today! One of my highlights was learning about some fantastic resources that we have–including telemedicine (to see pictures and other media to help with diagnosing things like rashes) and video conferencing to see patients in real time to help figure out what needs to be done. This day and age of technology is amazing! Oh! And the hospital plans to soon be transitioning to EHR–which will be so, so wonderful. The medical staff here work so hard to make sure the community receives excellent care. I went back and checked on my patients after clinic, and it was nice–we had some good conversations.

I also met the inspired local artist who made the drawing with the serenity prayer (http://nomemuckinaround.com/under-the-north-star/). He is such a kind, generous person, who shares his life story so openly. He is wise too. He works at the hospital with a vision, and he truly lives to help people.

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this is the ‘cheaper’ gas in town.

Then I ran errands–post office, bank, grocery store, gas station. Gas prices are high, as they say! (The cheapest I’ve ever paid for gas was 89c, and this is by far the most expensive in the US–but it’s still not as much as it costs in Europe!).

While walking downtown, people were so friendly and would smile and say hi, wish me a good evening or mention how lovely the weather is. I have not yet felt unsafe–even on a fortnight, even when people are out drinking.  There are no bars on the windows, no security guards at the bank, people don’t really have to lock their doors. The town lacks the sense of danger–not that it doesn’t have any issues–but that it is refreshingly safe to go out and about.

sunset

West end of the beach

The sunset was gorgeous (again), but this time the sun was disappearing at 8:30!!! More than an hour earlier than when I arrived, which also means more than one hour later as well (which means ~ 2 hours lost of daylight in 3 weeks)! Not only that, but every time I looked out at the Bering Sea, the sun moved like a late sunrise across the sky today, the reflection it made on the bering sea just moved along down the water. It’s strange to see the sun drifting along the lower sky all day. Growing up in PNG, the sun always rose high above us at noon. It pretty much always rose at 6am and set at 6pm, with only slight variation.

I took a walk along the sea, and walked in splayed-out, ebbing and dancing waves. It’s so therapeutic to watch the water come and go and splash and churn and sweep. I found some lovely sea glass. There’s a lot of it here–from a lot of broken bottles. The light was reflecting pinks and periwinkles on the wet shore broken by driftwood and drift dredge pieces. And the sand and the rocks sparkle with gold.

sunset beach

East end of the beach

My charming sea glass welcome decoration (that I got at Bearing Song & Gifts): sea glass hanger

and a green glass buoy: green glass buoy

 

 

 

 

 

 

 

It was a beautiful evening! I pray for peace and wholeness and light.

 

On Call! First day.

My first day on call started with a bang. On call means we are the Emergency Medicine physician, the Internist that admits patients from the ED (ourselves) to the hospital (ourselves), the OB triage nurse and the Obstetrician, the Pediatrician and the Emergency Radio Doctor.

And it’s All. On. Paper. Sheets and sheets of paper. I know this was the common standard before and still now in small rural hospitals, but since I was pretty much brought up on electronic health records, I’m not very efficient in navigating paper. It’s akin to a kid raised on computers going to do a a research project in a library. I know I’ll get it down~ it just takes time. I still need to learn how to dictate!

Windy river

This reminds me the course of my day in getting from point A to point B. Lots of running around and sometimes dead ends, but hopefully overall it’s headed in the right direction! I know things will become more efficient with time, and in the meantime I’ll appreciate the beauty of it as it is. :)

 

Today I saw eight patients in the ED (which doesn’t seem like much, except that of those I admitted three of them (to myself)…all three related to alcohol). Additionally, I had two OB preterm labor rule outs, which is more intense, because we do not have the necessary equipment to take care of premature babies, and it’s important make the right call. I had several emergency radio calls from the villages, and a few of them I (with help from my superiors) decided to send to Nome. One by MedEvac, and three by commercial airplane, which takes longer, but is more cost-effective.

The breakdown of types of patient visits:
3 Pediatrics
2 OB
1 Ortho (axed finger with open fracture)
2 EtOH withdrawal
1 Pancreatitis (related to EtOH)
1 Rule out TB
4 Emergency radio calls

But everyone was so willing to help, and so kind and encouraging. The nurses (again) jumped in to help me out and to back me up. I was surprised at how many of them were fairly new as well! There were plenty of support staff, awesome medical student and PA student to help me with patients. And the A-mazing long-term doctor was doing things behind the scenes constantly to make sure everything was completed, calling social work, arranging transportation and accommodation for our pediatric patient, whose parents were unable to be his guardian, and his uncle (who had a barrier against him staying in housing provided by the hospital, because of past crime) was his guardian. So a lot of social work needed to be done. What would I have done without all of them!?!

The paramedics and flight team helped stabilize a young man who was going through alcohol withdrawal and delirium tremens (Latin for shaking frenzy). This is a life threatening condition in the extreme of alcohol withdrawal. I haven’t been the one *in charge* of caring for DTs before. While it’s not necessarily difficult, it’s scary.

I shuffled through papers, lost a few (somewhere between the two floors that we work on), and I shuffled my brain trying to figure out the paperwork. I feel quite disorganized and lost in a paperwork system! I don’t have my own system for this yet–I need a clipboard and paper files and a way to carry papers around among four departments without losing them. :) I really miss electronic health records; it’s so clean and relatively seamless—everything can be found (labs, admission orders, notes, templates, communication from other providers, consults, phone numbers, fax numbers, consultant numbers…etc). in one desktop, anywhere. It’s

Overall it was a great day. I think about the need and what can be done for a community for public health education, empowerment, raising health literacy (the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions (CDC)), providing input and investing into the system to help wherever it is needed.

Highlights:
In spite (or maybe because) of me feeling a a little bit overwhelmed, the new radiology tech (from Belarus) was so kind. He told me that I radiate positive energy (and I trust someone like him to know about energy radiation). :) I hope it endures.

The Radiologist and I had a fun conversation about Papua New Guinea–he is brilliant and interested in lots of things. He taught me an interesting case–where he diagnosed twins on x-ray! (they had to do an x-ray for something else, and the patient had not had an ultrasound yet, so that’s how they discovered that there were two babies). I have never seen an x-ray of fetuses inside a mother before.

Also, some of the nurses invited me to a village cultural event in Teller this weekend! I am so excited to get to see some of the local culture. :)

resilience practices

My mentor gave me this. And it’s a pearl of advice.