Commentary

Into the Wild: PA Edition


 

The island of Adak is Alaska’s last frontier. There are no stores, doctors, streetlights, traffic lights, or even a need for license plates. Just the lonely cry of a bald eagle and the howl of the arctic wind accompany you along the dark streets of this ghost town on the edge of the earth, where the North Pacific and the Bering Sea collide. The frigid Arctic front travels down the west coast, while the warmer Japanese current comes up the Pacific side. The low tundra does little to block the winds generated by that confluence, which often whip at 90 mph or more for days on end. Otherwise, the weather is generally gray and misty, and temperatures range from about 20°F to 65°F.

The weather matches the ambience and surroundings—decaying shambles of a once grand Navy base with facilities designed to make life as pleasant as possible for service members. But the Navy left in the late 1990s. By the time I arrived to practice here in 2013, only a few hundred people inhabited the island. There was virtually no economy, and almost all the roads and buildings were deserted. Man’s creation had fallen victim to vandals and nature.

My practice claimed a converted high school principal’s office and a two-bed emergency department (ED) that had some nice equipment—but with no medical aid, x-ray technician, phlebotomist, or lab technician, there was only me to operate it.

One of the oddities of the Alaskan bush is that medical providers often perform as All Species Providers; my first patient, Sadie, was a very well-behaved black Labrador retriever. Unable to anesthetize her, I was thankful for her even-tempered, patient breed (and for my experience as a veterinarian). Sadie lay calmly on the ED bed, her head in her owner’s hands, while I sutured her forepaw. In hindsight, she was one of my easier cases.

Adak’s isolated location (450 miles from the nearest settled outpost), rugged terrain, and vast wildlife come with an elevated risk for injuries and no shortage of challenges in treating them. During my first week, an autistic child presented with a foot laceration. There was no electricity when he arrived, as was often the case due to the wind; the only available light came through the open door. It was dusk and snow was gently falling, but we huddled in the doorway, as the patient’s mother and my husband held the boy while I sutured him. I just managed to get the last stitch in before the child entered his incoherent world.

Into the Wild: PA Edition image Credit: iStockphoto.com/mbarrettimages
Anchorage, the nearest evacuation location, was 1,200 miles away. In the absolute best case (ie, the weather conditions were suitable for planes to take off and land), it was a 3.5-hour flight—that is, it would take 3.5 hours for a plane to arrive from Anchorage (if one happened to be ready) and then another 3.5 hours to transport the patient back. This fact was always in the back of my mind, but you can imagine how nerve-wracked I was in my first week (I had quite an initiation, as you can see) when a COPD patient presented in a cyanotic, dyspneic, and agitated state (SpO2, 80%). I immediately inserted an IV, administered oxygen, and got the nebulizer going. That was all I could do—other than pray that he would be able to breathe while we awaited transport, which was potentially days away.

Pages

Recommended Reading

The Power of Two: Revisiting PA Autonomy
Clinician Reviews
Who’s On First: A Look at Workforce Projections
Clinician Reviews
Hypertension in children linked to lower neurocognitive performance
Clinician Reviews
Why I Keep Fortune Cookies on My Desk
Clinician Reviews
The Death of a Dream: Closing an NP Practice
Clinician Reviews
CAM in MS: What Works?
Clinician Reviews
MS & Pregnancy: What's Safe?
Clinician Reviews
Beyond Salary—Are You Happy With Your Work?
Clinician Reviews
Negotiating The Professional Contract
Clinician Reviews
Sample Professional Contract
Clinician Reviews

Related Articles

  • Commentary

    The Paradox of Pain Management

    In the 1990s, pain assumed the position of the "fifth vital sign" and has since been measured as such. But this spotlight on pain has resulted in...

  • Commentary

    When is it time to stop hormone therapy?

    If a woman started hormone therapy in her 50s for bothersome menopausal symptoms and now she’s in her 60s, there’s a good chance that she may have...