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.

I should probably write something

Back in Alaska. In between rotations. Six weeks of pursuits designed to provide pleasure, good company and all that. As we would say in our progress notes for "interim history": no major events. Spent some good time with family, made some vehicle improvements, climbed a mountain, saw friends perform some killer music... good times.

You know, deep thoughts are nice and they have to be confronted at times, but sometimes, it's just pretty nice to enjoy life.

Two Rights Don't Make A Right

I see my life as a series of seasons, each with its own themes, decorations, sounds and thoughts. Entering this season, I prayed that I would truly come to learn, understand and embrace humility. Now part of that is learning to look at myself in an honest light, thinking neither too highly or too lowly of me. In fact, I think it's more about learning to think of me less.

Learning humility takes on many forms, but in my case, it has involved realizing that my own talents and efforts are not always sufficient. Sometimes, no matter how hard I try and how well-equipped I may be, I fail. I think I tend to withhold effort in most of my endeavors so that I always have the mental excuse that I could have avoided failure "if I'd REALLY tried." Sad to say, I have discovered that I can REALLY try, and still come up short.

Along this road, I have begun to take joy in being content in my weakness. If I allowed myself reign to condemn and punish myself for every shortcoming, I would quickly become miserable, yet through failure, I am learning to base my joy in things other than strictly defined "success."

Part of being a third-year medical student is acquiring new skills and knowledge through experience. Clearly, some experiences present themselves frequently while others are more rare and difficult to obtain. It is normal to desire fairness and equality in the distribution of these experiences. In fact, many would say that they have the right to experience the same procedures as every other medical student, and if some one else gets to do something they don't, it is unfair and justifiably unjust.

And just as I'm experiencing this, the voice of God breaks through (in the form of a book called The Shack) and announces to me the ridiculosity of this concept we have of "rights."

We have essentially taken things that we should receive out of love and fashioned rules that we can collapse upon in the event that we are not loved. What a tragedy that such efforts have been made in the past to simply claim what should be freely given. Rights to freedom, rights to a voice, rights to peace. And yet these rules do not and cannot replace what was missing in the first place, instead imposing a rigid framework devoid of warmth with only a token nod affirming that yes, you probably should get this.

How bold and daring we may be should we willingly give up this frantic pursuit of love for ourselves, in both big and small ways, in exchange for the knowledge and security that we are loved already and that the one who loves us is already working for our good. Humility is choosing to stop demanding love and start accepting love on its own terms.

Defervescing

Not only is defervescing one of my new favorite words, but it's actually pretty descriptive for my life right now. Since my last post, things have settled down a little here in Pocatello. I'm starting to catch on to the rotation and getting more comfortable operating as a 3rd year medical student. I still screw up on a daily basis, you know, the kinda thing where as soon as you open your mouth, you realize the words coming out of it don't actually make sense. But all in all, things are feeling just a little less feverish.

I'm a little more settled into a routine and getting used to 6-7 hours of sleep. This was a slower week, which wasn't great for learning, but allowed me a chance to get my feet back under me after a long run of not being really settled. Hey, I even went rock climbing!

In the neonatal intensive care unit (NICU), we have a status for babies who are in the clear and developing as they should be. They're called "Feeder/Growers" and that's a good thing. It means all their systems are working right, and the only thing they have to do is keep eating, digesting and storing away energy as they develop. Yep, that sounds familiar. Lovin' it.