Welcome to Alaska

Another call day! It started out slow this morning—with just one patient for alcohol overdose. Then I worked on my clinic notes, since I left them yesterday for the sunshine! I saw a few more patients—a kid with thoughts of suicide, but he didn’t really want to kill himself. He just felt so much grief since a family member died, and he didn’t know what to do with it all. He is a great kid with a lot of potential in his future. It seems like sometimes the youth are just lost—not unusual for anywhere in the world, where the culture has undergone a massive shift. I think it would be hard to know one’s identity, purpose and meaning when everything your culture stands for has been dismantled. The subsistence lifestyle is optional now, people may or may not choose it.

Then I fielded several radio questions from the villages. Some of the patients should come in to be seen by a doctor, but they are not emergencies. But the winds are so high today (60mph out on St. Lawrence Island where Gambell and Savoonga are located, and 40 mph here in town). It makes it hard to know how to timely to be.

Map of St

There are a couple of medevacs trying to come in this evening. I hope they make it safely with this wind!

The most difficult case that I had today was a patient with big blood clots in both sides of her lungs with lots of large lymph nodes, suggestive of cancer, but it could be other things. Again, it’s the question of who is ok to stay here, and who should be sent to Anchorage for further work up/management. Some doctors say send them to Anchorage, others say we can keep them here to stabilize them and do the work up. Odds are they will need to go to Anchorage anyway for more diagnostic testing, so should they go now to have it all done in one place, or should I try to do as much as I can here until I figure out better what the patient needs, and then send them with half a diagnostic workup done?

Every day is a new day that presents a new problem with new factors. When will I be experienced in all the factors, so that I feel comfortable? Are there infinite factors? I wish I had more experience. But that’s what I’m getting now. More experience. :) I had a conversation with the Internal Medicine doctor, explaining that I’m new here, and I’m not sure how much we should try to do here, and asking when they prefer we send a patient like this earlier in the work up, or later on (and that the doctors here even had different ideas about when patients should be transferred). He reminded me that I will get experience as I try more things, and that everyone has different thresholds of comfort, and some doctors keep patients around longer, and others fly them to Anchorage for anything that may require a specialist. …And that my decision just depends on my level of comfort. Sometimes it’s good to take on more complicated patients, because that’s when I will learn more. Helpful, but not helpful. While it is absolutely true, he didn’t define anything black and white. Become comfortable with ambiguity. And then I joked about how then if something goes wrong or I make the wrong call, then I will become more terrified and send everything to Anchorage. We kind of laughed. My favorite thing that almost every consulting doctor says (and usually I think I can hear a smile in their voice) is “Welcome to Alaska.” :)

Medevac

Medevac

A great quote (On my friend’s sweatshirts who works in the Emergency Room):

If it is to be, it is up to me

4 thoughts on “Welcome to Alaska

  1. Hi Shana,
    Love the indepth post…the length of time that it takes to be comfortable with ambiguity will most likely depend on the degree and number of complicated cases that you encounter. I believe that you will feel like a seasoned pro by the middle of your first year in Alaska. You will think back about your uncertainty and chuckle while you give the same ambiguous advice to the new docs. :)

    I want to get that sweatshirt in your photo for my ten year old grandson. I love that has both the Native language and English translation. In the meantime, I will settle for the English translation, print it out and post it on the wall in his bedroom.

    I eagarly await your next post.
    Your strongest supporter, Cathryn

    • Thank you so much!!! My friend had that tattooed on her arm, and it was always such a great reminder! :) Thanks for your support!
      Much love,
      Shana

  2. Beautifully written and great lessons for all of life!
    “Become comfortable with ambiguity” That is truly what makes us better people. I think that if we don’t, we become unable to see anything outside of the box we know and are comfortable with.
    Also, push yourself… learn everything you can, trust what you know. Don’t just send patients away because it’s easy. To learn all you can, you have to push yourself to exhaust what you know and what you can do with the resources you have and the knowledge you have.
    I think about PNG with the extreme limitations of resources we had growing up and how the radio Dr many times was able to save us many flights and a lot of $ from not having to do so many medical evacuations.
    –I think that has changed more now in PNG… there seem to be more medical evacuations… or is it just that I pay attention to them more than I used to or that we now have more resources so therefore it happens more?
    It’s interesting how people find a way to survive with the resources they do or don’t have. I suppose we survive better with more resources… most of the time.
    I sometimes think we spend outrageous amounts of resources on people who are dying in the ICUs just so that the family can go through 4 of the 5 stages of grief: denial, anger, bargaining, depression… but rarely do we see the last one: acceptance.

    We just had a Somali man in the ICU /hospital for months. His family refused to let him go, b/c it isn’t in their culture to withdraw care. They don’t understand that he has terminal cancer and many other comorbidities /problems and that in fact we are keeping him alive with a breathing tube and vent and tube feeds. Finally one of the Attendings told the family that we could no longer do anything for the patient and that we would not treat him anymore, but that we would not remove the breathing tube or tube feeds or pain meds -things that keep him comfortable. So, now he lays there waiting to die. It’s really sad -there is such a disconnect between what we can do in modern medicine and what people understand about it.

    The process of being sick and then eventually of dying is very complicated in our Western medicine. Much more complicated than in PNG. Still just as sad, but more complicated because we can do so much that people expect us to get patient’s better and not let them ever die… or so it seems.
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    • Awwww, thanks dear, wise sister! I love what you wrote. I agree~I think the world in general has/uses more resources now than what we had. I’m amazed what we have access to! I so agree with the complications of our system. I am starting to read The Tibetan Book of Living and Dying, which has lots of great insight into a different way of accepting the full circle of life. Love you!!!
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