Birthday(s) 2009

It's always hard to come back after being gone for so long. The occasion this time is a 6 hour flight from Anchorage to Chicago. I didn't bring much to read and have had some time to reflect and eventually realized I could write without the distractions of the internet.

A couple days from June rise to the top when I think about blog-worthy events in my life lately. The first was my birthday. Prince of Wales Island is in Southeast Alaska, a large island home to around 5,000 people. I spent my birthday week out there with a family doc from Wrangell putting on clinics at various small towns. I awoke on my 27^th birthday in a vacation cabin overlooking a lake and spent some time in prayer preparing for the coming year and reflecting on the last. My doc wished me happy birthday and after a hearty breakfast of oatmeal, we headed to work at the Whale Pass library, which was hosting the day's clinic.

Most of the patients were of the run-of-the-mill primary care variety, but about midway through, we were informed that there was a man in the parking lot with a large laceration that would not come in for some reason. I went out and discovered that he was concerned about the cost. After looking at his injury and persuading him that he shouldn't let cost be a barrier, I found myself repairing the injury. I casually mentioned that it was quite an interesting thing to be doing on your birthday and he replied that he would be celebrating his the next day.

We closed up shop and headed out to Naukati for an afternoon clinic, finally ending up at Rosie's, a seaside restaurant in Craig, for a birthday dinner of halibut oscar. It had been an amazing day.

Except it wasn't my birthday. I was a day off. I had called my parents from the lone hill in Naukati where cell phones get reception, expecting birthday wishes, but as the conversation drifted on, I ended up asking, “Aren't you going to wish me happy birthday??” Oops. Fortunately I hadn't missed it, but would get to have my 27^th birthday... again.

I spent my actual birthday, June 4^th, in Koffman Cove and woke up on a church floor, not quite as picturesque. Clinic wasn't quite as interesting, but I had an excellent steak dinner with an older couple after paying them a house call. From their beach front, I watched whales spouting, played in the tide pools and reveled in the surrounding beauty with my God. Following dinner, we went for a hike through massive cypress trees to a waterfall and then a drive through the woods of Prince of Wales Island... a perfect end to my birthday(s).

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.