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.