I sure know how to pick them

We picked up two new kitties last week. I said all I wanted to make sure was that their personalities seemed good and that they were boys. The vet is in this week so I took them in for their first shots and deworming... they are both girls. 0 for 2. Oh well they are both doing really great, super healthy, and amazingly cute. Now it will just be a naming game.

Month in update..

So it's been over a month?! I got to a point where nothing was working right so I just gave up on telling people what was happening. But we finally got the house! It was a long, frustrating, drawn-out process, but definitely well worth it. That and I was so excited about having it that I had everything unpacked in about a week. Theres still a few things - like the den/office/storage room that we just shut the door on for now. I even have some of my decorating stuff done.

The best part is that its starting to feel like a home- home cooked meals, candles, and pets!!!! Got a pair of kitties the other day: absolutely adorrable and hysterical to watch. We still need to work on making sure they use the litter box everytime, but accidents will happen. Also Sadie is on the way! Unfortunately the plane left early without her this morning so she is coming on a later flight but it means an overnight in Anchorage ...and no morning flight so we have to wait until tomorrow afternoon :(

Finally got through my 90 days at work- passed the review with flying colors! There is a lot of exciting things coming up in the next few months. We are expanding our services into the clinics and soon I'll be taking over the Coumadin program- but I have to complete the class first.

Also exciting is the fact that we are talking about holiday travels already. I have finally reached the point where it feels not like another school rotation and really missing everyone from back home.

alright... thats a summary for now, more stories to follow later. oh and its snowing already- started before the end of September

It's here !!!!!

My sewing machine arrived yesterday- a belated birthday gift but excellent. I was like a little kid at Christmas: jumping aorund, squealing, etc. I was terribly excited. It got even better when I started reading the manual and got a feel for all the stitch cpabilities- 60 stitches and all the extras too, especially for quilting.

Now I'm working on gathering fabric for a quilt of my own. I already have fabric and a design for a Christmas quilit. Now I just need the space to spread out and make a mess!

I did it!

I got it - finally got it! A license that is. So finally I can say I'm a real pharmacist now!!!!! Unfortunately that also means Im going to 10 hour shifts starting next week. But on the plus side it means a day off every week too!!!!

I cant tell you how excited I am about this! I've been smiling all day :)

B11- we have a bingo, woo hoo!

I completely forgot to mention that the pharmacy gang all went to bingo again the other night and it was my turn to win. I won on that sneaky number B11 that I always seem to need. It was all the more better that the caller that night was very enthusiastic when winners were announced. We had a little mantra going about needing a new fridge and it worked! It wasnt the big jackpot bingo but hey every little bit helps!

Well thats that

Well the house isnt quite move in ready and my attention to detail may have found a sewer issue... and it got all my hopes up to be in the house again. I had visions of furniture arrangements and decorating themes..... It just makes it that much harder to not be living there yet...

It also doesnt make it any easier knowing that we cant bring Sadie or Simba until we have the house. At least we know they are in good hands and are getting plenty of love back home :)

here's to hoping...

We're doing a walk-through on the house today after work. Here's to hoping that a. Hector has finally completed the repairs more than 2 weeks beyond schedule and b. the repairs are done correctly and completely. Keep your fingers crossed!

Oh and we have a fridge...but no kitchen for it too :(

Postal service gets perfect game

My plates lost out....

I found this really awesome set of plates on super clearance from Kohls.com. I figured that in addition to supporting my sister's salary, the plates would fit a really awesome cabin theme/Alaskan adventure theme.

Well Kohls shipped remarkably fast and they arrived today on the first day of the expected arrival window. However, the post office managed to mangle the box enough to smash every single one of 8 plates and the platter. Thats all 9. Remarkable.

Success!!!!

Banana bread out of the oven and cooling as we speak. This day was a long time coming, but I finally have baked something to be proud of!

Here's the back story on kitchen injuries that I promised a while back:
I seem to have the worst luck in the kitchen as far as being able to harm myself with the silliest of things. It all started in high school when I burned my wrist taking pizza out of the oven at youth group. Then college came and I managed to scar my thumb with a nice cut from doing dishes (I think this also coincides with my extreme distaste for dishes), sliced my other thumb on a knife doing dishes (didn't help me to reconsider my opinion of dishes), stabbed my hand with a fork doing dishes. College also landed me some more burns too. I also manage to have some freak accidents outside my kitchen. for instance thank you Kim for the shattered glass at bowlkign that flew straight into my knuckle. And of course most recently the burned foot. But it all seems to be better if I have some sort of supervision while I work. But I have yet to figure out how to make it stop. The food turns out ok when I am cooking and baking is a new process that as of today seems to be on the up and up!

Rain is back :(

The rain came back, I think it literally stopped only for my birthday.

Stopped by the house today but couldnt really see much, just made me wish I had the keys. I am starting to get really anxious to get settled in and unpacked. But not yet. It was especially hard to get my couch and not unwrap it like a gigantic birthday present.

Went rummaging this morning. It's really hard to pass things over when they are only $2 or $3 so I keep coming home with many more things.

Stopped at Saturday market and while not overly large I did manage to find the booth selling fabric! Went a little hogwild on that one. But with the promise of a sewing machine for my birthday, it's really hard to resist. I found a great find for a new quspaq (hopefully I can make it tomorrow) and the plans are under way for a Christmas quilt! Why do I always pick expensive hobbies though?

Today Angie showed me that the AC store actually has a furniture section in it as well! I've been here awhile and just discovered that tidbit. Of course everything is marked up 'a bit' due to shipping.

Whew!

Spent the night making 4 batches of jam!!! It wouldnt be near as easy without the help of some great friends though. Not as hard as I thought it would be but definitely couldn't see doing it by myself.

Happy Birthday! what?!

My very first birthday greeting this year came in an advertisement email the message line read:

A Birthday Surprise (Just for you)! Old Navy Women's Maternity...

Happy Birthday to me.

It's here, but oyu cant have it!

Here's the story of Jake's truck arriving in Bethel:
We were told by the moving company overseeing the entire move that his truck would arrive "sometime in August" on the barge.

I called the barge company and told them my story. They asked for my shipping ticket number, I never got one and explained that I was only told sometime in August. Thankfully a really great customer service representative took the time to look it up and provide an exact date- the barge would be arriving August 6th, weather providing. She also told me that the truck may not be unloaded right away but we could call and ask.

August 6th- we called the barge and were told that yes the truck was here but no we couldn't have it as it wasnt running and they couldnt get the truck out of the shipping container. It looked so sad (but amazing how it fits in a conex like that).

Not the out of gas issue we originally thought either. Something electrical.... not a good sign. Overly frustrating too as it was in excellent working order when it left our hands and it had to have been working when loaded in Seattle according to the dock worker as it was backed into the conex.

A quick trouble shooting call to our excellent mechanic, aka Dad to the rescue, and it was assumed that the batteries drained in transit and the alternator couldnt work well enough to charge both and try to run the engine. So a short 30 minute charge on one battery, disconnect of the second battery, and off it went runing smoothly. That lasted all of a few hours until we ran into town and Jake got stranded at the post office. Another quick diagnostic phone call revealed that the bolt made a loose connection and the second battery would need to be reattached. A quick 15 minute idle and it was back in good working order. Has been ever since!

And that's the how close we got to the truck that belonged to us but wasnt quite within touch.

who does that - bonus post!

Umm me that's who.

For family and friends who are well versed in my kitchen adventures (or mishaps I should say) you might find this believeable, for the rest be introduced to my unbelievable luck at injury in the kitchen:

I burned my foot while cooking today.

Yep read it again. Thats right my foot. I happened to be stirring the BBQ sauce on our slow cooked ribs (delicious! by the way) and managed to splash boiling sauce onto my foot. Didnt think it was that bad until I cleaned it up and found a blister.

And that sums up my kitchen mishaps. Maybe tomorrow I'll provide the full saga but for tonight- bedtime.

Has it been that long?

I can't believe that it's been a whole 2 weeks again since my last post. Well since then I have survived the board exams, manuevered Anchorage, become "homeless" but bought a couch :), and am still just plugging away at life.

NAPLEX exam = passed ! Sweet really glad about that one. Nothing shakes your core knowledge more than sitting a board exam. I am convinced of it.

MPJE= well I took this exam first and it flew by. I was done before I realized it. I think that I spent more time preparing for this one though and spent the entire freedom flight (Alaska Airlines Flight 46 daily evening service from Bethel weather permitting) and read the Alaska Pharmacy law book from cover to cover. Here's to crossing my fingers that it paid off.

So what's the word on the license then? Assuming I have passed the law exam it's just a matter of the Board of Pharmacy receiving one intsy piece of paperwork proving my work experience which they have previously rejected. It's just a waiting game on the snail mail service from Madison to Juneau so in theory....any day now.

The house: still waiting to close; repairs are coming along- foundation is complete and interior repairs are almost set. The delay here: exterior repairs due to rain delay. I swear it's monsoon season. But not having the keys hasnt stopped my overwhelming desire to settle decorating and furnishing issues- hence the couch purchase (first piece of my own true new furniture) makes me feel accomplished. I was reassured today that we should have keys by the end of the month- but I'm not so sure how well they'll be backing up that statement. So just keep living out of a suitcase and popping on over to the friend's garage to get tidbits out of our stuff.

The homelessness: Well temporary housing needed to be passed on the next new arrival. So oiut we went August 7th. In the meantime we have gracious friends who have offered their guest bedroom. It hasn't been so bad, actually really fun making some great new friends. Lots of cooking and eating and laughing together. All for the low price of pet and housesitting duties as they are off to Anchorage for their wedding. I also had a blast helping her prepare for the wedding by making favors, dog collars- you should see how cute!, and learning how to make jam and jelly! We really are living as if on the last frontier.

I think thats everything up to speed now and I do promise to be more regular on posting.

delays

Sorry for the lack of updates, but with Board exams (yes plural) tomorrow much time has been spent away from the computer. Today at work the computer system has been down for a better portion of the day, leaving time for last minute review and making travel/shopping plans.

But for today I thought I would leave you with this gem as heard on the local radio station id:

Cuter than a spotted seal before it becomes your dinner


And that is an only in Alaska moment prouldy brought to you from Bethel.

Why is the weather always clear at 2am?

I met up with my buddies on the LifeMed team just the other night. They are some good guys and always provide a good laugh. They invited me along again for a short puddle jump flight to Tuluksak for a sick baby- par for the course for me after all my travels during RSV season. It was literally a 15 minute flight but poor weather made us go into a holding pattern. Can you believe it?! I couldn't believe having a holding pattern to land at a delta village runway but it made sense. Despite the poor weather it was still one of the best flights I'd ever been on thanks to trusty
Eric the pilot. So a 15 minute flight turned into 33, those guys have great stories to tell. And an extra bonus is adding another village to my list of visited villages. This trip also provided some photos of tundra during the summer time. These will be added to facebook after this weekend when I go out berry picking for the first time in the tundra!

Really?

There is currently a student on site who had the great opportunity for village travel (as if Bethel wasn't remote enough). Now granted this student could generate a whole soap opera in what I've overheard so far, but thats too much for this space. Let's sum it in that she is in her final year at a very recently accredited school and on her first practical pharmacy experiece rotation. And she really wants to come back and work up here. Overall she's very pleasant to work with but I feel there are some delusions still left behind in her mind despite being in the bush country of Alaska for awhile now. As she was getting prepped for said village travel she was informed that it was a nice coastal village of ~500 people. She was then informed to pack a lunch to which she responded- "Oh what about a restaurant, I'd really like to eat at a restaurant". Needless to say there is no restaurant in said village and if you're lucky the store in town might have some spam and lard on the shelves but that is as exciting as it gets. Welcome to the real bush country of Alaska.

Counter the counter

Well we had a whole week of offer vs counter offer vs counter of counter offer (if I hear the word counter again...) enought to make your head spin; it sums into there is an accepted offer on the table pending the inspection. Whew!

Also spent time studying for the NAPLEX; need to overcome the overwhelming feeling of where do I start reviewing 4 years worth of education?

Payday came, payday went with an early overexcitation of getting paid more than expected...then distracted by a brutally high paced work day. A nice relaxation night of going out for dinner and paying for the first time in a long time and grocery shopping for the week. This culminated in a nice evening watching old Northern Exposure DVDs. It really is a great series.

Another relaxing Saturday sleeping in, getting our first booze run of the year, catching up with some people, online shopping- minimal purchases and creation of wish list should the new home come to fruition, and more Northern Exposure. Today however was a crackdown on the studying. I feel like I found some great resources for practice questions and then felt like there is no way I will ever pass this massive exam. Plunged into a law review instead. I also rationalized taking a topic a night for review and practicalizing the study by maximizing my test taking efficiency. All my friends did it so I can too!

Additionally I spent a lot of time compiling a law review not only for my benefit but also as a presentation to the current students here at YKHC. I'll also be nice and share with my new found frined and colleague who has yet to take the Alaska MPJE. As Alaska's pharmacy regulations are quite minimal, there should be a whole lot of information on federal laws to remember.

And now back to the books before bed.

Much ado about a lot of things!

In the past few days I have placed an offer on a house and FINALLY gotten my ATT and thus signed up for my Board exams. These are huge things in my otherwise uneventful life.

First off is the Boards: got the ATT and did a little happy dance right here at the pharmacy, people giggled. It was totally unexpected too; there wasn't any follow up to my daily calls or email, just a random letter in my box with my authorization code. And my other question isn't answered yet either, but we can address it another day. I had my choice from taking it in 4 days or taking it in 2 weeks. And yes I have been reviewing and studying, but that was a large weight to schedule the test that can determine the foundation of my career in under a week. So I went with the 2 week slot. This also gave me time to align my travel to Anchorage which is a pretty exciting thing. I am starting a LONG list in my head of things that I'll want to get and stuff into my 50lb alloted suitcases (hence I'm only giving myself one extra day of personal time in Anchorage to not get too crazy). I am dreading the almost 5 hours of testing and have opted at this time to not do the third law test all in one day. I have a year to do that test and will do it soon but just don't think my brain could handle 7.5 hours of constant strain. And I don't want to know how defeated that could make me feel.

Second now is the house: offer in, counter offer received, counter to counter in place. Hopefully final word by Friday. I am trying not to get too excited about it, but the inner girl in me is really enjoying playing house. I have to admit i started looking at paint colors already. Best comment ever was when Jake was asked his opinion he said that besides decorating being entirely up to me, it's not like he could really help pick colors anyway. Having the hosue within grasp is whole nother shopping list of items of itself too. But alas those will be put on hold until more paychecks start coming in.

And on that note, 2 more days til my first big payday!!!!! ...too bad I have a lot of it streamlined already into bills :(

A little pharmacy humor

Pharmacy can I help you ?

...yeah can you refill my cholesterol. I take it daily and Im out....

I believe you mean your cholesterol medication. Taking cholesterol daily is probably how you wound up with heart problems in the first place...

Fish!

We went on our first ever fishing trip upriver yesterday. We didnt catch anything, but at least someone on the boat did, Stephanie caught a King salmon. It was a fun afternoon though and despite being bundled in my sweatshirt still managed a sunburn. This also prompted us to have a serious conversation about jet boats versus prop boats and which one we might want to invest in come next spring.

On the home front, we have an offer down and now are waiting on the seller (happens to be the mortgage bank, ironically) on whether they will accept/counter/reject. We'll be working on getting an inspector in in the next few days too. An update from the moving company says our stuff is due to arrive in Anchorage on Wednesday after a brief steamship trip from Seattle. Then it's a waiting game, likely 2 weeks, at the airport as the cargo company is backed up with shipments. So there's a light at the end of all this.

More exciting news is the first paycheck is coming on Friday! and I can't wait. I've already come up with multiple ways of spending money but realize that wont likely happen until the 4th/5th paycheck has come in. But the new house will need a couch, some paint, some stools, a table and chairs, a desk and eventually get rid of the stained carpet in the first floor. Also more urgent will be getting a fridge and a working dishwasher, fridge higher priority than the dishwasher!

Delta Dentistry

Had the great opportunity to meet 2 new dentists out of Kentucky that are also new to Bethel, but I wonder if they realize what they got themselves into. Dental care on the delta is poor to say the least. Most patients would rather have teeth extracted then to try and save them and very rarely consider brushing nonetheless flossing. However, the other day I was observing our pharmacy waiting area and saw a patient flossing his teeth. It rather surprised me at first, but then I realized that wasn't dental floss he was using; nope that was the handle on his plastic shopping bag. I'm sure that had the dentists seen this they might have fallen over on the floor. And while the effort is appreciated, the execution is a failure.

Time

There's an unexplainable phenomenon up here that anything plugged into an outlet with a clock will inevitably run fast. I set the clock on the stove when we arrived and now almost 2 weeks later it's already ~30minutes fast.

And yet the people up here all operate on "Alaska time"- another phenomenon that unless you call someone every day, it's on a super delay and will get done when they feel it's appropriate to get done not dependent on your sense of urgency.

Crash!

Another bit of life wisdom:

New friends don't appreciate it if you borrow their vehicles but then run over their driveway marker on your way out.

It's ok, nothing permanent other than loss of a driveway marker.

A story, as promised...

And to appease the appetites for stories:

Our first Alaskan adventure came upon us last Sunday after an unexpected invitation for a boat tour of the Kwethluk river. Now it wasn't nearly as bad as Gilligan and the Skipper had it, but it was an adventure. The day was overcast and somewhat chilly, but that didn't stop us from packing a cooler and heading out with friends; there was an enclosed nylon cabin on the boat to protect us from the elements. We set out with Kevin, the subsistence teacher at McCann house and soon to be Mr. to Beth another pharmacist. We picked up Beth from the Ponsness's (another pharmacist and his family) boat after they had camped overnight on a gravel bar. We continued our way up river to sight see and eventually were able to see Three-step, a local mountain; not snow-capped or pictursque like Alaska postcards, but a welcome change to the continual tundra scenery. Soon after we got hung up on a gravel bar as the river levels are quite low. Poor Kevin had to change into his muckboots and push us back into deeper waters on his own. Water temp was most likely 40 degrees, so too chilly for us nonprepared folk to offer help. We decided that was far enough up river and to turn around. Soon after alarms started going off. Then we realized that we were out of oil. Kevin, usually prepared thought no big deal. But alas when he went to get his extra oil kept on board he soon realized his boss who had asked to borrow some the day before had in fact cleaned him out. So we floated downriver on the current and with the wid behind us we were cruising at a whooping 2 mph. We only had to float 6 miles to get back to the village of Kwethluk and cell phone service range. We werent too concerned as we didnt have any other plans and the sun came out and turned the day quite nice. After some many hours we had not progressed too far and the wind was starting to stall us. Soon we would have to worry about the tide pushing us back up river too. Time to start usign our McGyver skills. Kevin thinned the oil with gasoline and pushed the boat as far as we could go. Luckily that brought us into cell phone service range and we could call our rescuers. Then it was merely a waiting game and our energies were focused on keeping from running aground on the banks. We also noticed that we had taken on some water and fears of a sinking started mutiny rumors, but was not as it seems; we had merely lost a plug that was quickly reinserted and the bilge pump turned on. Our recuers had arrived with fresh oil and shortly we were on our way. We had about an hours travel time left to get back to Bethel and the boat docked. It was a mostly peaceful ride until we neared Bethel and the alarms started going off again; but we pushed through and arrived at the harbor. It really seemed like a short tour had turned into a day trip, but the nghttime brightness was deceiving. For though it appeared that the sun had just gone down it was 1am. Soon we were home and tucked into bed for a nights sleep before my first day of work. ..... Or so we thought until the smoke detector on our vaulted (and thus out of reach) ceiling started beeping every 30 seconds due to low battery....

Getting Settled

Slowly getting situated and realizing that this isn't just a vacation, this is a new life. Still shocking to run to the grocery store just for a few things and end up spending at least $50. Spent the afternoon touring town and searching out real estate FSBO. After an exhausting search I think we have it down to 3 different houses that we affectionately refer to as the dapper house, the green house, and the cranberry house. We still need to tour the cranberry house to ensure it's spot in the running, otherwise we are down to the pros and cons list of each property before making an offer. It's amazing what the variety is in real estate up here and justhow much your decision is based on curb appeal and location in this town. We drove by a couple listed as for sale, and scoffed at a few more asking prices. Also trying really hard to fight the temptation to buy more house than we really need. It is exciting to be thinking of wall colors for painting, potential layouts, and actually having matching furniture pieces! Say good bye to those college days and hello to the young professional life stage.

Even Longer...

I know it's been quite sometime, almost 4 months to be exact. Here's a quick synopses of the last 4 months: completed interview, accepted job in Alaska bush, finished school, graduated, celebrated graduation, traveled with family to NYC, watched softball games in Madison, packed a household for a cross-country move, said goodbye to friends and family, and then had an arduous ordeal in trying to fly out. Maybe I'll elaborate another time on the whirlwind encompassed in each individual aspect of that.

For now we are settling in to new lives in Bethel, AK. And for those that still don't know where that is, it is halfway between Anchorage and Russia. (Nope still cant see it from here) This includes the shock of cost of living differences and getting to know your way around town (only one paved road but 21 miles of gravel roads to get to know).

Looking forward to having a long weekend as being out of work got me pretty lazy and not ready to be back at 40 hours/week (Im sure many of you will grumble about that). I promise more regular updates (I'm starting a stash of stories to add). I will eventually get back to my daily posting and if not me I'll let Jake guest post when some interesting things come his way.

First Bethel moment for you to ponder: only one paved road yet already delayed by construction.

wow, it's been that long?!

I just realized that it's been a month since updating this. That is far too long. Busy with another rotation! Another trip back to Bethel- was truly a good feeling to be back. Not too happy that they lost a forcefully checked carry-on bag. That resulted in a hilarious story involving underwear..... lots more to do in the coming weeks to reach graduation though.

After a week back

Well after being back almost a week now, I still have lots of sorting and unpacking to do. But as of today the laundry is done. As of next week I should have some money in the bank after working again this week and I have my Teaser back. Today was a nice lazy Saturday with nothing other than laundry to do and it was glorious. It has also been nice to be back in warm"er" weather. Madison has been quite dreary however with too much fog and drizzle. Well back to laziness then for me.

A few days being touristy

Well we survived our trip to Seward and made it through the blizzard warning back into Anchorage. The drive was excellent, even in the snow. The best part was meeting Tong, a harbor seal at the sealife center. Today is my last day of vacation; time enough for a hearty breakfast, catch the iditarod start, do some last minute shopping and catch that plane. I cant believe how fast these weeks have gone by and that I will be waking up in WI after all this time in Alaska. It feels bittersweet though but all things must end and I have to return in order to graduate.

Return to civilization

Well after a week of shirking duties, I can give you an update. It was a bittersweet end in Bethel; I really was saddened at having to leave. But I can be happy knowing I made a bunch of friends, even randomly run into them in Anchorage. I spent all afternoon yesterday having a spa day to get myself reacquainted with civilized life. I had a brief tour of downtown anchorage and then had a fun night with a new friend getting mexican food and bowling. I had to repack everything this morning- made my luggage a lot more organized a bit easier to manage, especially by myself.

Well we leave in a bit for our drive to Seward, one of the best scenic drives in the country. We'll return to Anchorage for the First Friday celebrations downtown and some shopping time. We'll also be catching the Iditarod before I head out for my redeye back to Wisco. Looking forward to being home again and can't wait.

I think I'm allergic to Beaver

Well the hat making class is back on; went for the first time last night and got my hat making skills underway. I missed the first night because I was out with the medevac crew again for a long haul all afternoon. Still can't get over the excitement of those trips. More pictures to go on facebook soon. But anyways, we were all breathing in beaver fur last night at class- the downey stuff just gets everywhere. I think it's worse than the amount of hair I get covered in when I shave Teaser.
Plans are underway for sightseeing and tourism in Anchorage late next week, including a drive down to Seward to see the ocean and glaciers. Now I have to start thinking about packing all my stuff up after settling in for 7 weeks here.

Mundane weekend

Well after all the excitement of Medevacs it's back to the normal routine of cleaning, homework, and laundry for my Sunday. Not all that exciting. But the reality of only 2 weeks left before I come home also hit me. And a few days in Anchorage makes it seem even closer.

Wound care

I also spent time touring with wound care today. I saw my first case of really bad frost bite. Black toes, black heel, black sole. Literally black skin. But the real kicker was the temperature difference; that black skin is cold (even after 72 hours of being in the hospital). And from there it's just a waiting game. A lot of that tissue won't recover and it's sad, but the patient has their life.

Second memorable experience was the 8 year old girl with second degree burns, all because her older sister got mad during a steam bath and threw the water at her. I can only imagine the amount of pain for that poor little girl but she was a trooper and only shed tears during debriding the wound. She definitely put me to shame on my pain tolerance though. I think she was more irritated by our questions keeping her from her games than being in the hospital. And that courage goes for just about all the natives I have encountered thus far; it's really inspiring.

Village Travel= SUCCESS!

Well I finally reached a village; went on a medevac run (and then some more) to see a few villages. Check on facebook for some photos soon (too tired right now).

Travel was a blast and prop planes really let you see everything. It was so cool! The team was awesome as well; couldn't ask for better teachers and companions.

The trips in all just feel undescribable, there were so many things to see and do. It really opened my eyes to the real challenges of rural health care. We also discussed some other things like weather that can make those challenges even worse and more difficult to overcome.

Well you're not going to give me any blood either

Today I volunteered my finger to complete a quality control test on the equipment we use for testing INR levels for people on warfarin. It was giving us some variable readings and needed to be double checked. Well apparently my body didnt want to give up any blood after the finger stick and the pharmacist used the line above on me. I called her a vampire and said she shouldn't be so greedy. We had a good laugh and then milked my finger for blood.

Only in Bethel

Mandy told me to keep my eyes and ears open for those only in Bethel moments that are inevitable here. Yesterday one stood out above all the rest though.

The history of present illness (HPI) is a space on the visit summary form where the doctor/nurse can summarize the course of the current complaint. Yesterday's patient had listed under thier HPI: shot a moose over the weekend.

...Only in Bethel

Overheard at Lunch today

What is that?

Shrimp curry

I'll take a plate of fries then, thanks.

I learned my manners well

Well apparently it is the bug that keeps on giving; I have shared the nasty germ with my preceptor too. I just hope it doesn't affect the grading...

mmmm interesting

Funny that when you're sick and finally on the road to recovery you find some gatorade in hopes of replenishing your electrolytes.....after finishing 3/4 of the bottle you realize that it's expired, has been for 3 months. Appetizing.

Quinhagak Strike 3

Well I struck out on Quinahagak. Mark (one of the PA students) was gracious to share his germ with me and give me the worst flu I can remember. So I spent Thursday and most of Friday hidden away at home. The other guys left on Friday and were hoping for no travel delays as they headed back. Saturday got me out and about again. I went to Saturday market and found some good finds. It was a beautiful day (by beautiful I mean 20 degree weather and some scattered sun) so I walked home.
Today I got many Valentine's calls from lots of family (THANKYOU!). I have been catching up with some housecleaning and work projects since missing some time last week. I have to admit some procrastination to root for the olympians however.
Tomorrow is set to be a great day and we are planning on snowmachining so watch for some more great pictures on facebook soon. The rest of the week promises more snow too (everyone up here keeps wishing for more).
Unfortunately the fur hat making class that I was going to take next week has been cancelled; there was confusion over provision of supplies and then we lost a lot of students due to the mix up. They'll reschedule but not likely in my time here.
That catches you up for now. More to follow soon again!

Quinahagak strike 2

Village visit try 2: Another strike out. After checking in again for a morning flight and waiting about 45 minutes (after we had called ahead to check on flying status), a l o n g announcement with every flight number (obsolete as you don't get a boarding pass) and village we were told that they were on hold due to weather; this was followed by the weather forecast coming across the TV that declared blizzard conditions in Bethel. All in all another fun trip out to the airport.

The day was then made up of a stint in peds in which I say the cutest little 3 year old girl who reminded exactly of Sophia (without all the talking, pounding, and boomshackalackas). That was the moment homesickness set in, but just a little.

The afternoon was project time, super productive, and some experience in the workflow. I had to peel off and then relayer all my warmest clothes today too. I'll have to think of doing some wash soon too, clothes stash running low after 4 weeks.

Mundane Monday

A big lag in posts, but nothing fun or exciting going on here. I got to cook again for the super bowl party yesterday and that was fun (another batch of chili, some guacamole, and pecan pie bars). I even ate the chili (Mom and Dad would be so proud); growing up it was a battle, not just a struggle, for me to eat chili. In fact Mom and Dad usually added elbow macaroni so that I had something to pick at and eat. Oh how things can change as we grow up. Snowmachines were out in abundance again with another 2 inches of fresh snow here. They even managed to "break" one and by break I mean they disconnected Mandy's pull start cord from the handle. I had no part of this. The longer I am here though, the more interesting people I get to meet. It's not all that uncommon to hear of people who have just moved up here randomly. They all say Bethel has a strange charm about it and a unique attraction; I certainly believe that but I would have to guess that it's likely due to the openness and friendliness of the locals.
That's all from the weekend; plan for today is to be in the OB ward (part of working on my big project).

Pack a lunch and dress warm

Well today was long; I got up early after a night of constant awakenings with that inner fear that I wouldn't wake up and then miss my flight. We sat at the airport for quite sometime, another sign of the paces here in Bethel. I was totally shocked by the announcement "Flight to Hooper Bay set to board. Meet your pilot at the gate" - which is the only gate in this small building. Nno security, no restrictions, and much luggage left unattended throughout this room. I also thought it was so cute to see blankets draped over the noses of these prop planes as they were awaiting a flight. The waiting area also featured aerial shots of all the villages. This was interesting to be able to see the variations in sizes and potential in the village area. Some were quite shocking with an air strip being the largest, most prominent feature. Others were larger and featured some paved roads. No fears though, the adventure will continue as the flight has been rescheduled for next week. And a plus side, we didn't have to miss hamburger Wednesday (a huge favorite at the cafeteria). And talk of food makes me think that my grocery supplies are starting to dwindle again and its time for a trip to the store again soon.
Now if only I could stave off this head cold that thinks it can settle in...

Jealous Tuesday

Well something about jailhouse row is prohibitive of sleep, Im confident in that. Today the other 2 students are off exploring the tundra around Bethel on snowmachines and I am here, drudging away at pharmacy tasksssss... woe is me. Although I can't complain much as they are done next week and headed back to PA while I still get to enjoy Bethel for 4 more weeks. Tomorrow is a village visit to Quinhagak, travel booked. I should have many more pictures to post and some great insights into village life of the YK Delta. Soon I shuold have a chance to snomachine too I hope. I might volunteer to run a trap line too.... possibilities are endless depending on how you want to spend your time. There is another Saturday market coming up in a few weeks at which artifacts and crafts are sold so if anyone has requests for that special item, let me know. This weekend I have to decide if I'd like to see the Bethel dog show, an event that is put together with no real true classic champions, just sport here.
Enough rantings and on to homework again...

Photos

Alright friends and family- photos have been uploaded to Facebook. A lazy Sunday was spent cleaning and catching up on some internet time. I also took some time to write some postcards and letters too. Thinking of some movie time later tonight and then back to work tomorrow.

Claire you freaked me out

Claire sent me this email that freaked me out just a tad with a subject line of cat refuses to die.
Although it may sound familiar to most of my friends that know about Teaser, names and places have been changed to protect the innocent.


Check out the article: http://www.theonion.com/content/news/cat_refuses_to_die?utm_source=EMTF_Onion

Recuperating

18 girls, 2nd-3rd graders, awake til midnight and up way too early again in the morning. I must say that the ice skating attempt was comical though. And those sweethearts had their moments like offering me their smores. And those 40 some pancakes we made this mornign sure were good and flew off the pan. The night would not have been survived without the facemask and ipod earphones.
And so today has gone by with lots of naps and a pot of coffee. Nice and relaxing though.

Fish and Chips Friday (and Pizza and wings)

Well it's snowing again and warming up here so that's exciting. Today was another presentation and clinic day for me at the hospital. I have a case presentation to work up this weekend on glomerular nephritis and a clinical inquiry on postpartum contraception to finish. First off on the weekend line up though is the Girl Scout sleepover tonight at the log cabin. I've been recruited to come help supervise. The plan is to make a quilt, learn knot tying, and go ice skating followed by smore making! Should be fun.

Well my first trip to the gym made me feel quite out of shape, really need to ease back into this and not over do it.

Thank you Patti for care package #2. The nutella is much fought over this time, in fact Mandy jokingly said that I'll need to share in order to get that A I'm hoping for.

Not a whole lot else going on here; maybe a movie this weekend with the pharmacy gang, otherwise some homeowrk to hammer out.

Mediterranean Thursday

I can't believe that 3 weeks have almost flown by here already. I did keep saying I'd be back before anyone knew it. Today was a project day as the weather was much too cold to allow for a village visit; instead we will be flying to Kwethluk next Wednesday for an audit. Today was svery beneficial in minimizing that to do list though. I got a lot further than anticipated but still have things to keep me busy. If only I could figure out how to work Microsoft Office 2007 as well as 2003 in my undergrad days.

On a side note, the days are getting much longer. I can see the faintest sign of a sunrise on my walk to work now at 9am and the sun is still out as I walk home at 5Pm too. Now if we could just get the northern winds to stop.

I did another round of native dancing last night and was proud when I could remember some of the hand motions, but not all. The dances are depictions of every day life including wood gathering, dancing and drumming, and snow machining! It was great to see the laughter again from all the group members as certain ones had trouble remembering songs or as children were playing with the drummers.

But enough procrastination. I have to finish a clinical inquiry tonight; most people know who much I love these.....

Hamburger Wednesday

Today we coordinated wearing our qaspaq's to work, me and Beth (the other pharmacist who took the course) and Mandy my preceptor. I have apparently gained a reputation among the staff who admired all my work, but I just kept thinking don;t look too closely at the stitching. Many technicians were impressed and noted that although they were Yupik they had never even made a qaspaq. Additionally Sarah who had introduced us to dancing lent me some of her handmade jewelry pieces to complete the ensemble. Sarah and some of the other billing specialists were so touching and mentioned that when "cossacks" or outsiders take the time to learn about Yupik culture. They said it touches them here and pointed at their hearts. It made my day.

Thai Tuesday

Well the lack of sleep is catching up and Im much looking forward to bed tonight, hopefully I've reached that point of tired where I can just drift off into oblivion and wake up feeling like I lost a chunk of my life.

In the meantime my to do list has been tackled and is getting smaller so that is promising.
Other than the usual mundane pharmacy stuff not a whole lot going on. I did find a new addiction to an online game called bounce out which is great for insomnia.

Tomorrow is qaspaq day (not officially) and hopefully I can con some pictures to post for you guys. My time in clinic this morning again showed how the providers here are taking some fashions from the locals. Many nurses and some other providers wear qaspaqs in place of scrub tops. They can vary quite a bit too. Some have very ornate trim and some are just simple smocks. The biggest thing is the convenience of a large pocket, almost like a kangaroo.

Oh and the titles this week are inspired by the weekly menu for the YKHC cafeteria. It's quite diverse really, but not always appetizing. Good thing there's a kitchen where I can make stuff like homemade maccaroni and cheese and brownies (not helping the diet plan though).

Mexican Mondays

Alright so now that Monday rolled around I looked at my little to do list which doesn't seem so little anymore. I have a journal club to prepare (presenting a review of a scientific article), a patient case presentation (yay for bisphosphanates!), a lot of articles to read for my clinical inquiry which then needs to be written, and I'm slowly working on updating that anticoagulation program. My plate seems full. But I still have 6 weeks to get most of that done (only a few have earlier deadlines).
But enough about pharmacy.

This week should prove to be quite varietal. I have inpatient, outpatient, clinic time, and some meetings to attend. But best of all is the anticipated trip down river to Napakiak (just remember to say it with some spit). We may be snowmobiling/snowmachining there to check in with the health aides and check supplies.It's a tentative plan, but will get me out of Bethel for a day. The villages are really quite interesting; the architecture is quite variable depending on which area of the delta you are in, but some have boardwalks only due to tundra conditions. Many villages do not have any cars or trucks, rather the only motorized vehicles are ATVs, snowmachines, and boats in summer.

The first care package came today: thank you VAL!!!! It seems she is returning the favor from her days in Colorado. I will be all set and decked out for Valentine's day including use of my feathery heart pen! Many many thanks.

alright then on to recovery from my new addiction to the burritos served on the Monday buffet.

Movin' on up

Today is the day of my big move! I ham going from the housing unit I am currently at into House D of the "prison row estates". This is a set of housing owned by departments of the hospital for when they have TDY (traveling) staff members, students, or residents. They are so lovely named because while they are closer to the hospital, the town jail stands between the two. On the plus side, I should have more reliable internet.
Today is also the final day of quspaq class. I realized yesterday that the lifestyle and pass here are much different. We had quite a few students on Friday night, but not so many on Saturday, and we were running late. Although being late, leaving early, going to a long lunch all don't seem to be a problem. Everybody does things at their own pace and they will get around to it.
In addition to learning some more about the native culture, I've been slowly getting Yupik speaking lessons. It's really fun, but I am afraid that my pronunciation is still not so good. It is a throaty language with lots of noises. It doesnt translate well into words because until recently it has been a written language. I can say that the patients here, as just about everywhere else, truly appreciate when you tie a consult into their regular life or activities. While my pronunciation isnt exact there is an appreciation for the courage to try and a small little hello ( sounds like gem i) inevitably brings a smile.
The qaspaq class has been a blast. I was lucky to convince another pharmacist to take it with me and while the sewing may not be the best out there, we have some nice clothing to show for it and a lot of laughs to go along with it! Just watch out, you may all end up with qaspaqs some day.

TGIF! Don't waste the bacon!

This week has been crazy. I meant to update Wednesday night and a combination spontaneous nap plus lack of internet signal did not accomodate those intentions. Last night my preceptor offered her house as a chance to entertain. I was in my element getting to cook for everyone that came mostly pharmacists, significant others, pharmacy students, and a medical resident. Lots of fun.... it all culminated into a disscussion of fanny packs that landed Mark in the corner collapsed into a fit of giggles.
This weekend proves to be quite busy. Most of the time will be consumed by the quspaq class starting tonight, all day tomorrow and a wrap up on Sunday. In addition I need to also move locations into a closer unit.
I am excited about getting some tennis shoes in the mail today and hopefully can squeeze in some time to start a work out regimen and get after that New Year's resolution. The key will be continuing the routine once I get home.
This week I've also been busy with rotation tasks. I undertook a revamping of the anticoagulation program here. I am working with my preceptor to create an electronic format for filing and tracking patients involved in the anticoagulation program. We are also working on some patient handouts that will make reminders very easy.

Ptarmigans!

With the snowfall today, the other students and I are are very excited! We may have the opportunity to go ptarmigan hunting with some local folks. Ptarmigans have been described to us as the stupidest birds but provide the most entertainment and sport for hunting. Apparently they taste like quail when you get them and provide a good meal. They usually group together in small flocks and eat away. If you miss, shoot low, and a bullet bounces toward them they just stare at it for a moment and then go back to eating. If you aim properly and shoot them and they fall down, the others around them just stare at their fallen comrade and then go back to eating. If you are unlucky and shoot one that does not drop, the birds will fly about 10 yards from that spot and resume eating. So it sums up to easy pickings, and are a blast and fun, cheap entertainment.

Catch up

Ok, sorry about the big delay in posts. Apparently the internet I thought I had was just a wayward signal I was able to pick up.

Saturday market was a blast; I thought that it was a very nice sized event, although the freezing temperatures and wind chills kept many vendors and buyers away. I spent a lot of time at the fur tables though. Not only was touching encouraged but the vendors had many stories and much information on each of the individual animals. There were many native crafts (though pricey) and many people there to catch up and visit. Additionally there were many vendors that created their own crafts that were not the typical traditional fare. It was really nice to see the generations working together at family tables. Many children were encouraged to make items and sell them. While these weren't perfect (and hence less pricey), I found the flaws and the excitement when one of their items was sold made the experience that much more meaningful. The women and girls make grass baskets here that are exquisite. I can't imagine the man hours put into making one and the price reflects the tediousness of the project.

Not as many people ventured out into the cold for the finish of the big sled race. The shortest race time was 18 hours and 26 minutes arriving back in Bethel on Saturday night but the last finisher didn't arrive until Monday night just prior to the awards banquette. All the mushers conceded that it was indeed a very tough trail this year. A smaller race, the Akiak dash, was postponed until today. Mushers awoke to a fresh snowfall that will inevitably improve the race conditions.

Sunday was a day spent watching football, making chili and puppy chow, and an encore performance on rock band. It felt nice to get back in the kitchen and cooking again.

Monday, a holiday, was spent lounging and relaxing prior to the banquette. It was nice to be able to stay out of the elements for a while. Tonight will be laundry and more cooking!

K300

Tonight was the start of the big sled race. Although it was cold, there was a lot of people on the river to watch the start. We were driving on the river! Seems a little crazy, but a lot of fun. One of the pharmacist's fiancee was accompanying a sled team as they took off. Conditions were not best for the race this year and so some dogs needed some extra help. They were a bit wound up and excited for the race. So to protect them, they wore little booties on their feet to keep the ice from cutting their paws and many (not all) teams tied a snowmobile/snowmachine to the sled to slow the dogs down and keep them paced. So we were able to meet the team and help a little. We were helping hold the dogs in place and keep them from getting the lines tangled. Oh wait, the dog I was asked to watch was a wheel dog, the ones directly in front of the sled who turn the team and inevitably are a bit crazy to begin with, who was in heat. That was a treat. Our musher that we assisted was Ramey Smyth. The events can be followed at: http://www.k300.org/core/kuskokwim-300/kuskokwim-300-race-updates/ which I will be helping update tonight between midnight and 4am.
Then after an extended nap, off to the Saturday market to look for some furs and crafts.

Adaptation

I think I've adapted already. If you haven't been following, the temps here have been unusually cold this week with severe wind chills (into the -30/-40 degrees). This morning though, I made the comment to the other students that it felt much warmer today... the temp was -6 degrees.

that's not my name

I understand that my name is long, I get that; but how many times in a 20 minute interval can you screw that up? Trust me, it's waaaaaayyyyy more than enough.

Well I didn't fill out that form, so I'm sorry you couldnt read that person's writing and created a logon name based of bad writing on a fax.
Sure let me spell that for you...
this is a new program, oh but it's still spelled wrong because they aren't all linked

Thanks for resetting that, but you typed it in wrong

Please see above comment 5 more times.

Yes I will wait and hold up all training sessions while you call your supervisor
BOY! YOU BEST PRONOUNCE IT RIGHT OVER THE PHONE!

Another day that makes me feel as if all signs are pointing that I shouldn't be here.


....But outside the training room, I LOVE it! I'm really looking forward to the upcoming events for the dogsled race. I am also thinking of taking some local classes while I am here on making traditional items like fur hats or a quspaq.

Midweek break

Today is day one of orientation- luckily we have been cut loose for an extended break so that we don't have to hear all about paid employees' benefits. As they taught us this morning- it isnt so much your status here, it is your relationship; that is the importance in our culture.



And thus far I'm hoping I've worked on achieving that. Last night, for instance, we were invited to some tribal dancing. Not only do they have a very positive attitude, but they love to jest (not so good for my gullibility though). The other pharmacy students came as well and we had a blast observing and participating in some of the dances. We learned the seal hunting, wood gathering, and bird hunting songs. The very last dance of the night was so funny that members couldn't make it through without busting up laughing. When I asked what they were dancing about this time: soulja boy!

Things are getting set for the big weekend ahead. After our visit to the cultural center and museum yesterday, we found out about the market this weekend which will feature native crafts and items such as furs. This and the fireworks are exciting extras with the big sled race. Fireworks aren't very common up here as the summertime is too bright to allow for them.

Soon I will learn how to publish photos and videos so you can see cultural artifacts and examples of the dancing.

Tuesday Highlights

Well yesterday was a whirlwind tour of the hospital, not very big but still just as easy to get lost in. By the end of the week all the pharmacy students are doing a cultural presentation on one part of the local culture. With that in mind, today we have a visit to the cultural center for som efurther insights after a crash course about local culture from an employee yesterday. Tonight we have also been invited to join a small dance group as they practice their traditional dances. Because it is small, there were hints of us joining in and participating in some dances. So we are quickly getting immersed into the local life. My love of ice cream may be forever altered as locals create their version of "Eskimo ice cream" or akutaq; this is made traditionally with seal oil or reindeer tallow (nowadays it is made with crisco and sugar) that is whipped sometimes with fresh snow. Berries, white fish, and a local plant. Not quite my favorite rocky road flavoring.

The next two days will be spent in training (typical). And after that we head into the weekend where the town will be filled to the brim with visitors for the big dog sled race. More to follow on that.

But I did finally get a nice hot shower and can start washing dishes without having to heat water on the stove. Although internet has been spotty at the house now, I do have plenty of access here at the hospital. Soon there will be papers to be writing, rounding, patient counseling, etc, etc. Back to the busy work of a pharmacy rotation.

Sunday Football

Finds it so wierd that football playoff games started at 9am here - when it was still completely pitch black dark!

Today is a get to know you party at my preceptor's house for the Packer game. There should be other pharmacists and other pharmacy students, maybe some technicians. Looking forward to it though.

And internet is here at the house- just by ehternet cables- no luxury of wireless though.

Bethel

Well I made it here to Bethel AK. It's a small place and I remember thinking as the plane was banking... where is this going to land? All I can see is Tundra. We disembarked onto the tarmac which we were warned was slippery and a chilly willy of 5 degrees out there. I can't say enough good things about my preceptor so far. She was born and raised near Madison, so there is lots to talk to and she has a great attitude about pharmacy and life in general.
Once the odor was cleaned out of the small house I am staying in, it's quite quaint actually. The cupboards are sparce though and I realize that cooking may be even harder for lack of spices and pans. But despite that prices are jawdropping.... $15 for a package of bacon, $9 for milk, $45 for a case of vitamin water.... and produce is iffy at best.
After the grocery store I started compiling a wish list for some care package materials.
On the plus side I will have the opportunity to work with pharmacy students from Philadelphia, get to volunteer at the K300 sled dog race next weekend, and if adventerous enough maybe become a member at the local gym to work on that New Years resolution.
Somethings to adjust to are the sunrise at 11am, the snow machines going whipping down the trail outside the house, and the wind. Now if only I could figure out how to get the hot water to work...

Travel Nightmares

Well Igot to Anchorage- 3am Madison time, 11PM local time. It's been an exhausting day, a not so hot plane ride and a sheer moment of panic as we were to be boarding. Hopefully that paperwork all sorts out tomorrow (not sorted out as of yet). I will keep everyone updated tomorrow with more stories, but for now.... long over due sleep.

Morning of flight

For the next 8 weeks I will have to live off everything I squeezed into one large suitcase (37.6 lbs), one large hiking packpack (15.8 lbs), one carry on suitcase, and my laptop bag serving as my "purse". I thing I have everything....

I have this saying with my family- "It's never truly a trip home until I leave something behind". And it's almost always true that I manage to leave something behind when I am visiting at home. Usually it's something small, but every once in a while it is something more necessary. So as I am packing up, I keep going through my head thinking is there anything tucked away that I could possibly need???? But my wonderful mother is right there saying, don't worry whatever it is you need, we will just ship it. Then I can really find out how long the mail system takes.

So now I just have to get through the snow here in Wisconsin to the airport and hope my flight isnt delayed. Then off to Anchorage where my complimentary Spa Basket awaits!

Packing stinks

I am not a fan of having to pack everything in my room up again for the third time this year. Especially since I know I will be repacking and m oving again in just a few months. It also makes me realize I have a lot of stuff and could use some purging.

On top of that, as my willpower and concentration start waning, I got an email from my preceptor that not all my paperwork is in order. But it's not my fault. Paperwork to be completed by me has been done for months, including the intern license necessary to do any work. The university hasn't sent in paperwork though. But my preceptor assures me I'll get to Bethel, one way or another; and hopefully I will get school credit for it.

Once I'm done with my packing, then I turn to pack up the cat too. She's like having a baby with all her accessories now. (Litter box, carrier, dishes, pills, treatment supplies, scratching posts, treats... it's a never ending list). I am really lucky my sister(s) are so willing to help me out.

But enough procrastinating, back to the packing.

Reflection on Pharmacy

To ring in the New Year I thought I would comment on something that has always amazed me since I learned it way back at the beginning of pharmacy school. The profession of pharmacy has come  a long  way in a short time. In school I learned that the pharmacy code of ethics from the 1950s specifically directed pharmacists to never talk to the patients about the drug or what it is used for  or any side effects, etc. Pharmacists could only direct patients back to the doctors prescribing these drugs. Now counter that with our daily activities only 50 years later: our primary task is to counsel patients and inform them all about their medications. It amazes me how short of a time frame it took to make a complete turn in our profession. And we are still changing...

Just yesterday I was able to precent an overdose in a 3 year old. It's not hard and it takes just  a few moments to double check someone else's math. It turns out that it was very important this time. My calculations gave a dose of 3/4 tsp on an antibiotic. The doctor wrote for 2 tsp. And I know that mistakes happen, it's not hard to omit a step. But some doctors can never admit to having made a mistake. When I called in this instance and simply stated that by my calculations I got  a different dose and wanted to confirm dosing, the doctor shortly said that should have been 1 tsp. 

And pharmacists don't get recognized for doing these activities. There is no reimbursement, no payment, and often no recognition or thanks. We just do it because it is the right thing to do. And hope that it proves our usefulness so we don't get replaced by robots.

Ok that brings you up to speed on my thoughts on the pharmacy profession.