Today l felt like an intern again! So much unknown and unfamiliar!
Wow! It was a hectic day! This afternoon I was supposed to have an easier introductory schedule of four patients, but all of a sudden by 1pm, I had eight on my schedule. My day was a jumbled melting pot of on-the-job learning. “Trial by fire” they all said (multiple times) today. In a haphazard way, I blundered about figuring out how things were done, learning where things are in clinic, discovering who does what role, where lab tests are, what kinds of orders we need, what swabs they use and where they keep them, how to get patients treated. Of my eight patients, I had to send the first two patients to Anchorage for higher level specialty care–one high-risk pregnancy to OB/Gyne and another to Orthopedics post-op wound infection.
Sending a patient to Anchorage takes much more time (it’s kind of like sending someone to emergency department from clinic), plus today for me it meant deciphering the code language (and chicken scratch) in their charts to figure out what benefits they have for travel/insurance, finding numbers from various corners of the office, calling the specialist (and usually waiting on hold for at least 10 minutes, since they field calls from the entire state), making a specialist appointment for them in Anchorage, extra documenting for clear communication, copying their chart, then faxing it, and helping out with social work (especially if the social workers are not available) to ensure the patient will have meals, transportation in a city foreign to them. Plus the regular part of their clinic visit must still be done (history, physical exam, prescriptions, fetal non-stress test, labs)….all in one appointment!!! Luckily most of the native patients have everything covered by the government, so there is kind of a universal access. This is really refreshing compared to the piece-meal system and myriad disjointed services normally used to provide care for the underserved.
To make things even trickier, I don’t yet have any computer access to see labs, place orders…etc. I didn’t know where any forms were (most of their records are still on the paper system, and because it’s all so unfamiliar, everything seems randomly scattered about. Other than an MS-DOS (!!!) system for labs and orders, there are no electronic medical records (EMR) to centralize and organize everything! I really, really miss EMR. Luckily I had an assortment of support staff helping me out with random tasks whenever they had extra time. They say this is how it is~jumping in head first! I also miss our “Desi” book from residency (a little pocket book with most everything you need to know to navigate the hospital and get things done!) …That might be my next project here. 🙂
Anyway, in spite of the chaos and being behind for most of the day (sorry for anyone who goes to the doctor and has to wait a while, it’s probably someone who’s new, or is working hard to transfer a patient somewhere else…or has some other complication! :)), I really enjoyed it. The staff here are still friendly and helpful and patient. One interesting thing I noticed consistently through the chaos today, is that the patients are very quiet and reserved, and hardly ever say much. I wonder what thoughts and perceptions are in their minds. I feel like I wish I could sit down a little more and take the time to be present with them and to sit in silence a little more, to allow time for them to talk. I hope once I become more efficient there will be more space and grace for a better understanding. Tomorrow hopefully I’ll have a little more time to learn my way around. I know it will all come in time. Like anything new, all of the scary, unknown, chaotic things eventually become familiar and known… and one day, comfortable.
Our hospital (museum)~just a few of the pieces of art and artefacts:
“The Whale Hunt”–a massive triptic mural on the wall outside the cafeteria (click on the biggest one–it’s so cool full size!). This is present- day whale hunting. The locals say there is no modern instrument better suited for whale hunting. And until recently, they still used their boats (see post on Umiaq Day 5 In My New Nome Town).
Waterproof parkas such as this were made by cleaning seal intestine and sewing it into a waterproof garment. They were worn by men when travelling by kayak.
These are kuspuks, the dress/jackets/parkas that women wear. The first time I saw one was in the airport, and I was going to ask the girl where she got it. it reminded me of something you can find at Anthropologie or Free People. Love!