A great weekend

A post I wrote during my last weeks in Anchorage... from a weekend on the Kenai River.

Friday: My doc has come to trust me quite a bit in the OR. I think that bodes well for my hopeful future as a surgeon, but regardless, Friday morning found me holding the scalpel over two patients: one, a young woman with questionable health, the other, an infant who had yet to see the light of day. I cannot describe the sensation of the moment, but it intertwined the weight of responsibility afforded by breaching the natural surfaces of the human body with the light-hearted elation of being the first to experience fresh, new life. Some element of self-preservation resonated as well, akin to the feeling of clinging to a rock wall high above the ground with only my fingers and toes as purchase, although my life was not the one at stake. Upon throwing the last stitch, the tension resolved and I was left with a great sense of satisfaction and, admittedly, relief.

Later in the day found me working with laparoscopic instruments in the recesses of another patient, shaky, yet excited to be operating. Surgeries I may never perform even as a general surgeon, but within my grasp thanks to a trusting, confident and gracious physician.

Later still in the day found me at a charity walk and let me highlight to you the joy afforded by finding that your delicious chili has STEAK PIECES in it. And that your entry ticket also buys you unlimited chocolate-covered strawberries, cotton candy, sno cones, corn fritters and fabulous prizes. Top that off with downtown statue-climbing utilizing the jump-lock-pull method to ascend said statue and hanging out on the sun, watching the sunset followed by a top-floor oceanside deck hangout to watch the sunset AGAIN and you have the right combination for a fantastic Friday.

Saturday: 70 degrees. Drift boats floating down the upper Kenai River with my dad and a buddy. Moose roast sandwiches for lunch on a gravel bar and a long nap reclined on a log in the sunshine. A puppy finding satisfaction in a prize fishhead. A brown bear frolicking on the shore not 30 feet away. Revisiting a place of youthful memories and sitting on a mountainside with the Lord. A welcome reception at home with food only a mother could make. Walking on the beach and then finally resting peacefully.

Sunday: You can't beat waking up to homemade blueberry muffins made with berries you picked on a venture into the wild in search of a bull moose. Unless maybe you count spending time with your sister and nephews and parents and worshipping with numerous friends and church family. Then again, there's a lot to be said for a relaxing afternoon catching up on school work on a comfortable couch. The drive home was beautiful.

The weekend was beautiful.

Life choices

I've lately been pondering the direction of my life. Mostly because I have to make some major decisions about it in the next few months. While I don't have any great wisdom or insight into what's making me do what I do, I have had a great deal of peace and reassurance lately.

I want to be a general surgeon, or maybe a pediatric surgeon. Or maybe a river rafting guide or a million other things (that's the subject for another post: wow I hate closing doors). But as I've struggled through giving up things that are exquisitely important to me: time spent with friends, time spent in the outdoors, living in the place that I love, I have come to a peaceful resolution. My life was never intended to be lived as a container for pleasure and self-indulgence. It was meant to be lived as a container to be filled with love and poured out on a hurting world. I'm rediscovering that trusting in God to provide a constant flow of love is the only way to keep that container full. When I try to fill it up, it's amazing how many holes start popping up.

On a similar note, I'm realizing my own inability to meet my goals. I set goals like: be a good friend to these 5 people, and subsequently ignore, put off and occasionally offend those 5 people. I set goals like: pour everything I have into doing well on my surgery rotation, and miss my lofty target by inches, but that's enough that the fall really hurts. I make goals like: get enough sleep and find myself awake at 11pm playing frisbee golf with my cousin in the twilight.

Maybe I should stop trying to set and achieve goals and live life in all its fullness right now, thanking God for the peace that rests in my heart when I realize I'm incompetent, but so loved. And there's no way I can mess things up bad enough to lose that.

So I'm going to keep struggling through my failures, as prideful and unrealistic as those failures may be, and be content to be just another messed-up guy walking with a God who redeems messed-up guys.

If - Rudyard Kipling

If you can keep your head when all about you
Are losing theirs and blaming it on you;
If you can trust yourself when all men doubt you,
But make allowance for their doubting too;
If you can wait and not be tired by waiting,
Or, being lied about, don't deal in lies,
Or, being hated, don't give way to hating,
And yet don't look too good, nor talk too wise;

If you can dream - and not make dreams your master;
If you can think - and not make thoughts your aim;
If you can meet with triumph and disaster
And treat those two imposters just the same;
If you can bear to hear the truth you've spoken
Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to broken,
And stoop and build 'em up with wornout tools;

If you can make one heap of all your winnings
And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings
And never breath a word about your loss;
If you can force your heart and nerve and sinew
To serve your turn long after they are gone,
And so hold on when there is nothing in you
Except the Will which says to them: "Hold on";

If you can talk with crowds and keep your virtue,
Or walk with kings - nor lose the common touch;
If neither foes nor loving friends can hurt you;
If all men count with you, but none too much;
If you can fill the unforgiving minute
With sixty seconds' worth of distance run -
Yours is the Earth and everything that's in it,
And - which is more - you'll be a Man my son!

Kotzebue

Apparently, API flies students all over Alaska to experience mental health in a setting other than a big-city psych ward. I'd heard I was going somewhere "rural" during my psych rotation at Alaska Psychiatric Institute for a while, but when I told them I wanted to go to Kotzebue a few weeks ago, I didn't really know why. Still don't, but wow. Awesome experience there.

I found out, officially, that my trip to Kotzebue had been approved last Friday, and concomitantly heard that I would not be allowed to see any patients during my trip out there. What?! That's what I DO. That's my JOB: See patients and tell doctors about them. But it was too late to line something up somewhere else, so I resigned myself to several days of doing nothing in a really cold place. Here are some things I saw out there:

- Negative 81 degrees (windchill factor, I know, I know, doesn't totally count)

- A med-peds doctor from San Diego with cerebral palsy.
His disease basically incapacitates him physically. He can walk, albeit very awkwardly, and talk, loudly and awkwardly, and write, with childlike scrawl, but the amazing thing is that he's made it through medical school, residency and fellowship and practices a sub-specialty in Kotzebue, Alaska. Incredible guy and very inspiring and upbeat.

- The heart of rural medicine, Noorvik, Alaska.
A nurse practitioner from Anchorage. One clinic. 5 health aides. The things they did to keep the clinic running were back woods. The facilities minimal by modern standards, but they kept trucking along providing health care to around 5 villages ranging from 100 to 800 people each. It was more common to see a snowmobile or a 4 wheeler running up and down the streets than a car or truck. People walked around with "parkies" with fur trimming provided by a successful hunt by the guy across the street.

- Totally awesome chili pepper chicken.
Didn't expect to find great food in Kotzebue, but was pleasantly surprised. Holy smokes. If you ever get a chance to eat at the Empress, it's worth the trip AND the high prices.

- Revival and healing in rural Alaska.
Went to church Wednesday day night at "Friends Church" in Kotzebue. Inupiaq after Inupiaq got up to talk about the darkness they had come from and the great love for the Lord that they now have. The hope, the joy and the love that they expressed openly spoke volumes of the transformation they had experienced. I heard stories of abuse, addiction and suicide attempts from folks who had smiles lighting up their faces as they contrasted life without hope with life in Christ. I left that meeting after being prayed over and blessed by 3 Inupiaq elders in an awesome conclusion to my trip.

I Still Think About You Sometimes

I'm not going to sit here and pretend like I've been blogging all along, but I am going to jump right back into what's now going on, which is what this is all about. I think my lack of blogging has actually been pretty reflective of my mindset this year.

So many good things to do. So little time. So much wasted time that could have been spent doing MORE good things. This is my life.

Adolescent psychiatry has offered me a rare insight into the minds of not just kids, but myself. I see in my patients many of my own thoughts, attitudes and desires amplified and mirrored back to me. It is always humbling to see a caricature of myself and realize it's probably closer to reality than is comfortable.

One of them thinks he has everything figured out. A young, athletic, good-looking guy who made some bad choices and ended up suffering the consequences. Rather than listening and taking the advice of those outside his situation though, he's just trying to plow through and make things work out the best he can. I feel for him, and really hope he makes it. He's still not making the best choices, but he has this air of confidence in himself and optimism that make you want to believe he's right. I'm not even making this up.

What am I learning from him? That I'm in the same spot. I've had my fair share of ups and probably fewer downs that I deserve, but the point here, I think, is that I would do well to heed the advice of those with an outside perspective, not quite so invested in my personal view of things. Anyway, kind of a tangent.

I probably won't post again for months, so if I don't, I've loved being back in Anchorage, have felt incredibly renewed since being here and am learning to walk by faith again. I believe that this will be a year of strength for me and am excited to embrace all that God has to offer in 2009. Peace.

A few words on medicine

Needless to say, this last month or so has been an experience. Another step in a series of life-altering events that, when the dust clears, will leave me with my head spinning and the tools of a physician at the tips of my fingers. How does such a thing happen? I actually wasn't sure it would, or at least didn't see how. But things are becoming clearer... one patient at a time.

For all the books, lectures and clever mnemonics, nothing compares with a living, breathing, feeling illustration of disease. And while that may sound like a morbid perspective of a human life, it is the stark truth that there are many names that may fade from my memory, but processes of illness that are indelibly etched in my mind for having known the face bearing the disease.

Another morbid truth I have come to accept is that intimacy with death highlights certain people in my mind. I could spend days upon days getting to know a patient, but my recollection of them is now dim in comparison with the vividness of one known briefly who is no longer among us. A code called last night found me in a line of people waiting to be the next to pump a heart that had stopped beating. As I compressed his chest, I briefly closed my eyes to connect with our Father, the one who made and knows intimately both me and the dying man beneath me, asking for His protection over both of us. Moments later, a pulse returned on the monitors and the resuscitation continued. In short, success, at least temporarily.

I don't mean for this all to come across as dark, it's just that the most profound moments are the ones that leave a lasting impression. Overall I've had an absolute blast on this rotation. My team has been wonderful and I will miss them when I come back to Alaska. I have less than two weeks left now and intend to make the most of them. While I don't anticipate a future in internal medicine, what I am doing right now is a joy.

Refreshment

I started this a while ago and never finished it, so now I'm finishing it.

After spending 10 days out on the Alaska Peninsula trying to gun down a moose or a caribou, I'm back in the civilized world counting down the days 'til I leave for Seattle to start my Internal Medicine rotation. I wasn't sure I would be able to say this with confidence when I reached this point, but after recent events, I'm ready to go back to work.

I think the reality of beginning a real profession was hard for me to adjust to at first and taking some time off allowed me to come to terms with the fact that my free time was becoming scarce as a rule. I'm actually pretty okay with the idea of not having a vacation for a while and buckling down to get some real learning done. A quick rundown of my 6 weeks of freedom:

Seattle: a few days to see friends, revisit some of my favorite places, do a little climbing and tie up a few loose ends before heading to Alaska. I quickly realized that hanging around Seattle with all my friends there busy with rotations would not be profitable.

Anchorage: (see: "Seattle" addend "and work and school" to "rotations") I also got to see some great live music courtesy of Marijke and Paul.

being back in both places was excellent, but it's not quite the same being there with nothing to do.

Kenai: Stacey needed some attention, so I spent several days in Kenai attending to her needs, several days basking in the glory of doing nothing and some time preparing for the hunting trips. It was great being back at church and seeing everyone. I heard some great truth that helped realign me with the fact that life isn't always about just basking in the love of God, but that there are times of that, and times where we endure and times where we must seek.

West Forelands: I grew up duck hunting with my dad, it was one of those father-son things that was really special for me. I hadn't been since possibly high school and possibly middle school, and getting back out on the duck flats was a high priority for my time in Alaska. My shooting wasn't what you would call stellar, but I managed to bring a few birds home. That wasn't really the point anyway, but if you've never had wild duck, you're missing out. It was a beautiful trip and an awesome time.

Alaska Peninsula: The big moose/caribou/black bear hunt. My dad has friends who live on Lake Clark in the middle of the Alaska Range and run a flight charter service. They picked us up and dropped us off on a lake out about 40-50 miles from the proposed Pebble Mine. It's rolling hills and spruce forests with willow thickets in the low places. Blueberries galore. Our hunt turned into a camping trip where we spent a good bit of time waiting out storms under shelter. We had steaks, burgers and blueberry pancakes to help us pass the time and I think I finished more novels that the previous 4 years combined. Despite not getting anything, it was great hanging out with my dad and brothers-in-law.


Port Alsworth: As we were unloading the float plane and preparing to hop the plane home, Glen Alsworth Jr. mentioned that if I had time, they could drop me off at a bear camp where they were picking up hunters and try to get a caribou. I jumped at the opportunity obviously and got to spend some great time in Port Alsworth, one of the most beautiful places in the world. The highlight was probably hanging out with the ground crew, an awesome group of 20-somethings who were tons of fun, but more importantly, really encouraged me in my faith and attitude toward God.

Alaska Peninsula: Two days of drenching rains, howling winds and rugged country. No trees out here. One of the ground crew guys, Micah, came out with me to do some small game hunting. Despite the weather, we got out and hiked quite a bit, but only glimpsed a caribou herd from across the valley. By the time we had stalked them and made it to where they had been, they were long gone. It was nice to see something though. I had a lot of time for reflection and prayer out there in the open country and started feeling more like myself than I had in a while. The morning the plane was coming, I got within 400 yards of a lone caribou, but we were on an open plain together and as soon as I began edging closer for a reasonable shot, he sensed danger and was long gone. They're usually not so skittish, but there had been wolves in the area.
Kenai/Anchorage: A few goodbyes and some more awesome truth from the home church and I was ready for Seattle. Truly ready.