Mike in Alaska

Mike: Rural Surgery and Rural Kayaking

I've just returned from my final day of shadowing in the operating room up here in Sitka, Alaska (pop. 8,500), which is the rural healthcare hub of southeast Alaska and the town I grew up in.

My morning was abbreviated (giving me time to write this) because I knew the final patient quite well and didn't want to make her uncomfortable while she had her first child. It was a fairly illustrative finish to a really great summer of shadowing. Last night, a young fisherman got tangled in some lines, resulting in a long night of surgery, and ultimately an amputated leg. He lost a great deal of blood, so despite his loss, he's actually quite lucky not to have been farther out at sea.

Throughout the summer I've been trying to wrap my head around what it means to be a "rural surgeon". At times it seems like an endless stream of fairly straightforward proceedures and operations, cholysystectomies, appendectomies, hysterectomies, and colonoscopies. Then there are emergencies and trauma, the rates of which are significantly higher in Alaska than other states.

In both the routine and the unexpected, there is a distinct difference everytime you perform surgery in a remote location.

Unlike the central valley, where a population of 200,000 is considered rural, it is truly surgery in isolation out here. Every incision carries a great deal of wieght with the knowledge that there is essentially no backup if things go wrong. Further, if any complication happens a few days down the line, the patient is likely to be back in the remote village the came from, with little or no access to care.

I've been incredibly lucky to have as a personal mentor for the last four years a general surgeon with an incredible amount of experience in an urban, academic setting, and who has come north for his version of semi-retirement, which until recently was literally five years of continous, unshared call, and surgery nearly every day.

From what I gather, he basically embodies the impossible mold of what a rural surgeon ideally should be. Ironically, it seems to be a task that cannot be trained for in a rural location. The expectation that one individual can competantly perform general surgery (and I dont mean the ever-narrowing slice of the abdomen reserved for general surgeons in most regions), and also handle any trauma/emergency that might arise is truly overwhelming.

Beyond the technical issues, to treat rural, primarily Alaskan Native populations in a culturally congruent manner, and truly gain acceptance into the community requires traits that simply cannot be learned. There's got to be an award I can nominate this guy for.

Beyond surgery, I've been spending an incredible amount of time on the water sea kayaking (all but three days of the summer). Its an easy addiction to aquire when, thanks to my job as a kayak guide, I can be paddling within 15 minutes of any impulse I might have to do so. Sitka is situated on an island among islands, with the open north pacific literally right at our doorstep.

As a sport, sea kayaking is truly unparalleled. It combines endurance, meditation, incredible beauty, and a connection with the ocean (and its many temperments) that perhaps only surfers can appreciate. Of course you cant go camping on a surf board, or cover 30+ miles a day.

This summer has been an exceptionally rainy and cold one, which is a strong statement considering that we average over 100 inches per year. Despite the mist, I've been spotting more whales than usual this summer, which is something I will never tire of (aside from the mile-long sprints only to have them turn around and swim away right when you get there).

I had a particularly pleasant encounter with three orcas the other day, who seemingly came out of nowhere, bobbed around on the surface for a few moments, and dissapeared equally quickly. Considering they are the most powerful predator on the planet, I feel surprisingly comfortable around them. More so than the giant and curious stellar sea lions that they regularly toss around like rag dolls (the transient orcas anyway). I could easily continue my rant, but this is a medical blog, so I'll spare you further details.

Though nearly a month remains, I can sadly feel summer slipping away. I'm very excited, however, as eight fellow 2nd year med students will be joining me in about a week for a six day paddle, as well as several days of hiking adventures around the area. I am also very excited to return to warm, sunny Palo Alto, great friends, and whatever fun Dr. Regula has planned for us.

Though I could now check my notoriously bad spelling, I will forgoe the process as a friend and I are off to explore a group of islands I've so far neglected and he's honking in the driveway.

Mike: Solstice in Alaska

What better day than summer solstice to submit my first blog entry. The reason I'm indoors is that it's quite rainy and windy, and essentially feels like a really long winter day. I braved the conditions and went for a paddle, which reminded me why I love this place. The bald eagles are incredibly thick this time of year (mating?), I can see over a dozen of them playing in the wind as I type this.
I start at the hospital on friday.
MP