The White Cloud continues to hang over me. I turned my pager off last night for the first time all week, and there were two calls - major hemorrhage & an MVA - within two hours. I could have walked to the MVA before the ambulance arrived. Paranoia only grows.

I made a milk run to Freddie's tonight and caught Steve Wariner on Prairie Home Companion playing a guitar piece that tore my heart in a way I haven't felt in a long time. I sat in the parking lot until he was done, although I left the engine running since the temps had dropped from a balmy -25 to -35. This morning, when I drove by on my way to proctor an EMT-I test, the temperature reading was nothing short of brutal at -41. I hope things warm up like they are predicting for Turkey Day.

My LPN supervisor shocked me on Friday by sitting down and telling me that if I left the clinic for an EMS job, she wouldn't hold it against me. After my interview last September, which I characterized afterward as hostile, I didn't think they were going to hire me at all. Apparently those with an EMS background have a proclivity to get "bored" with clinical work. Clinical work is not boring. I hardly know where the days go. My primary complaint is that it is not what I have been trained (and want to) do. I am still learning a lot, and I'm glad for a full-time gig, but it is a huge relief to know I won't be burning bridges if something more in line with my training surfaces. Unlikely, but hope springs eternal.

In the mean time, the dark is bothering me but the cold is not. The Subaru's engine block heater shorted out, and her check engine light has been on since the first cold snap in October, so we're biting the bullet (after a huge repair job on the Ford two months ago) and taking her into the dealership Monday. I think the cold is bothering her a lot more. I just hope she starts in the morning.

Peter made tacos for me tonight, as well as mixing some amazing new Vodka & Lemon drink he's created which is perfectly slushy after sitting out on the porch for fifteen minutes at thirty five below.
In light of the vodka, the pager is off. Goldstream, you are on your own tonight.



Discontent is growing. As I've settled into my job, I've realized that 80% of it consists of making phone calls. And even though they are a minority, the Crazy People make up a very loud and demanding percentage of that task. Week days are so busy that I don't notice too much, but as soon as I report to the fire station for training - especially EMS training - or watch an ambulance fly by as I'm leaving work, it gets a little harder to go back and take auto-cuff blood pressures and refill Lisinopril scripts for another day.

Fire station hours are not helping. I have been pulling my required 60 hours worth of shifts a month, not to mention having my pager on whenever I am home. However since earning my Paramedic License, I have run on Zero calls. If I'm at the station, the tones are dead all night. If I'm at home, anything that we get paged out for is on the other side of the district. This weekend, I had my radio on from Friday night through Monday morning. The only tone-out we got was for a chimney fire on Sunday night. The tone came out five minutes after I left the house, without my pager, to buy some printer paper in town. By the time I got back to the cabin 45 minutes later, all units were pulling back into the station. My white cloud status followed me all through Paramedic Academy & my internship, but this is getting a little ridiculous. If I ever had an edge, I can feel it slipping away now.

I love prehospital medicine, and I have a knack for the book-learning part of it at least. I got 100% on my recent advanced medic standing orders test at the station, and didn't do too badly on the scenario testing (besides some major and yet-un-resolved ACLS conflict-of-opinion with my proctor.) But without the dirt under my fingernails, the nagging feeling that a year of my life and thousands of dollars was flushed away keeps growing. I'm frustrated and even a little angry, all the while telling myself that this job, this life in a black hole of EMS, will pass. Most days, though, it doesn't feel like I will ever get to where I want to be.

As if I ever knew where that was.

In the mean time, I grit my teeth for eight hours and count my blessings for the rest. Three of them are in bed with me now:



Despite my lifelong obsession with animals and my genetic predilection for random trivia I have found a piece of dog minutia that had somehow escaped my radar. Although this is my fifth year in Alaska and my obsession with northern working breeds has only grown with our time here, the addition of Pico and a peculiar change he has undergone in the last month had Peter and I puzzled. Some quick google research brought us up to speed.

Northern breeds (and to some extent, Labradors as well) undergo a depigmentation of the nose in the winter, colloquially referred to as snow-nose. Nobody knows why. As the dog ages the pink nose becomes permanent, but during early adulthood a husky's nose will change between black and pink from summer to winter.

Figure I : Pico Puppy Nose, May 2009

Figure II: Pico Adolescent Nose, August trip to Deadhorse.

Figure III: Pico Adolescent Nose, early October. Just prior to first sticking snow.

Figures IV & V: Pico Adolescent Nose, November, three weeks after first sticking snow.

Figure VI: (Experiment Control) Nyssa, 6 1/2 years old. No northern bloodlines. No changes in nose pigment noted despite years of cruelly enforced winter-weathering.

The investigation continues ... in the mean time, we went over to the Goldstream Store on Friday night for some last minute eggs (farm-fresh! horrah!) When we pulled up in the parking lot, there was a dog-team tethered in the snow between the store & Ivory Jack's. As we got out of the car, the musher loaded his purchases, kicked the snow hook out and took off towards woods & trails behind the buildings. I love it here.



[update below]

With all the health care reform debate going on, I feel a little apprehensive about throwing my largely uninformed two cents in. But here they are anyway.

I have been paying for "disaster insurance" for the last four years. This insurance initially cost me $130 a month, and would cover my ass if my yearly medical bills were over $2000. As of this summer, this insurance costs me $250 a month and will cover medical bills over $5000 a year. I am fully responsible to pay out of pocket for all annual exams, incidental doctor's visits, emergency costs & medications up to that limit. Despite the apparent absurdity of paying $3000 a year in case I am hit by a car or perhaps by lighting, stories of people having freak accidents and ending up hundreds of thousands in debt had me scared enough to keep paying up.

This is a story in two parts, with no conclusion. Just so you know.

Part One: Ankle
In July, I was attempting to bikejor with Pico when he went after a whitetail deer and the bike rolled over my ankle. I did the usual Rest, Ice, Compression, Elevation for the first 48 hours, but still could barely bear weight by day three. On day eight I decided to eat the cost of an Urgent Care clinic and an X-ray, since the stability of the injured limb seemed to be deteriorating. I was told it wasn't broken and sent on my merry way, with a bill for $300 showing up in the mail in Alaska a month later followed by another for something like $80 in unexplained administrative fees. Two months later, it was still slightly swollen, painful & unstable. Because I was trying to complete the Firefighter I class at the time, I went to an Orthopedic PA clinic and ate the cost of another X-ray and exam hoping for a definitive answer and maybe some physical therapy exercises to do at home. Instead I was told that there was an old break and calcification which was probably impeding the healing, and that the Firefighter class would have to wait. That was it. That was two months ago. It is still a little swollen, still a little too sensitive to lateral movement, and I am now over $700 in the hole.

Part II: Fever
I started a job at a community health clinic a month ago. Inevitably, all the germy air caught up with my immune system and I came down with a nasty sore throat & fever on Wednesday night. Certain I'd gotten a flu of some kind, I was bracing myself for a week or more of feeling like a bug on a windshield. My supervisor told me to come in and be seen by one of the clinic docs, primarily because she doesn't yet know that I only skip work when I can literally barely walk. I called the human resources department, only to find out that my insurance at work doesn't kick in for 60 more days. SOL is the appropriate acronym here, I think. This morning I checked myself in and screened myself before anyone else arrived, to avoid spreading my gunk even further. The internist I work for came in and decided I had bronchitis, not the flu, due to an already broken fever & junky lungs, and prescribed me a Z-pack and a second day not further infecting his patients by staying in bed. I went home sick from my full time with benefits job at a sliding scale health clinic, and by 10AM my little cough had eaten up $200 more dollars in medical fees and pharmacy costs as well as all of the sick-time and vacation-time I have managed to accrue over the last six weeks.

I know that compared to most of the health-care stories, mine is a minor one. I am a healthy young person without any chronic medical conditions, and full-and-part time jobs that cover my tail for all the little medical issues & expenses I've sunk into over the last few years.
At the same time, I have paid nearly a grand for a sprained ankle and a one-day fever over the last six months. (I somehow neglected to mention my $700 visit to the Urgent Care clinic two winters ago, for six stitches and fifteen minutes of the good doctor's time. Or when Peter was told to go to the ER by a triage nurse because of body-fluids exposure [see previous post] and was charged over $1000 for the doctor to tell him not to worry about it.)

Now I work in a clinic where the majority of patients we see are either uninsured and paying out of pocket or on medicare/medicaid. Some work part-time, some are self-employed, and others can't or don't work. All of them are dealing with much higher bills and much more dire consequences if they don't seek and get the medical care and medication they need. Sometimes they get it, sometimes they don't, and the difference between the two is almost universally measured in money.

update: as of 11/06, add another $104 to the ortho bill. apparently they forgot to bill me for the 10 minute follow up appointment two weeks after the x-ray.