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